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·MANUAL OR IIYCJENE

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·MANUAL OF
HYGIENE
FOR USE IN INDIA
BY
CHARLES BANKS
M.1)., (M. Univ.Cilirsk., 1).P.H. Fac. Phy.Surg.(ilang.
AERINTENDENT OF EMIORATION AN)) PRO'I LOTOR ONVICIRANIN AT LIIK
MRT OF CALCUTTA (COVERNMENT OF BENGAL)
VUNICIPAL COVMINIONLK OM IN CORPORATION OF ('ALCUTTA
MÅÇMILLAN AND, CO., LIMITED
ST. MARTIN'S STREET, LONDON
BOMBAY AND CALCUTTA
1902
All mghts reserved

·OL.ASCIOW: PILI VELAT "Ik I'XIVERSITY like. BY KOHLIN ALACIJHOS AND (1) ·PREFACE This smal.m Manual of llygiene was originally intendere for nu in upr Primary Schools in Indin. The tush of writing it was alertaken by the author at the request of the late Smyon-licneral Harvey, Director-General of the Indian Meclical Servico. It is hope that in its present form, which is perhaps nioro advanced than it was originally intended to be, the Manual may meet the requirements of liniversity stulents and others who are beginning to stuly the subject of Hygiene. The author clesires to express his warmest thanks to Mr. Janick W'. Furrell, late culitor of the Calcutta levica, and to Captain Lcom Rogers of the Indian Melical Service, ofliciating l'rofessor of Pathology and Bacteriology, Medical College, Cilcuttil, for my valuable suggestions made by them for the improvement of the Manual during its preparation. (IIARLES BANKS. Caleltra, Fcbrumu y, 1902.

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·DEDICATED TO)
11. II. RISLEY, C.I.F.
OF TIK INII.17 (IVIL SERVICE
OFFICER
OF THE FRENCH ACADEMY ANI)
(FORRESIONDING MEMBER OF THIK
BIRIIN ANTITROPOLOGICAL
SOCIETY

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·INTRODUCTION. Out of every hundred cleaths occurring in India sepertu, eight-are suid to be due to discule, which can be to a very largókóxtent por altogether, prevented. During the tene years 1890 to 1899 over forty-three millions of people are reported to have cliccl in India from fever's, cholera and other bowl wmplaints, and small-pox, all of which are niore or loss proventible. Noarly five million leathx, from these disculsos and plaguc, occurred among the general population during the year 1899. Millions of people in India•either, through ignorance, cannot grasp the idea, or are cloliborutely unwilling to be convinced that the real cause of such clincuses is to be found in the air they breathe, the water they drink, the food they ont; that it may be conveyed in their clothing, in their skin, in their breath, and in the dischargrs from their bodies. They cannot understand, moreover, how the spread of clisease (an in any way he influenced by social customis, habits, moule of living, surroundings, the structure and situation of their lwellings, by overcrowding, or by climate. Outbreaks of discare are regarded by them is their kisnut or fate, or as julgments of goals and goaldessex, or the work of evil spirits. Prayors, fastings, sacrifices, strect processions, and other religious cermonies are resorted to in the belief that they are the most effextual means whereby tho ravages of the Reliance pon measures such 24 these always, however, ons in disaster. The disenso sproculs rapislly, punic ensues, people fly from their homes in their-I.antic effort to escape being attacked, and thus disewe mami We stayel. Sauna A ·2 MANUAL OF HYGIENE, carry the disease with them in their persons and belongmg: to othor places. Business comes to a stand-still. Poverty, misory, and distress prevail, and in many instancos (leath encls it all. If people were only wiso and would take kindly to those moasuros which Science has shown to be the host that can be aloptel in calling with outbreaks of ofitemic dincase, panic, riots, and dialocution of the affairs of the country generally would not take place, and a vast amount of poverty, sickness, and death would ho proveriter. A moro general knowledge of the laws si health woul! help considerably to bring about this happy state of allairs. It is with the view of importing some infuation on this important subjuct that this Manual of Hygiene has been written. DEFINITIONS. Hygiene. The term hygiene is derived from a Greek worl, hygicin, which means health. Akuowlodge of this subject teaches us how to live, where to live, what food to cat and what to avoil, what water is hilfо to drink and what is dangerous and unfit for it. It also teaches 118 how to construct our holes, and the langers of living in dirty and overcrowded houses and localities. It enables 114 to select the kind and quality of clothing we should weur, and the kind anıl amount of exercise best suited for us.' It teaches us that rest is required for both body and min), the value of xlorp), the evils of the 1180 of alcohol, tuhucco, opium, cocaine, and many other clebilitating drugs. Hygiene, in short, tells us what to do iu oriler to prevent discaso and keep our bowlies in an active and healthy statu. This branch of the subjøct is kuown is Personel Hygiene or Personal Health. Sanitation. The term sanitation is often used instead of hygione. The turni sanitation in, hower, more ·DEFINITIONS, 3 correctly applierl to the means taken to protect the health of tba general public and not that of individuals. This has been callal Public Ilygieno or Public IIoalth. Public Hygiene deals with the construction of houses, tho making and cleaning of roads, drains, sowers, lattines, stables, and cattlo-sheds, and the lisposal of all kinds of refuse in towns and villager. It also deals with the supply of water and the prevention of the pollution of water and air, and the alulteration of food supplies. Public health has also to do with the notification of infectious iliscases, the measures neelel to prevent them from spreauling, and this registration of births and deaths. GENERAL FUNCTIONS OF TIIE BOTY Before beginning the study of Hygiene proper it is necessary to know something about the general functions of the holy. The human buly, then, has been regarded as a machino which has to do certain kinds of work or perform certain functions. These functions aro (1) motion and locomotion ; (2) nutrition, which includes the cligestion of fuocl, rospiration or breathing, the circulation of the blood, etc. ; (3) reproduction in order to provent the human race from Hecoming extinet; and (4) regulation of thon various functions by the nervous system, to which the term inhervation has been applice. Even the lowest forms of lifo, which are composed of sirlyle cells, POSSCHS theho characters in a grgater br lens degree. Cell is the name given to the ultimate unit of living inattor. A cell is a sinall particle of semi-fluid living substance, or protoplasm, the onter surface of which may sometimes become sufficiently firm to forn a limiting-membrane or cell-wall. It nearly always contains a longer kernel-like boly or nudrus.

·MANUAL OF HYGIENE. THE HUMAN SKELETON. The human skeleton fornis the frame-work of the body, and is composed of more than 200 separate, hones. For tho purpose of closcription it may be dividod into thrco portioning namely, the head, trunk, and limb. (Fig. 1.) The Head or Skull is componel of 22 bones, of which the fact' contains 14. The skull forms i cavity for the protection of the brain, which is the most important part of the nervous system. The Trunk. The Crunk consists of the spine or backbone, the ribs, and the breast- Ironie. The Spine (Fig. 2) has also been callol the vertebral columın, because it is miulorup of small bonos called vertebre, of which there are 3:3 in tho spine in infancy. In grown-up peoplo the last nine vertebrw grow together and form two bones called the sacrum atid the coccyx respectively. n'he former is maslo up of five and the latter of four vertobræ. The vertebr have heen classified as gervical, or those found in the neck, which are seven iy: humber; F10. 1. -III'YA NKALKUN.

·THIE HUMAN SKELETOX. 5 C. 1. 2. 3. 4. • 6 7. D. 1. 2. 3. SP. -tr- 4. 5. 6. 7. 8. 9. 10. 11. 12 L 1. 2 3. 4. 5. A B Tui.:- TIE VERKIRAI ('OLIV. • A, side view, left side : 1. luck view : ('1-17 arreal wrtefas; 11 1-1:2. Hul vertelord"; L 1-1, lunulmur verturn; %, AlChum ; (, «"X"Lyx ; b], aj tu s prucosos i tr, truusvurdu procuws.

·6 MANUAL OF HYGIENE. 1 dorsal, to which the ribs are attached, which are twelv, in number; and loin or lumbur vertebre, which are five in number. The sacrum and coccyx como next in orilor. The spine forms a strong pillar for the support of the head, on which heavy weights are sometimos carried. The small bones of which the spine is made are kept together by means of structures called muscles and ligaments. In order to prevent injury to the spine from falls or sudden jorks small rings of an elastic substance called cartilage are interposod between the kitebre. The structure of the spino also enablos lls to walk, hend our boxlies, and maintain an croct posturc. Ruifiing through nearly tho cntire length of the spine is a canal or tube, callol the vertebral canal, for the protection of an important part of tho nervous system connected with the brain, called the spinal cor, which is contuinol within it. The Ribs. The ribs, which aro twelve in number on either side, the brenst-bono, and that portion of the spite to which the ribs are attached form what is called the thorax or chest cavity. (Fig. 3.) The first seven ribs are connected with the brcust-bono lsy means of long pieces of cartilage. The next three are attached to cach other by similar means and inulirectly to the broast-bone. The last two ribs have no connection with auch other, or with the other ribs or broust-bone, and aru. thotefore called free or floating ribs. The chest walls have thus been constructed in such a way as to give the greatest freedom of movement and at thu'samo time to protoct the important structures contained in the chest cavity, namely, the heart, lungs, and large blooci-vessels connected with thom. Limbs. The limbs consist of the arms and legs, and are spokoh of is the upper and lower limbs or extremivios respectively. Euch upper limb includes the shoulner-blacle, 1 - ·THE HUMAN KELETON. ollar-hono, arm, forcarm, and hand; each lower limbi anclucles the haunch-bono, thigh-bone, knoc-cap, leg, and foot. The shoulder possesses great froulom of movement. The arr, however, possesses still grcater freedom of move- -6 C Fia, 3.-TUORAS, SITOI LOER Crotx, 1xD UTPKR EXTREMITY. , cluviela; 1, MULINIA; (dumeris; d, ula; e, radius ; s, carmia; %, sternun; klorhen of vertelre. Anent," hecause the head of the nrm-hone (humerus) is round und works in a cup-shaped socket in the shoulder-blade, thus forming what is called a ball and socket joint. The foreum contains two honos (raulius and ulna), which enable 118, by means of the muscles attached to them, to direct the ·MANUAL OF HYGIENE. pulm of our hands clownwarrix (prorution) or upwards (supinatiou) ut pleusure. The wrist has cight the palm five, and the fingers have fourteen small honos. These are called the carpal, metacarpal, and phalangeal bones respectively. The upper limbs have been called the futhful ministers of the nind. The haunch-bonos uro" the strongest bones of the burly, and forin with the sacrum il cavity called the pelvis, which means a busin. The weight of the holy is supported chiefly by tho haunch-bones, with which the thigh vones have close relationship forming with them, as in the (ase of the shoulder, a ball and socket joint, in which, however, the movements are not so free as in the case of the shoulder. The thigh has a single bone (fem), which is the longest and thickest home in the boxly. The loy contains two bones (tibya' and fibula) and the foot twenty-six, of which seven FI-Tux Vry'l.Kh. are called tarsal, five meta" tarsal and fourteen phalangeal bones respectively. The lower limbs are used for the purpose of locomotion. à ·MUSCLES, 9 MUSCLEX, Muscles (Fig. 4) form the fleshy portion of our boclics, and it is by means of them that we are able to stund.crect, run, walk, lift weights, and perform most of the ordinary acts of life. They are divided into two kinds, viz., voluntury and involuntary. The voluntary muscles are those which arcaliectly under the control of the will, such as those of, Fici, J.-DIAURAN 10 SHOW THK AUTION OF THK BICEPS MINCLE OF THK ARM. The two tonduus by which the muscle is nttached to the scapuln Aro sven at a; P, the point of attachment of tho muscle to tho radius; F, the clhow joint; W, the weight of the hund. 18 and the The involuntary are thoro which cannot he controlled by the will, as, for example, the muscles of the heart by which it is enabled to boat, of respiration, and of the foul pipe ando alimentary cunul generally, by the action of which food passos downwards into the stomach, where it is rolled about during digestion and afterwarıls allowed to pulss into the small intestines, etc. All these movernents are performed without our knowledge, and the insules which perform them have accordingly been callal is.oluntary muscles. Regular and moderato 118c of ·10 MANUAL OF HYGIENE. the muscles (a11ses them to increase in size, while excessiva 1190 or listinu hus the opposito effect. NERVOUS SYSTEM. The nervous system is componerl of the brain anci spinal cord and the norven given off hy these structures. The binin and spinal con form what is called tho central pervous system. Nerves which convey impressions from the special organs of Hense, such as light in the ciuc of the aves, wound in the onse of the ear, an sinell in the A .B F1, 0, -A, FROST VITW OF A PORTION OF THE SPINAL. CORI, On the luft nu of the corn the nuterior motx, .IR, ille cut to show tha pt 101 Tonth, PR. B, CRONKITION OF TI Corro. 1, anterior fiantiro; P, jwanterior finire. li, central cu: C, gry mttei ; WW, wlute matter; AR, anterior roof: PR, tortor lant ; line hitnglion of junturior rout: T trumk of spoiwal nerve. When case of the nosc; and impressions from the skin, such ils lieat and touch, are called afferent nervos. these impressions roach the central nervous system other, nom os come into play. If light, for instance, is too strong, the eyes are immaliately shut; or if a thing which is touchul is too hot we amecliately pull away our hands. These movements, in common with all voluntary movements, are effected by the muscles of our boriy, an:1 the rerves by which we are able to perform them are cpleri cfferent nerves. The brain and spinal cord consist of nerves and small bowlios calle centres or ganglion cells, al it is ·NERVOUS SYSTEM. 11 these cells which receive the different impression. The pinal cord is about 18 inches long and } inch boul. It is composed partly of white and purtly of grey-looking matter, the white forming the outside portion and the grey the central portion of the cord. The spinal cord gives ott 32 pairs of nerves through openings on either side of the spirre, cach nerve having two POOTA. The spinal nerves not only carry impulses to the spinal corel, but carwy impulses to the muscles. The fibres in the spinal nervos which convey impulsos to the corl are called sensory, and those which convey impulses to the nuuscles are called motor fibros. When the spinal cord is injured thu motor norves may not be able to convey impressions to certain parts of the body. Movements and other actions are not thon possible, and the injural person is for this l'onachi said to be prolysed. Reflex actions are thosc actions which are performeel imconsciously or without the action of the will. Many of our ructions are performal in this way. Locomotion to a large extent, and the movement of the Jungs in respiration, are examples of actions of this nature The Brain (Fig. 7) is a very complicatod organ, and consists of vory many clifferent and important parts. It is dtvidlod into the corebrum and corebollum. The former is divided into two portions, one of which is situatel in either side of the skull cavity. These are called the corebral henrispheros, and all'a connected with each other. Beneath the corebrum or great brain, as it is also called, and at the back of the skull is the cerebellumn or small brain. • The brain is composed of the sume substance as the spinal cotl, andıgives off 12 pairs of nervos called cranial nervos, somo of which aro the nerves of the special senses, viz., smell, siglyt, tiste, and bearing. Others are for regulating the movements of the muscles of the cyoball and tongue.

·12 MANUAL OF HYGIENE. Another and very important no ve, called the pneuhuo gastric, which consists of both sensory and motor fibros, supplies branches to the lungs, heart, food-pipo, stomach, livor, etc., to enable them to perform their proper functions. M.08. SP- Flui. 7. HIDE VIEW OF THE BRAIN AND UM XR PART OF TIK NUINAL ('ORD. C, thc cua voluterl surface of the mght verulirul hemispheru: c'h, coru- Hollum ; M.Oh, modulla oblongnt ; N, Npiniu cord with wptual nurvos, B, thu Wxxllen and Aps, the mpolrich of the vertolotti The Sympathetic Nervous System is connertud chain of ganglia given off by the spinal nerves on either side of the spine. The organs in the belly'rand chest cavities receive branches from this system. It is the syni- ·SECRETION AND EXCRETION. 13 pathetic system of nerves that supplies the walls of arteries and regulates the amount of blood contained in them. It is the action of the symputhetic nerve which causes sudden blushing or blunching of the face. The sympathetic Hystem of nerves also regulates tho action of the stomach, heart, and other organs in the abilonien and chest to a large extent and helps to maintain the hent of the bowly SECRETION. In order to understand the meaning of the term socretion it is necessary to know something about the structure of glans, which perform this function. The term gland is derived from the Latin worel glans, which means an acorn, and is so called from its resemblance to that scell. (tlands are composed of small tuhos lined with cells. Samo glands are very snall and have one tube only, while other glands are of large size and contain many tubes. These small volls manufacture the various substances for the digestion of fool, such as the caliva or spittle which is fornied in the mouth, and the gastric juice which is formed in the stomach. They also, however, form other substances, such as the milk which is formed in the breast for the nourishment of infants. This is known as socretion. 'EXCRETION. Excretion means the removal from the blood of carbonic il'id, gas, water, troil, and other waste products which are formed during the performance of the various functiwia of the body. Special wrgans have beon provided for this purpohe, the chief organs being the lungs, kidneys, and skin.

·1+ MANUAL OF HYGIENE. 1 ou praat el s a b ... 10. MAR 2 ཀྱི b- 6 172 5 w FiriX. - DIAGRAM TU ILLIHTRATE TILK STREITUHR OF GLANDA, 4, Typical structuru of a moun nombrane with two lo vorn of op: thulal culls, a, b; r, the cunnuntive tishio loranth, with e, blond-VOAHCM and J, commective-tiswije culte.' B, the humu with one layer of rolls renting on b, the Ne-onlled banornent tuouehruno. 1, a simple turular ginud; 2, 4 tubular glana' dividing : 3, H NacCular gland; 4, divi led lc'ular gland with diut d; 2. A similar, glund mor lividol ; 1), il rilieTTONO gland, purt uuly lolay drawn,, lu Frys. 2-0 the blod-VUNGUN ilru oniittul.

·THE KIDNEY. 1.5 TUE KIDNEYS. The kidneys are two in number, one of which is situated on uither side of the holy, at the back near the vertebral column®and just below the ribs. Both kidneys are supplied with blood vessels (arteries and veins). Eachkidney, moreover, has a tubo called the uretor connected with it, which VOL R re g./ 1 kir.. 10.- A JALPINA CAPILE. vir, Hinall artury untering and forniing tho glowcı ulussal, and finally Ielving in a Suell voin, ve; c, tubulu; «, puthemum over tho glotuerulur; h, qiitlelumu ling the cusulu. Huci. !,- Tux URINARY ORGANS. K, kiduoyn; l'r, mutuin; BI, bolalder; 1, opuchings of uruturs, and ?, nenug ufuncthru w the bladder ; do, aorta; 1.C.I., inforior sone civile conveys the wasto matter (urino) from thc kidney to the Blacklor, from which it is dischargo ut intervals. "The minute structure of the kidneys is excoeclingly fritor esting but complicated. It consists of numerous small tulos, each of which is dilatel at one end forming a sac or capsule. Those are called Malpighian capulcs (Fig. 10.)

·16 JANUAL OF HYGIENE. 1 Insiilo those capsules are clusters of small arteries and voiris called glomeruli. The urine, which is formod partly in these structures and partly in the cells with which tho tubes are lined by a pro- CoAs of filtration and secretion, pissos along the small tubes, and ultimatory finds its way into the ureter and blacldler. Composition of Urine. Urine is a yollowish coloured fluid consisting chiefly of water and uica. It also, however, contains sonio chloriile of solium (common sult) and other mineral substances, such as line and magnesia, and some guson, chiefly carbonic acid gils. From 40 to 60 ounces of urine are excreter daily. The amount oxcrotul, howovor, depends very much upon the quantity of liquid consumo, and the amount of blool which circulates through the kiilneys. During hot weather the skin is unusually activo and giver off' a large amount of swert, while the kidnoys excreto very little urine indeed. Cold, on the other hand, drives the blool from the skin to the internal organs, and the kidneys in consequence act froely, and it large quantity of urine is eliminated, while the skin harlly acts at all. THE SKIN. The Structure of the skin. The skin consists of two chief layers. The first or outer layer is called the opidermis, cuticle, or scarf skin. This layer is made up of numerous small cells, which vary in shape at different depths. The uppermost volls, which are flat, are being continually cast off. The clocpost layer consists of round or cubicul cells, and contains pigment or colouring metter. Tho"pigment accounts. for the clifferences in colou, of different races of people and the degree of colour in peoplo of different caste or type who belong to the maine country. Exposure to great heut culises pigmentation of the skin.

·THE SKIN. 17 Inre are no bloccl-vossols in the opidermis. The second Inver, called the dermis, cutis, or true skin, is thick and tonigh. It is from this layer of the hidos of animals that leather is marlo. The small bloodl-vossols which nourish the skin, the roots of the hair, and the sweat and oil glands are all found in the clerniis. The dermis also contains elastic and connective tissue, and numerous small and B A Itti. 11. Tum Naia. .I, Nert 2011 of skin showing swart glans. ", pridlerinin; b, it dooLMT or Maghan (1924,7uent) lasur ; ”, d, deruis; , 1.t; %, muut glaudh; k, uts; 4, opreming of duct on sul fiucu. R. Mt of wkın mwing Julen Lid wolMLEUUN glanda 6, fino munclum conuertend with the mur bleult lin, C. delicate muscular fibres. When the epidermis or tipper layer is rubbed off, the clormix or lower layer bleeds freely. The Sweat Glands. "Yo swot glands have openings or pores all over the bly. There may be two or thrco millions of them. They are inch in length and you inch inabunietur. The Oil Glaulds. The oil glands secreto an oil which keeps the skin and hair soft and pliable, and prevents their from becoming alry and unhealthy. I.

·18 MANUAL OF HYGIENE. The Elastic Tissue. The elastic tissue in the vermiş CHISCH the furrows which appear in the skin in ole age. The Muscular Fibres. The muscular fibres during (0) truction for the oil out of the oil glands. They also stop the flow of swent from the sweat glauds when the borly is exposed to great cold, and in this way help to prevent loss of heat. On the other hand, these small muscles become relaxed during active exercise or exposure to great heat, in more sweat than usual then (ncipes from the slin. The sweat rapidly evaporates or dries , and in this way the body is kept (vol. If this were not the case the temperature of our bodies would become so great iu: to make it impossible for us to live. Perspiration or Sweat. Sweat consists chietly of water. It also contains some salts and oil. Sweat in acid in its nornial condition. When alkaline it smells bully. Two pints or more of sweat escape from our burlies daily. In hot countries the amount is much larger than in cold countries. It is sometimes more than 25 per cont. greater. When much wil is poured out the skin looks dirty and greasy. If we do not keep our skins clean the pores becomo blokol mp, the su cat cannot escape, and the health suffers. Our bodies begin to smell, and people wlio aro cleanly in their habits will object to our presence. Skin diseases are often caused by clirt and neglect. RESPIRATION Inspiration. M'he airwo breathe pilone's through the nostrils, mouth, threat, and windpipe into the lungsofie of which is situated on either side of the chest. The walis, of the chest, aw has been shown, are so vlastis in their coustruction that they can cusily rise aud fall during hrcathing Thuse movements are offected then, by virtue of the elastic ·RESPIRATION. Ratiire of the cheat walls and lungs, and by certain muscles, jumaluding those of the neck, chest, and belly. The niost important muscle of all, howevor, is the diaphragm or midrift, which is situated at the lowest part of the chest cavity, and separates it from the ahlominal cavity. The action of all theno muscles is regulated by the nervous system. It will be seen from one of the diagrans horo yiven that 16 Ab A Fri, 12.-DIACI Y, DAPIIRAM, AND ANOMINAL WALA RKHPIRITTO A, inspiration; B, uyiirty;_7r, trachen; 8l, wternum; 1), dinphrygin"; Ab, alxdozimlwni. The Nuded jurt in tu judiante tho statiounty air. the diaphragm is arch-shkpul. During the act of breathing it contracts or draws itself together; the arch slowly doses its curve, tho Tungy become filled with air, and extend downwards, following closely the descent of the arch of the diaphragm, and at thu suno tine the ribs are pushed out- ·20 JANUAL OF HYGIENE. 6 wards. The chest thus becomes greatly incronaca in size: All these movements are performed while taking in the lungs. This is called "Inspiration." (Fig. 1 d.) Expiration. When the lungs have taken in as much air an they can contain a short pull10 ensues., The chest walls then begin to fall slowly. 10 the movements are exiu:tly the opposite of those which take place during inspiration. This is known as “Expiration." (Fig. 12 B.) Respiration. The combiner wovements of inspiration and expiration constitute what is called respiration, or breathing. When is much air as possible is forced out of the lung boy expiration, that which still romiins in it in alled residual air. “The air which is left in the lung after un'orlinary expiration is called supplemental air. The air comprehended under these naine's cloes not leave the lungs, and is therefore called stationary air” (Iluxley). The Structure of the Lungs. In order to be able to understand what happens to the air taken into the lungs, it is necessary to have some idea of their stru•lure. The lungs, then, are comproscil of what are called air-cells, arranger together like bunches of grapes, ils shown in Fig. 13. These bunches of cells are on an average only joth part of an inch in diameter. Eruh, cell hus numerous minuto blood vessels coursing through its walls, which contain inftre blood brought from all parts of the buly. It has been Tiylily magnitul to show tho niraclli, : and minute calculated that if all the cells weit: Air tulc, . spread out they would prescita surfaco mensuring about fourteen thousanti square feet. We bronthe sixteen or soventeen times in the ninnte, and at each boronth the cells become filled with pure air. Fiu. 13,- Ny PIEK OP 1.I'M.

