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Book III.

PREVENTIVE MEDICINE.

PART I.

WATER IN ITS HYGIENIC RELATIONS.

THE USES OF WATER.

Adaptation of Water to Human Needs.—Few people who enjoy the benefits of water think what a wonderful and unanswerable argument is afforded by them in favor of the goodness of an all-wise Creator to his creature, man. Of all the fluids with which we are acquainted water is by far the best adapted to the almost infinite variety of human wants, and it is the one of all others most abundant in nature, constituting as it does about three-fifths of the surface of our globe, and nearly seven-tenths of the bodies of man and of most animals. If the common fluid upon which we had to depend were quicksilver, or oil, its boiling-point would be so high that articles of food which we attempted to cook in it would be seriously injured in the effort to prepare them by its aid; and, on the other hand, nearly all the advantages of ice would fail us, in consequence of the exceedingly low temperature at which these substances remain fluid.

Water in All Substances.—Water was considered by the ancient philosophers as one of the four elements out of which all visible objects were constructed; and, in reality, it enters to a greater or less extent into the composition of nearly all natural substances. Thus, for example, some vegetables, like cabbage or celery, contain as much as ninety-five per cent. of water; and, on the other hand, close-grained marble may contain as much as four per cent of water, or almost a quart to the cubic yard. On account of its remarkable solvent powers, which enable it to take up a smaller or larger quantity of nearly every substance with which it comes in contact, water is never found pure in a natural state; and, indeed, absolutely pure water for chemical purposes can only be obtained by repeated careful distillations.

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Air and Gases in Water.—A considerable amount of air generally exists in water, and is taken up by the gills of fishes, assisting them to accomplish the proper aeration, or rather oxygenation, of their blood. The air usually mingled with water may be expelled by boiling, but is absorbed again if the boiled water is agitated with access of the atmosphere.

Boiled Water.—The insipid taste of water which has been boiled is due to the absence of air. Many gases besides air may be artifically or naturally mingled with water, and some, like ammonia or nitric acid, are freely soluble in it. In sea-water, the presence of common salt, with small quantities of sulphate of soda or Glauber's salt, and, of the compound of magnesia and chlorine, called chloride of magnesium, render it entirely unfit for drinking, as many a hapless shipwrecked sailor has found to his cost.

Distilled Water.—At the present day, most sea-going vessels are provided with apparatus for distilling the water of the ocean, and so producing a pure and wholesome but insipid water, which can be rendered, however, more palatable by agitation with plenty of fresh air. Hence, the horrible agony of death by thirst among sailors is now much less frequent than formerly, although mariners inopen boats, or cast upon small, uninhabited islands, still sometimes scan with anxious eyes the briny waste around them, beholding—

"Water, water everywhere, but not a drop to drink."

Sea-Water.—Sea-water varies considerably in composition, being, of course, more concentrated, as a rule, in the tropical regions, where evaporation is most active, such, for example, as in the Mediterranean Sea and the Atlantic Ocean near the equator. According to analysis, the water in the English Channel contains in 1000 parts— 

Chloride of Sodium. .................... 28.05 
Chloride of Magnesium. .................  3.66 
Sulphate of Magnesia....................  2.29 
Sulphate of Lime........................  1.40 
Other Saline Materials..................   .76 
Total Solid Matter...................... 36.16

Besides these, and perhaps contributing largely to the healthful qualities of sea-water, there exist in the ocean small quantities of iodine and bromide, and extremely minute amounts of some of the common metals. It has been found that, by dissolving a little common salt and carbonate of soda, lime and magnesia in distilled sea-water, its taste is rendered much more agreeable; and this plan, it is said, is adopted in the Russian navy.

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Temperature of Sea-Water.—The temperature of the water of the ocean is much less easily influenced by the heat of the sun's rays than the air which floats above it. Thus, for example, between the tropics, where the summer air temperature may attain a height of 130 degrees or 140 degrees in the noonday sun, the temperature of the ocean rarely rises above 80 degrees Fahrenheit. At a distance from the coast, in temperate climates, the temperature of the sea does not vary more than about 20 degrees—being about 50 degrees in winter and 70 degrees in summer. This equability of the ocean temperature has a very important modifying effect upon the climate of maritime countries, rendering them cooler in summer and warmer in winter, thus often favorably influencing the health of the inhabitants. In some islands, as for instance in Madeira and others of these little islands, the thermometer has not, it is said, fallen below 60 degrees, or ascended above 80 degrees, from one year's end to another.

Purity of Rain-Water.—The water, which rises in vapor into the atmosphere from all the oceans, seas, lakes and rivers of the globe is condensed after a longer or shorter time, and falls to the earth again as rain. Rain-water, being in reality a distilled fluid, is the nearest approach to a pure water which we find in nature, and when caught in clean vessels placed upon elevated objects is almost free from contamination.

Impurities in Rain-Water.—It contains, however, small quantities of organic matter, nitric acid and ammonia, all of which are washed out of the air through which it descends as rain. The source of the nitric acid is believed to be the nitrogen of the atmosphere, which combines with oxygen under the influence of the electric spark during thunder-storms. Nitric acid in rain-water exists in such insignificant amount as to be entirely unimportant in itself; but it adds very seriously to the danger of impregnation with lead from lead pipes, roofs and cisterns by rapidly dissolving that metal and forming the very soluble and highly poisonous salt, nitrate of lead.

SOURCES OF DRINKING WATER.

Evaporation.—Our supplies of drinking water are, of course, derived originally entirely from the rainfall. We need not consider now how the water found it way into the air. Without entering into the details of the process of evaporation, all that the present object requires is, that we clearly recognize the fact that spring, fountain, river and lake are all alike fed from the clouds which float over our heads and send their rain upon the just and upon the unjust. Hence, then, man is wholly dependent for his supply of this vital element upon the rain which comes down from heaven. He may dwell upon the most arid plains, but he drinks from the stream which flows beside or underneath his feet —which stream is itself fed by floods that fell perhaps a thousand miles away—and what ever mystery attaches to subterranean waters, we may be sure that, by a long enough circuit, we can trace every drop back to the clouds.

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Various Fortunes of Rain.—The rain which falls upon the face of the earth meets with various fortunes. A part of it—the storm-water, which furnishes most of our drinking fluid—washes the surface of the ground, carries away from it in suspension many of its finely-divided particles, dissolves what it finds easily soluble along its path, is gathered into open drainage channels and, forming part of some river system, hastens to the sea. It touches geological problems at every inch of its way, some of which will be referred to briefly when speaking of soil and climate in their relations to human health.

VARIETIES OF WATER.

Rain-Water.—In classifying waters, we have first to consider them as regards their sources. Rain-water, as already mentioned, is sweet and soft, and when filtered is perfectly adapted to all the purposes of life; the one difficulty about its use being the impossibility of collecting it pure and preserving it without contamination for the long periods of time and in the large quantities which would often be necessary.

Spring and Well Water.—Spring and well waters are almost always more or less impregnated with the soluble ingredients of the earth and rocks through which they pass, and are therefore sometimes very unsuitable for the ordinary wants of life. As a general rule, they are colder than other waters, although hot springs are found in various parts of the world, some with a temperature as high as the boiling point.

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Mineral Springs.—Mineral springs, notwithstanding they are much used for drinking, are properly medicinal agents. They comprise all those waters which contain sufficient quantities of dissolved matters, such, for example, as iron or sulphur, as to produce thereby a positive effect upon the systems of persons partaking of them. The mineral springs of this country are frequently valuable remedial agents in some chronic diseases.

River-Water.—River-water is, to a certain extent, similar to springwater, but is much more apt to be contaminated with sand and clay, organic material from decomposing vegetable or animal remains, the refuse of manufactories, and especially with the sewage of cities and towns, to which it is probable immense amounts of sickness and death are annually due in all civilized countries. Unfortunately, river-water is that which is chiefly supplied to towns and cities, and therefore finds its way into the systems of vast numbers of our fellow-beings.

Stagnant Water.—Stagnant water is, from the large quantity of organic matter in a decomposing state which it holds in suspension or solution, exceedingly unfitted for drinking and culinary purposes, no matter how transparent it may appear; and it should, in consequence, be carefully avoided whenever running water can possibly be procured. Pond-water, canal-water, ditch-water and marsh-water all come under this category, and should be scrupulously shunned, under penalty of suffering from fever and ague, dysentery, typhoid fever, and many other dangerous maladies.

Another Classification of Waters.—Some authors upon hygiene further arrange the different kinds of water into three groups, according to the various uses to which they are applied. The first of these comprises the drinking waters, including the mineral waters, which, though medicinal, are chiefly so by being taken into the stomach; second, the washing waters, and third, the bathing waters, under which head the waters of the ocean are entitled, from a sanitary point of view, to a prominent place. A very important consideration in regard to water-supply, whether it be for a single family or for a large community, is, next after its purity, its abundance. Many instances are on record where, after comparatively expensive water-works had been constructed, it was found that the amount of water obtained was insufficient, and new arrangements must be made.

Quantity of Water Needed.—The quantity of water needed by man and animals must therefore be very carefully calculated. Repeated experiments upon a very extended scale in England have shown that a healthy man requires daily as drink from two to four pints of water, this amount being in addition to that which is swallowed as moisture in food. The amount required for cooking is estimated at from half a gallon to a gallon or more. To this quantity, Dr. Parkes considers should be added for daily ablution, including a sponge bath, five gallons; daily share of kitchen and other utensils, and house washing, three gallons; and share of clothes washing, another three gallons; making up a total of a little over twelve gallons for each individual daily. In the poorer districts of the city of London, the amount used is stated to be only about five gallons 'daily. A shower-bath will require about four gallons extra, and a plungebath from forty to sixty gallons. Where water-closets are used an additional quantity of from four to six gallons daily for each person must be provided.

