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DR. D. A. HODGHEAD: In summing up, in reply to the very lengthy discussion which you have been engaging in, I want to say, first, that I have been very much gratified to have interested the convention to this extent, because I feel that it is the most important question before California to-day from a health point of view. Now, I purposely left out of my paper any attempted solution of this problem, for several reasons, but one in particular, which is, that I consider the Board of Health of this State, and others who have made more study of sanitation than I have, to be much more competent to solve this problem than I am. In reply to the question of Dr. Laine as to how this shall be done, it does seem to me that it has already been answered in the way which I favor. That is, if it cannot be effectually done in any other way, let us have it by legal restriction, and if the people are not educated up to this point yet, let us educate them. That is what we have to do. Now, if you look over the health reports of this State, you will very readily see what ravages this disease is committing upon our population. We will find that the sum of deaths from tuberculosis is greater than from any other three combined diseases in this State to-day. We do not believe that consumption is a natural product of our State. It has been imported here. It has been imported here, because we have held out the inducements. If we have burdens-as one of our members has said-if the southern part of this State is to-day bearing burdens that are heavy, the people of the southern part of the State are chiefly to blame. We have brought this calamity upon ourselves, or we have allowed it to be brought upon us. The newspapers, possibly, to some extent, particularly the local newspapers in the different parts of the State, speak in favor of that locality, because people naturally think if they can get a drift, in their direction, of people who are sick, that those people will bring money, and they will buy land. And then our real estate agents, possibly, do more than any other one influence. They have flooded all the Eastern States with their circulars, and every spot of the State, from their point of view, is a paradise. Now, without detaining you longer upon these propositions, I will simply say that the solution of the question is not only in legal restriction, if it becomes necessary, but also in stopping the holding-out of the inducement that California's atmosphere is a specific against tuberculosis. We know, sincerely, that it is not so. We know that people die of consumption here just about as readily as they do in any part of the country; and if the atmosphere of California were a specific against tuberculosis, even then we would not be justified in allowing them to come here in such numbers, or in allowing them to come here at all. We restrict other things; we restrict smallpox at the boundaries of our State, and exclude any contagious disease. Whenever a ship comes into our harbor with smallpox or yellow fever on board, she flies the yellow flag, and certainly those things have not done us anything like so much injury as this one disease, tuberculosis. That is the one thing which we have to dread, not only on account of its influence upon the present generation, but, as I said in my paper, upon the generations yet unborn.

STREET SANITATION.

By W. F. McNUTT, M.D., M.R.C.S. Ed., etc., Professor of Principles and Practice of Medicine, University of California.

Street sanitation is a subject of vast importance to the people whose lives are spent in cities. While I feel that I need not apologize for occupying the time of this scientific association, as far as the subjectmatter is concerned, I do feel that I must apologize for the incomplete manner in which I have been obliged, for lack of time, to present the subject. If, however, I succeed in doing no more than arousing the attention of some members of this learned body to the importance of street sanitation, who will, on a future occasion, do greater justice to the subject, I will feel that my hurried effort has not been in vain.

The subject of sewerage or the best sewer system for cities, I will not attempt to discuss in this connection. To maintain a healthy body and a sound mind for a series of years in one of our great American cities, is no easy task. City life has many adversities; the active man pursues his occupation under many adverse conditions, while children. are beset with dangers on every hand. The unsanitary condition of our streets is a constant menace to health; they are never clean; filth of many kinds is allowed to accumulate on them. The air we breathe is loaded with poisonous materials and noxious gases; while the noises and jars of heavy teams on stone streets tell very severely on the nervous system.

