KSiy^» =^.- $0: LIBRARY OF CONGRESS. UNITED STATES OF AMERICA. VAGARIES OF Sanitary Science F. L DIBBLE, M.D. It is held as a fundamental principle in science that every opinion, before it is admitted as true and taught to others, should first be established by proper proofs, which must not in any way run counter to established truths, such as, for instance, that twice two are four and not five. Inferences and conclusions which are opposed to such truths are rejected by science. — Liebig. PHILADELPHIA J. B. LIPPINCOTT COMPANY 1893 V a 3' Copyright, 1893, BY J. B. LippiNcoTT Company. Printed by J. B. Lippincott Company, Philadelphia. THIS BOOK IS DEDICATED WITH PROFOUND RESPECT WORKINGMEN OF THE MEDICAL PROFESSION. CONTENTS PAGE Introductory 7 CHAPTER I. Sanitarians — Ancient, Mediaeval, and Modem 15 CHAPTER II. The Great Sanitary Awakening, with an Account of some of the Circum- stances which attended the Birth of Sanitary Science ♦ 29 CHAPTER III. The Air 50 CHAPTER IV. The Air (continued) 79 CHAPTER V. The Water 106 CHAPTER VI. The Soil . 142 CHAPTERVII. The Sewer-Gas 153 CHAPTER VIII. Cemeteries 181 CHAPTER IX. ' '^* 5 Public Funerals 205 6 CONTENTS. CHAPTER X. PAGE The Meat 215 CHAPTERXI. The Milk , 231 CHAPTER XII. Filth and Fecal Diseases— Typhoid Fever 248 CHAPTER XIII. Yellow Fever . 280 CHAPTER XIV. Cholera 292 CHAPTER XV. Diphtheria 329 CHAPTER XVI. Epidemics 345 CHAPTER XVII. Boards of Health 364 CHAPTER XVIII. The Vital Statistics 403 CHAPTER XIX. Conclusion 454 INTRODUCTORY. About five years ago, during an hour of leisure, the author of this book took up an annual report of a local board of health and read it. It was full of general misstate- ments and inconsistencies, and abounded in misrepresenta- tions of vital statistics. Yet this erratic and unreliable report was offered to scientific men, and to the medical profession, as a truthful exhibit of the value and working of Sanitary Science. On the strength of this report, the law- making power, to which it was addressed, was besought, in the name of the Public Safety, to formulate the most offen- sive and despotic legislation, to create new offices and to levy new taxes. The author was impelled, in a spirit of badinage, to publish anonymously in a newspaper a review of the document. The sonorous and impressive titles of State Medicine, Preventive Medicine, Sanitary Reform, Sanitary Science, and their relation to the great question of the public health had always been deeply ingrained in his mind. The object which these titles represented surpassed in importance all considerations of therapeutics as applied to individual patients in the daily practice of medicine, as much as ques- tions of national life exceeded those of the welfare of private persons. The author felt that in reviewing this report in a mirthful way he had done an unholy thing: he had trifled with the public health, had mocked its ministers who were organized as a board, and who were supposed to be calmly but deeply 7 8 INTRODUCTORY. meditating on the cause of those diseases which the medical profession had hitherto been unable to fathom, and which cause, as it was exposed to view by the light of Sanitary- Science, they made known to a world sitting in darkness. The author believed that the report which he had criticised had been carelessly gotten up by its makers (they were his professional and personal friends, as friends go), and had glided from their hands without their being aware of its incongruities. He never doubted for a moment the merits of State Medicine and Sanitary Science, and in treating them lightly felt that he merited, and he expected to receive, a condign punishment. His remorse was something like it would have been if, fifty years ago, he had laughed at his Sunday-school teacher, who in his ministrations had inadvertently donned a bad hat or worn a patched coat. As by unexpected impunity wicked men are often em- boldened to continue their transgressions, so the author's unlooked-for escape from chastisement encouraged him to go farther, and he reviewed a report of a State board of health, which was even fuller and fatter with nonsense than was that of the city board. This kind of skirmishing went on for a year or two ; shot after shot was fired in vain in the hope of drawing the ammunition from the sanitarians, when finally a reply came which in no way vindicated the absurdities nor explained the inaccuracies of their printed reports, but which was a biting taunt that the reviewer was an enemy of the public health. Besides, it was more than hinted, in a subsequent report, that the progress of Preventive Medicine was ob- structed by those physicians who saw in its ultimate triumph a diminution of their own revenues. It occurred to the author that if strictures on Sanitary Science could be replied to only with taunt and innuendo, it was fundamentally defective; so that, although his so INTROD UCTOR Y. 9 doing implied a doubt of the infallibility of its professors, and although it might indicate an irreverent spirit and lay him open to the reiterated charge of being an enemy of the public health, he ventured to look up its history and ex- amine its claims to be considered a science. He found that it had its origin in a kind of disorderly agitation that sud- denly seized the people of Great Britain, following an inquiry into the condition and manners of living of the poorer classes in that country. Sanitary reform was not conse- quent to any new biological or pathological discovery; neither was it connected with any line of scientific research. It owed its rise and progress in our own land more to the fondness and habit of imitating the English than to any other cause. In both countries, although its inception was perhaps unalloyed by selfishness, speculators within and without the medical profession were quick to discern and grasp the opportunity to be cheaply lifted to fame and fortune, and, stimulated in this way by self-interest, when the excitement was well under way, its momentum was irresistible. The theme of the whole movement was the causation by filth of infectious disease ; and the phenomena of zymosis were so treated as to explain the origin of such disease. It was boldly declared by the reformers that filth — organic matter in decomposition and fermentation — ^^was capable of exciting in the human system fermentative, zymotic, filth diseases, and these epithets were applied to all of those which had in them the element of contagion or infection. Zymotic disease was therefore preventable through the removal of filth and the hinderance of zymosis, and the science of Preventive Medicine was reared on this fantastic idea, which for the last fifty years has formed the basis of all sanitary legislation in Great Britain and America. It was never pretended that this whimsical theory had any foundation in scientific inquiry, and it never had the sanction I O INTR OD UCTOR Y. of thoughtful and practical men in the medical profession. Dr. Farr, who was one of the first, if not the first, to apply the term zymotic to disease, was careful to say that he used it only because it was more convenient than the pe- riphrasis of epidemic, endemic, and contagious diseases. At the very outset of his labors the author was struck with astonishment at the almost utter barrenness, on the part of the sanitarians, of anything like scientific investi- gation. Not less surprising was this other fact, — namely, that if perchance — which rarely happened — an investigation which merited the name scientific was by themselves under- taken, or, what was oftener the case, if a genuinely scientific inquiry into their pretensions was made by scientific men, the result, in either case, invariably was their complete overthrow. From time to time a sanitary orator at a sanitary con- vention would improvise some wild proposition about the air, water, and soil, or would indulge in some strange phantasy respecting the sewers, the cemeteries, or the markets ; this would be wafted with great thoracic vehemence from the larynx of one reformer to that of another, — nobody would investigate its truth or falsity, — soon it would find an echo in some sanitary journal, and straightway would be given a place among the " settled principles of Sanitary Science." If any resistance were offered to these vain imaginings, it was not listened to in a scientific spirit ; but the opponent was censured as a foe to the public health, and if he re- sented this imputation, he was hushed by the reproach that he was an advocate of uncleanliness, and, as we shall see later, was said to be " content to wallow in his own filth." The author's amazement had no bounds when, on ex- amining, one after another, the " settled principles of Sani- tary Science," he found that these had no scientific basis ; that they rested on froth, noise, and panic, and that the shapeless spectres which the reformers had raised to in- INTRODUCTORY. II timidate the public disappeared when they were looked squarely in the face. The whole sanitary movement had no resemblance to scientific investigation ; it could be likened only to a politi- cal upheaval or a fanatical religious awakening. Indeed, it can be fitly compared with the imposition on mankind of those false religions whose priests have held, at different periods of the world's history, whole continents in terror by their inventions. As, in order to sustain these false religions, it was necessary that their ministers should continually re- inforce them with some new dogma, so the vigor and stability of Sanitary Science depended on the ingenuity of its pro- moters to persistently summon up some new terror with which to frighten the people, and then proceed to caress them into tranquillity by the passage of some sanitary ordi- nance or by the pretended discovery of some antidote or antiseptic. These successive conjurations, combined with legislative enactments which imparted to them force, were called the " gigantic strides of Sanitary Science," There have been times during the progress of this work when the author has doubted the evidence of his senses. More than once, in order to be convinced that his own eyes did not deceive him, he has laid before others the state- ments and figures of professional sanitarians which were so absurd, so self-contradictory, that it did not seem possible that they could have emanated elsewhere than from the brain of a lunatic or an imbecile. When pressed to explain their tissues of paradox and absurdity, the reasons which they gave were often so trivial that if, in a well-regulated household, similar ones had been offered to soothe the budding curiosity of a nursling, its attendant would have been visited with reproof if not with summary dismissal. The author has often felt a sense of shame that many of those who were foisting this sanitary nonsense on the people, and on physicians, and demanding that it be embodied in 12 INTRODUCTORY. statute law, were nominally of the medical profession. In the beginning of this inquiry, he had no thought of pub- lishing its result. But, as the work proceeded, he became more and more impressed with its gravity, not only to medical men, but to the public at large. He esteems that an important point has been gained if he shall succeed in calming the fears, quieting the panics, and restoring the composure of his fellow-citizens, whose minds have been continuously excited and kept at a painful tension by sani- tary reformers, concerning the dangers of air, water, soil, cemeteries, markets, public and private improvements, and if he has shown that none of these, in the conditions in which they have been set forth by the pretended guardians of the public health, are causes of disease, and especially of infectious disease. In the main, in this work, the author has drawn no con- clusions ; he has submitted facts. That these facts are to his own mind demonstrative, that they have changed en- tirely his former belief in the etiology of infectious disease, he makes no effort to conceal. It was never anything but a ** belief" transmitted to him by oracular men who had no claim to be considered scientific. If, sometimes, he has betrayed a warmth of expression, it is because of natural indignation that he had not only been the dupe of noisy men who were posing as scientists, but that through their teachings he had been the instrument of duping others. If the objection be raised that the conclusions to which the facts here presented tend shatter the faith in Sanitary Science and leave the public health comfortless and the people nothing to lean upon, the reply is, that if the faith be false it should be discarded ; that in natural science an intelligent agnosticism is better than blind credulity in error, especially when the subject is of such weighty moment to humanity as knowledge of the causes of disease. Though in theological matters it may be debatable (in many minds INTRODUCTORY. 13 it IS firmly settled) that mankind is happier with a false belief than with none at all, a like conviction has never obtained in questions of physical inquiry, and it will not be denied that one of the first steps towards ascertaining the truth is to expose and remove error. Neither will it be disputed that the virgin mind, untainted in its sincerity, is fitter for the reception of truth, when this is made known, than is the mind which is clogged and darkened by false- hood. If further opposition be made, that the display of these facts will expose the pretensions of a large number of pro- fessional sanitarians, who, by playing on the fears of their fellow-men, have acquired fame and position ; and that it will wound a large number of amateurs of both sexes who have been seduced into dabbling and coquetting with Sani- tary Science, for the reason that it required no mental labor to become proficient in its mysteries, and who have found therein a solace for their ennui^ the reply is, that the objection is well taken, and from a social point should be considered, but should not be sustained in view of the vast importance to the people that no errors should be confirmed regarding the pubHc health ; and, moreover, attractive fields are being continually thrown open, which offer an ample refuge to that large class of minds which seek intellectual repose in improvisation rather than in scientific research. Those to whom truth is distasteful, lest it shall shock a life-long prejudice, are advised not to read this work, — it will only irritate them. It had better remain closed to those who fear that they will sink into depravity should they listen to evidence respecting the innocence of nature's metamorphoses. Those are cautioned not to open it who, though feeling secure in their own virtue, are so solicitous and apprehensive for the vulnerability of that of their neighbors, lest they retrograde in civilization and prefer nastiness to elegance unless their minds are steadily tortured 2 14 INTRODUCTORY. with hideous fables of disease and death. On the other hand, those timid people who for the last thirty years have had their waking hours vexed and their sleep plagued by an unceasing procession of sanitary terrors are invited to read it. It may comfort them. Those also are invited to read it who love truth for truth's sake, and who believe themselves sufficiently steadfast to receive it, and who can survey nature's changes in decay and death, not only with the same composure but with the same poetic fervor that they view her creative and formative processes, without im- agining, in the absence of all proof, that these mutations are inseparable from the explosion of epidemic disease. VAGARIES OF SANITARY SCIENCE. CHAPTER I. Sanitarians — Ancient, Mediaeval, and Modern. That instinct of self-preservation, the most powerful of all instincts, which is ever active with the individual, making him timid or courageous in the presence of danger, espe- cially the danger of epidemic and infectious disease, extends itself with no less potency to collective bodies of men for the conservation of communities, nations, and races. Man is hardly conscious of life when he begins to be tormented with the fear of death. His hope of a continued being and a fear of its extinction have often overcome rea- son and judgment, and have made him the dupe of the pre- tender and the charlatan in all ages. The most primitive people of whom we have any historic records, even in their transit through the wilderness, sub- mitted to as stringent sanitary codes as any of those which have been contrived in our own time. It was doubtless a prophylactic ordinance which marked the Jew with a fleshly sign that distinguished him from the rest of mankind. By the fifteenth day of the second month of their journey the Israelites had begun to worry about their health. The cloud yet rested on the tabernacle by day and the fire IS 1 6 VAGARIES OF SANITARY SCIENCE. blazed on it by night to guide the exiles in the desert, when their leader and prophet put forth a system of dietetics which, to a great extent, is observed by their descendants to the present day. Birds, beasts, insects, reptiles, and fish were proscribed which the experience of all other peoples has proved to be harmless; others were allowed and even commanded to be eaten from which we turn with disgust. The camel, the cony, the hare, and the swine were forbid- den ; they were unclean ; not only were these and everything in the waters that had not fins and scales denounced as an abomination, but the decree went further, ** Ye shall have their carcasses in abomination." They might eat the sheep, the ox, the goat, the deer, and the pygarg, and the locust and the bald locust, the beetle and the grasshopper, but " any creeping thing that creepeth" they should not be defiled thereby. They should not eat the blood, for the blood was the life. Neither should they eat any<-hing that had died of itself This they might sell to the alien or give unto the stranger. Experience and observation had probably taught their guide that the flesh of animals dead of disease was innoxious, for he had long before counselled them to love the stranger, reminding them that they, too, had been stran- gers in the land of Egypt. But his delicate and fastidious mind would not tolerate such food for the Jew. His people were a peculiar people, and his God was a jealous God. Attempts have been made to show that the aim of the prophet sanitarian was to set forth in these mandates the virtues of self-restraint and temperance. This can hardly be so ; for when the wanderers languished and murmured by the way, his method of infusing new courage into their hearts was by appealing to their appetites. If any message had been given to him from the flaming bush of the life eternal, he spoke not a word of it to the materialistic Jew. Many times he told his followers that he was conducting them to a land flowing with milk and honey, where they were SANITARIANS— ANCIENT, MEDIAEVAL, AND MODERN. 1/ to eat and fill themselves and wax fat ; and as they approached the river where he was to lay down his leadership and find an unmarked grave, he burst forth into a victorious song and laid before them a rich but unclassified menu, that Jew might taste with delight and that Gentile might adore. For the Lord had made Jacob to " ride on the high places of the earth, that he might eat the increase of the fields ; and he made him to suck honey out of the rock, and oil out of the flinty rock ; butter of kine, and milk of sheep, with fat of lambs, and rams of the breed of Bashan, and goats with the fat of kidneys of wheat ; and thou didst drink the pure blood of the grape." This sacerdotal hygiene took cognizance of the most secret relations of life. If a man or a woman had an issue, separation from the rest was enjoined for a stated period. The etiology of disease was in the fiat of Jehovah. The priest diagnosticated the malady, prescribed the treat- ment, made the prognosis, supervised the convalescence. The therapeutics of the Hebrews of that day would be no more acceptable to us than their prophylactic measures and their dietetics. The blood of the trespass-offering was to be put on the tip of the right ear of him that was to be cleansed of the leprosy, and upon the thumb of his right hand and upon the great toe of his right foot. When the wandering children were bitten by fiery serpents, they had but to look on the brazen serpent that their leader lifted up and they lived. If they were faithful to the statutes and commandments, they should not suffer the diseases that had been brought on the Egyptians. But if they did not keep the laws, " then the Lord will make thy plagues wonderful,, and the plagues of thy seed, even great plagues, and of long continuance, and sore sicknesses, and of long continuance.'* "The Lord will smite thee with the botch of Egypt, and with the emerods, and with the scab, and with the itch, whereof thou canst not be healed." \ Many centuries later appeared another sanitarian, a leg- b 2* 1 8 VAGARIES OF SANITARY SCIENCE. islator in the person of Lycurgus. His prophylaxis was of the most radical kind. The new-born Spartan child which gave no promise of future vigor was abandoned or destroyed. If permitted to live, not long after it had been weaned from the mother breast it was seized by the state, removed from the family, and made a part of the common stock. It was subjected to influences and exercises to strengthen and indurate bone and muscle and nerve. A public table supplied by the simplest food nourished the bodies of the Spartan youth. Those mental qualities which tended to self-preservation were stimulated and encouraged. Lying was a virtue and theft a duty. When the Spartan brave made love, he sought and won his bride by stealth and violence ; and the first-born of Spartan children were the product of a rape. Marriage could not be contracted by men before thirty, nor by women under twenty years of age. When the Spartan woman was likely to become a mother, the pictures of the handsomest young men were hung in her chamber, that gazing on them might produce a favorable effect on the child. That this system of legis- lative hygiene, which in our day would bear the pompous title of State Medicine, was effective to establish a vigorous body will not be denied. The Spartans were a healthy but a bad lot. Five hundred years later appears a man whose deep phi- losophy is set forth in such sententious phrase as, " Life is short, and art is long ; the occasion fleeting ; experience fallacious, and judgment difficult." He displayed such practical knowledge of the art of medicine that his works have been studied and admired for more than twenty-three centuries. The modern sanitarians, in their retrospective excursions to seek in antiquity a warrant for the vagaries and chimeras of their own creation, rest fondly on Hippoc- rates II. or the Great. In his book on " Airs, Waters, and Places," they find, or pretend to find, a treatise on hygiene. SANITARIANS— ANCIENT, MEDIMVAL, AND MODERN. 