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Shobhakar Dhakal · Matthias Ruth
Editors
Creating
Low Carbon
Cities
Creating Low Carbon Cities
Shobhakar Dhakal • Matthias Ruth
Editors
Creating Low Carbon Cities

Editors
Shobhakar Dhakal Matthias Ruth
School of Environment, Resources School of Public Policy and Urban Affairs,
and Development, and Department and Department of Civil and Environmental
of Energy, Environment and Climate Engineering
Change Northeastern University
Asian Institute of Technology Boston, Massachusetts, USA
Pathumthani, Thailand
ISBN 978-3-319-49729-7 ISBN 978-3-319-49730-3 (eBook)

DOI 10.1007/978-3-319-49730-3
Library of Congress Control Number: 2017930816
© Springer International Publishing AG 2017

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
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or information storage and retrieval, electronic adaptation, computer software, or by similar or
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The use of general descriptive names, registered names, trademarks, service marks, etc. in this
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Forewords
Nine years ago half of the people in the world lived in urban areas, and by 2050 the
world is likely to be two-thirds urban. Most people live in mid-sized cities while the
large urban conurbations are growing and emerging. Cities are visible from space
due to their night-time lights, and they resemble the light clusters of stars and
galaxies. Like stars on matter, cities exert strong attraction on people in the
hinterland where the population decreases as city populations grow.
This is one of the strong mega-trends that started with the emergence of
agriculture and early civilizations that accelerated during the industrial revolution,
leading to more than half of the people in the world living in urban areas.
Urbanization and industrialization brought affluence to many, but a third of the
global population was left behind. A quarter of the urban population lives in
informal cities.
Enormous progress, despite great inequities, was only possible because the
climate was stable since the onset of the Holocene almost 12,000 years ago. Global
mean temperature varied less than a degree. This made agriculture possible, and
thousands of years later gave rise to the industrial age.
The dark side of this process is that many people were excluded, and fossil
energy became the prime mover of the world. Combustion of fossil energy leads to
emissions of carbon dioxide and other greenhouse gases. Their increasing concen-
tration in the atmosphere led to climate change, threatening the very base of human
development. Recently, we have witnessed worrisome records. Concentrations of
carbon dioxide have reached 400 ppmv, compared to 120 ppmv during the
pre-industrial age, because humanity has emitted some two thousand billion tons
of carbon dioxide during the past two centuries. We still emit some forty billion
tons of carbon dioxide equivalent emissions every year. The threat of climate
change is endangering human development and has resulted in worldwide calls
for a paradigm change and immediate global decarbonization.
In 2015, two ground-breaking agreements were made; the unanimous adoption
of the 17 Sustainable Development Goals in New York City and the ambitious
Climate Agreement in Paris. The Paris Agreement calls for stabilizing temperature
change to two degrees Celsius compared to pre-industrial levels, and if possible
v
vi Forewords
significantly less. These ambitious goals imply complete global decarbonization

between 2050 and 2070.
Addressing climate change requires deep decarbonization throughout the world.
Cities are a critical part of global decarbonization because of their already large
direct and indirect global greenhouse gas contributions, as well as the opportunities
they provide because of ongoing rapid urbanization. Cities are centers for innova-
tion, new ideas, new policy experimentation, and large-scale infrastructural invest-
ment, adding to the climate change mitigation opportunities.
This book is very timely in addressing one of the greatest human challenges by
assessing from different perspectives how and what cities can contribute toward
global decarbonization. It provides fact-based knowledge and important lessons for
developing low-carbon and eventually zero-carbon cities. Urban climate change
mitigation knowledge and actions are fragmented along many disciplines and
sectors and a book like this, which pulls from many dimensions, is a key knowledge
source for actions.
Understanding the dynamics of urban development is one of the greatest
scientific challenges that transcends most disciplines. Understanding deep
decarbonization toward zero-carbon in urban areas is even more challenging. This
book shows that the key to resolving climate change dangers is in the cities of the
world.
This makes this book important and essential reading for all of those interested in
the future of urbanization and deep decarbonization. I hope that it will contribute to
the emergence of low-carbon cities and a sustainable future for all.
Nebjosa Nakicenovich
Deputy Director General and Deputy Chief Executive Officer,
International Institute for Applied Systems Analysis (IIASA)
There is no doubt that cities are the places where the battle against climate change
can and must be won.
Cities generate as much as 70 % of all energy-related greenhouse gas emissions.
They are also the places where 80 % of global gross domestic product comes from.
The capital to invest in low-carbon and clean energy technologies, the expertise
of the engineers and researchers inventing and constantly improving those technol-
ogies, and the buildings and factories and transport systems that require those
technologies to reduce emissions and energy consumption can all be found in cities.
A few years ago, low-carbon technologies were regarded as a niche affair. The
debate was still very much focused on whether renewable energy and energy-saving
technologies would ever be competitive with coal and oil. Now the debate has
shifted to how fast can we make this low-carbon transition happen.
Forewords vii
In 2015 installed power from renewable energy sources grew by over 8 %.

It more than doubled in 10 years, creating over eight million jobs worldwide in
the process.
Technology is not the issue anymore. As COP21 and the Paris Agreement
demonstrated, it is now a matter of how can we implement low-carbon solutions
to ensure that we steer clear of the worst case scenarios of climate change. Cities
have a crucial role to play in this.
The challenges to such implementation are certainly formidable. To achieve a
fundamental shift of global energy patterns toward a low-carbon scenario, we need
many things: vast funds, in particular to help developing countries strike a balance
between economic growth and sustainability; bold national policies that provide the
framework for this transition to happen; capacity-building of civil servants world-
wide; and in cities, particular, in finding and applying the best possible low-carbon
solutions.
All this has started already. Over 600 local governments have submitted their
2020 emissions reductions plans to the carbon Climate Registry, for a total of
1 GtCO2e in emissions reductions. This figure represents a sizable percentage of
the total 14 Gt gap between current Nationally Determined Contributions (NDCs)
and what would be needed to be sure to keep global warming under 2 C.
Yet, these are only a tiny fraction of the total number of cities and other local
governments across the globe. Whichever technological mixes and policy instru-
ments are chosen, monitoring and reporting progress is and will increasingly be the
cornerstone of the low-carbon transition in cities.
We need more progress monitoring, more analysis of what works and what does
not, and more academic inquiry to guide cities in their efforts to move away from
centuries of fossil fuel-based and energy-intensive growth.
As Secretary General of ICLEI, the leading global network of 1500 local
governments committed to building a sustainable future, I am therefore proud to
introduce this publication, which takes stock of existing projects and trends with
a multidisciplinary approach, looking at both the big picture and the small
incremental steps that can be taken to proceed on this path toward sustainability.
Gino Van Begin

Secretary General, ICLEI – Local Governments
for Sustainability
Contents
Challenges and Opportunities for Transition

to Low Carbon Cities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Shobhakar Dhakal and Matthias Ruth
Big Data, People, and Low-Carbon Cities . . . . . . . . . . . . . . . . . . . . . . 5
Paul Fleming
Co-benefits and Co-costs of Climate Action Plans
for Low-Carbon Cities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Matthias Ruth, Sanchari Ghosh, Sahar Mirzaee, and Nancy S. Lee
Optimizing Water-Energy-Carbon Nexus in Cities for Low Carbon
Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Shobhakar Dhakal and Ashish Shrestha
Grassroots Environmentalism and Low-Carbon
Cities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Kevin Lo
Emerging Low-Carbon Urban Mega-Projects . . . . . . . . . . . . . . . . . . 51
Federico Caprotti
Energy Consumption and Emissions Assessment
in Cities: An Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Lucia Alexandra Popartan and Francesc Morata
Low Carbon Urban Design: Potentials and Opportunities . . . . . . . . . 75
Edwin H.W. Chan, Sheila Conejos, and Michael Wang
Toward Low Carbon Cities: The Chinese Experience . . . . . . . . . . . . 89
John A. Mathews, Mei-Chih Hu, and Hao Tan
Low-Carbon Urban Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Stephanie B. Ohshita and Nan Zhou
ix
x Contents
Low-Carbon Waste Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

Eugene Mohareb and Daniel Hoornweg
Managing Greenhouse Gas Emissions in Cities:
The Role of Inventories and Mitigation Action Planning . . . . . . . . . . 129
Flavia Carloni and Vivien Green
Social Factors Affecting Low-Carbon Cities . . . . . . . . . . . . . . . . . . . . 145
Viresh Patel
Key Drivers and Trends of Urban Greenhouse Gas Emissions . . . . . . 157
Abel Chavez and Joshua Sperling
Potential Transformation Pathways Towards
Low-Carbon Cities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Rose Bailey
Eco-Districts as a Transition Pathway to Low-Carbon Cities . . . . . . . 187
Jennifer Lenhart and Joan Fitzgerald
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Challenges and Opportunities for Transition
to Low Carbon Cities
Shobhakar Dhakal and Matthias Ruth
Abstract Cities are already under pressures from several sustainability challenges.
Raising income, improving livelihood, health, education, and safety, providing
basic infrastructure provision such as water, mobility, energy, and housing services,
and ensuring clean air, land, and water are some of them. All of these, and many
others, compete for scarce financial, human, and intellectual resources. But many of
these also have direct bearing on a city’s carbon emissions, and investments in these
services may be undermined if the contributions to and ramifications of climate
change remain unchecked.
Keywords Sustainable cities • Low carbon cities • Climate mitigation • Climate

adaptation • Technology change • Behavior change • Institutional innovation
Cities are already under pressures from several sustainability challenges. Raising
income, improving livelihood, health, education, and safety, providing basic infra-
structure provision such as water, mobility, energy, and housing services, and
ensuring clean air, land, and water are some of them. All of these, and many others,
compete for scarce financial, human, and intellectual resources. But many of these
also have direct bearing on a city’s carbon emissions, and investments in these
services may be undermined if the contributions to and ramifications of climate
change remain unchecked.
In recent years, cities have progressively received more attention from
researchers, planners, and policy makers for the contributions they make to global
climate change. Climate change is already happening and poses a serious global
threat if not curtailed. The world is rapidly urbanizing, and the vulnerability of
S. Dhakal (*)
School of Environment, Resources and Development and Department of Energy, Environment
and Climate Change, Asian Institute of Technology, Pahaolyothin Road, Klong Luang,
Pathumthani 12120, Thailand
e-mail: shobhakar@ait.ac.th; shobhakar.dhakal@gmail.com
M. Ruth
School of Public Policy and Urban Affairs and Department of Civil and Environmental
Engineering, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
e-mail: m.ruth@northeastern.edu
© Springer International Publishing AG 2017 1