·DIGESTION. 21 Changes which take place in the Lungs during Respiration. The small blood vessels in the cell walls are constantly arri grcclily absorbing or helping themselves to the oxygen contained in the inspireel air, and giving off its impurities in the form of carbonic aciil gas, watery vapour, and other wasto natters. Every time we breathe we take in about throg-yuarters of a pint (20 to 30 cubic inchen) of pure air, and allow the same amount of impure air to escape from the lungs. DIGESTION. The object of digestion is to render the food which we cat fit for the nourishment and growth of our holies. The (ligested fool is absorbed by the small blooxl-vessels anill other structures in the walls of the stomach and intestine. Th, Digestive System Contx of the mouth, in which are the teeth, tongue, salivary and numerous other small glands which secrete or form the silliva or spittle, the soft palate which forms the back part of the roof of the mouth and encls in the wula or small tongue-liku bely which is seon at the back of the throat. The tonsils on either silo of the throat, the oesophagus, gullet, or found pipe, which convey's the food to the stomach, the stomach itself, the large and small intestines, the pancreas, and the liver are also included in the digestive nysteni. The digestivo Nystem is also called the alimentary Mystem. The route along which the food travels is called therefore the alimen- Larry canal, Teeth. 'Teeth begin to appear in infants when they aro andwout six months old. The first set, called the temporary or milk tgolli, are twenty in number. The secondo sot, called the permanent teeth, are thirty-two in number. The last of the molarx, or wisdom teeth, do not appear intil adult life. They may not appear until the age of thirty ·22 MANUAL OF HYGIENE. years even. The front teeth four in number in cach jaw, are called incisors or cutting teeth, Next to them the canines, which are narrow and blunt-pointed. There js one canine tooth on either side of the incisors in both jawx. Next to the canines on either side and in both jaws are two bicuspils; and, lastly, in grown-up people are three molars or griners, also on either side in both jaws, situated at the back. For 14 Tua TERNI Fr. 17.--NHYTOX (or Totii XHOW. IVI NTRITTURE, a, Chanel, i, dentine', (, (lvity. Teeth have a clown, neck, and fangs. The crownik covereil with enamel, which is very brittle because it contains two per cent. only of animal matter. The teeth, however, are niale chiefly of il substance raller dentine, which in hare like bune, but different in structure. The fangs of teeth are conted with a substance of a bonye nature called cement. The inside of tim fangs is filled with a substance called pulp, in which are a largú number of small branches oi blooul-vessels and norles, the main trunk of which enter at the tip of the tange. This iu'counts for the severe pain folt in decaying teeth. , ·DIGESTION. 23 ) • The Tongue consists almost entirely of inuscular tissue, hy muug of which it can be moved in every clirection. It is by these movements that the food is rolled about in the mouth and mixed with the saliva during mastication or chewing. The tongue is also of great help during the act of swallowing. The small bolies which project from the surface of the tongue, and which are best seen at the back, are called papilku. In the payllae are small delicate structures called tisto borlies for tilste bulbs. The tasto borlies in the, papillae in the front and sile portion of the tongue are for 'sweet substances, while those at the back are for bitter. The Salitary Glands. (Fiy. 16.) The glands of the mouth are situated at the angle of the lower jaw, under the jaw, and unilon the tongue. The nionth is also lineal with numerous smaller ylands, which secreto a substanco callcl mulus. 'The larger glands sexreto the muliva. The chief constituent of saliva is a forment, called ptoalin, which converts starch into grape ullgar. al, the sublingul kland, and tho The suliva also clissolven Numaxillary, with thicu ducts opening solid borlies, such as sugar ongle at d: Mutuel klound with duct and salt, anıl, ils was stattimi prong into the month at e. before, helps 128 to swallow our fool. Over twenty (Ainces of saliva are seereted daily. The Esophagus, Gullet, or Food Pipe is about 10 inches in length und situated hohind the wind pipe, which is protected against the entrance of food by a covering or lid called tho epiglottis, which closes when the foul is being swallowed. Fri 16, - DINSK"110) 10 OW 101k NALINARS (INS. into the flow of the mouth by thio ·24 JANUAL OF HYGIENE. Our foord does not trop into our stomachs sullenly. K is curied down the gullet hy a series of what w.wale? A -H F- . l'oct. 17.-TUE ORO IS OP 'Ilik ('IL EST AND ABOVKY NEPARATED HY TUI DI PARAGM, AKEN FROM THE Back. A, tuin, where the found JMLS('M through (Mephington): , henrt; C, Ntomuh; 1), the mpolech, E, hinrys, F, men mtotinu; (i, livor; 11, MITUR. I, -mall intestino. . vermicular or worn-like movements. It is by this action that water and food can be swallowaal hy persons whilo standing on their heals, and that horses and cows can swallow while grazing. The Stomach is merely a hagy, which is larger ut, tho ono end than the other. The entranco to the stomach is known as the cardiac and the outlet as the pyloric orifice or opening. It is about 12 inches long., Tho gullet enters ·DIGESTION. 25 waar the middle. The interior of the stomach in line with Peuge glans, called peptie glands, which serreto a liquial called the gastric juice. The gastric juice, amongst other ingredients, contains hydrochloric acid and substances called peprint and remin, both of which are fermenta. It is chiefly by means of these substances that cligestion in rrioll out in the stomach. dont 210 Quince's of yilstric juice sure secretul daily. The food is misol with the yustrie juice by the movements of the stomach walls - G.B D- R.K S Spl P -L.K -S.1 Cc. -R -B • FI, IN DITO.RAY OF ORINSINABXNKU (i, guillot; 8, stumiach: 1), Judunum with balle THLncretie ducts mening on INDICT Sole; NI, null intest; ('', (nem with vermiform juudis; (con or liligo intestine, R, 1 ce : 1., laser, li.B, Killl bullet, l'ANCICILN: Spl. peen. R. Kuid I..h, right and juſt kulnoy's; B, bludus with twu urutuskumu mtu, it at the ular onu. caused by the action of certain layers of muscles in the silino way in the food in nuined with saliva in the mouth by the movements of the tongue. (tastric juice digests nitrogenotus-food, but stops the digestion of starch. When fool is digester! in the stomach it is convertel into a substance callo chymo, which has a sour smell and tasto. During digestion in the stomach the nitrogenous food stuffs are converted into boulies culled peptones. These peptones und ·26 MANUAL OF HYGIENE. salt, sugar, and other substances are partly absorbed in the stomach and partly in the intestines. The Intestines are divided into the small and large intestine rexpertively. The small intestine conies first, and Fir, 19. is about 20 fect, while the large intestino is only 5 feet in length. The first portion of the small intestino is callal the duodenun, which is only about 10 inches long. The dulenum has numerous muuall glands in its walls, which socrete a fluid resembling saliva. This fuid heljasto digest the starchy fool which cacapes thet action of the saliva in the mouth and stomach. The duodenum is an important structure also, from the fact that it is into ·U. ince, DIGESTION. 27 this part of the small intestine that the hile which is i merl in the liver and the pancreatic Huid, which is formed in an organ called the pancreas, both enter. The pancreas, it may be here stated, is an organ 7 inches long and 11, inch wide. When the clıyme passes out of the stomach into the duodenum it beconies nised with the pulncreatie Huidh an bile. The former helps to completo the digestion of stichy fool. the Pancreatic Fluid, besidles acting on starchy and nitrogenous food, contains al substancil which mixos with fats and oilx in fool, making in emulsion which is casily absorbeil. Bile, als bv will Ix pointull out presently, -Z has a similar action. 'Trypsin is the name given to the forment in the pancreatic fluidl, which converty nitro gonous food into peptones, .3.v The small intestines have mumorous small structures called villi, containing blool. Vessels and lacteals, which absorb the digested food, and c, putheliumi Joloud-Voboch; l, also numerous small glandly, which secrete a fluid calleci® the intestinal juice. The fluid in the lactmuls is called chyle, which has a milky appeurintestino themselves have also a large supply of luotuals and blood vessels. The Liver is situated on the right side of the holy behind the lower rjhs and helow the diaphraynı or widriff. لما ننن . O SLOT 20 'to. .- 'Two VII. TINY MAGITTER Luetulla ·28 MANUAL OF HYGIENE. Tt extends in health to about half .in inch holow the ribs, and can be felt during inspiration. a healthy liver wangkor from 10 to 60 ounces. It sometimes, however, beronies greatly onlargoul and heavior from discan. The liver is mule np of cells cach about the oth part of an inch in size. The small cells secrete bile from the blood carrieel in the bloul-Vennels which pass through it. The amowit of bilo secreto laily is about 10 ounces. When madu the bile in conveyed in numerous small tubes, called bile diucts, into al single larger duct which, as his boon xtatod, pours its contents into the duodenium. If there is any obstruction in this large duct tho bile which shoule: pless into the cuolenum gets absorbed by the bloodl-vossols, is carrier in the circulation to all puurts of the boily, and gives rise to what is called jaunlice. Bilo emulsifies fit, prevents fool from decomposing in forming guy, and helps the cligesterl fool to pilsn ensily along the alimentary canal. It is afterwarıls partly absorbed by the intestine, gots into the blood, and helps to keep up the heat of the body. A substance called glycogen or animal sturch is formod in the liyer in large amount. (ilycogen becomes converted into Hugar. Sometimes the pugilr formed in this Way is so great in amount that it cannot all loc male ilso of, and the excess quantity pulse's out of the system in the urine. The clis- CALMO called diabetes is due to this callsc. Tre large intestine absorbox whatever fluid remains after digestion, collect its wilste prodlucts, and ultimately PANNOR them out of the system. THE BLOOD IND ITS (IRO'I'LATION. We all know that the blood which incapers from a cut arterie is of it loright red, and that from il cut rein of a durk purplish colour. When it crop pouf blood is placed ·THE BLOON) AND ITS CIRCULATION. 29 wndler a microscope it is found to consist of innumerable Who wish-looking small flat luulies called blooul corpunolex, wlrich float about in il colourless liquid called the liquor sanguinis (blood liquid). There are two kinds of blood Corpuscles, viz., the real and the white. Red Blood Corpuscles il'e only thout the oth part of any inch in diameter and the oth purt of an inch in thickness, so that is one drop of blood we may have 7. By .8 E- Elmi lic! 21.-Brown ('ORII YIX. id curulen Scho'l on the flat; 1', reel pancle's mon on niige, and rul tether into russ; I, h, coloul lume curpolincolen, lella 2oot sco; c, d, r colourlose comples, nucleun nuen, ", cuntamm also granulen, 1 several millions of them. When observer under the microscape they are seen to run together in the form of rolls of coins. These corpuscles vary in size, shape, and structure in different animals. It will be remembered that, when dealing with respiration, it was pointed out that these little corpincles take up orygon, which they convey to all parts of thy boly. This is their chief use. The bloox! adeo contains the elemeilts of nutrition for the tissues of tho Lexly., ft Curries away the waste products w, the different organs which excrete them. 'It is from the blood, moreover, that the waliva, gastric, and vther juices are forma, It also helps to keep the burly warm.

·30 MANUAL OF HYGIENE. White Blood Corpuscles. We always find in blood som small white buclics, called white blood corpusclos. In healthy blool there is usually one or two to about every five' or six hundred rod corpuscles. In some discilace the number of whịto corpuscles may be very great. White blood corpuscles are globular in shape and larger than the red, or about the oth part of an inch in diameter. Iy, the living state they are always changing their form. Each of the white or colourless corpusclos has in its centro what is tornued a nucleus. The nucleus can be brought into view when a little water or liluto auctic acid is also to blood when it is being examined under the microicorue. Certain colouring matters do the silme thing. There is il nucleus in the white blood corpuscles of all animals. The red blood corpuscles of human beings and animals which suckle their young have no nuclei. The level (corpuscles of birlx, dishes, and some other animals have, however, large nuclei. Coagulation of the Blood. In clotted blood the red solid portion consists chiefly of the rod blool (Orpuscles caight in a net-work of it substance called fibrin. The liquid portion is called serum. This is the same substanco ils that which escapes from it blister of the skin whon it is oponed. Blood alwilys clots when it comes in contact with any outsidle object, and it is the fibrin chiefly which causea this. If this did not happen wo might bleed to death from oven small wounds. The blooil serum contains a large quantity of albunen. It also contains sola and potash and other mineral sulistances obtained from the food which we eat. Sovla is one of the chiofonstituents of blood serum, and is got chiefly from tho comnion salt which wo 1180. Those mineral substances, cailed alk; lies, kcop the fat, which is liquefied in the alixhentary systemi, in the same liquid state in the blood, and thus makes it more tit for the nourishment of our boxlies. All the other ·THE BLOOD AND ITS CIRCULATION. 31 solid mineral matter which we consumc, such as line and iron spltx. aru similarly dissolved to be male fit for nature's use. Blou also contains gaac's, such as carbonic au-id yas, nitrogen, and oxygen. One volume of blood contains about . volume --Ribs Right Lwag --Left Lung -The lloart FI:. -NUONIN. THE POSITION ON THE APES OF THE HEART. of these gildes. The blommal weighs over one-thirteenth part of the entire weight of the body, while the gukes in sidution represent in their free state about one half of the ontiry'volume of the blool, of which about : are carbonio o acid, and about oxygen. There is also a little nitrogen. The Circulation. The circulatory system consists of the heurt, arteries, capillaries, and veins.

·32 MANUAL OF HIYOJENE. The Heart is al muscular organ contuining four cavities, which are separated from each other hy partitions. The two upper cavities are called the right and loft aurillos, and the two lower the right and left ventricles respectively. The right auricle opens into the right ventricle, and the loft auriole into the left ventricle. Each of these openings is provided with little valves or cloors, which open anul xhut ulternatoly. It is situatel within the chest cavity (Fig. 2:2) and is inclined more to the left than the right sicle. The pointal end of the heart, called the apex, may he folt beating il little below the left nipple between the fifth and xixth ribs. The sounds produced when the heart beats may also bo heard if the car is applied to this part of the chest wall. "Arteries are the tubes through which the pure blood from the heart is listributed to the clifferent parts of the hody. They are of an elastic nature, so that when the blood pannes into them they yield, become distended, and afterwarels contract, and thus force the blood onwarix. It in this action which causes the pulsation at the wrist and elsewhere. The heart beats from 70) to 90 times per minute in healthy adults, but much more quickly in children. The number varices also in clisease, and under numerous other conclitions, such as during rest, exercise, and sleep. Capillaries are the smaller tubes in which arteriex end. They are of microscopic size, and are no munierous that we cailnot pimeture any portion of our skin without causing blood to 0020 from them. Arteries have three different layers or cunts. Capillarios have only one cout, which is exceclingly thin, and consists of small delicate cells, through which the elements of nutrition contained in the blote pailss to tho tissue's. At the same time wastu nitters are thrown out of the tissues and pass' into the blood, which pulssex on to the veins, which begin where the capillaries on.

·THE BLOOD AND IT'S CIRCULATION.
33
Veins are tubes which convey tho impure blood back to
thu !:cart and thence to the lungs, where it is purifice as
FIG. 03.
KINNI.IT (I'.
NITOWIN. IIINN
describoil under respiration. The veins are provided with
small valves pFig. 23) at intervals, so that the bound
w lich hils pussed on may not be allowed to return during
its journey to the heart.
The Main Artery of the body is called the aorta. It
hegirm at the left ventricle, puuse's up a little way behind
VENA
CAVA
PULMONARY
ARTERY
TORTA
ARTERY
PULMONARY
VEINS
IGHT
URICLE
AORTAL
URICLE
Fir, 24.-TTK VIEART.
the breast-bone, then makes it course and PLASON
downwards
alongside the back-bone, dividing lower down into two

·34 MANUAL OF HYGIENE. branches, which ayuin sullivide into two branches, one i which passes down either leg. The latter give ofbestill smaller branches to supply uutrition to the muscles and other tissues. The morta also gives off branches to supply the head, neck, and arms. The large veins which receive impure bloul, from the small veins of the upper and lower R.J.K LJ.V. S.C. S.C B P.V. *B.ET 1.L. RA RI 12 LP I'll. Vi PRONT VIEW OF THIN IHART, Cirrar VASKIN, IND 1.1 Min. (The lungs have been cawn ilmulo in uneles to show the other structures fully Tlace oute lısein of the portinluin and the pleuru have won lolunturi) R.1, 1xht ntriclu; I. P, lef veutrelo; R.1, right uncle ; l..l, lest lo: In, ilta; P..l, pouda onary artery ; P. I, pulmonary Poink; R l., 114ht lung l... loft lung l... Vona LVL NIIMUOTAC, nubel.van cls Carous; K./.1. ill..!', right and left juguuli VenTIN; O'rta mferion; , bacl 11, B, Loronen. All the grout vernes ut those of the lungu aru cut. 1 portions of the bowly empty themselves into the right auricle throw.ch large veins called the vena caviť. Thie impure blood passes from the right wiele into the right ventricle, and the right ventricle in'sts turn pump it through the pulmonary artery on to the lungs to be purified. When purified it comes back to the left auriile through the pulmonry veins. The left auricle nonds the prvified blood into the left ventricle, and the left ventricle in its turn ·AIR. 35 sends it into the aorta to be clistributed as already describedl. (Figs. 24, 25.) Small valves are placed at the different openings of the heart to make sure that the blood goes the right road and to prevent it from rushing back to where it came from. The blood is sent from the auricles into the ventricles by a contraction of the auricles in the upper half of the heart. It is formed into the norta and the lungs from the ventricles by a similar contraction of the ventricles. - AIR. 04 The Composition of Air. Pure air consists of two gasos, namely, nitrogen and oxygen, which alle mechanically mixed; that is to rily, do not combine chemically to forne a third borly as hydrogen and oxygen co to form water. Air is sokkon pure. In allery 100 parts of what may be for all practical purpose regarded as pure air there are of Oxygen, 20-99 parts. Nitrogen, 78.97 ('arbonic Arul, Watery Vapour, Traces. Ammoni, Ozone, Ozone in an active form of oxygen. The Physical Characters of Air. Air cannot be soon in its gaseous fuim. It can, however, be liquefied hy great cold or pressure, which brings the small particles of which it is composed more closely longeother. On the other hand, air expands, increases in bulk, and becomie's lighter when located.' Pure air has no smell. The Need of Air. Fires and lights go out when the • air supply is cat off. On the other harul, fires burn morc briskly wheil a liberal supply of air is provided by blowing into then with a pair of bellows or through a piece of hollow ·36 JANUAL OF HYGIENE. hambon, or other tube, or wing a punkah or fan. Ther? offerts are due entirely to the oxygen contained in the air. Just as combustion is impossible without air, so human beings and animals could not live without it. The oxygen, of the air wo breathe, purifies blooil, enables 118 to mako use of the food wo eat, and fits it for the support and growth of our buulier. It also proluces heat, and thus hulps to keep our boulies warni. ('ombustible substances bumi with great rapidity in puro oxygen. In the same way, if wo breatheil puro oxygen, our tissues would be rapielly consumel. In fact it would be impossible to live. The oxygen of the air is therefore mise with strogen gas, which ilutes it and renilers it fit for breathing. The Kind of Air required. Air must be as pure and fresh is possible. The purest air is to look found in the neighbourhool of the sent, on the tops of mountains, and in country districts. Ozone is found in larger quantity ricar the real than olsewhere. The most impure air is to be found in large cities and towns where there is much tracle, and where manufactures are carried on to a large extent, und in all places where the removal of clirt is neglectol. IMPURITIES OF EXPIREI) AIR. Carbonic Acid. The expireul air is estimated to contain, about 100 to 120 times more carbonic acirl than the inspired air. The amount of carbonic acid given off is about throc-fifths of a cubic foota every hour. The amount, however, (lepende very much upon age, sex, and whether a person in working hard, taking cxercise, or resting. The impure blood in the lungs is dark in colour, like the lood which escupes when a vein is cut. After abuorbing oxygen it becomes bright red in colour, like the blood which spouts ont in jots when in artery is cut. If the blood which flows ·IMPURITIES OF EXPIRED AIR. 37 . froni a vein is collected it can he purifical hy passing oxygen through it. Bright coloured pure blood from artories can, on the other hand, if collector, he madle dark and impiu'd hy passing carbonic acid gas through it. The prosence of carbonic acid in expired air can be shown in the following manner. Bitathe into a clean bottle, maule of clear glans. Pour sonjo' fresh lime water into the bottle, and whake it well. The limo watem will turn milky white owing to the carbonic uid combining with it. A chalky compound (calcium carbonate or carbonate of lime) is formed. A light is speedily extinguisher when put into carbunic ausil yas, and it is due to the accumulation of this gan and Joss of oxygen that a burning canillo graulually goes out when put into il glass jar from which air is excluded by covering it up with a lid. Expired air is estimated to contain about 16:033 volumor of oxygen, 79-557 of nitrogen, and 4:380) of urbonic acid gas in one hundrel volumes. Watery Vapour. About 25 to 10 ounces of watery l'apour escape from the lungs daily. The expired air in saturated with it, that is to say it could not hold more. Its presence can be demonstrateel by breathing on il coll piece of glass or other substance. In cold countries it becomes concerned, and may be sco (scaping from the mouth like team, and it may also be seen running down the glass windows of varupical railway carriages, or dwelling woms, theatres, and similar places, the windows of which are kept xhut to keep out the coll. Organic Matter. The organic matter in the expireal air consists of , infinitesimally small purticles of dead tissue anel'the foul MOLNEN of their clocomposition. This is the most injurious in purity of expired air. It is contained in large amount in the watery vapur, which, if collerted and kept in a bottlo, rapiilly locomposes and gives off a nust offensive 1 ·38 MANUAL OF HYGIENE. olour. Other impurities, such an animonia, a substand: called urea and mineral matter, are also found in small quantities in expired air. The peculiar vickly olour of overcrowded and bully ventilated rooms most noticeable on entering such places from the frexh all outside in due not so much to the large, amount of carbonic acid present is to the foul organic matter. This foul matter, although obtaineil, in large part, from the lungs, is also given off from dirty skins, dirty feet, dirty mouth, lecayed and dirty teeth, and dirty clothing. The amount of organic matter, from these sources, present in the air, increases in proportion to the inérease in the amount of carbonic acid gils. It is, for this reason, found cowenient to julge of the extent of the pollution of the air of a room by estimating the amount of carbonic acid gas prosent, which is more easily clone. The carbonit acid xhoull never exceed 6 parts in 10,000 or 6 or threr-fifths of at purt in 1000, jurts of air. IMPURITIES IN THE AIR OF IXILABITED) PLACES. These consist of the impure nuatter given off by the lungy, skin, and other orgins of the buly. Firex, gan jutn, vil lampx, and candles during combustion, like the lungs, LISAP the Orligen of the air and give off carbonic acid gub, Watery vapour, particles of carbon, in other waste pro ducts. It ho's been estimated that two hard sperm cindles, or one oil lamp, Cousume as much oxygen and give out as much carbonic acid as one inani. It has also been estimatoil that one batswing gils burner consumes as muchi (vyger and gives out as much-carbonic acid as at least thro men. (ar sonic acid and other foul and injurious grues are also given off' in large quantities from decaying waste matter in ·IMPURITIES IN AIR OF INILABITED PLACES, 39 dirty streets, drains, newcis, chesspools, latrines, stables, cattleshed!n, over-crowded, bully selected, and ill-regulated graveyards, brickfields, marshes, manufactories, and other similar places. The air may also contuin portions of human hair, skin, fibres of dirty rays, the eggs of insects, and even the insects themselves. No less than 200 different kinds of living creatures are said to have been found in the air. The air of inhabitel.pluccs may also bu renderul impure loy the presence of dust which may be teeming with garins, of disease. • Diseases Caused by Impure Air. Headache, faintners, sickness, vomiting, and diarrhura are often caused by the foul air of rooms, public halls, theatres, and other overcrowded and bailly ventilateel buiklinge. People who costantly live under such conditions suffer froin loss of appetite, sleeplessness, low spirits, and general al health. The health of children more especially is liable to suffer fron, the cflect of lonel air. Bired air is often also the predisposing condition of discises of the lungs, such as bronchitis and consumption, and of small-pox, measles, cliphtheria, clysentery, plagile, diseases of the skin and eyes, and numerous other diseases. It said that the leath rate from lung cliseases is 3 or 1 times greator anong working people from the dust caused by the nature of their employment than ainongst other people. A great deal of the enteric fever and dysentery which Occurred amongst the British solliers during the South African war is said to have been caused by dust getting into the milk and water after they had been boiled. It in a well-known fact, to, that far more sicknens prevails and, inore cleaths occur in clirty cities, towns, villages, and houses than in places which are kept cluan, and whero the air is alway# fresh and puro. How to Keep the Air Pure. Every attention should ·40 MAXCAL OF HYGIENE. be paid to the careful construction and cleanliness of house's, crains, laurinen, etc. Refuse of all kind should be immediately removed and carefully disposer of. There should be a liberal supply of water for cleansing purposes. We should keep our houses, our boilies, and our clothes clean. An ontlet should be made for the smoke in cookhouses.' (ooking should not be done in sleeping rooms. Animals such an cowx, buflakes, gouts, cats, and clogs spoukl not be allowed to live in or near rooms incupied by human beings. Attention to matter of this kind will help very considerably to keep the air puru. 0 . IIOW' IMPURE AIR MAY BE PURIFIEI), Ventilation. Amongst the means whoroby imprire air may be purificul ventilation is the most important. Pentilation means the removal or dilution of the impurities of the air of inhabiterl rooms and buildings with fresh air from the outside unuitter through the windows, door's, or other openings. It is facilitated by the natural tendency of gasos to mix with each other, by wind and by heat. The following are some of the ways in which ventilation is offected. By Diffusion. Just ils smoke from a chimney or a pipo mixes with the air and gradually disappear's, or als coul gus mives with the air in rooms, so does the impuro air of rvomis tend to escape and mix with the fresh outside air. The fresh outside air similarly tends to enter the room and mis with the impure air. This is known as the "cliffusion of guses." Fire-places in cold countries help diffusion conxilerably. The heated impure air is drawn in the direction of the firo-place, rushes up the chimney, and its plaço is taken by the cold pure air from the outside. Gas flames, oncloace in glass globes, open at the bottom, and places neur opening communicating with the outsidlo uir, are ·HOW IMPU'RE AIR MAY BE PURIFIEI). 41 sometimes used for ventilating purposes. They create a ranglit in the same way as fires dois, and thus get rid of one of the impurities of the air. It is not desirable during cold weather or in cold climates, that one large opening only should be used for ventilation purposes. This methol of ventilating may cause cold daughts and give rise to *Chills. Several small openings are better. "Phix not only avoils dranghts, but the impurities of the air in every part of the room are thus morc casily yot rid of altogether or moro evenly diluteil. Furopean house's, on account of the roller climate", are constructed in an entirely (litterent way from housex, in India, anul the system of ventilation also differs very much. Valves in the walls near the ceiling alre sometimes used for ventilating houses in European countrics. They art very much like the jhilmils of the doors and windows of houses in India, which not only keep out the glare of the sun, and the rain, but help to krep the room cool, and allow the free entrance of air. l'entilating tubes are also used in European houses. The air is aclmitted through an opening in the wall near the Hoor, and carried op the inside of the wall to a height of 6 or & foet. The placing high up in the wall of bricks with Conical pulssilyr's through them is another method which is sometimes employeel. The hot impure air being lighter than coll air rises and is allowed to escape by other Openings places near the ceiling, Figs. 26 and 27 show clearly some of the methods of 'vontilation just described. In cold countries the combinail area of all the ventilating apertures should love about 24 squw inches for cach person. In the plains of Inclin much more may be allowed without any risk of cold being caught from imnghts. In fact sleeping rooms have in many instances as much door and window space in walls, and for many months in the year are kept opin all night ·42 MANUAL OF HYOTENE. long in order to encourage free movement of the air. Pur. kahs and electric fans are used cluring the hot weather for the purpose of keeping the air in mution, and thereby cause an indraught of air from the outside. The impurities of the air are also thus got rid of to some extent. T'he air of rooms at such times of the year is cooler than the air outside. The outside hot air does not tend, however, to rush into the rooms and mix with the cold air, als coll air Flo 21. EN MULATION BY CITE, GIN LION' IND IK NIET Fiel 27.-, Shemmigham valve; 1, Kiul Jariahn. Tobnu's tule. tends to rush into a hot room and mix with the hot air in it., This has been explained before. It is for this reason that the ventilating space of Indian houses needs to be so great, that rooms have to be worlarge and ceilings so high. In the huts of the poor and ignorant nativos of India there is, as a rule, no outlet of any kind for the air, which is vitintend by the smoke from firem, in auldition to human and animal impurities, excopt through small cracks in the walls, chinks in doors, through the thatch, or botwa-n the tiles of roofs. The houses of the well-turto are, as a rule, provide ·JIOW IMPURE AIR MAY BE PURIFIEI). 43 With sufficient means for permitting foul air to caape. Unfortunately, however, they are often not made use of. It is most necemury that provision should be moule for the ventilation of staircases into which foul air from all the adjoining rouns finds its way. In opening mule in the eroof will serve this purpose, but arrangemeyits must be made to keep out the rain. No houve", the staircase of whiçhº is not property ventilated, can be healthy. Well ventilated stah cases help to remove the impurities of the air of auljoining rooms. Fans driven by steam, or otherwise, are often used for ventilating the between decks of passenger ships, engine rooms, large public schools, mills, and other sinilar buildings. They do so cither by supplying fresh air or by forcibly with Irawing the impurities in the air. Mont good is effected by the latter methol. The former causes strong draughts, and all the foul air is not purified. Central air shafts in which fires are kept burning to create an upward draught are also sometimes used for ventilating purposes. Cual mines are ventilated in this way. Compressed air has also been used. Wind. Wind helps considerably in the ventilation of buildings by forcibly removing the impunities of the air. Rain. The purity and freshness of the air after a heavy and continuous shower of rain are due to the fact that the dust and other impurities have been washed out of it into the soil or water channels, Green Plants. Groen plants under the influence of the sun's rays split up carbonic acid into two elenients, curbon and oxygen., They use the carbon for their nutrition and grouth, and set the oxygen free. They are, therefore, ulso useful as purifying agents. Amount of Fresh Air needed for Ventilating Purposes.' The cubic capacity of a room is calculated by ·4+ MANUAL OF HYGIENE. multiplying the length, breaclth, and height togethet. Kach person should, if possible, have a cubic space mousuring 1000 fort. A room 10 feet long, 10 feet wide, andl10 foot high would give this amount of cubic space. The air in such a room should be changeel three times hourly. In other words, 3000 cubic feet of air must be supplied hourly. to prevent the carbonic acid yas and other impuritios accumulating to a dangeroun extent. Tu calculating the cubic capacity of a room, the space occupied by furniture should be declutal. room which afforils less than 300 cubic fect of Mace to rach individual is overcrowded. Some few years ago the writer inspected and submitted a report on a room in ('aleutta, the cubic capacity of which Why 540 feet. This room was occupied hy 8 persone, aftorling cuch person only 70 cubic foot of spire. There is it (aso on record, however, where a room in Leicester, in England, container 6 persons with only 51 cubic foot of air space cach, and with three gas-lights burning (Reynolds). The superficial area, or the Hoor space, allowed to cach person should not be less, if possible, than 80 or 90 square foot. This is calculated by length and breaulth measureincnts. Much grontor cubic space and Hoor arou are requireel in hospitals. Where it is not possible to give so much, a.s, for example, in schoolrooms, mosques, temples, chilrches, theatres, buildings for public meetings, and all places in which unhealthy excupations are curried on, but which are not continuously ixcupiec, such as printing prosses, shops, golowns, and mills, the very best means of ventilation should be provided. The best text of the impurity of air is smell. The amount of fresh air uluviitor into a room or building should always be sinfficient to prevent'the smallest trace of smell being parreptible on entoring them from the fresh air vutside.

