3. of Table…

3. of Table

+---------------------------+-----------+-----------+-------------------+ | | Bright’s | Accident. | Disease and | | | Diseases. | | Accident together.| +---------------------------+-----------+-----------+-------------------+ | =Mining Industry= | =19= | =135= | =935= | | Coal miners | 18 | 141 | 925 | | Durham & Northumberland | 15 | 96 | 774 | | Lancashire | 17 | 155 | 1069 | | West Riding | 16 | 114 | 912 | | Derby and Notts | 8 | 89 | 727 | | Staffordshire | 22 | 135 | 952 | | Monmouth and Wales | 27 | 243 | 1145 | | Ironstone miners | 15 | 86 | 774 | | Copper miners | 68 | 35 | 1230 | | Tin miners | 29 | 48 | 1409 | | Lead miners | 33 | 43 | 1310 | | Mine service | 20 | 75 | 1021 | | Farm labourer | 12 | 42 | 632 | | Occupied males | 27 | 56 | 953 | +---------------------------+-----------+-----------+-------------------+

This table shows that miners, as a class, are a temperate body of men; their mortality directly attributed to alcoholism being less than one-third, and that from liver disease being only two-thirds, of that of occupied males generally. In this respect they scarcely differ from farm labourers; their mortality from alcoholism is the same, and that from liver disease is only slightly higher.

Miners, as a class, suffer less than other occupied males from phthisis, as well as from cancer and diabetes, their mortality from the first-mentioned disease being below the average by 41 per cent., from the second by 16 per cent., and from the last by 29 per cent. Among miners, diseases of the nervous, circulatory, and urinary systems are less fatal than the average, but, with few exceptions, respiratory diseases are more fatal.

Coal Miners.--As a class, colliers compare favourably with men in most other occupations on the score of health. During the first thirty years of the main working period of life their mortality is substantially lower than is the mortality in other industries, although at ages under twenty and over fifty-five they die faster than the average.

The excessive mortality of colliers under twenty years of age may be accounted for by the fact that from 40 to 50 per cent. of the total deaths are due to violence, caused by the waggons and “tubs” in which coals are conveyed from the underground workings to the shafts. This form of accident falls mainly to the lot of the younger and less experienced colliers who are employed in “tramming” and “hurrying” the coals. When their mortality from accident is deducted, the residual death-rate of colliers under twenty years of age does not greatly differ from the average.

The comparative mortality figure of colliers, without distinction of age, from all causes including accidents, averages 925; but whilst on the one hand it does not exceed 727 among the colliers of Derbyshire and Nottingham, and 774 among those of Durham and Northumberland, on the other hand it ranges upwards to 1069 among colliers in Lancashire and 1145 in Monmouthshire and South Wales.

It is not easy to explain why it is that colliers in the several coalfields, working as they do in the same material, and spending an equal portion of the day underground, should differ so widely from one another in their mortality. For example, on reference to the accompanying table we see, with regard to miners under twenty years of age, that whilst on the one hand, among colliers in the counties of Derby and Nottingham, and also in Stafford, the mortality is lower than among “occupied males” by 7 and 5 per cent. respectively; on the other hand, among colliers in Durham and Northumberland, the mortality exceeds that standard by 54 per cent., in Lancashire by 63 per cent., and in Monmouthshire and South Wales by not less than 127 per cent. Again, in the counties of Derby and Nottingham colliers between their fifty-fifth and sixty-fifth years die less rapidly than the average by 4 per cent., but colliers of the same age in Staffordshire die more rapidly than the average by 35 per cent., and in Lancashire and Monmouthshire more rapidly by 40 per cent.

Various theories have been advanced to account for the great disparity just alluded to in the local death-rates among colliers. In the first place, we know that coal-pits differ greatly in geological character, in depth, in the grittiness or dustiness of the rock which has to be worked in order to get at the coal, in the amount and composition of gas present, in the quantity of water permeating the strata, in the thickness of the coal seams, in the temperature of the workings; and last, but most important, in the perfection or otherwise of the ventilation of the coal-pit. Again, it is known that the habits and consequently the health and comfort of coal miners vary extremely according as the colliery is situate in a country district, or, as is frequently the case especially in the Lancashire coalfields, in what is practically an urban district, perhaps bordering on a large town. These variations in the circumstances of life are certainly sufficient to account for wide differences in the health and longevity of coal miners.

Aged colliers, wherever they are employed, sustain a mortality which is considerably in excess of the standard; yet even among them the mortality varies greatly with locality. For whereas in the counties of Derby and Nottingham the mortality of colliers aged sixty-five years and upwards exceeds that of occupied males by 18 per cent., the excess amounts to 50 per cent. in Lancashire, 52 per cent. in Durham and Northumberland, and 80 per cent. in Staffordshire.

In the list of principal causes of death amongst colliers there are two diseases which have been the subject of exceptional comment, both in this country and abroad--namely, pulmonary phthisis on the one hand, and ordinary inflammatory diseases of the lung on the other. Almost all writers on the subject, whether in recent or in earlier years, agree in attributing to colliers an unusually low mortality from tubercular, and a correspondingly high mortality from non-tubercular, disease of the lungs. The accompanying table, which gives statistics for the years 1890–92, confirms the general opinion. Thus, taking coal miners in the aggregate we find that their mortality ascribed to phthisis is only about half of that to which other occupied males are subject, whilst their mortality from respiratory diseases exceeds the same standard by 21 per cent. If we take farm labourers as a standard by which the mortality of colliers should be judged, we find that whilst colliers suffer from fatal phthisis in the proportion of 97 as against 115 for farm labourers, colliers die rather more than twice as rapidly from diseases of the respiratory system other than phthisis. Although, as has already been stated, colliers as a class enjoy special immunity from pulmonary phthisis, nevertheless the disease prevails amongst them very unequally. The highest mortality figures from phthisis among colliers are 123 in the West Riding of Yorkshire and 107 in Monmouthshire, whilst the figures do not exceed 83 in Staffordshire and 69 in Derbyshire. In no English county does the mortality of colliers from phthisis even approach 185, which is the figure for occupied males in the aggregate.

In the West Riding of Yorkshire the mortality of colliers from phthisis has increased since 1881 by one-fifth part; but in other counties it has decreased by proportions in some cases as high as one-third of its former amount. Non-tubercular diseases of the lungs are excessively fatal to the colliers of Monmouthshire and South Wales, and still more so to those of Lancashire, where the mortality from these diseases is 76 per cent. above that of occupied males generally, and is more than double of what it is among the colliers of Northumberland, Durham, Derby, and Nottingham. These diseases have very considerably increased in fatality since 1881 in all the coalfields of England: the increase being equal to two-thirds of the former amount among the colliers of Lancashire, and to more than one-half among those of the West Riding of Yorkshire. Colliers nowhere appear to readily fall victims to intemperance. In Derby and Nottingham, as well as in Staffordshire, the colliers are especially free from that vice, their mortality from alcoholism being only half the low figure for colliers generally. Even in Monmouthshire and South Wales, where the figure for alcoholism is the highest, only 7 of the colliers die of this disease for every 13 that die from it in other occupations. Since 1881 the mortality due to intemperance has slightly increased among the coal miners of Lancashire, but has decreased in all other counties respecting which comparison is possible.

Ironstone mining.--This is one of the industries that are declining in this country. Miners of ironstone numbered barely 18,000 at the last census, and were fewer by nearly one-third part than at the census of 1881. More than half of these workers are to be found in the counties of Cumberland and York, and about an eighth part more are scattered over the counties of Stafford and Northampton. Speaking generally, iron-workers are a healthy body of men. They experience rates of mortality which are lower than those of “occupied males” at all periods of life between twenty years and sixty-five, and also lower than the rates for coal miners at the same ages. Both ironstone miners and colliers, however, suffer a much higher mortality than other workers at ages under twenty and over fifty-five years; the reason for this has not as yet been satisfactorily explained. It has been shown by Dr Ogle and other writers that the vital statistics of ironstone miners bear a general resemblance to those of coal miners. Recent investigations confirm this statement thus far, that in both cases the mortality from tubercular phthisis and from all other diseases except those of the respiratory system are below the average, and even this reservation does not apply to the statistics of 1890–2. Their comparative mortality figure from all causes is 774, and therefore considerably below that of coal miners in the aggregate. From disease alone (excluding accident) their mortality is slightly higher than that of colliers in Northumberland and Durham, but they suffer somewhat less severely from accident. Ironstone miners are a temperate body of men, their mortality figure from alcoholism being practically the same as that of colliers.

The extended tables of causes of death in my larger work show that ironstone miners suffer more severely than the average from influenza and from accident, but that under all other headings their mortality is below that of other occupations.

As compared with miners generally, the only diseases which show an excess among these workers are influenza, cancer, diseases of the liver, and suicide. Since 1881, the mortality of ironstone miners has decreased; but, as in the case of many other occupations, the improvement is limited to the lower ages, the rate having slightly increased at ages above forty-five years. Since 1881 the mortality of ironstone miners from alcoholism has decreased by more than half. There has also been a substantial decrease in their mortality from pulmonary consumption, and a slight decrease in that from other diseases of the lungs and air passages. Diseases of the nervous, circulatory, digestive, and urinary systems are, however, more fatal than formerly amongst these workers, and they are now more addicted than they were to suicide.

Copper Miners.--The number of men engaged in this industry is so small that it is scarcely safe to express an opinion as to their healthiness or otherwise, especially when, as in the present case, the period covered by the statistics does not exceed three years. At the last census scarcely more than 1000 copper miners above fifteen years were enumerated, their number having dwindled to less than a third part of what it had been at the preceding census.

If one may hazard an opinion from so small a number of deaths, it would appear that copper miners are an unhealthy body of men: their comparative mortality figure is 1230, or 295 above that of miners in the aggregate. Pulmonary consumption and other lung diseases appear to be very destructive to these workers, and the survivors certainly do wisely in endeavouring to find a healthier field for their labour by emigrating to other and more prosperous regions. At the next census it is probable that the copper-mining industry in England will have practically ceased to exist.

Tin Miners.--This is another unhealthy occupation; it is limited almost exclusively to the counties of Devon and Cornwall. The miners of tin at the last census numbered rather fewer than 10,000, and as the deaths in the course of three years did not exceed 336 in all, no very detailed observations on their mortality would be profitable. In consequence of the very general emigration of tin miners in recent years to South Africa and elsewhere, the age constitution of tin miners as a class has become exceedingly abnormal. Adults in the prime of life having left their homes in search of more profitable work abroad, the tin miners who are left at home are the least robust and healthy of their tribe, and this fact has a considerable effect on their mortality. Reference to the table on page 156 shows that tin miners sustain rates of mortality which are excessive at all ages. Their comparative mortality figure is 1409, or nearly half as high again as the average. Tin miners die two and three-quarter times as fast from phthisis, and one and three-quarter times as fast from other lung diseases as do occupied males generally; their mortality from cancer and from diseases of the nervous and urinary systems is also in excess of the average.

MORTALITY OF UNOCCUPIED AND OCCUPIED MEN.

In my previous work on occupational mortality, the death-rates of unoccupied men were compared, in considerable detail, with those of men following various occupations, in different parts of the country. A brief summary of what was then advanced at much greater length may fitly close the present section.

At the census of 1891 the number of unoccupied males living between the ages of twenty-five and sixty-five years was returned as 208,857. Of these, 35 per cent. were classed as “retired from business,” 6 per cent. as pensioners, and 23 per cent. as “living on their own means,” whilst 21 per cent. were referred to the class of “unoccupied persons,” including an unknown proportion of paupers and prisoners. Careful investigation of the facts leads to the surmise that somewhere between one-third and one-half of the unoccupied males, as above defined, experience a mortality which probably does not exceed that of occupied males at the same ages. If this be so, it follows that the mortality of the remaining two-thirds, or one-half, as the case may be, must greatly exceed even the high rates of unoccupied males in the aggregate. In the following table the rates of unoccupied males are contrasted with those of occupied males at the several stages of life.

+--------------+----------+------------+-------------------+ | | Occupied | Unoccupied | “Unoccupied” Rates| | Age-Groups. | Males. | Males. | per cent. of | | | | | “Occupied” Rates. | +--------------+----------+------------+-------------------+ | 15–20 | 2.55 | 35.86 | 1406 | | 20–25 | 5.07 | 29.58 | 583 | | 25–35 | 7.29 | 27.05 | 371 | | 35–45 | 12.43 | 35.71 | 287 | | 45–55 | 20.66 | 37.77 | 183 | | 55–65 | 36.66 | 59.44 | 162 | |Over 65 years | 102.32 | 105.86 | 103 | +--------------+----------+------------+-------------------+

The comparative mortality figures of occupied and of unoccupied males between twenty-five and sixty-five years of age are 953 and 2215 respectively. In other words, the number of males of definite age constitution, within these limits, that would give 1000 deaths among the general population, and 679 deaths in the healthy districts, would give 953 deaths among occupied, and 2215 among unoccupied, males. The comparative mortality figure of unoccupied males, therefore, exceeds that of occupied males by 132 per cent. The following table shows the chief causes of death that go to make up the comparative mortality figures for occupied males and unoccupied males respectively.

+------------------------------+--------+----------+-------------------+ | | | |Excess of Mortality| | Cause of Death. |Occupied|Unoccupied| of Unoccupied over| | | Males. | Males. | Occupied Males. | +------------------------------+--------+----------+-------------------+ |All Causes | 953 | 2215 | 1262 | |Diseases of Nervous System | 82 | 630 | 548 | |Phthisis | 185 | 448 | 263 | |Diseases of Heart | 126 | 240 | 114 | |Influenza and Respiratory | | | | | Diseases | 254 | 350 | 96 | |Cancer | 44 | 96 | 52 | |Diseases of Urinary Organs | 41 | 82 | 41 | |Alcoholism and Liver Diseases | 40 | 76 | 36 | |Accidents, including Lead | | | | | Poisoning | 57 | 81 | 24 | |Suicide | 14 | 28 | 14 | +------------------------------+--------+----------+-------------------+

It thus appears that nearly two-thirds of the enormous excess in the mortality of unoccupied as compared with occupied men is due either to diseases of the nervous system, or to phthisis. The heavy mortality from both these diseases would appear to partly depend on the circumstance that the unoccupied class includes a large proportion of insane persons who are exceptionally prone to phthisis. Among other causes of death, diseases of the heart account for 114, and influenza (with respiratory diseases) accounts for 96 of the excess in the mortality figure of unoccupied men.

The mortality attributed to cancer is double, and that attributed to intemperance and liver disease, to diseases of the urinary system, and to suicide, is about double as heavy among the unoccupied as it is among the occupied class. The excess of mortality from accident among unoccupied males possibly results from the addition to their ranks of men who, having been permanently disabled whilst at work, drift into the unoccupied class, and finally die from their injuries.

At the census of 1891 London contained 1,230,010 occupied males aged fifteen years and upwards, while the industrial districts contained 1,833,295, and the agricultural districts contained 1,246,156 at the same ages. More than half of the occupied males in England and Wales are therefore included in these three sections of the population.

The mortality of occupied males exhibits very wide variations in different parts of the country. These variations are exemplified severally by London, by the group of districts representing Industrial England, and by the areas representing Agricultural England.

At each of the seven age-groups, between fifteen and sixty-five years, the highest death-rates occur in the industrial, and the lowest in the agricultural, districts, London occupying an intermediate position.

The comparative mortality figure among occupied males, at ages from twenty-five to sixty-five years, is 1147 in London, 1248 in the industrial districts, and 687 in the agricultural districts; these figures being respectively 20 per cent. above, 31 per cent. above, and 28 per cent. below, the figure for all occupied males.

Phthisis and respiratory diseases are more fatal than any other causes of death to occupied males, both in London and in the industrial districts. In London these two headings contributed almost equally to the mortality figure. The industrial districts, on the other hand, show less mortality than does London from phthisis, but the difference is more than made up by the heavy death-roll from respiratory diseases. In the agricultural districts the mortality figure for phthisis is less than half of that of London, and the figure for respiratory diseases is still lower. After due correction for age constitution, these two classes of disease in the aggregate cause 48 per cent. of the total mortality among occupied males in London, 47 per cent. in the industrial districts, and 36 per cent. in the agricultural districts, against 43 per cent. for all occupied males within the same age limits.

JOHN TATHAM.

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XI. THE DISEASES OF SOLDIERS AT HOME AND ABROAD

The soldier is liable, like other members of the community, to various diseases due to his occupation and surroundings, although at the present day the hygienic conditions of barracks and military duties are so carefully supervised that he is, when on home service, placed under much more favourable circumstances than men of his own class in civil life. It is, therefore, somewhat disappointing to find that under these circumstances, knowing soldiers to be more or less picked men, they are not, judging from tables of mortality, more healthy than their civilian brethren of the same age. It is a matter of common observation that the army ages a man quickly; the old soldier of a regiment, who is looked upon more or less as a privileged individual, and generally given some sort of employment which relieves him from “sentry go” and the more arduous duties of his profession, is seldom over forty years of age, and ought to be therefore at his best; but partly from the monotony of his existence, and partly from excessive smoking, drinking, and night duty, the private of twenty years’ service is, as a rule, a worn-out machine, his mental faculties blunted, and his body, if not the seat of actual disease, aged and almost useless. These effects are still more marked when a man, as is generally the case, has spent a great part of his service abroad, for to the effects of hot climates and the diseases incidental thereto must be added, in a greatly enhanced degree, the enforced ennui and idleness which are the bane of the soldier’s existence in all stations in times of peace, and especially in the tropics. We all know how much more likely we are to rust out than wear out, and the enforced idleness which the soldier, especially in the infantry, has to encounter, leads to sluggishness of the functions of the body, while in many, drunkenness, increased smoking and debauchery, exercise an injurious influence upon health, apart altogether from the actual diseases to which they may give rise. An old soldier, for these reasons, can seldom eat his rations, and his system seems to be in that receptive condition that he readily falls a victim to epidemic disease prevalent in the neighbourhood, and this the more owing to his tendency to haunt the lowest and most insanitary parts of the town near which he may be quartered. This is seen more particularly abroad, where the native quarters are in marked contrast to the clean and sanitary military cantonments, so that medical officers have come to regard it as almost certain that the soldiers will soon suffer when an epidemic breaks out among the civil population. Statistics prove that the longer soldiers serve, the greater is the proportional mortality among them.

After these preliminary remarks we will proceed to discuss the peculiar health conditions under which soldiers exist, and their effects as regards their duties, habits, surroundings, and dress: firstly, at home; secondly, abroad, with special reference to hot climates, both dry and damp, and the diseases from which they suffer in such climates; thirdly, the special dangers to health incidental to active service.

The peculiar conditions of military as contrasted with civil life are that the soldier must perforce (in most cases) remain unmarried, that his daily wants are all provided for by the State, so that his pay, though small, is practically all pocket money, which may, if he is so inclined, be all spent on drink and debauchery; that his personal liberty is a good deal restricted, tending to irritability and low spirits in many temperaments; that he has no privacy, living as he does in rooms common to him and many others; that he has to dress in clothes in which hygienic principles are sometimes overruled by the necessity for ornamentation and smartness; and that his duties frequently entail great exposure to varieties of temperature and loss of sleep.