1 9 whose title they have transformed into their own shibboleth of " pure air, pure water, pure soil," as the essentials of public health. That they have never read or that they misrepresent the Great Father is plain, for there is abso- lutely nothing in his book on " Airs, Waters, and Places" that can possibly be twisted to the modern sanitarians' use. Their prototypes belong to the charlatans of an earlier and a later age. A thousand years have rolled on from the time of Hippoc- rates, when the mediaeval sanitarian arises to teach and guide his fellow-man in the maintenance and promotion of his health. The school of Salerno, in the tenth century, emits hygienic maxims in Leonine rhymes, which afford amusement, if not instruction, to the reader of to-day. This famous body, which existed for centuries, seems to have been entirely neglected by the modern sanitarians, for we do not remember ever to have seen it alluded to in any of their writings. In some of the apothegms of this school they will find a counterpart of their watchwords, " pure air, pure water, pure soil," sometimes done into English, some- times into French verse. In pestilential times the astute, mediaeval reformer discovered the etiology of epidemics in the machinations of the Jews, and his prophylaxis consisted in first robbing and then roasting and hanging these un- happy people. From the Middle Ages to the present time are strewn accounts of efforts to promote the public health, — all or nearly all, however, founded on false notions of the etiology of the diseases which these endeavors sought to control. It cannot be gainsaid that the Mosaic theory of the etiol- ogy of epidemics — to wit, the Divine will — can be less suc- cessfully contradicted than any invented by the sanitary reformers. The feebleness of sanitarians and boards of health so impressed Noah Webster that he declared in his work on 20 VAGARIES OF SANITARY SCIENCE. epidemics, a hundred years ago, that he found " no suffi- cient evidence that health laws ever saved a country or city from pestilence in a single instance; but abundant, positive proof of their inefncacy in a great number of cases ;" and he remarks that men have perished by millions in the most salubrious regions, exposed to no local causes of disease whatever, except such as exist in the most healthy periods. In the progress of this work we expect to show that, not- withstanding the boasts of the sanitary reformer of to-day, his methods of dealing with pestilence in its relation to public health are almost exactly like those of ancient and mediaeval times. But our business in these pages is to con- sider the rise and progress of the modern sanitarian, and particularly as he exhibits himself in our own country. Twenty-five years ago he was in embryo. The ferment about sanitary reform, which had existed in England for a quarter of a century before, had just reached our shores. There was then no occasion for alarm about the public health. There was no reason to doubt that here, as else- where in the civilized world, the general death-rate of hu- man beings was diminishing ; that the mean duration of life was being extended ; and that, too, except through a gen- eral advancement in civilization, it was being accomplished independent of any known human agency. But the occa- sion was ripe for noisy, superficial men to be heard, and these commenced to bring themselves into prominence as scientists. They began to prate loudly of air, water, and soil. These elements, indispensable to life, were pestilential, polluted, contaminated. Towns and cities which had been renowned for centuries for their health were suddenly dis- covered to be the breeding-places of epidemic disease. Suspicion was cast on sources of water-supply which for generations had furnished a delicious and healthful bever- age. The reformers told us that the very fact that these waters were clear and sparkling and grateful to the taste SANITARIANS— ANCIENT, MEDIMVAL, AND MODERN 21 should arouse our distrust, for just such waters had been proved to contain the essence of contagious ailments. The soil, too, had become saturated with putridity; it was a seething volcano of disease ready to burst forth at any moment. The mysterious relation of disease to these airs, waters, and soils demanded an intercessor to negotiate the conditions of health between them and the people; this mediator should be the sanitarian ; the brokerage was to be paid by a draft on the public funds. The sanitary reformer saw, or pretended to see, the hidden principle of disease lurking in every operation of nature whereby organic substances were decomposed and their original elements set free to assume a new role in the uni- verse. The fanciful thought that certain types of diseases, febrile, eruptive, epidemic, and contagious, which had been no less fancifully named zymotic, were, in their advent and course, analogous to the fermentative process, was for the sanitarian an attractive basis for his theory ; and he went a step farther and called them " filth diseases." He made no investigation ; he relied on his riose for in- formation : this taught him that all of those transformations of matter, those reciprocal offerings of animate and inani- mate bodies, the cessation of which would bring disaster and destruction to all life on the globe, were the sources of zymotic and, as he called it, preventable disease. Herein lay the septic ferment, the morbific element ; and as new biological discoveries were made, which seemed to show that the principle of disease was a material object, a germ, he attempted, with a most ludicrous result, to apply it to his theory. He adapted to this discovery the parable of the sower : the filth was the soil, the germ was the seed, the harvest was zymotic or preventable disease. This jumble of fancies, words, and phrases was baptized with the name of Sanitary Science ; its advocates called themselves, at first, sanitary reformers, and later, sanitarians. 22 VAGARIES OF SANITARY SCIENCE. We expect to show that there is no more proof of the evolution of a noxious element in the breaking up of or- ganic matter than there is in its creation, or in the union and decomposition of inorganic substances ; that in either case nature's analyses and nature's syntheses are equally inno- cent. To bring themselves into notice the reformers took every opportunity to excite and magnify the fears of the people about their health ; they foretold epidemics that never appeared ; on the other hand, epidemics broke out of which they gave no warning. Were a new convenience devised, whereby our houses were made more inviting and more comfortable, they cre- ated a new fright, and persuaded us that the improvement could be tolerated with safety only by the supervision of a health inspector. Were any method brought out to produce a new article of food, whereby the price of a necessity or luxury of Hfe could be lessened to mankind, the cry of danger to the public health was raised. Did some enter- prising man introduce a cheaper meat-supply, which implied the alimentation of millions, interested parties invoked the public health to suppress it, and found coadjutors in sani- tarians and boards of health to so encumber its distribution that the beneficent project was often defeated. Were negro domination in a city obnoxious, " the settled principles of Sanitary Science" demanded that the State Executive should appoint its officials, and Jacksonville's autonomy must be sacrificed to maintain the public health. Were an inter- national political crime contemplated, Sanitary Science fur- nished the excuse ; and our self-preservation depended on the seizure of Cuba as a precaution against yellow feven The reformers darkly hinted that there existed among us an unprincipled body, which to advance its interests did not scruple to plot against the public health, and nothing swelled their importance so much as the system of espionage and SANITARIANS— ANCIENT, MEDIEVAL, AND MODERN. 23 secret accusation which they ordained and fostered, whereby • every quarrelsome man and every spiteful woman, in seeking revenge against a neighbor for a real or fancied grievance, felt secure of finding a confederate in local boards of health. This was carried to such an extent that their own public reports acknowledged from thirty to forty — private admis- sions sometimes made it fifty — per cent, of all complaints as groundless, most of them based on ill-humor. In Boston, in one year, sixteen hundred and thirty complaints were in- vestigated, in which no cause for action was found. The Sanitary Committee of the New York Board of Health * reports, " Many complaints upon investigation proved to have been exaggerated and in some cases to have originated in malice or a desire to secure personal aggrandizement." One city of sixteen thousand inhabitants f declared that many of the complaints made to its board of health were ** the result of spite." Bewildered and frightened men bore all this because they were led to believe that the public health was in danger. They tried to save their wives and little ones from perils that existed only in the brain of the sanitarians. Power was conferred on these to issue decrees which they called " Sanitary Codes," every one of which, if we except those pertaining to isolation and vaccination, is useless, silly, and oppressive, and has no bearing whatever on public or private health. They told the people that if they would delegate to them the authority to enforce these statutes and com- mandments, they would be saved from epidemic disease ; but if they were unheeded, not the plagues and the botch and the emerods of the Egyptians would seize them, but worse. They prophesied the return of the mediaeval pes- tilence, — the Black Death of the Middle Ages. Dangers beset us at every turn ; if we stayed in the * 1886. f Connecticut Board of Health Report, 1SS6. 24 VAGARIES OF SANITARY SCIENCE. cities, we were poisoned by sewer-gas ; it was sure death to go away from home ; if we ventured a visit to the country, the water-cooler with its impure ice was in the palace-car,* or it was filled from the polluted road-side well. Milk and cream were dairied in barn-yards ; the gases of decay from foul soils, cesspools, and privies were leeching into hotels and dwellings ; there were in-door sanitary conveniences for taking typhoid fever from defective water-closets, " which constitute at least nine-tenths of all the hotel fittings through- out the country, not excepting even Saratoga." There were out-door sanitary conveniences over pits and vaults, increas- ing dangers a thousand-fold to those who were subjected to these putrid emanations. What arrested the attention of observers was the facility with which the professors of the new-born science achieved celebrity. In every other department — mechanics, science, or art — distinction was attained only by protracted and patient industry and study. But in the very dawn of Sani- tary Science, its apostles had but to foretell some great dis- aster, improvise a rhapsody on cleanliness, offer an essay on sewer-gas, or publish a diatribe on the grinding landlord, and they were greeted by their fellows at the next sanitary convention as the Eminent Sanitarians, and henceforth were to enjoy the triple dignity of prophet, legislator, and sage. They found a powerful ally in the priesthood. Here was a body of men who were genuine lovers and promoters of the public weal. They were made to believe that the gen- eral health depended in some way on obedience to the man- dates of the sanitarians ; and the pulpit thundered in favor of sanitary reform. To the tender, susceptible, and prophetic female mind, which conceived an indissoluble tie existing between phys- * Sanitarian, vol. x. SANITARIANS—ANCIENT, MEDIEVAL, AND MODERN. 2$ ical purity and bodily health, the infant science offered peculiar charms. The sanitarians rehearsed the seductive tale that the sphere of woman lay in sanitary reform, and, after toying with it for a season, she embraced the new doc- trine, and by her ready pen and ready utterance has prob- ably done more to nurture and popularize the same than all the clergy and doctors put together. She was told that, while the more profound secrets of the dawning knowledge were hidden from the wise and prudent housewife, and re- vealed only to those who had solemnly consecrated them- selves to their interpretation, still she was amply competent to grasp the minor points and be useful to herself and fam- ily. She could look after the plumbing. If there were anything here to arouse suspicion, the alert mistress had in her closet an unerring test for sewer-gas in that carmin- ative, anti-flatulent, anti-spasmodic essence of peppermint. When this was poured into the pipes, if she smelled it, or thought she smelled it, she could rescue the household by telephoning the family plumber before it was too late. Those ladies who had a literary turn gave expression and vigor to the new science in their novels. Filth and sewer- gas as causes of disease and drainage as its preventive and cure were set forth in graphic story and threatened to dis- place altogether those finer particulars of obstetrical knowl- edge which had so often adorned their tales and entertained and instructed their readers. In Robert Ellsmere we have a most happy combination of both sanitary and obstetrical science. Here and there the sanitarians suborned a talented mem- ber of the medical profession and subsidized him to their uses. Though the profession at large tendered no direct opposition to the current of sanitary reform, and in some cases were persuaded as public bodies to endorse boards of health, many of its members looked on incredulously, and some of the most influential denied flatly the dictates of B 3 26 VAGARIES OF SANITARY SCIENCE. the sanitarians respecting the origin of epidemic disease. As sensitive to the pubHc good as to the welfare of their individual patients, and trusting that perhaps there might be a grain of truth somewhere in this whirlwind of chaff, medical men yielded to the tempest of sanitary reform, and tolerated by their silence the charlatanry of its advocates. Many of them, doubtless, believed in the tradition which had been handed down, of the danger to health from putrid emanations and the decomposition of organic matter. We purpose to show that, in every instance where this subject has had a careful and systematic investigation, medical men have acknowledged a surrender of their prejudices. When it suited their interests, the sanitarians juggled with tables of mortality and misrepresented vital statistics. They stifled all investigation, all discussion. If any man dared, for a moment, to oppose the fury by calling for proof of the new doctrines, he was branded as an enemy of the public health. Meanwhile, by keeping the people in a continual ferment and panic, they established a veritable reign of sanitary terror.* The kingdom of Sanitary Science suffered violence, and the violent were to take it by storm. The reformers called for "aggressive sanitation." They demanded heavy fines and imprisonment for those who should transgress their sanitary codes. One eminent sanitarian f in a pubHc lecture declared that the causes of infectious diseases and the means of pre- venting them were as well known and as readily controlled as those of railroad dangers, and he suggests that it be en- acted, etc., " that every legal resident in every town in Con- necticut, who shall, while residing in the town, have either of the following diseases, viz., yellow fever, cholera, small- * See note at end of chapter. f Connecticut Board of Health Report, SANITARIANS— ANCIENT, MEDIEVAL, AND MODERN. 2/ pox, typhus fever, scarlet fever, typhoid fever, shall be enti- tled to receive from the treasury of the town three dollars for each day that he is confined to his house by such sick- ness ;" and that " every person so afflicted shall be subject to such regulations and restrictions as the board of health of the town shall determine." Another health-officer,* in Michigan, says that the world can never be reformed by moral suasion alone ; and, im- patient of the slow process of the law, he advocates a prompter method, and says, " If tenants whose humble homes have been visited by the angel of death would mob the landlord and throw him into the reeking cesspool, it would do more good than the best hygienic tract on sewer- gas that was ever written. If a thousand emigrants es- caping from a foul steamer would burn it up, it would do more good than an act of Congress. If the proprietor of a dairy distributing milk from premises where there is small- pox, scarlet fever, diphtheria, or typhoid fever, were set upon and hung on the nearest lamp-post, instead of having him prosecuted, this would infuse a healthy vigor into the makers of law." The sanitarians affected a deep concern for the " humble home," and they summoned us to behold their efforts to ameliorate the condition of the poor, who were at the mercy of the grinding landlord. This self-eulogium on the one hand and denunciation on the other attracted observa- tion and excited criticism. People asked who were these humane men and what had been their previous history. They had never before been distinguished for benevolence. A goodly number of them had had the sympathy of their neighbors for their want of success in former endeavors in life; others were second-class ward politicians. But with the help of the dilettaiiti of both sexes they organized foi * Sanitarian, vol. xi. 28 VAGARIES OF SANITARY SCIENCE. business, and for nearly a whole generation have held the people on the verge of a panic, reminding them that some portentous calamity was impending. It is a suggestive and significant fact that, in order to avert this calamity, we were bidden to clothe the sanitarians with power, invest them with office, and provide them with money. Note. — A factory whicli had been in operation for forty years, and around which had grown up a small town whose prosperity depended on it, had suffered great persecution and had spent large sums of money for defence against a band of speculators who had invested in real estate in the vicinity, and who now complained of the factory as dangerous to the public health. The author is sure that tens of thousands (maybe fifty thousand) of dollars of expense had been caused this company. He asked for information and, at first, received an exultant reply that the company had had a costly fight, but had beaten its enemies, and that when the superintendent returned, who was then absent, he would gladly furnish the details. Not so with the wary superintendent. He said that it was true that his company had suffered great trouble and expense, extending over a period of two or three years, but he asked to be excused from giving any facts ; they were then on veiy good terms with the board of health and preferred to remain so ; that to reopen the case by publishing anything which had occurred might make further trouble, and they wished to let the matter rest. The author called in person on a water company which had endured a long and expensive contest with the health authorities on account of the pretended dangerous water it was supplying. A rival was in the field, and in order to succeed had invoked the public health. The company admitted they had suffered grievous wrong, but as they had won their case they did not wish to say anything for publication which might again stir up the matter. The agent of a steamship company gave the author a verbal account of the annoyance and expense it had been put to by a certain board of health. When leave was asked to publish the story, the agent showed great concern lest making it known should subject his company to sanitary vengeance. Not long ago an alarming account was given of the horrible sanitary con- dition of a public building in one of our large cities. Employees and visitors were in imminent danger every hour of being poisoned by sewer-gas. This condition had existed for twenty-five years. At certain seasons there are be- tween eight hundred and one thousand people engaged in the building during the entire day and sometimes part of the night. Large numbers visit it at all seasons of the year. The author inquired carefully of many of those em- ployed there if they knew or had ever heard of any sickness arising from the THE GREAT SANITARY AWAKENING. 29 building. At every inquiry he was laughed at. One of the principal officials then told him that there was a one-hundred-thousand-dollar job in prospect, and he gave information to show that the whole sensation was got up by a ring of speculators. When leave was asked to publish these details the official wilted at once, and implored the author not to give them publicity; that he (the official) would be held up as an enemy of the public health, and it might cost him his position, but that if called before a proper committee he would state the facts. These are only a few instances, not to mention direct charges of blackmail, which the author has met with, showing that men and corporations prefer to suffer their wrongs in silence rather than encounter the vengeance of boards of health. CHAPTER II. The Great Sanitary Awakening', with an Account of some of the Circumstances which attended the Birth of Sanitary Science. About fifty years ago a report was made to the British House of Commons on the health of towns and the con- dition of the laboring classes in Great Britain. This docu- ment gave a sorrowful account of the labor, wages, food, clothing, and shelter of these classes. A large popula- tion lived in cellars ; one room frequently accommodated two, three, and four families. Parents with children above the age of puberty occupied the same bed. The lodging- houses were yet more crowded ; three and four adults were often found sleeping under the same coverlid. Dr. Neil Arnott * describes a portion of Edinburgh that he visited. " We entered a low passage like a house-door, which led from the street through the first house to a square immediately behind, which court was occupied entirely as a dung-receptable (with the exception of a narrow path * London Lancet, vol. ii., 1842-43. 30 VAGARIES OF SANITARY SCIENCE. around it) of the most disgusting kind. Beyond this court the second passage led to a second square court, occupied in the same way by its dung-hill ; and from this court there was yet a third passage leading to a third court and dung-heap. There were no privies or drains there, and the dung-heaps received all the filth which the swarm of wretched inhabitants could give. The interiors and inmates corre- sponded to the exteriors; we saw half- dressed wretches crowding together in one bed to be warm, though in the middle of the day. Several women were imprisoned under one blanket, because as many others, who had on their backs all the articles of dress that belonged to the party, were then out of doors in the street." The common lodging- houses were resorts of the miserable of both sexes, bedded together promiscuously at night, " men, women, and chil- dren in an atmosphere odorous of gin, brimstone, and onions, and human miasms. Thirty and forty are often herded together in a couple of small rooms, four, five, and six in a bed ; and should one of the helpless inmates (as is often the case) die of typhus fever, it is by no means uncommon to find the identical unchanged beds occupied on the very next night by fresh sleepers." An inquiry into the manner of living of the laboring population in the inner ward of St. George's, Hanover Square, showed that one thousand four hundred and sixty- five families had two thousand one hundred and seventy- five rooms, and two thousand five hundred and ten beds ; nine hundred and twenty-nine families had each one room, and six hundred and twenty-three each only one bed. The Wynds of Glasgow * comprised a population of from fifteen thousand to thirty thousand persons. " This quarter consisted of a labyrinth of lanes, out of which numberless * General Report on Sanitary Condition of the Labor Population of Great Britain. THE GREAT SANITARY AWAKENING. 3 1 entrances led into small, square courts with a dung-hill reeking in the centre. In some of these lodging-houses we found (at night) a whole layer of human beings littered along the floor, sometimes fifteen and twenty, some clothed and some naked ; men, women, and children, huddled pro- miscuously together, their bed a layer of musty straw inter- mixed with rags." Many of the houses of the poor were built around courts, with a pit in the middle to receive the filth of the occupants. " In some the whole courts up to the doors of the houses are covered with filth." * Their food was scanty ; meat not at all, or rarely once a week. There were in Liverpool eight thousand cellars occupied by from thirty-five thousand to forty thousand people out of a total of two hundred and fifty thousand. The working classes here numbered about one hundred and seventy-five thousand ; a very large pro- portion of these had " no means of getting rid of their filth but by throwing it into the street," so that " the air is con- stantly contaminated by the emanations from this surface of putrefying and offensive matter," In one cellar thirty people slept every night ; a hole was dug in the floor for the offal and filth of the household ; in another were three cart-loads of dung mixed with the offal from slaughter- houses, and ** the family in the cellar lived and slept con- tentedly cheek by jowl with the putrefying mass." Com- parisons were made of the mortality of English towns, showing the enormous disproportion of deaths between the poorer classes and the well-to-do. These tables of the death-rates were misleading in that they took no account of the birth-rate. The scope of those who made these inquiries and who furnished the reports seemed to be to show that the filth in some way was the cause of the disease that prevailed, * Sanitary Condition of Laboring Classes in England and Wales. 