S. Dhakal, M. Ruth (eds.), Creating Low Carbon Cities,
DOI 10.1007/978-3-319-49730-3_1
2 S. Dhakal and M. Ruth
existing and new cities is high, given that large shares of their populations are
exposed to the changes in temperatures and precipitation patterns, sea level rise,
and extreme weather conditions, amongst others. Sound global climate risk miti-
gation requires developing low carbon cities. Cities’ contribution to global CO2
emissions are high, with direct emissions and those from electricity generation
estimated to be in the range of 71–76 %.
Apparently, the world cannot address deep climate change mitigation without
tapping immense mitigation opportunities in cities. As centers of economic and social
activity, recipients of major infrastructure investments, and incubators of technolog-
ical and lifestyle changes, cities play a major role in shaping the future of humanity.
This role is only increasing as urbanization continues and as ever more people and
economic assets are concentrated, often in environmentally fragile locations along
coasts and hillsides, and pushed onto agricultural and wetlands and into forests.
Ecological modernization as one dominant approach, pursued globally, assures
to provide services and goods to growing urban populations through growth in
(urban) economies and thus expanding the technological, infrastructure, and finan-
cial resource base. Ironically enough, however, that strategy to date has largely
exacerbated the root causes of the urban predicament—emissions increase with
growth, fragile ecosystems are further degraded, and human-made infrastructures
are overwhelmed. And in many of those places, where indeed a decoupling of
economic growth from environmental impact is seen, much of it is made possible
by outsourcing the problems to other locations. Islands of green behaviors in
individual parts of a city or country are accompanied by higher environmental
impacts in those locations from which the more affluent urbanites draw the energy
and resources to maintain their lifestyles. For example, from several studies at the
household level and at the city scale, it is apparent that per capita CO2 embedded in
consumption activities and the cross-boundary implications of urban consumption
are enormous and surpasses direct emissions.
Rather than simply ask, for example: How can a city reduce its carbon emis-
sions? We must also ask: What are the unintended consequences of climate action
that spill over to other geographies and populations? How do actions today foster,
or limit, decarbonization efforts in the future? How do these actions contribute to,
or distract from, other key sustainability goals? With this volume on Low Carbon
Cities we embrace many of the challenges and opportunities experienced in cities
and showcase examples of policies, planning, and governance that point towards
sustainable solutions. Many of these examples are, in essence, localized experi-
ments, tuned to the broader goal of decarbonizing urban growth and development
and adjusted to local conditions. The chapter on “Low Carbon Urban Design:
Potentials and Opportunities,” for instance, demonstrates how low carbon urban
design can shape the carbon footprint of cities. Similarly, the chapter entitled
“Toward Low Carbon Cities: The Chinese Experience” highlights examples of
how low carbon city development in China has progressed in recent years, and
provides insights on challenges and opportunities for future developments. The
chapter dedicated to “Emerging Low-Carbon Urban Mega-Projects” showcases
emerging low carbon mega-project such as the Masdar Eco-City and the
Challenges and Opportunities for Transition to Low Carbon Cities 3
Sino-Singapore Tianjin Eco-city. These examples are framed by more general,

conceptual perspectives that are intended to draw lessons from one setting to
another. For example, the chapter on “Co-benefits and Co-costs of Climate Action
Plans for Low-Carbon Cities” places low carbon strategies in the context of other
urban development goals by identifying the co-benefits that may be generated by
these strategies. Attention to co-benefits, so the argument, may elevate some low
carbon strategies in the planning and policy process, allocating more resources to
them than if co-benefits had not been considered. One such area, the water-energy-
carbon nexus in urban water systems, where such synergy exists and can be
harnessed is described in the chapter entitled “Optimizing Water-Energy-Carbon
Nexus in Cities for Low Carbon Development”, which opens up opportunities to
address energy security, water security, and climate change mitigation
simultaneously.
Recent studies, notably the Human Settlement Chapter of the Fifth Assessment
Report (Mitigation) of Inter-Governmental Panel on Climate Change noted that,
despite ambitious goals and many city level actions, the evidence of meaningful
mitigation from cities yet remain elusive. Either city level climate change mitiga-
tion actions are inadequate or are at an early stage of implementation or there are
many implementation problems. Stakeholders, actors, and governance are key to
the success of climate action plans and social factors are central issues not to be
forgotten (see the chapter on “Social Factors Affecting Low Carbon Cities”).
The identification and implementation of decarbonization strategies are shaped
by a diverse set of actors. These include the planners and policy makers who shape
the physical and institutional boundary constraints, the investors who provide
capital for the development and deployment of strategies and who, together with
insurance and reinsurance companies, identify and share risks. Others include the
community, citizens, and citizen groups who articulate local preferences to which,
ideally, planners, policy makers, and investors respond (see the chapter entitled
“Grassroots Environmentalism and Low-Carbon Cities”). However, it is not only
the work of each of these groups that determines the extent to which the dynamics
of cities unfold and carbon mitigation is streamlined in that realm, but also the
institutional and social networks that connect them with each other at the urban
scale, as well as across cities within a nation and across the globe. Under a new
climate regime, new knowledge as well as actions are necessary. Universities and
other research institutions, as well as government agencies, private business, and
nonprofit organizations play a particular role in these networks, often serving as
catalysts for change by providing knowledge products and case examples for
applications of low carbon technologies and strategies.
Managing the carbon profile of cities often means stimulating and managing
urban networks that consist of a wide variety of stakeholders in the public, private,
and nonprofit arena. Since the global climate problem seems overly daunting to
many of these stakeholders and since no individual city can noticeably influence the
size of the problem or the speed at which it unfolds, the real challenge lies in the
need to “think big” but to start small and to scale up fast. New technologies, such as
access to and utilization of the large data streams describing activities of
4 S. Dhakal and M. Ruth
individuals, business, and agencies in the urban system can offer actionable infor-
mation and new opportunities at unprecedented granularity (chapter “Big Data,
People and Low Carbon Cities”). Innovations in and deployment of green building
and clean energy technologies can lay the footprint for lower carbon emissions
(chapters on “Emerging Low-Carbon Urban Mega-Projects,” “Low-Carbon Urban
Infrastructure” and “Low-Carbon Waste Management”). But these technologies
alone will show limited impact if, for example, they are not scaled up and not
adequately supported by financial instruments, many of which are as innovative as
the technologies themselves (see e.g., the chapter on “Low Carbon Cities: The
Chinese Experience”), and if they are not combined with the social factors and
political will for implementation (see chapters entitled “Grassroots Environmen-
talism and Low-Carbon Cities,” “Social Factors Affecting Low Carbon Cities” and
“Eco-Districts as a Transition Pathway to Low-Carbon Cities”). In short, deploy-
ment of low carbon strategies requires more than development of low carbon
technologies. Instead, it requires also innovation in the legal, institutional, and
financial world, and new governance structures that allow low carbon technologies
and behaviors to unfold and flourish.
Transition to low carbon cities must enable cities to begin to operate in different
ways and use new performance measures by which their progress and development
are assessed (see the chapters on “Energy Consumption and Emissions Assessment
in Cities: An Overview,” “Managing Greenhouse Gases Emissions in Cities: The
Role of Inventories and Mitigation Actions Planning,” “Potential Transformation
Pathways Towards Low Carbon Cities: The Big Picture”). Instead of traditional
economic growth goals, stakeholders must drive a city towards a decoupled growth-
environment scenario. A change in the mind-sets of social actors, planners, and
policy makers will be required by which globally agreed-upon targets on emissions
reductions are met by diverse, locally fine-tuned experiments. All this, in turn, calls
for a change in focus from plans and policies to actual implementation, from
incremental changes to the transformative ones, and towards a long-term enabling
environment. It is our goal to contribute with this volume to that shift in mind-sets,
strategies, and actions.
Big Data, People, and Low-Carbon Cities
Paul Fleming
Abstract Information- and communications-technology systems are now

collecting and analysing previously unimaginable amounts of data in cities. Big
data and the “internet of things” are allowing communications between city infra-
structure (buildings, transport systems, equipment, and appliances) and people. For
example, data are collected by a wide range of public and private organizations, and
people are sharing their own local weather and local solar-electricity production.
This chapter discusses how cities can use the information from this increasing
volume of data to decrease their carbon emissions, help create new employment
opportunities, facilitate future infrastructure investment, and more effectively
engage with their citizens.
Keywords Energy management • Low-carbon city • Future city • Smart grids •

Community engagement • Citizen data • Data analysis
Key Terms
Big Data. The large volume of structured and unstructured data that is now
available from buildings, transport systems, people, etc. It refers to data that are
too big to be analysed using traditional data-processing techniques.
The Internet of Things. The representation of uniquely identifiable objects on the
Internet. A medium for transferring data between a data source and the processes
that monitor those data sources. Enabling things to communicate with each other.
Virtual power plant. A collection of distributed energy-supply technologies (fossil
fuel or renewables) that can be virtually managed as “one single power plant”.
Smart grid. An energy network that is able to optimise energy supply with demand
by monitoring and controlling energy supply, storage, and demand. It decreases
peaks in demand by remotely switching off equipment or shifting the use of that
equipment to another time period.
P. Fleming (*)
Institute of Energy and Sustainable Development, De Montfort University, Leicester, UK
e-mail: pfleming@dmu.ac.uk

DOI 10.1007/978-3-319-49730-3_2
6 P. Fleming
Smart city. A city that uses information and communication technology to help
improve governance, mobility, carbon emissions, and peoples’ quality of life. It
uses big data and Internet of Things to manage city infrastructure and to provide
feedback from, and dialogue with, city stakeholders and citizens.
Digital divide. Inequality between people and cities in terms of their access to, and
knowledge of, information and communication technology.
1 Introduction
Cities have been taking action to decrease their greenhouse-gas emissions for many
years. Organisations—such as Energy Cities [1], Fedarene [2], ICLEI [3], Climate
Alliance [4], the Covenant of Mayors [5], the C40 Cities Climate Leadership Group
[6], Eurocities [7], and the OECD [8]—all possess a wealth of information on how
to decrease greenhouse-gas emissions at the city scale. Traditionally, local and
regional emissions data were derived from annual records of electricity, gas, oil,
and solid fuel use, which account for >80 % of emissions [9]. City energy managers
then focused on specific programmes to decrease their emissions and estimate the
potential reductions [10]. Sub-hourly data from utility meters and building energy-
management systems now provide energy-related data almost in real time. Traffic-
management systems provide real-time traffic information and make it available on
the Internet. The Internet of Things has resulted in many devices being Internet
enabled, thus allowing for two-way communications with “things” that are now
being controlled rather than just measured. This brings with it the potential for
“smart” systems. However, these smart systems must be robust to cope with
potential disruptions. For example, they may need to include local data storage to
address potential cascading failures when electricity network interruptions disrupt
the performance of sensors and communications networks. Such disruptions could
undermine the reliable operation of future smart networks as well as that of future
smart cities. An example is the city of Lancaster, UK, where flooding caused the
electricity system to be unavailable for 4 days resulting in a loss of data commu-
nications and problems for people living and working in the city [11].
Future cities will not operate the way cities did in the past, with centralised
power supplies. Separate electricity, gas, heat, and transport networks will not
deliver ambitious energy- and carbon-reduction measures over the long term.
These networks will need to be integrated, expanded, and made part of an effective
ICT (Information and Communications Technology) network to collect, share, and
analyse data to provide information required to optimise their operation. The
networks will also need to have an element of both electrical and thermal storage
to cope with “peaks” and “troughs”. Information technology can then provide the
communication between city energy supply, energy demand, and energy storage,
thus enabling intelligent demand-management measures to optimise efficient
energy supply, storage, and use [12]. Transport will also be part of this integration,
and electric vehicles will have the potential to act as electrical sources for energy
Big Data, People, and Low-Carbon Cities 7
storage for powering buildings as well as vehicles. There will be not only individual
heat and power generation but also individual energy storage in homes and busi-
nesses. Homes and businesses will no longer be just consumers, they will be energy
producers as well. The city energy supply will therefore be much different than it
has been in the past. Traditional, highly centralised power generation will be
replaced with new decentralised systems that will operate at a very local level.
These systems will match the intermittent supply to the demand by using demand
shifting and storage. Data analysis will be a key part of the successful operation of
such decentralised systems. People and businesses should then have greater engage-
ment with heat and power suppliers because they are producers (and generating an
income) as well as consumers (consuming at different prices at different times of
the day with new tariff structures). Complex control software must be available to
optimise such different supply, demand, and storage options at scale. Many local
producers are already sharing their data on solar-electricity production on Web sites
(e.g., www.pvoutput.org) to share, compare, and monitor live photovoltaic-
electricity generation. These new decentralised systems will help overall system
resilience; however, many legal, ethical, and operational challenges must be over-
come before they will be widely adopted.
In the past, city managers had relatively limited engagement with users of the
city’s day-to-day services. They had to arrange specific public meetings or surveys
to get feedback on how effectively systems were operating as well as any proposals
for new city infrastructure. However, we now have cities with dedicated telephone
and Web-based “hot lines” and people using social media, again allowing for
two-way communications, to tell the world their views on a wide range of
things—including low-carbon cities. Cities can now use the data from city infra-
structure (buildings, transport, etc.) and data from people (by way of Web sites and
social media) to help deliver a low-carbon city. They can more rapidly identify
when things are going wrong—such as power outages or internet failures as well as
traffic delays—so they can maintain smooth operation of the city.
An integrated, multi-disciplinary approach, in partnership with other stake-
holders, is needed to achieve the deep cuts in carbon emissions needed to meet
international targets. For example, achieving a 5 % reduction in energy consump-
tion in a building can be delivered through addressing one single technology. Either
providing additional thermal insulation, improving heating or cooling systems, or
improving building-control systems should result in >5 % savings. However, our
challenge is for western cities to achieve savings on the order of 80 % to keep the
global temperature increases to <2 C as agreed at the Paris COP in 2015 [13]. To
do this, it is not sufficient to determine a solution from one single technology or
discipline. An interdisciplinary approach must be employed using several technol-
ogies (thermal insulation, heating and cooling systems, lighting and ventilation
systems, and improved controls), and then we must go beyond the technology itself
to address how people effectively make use of these technologies in their daily
lives. A comprehensive, whole-systems approach to energy and carbon emissions is
therefore needed at the city scale.
8 P. Fleming
Information- and communication-technology systems now allow for the collec-