As regards the first of these points, it is known from statistics that married men, as a rule, live longer than the unmarried, apart altogether from the dangers of venereal diseases. This is not difficult to understand, seeing that the married man has more solid comforts, and is not tempted to spend his evenings abroad, also that he has that incentive to steady work and moderation in all things which the celibate has not. Again, the average soldier has undoubtedly more pocket money than the average civilian of his class; he has no incentive to save; he is tempted by numerous companions of both sexes to excess of all kinds, and spends most of his evenings abroad, consuming more drink and tobacco than is good for him. Vanity and desire to be smart frequently cause him to dress in garments much too thin for the state of the weather. Discipline has, no doubt, a very depressing effect upon the health of some men. Restraint and the petty tyranny of superiors exercise a bad effect upon their spirits, causing loss of sleep, and often leading to drinking. In spite of the great improvement in the treatment of the men which has been effected in our army in recent years, suicides are still too common, though not nearly so frequent as formerly, or as they are in other armies.

As regards the herding together of men in barrack rooms, this is an evil which is almost unavoidable without great increase of expense, but if it could be altered it would certainly make the army more attractive to the better class of men. Formerly there was great overcrowding and consequent sickness, but at the present day, in almost all barracks, each man has at least 600 cubic feet of space, a larger amount than men of that class usually enjoy in civil life. Before the need for fresh air was so fully recognised as it is now, there was great mortality in the army from chest complaints, especially from consumption, as also in the navy; but now the regulations are very strict, the number of men to be accommodated in each room, so as to give each his 600 cubic feet, is painted on the barrack-room doors, and any overcrowding, beyond the regulated numbers, must be reported upon and explained by the officers, regimental and medical. The public are now, generally speaking, fully alive to the need for fresh air and ventilation, but disregard of the necessity is still a very fertile cause of disease in civil life, especially when to lack of fresh air is added the fact that such air as there is is laden with dust or other solid matter, as in mines or workshops. In former years the large amount of lung disease in the army and navy was in exact proportion to the amount of overcrowding, but now the soldier and the sailor do not suffer more from these diseases than do the civil population. In the first ten years of the late Queen’s reign, the deaths from lung diseases in the army per 1000 of strength were at the rate of 7.82, but in 1898 there were only 2.5 cases per 1000 admitted to hospital, of whom a very small proportion died, the majority being invalided or cured. Apropos of this I need only remark that the latest plan of treating consumptives is to keep them day and night in the open air. Cold fresh air is no longer so much dreaded as formerly. That it is not the cause of consumption can be abundantly proved from army statistics. From these statistics one may learn how, in the old days of overcrowding, pulmonary consumption was much more prevalent among the troops serving in the delightful climate of the West Indies than in England, or in Canada, owing to the scandalous manner in which the barracks in those islands used to be kept overfilled. Now, except when yellow fever appears and carries off the men, the West Indian station is the healthiest quarter of the British army, not excepting even the home stations.

As regards the dress of the soldier, there was formerly in the army a good deal of disease of the heart and great blood-vessels. This was undoubtedly caused by restriction to the circulation from tight clothing, and from the pressure on the chest of the straps which supported the knapsack and accoutrements. At the present day the tendency is to do away with everything tight: the stock has disappeared, the tunic is made to fit more loosely, and the weight to be carried is so arranged that there is no pressure on the chest. The dress for hard work is made of light material, serge or drill, allowing free transpiration from the skin, and even the stick-up collar of the tunic is being done away with, at all events for the campaigning dress, and is being replaced by a turned-down collar, as may be noticed in pictures of officers on active service in South Africa. One wonders that any men survived the active service in India in the old days of the tightly-fitting, thick cloth clothes, insufficient head-dress, and straps supporting the knapsack and ammunition pouches crossing over the chest. The fighting at the Alma was in full-dress uniform, and there is no doubt that there was a great deal of unnecessary suffering and mortality from this cause. Instinct and common sense alike urge against doing hard work and long marches in tight clothes, which overstrain the heart. We still hear every now and then of serious consequences, both in England and on the Continent, from holding fatiguing field days in hot weather. Doubtless we must attribute part of the trouble to excessive smoking and drinking. “Soldier’s irritable heart” is attributed to the uniform and to men having to stand for long periods in a constrained attitude; but I am disposed to blame beer and tobacco for part of the mischief: tobacco especially, I believe to be a cause of heart trouble among soldiers, though many authorities doubt it, seeing that Continental soldiers smoke more than ours do and suffer less. Our men, however, as a rule, smoke and chew much stronger tobacco than other people; they indulge in it in the early morning on an empty stomach, and at all other times, and I have known a man who was anxious to be invalided out of the army produce the most marked cardiac symptoms by the surreptitious use of strong cake tobacco. The men of the navy, who have always had a looser and more workmanlike dress than the army men, do not suffer to the same extent from heart troubles. Such complaints are more prevalent in that corps of the army which has the hardest work and the tightest clothes, viz., the Artillery. With more rational ideas prevailing at the present time, the amount of heart complaint has diminished, and there is now proportionally only one-third the amount which existed about the time of the Indian Mutiny. In making this statement we must, however, bear in mind that our soldiers are younger than the men of those days, and in such the effects of these diseases are less likely to manifest themselves. However, there is no doubt that not only in respect of cardiac, but of all other maladies, the army is much healthier than it used to be since reforms in dress and the general treatment of the soldier have been instituted. Old medical officers say that they never see the same class of diseases they used to. Walks round military burial-grounds, especially abroad, tell terrible tales of mortality among troops in former years. In the “Happy Valley” in Hong Kong may be seen a monument erected to over 500 men of one regiment who perished there from disease.

Of the duties of the soldier that have a prejudicial effect upon his health, the most injurious is night guard. The medical authorities are charged to make representations to the authorities whenever in their opinion the turn of men for this duty is becoming so frequent as to be liable to cause illness. To the civilian mind it may seem a trifle that each man should come on guard not oftener than say once in five days, but when we consider the long hours of monotonous standing or walking about in the cold and darkness, perhaps too in rain, which this duty entails, one can understand how this prematurely ages the soldier, and can sympathise with the latter’s ambition to get a billet which gives him all his nights “in bed.” This is altogether apart from the great risks of inflammation of the lungs or rheumatic fever caught in this way, especially as the intervals of “sentry go” are, in the winter, usually spent in a superheated guardroom, from which the soldier passes to his cold and solitary vigil. I have known among cavalry in cold weather an immense amount of sickness caused by the men, after getting very hot while grooming their horses in the hot stables, leading them out to water in their shirt sleeves. Either from lack of time, desire to save their clothes, carelessness or reluctance to appear “molly coddles,” the neglect to put on their jackets frequently resulted in attacks of pneumonia, quinsy, etc., etc., which the distribution of woollen jerseys subsequently did much to prevent. Those who imagine that soldiers lead a lazy life little realise how hard a young cavalry or horse artillery soldier has to work before he becomes master of his craft. What with learning to use his weapons, his drill, riding and the care of his horse, clothes, and accoutrements, the recruit, if not well fed and cared for, is very prone to break down under hardships.

To turn now to causes of sickness among soldiers abroad. This is so largely a consideration of the whole question of the effect of hot climates on the European constitution, that I can only briefly treat of it here. The first points to note are that, owing to the impossibility of the troops working in the sun, and to the provision of native servants to do many of the things which the soldier does himself at home, the men have much more spare time; the climate causes a great craving for drink, and the great activity of the skin renders the system more liable to sudden chills. It is a curious and remarkable fact that whereas most severe illnesses at home are due to chest troubles, the abdomen is that part of the body which suffers most severely in the tropics; hence it has been well said that tropical disease generally “hits below the belt.”

Let us consider first the conditions of life in a hot, dry climate, such as Egypt and India in the warm weather, and next, in a moist climate like Ceylon or the West Coast of Africa. The great difference between Egypt and India is in that in the former the nights are comparatively cool owing to the rapid radiation of heat from the sand as soon as the sun goes down in the cloudless sky, while in Northern India in hot weather, the nights are almost as hot as the days. Only those who have had experience can realise the power of the sun in those climates; to go out into the sunlight without a hat, even for a few minutes, is to be struck down, or to get a splitting headache for the remainder of the day; the skin is burned, and the lips cracked by the hot wind, so that even when driving at midnight one turns away his face as from the open door of a furnace; while to sleep, except under a constantly waving punkah, is almost an impossibility for most Europeans. Bungalows are kept closed up to exclude the hot wind except at one or two windows, where it is allowed to enter through grass mats kept constantly saturated with water. The air is only changed by throwing the house open for an hour or so at dead of night, after which all openings are again closed so as to bottle up, as it were, a supply of comparatively cool air before sunrise. Hence exercise in the open air is an impossibility except before sunrise and after sunset. In the military stations in India soldiers can be seen sitting all night about the cantonments, unable to sleep in their beds on account of the heat of the barrack bungalows, which, like all buildings, retain the heat of the sun far into the night. When we think of the effect of such a life on the private soldiers, without a taste for reading or other resources within themselves, can we wonder that their health suffers, and their spirits become depressed, or that the raging thirst such heat engenders should lead to drinking? If the temptation to indulge in alcohol be yielded to, the liver, already in an irritable condition from the heat, and from the digestion of a diet of meat much too heating for the climate, soon becomes congested, or even suppurates; or the nerve centres which control the temperature of the body, already over-worked, break down completely, and heat apoplexy supervenes. It is a remarkable fact that a temperate man rarely suffers from heat apoplexy, for the body in health can adapt itself to enormously high temperatures. On the other hand, I have been much struck by the distress caused by the heat among beer-drinking soldiers, compared with the immunity experienced by the more temperate officer, doing the same work on a march. The measures to mitigate the effects of such a climate are to get as much exercise as possible during the comparatively cool hours of the morning and evening, and to be as much in the open air as possible at night; to have a diet as cooling as possible--fruit, vegetables, fish, etc. (all of which are unfortunately very difficult to procure at that season), and to try to interest the men with books, lectures, and indoor occupations, such as woodcarving, bootmaking, etc. Also to let them have plenty of temperance drinks--tea, lemon juice, etc., etc. Sleeping in the open air is the pleasantest at these times, but unfortunately sudden storms are apt to arise in the night which cause annoying breaks in one’s rest, and again one has to retire indoors at break of day, just when the air is coolest and sleep most refreshing. The alternative is to sleep under a punkah indoors, but the punkah-pulling in soldiers’ barracks is frequently most unsatisfactory, and the broken rest from the heat and mosquitoes is a serious cause of deterioration of health in the soldier. To the educated officer with books, and perhaps music and painting to while away the long, hot hours, the life in the hot weather is not unpleasant, dinner is not taken till perhaps 9 P.M., and social intercourse passes the time till long past midnight, then a few hours of sleep in the coolest time of the twenty-four hours, supplemented by a siesta in the daytime. All open-air work is over by 9 A.M. The more closely the life of the soldier is made to resemble that of his officers, the better will be his health. A word of warning is necessary about the swimming-bath, which, though it gives the most delightful form of exercise, is somewhat dangerous, for the bath being generally under cover, the water is much colder than the outer air, and lengthened immersion is very apt to cause liver and other internal congestions, the commencement of grave tropical disease.

Contrast with the above description that of a moist, hot climate. The air, instead of being hot and dry, is ladened with moisture, the slightest exertion causes profuse perspiration, which renders all the garments damp and clinging; the moisture of the atmosphere renders evaporation from the body and consequent lowering of the temperature much slower; there is experienced a total lack of energy, but as there is no hot wind, the houses can be kept open all day long; there are frequent showers, and vegetation is abundant, and affords plenty of shade for those who care to remain out-of-doors all day. There is not, therefore, in a climate like this the same amount of confinement indoors, but the constant heat and perspiration are very enervating, and soon lead to marked pallor in Europeans. The great danger in such a climate is from the damp clothing; the skin being so active is full of blood, and a sudden cooling from sitting in a draught in damp clothes drives the blood to the internal organs, causing congestion of the liver and spleen, dysentery, etc. To avoid this it is most important always to wear flannel next the skin and to change after exercise. By doing this the risks of such a climate are much mitigated. In two years in Ceylon I never had a day’s illness, and the good health of the army in the Ashanti expedition of 1895–96 must in a great measure be attributed to making the men carry a dry shirt on the march, into which they changed at once on arriving at the halting place. The most important disease of those climates is malaria, due to a minute organism in the blood, now proved to be generally communicated by the bites of mosquitoes. The obvious preventatives are to avoid being bitten by mosquitoes, to destroy the breeding places of these insects by draining the pools in which their larvæ develop, to avoid going out at night, when these insects are most active, and to keep them off by mosquito curtains. Smearing the exposed parts of the body with carbolic oil will repel these pests. There is no reason why soldiers in tropical barracks should not be supplied with mosquito curtains, when it is not hot enough to demand the use of punkahs, which also keep off the insects; and I have no doubt this will be done in all feverish stations as the result of recent teaching.

In sleeping under a punkah, and in fact at all times in the tropics, where the individual retires to bed bathed in perspiration, one of the best means of avoiding chill of the abdominal organs is to wear a long silk scarf (kummerbund) or a flannel “cholera belt” round the body.

One of the older theories about malaria was that it was due to some miasma arising from the ground, and especially from ground which had been recently disturbed. However erroneous this idea may be in theory, in practice many instances are on record of its apparent truth. I can never forget the results of sending men to a so-called sanitorium which had been made in the far East by levelling the top of a mountain and building barracks thereon. Almost every man who went got an attack of malarial fever, and this is in accordance with the experience and superstition of the Chinese. They say that the “Fung Shui,” or genius loci, of a place is a dragon who lives in the ground, and if you disturb the soil you irritate him, with the result that he avenges himself by spreading fever among his aggressors. Therefore the soil about barracks and encampments should be disturbed as little as possible, and all shallow pools of water should be drained or treated with a small quantity of paraffin oil to kill the larvæ of mosquitoes.

Other scourges of the tropics which cause sickness and mortality among our soldiers are liver disease and dysentery (generally due to chill as above described); and those diseases due to contaminated water, e.g., enteric or typhoid fever, cholera, and some forms of dysentery. This is so large a subject that I cannot say more on it than to indicate that the germs of the disease may, while almost invariably matured in water, be taken into the system with milk, water, or food, and the best precautions are rigid prevention of adulteration of the milk (to be secured, if necessary, by having the cows milked before a responsible European), boiling suspected drinking water, and the most perfect cleanliness in the preparation of all food. Notwithstanding the greatest care and expenditure in obtaining the best water for our large Indian stations, enteric fever seems rather to increase than diminish, but that is due, I fear, to the carelessness of the soldiers in drinking from contaminated sources in the bazaars, or in their walks abroad. The well-water of India and the native made aerated waters are almost invariably open to suspicion, and ordinary filters are, I fear, only a delusion and a snare. I am acquainted with at least one terrible outbreak of cholera distinctly traced to the use of filters. The bacterial filters of Berkfeld and Pasteur-Chamberland are reliable, but are so difficult to work and keep in order that it is much better to trust to boiling the water. In a tropical climate, when soldiers on the march acquire an intense thirst, it is practically impossible to make them wait till water can be boiled and cooled before quenching their thirst, and we have had recently a terrible example of the effects of foul drinking water in the outbreak of enteric fever among our troops in South Africa. My own practice in India when out shooting was to carry boiled water or cold tea, but to slake my thirst as much as possible by sucking a lemon or lime, a practice which most travellers and (generally) soldiers also could follow with advantage. Another use of these fruits is to squeeze a little of the juice into water which is not above suspicion, as it is known that acids kill the germs of cholera, and also possibly of enteric fever. I may add that limes are very abundant and cheap in most tropical climates, and could generally be served out to the troops.

I have already stated that heat apoplexy is most likely to attack those addicted to alcoholic excess, and is not likely to be prevalent among temperate men in the airy dwellings of Europeans in the tropics; but any great overcrowding, such as occurred in the Black Hole of Calcutta, would be likely to cause fearful mortality. Great and sustained exertion in the hot sun of Egypt or India might cause heat apoplexy or sunstroke in the most temperate. It is marvellous, however, what an amount of exercise temperate men can take when “pig-sticking,” for instance, in the hottest weather in India, with impunity.

The Europeans in India, who live in roomy and clean dwellings, suffer remarkably little from the plague, which is now threatening our shores, but has so far not obtained a foothold owing to rigid sanitary precautions.

A very troublesome complaint among soldiers in the tropics is “Dhobie itch,” a form of ringworm locating itself under the arms and between the legs, where the skin is always moist from perspiration. In one regiment I had charge of, about 75 per cent. of the men had it, causing a considerable amount of suffering and inefficiency. The disease is spread by inoculation from dirty clothes, or such as have been washed in impure water, and the best preventative is the use of clean and frequently changed underwear.

By the adoption of the measures above indicated it is possible for Europeans to enjoy good health in the tropics, but in war it is impossible to observe many of these precautions. It is well known that in all climates the ravages of disease are infinitely more fatal than the weapons of the enemy. The existence of hostilities, with the hard work and privations thereby entailed, usually puts all health considerations into the background. In the Crimean war three times as many of our men died of sickness as at the hands of the Russians, and the proportion will be found even greater in the present war in South Africa, in spite of the deadly accuracy of modern weapons and of the fact that the theatre of operations is one of the most salubrious regions in the world. And it is not difficult to understand why this should be so when we reflect upon what active service means--the prolonged and intense exertion, the loss of rest, deficiency of food, which at the best is coarse, unpalatable, and badly cooked--in a word, starvation; the bad water, the fouling of the camping grounds by the excreta of thousands of men and animals, the heat by day and the cold by night, the clothes alternately saturated by perspiration and frozen by the bitter night wind, also the clothes becoming dirty and infested by vermin owing to their wearers being unable to change them for weeks. In the stress of campaigning men have become ill from want of time and opportunity to secure the daily evacuation of the bowels, which is so necessary to health. These are a few of the conditions incidental to active service, and when we reflect it is not difficult to understand that not only are there many diseases induced by campaigning proper, but that if a man have one weak point about him, such hardships are bound to find it out. We have only to glance at the casualty lists published in the newspapers every morning, to see how various are the causes of death among our men at the front. So well is this recognised that every man is medically examined before going on active service, and all with any defect of constitution are rejected. Here I may incidentally remark that the prevention of venereal diseases in the army is a matter of national importance, for the men who are thereby unfitted to endure the privation of a campaign are many, and all reasonable measures for the prevention of such diseases should therefore have the support of patriotic people.

It is well known that excessive fatigue alone will cause a feverish condition of the body, leading to weakness and loss of appetite, and when that is induced the body is in a favourable condition for the reception of the germs of specific diseases. Service conditions obviously predispose to such diseases as pneumonia, rheumatism, quinsy, frost-bite, etc., etc., and in hot countries to heat apoplexy and sunstroke.