32 VAGARIES OF SAXITARY SCIEXCE. and the medical officers appeared to comprehend it, and framed their answers to correspond to this aim. A very large majorit}' took no notice whatever of the ignorance, povert}', intemperance, and imprudence of these people, but expressed their belief that the filth in which they lived was the cause of the high mortality. A few, either because they were less obsequious, or less keenly alive to what was ex- pected of them, blurted out the fact that they found the •' dung-heap and the poison, but all the inhabitants in health," quaHfying the statement, it may be, with the infor- mation that this poison was waiting for '* a change in the weather or temperature," and all would be sick with " head- aches, constipation, small-pox, and fever; and in many cases atrophy." In Truro, fever prevailed where there was only a small amount of decomposition. In Kent and Sussex, filth pre- vailed ever}'where ; but Dr. Tuffnal states that " throughout the greater part of these counties comparatively few diseases can be found to arise from want of sanitar}- precaution." At Brighton were filth and overcrowding, but " the more seemingly unhealthy districts quote no fever." Dr. Baker says the cause of ill-health in Derby is the factory system as a whole; "because beginning with childhood, and going on to youth, it brings up puny parents of a puny race, who in their turn perpetuate and increase the evil." In Birmingham, the river Rea is the main sewer of the town ; in summer it is covered with a thick scum of offen- sive and decomposing matter. About fift}^ thousand of the people here live in narrow, ill-ventilated, filthy, badly-drained courts. Most of the houses are three stories high. In each court is an ash-pit, a pri\y, a wash-house, one or more pig-styes, and heaps of manure. Many of the lodging- houses are in a loathsome condition, crowded with beds occupied indiscriminately by both sexes. In the da}1:ime these houses are thronged with dirt^-, half-dressed women THE GREA T S ANITA RY A WAKENING. 3 3 and children ; in the evening the inmates are eating, drink- ing, and smoking. The slaughter-houses are scattered all about the town, but " we do not find that any injury to the public health is derived from the state of the slaughter- houses." The knackers' yards, skinners' yards, and catgut- factories are extremely offensive, " but we do not find that these situations are more than others the seat of fevers or contagious disorders." Contagious fever is so rare here as to be almost unknown, and there is no part of the town where fever exists more than another. " We find it occur- ring in the elevated as well as in the lower situations." Surgeon Ryland declared bluntly that locality had nothing to do with typhoid fever ; that it occurred quite as much or more in the higher and better-drained parts of the town ; and that undrained houses and collections of stagnant water are insufficient to cause the disease. Children here entered the factories at as early an age as seven years. Dr. Howard says the amount of fever in Manchester is not large for a town so " peculiarly fitted to promote the dif- fusion of contagious disease." Indeed, he says the exemp- tion is remarkable, when the entire absence of cleanliness is considered; and he thinks that contagion is the great element, for the filth in some of the streets and courts that are exempt from disease is horrible ; large, open cesspools, filthy and dilapidated privies full to overflowing, " disgust- ing and offensive beyond conception." " Abominably filthy places remain free from fever for long periods ;" and he believes poverty and destitution are more powerful causes, and that something besides filth is necessary to generate the disease. He shows by a table that the outbreaks in Manchester for forty-five years have corresponded to periods of great distress, bad harvests, and consequent scarcity of food and work. He remarks, too, that when the number of deaths was greatest, the number of births was greatest also. The wages of the men in Manchester for ten years. 34 VAGARIES OF SANITARY SCIENCE. ending 1841, varied from nine shillings to nine and sixpence per week. The wages of women and children averaged from five to eight shillings. Marriages were contracted early in life, and one witness testifies that ** few women in his neighborhood ever marry until they have had or are about to have their first infant." In Salop, Cheshire, and North Wales, many families have only one room ; here four or five and sometimes eight or ten people sleep. The houses abound in filth. But " not- withstanding the crowded and deplorable state of these habitations contagious diseases do not appear to have gen- erally prevailed." In Inverness the nastiness is past endurance. " There is not a street, lane, or approach to it, that is not disgustingly defiled at all times, so much so as to render the whole place an absolute nuisance." Fever is here, but the doctor writes, " For many years it has seldom been rife in its pestiferous influence." " The people owe this more to the kindness of Almighty God than to any means taken for its preven- tion." * No effort was made in this report to adjust these discrepancies of the medical officers. In the vast majority of cases, however, the filth was ac- cused as the sole generator of disease. The piercing eye of Dr. Barham had noticed fever connected with a " near proximity to even a small amount of organic matter," and all measures for improvement he says may be neutralized *' if a little nidus of morbid effluvia be allowed to remain." It was easy to show that the death-rate was higher among filthy people than elsewhere. These were generally poor, badly fed, clothed, and sheltered, often intemperate, and almost always imprudent and wasteful. They produced children in abundance at an early age ; these were not and * General Report on Sanitary Condition of the Labor Population of Great Britain. THE GREAT SANITARY AWAKENING. 35 could not be properly cared for, and it was well that so many of them died. Mr. Chadwick showed that in some filthy and unhealthy districts the death-rate was sixty-eight per cent, and the birth-rate forty-eight per cent, higher than in some healthy and well-drained localities, and he ascribed the high death- rate only to the filthy condition of the people. The tables and figures which this amiable enthusiast presents must always be viewed with caution, for whenever they are analyzed they rarely sustain his conclusions. Most sur- prising of all is the fact that in spite of the accumulation of misery, poverty, and dirt, the human death-rate for three centuries had been steadily declining. So far as estimates can be depended on, says Mr. Chadwick, the deaths in London in 1700 were one in twenty; in 1800 they were one in thirty-nine. In 1799 the average age at death was twenty- six years; in 1830 it was twenty-nine years. All this was taking place long before the era of, and was not dependent on, sanitary reform. During the progress of an inquiiy * that was made by the metropolitan registrars into the sanitary condition of those portions of London which yielded high mortality rates, six, eight, ten, or even a dozen persons were often found sleep- ing in one room. The only protection from cold which they enjoyed was through " a few coals during the severe weather from the benevolent." The children were numer- ous ; they were herded together and " walking on the cold stones or sitting at the door in all weathers." With the adults, " spirits often supply the place of lodging, food, and raiment." The houses were old and filthy, occupied by people of " the lowest description, uneducated and foul- mouthed; mendicants, costermongers, thieves, and aban- doned females." Their " food consists of salt fish and other * Fifth Report of the Registrar-General of England and Wales. 36 VAGARIES OF SANITARY SCIENCE. scraps collected by the mendicants and disposed of to the general dealers." The men spent one-third of their earn- ings in drink ; the women mostly indulged in gin, and stu- pefied themselves and their babies with paregoric. The mortality from zymotic disease was 6.013 P^^ 1,000,000 of inhabitants for cities and 3.142 for the country. The re- formers ascribed this difference to the filth which surrounded the people in the cities. They paid no attention to the facts that where the mortality was highest, the people suffered in the winter from stinging cold and from stifling heat in sum- mer; that the year round they endured a gnawing hunger, a burning thirst that alcohol itself could not quench, and a throbbing anxiety that nicotine and opium could not soothe. A further glance would have shown the reformers that the high mortality was not alone from zymotic diseases. The same returns which gave the proportion of zymotic diseases in city and country showed that the mortality from diseases of the nervous system was 4.267 per 1,000,000 in the cities and 2.256 in the country. The deaths from respiratory dis- eases were 7.967 per 1,000,000 in cities and 5.327 in the country, and the mortality from diseases of the digestive organs was 1.972 per 1,000,000 in the cities and 1.042 in the country. But the reformers only saw, or only pretended to see, that the drainage was defective, and that the yards, courts, houses, and bodies of many of these people in the cities were foul. Zymosis was going on, filth was created, and the conclusion was irresistible that this was the cause of zymotic, or filth diseases ; they refused to search further for the cause of the high mortality. These disclosures of the condition of great masses of the people in Great Britain touched the conscience and aroused the compassion of the English nation. For the moment no direct opposition was offered to the filth pathology, and with a great sound of trumpets it was proclaimed that good THE GREAT SANITARY AWAKENING. 37 drainage and the removal of filth would exterminate that class of diseases known as zymotic or contagious, and the cry was raised for sanitary reform. The cemeteries received the first attention. These, both in London and in other towns, were in a disgusting condi- tion, and common decency called for a change in the care of them and in the method of burial. The evidence against them was most revolting ; but as will be shown in another chapter, not a single case of disease was proved to have originated from one of these cemeteries. Sanitary reform, the Lancet said, was now the order of the day ; we are " likely to be beset with blue-books, white- faced pamphlets, speechifying and figure-making, jobbery and intrigue ;" but the work must go on. Doctors poured in their reports that fever occurred under their care where drainage and ventilation were defective. Dr. Stark * de- clared there were three hundred thousand cesspools in London, with an aggregate exhaling surface of sixty-two acres ; they would make together an enormous receptacle ten miles in length, fifty feet in width, and six feet six inches in depth. In 1849 i^ was said that the public mind was now " on the right scent ;" the cholera was making great ravages and insufficient drainage was the cause ; " all cholera cases appear where the victims have been exposed to exhalations from drains, cesspools, etc." Associations were formed to improve the sanitary state of towns throughout the kingdom. If here and there a medi- cal man Hke Dr. Corrigan declared his belief that facts were in direct opposition to the new theory, he was quickly smothered in the ferment. In 1850 it was discovered that " the Thames water is polluted with every conceivable filth and abomination ;" the water of all the companies " is con- taminated with dead and living organic matter ;" and Mr. * Lancet, vol. ii., 1 848. 4 38 VAGARIES OF SANITARY SCIENCE. Bowie, a surgeon, testified that it " is thick, muddy, discol- ored, putrid, and unfit for culinary or drinking purposes." In a feeble way, Dr. Alfred Taylor * tried to restore a little calmness by affirming that if the organic matter did not affect the color and taste of water it was not unhealthy ; but in the state of the pubHc mind such reassurance was in vain. The soil, too, of London had been absorbing filth ior centuries ; it was nauseated with putridity ; ready to vomit forth disease and death ; the sewers were so constructed that they not only poisoned the air of the streets, but foul air entered through them into the houses, bringing bedrooms and nurseries in communication with the sewers ; the water was polluted, the air infected, the sunlight intercepted. And then it was ascertained that enormous quantities of diseased and half putrid meat and fish were sold, which generated disease. In 1857 1 the Thames was a vast sewer ; the most filthy and dangerous river in Europe ; " the stench for miles is intol- erable ; the moving mass of filth threatens the millions of inhabitants with pestilence and death ;" it was a disgrace to the metropolis ; a national calamity. A little later and the Thames was charged with sewer-gases ; " and these gases are admitted to be poisonous." An occasional protest was made against this furor. One physician hinted that the way to ascertain if the Thames was a source of disease was not to take a steamboat ride on it and toss bits of white paper into the water and then pronounce authoritatively from that evi- dence, but, by a series of observations, compare the dis- ease on its banks with that remote from it. This, he said, had not been done. Another writes that ** a little calm discussion was desirable ;" and " it is not proved [if it is, where are the proofs ?] that it [the river] acts prejudicially * London Lancet ^ vol. ii. f Ibid., vol. ii., 1857. THE GREA T SANITAR Y A WAKENING. 39 on the health of the metropolis ;" and it was declared that there was " not one tittle of evidence springing from obser- vation" to support the conclusions that press and public drew from the statements respecting the impurity of the river. No heed was paid to these retorts, and the next year the London Lancet had a certain feeling of satisfaction in hear- ing that the Chancellor, Mr. Gladstone, and Mr. Cayley had been driven from committee-room " handkerchief to nose," and now " that their stomachs heave, they smell a dreadful smell ; their minds expand," and there is an " epidemic diar- rhoea of motions for relief" The editor says that many physicians declare that this sewage in the river is in no way bad for the health; and, what is still more strange, that some of these are men of science and known ability. The promulgation of such views at this time is a great error, for it may postpone legislation on the subject. All investi- gations to ascertain if the Thames had ever really been the cause of disease seems to have been carefully avoided ; the reformers, however, were unceasing in stirring up panics about the river. One report* says it is truly wonderful that some plague or epidemic has not sprung out of the putrescent water. The river is one vast uncovered sewer, reeking with noxious and pestiferous abominations, and that men should be found who say that this does not injure health must " inflict the greatest injury on science, and pro- duce in the mind of the public great mistrust of its pro- fessors." This water has been found to contain sewage, sulphuretted hydrogen, muscular fibre tinged with bile, husks of wheat, and potato cells. The danger is " imme- diate and imminent." Dr. Letheby declares that " the water is now in a high state of putrefaction ;" it " abounds with the highest forms of infusorial life," and that which is near * London Lancet, vol. ii., 185S. 40 VAGARIES OF SANITARY SCIENCE. to shore is poisonous to almost every living thing but vibrios. In July, 1859, the filthy odor of the Thames warns us of approaching pestilence ; " its noisome stench" has reached the House of Commons ; much illness, and, indeed, death, are in Westminster, " owing most unquestionably to the putrid and disgraceful state of the river, aided by the intol- erable heat. Lord Alfred Hervey was taken sick while attending a committee, from the effect of the horrible state of the Thames." " It is truly horrible to contemplate what may be the result." Strange coincidence ! In the same volume of the Lancet which furnished this information we read,* " The population ef London now appears to be in a very healthy condition." " In the last two weeks deaths of persons at all ages from typhus and common fever decreased from forty-three to twenty-one ; and fatal cases of zymotic disease in the aggre- gate from two hundred and ninety-one to two hundred and fifty-three." For one or two weeks only during this season was there any increase in mortality, and this arose not from zymotic but from local and constitutional diseases. And the summer, as a whole, was far more healthy than the average. But all over the land it was said,t there is " one deso- lating germ of filth which is ever active in the fruition of dis- ease ; one accumulating poison, deadly alike in the cesspools of large cities and in the middens of country cottages." Typhus fever, cholera, scarlatina — the three great scourges of European populations — find here their nidus. The excitement spread like wildfire. Meetings were held all over the kingdom, — in halls, school-houses, and drawing- rooms, — presided over by noblemen of distinguished lineage. A Ladies' National Sanitary Association for the Diffusion * June 19, 1858. f London Lancet, THE GREAT SANITARY AWAKENING, 4 1 of Sanitary Knowledge was formed in London, with branches in different towns. This had for patrons and patronesses crown princes and princesses, dukes and duchesses, earls and countesses, bishops, right honorable and honorable, and distinguished men of the learned professions and promi- nent laymen, with a long list of secretaries and committees. The society's report for 1861 said there had been already spread over the country 138,500 sanitary tracts, 10,000 on " The Cheap Doctor," 8000 on " The Sick Child's Cry," and 8000 on " Never Despair." Sanitary classes were formed; lectures were delivered on catching cold, on drainage, food, air, clothing, etc. The ladies put their sanitary reason into sanitary rhyme, and " Never Despair" found expression in these lines : ** When times are hard and money scarce And you are full of care, There's one thing you must never do, You never must despair. " It makes the spirit faint and fail. It wears the health away ; It takes all vigor from the heart And wastes life day by day." To illustrate the danger of filth we have the following stanzas : " If things get worse and worse within, And heaps of filth and rubbish lie Fermenting, steaming at your very doors, How can you wonder that your children die ? " Work till you've cleaned within, without. And done your duty, done your best ; Then may you claim it as a right Your landlord he must do the rest." Instructions for the baby were given as follows : 4* 42 VAGARIES OF SANITARY SCIENCE, " When baby ought to eat, He'll have some teeth to bite, And if he must have any food, Be sure it's soft and light." Tight lacing was treated in this way : " Now if you press the body round, The soft bones soon give place, And then the lungs can't freely breathe. Nor the heart have full space. " Proud thoughts, high looks, and selfish ways. Words that give others pain, — These things we all should by God's help Incessantly restrain." In a sanitary ditty on " Naughtiness and Sickness" the greedy boy is admonished that, — ** The greedy and the gluttonous Get sick and can't enjoy What would have been quite nice and good Shared with another boy." These hygienic idyls seemed to have charmed the people. One essayist on woman's work in sanitary reform said that these tracts in verse were " very suitable for reading aloud at Maternal Meetings ;" and he called on female writers to " make imaginative literature a vehicle of popular sanitary instruction ;" to tell us why preventable disease and death forever sit scattering our hopes and joys and holding a grim carnival among our loved ones." " Let us have," he cried, "a sanitary Jane Eyre, Adam Bede, and John Halifax." One physician writes, " You ladies will do a good work, if you only bring us medical men to lecture to the people. But we cannot put ourselves forward. If your association were only to do this, you would do a good work." Mothers' meetings were called ; tea meetings were held, THE GREAT SANITARY AWAKENING. 43 to which " Bible women" were invited ; missionaries were sent out ; these were supplied with brooms and brushes to lend to the poor, and a special fund was set apart to supply- skipping-ropes, balls, and toys to poor children. By Janu- ary, 1865, the Ladies' Association had sent out more than seven hundred thousand tracts, " a moral force that implies vast extension of sanitary information." * Out of such fury and tumult, and with the aid of such hysterical throes, the world witnessed the birth of Sanitary Science. The infant came near being suffocated in the trav- ail by the very ladies who had assisted at the accouche- ment ; for, in arranging one of the lecture courses, a " homoeopath" had either crept in or had been smuggled in by the ladies as one of the speakers. This caused a great commotion ; the Lancet scolded them soundly. It told them they could not have taken a surer course to throw doubt on their ability to conduct or even understand Sani- tary Science ; and added, " In their innocence they may imagine the sanitary conduct of a homoeopath would be the same as that of a medical practitioner of any other school ; but this is an error." It protested against the associa- tion lending itself to the propagation of miserable fancies. History is silent as to the result of this contest. Our own experience and observation have been that, whenever the ladies take it into their heads to boom a homoeopath or any other doctor they never fail to succeed. The prince consort died in December, 1861, of typhoid fever. Windsor Castle was, in the opinion of the best engi- neers, the most complete in sanitary works of any large building in the world. The pythogenic nature of this fever was now established in the minds of the reformers, and if nothing were found to account for the prince's illness the doctrine was in danger. Finally some witnesses were pro- ^ Report of Ladies' Sanitary Protective Association, 1S65. 44 VAGARIES OF SANITARY SCIENCE. duced who testified that they actually had smelled some smells somewhere about Windsor Castle, though why the prince consort should be the only one taken sick the sanitary re- formers did not explain. They publicly exchanged con- gratulations, however, that the prince's illness and death had given a great impulse to Sanitary Science, and that the towns generally were sounding the alarm. A few medical men made one more attempt to stem the torrent of nonsense. They called for calm investigation, for proof; they said the new doctrine was inconsistent with facts. They were, for the most part, overwhelmed, and were only too glad to be silent after being pilloried in the Lancet. They knew too well to whom the editor was point- ing when he wrote that " people are yet found who literally wallow like unclean animals in their own filth and protest that it is wholesome. They foul their water sources, drink with gusto the sparkling fluid, and vow there is no water to be compared with it. By these means children are cut ofif by thousands ; adolescents grow up with the seeds of de- bility and disease ; adults are struck down in their prime ; the sum of life is shortened ; the productive and protective powers of the country are diminished." In 1867 the Thames water had great quantities of putres- cent animal matter on account of the late rains, and in the city " the pumps are spouting poison." Meantime, all sorts of patent sanitary fittings were advertised in the Lancet, — patent stack- pipe water-closet ventilators, filters to filter the water, smoke-stacks for sewer-gas, — all warranted sure pre- ventives of disease. Every new fright brought out new patents. The Lancet was very angry because Dr. Letheby had proved that the water-supply had nothing to do with the cholera of 1866; there were some slight symptoms of reac- tion, for people were beginning even to lose faith in the legend of the Broad Street pump. The analyses of the THE GREAT SANITARY AWAKENING. 