tion and analysis of previously unimaginable amounts of both city-infrastructure
and people-related data. Data are therefore available to help estimate people’s
carbon emissions almost in real time. The challenge is how we move from this
“big data” to “big knowledge” and how we develop better approaches to data
visualisation. This will help cities to share data and compare the performance of
different lifestyles, homes, businesses working practices, etc. These data could also
help businesses develop new products and services based on more detailed and
relevant information about carbon emissions. Services reflecting this concept have
been developed, for example, by Uber and BlaBlaCar for mobility services. Overall
these data can then be used to manage the “carbon system” of the city. They can be
used to enable a city to operate a smart-electricity grid, smart-heat grid, and smart-
transport grid as well as help create new employment opportunities and facilitate
inward investment and better engagement with, and participation from, the public.
2 What Data Exist
Data are routinely collected regarding energy supply (electricity, heat, and trans-
port) and fuel type (fossil-fuel heat, fossil-fuel electricity, renewable heat, renew-
able electricity, and transport-related fuels). We can measure this supply by
different types in real time. Smart meters are available in people’s homes. Data
are also collected, by way of automatic meter readings of the energy demand in
buildings and industry (electricity and heat in buildings) and transport (electricity
and oil). Building energy-management systems (BEMS) collect data on tempera-
ture, lighting, ventilation, etc., in different rooms in different buildings. Air quality–
monitoring stations collect local weather and air pollution data. Process-control
systems record data on industry, and transport-management systems collect data on
vehicle movements, passenger loading, congestion, car-park occupancy, electric-
vehicle charging points, bus and train times, etc. Car manufacturers collect data on
engine performance, speed, location, etc., which can be used to provide feedback to
drivers so they change driving styles to decrease emissions. Remote sensing by
satellite enables the monitoring of local air pollution in real time, and examples
exist of waste being tracked from the recycling point to eventual reuse and disposal.
Geographical Information Systems allow this information to be displayed as
maps, and new techniques are being developed to help people visualize these data.
People can share information about themselves and their “happiness”. All of these
data can be collected and analysed. Systems are now moving beyond monitoring
and displaying information to also controlling things. Washing machines, cookers,
heating systems, and televisions can now be switched on and off remotely by way of
mobile phones. Machines can communicate with machines without human inter-
vention. However, gaining access to these data at meaningful geographic and
temporal resolutions and ensuring consistent quality can still be a problem.
All of this now makes it possible to better predict energy use in cites and to offer
people incentives to both decrease and time-shift their heat, light, and power needs.
Cities are installing improved information and communications technologies, and
open-source approaches are allowing access to large data sets. They are now using
these data to become intelligent future cities and citizens. Communities and indi-
viduals are self-reporting and sharing their data. These data can then be analysed to
act as a proxy for population density or to highlight future development options for
communities. However these data bring ethical, security, and privacy issues. People
are become more concerned about how their data are used. Whose owns the data?
What is proprietary data, and what is publicly available? Legal, ethical, privacy,
and security issues still remain to be overcome.
3 What Data Do Not Exist
Using data that currently exist, it is possible to estimate the annual carbon emissions
at a city level, but this cannot yet in be done in real time or in terms of understand-
ing the detail of citizens’ behaviours. The challenge is taking these existing data,
obtaining further data, and making use of the information provided by these data.
We do not yet have the quality and quantity of data to provide a true city-wide
picture in real time. Data are not available uniformly; rather, there are concentra-
tions of data. For example, there are substantial energy-related data for buildings as
well as transport-related data through traffic-management systems, car parks, and
bus and train time information. However, there are still minimal data available on
carbon emissions associated, for example, with food procurement and waste. How
to deal with the variations in availability and quality of data is a key issue for cities
not just to address the digital divide but also for the research community to develop
new algorithms to help close the gaps in data and knowledge.
A further key issue is the collection, storage, and processing of these data.
Substantial interoperability issues associated with data acquisition still remain.
Data are collected in different formats over different time periods at different
locations, and they are of varying quantity and quality. For example, whilst
common standards for energy-related data exchange have been suggested [14],
they have not yet been widely adopted. More data are becoming available all the
time with the Internet of Things and open-source approaches. However, the issue is
not just the existence of data but the relevance, quality, and usefulness of these data
as well as how to address the associated security, privacy, and ethical issues.
Maintaining quality of data over time still remains a major issue.
10 P. Fleming
4 What More Is Needed?
First, as we collect increasingly more data, we need better institutions to oversee

their collection and management. This is needed not only to ensure quality but also
to reassure the public that ethical, privacy, and security issues have been addressed.
Second, we need better ways of extracting useful information from these data,
information to help city decision makers improve the management and future
infrastructure of our cities. Finally, additional real-time data are needed to help
provide more information about carbon emissions from infrastructure as well as
from people. These data will then need to be collected, processed, stored, analysed,
and presented to users. Interoperability, ethics, privacy, and security issues must also
be resolved. We need infrastructure-related data on buildings, transport, food, and
waste as well as people-related data in terms of their attitudes and behaviours. Using
these infrastructure and people data, “typical” citizens in different house types—
with different jobs and taking part in different leisure and social activities— could be
constructed. These virtual citizens could then be compared with people’s similar
lifestyles and advice and guidance given on how to decrease emissions through
making changes in lifestyles. This reduction could then be measured and quantified.
As more data become available, we will need to develop new techniques to
analyse them, E.g., new approaches to presenting these data in the most appropriate
way to different users including city leaders, city mangers, city businesses, and
citizens. For example, city leaders may not have traditionally used this level of data
before. They will need to have information derived from the data in different forms
than that needed by city managers. They will also be very acutely aware of ethical,
privacy, and security issues that can cause significant reputational damage if not
addressed effectively from the outset. In addition, we still must overcome the
digital divide and address regular public concern over the release of heath and
other data to private companies. Ethical, security, and privacy issues will therefore
be key issues to address in parallel with other data-quality, -management, and
-visualisation issues.
5 How to Use Data
Data visualisation is key to making better sense of data. We must know how to
present the most appropriate outcomes from the complex analysis of large data sets
to city practitioners and the public so that they are able to use it effectively. This
ranges from providing simple smiley faces to represent electricity gas- and water-
consumption trends in buildings [15] to city dashboards [16] to complex visualisa-
tion of multi-layer urban-data platforms for citizen and policy-maker exchange as
in Live Singapore [17] (http://senseable.mit.edu/livesingapore/index.html). The
growing areas of data mining and data visualisation will continue to be key future
research topics. Such an approach is being adopted by the European Commission’s
Collective Awareness Platforms (https://ec.europa.eu/digital-single-market/en/col

lective-awareness), which are supporting environmentally aware, grassroots pro-
cesses and practices to share knowledge, achieve changes in lifestyle, production,
and consumption patterns, and set up more participatory democratic processes all
using city-wide data to engage with different users. An example is the Political and
Social Awareness on Water Environmental Challenges (POWER [http://www.
power-h2020.eu/overview/]) project, which engages policy-makers, professionals,
and citizens in water-related issues identified by the European Innovation Partner-
ship (EIP) Water Action Group City Blueprints, thus improving the implementation
capacities of cities and regions (http://www.eip-water.eu/City_Blueprints). This
project brings together public bodies, private bodies, and communities to share
knowledge and data by way of a digital social platform to address specific local
water-related issues through building on the analysis of local city data.
Large amounts of data—including data from both city infrastructure and citizens
available in real time—are therefore being collected, stored, analysed, and
presented to potential users. The infrastructure, in terms of networks and smart
grids (smart heat, smart electricity, smart transport, and smart energy storage), is
being expanded. In terms of information from the average citizen, people share
about the following:
• where they are, how they travel, and how much electricity, gas, and water they
are using in their homes or at work;
• what temperatures they maintain in their home and working environments; and
• what information they are sharing with other people on social media and other
Web sites.
In addition, businesses share their energy efficiency and benchmark these data
with those of similar businesses in other countries. The information gathered from
these data can be used to help deliver and manage a low-carbon action programme.
Information from the analysis of these data thus inform the delivery of large-scale
low-carbon interventions such as a district-wide or community-wide refurbishment
projects, new low-emission vehicle programmes, air-quality action zones, refur-
bishment of non-domestic buildings, new business opportunities and models, etc. It
also allows for the ongoing monitoring of these schemes and provides evidence to
convince decision-makers of the business case for further investment.
These data can inform a city-wide carbon-management system that can measure
and control the operation of different city infrastructures. Machine-to-machine
communication will deal with the control and operation of some systems. It can
provide people with real-time feedback on carbon emissions as well as information
about emissions from homes, businesses, and modes of transport. Such emissions
are related to different peoples’ lifestyles. It can form part of a city dashboard by
describing current city-wide emissions. It will enable cities to move beyond simple
monitoring to introduce control, management, public engagement, and pubic feed-
back. However, data quality, long-term storage and management, ethics, interop-
erability, and privacy issues remain to be resolved.
12 P. Fleming
6 Conclusions
Big data and the Internet of Things are now providing the opportunity to help
deliver a low-carbon city. The amount of data and the number of things connected
to the Internet are increasing. Future cities cannot operate the way they did in the
past with separate electricity, gas, heat, and transport networks. These will not
deliver the internationally agreed-upon energy- and carbon-reduction targets. The
networks will need to be integrated as well as have an element of both electrical and
thermal storage with the electrical storage including electric vehicles where the
stored electricity is used to power buildings as well as the vehicle. Information
technology provides communication between energy supply, energy demand, and
energy storage, thus resulting in intelligent supply- and demand-management
measures to optimise energy supply, storage, and use. Homes and businesses will
be producers as well as consumers of energy. From an energy perspective, we now
(in theory) have access to the real-time data to develop a virtual power plant for a
city. It is conceivable to link a smart-electricity network with a smart-heat network
and a smart-transport network having both electrical as well as thermal demand
response and storage.
Analysis of the vast amount of data and the information from this analysis is then
used to inform the “management” of the city. Much of this ongoing, daily man-
agement is performed automatically, machine to machine, by way of software.
Specific fault correction and efficiency improvements are performed by energy-
service companies. Information from the analysis of these data will enable cities to
better understand the needs of their citizens through a more regular dialogue based
on citizens’ real-time carbon emissions to move beyond simple monitoring to
intelligent control. However, ethical, privacy, and security issues need to be
overcome, and the digital divide could prevent some citizens from realising the
full benefits of a smart city. The key is ongoing monitoring and evaluation at a city
scale. From an energy manager’s perspective, this involves moving from monitor-
ing, target setting, and investment in buildings to monitoring, target setting and
investment in cities. It means moving toward smart cities.
7 Summary
• Data are available to help estimate and manage carbon emission at the city level.
The amount of data is increasing, and the relevant data can be harnessed to
decrease carbon emissions in our cities.
• Both data from city’s infrastructure—homes, businesses, and transport—and
data about people living, working, and studying in cities are available.
• Security, privacy, and ethical issues, as well as the digital divide, must be
addressed from the outset.
• Citizens, communities, and businesses are sharing their data.
• Data can help justify low-carbon investment opportunities, and ongoing city
management can be delivered through virtual power plants and smart grids with
energy supply, storage, and demand management.
• Using these data, it is possible to develop evidence-based policy regarding city
efficiency. The main goal is to evaluate a city’s performance in decreasing
greenhouse-gas emissions and to evaluate citizens’ responses to this policy.
References
1. Energy Cities: http://www.energy-cities.eu/