The commonest specific diseases of campaigns are dysentery, enteric fever, cholera, and malarial fevers. Dysentery has always been the great scourge of armies in the field in almost all climates, and the causes may be briefly summed up as bad food, bad air, bad water, and chills. The unwholesome food may cause disease in two ways: owing to its coarseness and being badly cooked, it may give rise to inflammation and irritation of the bowels, or it may be deficient in those still imperfectly understood constituents which are necessary to prevent scurvy. It is unnecessary to dilate further on the food question, the points of which are obvious, but as regards scorbutic dysentery I may say that it is very liable to appear among soldiers in the field, and our authorities endeavour to ward it off by giving, whenever possible, rations of fruit, vegetables, jam, and lime juice. As regards bad air, the condition of camping-grounds whereon large numbers of men and animals have lived even for a few days must be seen to be realised, and when to that is added the stench of dead bodies of men, horses, and cattle, as on a battlefield, it can be easily understood how frequently the air which men have to breathe on active service must be such as to give rise to bowel complaints. Again, in some countries where our troops have to operate, such as in the West African jungles, the air reeks with the smell of decaying vegetation in the stagnant depths of the primeval forest, and such air is most unwholesome.

Bad water is the principal cause of dysentery, but whether a man can acquire true dysentery thus, unless the water has been fouled by the discharges of a previous case of the disease, is not quite certain. Generally, such fouling is not difficult to establish. The drinking of water in which are immersed the rotting carcases of men and animals, and other nameless abominations--such water as our soldiers drunk at Paardeberg--is, as might naturally be expected, likely to cause diarrhœa running into dysentery, especially when all the other causes of that disease exist also. Chill I hold to be an exceedingly common cause of dysentery, having contracted the disease myself from that cause alone after leaving the tropics. It is most important to avoid sudden cooling of the surface of the abdomen by changing into dry flannels immediately on halting, and keeping that region warm, especially at night, by a thick woollen or silk covering. Unfortunately such precautions are generally impracticable on active service.

Enteric or typhoid fever has only been recognised as a distinct disease apart from typhus fever since the researches of Sir Wm. Jenner in the late Queen’s reign, and therefore, whether it used formerly to be as great a scourge in the past as it is now, it is impossible to say. At the present day it is without doubt by far the most fatal disease to which our soldiers are liable either in peace or war, and experience in Egypt, India, and South Africa, where it seems to become more and more fatal in spite of all that science can do to check it, almost causes us to despair.

Protective inoculation on the same principle as vaccination is the latest plan, tried extensively in South Africa, but the reports to hand so far do not show that it has had any marked success as a preventative, though it is hoped that it will prove to mitigate the severity of the attack. The disease is most prevalent and fatal among young men, which is a strong argument against the employment of very young soldiers; but on the other hand many middle-aged men, whose deaths the country is even now deploring, have lately succumbed. There is little doubt that in England and other temperate climates this disease is almost invariably due to bad water, but in India and other very dry climates, where it has continued to spread in spite of the most rigid precautions, the opinion is gaining ground that the germs may often be spread by the wind carrying them about into food and drink from the dry excreta of previous sufferers, deposited on the ground. Flies also are suspected of bringing about the same effect. Even in India and South Africa, however, it is remarkable how often epidemics are associated with contaminated water--for instance, Paardeberg and Bloemfontein (where the enemy cut off the regular water supply), and when one has had experience of the way in which the ground is fouled by the natives of Africa and India, there is little wonder that the water supply suffers. It seems certain that people can drink sewage contaminated water with comparative impunity, but the germs of enteric once admitted into the water, an epidemic is almost certain. The Hindoos always wash their buttocks after defecation, and hence generally perform that act near water, and in the hills in India often when I have been tempted to drink from an apparently pure mountain stream, I have noticed, just in time, the evidence of this disgusting practice. Again natives generally build their huts near a water supply, and hence nearly every rivulet is contaminated. In a hot country it is therefore most difficult to prevent men quenching their raging thirst with obviously polluted water. The Boers are reported to be very filthy in their habits, and as enteric fever is rife among them, it is not difficult for us to understand how so many of our men have contracted the disease in such a thirsty land, where I am informed even doctors, well aware of the risks, could not resist the temptation of drinking the dirty water by the roadside. The only safeguard with suspicious water is to boil it; filters only give a false sense of security, but wells can be purified with Condy’s fluid and acids, and of course rain water, if carefully collected and stored, or a stream, if guarded from its source, may be trusted, as also wells sunk at the time by the Royal Engineers. Many observers think that enteric fever may be caused by excessive fatigue and exposure to the sun, with absorption of poisons from the bowels, especially if they are overloaded with decomposing excreta due to constipation from heat, hard work, unwholesome food, and want of time and opportunity to secure a regular evacuation. In the navy, where condensed water is largely used for drinking purposes, enteric fever is rare, except when contracted ashore; but as soldiers cannot, as a rule, be supplied with condensed water, we must rely on the above precautions as regards water, cleanliness in the preparation of food, care in the disposal of excreta (and it is important to remember that enteric urine is as dangerous as stools), and constant supervision of natives and camp followers.

Cholera is like enteric fever, generally a water-borne disease, and much the same remarks apply to both. On active service, tea, coffee, and cocoa should be drunk in preference to water, as far as time and the supply of fuel will allow, and all drinking water should, if possible, be boiled. When green cocoanuts can be procured each will furnish nearly a pint of deliciously cool and perfectly wholesome “milk.”

I have said enough to show what a vital point the water question is on active service, how the health of an army in the field is largely dependent upon obtaining pure drinking water; and while all officers, regimental and medical, must never weary in their endeavours to secure such a supply, the men themselves ought to be instructed and exhorted to exercise the necessary vigilance and self-restraint, and, if necessary, punished when they fail to do so.

Malaria is always a great danger to soldiers on active service, not only in tropical regions, but also at times in our own latitudes, as was seen in the Walcheren Expedition. Though our theories as to the cause of the disease have lately been altered by the discovery as to the agency of mosquitoes in disseminating it, the old rules of not disturbing the ground, sleeping on raised platforms (as was done in the Ashanti Expedition of 1895–96), avoiding the neighbourhood of marshes and jungly ravines, preventing chill by changing into dry flannels on halting, never starting off in the morning without a cup of cocoa or something of that kind, and taking a daily dose of quinine, should on account of their proved utility still be followed. To keep off mosquitoes in the absence of curtains and punkahs, the face and other exposed parts of the body should be smeared with carbolic oil.

Sunstroke and heat apoplexy are causes of mortality on active service, and even at home in hot weather we have had lamentable results from overworking our soldiers in improper clothing and head-dresses. The obvious precautions are, the avoidance of overcrowding and overloading the men, the wearing of a suitable head-dress, loose porous clothing, the provision of plenty of non-alcoholic drinks, and marching in as open order as possible, so as to give every man enough fresh air. The greatest precaution of all, viz., avoidance of work in the sun, cannot, of course, be generally adopted on active service.

Sore and tender feet cause a great deal of inefficiency on active service, though our army boots are generally very good, with plenty of room and low heels, but a less rigid sole would be an improvement. The socks should be woollen and not too thin or loose, the feet should be kept clean and well soaped immediately before putting on the sock, and blisters should be carefully treated.

Many of the above suggestions may appear incapable of being carried out in the stress and hurry of active service, but, of course, anything which will prevent disease contrives “a double debt to pay”; it keeps the men in the fighting ranks, and prevents their becoming not only useless but a burden and trouble to their healthy comrades. Every soldier is said to cost the country about £150 before he can be placed in the field as efficient, therefore sickness entails very heavy pecuniary loss to the country, and all reasonable precautions will ever receive the earnest attention and support of capable leaders. In fact, without due regard to many of them it would be impossible in some countries for white men to remain in the field at all, and the Ashanti Expeditions of 1873 and 1895 have well been called “doctors’ wars.”

In conclusion, if my remarks have given rise to the impression that the soldier is a drunken or unreliable creature, such is far from my intention. He only presents, and that in a degree mitigated by discipline and respect for authority, the faults of his class. My experience of the average working man, which is large, is that the majority cannot refrain from drinking so long as they have money in their pockets, regardless of the consequences to themselves and their families, and that to offer a man drink is their ordinary way of showing kindness and good-fellowship; while their general want of self-restraint is very disappointing, considering the educational advantages they have enjoyed compared with their fathers.

J. R. DODD.

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XII. HEALTH IN THE MARINE SERVICE

Although from time to time there have been energetic workers in the cause of marine sanitation, there is probably no other department in which the great advances in hygiene have produced so little good result.

It must be conceded at the outset that the seamen’s lot is by no means an enviable one, and that his sanitary environment falls considerably short of modern requirements. Legislation is slow, and the lack of knowledge by the public of the requirements of the Mercantile Marine is no doubt in great measure responsible for this. At a first glance it might naturally be supposed that a life at sea was a healthy one; living in fresh air, and removed from the unhealthy conditions of large towns, it might be expected that the general health of seamen would bear favourable comparison with the corresponding class of the community on shore. But there is another side to this picture. In the first place there is practically always local overcrowding on board ship, and in dealing with this question the hands of port sanitary authorities and their officers are tied by the Shipping Acts. By the Merchant Shipping Act, the minimum space allowed per head is only 72 cubic feet, and in this space a man has not only to sleep, but to feed and live when not engaged on duty. It has been contended that inasmuch as one-half of the crew is always at work, the forecastle provides double this amount of space. But this is entirely a fallacy, for while half the men are always off duty, there is practically continuous occupation, and therefore no opportunity of opening doors, skylights, and other ventilators, to admit of free perflation. Another serious difficulty to contend with is the presence of moisture. Nearly all forecastles are badly ventilated, and the greatly increased use of steel and iron in modern vessels leads to the condensation of moisture, or “sweating” due to change of temperature. It is no uncommon thing to find the bunks and bedding in the crew’s quarters saturated with water from this cause.

While it can scarcely be stated that any special diseases are associated with the sailor’s calling, there are undoubtedly many which are caused by the conditions under which he performs his duty. His work is intermittent, consequently his intervals of rest, broken by sudden and severe exertion, throw undue and violent strain upon the circulatory and respiratory organs. In steam vessels the changes of climate are rapid, and their influence trying to the system. In spite of all the improved methods of storing and preserving food for long periods, there is still much to be desired both in the actual dietary of the sailor, and still more in the rough and inefficient manner in which it is cooked for him. The loss of life from drowning and other accidents connected with casualties to the vessel is large. Again, the habits of the seaman must be taken into account. From the mere fact of his being for long periods confined on shipboard, without any amusements except those provided by his fellows, it is perhaps not surprising that on arrival in port he should give way to full indulgence in pleasure. Unfortunately, moreover, the parts of sea towns frequented by sailors are generally the lowest, and the temptations of the worst kind. This explains the frequency of alcoholism and venereal disease among our Mercantile Marine, and in addition the tendency to contract the diseases to be met with in such localities.

The principal diseases to which seamen are liable are:--

1. Those due to the special character of their employment, such as aneurism, emphysema, hernia, and heart disease, and in steam-ships, heat apoplexy (stokers).

2. Those due to their habits, viz., venereal disease and alcoholism.

3. Diseases of climate, liver disease, malaria, yellow fever, dysentery, cholera, plague, etc.

4. Diseases influenced mainly by immediate environment and insanitary conditions, such as rheumatism, phthisis, bronchitis, and various forms of lung disease, under which must also be included scurvy and beriberi.

There is unfortunately no reliable record of sickness in the Mercantile Marine.

The returns of the Board of Trade show the mortality rate from all causes in 1898–99 to have been 9.60 per 1000 in the Merchant Service, while the corresponding rate in the Royal Navy was, for the year 1899, 4.91 per 1000, or practically one-half.

The returns of the Mercantile Marine show that of the 9.6 per 1000, 7.4 were from injury, and 2.2 from disease; the 4.91 per 1000 of the Royal Navy being made up of 3.56 from disease, and 1.35 from injury.

The following table shows the disease and accident mortality incidence in sailing-vessels as compared with steam-vessels.

+-----------------------------+--------+------+------+-----------+ | 1898. |Sailing.|Steam.|Total.|Percentage.| +-----------------------------+--------+------+------+-----------+ | Wrecks and Casualties | 425 | 607 | 1032 | .58 | | Accidents other than Wrecks | | | | | | and Casualties | 129 | 157 | 286 | .16 | | Disease | 149 | 249 | 398 | .22 | +-----------------------------+--------+------+------+-----------+ | Total | 703 |1013 | 1716 | .96 | +-----------------------------+--------+------+------+-----------+

1. Diseases due to Employment.--The violent exertions called for at times of emergency fully account for the frequency of heart disease, especially of cardiac hypertrophy, and also of hernia, while the occurrence of aneurism may be assigned to the same cause, though doubtless greatly aided by the influence of syphilis. With the large increase in size of sailing-vessels and the consequent introduction of labour-saving appliances, this class of disease is showing a decided tendency to decrease.

Injuries are more common on sailing-vessels than on steam-ships, owing to the greater amount of work aloft, and the more laborious efforts involved in working the sails.

The “heat stroke” of stokers requires special notice. It is far more common in vessels of the Merchant Service than in those of the Royal Navy. Stokeholds in the navy are better ventilated, and forced draught, if necessary, tends to a freer supply of air. The “fireman’s frenzy” appears to be caused by the continued high temperature, coupled with insufficient ventilation, and often associated with alcoholism. Much can be done to diminish heat stroke by due attention to the ventilation of stokeholds and confined spaces in connection with them. The utmost advantage should be taken of the up-draught caused by the heat of the furnaces to remove foul and vitiated air. Men engaged in this class of work should be freely supplied with oatmeal water, as this is the most wholesome method of replacing the large quantities of fluid lost by perspiration. The same class of men are, moreover, specially liable to diseases of the eye caused by the glare of the furnaces, and the constant irritation produced by particles of coal and dust.

2. Diseases caused by the Habits of Seamen.--Of these the two most common are alcoholism and the various forms of venereal disease. The irregularity of a sailor’s life, especially in these days of rapid transport, sufficiently explain without justifying his failings. A man whose home life is interrupted by voyages across the sea, who is thrown upon his own resources in foreign ports, and who is from the nature of his calling almost of necessity confined to the shipping quarters (invariably the lowest) of the towns he reaches, is not unlikely to seek for amusement where it is most easily obtained, and wine, women, and music occupy a considerable part of his spare time under such circumstances. Much has been done by the Board of Trade and voluntary associations to protect the sailor, by taking care of his money when first paid off (when the temptation to squander it is strongest), and enabling him to draw it at his own home, by arranging for his being sent by rail to his destination, by protecting him from “crimps” and unauthorised agents, and by providing Sailors’ Homes, where he can live at a reasonable cost, without being plundered by unscrupulous persons, but there is still much to be desired in this direction.

3. Diseases of Climate.--To a great extent these can scarcely be avoided. Seamen suffer much from tropical diseases. No doubt their careless habits and unwillingness to take reasonable precautions in unhealthy climates are in some measure responsible for this. Simple rules for the preservation of health, greater care in dieting, and, above all, limitation of indulgence in alcohol, would be of undoubted value, and a recent suggestion to afford information on such subjects to seamen through the medium of Sailors’ Institutes and Homes would doubtless lead to good results. Diarrhœa, so common a disease in hot climates, is mainly caused by the ingestion of improper articles of food and drink. Seamen do not realise the importance of the source and purity of drinking water. One common cause of this disease is the carriage of water in casks and tanks on deck, or in places where it is easily affected by the temperature of the sun. Any simple arrangement for reducing by evaporation or other method the temperature of the water supply has considerable effect in this direction. Dysentery, so far as prevention is concerned, can be guarded against in the same manner as diarrhœa--water, however, being the main agent in causation. Cholera, yellow fever, and plague call for no special comment. Where these diseases are known to exist, shipmasters should be careful to warn their crews as to the danger, and explain how best to avoid them. Men should be kept on board as much as possible during the stay of the vessel in an infected port, and especially should they be required to return at night. A careful watch should be kept for any suspicious sickness, and medical advice sought at an early stage of any illness. The sanitary condition of the vessel itself must be the special care of the master. Malaria, now known to be due to a specific organism, conveyed by means of the bite of a species of mosquito, is much under the control of the master of a vessel, who should prevent his crew from remaining on shore in a malarial country during the night, or in the evening, when special danger exists.

4. Diseases due to Insanitary Conditions and Environment form a long and important series. These are essentially the diseases which can be controlled, if not altogether prevented.

Rheumatism and its allies are mainly due to cold and exposure, and still more to the difficulty of obtaining dry clothing on board ship, and the constantly wet condition of bedding, etc., from the sweating of iron vessels. These causes can be avoided. The condensation can be prevented by the universal use of sheathing over iron decks and of a non-conducting lining over and around bunks, the proper provision of heating stoves, and the free ventilation of forecastles. There is further no reason (especially in steam-vessels) for not providing facilities for dry clothing, and preventing it being taken into the sleeping bunks. These two precautions, together with the free use of woollen underclothing, would tend to greatly reduce the “sailors’ curse,” rheumatism. Lung diseases are very common, and are caused chiefly by the close aggregation of men in confined and ill-ventilated quarters. The difficulty of the system of watches prevents the proper airing of a forecastle, and men coming off duty enter an atmosphere already fouled and polluted by those who have previously occupied it. The cubic space per head should be largely augmented. The Royal Commission on Labour has recommended that 120 cubic feet should be the minimum, and bearing in mind the special difficulties, this would seem to be a moderate figure. The present 72 cubic feet is ridiculously inadequate, and only remains the legal minimum by reason of the proverbial ignorant conservatism of the sailor.

Scurvy happily, under ordinary circumstances, is almost unknown in its acute form. During the last twenty years our ideas as to its causation have undergone considerable change, and it is no longer possible to assert that the one essential for its production is the use of salt meat, and the absence of vegetable food. In one of the recent Arctic expeditions, owing to the loss of all the stores, the crew lived for more than twelve months exclusively on fresh meat, and no symptoms of scurvy made their appearance. There is little doubt that the condition of the blood producing the symptoms we call scurvy is caused by the ingestion of food in an incipient stage of decomposition, although a free supply of natural vegetable acids will tend to delay its appearance. Slight manifestations of scurvy are still common among sailors, and there is one point of great practical importance in connection with this. More care is required in the examination of tinned meats, the date of packing should in all cases be stamped or indelibly marked upon the tin, and those tins that are found on examination to be in any degree defective, should be destroyed under official supervision, and not be allowed to pass into the hands of unscrupulous dealers.