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Water Supply for Cities.—Professor Rankine estimates that the average daily allowance for each individual in large towns should be ten gallons for domestic purposes, such as those already enumerated; ten gallons for municipal purposes, such as washing streets, extinguishing fires and so forth, and ten gallons more for trade purposes, at least in manufacturing communities. This total of thirty gallons per head, large as it may seem at first sight, is actually furnished to many towns at the present time. Thus, for example, the amount furnished daily to each individual in Paris is thirty-one gallons, and the different London water companies supply from twenty-one to thirty-four gallons daily per head to the entire population.

Supply in American Cities.—In American cities the item of waste enters largely into the account, so that much greater quantities are theoretically furnished. For instance, in Washington 138 gallons, and in New York about 100 gallons, are supplied daily for each inhabitant. In large towns and cities, especially with the combustible buildings so common in the United States, the source of supply must be capable of furnishing, a quantity, in case of extensive fires, vastly in excess of the average consumption. In the great fire of Boston, in 1872, when about sixty acres in the business portion of the city was involved in the burned district, whilst the daily consumption of water was a little over 12,000,000 of gallons, nearly 17,000,000 of gallons are thought to have been used.

Waste of Water.—The amount of waste is so great that, according to the report of the Chicago public works, one-half of the water pumped is wasted, and the cost to the city of wasted water in St. Louis was estimated at $4,000,000 in ten years. In some cases an attempt has been made to diminish the necessity for a very large amount of pure water by having two sets of pipes and introducing two kinds of water, one pure enough for drinking and culinary purposes, and the other suited to the less delicate uses, such as most of the municipal and trade purposes. But, in addition to the seriously increased expense of such a double system, it is found in practice that the purer water is generally employed for nearly all purposes, and little saving is therefore accomplished.

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Method of Supply.—In England, and on the continent of Europe, there are many places where the water-supply is only let into the distributing pipes of a certain section of a town, for example, during a few hours each day, and the turned off and transmitted to another part for another short period. This is called the intermittent supply system; but it has so many disadvantages, prominent among which is the entrance of foul air and organic matters into the empty pipes, whilst they are not in use for delivering the water, that it has seldom been adopted in this country, and is stated to have fallen into disfavor abroad.

DISEASES FROM MINERAL IMPURITIES IN WATER.

Purifying Ingredients.—Since all river, spring and well-waters contain a certain amount of dissolved matters, taken up from the soil through and over which they pass, it becomes a very important consideration to determine what these ingredients are in any particular sample of water, and also the kind and degree of such impurity which will not prove injurious to health. Dr. Letheby, from investigations made in sixty-five English and Scotch towns, arrived at the conclusion that from five to twenty grains to the gallon of the compounds of lime and magnesia are necessary to render drinking water in the highest degree wholesome.

Saline Impurity.—But any quantity of saline impurity exceeding thirty-five grains to the gallon renders a water unfitted for the freest domestic use. Such water would be popularly designated as a very "hard" water, but a good deal of difference is caused by the nature of the hardness, that due to sulphate of lime, and called the permanent hardness because is is not removable by boiling, being decidedly most prejudicial to health.

Diseases Caused by Alkaline Waters.—The symptoms referable to an excess of alkalinity, arising from the presence of these earthy salts in a drinking water, are mainly those of a dyspeptic nature. At first the employment of hard water by persons who are unaccustomed to it produces diarrhoea, which is occasionally serious or even dangerous in its character. But the long-continued use of such a drinking fluid is thought to cause habitual constipation, with the heavy train of evils, including piles and liver complaint, which depend upon it. Calculus, or stone in the kidney or in the bladder, which gives rise sometimes to the most horrible agony human beings are ever called upon to endure, is believed to be due, in many instances, to an excess of lime and magnesian salts in the drinking water.

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Cause of Goitre.—The swelling of the thyroid gland in the neck, producing the repulsive deformity of goitre, or Derbyshire neck, seems to be intimately connected with mineral impurities in water. In Nottingham, England, where this disease is not unfrequently met with, the common people attribute it to the hardness of the water, and other parts of Great Britain it is found to prevail only, or at least especially, in those districts where the magnesian limestone formation abounds.

Goitre in Switzerland.—Dr. Coindet, of Geneva, Switzerland, asserts that Goitre is speedily produced in persons who drink the hard pump-water in the lower part of that town, whilst in other parts of Swizerland the use of spring-water has been followed by the development or augmentation of goitre in a very few days. In India also it has been shown conclusively to prevail, to any marked extent, only where the magnesian limestone rocks underlie the soil; but whether it is the lime and magnesian salts, or whether, as has been suggested, it is the presence of sulphide of iron in the bed-rock formation, which is the direct cause of the development of Goitre, has not yet been positively determined. It appears certain, however, that Goitre is originated by some water impurity, and that this contamination is of an inorganic and not of an animal or vegetable nature.

Organic Impurities in Water.—A small quantity of organic matter of vegetable origin, that is to say, an amount not exceeding three grains to the gallon, is not generally found to be injurious, but even very minute quantities of organic material of animal origin, especially if this material is composed of the waste matters, such as urine or excrement, from man or animals, is the great cause of unwholesomeness of water. Probably one-fourth of the sickness and death in civilized communities arises directly or indirectly from this one cause, and, unfortunately, even when we are fully forewarned of this imminent danger to health, it is exceedingly difficult, in most thickly populated places, to secure a source of water-supply with which sewage has not been mingled.

Impurity of Western Rivers.—The earthy and organic matters which are so abundant in the river-waters of many of our Western States, almost invariably produce diarrhoea in those who are unaccustomed to their use; though this complaint gradually ceases to manifest itself in most cases if the drinking of such water is persisted in. The water of the Mississippi, the Missouri, the Kansas and the Rio Grande has frequently been found to give rise to severe diarrhoea, continuing for several weeks, and occasionally terminating in ulceration of the bowels and death. Even in persons who can under ordinary circumstances drink the waters of these rivers with impunity, frequent intestinal discharges are produced when floods, such as has recently been experienced in Cincinnati, have caused an. unusually increased amount of earthy and organic matter to be carried along in suspension, from the head waters of the tributary streams, and from the overflowed banks.

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Effect of Metallic Impurities.—The effects of minute traces of metallic substances in drinking water have not yet been ascertained with sufficient accuracy, but it is quite possible that the entire sanitary condition of a district may depend in some measure upon impurities of this description. Mr. Wanklyn suggests that the well-known salutary effect of what is called change of air may be, in reality, partly due to the escape from some extremely small metallic impurity in the water of the section of country from which removal takes place.

Cause for Bright's Disease.—It has long seemed probable that the increasing prevalence of that terribly fatal malady, "Bright's disease," especially in cities and large towns, may be due to the poisonous effects of exceedingly minute quantities of lead, dissolved from the lead pipes so generally employed as service-conduits, notwithstanding the protective coating which usually forms so promptly upon them.

Lead Poison in Water.—These are probably very common throughout our whole country, and, contrary to what at first sight might be imagined, it is likely that lead much more frequently and seriously affects the health of people inhabiting small villages and country houses, than that of residents in cities, notwithstanding the latter constantly use water which is brought into their houses through long lines of lead service-pipes. The explanation of this seeming paradox is that river-water, which is that usually supplied to citizens, contains in almost all cases a small amount of the sulphate of lime, sulphate of magnesia, or some other compound of sulphuric acid, which, when brought in contact with the lead pipes, is decomposed, and the resulting sulphate of lead which is formed has the happy faculty of clinging to the inside of the pipes where it is produced, and thus constituting an insoluble lining, which not only protects the tube from further corrosion, but also, what is of far greater importance from a sanitary point of view, prevents any further contamination of the drinking Water which flows through the conduit.

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Lead Poison in Rural Districts.—In rural districts, on the other hand, wherever rain-water is used for drinking purposes, it is exceedingly liable to be contaminated with lead from lead-lined cisterns, lead service or collection-pipes, lead roofs, or from the solder of tin roofs. As a rule, the purer the rain-water, the greater is its action on lead with which it stands in contact; hence, therefore, the presence of a minute quantity of some salt of sulphuric acid in water is of a very great importance, and serves as an invaluable protection against lead-poisoning to the human beings and animals who may employ it for drinking purposes.

How Lead Poisons Water.—When pure water recently boiled is placed in, or run over, lead, no action takes place; but if the water, after being boiled, is exposed for a short time to the air, from which it absorbs oxygen and carbonic acid, and is then brought in contact with lead, we soon find that a whitish film, which on chemical examination is found to be composed of the carbonate of lead, is formed upon the metallic surface. This whitish film, which easily separates from the lead on which it appears, and becomes mechanically mixed with the water, is very poisonous. Since, as already mentioned, rain-water contains usually some nitric acid, in addition to the oxygen and carbonic acid which it absorbs from the air, and this nitric acid combines with lead to form a very soluble and poisonous nitrate of lead, it is much more dangerous than even pure aerated water, after standing for a short time in contact with a leaden surface. Rain-water intended for drinking or cooking purposes ought therefore never to be collected from lead or tin roofs, transmitted through lead pipes, nor under any circumstances stored in lead-lined cisterns of any kind.

Virulence of Lead Poison.—In the celebrated case of the accidental poisoning of the ex-royal family of France, at Claremont, by lead which was taken up in the drinking water, the amount was found not to exceed one grain of the metal to the gallon of water. From cases which have since been observed, it would appear that the habitual use of water containing one-tenth or even one-twentieth of a grain per gallon, is sometimes attended with danger. In his investigation into the cause of that curious disease, as it was formerly considered, the Devonshire colic, Sir George Baker, who discovered that it was only a form of lead-poisoning due to the drinking of cider fermented in lead-lined vats and troughs, found that eighteen bottles of cider he examined contained four and a half grains of lead, or a quarter of a grain to each bottle.