2. Fedarene: http://www.fedarene.org/
3. ICLEI: http://www.iclei.org/
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5. Covenant of Mayors: http://www.covenantofmayors.eu/index_en.html
6. C40 Cities Climate Leadership Group: http://www.c40cities.org/
7. Euro Cites: http://www.eurocities.eu/
8. OECD: Urban Energy Handbook—Good Local Practice. OECD, Paris (1995)
9. Shackley, S., Kersey, J., Wilby, R., Fleming, P.: Changing by Degrees: The Potential Impacts
of Climate Change in the East Midlands. Ashgate, Aldershot (2001)
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761–771 (2004)
11. Kemp, R.: Living Without Electricity. Royal Academy of Engineering, London (2016) http://
www.raeng.org.uk/publications/reports/living-without-electricity
12. Boait, P., Ardestani, B.M., Snape, J.R.: Accommodating renewable generation through an
aggregator-focused method for inducing demand side response from electricity consumers.
IET Renew. Power Gen. 7(6), 689–699 (2013)
13. UNFCC: http://newsroom.unfccc.int/unfccc-newsroom/finale-cop21/
14. AMON: http://amee.github.io/AMON/
15. Stuart G., Fleming P. (2014) Smart energy performance indicators for live historical and
normative feedback systems. Improving Energy Efficiency in Commercial Buildings
(IEECB) conference 2014, Frankfurt, pp. 400–414
16. Future City Dashboard, Glasgow: http://dashboard.glasgow.gov.uk/
17. Kloeckl, K., Senn, O., Ratti, C.: Enabling the real-time city: LIVE Singapore! J. Urban
Technol. 19(2), 89 (2012)
Paul Fleming is a professor of energy management and the Director of Sustainable Develop-
ment, Institute of Energy and Sustainable Development, De Montfort University, Leicester,
UK. His research focuses on energy efficiency, renewable energy, and greenhouse gas emission
reductions at the local to regional levels, in particular on the analysis of energy-related data to help
achieve deep cuts in emissions. This works addresses the technical, non-technical, and public-
engagement aspects of delivering low-carbon cities and improving citizens” quality of life.
Co-benefits and Co-costs of Climate Action
Plans for Low-Carbon Cities
Matthias Ruth, Sanchari Ghosh, Sahar Mirzaee, and Nancy S. Lee
Abstract City-level climate action plans are often designed to address specific
issues such as to cut GHG emissions from traffic congestion. The benefits from such
plans would include the direct effects of reducing contributions by cities to global
atmospheric GHG concentrations. Additional benefits may be present in the form of
energy savings, reduced air pollution, improved public health, and many more. The
presence of such co-benefits (and of co-costs) may affect the rank-ordering of
particular actions when they are compared against each other. This chapter provides
a structured approach to the assessment of co-benefits and co-costs, and their
implications for selection among climate actions. Using network analysis we assess
existing urban climate action plans from around the world, focusing on the notion of
co-benefits and co-costs. We find notable similarities and differences in the way
co-benefits and co-costs guide urban climate plans, and we offer guidance for the
social discourse on prioritization of strategies.
Keywords Mitigation • Adaptation • Co-benefits • Co-costs • Urban climate
1 Introduction
Importance of City-Level Climate Mitigation and Adaption
The Fifth Assessment Report of the IPCC (2014) [1] has pointed out that there is a high
probability that around half of observed climate change is attributable to anthropo-
genic sources of greenhouse gas (GHG) emissions over the period 1951–2010. Cities
have become dominant sources of GHG emissions from energy consumption [2] as
well as the victims of climate change induced vulnerabilities due to the presence of
M. Ruth (*)
School of Public Policy and Urban Affairs and Department of Civil and Environmental
Engineering, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
e-mail: m.ruth@northeastern.edu
S. Ghosh • S. Mirzaee • N.S. Lee
School of Public Policy and Urban Affairs and Resilient Cities Lab, Northeastern University,
Boston, MA 02115, USA

DOI 10.1007/978-3-319-49730-3_3
16 M. Ruth et al.
factors such as expanding urban heat islands, growing urban populations near coast-
lines, exacerbated levels of pollution, and rising population density [3, 4]. With
growing rates of urbanization [5] and often lacking national action, increased attention
is placed on city-level climate change mitigation and adaptation plans, most notably in
the larger cities such as New York and Chicago in the USA, London, England, Cape
Town, South Africa, Shanghai, China, and Melbourne, Australia, but also smaller
cities around the world like Livermore and Alexandria in the USA or Freiburg in
Germany. Cities are developing their own, specific action plans targeted at cutting
their greenhouse gas emissions, reducing the impacts of climate-induced risks, and
implementing measures to enhance community-level resilience to counter these risks.
Their policies range from promoting efficiency in energy use in the transportation,
agriculture, and industrial sectors, to building green infrastructure and automated
wastewater recycling facilities, building flood control infrastructure, and establishing
solid waste treatment and recycling facilities.
Significance of Including Co-benefits and co-costs

in City-Level Climate Action
City-level climate action plans are often designed to address specific issues such
as to cut GHG emissions from traffic congestion. The benefits from such plans would
include the direct effects of reducing contributions by cities to global atmospheric
GHG concentrations, plus the co-benefits that are generated in terms of energy
savings, reduced air pollution, and improved public health [6–9]. While the direct
benefits for global climate are diffuse and will occur over the long term, co-benefits
accrue more immediately and directly to the city [10] and thus may potentially
provide additional impetus for climate action at the city level.
Failure to include all co-benefits will lead to underestimation of the full

benefits of climate change mitigation. The majority of co-benefits identified
in climate action plans are health-related. Health co-benefits refer to the
reduction in health-related costs due to improvement in air or water quality
as a result of climate change mitigation policies.
2 Economic Argument for Including Co-benefits and Co-costs
Optimal Abatement Levels Including Direct Benefits

and Co-benefits
To define and capture co-benefits and co-costs requires systematic treatment of

system boundaries in space and time, and commensurability of these costs and
Co-benefits and Co-costs of Climate Action Plans for Low-Carbon Cities 17
Fig. 1 Primary benefits and co-benefits
benefits with other performance measures. For example, monetary values may be
imputed for public health costs of declining indoor air quality that results from
reduced ventilation of living spaces. Changes in comfort, for example, are more
difficult to quantify in monetary terms, as are the increases in national energy
security that result from reductions in domestic heating and cooling requirements.
As the scope of analysis increases, the ancillary effects of policies and investments
become more diffuse, and the ranges of estimates for costs and benefits broaden
(Fig. 1). This calls for the establishment of standards and agreed-upon procedures
for such accounting, at least for two main reasons. First, to the extent that total
benefit and cost measures are used to guide policy, selective inclusion or exclusion
of (co-) benefits and (co-) costs will bias decision-making [11]. Second, total
ancillary benefits may exceed primary benefits [12], and even where they do not,
their inclusion may help magnify the primary benefits [13] and can alter the rank-
ordering of preferred policy choices [6].
Figure 2 shows the standard case of damage costs, D (Z ), declining for increas-
ing levels of emissions reduction, Z. The costs of carrying out those reductions
(the abatement costs), R(Z) are usually assumed to rise both monotonically because
avoiding the next unit of pollution will be ever harder to do. From an economic
standpoint, the optimal abatement level Z0 is obtained when the benefits from
reducing emissions by the next unit just cover the costs of avoiding that next unit
from being released into the environment. An excellent illustration of such abate-
ment cost curves is the global abatement cost curve [14], which shows the abate-
ment cost of 1 ton of carbon dioxide across various sectors through 2030, relative to
a business-as-usual (BAU) development.
The presence of co-benefits shifts the emissions cost curve R(Z ) downward,
for at least some level of emissions reductions, thus resulting in optimal abatement
18 M. Ruth et al.
Fig. 2 Standard damage cost and abatement cost profiles
Fig. 3 Schematic representation of multiple decision-making criteria for alternative low-carbon

strategies
levels larger than Z0, while co-costs shift R(Z ) up, thus making emissions reduc-
tions more costly and leading to abatement levels below Z0. The increased com-
plexity and uncertainty associated with measuring co-benefits and co-costs,
however, will make it very difficult to identify with standard economic instruments,
at any meaningful level of accuracy, “optimal” low carbon strategies.
Instead, social discourse will need to help decision-makers prioritize among the
many mitigation options and their respective co-benefits and co-costs. To do so,
various methods exist to structure the disparate information and associated uncer-
tainties about co-benefits and co-costs, such as the visualizations of multiple
decision criteria schematically shown in Fig. 3 for five stylized categories of
co-benefits and co-costs (see, for example, Dias and Domingues [15], for a critical
discussion and examples). Of course, many of these co-benefits and co-costs have
been already alluded to in the climate action plans of cities, albeit often in less
structured ways. The following sections of this chapter review the extent to which
these plans do consider ancillary benefits and costs, and how those are perceived to
be connected to low-carbon goals.
3 Representative Cities and Their Climate