45 same waters by different chemists showed entirely different results, and all was bewilderment and confusion. Even the water from the chalk-wells showed contamination, and the cry was now raised that there were fissures in the chalk for- mation that allowed the ingress of sewage. The Lancet recorded the " spread of infectious diseases, of holocausts of infant life, of death-rates shockingly exces- sive." " How is it that this death-page of our national his- tory yet remains where it was years ago when our scientific knowledge was less ?" Severer laws must be enacted to save the people. Fever was reported at Barnsley; a cesspool was found here within a dozen yards of a pump, and the Lancet says, " There does not seem to have been any attempt to ascertain whether the inhabitants of the district were or were not systematically drinking the discharges from one another's bowels." There certainly seems to have been no attempt made to show that this condition had prevailed, it may be for a cen- tury, without producing fever in Barnsley. The Prince of Wales's illness with typhoid fever now gave another impetus to sanitary reform. The cause could not be ascertained any better than that of his father's sick- ness ten years before. It was discovered that at Londes- borough Lodge, where the royal party was located, a water- closet, which had free ventilation with the outside air by an open window, was close to the prince's bedroom ; but the British Medical and Surgical Journal said that this was the case in thousands of instances in London, yet no fever was the result. It was then found out that the prince was in the habit of riding by some carrion that was exposed to allure the pheasants ; also it was proved that he had actually passed by a pile of manure which had painfully affected the nose of His Grace the Duke of Beaufort. Though the Lancet was reluctant to believe that the constitution of the 46 VAGARIES OF SANITARY SCIENCE. heir to the British throne was so feeble as to collapse under so simple a matter as a bad smell from a manure-heap, yet in some one of these various ways he must have contracted the fever, because it was conceded by the most eminent sanitarians that this was the type of filth diseases. Every new alarm that was invented was heralded as a "gigantic stride" of Sanitary Science. In 1875 the sanitary aspects of the sacraments were discussed ; there was danger of contagion in the communion wine-cup. Again, blood- poisoning had been caused by Hcking gummed envelopes, and there was disease and death in the books of the circu- lating libraries. Dr. Farr now fulminated against the Thames water; it was loaded with filth. Dr. Letheby declared the alarm unnecessary, and the Lancet pronounced this contra- diction " a scandal in the scientific world," and insisted that it was time that the richest city on the globe should know the truth about its water. The Lancet said, " The demon filth which surrounds and poisons us on all sides is not to be exorcised by gentle lan- guage. No words which society will permit us to use are too coarse to hurl at the monster. It is not pleasant to drink the diluted excreta of men or even of pigs ; but it is still worse to drink the ^^^?> or germs of cholera or typhoid fever." When the fever broke out at Wolverhampton and some- body suggested contamination of the water and that it be examined, he was withered by the reply that it was "a waste of time to analyze such water ; of course it was con- taminated." "A moment's thought" of the foul soakage was sufficient to indicate its character. The epidemic in Croydon in i Z'j^y staggered the sanita- rians for a moment in their filth-theory of disease. Croydon had had for twenty-five years all the advantages of efficient sewerage, good water, and good sanitary administration, yet in twelve months there were twelve hundred cases of ty- THE GREAT SANITARY AWAKENING. 47 phoid fever in the town, and " this seemed to render doubt- ful some of the fundamental principles upon which sanitary- measures are founded." But the reformers soon rallied; the old theme was revived, and in 1880 the Thames was again a putrescent pond and a fermenting sewer, menacing the people with disease and death. One memorial made to the Lord Mayor on the stench of the river recited that a man fell into it a few days before and was found dead, although he had been in the water only two minutes, " having been actually poisoned by the deadly properties of the water." The Thames through London is more and more polluted ; * it is no better than a common sewer. No one can go to London from Woolwich with comfort. There is a disgrace- ful system of house-drainage in the best parts of London. Sewer-gas is a special product of our refined system of sewerage. " We have now a perfect apparatus for treasuring it up and laying it on in our houses." Disinfectants are of no use ; they are only disguisers. Poisoning by sewer-gas which has been deprived of its smell is the source of much sickness ; the odor may be destroyed, but the poison re- mains. In 1884 1 the condition of the Thames was as bad as it could be ; "a deadly, insidious odor arises in the form of sewer-gas," polluting air and water for miles. The river " can only be compared to a huge sewer-tank, putrescent and most offensive. We are living in extreme risk." " It is literally dangerous to breathe the air," and there was a con- tinual wrangle over the conflicting analyses of the water ; and so on to 1890, October 25, when we read in the Lan- cet that the progress of sanitation and increase of typhoid fever in India was an anomaly ; but trust in the filth pathology was unshaken. The florists of Liverpool were now deeply stirred about * Builder^ 1881. f London Lancet, vol. ii. 48 VAGARIES OF SANITARY SCIENCE. the public health ; they implored the mayor to place restric- tions on the hawkers of flowers in the streets, for many of them lived where infectious diseases prevailed. For once the Lancet was incredulous, for it said " the exhalations from some flowers are antiseptic," and it hinted that " the dread of competition" in the minds of the florists excited " their zeal for hygienic purity." If the reader thinks this is a travesty on the rise and progress of Sanitary Science, let him be assured that the story is taken, not from the wild ravings of irresponsible newspapers, but for the most part from the pages of the most influential journals that were printed in Great Britain between the years 1845 and 1 891. In all of this sanitary inebriety there is no trace of scientific research. If an Eng- lish physician questioned the filth pathology of epidemic disease, and suggested an investigation, he was quickly si- lenced by the ribaldry of the London Lancet. Scotch and Irish medical men, like Christison, Hughes Bennett, Stokes, and Graves, maintained a point-blank denial to the new doc- trine ; they declared that it was antagonistic to the facts. The stubborn truth faces us all through these forty-five years that, while the people in England were breathing this pestilential air, drinking this polluted water, living on this contaminated soil, eating this diseased and putrid meat and fish, the death-rate was not increased, but, on the whole, was steadily diminishing, as it had done for three hundred years before the dawn of Sanitary Science. The birth of Sanitary Science in America was not pre- ceded by the tedious, irritable, and painful gestation which heralded its advent in England. Indeed, the infant science can hardly be said to have had an embryotic existence in this country, for it was greedily accepted as it came forth from the hands of the English reformers, by a set of men here who soon found that by ingeniously exploiting its vagaries they could attain to an importance and acquire a THE GREA T SANITAR Y A WAKENING. 49 position and emolument that had heretofore been denied them both in the community and in the medical profession. What the American sanitarian lacked in originality was amply compensated to him by the faculties of imitation and volubility of expression ; and, as will be seen later, as whim and chimera one after another were hatched in and launched from the brain of the English reformer, they were seized at once by his American copyist, without examination or in- vestigation, and were appropriated and published by him without delay as the " settled principles of Sanitary Science." The excitement began soon after the close of the Civil War, and by 1870 had reached a kind of frenzy. Whole sections were deeply moved by the elocution of the re- formers. Sanitary surveys and inspections were made which showed that towns and cities, great and small, were on the brink of a dreadful precipice ; their inhabitants were located on a filthy soil, were enveloped in foul air, and were drink- ing foul water. Sanitary conventions were held, sanitary platforms were erected, on which the sanitary orator mounted, and, with flaming eye, declaimed to his quaking audience that the conditions under which they were living invited the direst of all pestilences, — the Black Death of the Middle Ages. Strong men were aroused to action, and were re- solved to save themselves and their families, if possible, from the perils which environed them, on account of the pestilential, polluted, contaminated air, water, and soil. 50 VAGARIES OF SANITARY SCIENCE. CHAPTER III. The Air. " There are indeed two things ; knowledge and opinion ; of which the one makes its possessor really to know, the other to be ignorant." — Hippocrates. To avoid all cavil and misconception, let us premise this chapter with a disclaimer of any desire or intent to disquiet the prejudices of enlightened mankind in respect to cleanli- ness. That purity of body is a necessary accompaniment of purity of mind and morals needs no argument to sustain. Indeed, this proposition loses its force in proportion as any labored reasoning is obtruded to support it. As a corollary, this other proposition may attend the previous one, — to wit, that a clean body and clean surroundings, — pure air, pure water, and pure soil, — in so far as they add to the comfort, decency, and dignity of the human family, are not only accessories but essentials as well to individual as to public health. In reality, the amiable delusion that a want of cleanliness was the cause, or one of the causes, of infectious disease might have been allowed to remain, for it was harm- less, except as the violence of the sanitary reformers forced it upon us, to the exclusion of all other causes, and com- pelled us to examine critically the evidence with which they upheld it. The " opinion," the belief, that decomposing organic matter, animal and vegetable, by contaminating the air, is the prime factor in the production of certain diseases, nota- bly epidemic and contagious, has always possessed not only the popular mind, but also to a great extent that of medical men who have given the subject no investigation. Organic matter in decomposition evolves certain gases ; but no one claims, and every one who has examined the THE AIR. 51 subject with care will deny, that any single known gas or any known combination of the gases of putridity is capable of causing disease. Some of them, in a concentrated form or by displacing the oxygen of the atmosphere, cause asphyxia and death. But no known element which is ex- haled in the breaking up of organic compounds is any more capable of generating disease than any which is given off in the decomposition of inorganic bodies. So it was left for the sanitarian to imagine a something which he called sometimes a " septic ferment," sometimes a " morbific element," sometimes a " subtle poison," sometimes the " mephitic gases," and later this something was desig- nated by the Massachusetts Board of Health as the " un- known factor." Not content with these definitions, the sani- tarians, as we shall see, made use of symbols which, to the popular mind, expressed the highest degree of terror. The hidden principle of disease which was given off in putrefac- tion was represented sometimes in words, sometimes in figures, as " a demon," " an unclean spirit," " a monster," " a snake," " an unseen vampire." It was plain to every observer that huge masses of organic substances were continually in process of decay, giving off sometimes the most offensive gases, yet no infectious disease was present. On the other hand, infectious diseases often invaded a family and a neighborhood when no visible de- composition of organic matter was in progress. According to the sanitarians, it was this imaginary ele- ment that was developed in filth which caused the mediaeval pestilences that devastated Europe, and which they predicted would surely return to us unless we gave heed to their warnings. A large number of the writers on hygiene approve, to greater or less extent, this theory of infectious disease, and it has always been the sole stock in trade of modern boards of health. John Howard, in his book on prisons, says Dr. Hales and 52 VAGARIES OF SANITARY SCIENCE. Sir John Pringle observed " that air corrupted and putrefied is of such a subtle and powerful nature as to rot and dissolve heart of oak." Bancroft * says Lord Bacon thought that no effluvia were so infectious and so pernicious to mankind as those which issued from putrefying human bodies. Fonssagives f says the " morbific principle" that proceeds from decomposing animal matters can produce the gravest maladies. Thus, he says, bursts out a pestilence after a battle, and the decom- position of matters in privies causes dreadful septicaemia. Tardieu % says that the centres from which putrid emana- tions are disengaged are the types of unhealthfulness. This can hardly be otherwise, for it is not only by their composi- tion {nature intime) that they act, they strike the senses, and produce on the most delicate organs " une impression penible'' which seems the announcement of a real danger. Galen, he says, assigns the cause of pestilential fevers to putrid air from bodies left on battle-fields, and St. Augustine reports a cruel pestilence caused by masses of decayed locusts. Tardieu relates a number of similar antiquated stories to prove the noxious character of putrid emanations ; but when he discusses certain trades, like tanners, curriers, catgut-makers, etc., he says that though they are foci of dis- agreeable odors, they are not unhealthy; and when he treats of voiries, although these contain everything conceiv- able that is foul, he declares they not only do no harm, but he has known them to re-establish health that has been impaired. All of the noisy and influential EngHsh sanitarians have persuaded themselves that filth is the great cause of con- tagious disease. In the reports of the medical officer of the Privy Council, London, 1874, is a recital of forty-two in- * Yellow Fever. f Hygiene Navale. % Dictionnaire d'Hygidne, article ** Emanations Putrides." THE AIR, 53 spections of towns where occurred in 1873 outbreaks of small-pox, scarlatina, typhus and typhoid fevers, and diar- rhoea, which are ascribed to polluted water and accumula- tions of filth. The reports are not complete, inasmuch as they do not state how long these towns had been exposed to these conditions and had been free from such diseases. In 1874 Dr. John Simon published "Filth Diseases and their Prevention." He ascribes the disease-producing power of filth, not to any known gases which may arise from it, nor to the fact that it is disagreeable to the senses, but to a " septic ferment" which, he says, is generated in filth. The dis- eases caused by this " septic ferment" are diarrhoea, enteric fever, cholera, erysipelas, pysemia, and diphtheria. He gives a short account of one hundred and forty-three outbreaks between 1869 and 1873, where privies, cesspools, and defec- tive drains were discovered, though he does not state in what particular the sanitary condition of the afflicted towns differed from all others in Great Britain where no epidemics occurred. Parkes, in his elaborate work on hygiene, though he gives numerous examples where disease has been imputed to foul air, water, or soil, is careful not to commit himself to the filth-theory of disease, and makes no allusion to the " septic ferment," which Mr. Simon considers the generator of infec- tious disorders. Miss Florence Nightingale, in her work on nursing, says, " I was brought up, both by scientific men and ignorant women, distinctly to believe that small-pox, for instance, was a thing of which there was once a first specimen in the world which went on propagating itself Since then I have seen with my eyes and smelt with my nose small-pox growing up in first specimens, either in close rooms or in crowded wards, when it could not have been by any possi- bility caught, but must have begun. Nay more, I have seen diseases begin, grow up, and pass into one another. I have 5* 54 VAGARIES OF SANITARY SCIENCE. seen, for instance, with a little overcrowding, continued fever grow up ; and with a little more, typhoid fever ; and with a little more, t}^phus ; and all in the same ward or tent. Dry- dirt is comparatively safe dirt ; wet dirt becomes dangerous. Uncleansed towns have been made pestilential by having a water-supply." In our own country the filth theory of disease has taken deep root with the sanitarians. Hardly an epidemic has occurred anywhere in this country which their official reports have not loosely ascribed to filth. If an ancient cesspool, a profligate privy, a suspicious well, an untrapped sink, or the contents of a dish-pan on the surface of the ground could be found anywhere in the vicinity of an epi- demic it sufficed to explain its origin, although the same condition might prevail in millions of cases where no sick- ness occurred. In the Sanitarian, April, 1878, a lady writes that dirty dish-cloths are a cause of typhoid fever ; she had smelled a whole houseful of typhoid in one dish-rag; she is sure it caused four cases in one family where she " ran in" to assist. In " Home and Health : A Cyclopaedia of Facts," by C. H. Fowler, D.D., LL.D., and W. H. DePuy, A.M., D.D., article " Fever Infections," we are told that all fevers, like typhus, small-pox, etc., arise from a subtle poison. " This poison has been actually condensed out of impure air poisoned by filth and decay, and appears in the form of a dirty-looking, half-solid, half-fluid, half-gelatinous stuff, a few drops of which inserted into the veins of a dog will inoculate that dog with typhus fever." Mr. Waring * says that as to the exact causes of disease we know comparatively little, but there are certain well- established truths. " One of these is that man cannot live in an atmosphere that is tainted by exhalations from putre- * On Sanitary Drainage, etc. THE AIR. 55 fylng organic matter without danger of being made sick, — sick unto death." Professor S. W. Johnson says the filth of vaults and cesspools " may long remain simply disagree- able without being dangerous, and may again of a sudden, in a way whose details have as yet escaped our observation [italics ours], become the seed-bed or the nursery of the infection that breaks out in fevers and dysentery." " Clean- liness," says Professor Lindsley,* " public cleanliness, is the highest aspiration of the public hygienist. Filth in any form is the fatal foe of human life,— a foe unsparing, insid- ious, unceasing, mahgnant, and deadly." "Already," he cries, " the city of New Haven has had to erect a special police prison in its most unsanitary ward. Cleanliness is the grand aim of the sanitarian's efforts." Says a distinguished sanitarian,t " We thus see that all the great epidemics of mankind originate in filth and are propagated by filth. Of all the forms of filth, none are more active than the direct and indirect products of animal life. Man is a poisonous animal; his touch brings rottenness. Human filth is the hot-bed of epidemic disease." As a breath fans the fire, " so the fever-germ may be carried a long distance and, falling into some magazine of unsanita- tion, may explode into a frightful epidemic." " These fever- nests seem to attract the wandering epidemic germ, just as the depot of nitro-glycerine seems to fascinate the fool- hardy hand which shall wake up this bottled earthquake." " Does death end all ?" he asks. " Certainly not. There remains the funeral. What is the funeral of the yellow- fever dead ? As soon as death is certain, the body, in all its filth and with the garments it last wore, still warm with the remains of life, is seized by some hired grave-digger, thrust into a coffin, hurried into some cart, and toted off to the * Connecticut Board of Health, 1883. f Eighth Report Michigan Board of Health. 