Lead Palsy.—Under some special circumstances, not at present well understood, extremely minute amounts of lead in water may prove injurious. Thus, for example, Dr. Angus Smith speaks of cases in which lead-paralysis, or palsy, was apparently produced by water containing only one one-hundredth of a grain of lead to the gallon.

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Detection of Lead in Water.—The method of detecting the probable presence of lead in a sample of drinking water is so simple that every reader is advised to take the first opportunity of examining their own water-supplies, and so making sure that they or their families are not liable to the insidious dangers of lead-poisoning. In order to determine whether a water is contaminated with lead, all one has to do is to drop two or three drops of the solution of sulphide of ammonium into the suspected fluid, contained in a white bowl or large cup, and observe whether a brownish or yellowish coloration is produced. If the liquid remains perfectly clear and colorless you may be sure that it either contains no lead, or that such a metallic impurity is present in a quantity of less than one-tenth of a grain to the gallon, an amount which is not generally injurious to health. If, however, a slight brownish tint is produced in the water which is being tested, it must not be too hastily condemned as poisonous, since either copper or iron might give rise to the same coloration with the reagent. Such a suspicious water ought, however, to be promptly analyzed by some good analytical chemist before being employed for either cooking or drinking purposes any further.

Applying the Test for Lead.—The sulphide of ammonium may be purchased at a small cost, say for twenty-five cents an ounce, of most dealers in chemicals; and, as its odor is extremely disagreeable, it should be kept carefully corked until the moment it is used. The experiment should be made upon about half a pint of the suspected water; and, if the contamination is supposed to be caused by lead pipes, it is a good plan to test a portion of the liquid which has stood over night in the conduits. The mode of discriminating the precipitate caused by iron from those due to the dangerous metals, lead and copper, is to let fall a few drops of hydrochloric acid, called also muriatic acid, into the fluid. If the brownish or yellowish-brown tint disappears, we may know that innocent iron is the only metallic impurity; whilst if, on the contrary, no change is effected by the addition of the acid, one of the poisonous metals, lead or copper, is present. No water, however, in which the slightest tinge is produced by adding the sulphide of ammonium, should be swallowed by man or beast until a rigid investigation by a competent water-analyist has proved it to be harmless.

Difficulty of Obviating Lead Poison.—Attempts have been made to obviate the danger of water contamination from lead pipes in various, ways, but not as yet with complete success. In some instances the pipes have been lined with other metals, such as tin or zinc; but, at least in some instances, a galvanic action has thus been set up, which corroded the conduits with great rapidity, and probably led, therefore, to still more dangerous pollution of the water supply. Coating the pipes on the inside with coal-tar, bituminous varnish, solution of gutta-percha and of India-rubber, have also been experimented with, as yet with but partial success.

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Lead Diseases.—The injurious effects of lead upon the human system are displayed first, in the production of dyspepsia; later, obstinate constipation and a peculiar kind of colic, so common among painters from the influence of lead that it has received the name of "painter's colic;" and finally, disturbance of the nervous system, especially that peculiar form of lead-palsy called wrist-drop, in which the power to lift up the hand is more or less completely lost.

Iron in Water.—The presence of iron in a water, rendering it what is called Chalybeate, from the old Greek name for iron, renders it to many persons only a useful tonic, but in some people it causes severe headache and serious disturbance of the digestive organs.

Arsenic in Water.—Arsenic, copper and mercury are rarely found in drinking waters in America, except in streams flowing near chemical works, or unless they are introduced designedly with some murderous intention. These metals may therefore be practically ignored in the consideration of water from a hygienic point of view.

Infectious Diseases from Impure Water.—The principal acute diseases which are due to impure water are Cholera, Typhoid Fever, Diarrhoea and Dysentery; and, although it is only within a comparatively recent period that mankind has begun to realize its dangers from this source of these maladies, the accumulated evidence is already very conclusive.

Cholera Due to Impure Water.—Among the remarkable outbreaks which go to prove that this mode of cholera propagation is not at all uncommon, may be mentioned the following, condensed from Mr. Simons' eighth report as medical officer of the English privy council, during the prevalence of cholera in England in 1865: A gentleman and his wife from the village of Theydon-Bois, in Essex, had been lodging at the town of Weymouth for two or three weeks, and returned home towards the end of September. On their way home they passed through Dorchester, where the gentleman was seized with diarrhoea, vomiting and cramps, which continued more or less during the next day and the day following, when he reached his own home. During the journey the wife also began to complain of pain in the abdomen, which was followed by diarrhoea and eventually by cholera, from which she died.

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Cholera Infection.—A few days after their return the same terrible disease rapidly attacked other members of the household, so that, within a fortnight, in that one little circle, eleven persons had been seized with cholera, including the mother, father, grandmother, two daughters, son, doctor, serving-lad, serving-maid, laborer and country-woman, and of these eleven only three survived, namely, the son, a daughter and the serving-lad. Later, in the country-woman's family, there was another fatal case. It cannot well be doubted, concludes Mr. Simon, but that the exciting cause of this succession of events was in some way or other the return of the parents from Weymouth—of the father with the remains of choleraic diarrhoea upon him, of the mother with apparently the beginnings of the same complaint. But this is only part of the case, and the remainder teaches a most impressive lesson. All the drinking water used in the house came from a well beneath the floor of the scullery, and into that well there was habitual soakage from the water-closet.

Another Case of Infection.—Another famous illustration is found in the history of the "tea-water pump" of Broad street, near Golden Square, London, which, during the cholera visitation of 1854, killed nearly 500 persons in a single week, in one of the fashionable localities of the city. It has long been known that water containing five or six grains of lime and magnesia, to the gallon is much to be preferred for making tea to water of any other quality. This is because the lime precipitates the astringent matter of the leaf, yet does not interfere with the solution of the desirable constituents; and hence certain wells which have this proper proportion of mineral matter come to be valued very highly by persons of nice taste.

The Famous London Pump.—At any rate, the Broad street pump had in London the reputation of furnishing, in its cold and sparkling waters, a better medium for "the cup which cheers but does not inebriate," than was elsewhere to be found. When the cholera invaded this neighborhood the wealthy residents retired to the fashionable suburbs which were still uninfected; but, to the surprise of many, the cholera broke out among them with terrible severity. The health officers soon discovered, however, that those who were attacked had sent in every day to their favorite Broad Btreet pump for their water-supply, and, by removing the pump-handle, they quickly put an end to the epidemic.

A Remarkable Incident.—One incident connected with this outbreak was very remarkable: A wealthy spinster, who was not so tired of life as to remain quietly in the path of the pestilence when it approached, withdrew to a suburb called Hampstead. But her tea was particularly dear to her, and every day her serving-maid was sent three miles to the Broad street pump for a kettle of tea-water, and this spinster and her maid were the only persons attacked with cholera in Hampstead.

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Avoiding Cholera.—A first and highly important warning, therefore, which these and many other similar occurrences give us is never to drink any water which, by any possibility, could have become contaminated with the smallest particle of discharge from the bowels of a person suffering from cholera or choleraic diarrhoea.

Typhoid Fever from Polluted Water.—The remarks which have been already made with regard to the influence of impure water on the spread of cholera, apply with still greater force to the causation of typhoid fever. So common is this mode of propagation that the assertion may be ventured that few readers of these pages have not lost some near relative or beloved friend from this dreaded disease arising in this way, although the true source of the infection was perhaps, at the time it occurred, quite unsuspected.

Spread of Typhoid.—Sir William Jenner, than whom no higher medical authority could well be quoted, in commenting upon this point, says: The spread of typhoid fever is, if possible, less disputable than the spread of cholera by the same means; solitary cases, outbreaks confined to single houses, to small villages and to parts of large towns, cases isolated it seems from all sources of fallacy, and epidemics affecting the inhabitants of large though limited localities, have all united to support, by their testimony, the truth of the opinion that the admixture of a trace of excrement, but especially of excrement from a typhoid-fever patient, with the water supplied for drinking purposes, is the most efficient cause of the spread of the disease, and that the diffusion of the malady in any given locality is limited or otherwise, and limited just in proportion as the dwellers in that locality derive their supply of drinking water from polluted sources.

Poison from Leaky Drains.—In the adjoined cut is shown how putrefying animal matters from a leaky drain and an overflowing cess-pool soak diagonally into the well and contaminate the well-water, which is pumped up and used by the family without, perhaps, a thought of danger from this terrible sanitary defect.

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Deadly Effect of Water Impurity.—According to the late Dr. William Budd, it also appears to be highly probable that, when the poison of typhoid fever enters the system by drinking water, infection is much more certain than when it is disseminated by the air and is breathed into the lungs. In support of this statement, he instances an outbreak which occurred in Wales, where out of ninety or a hundred persons who attended a ball, fully one-third was shortly afterwards laid up with fever. Although the water was not examined, there was satisfactory reason to believe that it was polluted with sewage.

Typhoid Poison from a Well.—In the report of the American Public Health Association for 1873, Dr. Austin Flint gives an account of an outbreak of typhoid fever in Vermont which it was possible to trace, in the most circumstantial way, to the poisoning of a well in some such method as has been described. A young man traveling through that region by stage-coach was taken ill, and, when he could go no further, was left at a tavern in a little hamlet to be cared for, his illness soon proved to be typhoid fever. A small watercourse, in a shallow valley, divided the village into two portions, each of which consisted of half a dozen houses or less. In a few days new cases of the fever made their appearance in that part of the hamlet to which the tavern belonged—every house, in fact, but one was invaded with this disease—whilst on the other side of the stream not a case occurred. It appears that the tavern well, which was the only one upon that side of the village, furnished the water-supply to all the families belonging there but one. That one family had had a quarrel with the landlord of the hotel, had consequently deserted the tavern well for a more distant supply of drinking water, and so escaped swallowing the specific poison of typhoid fever in the water by which all their neighbors were stricken down.