·WATER. . Concluding Remarks on Ventilation. Doors, windows, and other openings should be kept open as much als gossible olay and night. Fresh air is specially needle during sicknent. The pruutice of shutting up door and windows during sickness in Inclian families is very commun' and exceerlingly dangerous. The çril is often inercipuud by the smoke arising from burning luge of wound and lamps, for which, as has been alreadly stated, there is no ccape, and by the foul matter from the lungs and bunlies. of the large number of rolutives and friends attending the gick. WATER. The Composition of Water. Water is composed of two guses, namely hydrogen and oxygen. These two gines are not mechanically mixed in forming water ! lre the nitrogen and oxygen of which air is composedl. They combine chemically to form water in the sumo way as carbonic acid combines with the lime in lime water to form a chalki compound which is neither the one nor the other, but a new and solid substance composed of both. Water is for this reason known as it chemical compound. When mule slightly acidl, water can be split up into hydrogen and oxygen by the use of clectricity; anul, on the other hand, the two yunon may be maleato combine to form water. Wator mily exist in the form of either a yils, a liquid, on a solid. Steyim, mist, clouds, low, rain, show, hailstones, anl ićo fro all forms of water. Thy Use, of water. Water is required for the gllstenance and gravth of all animals ariil plants. Without water life could not exist. Three-fourths of the weight of our buddies consist of water, part of which is got from the ·46 MANUAL OF HYGIENE. 6 food wc cat. Some vegetables, such is turnips and potit toos, consist almost entirely of water. The greater portion, however, is taken into our systeins in drinking water, builo and other liquiils. Effects of the Scarcity of Water. Without water the croju would withor and clic, fool would baronſe Acurce and dear, and faniine, sickness, and deuth woull cusue. Wells and tanks are sometimos tho prily source of water •supply for the crops when the rains fail. Thg water drawn from these sources is allowed to flow into the tickls or gardens through shallow surface crains or channels, and in this way the crops are kept alive. Tuisperation is called irrigation, and may be seen on a small scale in almost any Indian village at certain scusOns of the year. Irrigation on a much more extensive scale, however, is curried on by the (overnment in those parts of the country in which the rainfall in scanty or where the rains ofton fail alugether. Many thousands of miles of canals have been male for this purpune. In the year 1898 no lose thin 46,000,000 acros, or nearly 72,000 square miles of land, which would otherwiso havo remained dry and harren jungle, were by means of irrigation with water obtainel froni tanks, wells, and canals, yielling rich harvests of grain and other produce for human usc. Moreover, 1,000,000 more acres, chictly in the l'unjab and Sindh, were at that time alwut to be brought under cultivation in the same way. It will thus be seen that water is of the gruntcxt value to the growth of the crop. Water is of 10 less value, however, for the growth and health of our bolies. Without it our kidneys and other organis cou'd not perform their natural functions; our skil. yould, CINC to åct, and become dirty and cliseased. We should be unahio to wash our clothes, keep our houses clean, or wok our fool. Drains would become stagnant and the ·SOURCES OF WATER SUPPLY 17 afr would be poisoned with foul gilsce. Sickness would break out, and we should all soon dio. Quantity of Water required. In European houses between 20 and 25 gallons of water are required daily per individuyl for drinking, cooking, washing cuking utensils, washing clothes, bathing, and other household purposes. • Benido this, in large commercial towns, al supply is needed for carrying on tracle, for keeping sowers and drains clean, for watering streets, and other purposos. About 330 gallons are considered sufficient for all purposes. In towns in India a smaller supply has been found sufficient. SOURCES OF WATER SUPPLY. Springs. Water is sometimes obtained from great depths in the ground through springx. Follow tubes are sometimes munk in the ground to great clepths in Surfuco Wall Surface well Deep Well Spring Surface well Artesian Well Ariel Well Fic: 28.-NOI'ROWN OF WATIR NIPPL.. priler to obtain a supply of water, the water in such CRACA being raised by pumping. 'i'here are known as tube-wells. Water, obtained from this your is the best and safest for armking purposes. Springs and lube-wells should, how- "hac carofully protected against pollution. Deep Wells, "Wells over 50 feet in depth are sometimes, though not quite correctly, described as deep wells. It is more correct to regard as deep wells only such wells over, ·18 MANUAL OF HYGIENE. 24 aro nunk through the surface soil and through an underlying impervious stratum into a deeper Water-hearing one (Willoughly). Deep wells in some cases do not excecil 20 foot in clepth. Water fron this source is, as a rulo, also goxul and safe to use". Artesian Wells (Fig. 28), are marlo by boring, and extend to a great depth at times through various impermeablo strata beforo water is reached. The water " sometimes (Mapes from them like the water from it fountain, owing to the great prossuro to which it is subjectel. Surface Wells. Wells which are less than 50 feet in depth, and aro not of the character above described, are sometimes called surface wells. Surface wells are sometimes mere hollows in the ground. They obtain their water supply from the sunfrue soil, and are therefore very easily polluted boy dirty water and other filthy liquids, and should not be used. These wells may be comparatively cloop, and yet be surface wells in the true sense of the term. - Tanks. The water of tanks is often used for drinking and other comestic pur"[*]80. Unless specially set apart for human ve and carefully watched, which is not any, water from tanks is exceelingly uwife to uno, because they are as a rule very bully polluted owing to the clirty habits of the people who liso them and boy animals. Hills and Lakes. Water from hills and lakes situated far away f.um human dwellings, in places where the land is not cultivated or used for grazing cuttle, and where there is little or no rlecnying animal or vegetable refuse, is gowwl and wholesome. Many large towns obtrin their water, supply from such OurCCs. Bombay and Maulras, for example, obtain their water supply from clintant hills. Loch Katrine, a lake situated at a distance of over 30 miles 11 ·SOURCES OF WATER SUPPLY. +9 foom Glasgow, a town as largo in size and almost as large in population as Calcuttil, is the principal source of the wator supply of that great city. Rain Water. Rain wator collectod and stored in large cisterne underground is sometimes the only source of the water slipply. In large manufacturing and dirty towns rain water is rendered unsafe for 1190 hy tho guses and other impurities contained in the air. In country districts where the air is pure rain water may he safely usal, and in, much softer and hetter fitted for general usc than water 'obtained from most other sources. Soa Water. It now and again happens that the supply of drinking water, carried in the large iron tanks with which all steamers and ships arc fitted, is exhaustod bofore the place of destination is reached. In those circumstances the crow and passengers have to fall hack upon the 11ne of sea water which is freed from its salt and other impuritics, which make it unfit for ise, hy boiling it in specially constructed boilers and collecting the stcam in separato chambers or condensers, where it forms water on cooling. This process is known as distillation," and the water thus obtained is callel “clistilled water." Rivers. Many large citios obtain their entire water supply from rivers. London, for example, is supplierl chiefly from the River Thames and Calcutta from the Hughli river. Many lakhs of rupees are spent yearly in the colloction and purification of water obtained from this The water before this purifieel hy passing it through filtering beds made of stone, bricks, or other material; of different sincs, and hand of coarso and fine quality, which must be thoroughly cleaned before hzing used. After being thus purified it is conveyed in large underground pips or mains and clistributed throughout the city by uoans of smaller branch pipes male of galvaniscci source.

·50 MANUAL OF TYGIENE. or wrought iron or leal. These pipes should he so care fully constructoil that foul guses or liquids and other impure matter may not be able to find their way ir.to the watur supply through cracks and other (lefacts Sovere outbreaks of discuse have often been caused in this way. W'ator sometimes acts on lead and dissolves it One-sixtioth purt of a grain of lerul in al gallon of water will cause colicky puins in the belly and other symptoms of luul poisoning. The water thus purified is often converal into the houses of those who can afford to pay for it. The pxoor have it at their cloors, and a liberal supply can be drawn from the stand pipes by merely turning a tap or handle, or in some cases by pressing a knob. Dirty tanks anxl wells are no longer required in such cities, and the few that aro not filled up are now-il-day's seul chiefly for supplying water for washing Hours and as it porecaution against fire. I'cople who like properly filtered water only live cleaner and healthier lives than those who, cither of their own choice or berulline there is no other supply available, continue to rise the water of tanks and wells. Since the introduction of the filtered water supply into (alcutta the cleathy from cholera and other water-borne disenses have been very considerably reduced in number. Tho sulmo freerlom froni such liscises is enjoyed in other towns with a good supply of filterud water. N HOW WATER IS POLLUTED. Pollution of Wells. The well may be a shallow one. It may be dlug in a lone and poronis or soft and san:ly'soil throngh which impuro liquials casily purvolkta. Hidher there muy be no nasonry walls, or the walls, if any exist, niay be broken and out of ropair generally. The mouth of the well may be below the level of the surface of the yround.

·Latrine
com Shed
Stable
Drain
Drain
CessPOOL
brain..
Orain
JOW' WATER IN POLI.UTEI),
with
.
31
FIG. 29.-SBOWING BOW THE WATER IN WELIS IS SOMETIMES POLLLTED IN INDIA.

·52 MANUAL OF HYGIENE. It may be situated near a dirty drain, or a badly corstructed and unclean latrino, cesspool, stable, or cattleshed. Buffaloes, cow's, and other animals may be tied up too close to it. The washings of the street, latrines, and foul contents of druins, and the discharges of animals can thus easily find their way into wells such as those which have heen. closcribed above. There aro other ways, howover, in which wells are often polluted. If the well is not covered, straw, . loaves, and dust may he blown into it. The water may be cofiled by birds, which often build their nests in wells. It is a common practice in India, too, for people to wash their dirty clothes and hathe themselves while standing over wells, and dirty vessels and dirty ropos are often used for the purpose of drawing water. Morcover, it often happens that wells are not cleaned out for years at a time. Mud, broken pots, piccos of rope, and other refuse in consequence collect at the botton, and sooner or later stop the spring from which tho water flows. No frosh water can get into the well, and that which it already contains soon beconies unfit for line. Theso, thon, are some of the ways, all of which the writer hus soon, in which the water supply of wells may be polluted and rendered unsafe for human use. Pollution of Tanks. a rule, morc pollutool than wells. Ignorant and dirty people oftop build their latrines near them, or the margins of the tanks may be used instead of latrines, with obvious results when a shower of rain falls. The liquid refuse from latrines, cattleshols, and similar places, and the foul contencs of drains are often allowed to flow into tanka. Dhobies not unfrofuently ply their travle in them, and they ale in tuany cases resorted to by thousands of people daily for bathing purposes. Further, hoggars and others with all kinds of loathsome discases are often to be seer. using the water of Tanks are, ds 1 ·HOW WATER IS POLLUTED. 53 tanks for washing their sores and the rays with which they Aro (lresacd. U Pollution of Rivers. Besides heing polluted in the same way as tanks, rivers are still further defiled by the highly objectionable and dangerous custom of throwing the bodies or the ashes of olcad persons and the carcascs of animals into then, The liquid refuse of factories and mills is often disposed of by allowing it to run into rivers, while the whole of the sewage of large towns is often got rid of in this way. Rivers are also polluted by refuse being thrown into them from steamors and ships, and by the dirty and careless habits of boatmen. The night soil of villages is often collected and thrown into rivers. The result of all this sinning against the laws of health is the frequent outbreak of epidomic diseases of the most virulent kind. Impurities in Water (Fig. 30). When water is allowed to stand in a glass tube particles of sand, mud, or other solid bodies which it may contain will sink to tho bottom. The eye may be able to tell what those particles are. The most dangerous impurities in water, however, such as the germs of cholera and othor (liseases, are so vory small that they can be seen only under certain conditions and often with great difficulty, with the help of a very powerful magnifying instrument called a microscope. The eggs of worms and the young of mosquitoes may also be found in water, and theso may give rise to disease in people who drink it. Wornis are often caused in this way. Malarial fever, which CUISCH no many deaths yeaMy, may possibly be due in many cases to the lise of water contuining the parasites which Cause that disenso. Rocónt discoverion, however, show that the' bites of mosquitoes of a cortuin kirul (anopheles) are the most common cause of malarial fever. Elephantiasis, a clincase in which the legs, arnis, and other parts of the horly become enormously enlargul, and which is so common in

·54
MANUAL OF HYGIENE.
many parts of India, for exanıplo, Orissa, is another discanu
which it is supposed may be caused by water rendered
impure hy mosquitoes. Recent investigations have shown
1680
00
TITTATILE
Fic. 30.--MICRO
VIEW OF SOME DROP OF WATER TAKEX RON
A LONIN ('18 TE..X.
that this cineasu may also be caused directly by the Lites
of those insects. Cholera, dysentery, diarrhæa, and enteric
favor idro other well-known discuscs which may be causcd
by impurities in water.

·HOW WATER IS POLLI"TED 05 1 A few Special Observations on the Impurity of Water. If on placing a drop of water from a well under a mitroscope fragments of cotton or portions of the human bouly are found, the only conclusion to be drawn is that the well is being, polluted by household impuritics, the water is unfit for use, and that the well should be abandoned at once, When many pwople or several members of a family, living in the sumnc villago, strert, or house, are attricker with cholera pt or about the same time, the well, tank, or, other source of water supply is most like to be the cause of the outbreak. In such case's the water on inspection may be clear, taxte well, appear to be pure and wholesome, and be well liked by those who drink it. It should be notul, however, that water of this kind may be very badly polluted with discase germs, and therefore most dangerous to health if wel. How we can tell when Water is Polluted. The best test is the health of those who drink it. If there is no sickness in the form of malarial fever, with enlarge spleens, cholera, and so forth, the water may be regarded as safe ichid fit for use". If, however, sickness breaks out the water supply should immediately receive attention. In large cities, such ils Calcuttil, the water is csamined weekly to iscertain the degree of purity or impurity of the supply. Wherever possible this should be clone', ils prevention of disease is better than cure. The examination of water muy be divided into three parts, namely: (1) Physical, (2) chemical, and (3) bacteriopgical. Physical. Examination of Water. In this examination the colour, clearness, sciliment, smell, lustre, and tuste have to be noted. Good water has always a bluish colour. Groyish water hay be your alls. Groenish waters are not necessarily , bad. Yellow and brown waters are always maafo" to use. Water should be clear and free from ·56 MANUAL OF HYGIENE. nor' Rollr. depoxit. It may, however, in has been alrcarly stateci, contain wand or other mineral matter, which gives it yellow colour, and yet be pwrfectly safe. (iood (Irinking wator should be free from smell. Smoll can be easily detected by heating the water and inhaling the strain that riscs from it. Pure water should be neither bitter, sweet, sult, It should be practically tusteless. Chemical Examination of Water: This examination enables us to ascertain, amongst other things the extont to which any given sample of water is polluted with organic, mattor of human, aninial, and vegetable origin, and the degree of softness or hardness of water. 'A chemical examination can be made and the results understood only by persons who have acquired a thorough knowledge of chemistry after long and diligent study. The results of a chemical examination may show the water to be apparently of good quality, and yet it may contain the germs of the most fatal forms of epidenic din also, the presence of which can be detected only with the holp of the microscope. Bacteriological Examination of Water. The presence of fibres of cotton, wool, and such like objects can usually be casily detected, but can sometimes luc brought into view only by the line of staining reagonts. Mr. Hankin this clcscribes the mothod of counting the number of gorms or micrubos in wator: “The method of couiting thenı depends on the fact that microbes whose presence in water we have to doal with can only grow in meat jelly. A small quantity of water to be tosted is ukle and mixed with some nielted meat jelly. The jelly is allowed to cool. Twenty-four hours later the jelly, which previously had been porfuctly transparent, will be seen to contain numerous white or yellow spots. "The reason for this change is as follows: Wher the jelly became solid cach microbe was Sxed at ono point or other in the jelly, presumably separate from its ·BACTERIOLOGICAL EXAMINATION OF WATER. 57 neighboun. Each microbe began to grow and reproduce. Jach parent microle and the daughter microbes necessarily remain wyether, as they cannot more through the jelly. They thus form a small colony, which is time goes on becomes so large is to be risible to the naked cre. ,(ienerally these colonies are as lurge as small pinhouls, and we als visible in the jelly as the small spots mentioned above. By counting the colonies we obviously arrive at the number of microbus present in the water udel. If the bulk of this water is known, we can calculato how many microbes were present. This is called a bacteriological examination, autol can be performed only by an expert in such matters. How to Prevent the Pollution of Water. If wells are reul they should be iLM decpils possible. The walls should be mulo of thick stone, bricks, or other similar har material. The walls should be set in cement, and should extent two or three feet above the level of the ground, forming a parapet. There should be no cracks in the walls. When the walls begin to sink, or otherwise get out of order, they should be required at once. The ground round the well should be pilved with stone slabs or brickx on milye, set in cement, and the pavement should have a slopo, 3 or i feet in width, to allow the spill water to run off. A small drain should be constructed round this pavement to catch the spill water, which should run into a branch drain from the main drain surrounding the pavement, and thus be conveyed to a safo clistance from the well. This will provent it sogking into the ground and getting back into the well. The mouth of the well should be covered, leaving an opunitug large enough to admit a hycket. A small trap door with hinges should be provided with which to cover the opening after drawing water from the well. This will hello to koop ont birls, dust, louves, straw, and other ·58 MANCIL OF HYTTENE. of impuritios. An iron bucket with a chain running over a pulley should he attached to cach woll, anıl the use of this bucket only for drawing water should be insisted upon. This will prevent the line of dirty vessels and ropes. The LINC of pumps would be better still (Fig. 31)., When it is possible to have repairs executed without great leluy, if, they get out of orler, pumps are the Very best megnis kveping wells clean, and should be used in every town and village whore there is no filtered water supply. Buthing ind washing of clothes and cooking rensels near Wells shoull be prohibited. Wells should be periclically cleanel out. Lastly, but not least, cvory town in virage should be kept thoroughly clean. No kind of ofroniive matter should be allowed to remain either in the streets, around human dwellings, or elsewhere, because sooner or later it will got dried up by the sum, converted into dust, blown about in the air, and ultimately find its way into the water supply. When tanks are the chief or only yource of supply of drinking water to al community they should be l'escrvod for that purposes only. They should be as cleep as possible, so that the water may be kept cool and every procution taken to keep them from being polluteil. How to Purify Water. It has been alreadly observed that water from springs, deep wellx, certain hilly districts and lakex, rain water, pipe water supplied by municipalities ureas a rule, reliable and safe to rise for all domestic purposes. If there is any doubt, however, as to the purity, of water, steps should be taken to purify it. There are several ways in which water may be purified. • Distillation. This was deu-ribed when vlcaling with se's water, under the healing "Suurves of Water Supply** Boiling. Builifig for ten minutes will destroy almost overy known form of clincase gorms which water may contain. Kepenteel boilings will make the most impure water ·HOW TO PURIFY WATER. 59 FIG. 81.SHOWING HUW THE POLLLTIUS OF THE WATER OF WELLÄ MAY BE PREVESTED. 1. Well with mancary walls 2. Bathing platform at a safe distance. 3. Water pipe. 4. Pumr. 5. Drinking water in cistern with covor and tap. 8. Drain for waste water. 7. Masonry pererrent around well. R. Ground surrounding pavement 9. Surface water kept out of well ·60 MANUAL OF HYGIENE. perfectly wife to drink. When water has heen hoiled it must not be allowed to stand unuser! too long, and must be protectal aguinst the entrance of dust and other impurities. This can best be done loy keeping it in stoppered bottles. Water which has been boiled is not so palatable as amboileal water. It is, however, wife, which is much better. Ine order to make water which has been boilo more palotilblo. it is often recommended that it should be well shaken, 80 ay to mix it with the air. This, however renders the wator liable to pollution by cliscasc germs, and shoulel, therefore he avoidel. The Use of Chemical Substances. Hluth clears muddy water by carrying the mul and other suspendud matters to Lito bottom of the vessel containing the water. Alum is eron believed to be able to kill or prevent the growth of gernis. Six grains of alum to a gallon of water are sufficient. Permanganate of potassium is, however, the best of all chemical substances. Its lisc is believeil loy somo people to be the best means of cleansing the water of wells which are believed to be infected with cholera geimis. MK Hankin, who has given the question a grout deal of attention in his pamphlet on the cause and prevention of cholera gives the following directions for the treatment of wolls with this substance : “Care should be taken to explain to the villagers thịt permanganate is a walt-like suhstance in whose preparation only mineral substances are employed, and therefore itx tino ought not to le objected to by the strictent llinda. "The villagers should be warned against the danger of drinking any water except that froni treated wells. It should also le explained that the permangannie is not a medicine for patients, hut merely a means of cleansing water.' "Put two ounces of permanganate in the solid state into ·HOW TO PURIFY WATER. 61 a dol or bucket that has been filled with water from the well about to be treated. Stir it up anil pour the rout solation thus produced into the well, leaving the portion of permanganate that is not yet (lissolvall at the bottom of the dol. Lowor the dol into the well, draw it up, pour back the water as before. Repeat the process till all the per manganato has been dissolveol. After half an hour draw up some of the water and examine it. If a real colour is still present erough has been added. If the red colour has (lisappeared, then more permanganate should be added to 'the water in the well. In all cases enough permanganato should be added to proluce a faint red colour lasting : 1 hours. “ If the water in the well is bac, more prrmanganato will be necessary. In such a caso it will be found that the strong, red colour at first prodlucod slowly changes to brown, and then faules away. This is because permanganate and clirt destroy one another. Therefore, permanganate must be aclılarl in order to produce a lasting colour. If the water in the well is clean a smaller quantity of permanganate will be found to be sufficient. From one to eight ounces of solie permanganate will be found to be sufficient for orlinary wells. If possible the permanganate should be le at night in order to leave the wells unclisturbed as long as possible. The water will be fit to drink on the following morning. If at this time the water has the red colour it will have a slightly wpleasant taste, but it is perfectly harmloss. If the inhabitants do not like the taste, they should he instructed to pump out the wątor until the colour vanishes. Always care should be taker to treat with permanganate all the wells in the place, not only those used for drinking, but also those used for washing pumposes. The village police may be employod to show the operator, the positions of the different wells. molc .

·02 MANUAL OF HYGIENE. 1) After, but iint before, there wolls have been found and trented, search should be made for a well nour the police station that the police will have forgotten to show. This tell or any other suitable wells should be treated with a double quantity of permanganate. Bhisties may then be employed to pump out its water until the colour has nearly vanished, Tho inhabitants should be advised only to use this well until the following morning, when the water of the other wells will be fit to drink. The well thus selectoll, for iminecliate use may afterwards he further treated with permungunate. “Usually water is stored in the houses in yhurrahs for washing and other purposes. This should doe poural away, and, if possible, the inhabitants should be pursuaded to wash their lolus and other vessely with water containing permanganate. Unless this be done, isolated ones of cholera aro likely to occur m'en four or five clays after the treatmont of the wells." Filtration. The purification of water by means of.filtration is silfe only in the hands of persons who possess an intelligent knowledge of the construction of filters, how they act, how they should be sol, and how they may be kopt in safe working order. The great majority of people know nothing about them, and hence the use of filters for domestic purposes is ofton fraught with the greatest risk to health. The writor had cxccasion not long ago to inquire inti, an outbreak of enteric fever on a steamer in the poſt of Calcuttil, which was shown loy a skilled bacteriologist to be due to the use of water from it small clomestic filter, which was highly pollutel. No less than eighteen persons were attucked with the disease. (Charcoal and sand are usce il that well-known simple and cheap Indian filtër, which consists of three earthenwaro vessels (ghurrahk), arranged one' above the other in a woolon frame, The purification of water by filtration, through sand, ·HOW TO PURIFY WATER. 63 יויאן depends upon the presence of numerous small living vegetable boclics, which form a klime upon the surface. Spotier or later the slime becomes ho compact as to prevent the water passing through. When this happens some of it has to be scraperl uit. When new sand is used the water which PxLsses through it is not safe to 11e until this layer of slimo has frymedl. Twenty-four to forty-cight hours are generally suflicient for this purpose. Thorough cleansing of the sand before 11sc, however, will make it fairly Mufe even before the slime has formel. In Germany the filtered water is not servod out from a newly male filter-bed, but rturned to the settling tanlas until a fresh growth has formed, and thu bacteria reduced to 50 cubic centini. (\'illoughby). The lise of the ortlinary cheap domestic filters, now described, and those most generally to be found in householls, whould be alındoned. It would be far better to get rid of solid particles of matter, and then merely lwil the walen If, however, domestic tilters are seul at all, the Pasteur-Chamberland or the Berkefelel filter should bor preferred. The filtering material in much of those filters consists of hollow cylindler's or cauilles closcul azt one end, and having at the other fine carthenware or metal caps, through which the filtered water pisses. The canilles of the Pasteur-C'hamberland filter are made of purcelain, il very fine form of carthenware, and asbestos, which is a mineral fibrous substance. The candles of the Berkefelel filter, on the other hand, are made up of compressed and bakul carth, consisting chictly of the hard finty skeletons of infinitosnally small organisms called diatoms. They Inve 'heen described by the Berkefeld Filter Company us beings hardly larger than the bacteria which they are mount •to catch. The Berkefeld filters give a flow of water through the candles five to ten times as rapid as the Pasteur-Chamborland," thu reuson, assigned being that the candles are .

·64 MANUAL OF HYGIENE. porous to the highost (legree. The Berkefell Filter Compuny observe that in this large supply of perfoutly pure water, together with its absoluto certainty of retaining on its surface all cliseune germa, rosts the great practical value of the Berkefelel filtor to the public. The niain objections which have been stutol nguinst the use of the Berkefeld filter are, that the candles are masily broken and their repliuement is expensive, and that they require to be boiled every day or two to be madlo quite wafo for 11se'. On the other hand, it is stated that the l'asteur-('hamberland filter is difficult to break, ani nay last, with care, for months at it time. Ita is also easy to clean, unil, as the British Mrilical Journal observes, the application of the Pasteur germ filter for water for some yerlin in 200,000 quarters of the French Arniy has shown that it is offectual in preventing opicleniion of cholera, typhoidl fever, cliarrher, and sinuilar cliseases. Drs. Sims Woodheal and Wool, in their report un filters publishel in the British Melical Journal of December, 1894, sily: “The l'anteur filter does prevent the communication of water-borne diseases, as is claimed hy the vendors. Almost all other filters miny materially increase the risk of acquiring infoctious clisease, and are to be looked upou as an unmitigated cuil." The Innert has also obscrved that the purifying efficiency of the Pasteur-Chamberland tube is also attested by pract:- cal experience, and that the use of the lastcur filter is a real preventiv. of water-borne diseilsc. On the whole, the bulk of the evidence regarling the respective merits of the two forms of filter above described is in favour of the Insteur - (Chamberland. These filters may be maule of earthenware, stoneware, or enamelled iron, and may be eithor«plain or decorated. They are made in many differont fornuis, of differont sizes, and to servo various p1.p0808.

·FOOD AND DIET. 65 They may be no small as to be oasily carried in the pwxket, or large enough to supply water to an entire village or town. "They may be attached to municipal water service pipes, or used for sterilising liquids of all kinds, incluing oien leef-tea. Great care should be taken to avoid the use of broken candles. How to clean the Candles. They may le rubheil with il piecp of clean rough cloth or with a brush. "They should then he boiled for an hour, or they may be pussed through the Hano of i spirit lanıp or biked in front of a hot firo. (reat care should be taken in replacing the endles after cleaning them, otherwise they will allow the water to puss through unfaltored. FOOD AND DIET. Every ut which we perform is accompanied ly low of body tissue. The food which we eat replaces this luss, producon, warnth, and supplies the power to co work. Composition of Food Food may be either liquid or solid in form. Whatever its form, it gourd nourislıing diet must contain a certain quantity of water, albumen, carbohyclratex, fats, and willlx. Water. The greater portion of solidl food consists of water. Potatoes, for example, contain 75 per cent. of water. In ullition to the water contained in our food, four pints of more of drinking water are required daily to keep us in yood houlth. In hot countries very nich more is required to make up for the grout lues of Huid through the skin. Albumen.. The white of an egg consists chiefly of this batando ; no also does the curl of milk. It is also found in muscle and in blood, and in peus, beans, dhul, and all cerculs, such as wheat, oats, and rice. Foods containing called albuminatos or nitrogenous foods, because they coutuin nitrogen, which is not found in any other ulbunien urg ·66 MANUAL OF HYGIENE. class of food. Albuminous food is und chiefly for the repair of the tinaties of the body, growth, and giving strength. Albuminatos aro Hometimos called flush formers or protods. Carbo-hydrates contain carbon, hyclrogen, and oxygen. They do not contain any nitrogen, and are sometimes for this rouson culler non-nitrogenous foule. Sturches and sugar lelong to this group. Rico, sugo, potatoos, urrowroot, whout, millots, Inulian corn, canoatyar, and boot sugar uro the best known cxamplos. Rico contuins no luss than 83 per cent. of curlw-hydratos. Starchy food of this kind is converted into a form of sugar callod grape nugar, through tho action of the saliva, which continues for a short time after thu fuol has pilssoil into the stomach. Food of this kind should be woll chewed and mixed with the sliva before being swallowed. Infants imer six months old cannot digest starchy foxxl, because no suitable fornient is formed in the cligestivo system until the age of nearly onc year. llent and energy aro obtained froni curl-hyclrates. Fat in said to be former, but this is now regarded as doubtful. Fat. Butter and oil, such as mustarl and cocoa nut oil, are the best known forms of fat. 'The fatty covering under the skin and the fat clepsited elsewhere in our boulius is got to some extent, probably, from the starchy and fatty foods wc cat. Albuninous fools, however, it has been contendeel hy some writers are the chief source of the fat stored up in the body. Fats taken as four produce twiću as much heat in carho-hydrates, and are therefore extremely unoful in cold clinutes. They also help to strengthen the body. Tho (ligestion of albumen is very much helpeel by the presence of fat. Thu white of an egg is thus moru ousily digested when liiken with buttor. Cou-liver qii in amall clonos is, for the same ronson, given in such cases whero, the stomach is weak and cligostion had. Cod-liver oil is, moreover, highly nutritious.

·FOOT) AND DIET. 67 Salts. A salt is a chemical substance formed by the combination of an acid with a basc. Common sult, which is a cunthination of sodium and chlorinc, is the most inoful and the most largely used salt and the best example Limo salts are congumed to a largo extent in India with quan. Salts of different kinds are contained in varying amount in the vegetables and fruits which we eat. Bunos would become soft without them. The disonso, known as rickets, is due to a deficiency of lime sults in food or water. It is owing to an insufficient supply of iron salts, which are of grcat benefit to the blool, that people sometimes look pnle and unhonlthy. It was due to the want of vegetables, which contain certain salts, that severo outbreaks of a clisonae called scurvy wore to common among sailors during long non voyages in past years. Lime juico, which contains the necessary salts, is now arried in all shipw us a substitute for vegetables when they run short. Salts aro also required for the formation of the juices with which our food is digested. A diot, which consists of 5 ounces of nitrogenous food, 15 oucos of carbohyclraten, 3 ounces of fat, anul 1 ounce of salts daily, is the most perfect diet for a man doing an ordinary amount of work. Somo writors, however, would allow only 4 ounces of nitrogenous food, 8 ounces of carbo-hydratos, 2 ounces of fat, and ono-half ounce of sults. It has been calculated that if a hundrod prisoners were feil on bread alone they would roquiro daily 380 pounds to make up the loss of carhon and nitibyen from their bodies. Three hundred and fifty-four pounds of flesh would be required if flesh alone were given. ff, however, both brcad and meat were givenp 200 pounds of bread and 60 pounds of necat 'would be sufficient. The chiof thing to bear in mind is that it is impossible to remain in good health if an insufficient såpply of any me of the principul elements of food is consumed. - ·68 MANUAL OF HYGIENE. DIFFEREYT KINDS OF FOOD, Animal Food. Milk Milk is one of the most ralıuable articles of food in both sickness and health. It is the best food for infants, because it contains all the elements of a perfect diet in the right proportion, and is easily digested. Infants should be feil solely on milk, until they are noarly one year old. (irown-up people may be kept alive by juilk during sickness for several weeks at a time. Several pints, however, may be required laily in these cases. Tho acklition of a little sugar makes milk moro' suitable as an article of diet. The natural foorl of infants in human tailk. Cow's muilk, madlo as much like human milk as possible, is, however, by dilution with water and the audition of a little sugar, sometimes given to very young children. Ann's milk, which more closely resembles human milk than does that of the cow, is also of great unu, but expensive. Older persons use cow's milk a great deal. The 1180 of goat's and buffalo's milk is very common in Inlia. Composition of Milk. All kinds of milk contain a laurye amount of water, varying froni 81 to 90 parts por 100 parts, and from 1 to 7 parts of fat, which forms the crearn when milk is allowed to stund. There is more albumen (from which the casoin or curl is formed) than fut in milk. Sugar and salts are also contained in milk in small quantity. Butter is maule from the fut of milk and checso froin the albumen or curl. In muaking* checse, however, the fat is sometimos retained. Diseases caused by Milk. We already know that cholera and other diseasos are often caused by the addition of polluted water to the milk. This proctice is very common. Pain, sickness, vomiting, and diarrhoea are often caused by milk which has turned sour. European children ·DIFFERENT KINDS OF FOO1), 69 who are brought up bottle-ful often suffer from symptoms of the kind because their hottles are not kept clean. Feeding-hottles should not have tnhus because they cannot he kopt cloan. Consumption of the howels and scarlet fever may alag be cured by using infocted milk. How to prevent Disease being conveyed through Milk. The milk of healthy cows only should be rol. Water should nover be added except when necessary in the ("LAC of infants and sick persons. Milk Vonnels should not loo Washeil with dirty water. Boiling water only should be used for this purpose. Cascs of epidemic discase occurring near dairics or places in which milk is sold should be immuliately removed to some wife place for treatment. Cows shoull not be milked by people with dirty hands. Milk should always be will before it is used. Milk, ius in the cake of wator, should not be kept stunding too long after it has been boiled. It should be covered to keep out dust, in which the germs of discasc are, il we know, often carried, and also to keep out flics which may infoet it. Eggs. Fyys also contain all the elements of a perfect fool. They contain albumen and fat in large amount. The white of one eye is still to low equal to three teaspoonfuls of a boof extract. Frosh eggs only should be sol, as stule egys can be thoroughly poisonous. Flesh. Flesh is highly nutritious. It consists of water 7.5 per cont., albumen 20 per cent., and fat 5 per cont. 'It, howovor, contains hardly any curl-hyılraten. Beef, mutton, fowls, and fish are the forms of animal fool chictly lined in Incliiz. Beef extracts are oxtensively used in cases of sickness. Phey are merely stimulants, however. Dr. Ilutushison, a distinginshod Avriter on fool, says that, far as nutrition is concernerl, one can prepare at home cqually your beef juice at much less cost, in one instance at a 200th part of the expense of the fashionable article. It is really pathetic, - ·70 MANUAL OF HYGIENE. Rays Dr. Hutchison, to see poor peoplo in cases of illness paying large sums for so very small a return. The great majority of the natives of India are not flesh eaters. The only real objection to the inc of vegetables only is that the stomach has to be clistended to its utmost limit threc times claily in orior to obtain enough nourishment for the system, Dr. Hutchison maintains that the use of a strictly vegetable clict means a low standard of life, of energy, and resistance to clincaso. Much time and energy arı, marcover, wasted in digesting so much vegotuble matter. The use of flesh in too large amount Catacs gout and nervous irritability: The flosh of immature is not so nutritious as 'that of fullgrown animula. "Signs of Good Meat. The flesh and fat should be fresh, firm, tender, of ruldish colour, and healthy looking. Wholesomo meat should not contain too much hloor. The fat should be bloodless. Moat shoull hc of the same quality throughout its entiro substance. Softoning, offensive umoll, and groonish discoloration indicate that moat is bad and unfit for human 1180. Vegetable Foods. Theso have been divided into six classes :--1st. Farinaceous fuocls or coreals, such as rico, wheat, barley, maize and millet. End. Pulses, such as dhal, peas, and beans. Bril. Roots and tubers, such as potatocs, beetroot, carrots, turnips, tapiocil, arrowroot, and ground muis. 4th. Groen vogotablos, such as spinach (sag), asparagus, brinjala, cauliflower, and cabbages. 5th. Fruits, such as orangos, grapes, mangoos, lemons, guavas, papiyas, and plantains (Reynolds). 6th. Fungi, a class of food to which mushrooms belong. Farinacuous foods, and rice in particular, nulses, and tubers are largely consumed by natives of India. Rico and dhal form the solo articles of diet in numerous instances.' The consumption of rice, ghee, and sweetnients in large quantity causes stoutness in persons of inactive habits.