No street made of poor material, badly laid, can be kept in a sanitary condition. A properly made street implies engineering knowledge on the part of the constructor and an appreciation of the fact that durability is not the only, or even the chief, quality of a good street; its smooth, even surface is absolutely necessary for cleanliness, and an even, smooth surface necessitates a thoroughly made street-bed. A hollow in a street surface is a trap for rubbish and moisture, a generator of noxious gases and destructive germs. A street surface should not only be smooth, but slightly convexed in the center, just sufficient to let the water find its way to the gutters. If on level ground, there should be a slight fall from the middle of the block each way. Water cannot remain on a street so constructed. The fire-plugs in these level blocks, instead of being placed at the street corners, as is invariably the case, should be in the center of the block. Thus situated they answer equally well in case of fires, and are available for washing the properly constructed street. Street washing is an absolute sanitary necessity, and the water answers the double essential purpose of flushing the sewers. The sewer traps at the street corners should be carefully and effectually screened to prevent, as far as possible, decomposable materials from entering the sewers. Very much of the decomposition that takes place in the sewers is entirely preventable by well-fitting screens to the traps. Streets made with stone blocks, the spaces between which are filled with sand, are necessarily unsanitary; it is impossible to keep them clean. Decaying rubbish, manure from horses, which contains the tetanus bacillus, glanderous discharges from animals, sputa from consumptives, typhoid and cholera bacilli, etc., accumulate in the sand. between the blocks, and are being constantly carried about by the wind. In this city the garbage and refuse materials from back yards and

stables, which contain the discharges from typhoid or cholera patients, or the poisonous bacilli of scarlet fever, diphtheria, consumption, glanders, etc., are carted through our streets in open, leaky wagons, leaving a trail of filth and poison. Nothing can be more criminally careless and disgusting than the manner of carting dead animals through our streets on open carts; many of them, too, having died of the most contagious diseases, their poisonous secretions being deposited on our crowded thoroughfares.

In hundreds of cases of the contagious diseases, whose source is considered so mysterious, the contagion is inhaled with the street air. The poisonous material becomes desiccated and mixed with the sand and dust of the street and whirled about by the wind.

A smooth-surfaced street kept well swept, sprinkled before sweeping, and frequently well washed, reduces the chances of street contraction of contagious diseases to a minimum. Every garbage cart should be built and kept constantly under the surveillance of our health department. All garbage should be destroyed by fire. Every city should have its garbage crematory. The dumping or depositing of poisonous garbage and refuse material within the city limits is a satire upon a health department. Every dead animal should be removed in a water-tight cart closely covered. The present revolting and dangerous manner of carting dead horses through our streets on open carts is a reproach to our health department. Some of the diseases of which these animals die are most virulent and fatal to human beings, their contagium possessing a particular enmity to man.

Another source of street contagion is our street cars and public carriages; hundreds of people with contagious diseases ride in these public conveyances. Children with diphtheria, or while the scarlet fever desquamation is in process, scatter the poisonous germs in profusion about the cars and carriages, consumptives deposit their bacilli-loaded sputa, and syphilitic patients leave the germs of their loathsome disease. It should be the duty of the health department of a city to reduce this source of contagion to its minimum. The usual washing of cars with cold water is extremely inefficient. Every car and carriage should be carefully cleaned and fumigated at least once a week.

We have as yet but one known material with which to construct an ideal street, a street that is capable of being kept in a sanitary condition, viz., bitumen.

Macadam is the best country road, but cannot be kept washed and made entirely aseptic for a city. Yet a macadam street, by being kept in good condition and well moistened, can be made a comparatively healthy thoroughfare, and on very steep grades is the only material that makes a street that can be used. Wood and brick are too porous for street material; they readily absorb the numberless poisonous street filths, and pollute the atmosphere with noxious vapors and life-destroying germs. It is possible to keep a stone street clean, by filling in between the blocks with cement or asphalt, which leaves no absorbing surface. But even cleanliness, though next to godliness, does not constitute a perfect sanitary street. There are other methods of destroying health and life than by poison. The noise and jar and rattle of carriages and heavy teams on stone streets, are very fatiguing to the nervous cells and destroyers of vitality. The excitement and turmoil and rush of a great city are enormous taxes on our nervous systems, but when

we have in addition the day and night stone-street rattle and jar, the nervous system must sooner or later yield to the inevitable. With the unrest, the strain, the fret, fret, fret of stone jars and shocks, there is no rest, no peace, no undisturbed repose, and where rest and peace are not health cannot dwell, cannot be maintained. It should be the duty of our health department to prevent as far as possible the noises, i. e., air shocks and earth shocks. Nature has declared that rest and repose are essential restoratives, and that no brain can do its best work, can work to its full capacity, that has not had a few hours' rest, a few hours' freedom from air and earth shocks in every twenty-four.