56 VAGARIES OF SANITARY SCIENCE. graveyard ; and, when its turn comes, it is dumped into its grave and covered from sight forever. ' Mud to mud' would close the fitting burial service. Death is terrible; such a death and burial are horrible." Another distinguished sanitarian,* when discoursing on decomposing organic matter, says, " It is perfectly safe to say that a foul-smelling air is a dangerous air. Every now and then Death makes a visit to the household, carrying off its brightest members, ruthlessly slaying father, brother, sister ; the strong man, the feeble infant. Why this sacrifice, — this ruthless slaughter? Who are the invisible monsters invading this happy circle ?" " Let us look around," he says. Smell informs him that there are decaying vegetables in the cellar, " pouring forth into the air deadly emanations ;" this " stagnant, poison-laden air" finds its way into the lungs of the occupants of the house. " We ascend to the kitchen ;" here are what every one recognizes as " kitchen-smells." In one corner is the wood-box. Turn the contents on the floor, and, "shade of Hygeia, what a smell !" Rotten bark, apple-cores, odds and ends," making " a putrescent con- glomeration teeming with filth, redolent with putrefaction, and crawling with vermin." In the pantry are fragments of mouldy bread, " a magnificent place for germs of every description to hold high carnival." The beautiful carpet in the sitting-room "conceals beneath its delicate shades a conglomerate accumulation of contributions from every source of impurity within the dwelling and without." The parlor is still worse. Above are closets, chambers, and garret, "charged with the most virulent enemies to health." In the yard myriads of insects are crawling where the dish- pan has been emptied. "A few feet distant is an edifice which we are at a loss to know how to describe ;" but the air from it " is freighted with the agencies of death." Then there * Tenth Report Michigan Board of Health. THE AIR. 57 is the well. " Only think of the condition of a family with death enthroned in the well and daily dealing out his poi- sonous draughts to its members !" " Some one may say the picture is highly colored ; but the experienced sanitarian will certainly say we have not told half the truth." If we only had microscopic eyes we should see in many of these houses " not an army of brave soldiers coming to our rescue from disease and death, but the emissaries of death in countless numbers, intent upon our destruction, ready to pounce down upon us at the first favorable opportunity, rack us with pain, and finally devour us." This " experienced sani- tarian" does not say whether he is describing his own resi- dence or the typical Michigan habitation. Nothing short of these liberal quotations could possibly illustrate the native grandiloquence of our sanitarians. Lest the reader shall exclaim that this is a parody on Sanitary Science, and that we have here introduced the insane ravings of some backwoods revivalist on the terrors of the judgment day to an audience temporarily bereft of reason and powers of comparison, we here affirm that these were the declara- tions of eminent sanitarians who have the prefix of professor and the affix of M.D. to their names ; that they were ad- dressed to bodies of sanitarians in convention assembled, and that the subject of the discourses was Sanitary Science. In all of this improvisation — and sanitary literature every- where is overflowing with similar harangues — there is not a particle of evidence to sustain the filth-theory of disease, except such as is offered by the field-of-battle story of Galen, the locust story of St. Augustine, mentioned by Tardieu, the positive testimony of Miss Nightingale's eyes and nose, and the no less positive evidence of the lady respecting the dish- rag origin of typhoid fever. It would be unbecoming in us to deny the direct testi- mony of the two Doctors of Divinity in the " Cyclopaedia of Facts," regarding the " subtle poison" of fever which 58 VAGARIES OF SANITARY SCIENCE. they so minutely describe as '' dirty-looking-, half solid, half fluid, half gelatinous," and which must have been seen by them alone ; for it is mentioned nowhere else than in their book, and, so far as we have inquired, it is not to be found in any of the chemical or biological laboratories. The remaining proof which sanitarians have to offer con- cerning the noxious character of putrid emanations lies only in the occasional coexistence of these and disease. There is no more scientific proof that putrid emanations cause infectious disease than that they are the sources of acute or even chronic inflammatory complaints ; and it needs only a little higher flight of sanitary imagination to pro- nounce the latter filth-diseases, because they happen in a neighborhood where a cesspool, or privy, or drain may be found. The " opinion" of many of the most thoughtful medical men has been often expressed, that this coexistence of putridity — filth — with disease has not the relation of cause and effect. The author has been unable to find a single instance, where this subject was scientifically investigated, in which the proof was not overwhelming that organic matter in any of its chemical changes was incapable of producing epidemic disease. Dr. Ferguson says, " It is, in truth, unnecessary to mul- tiply facts and illustrations to prove that putrefaction and the matter of disease are altogether distinct and independent elements; and that, however frequently they may be found in company, they have no necessary connection." Dr. Chisholm,* in an article on contagion, after enumer- ating whole tribes and nations who maintain their health in the presence of the worst putridity, cites the towns of Bris- tol, Bermondsey, Conham, and Bitton. In these cities, bone- boiling, glue-making, fat-rendering, and tanning are going * Edinburgh Medical and Surgical Journal, vol. vi. THE AIR. 59 on, which fill the atmosphere for a mile around with a dis- gusting fetor. In Bristol the streets are narrow, the houses crowded and ill-ventilated ; yet the harmless nature of these exhalations is daily verified. Neither the workmen nor the inhabitants are made sick ; the reverse is the fact ; they are the most healthy of any of the laboring poor. After a care- ful survey, Dr. Chisholm, who almost apologizes for saying so, concludes that the theories of ingenious chemists re- garding the power of animal efifiuvia to produce disease receive no support from practical knowledge or the econ- omy of nature. Dr. Nathaniel Bancroft * says, " I have no desire to weaken any of the prejudices which tend to promote clean- liness in civilized countries, any further than is absolutely necessary for the manifestation of truth on a question of great importance to mankind ;" but he declares that there is no connection between offensive smell and nastiness and contagious fever. That putrefaction, which is but a natural separation of organized matter, is the servant of chemical attraction, and the products are as certain and constant as the combination of soda with muriatic acid. Dr. Graves f says, " The causes of epidemic disease es- cape the scrutiny of both nostrils and vision. Filth is the outward and visible sign of poverty, and, like poverty, is itself an evil ; it oftener accompanies than causes disease." Dr. Stokes quotes the report of a sanitary inspector of an Irish town of four thousand inhabitants. Every part " was teeming with effluvia from such decayed substances as are admitted to be of the most noxious kind, but this town has always been a remarkably healthy place." Dr. Pratt declares that if fever were caused by decomposition of animal and vegetable matters, Ireland would have been depopulated long ere this from sea to sea. He gives this * Yellow Fever. ■}• Dublin Quarterly^ vol. vi. 60 VAGARIES OF SANITARY SCIENCE. opinion on the experience of twenty-five years' practice of an Irish dispensary officer among the agricultural classes, where the house-yards are often heaped up to the very door with manure, and are the receptacles of slops and refuse of all sorts, which ferment and " produce a green and stagnant pool," where gases are generated which burst on the sur- face. Dr. Pratt says, " In such places a case of fever of any type rarely occurs, the average length of life is as high as elsewhere, and illness except common colds is almost unknown." Dr. Stokes says, in his lecture on public health, " There is no proof that dirt ever in itself caused a case of specific disease. The real antagonistics to any successful pre- ventive medicine are poverty, destitution, ignorance, apathy, insufficient and improper food, filthy habits, overcrowding, bad ventilation, insufficient clothing, the living in ruined and neglected tenements, the destruction of proper pride and the blessed influence of home." Dr. J. C. Warren * made a thorough study of the influ- ence of putrefaction in the production of disease. The workmen in those trades most exposed to putridity were most exempt from infectious disorders. He says the whaling- vessels are saturated with putrid animal matter, in hot as well as cold climates ; the odor is sometimes intolerable to those not habituated to it ; but the seamen on these ships are more healthy than those engaged in any other ser- vice. Dr. Davis f records his studies of the influence of occu- pation on health. He found that the health of brewers, distillers, tanners, curriers, glue-makers, tallow-chandlers, soap-makers, of all of those, in fact, who were exposed to putridity in its worst forms, was never impaired by these occupations, and though the stench from glue-making is a nuisance to the entire neighborhood, " many assert that on * Boston Medical and Surgical Journal, 1829. f Ibid., 1833. THE AIR. 61 entering this employment they experience a marked increase of appetite and health." Notwithstanding that those who are engaged in tanning are exposed to masses of putridity, dampness, and dust, experience has shown that this trade is a benefit to consumptives. One of the most searching investigations of the influence of putridity on health was made by Parent Duchatelet in 1832.* This distinguished hygienist was guided in all of his inquiries by the love of truth. Unlike the sanitarian of a later day, he sought neither to exalt himself nor to in- crease his revenue by exciting a panic in the public mind. If an imaginary danger appeared, he strove to allay the fears of his fellow-citizens. The village of Montfaucon was just outside of Paris. Here was the depot for all of the refuse and fecal matter of the great city, and here the faeces were converted into poudrette. Here were also bone-boil- ing, glue-factories, and the rendering of dead and diseased animals. Very often the authorities were appealed to for their suppression on the ground of danger to the public health. When the cholera was approaching Paris in 1832 these petitions increased, signed largely by medical men, who represented that if Montfaucon did no harm in ordi- nary times, it was only waiting for the spark of an epidemic to explode in pestilence ; that localities like this invited the disease; that here it would centre and diffuse itself over the country. Parent was appointed to investigate and re- port. He says the odor here was " insufferable, indescrib- able, insupportable." But if we interrogate the workmen, they, without exception, answer that, far from being nox- ious, these odors are beneficial to their health (" contribucnt a leur bonne sante'). Parent says that in every direction where he inquired of the inhabitants and of workmen in other employments in the vicinity, though they complained * Hygiene Publique. 6 62 VAGARIES OF SANITARY SCIENCE. loudly of the nuisance, they admitted that their health never suffered. The children here were in the best of health ; so were the women. One of these particularly attracted the notice of Parent on account of her fecundity ; he says she was " kabi- tuellement enceinte f' her children had great force and vigor. He had seen this mother nurse her infant and toss it after- wards into the carcass of a horse for a cradle. When the cholera arrived in Paris it appeared to shun Montfaucon ; the mortality from that disease here was very small in com- parison with the rest of Paris. The village of Noisy-le-Sec received the refuse of the Montfaucon establishments. M. Dumoissin, the mayor, told him that those nearest the animal remains suffered the least during the epidemic ; that his observations had destroyed all his previous opinions respecting these putrid matters, and that the peasants who handled them, far from thinking them harmful, believed that their fermentation purified the air. Fleury,* after reviewing the evidence respecting emana- tions from putrid animal substances, says, in view of no in- creased mortality nor increase of infectious diseases in the presence of immense masses of putrefaction, we not only recognize their innocuousness, but perhaps must admit that these emanations exercise a favorable and prophylactic influence. ■ Dr. John Snow f says the mortality of persons engaged in any occupation is the best criterion of its salubrity. The death-rate of males of twenty years and upward in London for eighteen months ending July, 1856, was 241 per 10,000. The death-rate for those males of twenty years and upward who were employed in trades where organic decomposition was continually going on was 201 per 10,000 in the same * Cours d' Hygiene, 1852. •j- London Lancet, vol. ii., 1856. THE AIR. 63 time. Dr. Snow estimates that a man working with his face one yard from offensive substances would breathe ten thou- sand times as much of the gases given off as a person living a hundred yards from the spot. He says the health of persons employed in any occupation is necessarily the measure of the effects of such occupation on the public health. Bone- boiling, skin-dressing, and other offensive trades are carried on at Lambeth ; this part of London contains many of the other causes that are supposed to promote cholera; the ground is low, covered by a poor, crowded population ; yet the deaths here from cholera in 1854 were 29 per 10,000, whilst in London at large they were 45 per 10,000. Dr. Snow concludes that " the science of public health, Hke other branches of knowledge, may be as much benefited by the removal of errors which stand in the way of its progress as by direct discovery." Dr. R. F. Foote writes to the Sanitary Review * that out- side the doors of the houses in Constantinople is a heap of animal and vegetable rubbish ; dogs are the only scaven- gers ; apartments are overcrowded, several members of a family living and sleeping in one room ; there is no drain- age ; large cesspools are near the houses, and the privy is on the ground-floor beneath the living-room. " With all these deficiencies, we are bound to consider Constantinople a healthy city." The result, he thinks, is due to " climate," and whatever may be the causes which tend to affect the public health, it is not the less true that it is more flourish- ing in Constantinople than in any other of the large towns in Europe. Dr. William Budd f says nothing proves the falsity of the pythogenic theory of fever more than the summers of 1858- 59 in London. Here "an extreme case, a gigantic scale in the phenomena, and perfect accuracy in the registration of * Vol. iv., 1857. f British Medical Journal^ iS6i. 64 VAGARIES OF SANITARY SCIENCE. the results — three of the best of all guarantees against fallacy — were all combined to make the induction sure." " For the first time in the history of man the sewage of two million people had been brought to seethe and ferment under a burning sun in one vast open cloaca in their midst." Stench so foul had never ascended to pollute the air. " Never before had a stink risen to the height of an historic event." The law courts were broken up by the noxious vapor ; the steamers lost their usual traffic ; day after day were passionate appeals from " those condemned to live on the Stygian banks." " Members of Parliament and noble lords, dabblers in sanitary science, vied with professional sanitarians in predicting a pestilence." " Meanwhile, the hot weather passed away ; the returns of sickness and mor- tality were made up, and, strange to relate, the result showed not only a death-rate below the average, but as the leading pecuHarity of the season, a remarkable diminution in the prevalence of fever, diarrhoea, and the other forms of disease commonly ascribed to putrid emanations." Dr. Letheby, in his report, said, *' With all this condition of the Thames, however, the health of the metropolis has been markedly good; in the corresponding period of 1857 the cases of fever, diarrhoea, and dysentery attended in the city by the medical officers of the unions amounted to two hundred and ninety-three of the former and one hundred and eighty-one of the latter ; but during the past quarter, the quarter of the stench, there were only two hundred and two of the former and ninety-three of the latter." " So that while pythogenic compounds were poisoning the air with a forty-thousand fever-power, pythogenic fever, so far from rising in proportion, fell vastly below its average." Dr. McWilliams, the medical supervisor, said that not only was the general sickness less in 1858-59, but he adds, " As regards the type of those forms of disease (including diarrhoea, choleraic diarrhoea, dysentery, etc.) which in this THE AIR. 65 country noxious exhalations are supposed to originate, we find the additions for the four hot months from this class of complaints 26.3 below the average of the three previous years, and seventy-three per cent, less than that of 1857." Dr. Budd says, " Before these inexorable figures the illusions of a half-century vanish in a moment." The irrigation of lands with sewage on a large scale had been in operation in Milan and Edinburgh for one hundred and fifty years before the dawn of Sanitary Science. It was really nothing more nor less than manuring fields, a process which had been going on by nature and art since the foun- dation of the world. The proposal to so dispose of the sewage of cities was a grand occasion for the exercise of sanitary fancy to awaken anxiety about the public health. As usual the sanitarians made no investigations, no inquiries. They simply let their imaginations have play, and cried aloud that the emanations from these farms would produce pythogenic diseases ; sewage would percolate into the wells ; the sewage was charged with the ova of entozoa, and was certain to cause tape-worm and other entozoic diseases in man and animals ; and " the effects of sewer-gases were never so bad as when sewage was spread out on the land ;" that the propagation through sewage " of certain epidemic diseases, especially cholera, enteric fever, and diarrhoea, among communities is one of the best-established facts in Sanitary Science." Horses and cattle that would eat the grass grown on these lands would be diseased ; milk and butter would be poisoned, vegetables grown here would not only absorb the sewage but the germs of disease. At Gennevilliers, where a farm took about one-half of the sewage of Paris, they said that the grass and the vegetables took up the filth.* " You can break them and squeeze water out that has a decided smell of sewage." One sani- * Sewage Disposal, Robinson. 6* 66 VAGARIES OF SANITARY SCIENCE. tari'an said he was now " in a position to explain the occur- rence of typhoid fever from the use of milk." These predictions of disaster retarded and hampered the profitable undertakings. The hue and cry about the public health, sometimes prompted by fear and sometimes by self- interest, was so great that governments were forced to in- vestigate these farms; always with the same result, — that this broadcast flowing of sewage was proved to be innoxious. It was shown in some cases that there had been a decided and constant fall in the death-rate among the inhabitants on and about these fields after the flow of sewage had begun. In Norwood district, where there is a sewage farm of sixty acres, the death-rate had fallen* from 18.6, the average of three years ending 1865, to 13.4, the average for the seven years ending 1872. At other farms the death-rate was equally low. At Breton one hundred and twenty-one acres take the sewage of five thousand people ; the workmen here are uniformly healthy ; the water is drained five or six feet from the surface ; it is clear and free from odor, and is proved to be of good quality. The Aldershot field of one hundred and twelve acres takes two hundred thousand gallons daily of sewage. At Banbury, Rugby, Carlisle, and other places, although some of the grounds are reported in a condition of negligence, the workmen and inhabitants are all in good health. Dr. Arnott had explained exactly how the Edinburgh farm would cause epidemic disease. Professor Christison said his prejudices for years had been against the irrigated meadows there, but he had been forced to surrender them. The nuisance was not denied ; it was sometimes intolerable ; but he was satisfied that neither enteric fever nor diarrhoea nor dysentery nor diphtheria, either in epidemic or non- epidemic seasons, was found in and around them more than * London Lancet ^ 1873. THE AIR. 67 elsewhere. Dr. Arnott had said these fields must cause pes- tilence. Professor Christison declared that the fact remained that they had been there for two hundred years and no dis- ease could be ascribed to them ; indeed, if any part of Edin- burgh was freer than another from zymotic disease it was these sewage-irrigated meadows. M. Durand Claye * reports on the farm at Gennevilliers ; he says the plain here is a proper filter to absorb and purify impure water ; that under the thin layer of earth, where the sand and gravel begin, there is no trace of organic matter ; a proof that the superficial layer of earth is a complete filter (un filtre energique) for the sewer-water. From a well in the midst of the fields the water was pure, limpid, and tasteless [parfaitement pur de matures fermentiscibles). The water from the drains is equally pure. The death-rate here had been steadily declining since the farm was established. Professor Corfield says that when a sewage farm is a large filter and the effluent water is collected in subsoil drains, this water is perfectly fit to drink. He knows where it is usually drunk by the workmen. The farms have not caused by noxious emanations any injury to the health of neighbor- hoods where they have been placed ; there is no evidence that the sewage affects the wells ; and he does not think there is a single case where sewage farms, " badly conducted as many of them are," have caused the least injury to health. At Sherburn, Massachusetts,t the water that leaches from drains five feet deep beneath the surface of the sewage farm is as clear as spring-water, and was selected as such by an expert. Iq i888,t M. Ogier reported to the French government on the condition of the farm at Gennevilliers. His conclu- sion was that no better or safer way of disposing of the Paris sewage could be devised. * Annales d' Hygiene, 1875. f Sanitarian, vol. xiii. \ Annales d'Hygidne. 6S VAGARIES OF SANITARY SCIENCE. In the summer of 1890, Dr. Henry J. Barnes * visited the sewage farms of Edinburgh, Birmingham, Leamington, and Croydon in England, and Gennevilliers, near Paris. The health officers at Edinburgh and Leith declared their hos- tility to the sewage irrigation ; but admitted that the district was " most healthful," and that there was no evidence of any injury resulting from the sewage. During the cholera epi- demic at Leith and Edinburgh in 1865-66, although these farms received the cholera evacuations, not a case occurred on them or in their vicinity. At none of the others that Dr. Barnes visited in England was there any disease re- ported as springing from the sewage. He inspected Genne- villiers on a hot day in August, and drank of the effluent water of the sewage, being assured of its purity. The in- habitants here were engaged in raising funds to erect a monument to M. Durand Claye, who, regardless of threats of personal violence, of persecution by lawsuits, and opposed by nearly all the savans in Europe, had caused the trans- formation, through this flow of sewage, of sixteen hundred acres of barren sand into a beautiful garden. The town had increased in population thirty-five per cent, since 1868. The death-rate for five years preceding the irrigation was 32 per 1000 ; for the last five years it has been less than 25 per 1000. In 1882, when typhoid fever raged in Paris, there was no in- crease in Gennevilliers ; and not a case of cholera was here in 1884, when this disease was epidemic in the city. In 1 88 1 a pecuniary loss was reported f from the sewage farm at Reading ; but " looked at from a sanitary point of view, the farming operations had been a great success." Reading had never before been in such an excellent sanitary condition. In Chemical News, % Mr. Hope, an enthusiastic advocate * Boston Medical and Surgical Journal, 1891. I London Lancet, vol. ii. % 1880. THE AIR. 69 of sewage farms, suggests a convalescent hospital for diseases of the chest in the midst of his sewage fields, " guaranteeing to the patients a certain number of irrigations in the month with genuine unadulterated London sewage ;" " where Lon- don beauties might come to recruit their wasted energies at the close of the season, attired in a costume de circonstance ^ with coquettish jack-boots; and would perhaps at times Hsten to a lecture on agriculture from the farmer himself, while luxuriating in the health-restoring breeze." Through this system of sewage-disposal much waste land had been brought under cultivation, which had afforded employment and subsistence for a large number of people. The sanitary terrorists had done all they could to prevent it. Dr. H. Gibbons, Sr.,* says that the origin of enteric and kindred fevers has been associated with filth ; to deny this is rank heresy. Nevertheless, facts will sustain the assertion that the specific causes of infectious disease have no odor ; that in the majority of cases the localities where the vilest filth exists are free from infectious diseases. " Objection may be made to this view, that it is a defence of carelessness or filthy modes of life. But it is simply a defence of truth. There is a seeming policy in holding before the eyes of com- mon people the spectre of death lurking in filthiness and foul odors. But cleanliness is virtue in itself enough to be cherished for its own sake, and not enforced by false ter- rors. Still more should the error be avoided by the medical inquirer." Dr. Gibbons says that in San Francisco the health authori- ties require the Chinese to have five hundred cubic feet of air to each occupant. The public health is supposed to demand this law. If they are found with less, they are fined and imprisoned. " I have seen in the county jail as many as thirteen Chinamen confined in a single cell about twelve feet * Pacific Medical and Surgical Jouitial, 1882. 