·DIFFERENT KINDS OF FOOD. are People who live chiefly on food of this kind are generally of poor physique, cannot exert themselves much without getting exhausted and out of breath. Dhal, pous, beans, and wheatflour macle into chaputtion should form a portion of the dietary of rice caters, because rice contains sinall quantities only of albumen and fat, whercus pulses and wheatflour rich in albumon, which is 80 necessary to the maintenance of good hcalth. Chaputtios khould he made thin, so that they may be woll coukod.. Swutness and weight can loo much reduced by the use of these articles of diet in the manner suggestol. There are Various kinds of chal, of which urhur, mushoor, moong, and gram hal are perhaps the best known. The last is the least wholesome of these four kinda. Kasarce is another pulso in common use, which, however, has a bal reputation. They may line taken instead of tesh. Fish may also be used to supply some of the nitrogen required. Milk and oatmeal porridge or wheatflour would enable us to perform harul work for a long time. Inolian com (maize) contains more fit than intmeal, and is perhaps for this reason a better article of clict if well cookoul. Vegetables contain water, ucids, and silts. They should always be fresh and carefully washel, and they should yonerally le well cookal. I'ncooked vegetables should be very thoroughly cleaned before being caten, as they may contain smull worms, or the oggs of insects, or the gefnis of clisease of various kiucis. Fruit contains water, in large amount, acicle, and salts, Sugar aml oil are also contained in many kinds of fruit. Fruit shouldl nover be enten unless when frosh ripe, and clean. Over-ripo, locaying, or uripe fruit causes discase of the stomach anil bowels. Fruit which has been preserved in tins may cause similar semptoms owing to the presence of lead, tin, copper, or ·7 MANUAL OF HYGIENE. other substance absorbed loy the juice from the metal of the (all. Preservation of Foods. Food is sometimes preserved"by freozing, or by using currents of cold air, as in the cise of the carcases of cattle and sliecp). Food may also le proscrveil in ice. Alcohol, vincgur, and other sillatances are often used for the purpose. Beef for the use of mailors is often preserved in brinc. Drying is sometimes resorted to, an in the case of fish, vegetables, and fruit. Foovis of almost every closcription, such as milk, tish, fruit, and jams, are also sometimes preserved in tins or bottles hermetically sented after all the air has been expelled by hunt. If you Oscapes when a tin is opened the contents are bad. Bully PPONCrved foods are exceedingly dangerous to me. They give rise to nymptoms of poisoning, which closely rescriblo cholera. This is known as ptomaine poisoning. Adulteration of Food. Water may loc adılal: to milk, or the cream may be removed and four or other similar starchy fool added to give the milk a thick appearunce, Ol' sugar or salt may be aclied. Plantains and mnoat fat and other substances are often added to butter, ground maize to tlour, and wild to sugar. Ghee is often adulterated with ground-nut, coconut, or poppy oil. Arrowroot may be miserl with cocoa and chocolate, or the starch granules of potatoes, rice, sago, or tapioca may le uscil. Alum is oftin auldal to bread to give it a white appearance. Tua leaves are sometimes mixed with other kinds of leaves or with tea leal" ('n which have already been used. These are a few examples of the manner in which food supplies may be adulterated. The practice of adulterating food supplies - 3 perhaps more common in India than in any other colatry in the world. Cf all forms of adulteration that of milk with pulutul water is, perhaps, the most to hiç feared. Cooking Food is cooked to softon, it, to inake it more ·DIFFERENT KINDS OF FOOD). 73 attractive and more easily cligestible, and thus fit it for the nourishment of our lwulies. Cooking also destroy's small parasitic and other animals, their eggs, and the gernis of clisease. Cooking also enables certain kinds of fooxl, such ay milk and moat, to be kept for a considerable length of time without turning hval or becoming unfit for me. Methods of Cooking. Food may be boiled, steameti, ronsted, luked, friedl, grillo, or braised. The method of cooking food should be varied as much as possible, otherwisc it will lose its relish. Every attention should be puid to cleanliness. Cooking pots which aro nime of copper shoull le rogularly tinnel, otherwise thero is danger of some of the copper being dissolved and causing pwisoning. Cooking vessels made of aluminium are to be preferred to those male of copper. Rice and other starchy fouls should be cooked slowly, and green vegetables quickly. Well-cooked rice is soft and free from lumps. Each particle shoull bo scprnte. Mustard oil is often used in Inclia for cooking purpoNCA, chiefly beciuise it is cheaper than butter. Dhal should be very carefully cooked), otherwise it will cause irritation of the bowols. Length of Time required to Digest what we eat. This varios gruntly. Boiled rice, for example, is digorted within one hour. Boiled cabbage requires four hours. Roasted potatoes take 2), and boiled potatoes 3} haturs. Indian corn breal, baked, takes 34 hours. Raw oggs arc digestod within 1.4 hours, rousted egys in 3. hours, and har boiled eggs also in 3} hours. Fried hoof, hoiled fowls, roastod fowls, and rousted duck take four hours, while roustod pork takes 5} hours. (For the digestibility of some other articles of food sce the following tables):

·74 MANUAL OF HYGIENE. RELATIVE DIGESTIBILITY OF ANIMAL SUBSTANCES. (RUSSELL..) ARRICT.RH or Dier. llow COOKED. . 'lim OF CITIIL'ATIOX. Hlouir. Minute. + 1 · 0 > 30 15 0 15 30 . 1 . .30 45 Pig's feet (AOUSCI) Tripo (NO1180(1) - Kugs (whipped) Salmon trout Venison stunk Bruins (x liver Coal fish (cured lry). FENN Turkey (iclatiue (ioone l'ig (nucking) lanıb (Chicken Beef Beef Abutton Mutton Oysters Cherne Esko Egen Beef Fow'ls Howls Ducks ('artilage - Pork Tendon Boilea Boilea Raw Boiler Broiled . Boileal Broila - Boileil Rorstel Boiled Boiler] Roasted Roasted Broiled - Fricusnccal Boiler Ronster Boileel Route Stewell - Kaw Hari Ixoileil - Frient Friedl Boiled Rerusteel Roasted Boilta Roasted Boiled . 3 0 . - 3 3 3 3 3 4 4 15 30 30 :30) 30 0 - 14 0 15 1.5 $ 4 30 ·DIFFERENT KINDS OF FOOD). 75 RELATIVE DIGESTIBILITY OF VEGETABLE SURSTANCES (RUSSELL). ARTICLES OF DIET. Ilow 'REPARKD. TIME OF CHENIFICATION flour. Minute . 2 - - - Rico Boileil Apples (sweet and mellow) Raw Sigo Boilca 43 Tapioca Boiled 0 Burley Boilcil 0 Apples (nour and mellow) Raw 0 ('abbage, with vinegar Raw 2 0 Beans Burled 2 30 Sponge enke Bukod 2 30 Pursnips · Boilcc Potatocs Roasted 2 30 Potutoca Baked 33 Apple dumpling Boslal 0) Inclian corn cake Baked 3 Indian corn brcaul Baked 3 1.5 Carrot Boileri 3 15 Wheaten bread Buker 3 30 Potatoes Boiled 3 30 Turnip - Boilet 3 30 Beets Boiled 3 43 (abbage Boiler 4 0) The greatest attention lould he paid to cleanliness during cooking. Smoking should be prohibited, and servàntos, other than the cooks and those who assist in cooking, should not be allowed in the cookhouse, und no one should he allowed to sleep in the cookhous. Cuoking utensils should be cleaned with boiling water, immediately aftor and Before rire, and on no consideration should dishcloths, which have not been carefully boiled, he used. Thore should be an abundant supply of wholesome water for cooking purposca. Articles of food, such as vegetables, should be well washod before being cooked. Everything . .

·76 MANUAL OF HYGIENE. about the cookhouse, inclucling the floor, wall, and ceiling, should be kept spotlessly clean, and only cooks who are cleanly in their habits should be employed. Bating. Everything we eat should be fresh and wholosome, caten slowly, and well chewed, so as to thoroughly mix it with the saliva, which is formed chiefly during cating. Quick eating causes over-loading of the stomach and indigestion. Food should be caten as soor as possible after it is cooker. If it is allowed to stand it becomes.cold, and may be polluted by flies or clust. If it is necessary to let cooked food stand for a time it should be carefully coveral. It is a common but dirty and dangerous pructie, in India, for several persons to ont out of the fine dish. When possible etish porson should eat out of a separate dish. Tho hands should he thoroughly cleaned before cating, more especially the nails, under which dirt and diseasc gernis may Jurk. Leaves should not be used instead of platos. If used at all, they should not be used a second time. Our moals should be taken at regular hour's daily. Rooms in which we eat should be large and clean, and all the neembers of a family Ahould sit down to their moals at the same time. A short rost from lalxour is desirablo both before and after meals. It is not good to cat between meals. An intorval of 5 or 6 hours is required. No heavy food should be eaten just before going to bed. In hot countries, and during hot woáther in cold countrica, meat should not be taken in large quantities. Fruit and vegetables are hotter. The amount of food roquirol to koep the body in a healthy and active state will depend upon the aniount and nature of the work which has to be done. We should, however, bio careful to avoid eating either too much or too little. Time of Eating. No rules can be definitely fixed. As a general rule three meals are taken daily hy Europeans and two by Natives of India. Children shuuld be fed át inter- ·DRINKS. 77 vals of throc and adults of five hours. Very young children and sick persons require light and nourishing food often and in snall quantities. Drinks. Water from a pure source in the safest and host liquid tu drink. Alcohol, it hus heen contended by some, is a fool, prevents waste of borly tissue, strengthens the liscles, prevents loss of heat, and keeps out the cold. Others contend thuty it is not a food, that it prevents the waste products of the body being got rid of, and in this. way increases the weight of the body, that it simply paralyses the muscles so that the person who takes it does not know that he is tired, that it protects against neither cold nor heat, but that the tomporature on the other hand falls below normal after taking alcohol, and that it is in 110 sense of the term a stimulant. P'coplo who indulge freely in tho use of alcohol lecome blotched in uppouranco, acquire a craving for it, and often become (Irunkarila. Much of tho povorty, distress, and many of the mental and physical ailments which cxist in the world are due to the abuse of alcoholic liquors. Among arguments which have been raised against the use of alcohol, it has been stated that it undergoos no change when taken into the system, that it is alcohol in the still, alcohol in the stomach, alcohol in the blood, alcohol in the brain, in the liver, in all the tissues, alcohol in the breath, in the perspiration, and in all the ekcretions. In short, that alcohol is not used in the budy, but leaves it as it enters, a rank poison. While this, however, is not quite the cnsc,'it is a fact that not more than, perhaps, two oices of absolute alcohol can be made tise of Claily loy the system, without any traces appearing in thac excretions. According to the most recent inquiries into the subject, it is a serious mistakt to take alcohol oven in the smallest quantities. Professor Horsley declares that it is hurtful even when taken as an article of diet, ·78 MANUAL OF HYGIENE. . and that, while it stimulates temporarily, it does so hy deranging the brain machinery, the wheels going more quickly, as it wore, because of the loss of controlling power, and that paralysis or benumbing follows. It is otherwino with tea or coffee. These are good stimulants, and may be taken instead of alcohol when one is tired. So muy meat extracts. One quarter pound of oatmical in three or four quarts of water, with an ounce of sugar, well boiled, has hoon highly spoken of as good for quenching the thirst and onabling u porson to porform an unusual amount of contimuus labour. (Russell, Edinburgh.) Touldly and arrack aro thu forms of liquor chicfly nised by natives of India. They are often adulterated with poisonous drugs, such as chatura, opium, and Indian hemp, and are very hurmful. It is sufor to avoid altogether the use of alcoholic liquor's, or to 1190 thom only under skilled medical advice. Condiments. Thoso are taken with food to increase the secrotion of suliva in the mouth and gastric juice in the stomach. If taken in excoss they irritato and produco cisor lors of the alimentary cunal. Some of them are extremely 11seful in cases of colicky prins in the helly, and for many other purposes. They aro often harmful, however, in certain cases even when takon in moderate amount, and should never be given tochildren. The host known condiments are mustard, chillius, pepper, ginger, cloves, currlanoms, and nutmegs. LOCAL CONDITIONS, Soil. Soil consists of particles of mineral mattor derived from rocka, such as granite, and chalk, and the waste products of plants and animals. The broken-up puit of thi rock immodiately under the soil is called tho subsoil. The surface portion of the soil contains gerins, which set up certain chemical changes in the vegetable matter, which is converted into food suitable for the sustenance and growth ·LOCAL CONDITIONS. 79 of plants. This food consists of the gaacs and other products which aro given off cluring (locomposition. If they were not used up hy' plants such products would be infurious to health. This explains the benefit of bringing trenching grounds under cultivation, and 18 in suhooquently explainod of planting flowers, troos, and shrubs of various kinds in graveyarıds. The germs of discasc, such as enterio fever and cholera, frequently, as we know, find their way into wells and other sources of water supply ly percolating through the soil. When there is an absence of water from the soil, air takes its place. The amount of air present dopends upon the naturo of the soil. A loose sanely soil, for example, may contain als much is 50 per cont. The ground uir and guxos doriverl from sowcra, Irains, and other foul placos may travel great distances in the soil, find their way into dwelling rooms, and give rise to cliseases of a very dangerous nature. It is to keep air of this kind out of houses that floors are male of masonry and houses are sometimes built on arches. Further, it is to encu po breathing such gases that ruined brols are used for sleeping in, instead of lying on floor'r. The dangers of male moil as buikling sites and of clamp noil were pointerl out in a former chapter. Climate. Tho torn cliniatu is lined to indicate tho motoorological conditions of il place, such as temperaturo and its variations, the humility or dryness of the utmansphore, the rainfall, the prevailing winds, the charactor of the soil, and water supply: Climate depends to a large oxtent upon the geographical situation of a pluce, and its latitude. For these reasons climates have been classi'ked ay warm, tempcrate, cold, mountain, and marino climates. It is a familiar fact that coruin diseases uro poculiar to certain climates. They have for this rtison been called “climatis diseases." Many diseases, however, ·80 MANUAL OF HYGIENE. attributed to climate are often caused by careless living und violation of the laws of honlth, but there is nothing to show that climate is the direct cause of illness ;' in fact, the human system adapts itself in a wonderful manner to almost any kind of climate. IIcat and moisturo are the two most csa'ntial and potent culisus of doconi position in all animal and vegetable matter. It is duo to those conditions that meat and fruit go bad no quickly, and so often give rise to bowel complaints. "Wo also know that heat and moisture are favourable to the growth of the geims which cause discases, such ils cholera.' Ilonce it is that cholera and dysentery are set comnion in Inclin. Such diacunes can be provented to a large extent by the use of a pure water supply and improved hygienic surroundings generally, hy eating only wholesome food, and hy living a regular and careful life in every other respect. METEOROLOGY. Meteorology has been defined as the science of the phenomena of the atmosphere. It incluules atmospheric prostire, humility and temperaturo, winds and their cusation, velocity and direction, and rainfall. Atmospheric Pressure. The barometer is an instrumont which has boon devised for uscertaining variations in thu prussure of the atmosphurc. A column of mercury, which varius in height with the pressuure of the superin.. cumbent atmosphere, is sometimes ined for this purpose. The mean weight of a column of the atmosphere at freezing point and sea lovel has been ascertained to be the sun as the weight of a column of mercury thirty inches' high and of the same sectional area as tho" column of the atmosphere. The pressure of the atmosphere under those conditious is 14.7 pounds pressure to the squuro inch.

·METEOROLOGY. 81 Humidity. There is always in the air a greater or less amount of moisture. This is spoken of as the humidity of the atmosphere. A heated atmosphere can hold a much iarger quantity than a cold one. Ilence it is that moisture Condenses on.cold surfaces, such as that of a glass containing ice, and evaporatos when exposed to heat. When the atmosphere at a given temporature contains as much moisture as it can hold it is strid to be saturated. The amount of moisture in the air varies greatly in different countries, and even in clifferent parts of the same country, and very markolly so in India. The air, for example, in the dry sandy (lesert of Sind and other purts of Northern India is at certain reasons of the year so dry as to cause the skin to cruck, while in some parts of the Presidencies of Bengal, Malras, and Bombay the air generally is situratorl. The perspiration in consequence Hows freely from the skin, and evaporation being checked, great discomfort and fatigrie illo procural. Some delicnte people with weak chests and other cliseuses enjoy better health in hot, moist climates. As a rule, however, clry cliniutos are preferred. The temperature at which air begins to deposit its moisture is known as the dew point, and the instruments which are riscil for ascertaining the amount of moisture in the atmosphere are called hygrometers, Temperature. The temperature of the atmosphere varios greatly in different countries. It also varies with iho scason of the year and time of day. Despite these variations, however, the tenporature of the human body in a state of health is maintained at an almost constant level. Tie normal temperature of the baly is about 98:6* Fahrenheit. 'If thc'tenipurature of the atmosphere rises to a great Extent, so also, hut to a very small extont, does the lemperature of the body. Perspiration is the chief means whereby the temperature ·82 MANUAL OF HYGIENE. is kept at its normal lovel. Racliation and conduction of heat also help considerably. Prolonged exposure to great heat or grout cold sooner or later destroys the tissues of the boly, or may even crise (leath. The instruments usoil for incertaining temperature accurately are called thermometers. Mercury, which boils only when great heat is applied, is liscil for rcorling high temperatures or temperaturos ahovo the normal, and alcohol, which does 4100 frecze, to record Voo "Boiling point of Water 50 20 * Melting point ofice ( enngrade Fahrenheit Neaumur Flu, 32.-THERMOMKRINALES low temperatures. In thermometers the lower limit is called zero, which in two forms of thermometers, called the Centigrado and Reaumur respectively, is the melting poiit of puro ice or the freezing point of pure water, which is the silmio thing. The uppur limit in these two fornix, and also in a third torm, called the Fahrenheit thermometer, is the boiling point of water at the sca levol. In the lattor thermometer, however, the freezing point is 32 degrees. The boiling point in the Fahrenheit thermometer is :13 clegilos. Between these two points the stom of thermomotors is divided into units or degrees. The stom of tho ·METEOROLOGY. 83 Centigrade thermometer is divided into one hundred, that of the Rouumur into eighty only, while that of the Fuhrenheit is divided into 180 degrees or units between the froozing and boiling points. The temperature is said to bo so many slegrocs Centigrulc, Reaumur, or Fahrenheit, accorling to which of the three scules is adopted. (Fig. 3.2.) Thermometers specially constructed to record the lowest temperature of the atmosphere in a given period of time are called minimum, and those constructed to show the highest tompernture in a given period of time are called maximum thermometors. Thermomotors are also mule for 1190 in sick rdoms and for ascertaining the temperaturu of hut water used for bathing and other purposes. There are also what are called shade and sun thermometers, and thermomotors for measuring the heat given off by the carth (terrestrial ruliation thermonieters). Winds. When dealing with the subject of ventilation it was pointol out that hot air being light tends to rise and escapo, and that the hoavy cold air rushes in to take its plowo, and thereby causes strong draughts. W'ins are caused in the same way, the chief agency being the sun's rays, which heat the atinosphero of certain portions of the carth's surfaco during its rotation, while other portions are unaffected by them and remain comparatively coll. "The velocity of the wind depends upon the differences in the atmospheric pressuro, and varies from a scarcely perceptible moverncht to a velocity of over soventy miles, amounting to what is terme a hurricane. Anemometers are small instruments by which the velocity of the wind is detorminod. Cold 'winds are dangerous to health unless our bodies are well proiected 'by warm clothing. Rainfall. We have already learnod'that when warm air containing moisture comes in contact with a cold' ohject the moisture is depositod. Rain is carised in a similar ·84 MANUAL OF HYGIENE. manner by currents of cold air coming in contact with Warni moist air, or when the warm moist air comes in contact with the tops of cold mountains. The heavy rains during the south-west monsoon in India is caused in this way by.condensation of the moisture in the hot moist winds blowing from the Indian Ocean coming into contact with . the cold mountains along the west coast. The rainfall varios groatly in the different countries and parts of the 'Hame country. The rainfall, for example, in como parts of Inulia may not exceed 60 to 70 inches in the year, while on the Asaam hills as much as 600 inchos may fall yearly. On the other hand, thoro may be no rainfall au all in certain places throughout the entire year, as, for example, in Adlen and some parts of Sind, where the average yeurly rainfall may not be more than a very few inches. We have dealt with the subject of scanty rainfall and the evils caused by it. The level of the ground water doponds largely upon the amount of the rainfall, and the health of people to a largo oxtont upon the depth of the ground water level. The amount of the rainfall is ascertained by collecting the rain in rain-gauges and mousuring the quantity collectod in a given time. INFECTIOUS ANI) CONTAGIOUS DISEASES. Thiseases of this kind are popularly spoken of us "catching discasos," in the same sense 18 wo speak of catching a cold. Thero disenses may be spreal (at) by direct contuct, () through the air, (c) through water, (d) by food, (e) by clothing. Small-pox, plaguo, and skin diseases, such as itch and ringworm, are good examples of discuss which may ho convoyed by direct contact, and are for this reason callel contagious diseases. Small-pox and plaguo can also, however, he conveyal through the air. •Measles and mumps ·INFECTIOUS AND CONTAGIOUS DISEASES. 85 are other examples of diseases which can be conveyed through the air. Small-pox, plague, mearles, and mumps, and nearly all diseases of this class, can, moreovor, le conveyal by means of clothing. Discascs which are convoyed through thg air and by means of clothing are called infectious diseases. It will thus be seen that sono discases are both infectious and contagious, and cither of ai L! Fio. 33.-BACTERIA OF CHOLKRA. (* 1500.). (Reproducod from a photogryph takun ly Mr. J. K. Bermurd. these two terms is often, for this reason, used to mean tho sanno thing Cholera and entoric fover are the best examples of clincases which are water-borne. They may also he caused by polluted milk. Malarial fover may also •prohally be caused by drinking in pure water. Con- Burhaption is the best known example of infectious di puses under this heading which may be comraunicator by food. It may perkups be inducul hy drinking the milk or cating the affected portions of cows suffering from that disease, ·86 MANUAL OF HYGIENE. are also Each corni just as tapo-worm is caused by cating the flesh of cliseased pigs, but the question is at present the subject of dobato. The Cause of Infectious and Contagious Diseases. Most of these discascs have been proved to be caused by small living boxlics callol gernis or bacteria. They callod hicilli, microbes, or microorganisms. Those gernis, aro No small that, according to Hankin, if Go cholera germis vero put in a row they woull form a line the length of which would be equal to the thickness of a hair. It has also boon calculate that if it wero possible to string then together 25,000 guinis would measuro only. onohalf inch in length. Thoso germs are of various sizes and shapes. They may be round or oval, struight, curval, or even shaped like a corkscrow (Figs. 33 and 34). They, is a rule, multiply hy division. diviclus into two; the two divide into four; the four into eight, and so on until there niay bo millions of them in a single drop of liquid or material on which they feoil. The Conditions under which Infectious and Contagious Diseases spread most rapidly, and how to avoid them. Infuctious and contagious diseasch spread most rapidly in bully lighto, bully ventilated, and oror-crowded hounos ; in places which are clirty, where the houses are too closely built togother, whore the water is pollutul, anul : the habits of the people are unclean. It is sai: that under favourable conditions one germ may multiply and proluce as many as 17,000,000 in twenty-four hours. In order to escape being attackal by such dimases it is most important that wo should drink pure water anu mulk, oat good food which has been well cookod, and keep uur houlies, clothes, horacs, and surroundings clean. The gerins of clise..so grow and multiply most rapiilly in the holics of the woak and unhealthy. In the systems of hculthy pooplo ·INFECTIOUS AND CONTAGIOUS DISEASES, 87 - thic germs are, as it were, caten up by the blood, and thus kept from doing harm. The importance, thereforo, of living regular and hculthy lives is obvious. Epidemic. The term opidemic is applied to discnscs which attack, at or about the same time, many people living in the same town, village, or house, and are capable of being convoyal from one plave to another in air, clothing, or otherwiso. Endemic in the term applied to disguson which arg, always present to some extent in certain places to which they appear to be generally confinal. Sporadit in the term applied to cases of infectious (liscases occurring singly or in vory small numbers and at irregular intervals in more or less widely mouruto parts of a town or district, one case apparently having no conncction with another. Period of Incubation. The interval which occurs between the time of infection and of the appearance of symptoms, and during which the disense is quietly develop ing in the system, is called the period of inculation. IMMUNITY. It is a well-known fact that some persons are more liable to be attricked with certain discases than their neighbours. It is for this reason that discasos are sometimes suid to run in the blood of certain faunilies. Such lisouses are called hercilitary discasos. Cornumption of the lung and cancer are good examplos. Diphtheria und enteric fever aro examples of infectious 'clisouses which are suid to run in fanolios. . On the other hand, some peoplo who are proof against certain cliseases, and are said, therefore, to enjoy what is called an inmunity to these discases. If born.in the person, it is called "natural or innate immunity." It ·88 MANUAL OF HYGIENE. is a well-known fact that one attack of small-pox makor a person very much less likely to be attacked with the disease a second time. Vuccination also protects against small-plox to a large extent. Further, it is with the view of protecting people from being attacked with plagio, cholera, and other dincases that inoculation has been so largely practised in, Iulia in pust years. The freedom froni small-pox, conforreil al Fiv, 31.-- BACILL'S OF CUANI'NITION, by either a previous attack of the (liscase or by vaccination, and from plague and other diseases by inoculation is known als ucquired immunity." SMALL-POX AND VACCINATION. Small-pox is a cliscaso which attacks all clussos of "people, but soems to act most severely on dark-skinned rybos. Children are its post common victims. The discuse is markcy by several distinct stages, namely: Stage of Incubation. The period is 11 or 12 days.

·SMALL-POX AND VACCINATION 89 Stage of Invasion. For two or three days after this the porron has healache, shiverings, puin in the back and legs, sickness or vomiting, high temperature, and occasionally convulsions. This is tormeil "the stage of invasion. . Eruptive stage. The rash begins to appear on the .face, then the neck and trunk, and finally on the legs and urms. The mouth, Rose, cyor, and throut become affected, and cough is a marked symptom. This stnge lasts four or five days, and the rash assumes the form of clear small vesicles with a depression in the centre. During this stage the fever becomes less. This stage has been called “the stage of the rush or the cruptive stage." Stage of Maturation. The vesicles now begin to unteryo a change. Instead of remaining clear they becomo turbidl•and opaque, and a rul ring forms round them. This change is nccompanied by another rise in the temperature called the "secondary fever.” This stage is terned the period of maturation or ripening of the pwku. Stage of Dessication. The fifth and lust stage is the formation of scabs, which gradually fall off, leaving During this stage the fever abates. This is termed “the stage of dessication, meaning thereby the drying up of the pocks. Small-pox has difforent degrees of severity, being sometines very mild, and culing in rowery. It is often sovore, rand ends in denth from high fever, affections of the chest, or other complications. It often caligen permanent and total loss of kight and henring. Note carefully that a mild case in one person may give rise to a very malignant form in another person. There is another diseaso, viz., chicken-pox, which might he mistaken for small-pox, and it is just as well to know something about it niso. scals.