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An Impressive Lesson.—The above diagram teaches a most impressive lesson. It represents the relative positions of the well and privy of a house in Lynn, Mass., with a view of the general arrangement of the bedrock upon which the foundation layer of porous gravel rested. Five cases of typhoid fever occurred in this house during the year 1875, and seven more cases of the same disease, with one death, among other persons who used the water. Hence this well, like that of the Vermont tavern-keeper, became the centre of infection of typhoid fever for the whole neighborhood.

Sanitary Well-Digging.—In such instances as this, there is no manner of doubt that the well-water becomes contaminated by the washing or soaking through the ground from cess-pits or other receptacles for the evacuation from the bowels of diseased human beings. Direct experiment has proved that, in a light, porous soil, a well eighty feet deep will drain a portion of earth in the shape of an inverted cone, the point of which is at the bottom of the well, and the base of which is on the surface of the ground, where it has a diameter of about 600 feet, or nearly eight times the depth of the well, and so in proportion for shallower wells. Hence if, in the centre of a large village building-lot, 150 feet square, is dug the well of forty feet deep, for supplying the mansion with water, and at any one of the corners of the yard, as far distant as possible, is sunk a more or less shallow pit to serve as a cess-pool, the chance of contaminating the first pit with rainwater washings from the second pit or cess-pool is very great, and the danger of infecting the whole family with cholera, typhoid fever and probably other maladies, should a single case of these diseases find access to the grounds, imminent.

Danger in Farm-Houses from Polluted Water.—Of course, the same conclusion holds good for country farm-houses or dwellings when, from motives of convenience, although there is space enough and to spare, but a short distance is interposed between the sides of the hole which is called the well, and which furnishes the drinking water, and the other hole near by which is called the cess-pit, and used as a receptacle for filthy, often poisonous, excrement. Moreover, there are no doubt many instances where, owing to the inclination of beds of sand or gravel, strata of rock and so forth, impurities of these and other dangerous varieties may be carried, by underground currents, much further than the distance which, have been mentioned as measured upon the surface of the earth. In other words, a cess-pool on a hill-side, 500 feet or more away from a well, may infect the water of the latter, if underground currents favor such contamination.

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Foul Wells and Graveyards.—Practically, it is beyond all question that, in multitudes of instances throughout the United States, the cess-pits feed the wells, and it is equally certain that such wells feed the graveyards, of villages and districts where so glaring and culpable neglect of hygienic precaution is allowed to occur. In this connection it cannot be too strongly impressed upon my readers that the filtration of water through the earth, even though sufficient to remove all visible impurities, does not necessarily render it safe and fit for use; that is to say, clear water is not necessarily pure water, any more than cold air is necessarily pure air.

Cess-Pool Poisons.—The accompanying illustration forcibly depicts the danger so much insisted on from the contents of cess-pools soaking diagonally through the soil. The well here represented was twenty-five feet deep, a portion being sunk into the bed-rock. The vault of the privy was only ten feet distant, and there was also a cess-pool in the garden below, and a stable close at hand on the left. The water was clear and of good taste, and had been used for many years; but the occurrence of typhoid fever in the house, to which these premises were attached, aroused suspicion, and on examination it was found to be largely contaminated with dangerous organic matter, doubtless from the vault, cess-pool and stable. Five cases of typhoid fever occurred in the family living upon this property, and several more cases, with one death, among the neighbors using the well-water. Here the water was drank habitually for years by a score or more of people without apparent injury, until the fall of 1876, when it doubtless became polluted with the germs of typhoid fever from some pre-existing case of that disease, perhaps by some such mode as that described by Professor Austin Flint, and already referred to a few pages back.

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Diarrhoea and Dysentery from Impure Water.—The instances of outbreaks of these two diseases from contaminated water-supply are very numerous, and probably most of persons can recall examples of this kind. The impurities which produce diarrhoea and dysentery are suspended earthy matters, such as are found in most river-waters after a rain; suspended animal and vegetable material; sulphates and chlorides of lime and magnesia, and nitrates of ammonia and of lime. Besides the numerous outbreaks traceable to direct sewage contamination, there are several instances recorded of indirect poisoning of a water-supply from this source, as in the following curious case.

Outbreak at Salford Jail.—In the Salford, England, jail there was a sudden outbreak of diarrhoea of a choleraic type, which affected more than half of the prisoners; while of the officers and their families, who were distributed throughout the building, not one was attacked. The food of the convicts was examined and found to be good; it was evident, also, that the air did not contain the cause of the disease, because both classes above mentioned were under the same conditions in that respect. Suspicion was therefore directed to the drinking-water. It was then discovered that, though the water supplying all parts of the prison was derived from the same source, there was one cistern for the use of the officers, and another covered cistern for furnishing to the prisoners their allowance, and that the untrapped overflow-pipe of the latter communicated with an open sewer. On the day of the outbreak of diarrhoea in the jail, the water from this cistern was observed to be colored and to taste unpleasantly.

Sewer-Gas Poison.—It had obviously absorbed sewer gas, which had ascended through the overflow-pipe, and that this had been the real cause of the disease was indicated by the fact that the diarrhoea disappeared almost as rapidly as it had broken out, when the cistern was emptied and the pipe efficiently trapped.

Diarrhoea in Country Districts.—Dr. Wilson declares that, according to his experience, much of the diarrhoea which prevails in country districts during the summer and autumn amongst children is due to polluted water, drank either as it is drawn from the well or when mixed with milk, fraudulently or by accident.

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Fluxes from Impure Water.—An old author mentions as a curious fact, which is highly suggestive to us at the present day as well, that ship's crews, when ordered to Tortola, in the West Indies, were invariably seized with fluxes caused by the water; but the inhabitants who used tank-, that is rain-water, were free from the diarrhoea, and so well was this known that, when any resident of Tortola was invited to dinner on board of a man-of-war it was no unusual thing for him to carry his drinking water with him.

Impure Ice as a Cause of Diarrhoea.—The fact that ice is now used by almost all classes to an extent which entitles it to rank rather as a necessity than, as formerly, as a luxury of life, renders it important that its purity should be as jealously guarded as the water-supply. It is popularly believed that water frees itself from dangerous organic matter, as it does to a great degree from certain saline contaminations during the process of freezing, and also that the vegetable or animal germs of typhoid and other fevers are killed, or at least rendered sterile, by congelation of the water in which they exist. Both these ideas are, however, unquestionably erroneous, as has been repeatedly proved by the various experiments which ignorant hotel-keepers try without the least intending it, upon their guests, on a scale which would make the boldest vivisector stand aghast before the suffering inflicted, even if it were only upon the brutes which form the subjects of his researches.

A Case of Impure Ice Poison.—Such was notably the case in an epidemic of intestinal disorder which occurred at the watering-place of Rye Beach, N. H., in 1876. From the account of Dr. Nichols, who attended most of the patients, it seems that, early in the season, a mild form of disturbance of the stomach and bowels made its appearance among the guests of a particular hotel at this favorite summer resort. The symptoms were in general giddiness, nausea or vomiting, diarrhoea and severe abdominal pain, accompanied by fever, loss of appetite and mental depression. The well and drainage system of the establishment, which had recently been put in complete order, was found almost faultless, and the milk-supply of unquestionable purity; but on the attention of the physician being directed to the stock of ice provided for the guests, conclusive proof of its dangerous quality was promptly obtained.

The Contaminated Ice Pond.—Both the house in which the ice was stored and the water from the melted ice gave off a decidedly disagreeable or even offensive odor. Finally, a visit to the pond from which the ice had been gathered disclosed that fact that much of the water in it was dark-colored, foul and highly contaminated with filthy marsh-mud and decomposing saw-dust. Chemical analysis showed that both it and the suspected ice contained a large excess of organic and volatile impurities, including four one-hundredths of a grain per gallon of albuminoid ammonia.

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The Conclusive Test.—The conclusive test, however, of injurious quality pertaining to this ice was afforded by its disuse in the hotel, coincident with which was noticed an abrupt improvement of the symptoms in all who had previously been ill, and the entire absence, so far as known, of any new cases.

Yellow Fever Germs in Ice.—In Connecticut, the Board of Health informs us that, in several instances, attention has been drawn to sewage-contaminated ponds with ice-houses upon their borders, and that several isolated cases of typhoid fever, and one death, from the free use of ice polluted by sewage, had been recorded in that State during 1879. The curious natural experiment of the United States steamship Plymouth, elsewhere detailed, shows conclusively that the germs of yellow fever are not infallibly destroyed by a freezing, probably not by a zero temperature, and contributes its share of proof that impure ice, especially when gathered from ponds polluted by sewage, may constitute a prolific cause of disease.

Dangers in Snow-Water.—Snow-water, pure and fresh as it seems whilst flowing in the sparkling streams which descend snow-capped mountains in our Western States, may be very dangerous to health in consequence of organic impurities contained in it. Mountaineers, to whose long observation and experience in the wilds some attention is due, attribute the origin of the so-called mountain fever to the melting of snows and the drinking of snow-water.

Mountain Fever Due to Snow-Water.—This disease is apt to prevail in the Rocky Mountains in the spring, that is, during May and June, when the ice in the streams breaks up and the snow commences melting. In one instance, out of a party of 367 officers and men, 110 were affected with mountain fever in a few weeks after commencing to drink snow-water, which is described by the medical officer attached to the expedition as being cold, clear and perfectly free from the alkaline taste generally found in waters of that region.

Ague from Impure Water.—Although the poison of fever and ague is probably, as a general rule, conveyed into the human system by being breathed into the lungs, some cases seem to show that it may also enter the body by drinking water.