Beriberi is a common disease among certain natives on board ship. The disease has the habit of remaining dormant in a vessel, also of recurring from time to time when conditions for its development are favourable. Though it has been ascribed at different times to malarial influences, to a deficiency of nitrogenous food, and to a definite microbe, these explanations have failed to satisfy all the requirements of the conditions under which it appears. Manson believes that it is due to a toxine, produced by a saprophyte living outside the body, and that as the soil or ship becomes infected, man is poisoned therefrom. It occurs invariably on board ship in connection with moist, overcrowded, and heated forecastles, where ventilation is deficient, and may therefore in this sense be said to be a disease caused by want of sanitation. Further, as favouring this view is the fact that patients removed to hygienic surroundings, and properly fed, rapidly recover. To prevent beriberi all that is necessary is to keep a vessel clean and dry; to see that there is no accumulation of bilge water or foul matter under the flooring of the crew’s quarters, and that these are properly ventilated and not overcrowded.[46]

Enteric fever is undoubtedly the most common disease to which seamen are liable. Thus in the port of London, out of 791 cases of infectious disease occurring on board ship from 1895 to June 1900, no fewer than 290 were enteric fever. The figures are as follows:--

---------------------+----------------+---------------+--------------- | Cases of | No. of Cases | Percentage Year. | Enteric Fever. | of Infectious | of | | Diseases. | Enteric Fever. ---------------------+----------------+---------------+--------------- 1895 | 31 | 129 | 24.0 1896 | 53 | 145 | 35.1 1897 | 54 | 179 | 30.1 1898 | 55 | 121 | 45.4 1899 | 66 | 160 | 41.2 1900 (6 months only) | 114 | 187 | 60.31 ---------------------+----------------+---------------+--------------- Total | 373 | 921 | 40.49 ---------------------+----------------+---------------+---------------

The large proportion during 1900 is due to the number of cases brought from South Africa.

The causes of the large number of cases of enteric fever are three:--

1. The congregation of seamen in the unhealthy quarters of foreign ports.

2. Want of care in the selection of sources of water supply.

3. Improper methods of carriage and storage of water.

Most of the infected or dangerous sources of water supply are known, and great benefit would result if consuls and other representatives of this country abroad were instructed to warn shipmasters of the special danger. Water should always be stored on board ship in galvanised iron water tanks, which should be carried in such places that they can be easily reached for cleaning purposes. They should be provided with large manholes so situated that where possible natural light can penetrate to the bottom of the tanks when the covers are removed. They should be periodically emptied, cleaned, and coated with a cement wash.

Lastly must be mentioned the digestive troubles so common in seamen. The insufficient and monotonous dietary is of itself sufficient to cause this, and when one further considers the unsatisfactory way in which such food is ofttimes cooked, it will be at once seen how serious a matter this may become. There is no compulsory diet scale, nor theoretically is it wise that there should be. It is felt that if such were laid down by law it would speedily become a minimum beyond which the owner or master would not care to go. The Merchant Shipping Act requires that a diet scale shall be produced when men are engaged, and shall form an essential part of the contract, any departure from which shall constitute a breach of the agreement on the part of the employer. Several improvements on the old scale (still usually in vogue) have been made, but in practice these are scarcely ever adopted. In the present day there are far better opportunities for giving men fresh meat and vegetables, while the use of preserved foods should obviate to a large extent the necessity for salt meat. It can be clearly shown that a reasonable dietary can be provided at a less cost than the antiquated one generally in use, while the advantages from the improved health of the crews and the consequent increased discipline and work are beyond dispute. But even if the dietary be good, the cooking is generally bad. Here legislation is needed. At the present time the master and certain other officers of a ship are required to hold certificates, granted after training and examination, and it is equally necessary that in the case of the cook, some definite standard of knowledge of the work he undertakes should be required before appointment. In the majority of cases a man is rated as “cook” because he so describes himself, or has acted in a similar capacity before. There is no difficulty in organising a system of instruction and examination for ships’ cooks in large centres, and the result of such would be to the advantage of shipowners as regards economy of food, as well as increased efficiency on the part of their crews. This work has already been initiated in several ports, notably London, Liverpool, North Shields, and Glasgow, but the question still demands the most careful attention.

Much ill-health and disease would be avoided if more care were exercised in the selection of men for the Mercantile Marine. The Merchant Shipping Act (sect. 10) provides for the medical inspection of seamen if required, but as a matter of fact, this provision is practically a dead letter, and men are allowed to “sign on” without any inquiry as to their physical fitness for their occupation.

W. COLLINGRIDGE.

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XIII. RAILWAYS

There is not much to be said respecting the nature of the injuries sustained by those at work on railways. The occupation cannot be described as unhealthy. A very large proportion of the work is done in the open air, and the normal lives of the men appear in every way up to the average.

The accidents that occur are mainly what would be called surgical. A large proportion consists of crushed hands and fingers. Instead, therefore, of entering into details respecting the character of these injuries and the manner in which they are received, it will be more useful to give a short account of the progress of legislation in respect to accidents upon railways.

The Mines and Factories Acts had their origin in the desire to preserve children from overwork and bodily injury. The protection thus accorded was gradually extended to women. The next stage was the inclusion of men in many of the factory provisions, and finally the Acts which had originally been intended only for the protection of health began to be timidly and cautiously extended to other and wider objects. But the movement for the prevention of accidents on railways commenced by aiming at the safety of passengers, and it was only in the last year of the nineteenth century that railway servants were included in the category of protected trades. Limits of space prevent my attempting to trace the movement in detail, nor indeed is it necessary. I shall therefore only mention certain epochs which have marked its progress.

As most people are aware, the railway movement began about the year 1830, the year Huskisson was killed, and proceeded until in 1840, there were nearly 1000 miles of railways in the United Kingdom. But about this time the importance of railways became so recognised that in 1840 they were placed under Government supervision. In 1841 a Bill was brought into Parliament to give the Board of Trade powers to issue regulations for the prevention of accidents upon railways, and referred to a Special Committee, presided over by Lord Seymour, and with Sir Robert Peel, Sir James Graham, and others as members.

The arguments for and against the proposal were exactly the same as they have always been upon the subject of State interference in matters of trade. On the one hand, the Board of Trade Inspector-General, Sir Frederick Smith, contended that the power was necessary. The railway companies said that by interfering with the responsibility of railway officials more harm than good would be done. Those who are acquainted with the general trend of public opinion upon factory questions in those days will not be surprised to learn that the proposal was considered likely to “disturb the amicable spirit which then existed between the Board of Trade and the railway companies,” and “to engender on the part of the railway companies a desire of concealment and feelings of jealousy which would not otherwise arise.” The Committee therefore limited its recommendations to empowering the Board of Trade to suggest improvements. These recommendations were carried into effect by an Act known as Lord Seymour’s Act, which provided for the appointment of inspectors of railways, the reporting of accidents, and the punishment of engine-drivers, guards, porters, or other servants of the company who were guilty of negligence. It was urged against the railway companies that expense was no object where life was concerned; to which Mr Brunel, the celebrated engineer, retorted on behalf of the railway companies by asking why the Government did not have a large force of men on the Serpentine when it was frozen, to prevent accidents to skaters. He submitted that in considering the question of safety it might be considered as a question of cost also. On the other hand, it is interesting to note that George Stephenson considered it would be advantageous that the Board of Trade should have power to make regulations. Coming from such a man, himself a large railway proprietor, the opinion is of great weight.

The next time the question came before Parliament was in 1857, during Lord Derby’s administration, when the matter was referred to a Select Committee. The Committee was against interference with railway companies, except as regards the times of trains, with respect to which they thought that the public should have some means of obtaining prompt and cheap redress in the recovery of penalties in every case of want of punctuality. They also made a few minor recommendations. The subject was again discussed by a Royal Commission appointed in 1865. But the times were not ripe for the adoption of State interference. The laissez faire system was in full force, and the Committee recommended that the railway companies should not be interfered with. Meantime the management of the railway companies seems steadily to have deteriorated. The year 1872 was a year of considerable commercial activity, marked by a great rise in the price of coal, and by an increase in the number of railway accidents. In those days it was estimated that several railway accidents to trains took place every week, sometimes as many as four were reported on a single morning. In fact, as stated in the Annual Register for 11th September 1872, “Railway accidents are now becoming of such frequent occurrence that, unless a number of people are killed or seriously injured, no notice is taken of them.” The number of accidents to individuals was also very great. In that year no less than 1145 persons were reported killed, and 3038 were injured. Some of the accidents, too, were of an appalling character. At Wigan in August 1873 a portion of a railway carriage, with a lady in it, was hurled over a wall and through the slated roof of a foundry. The rest of the carriage was smashed to pieces.

In order to secure more precise returns of accidents by checking those made by the railway companies, it was provided in the Railways Regulation Act of 1873 that coroners should make returns to the Secretary of State of all deaths occurring on railways.

The public feeling which these accidents excited led to the appointment of another Royal Commission in 1874, during Mr Disraeli’s administration. It was presided over by the Duke of Buckingham. The Committee sat for three years and heard evidence at great length. They ended by recommending that the Board of Trade should have power to make requirements as to siding and station accommodation, and as to defects in rolling stock, permanent way, and works. They declined to recommend that general powers should be given to the Board of Trade to make general changes calculated to secure the safety of the railway servants, but they thought that servants ought to receive compensation for injuries in all cases of negligence of the companies’ officials, but not for the negligence of their fellow-servants.

In the evidence that was given it seems to have been admitted that overwork was not universal or even general on railway lines, but a good many remarkable instances of overwork were adduced. Thus Captain Tyler, a Board of Trade Inspecting Officer, gave evidence that at Wakefield in 1864, a man had been regularly on duty as a signalman 25 hours a day every third week, and 37 hours every thirteenth week. The man had made this arrangement in order to get extra time off duty; and in another case, in 1874, a signalman had actually averaged 17 hours work a day regularly.

Nearly all the witnesses complained of the couplings as a fruitful source of danger. Captain Tyler recommended automatic couplings as then used in America.

The next Act of importance regarding accidents upon railways was that passed in 1889, when Sir Michael Hicks-Beach was President of the Board of Trade. The principal objects of the Act were to secure the adoption of the block system of running trains, to cause points and signals to be interlocked, and to enforce the use of an improved brake. The principal object of the Bill was to promote the safety of passengers; there was a clause dealing with automatic couplings, but the clause was ultimately withdrawn from the Act.

During all these years, however, repeated recommendations were made by the Board of Trade officials to the railway companies to adopt various means of saving life. The companies were not obdurate or unreasonable; in particular instances and small points they repeatedly gave way and adopted suggestions. But in the main they declined to introduce automatic couplings, or other life-saving appliances on a large scale. Their refusal was based chiefly on the ground of expense; but they also defended their action on the ground that the proposed appliances were not suitable or practicable, and that if adopted they would not produce beneficial results.

Before narrating the next steps which were made in the direction of securing safety when Mr Ritchie became President of the Board of Trade, it will be of use to examine in outline the condition of railway service as regards accidents, and the means by which the number of deaths and other injuries is ascertained. Reports of accidents on railways exist from the year 1848 onwards; but in forms which render them very difficult to compare with accidents in more recent times. It was not until the passing of the Regulation of Railways Act of 1871 that the reporting of accidents was placed on its present footing. By section 6 of that Act it was provided that accidents should be reported to the Board of Trade, in such form and with such particulars as the Board of Trade should prescribe. In earlier years the reporting of accidents was not very systematically done, and in 1872 the inspector reported that “accidents to servants do not appear in many cases to have been reported by certain of the railway companies; and their numbers would, if the whole truth could be ascertained, be very considerably increased.” Moreover, no uniform standard of injury was prescribed, so that various companies adopted various standards of reporting. Some reported all accidents, even trivial ones; others reported only the serious ones. But in the year 1895 an order of the Board of Trade was made during the permanent Secretaryship of Sir Courtenay Boyle, by which the standard of accident to be reported was assimilated to the standard already in force for the reporting of accidents in factories and workshops, namely, that all fatal accidents should be reported, and all non-fatal, whenever they incapacitated a man from work for five hours on any one of three days next after the accident. The advantage of this order was that it at once established a basis of comparison between the dangers of work in factories and in railways. But there is ground for thinking that the standard was a little low. A trifling finger cut may prevent a man from working in some trades for an afternoon. The reporting of every trivial accident tends also to obscure the graver ones, and in some cases to make dangerous trades appear less dangerous than they really relatively are. In any case, however, it is desirable to have one standard of reporting, and it is a matter for regret that there is no standard of reporting non-fatal accidents in mines, so that it is still impossible to compare mines with factories or railways as to the non-fatal accidents that occur in them.

The numbers of persons employed on railways largely increases from year to year. Returns of these numbers are now furnished every three years. We have therefore not at hand the means of working out the percentage of accidents in every year exactly; but without the danger of grave inaccuracy we may assume that the increase in the numbers employed is uniform during each period of three years, and thus we may by a process of proportion arrive very nearly at the numbers of men employed at any particular period. On looking at the figures for any year, say for the year 1898, we find them set out in two tables, one showing those due to the movement of trains and vehicles, the other to those which occurred otherwise than by moving trains. They are divided up so as to show 41 different occupations of the persons killed and injured. From these tables we find that, in 1898, 522 railway servants were killed and 12,826 injured, out of a total of 534,000. This would give 1 in 1000 killed, and 24 in 1000 injured each year. When we reflect that this figure is about the same as the numbers killed and injured in mines, it might perhaps be argued that the figures are not very large, for it must be admitted that service on railways must always be considered rather a dangerous occupation. But an analysis of the risks to various branches of railway labour dispels this illusion.[47] For in these figures are reckoned numbers of men whose duties are not of a manual character, such as 53,000 clerks, who hardly ever meet with death or accident except from causes common to the whole community. Besides, about 70,000 mechanics are employed in building engines and locomotives, and work in factories, which are under the Home Department, and, strictly speaking, are not railway servants at all.

In railway service there are three occupations which from the number of accidents reported appear to present special dangers, namely, plate-laying and repairing of lines, shunting and managing goods trains. When plate-layers (of whom there are 63,000) sustain an accident, it is generally by being run over, and in more than one case out of every three they are killed outright. Out of every thousand 2 yearly meet their death, and 3 are injured. Of goods guards and brakesmen, nearly 15,000 in number, 3 out of 1000 are yearly killed, and 48 of 1000 are injured. But the business of a shunter presents the gravest dangers. The number of shunters is 9244, and with the exception of the calling of a seaman it is the most perilous trade known. For no less than 5 men are yearly killed and 66 are injured out of every 1000 employed. And from this it follows that if the average duration of a man’s service be from the age of twenty to forty, the balance of probability is against his leaving the trade without a violent death or injury. This is not satisfactory. It has been pointed out that this yearly death risk of 5 in 1000 per annum is greater on the average than that to which soldiers are exposed, taking one year with another, and war with peace. This is probably true, but the risk is far less than that of soldiers in a campaign. It has been estimated that the year’s loss from October 1899 to October 1900, of the troops serving in South Africa, has been 19 per thousand privates, and 72 per thousand officers killed, in addition to 30 per cent. of officers and privates who have died of disease. Thus of the officers engaged about 1 in 10 has died, and of the men 1 in 20.

But any figures of deaths due to accidents in industry are too large if they are preventable, and it is too much that in ten years a railway servant should run the same risk as a private in a year of a campaign.

The work of shunting is necessary to rearrange, or, as it is called, to marshal the trains. At a large goods depôt a number of trains laden with trucks come in destined for various localities. The trains have to be dissected, and all the trucks resorted, and made up into fresh trains to be sent off in various directions. Hence, therefore, it is necessary for an engine to draw the waggons on to a line of rails, and then to shunt or direct them on to sidings in different directions in order to sort them into their right places. This involves the coupling and uncoupling of the waggons. Passenger waggons have a screw coupling by means of which they are screwed up together, so that the buffers press firmly together, and thus jolting is avoided. But goods waggons have no such luxurious appliances, nor have they in all cases spring buffers. The coupling is simply a ring hitched into a hook at the end of a three-link chain, and on the starting or stopping of a goods train any one may hear the succession of slams with which the waggons clash together. When it is necessary to shunt, an engine pulls the waggons along to the place where they are to be detached. While the tension is on, of course, it would be impossible to unhook, therefore the engine stops suddenly. For an instant the waggons by their momentum go forward, bumping up against the engine and one another. For that instant, and until the rebound takes place, the hooks are free, and a skilful man, generally with a pole, and but rarely running in between the waggons, neatly slips the ring off the hook. This is all done while the waggons are in motion, so that he has to run alongside the train, skipping over the signal wires and hopping over the cross rails, keeping his eye always on the coupling, and sometimes encumbered with a pole in one hand, and at night with a lamp in the other. If he does not look out he may fall between the wheels, or be run down by the engine. And while engaged in his work express and other trains come tearing down the main line, exposing every one to the risk of being run over. Therefore in all goods sidings it is desirable in the interests of safety that the through traffic should be as small as possible, that there should be plenty of room between the lines of rails, that wires and other obstacles should be boarded over where possible, and that there should be a good light at night. But many sidings are greatly crowded; the work has to be got through rapidly, and accidents are the result. On the other hand, in the private sidings of collieries operations are leisurely; no express trains come along the line, there is no night labour, and consequently the accidents are very few. In America until lately the means of coupling waggons were more imperfect than those in England; many accidents therefore occurred, and the trains frequently broke asunder.

In order to expedite work and promote safety, experiments were made in 1868 with automatic couplings which should close like a snap-lock. American waggons differ from those in use in England, in that they are longer and larger, and have a central buffer. In 1874 the public attention was called to the great number of railway accidents, and in the more civilised states, such as Massachusetts, a movement arose for the compulsory employment of automatic couplings. Finally a coupling was devised, very like a hand with the fingers bent, and a hinge at the knuckles. When two waggons were brought together the hand caught automatically into a similar hand on another waggon, and could be released by withdrawing a pin. At first these couplings were badly made; gradually, however, they improved, and are now on the fair road to perfection. They were gradually introduced upon one railway after another. The rich eastern States took the lead, the wild west was more slow; but curiously in proportion as the couplings were adopted, so did railway accidents become less. It would be wrong to conclude that therefore the whole of the diminution of accidents was due to the adoption of couplings. But it is a fair inference from the state of railway management in the east and west of America to conclude that with careful management and State-imposed regulations, accidents can be very materially reduced.

This was the state of the problem in 1898, in which year Mr Ritchie, then President of the Board of Trade, determined to make an effort in favour of safety. For this purpose he commissioned Mr Hopwood, the Assistant Secretary of the Railway Department, to visit America and examine the system of coupling there in use, and its effects in preventing accidents. In December 1898 Mr Hopwood presented his memorandum. He says (quoting the Railway Times), “Our Railway Companies’ Association still lacks the moral force, to say nothing of the initiation which characterises its sister body across the Atlantic.... This view fairly reflects the opinion I formed that the progress made in the United States is greatly due to the fact that the American Association has taken great trouble, and the railroads have not spared expense in order to give a trial to promising inventors,” and he concludes by recommending that Parliament should be asked for powers to be given to the Board of Trade to order the use of a suitable coupling. In accordance with the recommendations in this very able report, the President of the Board of Trade introduced a Bill providing for the compulsory use of steam brakes for engines, and automatic couplings for carriages and waggons, also brakes on both sides of waggons, and labels on both sides of waggons, but giving to the companies two years and five years respectively to introduce these improvements.