Discussion of Paper Read by Dr. W. F. McNutt.

DR. WINSLOW ANDERSON: The subject of street sanitation I believe to be a very important one for the consideration of this convention. It is a fact, and I am sorry to acknowledge it, that San Francisco has almost the dirtiest streets of any city of its size in the world. The pavement is bad, as the doctor has pointed out in his excellent paper, but there is no excuse, there can be none, for keeping our streets in such a deplorably dirty condition. Every day when the winds are blowing the dust and dirt and microbes are inhaled by the multitudes on our streets. We know that disease may be communicated in this way. We know that drinking water and milk exposed to such dust become contaminated-they become disease-laden. Fresh meat, when exposed to atmosphere laden with germs, also absorbs pathogenic bacilli, and it does seem that something should be done, some attempt should be made to endeavor to keep our streets clean. I do believe that street sanitation in the manner indicated in this paper is a very important subject, and one worthy our attention.

DR. M. REGENSBURGER: Street sanitation in San Francisco could be better in many ways, it is very true. We have laws here which are never carried out. The doctor remarked in his paper that there were certain things that were not creditable to the Board of Health. I beg to differ with the doctor on that subject, for the reason that the laws have been passed by the Board of Health, but our Board of Health here is handicapped by its laws not being carried out. We simply make the laws, and the Board of Supervisors is supposed to carry them out. We have laws regarding garbage, and the removal of garbage, and that no garbage shall be removed from any house, except in air-tight wagons, so that none can escape, but as you pass the wagons it falls in your face. So the fault does not lie with the health authorities, but with the Board of Supervisors. Regarding the streets: The keeping of our streets in good condition is very simple if properly carried on, and the present system could be remedied very rapidly. I would like to remark right here, that I think Dr. Anderson is wrong when he says that the streets here are in a filthier condition than anywhere else in the world. The doctor has traveled, and I have traveled, and you take the large cities of the United States-take New York City or Chicago, and you will find the streets there in a great deal filthier condition than they are here. It is true everything cannot be done in one day. This city has, within the last five or six years, improved her streets by bituminous pavement, which is being laid all over the city as rapidly as it can, and in a few years San Francisco will be one of the cleanest

cities of the world. The question of cleaning the streets is a very simple one; that is, each individual property owner should be compelled by a very strict law to keep his part of the street clean. By this method the streets of San Francisco would be in excellent condition, and it would cost the city nothing. Simply pass a law compelling the property owners to clean the streets before their property; clean the sidewalks. We have a law preventing the throwing of garbage on the street, but it is a law that never has been carried out. Garbage is thrown all over the streets here, due to the negligence of the police department. The Board of Supervisors should enforce these laws. If our city were in as bad a condition as has been pointed out here, would not our mortality reports show the condition? San Francisco is, to-day, if not the healthiest, one of the healthiest cities in the world. The contagious diseases here are very few. I do not think that within the last year we have had more than twenty-five or thirty genuine cases of diphtheria. The same can be said of scarlet fever and typhoid fever. I do not believe in giving San Francisco a black eye-coming here and reading a paper on general sanitation, and then damning San Francisco. San Francisco is a healthy city, and one of the healthiest cities in the world, and it is a young city. If we had the proper authorities to carry out the laws, there is no doubt that there would not be a cleaner city in the world.

DR. W. F. MCNUTT: I would simply say that I am very glad to hear from Dr. Regensburger that we have good sanitary laws. I had not read the laws, but I have seen the streets, and while there may be laws against carting dead horses and dead animals over the streets, trailing their venomous secretions along in the track of the cart, nevertheless it is done, and I am very glad to know that the fault must be with the Supervisors, as the doctor says that there is a law against carting garbage in that way. I think it would not be doing, perhaps, too much to interview the Supervisors a little on this subject, and call their attention to it. Perhaps if the Board of Health were to follow them up a little we could get rid of a good deal of this. I have never been on the Board of Health; I hope I never will be; but nevertheless I am very glad to know that the trouble comes with the Supervisors. We will go after the Board of Supervisors.

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