70 VAGARIES OF SANITARY SCIENCE. square, containing by computation less than ninety cubic feet of air to each ; and this for violating the five hundred cubic feet of air ordinance." The city of Oakland, built on a sand flat, has until within a few years obtained its water from shallow wells dug fifteen or twenty feet deep, whilst all the sewage and filth of the city was deposited in the soil about them. " But Oakland is and always has been a healthy locality, having much less of typhoid fever and diphtheria than scores of cleanly, well- drained, and hilly places on the Pacific coast." After citing other cities similarly situated to Oakland, Dr. Gibbons con- cludes : '^ First. The specific poison of infectious diseases has no odor. " Second. It may be associated with offensive odors, and it may not. In by far the larger proportion of cases it is not. " Third. Offensive odors cause no permanent disease. " Fourth. Certain emanations offensive to smell, notably if sulphur be the basis, tend to destroy organic germs. *^ Fifth. Water which has been polluted by excrementi- tious or other organic matters is mostly drunk with impunity ; the gastric juice digesting or destroying the organic germs. The production of disease by such water is the exception and not the rule." Professor M. P. Cazenave,* of the faculty of Lyons, gives an account of his visit to Tunis. " There is," he says, " a net-work of sewers here without any regular slope, open to the air, filled with excrement and animal and vegetable re- mains, the accumulation of years. The ground-work of these sewers is not protected by masonry, so that the soil is impregnated with filth and the atmosphere is loaded with fetor. The cemeteries are in a dreadful condition, the cofifins being placed only a httle below the surface. What * Annales d'Hygidne, vol. xvii., 1887. THE AIR. 71 becomes," asks Professor Cazenave, " of that aphorism of public hygiene of Fonssagrives, that a city's health is in pro- portion as its sewerage is perfect and its cemeteries well arranged ? In spite of its condition, Tunis enjoys as good health as the greater part of European cities. Here is a striking example {confirmation eclatante) of the falsity of the opinion that ascribes a dangerous quality to a repugnant and detestable atmosphere." Unwilling to yield all his prej- udices, the professor says, when these sewers are remade and this old infiltrated soil is stirred, where are sleeping legions of infectious microbes, an explosion of typhoid and cholera may result. "But for the moment let us register this fact :" the " vast sink that represents the subsoil of Tunis engenders odors, but does not engender epidemics." Typhoid fever is rare here. It is our troops who are lodged often on the heights under apparently satisfactory conditions that furnish the greatest amount of typhoid fever {qui payent le tribut le plus large). The professor wished to believe that the people of Tunis had some hereditary resistance ; that there had been some natural selection whereby the fittest had survived and the feeble eliminated ; but the constant stream of European immi- gration had not been the occasion of any epidemic, and he says we must conclude with Bouchardat, that these odors are innocent ; and he asks. May not sulphuretted hydrogen and its compounds, which are constantly disengaged from these places, be antiseptic and destructive to certain classes of microbes ? En resume, he says science demonstrates that our senses are not competent as guides in hygiene. The testimony of travellers and residents in China — missionaries and physicians — is abundant and uniform as to the disregard in that vast empire of everything which is considered with us as sanitary precaution. Dr. Wilson * * Medical Notes on China. 72 VAGARIES OF SANITARY SCIENCE. says the Chinese import no manure and derive no benefit from agricultural discoveries in Europe. Close to houses are placed large earthen vessels which receive all decom- posable refuse, to which is added urine ; in the corrupting mass at a heat from 80° to 86° multitudes of maggots form, giving to it life and motion. These pans are arranged along the public walks ; when putrefaction is at its highest point, the contents are carried in open buckets on the shoulders of men to the fields. Human ordure is carefully collected and highly valued. The water in the canals is filthy in the extreme; the banks are lined with ooze and abound in animal and vegetable products ; the offal dams up the canals and the stench is unbearable. Dr. Wilson reports that the English crews had fever and ague, but little dysentery, and typhoid or continued fever is not alluded to. Williams * says the streets in Canton are twelve, many of them only eight, feet wide. Public necessaries and offal are borne through them ; they pollute the air ; the sewers often get choked and exude their contents on the walks. The ammoniacal gases generated by this filth aggravate oph- thalmic disease, and it is matter of surprise that cholera, plague, or yellow fever does not visit this people. The Chinese transport cakes of human manure through the streets, thus creating an intolerable nuisance. Tanks are dug by the wayside ; pails are placed in the streets for the convenience of the people. Urine, faeces, soot, bones, fish, mud from canals, offal of all kinds are thrown into them. Fermentation takes place, maggots swarm, and the disgust- ing mass is conveyed through the streets. Mr. Williams says that, in general, the Chinese enjoy good health. They are as long-lived as other people. Ophthal- mia, dyspepsia, cutaneous and digestive diseases, and where * Middle Kingdom. THE AIR, 73 there is rice-culture, intermittent fevers prevail. Cholera has raged in some parts of the empire, but has never been epidemic at Canton. When it has appeared in China, it has invaded some towns and passed by others just as obnox- ious. Surgeon John Rose * says that cholera at Shanghai is sometimes seen sporadically, but is seldom or never epi- demic. He says it is remarkable, considering the filthy condition of the canals, that violent epidemics do not more frequently come, for the canals which supply the people with water for domestic use are the receptacles of all sorts of refuse. Dr. F. Wong f says that during a residence of more than ten years in Pekin, he has seen only two cases of typhoid fever among foreigners. This is more curious, he says, as the conditions usually supposed to be productive of that fever are here in full operation, and large numbers of people use water and inhale air charged with the impurities of human excreta. In 1873, J Dr. Dudgeon writes of the remarkable exemp- tion of the inhabitants of Pekin from fever : " If foul smells create fever," he says, "there ought to be no immunity here." The condition and mortality of Pekin explode the belief that offensive odors are harmful. Hundreds of peo- ple live in and around and above cesspools, yet look well and healthy. He adds, " Many diseases prevail here, as in the West, without the agency of this reputed cause, — nox- ious odors ; and the causes exist at all times here without producing such diseases." The most convincing proofs of the sanitary condition and freedom from zymotic disease in China are found in the reports for twenty years of the medical officers of the Impe- * London Lancet, vol. i., 1862. f Ibid., vol. ii., 1872. \ Ibid., vol. ii. D 7 74 VAGARIES OF SANITARY SCIENCE. rial Maritime Customs. There is a remarkable uniformity of statement from these physicians, scattered over a thou- sand miles in extent of this country. These reports are made half-yearly, and contain an account of the health and prevailing diseases in China among natives and foreigners. Except small-pox and occasional limited epidemics of cholera and one of diphtheria, which occurred in Pekin in 1866, no outbreak of any importance is recorded for twenty-five years. From Ichang, the doctor writes, " Why disease is not always with us, not why epidemics should sometimes come, is the problem," and the immunity from disease " must be ascribed to meteorological conditions." " In Corea small- pox, ague, and cholera are reported ; typhoid ought to be common, as all the conditions are favorable to its existence; as yet(i885), however, no cases have presented themselves." In 1886, Dr. McFarland reports the sanitary condition of Ichang as most deplorable, but there " is an absence of epidemic disease." At Han-Kow, in spite of the filthy condition, the health of the city compares favorably with that of any port in China. Dr. Lowry writes that at Parkoi animal and vegetable substances lie decomposing on all sides ; privies are open in the most exposed places ; the houses are little better than the streets ; in some of them an open gutter runs through into which all filth is thrown ; the floors are saturated with excrement and the stench is vile. The diseases that he mentions as occurring here are scrofula, skin-diseases, small- pox, and syphilis. He makes no allusion to typhoid fever or diphtheria. Dr. White * reports no serious illness at Ching-Kiang ; on account of the filth " the wonder is that a man, woman, or child survives." [886. THE AIR. 75 Dr. Deane wonders that there is so little sickness at Kuing-Chow. For twenty years these reports have been made, all uniform in tone, with a remarkable similarity in lan- guage, giving disgusting details of the vile sanitary condition of the country and its immunity from contagious disease. But Hebrew prophet, Christian martyr, Mohammedan fanatic, or Mormon saint never clung to his faith with greater tenacity than do these English medical men to theirs. Their reports are full of expressions of surprise that epidemics do not come ; they seem lost in wonderment ; but never express a doubt of the filth-theory of these epidemics. In 1886, however. Dr. Daly, the only dissenter in the group, in reporting on the health of Ning-Po, says we live in houses near large kongs filled with old and putrefying fseces, the accumulations of months, especially during the summer, when manure is not wanted for the fields. In spring and autumn they are removed in boats, which travel the canals where the natives wash their vegetables. " I have often seen women doing this within a few feet of a night-soil boat. On the banks of the canal on which the largest traffic of these boats occurs is situated the dairy that supplies most of the foreigners with milk, and in this canal the dairy-folk wash their utensils. No precaution is taken with the excreta from cholera or from fever patients." Dr. Daly seems in a little doubt about the pythogenic theory of the origin of typhoid fever, for he says, " If" it be a right one, it is not universally apphcable ; "if" it were, the disease would rage here, for everything to favor fecal decomposition exists, — warmth, stagnation, accumulation, and partial seclusion, — " yet no case of typhoid has occurred for many years among the foreigners, and it is an extremely rare disease among natives." The editor of the Chi7ta Medical Missionary, September, 1888, asks, " Do sanitary measures limit disease in populous cities ?" He says a lesson can be learned from the condition 76 VAGARIES OF. SANITARY SCIENCE. of Canton and hundreds of other cities in China, where generation after generation has passed without any benefit from sanitary measures. In other countries millions of dollars are spent under the direction of the ablest scientific men to ward off disease. But in China no attention is paid to the subject. "Wherein do the results differ ?" he asks. Canton has 1,500,000 inhabitants, and there are 333,333 persons to the square mile ; the streets vary from five to eight feet in width, a few being twelve or fifteen ; the actual space for each person in the city is fifty-five and a half square feet. There are no drains in Canton; there are ditches loosely walled up, but there is no fall to carry off the water. The ditches are generally choked with filth, and offensive gases are poured forth. The water is derived from wells, the river, and springs. The impure river water is used by a small part of the population. The largest part of the water-supply is from wells four to ten or fifteen feet deep; a great part of this is the refuse water which has been used by the 1,500,000 people. " It percolates through the filth of the sinks and ditches, and then through soil which has been saturated for centuries with animal, vege- table, and saHne deposits." The custom of burning incense at the house-doors morning and evening is supposed to exert some counteracting influence on noxious gases ; but the writer truly says it does not differ from ordinary smoke, and only adds so much more carbon to the air in minute particles. Here is Canton, he says, on the border of the torrid zone, destitute of all the sanitary appliances which modern science pronounces essential for the pubHc health ; with a population three times as dense as that of any western city ; with impure water and abounding in filth and offensive smells, so that it is a by-word with travellers. A practice of thirty years convinces the editor that Canton is not more unhealthy nor is it any more subject to epidemics than Western cities. THE AIR. 77 W. K. Burton,* professor of sanitary engineering at Tokio, gives an account of the sanitary condition of Japan. All faeces and urine are carefully stored in receptacles until fermentation is accomplished. The mass is then diluted and poured on the fields. The farmers and peasants who live near these putrid masses and handle them "enjoy remarkably good health," The professor says, '* It is not too much to say that the soil on which most of the large towns in Japan stand must be sewage-sodden, with the result, of course, of contaminating the air both inside and outside the houses." But the worst of all is, " the water for domestic purposes is drawn from shallow wells dug in this soil. The water, of course, is simply dilute sewage." The death-rate for the whole empire is 19.33 P^^ 1 000, while in the least healthy districts it is only 24.22 per lOOO of the population. The death-rate of Tokio, with its filthy air, water, and soil, and bad drainage, is 21.08 per 1000. The sanitarians assure us that the two most sensitive and unerring tests of the hygienic condition of a city or country are the proportions of infant mortality and mortality from zymotic diseases to the total number of deaths. These rela- tions are so intimate that, given the hygienic condition, they can predict the mortality, and vice vei'sa. Professor Burton says the infant mortality is very low in Japan, his explanation being that *' there is great attention paid to the children by their mothers." The mortality from zymotic disease is also very low. He gives a table, which, he says, is furnished by Professor Bealz, M.D., who has prac- tised in Japan for thirteen years. The table shows that in 1888 there was a total of 756,367 deaths. Of these, 45,715 are set down to infectious or zymotic diseases. In 1887 there was a total of 753,855 deaths, and 113,696^ * Sanitary Record^ 1890. 7* 78 VAGARIES OF SANITARY SCIENCE. were of five years and under, — only about one-third of the amount of infant mortality that occurs in our large cities. Professor Burton attributes this comparative immunity from infectious diseases to " climate." It seems never to have occurred to him as a possibility that the sewage-sodden soil of Japan, contaminating the air inside and outside of the houses, and the diluted sewage forming the drinking-water of the people may have nothing to do in the production of infectious disease. He says that Japan has acquired the title of " the Sanato- rium of the East." His statements are corroborated by the statistical tables of births and deaths shown at the second national industrial exhibition at Tokio, in i88i. The percentage of zymotic to total mortality for the year ending 1879 was 13.66, about one-half what it is in our cities which have the most careful sanitary supervision. The following year the per- centage of zymotic to total mortality rose to 19.13. The general death-rate for the empire was 17.01 per 1000 of the population. The percentage of mortality under ten years of age in 1879 was 28.70; in 1880 it was 25.76. For the year ending 1880 there were 2863 deaths from typhoid fever in the empire, and 534 from diphtheria. Professor Corfield * says that the large undrained cesspool and the latrines at Belgaum, in Bombay, have existed from time immemorial, with the wells in close proximity. " The whole ground in and about the lines is pregnant with abom- ination," with a mean temperature of 74° F. Yet, "as usual, at Belgaum there wag comparative immunity from fever," and " Belgaum has long possessed a reputation for salubrity." If Professor Corfield had not told us, we might have thought the salubrity of Belgaum depended on " cli- mate," as did that of China, or that '* great attention was * Treatment and Utilization of Sewage. THE AIR, 79 paid to the children by their mothers," as in Japan. It was neither. Professor Corfield does not seem to be indulging in raillery when he says that the reason for Belgaum's salu- brity, surrounded by such putridity, is, " The town is laid out with some regularity, and the principal streets are kept in good order.'* CHAPTER IV. The Air — (Continued). If we turn to the reports of boards of health in our own country, the proof is no less abundant and conclusive that putrid emanations corrupting the air are not competent to cause disease. Those towns and cities which in these re- ports suffer the most obloquy on account of their filthiness appear in the mortality tables to enjoy the largest measure of health. In fact, our sanitarians offer the interesting phe- nomena of laying down certain inviolable principles of public hygiene, supporting them by the most flaming elo- quence, and then industriously and with apparent uncon- sciousness collecting an overwhelming mass of statistical testimony to show there is not a word of truth in the origi- nal propositions. The first report of the Massachusetts Board of Health contains an account of an inspection of the slaughter-houses at Brighton. " The stench about all of these places so kept is horrible ; and, although the day of inspection was a fine, dry one, with a free northwest wind blowing, the odor of some of them could be observed for more than half a mile very strongly." " Here is a putrid mass consisting of blood, which decomposes almost as soon as it falls upon such material, the excrement of the animals killed and of 80 VAGARIES OF SANITARY SCIENCE. the hogs, the half-digested food contained in the entrails, and the offal itself, covered with decomposing matter ; in this filth the hogs wallow. The surrounding ground is fil- tered with decomposing matter. The slaughter-house hog not only eats flesh, but flesh in a state of putridity ; and is, therefore, entitled to be regarded as the carrion beast. If he is good to eat, so is the crow and buzzard. Few persons would be willing to eat him if they saw him in his putrid sty, with wreaths of entrails hanging about his neck and his body smeared with blood. Human instinct (which is some- times better than reason) recoils from such food. The slaughter-house pig-pens are filled with animal m.atter, with rotting blood, mingled with excrement, and are, therefore^ a source of danger to public health^ Close to this description the board admits that Brighton is not an unhealthy town ; that in 1865-66 its death-rate was less than that for the State; and there is no record, nor any charge, that anybody was ever made sick by this putridity. Amazing coincidence ! In the next report is a table of deaths of persons above five years of age from typhoid fever in Massachusetts for the ten years ending 1868. There are twenty-eight towns reported, which have a population of be- tween three and four thousand each. Towns. Population. Number of deaths from Typhoid Fever. Dennis 3592 43 Harwich 3540 57 Provincetown . 347° 18 G. Barrington 3920 36 Salisbury 3609 29 Watertown 3779 19 Greenfield 3211 56 Palmer 3080 32 Dartmouth 3435 29 Easton 3076 30 Groton , , 3176 28 THE AIR. 8 1 Tewns. Population. Number of deaths from Typhoid Fever. Medway 3219 30 Wrentham 3072 22 Milbury 3780 29 Grafton 3961 58 Ware 3374 4^ Amherst 3415 Zl Rockport 3367 26 Ipswich 3311 23 Deerfield" 3038 40 Hollister 3125 26 Stoneham 3298 29 Wakefield 3244 19 Webster 3608 62 Braintree 3775 23 Canton 3318 13 Leominster 3313 21 Spencer 3024 30 The average population of the twenty-eight towns is three thousand three hundred and ninety-seven ; the average number of deaths from typhoid fever for ten years is thirty- two. Brighton's population is three thousand eight hun- dred and fifty-four; the number of deaths from typhoid fever for ten years ending 1868 is nineteen. In proportion to population, Brighton, with all its filth, so vividly described by the board of health, had only about one-half of the amount of typhoid fever that the other twenty-eight towns had, which were not reproached for uncleanness. Yet, in the same book. Dr. Derbe says that typhoid fever is " born of impurity." As Dr. Budd would say, " Before these inex- orable figures, the illusions of a, half-century vanish in a moment." The board ascribes the salubrity of Brighton to its favorable location and to the good condition of its people; it says nothing about the location of the other twenty-eight towns or the condition of their people. The Massachusetts Board (1879), in discussing the cause of typhoid fever, says, " Since the investigations of the board / 82 VAGARIES OF SANITARY SCIENCE. have been directed to this point, it has repeatedly been shown that immense amounts of urine and excrement, — oxydized, incompletely oxydized, — and as they come from the bladder and intestines, are consumed in drinking-water and inhaled at the rate of nine thousand litres of contam- inated air a day, and this for years by young, old, and mid- dle-aged persons, without any disease resulting that may be attributed to filth." The same board's report for 1 880 contains an account of an inspection of schools in that state by Mr. E. W. Bow- ditch. Some of the schools in New Bedford have standing water in the cellars ; a great many bad smells are reported ; disgusting urinals and privies scarcely fit for animals, much less for human beings. In one school peppermint showed ten leaks in the plumbing; the drains were not tight in another ; in another a " sickening smell" pervaded the build- ing, and untrapped wastes connect with sewers ; at another, sewers and private drains ventilate into the building, and some of the schools are supplied with water from a " sus- pected well." These buildings have a seating-capacity of four thousand six hundred and twenty-six ; this year there had been altogether one hundred and fifteen cases of scarlet fever and diphtheria, some measles, and in one school " some sickness." The Lowell schools were in equally bad condition, and in equally good health. The privies in one school were in the worst order he had ever seen. This eminent sanitarian is always so rich in details that we cannot help giving them in his own words. " At one school the rear of the building on the boys' side seems to be used as the common urinal ; on the side and front walls of the building were counted eight different places urinated upon and wet at the time of inspection." Mr. Bowditch is kind enough, however, to add, ** It is stated that this was doubtless owing to boys from outside the school." At THE AIR. 83 Bartlett Street school " the boys have urinated on the walls of the building within five feet of the entrance-door !" Mr. Bowditch seems to have lost all patience with these auda- cious and depraved youths who are violating the funda- mental principles of Sanitary Science ; for he withholds his absolution from the boys of the Bartlett school, and very likely would not believe the young rascals if they laid their tricks to " the other boys." The Cedar Street school has six rooms, with seats for about three hundred pupils. The ventilation is by windows only. There is standing water in the cellar within two feet of the cellar floor. The water-closets are in the basement, and the ceiling is neither lathed nor plastered. " There is a sickening smell up to the top of the basement stairs." " Pep- permint showed that the drains were not tight in the base- ment." " There is a pig-pen on the opposite side of the street, and a neighbor's privy and poultry-yard seventeen feet of one side of the building, and fourteen school-room windows look out on them." " There have not been many absences lately ; not over twenty from sickness ; but two deaths, and these happened during vacation." In the High School, " cellar air" is used for the steam radiators ; a num- ber of these are so situated that " water-closet air instead of cellar air" is introduced into certain rooms. No sickness is reported in the High School. Mill Street school is in very bad sanitary condition, but Mr. Bowditch says " there is very little sickness of any kind." At Maxwell Street school is an untrapped sink. " Smells here come up the sink, but it is not known whether from a cesspool or privy." " One case of sickness only" is reported at this school. Mr. Bowditch * inspected the summer resorts of Massa- chusetts. As far back as 1869, Dr. Derbe, he says, had pre- dicted that Martha's Vineyard would " sooner or later be * Massachusetts Board of Health Report, 1879. 