Mitigation Plans
The map in Fig. 4 depicts the cities selected for this study spanning all continents
except Antarctica. It is evident that the cities in the developing nations are having
explosive rates of population growth as compared to the cities in the developed
countries.
Cities in Developed Nations
The selected cities in the developed nations comprise 9 out of the 20 most densely
populated cities in the USA (Chicago, Boston, Columbus, Los Angeles, Phoenix,
San Diego, New York, San Jose, and Austin) and eight select cities in Europe,
which have an ongoing city climate action plan (London, Rome, Paris, Malmo,
Stockholm, Rotterdam, Madrid, and Hamburg). Our sample also contains the four
Fig. 4 Cities with climate action plans and their population

20 M. Ruth et al.
biggest cities in Australia (Sydney, Melbourne, Brisbane, and Perth), Tokyo in

Japan, and Calgary and Ottawa in Canada.
Cities in Developing Nations
Eleven cities in the developing nations constitute a comprehensive list of cities with
ongoing or recently initiated climate action plans among the emerging and less
developed economies. These cities are Hong Kong, Beijing, Guangzhou, Shanghai,
Tianjin, Wuhan, and Chongqing in China, with the last four constituting the mega-
cities with populations exceeding ten million [15], Cape Town and Lagos in Africa,
Mexico City and Sao Paulo in South America, and New Delhi and Karachi in South
Asia.
Climate Action Categories
The review of city-level climate adaptation plans reveals 14 broad categories of

actions, summarized in Table 1. While each city action plan in the developed or
developing countries is predominantly designed in the context of climate change
issues of that particular city, notable structural differences exist. For example,
developed-country cities like New York, Chicago, Boston, and London have been
Table 1 Action categories

Action category Description of category
Transportation technology Improvement in fuel efficiency and transportation
infrastructure; emphasis upon the use of public transport
Green buildings, systems, Energy efficiency in building construction and operations
and operations and encouragement of green infrastructure
Water and wastewater Efficiency in water use and conservation, and recycling
management of wastewater
Public relations: agencies Collaborating with communities on climate action strate-
and community engagement gies, developing community energy programs and green
organizations and promoting climate education in schools
Recycling and waste reduction Residential and commercial solid waste reduction and
methods for recycling waste matter
Outdoor and indoor air quality Methods for minimizing exposure to air pollutants such
as ozone, carbon dioxide, lead, and particulate matter
Green businesses Promotion of green businesses like eco-industry,
eco-agriculture, and green service industry which can
facilitate employment generation
Energy conservation Promotion of energy efficiency standards for new buildings
and commercial facilities, appliances and the water sector
(continued)
Table 1 (continued)
Action category Description of category
Renewable energy Encouraging the use of solar and wind energy and green
electricity for clean air, and conservation of fossil fuel
Land use and food systems Urban design for energy conservation, tree planting and
establishment of community gardens and adoption of
sustainable land use and overall promoting smart growth
policies for cities
Behavior change Raising public awareness of climate change and motivating
them to conserve energy, use more of public transport,
conserve water and reduce waste, and promote green
infrastructure
Research, studies, and Establishing centers and encouraging studies on the impacts
assessments of climate change and how to build resilience
Severe weather forecasting/ Developing and implementing warning systems and
warning response plan for combating severe weather
Healthcare: climate change Promoting awareness on climate change related diseases,
related diseases developing emergency health measures for them and
enhancing the capacity of medical personnel to effectively
manage climate change related health diseases
forerunners in devising strategies that involve community participation and using

low-carbon strategies as part of an economic development agenda to create “green”
jobs. Cities like Sao Paolo, Shanghai, Mexico City, and Cape Town exhibit an
evolving climate action framework with broad perspectives on the interactions
among energy, water, building infrastructure, transportation, and land use, but
community representation as part of climate action strategies remains low in
many of these cities, especially those in Asia.
4 City Climate Action Plan Analysis
Differences in Action Categories and Their Frequencies
Table 2 illustrates the ranking of categories in each continent based on the fre-
quency of the categories mentioned in their respective action plans. The action
categories have qualitative differences since the goals, methods of implementation,
and infrastructure vary among various cities around the world. However, the
frequency ranking is carried out for two main reasons. One, it is a first step towards
identifying which mitigation strategies have been perceived to be of high impor-
tance by city climate action planners and policy makers. Secondly, knowledge of
this ranking will generate initial discussions on the extent to which cities in
different regions prioritize climate action policies and allocate their resources
towards such policies.
Another random document with
no related content on Scribd:
a water-closet; by some horrid drain; by proximity to a pig-sty; by an
overflowing privy, especially if vegetable matter be rotting at the
same time in it; by bad ventilation, or by contagion. Diphtheria may
generally be traced either to the one or to the other of the above
causes; therefore let me urgently entreat you to look well into all
these matters, and thus to stay the pestilence! Diphtheria might long
remain in a neighborhood if active measures be not used to
exterminate it.
210. Have the goodness to describe the symptoms of Measles?
Measles commences with symptoms of a common cold; the patient
is at first chilly, then hot and feverish; he has a running at the nose,
sneezing, watering and redness of the eyes, headache, drowsiness, a
hoarse and peculiar ringing cough, which nurses call “measle-
cough,” and difficulty of breathing. These symptoms usually last
three days before the eruption appears; on the fourth it (the
eruption) generally makes its appearance, and continues for four
days and then disappears, lasting altogether, from the
commencement of the symptoms of cold to the decline of the
eruption, seven days. It is important to bear in mind that the
eruption consists of crescent-shaped—half-moon-shaped—patches;
that they usually appear first about the face and the neck, in which
places they are the best marked; then on the body and on the arms;
and, lastly, on the legs, and that they are slightly raised above the
surface of the skin. The face is swollen, more especially the eyelids,
which are sometimes for a few days closed.
Well, then, remember, the running at the nose, the sneezing, the
peculiar hoarse cough, and the half-moon-shaped patches, are the
leading features of the disease, and point out for a certainty that it is
measles.
211. What constitutes the principal danger in Measles?
The affection of the chest. The mucous or lining membrane of the
bronchial tubes is always more or less inflamed, and the lungs
themselves are sometimes affected.
212. Do you recommend “surfeit water” and saffron tea to throw
out the eruption in Measles?
Certainly not. The only way to throw out the eruption, as it is
called, is to keep the body comfortably warm, and to give the
beverages ordered by the medical man, with the chill off. “Surfeit
water,” saffron tea, and remedies of that class, are hot and
stimulating. The only effect they can have, will be to increase the
fever and the inflammation—to add fuel to the fire.
213. What is the treatment of Measles?
What to do.—The child ought to be confined both to his room and
to his bed, the room being kept comfortably warm; therefore, if it be
winter time, there should be a small fire in the grate; in the summer
time, a fire would be improper. The child must not be exposed to
draughts; notwithstanding, from time to time, the door ought to be
left a little ajar in order to change the air of the apartment; for proper
ventilation, let the disease be what it may, is absolutely necessary.
Let the child, for the first few days, be kept on a low diet, such as
on milk and water, arrow-root, bread and butter, etc.
If the attack be mild, that is to say, if the breathing be not much
affected (for in measles it always is more or less affected), and if
there be not much wheezing, the acidulated infusion of roses’
mixture[228] will be all that is necessary.
But suppose that the breathing is short, and that there is a great
wheezing, then, instead of giving him the mixture just advised, give
him a teaspoonful of a mixture composed of ipecacuanha wine,
syrup, and water,[229] every four hours. And if, on the following day,
the breathing and the wheezing be not relieved, in addition to the
ipecacuanha mixture, apply a tela vesicatoria, as advised under the
head of inflammation of the lungs.
When the child is convalescing, batter puddings, rice, and sago
puddings, in addition to the milk, bread and butter, etc., should be
given; and, a few days later, chicken, mutton-chops, etc.
The child ought not, even in a mild case of measles, and in
favorable weather, to be allowed to leave the house under a fortnight,
or it might bring on an attack of bronchitis.
What NOT to do.—Do not give either “surfeit water” or wine. Do not
apply leeches to the chest. Do not expose the child to the cold air. Do
not keep the bedroom very hot, but comfortably warm. Do not let the
child leave the house, even under favorable circumstances, under a
fortnight. Do not, while the eruption is out, give aperients. Do not,
“to ease the cough,” administer either emetic tartar or paregoric—the
former drug is awfully depressing; the latter will stop the cough, and
will thus prevent the expulsion of the phlegm.
214. What is the difference between Scarlatina and Scarlet Fever?
They are, indeed, one and the same disease, scarlatina being the
Latin for scarlet fever. But, in a popular sense, when the disease is
mild, it is usually called scarlatina. The latter term does not sound so
formidable to the ears either of patients or of parents.
215. Will you describe the symptoms of Scarlet Fever?
The patient is generally chilly, languid, drowsy, feverish, and
poorly for two days before the eruption appears. At the end of the
second day, the characteristic, bright scarlet efflorescence, somewhat
similar to the color of a boiled lobster, usually first shows itself. The
scarlet appearance is not confined to the skin; but the tongue, the
throat, and the whites of the eyes put on the same appearance; with
this only difference, that on the tongue and on the throat the scarlet
is much darker; and, as Dr. Elliotson accurately describes it,—“the
tongue looks as if it had been slightly sprinkled with Cayenne
pepper.” The eruption usually declines on the fifth, and is generally
indistinct on the sixth day; on the seventh it has completely faded
away. There is usually, after the first few days, great itching on the
surface of the body. The skin, at the end of the week, begins to peel
and to dust off, making it look as though meal had been sprinkled
upon it.
There are three forms of scarlet fever,—the one where the throat is
little, if at all affected, and this is a mild form of the disease; the
second, which is generally, especially at night, attended with
delirium, where the throat is much affected, being often greatly
inflamed and ulcerated; and the third (which is, except in certain
unhealthy districts, comparatively rare, and which is VERY
dangerous), the malignant form.
216. Would it be well to give a little cooling, opening physic as
soon as a child begins to sicken for Scarlet Fever?
On no account whatever. Aperient medicines are, in my opinion,
highly improper and dangerous both before and during the period of
the eruption. It is my firm conviction that the administration of
opening medicine, at such times, is one of the principal causes of
scarlet fever being so frequently fatal. This is, of course, more
applicable to the poor, and to those who are unable to procure a
skillful medical man.
217. What constitutes the principal danger in Scarlet Fever?
The affection of the throat, the administration of opening medicine
during the first ten days, and a peculiar disease of the kidneys ending
in anasarca (dropsy), on which account, the medical man ought,
when practicable, to be sent for at the onset, that no time may be lost
in applying proper remedies.
218. How would you distinguish between Scarlet Fever and
Measles?
Measles commences with symptoms of a common cold; scarlet
fever does not. Measles has a peculiar hoarse cough; scarlet fever has
not. The eruption of measles is in patches of a half-moon shape, and
is slightly raised above the skin; the eruption of scarlet fever is not
raised above the skin at all, and is one continued mass. The color of
the eruption is much more vivid in scarlet fever than in measles. The
chest is the part principally affected in measles, and the throat in
scarlet fever.
There is an excellent method of determining, for a certainty,
whether the eruption be that of scarlatina or otherwise. I myself
have, in several instances, ascertained the truth of it: “For several
years M. Bouchut has remarked in the eruption of scarlatina a
curious phenomenon, which serves to distinguish this eruption from
that of measles, erythema, erysipelas, etc., a phenomenon essentially
vital, and which is connected with the excessive contractability of the
capillaries. The phenomenon in question is a white line, which can
be produced at pleasure by drawing the back of the nail along the
skin where the eruption is situated. On drawing the nail, or the
extremity of a hard body (such as a pen-holder), along the eruption,
the skin is observed to grow pale, and to present a white trace, which
remains for one or two minutes, or longer, and then disappears. In
this way the diagnosis of the disease may be very distinctly written
on the skin; the word ‘Scarlatina’ disappears as the eruption regains
its uniform tint.”[230]
219. Is it of so much importance, then, to distinguish between
Scarlet Fever and Measles?
It is of great importance, as in measles the patient ought to be kept
moderately warm, and the drinks should be given with the chill off;
while in scarlet fever the patient ought to be kept cool—indeed, for
the first few days, cold; and the beverages, such as spring water, toast
and water, etc., should be administered quite cold.
220. What is the treatment of Scarlet Fever?[231]
What to do.—Pray pay particular attention to my rules, and carry
out my directions to the very letter—as I can then promise you that if
the scarlet fever be not malignant, the plan I am about to
recommend will, with God’s blessing, be generally successful.
What is the first thing to be done? Send the child to bed; throw
open the windows, be it winter or summer, and have a thorough
ventilation; for the bedroom must be kept cool, I may say cold. Do
not be afraid of fresh air, for fresh air, for the first few days, is
essential to recovery. Fresh air, and plenty of it, in scarlet fever, is
the best doctor a child can have: let these words be written legibly on
your mind.[232]
Take down the curtains of the bed; remove the valances. If it be
summer time, let the child be only covered with a sheet: if it be
winter time, in addition to the sheet, he should have one blanket over
him.
Now for the throat.—The best external application is a barm and
oatmeal poultice. How ought it to be made, and how applied? Put
half a teacupful of barm into a saucepan, put it on the fire to boil; as
soon as it boils take it off the fire, and stir oatmeal into it, until it is of
the consistence of a nice soft poultice; then place it on a rag, and
apply it to the throat; carefully fasten it on with bandage, two or
three turns of the bandage going round the throat, and two or three
over the crown of the head, so as nicely to apply the poultice where it
is wanted—that is to say, to cover the tonsils. Tack the bandage: do
not pin it. Let the poultice be changed three times a day. The best
medicine is the acidulated infusion of roses, sweetened with syrup.
[233]
It is grateful and refreshing, it is pleasant to take, it abates fever
and thirst, it cleans the throat and tongue of mucus, and is peculiarly
efficacious in scarlet fever; as soon as the fever is abated it gives an
appetite. My belief is that the sulphuric acid in the mixture is a
specific in scarlet fever, as much as quinine is in ague, and sulphur in
itch. I have reason to say so, for, in numerous cases, I have seen its
immense value.
Now, with regard to food.—If the child be at the breast, keep him
entirely to it. If he be weaned, and under two years old, give him milk
and water, and cold water to drink. If he be older, give him toast and
water, and plain water from the pump, as much as he chooses; let it
be quite cold—the colder the better. Weak black tea, or thin gruel,
may be given, but not caring, unless he be an infant at the breast, if
he take nothing but cold water. If the child be two years old and
upwards, roasted apples with sugar, and grapes will be very
refreshing, and will tend to cleanse both the mouth and the throat.
Avoid broths and stimulants of every kind.
When the appetite returns, you may consider the patient to be
safe. The diet ought now to be gradually improved. Bread and butter,
milk and water, and arrow-root made with equal parts of new milk
and water, should for the first two or three days be given. Then a
light batter or rice pudding may be added, and in a few days
afterward, either a little chicken or a mutton-chop.
The essential remedies, then, in scarlet fever, are, for the first few
days—(1) plenty of fresh air and ventilation, (2) plenty of cold water
to drink, (3) barm poultices to the throat, and (4) the acidulated
infusion of roses’ mixture as a medicine.
Now, then, comes very important advice. After the first few days,
probably five or six, sometimes as early as the fourth day, watch
carefully and warily, and note the time, the skin will suddenly
become cool, the child will say that he feels chilly; then is the time
you must now change your tactics—instantly close the windows, and
put extra clothing, a blanket or two, on his bed. A flannel night-gown
should, until the dead skin has peeled off, be now worn next to the
skin, when the flannel night-gown should be discontinued. The
patient ought ever after to wear, in the daytime, a flannel waistcoat.
[234]
His drinks must now be given with the chill off; he ought to have
a warm cup of tea, and gradually his diet should, as I have previously
recommended be improved.
There is one important caution I wish to impress upon you,—do
not give opening medicine during the time the eruption is out. In all
probability the bowels will be opened: if so, all well and good; but do
not, on any account, for the first ten days, use artificial means to
open them. It is my firm conviction that the administration of
purgatives in scarlet fever is a fruitful source of dropsy, of disease,
and death. When we take into consideration the sympathy there is
between the skin and the mucous membrane, I think that we should
pause before giving irritating medicines, such as purgatives. The
irritation of aperients on the mucous membrane may cause the
poison of the skin disease (for scarlet fever is a blood poison) to be
driven internally to the kidneys, to the throat, to the pericardium
(bag of the heart), or to the brain. You may say, Do you not purge if
the bowels be not open for a week? I say emphatically, No!
I consider my great success in the treatment of scarlet fever to be
partly owing to my avoidance of aperients during the first ten days of
the child’s illness.
If the bowels, after the ten days, are not properly opened, a dose or
two of the following mixture should be given:
Take of—Simple Syrup, three drachms;
Essence of Senna, nine drachms:
To make a Mixture. Two teaspoonfuls to be given early in the morning