The Bill was introduced by Mr Ritchie on 27th February 1899. He said, “I am afraid that whatever we do, a number of accidents amongst railway servants will continue to happen. They are engaged in extremely dangerous operations, and necessarily many accidents must and will continue to occur. But, sir, if it is possible by legislation or otherwise to take means to reduce the number of accidents, I think it is the bounden duty of Parliament to take those means.” Of course this announcement caused considerable agitation in the railway world, and on 16th March a deputation of the private waggon owners of the United Kingdom pressed upon the President of the Board of Trade the necessity for further inquiry. Mr Ritchie endeavoured to meet the current of opposition which his proposals had aroused, by offering to make it clear that the portion of the Bill dealing with automatic couplings should not come into operation until a satisfactory coupling was found, but he ultimately decided to withdraw the Bill and refer the whole question to a Royal Commission. He determined, however, that the inquiry should be an effective one, and therefore he enlarged its scope, and referred to the Commission not merely the question of coupling, but the whole question of accidents to railway servants and the means of preventing them. This action had very important consequences, as will presently be seen. He selected as Chairman Lord James of Hereford, who had already done excellent work as the mutually-accepted arbitrator in various disputes between capital and labour, and whose disinterestedness and fairness could be relied on. The Commission was composed of members of the House of Lords and Commons, representatives of the railway companies, private waggon owners, and railway servants, experts and Government officials. It was supposed in some quarters that the question had been comfortably shelved for at least three or four years. But the Chairman took a very different view of the position. With almost unexampled energy, he assembled the first meeting on 16th June 1899, a fortnight after the warrant appointing the Commission had been signed. The last witness was heard on 3rd August, and the report was presented to Her late Majesty the Queen on 20th January 1900.

From the very mixed character of the Commission, it might have been expected that views would differ, and that it would have been difficult to draw a report that would be signed both by the railway companies’ representatives and by the representatives of the men. But the report was unanimous, and what was more remarkable still, it went far beyond the proposals of Mr Ritchie for couplings, and dealt not only with these, but proposed a means of preventing all accidents whatever. The principle that lay at the whole root of the report was the assimilation of means to prevent railway accidents to those already adapted for the prevention of similar accidents in factories and mines.

In the Coal Mines Regulation Act, 1860, a procedure had been adopted of special rules in mines. The rules were to be agreed upon by the Secretary of State and the mine owners. If they could not agree, then arbitrators were to be named who were finally to settle them. This procedure was adopted in all successive Acts relating to coal mines. Being found useful, it was adopted into the Factory Acts in 1891 in all cases of specially dangerous trades, among others the cases of industries where lead poisoning, phosphorus poisoning, and other dangers are experienced. But by the Factories Act, 1901, an order of the Secretary of State, after hearing the parties, is now substituted for arbitration.

When the Royal Commission sat, the first question that arose was whether the accidents to railway servants were so numerous as to constitute it a dangerous trade. Figures soon settled this point, and appear from the following table:--

-----------------------------------------+---------------+---------------- |Killed from all|Injured from all Description of Labour. | Causes per | Causes per |1000 employed. | 1000 employed. -----------------------------------------+---------------+---------------- Railway Servants in general, excluding | | Contractors’ Men, Clerks, and Mechanics| 1.24 | 31.0 Goods Guards and Brakesmen | 2.92 | 61.0 Permanent-way Men or Platelayers | 1.9 | 16.0 Shunters | 5.08 | 78.0 Men Porters (railways) | 1.15 | 63.0 Seamen (merchant service) | 5.2 | Not known. Coal Miners (underground) | 1.37 | No figures | | available | | for purpose | | of comparison. Coal Miners (surface) | 0.92 | Ditto Metalliferous Mines (underground) | 1.34 | Ditto Metalliferous Mines (surface) | 0.43 | Ditto Factories--Textile (males) | 0.1 | 6.2 „ Textile (females) | ... | 2.7 „ Non-textile (males) | 0.2 | 13.8 „ Non-textile (females) | ... | 2.0 „ Extraction of Metals (males) | 1.1 | 16.4 „ Shipbuilding (males) | 0.5 | 39.3 „ Dock Labourers | 1.4 | 57.0 -----------------------------------------+---------------+----------------

From this it will be seen that while on the average work on railways is almost as dangerous as mining, yet where particular branches of it are considered, such as shunting, it is far more dangerous, and those who advocated a policy of non-interference found it impossible to explain their position consistently with the admission of the expediency of the existing factory and mine laws. It is impossible to put the matter more clearly than in the following short interrogation of one of the principal witnesses on behalf of the railway companies by the Chairman.

Q. 6374. Do you approve of a dangerous trade being inspected?--Yes. All dangerous trades?--Yes. For instance, merchant-shipping?--Yes. Mines?--Yes. Factories?--Yes. Textile and non-textile?--Yes. Machine shops on your railway?--Yes. The witness, however, contended that the case of railways was different from that of mines and factories, because railways were more amenable to public opinion.

Another witness who held these views was compelled to admit that the force of public opinion had not on all lines secured punctuality of trains. On the other hand, an argument was brought forward by Mr Gibb, the General Manager of the North Eastern Railway Company, which deserves attention, because it exhibits a phenomenon that is frequently observed in industries. By a table he showed that the accidents on railways since 1872 had been decreasing in a ratio almost as fast as the decrease in mining and factory accidents. At first sight this would appear to show that accidents decrease as fast without legislation as with it. But it must be remembered that the Mines and Factories Acts had been some years in operation, and had already before this date effected their principal results, and that the accidents were far fewer than in the dangerous branches of railway service. Moreover, the reports of previous Royal Commissions on Railways had been followed by legislation, and by increased vigilance on the part of the companies. It was proved also that this decrease had not taken place in the dangerous branches, and that the number of deaths of men engaged in shunting had actually increased.

The position taken up by the railway companies deserves attention. Their representatives were confronted with a vista of increased wages, increased cost of coal, and a fall in profits. It was asking much to expect them to apply the knife to their own throats and vote that restrictions should be imposed upon them. As a rule, although we all believe in the necessity of compelling others to do right, few people can be brought to believe that it is needful that the same principle should be applied to themselves. And yet, to the everlasting credit of the railway companies, it must be said that as soon as they were convinced that a case for intervention had been made out, they acquiesced in it. And the waggon owners, although the accidents on private lines were exceedingly few, withdrew their objections. In the result a report was unanimously signed, recommending that in the case of all dangerous trades of railway service the Board of Trade should have power to propose regulations which in case of dispute were to be settled by the Railway Commissioners.

The question of the possibility of automatic couplings was discussed before the Commission. If it had been fully gone into, the question would have taken years to consider, and, without experiments, no conclusions could ever have been arrived at. But with great tact Lord James determined that unimportant issues should be eliminated. He referred the question to a strong subcommittee, and before the Commission had gone far it was seen that it was quite possible to deal practically with railway accidents, without first determining whether or no there was a practical automatic coupling. No definite opinion on this question was expressed by the Commission.

To give effect to these recommendations Mr Ritchie introduced a Bill into the House of Commons. It was taken charge of by Lord James of Hereford in the House of Lords, and with some amendments it passed both Houses without opposition. The effect of this Bill is to bring dangerous processes on railways under regulations similar to those which can be made in the case of dangerous processes in factories and mines. No particular operations are specified; there are powers to meet all dangers as they arise. It is too much to say that this Bill will not need amendment, but it must be a source of satisfaction to the late President of the Board of Trade and his officials to have inaugurated, and successfully carried through with the unanimous consent of all interested parties, a scheme of legislation which brings railway labour within the circle of protected industries, and which establishes a fundamental principle so wide as probably to dispense with the necessity for further legislation upon the subject for many years.

HENRY CUNYNGHAME.

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XIV. SAFE-GUARDING OF MACHINERY

Amidst the variety of dangers which attend those who are employed in factories none occupies so prominent a position as that arising from machinery moved by mechanical power; others, such, for instance, as periodical outbreaks of industrial poisoning or the occurrence of disastrous explosions, may from time to time attract public attention more vividly, but we have only to refer to the statistics issued annually by the Home Office to perceive how ever present and ever recurrent are the risks incurred by factory workers from machinery. From these statistics it appears that during the year 1899 there occurred in factories 301 fatal and 19,321 non-fatal accidents, all attributable to machinery moved by mechanical power. Beyond, however, stating that the numbers are the highest yet recorded in any one year, no useful purpose would be served by comparison with former years, or by inquiry as to the reasons of the increase in spite of legislative and executive requirements for safe-guarding. The Factory and Workshop Act of 1895 introduced such an entirely new element by the inclusion of every dock, wharf, warehouse, laundry, etc., in the definition of the term “factory,” that any comparison would be entirely misleading, whilst the facilities afforded in recent years by the introduction of, and improvements in, gas engines have added largely to the number of small factories using mechanical power, and therefore to the number of persons brought into direct contact with machinery. The statistics quoted are, however, in themselves sufficient to establish the importance of the subject of safeguards and the prevention of accidents.

In searching for the causes of such a large number of annually occurring accidents they are found to be various, but after enumerating several, such as carelessness on the part of operatives, unsuitable clothing, insufficient lighting, etc., there remains a very considerable proportion directly attributable to the absence of proper safeguards. It is with this cause that this paper proposes chiefly to deal.

With a view to prevention of such a distressing number of accidents, Parliament has, from time to time, passed enactments requiring certain steps to be taken for safe-guarding machinery, and the appointment of Inspectors has been made for the purpose of seeing that these provisions are duly carried out. Much, however, still remains to be done, not only through further legislation, but also by enforcing the requirements of the law as it at present stands. The latter course at first sight might appear to be feasible enough, but in reality it is a Herculean task, as difficult to accomplish as the destruction of the many-headed hydra of ancient fable, and is due to the fact that as fast as the requirements of the law are insisted upon and carried out in the case of machinery already existing in factories, so fast do makers of machinery send out new machines in a similarly defective condition. If the desired finality is to be arrived at, it must be by pressure brought to bear upon machine makers. At present machinery does not come within the provisions of the law as to safety till it is in actual use, when the attention of the user is perhaps first drawn to its defects by the occurrence of an accident. Much, no doubt, could be done were purchasers in all cases to insist on due regard being paid to this point by makers, but experience shows that this is done in very few instances. Whilst some parts of prime movers and mill-gearing must necessarily be fenced after being placed in position, there is no reason whatever why the effectual guarding of cog-wheels, the countersinking of set-screws, the provision of loose pulleys and strap forks, and the substitution of plate wheels for exposed arm wheels, which are all intrinsic parts of machines, absolutely necessary for ordinary safety, should not be dealt with in the first instance by makers who can provide more effective and neater guards at a much less cost than the user.

The subject of safe-guarding machinery is such a wide one that it will be impossible, within the limits of this paper, to do more than briefly touch upon the more salient points which naturally present themselves to one accustomed to inquire into the causes of machinery accidents. For this purpose it will be most convenient to deal with machinery under the four following headings:--

1. Prime movers. 2. Mill-gearing and belts. 3. Machines for manufacturing purposes. 4. Hoists and other lifting tackle.

Each of these divisions is separately dealt with by the provisions of the Factory Acts, but it should be pointed out that whereas belts have herein been coupled with mill-gearing, yet by Section 37 of the Factory Act of 1891, all “driving straps and bands” are expressly included in the term “machinery” and are therefore subject to the provisions laid down for the third division.[48] They are, however, so intimately connected with mill-gearing as more properly to belong to that class, and they will therefore be more conveniently dealt with in connection with mill-gearing, between which and the machine tools themselves they are the connecting link.

Prime Movers.--Prime movers are of various kinds, consisting of heat engines, such as steam, gas, and oil engines, electric and hydraulic motors, water-wheels, turbines, and wind-mills. Of these, those most commonly found in factories are steam and gas engines. The provisions of the Factory Acts as to safe-guarding prime movers are absolute. No matter what its position, every part of an engine moved by mechanical power is required to be securely fenced, and such fencing must be constantly maintained. Thus:--

Factory Act, 1901, Sec. 10.--“Every fly-wheel directly connected with the steam, water, or other mechanical power, whether in the engine-house or not, and every part of any water-wheel or engine worked by any such power, shall be securely fenced.”

“Every wheel-race, not otherwise secured, shall be securely fenced close to the edge of the wheel-race.”

Such absolute provisions, if strictly carried out, should be amply sufficient to prevent almost all accidents arising from prime movers; but the danger lies in the fencing being in the first instance insufficient, or not properly and constantly maintained, in accordance with Sec. 10 (d) of the Factory Act of 1901. Accidents caused by prime movers are, of course, restricted in number, partly owing to the fact that they are usually in the sole charge of one man, and partly because, in the case of steam engines at least, they are generally placed in a house or compartment set apart for them, but it will be noted that the words “whether in the engine-house or not” are expressly used for the protection of the engine attendant himself.

Occupiers of factories, owing to their absolute obligation to fence securely every part of a prime mover, and to their liabilities for any neglect to do so, should be specially careful to see that the law is fully carried out before an engine is put into use; whilst no exception should be tolerated for a moment by those whose duty it is to enforce the requirements of the law.

The necessity of fencing being thus absolutely enjoined for every portion of a prime mover, the only point that remains is as to what constitutes secure fencing. Types of engines, however, are of so various a character, and the local surroundings so distinct, that it must suffice for the purposes of this paper to point out what parts of an engine are most liable to cause accidents, and, generally, the most approved steps which should be taken for their prevention.

Steam Engines.--As regards steam engines, all parts on the floor or platform level, such as fly-wheels and fly-wheel pits, crank and crank-pits, crank shafts, connecting rods, cross-heads, etc., should be securely fenced by means of rail fencing, whilst in the case of large vertical or beam engines, all stairs, platforms, and stagings should be efficiently guarded in similar manner. The fencing adopted should consist of double rails, the upper one being not less than 3 feet in height, whilst in many instances a skirting board 5 to 6 inches in depth should be added; single rails are either so high that persons may slip under them, or so low that they may fall over them. Care should also be taken that no railing be placed within a foot of the moving parts, the placing of such rails too close thereto being a source of great danger; whilst, on the other hand, the practice of leaving so much space between any moving part and the guard as to allow of a passage between them is equally to be condemned; moreover, the keeping of oil-cans, tools, etc., or the hanging up of clothes within the space fenced in accordance with statutory obligations should be absolutely forbidden. Other parts of steam engines requiring fencing which may be mentioned are piston rods prolonged through the end covers of cylinders, governor balls encroaching on a passage, and pinion wheels operating the governors.

Gas and Oil Engines.--The use of prime movers of the gas engine type has enormously increased of late years, adding greatly to the number of small factories as distinct from workshops. The safe-guarding of these, though they are relatively much smaller than the generality of steam engines, is none the less essential, for whereas the latter are usually placed in an engine-house specially built and separated from the factory itself, the former are in numerous instances placed within the factory, in some cases with a wooden compartment erected round them, and in others with nothing but the statutory fencing separating them from the rest of the works. Where these compartments are large enough, similar railing to that described above for steam engines will be found sufficient, but in many instances they are so confined as to necessitate more complete fencing in order to comply with the requirements of the Acts as to fencing securely any fly-wheel, whether in the engine-house or not.

Wherever possible gas engines should be placed in a room set apart for them, so as to be isolated from the approach of unauthorised persons; those situated in the machine room of a factory are not only a source of danger to those employed therein, but so contaminate the atmosphere as to necessitate the provision of a fan to remove the fumes. In many cases, owing to the confined space of the engine compartment, or to the fact that the fly-wheel is in an exposed position facing into the machine room, a complete wire-work guard should be provided; these can be made either to slide, swing, or to be lifted so as to suit local surroundings; an illustration of such guards is shown in Fig. 1. Shaft ends projecting into passages should be fitted with metal caps so as to avoid the danger of clothing being caught. The common practice of starting a gas engine by hand, by pulling round the fly-wheel, is also attended with risk, but this can be avoided by the use of a starting handle, Fig. 2.

Other Prime Movers.--Very similar rail-fencing to that described above for steam and gas engines may be applied in the case of other prime movers where electricity or water provide the moving power. As regards water-wheels, it should be noted that, although situated in a wheel-house, the same obligation to guard securely prevails as in the case of a steam engine, and in every instance the wheel-race must be fenced close to its edge.

As for turbines and wind-mills, the most dangerous parts requiring to be fenced will be found to be toothed gearing and shafting.

Electrical Generators.--The special risks attendant on electrical generators from shocks scarcely perhaps come within the scope of this paper. Ordinary rail-fencing may be relied upon for protection of moving parts, though the railings should be made of some non-conducting material such as wood.

Mill-Gearing.--Mill-gearing is defined by Section 156 of the Factory and Workshop Act, 1901, as comprehending--

Factory Act, 1901, Sec. 156.--“Every shaft, whether upright, oblique, or horizontal, and every wheel, drum, or pulley, by which the motion of the first moving power is communicated to any machine appertaining to a manufacturing process.”

The provisions of the Factory Acts bearing on mill-gearing enact that:--

Factory Act, 1901, Sec. 10 (c).--“Every part of the mill-gearing shall either be securely fenced, or be in such a position, or of such construction, as to be equally safe to every person employed or working in the factory, as it would be if it were securely fenced.”

Factory Act, 1901, Sec. 13 (3).--“The cleaning of mill-gearing whilst in motion is, moreover, prohibited for women, young persons, and children.”

Accidents caused by mill-gearing and belts are not only amongst the most numerous, but certainly amongst the most serious of all those to which persons employed in factories are subject, and yet nearly all such may be avoided by strict observance of the precautions proposed to be set forth herein.

Mill-Gearing.--First, as to construction and position, whilst the distance between the bearings which support a shaft must vary with the weight of the shaft and pulleys, and tension of the belts, it should never exceed 13 feet, and in order to comply with the requirement of the law quoted above, both shafting and pulleys should, wherever possible, be not less than 7 feet above the floor, otherwise the obligation to fence prevails. Shafting of considerable length is composed of separate parts connected by couplings. These couplings should always be near a pedestal and not in the middle of a span, and should invariably present a perfectly smooth surface, free from bolts or screws, which are liable to catch the clothes of workmen--the old-fashioned couplings with projecting heads of bolts and screws (Fig. 3) are the worst possible form; there are many kinds without any projections whatever (Fig. 4). Ends of keys fixing the pulleys or bevel wheels on to the shafting should either be cut off or protected by a key cover. All set-screws fastening collars to the shafting should be countersunk (Figs. 5 and 6). In fact it should be an absolute rule that projections of every kind should be removed from shafting. The dangers of shafting, however, do not cease with projections: it is an established fact that perfectly smooth shafting is highly dangerous; should the shaft be greasy or his clothing damp, a workman may be caught by a perfectly smooth shaft. That being so, no one should ever be allowed to come into direct contact with shafting in motion: cleaning or lubricating should only be done when it is at a standstill.