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Diarrhoea Outbreaks from Impure Water.—As general conclusions in regard to contaminated water, it may be stated that: 1st. An outbreak of diarrhoea arising in a community is almost always owing to impure air, impure water, or bad food. If it affects a number of persons suddenly it is probably due to one of the last two causes, and if it extends over many families, almost certainly to water. But, as the cause of impurity may be transient, it is not always easy to find experimental proof.

Dysentery Outbreaks from Impure Water.—2d. Diarrhoea or dysentery constantly affecting a community, or returning periodically at certain times of the year, is far more likely to be produced by bad water than by any other cause.

Cholera Outbreaks from Impure Water.—3d. A very sudden and localized outbreak of either typhoid fever, or cholera is almost certainly owing to the introduction of the poison by water.

Malarial Outbreaks from Impure Water.—4th. The same statement is true in cases of ague or malarious fever; and, especially if the attacks are serious, a possible introduction by foul water should be carefully inquired into.

Diphtheria Outbreaks.—5th. Where diphtheria proves particularly fatal and carries off several members of a family there is always reason to suspect contamination of the water-supply, which should be remedied as quickly as possible for the sake of the survivors.

Worms from Impure Water.—6th. The introduction of the eggs of some of the intestinal worms, by means of drinking water, is proved in some instances and rendered highly probable in many others. People residing in districts where shallow dip- and draw-wells are in common use, seem to be particularly subject to parasitic worms in the bowels.

Pure Water a Sanitary Necessity.—7th. Although it is not possible at present to assign to every impurity in water its exact share in the production of disease, or to prove the precise evil influence on the public health of water which is not extremely impure, it appears certain, says Dr. Parkes, that the health of a community always improves when an abundant and pure water-supply is given; and, apart from this actual evidence, we are entitled to conclude from other considerations, that abundant and good water is a primary sanitary necessity.

Rocks Yielding Pure Water.—As a general guide to the water impurities that may be expected in waters from the various geological formations enumerated, the following condensed summary of the best known facts, as given by Dr. Parkes, will prove useful. The granitic, metamorphic, trap-rock and clay-slate waters are generally very pure, often not containing more than from two to six grains per gallon of solid matter, which is chiefly made up of carbonate and chloride of sodium, with a little lime and magnesia. The organic matter is very small in amount usually, but shallow wells in disintegrated trap-rock may, of course, be fouled by surface washings or soakage. The water from millstone grit and hard oolite is also very pure, sometimes containing only four grains per gallon of mineral matters, which comprise the same saline materials as are found in granitic waters, with the addition of sulphates and a trace of iron.

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Rocks Yielding Impure Water.—Soft sand-rock waters, on the contrary, are often impure, containing much sodium chloride or common salt, sodium carbonate, sodium sulphate, iron and a little lime and magnesia, amounting altogether to from thirty to eighty grains per gallon. The organic matter may also be abundant, that is, to the extent of from four to eight grains to the gallon, or even more. Occasionally, however, these waters are quite pure.

Sand and Gravel Waters.—The loose sand and gravel waters also vary much in their composition, and in tolerably pure gravels, not near towns, the water is often very free from contamination. In many sands, which are rich in salts, the water percolating through them is, of course, much affected, the dissolved solids amounting sometimes to seventy grains per gallon, and consisting of sodium chloride, sodium carbonate, sodium sulphate, with calcium and magnesium salts, and a good deal of organic matter. The water from the sandy plains of southern France is said to contain enough organic matter to produce ague in those who drink it.

Lias Waters.—Water from the lias clays varies greatly in composition, but is often impure, even 217 grains per gallon of mineral matters having been found in one instance.

Chalky Waters.—The typical "hard" water, from chalk formations, is very sparkling and clear, highly charged with carbonic acid, and contains from seven to twenty grains of calcium carbonate, a little magnesium carbonate and sodium chloride, with small and immaterial quantities of iron, silica, potassa, nitric, sulphuric and phosphoric acids in combination; organic matter is usually in small amount, and it is therefore a good, comparatively wholesome and pleasant water, which, though hard, softens greatly by boiling.

Limestone Waters.—The waters from limestone and magnesian limestone regions are also clear, sparkling liquids, of agreeable taste, but they differ from the chalk waters in that they contain usually more calcium sulphate, the sulphate of lime or gypsum, sometimes to the amount of twelve grains per gallon, and in dolomitic districts much magnesium sulphate and carbonate. They are not so wholesome as the chalk waters, are hard and soften less on boiling.

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Selenite Waters.—Waters from selenite rocks are sometimes highly charged with sulphate of lime, even to the amount of twenty grains per gallon. They are unwholesome to many persons, producing dyspepsia and constipation, alternating with diarrhoea; are hard waters, which soften little on boiling, and are unsuited to either cooking or washing. Genuine clay waters are not common, for very few springs exist in the stiff clay.

Clay Waters.—The water of clayey districts is chiefly surface, and soon runs into converging streams. They often contain much suspended matter in the form of mud, but few dissolved constituents. Waters from the mixture of sand and clay brought down by the rivers, perhaps of former ages, and called Alluvium, are generally impure.

Alluvial Waters.—The alluvial waters contain calcium carbonate and sulphate, magnesium sulphate, sodium chloride and carbonate, iron, silica, and often much organic matter, the total amount of solids reaching 120 grains or more. Occasionally the organic matter oxidizes rapidly into nitrites, and, if the quantity of chloride of sodium is large, it might be incorrectly supposed, from analysis, that it was contaminated with sewage.

Surface Waters.—Surface and subsoil waters are often highly impure, and, although very variable in composition, are always to be regarded with suspicion until proved to be safe.

Heath Waters.—Heaths and moors, on primitive rocks or hard millstone grit, may supply a pure water, perhaps slightly colored, however, with vegetable, matter. Cultivated lands, with richly manured soils, frequently give a dangerous water, containing both organic and saline matters in large quantity.

Soil Waters.—Some soils contain potassium, sodium and magnesium nitrates, and give up these salts in abundance to water which soaks through them. In towns, and among human habitations, the surface and shallow-well water is often very unsafe, as already explained. It may contain large quantities of calcium and sodium nitrates, nitrites, sulphates, phosphates and chlorides. Organic matter exists often in large amount and slowly oxidizes, forming nitric acid and ammonia.

Marsh Waters.—Marsh-water always contains a large quantity of vegetable organic matter, it being not unusual to find from twelve to forty grains per gallon, and sometimes even more. Suspended organic matter is also common, but the amount of saline impurity is very variable.

Poisoned Waters from Graveyards.—In water from graveyards, ammonium and calcium nitrites, and sometimes fatty acids, with much organic matter of animal origin, are met with. The water of a well at St. Didier, France, more than 300 feet from a cemetery, was found to be largely contaminated with ammoniacal salts and organic matter, which was left on evaporation. The water was clear at first, but had a vapid taste and speedily became putrid.

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Artesian-Well Waters.—Artesian-well water varies greatly in composition, being so highly charged with saline matter sometimes that it is quite undrinkable. The artesian well at Grenelle, France, contains enough sodium and potassium carbonates to render it alkaline to the taste, although it is used for the water-supply of the town. In some cases artesian-well water contains an appreciable amount of iron; in other instances, when drawn from the lower part of the chalk formation, or the green sand below it, it is tolerably pure. The temperature of the water is usually high in proportion to the depth of the well. Thus, for example, a well at Louisville, Kentucky, bored to the depth of over 2000 feet, discharges an immense volume of water, the temperature of which is 75 degrees Fahrenheit. The amount of air in the water of deep artesian wells is often small, and this circumstance, with the frequently elevated temperature and high degree of saline impregnation, is apt to make such wells very unsatisfactory as sources of water-supply.

Seashore-Well Waters.—Lastly, water from wells near the seashore is apt to be brackish and objectionable on that account, even though it does not contain much organic matter. Dr. Parkes mentions one instance where a bored well, 150 feet deep, near the sea, yielded water impregnated with 500 grains of solids, including 380 grains of chlorides, per gallon.

THE DETECTION OF CONTAMINATED WATER.

Vigilance Over Drinking Water.—As a general rule, the examination of drinking water, in order to determine its purity, and consequent safety as a beverage, involves a chemical and microscopical analysis, which should always be made when circumstances permit. Moreover, it must not be forgotten that water which is usually pure and wholesome, may be at any time polluted by the fouling of its source during heavy rains, the occurrence of floods, the alteration in the customary course and flow of sewage, manufacturing refuse, and so forth, above or below ground. Constant vigilance over the condition of the water-supply is, therefore, exceedingly necessary to health; but as complete investigation requires the skill of a professed analytical chemist, those methods of examination need only be described in detail which are especially used as giving us warning of danger, with a few of the simpler tests.

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Character of Water Tests.—For hygienic purposes, then, we examine water in order to discover whether it contains any suspended or dissolved ingredients which are likely to be hurtful. Some saline materials often found in water, as already mentioned, are not injurious when present in small quantities only, whilst others, consisting of or resulting from putrefying animal matter, are at once recognized as very dangerous to health. In any instance, reliance must not be placed upon the results of single tests, but all the circumstances of the case must be searched out and carefully considered.

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Color Test of Water.—The examination of water by the ordinary senses, at least as regards its color, clearness and lustre, may be made by filling any tall glass vessel, preferably one having perpendicular sides, with the fluid, and standing it over a sheet of white paper, comparing it if necessary with a sample of pure filtered or distilled water, placed in a similar jar alongside. Perfectly pure water has a bluish tint, but most ordinary waters have a grayish, greenish, yellow or brown appearance. The best samples are tinged bluish or grayish.

