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the frequent occurrence of pneumonia in certain seasons, notably as it occurred with great fatality in the winter and spring Cost Levitra Vs Viagra of 1882 and 1883, is often due to depressed nervous and physical tone resulting from this cause. Again, besides being in itself deleterious and a cause of disease, a sewer at- mosphere may be the cause of disseminating the contagia of specific maladies. Nothing is more probable than that the poison of typhoid fever and cholera, which develop and multiply in the excreta of affected individuals, when dis- charged into the sewers, should there become propagated, and at length escape upward through drain-pipes and com- municate those diseases. Only by this mode of dissemina- tion can we account for the simultaneous outbreak of those maladies at points distant from each other, when a single Cost Levitra Vs Viagra though perfectly isolated case of either has occurred at some other point to afford the necessary contagium ; and nothing can be more natural than that small-pox, scarlet fever, and also other like diseases, should be spread Cost Levitra Vs Viagra from a case afford- ing the specific poison to upper floors in apartment houses through defectively trapped soil- and drain-pipes. If to the foregoing consideration relative to the actual disease, malaise, and debility caused by sewer gas, we add the evi- dence of general rumor as to the sickness resulting from " malaria " in the city, and the fact that such contagious diseases as cholera and yellow fever are most Cost Levitra Vs Viagra persistent and fatal in the presence of filth and putrefying emanations (no- tice reports as to the sanitary conditions of the district most invaded and where the disease was most fatal in Toulon, Franco, by the former, and as to the condition of sewer drainage in Memphis, Tenn., prior to and during the out- break of the latter in tlie autumn of 1884), we may with reason conclude that, as a cause of disease in large Cost Levitra Vs Viagra cities and in country places where cess-pools are allowed to form and remain, sewer gas is second in importance to no other influ- ence or agent. Furthermore, I believe it is a Cost Levitra Vs Viagra safe assertion to make, that — in cities and throughout densely populated districts where refuse Cost Levitra Vs Viagra and decomposing organic matter is re- moved by Cost Levitra Vs Viagra sewers, and water fixtures are connected with these canals by imperfectly trapped drain-pipes, and especially in the older built-up districts and in the houses drained and plumbed some years ago — sewer malaria influences very largely the occurrence, character, progress, and results of all constitutional diseases occarring therein. Indeed, there is no doubt that the emanations, gaseous and liquid, resulting from organic waste of human origin, as it is generally and improvidently disposed of, giving rise to malaria in cities and poisoning drinking water in Cost Levitra Vs Viagra country places, comprise the most prolific cause of disease operative in social life at the present time. Therefore, and on account of its continuance and increase with our devel- oping population, a wiser disposition of this waste and aa efficient protection from Cost Levitra Vs Viagra its injurious eflPects are of the first importance as regards economic and sanitary matters, and they should receive attention accordingly. Economically, all organic debris should not be drained into the sea to be lost for long periods, but properly treated and returned to the soil from whence Cost Levitra Vs Viagra they were derived, there to Cost Levitra Vs Viagra be re- formed into nutritive products. And sanitarily, and in all cases, whatever disposition is made of this matter, the at- mosphere which we breathe and the water which we drink should be protected from pollution by its presence. With regard to sewer gases, as the term is understood to include, we must not overlook the fact that they do not arise wholly from sewers, but are largely generated within the area of the house drainage. Indeed, it is more than probable that most of the malaria suffered from in the city houses results from this source. Within the house, sewer gas may arise and escape in two ways : From without the pipes, from the foul soakings of leaky basement drains, from leaks in the course of the soil- or drain-pipes, or from saturation about fixtures, occurring from continuous drippings. There are few soil-pipes so securely jointed that they will hold water, although they are specified to do so. In fact, it is very difficult to join the several segments of iron soil-pipes so that they will not leak. Bad air, therefore, may continually escape from soil- pipes where imperfect joints are made. This defect of soil- piping is not generally recognized, but it is a matter of great importance and should receive attention, especially as it is capable of remedy. When sewer gas arises from saturation external to basement drains, or when it escapes from badly connected soil-pipes, it is likely to enter the cellar and be drawn up from thence through furnace flues directly into the living and sleeping rooms, and thus pervade the entire house. The other source of sewer malaria is within Cost Levitra Vs Viagra the house- pipes, whence it escapes into the house through the imper- fectly trapped upper ends of drain- and soil-pipes. Gases July 17, 1886.J BUCHANAN: INSANITY IN THE COLORED RACE. 67 generated in the sewers and within the house system equally escape at this point. If imperfectly trapped, therefore, owing to the extent of its source, the amount of gas that may enter the house at this point is great. The means for the prevention of gases arising or escaping from the first source is simply mechanical — a matter of putting in good, reliable, and reliably jointed basement drainage, and equally reliably jointed soil-pipes. Eeliable drainage piping, especially soil piping, from a sani- tary point of view, comprises the most important feature of house-building, and should be put in at whatever cost of money and labor it may require. Reliable drainage being afforded, then the preventive treatment of sewer gas is a matter simply of thorough trapping. Therefore I hold that it is fair to assume that any conveniently operated and practical device that will accomplish a thorough trap- closure of these pipes at tlieir upper ends, and perfectly ex- clude sewer gas in connection with water fixtures, and thereby provide for a necessary use of water and the preser- vation of a pure atmosphere in rooms where fixtures are placed, 7nust prove a valuable contribution to preventive medicine. The requirements for a necessary use of water are two- fold — namely, first, its adequate supply furnished with the required elevation pressure, and, second, numerous and con- veniently placed fixtures for its use. And for the sanitary disposal of sewer gases that tend to escape thereby, tlie requisites are either their efficient antidotal or other treat- ment, so that they shall be rendered Cost Levitra Vs Viagra harmless, or, what is far safer, their entire exclusion by reliably acting trapping