Access to Shafting.--Where shafting is of the requisite height named above, no further protection is required round the shafting itself, but seeing that it is necessary at times to reach it, proper and secure means of access should be provided. This can be done either by a service platform, when the shafting is very high, or by ladders adapted for the purpose. A service platform, whilst providing easy access to shafting, should keep the attendant at a safe distance from it, and at the same time guard against his falling. With a view to this it should be provided with a hand-rail not less than 3 feet in height, and a skirting board of 5 to 6 inches in depth to stop the foot in case of slipping. Ladders should invariably be supplied with hooks at the upper ends and spikes at the lower, the latter where the nature of the flooring permits. In no case, however, should an attendant be allowed to fix a ladder against a wall so as to place himself between the shafting and the wall.

Fencing of Low Shafting, etc.--Where, however, shafting and pulleys are not of the desired height above the floor, the obligation to fence both arises. When shafting is near the floor it should be completely covered by a sheet-iron or wooden casing, and the pulleys fenced so as to afford a safe passage for workmen by either stepping over the casing or crossing it by means of steps according to the height from the floor. Shafting from 3 to 6 feet above the floor should be protected by a secure rail preventing access to it except by passages so arranged and boarded as to prevent any contact with the shafting. Vertical shafts should in every case be surrounded by a sheet-iron or wooden sheath firmly fixed.

Pulleys.--Whenever driving pulleys are so situated that a workman has reason to pass near them, they should be securely fenced by means of boards or metallic netting, and it is desirable to fill up the pulleys with a disc of wood or sheet-iron fastened to the arms by means of screws. Loose pulleys should not be placed on the shafting itself; lest they grip the shaft and carry the belts round with them, but should be mounted independently.

Driving Belts.--Driving belts are a constant source of accidents. When a belt has been thrown off its pulley it should never be allowed to rest upon the shaft; when in that position it is liable to be wound rapidly round the shaft, carrying with it anything with which it comes into contact. This danger is easily avoided by means of a belt rest or hook fixed according to available surroundings. Another fruitful source of accidents through belting is the method in which they are joined; one should always be selected which presents no projections capable of catching clothing or dealing severe blows. Accidents have frequently occurred in both ways; hence the necessity of avoiding all projections on belting.

Shipping of Belts.--Accidents constantly occur during the shipping of belts. Workmen should be absolutely forbidden to put a belt on to a pulley by hand whilst the shaft is in motion at its full speed. It should be stopped altogether, or at least be greatly reduced in speed, in which latter case a man should be ready to complete the stoppage at once in case of danger occurring.

Belt Poles.--Where it is desired to avoid stoppage of the engine or shafting, belts should in all cases where possible be put on to the pulleys by means of a belt pole. It should be carefully borne in mind, however, that a short belt pole is in itself a source of danger, owing to its liability to deal a severe blow in case of the pin of the pole becoming in any way entangled; fatal accidents have occurred in this way, and therefore it is most important that the length of the pole should be nearly equal to the distance of the shafting from the floor, thus forcing the workman to hold it at his side instead of in front of him. In cases where, for some reason or other, a belt pole cannot be used, the necessity of stopping the shafting in order to put on the belt by hand may be avoided by means of an appliance termed a belt shipper, of which there are a number of types, and which enable a workman to ship a belt with the shafting in motion whilst he is standing on the floor.

Protection of Belts.--Owing to the danger arising from clothing being caught by belts, it is desirable in many cases to protect them; thus belts passing through floors should in all cases be surrounded with a casing of wood; oblique or horizontal belts should be protected by a railing preventing access to them, or by a trough below the belt securely fixed; the same remarks will apply to driving ropes, whilst the splicings of the latter should be frequently examined, owing to their liability to break and cause serious accidents in falling.

Bevel Wheels.--Bevel wheels on shafting should be encased with sheet-iron cover, with one of its faces opening for purposes of oiling.

Means of Stopping Machinery.--Many of the most serious accidents through mill-gearing and belts might be avoided if means existed for stopping the machinery quickly. When it is necessary to go to the engine-house to warn the engine driver to stop the engine, the mischief is done before this can be effected; some means, therefore, should be at hand to stop the machinery at once. In choice of the method by which disconnection is to be accomplished, preference should be given to one which brings it into play from many parts of the factory by mechanical or electrical means, whilst in some cases a brake acting upon a special pulley is provided and brought into play at the same time by the same means. The stoppage of the engine or the disconnection of the main shaft is attended by the disadvantage of stopping the whole of the machinery in the factory, and it is better, therefore, to disconnect each driving shaft individually, thus stopping the machinery in one room only. The disconnecting arrangements which are open to selection are numerous, but mainly consist of two classes, viz., toothed and friction clutches; of these preference may be given to friction clutches for various reasons.

Lastly, with regard to mill-gearing, its care should be entrusted to special and experienced men, and no one else should be allowed to interfere with it. Attendants should, as far as possible, only approach it when it is at a standstill, and their clothing should invariably consist of tight-fitting jackets or jerseys, with nothing whatever loose about them.

Machine Tools.--Having thus disposed of the two first main branches of our subject, viz., prime movers which supply the motive power, and mill-gearing and belts which transmit it, it remains for us to deal with the vast number of machines to which the motive power is communicated and by which the manufacturing processes are carried out. These are so numerous that it would be useless to attempt to deal with them individually in this paper. It will, however, be possible to set forth certain rules which should invariably be observed in order to minimise the risks which at present unnecessarily present themselves to those whose duty it is to attend to machine tools. Whilst the danger of accidents from prime movers and mill-gearing is greatly restricted owing to the fact that they are, or ought invariably to be, in the sole charge of a limited number of experienced persons, the machines themselves are attended to by large numbers of men, women, young persons, and even children. There is, therefore, the greater necessity for taking every precaution possible to prevent the occurrence of accident thereby.

The provisions of the Factory Acts with regard to machine tools are as follows:--

Factory Act, 1901, Sec. 10 (c).--“All dangerous parts of the machinery shall either be securely fenced, or be in such a position, or of such construction as to be equally safe to every person employed or working in the factory, as it would be if it were securely fenced.”

Factory Act, 1901, Sec. 10 (d).--“All fencing shall be constantly maintained in an efficient state whilst the parts required to be fenced are in motion or use.”

By these provisions it will be observed that machine tools are placed on the same footing as mill-gearing, but with the additional precaution that--

Factory Act, 1901, Sec. 13.--“A child shall not be allowed to clean any part of the machinery in a factory while the same is in motion by the aid of steam, water, or other mechanical power.”

In connection with this latter provision it is important to notice that in the case of Pearson v. Belgian Mills Co., (1896), 1 Q. B. 244, it was held that the words “the same” in the section, refer to the machinery as a whole, whether fixed or in motion, and not merely to such parts of it as are in motion; the employment, therefore, of a child to clean the fixed part of machinery in motion constitutes an infringement of the Act.

Further enactments for safety in connection with machines are that--

Factory Act, 1901, Sec. 12 (3).--“A child, young person, or woman shall not be allowed to work between the fixed and traversing part of any self-acting machine while the machine is in motion by the action of steam, water, or other mechanical power.”

Factory Act, 1901, Sec. 12 (1).--“In a factory erected after the commencement of 1896, the traversing carriage of any self-acting machine shall not be allowed to run out within a distance of eighteen inches from any fixed structure, not being part of the machine, if the space over which it so runs out is a space over which any person is liable to pass, whether in the course of his employment or otherwise.”

Factory Act, 1901, Sec. 12 (2).--“A person employed in a factory shall not be allowed to be in the space between the fixed and traversing portions of a self-acting machine, unless the machine is stopped with the traversing portion on the outward run, but for the purpose of this provision the space in front of a self-acting machine shall not be included in the space aforesaid.”

Factory Act, 1901, Sec. 156.--“The expression ‘machinery’ shall include any driving ‘strap or band,’ which are therefore subject to the same provisions as to safety as mill-gearing and machine tools.”

The Acts also give powers to deal with dangerous machinery or parts thereof:--

Factory Act, 1901, Sec. 17 (1).--“By application to a Court of Summary Jurisdiction for an order prohibiting the use of a machine dangerous to life or limb until it is duly repaired or altered.”

Factory Act, 1901, Sec. 13 (2).--“By notifying it as dangerous, in which case it becomes illegal for young persons to clean such parts in motion.”

Fencing of Dangerous Machinery.--With respect to the fencing of machinery in a factory, the importance of the words “all dangerous parts of the machinery,” which were superadded by Sect. 6 (2) of the Factory Act of 1891 to Sect. 5 (3) of the Act of 1878, should be carefully noted. Formerly there was absolute obligation to fence only in respect of prime movers and mill-gearing, whilst in the case of other machinery which an inspector considered dangerous, he was required by Sect. 6 of the 1878 Act to serve notice to fence on an occupier, who was empowered, if he thought fit, to have the matter determined by arbitration. Now the obligation to fence extends to all dangerous parts of the machinery, and the question whether it is dangerous or not has to be decided by the Court in each case. In connection with this it should be noticed that in the case of Hindle v. Birtwistle (1897) the Court of Queen’s Bench held that the enactment applies to all machinery from which, in the ordinary course of working, danger may arise by reason of carelessness on the part of the workmen, or of external causes. It should therefore be sufficient, in order to prove the dangerous character of any part of a machine, to show that accidents are frequently caused thereby.

In propounding certain rules for safety, which should be carefully carried out in the construction of all machines, it may be pointed out that these are not based upon mere opinion, but on the experience and statistics of many years.

Set-screws.--It has been one of the most pernicious habits of almost all machine makers in this country to send out their machinery bristling with projecting set-screws, etc., which are not only unsightly, but also the frequent source of accidents through catching clothing. They are often situated either on or in close proximity to shafts, spindles, collars, or cog-wheels, whereby the dangers attendant on these are greatly enhanced. Hence our first rule, which should be absolute respecting all machinery, should be: (1) No projections shall be allowed on anything that revolves. There are various methods of avoiding such projections by countersinking or otherwise, of which illustrations are given above (Figs. 7 to 9).

Toothed Wheels.--Toothed wheels are probably the cause of more accidents than any other portion of a machine, and their protection has been and is still sadly neglected. They are frequently sent out by makers either with no guard whatever, or with such an inefficient guard as only to partially cover the wheels, thereby doubling the danger to be met by forming two points of junction between the wheels and the guard instead of one only presented by the wheels themselves (Figs. 10 to 12). Our second rule should therefore be: (2) All toothed wheels shall be so effectually covered as to leave no danger between the guard and the wheels.

Shaft or Spindle Ends.--Machine makers frequently leave projecting shafts or spindles at each side of a machine so as to allow of choice in the arrangement of pulleys. These are frequently a source of serious accidents, and our third rule should be: (3) All exposed shaft ends shall be securely covered. This can easily and simply be done by means of a metal cap fitting sufficiently close to revolve with the shaft, but which will instantly stop on clothing, etc., being caught by it (Fig. 13).

Loose Pulleys and Strap Forks.--Most machines are now supplied by makers with loose pulleys and strap forks, but exceptions can be found, more especially in the manufacture of cotton, in the case of carding engines and drawing frames; on the former, though loose pulleys are invariably supplied, strap forks are in most instances absent, thus necessitating the moving of the belt from one pulley to the other by hand or by a stick, a very dangerous proceeding, causing frequent accidents. The most dangerous point is where the belt first touches the driving pulley, and this is guarded where a well-arranged strap fork is provided. In the case of drawing frames both loose pulley and strap fork have generally been omitted, with the result that the undershaft cannot be stopped for cleaning without throwing the belt off by hand, causing additional danger in replacing the belt on the pulley. Our fourth rule, therefore, should be: (4) Loose pulleys and strap forks shall be provided for all machines.

Plate Wheels.--Arm wheels running at high speed are frequently the cause of accidents. Such are specially found in the balance wheels of power looms, the rim pulleys of self-acting mules, and the speed wheels of platen printing machines. These wheels can in almost all cases be made safe, and our last rule should be: (5) Plate wheels or wheels filled in shall be substituted, wherever possible, for arm wheels running at high speed (Fig. 22).

Each of these rules relate to intrinsic parts of the machines, and should therefore be dealt with by the makers themselves, who can carry them out with little or no extra cost at the time of making. Unfortunately, however, it has been in many instances the practice to have one type of machine for the home, and another for the foreign market, the latter with much more efficient guards, owing to the stricter laws which prevail in certain countries as to the occurrence of accidents.

Hoists.--We now come to the last head of our subject, viz., the safe-guarding of hoists and other lifting tackle. The requirements of the Factory Act as to these are absolute.

Factory Act, 1901, Sec. 10 (a).--“Every hoist or teagle shall be securely fenced.”

The importance of this enactment may be gathered from the fact that in 1899 there occurred 27 fatal and 315 non-fatal accidents from hoists alone, whilst other lifting tackle was responsible for 66 fatal and 1497 non-fatal. Parliament has fully recognised the dangers arising from this class of machinery by the omission, in the Factory Act of 1891, of the limitation contained in the Act of 1878, “near to which any person is liable to pass or be employed,” thus placing hoists on precisely the same footing as prime movers, the fencing of which, as shown above, is absolutely compulsory.

Cage hoists are most frequently found in factories, and in these the cage should invariably be roofed over, whilst each side of the cage should be cased in, except that used for exit, thus avoiding danger from anything falling down the hoist-way, and also from projecting obstacles therein. On each floor the hoist-way should be guarded by doors not less than 5½ to 6 feet in height. The single bar or chain which used so frequently to be found is a constant source of danger from persons looking down the well and being trapped between the bar and the bottom of the cage. Falls down the hoist-way through absence of any protecting gate, through the latter being carelessly left open, or owing to the cage being moved to another floor without warning, frequently occur. For perfect safety hoists should be in the sole charge of a special attendant, whose duty it should be to travel with the cage, opening or shutting the doors at each landing as required, the fastenings of which should be accessible only from the inside. Otherwise, automatic gates may be used, so adjusted as to open on the arrival at, and close on the departure of the cage from, each landing; it should not be practicable to open these from the outside, and where there is not sufficient headway for a gate six feet in height, it may be made to telescope.

There are several patent hoists which answer to this description in greater or less degree, but we must content ourselves here with an illustration and description of one of the best methods of safe-guarding hoists, viz., by means of the Knowles safety locking gear for cage hoists (Fig. 14).

Careful attention should be paid to the gear for suspending the cage, in order to prevent accidents from the breaking of the ropes and the precipitation of the cage to the bottom of the hoist-way. For greater safety two wire ropes should be used, which should be periodically and systematically examined. Some one of the various safety gears for arresting the fall of the cage should also be adopted; in this connection we give an illustration (Fig. 15) of “Morgan’s patent safety catches,” which sustain the cage in case of the hoisting ropes breaking through some mishap. In the matter of safe-guarding hoists, also, we are far behind other countries where the law compels employers to provide safety catches and doors for every cage hoist.

Teagles.--Hoisting of goods is often performed by means of a teagle either outside the buildings of the factory, or inside through openings in the floors. In the latter case these openings in each floor should be securely railed; whilst in the former the attendant should invariably be supplied with a safety belt, strong enough to suspend him in the air should he fall. In case, however, of an outside teagle, the dangerous and laborious work of swinging the goods into the room can be avoided by the use of a self-landing and delivering hoist (Fig. 16), which will not only lift goods off the lorry and take them into the room, but will also pick them up inside the room, travel with them outside the doorway, and lower them on to the lorry.

Cranes, Winches, etc.--Although the Factory Acts deal specifically only with “hoists” and “teagles,” yet the numerous accidents mentioned above as attributable to other lifting tackle, plainly point to the urgent need for safeguards, and care in its use. The provisions of the Acts as to hoists are of long standing, and were enacted when the term “factory” did not embrace every dock, wharf, quay, warehouse, and building in course of erection. Great care, however, should be taken to securely fence all bevel wheels of cranes, winches, etc., and periodical examination of all chains, ropes, etc., should be strictly carried out. It should be remembered that steam cranes partake of the nature of the two first divisions of our subject, viz., engines and mill-gearing.

In the preceding pages some pains have been taken to set forth certain regulations which should equally apply to all machinery. It has been shown that the provisions of the law as to fencing prime movers and hoists are absolute, and equally so those applying to mill-gearing unless it be in such a position and of such construction as to be equally safe, as if it were fenced, whilst the machines by which the manufacturing processes are carried out are dealt with by means of the general instruction that “all dangerous parts of the machinery shall be securely fenced,” subject to the same reservation as to position and construction as in the case of mill-gearing. Except in the instances of grinding in tenement factories, chaff-cutting machines, and perhaps it may be added, of self-acting machines, the law has not yet entered into any details as to safe-guarding machine tools. Apart, however, from general rules applicable to all, there remain certain machine tools which, owing to the nature of their construction and use, are peculiarly liable to the occurrence of accidents. For these special guards are necessary, and their invention and use have been spurred on by the liabilities of employers under the Compensation Acts. It would not be possible here to illustrate a tithe of these machines and the most approved guards invented for them, but it is proposed to select a few machines which are shown by statistics to be the most frequent cause of accidents, and the means by which these accidents may, in part at any rate, be obviated.

Self-acting Mules.--Dealing first with our great textile industries, and specially with that of cotton, it will be found that by far the greatest number of accidents occurs in the mule-rooms. Owing to the complicated nature of their construction no one illustration could exhibit all the necessary guards for self-acting mules, but an analysis of the accidents caused by them shows that the parts which are the most fruitful source of injuries to workers are:--

1. Scroll or draw bands and pulleys. 2. Carriage wheels and slips.

For the first, incomplete and approved guards are shown in Figs. 17 and 18; whilst for the second, two types of guards in common use are illustrated in Figs. 19 to 21.

Looms.--Next to mules, power looms are the most frequent cause of accidents in a cotton mill. These present an excellent specimen of the dangerous character of exposed arm wheels running at high speed alluded to above. An illustration of safeguards for the ends of looms will be found in Fig. 22. During 1899 flying shuttles were the cause of 1 fatal and 161 non-fatal accidents. Shuttle guards, of which an example is given in Fig. 23, are either rigid or semi-automatic, but in either case great care has to be taken that they are not fixed too high on the slay cap.

Turning to non-textile machinery, probably no three classes of machine tools show so large an array of accidents as:--

1. Circular saws. 2. Planing machines. 3. Power presses.

Each of these classes present dangers peculiar to itself, and therefore needs special safeguards.

Circular Saws.--Circular saws during the year 1899 were responsible for 1289 accidents, of which 9 proved fatal. The purposes for which they are used are so various that no one universal guard is practicable, but in all cases a riving knife should be provided at the back of the saw, whilst as much of the top and front should also be covered as circumstances will permit. Figures 24 to 27 show illustrations of a few guards which appear best to fulfil these requirements.

Planing Machines.--Accidents through planing machines are of frequent occurrence. They are often of such a severe nature that no planing machine should be permitted to be used without an efficient guard, of which an illustration is given in Fig. 28.