Green Waters.—Green waters generally owe their colors to vegetable matters, chiefly microscopic plants, and are usually harmless, although certain bluish-green plants of this kind give rise to the disagreeable smell popularly denominated the pig-pen odor, and probably render the fluid unwholesome as well as disgusting.

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Yellow Waters.—Yellow or brown waters are the most to be feared, as their color is often due to animal organic matter, such as sewage. It is sometimes the case, however, that a yellow or brown tint is due to decomposed vegetable material, such as peat, or decayed wood, and the fluid is then merely unpleasant and not hurtful. Water is also occasionally colored in this way by some salt of iron, although in most instances the metal is precipitated as oxide of iron in the sediment.

Microscopic Tests.—The lustre or brilliancy of a water, which is recommended as a good test as to the amount of air which a specimen contains, can readily be judged by the eye; but the only satisfactory examination of the sediment must be made with the microscope, which ought to have a power of about two hundred and fifty diameters, although even an instrument of half that capacity will often reveal much of interest and importance in the deposit of a suspected drinking water.

Taste Not a Good. Water Test.—The taste of a water is a very uncertain indication in regard to wholesomeness. Of course, any badly-tasting water ought at once to be rejected, but some very agreeable waters, as far as their tastes are concerned, have proved to be dangerously contaminated with sewage of the vilest character. And yet many people are to be found all over the country who think that if a water is bright and clear it must be good; nay, if it is the drinking fluid of their own wells which is called in question, they will often indignantly resent the faintest suggestion that it can possibly be in the least degree injurious to health. As remarked by Dr. Fox, however, such cases as that of the servant who, coming from an obscure village near the Dartmoor, in the southwest part of England, objected to the pure water of a distant town where she was in service, because it was devoid of both taste and smell, are becoming rare.

Where Taste Test Fails.—As regards dissolved mineral matters, taste is of little use, and differs much in different persons. On an average, common salt is not recognized until it reaches the quantity of seventy-five grains per gallon, whilst carbonate of lime is perceptible when dissolved in a water to the amount of ten grains per gallon; iron, however, can be recognized by its astringent flavor in very small quantities, occasionally as minute an impregnation as two-tenths of a grain per gallon may be thus detected. A permanently-hard water has sometimes a peculiarly insipid or slightly saline taste, if the total salts amount to thirty-five or forty grains per gallon and the sulphate of lime or gypsum to six or eight grains.

What Taste of Water is Due to.—The taste of good drinking water is due entirely to the gases dissolved; water nearly free from the hardness of carbonate of lime, held in solution by carbonic acid, such as distilled water, is not so pleasant as the brisk, highly-carbonated waters; it may be called flat, but it is difficult to define the kind of taste or the absence of it.

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Smell as a Test of Water.—To observe the smell of a water, a portion of it should be poured into a wide-mouthed bottle or flask, so as to fill about one-third of its capacity, and then well shaken up. If the smell is unpleasant, the fluid may be at once pronounced unfit to drink. Should no smell be discovered, the flask should be gently heated by placing it in hot water of about the temperature of 110 degrees, and again shaken, and if there is still no odor evolved, a little caustic potash should be added to the warm water. Any unpleasant odor which may be given off after this further test indicates with tolerable certainty that the water contains organic impurities in considerable quantity. The occurrence of a milky precipitate of lime, on the addition of the caustic potash, will at the same time show that you are dealing with a hard water.

Form of Smell Test.—This test by the sense of smell is more delicate if employed in the following manner: Fill a pint bottle two-thirds full, cork it tightly and set it at a window where it will be exposed to the sunlight all day. The next morning, after slightly warming the bottle, uncork it and examine the odor, which, if at all putrid, indicates organic matter in dangerous amount.

Rules for Pure Water.—Although the general characters of a water, when examined as directed above, give only an imperfect idea of its value, they are yet important when no other investigation can be made. If the water be colorless, clear, free from suspended materials, of a good lustre, yet not too brilliant, devoid of smell and taste, except such as are recognized as characteristic of a safe and usable water, we shall in a majority of cases be justified in pronouncing it a wholesome drinking fluid; whilst, according to the degree in which it deviates from these characteristics, will we proportionately be sustained in regarding it with grave suspicion.

Chemical Tests the Best.—Visible suspended matter is probably often the most dangerous, although there is little doubt that the microscopic germs of various diseases may exist in small aggregations, without being recognizable at all by the naked eye of even the most practised observer; and, of course, the metallic impurities, such as lead and copper, for detecting which rules have already been given, must often escape discovery by any examination which does not include the application of chemical tests.

Hessler Test of Water.—The one of these chemical reagents which it would be well to apply in every instance where it is possible to do so, is the "Nessler's test," an ounce of which may be procured from almost any good chemist for twenty or twenty-five cents. It constitutes a test for the products of decomposing animal matters, especially sewage materials, including human and animal excrement, and is therefore capable of giving timely warning against the most dangerous of the common pollutions of drinking waters.

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The Ammonia Test.—In the whole round of chemical analysis there is no determination which surpasses that of ammonia from putrefying animal matter by this method in point of delicacy. It is questionable whether any other approaches it. The Messier reagent is said to be capable of indicating one part of ammonia in twenty million parts of water, and even this assertion, surprising as it may seem, is given as an understatement of the delicacy of the test. Such being the characteristic of this way of calculating the ammonia, the great advantage of causing determinations of organic matter to depend on measurements of ammonia will be manifest to every one.

Form of the Nessler Test.—In order to make use of this reagent, fill an ordinary wine-glass or small goblet which will hold from two to four ounces, nearly full of the water it is wished to examine, and add three or four drops of the Nessler's solution. If a yellow or brown color, or a brownish precipitate, be produced, the water contains ammoniacal salts. As a rule, this should be regarded as a very suspicious circumstance, and should the coloration be well marked, it is almost sufficient of itself to condemn the water for drinking purposes. If a milky or curdy precipitate is also formed, it shows that the fluid is a hard water, and more or less unfit for washing. Should this whitish precipitate be excessive, it hides to a certain extent the yellowish color indicative of ammonia, so that it is necessary to take a fresh sample of the water, add to it a few drops of strong solution of caustic potash or soda, and after the precipitate of lime which is thus caused to fall has subsided, test for ammoniacal compounds with the Nessler's reagent.

The Soap-Test of Impure Water.—Clark's soap-test for determining the hardness of water is prepared by dissolving a small quantity of soap, say one ounce in half a pint of a mixture of equal parts of alcohol and water. It is used by dropping it into a measured quantity, such, for example, as an ounce of the water to be tested, until the fluid when shaken begins to form a beady lather—the relative number of drops required to produce this effect nearly indicating the comparative degrees of hardness of the waters undergoing examination.

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HYGIENIC USE OF BATHS.

Water Test Should Always be Made.—This soap-test may be used to decided advantage in all "hard-water" districts, and every one should test his water-supply at the earliest opportunity, with it, with the Nessler's reagent for organic ammonia indicating pollution by sewage, and with the sulphide of ammonium for contamination with lead. And the application of these two latter tests is important, even although the drinking water in question has been in use for a long time by various members of a family without apparent injury, for many instances are on record in medical books where chronic derangements of health have been due to impurity of the water taken into the stomach, and yet this source of injury has been entirely unsuspected until a chemical examination of the water-supply has revealed the insidious origin of the trouble.

Water Precautions for Travelers.—A wise precaution when traveling, especially in unhealthy districts or during an epidemic of any kind, is to drink none but boiled rain-water, which you can make sure has not been exposed to contamination by lead pipes, roofs or cisterns. To be effectual, the boiling ought to be continued briskly for half an hour or longer. Rain-water is preferable in limestone regions, because the hard water containing lime is partially or not at all improved in this respect by boiling, and gives rise to serious diarrhoea in many of those unaccustomed to its employment. Such hard water is also probably one great cause of the very painful calculous disorders.

HYGIENIC USE OF BATHS.

Temperature of Baths.—Coming now to the detailed consideration of water as applied to the human skin in the form of a bath, in order to accomplish the important hygienic purposes described, it is obvious, in the first place, that temperature has a powerful influence in this respect.

Cold Baths.—The range of the cold bath varies more than that of any other kind, extending, as it does, from 84 degrees Fahrenheit down to 33 degrees of the same scale. The lower temperatures included between these limits would, of course, test the endurance of even the strongest to encounter safely the severe shock which is generally produced by the sudden application, and still more the prolonged immersion of the body in a water so near its freezing-point; but from 84 degrees to. 74 degrees the reaction required is so slight that few persons who are not actually invalids are too feeble to manifest it.

First Effect of the Cold Bath.—A shock is experienced throughout the whole nervous system, more or less severe, according to the lower or higher temperature of the fluid, and the contracting effect of the cold aids the spasmodic contraction occurring in the small blood-vessels to drive the blood to the inner portions of the body, and allow the surface to become quickly chilled.

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Second Effect of the Cold Bath.—But if the cold is not too severe, or the individual is not exhausted by fatigue, or enfeebled by disease, a change in these conditions promptly manifests itself soon after leaving the bath, especially if the skin is rapidly dried by friction with some absorbent substance. The heart and pulse return to their normal rate of movement, the nervous system recovers from the shock which it has undergone, the blood flows back to the surface of the skin, and a glow of renewed warmth is felt throughout the entire body.

A Guide to Cold Bathing.—This agreeable change in the condition of the circulation and the sensations is called the reaction, and constitutes our very best guide to the employment of cool or cold bathing. If the water of a bath has been colder than is adapted to the strength of an individual's constitution, reaction comes on but slowly, and several hours may elapse before the natural balance of the circulation is fully restored. In such a case, the hands, feet and nose remain chilly, and also cold to the touch of another person. The fingers, lips and indeed the whole face, has a bluish tint, and a more or less shrunken appearance. The pulse continues weak and slow, and languor and feebleness characterize all the movements. Of course, the method of deriving the greatest amount of benefit from these indications is for each person to cautiously test the power of his system to establish reaction, commencing with a bath of 70 degrees or 65 degrees, and gradually descending the scale of the thermometer, as he finds he is able to fully react from the depression produced by venturing among its lower depths.