occasionally, and to be repeated in four hours, if the first dose should not
operate.
In a subsequent Conversation, I shall strongly urge you not to
allow your child, when convalescent, to leave the house under at least
a month from the commencement of the illness; I therefore beg to
refer you to that Conversation, and hope that you will give it your
best and earnest consideration! During the last seventeen years I
have never had dropsy from scarlet fever, and I attribute it entirely to
the plan I have just recommended, and in not allowing my patients
to leave the house under the month—until, in fact, the skin that has
peeled off has been renewed.
Let us now sum up the plan I adopt:
1. Thorough ventilation, a cool room, and scant clothes on the bed,
for the first five or six days.
2. A change of temperature of the skin to be carefully regarded. As
soon as the skin is cool, closing the windows, and putting additional
clothing on the bed.
3. The acidulated infusion of roses with syrup is the medicine for
scarlet fever.
4. Purgatives to be religiously avoided for the first ten days at least,
and even afterward, unless there be absolute necessity.
5. Leeches, blisters, emetics, cold and tepid spongings, and
painting the tonsils with caustic, inadmissible in scarlet fever.
6. A strict antiphlogistic (low) diet for the first few days, during
which time cold water to be given ad libitum.
7. The patient not to leave the house in the summer under the
month; in the winter, under six weeks.
What NOT to do.—Do not, then, apply either leeches or blisters to
the throat; do not paint the tonsils with caustic; do not give
aperients; do not, on any account, give either calomel or emetic
tartar; do not, for the first few days of the illness, be afraid of cold air
to the skin, and of cold water as a beverage; do not, emphatically let
me say, do not let the child leave the house for at least a month from
the commencement of the illness.
My firm conviction is, that purgatives, emetics, and blisters, by
depressing the patient, sometimes cause ordinary scarlet fever to
degenerate into malignant scarlet fever.
I am aware that some of our first authorities advocate a different
plan to mine. They recommend purgatives, which I may say, in
scarlet fever, are my dread and abhorrence. They advise cold and
tepid spongings—a plan which I think dangerous, as it will probably
drive the disease internally. Blisters, too, have been prescribed; these
I consider weakening, injurious, and barbarous, and likely still more
to inflame the already inflamed skin. They recommend leeches to the
throat, which I am convinced, by depressing the patient, will lessen
the chance of his battling against the disease, and will increase the
ulceration of the tonsils. Again, the patient has not too much blood;
the blood is only poisoned. I look upon scarlet fever as a specific
poison of the blood, and one which will be eliminated from the
system, not by bleeding, not by purgatives, not by emetics, but by a
constant supply of fresh and cool air, by the acid treatment, by cold
water as a beverage, and for the first few days by a strict
antiphlogistic (low) diet.
Sydenham says that scarlet fever is oftentimes “fatal through the
officiousness of the doctor.” I conscientiously believe that a truer
remark was never made; and that under a different system to the
usual one adopted, scarlet fever would not be so much dreaded.[235]
221. How soon ought a child to be allowed to leave the house after
an attack of Scarlet Fever?
He must not be allowed to go out for at least a month from the
commencement of the attack, in the summer, and six weeks in the
winter; and not even then with out the express permission of a
medical man. It might be said that this is an unreasonable
recommendation but when it is considered that the whole of the skin
generally desquamates, or peels off, and consequently leaves the
surface of the body exposed to cold, which cold flies to the kidneys,
producing a peculiar and serious disease in them, ending in dropsy,
this warning will not be deemed unreasonable.
Scarlet fever dropsy, which is really a formidable disease,
generally arises from the carelessness, the ignorance, and the
thoughtlessness of parents in allowing a child to leave the house
before the new skin is properly formed and hardened. Prevention is
always better than cure.
Thus far with regard to the danger to the child himself. Now, if you
please, let me show you the risk of contagion that you inflict upon
families, in allowing your child to mix with others before a month at
least has elapsed. Bear in mind, a case is quite as contagious, if not
more so, while the skin is peeling off, as it was before. Thus, in ten
days or a fortnight, there is as much risk of contagion as at the
beginning of the disease, and when the fever is at its height. At the
conclusion of the month the old skin has generally all peeled off, and
the new skin has taken its place; consequently there will then be less
fear of contagion to others. But the contagion of scarlet fever is so
subtle and so uncertain in its duration, that it is impossible to fix the
exact time when it ceases.
Let me most earnestly implore you to ponder well on the above
important facts. If these remarks should be the means of saving only
one child from death, or from broken health, my labor will not have
been in vain.
222. What means do you advise to purify a house from the
contagion of Scarlet Fever?
Let every room be lime-washed and then be white washed;[236] if
the contagion has been virulent, let every bedroom be freshly
papered (the walls having been previously stripped of the old paper
and then lime-washed); let the bed, the bolsters, the pillows, and the
mattresses be cleansed and purified; let the blankets and coverlids be
thoroughly washed, and then let them be exposed to the open air—if
taken into a field so much the better; let the rooms be well scoured;
let the windows, top and bottom, be thrown wide open; let the drains
be carefully examined; let the pump-water be scrutinized, to see that
it be not contaminated by fecal matter, either from the water-closet
or from the privy; let privies be emptied of their contents—
remember this is most important advice—then put into the empty
places lime and powdered charcoal, for it is a well-ascertained fact
that it is frequently impossible to rid a house of the infection of
scarlet fever without adopting such a course. “In St. George’s,
Southwark, the medical officer reports that scarlatina ‘has raged
fatally, almost exclusively where privy or drain smells are to be
perceived in the houses.’”[237] Let the children who have not had, or
who do not appear to be sickening for scarlet fever, be sent away
from home—if to a farm-house so much the better. Indeed, leave no
stone unturned, no means untried, to exterminate the disease from
the house and from the neighborhood.
223. Will you describe the symptoms of Chicken-pox?
It is occasionally, but not always, ushered in with a slight shivering
fit; the eruption shows itself in about twenty-four hours from the
child first appearing poorly. It is a vesicular[238] disease. The eruption
comes out in the form of small pimples, and principally attacks the
scalp, the neck, the back, the chest, and the shoulders, but rarely the
face; while in small-pox the face is generally the part most affected.
The next day these pimples fill with water, and thus become vesicles;
on the third day they are at maturity. The vesicles are quite separate
and distinct from each other. There is a slight redness around each of
them. Fresh ones, while the others are dying away, make their
appearance. Chicken-pox is usually attended with a slight itching of
the skin; when the vesicles are scratched the fluid escapes, and leaves
hard pearl-like substances, which, in a few days, disappear. Chicken-
pox never leaves pit-marks behind. It is a child’s complaint; adults
scarcely, if ever, have it.
224. Is there any danger in Chicken-pox; and what treatment do
you advise?
It is not at all a dangerous, but, on the contrary, a trivial
complaint. It lasts only a few days, and requires but little medicine.
The patient ought, for three or four days, to keep the house, and
should abstain from animal food. On the sixth day, but not until
then, a dose or two of a mild aperient is all that will be required.
225. Is Chicken-pox infectious?
There is a diversity of opinion on this head, but one thing is certain
—it cannot be communicated by inoculation.
226. What are the symptoms of Modified Small-pox?
The modified small-pox—that is to say, small-pox that has been
robbed of its virulence by the patient having been either already
vaccinated, or by his having had a previous attack of small-pox—is
ushered in with severe symptoms, with symptoms almost as severe
as though the patient had not been already somewhat protected
either by vaccination or by the previous attack of small-pox—that is
to say, he has a shivering fit, great depression of spirits and debility,
malaise, sickness, headache, and occasionally delirium. After the
above symptoms have lasted about three days, the eruption shows
itself. The immense value of the previous vaccination, or the previous
attack of small-pox, now comes into play. In a case of unprotected
small-pox, the appearance of the eruption aggravates all the above
symptoms, and the danger begins; while in the modified small-pox,
the moment the eruption shows itself, the patient feels better, and, as
a rule, rapidly recovers. The eruption of modified small-pox varies
materially from the eruption of the unprotected small-pox. The
former eruption assumes a varied character, and is composed, first of
vesicles (containing water), and secondly of pustules (containing
matter), each of which pustules has a depression in the center, and
thirdly of several red pimples without either water or matter in them,
and which sometimes assume a livid appearance. These “breakings-
out” generally show themselves more upon the wrist, and sometimes
up one or both of the nostrils. While in the latter disease—the
unprotected small-pox—the “breaking-out” is composed entirely of
pustules containing matter, and which pustules are more on the face
than on any other part of the body. There is generally a peculiar
smell in both diseases—an odor once smelt never to be forgotten.
Now, there is one most important remark I have to make,—the
modified small-pox is contagious. This ought to be borne in mind, as
a person laboring under the disease must, if there be children in the
house, either be sent away himself, or else the children ought to be
banished both the house and the neighborhood. Another important
piece of advice is, let all in the house—children and adults, one and
all—be vaccinated, even if any or all have been previously vaccinated.
Treatment.—Let the patient keep his room, and if he be very ill, his
bed. Let the chamber be well ventilated. If it be winter time, a small
fire in the grate will encourage ventilation. If it be summer, a fire is
out of the question; indeed, in such a case, the window-sash ought to
be opened, as thorough ventilation is an important requisite of cure,
both in small-pox and in modified small-pox. While the eruption is
out, do not on any account give aperient medicine. In ten days from
the commencement of the illness a mild aperient may be given. The
best medicine in these cases is, the sweetened acidulated infusion of
roses,[239] which ought to be given from the commencement of the
disease, and should be continued until the fever be abated. For the
first few days, as long as the fever lasts, the patient ought not to be
allowed either meat or broth, but should be kept on a low diet, such
as on gruel, arrow-root, milk puddings, etc. As soon as the fever is
abated he ought gradually to resume his usual diet. When he is
convalescent, it is well, where practicable, that he should have
change of air for a month.
227. How would you distinguish between Modified Small-pox and
Chicken-pox?
Modified small-pox may readily be distinguished from chicken-
pox, by the former disease being, notwithstanding its modification,
much more severe and the fever much more intense before the
eruption shows itself than chicken-pox; indeed, in chicken-pox there
is little or no fever either before or after the eruption; by the former
disease, the modified small-pox, consisting partly of pustules
(containing matter), each pustule having a depression in the center,
and the favorite localities of the pustules being the wrists and the
inside of the nostrils: while, in the chicken-pox, the eruption consists
of vesicles (containing water), and not pustules (containing matter),
and the vesicles having neither a depression in the center, nor having
any particular partiality to attack either the wrists or the wings of the
nose. In modified small-pox each pustule is, as in unprotected small-
pox, inflamed at the base; while in chicken-pox there is only very
slight redness around each vesicle. The vesicles, too, in chicken-pox
are small—much smaller than the pustules are in modified small-
pox.
228. Is Hooping-cough an inflammatory disease?
Hooping-cough in itself is not inflammatory, it is purely
spasmodic; but it is generally accompanied with more or less of
bronchitis—inflammation of the mucous membrane of the bronchial
tubes—on which account it is necessary, in all cases of hooping-
cough, to consult a medical man, that he may watch the progress of
the disease and nip inflammation in the bud.
229. Will you have the goodness to give the symptoms, and a brief
history, of Hooping-cough?
Hooping-cough is emphatically a disease of the young; it is rare for
adults to have it; if they do, they usually suffer more severely than
children. A child seldom has it but once in his life. It is highly
contagious, and therefore frequently runs through a whole family of
children, giving much annoyance, anxiety, and trouble to the mother
and the nurses; hence hooping-cough is much dreaded by them. It is
amenable to treatment. Spring and summer are the best seasons of
the year for the disease to occur. This complaint usually lasts from
six to twelve weeks—sometimes for a much longer period, more
especially if proper means are not employed to relieve it.
Hooping-cough commences as a common cold and cough. The
cough, for ten days or a fortnight, increases in intensity; at about
which time it puts on the characteristic “hoop.” The attack of cough
comes on in paroxysms.
In a paroxysm the child coughs so long and so violently, and
expires so much air from the lungs without inspiring any, that at
times he appears nearly suffocated and exhausted; the veins of his
neck swell; his face is nearly purple; his eyes, with the tremendous
exertion, seem almost to start from their sockets; at length there is a
sudden inspiration of air through the contracted chink of the upper
part of the windpipe—the glottis—causing the peculiar “hoop; and,
after a little more coughing, he brings up some glairy mucus from the
chest; and sometimes, by vomiting, food from the stomach; he is at
once relieved until the next paroxysm occurs, when the same process
is repeated, the child during the intervals, in a favorable case,
appearing quite well, and after the cough is over, instantly returning
either to his play or to his food. Generally, after a paroxysm he is
hungry, unless, indeed, there be severe inflammation either of the
chest or of the lungs. Sickness, as I before remarked, frequently
accompanies hooping-cough; when it does, it might be looked upon
as a good sign. The child usually knows when an attack is coming on;
he dreads it, and therefore tries to prevent it; he sometimes partially
succeeds; but if he does, it only makes the attack, when it does come,
more severe. All causes of irritation and excitement ought, as much
as possible, to be avoided, as passion is apt to bring on a severe
paroxysm.
A new-born babe, an infant of one or two months old, commonly
escapes the infection; but if at that tender age he unfortunately catch
hooping-cough, it is likely to fare harder with him than if he were
older—the younger the child the greater the risk. But still, in such a
case, do not despair, as I have known numerous instances of new-
born infants, with judicious care, recover perfectly from the attack,
and thrive after it as though nothing of the kind had ever happened.
A new-born babe laboring under hooping-cough is liable to
convulsions, which is, in this disease, one, indeed the great, source of
danger. A child, too, who is teething, and laboring under the disease,
is also liable to convulsions. When the patient is convalescing, care
ought to be taken that he does not catch cold, or the “hoop” might
return. Hooping-cough may either precede, attend, or follow an
attack of measles.
230. What is the treatment of Hooping-cough?
We will divide the hooping-cough into three stages, and treat each
stage separately.
What to do.—In the first stage, the commencement of hooping-
cough: For the first ten days give the ipecacuanha wine mixture,[240] a
teaspoonful three times a day. If the child be not weaned, keep him
entirely to the breast; if he be weaned, to a milk and farinaceous diet.
Confine him for the first ten days to the house, more especially if the
hooping-cough be attended, as it usually is, with more or less of
bronchitis. But take care that the rooms be well ventilated, for good
air is essential to the cure. If the bronchitis attending the hooping-
cough be severe, confine him to his bed, and treat him as though it
were simply a case of bronchitis.[241]
In the second stage, discontinue the ipecacuanha mixture, and
give Dr. Gibb’s remedy—namely, nitric acid—which I have found to
be an efficacious and valuable one in hooping-cough:
Take of—Diluted Nitric Acid, two drachms;
Compound Tincture of Cardamoms, half a drachm;
Simple Syrup, three ounces;
Water, two ounces and a half:
Make a Mixture. One or two teaspoonfuls, or a tablespoonful, according to the