84 VAGARIES OF SANITARY SCIENCE. visited by pestilence." Here he found privies, " shallows in the ground or on the surface," and the drinking-water is reached at from eight to twenty-five feet. The population in summer is about fifteen thousand, and at the height of the season it reaches double that amount. There are two ponds here that are veritable cesspools for the filth created by the thousands of visitors ; rank marsh grass, masses of refuse sewage, " everything that is nasty," can be found in these ponds. All over the town, sinks deliver their water from six to fifty feet from wells ; the privies are not much farther off; and there are no traps to the kitchen wastes. At one large hotel the swill-barrel almost touches the well ; across the street is a mass of filth several inches deep. The " proprietor states it is hoed out every autumn." One public-house has " several privies within a radius of fifty feet." The old well has six privies within twenty-five feet. Another house has its well within a foot of a sink-drain. The proprietor admits that the drain is a little too near the house, for the stench keeps him awake nights. The well at another house is seventeen feet from a cesspool ; it is such " beautiful water" that the neighbors come for it. Another house has a well within twenty-five feet of one cesspool and four privies. This well is used by five families. Another house has twenty-four privies and thirteen cesspools within a radius of one hundred and forty feet ; the well here is used by a number of families. At another house fourteen privies could be counted, " all within range." Of forty-two wells that were examined, the water of twenty-two was found impure. Mr. Bowditch mentions only two cases of sickness as having occurred at Martha's Vineyard. Into the large boarding-houses sewer-gas was flowing; in one, peppermint poured into a basin permeated all the others ; and it is the habit to empty chamber-slops into the basins. THE AIR. 85 In one of these houses there had been " one case of sore throat during the past summer." In a hotel for one hundred and fifty guests, none of the joints in the plumbing were tight ; here, Mr. Bowditch states, " there has never been a serious case of illness in the house for sixteen years." Another house takes one hundred and seventy-five guests ; the soil-traps here are all unventilated. A field one hundred and eleven by forty feet received all the soil-pipe matter. Outside the house is a two-story privy, with twelve sections; the pipes between the second and third floors leak sewer-gas. " There has been no sickness in the house." Visits to other resorts showed an equal amount of filthiness, and a cor- responding amount of good health. We cannot sufficiently admire the school-girl naivete of the eminent sanitarian who records these inspections. The humor of the situation lies in this, that he seems entirely oblivious of the fact that he is accumulating the best of evidence to show that the filthy condition of these places had nothing to do with the production of disease. The Rhode Island Board of Health Report for 1883 nar- rates an inspection of thirty-nine summer hotels in that State. These were reported in good sanitary condition ; and it is comforting to note that just as large a measure of health prevailed in them as in those which were reported in bad sanitary condition by Mr. Bowditch. But nothing which the reformers themselves have col- lected can illustrate the harmlessness of filth like the sani- tary history of Newport. It is recorded in the Sanitarian^ vols, ix., X., and xi. As early as 1872, Dr. Sims was taken ill at Newport, and ascribed the attack to impure water ; but it was 1878 before the public was aroused, or even suspected the dangers which menaced the city with destruction. It was now found out that blasting epidemics were ready to explode, on account of the filth which had been " deposited here for two centuries." The wells were fed " by springs of 8 86 VAGARIES OF SANITARY SCIENCE, dead water that has passed through the bodies of a whole neighborhood." In summer, when there was the greatest accumulation of refuse, there was the most obstruction to the outflow of sewage, and there is an " accumulation of festering filth." " Newporters are sleeping over a smoulder- ing fire which will ere long break forth like a volcano !" In winter the houses are ventilating-chimneys, " sucking in from all directions foul air from the soil ;" and there is no barrier from the organisms which swarm in the ground-air around leaching cesspools, leaky drains, or the filthy-made ground." Newport was destitute of sanitary authorities. Of all the well-water analyzed in i88i, only one specimen was good. By December of the same year it was found that Newport's ice was contaminated with sewage, and the public water-supply was polluted. Professor Raphael Pumpelly has proved that water filtered through one hundred feet of sand will retain its impurities. It was affirmed that Newport's Common Council " gloated in municipal dirt ; its sensibilities were so blunted by muni- cipal filth that it was incapable of appreciating the advan- tages of cleanliness." The pest-wagons of night-scavengers and leaky swill- carts traverse the streets, dribbling their filthy contents all over the city. Back-yard excrement-storage, cesspools, piggeries, manure vaults, and various factories add to the soil-poisoning and welcome "the patrons of fashion and fever." " Filth reigns supreme." The waters of the wells differ only in degrees of impurity. Newport's water is doubly poisonous ; it has too much solid matter, and is also poisoned by leakage from cesspools. Its air is laden with cesspool effluvia. The city is blind to dangers depending on foul water, air, and soil. It is now discovered that barn- yards and privies drain into the pond where ice is cut. The City Council is obstructing sanitary reform ; it has permitted certain portions of the city to become a perfect nuisance. { THE AIR. Sy In spite of the winter's rain and snow (i88i), "the stench from the polluted soil is very evident." Consulting sanitary experts were hurriedly sent for. Dr. Bell, of New York, said Newport's greatest evil was a water- logged soil ; so that in winter, the cellars being warm, they soak in all moisture which cannot be absorbed ; this mingles with the vapors and is carried with them up through the houses ; these cellars are malarious nides ; and he told the dreadful truth that the dangerous constituents of cesspools were absorbed into the soil, while the inert, harmless residue was carried away. Dr. Bell said that if, in addition to soil- dampness, further dampness were added, the danger in- creased, making a most offensive condition, " dark, mouldy, and to be likened only to the clammy sweat of death." The experts found things so bad as to allow no possibility of doubt as to the relation of cause to effect in producing disease,- — soil-pipes broken and cracked, joints with no cement, some pipes plugged up entirely, and a backward flow of sewage into cellars and under basement-floors, '* poisoning the water, though to the taste it seemed excellent." The experts found only one house in Newport that had not sani- tary defects, and in this the furnace took the air direct from the cellars. Several of the houses were " mere death-traps." "Go into any of the hotels, from the greatest to the smallest, and you will find the air laden with cesspool efflu- via," wrote Dr. Sims. Dr. Peters said he had never seen a street so fair and yet so foul as Bellevue Avenue ; and he described other streets of approximate filthiness, where were smells from drains, sewers, and out-buildings ; out-houses were clustered so closely as not to allow circulation of air ; and he did not believe that delicate persons could recover their health here. In 1882, Dr. Storer writes,* " The excitement in Newport, * Proceedings American Public Health Association. 88 VAGARIES OF SANITARY SCIENCE. which was already blood-warm, has risen far above fever- heat." A meeting was called of the summer residents, rep- resenting a capital of twenty millions of dollars. The clergy took an active part ; the ladies joined the Sanitary Protec- tive Association, and by vote and voice cheered the move- ment on. Dr. Storer writes that in 1876 nearly one-fourth of all deaths in Newport were from zymotic diseases ; in 1877 these were one-sixth of the whole, in 1878 more than one-sixth, and in 1879 nearly one-fourth. "What more startling evidence than this," he cries, " of all that the sani- tarians have asserted concerning Newport can be asked for ?" Besides, there are eleven undertakers here ; and now, to add to Newport's horrors, opium-taking, whether as a cause or effect of the filth, is going on to such an extent that " there are thirteen habitual opium-drunkards," who use over thirty-four thousand grains of opium each month. In all this sanitary delirium only twice is there any record of any one having tried to face the danger with anything like composure. At one of the meetings of the Sanitary Protective Association, Mrs. Lieber asked what sanitary dangers were in Newport that did not exi^t elsewhere. And Mr. Davis timidly inquired if, theory aside, there had ever occurred any serious sickness from these causes among summer visitors. Both were quickly squelched; for the clergy and the doctors reasserted the dangers, and we hear no more from the remonstrants. They were very likely glad to keep still, lest, like the London obstructionists, they might be pointed out as " wallowing in their own filth." The sanitarians who reported on China, Japan, Belgaum, and Brighton told us why these places were so healthy ; none of them, however, condescend to explain the cause of Newport's salubrity. Mr. E. W. Bowditch, in his report of inspection at New- port, says, " Bearing in mind that the city water is undesir- able to use, that perhaps a majority of the wells are already THE AIR. 89 tainted, and that the sewer system is of little or no value save to concentrate nuisances at certain points, that no pre- caution is taken against zymotic disease except to placard front doors, the apparent freedom from preventable sickness is remarkabley Newport has always enjoyed a world-wide reputation for healthfulness. Registration showed always a smaller death- rate than that of the State of Rhode Island at large ; and it was admitted that this low rate was augmented by the death of many invalids who were conveyed there in the last stages of illness. For ten years ending 1880 the death-rate for the State of Rhode Island was 15.9; that for Newport was 14.5 per 1000 of population in the same time. It may be thought that this low death-rate depended on a low birth- rate. This is not so ; for Newport's birth-rate for ten years ending 1879 was 24.2 against 22.3 per 1000 for the State. In 1880 the per cent, of zymotic disease to total mortality was 28.09 ^"^^ th^ State and 17.35 for Newport; and nearly every year when this subject is mentioned in the Rhode Island reports, Newport is recorded as possessing advan- tages over the State. The period of sanitary activity began in Newport in 1880 with the formation of the Sanitary Association. The period of sanitary law was established in 1885, when a board of health was organized. The board reports that a large amount of work had been done in removing unsanitary conditions. The air, water, and soil have been made purer by the improvements. Sanitary codes have been passed; sanitary inspections without number have been made. We naturally turn to the vital statistics to ascertain the effect of these measures on the health of the people. For the ten years ending 1890 the average general death-rate was 15.7, against that of 14.5 for the ten years ending 1880. For the six years ending 1890, the period of sanitary law, the aver- age general death-rate was precisely the same as the pre- 8* 90 VAGARIES OF SANITARY SCIENCE. vious six years, — namely, 15.73. If we look a little closer for the effect of sanitary law and sanitary measures on zymotic disease in Newport, we find that for the five years ending 1884 there were 91 deaths from cholera infantum, and 114 deaths from the same disease for the five years ending 1889. There were 22 deaths from croup for the five years ending 1 884, and 30 from the same disease for the five years ending 1889. For the five years ending 1884 there were 26 deaths from diphtheria, and for the next five years there were more than double that number, — namely, 56 deaths. There were 46 deaths from typhoid fever for the five years ending 1884, and for the next five years there were 5 1 deaths from the same disease. In the mean time there was not much change in the population of the city. The State census made it about 19,500 in 1885, and the Federal count was about the same number in 1890. So we have the interesting phe- nomena at Newport of the removal of unsanitary conditions, and not only a marked rise in the general death-rate, but a decided increase of those diseases which the sanitarians tell us are caused by such unsanitary conditions. Inexplicable circumstance ! A few months after the culmination of the febrile sanitary excitement at Newport, Dr. Storer read a paper * before the Sanitary Protective Association of that city to show that it is one of the best places in the United States for consump- tives. He does not tell us how it can profit a man to gain immunity from phthisis only to be suddenly cut off by diphtheria, typhoid fever, and dysentery. The water-logged soil which the consulting sanitarian said was Newport's greatest evil, and from which was being sucked into the houses not only poisonous air but " organisms" of disease, has suddenly undergone a change. Dr. Storer says in his paper that one of the reasons of Newport's comparative ex- * Sanitarian, January, 1883. THE AIR. 91 emption from consumption is the absence of " soil-moisture." Without a single word of warning against zymotic disease, or about " the clammy sweat of death," he entices not only the consumptive to Newport, but others, and that, too, in the winter, when the danger, according to the sanitary ex- perts, is at its height. He recommends its " soft, balmy, soothing, sleep-inducing climate in the amelioration and cure of nervous diseases." For nine months in the year " it is a veritable haven of rest." The citizens of New Haven,* says the health officer of that city, who have often been told of their danger, " go on year after year, rivalling a miser in storing up their own excre- ment and every other species of repulsive and loathsome nasti- ness in receptacles as near as possible to their own houses." " Where, then, is their boasted intelligence and their pru- dent regard for their families ?" And when, in the interest of these " suffering and stricken families," attempts are made by the wise and good sanitarian to deprive them of their " odorous and odious subterranean accumulations, they dis- pute their power." " They cry out, * Oppression ! Sacred rights of citizenship invaded !' and resistance to the utmost is threatened." " Look among the houses of the working- classes, and see how often the industrious mechanic and laboring-man is wronged and made the victim of his land- lord's power." There is no property, he says, which makes such large returns as that which is rented to the laboring- classes. " They need the protection of constituted au- thority." " This suffering and afflicted portion of our fellow-citizens have rights." In the masses of filth, which are stored so near dwellings, germs of disease find the most favorable conditions for existence. " Cesspools, filthy drains, and filth in any form afford a fertile soil for the reproduction of the typhoid-fever germ." In 1884 he reminds the people * Connecticut Board of Health Report, 1SS3. 92 VAGARIES OF SANITARY SCIENCE. of their danger from cholera. He says a single evacuation from a cholera patient, thrown into a privy or cesspool, will infect a whole neighborhood. The people of New Haven had long neglected the warn- ing voice, and had often been rebuked by the sanitary officials for their stinginess in not providing money for these authorities. More liberal appropriations were now called for in view of the approaching epidemic. Their health- officer told them that never before had such timely notice been given to a people ; the fulness of time was come ; there was sure to be much sickness during the next summer; ** whatever is done must be done quickly ;" "the occasion will admit of no delay." And now, as if ravished by the spirit of prophecy, the sanitary seer exclaims, ** The cholera will come to the country !" " The cholera will come !" * The impenitent citizens of New Haven huddled together and waited for the result, but seem to have held on to their money. That year, which was to bring such disaster to them, the general death-rate was 17.9 against 17.55 P^^ 1000 for the year before, and the proportion of zymotic to total mortality was six per cent, less than that of the pre- vious year. New Haven went on storing up its filth, so that in 1885, when a census of the privies and cesspools was taken, it contained more than 12,000 of these structures, and there were not fewer than 5000 untrapped basins and kitchen- sinks "and otherwise defective plumbing." In addition there were nearly a thousand wells in daily use, most of them " less than twenty-five feet from some leaching filth- pit." In 1887 1 the health-officer of that city reports to the State board that the city board of health has been restricted in its * Connecticut Board of Health Report, 1884. t Report of New Haven Board of Health. THE AIR. 93 action by having no sanitary ordinances. It has to learn of the " existence of infectious diseases as best it can." It is " still further hampered by parsimonious appropriations" from the City Council. In short, the board has neither power nor money. The city's air is pestilential, its water polluted, its soil contaminated, and there is no remedy. In the State Report for 1890, Dr. Osborn compares the death-rate of New Haven with what it was twenty-one years ago. In 1869 it was 23.37; ^"^ 1S89 it had fallen to 17.50 per 1000 of the population. He compares the proportion of zymotic to total mortahty for the five years ending 1873 with the five years ending 1888, and finds that the percentage of zymotic to total mortality in the first period was 2944, and that of the second period was 21.68. As the death-rate of Newport, both general and zymotic, went up with the removal of causes of disease, so did that of New Haven steadily decline as these causes were multi- plied. It is fortunate that we are not left to conjecture the reason of this decline. We could never have guessed it. Like China, New Haven had a " climate ;" the mothers there " take good care of their children," as in Japan ; like Bel- gaum, it is regularly laid out. If we had not been told the reason, we might have been contented with the fact that it was " remarkable," as at Newport. The health-officer of New Haven is not the man to leave us in the dark on this momentous subject. In a communication to the State Board of Health he says New Haven's sanitary condition is due to " moral suasion," The Connecticut Board of Health reports an inspection of the borough of Stamford in 1884. A stream here pol- lutes the air with a disagreeable stench, and there is no method to dispose of sewage. In a thickly-populated street there is a large blind-ditch, an elongated cesspool half a mile in length ; the ground on each side is infiltrated with sewage ; the ground under the houses is saturated with it, 94 VAGARIES OF SANITARY SCIENCE. and the gases pass up through the buildings. The citizens of Stamford are hving over a "vast underground retort, generating its deleterious gases to corrupt the soil about its dwellings, poison the water of its wells, and defile the air of its houses." Stamford had been noted for its health for two hundred years. That very year its death-rate is recorded as 14.6, against 15.6 for the county, and 16.6 per 1000 for the State. The next year frightful epidemics of diphtheria* broke out in Greenwich and New Canaan, two neatly-kept adjoining towns, in hourly communication with Stamford. Stamford escaped the disease. Was it the "vast under- ground retort" that protected it from diphtheria that year ? The same year an official inspection of summer resorts was made in Connecticut. Some of the places were in a very unsanitary condition ; others were reported irreproach- able ; all were equally healthy. A number of the jails were also inspected ; all were very filthy, but the inmates were in excellent health. At the State prison is a large open filth-pit, just outside the walls, which is infrequently cleaned and never disinfected ; the excreta of the prisoners is received in pails, and there are no flues whereby the cells are ventilated. There is veiy limited air- space, and the building is damp ; the walls and floors are wet from the condensation of moisture. "The health of the prisoners does not seem to suffer from these influences." " It appears to be true that the prisoners often have better health than before they were committed." The New York State Board of Health Reports give no less positive evidence of the harmlessness of filth. Newtown Creek and Hunter's Point, on Long Island,t are so foul that Mr. F. Law Olmsted smelled the odor from them as high as Forty-sixth Street, in New York City. Dr. Agnew smelled * Connecticut Board of Health Report, 1886. f Third Report New York State Board of Health. THE AIR. 95 it at Madison Avenue ; in fact, the testimony proves that the stench spread its way from Fifteenth to Seventy-eighth Streets in the city of New York. Odors of putrescent animal matter, putrid fish, offal, fish-scrap, bone-boiling, common manures mixed with tarry smoke, kerosene smells, forming " a series of stenches that have acquired a magnitude that can hardly have been witnessed elsewhere in the world." The Fourth New York Board of Health Report says " the greatest of all stench nuisances is the creek itself;" its borders are crowded with nuisances. The governor is ap- pealed to because " the security of life and health, as well as the value of property in said town," is at stake. It is not claimed that any case of disease or any epidemic has ever arisen from these foul nuisances. The author has visited Hunter's Point many times ; has conversed with physicians who have practised there many years ; with druggists and citizens generally, to ascertain if disease, especially zymotic disease, prevails there more than elsewhere. The replies are singularly uniform, to the effect that none has ever been suspected to have arisen from this foulness. The citizens are aggrieved that such vile nui- sances exist, but they do not believe their health is impaired thereby. In the Fourth Report of the New York State Board of Health is an account of an investigation of the Glen Cove starch-factory at Sea Cliff. Two hundred and twenty-five people, mostly summer residents, signed a petition to the governor for its suppression. The petition said the foul stench and gases so permeated the atmosphere as at times to render respiration oppressive and produce nausea ; that they interfered with the enjoyment of Hfe and property, and caused great physical hurt; that they were prejudicial to the sick and destructive to the comfort of those in health. Dr. L. deposed that he and