Time for Cold Bathing.—It is recommended by some authors to resort to cold bathing either about an hour before breakfast in the early morning, or else late in the evening just before retiring for the night. The early morning bath of this kind may do very well for some few people of unusually vigorous constitutions, but as a general rule the evening is a better time for such a test of strength; and for many persons the middle of the morning, that is to say, about three hours after breakfast, when the first meal of the day has been nearly all digested, and the system is fortified thereby to bear the shock and establish the necessary reaction after it, is decidedly preferable to any other period of the twenty-four hours.

When to Avoid Cold Baths.—Under no circumstances should a cold bath be indulged in either immediately before or immediately after a meal, on account of the tendency which its inevitable shock will have to produce more or less disturbance in the process of digestion by congesting the stomach and intestines. Nor are cold baths suitable for individuals in either extreme of life, because both in infancy and in old age the power of developing animal heat is least efficient in its operations, and the reaction is accomplished slowly or not at all.

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No Cold Bath After Fatigue.—Protracted labor or exercise, whether mental or physical, if so long continued as to leave the body suffering from feelings of great weariness or exhaustion, absolutely forbid the use of the cold bath. It was under these circumstances that Alexander the Great, of Macedon, nearly perished, from plunging after a long and fatiguing march into the icy current of the river Cydnus; an imprudence which, it is said, did actually prove fatal to the German emperor, the aged Frederick Barbarossa, at the head of his crusading army, seventeen hundred years later. In adverting to this latter event an ancient author quaintly observes: "No wonder if the cold water quickly quenched those few sparks of heat left in him at seventy years of age."

Duration of the Cold Bath.—The duration of a cool or cold bath must vary very much with the temperature of the water. When very cold the period of immersion should not exceed one or two minutes, whilst with water between 60 and 70 degrees, the duration of the bath may extend to a quarter or even half an hour; in every instance, however, we must be guided by the completeness of the reaction on coming out of the water.

Friction After Cold Bath.—Energetic friction of the whole surface of the body after bathing is highly beneficial as tending to produce the necessary degree of reaction. Active physical exercise, as well as warm and stimulating drinks, likewise aid in accomplishing the same desirable result. Even when a person is accustomed to the daily use of the cold bath, any sudden reduction of strength, such as may result from intemperance in eating, an evening debauch, or excess of any kind, particularly of the sexual powers, or even over-exertion in walking or in field-sports, will forbid recourse to it the following morning.

River-Bathing.—Bathing in rivers is even more to be recommended than that in ordinary bath-rooms during the summer season, as the gentle exercise of walking to and from the river-side, and of swimming whilst immersed in the water, promote the reaction which is so conducive to health. Evil consequences are, however, apt to result from river-bathing, if the baths are too prolonged, if too violent exertion is indulged in, or if the rays of the sun overheat the head of the bather. Dr. Bell states that he has seen continued fever, of some days duration, and violent headache, with slight delirium, arise in boys who had thus imprudently exposed themselves.

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VARIETIES OF COLD BATHS.

Cold Sponge-Bath.—There are various ways of employing water in cold bathing, according to the force of the current of fluid, the amount of surface to which it is applied, and so forth. Affusion and sponging are the mildest ways of using cold water as a bath, and there are few persons, not actually invalids, who cannot thus employ water, of moderately low temperature, with benefit. After the slight depression of the bodily warmth, produced by sponging with fluid of 60 or 65 degrees, of course but a mild reaction follows, but this is suitably proportioned to the feeble energies of debilitated persons. By a repetition of the process a greater endurance is developed, and colder water may ultimately be resorted to, with correspondingly increased advantage. The cool or cold sponge-bath is sometimes of great service in treating typhoid fever, and others of the eruptive diseases, as will be explained in the second part of this work.

The Shower-Bath.—In a shower-bath the water falls in divided streams, and thus, being generally distributed over the whole body, gives a severe shock to the system; such a one, should the fluid be of a low temperature, as only the most vigorous persons can endure.

The Cold Douche.—The cold douche differs from the shower-bath in that the water of a douche is poured upon the surface of the body in a solid column, instead of a number of small streams. It is sometimes highly efficacious in reducing the violent excitement of delirious or insane patients, but, being a very powerful agent, should be used only with caution and close watching, never in the indiscriminate way customary in some so-called hydropathic establishments, from which it is said that more than one sudden death has been the lamentable result.

The Bath for Old Age.—The advance into old age of those who, in the vigor of youth and maturity, have accustomed themselves to the regular use of the cold bath, does not necessarily interpose an obstacle to the continuance of the practice of bathing, provided the general health remains good. But if there be evidence of feebleness of the functions, or disorder in any one of the great systems of the body, such as the digestive apparatus, or the muscular system, so as to prevent the customary allowance of nutritious food, or of exercise being taken, the cold plunge or shower-bath should be given up, and simple washing with cold water, followed by active friction, substituted in its place. Should even this prove rather too great a shock for the enfeebled powers of life, as may be evinced by want of prompt reaction subsequently, recourse to anything but the tepid or warm bath must be strictly prohibited.

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The Water-Cure.—The evidence in favor of great benefit being derived in suitable cases from the so-called water-cure, in the numerous hydropathic establishments of Europe and this country, is very convincing; and, in fact, it is probable that persons generally of great mobility of temperament, who are readily excited, and readily depressed, and whose nervous system is soon exhausted by either bodily or mental efforts, will often find relief in the systematic use of a moderately cool or cold bath.

Objection to Hydropathy.—The difficulty is with establishments of this kind that, being carried on as business enterprises, their proprietors are not withheld, by any philanthropic considerations, from looking at every case which applies to them with an eye to business, and recommending their particular cure to all possible patients, except where they are very sure that positive injury will result from the treatment. It is therefore advisable, in every instance, to consult some reputable physician, who is not devoted to any exclusive system or dogma of medical practice, before submitting oneself to the powerful agencies of water as applied by hydropathic practitioners.

Cold Bathing Removes Heat.—Dr. Bell judiciously remarks that there is a class of people, who suffer from a sedentary life, devotion to the desk in business, or to study, and complain of a troublesome heat and dryness of the hands, and sometimes of the feet, with accelerated pulse and thirst; their appetite is not good, nor their sleep sound or refreshing. Though their systems be actually weaker than usual, yet is there morbid activity of the skin, owing, in part, to the vessels of the integument not relieving themselves by free and regular perspiration. Cold bathing, by moderating cutaneous excitement, and relieving the perspiratory organs, removes the unpleasant feeling of heat and dryness; and, by sympathy, produces nearly correspondent effects on the stomach.

The Flesh-Brush and Exercise.—The use of the flesh-brush and exercise in the open air are, it may be supposed, powerful auxiliaries to the measures just recommended.

Cold Bathing for Rheumatism.—There are many persons who, though enjoying what is often called full health, are liable to colds, rheumatic pains and stitches from any slight exposure to cold or moist air. Their vascular and nervous systems are both tolerably excitable, and they are readily thrown into perspiration from even moderate exercise or warm apartments. In them it is desirable so far to regulate the functions of the skin. as to moderate its stimulation, and prevent the consequent debility which follows this state. Cold bathing accomplishes this purpose, and keeps the skin in a less constant condition of excitement, renders it less liable to sweat so freely from exposure to external warmth or by active exercise, and, of course, prevents the subsequent languor and susceptibility to morbid and enfeebling agencies. It would be a great mistake, in such a case, to talk of the tonic action of cold bathing. Its beneficial operation is evinced here at a time when no stimulus or tonic is admissible, and in habits sanguine and plethoric, on which nearly similar effects with those from cold bathing would be produced by a moderate bleeding, reduction of the usual quantity of food and diluent drinks.

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HYGIENIC APPLICATION OF WARM BATHS.

Temperature of Warm Bath.—When the water used for bathing has a temperature of from 92 degrees to 98 degrees Fahrenheit, it produces upon the skins of most people the sensation of warmth, and although water of this degree of heat is usually employed chiefly for cleansing purposes, yet it has hygienic properties of a sufficiently marked character to render it worthy of especial notice. Since water is a much better conductor of heat than air, and especially than confined air, as much caloric is extracted from the human body when immersed in water which is only a few degrees lower than the average human temperature, as by air of much greater relative coldness.

Effect of Warm Bath.—The warm bath diminishes the frequency of the pulse, especially when it has been greater than natural, and this effect is almost exactly in proportion to the duration of immersion. It also renders the respiration slower, and diminishes the temperature of the body, relaxes the muscular fibre, increases the bulk of the fluids by absorption, or perhaps only by restricting evaporation from the skin, removes impurities from the surface, promotes desquamation and renewal of the cuticle, lessening the hardness of the nails and indurations of the epidermis.

Separation of Outer Skin.—The separation of the outer layers of the scarf-skin or epidermis, which may often be seen floating in small whitish fragments upon the bath water, is due to two causes. In the first place, it is softened by the water, and so rendered more easily removable by slight friction; and secondly, it is in part pushed off by the increased fullness of the blood-vessels underneath. A humorous writer has compared the epidermis which covers the whole surface of the body to a tight shirt, and a dirty cuticle, therefore, to a dirty shirt which is gotten rid of by the aid of a bath.

Take Short Warm Baths.—A prolonged daily use of the warm bath is apt to cause eruptions on the skin similar to those which managers of water-cure establishments pronounce critical, and of the greatest advantage in certain diseases of the nervous system.

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Warm Baths Soothe the Nerves.—An immediate and very agreeable effect of the warm bath is to soothe a nervously excited condition and promote sleep, which to many people is peculiarly refreshing when procured by this means.