age of the child—one teaspoonful for an infant of six months, and two
teaspoonfuls for a child of twelve months, and one tablespoonful for a child of
two years, every four hours, first shaking the bottle.
Let the spine and the chest be well rubbed every night and
morning either with Roche’s Embrocation, or with the following
stimulating liniment (first shaking the bottle):
Take of—Oil of Cloves, one drachm;
Oil of Amber, two drachms;
Camphorated Oil, nine drachms:
Make a Liniment.
Let him wear a broad band of new flannel, which should extend
round from his chest to his back, and which ought to be changed
every night and morning, in order that it may be dried before putting
on again. To keep it in its place it should be fastened by means of
tapes and with shoulder-straps.
The diet ought now to be improved—he should gradually return to
his usual food; and, weather permitting, should almost live in the
open air—fresh air being, in such a case, one of the finest medicines.
In the third stage, that is to say, when the complaint has lasted a
month, if by that time the child is not well, there is nothing like
change of air to a high, dry, healthy, country place. Continue the
nitric acid mixture, and either the embrocation or the liniment to the
back and the chest, and let him continue to almost live in the open
air, and be sure that he does not discontinue wearing the flannel
until he be quite cured, and then let it be left off by degrees.
If the hooping-cough have caused debility, give him cod-liver oil, a
teaspoonful twice or three times a day, giving it him on a full
stomach after his meals.
But, remember, after the first three or four weeks, change of air,
and plenty of it, is for hooping-cough the grand remedy.
What NOT to do.—Do not apply leeches to the chest, for I would
rather put blood into a child laboring under hooping-cough than take
it out of him—hooping-cough is quite weakening enough to the
system of itself without robbing him of his life’s blood; do not, on any
account whatever, administer either emetic tartar or antimonial
wine; do not give either paregoric or syrup of white poppies; do not
drug him either with calomel or with gray powder; do not dose him
with quack medicine; do not give him stimulants, but rather give him
plenty of nourishment, such as milk and farinaceous food, but no
stimulants; do not be afraid, after the first week or two, of his having
fresh air, and plenty of it—for fresh, pure air is the grand remedy,
after all that can be said and done, in hooping-cough. Although
occasionally we find that if the child be laboring under hooping-
cough and is breathing a pure country air, and is not getting well so
rapidly as we could wish, change of air to a smoky, gas-laden town
will sometimes quickly effect a cure; indeed, some persons go so far
as to say that the best remedy for an obstinate case of hooping-cough
is for the child to live the great part of every day in gas-works!
231. What is to be done during a paroxysm of Hooping-cough?
If the child be old enough, let him stand up; but if he be either too
young or too feeble, raise his head, and bend his body a little
forward; then support his back with one hand, and the forehead with
the other. Let the mucus, the moment it is within reach, be wiped
with a soft handkerchief out of his mouth.
232. In an obstinate case of Hooping-cough, what is the best
remedy?
Change of air, provided there be no active inflammation, to any
healthy spot. A farm-house, in a high, dry, and salubrious
neighborhood, is as good a place as can be chosen. If, in a short time,
he be not quite well, take him to the sea-side: the sea breezes will
often, as if by magic, drive away the disease.
233. Suppose my child should have a shivering fit, is it to be
looked upon as an important symptom?
Certainly. Nearly all serious illnesses commence with a shivering
fit: severe colds, influenza, inflammations of different organs, scarlet
fever, measles, small-pox, and very many other diseases, begin in
this way. If, therefore, your child should ever have a shivering fit,
instantly send for a medical man, as delay might be dangerous. A few
hours of judicious treatment, at the commencement of an illness, is
frequently of more avail than days and weeks, nay months, of
treatment, when disease has gained a firm footing. A serious disease
often steals on insidiously, and we have, perhaps, only the shivering
fit, which might be but a slight one, to tell us of its approach.
A trifling ailment, too, by neglecting the premonitory symptom,
which, at first, might only be indicated by a slight shivering fit, will
sometimes become a mortal disorder:
“The little rift within the lute,
That by-and-by will make the music mute,
And ever widening slowly silence all.”[242]
234. In case of a shivering fit, perhaps you will tell me what to