·90 MANUAL OF HYGIENE. Chicken-Pox is a disodic which occurs chicfly amongst children. It is attended with a rash resembling that of amall-pox. It is contagious, and sometimes appears in opidemic form. The period of incubation may be 10 days, longer or shortor. The rash sometimes appears, without anything harring occurred to attract attention. There may be, however, slight fover for a fow hours, but as a rule not longer than 24 hours, before the msht is visible. The fever is never so sevoro as in small-pox. The rasil comos out in crops of two or three vesiclos at different times, so that, somo may still be quite clear and translucent, while others have alrowly turned turbid from the formation of pia inside. The vesicles are about the size of a split-poa or smaller. The disenso reaches its height in from 7 to 10 (lays, anul is all over within a fortnight. Death seldom occurs from it. With these fow romarks on small-pox and chicken-pox wc shall proceed to considler vaccination. . VACCINATION. Vaccination means inoculation with lymph, that is tho introduction of lymph into the system as a means of protection aguinst small-pox. It has been called “the new inoculation" in orler to distinguish it from a practice which prevailerl from very carly times, and still prevaili in some parts of India, called “inoculation" or "country raccination," hy which the poisi of small-pox is introduced into the system of healthy persons with the view of preventing or lessening the severity of an attack of smull-pox. This effect hus sometimes beon obtuined, but the factice is liable to spread the discase to an alarming extent and small-pox contracted in this way has often proved fatal. Hence it is that laws have been passed to prevent ·VACCINATION 91 inoculation with sniall-pox matter, and the pructice is Now regarded in many countries as a most scrious 'crintu. Inoculation was introduced into Englund curly in the 18th century from Constantinoplo, the capital of Turkey, aful was in use till near the close of the name century, when the importal Jeuner discovered the new inoculation,” now better known as “Vacaination." It fecame known that the cow wus sonetimes attacked with a disease called "Cow-pox," and that those who milked such cow's and got cow-pox curiously enough did not get small-pox, iml it is on record that an English farmer named Benjamin Jesty intentionally inoculatex his wife and two sons from a cow suffuring from the lisenso as a protection against small-pox. A similar belief is known to have existed in Germany about the same time, wher, it is said, a schoolmaster vaccinated two children with the name object, in viow. Dr. Jenner took up the question, and in the face of much ridiculo worked at it till he establislied its truth, and in 1798 be published the results of his experiments. One writer has said : “Ju the last century the resulting mortality in somo of the countries of Europe Wals often cqual to the entire population of one of their largest cities. If a molern traveller could find himself transporter to the streets of the city of London ils they appeared in the cartier part of the present contury, it is probable that NO peculiarities of architecture, drons, or behaviour would be to him so strikingly conspichous ne the enormous number of pock-marked visages he would encounter among the people at every turn." Sinte vacgination was introduced matters have assumed an entirely different aspect. A pitted' face is now-a-days almost one of the rarest objects to he seen in the British 1xlos. Unfortunately, the same cannot be said of India.

·93 MANUAL OF HYGIENE. - Thousands of men, women, and children have been blemished for life through ignorance and prejudice, and thousands still obstinately refuse the gift of one of the greatest blessings that scienco has over offered them, and most strenuously oppose what is calculated to be for their greatest good. This state of matters is to he very much ingretted, but until the importance of vaccination is fully. realised, it is the duty of ovcry educated and intelligent person who has the interests of vaccination at honit to cudeavour to convince people of its real value by evory possiblo argument in its favour. Vaccination, wo must . understand, does not always protect against antall-pox, nor, inloed, cloos ono attack of small-pxox protect aguinst al socond attack. Every person should carefully remember these two fouets. If, however, vaccination hits been successfully performal, the chancos are that for a number of years at any rato the vaccinated person is in the great majority of instances) proof against small-pox. Four good marks may The taken as sufficient to protect for a period of five or six yeilis, in some casos longer, and in others for a whole lifctime. A child with four good pocks has greater security than a child with two, and still greater than a child with one only. The vaccinator who vaccinatos unsuccessfully does more harm than gooil, because ignorant people do not know when vaccination is successful, and believe it to be sufficiont if the child's arm is only scratched, and afterwalds turne red and forms a Acah, and are very much disappointed if their child should get small-pox afterwarls. This is ono way whereby the confidence of tho people is lost and vaccination brought into disrepute' by unskilful and carolus Vaccinators. The following are the statistics of twenty years of one of the London smull-pox hospitals, which boar out the truth of the abovo statements : M ·VACCINATION. 93 Death rato . PATIENTS ADMITTED WITH SMALL-POX. Number indinitted. per l'ent. 1. Having one scar, 2001 7.73 2. Having two scarr, 1446 4.70) 3. Having three scars, 518 1.95 4. Having four scurs, 544 0-55 5. Said to have been vaccinated but having no scars, 370 23:37 The practice in small-pox hospitals in Engliu is to leraceinato all nurses and attendants. Onc writer siya regarding an epidemic in 1876-77: “All rovacrinatoa attendants have escapod, whilst the only one who had not been revaccinated took sniall-pox and lial of it." Out of 1500) such attendants +3 contractel small-pox, and not ono of these 43 had been revaccinated. The following statement is an extract from a report on an out bronk of small-pox in Glasgow, and shows the effect of vaccination on the death rate : EFFECT OF MORTALITY. Of 623 cases vaccinuter, 8 per ceut. died. Of 266 casos un vaccinatod, 31 Patients with good marks, 3.8 Paticuts with bud marks, 21 Patients with no inarks, 30 Revaccination at the age of puberty haly practically the effect of alsolishing small-pox. The following suggestions should be carcfully observed : 1. As a rulo every child should have four good pocks. 2. Revaccination should be done every six or seven porson should 'never pass the tinie of puberty without revaccination. 3. Revaccination should be done during epidemics of small-pox without regard to the length of time that has elapsed since prinary vaccination. - . Marx.

·94 MANUAL OF HYGIENE. Oncc. 4. Every chill, even the newly horn, should he vaccinaturl if small-pox is prevalent. The younger the child tho gronter in its chance of taking the liscaso. 5. Evory child should be vaccinated before it is five months old whether small-pox is epidemic or not. 6. If for any reason it is suspected that a person is abont to develop amall-pox, that person should be vaccinato ai By doing so the diseasc may be avorted, or what might otherwise have been a bad attack may turn out a comparatively mild one. It is well known that vaucination will overtake and destroy the small-pox infection even when the small-pox infection las hiul a start of two or three days. Aftor all, however, small-pox nay appear if the vaccination is done too late. 7. If small-pox breaks out in a house all the other members of the family should lo immediately Vacrinatel. It has bcon alromly mentioned that cows suffer from a disoare called "Cow-pux." This disease resembles sinallpox in the human subject in so far as it passes through similar stages. There are, however, fow if any of the grave symptoms which attend human small-pox. The discano in the cow ain only proxluce pocks when the lymph is appliod (lirectly, whereas it is well-known that small-pox may be contracted at a grunt distanco through the air or infocted articles of clothing, etc. It is to cow-pox, as has atroauly been stated, that we are indebted for lymph suitable for human purposes. This lymph is of two kinda, viz., "bovine," or the so-called"calf-lymph," and humanised lymph. Calf lymph is the virus of cow-pox which has passed through a successive series of calves becoming thus roro fit for human usc. Humanised lymph is thut which is taken from a human being, as in arm-to-arm Vuccination. The original supply, ·VACCINATION. 95 however, was calf-lynıph, the supply having heon kopt up in the human subject instcud of the calf. This constitutes thu differenco hotween the two. Lanoline lymph or lymph preserved in lanoline has of recent years been intrulucccl into India and from careful experiments conclucted in the Animal Vaccination Depòt at Barjoeling has been found to be a most successful method of storage and preservation, and when carefully lisud provog most successful in Vaccination operations. Vruccination direct from the calf, however, is the most 'suitable methoil from overy point of view. The system of Vaccination direct from the calf is to be worked in the following manner as described by Major 1)yxon in his report on the working of the Vaccination Department in Bengal during the three years 1890-91, 1891-92, 1892-93 : "A calf is to be procure through the village hcucman (ils a rule for nothing, though cight annas to one rupec per calf ryny sometimes have to be paid) and is inoculator with lanolino lymph obtained from one of the depots, on its abılomon, which must of course be first washal with soap and water and then shaved by the vaccinator. From this calf all the village children are vaccinated, as well as a calf from much of tho neighbouring villages, which are brought in for the purpose and returned to their owners inmuliatoly after inoculation. When the lymph is ripe on those calves, which is usually on the sixth day after inoculation, the Vaccinator's procool to the village and vaccinate from the calves all the children of those villages, as well as fresh calvck from other villagor. In this way animal vaccination iss aptent throughout the district, and the cvils of arm-toarmyaccination aro avoided. No harm is done to the calf, which requires no particular care doring the period tho lymph is ripening on it.” In Bengal in 189; there were 3844 deaths from small- ·96 MANUAL OF HYGIENE. pox amongst children under one year of age, or 17-18 per cont. of all the cleaths from small-pox during that year. In the same your there woro 6273 conths amongst chilelron from one to six years, or 31-18 por cont. of all the deaths from small-pox, and 39:37 amongst chiklrcn from six to twelve years, or 17.60 per cent of all the deaths from Anilall-pox. The total number of cleaths at all ages from small-pox during the year 1892 was 2:2,359. Thorofore 15,000 children under twelve years of age clied from small-pux whose lives might have been saved if they haul been properly protectel against that clisease by Valcriation. For the purpose of showing the value of vaccination I have macle UNO of two tables from the report of the Sanitilry Commissioner for Bengal on vaccination for the three years 1890-91, 1891-9:2, 1892-933. in Darjeeling 7357 children under it yeur were available for vaccination. The number successfully rzuccimleul. was 4008. In Puri (Jagannath) 29,691 children under one year were available for Vaccination. The number Kulcessfully vacrinated wils 185. During the year 1892-93 Darjeeling returned 18 leatlis from small-pox, or '08 per 1000 of the population. During the same year l'uri returnal 22:21 deaths from snia!l-pox, or 2.12 per 1000 of the population. In 1887-88 Sheffield in England suffered from an opidemic of small-pox. The following statement show's what happenel: . CHILI)REN UNDER 10 YEARS OF AGE Attack rato per 1000. Death rate por 1000, Vaccinated, Unvaccinated, 101 44 ·VACCINATION. 97 PERSONS OVER TEN YEARS OF AGE. Attack rate por 1000. 3 19 94 [cath rato per 1000. 08 1 51 Vaccinatel twice, Vuccinatel once, Unvaccinatel, These figures show what holls good both in Sheffield in •England and Puri District in India, that whero the greatest opposition to vaccination exists thore exists also the largest cleath rate froir small-pox. Development of the Pock. On the second or third clay after vaccination a slight elevation can be felt with the finger, and on closc examination half a dozen or no small vesicles may be noen, which griulually run together forming ono single large vesicle, which bulges round its elges and becomes depressed in its centre. At the sumo lime a red ring is noen mund the pock, called the “arvola." These constitute a typical vaccine vesicle. During the lovelopment of the pock there is usually wlight fever, restlessness, and itching. (are should love tulkon that the pock is not injured, and healing will take place all the moro specclily. After the sth lay the contents of the vesiclo begin to lose their clean and translucent appucarance and turn turliel owing to the formation of pus inside. A Crust begins to form near the centre of the pock, and gradually spreuls till the whole of it is converted into a scal, which dlopending upon the care taken falls off from the 15th to the 35th clay. When the crust falls off a ruklish clepressed car is seen, which gradually turns puler. This açar is the true characteristic of a successful vaccination, and as a rulo romains permanent. The consideration of vaccination cannot be moro aptly concludod than by quoting the words of a clistinguished writer, who silys rogarrling small-pox : “The loftiest end to buy reached is its completu rentoval > G ·98 MANUAL OF HYGIENE. from all civilised countries, and indeed from the face of the earth by universal vaccination and revaccination. The day is not far distant when the man, wonan, and child unpro tectoe hy vaccination will properly be regarded as an cneny of the human race and treated accordingly. Evilenco of the most satisfactory character as to siiccessful Vaccination should be imperatively required of all applicants for almission to schools, acaulemios, colleges, charitable institutions, public libraries, art galleries, and places of labour legislaturos, political, religious, and deliberative huulies; of every purchaser of a ticket for purpose of travel; and ot every voter. In audition"there should be in every district a systematic and periodical inspection of ail persons registered in the census by persons qualifiel and competent to perform compulsory vaccination. This is the scientific treatment of small-pox." CIIOLERA. The germs of cholera, ils has been alrously stated, find their way into our horlies chiefly through water, and milk to which water has been ulded. The poriod of inculution is from a few hours to three days. Symptoms of the Disease. When the garmis are swallowed, they grow and multiply rapidly in the stomach ar::1 lowels. Great sickness and vomiting occur, nd copious discharges of fluid, like rice water, escape from the bowels. Cramps occur in the belly and legs. The skin becomes cold, the pulse weak, and the patient soon begins to look lifeloss. The disouse often attacks whc.o fa.nilios and villagon. Out of every 100 persons attackel with cholera, nu less than 60 to 80 or even more die. How to prevent Cholera. The best way to prevent cholera is by drinking none but puro water and puro 0 ·CHOLERA. 99 milk, and cating none but clean food. We should lic Meanly in our persons and habits. People attending cholera putients shorld be careful to wash and dininfert, their hands before eating or drinking, otherwise thoy will run the risk of catching the discase themselves. The ovomited matter and the discharges from the bowels of the sick should bo destroyal ly burning, or mixal with a disinfectant immediately they cacape from the body, carried to a safe distance, and buried deep in the ground, but nevor near any source of water 'supply. Anti-Oholera Inoculation. Anti-cholera inoculation is à now form of proventivo treatment which has done gouxl. The effect of the operation does not last ao long as that of vaccination. The small operation consists of putting a hollow noodle into the skin above the hip. A small quantity of a specially-prepared Huid acrum is forced through the needle under the skin. The person thus inoculated may get a little fever and slight healacho after the operation, but gets well in a few hours. Wo should get ourselves inoculated during outbreaks of cholera. Treatment of Cholera. Treatment is always attondod with the best results in the first stage of the cliscase. Tho patient should be kept warm. As tho of the disease do not grow in acid solutions, 10 or 15 drops of diluto aromatic sulphuric acid, hydrochloric acid, acetic acidp or cven a little vinegar or lime juice should be given. In the first stage of the illness, one drop of lundanum may be given to a child one year old, and one drop for every Foar of the patient up to twenty or thirty drops may bo givere to grown-up persons. In tho latter stages of the (liscase opium should never be given. On tho other hand, the patient should be stimulated and kopt warm. The legs should be rubhod if cramps are present. Ice germs ·100 MANUAL OF HYGIENE. may be sucked in liberal quantity, and small quantities of milk, conjee, or rice water should be given at short intervals. MALARIAL FEVER. This is one of the most common fovers in India, and accounts for il very great deal of ill health, poverty, and distress. No fewer than 4,126,381 deathx froni, fovers, no doubt chiefly of malarial origin, (xaurred among the general population of India during the year 1899. The discaso is caused by a small living animal parasite which is found in the bloor. The disease prevails chiefly in places where tho watur supply is baul and the soil water-loggul, and it is believol by some that the parasito may bo conveyed into the system through water. Mosquitoes of a particular kind, called "anopheles," are, however, known to be the chief moule of spreading the clincarc from one person to another. The period of incubation is fixed at from 3 to 12 lays. The attack nay, howover, come on at once. Symptoms of the Disease. Malarial fever has a hot, a cold, and a sweating stage. The patient feels very well after an attack is over. If nothing is donc to cure it, how'over, repeated attacks will occur. The blood is soon destroyed, the spleen enlarges, and the patient becontos pule and ill-looking, and may remain in poor health for, yours, and ultimately clio either from the discaso itself or something else brought on ly it, such as dysentery or some affection of the liver. How to prevent Malarial Fever. All hollows sãould be filled up to prevent water from lolging in them and thus Porining breeding places for mosquitoes. For the samc reason all old tin cans, carthen Jots, or other recep- ·MALARIAL FEVER. 101 tacles should not be allowed to lic about houses. Water should not be kept stonding too long in luth-rooms or elsewhere in or near Iman dwellings. Kerosine oil kills the larvae of mosquitoes when poured on the surface of water. It may be ysed when dealing with tanks. We should get orid of mosquitoes or sleep inside curtains to keep them from, biting 118 More espocially, it is desirable that wo should protect ourselves at night, as the momuitoes whoso hites hring on attacks of malarial fever are most active atº night time. Persons suffering from malarial fever should be kept separato. Captain Birclwood, of the Indian Medical Servico, sifggests the following further measures, viz., tho prohibition of digging and excavating of carth or pronds, the prevention of brick or tile making close to towns and villagos, the use of masonry cruins, and that all canals and irrigation channels within municipal limits should be lined with cement, the unc of guuzo windows and doors, and tho moro genorul use of quinino. Treatment of Malarial Fever. If the lisenso is already in tho system, the best way to kcop off' attacks in hy taking quinine. This medicine can be bought at any Post Office in India, in five-grain pice packets. During the year 1899 no less than 3,337,236 of these five-grain puckets were soll in Bengal alone. An aclult may take as much as four or five grains every four hours, or even larger dock at longer intervals, and young children one or two yiring three times daily. There can be no doubt that of all remalios for malarial fovet quinine has been proved to be tho niost valuable. PLAGUE. . The germs of plague are supposed to get into the system through the skin by direct contact, through the lungs, by ·102 MANUAL OF HYGIENE. contact with infocted clothing, or through living in an infected house. It is believed that the disease is convoyed from place to place by dogs, cats, raio, mice, anta, flics, bugx, fions, and lice. It is also bolievail that tho germs can bo convoyed by clothes, grain, and other food supplies, such ils ghee; oil, jaggery, milk, butter, curls, counnuts, datos, etc., infected by rats or other animals, and through the air. It is very important, therefore, during..piclenics of pluglio to expose grain, etc., to sunlight, which kill, the gernis of the discase. The dangers of oll rags are supposed to lio in the Heus carried about in them. It is still uncertain, however, how far bugs and floas amount for the spread of plugue. Cattle, horres, and fowls do not, it is suyposcil, suffer from the discuse. Monkeys and squirrels do. The sputuni, vonited matter, and discharges of patients may also sproul tho clineuse. Eating with incloun hands and clrinking out of vessels used by the sick havo boon known to cause the discuso. The saliva, it is said, miny harbour plague germis for weoks after convalescence. The period of incubation in this discuse is from two to noven days. Symptoms of Plague. Three days are snid to be the most common interval botween the time of oxposuro to the discare and the appearance of the symptoms. Ten days are perhaps the longest interval. The symptonis appear suculenly. Shivering, high fever, quick pulse, quick breathe ing, intense homlache, red cycs, vomiting, and great weakness are the chief symptoms. There may also be coughing, and the pationt may be unable to sleep. Sweding of the glands ure common in the armpit, front of the clhow, groins, neck, and other parts of the body. These swellings are very hard and painful, and the patient resists any' attempt to examine them. The patiunt niay bo noisy, but as a rule is dull and takes no interest in whut is going on ·PLAGUE. 103 around him. Tenth may take place within two days after the symptoms appear. How to prevent Plague. Professor Haffkine hus anid that if an actualiy first case of plague is discovered in a biz population it is almost as easy to arrest its development als to put out a burning match, but that it is hopeless to check it after the discase has spread. Professor Matſkine was shown some houses in Bonibuy in which there were 700 to 1000. ponple living whore cnses of plague were occurring :uily all over the warıl. He came to the conclusion thnt something more than the burning of sulphur in the streets and other measures were required to arrest the growth of the disease in the city. In view of the success of varcination in preventing smali-pox, Professor Ilaftkhie began to work out a moans of preventing people from being attackel with plague. As the result of his lahours he was able to prepire a serum which he found had this effect, and first tried the effect of it on ruts, which catch plague rcaulily. He says, "Take twenty healthy rats got from a ship, which has come from a port where there is no plaguio. Inoculato ton of these rats with the scrum and leave the other ton alone. Put the twenty rats all together and put a rat suffering froin playne among them. It will be found through course of time that cight or nine or all the rats that have not been inoculated will die of plagne, and only oite or none of the inoculatel rats will die." Professor Haffkine, afier careful observations on rila, began to inoculate human beings. European and Incliun gentlemen aliko offered themselves, to be inoculated to prove the harmlessness of the operation, which is done in the same way his inaculation against cholera. Major Bunnerman, of the Indian Medical Service, Superintendent of the Plagne Research Laboratory, Bombay, in a report dealing with the value of inoculatiori in preventing plague, based on care- ·104 MANUAL OF HYGIENE. ful and reliable tests made during the cpidemies between the years 1897 and 1900), arrives at the following conclusions, viz. : (a) That inuculation is harmless ; (b) That when given before signs of plague are opparent t has in many cases at least tho powor of avorting the discayc; (c) That inoculation confers a high degree of immunity from plague, and so rolucce very greatly the number of attacks, and that when, in spite of inoculation, a porson is attacked, his chances of recovery are very greatly incralsed. Professor Ilaffkino's serum therefore promines well, and evidenco as to its real value as a preventive of plague is daily accumulating. Treatment of Plague. No kind of trcatment soems to be of much value. The patient should be kept lying down. Patient sufforing from plaguo an be best treutel in hospitals, where they receive gool melical attendance and kind, skilful, and careful nursing. The chances of other monibors of the family and of people living in the neigh bourhood catching the clincunc are thus greatly lessened. Moreover, removal to a hospital is one of the best ways of keeping the clirenso from sprcaling generally. The fear of hospitals and concealment of cases have been the chief causes of the spread of plague in India. DYSENTERY. This discasc is calised by a vegetable parasite, which is to be found chiefly in the bowel discharges. The partisites have also been found in the walls of the bowel, the sputum of thoʻpationt, ånd in liver and lung abscesses. . The disease is very common in India amongst both Indians and Euro- ·DYSENTERY. 105 . peans, and particularly in jails and other places where many people live togother and where there is insufficient ventilation. Changus of tomperature, chills, lad fool, badly cooked food, raw vegetables, bad air, baut water, all predispose to attacks of the diseilsc. Symptoms of Dysentery. The lower bowel in dysentery becomes ulcerated. Thc ulcers may be very small in mild cases or very large in severc casos. There is always griping and pain, which are sometimes very great. The disc-larges from the howel, consisting chiotly of slime and blood, may be passed several times in an hour in Juul cilsus. There discharges are so clungerous, that in jails and elsewhere it is the rule to have them burncl. Patients after reco very often remain in poor hicalth. IDysentery is one of the most common causes of abscess of the liver. Prevention of Dysentery. The only way to avoid an attack of this discoYC is to be careful about what we cat and drink, avoid chills, and have plenty of fresh air. Treatment of Dysentery. Completo rest in bed is necossary A close of castor oil and lauclanum is a mufo molicine to take in the first stage of the discuso. Ipecacuunha is also a valuable medicino to VIAC. Milk fool should alone be taken. Flot moist applications to the belly are vory soothing. Careful meclical treatment and good narxing are often neuled. If a case of dysentery is treated in its curly stage with replated doses of suline purgativo, such as Eikom salts, beginning with one half vunce in water, and giving toaspoonful doses every two hours afterwards until the bowels are very frcely opened, the disease 'in most cases will be cut short.

·106 MANUAL OF HYGIENE. ENTERIC FEVER. This discase, like cholera, is caused chiefly by polluted milk and water. It is believed that it can also be caused by bud gas from foul craina. Attendants on the sick, may contruct this discaso also through soiled hands. Enteric fever, until recently, was supposed to be a disouse of raro.occurronco amongst natives of Inclia. ('aptain Rogers, I.M.S., has, however, latoly shown that it is very common amongst thom in Calcutta Europeans are often attacked soon after they arrive in India. It is common amongat soltiiors. The gorms are found chictly in the clincharges from the bowels. They are also, however, found in the urine durmg convaloscenco. If any of those discharges are thrown carelessly about anywhere, thoy dry up, get blown about hy the windl, and often find their way into our water and milk supply. The gernis, it is suid, inay remain in an activo stato in the forın of Just for a long time. The dischargos may also find their way into wells and turks ly soaking into the ground. Water thus polluted, if usul for washing milk vessels, or auldal to milk, will spread the discasc. It is very important that all rischarges from the bowels should be destroyed or disinfected at oncc, as in cases of chulera. (treat caro should also be taken to keep the hodding and clothes of the patient thoroughly clean. Symptoms of Enteric Fever. This discaso has a long, period of inculation (10 to 15 days), and the patient inuy be ill all this time and yot able to walk about. Enteric fover is a discase in which the small bowel ha numorous ulcers. Frequent and loose discharges frow the bowel, very liko poa-roup in colour and consistency, are & contmon symptom. The bowel becomes exocodingly thin owing to the ulcors cating into it. The ulceration also ·ENTERIC FEVER. 107 causes blecling at times, and not infrequently the ulcers eat completely through the walls of the howel, and in this way cause the suditi death of the patient. Prevention of Enteric Fever. This is a discasc in which inoculation as a preventive measure has also been triedo with good results so far. Ilero agyin, however, goorl drinking wator, good milk, and good foul are the best means of provention. Treatment of Enteric Fever. The patient shoull be kept lying in bed until all danger from bleeding or risk of perforation of the bowel has disappeurol. In no kind of disease is careful medical attendance and nursing more nocle. If the greatest card is not taken when the patient is beginning to get well, a second or even third attack nay Occur. HYDROPHOBIA. This disease is very common amongst both Europeans and Indians. It is caused by the hito of animals suffering from a cliscasc callecl rabies. The waliva of such animals is sufficient to cause the disease if it comes in contact with al sore or abrasion of the skin of the hand or other part of the bly. The lites of rabid cloys are the most common Causc. Foxos, wolves, jackals, cats, and cron cows and horses may suffer from rabice. Animals affected with this discano uro said to be mail. The madness may be of either a raving or a durnb kind. Symptoms of Raving Madness in Dogs. The clogs are at first quit, full of fear and do not cure to move about. They soon afterwards become ill-nutured and refuse to cut their food, but will chew piocos of wood, cloth, mud, or anything else they may find lying about,vand in this stage aro apt to run wildly about snapping at anything it anybody they happen to moet.

·108 MANUAL OF HYGIENE. L Symptoms of Dumb Madness in Dogs. In this form of madness the chief symptoms are the early loss of power of the hind legs and lower jaws: l'he animal cannot swallow, and soon dios. Symptoms of Hydrophobia in Human Beings. The poriod of incubation in this dixerso is longer sometinios than in any other known form of discuse. Symptome may not appear for many months aftor the bite. The first wymptoms are very often discomfort and pain in the place where the patient was bitten. The first symptoms, howcvor, may he loss of spirits and sleeplessness. The appctite may also be lost. There is a choking feeling in the throat, and the patient may not be able to swallow even water without bringing on xpulsms. Broathing is difficult. The patient has a scared look. The ruliva which collects in the mouth is spit anywhere, and even into the forces of thu attendants. The patient becomes very noisy, and soon dies from exhaustion. Tho attack acldlom lasts longer than from two to four days. Recovery scldlom takes place. Treatment of Bites of Rabid Animals. Animals supposed to be in which have bitten anybody should not be killed. They should be kept tied up to sce whether they are really mal. Caustic or a hot iron wire should be freely applied to the wound. If the animal is mal, the patient should go at once to the Pasteur Instituce for what is called the anti-rabic form of treatment. The rosults of this treatment at the Pastour Instituto in l'aris, in 1899, show a death-rate of 0-25 per cent, or 1 death in every 100 persone treated. The cleath-rate among those: bitten by rabid animals, and who have not 'undergone treatment, varies according to the class of the animal. Some `authorities give the clouth-rate among those bitten by rubid clogs us 30 to 35 per cont., others 50 to 55 ·TREATMENT OF BITES OF RABID ANIMALS. 109 per cont., or higher, or a mean death-rato of 42 per cent., that is 168 in every 400 persons. Amongst those hitten loy wolves and jackals the cleath-rate is about 80 pur cont., or 320 in every 100 PCIONS. There is at Kandui ali Instituto to wbich persons who are bitten by rabid clogs our other animals may go for treatnient, and I wouldl strongly advise any person who may bo bitten to there at once. 'The following directions for those who wish to go have locon drawn up by Colonel Bumber, of the Indian Medical Servicc :-Place where the Institute is Lucntcl.-- Kusuuli, a hill station 9 miles from Kalka Railway Station. Kalka is 38 miles from Umballa liy railway. Conroyince.---Landlies and horses. Situation of I[ospital. - Manor house. Trrutinents - Free to all classCS of people. Nature of Treatment.--Ilypo clorniir inoculation, causing little or no juin, merely the prick of the needle. No confinement to bed or quarters during the entire course of the treatment. Perind of treatarnt. Fortnight to three weeks. Attrulancr.-- Daily at 10.30 A.M. Arromnolution. Persons bitten by rabid animals are troated an outelour patients. Lolgings for Europeans and Eurasians, vlak bungalow and hotels; for Indians, sorai and private lolging houses in bazar. It is unclerstool that a philanthropic Indian gentleman his recently given funds for providing free accommolation fut sixteen poor Native patients, whilo a Parsi gentlurian provides blankets and clothing during the cold weather, and foort if necessary. IC in particularly requested that patients should avail themselves of the treatment without Any 198s' of time, as the sooner they place themselves under treatment the groutor are the chancce of their inmuity from hydrophobia. 321 cases of bites wert trouted between 9th August, 1900, and the end of the following yout. Of the animals which 'inflicted the bites 282 were clogs, 37 ·110 MANUAL OF HYGIENE. jackals, 6 wolves, 3 foxos, and horaca, mules and cats one ench. Jackal bites are reported to have been most severe, requiring special care, as the virus irr ufon slight would caused by jackals is very strong. Major Sumple, R.A.M.C., the medical officer in charge, remarks in his report that many of the native patients arrive with the iden that they are coming to a hospital, and that they have got to remain : in bed during the whole course of twentment; they scom agrocably surprised on learning that this is not the caso, and that thoy can go about as usual. How to prevent the spread of Oontagious and Infections Diseases. The chief means whereby this objdet may be cffected are: (1) notification, (2) isolation, (3) segrogution, an. (1) disinfection. Notification of all casos of infectious disoaso should bo insisted upon ovorywhere. This woull enable the Houlth Authorition to tako stops to prevent outbreaks of disease assuning scrious dimensions. In cvery instance where suitable accoinmodation is not available for treating infoctious cases in privato houses, the patient should be removal to a hospital specially set apart for the recoption and treatment of such cilsos. This is called isolation. It would be far better in the interests of the patient, friends, and othor people, if all such CILACS were trouter in hospitul, and they aro very ill-ulvined who raiso objections. It is sometimos considera desirablo not only to remwo the sick, but also to prevent thonc who have been in contact, with the sick from inixing with other people until it is certain thui the risk of infection is over. Special camps ure sometimes provided for this purpose. This is kriown us gegregation.