Power Presses. Power presses like circular saws are put to so many uses that various forms of guards are needed to suit the variety of work. They are usually put into motion in one of two ways: either the plunger is released by means of a foot treadle or by a hand lever. Of these the latter naturally presents the fewest elements of danger, owing to the necessary position of one hand whilst using the lever. Additional safety has recently been imparted by the introduction of machines furnished not only with hand levers, but also fitted with slides obviating any necessity for either hand to approach the die.

Fig. 29 illustrates an approved guard for an ordinary tin stamping or cutting press.

ADDENDA.

FIG. 14.--DESCRIPTION OF KNOWLES’S IMPROVED SAFETY HOIST.

The rod A, which extends the full depth of the hoist well, is attached at its upper end to the lever B, the latter carrying the lever C with the stop or projection D, which drops into the toothed rim S on the side of the starting pulley E, and locks the hoist when a door is open, as in Fig. 1. Each door is provided with the lever H, mounted on the centre I, one end being coupled to the rod A by the arm K and rod L, the other end being fitted with the bolt or draw-bar X. To the lever C is attached the hook T extending over the lever B, by which the stop or projection D, on the lever C, is lifted out of gear with the tooth rim S in making an upward movement, caused by dropping the bolt or draw-bar X. When the lever B drops, by the action of opening one of the doors, the stop or projection D on the C is pressed or forced into the toothed rim S by the spring V, as shown in Fig. 2. This apparatus operates as follows:--When the attendant desires to work the hoist, he simply closes the door and drops the bolt or draw-bar X into the hole or slot N in the threshold O, which lifts the levers B and C by the upward movement of the rod A, and moves the stop or projection D from the toothed rim S, as in Fig. 3, at which point it remains until one of the levers H is operated from the inside by the attendant, when it is locked, as shown in Fig. 2. When the stop or projection D is removed from the toothed rim S, the starting band or chain P is at liberty to be operated in the requisite direction at will. To prevent the hoist being started when a door is open, the lever H is latched into the catch or fixing R. It is impossible to start the hoist until the attendant has both closed and bolted the doors.

FIG. 15.--MORGAN’S PATENT SAFETY CATCH. (An improved safety gear for colliery cages, hoists, lifts, etc.)

To sustain the Cage, in case through any mishap the Hoisting Ropes break.--In the arrangements of these catches, two strong steel colliery rods are stretched from top to bottom of the hoist well, and the cage is fitted with two or more cams, across the face of which grooves are made to correspond with the strands of the steel guides.

The cams are fitted in a steel casing, through which the guides pass, so that should the hoisting ropes break, the steel guides are at once gripped by the cams, which hold the cage suspended.

H. S. RICHMOND.

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XV. AGRICULTURE; HORSES; CATTLE

Agriculture

(1) Labourers.--The manifold occupations included under the general term of tilling the soil, exercises a beneficial effect on the husbandman as regards mere length of days, for he often lives far beyond the allotted span, although he rarely comes to the end of his career a hale and hearty old man. His operations are carried out for the most part in the open air, leisurely, and in a greater or less degree of isolation. His condition, therefore, has its drawbacks as well as its advantages. As one of the oldest occupations of mankind it has been very largely adopted as a means of gaining a livelihood, and, until recently, the supply of farm labourers has exceeded the demand. It is badly paid; the farmer, at least in England, has many anxieties, disappointments and losses in his crops and stock; the labourer receives but small wages, and has perforce to put up with scanty living and poor accommodation. The living is made worse by the ignorance of cooking and domestic economy, which is so general amongst the wives and daughters of the labouring class. Field work begins early in the morning, and leads to exposure in all weathers. It is usually so monotonous, that it is unattractive to the better intellects amongst the lower orders; it is sometimes very hard, as during hay-making and harvest, and it is occasionally dangerous, as in hedging and ditching.

“Rheumatic” affections are foremost amongst the bodily ills of field workers, not often as acute rheumatism, but rather in some of the protean forms which affect the connective tissues. Osteo-arthritis, sciatica, lumbago, and valvular heart lesions are commonly met with. Indeed, the rheumatic affections of old age have been known for so long a time that Scapula, in his great lexicon, says, with doubtful, though picturesque, etymology, “Γέρων, the Greek word for an old man, has been derived by some παρὰ τὸ εἰς γῆν ὁρᾷν, because old men by their stooping look towards the earth; though others, with more probability, derive it from the same stem as Γέρας, on account of the reverence due to age.” The etymology, whether right or wrong, draws attention to the stooping habit which is typically a senile kyphosis, though it is accentuated by occupation, and is found early in middle life in agricultural labourers, as often as in tailors, cobblers, clerks, Swiss mountain porters, and, latterly, in some bicyclists. True senile kyphosis or stooping arises from simple weakness and wasting of the tissues, with absorption of the intervertebral discs, and is not necessarily due to rheumatism. But amongst agricultural labourers, it is usually associated with osteoarthritic changes, which tend to unite the individual vertebræ by bridges of bone, whilst it thickens the spines and hardens the ligaments. The stage of anchylosis is often preceded by a period of inflammatory softening, which leads to more or less deformity of the vertebral column, for lateral curvature is nearly as common as the forward stoop to which the name kyphosis is given.

The same factors of hard manual labour, often in constrained attitudes and under unfavourable conditions of weather, produce other “rheumatic” affections, such as pains in the limbs, aching in the bones and stiffness in the joints, which disturb the comfort without lessening materially the wage-earning power of the rural population. No one can have attended the local fair or feast without noticing the peculiar shuffling walk, and the knock-knee of the ploughboy, the results respectively of flatfoot and over-growth, aided by badly fitting, uncouth boots, and a habit of walking over uneven surfaces.

The palmar fascia of the hand often becomes contracted--Dupuytren’s contraction--a condition whose cause is unknown, though it has been variously attributed to such predisposing causes as gout and rheumatism, or to habits and occupations necessitating pressure in the palm and flexion of the fingers, as in digging. The contraction usually begins in that portion of the fascia which is continued on to the sheath of the flexor tendon of the little finger, afterwards attacking the portion extending to the ring finger, and sometimes the remaining fingers. The fingers are thereby flexed and drawn down towards the palm, with which they may even be fixed in contact. This form of contraction may be distinguished from that due to a contracted tendon, by the puckering of the skin in consequence of its adhesion to the fascia, and by the contracting band bifurcating to be inserted upon either side of the flexor tendon, whilst the contracted tendon is placed centrally, and can be traced under the annular ligament.

The kindness of the late Dr Tinley, and Dr Granger at Whitby, and of my brother-in-law Mr G. H. Fosbroke, the County Medical Officer of Worcestershire, has lately allowed me to examine the death returns of two typically rural districts. The chief causes of death are bronchitis, including pneumonia and pleurisy; heart disease, a very vague term covering a multitude of pathological conditions; and phthisis. The deaths from bronchitis and heart disease, in a period of ten years, are nearly equal in number, whilst those from phthisis were only half as many as either of the other two.

Typhoid fever is endemic in many districts, owing to the improper disposal of excrement, and from the use of polluted water in surface wells.

Some of the older countrymen living in the fen districts east of Cambridge still take opium regularly to keep off ague, and I have a working hypothesis that these same dwellers in districts which were once highly malarious are now more subject to cancer than persons who live in towns where the soil is drier and insects are fewer. Be this as it may, however, gardeners and those who have to handle soot in the course of their work are liable to develop epitheliomatous ulcers of the hand and wrist more often than those who are free from such source of local irritation.

Lunacy is increasing markedly amongst the rural population in some parts of the country, and notably in Ireland. This is probably due to the tide of emigration carrying away the more highly endowed and enterprising, whilst it leaves the old and those who are enfeebled in body and mind.

Agricultural labourers do not, on the whole, fare very badly. Even with low wages and bad sanitary surroundings, the social condition of the English farm hand compares most favourably with that of the peasantry in many European countries. The absence of the three great diseases epidemic amongst those who are reduced to the lowest depths of misery by chronic starvation, is a proof of this superior position. The three diseases are ergotism from the use of spurred rye; pellagra due to bad maize; and lathyrism caused by the consumption of the chick-pea.

Ergotism is rife amongst the rye-eating inhabitants of Germany, Bohemia, Sweden, Russia, and the central provinces of France. It occurs especially after rainy seasons, and the bread made from the diseased rye is violet in colour, and of a disagreeable taste and smell. It is usually badly made and badly baked. The symptoms of ergot poisoning are either acute or chronic. The acute form begins with giddiness, headache, lassitude, and disturbances of sight and hearing, which have led to its being called “ergot intoxication.” The chronic poisoning is ushered in with symptoms of ergot intoxication, but the later stages are either convulsive or gangrenous. The convulsive form is marked by intermittent clonic spasms of the limbs, with dilatation of the pupil, delirium, and coma, which soon ends in death, without any appearance of gangrene. The mortification in the gangrenous form is preceded by pain in the part, with intolerable “creeping” feelings, followed by diminished sensibility, which ends in dry gangrene, and finally in separation of the affected tissues. The patients suffer occasionally from vomiting of blood, or from passing blood in the urine, the bleeding being as difficult to arrest as in hæmophilia.

Pellagra from the consumption of bad maize, truly known as the malattia della miseria, is epidemic in parts of France, Spain, Italy, Africa, and Brazil. It requires for its full manifestation a most wretched peasantry. Pellagra is characterised by headache, depression of spirits, sleeplessness, cramps, palsies, giddiness, and dyspepsia. There are vague but often severe pains in the spine and joints, and there is a skin eruption, which begins in April or May, and goes from bad to worse, until it begins to improve in July or August. The eruption is an erythema of the parts exposed to the sun. The skin becomes swollen and tense, with petechiæ and bullæ, which leave indolent ulcers when they break. The attacks recur in the spring of each year, until in time the skin becomes thickened and of a light sepia colour. The nervous symptoms culminate in a settled melancholia. The spinal cord appears to be definitely affected both in ergotism and pellagra, the posterior columns suffering chiefly in ergot poisoning, the lateral columns in pellagra.

Lathyrism results from the use of the chick-pea (Lathyrus sativus, cicer, or clymenum) as an article of diet. Like ergotism and pellagra, it is associated with extremely wretched conditions of life, and has been observed in France, in the Abruzzi, at Allahabad, and in other parts of India. Oxen, horses, pigs, and geese are attacked as well as men. The symptoms point to an affection of the lower part of the spinal cord, and are manifested by a sudden inability to use the legs in the ordinary manner. The legs are so stiff that when the patient walks he is obliged to throw his body into a succession of curves, so that he describes a screw or figure of eight as he proceeds. There is much hyperæsthesia of the lower extremities, which may be followed by loss of sensation, though the patient complains of the same tingling sensations as are felt in ergotism. The onset is usually sudden, and is coincident with the advent of cold weather, but the symptoms take four or five weeks to reach a maximum.

The increasing use of machinery in ploughing, reaping, threshing, and other farming operations leads necessarily to a greater number of machine accidents than was formerly the case when labour was abundant and machines were few. Even small farmers now possess a chaff-cutter, and injuries to the hands and arms produced by its cog-wheels are correspondingly frequent. Much more serious injuries are caused by the large threshing and reaping machines, which are sometimes tended by unskilled persons, as they are often let out on hire. Overstrain from the lifting of loads in awkward positions during harvest is no uncommon cause of hernia in those who are otherwise predisposed to this condition. Poisoned wounds of the hand, and penetrating wounds of the eye, are often sustained in the occupation of hedging and ditching, a form of labour which is also the cause of rheumatism. Occasionally, too, an agricultural labourer presents himself with a viper bite, for vipers are still indigenous in several parts of England. He complains of a burning pain at the part bitten, the limb swells and becomes discoloured within an hour or two, there is great prostration marked by sweating, vomiting, feeble pulse, and restlessness. The more acute symptoms usually pass off in the course of twelve to twenty-four hours, but in unhealthy persons the swelling increases; there may be suppuration, and the bite then ends in a severe attack of inflammation of the tissues, known as cellulitis.

In like manner stings from bees, wasps, hornets, and gnats, which are usually of small importance, may become serious, either from the bad condition of the patient’s health, or from the position of the sting, as when the mouth or conjunctiva is affected. A tolerance is established for bee-stings and gnat-bites, as is shown by the very slight reaction which takes place in bee-keepers and the inhabitants of mosquito countries, as compared with the sufferings of a town-bred man who is stung by either of these insects.

In mushroom-poisoning the poisonous constituent is muscarin, a nitrogenous body allied to cholin. It causes vomiting, diarrhœa, and prostration, with convulsions and contraction of the pupil. Death may occur from syncope and failure of respiration, but such an ending is rare, except in children, because the vomiting promotes the evacuation of the poison. Atropin is the physiological antidote, and a subcutaneous injection of as much as ¹⁄₃₀ to ¹⁄₁₆ of a grain may be given hypodermically, whilst diffusible stimulants are administered by the mouth.

(2) Gardeners appear to suffer from many of the affections common to farm-labourers, except that as they receive higher wages they are better clothed, better fed, and better housed, and are thus able to withstand climatic changes more successfully. It is said, on the other hand, that gardeners are somewhat more liable to phthisis. Their work in hothouses causes them to catch cold more easily, and may thus increase any predisposition to infection by the tubercle bacillus. The handling of such plants as the Primula obconica sometimes produces a very troublesome erythema of the skin, whilst constant contact with fresh soil allows greater opportunities of contracting tetanus.

The Museum of St Bartholomew’s Hospital contains an interesting specimen, showing that the epitheliomatous form of cancer sometimes follows the irritation produced by gardening. The specimen consists of the hand and part of the forearm removed on account of a growth covering nearly half the surface of the skin. The growth is warty, very vascular, superficially ulcerated, and with an everted sinuous edge. It bears a close resemblance to an ulcerated cancer of the scrotum in chimney sweepers. The patient was forty-nine years old. Five years before the amputation of his hand he was employed as a gardener in strewing soot over the ground for several mornings in succession; a warty growth then formed, and it increased and ulcerated in the spring of both the following years, whilst he was similarly employed. After this, though he was no longer in contact with soot, the disease increased until the limb was removed. He recovered completely after the operation. The case is related by Sir James Earle in his edition of Percivall Pott’s works.

Dupuytren’s contraction of the palmar fascia is by no means uncommon in gouty and rheumatic gardeners as they become advanced in years. It is best treated by dissecting out the contracted bands, if this can be done without suppuration, the resulting scar being afterwards kept supple by daily massage.

Horses.

(3) Ostlers, Stablemen, and Cartmen.--This class of men, from their close attendance in stables, necessarily contract the diseases which are transmissible from horses to ourselves. Foremost amongst these diseases are glanders and farcy, of which I have seen several cases in veterinary students; and tetanus, whose bacillus is said to live in the horse’s intestines.

Glanders, in its acute or generalised pyæmic form known as farcy, attacks grooms, ostlers, coachmen, knackers, and veterinary surgeons, because they are brought into contact with diseased animals. It has also been seen as a result of accidental infection in the pathological laboratory during the preparation of mallein; in surgeons who have operated upon glandered patients, and even in washerwomen who have washed the clothes of those affected.

Glanders occurs in an acute form which kills in eight to fifteen days, and a chronic form said to last as long as eleven years.

Acute glanders in man has an incubation period of three to eight days, though the symptoms are occasionally delayed for three weeks, or they may appear within twenty-four hours, and suppuration may occur at the end of the second day. The patient complains of a general feeling of ill-health with headache, and such vague pains in the muscles and joints as lead him to think that he is about to have acute rheumatism. The symptoms increase in severity, and there is often sufficient gastro-intestinal disturbance associated with deafness and stupor to lead to an erroneous diagnosis of typhoid fever. The pulse is full and soft, beating 90 to 100 in a minute; the skin is dry; the mouth foul, and epistaxis is frequent. Swellings--“the farcy buds”--soon appear in the intermuscular planes near the joints on both sides of the body. The swellings are at first hard, but they quickly soften, point, burst, and leave large foul ulcers, which eventually contract into sinuses if the patient survive. The case may then be looked upon as one of chronic pyæmia, especially as rigors are numerous and severe, but all doubt as to the true nature of the disease is set at rest when the face becomes affected. The skin over the nose is reddened and swollen, whilst the mucous membrane is injected and discharges a fœtid secretion, clear at first, but soon becoming yellow, purulent, viscid, and finally blood-stained. Ulceration of the nasal mucous membrane occurs less frequently in man than in the horse. The conjunctivæ are often affected in a manner similar to the nasal mucous membrane, and the inflammatory condition spreads to the pharynx, palate, and glottis. Dyspnœa, with pleuritic pain, may be a marked symptom of the disease, extensive gangrene may occur, and death follows.

Glanders is generally inoculated through a wound or abrasion, but the bacilli are able to penetrate to the uninjured lymphatics of the skin by way of the hair follicles, and in the case of two veterinary students who have been under my care the infection was directly traceable to their being sneezed over by a glandered horse they were examining. If a wound be the seat of infection it may heal, but in a day or two it becomes swollen and painful, an eruption of vesicles often appears round it, and the lymphatics become swollen and painful, though the glands are rarely affected. The skin, in some cases of farcy, shows erythematous patches like those of erysipelas or erythema nodosum. The patches become pustular or phlyctenular, or a pustular rash without umbilication may first be noticed. The latter form of rash is said to be of very grave significance, for recovery seldom if ever takes place when it makes its appearance.

Glanders affects many animals besides horses, mules, and donkeys. It has been seen in lions, leopards, tigers, and bears in various menageries; field-mice, guinea-pigs, and hedgehogs are highly susceptible. Infection may result not only from direct contact with the sick animal and its nasal discharge, but also from the pus, saliva, and milk. Food and drink may convey bacilli directly into the alimentary canal, which is thus affected primarily, the nasal mucous membrane becoming involved as part of a secondary process.

Chronic glanders may last for years, the patient suffering from acute but intermittent attacks of fever, in one of which he may die, or from which he may wholly recover. The skin in these cases is often the part chiefly affected. It becomes swollen and œdematous, with nodules, which only appear in one part and break down into indolent ulcers. The ulcers heal and leave scars which, with the destruction of the septum of the nose and the ulceration of the pharynx and soft palate, sometimes raise a suspicion of syphilis.