do?
Instantly have the bed warmed, and put the child to bed. Apply
either a hot bottle or a hot brick, wrapped in flannel, to the soles of
his feet. Put an extra blanket on his bed, and give him a hot cup of
tea.
As soon as the shivering fit is over, and he has become hot,
gradually lessen the extra quantity of clothes on his bed, and take
away the hot bottle or the hot brick from his feet.
What NOT to do.—Do not give either brandy or wine, as
inflammation of some organ might be about taking place. Do not
administer opening medicine, as there might be some “breaking-out”
coming out on the skin, and an aperient might check it.
235. My child, apparently otherwise healthy, screams out in the
night violently in his sleep, and nothing for a time will pacify him:
what is likely to be the cause, and what is the treatment?
The causes of these violent screamings in the night are various. At
one time, they proceed from teething; at another, from worms;
sometimes, from night-mare; occasionally, from either disordered
stomach or bowels.
Each of the above causes will, of course, require a different plan of
procedure; it will, therefore, be necessary to consult a medical man
on the subject, who will soon, with appropriate treatment, be able to
relieve him.
236. Have the goodness to describe the complaint of children
called Mumps.
The mumps, inflammation of the “parotid” gland, is commonly
ushered in with a slight feverish attack. After a short time, a swelling,
of stony hardness, is noticed before and under the ear, which
swelling extends along the neck toward the chin. This lump is
exceedingly painful, and continues painful and swollen for four or
five days. At the end of which time it gradually disappears, leaving
not a trace behind. The swelling of mumps never gathers. It may
affect one or both sides of the face. It seldom occurs but once in a
lifetime. It is contagious, and has been known to run through a whole
family or school; but it is not dangerous, unless, which is rarely the
case, it leaves the “parotid” gland, and migrates either to the head, to
the breast, or to the testicle.
237. What is the treatment of Mumps?
Foment the swelling, four or five times a day, with a flannel wrung
out of hot chamomile and poppy-head decoction;[243] and apply,
every night, a barm and oatmeal poultice to the swollen gland or
glands. Debar, for a few days, the little patient from taking meat and
broth, and let him live on bread and milk, light puddings, and arrow-
root. Keep him in a well-ventilated room, and shut him out from the
company of his brothers, his sisters, and young companions. Give
him a little mild, aperient medicine. Of course, if there be the
slightest symptom of migration to any other part or parts, instantly
call in a medical man.
238. What is the treatment of a Boil?
One of the best applications is a Burgundy pitch plaster spread on
a soft piece of wash-leather. Let a chemist spread a plaster, about the
size of the hand; and, from this piece, cut small plasters, the size of a
shilling or a florin (according to the dimensions of the boil), which
snip around and apply to the part. Put a fresh one on daily. This
plaster will soon cause the boil to break; when it does break, squeeze
out the contents, the core, and the matter, and then apply one of the
plasters as before, which, until the boil be well, renew every day.
The old-fashioned remedy for a boil—namely, common yellow
soap and brown sugar, is a capital one for the purposes; it should be
made into a paste, and spread on a piece of coarse linen, the size
either of a shilling or of a florin (according to the size of the boil); it
eases the pain and causes the boil soon to break, and draws it when it
is broken; it should be renewed daily.
If the boils should arise from the child being in a delicate state of
health, give him cod-liver oil, meat once a day, and an abundance of
milk and farinaceous food. Let him have plenty of fresh air, exercise,
and play.
If the boils should arise from gross and improper feeding, then
keep him for a time from meat, and let him live principally on a milk
and farinaceous diet.
If the child be fat and gross, cod-liver oil would be improper; a
mild aperient, such as rhubarb and magnesia, would then be the best
medicine.
239. What are the symptoms of Earache?
A young child screaming shrilly, violently, and continuously, is
oftentimes owing to earache; carefully, therefore, examine each ear,
and ascertain if there be any discharge; if there be, the mystery is
explained.
Screaming from earache may be distinguished from the screaming
from bowelache by the former (earache) being more continuous—
indeed, being one continued scream, and from the child putting his
hand to his head; while, in the latter (bowelache), the pain is more of
a coming and of a going character, and he draws up his legs to his
bowels. Again, in the former (earache), the secretions from the
bowels are natural; while, in the latter (bowelache), the secretions
from the bowels are usually depraved, and probably offensive. But a
careful examination of the ear will generally at once decide the
nature of the case.
240. What is the best remedy for Earache?
Apply to the ear a small flannel bag, filled with hot salt—as hot as
can be comfortably borne, or foment the ear with a flannel wrung out
of hot chamomile and poppy-head decoction. A roasted onion,
inclosed in muslin, applied to the ear, is an old-fashioned and
favorite remedy, and may, if the bag of hot salt, or if the hot
fomentation do not relieve, be tried. Put into the ear, but not very far,
a small piece of cotton wool, moistened with warm olive oil. Taking
care that the wool is always removed before a fresh piece be
substituted, as if it be allowed to remain in any length of time, it may
produce a discharge from the ear. Avoid all cold applications. If the
earache be severe, keep the little fellow at home, in a room of equal
temperature, but well ventilated, and give him, for a day or two, no
meat.
If a discharge from the ear should either accompany or follow the
earache, more especially if the discharge be offensive, instantly call
in a medical man, or deafness for life may be the result.
A knitted or crocheted hat, with woolen rosettes over the ears, is,
in the winter time, an excellent hat for a child subject to earache. The
hat may be procured at any baby-linen warehouse.
241. What are the causes and the treatment of discharges from
the Ear?
Cold, measles, scarlet fever, healing up of “breakings-out” behind
the ear; pellets of cotton wool, which had been put in the ear, and
had been forgotten to be removed, are the usual causes of discharges
from the ear. It generally commences with earache.
The treatment consists in keeping the parts clean, by syringing the
ear every morning with warm water, by attention to food, keeping
the child principally upon a milk and a farinaceous diet, and by
change of air, more especially to the coast. If change of air be not
practicable, great attention ought to be paid to ventilation. As I have
before advised, in all cases of discharge from the ear, call in a
medical man, as a little judicious medicine is advisable—indeed,
essential; and it may be necessary to syringe the ear with lotions,
instead of with warm water; and, of course, it is only a doctor who
has actually seen the patient who can decide these matters, and what
is best to be done in each individual case.
242. What is the treatment of a “sty” in the eyelid?

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Creating Low Carbon Cities 1st Edition

Low Carbon Urban Infrastructure Investment in Asian

Climate Action Planning: A Guide to Creating Low-

Hydrothermal Reduction of Carbon Dioxide to Low-Carbon

Forest Carbon Practices and Low Carbon Development in

Low carbon Energy Security from a European Perspective

Integration of Low Carbon Technologies in Smart Grids

Multiphase Reactor Engineering for Clean and Low Carbon

Investing on Low Carbon Energy Systems Implications for

Creating Low Carbon Cities

ISBN 978-3-319-49729-7 ISBN 978-3-319-49730-3 (eBook)

Library of Congress Control Number: 2017930816

© Springer International Publishing AG 2017

Printed on acid-free paper

This Springer imprint is published by Springer Nature

significantly less. These ambitious goals imply complete global decarbonization

In 2015 installed power from renewable energy sources grew by over 8 %.

Gino Van Begin

Challenges and Opportunities for Transition

Low-Carbon Waste Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

Shobhakar Dhakal and Matthias Ruth

Keywords Sustainable cities • Low carbon cities • Climate mitigation • Climate

© Springer International Publishing AG 2017 1

Sino-Singapore Tianjin Eco-city. These examples are framed by more general,

Abstract Information- and communications-technology systems are now

Keywords Energy management • Low-carbon city • Future city • Smart grids •

© Springer International Publishing AG 2017 5

Information- and communication-technology systems now allow for the collec-

2 What Data Exist

3 What Data Do Not Exist

4 What More Is Needed?

First, as we collect increasingly more data, we need better institutions to oversee

5 How to Use Data

Collective Awareness Platforms (https://ec.europa.eu/digital-single-market/en/col

1. Energy Cities: http://www.energy-cities.eu/

Matthias Ruth, Sanchari Ghosh, Sahar Mirzaee, and Nancy S. Lee

Keywords Mitigation • Adaptation • Co-benefits • Co-costs • Urban climate

Importance of City-Level Climate Mitigation and Adaption

© Springer International Publishing AG 2017 15

Significance of Including Co-benefits and co-costs

Failure to include all co-benefits will lead to underestimation of the full

2 Economic Argument for Including Co-benefits and Co-costs

Optimal Abatement Levels Including Direct Benefits

To define and capture co-benefits and co-costs requires systematic treatment of

Fig. 1 Primary benefits and co-benefits

Fig. 2 Standard damage cost and abatement cost profiles

Fig. 3 Schematic representation of multiple decision-making criteria for alternative low-carbon

3 Representative Cities and Their Climate

Cities in Developed Nations

Fig. 4 Cities with climate action plans and their population

biggest cities in Australia (Sydney, Melbourne, Brisbane, and Perth), Tokyo in

Cities in Developing Nations

Climate Action Categories

The review of city-level climate adaptation plans reveals 14 broad categories of

Table 1 Action categories

forerunners in devising strategies that involve community participation and using

4 City Climate Action Plan Analysis

Differences in Action Categories and Their Frequencies

To make a Mixture. Two teaspoonfuls to be given early in the morning

Make a Mixture. One or two teaspoonfuls, or a tablespoonful, according to the

234. In case of a shivering fit, perhaps you will tell me what to

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