·DISINFECTION. 111 DISINFECTION. Disinfection has been defined as the destruction of the most stable known infective matter, that is to say the vlisinfection of the yerms of disease and their spores. The agents employait for offocting this are known 16 disinfectants. Some chemical agents merely restrain tho growth of disuse yorms, but do not destroy them. These are called antiseptics, of which borax and boracic acid, se for preserving food stuffs, and lime aro examples. Others simply contrcal smells, and are known as (leodorants. ('harcoal and camphor are inol for this purpose in urinals. Tar is largely usul for the walls and wood-work of latrives and receptacles for refuso. Condy is fluid and cucalyptus are ligely usul in European families. Disinfection may be carried out in three different ways: 1st, hy fumigation; 2nci,oby the use of chemicals; 3rd, by hent. Fumigation. Funigation with sulphur is al mcthout which is well known everywhere, and is still very largely cnrployell in India. The 1180 of sulphur fumos has, how cver, been shown to be it more farce. The only real gooxl obtained is when the doors and windows are opened after fumigation to admit fresh air ('hlorine gas and carbolic acid vapour have also been 11801l. It may be suid, howeter, of fumigation in general that it is of little vise. Chemical Disinfectants. The best disinfectants, and those most commonly useit, are carlolic acid and corrosive subliniate. Calvert's carbolic powder, Macdougall's powiler, Jeyo's phonyle, and Lawo's disinfectants aro useful forms of chenkicul disinfectants. The latter may he used in tho liquid form, in the form of soap, or as a powder It has been extensively used in cases of sickness for washing, for cleaning floors, for latrinos, urinals, and numerous other purposes.

·112 MANUAL OF HYGIENE. Heat. This is the host disinfectant of all. The forma in which heut has been employed are by the direct use of the flame, hy hoiling, hy the 1180 of dry gas vapour generatod in & disinfecting chamber or stovo, by stoam vapour and steam, and by means of Anturatoil steam confined under pressure in stovca. Hot air is objectionable, on the ground that the tomperature necessary to clestroy the germs of disease is so great that the articles to be disinfected would . in most cases be clestroyed. Leather an! inclia-rubber gools are clestroyeul when exposal to groat hout in any form. I'rolonged boiling destroys almost all gorms of infectious disease. For all practical purposes boiling is a safe and simple means of clisinfection for ordinary household 1180. Boiling is also largely used for sterilising water and milk, and instruments used for performing surgical oporations. For the disinfection of moms the use of what are called Equifox sprayers is to ho recommended. Theso aru small huul pumps into which the clisinfocting liquid ix poured. By working the handle the fluid is forced out of thic primp in the form of a fine spray. For disinfection on a large scale, however, such as, for example, the haricing ind ciothing of a patient or the crew of a ship), special arrangements are necesslry; and, as those are very exponsive, they have to be provided by the llonlth Authorities. Largo steam disinfectors are used, of which the " Equifex Stuie" is the best. Tho articles to he disinfortul are ptit into a large wire cage, the door of the stove is shut and firmly fixed by means of scrowy, steam under pressure, in orler to get the grintost hont possible, is theradmitted. After the expiration of half an hour, or less time evor, the artides thus treatal may be safely removal and led ayuin. Every large city and town should be provided with Equifex stoves for public lise. The following instructions, based chiefly on sugyostions ·DISINFECTION. 113 contained in Parkos' IIygiene, regarding disinfection may he found inseful in dealing with cases of infectious and coftugious disease." A . . I. DISINFECTION OF EXCRETA AND DISCHARES. The following solutions havo hoen rocommepded : 4. Carbolic acid solution (1 in 20), i.e. I part of acid in every 20 parts of water. B. Mercutic chloriile solution (1 in 1000). FORMULA GENERALLY USED. Bichlorile of mercury, Hydrochlork: acid, 1 0% ('unimercial aline blue, - 5 graisia Water, 3 gallons V.B.--This solution corroles metals and is poisonous. C. Izal solution (1 in 20). D. Lawe's fluid (5 in 100). Eftpier of these solutions should be applied to the vomited matter or excretit immerliately they are expellal ; they should then bo collectal and mixoil with an equal quantity of the clisinfecting solution, allowed to stand for a quarter of an hour, and then be burnt or buried. Dry carth, charcoal, quick-linie, chlorido of lime, and carbolic acid powder are useful doodorisers. Quick lime, 5 parts, and carbolic acid, 1 part, muko a gocul deodorising mixture. II. DISINFECTION OF CLOTHING AND BEDDING. 1. Burning is best, and all articles of little value should be burne. 2. Boiling, or at least soaking, of infected clothing and Bodding for 24 hours in some disinfecting liquid, such as one of the followiny, is useful : (c) l'zal, 5 parts X 100 water. II ·114 MANUAL OF HYGIENE. (h) Chloride of lime, 2 ounces to 1 yallon of water. (6) Carbolic acid, 5 parts to 100 of water. (11) Bichloride of inercury (1 in 1000) solution. (c) Lawe'd fluid (2 in 100). After Aonking in any one of those solutions, the clothing should be builed and thoroughly wished with soup and warm water. III. DISINFECTION OF ROOMS AND FURNITURE. Fresh air and sunlight should be freely :mitted. All woocl-work should be well scrubbed with spft nc up and hot water, or wished with il mercuric: chloride solution (1 in 5400), chloride of limc (1 in 100), or Lawre's Huid ( in 100). The walls should be treated similarly. Spraying with it hand pump will suffice (Fig. 35). Bamboo syringes arc sometimes used for this purpose. 'Those disinfectants are also useful for clisinfecting diains, latrines, and sinilar places, In weak solution they may be used for disinfecting the hands and belies of attenılants on the sick and others brought into contact with the infection. The vapour of formic aldehy.le has been highly spoken of as a disinfectant for loonis. Any valuable articles of clothing mado of silk or other expensive inaterial which would be spoileal loy clisinfecting them shoull be spreal out an: carefully exposed to the sun. All rooms in which the sick are treated should be kept scrupulously clon and well ventilated. The room should contain u8 little furniture as possible. Clothes, mats, books, papers, etc., should be removod. Nothing should be taken out till disinfocted, and this more especially applies to the discharges from tho boly. Nuncs should always be dressud neatly and cleanly, and should be careful not to eat with infected hunds. The spread of discuse can also be 6

·DISINFECTION.
115
Fru. 34.
checked to a large extent by personal cleunliness, avoiding
overcrowding, fresh air and light, and the lime-washing of
houses inside and outside.

·116 MANUAL OF IIYGIENE. PERSONAL HYGIENE. Exercise. It is impossible to remain in good healch without taking exercise of some kind. Exorcise is generally taken with the object of improving the quality and incrcasing the size and strength of the muscles of our bodies It clocs a great deal more than that, howover. It helps to keep tho other parts of our bodies in a healthy and active stato. During exercise the blood passes much more quickly through the lungs than at orclinary times, and more air and consequently more oxygen are inhaled and more carbonic acid gas is given off. There is also a large increase in tho amount of watery vapour exhaled. In ordinary breathing 480 cubic inches of air are taken into the lungs per minute. During walking at the rate of four miles per hour 2400 cubic inches of air aro inhalrd per minuto, while at the rate of six miles per hour the amo:int inbaloil is 3360 cubic inches. During exercise the lùngs and chest walls should bo perfectly froe in their movements. Difficult breathing and sighing while taking exercise point to the fact that there is too niuch blool in the lungs, and that rest is needed (Parkos). During exercise there is an increased flow of swoat, which also contains wasto mattor in large quantities. More work is imposed on the heart, which becomes stronger and thicker when uscal properly. The blooxt is purified, the appetite improves, and food is moro casily (ligosted. Exercise also helps to keep up the hent of the bowly Our brains, morcover, work locttor if we tako pbysical exercise regularly. Exercise is furticularly necessary in Indii, where the heat tends to nakoʻv@ople lazy and inactive. Persons who travel ahoút in p'lkies and other conveyances and take no exercisd and who cat a great cleal, and more especially such food as frt and sugar, generally become, as has already been stated, very stont.

·EXERCISE. 117 Thc forms of excrcise are numerous. We should all select that form which suits is best, whether it be ridling, gymnastics, bicycling, walking, cricket, tennis, badminton, football, hockey, golf, rowing and boating, or the iso of dumbells, or wrestling. Many of these fornis of exercise are yvell kilown and much likel by the natives of India. 'The exercises taken should vary to somo o&tent, so that no pyt of our bodios will suffer from neglect. It is suppoged that a walk of ninc miles daily is sufficient, exercise for a man whose cluties (luring the day are of a seclentary nature (l'arkes). If our labours are of a physical kind, our spare tinic shoull he spent in harmless amusements and improving our minds. It often happens that young persons become too fond of ganics and other amysoments, and neglect their studies, and grow up with big boilies, but little mental culture. In trying to develop our strength and our boilies, our brains should not be entirely neglected. “It is the mind that makes the man." Rules as to Exercise, Excessive or bailly-regulateel exorciso causes too much pressure in the blooil.vessels in the lungs, awl bleeling sometimes takes place from this cause. Heart (liscise is often (illised in the same way. Too littlc exercise, on the other hand, also does harm, and may even bring about il condition of the lungs which makes them more liable to be attacked by clixeilses, such as consumption and bronchitis. Fatty fool is of great benefit to those who take much exercisc. Spirits are injurious. Water is the best liquid to tako, and should be taken, during hard excrcise, in small quantities at short intervals, instoud of in margt grantities after exercise is finishol. It is best to tako excitise in the open air, hecause as much oxygen as possiblo is required to purify the blooil, which cliving exercise contuins a very much larger amount of carbonic acid than during fest.

·118 MANUAL OF HYGIENE. Rest and Sleep. Rest of body and mind is as much neoded as exercise for the maintenance of good health. It is during r'ost that the repair and the renewal of our tissit.A take place. Rest is ohtained chiefly during the hours of sleep. Sloep has for this reason been called “Nature's swot restorer.” Sleep is most sound and refresling in rooms which 'ure quiot, dark, well ventilated, and neither too hot nor too cold. Circat heat „prevents sleep, and prolonged sleoplossness brings on ill-healt}. It is 'for this rolson that punkahs, electric fans, and other artificial moans of proclucing a feeling of coolness in the air aro isci in India during hot weather. Hari beuls are more healthy to sleep on than soft bals. It is a mistake to lie upon floors. They may be damp, or foul air from the underlying ground may be inhaled. Fever, dysentery, chills, and rheumatism may be causal in this way. There is, more ovor, great danger of being bitten by snakes or other poisonous animals. The use of raised bells is strongly recommended. In ortler to enjoy a good night's rent it is important that our bedding should be clean. The clothing which wo wear at night should le male of some light woollen material. Linon sheets should be uscil, and the under covering should be made of the same material. After we got out of bed in the morning our bel clothes and bolding should be well airal and exporul to the sun, and as much air should be admitted to our badl-rooms as possible. During sloep our headls should not be covered. This leads to rebreathing the foul air exhaled from the lungs. It is for this reason also that two persons should, not sleop together. Separate berls should le usod. Animals -ahɔuld not be allowed to sleep in hod-rooms, as they use up the oxygun of the air,, and give off carbonic acil gas. Lamps, candlay, and charcoal fires also, as we know, vitiate the air, and should not be kept burning in bed-rooms if it is ·REST ANI) SLEEP. 119 possiblo to do without them. Cooking should always be done in cook-haises, and novor in sleeping roonis. Sleeping rooms should contain as little furniture as possible, as furniture taken up air spilcu. Mosquito curtains are oxtremely useful as a protection against mosquitoes, whose bites listurh sleep, and, as we know, can cause malarial • fever. We should not retire to rost on empty stomachs, because even during sleep the heart, lunga, and other organs, continue to work, and require to be nourished. A. light moal will not only supply the energy to enable our organg to perform their duties during the hours of sleep, but will also insist in inducing sleep. We should not retiro to rost immediately after eating a heavy moal. The heart and stomach aro both situated on the left side of the busly, and close to cach other, although soparated by tho diaphragni, or midriff. A full stomach interferes with the freo action of the heart ; a person should not thorofore to sleep lying on the left side. It is better for this reason to lie on the right sido Palpitation of the henrt, which is a common complaint, is often cancel by pressure of the stomach on the heart. This happens when the stomach is clixtended with gus arising from indigestion. In cases of slecplessness it is best not to struggle to go to sleep. Sloop often comes when Jeant expected, and to struggle to go to sleop ofron makes the ulveploss feeling much worse. The nine of drugs to induce slcup should be . strictly avoided except under modical advice, The Amount of Sleep Required. Infants require 16 hours of sleep every 24 hours, children two years of age roqilije 14 hours. • Children four years of age require 12 hours. cight 11 10 At 16 ycars of age 9 hours are required. Women need 8 twelve, ·120 MANUAL OF HYGIENE. and men 7 to 8 hours of sleep. Old people require more (Reynolein). Cleanliness and how to Cleanse the Skin. Warm water and soap are best for this purpose Soap is usod to make the removal of fat onsy. Soap which dries up the skin or makes it tencler should nover be lised.' Hard water is not good for closing purposes. It takes up the fut, and makes the skin dry and harsh. Doiling makos harrl water moro fit for 11se. Rain water, which is soft, is the best water to use for bathing A nail brush, a piece of flannel or al sponge, may be used with aulvantage. In hot countries, such as Inclin, Ehe wholo boly should lic washed thoroughly once a day at least; and those parts of the buly, such is the hands and foet, which are exposed, should be washed several times daily. When special clausing is desirablo, ar, for example, before commencing surgical operations, turpentine is of the greatest service. It removes all traces o*' fat and smell, Bathing. A cold bath is very refreshing, but we should not remain in it too long. Aplungo into cold water and out again is sometimes sufficient, and may be takon even whon the skin is hot and perspiring. If the skin bogins to glow immediately afterwards it is safe to take cold baths. If, however, shivering occurs, and the tips of the fingers and tocs remain blue and coll, they are hurtful. Aftur bathing, the holy should be well rubbel and cried with a thick, heavy coarse towel. The habit of walking home froni batning places with wet clothes clinging to the body is attended with great danger to health. When bath cannot be taken, the body nay be rubhod with. a tiwel which has been dipport in cold water, or a sponge may be used. The skin cools after warm baths. A warm bath, or sponging with hot water, is sometimos 'rzsed to reluce the ·CLEANLINESS, 131 heat of the borly in fever cance. The warmth brings the blooul to the skin, and the air alstracts some of the heat. IC is due to this cause that the forer in reluceil. Delicate persons, who have not much blood in their bodies, sometimes faint in hot baths owing to the rush of blood to the skinie 'warm bath is also very healthful and agreeable · when a person fecls cold and chilly. Twkish Baths cadisc profuse sweating, and are thus il very useful nrans of helping to clean the skin. Bathing, cither in cold or hot water, should not be done after eating a heavy meal. The cold water drives too much blool to the walls of the stomach, while the hot craws the blood away. In both ways the proper digestion of fool in intertical with. “ Births may loc roughly classificelo ile follows: cold bath, 60° to 70° F.; tepid bath, 85° to 95° F.; warm, lxth, 969 to 101° F.; hot bath, 101° to 111° F. A Wie'm bath for a child should have a temperature of 96° to 98''F. The water of a cold bath should never have a lemperature less than 59" F., that is, about forty logrees lower than thc tenperature of the healthy human body” (Simmons and Stenhouse). Effects of Sudden Chilling of the skin. Sudden cooling of the body, after hard exercise or exposure to great heat, is sometimes very dangerous. It often causes col.lx, and, owing to the blood being suddenly crivon from the skin, inflammation of the lungs, liver, kielney, and other orgins often rosults. C'hills, too, often (uuse cliarrhoen. It is to prevent chills that kummerbunds are worn in India. Nails. Nuils are made of the same kinıl of ells as skin, The çelis have merely undergone il process of harlening. Tho'horns of aninals are also outgrowths from the skin. 'Nails are firmly fixed and have roots, just as hairs have roots. Nails strengthen the tips of our fingers and toes, which they also protect to some extent. The finger nails ·122 MANUAL OF HYGIENE. sometimes fall off owing to the finger tips being used too much. Thu finger nails also cnable us to pick up small objects, and are useful in numerous other ways. Nails should be kept short and neatly trimmal. Knives, or other instruments, should never he used to remove dirt from underneath theni. They make matters worse by raising the nail, and causing dirt to collect more easily and in larger amount. Nail brushes shojald be used instead. It will, howeror, be unnecessary for grown up people to 1180 oven nail brushes if the 18c of instruments for cleaning their nails in carly life is avoided. Toe nails should be cut square. When boots or shocs are worn, they should not be too short or pointul. A bully shaper and badly fitting bort distorts the feet, causes (Orns, and makes the great too nails grow into the flesh. This is a very painful affection, which often requires the removal of the nail. In ingrowing too nails, the removal of a wedge shaper portion of the point of the nails, lcaving the corners utourhed, helps to remedy the complaint. Thinning the surfaco of the nail by scraping is also izseful. This treatment makes the nail grow where it is out or scrapel, and stops its growth at the corners. Asiall piece of cotton or rng, placed under the corners of the ingrowing nail, cloes youd. The nails, especially those of the fingers, should always he kopt perfectly clean. Nothing is more objectionable or offqusivo to the eye of an onlooker than an accumulation of dirt under the nails. Tho (lirt nay, morcover, be the cause of some of the worst form of diseases Hair 18 also an outgrowth from the skin. In cold climates the head should not he washed more than once a week or once a fortnight. Soap and soft "warm Vater should be used. The white of an ogg has been recommendo.l for this purpose, because it does not dry up the hair so much as soap ducs. Some people wash thoir hair ·CLEANLINESS. 123 daily. This is almost unavoidable in hot countries whore the skin is so active. It is not, howover, altogether a yount practice, as it removes the fat, and, in this way, it is said Lo canso the hair to turn prematurely groy. A good rule is to wash the hair as little as is consistent with cleanliness. It should be combed and brushed several times a day. This helps to renlove dirt. The brush should not ho tro hard, otherwise the hair will be broken. The uso of a harl brhah also tons to cause "scurt" (Reynolds). The hair is, ils a rule, most abundant when heavy and tight coverings for the head are not worn. When possible, it is desirable to keep the houl bure. Dirt and neglect brood vermin and leaul to clisease of the scalp. Teeth. It is most important that our tooth should be kept in good order. Stomach disorilers and bad health genorally are often caused through bad teeth, or loss of these most important organs. Our tecth should be kept thoroughly clean by the use of a soft tooth brush, or other similar means, immaliately after outing. The mouth should also he alrefully washeil with some simple mouth wash, which will prevent the germs that cause decay from doing any mischief. Listerine and onthymol form excellent mouth Wishes. A pule solution of permanganate of potassium in water is also useful for the sanic purpose. A fine throad drawn between the teeth helps to remove food particles. Ricarbonate of worla is extremely useful for removing, fat. The use of toothpicks should he avoided. If, however, it is necessary to use thom, toothpicks muule of soft quills or soft wood are better than toothpicks made of metal or other hartl suhstance, which break the teeth. Attention to these detitia will prevent clecay and discoloration. If the habit of thoroughly® cleaning them with a soft brush or similar means and plain water or simplo mouth wash after doud is acquirell in chillhood, the 1180 of carbolic powder, chalk, ·121 MINUAL OF HYGIENE. camphor, charcou, or anything of that kind will not be NOCCSSilly. If, however, in aclult life, decay begins to appear, a dentist should be immerliately consultal, ils nothing is so painful as toothacho, and nothing so offensive as the foul gunos which escape from bacl tcoth. Artificial teeth are the best remely for incligestion and poor health causcd by the loss of natural teeth. 3 1 CLOTHING (lothing is worn to keep the body warm and dry, to. protect it against great coll or great heat, and against injury, clisease, and clirt. In most parts of Incona during the groatcr part of the year the heat is so intense that tha, majority of the inhabitants wear clothing merely for the silke of decency. Much of the clothing card in most countries serves only the purpose of personal adornment. Materials used for making Clothing. In coll countries thick warm woollen material is best. In hot countries white cotton is chinelly soul. ('lothing which does not conduct heat readily, and thus (loes not allow heat to escape casily from the borly, is the warmest. Kur is the best in this respect, but is used only in very cold countries. Wool, silk, cotton, ilnd linen come next. Linen conducts hcat quickly, and therefore feels colel. Watcrproof material, such as oil skin, tarred cloth, or cloth covereel with Indiarubhcr, is the worst of all to unc, because it causes excessive perspiration and prevents absorption. When waterproof coverings are worn, they should be well ventilated. Woullen material absorbs sweat, and thus prevents chiùls caused by evaporation. ('otton does not possing this quality. Wooden material of light weight, light in cotour, and porous in the most suitable material for clothes in all climatot, especially in countries with great daily and seasonal variations of temperature.

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·126 MANUAL OF HYGIENE. The Construction of Clothing. Clothing should be made to fit comfortably. No part of our huxlies should be constricted or any of our internal organs pressed upon. Fortunately, amongst the people of India the use of stays and the habit of tight lacing, 'vhich compress the organs of the chest and abclomon (Figs. 36, 37, 38, and 39) and aro 80 injurious to the health of European women, are not practisod, and boots, which so often dietort and cause many painful affections of the fect, are seldom w' in (Fig. 40). FIU, 40.- For DIXTORTED BY TIGNT 130014, IN SILK 41. Foor. Dhotios and saries, however, which are worn, should not be drawn too tightly round the waist, and the vau of hoavy ornaments for the wrist and ankles, which iure injurious to health, should be abanılonel. Clothing should he suspended from the shoulders, but preferably from a broadband fitting comfortably round the boy above the pe vic boner. It shoull nover give too much support to the body, puich should be froc in all its movemonts. Supports, such as stays and boots of a particular shape, have sometimes to be used in cases of bodily defects or weakness, or to "help to roctity doforniitios. If possible to do without them, ·EFFECTS OF EARLY MARRIAGE. 1:27 they should never be used. It is unwise and unsafo to sit in clothes which are damp from either rain or sweat. They should be changed at once. Cloth which has been dyed should not be worn next the skin. Clothing should bo porous, to allow of ventilation, Our clothes should be alcin, frequently exposed to the sunlight, fit comfortably, and be adapted in thickness of texture to the scasou of the year., Dirty clothes canso cliscaso of the skih and verpin. Iwosely fitting clothing mule of cloth. CO:ll'80 texture is Willmer than light clothing of finc texture. During cold weather the use of blankets at night will prevent chills and clincirses caused by them. The exposure of infants to coll is extremely dangerous. They should be thickly cluel, more specially during wild weather. Attention to the above details regarding clothing will help to kocp the body in a strong and healthy condition. EFFECTS OF EARLY MARRIAGE. Early marriage, which is the custom anong lindus, is regarded by Dr. Mohendra Lal Sircar, a distinguisheil member of the medical profession in (alentti, as the greatest evil of India. In his report for the year 1899, the Sanitary Commissioner with the Government of India observes that no less than 88 per cent of the total number of women in India between the agus of 15 and 39 were shown at the consus of 1891 to be married. It is further observed that 8·4 per cent. of the children born in Calcutta and 1807 por cent. of those horn in Bombay are born dearl. Theolwge number of still births is ascribed to the youthful ago of mothers, the unhealthy sanitary conditions in which .they live, and the physical labour thoy are called upon to endure during pregnancy. Marriago should not take placo until thu body is fully developed, otherwise it is impossible ·128 MANUAL OF HYGIENE. for the offspring to be strong and healthy or the race to he anything but feeble. Early marriage is, moreover, most injurious to the health of young mothers. Dr. Mohendra Lal Sircar a fow yours ago remarked it a public mooting: “ Froni medical observation extending over 30 years ho could sily 35 per cent. of Jindu women (lied prematurely through carly marriage, 2.5 per cent. more were invalided by the Milino cause, and the vast majority of the l'onainder suffered in horlth froin it." A Bombay Ciovernment School Inspector Mlys : “Hindu and larsi boys are both sharp and intelligent, and until the age of sixteen few teachers could desire more clicrgetic or painstaking scholars and students. The result of their carly marriagos and consequent cohabitation is simply sloplorable: the great majority of the boys are exhausted and spent before they reach sovcuteen. Their former energy and youthful brightness are gone. Henceforth, for purposes of close application on the part of the stndent, they are an utter failuro and disappointment." marriage is, it will thus be seen, in every respect wrong THE CARE OF CHILDREN. The care of children has already been partly considered in connection with the subject of food, clothing, rost cxcrciso, and sleep. The high death-rate amongst children in all countrios is duc largely to premature births, hereclitary tendencies, congenital defects, the want of knowledge as to how children should be feel and clothod, and other mattors relating to their proper upbringing, overlaying in bed, to ignorance of disease and how to prevent it, and more ospecially diseases of an infectius nature, to many of which children are peculiarly liable, ils, for example, small-pox, and to insunitary sur- ·THE CARE OF CHILDREN. 129 . . roundings. In India the youthfulness, immaturity, and inexperience of mothers are also largely responsiblo. Children, and more cspecially intants, are very sensitive to cold, and should therofore lo kopt warm. Their clothing should fit comfortably, and the use of pins should be avoided. Their skins are very, tonder and casily irritated. The skin and clothing should therefore be kept spotlessly clean. Fresh air and exercise aru absolutely essential to good houlth. Children should be kept in the open air as much as possible. In India it is of course necessary to protect the head aguinst too great exposure to the sun. This observation, however, applics more particularly to European children. The clothing of chillren should be changed immediately aftor their play is over, their skin should be well rubbed and cried, and dry clothing should be put on, otherwise they will run the risk of catching a chill. The hours of sleep and the time of going to bed and getting up in the morning should be carefully regulatod. This is required of parents, in the case of children attending certain public schools in England, by teachers who fix the hours for children of different ages. Sleeping rooms should be well ventilatod, overcrowding avoided, bodding kept clean and exposod daily to sunlight and air. The greatest attention should be given to the food of children, becauso a great many of their ailments are caused by unsuiteble food which thoy cannot digest. It is most important that the bowels of children should be kept regular in their action, but the use of medicines for the purpose should be avoidod as much as possible Carefully selected, well propared, and easily digested food will help considerably to do this. Chidren should be taught to be cleanly in all their Xabits. The importance of providing gooul ventilation for school- ·130 MANUAL OF HYGIENE. rooms has already been discussed. The subject of lighting should also reccive the most careful attention. Schoolrooms should be so constructed that sunlight may be evenly distributerol and glare and shadow avoided iis much as possible. Electric light is the best form of artificial light for realing and general line". It should not, however, boce allowed to fall clirectly on the eyes, or injury and clefortive vision inre likely to result therefrom. In this connection attention is directed to the importance of having defects in the myesight of children attended to clirectly they are discovereel. It is i'esirable also to be on the outlook for clofects of this kind which are often caused through rcarling books, printed in too small type, or in a haul light. It is also nechatry, in cold countries, to provide arrangements in schoolrooms to secure warmth. And lastly, as the health of children often suffers from the constrainer position in which they sit at their desks during the hour of study it is considerent desirable to give in the form of an appendix what has broon said on this important subject by Mr. Priestly Smith and Mr. T. G. Roopor. These rules cannot, perhaps, he applied in the cisc of children attending many of the small village schools in Iulia where the floor is often their desk, sent, and slate combined. They might, lowever, le appliar with sulvantage to the houlth of students in some of the higher schools of learning. . EFFECTS OF EXCESS AND INTEMPERANCE IN THE USE OF TOBACCO, OPIUM, ETC. Tobacco is the leaf of a plant called Nicotianna Tab'cum. It is *prow'n very largely in South America, India, and other pirts of the world, and is user extensively everywhere. It is, as a rule, smuked. It is, however, occasionally chewed.