The disease depends upon the presence of the bacillus mallei and the toxic substances produced during its growth. The bacillus may be isolated from the abscesses, blood, enlarged skin follicles, and the ulcers. They are more easily recognised in properly stained “smear preparations” than in sections, and are readily cultivated in three to five days on acid potato media at a temperature of 35° to 37° C. as a brownish, moderately thick and opaque growth. The active principle of the growth is “mallein,” which can be obtained as a syrupy fluid. Mallein injected into a glandered animal produces an inflammatory swelling at the seat of inoculation. The tumour is tense, painful, and very extensive. The lymphatics from the seat of inoculation to the neighbouring lymphatic glands become inflamed, and are painful, swollen, and sinuous. The local tumour increases in size for twenty-four to thirty-six hours, but does not suppurate unless septic organisms have been introduced at the time of the inoculation. It subsides slowly in eight to ten days. Inoculation is followed by a general reaction, which appears within eight hours of the time of injection, reaches a maximum in ten to twelve hours, and lasts twenty-four hours. The animal shivers and sometimes has well-marked convulsions. The test is a very valuable one for latent glanders in horses, and as mallein diluted with ten times its volume of a ½ per cent. solution of carbolic acid preserves its qualities unimpaired for many months, it is now largely used in all parts of the world. A healthy horse either does not respond at all to a much larger dose of mallein than will affect a sick animal, or else a small swelling appears at the seat of inoculation, which only lasts for twenty-four hours. Glandered men, in the few cases where it has been employed, show the same reaction to mallein as glandered horses. The Straus test is also valuable in the diagnosis of glanders. It consists in diluting the suspected secretion with sterile water, which is then injected into the peritoneal cavity, and beneath the skin of male guinea-pigs. The testes appear to swell two or three days after the injection, and the animal dies in four to fifteen days with acute inflammation of the tunica vaginalis, the testicles and epididymis being only rarely affected.

Acute farcy is very fatal, but 50 to 60 per cent. of the patients affected with chronic farcy recover. The treatment at present is most unsatisfactory. Stimulants and tonics must be given liberally. Every abscess must be opened and disinfected as soon as possible, and benzoate of soda may be administered in drachm doses three or four times a day. In chronic cases marked improvement is said to have taken place after the continued injection of mallein in doses of ¹⁄₂₀ to ¹⁄₁₅ c.c. at intervals of two or three days.

Tetanus, often called lockjaw, is due to the poison produced by certain bacilli, which were first isolated by Kitasato, Tizzoni, and Cattani, in 1889. The micro-organisms are delicate threads with somewhat rounded ends, which reproduce by sporing. When the bacilli are about to spore one end becomes enlarged, and the organism resembles a pin or a drumstick. The spores are extremely tenacious of life, they resist the effect of high temperatures for an unusual length of time, they survive a temporary immersion in strong antiseptic solutions, and they have been known to retain their vitality for more than twelve months if they are protected from light and air. The parent bacilli are widely distributed in garden earth, in dust, and in the excrement of animals, especially in those of the horse, for this animal seems to be their natural host. They have been found, therefore, in stables and in manured fields, and they have the power of growing outside the body.

During their growth the bacilli produce a powerful poison, which is formed so slowly that it may take two or three weeks to produce its full effects. This poison is formed at the seat of inoculation, for the bacilli do not seem to travel far from the place where they are introduced, and it is generated more rapidly and abundantly in suppurating than in aseptic wounds. It produces its effect by a definite action upon the nervous system, and probably travels through the circulation, though there is still some doubt whether it does not reach the spinal cord by way of the nerves, so definite are some of its early effects. Tetanic symptoms can be produced by the inoculation of toxins, which have been purified of bacilli, and mice appear to be especially susceptible to the disease thus produced.

It will be clear from what has been said that tetanus is by no means rare. It may ensue from a wound at any part of the body, the wound varying in severity from a total crush to a slight abrasion which has passed unnoticed, and the case is then looked upon as one of spontaneous origin. It is especially frequent after injuries of parts which are usually dirty, and is consequently somewhat more common after wounds of the hands and feet. Though gardeners, horse keepers, and agricultural labourers often suffer, I have repeatedly seen cases in people who have been run over, and inoculated with the foul mud of an ill-kept London street. Horses, sheep, and cattle are also liable to infection. But on the whole tetanus has become less frequent, since an attempt has been made to keep wounds aseptic, or at any rate to shorten the process of suppuration.

The onset of the disease is usually marked by a feeling of general uneasiness and depression, unless the wound is too severe to allow of this manifestation. The first symptoms usually consist of a feeling of stiffness or soreness about the jaws and throat, with some tonic contraction of the platysma-myoides, causing the risus sardonicus, which is particularly well marked when the patient is asked to protrude the tongue. Spasms of greater or less severity then occur in the voluntary muscles, the pain varying greatly in different patients, though it is usually less than that of ordinary cramp. The muscles, especially those of the abdominal wall, are in a state of persistent tension in the intervals between the attacks, the tension being reduced to a minimum during sleep or anæsthesia produced by artificial means. The intellect remains undisturbed unless there is much fever. Death takes place from exhaustion as early as the third day in acute cases, but it is often postponed for a fortnight or three weeks.

The prognosis seems to vary with the rapidity of onset, for the mortality is great when the incubation is under ten days, whilst nearly half the patients recover if the symptoms do not appear for more than a fortnight after the injury.

The treatment is largely prophylactic. A wound contracted under suspicious circumstances, as when other cases of tetanus have occurred in the same village or stable, should be immediately rendered aseptic by a process of thorough cleansing. This is preferable to the use of the actual cautery, which leads to suppuration, and thus tends to increase the growth of the bacillus. When the initial symptoms appear, the injured part must be removed, as the wound is a local factory for the production of the nerve poison. Doses of antitoxin must be administered by hypodermic injection, and I prefer to do this by injecting it deeply into the gluteal muscles rather than into the brain or subarachnoid space, as is now the custom. The maximum dose of Tizzoni’s antitoxin is 40 c.c., which is equivalent to 2,500,000 units. This large dose may be given at once, 5 c.c. injections being afterwards given two or three times a day until the tonic contraction of the muscles has disappeared. The antitoxin appears to cure the slighter cases, and it produces a temporary relief in the most severe, but all the severe cases I have seen have died in spite of treatment.

Hydrophobia, the rabies of animals, is another form of poison acting upon the spinal cord, to which huntsmen and stablemen are peculiarly liable from the nature of their occupations. The pathology of the disease, however, is much less clearly understood than in the case of tetanus. Dogs, foxes, wolves, and cats; horses, cows, and deer, may contract rabies and transmit it to man by the saliva, or more rarely by the milk; whilst monkeys, rabbits, and guinea-pigs are susceptible to infection. The latent period appears to vary enormously, as its limits have been given as fourteen days to five years, though the ordinary incubation period seems to be from three to six weeks, the length of time depending upon the ease with which the poison reaches the nerve sheaths, and passes along them to the nerve centres in the medulla and upper part of the spinal cord. There is no doubt, however, that the poison of rabies can be absorbed from the uninjured mucous membranes of the body, especially from the conjunctivæ and the nasal mucous membrane.

In the cases which I have seen the symptoms have been preceded by two or three days of mental agitation and apprehension without apparent cause. Hiccough and difficulty in swallowing were the earliest signs of the disease, and these slight symptoms of undue reflex irritability gradually increased until the whole body became convulsed, the patient’s sufferings being increased by the viscid saliva, which he has attempted in vain to expectorate. Death took place suddenly either from cardiac failure or from spasm of the glottis.

The Pasteur treatment offers the best chance of a cure to a person who has been inoculated with rabies. Its success depends upon the fact that the spinal cord of a rabbit dying of rabies contains the poison, which becomes progressively less virulent after death, if the cord be protected from decomposition by exposure to pure dry air, until on the fifteenth day it is harmless, and a solution of the cord may be injected into a susceptible animal without producing any effect. Successive inoculations of an animal already infected show that it is possible to establish a condition of complete tolerance, even for a strong dose of the poison previously introduced, though the process of inoculation has not been begun until five days or longer after the bite. The Pasteur treatment at the present time consists of a series of simple inoculations lasting fifteen days, during which emulsions from cords of fourteen to three days’ desiccation are injected in doses of 3 to 2 c.c. at a time under the skin of the abdomen. There is also an “intensive” method, for more serious cases, such as the bite of a mad wolf, or when the wounds have been on the face. In this method the number of injections which are usually spread over five days is compressed into three days, the whole duration of the treatment being twenty-one days, a fresh series of injections being recommenced on the fourteenth day. Certain modifications of Pasteur’s method have been adopted, notably the use of an antirabic serum from the dog, prepared by Babes of Bucharest, and an attenuated vaccine by a process of peptic digestion, recommended by Tizzoni and Centanni.

As anthrax or charbon, sometimes known as splenic fever or malignant pustule, is considered elsewhere in this work, it is only necessary to state that the disease is due to the Bacillus anthracis, which is readily communicated from domestic animals to man. It is met with in the following classes: (1) those who come into contact with living animals suffering from anthrax, as drovers, shepherds, farmers, farriers, and veterinary surgeons; (2) those who touch the carcasses of animals that have died of anthrax, as knackers, slaughterers, and others; (3) those who handle the offal, skins, hoofs, horns, hair, wools, and other derivatives from such diseased animals, as tanners, fell-mongers, wool-workers, hair-workers, horn-workers, rag-sorters, plasterers, furriers, felt-workers, brush-workers, mattress-makers, and so forth; (4) in those who have a less direct connection with infective materials; as, for instance, those who live in the neighbourhood of such manufactories or occupations, for the disease may be carried by animals and insects; (5) anthrax has been transmitted from person to person by accidental contact, and may be contracted at a post-mortem examination upon a patient or animal who has died of the disease. There is some reason for supposing that small meat-eaters are more susceptible to anthrax than those who are accustomed to much animal food.

Influenza has long been known to occur in horses, and in several epidemics the disease has been observed to spread from these animals to their attendants. Mr Youatt first pointed out that influenza attacked horses in very local epidemics, so that the majority of horses on one side of a yard might be attacked, whilst there was not a single sick horse on the other side. These prevalences and exceptions are altogether unaccountable, but the probability of the disease is in tenfold ratio to the number of horses inhabiting a stable. Two or three shut up in a comparatively close stable would escape, and out of thirty distributed through ten or fifteen little stables, not one would be affected. But in a stable containing ten or twelve horses, although proportionately larger and better ventilated, the disease would assuredly appear, and when it enters one of the largest stables almost every horse is affected. Horsekeepers may also suffer from horsepox or “grease,” a specific eruption transmissible from the horse to man, of which further details are given at page 246.

Much riding early in life may produce a condition of knock-knee or bowed legs quite apart from rickets. Later in life, the tendon of the adductor longus muscle at its point of origin below the spine of the pubes, and more rarely the tendon of the adductor magnus, may become partially calcified, leading to the condition known as “cavalryman’s leg,” whilst the calcified portion is known as “rider’s bone.” A wrench or sprain of the adductors, “rider’s sprain,” is not an uncommon accident in the hunting-field. It leads to a very troublesome form of chronic inflammation, which may quite prevent riding exercise, and has proved the starting-point of a “rider’s bone.” “Rider’s bursæ” are described as occurring in the fold of the groin and on the inner side of the knee. They are probably enlargements of the ilio-psoas bursa or of the bursæ situated between the semi-membranosus and semi-tendinosus tendons, or beneath the inner head of the gastrocnemius muscle, but I have never seen cases of either occurring in riders, though they are common enough in tuberculous patients. Popliteal aneurism is said to be somewhat more common in jockeys and grooms than in other persons, and these occupations lead also to an increased liability to fractures and dislocations.

Cattle.

(4) Butchers, Slaughterers, and Tanners.--Butchers and slaughterers suffer from an undue tendency to diseases of the throat and chest, because their occupation, at any rate in London, entails very early rising to attend market, their shops are usually quite open, and they are some of the few tradesmen who still cry their wares. Their wounds are very likely to become poisoned, and as they are often overfed and gross in habit, erysipelas is a common sequel of slight injuries. Many porters from the Metropolitan Meat Market apply annually at St Bartholomew’s Hospital for the relief of hernia and ruptured muscles, which they attribute to the strains produced by carrying heavy carcasses and to slipping on greasy pavements. The hospital practice seems also to contain a considerable proportion of cases of aneurism amongst the same class of men.

It is said that the habit of eating tiny bits of raw meat from the chopping block sometimes causes butchers to become infected with the various parasitic worms, which can be transmitted in this way. Their meat-eating and beer-drinking habits, coupled with a sedentary occupation, must be held accountable for their obesity and for the frequency with which they suffer from gout.

I do not know whether tanners are liable to any special diseases except anthrax, but in the business of leather-dressing which is carried on in connection with tanning, the various eruptions produced by aniline dyes are not uncommon, and there is some danger of arsenical poisoning from the use of orpiment.

(5) Cowmen and Dairymaids.--Cowmen and dairymaids in those counties where they are brought into direct contact with cows as milkmaids, are liable to several diseases by reason of their occupations. Foremost amongst these, and of the greatest historical interest, is vaccinia or cowpox, though it is quite a rare complaint in English dairy farms.

Vaccinia is a specific disorder occurring in epidemics amongst bovine animals. It is transmissible to the goat, dog, ass, camel, rabbit, guinea-pig, monkey, and with greater difficulty to the sheep. It is characterised in the cow by a local eruption almost exclusively confined to the udder and teats. The eruption passes through the successive stages of papule, vesicle, and pustule, the number of pocks always being few, and there is considerable constitutional disturbance. The lymph from the vesicles of a cow suffering from pox is sometimes inoculated on the hands of the milkers, when inflamed spots appear more particularly about the joints and tips of the fingers. The spots become vesicular, with a swollen, hard, and inflamed base. The axillary glands become inflamed, and the disorder is attended with some constitutional disturbance. An analogous condition in the horse is called “grease” or horsepox, and inoculation of the horse with cowpox will produce “grease.” Cowpox in bovine animals and “grease” in horses can also be produced by inoculation with human smallpox. Both “grease” and cowpox are transmissible to man by inoculation, both diseases render him to a certain extent immune to smallpox, and both render him less liable to a second attack of cowpox or horsepox. It appears therefore that smallpox, cowpox, and horsepox are very closely allied to each other. They may be identical, the features being modified by transmission through different animals, or they may be descended from a common disease which was more akin to cowpox than smallpox.

Tuberculosis is so common a disease in cows that it is no wonder if phthisis in their attendants sometimes derives its origin from a diseased animal. The disease, however, is much more often carried by the milk, and it is therefore a wise precaution to boil every drop of cow’s milk for three minutes before it is given to a child or to one who is predisposed to consumption. I have seen local tuberculosis of the skin in one or two cases contracted by veterinary surgeons in the course of their duties. Free excision of the affected part has always been followed by prompt healing, and I have never known of any generalisation.

Diphtheria is sometimes carried by milk, the infection being derived either by accidental contamination or from the cow itself. The symptoms of diphtheria in the cow are those of “chapped teats,” viz., rise of temperature and an eruption on the udder and teats. The eruption begins as vesicles, which pass rapidly into pustules, scabs, or ulcers. When the disease is transmitted in this manner the cream and skim milk appear to be more dangerous than the new milk, probably because the organisms have a longer time to grow. Pigeons, turkeys, and cats have also been credited with the power of conveying diphtheria, and in the case of cats the accusation is proved.

There is good reason, too, for thinking that cows suffer from scarlet fever, and that the disease is transmitted by their milk, for in no other way is it possible to account for local epidemics of scarlet fever which have been traced to large dairy farms.

Cows certainly suffer from ringworm, and the tinea is transferred to those who lean their heads against them in the act of milking.

Foot and mouth disease is highly contagious amongst ruminants and pigs. It has often been transmitted to man, usually by the milk of cows suffering from the disease, sometimes by the butter, but most often by direct contact with diseased beasts. Milkmaids, cowmen, shepherds, and veterinary surgeons are thus especially liable to infection. The disease, as it occurs in man, is ushered in by rigors, diarrhœa, and some rise of temperature. On the second or third day a vesicular eruption appears on the gums and tongue, and it may also occur on the fingers or other seat of inoculation. Fortunately the disease as it occurs in man is not serious, and recovery usually takes place spontaneously in the course of a fortnight.

Actinomycosis.--This disease is sometimes derived by inoculation from cattle affected with the fungus, but it comes more often from infected grain. The symptoms are those of a chronic abscess affecting the skin, mucous membranes, or viscera, especially the lungs, liver, and ileo-cæcal portion of the intestine, where it is liable to be mistaken for appendicitis. It appears on the skin in the form of numerous globular masses, which are soft and spongy, and have an indurated erythematous base. Pus which contains the yellow granules characteristic of the disease exudes from the ulcerating points. The disease runs a very chronic course, which is shortened, and the patient cured by enormous doses of iodide of potassium. Doses of a drachm may be given three or four times a day, and the patient not only shows no symptoms of iodism, but improves markedly in general health.

(6) Shepherds suffer by reason of their occupation in two ways. They are of necessity closely associated with dogs, and are thus more liable to hydatids and rabies, whilst from the sheep they obtain flukes, and in the process of dipping they may suffer from arsenical poisoning.

A hydatid is the asexual and cystic form of the Tænia echinococcus, a small tapeworm consisting of three segments, found in the intestines of dogs and wolves. The fertilised ova are swallowed with impure water or with uncooked vegetables, like lettuce and watercress, fouled by the excreta of infected dogs. The hydatid cyst develops slowly in any part of the human body. It is most common in the liver and intermuscular connective tissues, but it is not unusual to find a hydatid cyst in the lungs, kidneys, pelvis, and brain, and I have seen specimens in which the vertebræ and os innominatum were involved. The symptoms are very obscure, and are usually dependent upon the amount of pressure exercised by the tumour. There is sometimes a characteristic hydatid thrill, but its absence does not invalidate the diagnosis. For practical purposes the cyst is composed of two layers, an external or adventitious covering formed by irritation from the tissues of the host, and the soft and white but tough internal cyst, filled with a limpid fluid, containing the characteristic hooklets. The inner lining of this cyst develops daughter cysts by a process of budding, though it is sometimes sterile.

The treatment is essentially surgical. Whenever it is possible the tumour should be freely exposed, the fibrous cyst opened, the fluid contents removed, and the whole endocyst withdrawn. The edges of the ectocyst may then be sutured, and the external wound closed if union by first intention can be practically guaranteed. But if there is any doubt as to the probability of securing asepsis it is better to free the edges of the outer cyst from its attachment to the surrounding organs, and then suture it to the sides of the external opening without including the skin. The cavity usually has to be plugged after the removal of a hydatid from the liver.

It is not supposed that the liver fluke, or Distoma hepaticum, is transmitted from the sheep to man, as is the hydatid from the dog to the man, but it is probable that the shepherd has become the involuntary host of the distoma in the same way as the sheep, by drinking water containing the amphibious snail (Limnæus trunculatus), which is the true intermediate host of the liver fluke in the sheep. This trematode worm has been found in subcutaneous abscesses more often than in the human liver. The treatment, when possible, consists in opening the abscess and thoroughly scraping out its contents, for they show a great tendency to refill.

Pig-keepers.--It does not appear that pig-keepers suffer from any particular diseases by reason of their occupation. It is possible that where only a few animals are kept and are afterwards eaten by the owners there may be some increased liability to trichiniasis, which is an inflammatory state of the voluntary muscles due to the irritation produced by the presence of the nematode worm, Trichina spiralis. I recently saw a young lady who was suffering from a chronic trichinosis. She had numerous hard masses beneath the skin of her legs, which were locally irritable when they first appeared, though they soon ceased to give trouble. At first it was thought that the tumours were multiple fibromata, but on cutting one out and submitting it to microscopic examination it was found to contain encapsuled trichinæ.

D’ARCY POWER.

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