Time to Take Warm Baths.—The best period for taking a warm bath is about an hour previous to the mid-day meal, because then the disturbance of the circulation will have time to pass off before food is introduced into the stomach, and the secretion of the gastric juice and other fluids necessary for digestion will not be thereby interfered with.

Duration of Warm Baths.—The duration of a warm bath ought not to exceed in ordinary cases half an hour, although in the warm water-cure of Leuk, in Switzerland, patients sometimes remain in the tepid fluid five hours in the morning and three hours in the afternoon, with alleged benefit. In the Leuk baths, persons breakfast from little floating tables, which afterwards serve to support books and newspapers for their amusement, and it is said that the Emperor Charlemagne used to hold prolonged levees whilst immersed in his warm bath at Aix-la-Chapelle, which was supplied by one of the numerous thermal springs of that famous city.

Warm Baths in Acute Diseases.—The relaxing and soothing influence of the warm bath is an invaluable aid to the treatment of many acute diseases, and being, as a general rule, devoid of danger in its application, is a remedy peculiarly adapted to domestic practice, particularly among children, before the skilled physician, who should always be sent for immediately when a person is attacked with any acute disease, has time to arrive. Its prompt remedial effects may often be observed in bilious colic, in painters' colic induced by the poisonous influence of lead, in spasmodic croup, in infantile convulsions, in mental excitement bordering on delirium or even violent maniacal frenzy, and in many other diseases, as will be more fully explained in the second part of this book.

HOT BATHS.

Temperature of the Hot Bath.—The hot bath is so designated if the water employed is above the natural blood-heat of about 98 degrees Fahrenheit, and may range as high as 110 degrees, above which it is seldom safe to use water over the whole surface of the body. Of course, habit will often enable a person to endure the local application of water having a much higher temperature than this without injury.

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Effect of Hot Baths.—Hot baths are decidedly stimulating, and rapidly produce redness of the skin with quickening of the pulse and respiration. Perspiration is poured out upon the face in great abundance, the mind becomes dull and inattentive, and, if the immersion is unduly prolonged, vertigo and apoplexy may supervene. One experimenter lost, during the short space of eight minutes, in a bath of the temperature of 113 degrees, about a pound and a half of his weight. Even a hot foot bath of 110 degrees is stated in one case to have quickened the pulse from seventy-seven to ninety-two, and to have caused some headache in about half an hour. In another instance a foot-bath of 113 degrees raised the pulse from sixty to one hundred and five beats per minute in five minutes, and flushed the face, but without bringing on headache.

Where Danger lies.—The hot bath ought therefore to be employed cautiously or not at all by persons of sanguine temperament, and those of robust or plethoric habit of body, especially if there is any hereditary tendency to apoplexy in their families.

Where Good is Derived.—This powerful remedy is, however, capable of doing good service in conditions of torpid, sluggish circulation, dry and cold skin, feebleness of muscular movement, and a low grade of sensibility; but great care must be used not to mistake this state of the system in an individual naturally weak and phlegmatic, or enfeebled by old age or chronic disease, for the languor of the vital processes which is produced by acute inflammation, or pressure of the blood upon the brain or upon the lungs.

When to Avoid Hot Baths.—In suspended animation from sunstroke, apoplexy, insensibility from inhaling noxious gases, or from swallowing narcotic poisons, disastrous results might be, and probably would be, produced by the application of a hot bath.

When to Use Hot Baths.—In exhaustion and torpor from exposure to intense cold, the hot bath, contrary to popular opinion on the subject, is a most valuable remedy. Some recent experiments performed in Russia, in order to determine what is the best way to resuscitate animals which have been subjected to such severe cold as to be almost fatal in its effects, gave the following results: Of twenty dogs treated by the customary gradual method of bringing them into a cold room which was slowly warmed, fourteen died; of twenty similar animals introduced at once into a warm room, only eight died; whilst of twenty in an analogous condition, which were placed at once in a hot bath, all recovered.

Local Hot Baths.—Hot baths applied locally to small portions of the body only have often proved beneficial in gout and in acute as well as chronic rheumatism, and are highly recommended by some authorities for the relief of piles, in certain affections of the kidneys, and in some female disorders. Sundry modifications of the hot bath, such as the Turkish bath, the vapor bath, and so forth, have, under certain circumstances, considerable value.

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THE HYGIENE OF SEA-BATHING.

When to Refrain from Sea-Bathing.—The long line of seacoast belonging to the United States, and the large proportion of our population which resides within a day's journey of the ocean, by placing a salt bath within the reach of many readers, render the subject of sufficient importance to be separately discussed. On paying a visit to the seaside, it is well to refrain from bathing, and indeed from exposure to the rays of the sun on dry land also, for a day or two if possible after arrival, or until the system becomes a little accustomed to the effect of the salt air and the surroundings. The rules already given in regard to the time of bathing, and especially as to not entering the water for an hour or so before or after a meal, ought to be strictly adhered to.

Duration of Sea-Baths.—The time spent in the water cannot be prescribed with the same exactitude, since the proper length of a dip in the ocean varies very greatly with the temperature of the water and air, the vigor of the individual's constitution, his temporary condition of health, and so forth. But in the state of the circulation we fortunately have a general guide, which every one can readily consult for himself, and quickly determine when nature decides that the bath should promptly terminate. After the first shuddering inspiration, which is generally produced by the application of cold water to the bare surface of the body, with the quickened pulse and breathing which for a few moments accompany it, the pulse, the action of the heart, and the respiration all become slower for a short time, and then are again accelerated.

Signs to Stop a Sea-Bath.—But if immersion in the cold sea-water is is too long continued, the pulse and the breathing are again reduced in frequency, a sense of chilliness comes on, and with this a slight blueness of the lips, and of the fingers underneath the nails, makes its appearance. The moment this is perceived it should be accepted as an imperative order to quit the water at once and restore the lost activity of the circulation, which it indicates, by energetic friction of the surface with warm, dry towels as speedily as possible. As a general rule, from five to fifteen minutes is amply sufficient time to spend in the surf, and it is far better to err on the prudent side by coming out needlessly soon, than to prolong the bath until the teeth begin to chatter and the fingers have the shrivelled, bluish-white appearance of a washerwoman's hand, thereby risking some serious internal congestion afterwards. When the water is unusually cold, and especially when the air is also chilly, a bath in the ocean, if taken at all, should be correspondingly brief.

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What Sea-Bathers Should Do.—In order to obtain the best results, a bather should enter the water whilst he is comfortably warm, and yet not in a free state of perspiration. It is a good plan to wet the head and breast first, or after wading only a short distance from the edge, for the purpose of avoiding the temporary fullness of the brain, which leaves some persons with a dull headache for several hours; also, if the sun is shining brightly, a bathing hat, or other protection for the head and nape of the neck, ought always to be worn.

Adjuncts of Sea-Bathing.—Floating, diving and swimming are excellent ways of adding to the pleasure of the sea-bath, but the latter should not be indulged in when the surf is very heavy, when the tide is running out, or when there is a strong current nearly in a line with the margin of the beach, as the latter may diverge a little from the coast, and carry the bather too far out to sea before he is aware of his danger.

BATHING ACCIDENTS.

Rescuing the Drowning.—A summer so seldom passes at the great seaside resorts without the sacrifice of one or more lives to the want of knowledge respecting the treatment of half-drowned persons, and its timely application, that a few suggestions seem to be called for here, in connection with remarks upon salt-water baths. When a person is seen struggling beyond his depth, the best plan is for a party of rescuers to form a line, holding each others' hands, so that the individual constituting the outer link may be drawn in by the others if grappled and endangered by the drowning man. In endeavoring singly to save an exhausted swimmer, beware of his death-grip, which is often fatal, and try to seize him from behind, by the hair or collar, and tow him to land.

Restoring the Drowned.—On arriving at the shore, if the person, when drawn out on the sand, makes no effort to breathe, lose no time in trying to secure shelter, warmth, stimulants, or even dry ground, but proceed at once, without a moment's delay, to practice artificial respiration, which should be continued faithfully for at least two hours, as even after that length of time without a sign of life, recovery has taken place.

A Good First Rule.—A good first rule is to instantly remove all obstructions to breathing, by loosening or cutting apart all neck or waistbands; then turn the patient on his face with the head down hill, stand astride of his hips with your face towards his head, and locking your fingers together under his belly, raise the body as high as you can without lifting the forehead off the ground, and while thus held give the body a smart jerk to expel, if possible, mucus from the throat and water from the windpipe. To facilitate this important preliminary, let an assistant at this moment pry open the mouth and pull out the tongue, seizing it by the aid of a dry handkerchief.

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A Good Second Step.—The next step is immediately to turn the body over on its back, slip a rolled-up blanket, shawl or coat under the shoulders, and proceed at once to imitate natural breathing. To do this let the operator grasp the arms of the patient just above the elbows, and draw them upward until they nearly meet over the head. ( See first cut.) After pulling them upward forcibly hold them in this position whilst you count slowly, one, two, and then bring them down to the sides again, and press, by means of the elbows, upon the lower part of the chest (see second cut), and the upper part of the belly immediately below the breast-bone, whilst you again count one, two. The former of these movements expands the chest and draws some air into the patient's lungs. The latter motion, which is like shutting together the handles of a pair of bellows, compresses the chest and drives some of this air which has been sucked in out again, thus imitating the process of natural respiration. This alternate expansion and compression of the chest ought to be repeated about fifteen times per minute, and kept up for two or three hours. It is probably more successful in resuscitating those who are apparently drowned than at first sight appears; because some of the people brought to shore under such circumstances as have been described, are dead from heart-disease or apoplexy, and are therefore hopeless subjects for treatment by artificial respiration.

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