·EFFECTS OF EXCESS AND INTEMPERANCE. 131 Like the chewing of pan, the chewing of tolucco is an exceedingly dirty and unhealthy practice. In India a small quantity of tobacco is often taken with pan, and cocaine is sometimos used in the sime way. Tobacco is also used, but less frequently, in the form of snuff. Snuti-taking lised to who a fishionablo practice. Composition of Tobacco. Tobacco leaf contains an oily material, and an alkaloid called nicotine. Both those substancoso produộc violent sicknose. One drop of the nicotino' winsufficient to kill a vlog. Tobacco smoko is also used to kill the small insects which infost plants. The amount of nicotino contained in different kinds of tobacco varios considerably. As a rule, not more than four or five drops are continal in one ounce of tobacco, and part of this antoant is got rid of when the tobacco is smoked. If this were not so it would be most dangerous to lifo to niso tobacco at lll. It is the oil and nicotine of tolucco which givo old wipos and the ends of chcroots their bitter taste. When tobacco is smoked, certain other injurious products aro given off from it, which have poisonous effects on the systom. How the Poisonous Products of Tobacco get into the System. When tobacco is smoked the proclucts of combustion get into the system through the lungs, the delicato structure of which has already been describod. It was also pointed out that the lungs absorb gases greedily. Since we know, as has been stated previously, that the interior of the lungs has an absorbing surface of no less than fourteen hundred square foct, we cannot be surprised at the elfects on the systom when poisopous gases, such as those contained In tobacco gmoke, are inhaled in large quantity. The poisonous substances in tobucco can also be absorbed by the skin when tobacco is applied to it, or through the ning membrane of the mouth, stomach, or nose wherf it is chewed or taken as snuff. The effect of the poison on the - ·132 MANUAL OF HYGIENE. system is exactly the same, no matter how it finds its way into the blooil. Effects of Tobacco on the system. Smoking in moderntion has a soothing effect on persons who are restless, and who are in the habit of using tobacco. It is believed to help digestion, and prevent the waste of body tissue. It puts off hunger. The risk, however, of becoming an invoterate smoker, and the evils resulting from the 1180 of ' tobacco in oxcess, arc so great that its 1 use even in moderation should never be indulgod in. When the halut. is acquirol it ain sellom be broken off, although the health may be considerably undermined by continuing it. Boys who foolishly, and because they think it manly, usc tobacco aro likely to grow up to be nicn with wcaker intellects and poorer physiques than boys who wisely shun it. When 118el to excess tobacco not only blackens the teeth and spoils the breath, but acts injuriously on the entire system. Slecplosstions, depression of spirits, healacho, unstoudy hand, and shaky legs inclicate the effects of tobucco on the nervous system. The circulatory system is also affected. There is violent palpitution, the heart beats aro irregular, and now and again a beat is lost. The pulse is also quick, irrogular, and feeble. Heavy smokers are often palo and unhealthy-looking, owing to the poor quality of their blood. Suvere pain is sometimes fult in the region of the hourt. Breathlessness in climbing stairs is another well-marked indication of the ovil effects of the excessive use of vobacco. The throat is irritutod, and a tough, glairy phloym, which gives rise to constant hawking, accumulates at the back of it. This is known as smoker's sora throat. Tho appetite is impaired, food cannot be properly digesteci, and the tongne becomes dry and foul. Tobačuo has also an injurious effoct on the eyes. The smoke may set up inflammation. After years of excess ·EFFECTS OF EXCESS AND INTEMPERANCE. 133 . : the vision often becomes dim, or tho sight may le entirely lost, owing to disense of the optic nerve. The Ovils are intensified when smoking is indulged in in the company of other smokers in a crowded room where the ventilation is bad, and the injurious effoct on nonesmokers also occupying the same room may bo very marked indeed. Professor Frusor, of Fxlinburgh University, one of whose loctures his lcon most helpful to the anthor,in dealing with the subject of tolucco, has recorrial „the fact that death from smoking has occurred in a novico after only two pipes, and in habitual smokers after seventoon or eighteen pipos woro continuously smoked. Opium. Opium is obtained from the poppy haul. In China it is nised much more largely than tobacco. In India the opposite is the caso. When the habit of using opium, is acquired it is almost impossible to break it off; and the evils resulting from its use aro vastly greater tbano thoso arising from thouse of tobacco. The confirmned opium cater soon becomes a complete wrock, mentally and physically. The use of opium in any form should never be resorted to except in cases of sickness in which thc mclical attendant thinks it necessary. Its use, however, even in such cases, should be stopped Ils soon as possible, as patients are apt to acquire a craving for the druy, and often continue to use it after they are well, and thus become habitual opium-eaters. Opium in cven the smallest quantity should never he given to infants under one year of age. Indian temp (Cannabis Indica) is another drug which vis largely consumul in India. (tanja, bhang, and subjee are all forms of the drug which are obtained from different jurts of the plant, such as tho flowers, Waves, and toms. It is usually smoked, but may be caten or drunk. It is used for many purposcs, but chiefly as a stimulant. Its ·134 MANUAL OF HYGIENE. usofulness has, however, boon overstuted. It acts chiefly on the brain. Persons under the influence of the drug aro ofton highly excited and quarrelsone, and may even commit murder. Tho druy is believed to cause insanity in many instances. Its 1180 is unnecessary and harmful, and the habit of using it should therefore never be formed. Cocaine. Cocaine is an alkaloid obtained from the leaves of the coca tree (Erythrocylan Coca). Major Buchanan, of the Indian Medical Servire, has lately called attention to the spread of the habit of cocair", eating in certain districts in Bengal, moro especially among young people, and has pointed out the danger' to health arising from its use. The subject has, in fact, come so prominently into notice that heavy fines have been recently imposed upon porsons for selling the drug without a licenso. Pan sellers are said to carry on the tracle to a large extent. Like all other habits, that of cocaine anting grows upon 'its victim ; and Major Buchanan has related a case where a boy ageil 15, a prisoner in the jail at Alipore, stated that since he had hocn taught the habit he would yoully run the risk of theft to obtain the drug. Cocaino at first makes tho porson who uses it feel somewhat the better for its usc, and allays the pangs of hunger, but afterwards produces great doprossion. The blackoned teeth, with the white cutting odge, are regarded as a characteristic feature in the cocaine eatrr. Tho person becomes a slave to the habit, and the health is underinined. In some cases it produces immediate "lepression. As in the case of tobacco, when the lige of cocaine is given up the consumer begins to put on weight. The Use of Pan. Pan chewing is cominon ainong almost all classcs of natives of India, and is, as a rule, began in oarly life. No distinct benefit to health can be shown to result from its use; on the other hand, diseases ·EFFECTS OF EXCESS AND INTEMPERANCE. 135 of the mouth and tongue are often caused hy it. The habit, like tulacco chewing, is a very filthy one. The red congue, the thickly coated teeth, the staina saliva which often trickles from the mouth, and the constant spitting in public thoroughfaros, public conveyances, on foors, walls, and ulsewhero, make those who inclulge in the practice objects of linguist to more cleanly individuals. They are well.alvisol who avoid its 1180 'In his report for the year 1901, Dr. Stuley, the Health Officer of Shanghai, obscrvos as follows: “Tulerulosis is rampant in Shanghai. Among tho foreign trsilent population one cleath in every seven is duo to tuberculosis, whilo among the Chinese it claims a larger number than any other discuro. It in, undoubtully, chiefly xproul by the spit of consumptives, and the clisgusting habit of the Chinese of profuso expectoration in public places is largely responsible." 'L another quart of the Almio report it is remarkel : “There are, probably, at the present time at least 5000 (alse's of consumption among the Chinese in Shanghai, the majority of whom individually spuit out, claily, millions of cleully tubercle brilli." This habit of promiscuous spitting is common in every comtry. The evils of the practice are now, however, generally recognisel, and strong otforts are being put forward in some countries to stop it. Notices, for example, are placed in conspicuous places in almost all the tramway care in New York and San Francisco cliroeting special attention to the fact that, any passenger fowl spitting in tho 9:{rx is liable to a fine of 500 dollars or six nionths' imbrisormont, or both. Steps of this kind are much needed in India, and more expecially in some of the largo cities and towux, if the staircases, floors, and walls of My fixtrater' Courts, Municipal Oflices, and other public huilling, are ·136 MANUAL OF HYGIENE. to ho maintained in a cleanly and sanitary coudition, to which thoy make absolutely no pretenco at present. Remarks regarding Habits. "Ilabits," it has been sulill, "are soon acquired, but when we try to strip them off, 'lis being flayed alive." It has also been said, “Ill habits gather by unscon degrees, as brooks run rivers, rivers 'run scas." Do not, therefore, begin, bad habits, and you will never experience the terrible difficulty of giving them up. Children who shun, the 1180 of alcohol, tobacco, and other injurious drugs, and who. abstain from the very appearance of evil in other directions, aro likely to grow up with moro vigorous minds and bodies than children who fall victims to such habits. They will, moreover, bo more useful and moro highly respected menbers of society. HOUSES. Before beginning to build a house it is necessary to observo certain precautions. Choice of a Site. We should first of all sclect a goor! site. In many districts in India the rainfall is heavy and rivers often overflow their banks. The houses of the poor, and others who are compellal, by circumstances, to live in such districts, are usually built on sites artificially raised and are surrounded by water during the wet season of thg year. Such sites are unhealthy. The site should be dry. High ground from which water readily runs off is best. Gravel, sandy and rocky ground, and sandstone, form good sitos. Clay is not good. Water does not pass fruely through clay. The water collects above it, and the ground becom's what is callod water-logged. Rheun.atism, fever, chest alections, and other discascs are common amongst people who live in houses built on clayey sitos. Damp ·HOUSES. 137 sites should, therefore, be well drained. Ground which is very loose ando porous is not quito safo either. There is alivays tho dangor of impure matter finding its way through loose soil into wells or other sources of wator supply: Water can always be got at a greator or less dopth in the ground: If it is found at a distance of less than 10 feet • froin the surface the site is not a goul ono. Blouses should not be built on "made sites," such, for cxample, is tanks which have been filled up with street swoopings, scraping, und stable refuse. Houses should not be built near refusc heaps, tronching grounds, brickfields, graveyards, marshes (jhils), or hear mills or factories which give off much smoke, irritating gases, or offensive smells. The danger of made soil is the carhonic acid gas and other foul produets which are given off from the decaying animal or vegetablo refrige. Plans. In all large towns and citics the law requires plans to be submitted for the approval of the niunicipal authorities boforo people can begin to buildl bul1808. If this were not donc, houses woull be built too closely together, and streets would be too narrow. spaces would be left; no provision would be mule for the admission of sufficient light and air. Water-closcts and latrinos would be built in wrong places, and the means of flushing and koeping them clean would not be supplied. There would perhaps he no easy mens of access to latrires, or too littlo space would be left to cnable the sweeper's to keep them clean. The importance of plans, therefore, is obvious. • The Construction of Åouses. The wind throughout a large portion of the plains of India during the hot Weather generally blows from the south or southeast during the hot months, and it is for this reason that houses in that part of the country should be built with a southorn No open ·138 MANUAL OF HYGIENE. aspect. The foundation of houses, floors, walls, roofs, and coilings should he made of good material, and the houses built on the most modern aunitary principles and strictly in accordance with law. No deviations should be allowed. The entire site should be covered with good milsonry to keep out tho clamp and ground air, and arrangerients should be moule for keeping the foundations well ventilatel and the walls dry. Damp-proof courses should be provided for this purpose. They should be made of hard glazed bricks, but never asphalt, felt, or slate. All houses in India should havo a plinth at least one fout high, and a verandah for protection against suii and rain and to avoid glaro. Roonis should not be more than twelve foct high, anl be well ventilated by means of windows and dours. There should be at least one diwr for each room. Two windows arc enough, and should be opposite ench other to socuro good ventilation, l'rovision should be made for the escape of smoke from fires with which it may be nocomary to warm the rooms cluring cold weather. Chimneys are used for this purpose'. Each fire-place should have il chimney which has no communication with any of the other chimneys of the house. The main from the roofs of houses in India either runs down the walls direct or escapes through spouts. As it falls it is often blown aguinst the walls. The walls in consequence become very clamp. The 1184 of guttors and pipes louding down the wall, situated at short distances from cach other, would prevent this to sonie Catent. All houses should be surrounded boy il masonry drain to carry off rain water. This will help to keep the ground cry. Thu foregoing remarks apply chiefly to masonry houses. Aglamp-proof course is a waterproof layer of masonry a littic above thu level of the ground to keep moisture from rising through the walls. 1 ·HOUSES. 139 Huts in Villages. The miles which are observed in the construction of masonry buildings of large and imposing size in largo cities and towns should be observed also in the construction of the huts of the most humble individual. They shouļd not be built too closoly together. The site should be a good onc. The materials should be the best which their menns can afford. They should he well lighted and ventilated. Air and light should, if possible, got into all rooms from all sides An outlet for smoke should' , ho provided. There should be a good water supply, suitable latrine accommodation, and the best possible arrangements should be made for the crefiul and speedy removal and disposal of refuse at a safe distance. The following is an extract from Grant's Iudin Mamal of Hygiene bearing on the subjuct, and cleserves careful attention: " For the repair and maintenance in a state of compurativo cleanliness of the ordinary housos of tho natives of this country, tho following twelve simple rules shoull be adhered to :-(1) The usc of cow dung as a covering for the floor and walls should be given up; it is a dirty habit cend an aunhealthy one, for cow-clung attracts excess of moisture and forms a nidus for microbes. (2) Mid floors should have tlu: surface dug up anul remoud crrry few months, a layer of fresh mud, to replace the mud taken away, buing laid on angl beaten in during dry weather. (3) Mud walls should be left in their natural anlitim internally or whitewashel every four months. (4) Every room should have either tuo windows about 2 ft. square opposite each other or else one 'windgão 3 ft. square opposite the door. Windows must open to the oater atr. (5) In the cook room there should be some sort of vertical opening or chimney in the roof to al bw of the reuily escape of smoke. (6) Dirty water and food refuse should on no account be thrown away in the immediate ·140 MANUAL OF HYGIENE. vicinity of the holisc, but carried to a drain or dust-irin respectively and there clepasitrd. (7) Tho curth round the dwelling should be worll brutm clown ortul null channel lule lrauling to the ditch or ruin at the sile of the roud, for disposing quickly of the rain water as it pour's off the roof. (8) 'The house shoull be opornend up as much as quassibile, morning and rrening, to allow of free perflation. (9) Its exterior should be whitruusked as often as necessary to keep 'it cool and clean. (10) Tho latrine must bo ontsäle the general building, with an impermeable jour of asphalt or cement, if possible, easily accessible from behinul for the, sweeper, cleancl dirily, and with a door and window large enough to allow of plenty fresh wir and light gaining admittance. (11) Whilst a few plants and small trees in the neighbourhood of a house are pleasant, there should be no interference with the free passage of fresh air and light to all parts of the dwelling, and all animals, such as cpta, ponies, fowls, etc., should be sepulrutely housed outside the house and its enclosure. (12) The occupants of the house should be limiterl to the proper number, and the unhealthy and objectionable practice of letting rooms to various familics prohibited." WASTE ANI) IMPURITIES. Refuse may be eithor solid, or liquid, or a puixture of both. Sewaçue consists chiefly of the solid and liquid dischargos of human beings. It also contains liquid material from stablus, cowsheds, and similar places"; "Water with which pots and pans havo heen cleaned or doors wasiyi, and bath water. Sowage is the feftise which it is most difficult to disposc uf, and requires most careful consideration, ·WASTE AND IMPURITIES 141 . Solid Refuse. Solid rofisse consists of ashes, lust, the swoopings of bousos and streets, waste paper, broken pots, rågs, frngments of vegetables, fruits, and other kinds of food, the rofusc of markets and slaughter houses, the droppings of animals, stable litter, and other matter of a similar nature. The streets of some large cities in India, such as Calcutta, from which hundreds of toris of refuse aro remowod daily, always look dirty and neglected owing to the objectionable practice of throwing ont refuse at all. hours of the day and night. This, and the practice of allowing it to accumulate around swellings, are franght with the greatest danger to health. Epilemic discasos, as we already know, are always most sovere in dirty places and amongst dirty peoplo. Liquid Refuse, cxcluding sowago, consists chicfly of ordinary household refuse water. The Disposal of Refuse. All refuse, such as food particles, ashon, and swoopings of floors, compounds, and court yarıls should be put into dust-bins with proper covers, and kept therc till the refuse carts or village sweepers conic round to remove them. Paper, straw, leaves, and other refuse are sometimes used for filling up tanks. Tho refuso of stables and cattlesheds, howevor, should never bo used for this purpuso. Mineral matter, such as building rofuso, is lost. Where possiblo rofiise should be burnod. In sqme large towns special furnaces, callecl incinerators, bavo been constructed for burning house and street refuso. In villages refiiso may be burned in any hollow at a safe distance from housog. When so disposed of, refuse is no longer dangerous to health, because the small germs, whiðh canis disease, grow and multiply most rapidly in 'those places where refuse on which they feed is to be found. In the rity of Glasgow, boys in uniform are employed to collect waste paper. Eighteen tons aro ·142 MANUAL OF HYGIENE. collected weekly, and the municipal anthorities make from it a profit of two hundred pounds, or three thousand rupees yearly. The boilers at the three largest stations of the cloansing clepartment are morcover fired, and the machinery is driven solely by the use of cinclers thrown out from dwelling-houses, and saved from the collected waste' by the , scavengers or swocpers. Solid refuse from stables, and cattlosheds should not be collected in acape ncar dwellinghouses. It is good for the crops, and should ho taken, to the fielels. DRY SYSTEM OF REMOVAL OF SEWAGE. Ip large villages and towns, baskets coated with clay, wooden buckets well tarred, and sometimes iron carts are used for the removal of the solid contents of latrines, All latrines should be provided with suitable receptacles. This will help to keep them clean, make the sweeper's duties casior and less disagrecable, and save timo. Karthenware vessels are generally used for this purpose. They should be kept thoroughly clean and well tarted. Brokon vessels should never be used. The night-soil may be mixed or covered with ashos, or dry earth, or the sweepings of the house. The 1180 of the chemical substances to mask smell will not bo needed if proper attention is paid to cloanliness. As a rulo tho liquid portion of sewage of villages in India escapes into the ground. This should be provented as much as possil·le. Urino and foul water should be taken to thic field or trenching grounds. The use of cesspools built in the plinth of hɔuser for collecting foul liquids should be forbidden. Trenohing. This is a well-known method of disposing of sewage by burying it in the ground. The trenches 1 .

·DRY SYSTEM OF REMOVAL OF SKAGE. 143 > shonld be large and shallow. Trenches one foot cloop and throo fuet brol should be used, and not more than threo inches of night soil put into them. The night soil should then he spread out, and afterwaris covered with the enrth removal in digging the trench. The earth and the night soil combine with cach other, and in a few weoks no smell remains. Deep trenches are very objoctionable, and should not be usca, The. Cultivation of Trenching Grounds. Trenching grounds are always more or less dangerous to health. The dangers are, however, grcatly lessened by cultivation. Unfortunately, tho great majority of the natives of India object to the 1180 of anything grown under such conclitions. Where this objection has been overcome, and trenching gronnds have been brought under cultivation, as in the city of l'uri (Jagannath), in Orissa, abundant crops of cabbages, cauliflower, mustard, Indian corn, and other grains are obtained, and a rich reward is reruped, not only in money, but in health. The value of the waste products of human beings and animals for agricultural purposes is beginning to be recognised. The inhabitants of villages know that crops are always most abundant in fields which are used as latrines, and when auch fields are put up to anction or leased ont, they always fetch a better price than fields which are not so uscd. It should be understood, however, that the practice of using fields as latrines is cxceedlingly dangorous, becauso, us has been pointed out, the discharges from the bowels often contain the germs of some of the most fatal forms of disease. All villages should he provided with well-built Intrines, and sweepers should be emploped to remove the contents to trenching grounds at a safe distance. There are very, many different kinds of latrines in Midden pits should nover be used. The best and inost suitable for small towns and 11se.

·144 MANUAL OF HYGIENE. villages is that known as “Donaldson's latrine," which is made of iron and fairly cheap. This latrine is so constructed that the solid and liquid waste matters are keſt separate. TIIE DISPOSAL OF SEWAGE OF LARGE TOWNS ANI) CITIES. Water Carriage System, or the Wet Method. Largo underground drains or sewers are used for gettiig rid of sowago in largo towns and citios. They may be built of bricks, or iron, or carthonware pipes may he used. They are usually round or oval. These sowers often empty themselves into rivers, and sometimes into the sea. Tho sowago of Calcutta runs into the salt wator lake situated several miles away from the town. If possible, the use of outlots of this kind for sowago should be avoided. In order to help the flow of the sewage, and for the purpose of flushing and cleansing the sowei's, an unfiltered water supply is provided. If an abundant water supply were not provided, the contents of the sewers would stagnate, clocompose, and give off cvil-smelling gusos. Sewer gus is believed to be the cause of many fatal diseases, and when constantly breathed is often the cause of ill-health amongst children in particular, and also amongst grown-up people. Typhoid fever, diphtheria, ordinary sore throat, and diarrhoea are the most common oxamples ef diseases which, it is believed, may be caused by sewer yah.. The, sewago from houses finds its way into the sewers thipugh small house pipes, which lead from the water closet or latrine situated inside the house. These house pipes should, therefore, be well mundo, consist of the best material, and ·DISPOSAL OF SEWAGE OF LARGE TOWNS, 1:45 havo a gool flow. In oriler to help the flow of sewage through the hruse pipos into the sowers, all water closets are provided with large iron tanks, situated near the roof. The water is allowal to flow out of the tank into the water Frivillig Hui. 11.-GILLI TRAP. closet pain, which receives the discharges from the boxly, by pulling a handle or by some other simple means. The waler washes out the contents of the pan, keops it clean, Ea h Fig. 42.-VARIOUN FORMS OF SYPRON TRAP. und helps to flush tho house pipes which convey the discharges to the street sowers. At least two gnllons of water are required euch time the water closct is used. In K ·146 MANUAL OF HYGIENE. order to provont tho oscape of gas from the sowers into the houso pipes, and from the house pipes into heusos, traps arc provided. Tho traps are merely bends in the house pipe or Acwors containing water, which helps to keep the gas from passing through. This layer of water is known as a “water scal." It is usual io to have a ventilating pipo attached to house pipos on the outside of the wall of houses extending well above the roof, to allow of the escape of any gas that muy by chance find its way back from the powers. 11 Fus. 43. -llonsK WITI (loon NANITARY ARNAVOXMENTS In the same way tho scwers should he ventilated by pipes placed at short distances from each other along the entire length of the sewers. The best traps are those known as the syphon and gully traps (Figs. 41, 42, 43). Vhen the water-carriago system for the dispositi of sewage 1 adopted, the sewers, drains, pipcs, guliypits, and overything connected with the system must be made of the ·DISPOSAL OF SEWACE OF LARGE TOWNs. 147 best material, carefully constructed, provided with the best form of trap, and be well ventilatel. There must also be a liberal supply of water for flushing and cleansing pirposes. Precipitation of Sowage. The solid and liquid portions of sewage are sometimes separated by the rudition of chemical substances. This is called the precipitation of Howage. Tho solideportion is made into cakes, which are sola es manare or burnt, The liquid portion may be filtered by allowing it to run through cinders with the object of purifying it. It should not be allowed to flow into rivers, or other water channels, the water of which is used for drinking purposes. Filtration of Sowage. Sewage is sometimes allowed to flow on to land without any attompt to separate the solid and quicl portions as (lescribed above. Porous dry land is best suited for the purpose. The land should be well drained. This mothol is adaptel for listricts in which the rain fall in scanty. Sewage farms are so called hecallso sowage is used in this way for cultivation on a very large scalo. Septic Tanks. Another method of purifying sewage is what is known as the "septic tank systen." The newage flows into settling tanks and then into large filters containing coke, breeze, or cindlurs. The liquid after filtration is clear and free from smell, and remains thus for months even when kept in bottles. This methodl promincs well. It is hoing largely used in England. Mr Silk, the Sanitary Engineer to the Government of Bengal, is carrying out Þexperiments in differont parts of tho Bengal province which promiso well. Incinerators. In jails and hospitals the night soil of patients suffering from choler, dysentery, and other diseases of this nature is destroyed by burning. Donald- ·148 MANUAL OF HYGIENE. son's incinerators are used to effecu this object. This is a most excellent mothorl of disposing of night soil, and if it could he alopted on a large scale would be the safest -urid best of all systems for the disposal of human refuse. This method ought to be trial in small village communities. Concluding Remarks, No kind of rofuse is more dangerous to health than the wasto matters from the bodies of human beings. Terrible outbreaks of cholera and enteric • fover havo often been traced to the pollution of the water supply with the clischarges from the bowels of patients suffering from these diseases. It is most important, therefore, that the groatest caro and attention should be given to their speedy removal and clisposal. The health of towns and villages will depend largely upon whether or not this rule is followal. DISPOSAL OF TUE DEAD BODIES OF TIUMAN BEINGS. . The practico of cromating or burning the bodies of lead persons ir, beyond question, the most sanitary. This is the practice amongst Hindlus. ('hristians and Muhammadans, for sentimental reasons, bury their lead. The dangors of this practice are in the foul proclucts given off from the boily during its slow decomposition in the grave, which may find thqir way into wells and other sources of water supply, que thus catino scrious outbreaks of clisenso. l'lants and shrubs, which are sometimes planterl in grave-yarls, make use of the products of docomposition of the holy for their growth, and in this way help to purify tho soil. In cremation the same. products are given off. They all, however, combine quickly with cach other to form compounds of a safer kind, which speedily become diffused throughout the atmosphere. The dangers aru thus reduced to a minimum in the quickost ·DISPOSAL OF DEAD BODIES. 1 19 manner possible. This is the great advantage of cremation. The only objection to it is, that if boilies are burned without carufiul inquiry as to the cause of death, cnsus of homicidal poisoning may not le detectul. Thoro aro, however, stronger arguments in its favour. Mummification is only mentional to be condemned. Burinl at sen is also not an uncogimon method of disposing of the end. Whatever niethol is adopted, the process should be conducted with the greatest ware and respect for the dead. (trave-yaris. should not be allowed to exist near human dwellings, or near any soure of water-supply. The mil should se porous and lry. (iraves should be not less than five or six feet leep. Coffins macle of imperishable materials or masonry graves are objectionable, because they delay decomposition. If coflins must be retirincil, they should be niadle of the niost perishable materials, light deal, or still better, basket-work, as advocatel by the “carth to carth system" (Willoughby). It is il common sight in India to nec dogs, jackals, and vulturus preying upon dead bodies which have been either left uburial or covered with a few inches of soil, and it is still more common to find human skulls and other bones of the holy lying scattered over large extents of land, moro cspocially on the banks of rivers. "This state of matters would not be allowed to continue in European countries. The inhabitunts of different towns and villages in India should give this subject their most careful attention, and vic with each other in trying to put a stop to the disposal of the dead in such a careloss and dangerous manner. DISPOSAL OF THE CARCASES OF ANIMALS. Rats, us we know, are one of the chief means of the spread of plaguc, and aru thcmaclvos liable to he uttacked with the disease. Dead rats should, therefore, not le ·150) MANUAL OF HYGIENE. touchell with the hands. Their bodies should be burniel immediately on discovery, after applying korosine oil to thum. Tho carcases of animals shoull never be allowed to lie about our streets or houses. In municipal towns deal animals, such as cats and dogs, are removed by domes in carts specially provided for that purpose. Immerkata removal and deep burial at a safe distance from human dwellings and water-supply is the proper way to dispose of the carcasos of animals in the absence of the means 'of burning them. In municipal towns persons are finel for not reporting or removing «lcad animals from their promises within three or four hours after discovery 1 VITAL STATISTICS. These consist of figures and other information renting to births, deaths, marriages, the sex and ages of pople, diseases and their causes, and trade or occupation and their effect on health. They also deal with the causes of the increuse or decrease of population in cities, towns, and villager. The increase of population may be due to births or to the arrival of persons from other places. The decrease mily ho clue to deaths from sickness or famine, or to the departure of persons who cannot find employment or obtain good wagus nour their own homes to other places where the conditions of labour and wages are suid to be better. Natives of India for this reason emigrate to British or other colonies, to Assam, and elsowhere. Many births in a place, and a great increase of its populatioit owing to people coming from othor places, indicates prosperity.: Tho. population of Calcutta has, for example, increased to the extent of 200,006 during the past ten yoårs. In cases where the number of denths or decreasu in the population is great, inquirics are made to find out the cuuso. In the ·VITAL STATISTICS. 151 year 1899 the death-rate amongst infants in the Bombay Presidency was 192.7 por 1000 of the population, whilo in the city of Bumbiry the death-rate was 798.69 per 1000. On inquiry it was found to be due to plague, scarcity, and the immigration of dustituto waifs. When the calls is discovereck steps are taken to prevent further loss of life. When, for example, fiimine is found to be the cause, finino works are started, and food is given. When small-pox is the catine, vaccination and ro-vaccination are the remedies. Cholera is generally caused by polluted water. When the health authorities, therefore, are informell that this discane has appeilreol in any town or village, immcdiate attention is directed to purification of tho water-supply. Vital statistics further show the result of the measures taken in particular instances of the kind stated, and the stops taken otherwise tn ingprove the health of a community. It will thus be soon "how nerussary and useful vital statistics are. Sanitary Inspections and Sanitary Laws. In all civilisod countries in the world laws have been passed to prevent people from doing acts which might injuriously affect the health of their neighbours. These aro called sanitary laws. If such laws were not passed our food-stuffs would be wulterated to a much greater extent than they are at present; articles of food unfit for wise would be sold in our bazaars; the water which we drink would be polluted with human and animal refuse; the air would be poisoned with foul gases; houses would be hadly built and evercrowded ; and strects would be narrow, clirty, and dark, owing to the absence of sunlight, which is su essential to houdth. There would be no open spaces left for taking exercise and breathing in puro fresh air; refusc would be allowed to acumulate everywhere; drains and latrines would not be kept cloan or in a good state of repair; dead bodies and the curcascs of animals would not be properly ·152 MANUAL OF JIYGIENE. disposed of; the practice of throwing them into rivers would becomo common; nothing would be done to prevent the outbreak of epidemic diseases or check their spreart; people sufforing from Amall-pox, cholera, plaguic, and other diseases of this kind would travel about in palkies, hackney and railway carriagos, and other public conveyancus; nolly would try to provent this; nothing would be done to cleanso and disinfoct the conveyances aftorwards, and other people using thom would thus be liable to catch the disease. in short, nuisances of every kind wonll be conmittel. When wo imngino the terrible consequencos which would result if no sanitary laws oxisted, it is not difficult to unciorstand how important and nocessury it is that people should be punished for disuboying them. The ohjoct of sanitary inspections is to ascertain how far, if at all, sanitary defects exist, and to enable the health authorities to take the necessary stops for their removal or mitigation. It is the duty of overy citizon to assist tho health authorities in their efforts to bring about an improved state of the health of communities. They should, for example, yet their children vaccinatod, and thus help to prevent attacks of sñall-pox; or inoculated when plagne is prevalent. When cases of discuse of this nature break out it is their duty to report the occurrence, so that proper steps may be taken by the authorities to kcop them from spreading. It is also the duty of citizens to obey the law themselves, and to aasist in trying to provent other people from evading it, and thereby bringing about the sanitary evils mentioned above. SOME ORDINARY AILMENTS AND ACCIDENTS, AND TIIEIR TREATMENT. Parasites. Parasites aro of two kindls, vaniely, animal and vegetable, and are so called beculuse they live anil grow ·VITAL STATISTICX. 153 Fiu. 41.--Tik Rolni) WURN. upon or within other animals and vegetables. They have been called also hangers-on. Tho hest and most familiar Ckamples of animal parasites are round worms, threacl wornis, tapo wornis, the itch insect, and lice. Ringworm of the boxly is the best oxample of a diseino which is caused by'vegetable parasites. Round Worms (Fig. ++). Round worms, 'which closely reserpblo carth worms in appearance, are very common amongst those who are careless in their habits, and in-, difforcnt as to what they eat or drink. They may bc a fimt in length, and often caist in very largo nuinbers in the human system. They inhalit chiefly the small intestino. They are sunotimes vomited, or may escape in the discharges from the bowels. They are supposed to get into the system in drinking water. The disease hits been known to prevail in India in almost epilemic form, Europeans and Indians alike suffering. Round worms may be got riil of by clearing out the howels as carefully as possiblo with a dose of castor oil and giving four or five grains of sintonin powiler carly in thu morning before taking any foul. Children, of course, clo not require such big doses of santonin. Thread Worms (Fig. 15). Throud worms are shall white wornis, which occupy the lower part of the howel, where they canse intense itching. They may Fra 13.-Tux TUREAU WORM, exist in thousands. Children are the most common sufferers. Alonspoonful of commorf salt in a quarter of a pint of tepid water injected .

·154 MANUAL OF HYGIENE. into the bowel is a useful and simple remedy. The bowel should be miule to empty itself before using the injection. Tape Worms (Fig. 16). Tape worm is not a very common ailment in India. It is caused by eating discased and undercooked mout, such as pork. Tho worms exist chiefly in the small intestine. They may be very many foot in length" They have a head about the size of that of a small pin. They are flat in shape, and abont one quarter of an inch to half an inch broad. The proper treatment for tape worms is to first thoroughly enpty the bowel with castor oil and abstinence from food, and then to tako a close YEEZY ROMALAISTELE t'ia. 47.-Tux ITCH INSECT. I'lu. 16. - Tux Tarx WORV. (a) ita licad (magniol); (6) joduts (natural 1170). of the cxtract of male fern. Those who suffer from worms of any kind should, however, consult a doctor privately, or if poor should go to the nearest charitable dispensary for advice, as diseasos of this kind require special treatment. Itch (Fig. 47.) This is a disease which is to be found chiefly between the fingers and tous. It may also, however, attuck the hips, wrists, and other parts of the Cosly. It is caused by a small insect which burrows under the sking where it lays its eggs, and where the young insects are hatched. Like ringworm, it causes intense itching. The ·NOME ORDINARY AILMENTS AND ACCIDENTS. 155 discuse is spread from onc part of the skin to another by this means, and it is also conveyed from person to porson by direct contact, as in shaking hands. The little tunnels under the skin, and the spot where the eggs aro deposited, can be seen with the naked eye. Iu bad cases of the disease painful sores may form, and the whole of the toos and fingers may become ono mass of stabs. Treatment. The best reniedy is sulphur, which kills the inscct, and thus cures the disease. It should be applied at , night to the parts affected; or, if the discuse has spread cxtensively, it may be necessary to apply the sulphur to every part of the skin from the neck to the toes. hot buth should be taken before doing so. One ounce of sulphur in powder mixed with four ounces of ghice makes a goodl ointment for the treatment of itch. It should be applierl every night for three or four nights. No clothing which has been worn by the sufferer should be again user! after the discuse is curul until it has been thoroughly boilo. Lice (Fig. 18), are too well known to nced description. They aro found chicfly in the hoiul, but also in othor parts of the body. They callino great irritation, and often govore inflammation of the affected parts. The animals themselves are easily killed, but their which stick to the hair, are very difficult to dostoy. Treatment. Mercury ointmont and carbolic acid are the Furi. -, the land lovin'; , niti n hair (uiugnfic); C, Anu (out. nize). best remedies. These may be obtained at a chemist's shop or charitablo disponsary. Tho ·156 MANUAL OF ITYGIENE. Puu. 49-RINKORY I soil's IN ILAIR 1180 of combs helps to get rid of the insects and their eggs. Cleanliness is the best means of prevention.. Bingworm of the Body (Fig. 49). This liscane Yg kuown under various Indian and English names. Mooro gives the following: -"Ducl, cauri, majee's dail, donaii, dhobi's itch, washernan's itch, Malabar itch, and Burmesc ringworm. Tho disease is causch hy a vegetable parasito, which resembles in appearance and growth the mouki which grow's on walls, books, boots, and other articlos which arc allowed to lio neglected in dark and damp places. The clisouse attacks chiefly the inside of the thighs and parts in the noighbourhood, also the buck, bolly, armpits, andl; even the face, scalp, ruots of the nails, and other parts of the body. It allisos intense itching, and the desire to scr;itch the part is irresistiblc. It is most troublesome at night. It provonts sleep, makes life miserable, and underminos tho health. Treatment. Moore reconnuens Gion powiler mixel with lime juice or vinegar to form a pusto, which should be well rubbed into the part at night for several nights in NIICCONSİON. The liscilsed part is thus bleached white, while the surrounding healthy skin assiumnes deep, brownish-red colour, and becomes very tender. The red- 110ss and tenslornioss soon disappear when the treatnient is stopped. When this powder is used old underclothing should be worn, as the drug stains clothing bally. 'Iodine. is also isoful, and may bo applied with a feather claily till the skin becomes vory tonder or until Misters form. Strong carbolic acid solution of 10 grains to the ounce of water applied with a brush play also be tried. A very a ·SOME ORDINARY AILMENTS AND ACCIDENTS, 157 . good romaly is whisky or country liquor. 'This may be rybbed into the cliseusel parts with a piece of rag until the skin almost begins to blecl. This is unflicient at times to curo tho disoare. The application of (toa powder after- Warols, however, will make a cure more certain.. Mercurial ointment lins also licen tried. (loa powder or malicines dorived from it are, however, hest of all. Diarrhoea Diarghoca is looseness of the bowel. The most gommon causes of diarrhoca arc haul food, tainted fish, and meat, uripe or over ripe fruit, mcooked or bully cooked vegetables, polluted wator, impure air, and chills. Malariil often causes diarrhoen, and, as has been alreadly stated, diarrhoca is one of the chief symptoms in cholera and enteric fever. It is often accompanied with severo puin, sickness, and vomiting. If it is canset hy eating bad fool, the patient may be madle to voniit and a dose of castor oil given with benefit. If it is due to any other canse, such as it chill, opium or chlorodyne may provo useful remcdius. Tanulinum in the best form in which to give opium. It should be given with great care, and moro especially, as has already been pointed out, in the case of infants. "The diot should consist of milk, rico, arrowroot, bread and milk. Fool of this kind should be given in small quantities often. The patient shoull lace kept lying clown. The lolly should be kept warm. A flannel lundage or kummerbund is useful for this purpose. When cholera is prevalent, diarrhoca should be attended to at once. Fainting. Fuinting is clue to weakness and sudden fililure of-the action of the heart. The patient becomes pale za told sweat breaks out on the face, the pulso becomes weak and fist, and vomiting may take place. The attack does not last Tong. Sudden scverc pain, such as is causal by a sovere.sprain, often causes fainting. Treatment. Pure fresh air is the best remedy. Tho 1 ·158 MANUAL OF HYGIENE. pationt's foot should he miserl, and if the frinting takes place while the person is sitting, the head.shoặld be hent forward between the kneos. The dress worn at the tinie should be loosenol, cold water may be applied to the face, smelling sales to the nose, and a little brandy, sal volatile, or other stimulant may be given. Apoplexy. This discase occurs as a rule in old poople. It may occur in middlo-ageil persons whose blood-Vossels are, from any special canee, cliseaserl. It is due, as a rulo, to a blcaling into the brain owing to one of the blooilvessels having ruptured. Symptoms. Tho attrick comes on suddenly. The patient losos the power of one side of the body. He may be unconscious and unable to spenk. His breathing is heavy and noisy. Treatment. The patient's hond should be slightly misel. No stimulants of any kind should be given. Tho rum in which the pationt is should be kept dark and quiet. No noines of any kind should be allowcıl. Cold should be applied to the heal. The feet should be kept warm. A mustard plaster may be applied to the back of the neck. Epilepsy. Suddenly, without warning at times, persons who suffor from this clisease give a shriek and fall to the ground. It has for this ronson been called "falling sick- 10988." They froth at the mouth, and if the tongue is bitten, as it often is luring attacks, the froth may bo stainai! with blood. The face turis blue. The muscles of the body are at first rigid or stiff, and then become convulsed. The patient is unconscious, and knows nothing about what is going on around. Breathing is ndisy. The fall is the most dangerous occurronce in this disease. The clisease may be caused in very many different ways. Children when gatting their teeth, or who suffer from worms in the bowel, often get fits of this nature. Treatment. The clothing of the patient should be ·NOME ORDINARY AILMENTS AND ACCIDENTA. 159 . loosened, especially about the neck, so as to make the kreathing casier. A piece of cork or wood should bo put between the teeth to protect the tongue. The patient should be put on his back. It does no good to throw cold water on the face or give anything to drink. The attack will soon palas off if the patient is kept quiet and alloyed plenty of fresh air. When children'yet fits of this kinch, a hot mustapil bath and application of cold to the hou is the lost treatment. Bleeding. Blooil may escape from oithor an artory or à voin. The blood from an artery is bright red, and cscapos in jets with every bent of the artery when a vessel of this kind is wounderl. Blood from a vein is of a dark purplish colour. It does not spout out in jets, but hus a stonly and constant flow. It can be stopped much more cusily than bleeding from an artery. The loss of blood, of course, will depend upon the size of the wound or injury, and the size and importance of the artery or vein which is wounderl. How to stop Bleeding. The finger, a pac), a piece of sponge, i pioce of cork, or something of that kind may be firmly applied to the spot from which the blood comos. When the bleedling is from a vein, the limb should be raised, and pressure applied over and below the wound. If from an artery, pressure should be applied above the wound. The pressure must not be applied too long or the parts pressed upon will dic. Cold water may be used. Water us hot as the hand can bear is, also, sometimes used to stop bleedling. Medicines are ofton applied to the blegling spot to cause the blood to clot, and thus stop further doss. Morlicines are also at times taken inwardly. 'The epils of the wounded vessels have sometimes to be tied. Bleeding from the Nose should be treated by-applying coll to the back of the neck and nosc, raising the arms, ·160 MANUAL OF HYGIENE. and holding the head back. The nose has sometimes to be plugged with cotton-wool. Bleeding from the stomach or lungs, and other forms of internal bleeding, should be treated by making the patient lie down. The patient should be kept quict, and should not be allowed to talk. Small pieces of ice may be given, and ico niny be applical over that part of the body from which the bleerling is believed to come. A doctor should be sent for, us casos of this kind are always serious. Treatment of the Patient. If a porson loscs much blood fainting may occur, and even death may take place. In CRACH of fainting smelling sults may he used. 'l ha lips should be rubled with stimulants, such as brandy, cther, ammonia, or camphor muy ho given inwarlly. Brudly may also be given. Melicine's, however, can only be used safely and wisely under the advice of a doctor. Ia all Cares of severo bleeding skilled help should be sent for without clelay. Injuries and their Treatment. Bleeding from injuries of the skin or deeper tissues of the body shonld be stopped. The part should be thoroughly cleaned. Carbolic oil, marlo of one part of carbolic acid and twenty parts of linsood or olivo oil, applied on a piece of rag is a gooul dressing to go. The chief object is to keep the parts clenn. If the wound is very large, or if thero are any signs of broken bonos, the patient should be kept quiet, and surgical aid sent for. Bruises are accompanied by swelling, blueness of the injurul part, and pain. The blueness is caused by the rupture of some of the small blool vessels, and tho éstápo of blood therefrom into the surrounding parts. Treatment. Rost and the application of cold at first, and warrath aftorwards, is the proper treatment. The part should be raised. ) V ·SOME ORDINARY ATLIENTS AND ACCIDENTS. 161 Sprains. The joints are tho soat of injury in sprains. They are cruised by the sudden twisting and tearing or rupture of the ligaments which support the joints. Swelling takes place all round the joint. Treatment. Rest, pressure with a firm bandage, and heat are the best form of trentment at first. If the swelling and pain continue to increase, the pressure should be removel. When the pain and swelling begin to luns away oil or some lininyent should be applied, and the part well rubbed with the! hand. Gentle movement of the joint is good at this stage, for if the joint is kept at rost too long it will become stift Broken Bones. When bones are broken the injured part should be hept at rest and in a straight position until surgical help arrives. Dislocations. Bones which are out of position are said to 1 dislocated. Surgeous only should be allowed to trent such caxi's. Sunstroke is ransel by exportire to the rays of the siin, overcrowoling, intemporanee, too hard exercise, and exhaustion. Symptoms. Fiintness, siekness, and vomiting may usher in the attack. The pulse is rapid und weak The liro:uthing is hurrical and noisy. The patient complains of intenso headache ind yielliness. The skin becomes 'ery hot, the face is flushed, and the patient may becomo unconscious. The temperature may rise to a great height, the heart suddenly fiuil, and the patient clic. Death nay take place very soon after the attack, or the patient may live for a day or two. Recovery takes place in about fifty cases in every hundred. It ofton happens that patients after recovery continue to show nervous symptoms. Treatment. The patient should be made to sit up. Cold in the form of ice in ice bags, if at hand, sboukl bw applied to the head, the back of the neck, and the chest; or tho 1 L ·162 MANUAL OF HYGIENE. . coldest wator that can be got should be poured over the head from a height. The patient shoull then he drial and well rubbel with the hands. A mustard plaster applied to the huk of the neck also does yooul. If fainting takes place, stimulants should be given. Ice-water, or water as cold as can he got, when drunk, is a safeguard against aunstroke. Provention of Sunstroke. This can best be secured by protecting the head and the back of the neck with a thick covering. In Inclia and other hot countries, solah topies and puggrcos are largely used for this purpose. Thick prds should be worn to protect the backbone or spine, and sun-glasses to protect the eyes from glare Overcrowding, intemperance, 100 hari exercise, and exhaustion should be avoidet. Burns and Scalds. Burns are caused by «lry henti, sush as a hot iron. Scalds are caused by moist hcat, such 48 steam or boiling water. Injuries of this kind are very dangerous, more cspecially in the crise of old persons and children. The larger and deeper the injury the greater the danger. Death froni shock often follows sovero hurns and scalds. The patients sometimes die from (liscases of internal organs following such injuries. Treatment. First, remove the object that may be calising the burn or scald, or remove the patient. If the clothes are on fire the patient should be made to lie down, and covered with a blanket or other thick covering, to put out the tlamcs. Water is also useful, and in the case of oil flames, sand. The burn or scald should be immediately covered up with cotton, wool, or a thick layer of rags dipped in calon oil to keep out the air. Carron oil is made of equal parts of linscorl oil and limo water. If no linseed oil is at hand olive oil may lo liscel instcad. The wool or rays will stick ·SOME ORDINARY AILMENTS ANI) ACCIDENTS. 163 to the burned or scalded part unless kept well soaked with the oil. Oil is also lisoful in helping to remove any of the closhing that may be sticking to the part. After the first two days or no, carbolic oil of the strength already statel will be found neful in treating the affected part. If the patient suffers from fuintnoss, stimulants should be givon and the feet kept warm. . FOREIGN BODIES IN THE EYE, EAR, NOSE, AND THROAT. The Eye. Forcign hodies in the eye, such as flics, dust, particlos of charcoal, and so forth, can be best removed with the corner of a handkerchief, or clean, lukewarm water may he allowed to flow into the cye. A drop of sweet oil is 1180- fulavlen anything burns the oye. The eye is a very delicato and sensitive oryan, and with the exception of simplo cnscs, such as those nientioned above, all ases should be treated by a doctor who has made it an object of special and careful study. The Ear and Nose. Children often put small objects, such as slate pencil, pars, beads, and the stones of fruit into their ears and nostrils, where they often romain for years. l'ens have been known to sprout in a child's nose. Ingccts find their way into the car sometimes, and give rise to much alarnı. Rough treatnient might push the foreign lody further into the car or noso Severo blecling from the nose might take place. The ear is still more delicato, and attempts to remove foreign bodies might injure the drum of th“ ear, or set up severe inflammation. Careful syringing of the cat with lukewarm water is the best way of trying to remove foreign bodies. The syringe should always be pointed slightly upwards towards the top of the patient's head, and the outer car should be pulled backwards and 1 ·164 MANUAL OF AYGIENE. downwards to open up the canal. A drop or two of oil poured into the onr is sufficient for insects. Forcign hodioz are sometimes very easily removed from the nose. 18 is always safest and wisest, however, to send for the doctor., Upon no consideration should Indian harhors be allowed to interfere with the car. Abscesses are frequently caused through their rough handling of this dolicute organ. The Throat. Foreign bodies in tht throat of a child may be removed by holding the patient up'y the heels and tapping the back sharply. The inside of the throat may bo tiekleel. It is sometimos nocessary and useful to , causo vomiting. Sometimes the foreign bowly, such an a fish bone, can be seen and casily remove with the fingers. Even when not seen the foreign holy may be within the reach of the fingers, and in this way can sometinios ho removal. Foreign bolics, which stick in the gullet of fu. pipe, can sometimes be forced downwarris hy swallowing a piece of boiled potato or bread well chewed. Recouurd to the help of a surgeon, however, cannot be avoider now and again, and he should be sent for at once in cases in which the lifo of the patient is in danger, or the foreign borly cannot be displaced. To only can lopt other measures which are sometimes found necessary. Snake Bites. Some snake bites are harmless. Others nrc deadlly poisonous. If there is any doubt on the point, the best thing to do is to treat the bite as a poisonous one. A pieco of string should be tial firnily above the scat of the bite, and other pieces at short distances one abovo the other. The ligntures should not he kept on too long, or, said when denling with bleeding, the purt yill die If - there is no round about the lips or inside the mouth; the wound may be snéked. The mouth and lips should afterwards be well washed and clisinfectel. Bleeding from the part which is bitten should be encouraged. Wounds may as was ·FOREIGN BODIES IN THE THROAT. 165 stinget be made with a small knife to cause frue bleeding. The bitten part pnay be, and sometimes is, ont out. l'ingers even have been amputated. The wonnd may be burnt with a hot iron, or some strong acid such as nitric or 'carholic acid may be applied. Ammonia in tho form of sal volatile should be given frcoly ils a stimulant Brandy is also good in cases of this kind. The fase of what is calloul anti-venom serum has been attended with good results in myny cases of snake bite. In snake biter, as in other serious cases, a doctor should be callel in tu trcat the patient. Stiilgs. The stings of wisps and other similar crcaturus can hest le trented by applying it strong solution of amnionia to the part. This stops the itching caused by formic acid, which is introduced into the skin through the Soap is sometimes used. It should be applial to the part freely. (ilycerine and oil are also useful. If the sting is left in the skin, it should be removed. Tho stings of some of thesc small animals, such as wasps, if numerous, may be dangerous to the life of the patient. If the symptoms are sci cra, it diay be necessary to give the pationt stimulants. Drowning. In cases of drowning, sund or other foreign matter should be removed from the month and noso. The clothing should be loosened. The tongue should be puller forwarl, and the patient kept warm. The body should be well rubbul, and warm bottles put to the feet, logy, and other parts of the body to secure this object. Artificial respiration should be resorted to and continued for an hour, orgver longer, until tlic patient begins to show signs of rowving Patients have been known to begin to show signs of life after artificial respiration has been carried on for five dionis. How Artificial Respiration is performed (Fig. 50). Got ·166 MANUAL OF HYGIENE. two pillows or two bundlles of clothes. Put the patient on his back, with his shoulders resting on one pillow or bundlo of clothes and his neck on the other. The head should 1,5 slightly hunt hackwards. The mouth must be kept widlo open, and the tongue pulled well forward. patient's arms above the ollows. Draw the arfns s'owly abovo the head, thus raising the ribs and causing the lungs to fill with in natural breathing. Slowly lower tho (irasp the ויין !! !IRIJKElf 188 העיר B F'ici30. --ARTIFICIAL REALIRATIox. Position of inspiration, A; of expiration, B. all'ms again, and press them against the chest walls. These two movements of raising and lowering the arnis should be performed about 16 or 18 times auch minute. Strangulation. Death takes place from strangulation in the sime vay ils from drowning. The corl, the piece of cloth, or whatever is round the neck, keeps the air fium entering the lungs, and the patient (lies from sufibutioiſ, Treatment. The first thing to do is to remine whatever constricts, the neck and give the patient fresh air. Cold wuter should be dashod on the face or other parts of the ·DROWNING. 167 inani. borly. The patient's forehead and chest should be well slapped with a wot towel. Artificial ruspiration may be neglect. Suffocation. This may be caused not only by hanging, but by covoring up the mouth and the nose. Young childron are often found dead in bed, having been accidentally suffocated by blankets and pillows. Foul gases, such as coulagns and the fumes of charcoal and other substances, ołten, cause death in this way. Cance of this kind shoule! ho treated like casos of strangulation. Poisoning. Treatment. The first thing to do is to remove the poison from the patient's stomach where this is ulvisable and possible. The stomach punip is useful for this purposc, but is safe only in the handls of a medical Melicines are sometimes given to make the patient Langt. Mustard, salt, and warm water are useful for this purpose. The quantities used for grown up people aro 0110 tiblespoonful of mustard flour, one tarspoonful of common salt, and twenty tablespoonfils of warm water. A tchspoonful of mustarul and a quarter of a teaspoonful of salt in half a tumblerful of warm water will be enough for children. The patient should drink it all. Vomiting should take place a few minutes afterwards. Tickling the inside of the throat will sometimos bring about the desired result. In cases of poisoning with sulphuric acid (oil of vitriol) and other cicls of this kind, the white of oys, nuilk, chalk, the plaster of walls, and olive oil are among the best substances to give. When acids have heun swallowed the patient should never be made to vonit on any account, otherwiso pain and burning in the stomach, food pipe, and mouth will be aggravatel. In cases of carbolic-ucid poisoning eggs, Juilk, vil, and stimulants are best. Such substaticos ius caustic soda, caustic potash, and ammonia are sometimes taken accidentally or intentionally. In these cases vinegar ·168 JANUAL OF HYGIENE. and water or lemon juice and water should be given, and afterwarıls sweet oil. The same rule should be followel in these casos as in cases of poisoning by ucils, that is, " never make the patient vonit." In opium poisoning, a very, common form of poisoning in India, the patient should be made to vomit at once. He should be kept moving about, otherwise he will fall asleep and perhaps clic while in this state. If cold, he should be kept warm loy rubbing his body and by the application of hot-water bottles.. Strong coffeo is useful. Artificial respiration is sometimes requireil. In poisoning by dhatura, hemlock, morphis, and hemſ, the troutment is the same is in cases of poisouing hy opiúni.

·APPENDIX. > RULES AS TO DESKS AND SEATS. • Mrebuiestley Smith Milys (Ophthalmir hvrier, June, 1886): - • Vuch ingenuity has been devoted to the construction of school desks anel sonts, and very muy different models, ench claiming some aclvantagcs, have been publicly exhibited during the last fow you's. At the ruquest of the Millane Elucational Company, I have lately designed it school desk which embolies the recognised/ tanelitials in an simple and incipensive a manner is Alvenis to me to lic possible. These recogniseel (Hºntials are as follow :-- “9. The seat must be of such herght as will allow the scholar's feel to rent flat upou the floor op footbound, iu brol enough to support the greitter part of the thigh. 2. The sent must have a buck placed at such height is to fit the hollow of the back below the shoulder blades, and support the borly in a vertical position. "3. The near edge of the desk must loe just so high above the sent that when the scholar sits muuru and upright with elbow's to the sides, the hand and forearul may resl upon the desk without pushing up the shouliler. 4.--As usul in writing, thic clesk must have a slope of 10° zo 150 (xbout Nu 5); ils noul in renling, it must support the look at an ungle of about 45°, and at a distance of at least 12 in. froin the eyes, 16 in. is better (30—40) cm). -As used in writing the mige of the link must overhang til allge of the sout by illi mch or two, in oriler that the schulur shall not lead to sloop forwarıls, and that the support to the back may be maintaineel. “6.- Cither the desk or the seat, or some part therem, must be uredi movable at plausure, so that although the desk usually overbungs ·170 APPENDIX. the seat, the scholar inay be able at iny time to stand upright in his place. “7.--The desks and seats must be of various sizex, in order that the foregoing conditions may holil goal for scholars of various ages. Adopting' with little alteration the proportious giveu by Snellen for the various qurts of his desk, I have, for the sake of convenience and cronomy, slightly altered the progression, and raincerf tie number of sizes to four. Lustcall of advancing by increments of one-tenth, which is loubtless the right methol froin the theoretical point of view, 1 liville the scholnrs acroreling to their heights into four CULMACA aclvancing in cach case by six inches ; thus 3 ft. 6 in. Lo 4 ft., 4 ft. to 4 ft. 6 in.., 4 ft. 6 in. to 5 ft., and 5 ft. to 5 ft. 6 in., The olimensions of the clenku are suited to these four heights. The table on the following page given the dimcusions of my desk the Hygienic Desk,' Nos. 1, 2, 3, and 4. * Its general construction is shown in the subjoined ligurns. The Hlinlards and the cronk picces which unite them are of cut iron. The back, the seat, the top of the desk, and the shelf bendith are of wood. The only points which require «lescription are, the book-ront, and the arrangement by which the desk is nulo murablo at pleuruire. "The flap which supports the book does not extend the whole wuth of the desk, Int occupies the milille portion only, leuving room for an ink-pot to be let into the wood at the side of it. This flap when in 18c in supportel by a sinall stop which hangs from its further edge, and which, though quite firm, can be proaseil back by a touch of the finger when the book-rest is no longer wanted. The flap in pivoted in such a way that its near edge sinks below the nurface of the desk when the Ilup is raised, and thus creates a groove for the book to rest in. “The woolen top of the closk in Acrewell to two slopm che in brackets whicl puns from back to front, one ut each sidle of the desk. Kach of these brackets carries beneath its lower or horizontal border a round iron rod, the two ends of which are fixeel to the bratrct. The mods slide freely through holes or eyes on the upper qurfage of the standlarıls. By this morns the desk is able to unor tit standaris i: a direction towarıls and from the scholur. When the desk is pulled forward a notch in thc noaz end of ench roul engages with the eye in which the rod slides, so that the desk is secured in ·APPENDIX. 171 this position, and is not liable to slide away froni the scholar if he lcans against it, By lifting the front age of the desk the notches ut diwngaged and the dexk is easily pushed buck, Ho that the scholar can stand up in his place. This is a njechanism which docs notaget out of or ler, and which cannot injurc those who use it, or le jural hy them. The whole desk can, I beliove, be made at a cost not match greater than that of many of the old-fashioned un-hygienic patverns iow in use. " “HYGIENIC DESK." IIKLOUT OF SCHOLARA No. 1. No. . No, 3. No. 4 3ft. in.-- jft. ft. - Ift. 6in. ift. Min.--ift.jsft.--3ft. Bin 107-122cm 122-137cm. 137-152cm. 162-108m. of Iloight of Nont fruta flour 18 13m. 33cm. 113 185 41 37 10 11 1 Brundth of Buit. 12 305 33 Min. 102 unght from ncult to cigo of desk lloight from went tu top of back 20cm. 2 . 21 1 1 el. "Overhang" of desk 1 1. Pley of louk 6 15 . 115 11.3 16 17 17 1. Breuith of closk (front to back) 13 38 1.3 38 Slope of dusk 1 in 5. Mr. T. (1. Rooper (II.M. Inspector of Schoolx) Nyt 1. THE DENK AXD BENCH. “1. Tlie height of the desk above the bench should be such that wlien tlic child is sitting down, he can place lwth his forcarms comforely on the desk, without mising or depressing his shoulders. The height of the lesk above the Hour or surface on which who tootmutya houkl correspond with the length of the child's leg frou kntc to heel. When the child is sitting down, hili logs should not dangle iif the air, his knees loc elevated above the bench.

·172 APPENDIX. 0 + “3.-The bench should be wide enough to givo suprort not only to the seat, but also to the upper part of the thigh. It should be at least 10 inches (lut better 12 inches) wide. To prevent slippity forward, the bench should be hollowed out towarıls the back to the clepth of an inch. “4.-Every bench should provide it support for the back of the sitter. This may consist of a bourd fixed at the back of thickrich, at right angles to the sout. The board should be hollowed onnan such a way thut the upper part of it may fit the concavity of the back. The exact licight of the back woull vary with the size of Wie child, but it will be from 6 to 7 inches. "3. -The look must overhang the bench during the writing lesson, in order that the child may be able to sit upright, and at the same time support his bruk. This posture is only possible when the desk overhange the bench from 1 to 2 inchex. “6. - The lesk shoull not be love for the writing lessous, but slight.y sloping The slope should not exceed an angle of 2 degrees. The difference between the upper and lower edge of the closk, therefore, should be about three inches vertially. “7.--As the clesk, which is most suitable for writing, is incenvenient for other purpuwes, the casiest plan of aslapting it to all usus is to make the upper prilrt of it movable. “8.-Desks of apopropriate sizes shoull be provided for ouch clugs. 2. Tux l'OSTURK IN WRITING. 1 "1.-The writer should sit upright, and should leau his luck ugainst the support provided for the purpose. 2. --The shoulders should be kept parallel with the elye of the desk. The writer inust not be allowel to screw the body round or to rest the chest aguinst the closk. There shoull bc a spilco ofon inch or a little nuore between the clunk and the body. "3.—The wright of the burly should bo disposed evenly ou Lupth bones of the sent. "4. –The hearl should not dlevop forward, much less ledh gilathe , It may be slightly bowed forward, and may notice il little from sile to ni ' in the eye follows the writing. “5.-The-forearms, and not the elbow's, should rest on the lesk. The pen should be passed acrini“tbonusa lsy it motenient of the haud and not of the arm. All'ini.

·APPENDIX. 173 66 “6.-The point of the pen should be at least ten inches (better twelve) from the eye. 7.- Jornake compliance with the above directions possible, the pnper or copy-book must lic opposite to the middle of the bly. The paper njunt not lie suarc on the desk before the writer hut it inust be tilted or askew. "The lower edge of the paper and the lower edge of the desk Bisurl form an angle of from 30-40 degrees. The paper is rightly placed when the clown strukes are being nrle nt right angles to the cage of the desk. "Tif: common attitude for writing often orilered by teachern" with the worils, Half turn right, left arın over slutex,' is liable to cause injury both to the spine and to the eyesight." GLARGOW: PRINTED AT 11B UNIVERSITY PRRAS BY KOBKRT MACLEHOST AND CO.

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