his family had suffered from nausea and sense of suffocation, and that the " aforesaid exhalations 96 VAGARIES OF SANITARY SCIENCE. and the vast quantities of bacteria and other forms of germ life engendered by said refuse are exceedingly deleterious to health." Dr. F. deposed that a patient of his complained that the odors took away his appetite, and " in my estimation said exhalations are and must be deleterious to health." Mrs. D. affirmed that her hotel accommodates two hundred and fifty guests, besides transient visitors ; that they have frequently been compelled to leave the table on account of the stench, and that this renders the enjoyment of life and property uncomfortable. Dr. N. testified that the refuse kills the fish, and these decaying cause " a new and in- creased danger to the life and health of those inhabiting the vicinity ;" and, besides, the property is decreased in value, and the holders are harmed in health and in peace of mind. The permanent population at Sea Cliff is seven hundred ; in summer it is about four thousand. None of these affi- ants, doctors or others, specified any epidemic, or even a single case of disease, that had been caused by the starch- works. A weaker firm than the Glen Cove Company would probably have gone under ; but this concern did not propose to wind up its business without a struggle. Five hundred and thirteen, mostly permanent, residents and property- holders in and about Glen Cove testified that they had lived there and near the factory " for the period set opposite to our respective names," and that the charge that it is preju- dicial to health was, in their belief, " untrue and without any foundation of fact to support the same." Then followed special affidavits of people who had lived in Glen Cove from five to fifty years, who declared that they never knew or heard of any disease being caused by these odors ; and a large number of fishermen who had fished here from three to twenty years deposed that the refuse did not in any way affect clams, oysters, or fish ; that these were as plentiful and in as good condition as the same found anywhere. Five THE AIR. 97 physicians of the place testified to its healthfulness, and to the harmlessness of the company's operations. At Lawrence and New Brighton similar nuisances exist, but no disease is reported from them. Cortland, Rhinebeck, Harrison, and Canajoharie are in an unsanitary condition, but no sickness reported. The stream that flows through Mt Vernon has been foul-smelling and disgusting for several years ; the health-officer says it '* cannot but be a source of disease ;" but no disease is reported. The Eighth Report of the New York State Board of Health narrates the sanitary inspection of Tivoli. Here the majority of the people use water from shallow wells ; the drains are so arranged that the sewage of one family is turned on to the premises of another, " any way to be rid of it for a time ;" two slaughter-houses are near the centre of the upper village ; ** one of the leading residents has his well below and within less than fifty feet of two pig-pens in a filthy condition, two privies ditto, and one barn ;" one well that supplies nine families is ten feet deep, and the water is so foul that the tenants ** don't think it healthy to use." No sickness is reported here. But with an unshaken trust in the filth pathology, the saintly reformer who reports on Tivoli sees in its health the interposition of the Divine hand, for he says, " There is, no doubt, a special Providence watching over these people, or they would not now be alive." The Ninth Report of the New York State Board of Health details the sanitary inspection of Tonawanda, Chatham, Fish- kill Landing, Matteawan, and Rye ; in these towns the soil and water were badly polluted, but the people were in good health. Rye was afflicted with great nuisances to sight and smell. From a very offensive pond here ice is cut. The death-rate of Rye that year is recorded as 10.75 P^^ thou- sand of population. The Pennsylvania Board of Health reports (1886) an inspection of the soldiers' orphans' home at E ^ 9 98 VAGARIES OF SANITARY SCIENCE. Mercer ; it is overcrowded in every department ; the build- ings are badly located, privies in bad condition, clothing deficient, and much of it filthy. The " general health has not been bad ;" only two deaths the past year, one fi-om sun- stroke and one from croup ; the only one sick at time of inspection was " a boy with toothache." The foundation of the city of New Orleans is made by the debris of the Mississippi River ; its soil is like a sponge ; it has and can have no drainage. Dr. Holt, formerly presi- dent of the Louisiana Board of Health,* says that there is hardly a privy whose contents have not free access to the soil, to saturate the ground. Water ninety-five feet from the surface has yielded a large percentage of urea and organic matter. The soil is saturated with human excrement ; the people of New Orleans live on a dungheap, and it may be said that they have a privy in common. Dr. Joseph Jones says that the main drains and canals of New Orleans are blocked up with offal, presenting a green, seething, putrefying mass of filth, belching forth noxious vapors. Large numbers of the people sleep on the ground- floor of houses badly constructed, badly drained, situated on land which is saturated with water, which is the seepage from privies and foul drains. Dr. Jones writes to Mayor Shakespeare f that examination and measurement show that there is a mud deposit in all of the drainage-canals in New Orleans, varying in depth from four to eight feet. Fer- mentation and the evolution of foul gases are constantly going on in this immense mass of filth. " Every known and unknown combination and product of the putrefaction of vegetable and animal matter can be found in these foul reservoirs." On page 212 of the same book. Dr. Jones says one-third of those dying in New Orleans die in poverty * Sanitarian, vol. vii. f Louisiana Board of Health Report, 1880-83. THE AIR. 99 and are buried at the public expense ; " one-sixth of those who die in New Orleans perish in silence and misery;" their deaths are certified to by the coroner. The general death-rate, white and colored, for the last four years has been 26.43, 25.02, 23.41, 23.92, an average of 25.19. The death-rate of the whites in those years was 23.59, 22.36, 22.90, 21.27, ^^ average of 22.53. The general death-rate of New Orleans is greatly augmented by strangers, sailors, and laborers on the river. Dr. Jones says * the death-rate of the whites — exclusive of foreigners and strangers and laborers on the various lines of railroads, who crowd the hospitals and prisons — would not exceed fifteen per thou- sand of the inhabitants per annum. If we apply the sanitary touchstones to this city, — the proportions of zymotic and infant mortality to total number of deaths, — we find that for the four years ending 1889 the percentage of zymotic deaths to total mortality f in New Orleans was 15.04, 16.7, 16, 18.7, an average of 16.61. The percentage of infantile deaths, five years and under, to total mortality for the same years was thirty, thirty-two, twenty- nine, thirty-three, an average of thirty-one. The average number of those who died in public institutions yearly was twelve hundred and fifty-five for the four years ending 1889. In the same time four thousand one hundred and thirty-nine deaths were certified to by the coroner, a yearly average of one thousand and thirty-five. The city of Washington contains twelve thousand less people, white and colored, than New Orleans. It has an abundant supply of good water, it is well sewered, its streets are broad and kept scrupulously clean, its plumbing is care- fully supervised, it has sanitary regulations without number; its sanitary inspectors are in emblazoned uniform; to the * Louisiana Board of Health Report, 1882. f Louisiana Board of Health Report, 18S6-S9. ICX) VAGARIES OF SANITARY SCIENCE. observer it is the ideal of the sanitarian, in direct contrast to New Orleans. For the last twelve years the infant mor- tality of Washington has been forty per cent, of the total mortality. Its mean death-rate * for thirteen years has been 23.88. The percentage of zymotic disease to total mortality for the four years ending 1889 was 19.9, 21.50, 22.19, 24, an average of 21.89, against that of 16.61 for New Orleans during the same time. That the general population of Washington is better sup- plied with the material comforts of Hfe than is that of New Orleans is plain to the most superficial observer. This is proved by the deaths in the public institutions and by those under the head of violence and neglect, which are probably coroner's cases. For the four years ending 1889 there died in the public institutions in Washington, including the gov- ernment hospital for the insane, where occur over a hun- dred deaths yearly, six hundred and ninety-seven, seven hundred and twenty-three, eight hundred and twenty-two, eight hundred and nineteen, an average of seven hundred and sixty-five. Under the head of violence and neglect there died in the same years two hundred and three, one hundred and eighty-nine, one hundred and sixty, one hun- dred and fifty-four, an average of one hundred and seventy- six. Dr. Hatch f reports on the sanitary condition of Sacra- mento : The drainage here is defective ; waste-water from kitchens is thrown on the surface; in the large majority of cases the privy is a mere hole dug in the ground ; when full, it is covered over and another is dug by its side ; per- colation from cesspools still further pollutes the soil. This, he says, has been going on in a low alluvial soil for twenty- eight years. The hotels and houses are so imperfectly * Board of Health Report, District of Columbia, 1889. t Board of Health Report, 1879-80. THE AIR. lOI plumbed that sewer-gas enters them. There is a slough but a few steps from the principal business street, which is daily and hourly befouled by filth. Dr. Hatch says, " Yet with these very evident defects, these violations of hygienic rules, the sanitary condition of the city is good and the death-rate by no means discouraging." That year, 1880, it was unusually high, — 19.7 per thousand, — but then the percentage of zymotic disease to total mortality was 14.6, and the percentage of infantile to total mortality was 24.7. The next year the death-rate in Sacramento fell to 18.2 per thou- sand. The New Hampshire Board of Health Report for 1891 says that Carroll County jail, which was reported in 1889 as the worst in the State as regards sanitary condition, is in no sense a decent place for the detention of criminals. There are about three hundred and fifty inmates in the Hillsborough County almshouse ; in this institution there is no system of sewerage worthy the name, and the old vaults are always in an unsanitary condition. No sickness is reported at either of these establishments. The sanitary condition of Grafton County jail is the most abominable to be found in the State. " It would be difificult to devise a more filthy and disgusting arrangement than is here to be found." In one story " the cells are directly connected with the soil-pipes." "The sanitary condition of the entire institution is such as to jeopardize the health of all those living within its walls." " It is not to be wondered at that the jailer lost a son from typhoid fever." The board writes to the county commis- sioners that " a fatal case of diphtheria has recently occurred at the jail." The commissioners reply, " There has been no case of diphtheria at the jail." " There is no sickness amongst those confined at the jail." ** The jailer's son con- tracted typhoid fever elsewhere, and came home and died there." Here was an imported case of typhoid fever into an institution which was in the vilest " sanitary condition." 9* 102 VAGARIES OF SANITARY SCIENCE. The reputed causes, not only for the spread but for the gen- eration of that disease, were here in the greatest abundance. Yet we find no case occurring there but the imported one, and " no sickness amongst those confined at the jail." In Science, vol. x., 1887, Mr. William Glenn writes that the Back Basin at Baltimore is a nearly stagnant pond two hundred by five hundred yards. It receives the drainage of about eighty thousand people. In Back Basin are the sediments of this drainage. " Here they undergo fermenta- tion and decay, at times giving off odors offensive indeed." Mr. Glenn says he has been in quite constant communication with the workmen who dredge this sewage, and who pass their days stirring about it. " They live in an atmosphere loaded with offensive gases." "And what of their health? With singular unanimity they declare that the occupation is a healthy one." Among a hundred men engaged in that work he had not heard, for nearly three years, of any case of zymotic disease. Men, he says, engaged in this business ought to sicken and die. " Curiously enough, they do not, more than men in other occupations." Mr. Glenn says he has no knowledge of what filth-diseases are or are not, and he has no suggestions to offer; he simply states the facts. In the report * of the Board of Supervisors of San Fran- cisco on Chinatown, headed, " Startling report of the hideous and disgusting features of Chinatown," the board says, " In a sanitary point of view, Chinatown presents a singular anomaly. With the habits, manners, customs, and whole economy of life violating every accepted rule of hygiene ; with open cesspools, exhalations from water-closets, sinks, urinals, and sewers tainting the atmosphere with noxious vapors and stifling odors ; with people herded and packed in damp cellars, it is not to be denied that, as a whole, the * San Francisco Daily Report, July, 1885. THE AIR. 103 general health of this locality compares more than favorably with other sections of the town, which are surrounded by far more favorable conditions." That portion of New York City which is bounded by Broadway, Fourteenth Street, and the East River contains about four hundred thousand people. There are streets in this district which are more densely inhabited than any other part of our globe, except portions of Naples and of the large cities of China. Here are the most filthy wharves, slips, streets, lanes, yards, houses, clothes, and persons to be found in the metropolis. When the inhabi- tants who live here bathe, they bathe in filthy water. Mr. Riis has told us about this part of New York in " How the other Half live." While the mass of the people in this quarter may be just as kind in their dealings with their fellow-beings, and as industrious as the masses are else- where, it is none the less true that this locality is the resting- place and abode of the most dissolute tramps of both sexes, and the lair of the most brutal loafers on the face of the earth. In 1889 the New York City Board of Health put forth a remarkable document. For convenience it divided the city mto six districts. The first, south of Fourteenth Street and east of Broadway ; the second, south of Fourteenth Street and west of Broadway ; the third and fourth extended north from Fourteenth Street on either side of Broadway to Fifty- ninth Street and Harlem River ; the fifth and sixth, north of Fifth-ninth Street to the end of the island and the Twenty- third and Twenty-fourth Wards. The death-rate for the city at large was 26.33 per thousand. The death-rate of the filthy and crowded district south of Fourteenth Street and east of Broadway was 22.55 per thousand. The third district, the next most crowded and filthy, had a death-rate of 22.10, against the death-rate at large of 26.33; and the highest death-rate in any of the filthy and crowded localities was 104 VAGARIES OF SANITARY SCIENCE. but 26.60, against 26.33, which was the death-rate at large for the city. There is probably — there must be — a gross error in this document. The author of this book does not pretend to be able to detect it. It is not the low birth-rate ; it may be in the large number of people in the first and third districts that are between the ages of fifteen and forty years. It is strange if the New York Health Board does not know better than any one unconnected with it where this error lies. If there be no error (which God forbid !) in the figures of the pamphlet we are considering, then the unblushing fact will not be conjured down, say what we will, that filth and overcrowding and intemperance and carelessness are more conducive to good health and a long life than are cleanliness, an abundance of fresh air, temperance, and prudence. The sanitarians were confounded at the results of their own reports, which pulverized their doctrine of the filth-genera- tion of disease. Resolute not to abandon it, for to do so involved their annihilation and put out of commission their boards of health, they proceeded to shift their ground, and the discovery of the microbe of disease momentarily afforded them a refuge. This, they said, unlocked the mysteries of Sanitary Science ; after all, it was not the filth that caused the disease ; it was the microbe that found in the filth the pabulum for its growth and the stimulus to its self-fecunda- tion. If the germ was absent, the filth was inert ; if the filth was destroyed, the germ withered and disappeared. Herein lay the essence of Sanitary Science ; and to pre- vent the disastrous conjunction of the germ and the filth the supreme efforts of the sanitarians should be directed. They made no investigations ; but the improvisations of amateurs, amatrices, and professors of Sanitary Science teemed with accounts of the antics of the newly-found germ in its beloved filth. Vain delusion ! THE AIR. 105 By and by some scientific men investigated the behavior of the disease-germ in the presence of putridity and decay. M. Miquel * says he will prove, contrary to the opinion of many authors, that vapor from masses in putrefaction is micrographically pure ; that the gases proceeding from it are always free from bacteria ; that the air itself from putrefying meat, even in its intensest putrefaction, distended by gas and giving off an insupportable odor, far from being charged with microbes, is entirely pure, if it is in a certain condition of humidity. The cholera microbe, when tested by its discoverer, was found to speedily disappear in the presence of putrid bac- teria. Mixed with well-water, the cholera bacilli retained their vitality f thirty days ; in the Berlin canal, six to seven days ; mixed with faeces, twenty-seven hours ; and in the contents of cesspools they could not be demonstrated after twenty-four hours. Fliigge J says that the refuse of cattle- stalls, kitchen-water, and general filth are excellent condi- tions for the putrefactive bacteria, but " they are totally unsuitable for the growth of infective agents." " We see in all waste-waters, in putrid fluids, etc., that the facultative (disease) parasites, even when they are sown in enormous quantities, die in a few hours, or, at most, in a few days." In the Centralblatt fur Bakteriologie, vol. vi., 1889, Dr. Justyn Karlinski records his experiments with the typhoid bacillus in sewage. He put two hundred cubic centimetres of fresh typhoid stools in a quart of filth from a privy which was rich with bacteria ; the bacilli in the stools were small in proportion to those in the specimen from the privy. Forty-eight hours later not a typhoid bacillus could be found. Four times this experiment was tried, with the same result. He sterilized two hundred cubic centimetres * Les Organismes Vivants, 1883. f British Medical Journal ^ vol. i., 1 886. J Micro-organisms. I06 VAGARIES OF SANITARY SCIENCE. of sewer filth and mixed with it ten cubic centimetres of typhoid f^ces ; for a whole month he was able to detect typhoid bacilli, though in small numbers compared with those in the typhoid stools. In sixty different observations he found the contents of the sewers acid ; the lower strata of some privies were almost feebly alkaline. He put fifty cubic centimetres of typhoid stools, which had more than two thousand colonies of typhoid bacilli to each cubic cen- timetre, with fifty cubic centimetres of privy faeces, with alkaline reaction. After the whole was carefully mixed he could find only a single typhoid to four hundred and sixty strange bacteria ; after five days, not one in nine hundred ; after ten days, not one in three thousand. He repeated and varied these experiments, always with the result that the more water and the more filth, the sooner did the typhoid bacilli disappear. ^'Je mehr Kanaljaiiche und wasser, je grosser die anzahl von Faulnissorganismen^ desto schneller gehen die sonst wider standfdhig en typhus bacillen, die mit den Dejekten in die Senkgruben gelangen, zu Grunde!' CHAPTER V. The Water. The tripod on which Sanitary Science rests — to wit, " pure air, pure water, and pure soil" — breaks down completely when we consider the second element of which it is com- posed. Regarding this, about the only point on which the sci- entists are agreed is that pure water is an ideal substance, that it does not and cannot exist in nature, and that waters differ only in degrees of impurity. So they have arbitrarily THE WATER. IO7 laid down certain formulae, and have classified waters as Pure, Usable, Suspicious, Impure, according as these were found to contain a less or greater amount of foreign mat- ter ; and, based solely on chemical analysis, there is a wide divergence of opinion about what constitutes a safe or a dangerous water for domestic uses. The satisfaction which the sanitarians derived from the anxiety and distress they had caused about the air we breathed was transposed into a riotous joy as they beheld the pangs they awakened after they had thoroughly aroused our suspicions about the water we were drinking. If they succeeded in having one condemned and rejected which was abundant, clear and sparkling to the eye, and grateful to the taste, and which the experience of a century had pronounced wholesome. Sanitary Science had made a " gi- gantic stride." They delighted to tell us that the brilliancy and stimulating taste of a water were perhaps the tokens of its impurity, and that such water might contain unspeakable filth. Our only safety lay in making it insipid by boiling. After it was boiled we added ice to relieve its tastelessness, and for a while went along in perfect security, when Sani- tary Science made another " gigantic stride" and discovered that the ice was contaminated. Boiling the water, to be sure, would destroy the morbific principle ; but freezing it, instead of removing impurities, actually concentrated them and made them more dangerous, and the disease microbe that lurked therein was none the less active and virulent. The very prismatic glow of the ice was the sign of danger. We had safely passed Scylla, but had gone to pieces on Charybdis. We were ready to sink in despair, when the countenance of the gracious sanitarian assumed a more be- nignant aspect as with outstretched arms he told us of the inexhaustible resources of Sanitary Science, which he was ready to invoke for the safety of ourselves and our families. He would inspect the ice. I08 VAGARIES OF SANITARY SCIENCE. The sanitarians teach us * that pure water, or water that is pure enough for potable use, should contain less than six grains of solids to a gallon ; there should be no indications of nitrites ; the amount of nitrates and free ammonia should be slight ; and of albuminoid ammonia there should be less than 0.0035 grain per gallon. It should be colorless, odor- less, and tasteless. Without tiring the reader with technical descriptions of the gradations of " Usable" and *' Suspicious" water, it is said to be " Impure" if there is decided smell or taste ; if it has over fifty grains per gallon of solids, and over four grains of destructible organic matter, with nitrates, nitrites, and ammonia to any great extent. It is conceded, however, that ten times this amount of these identical solids, with nitrates, nitrites, and ammonia mixed with our food, would be harmless, nor is it claimed that any artificial fluid con- taining this amount of proscribed solids, nitrates, and am- monia would have the least effect to produce disease. Sanitary literature is overrunning with " behefs" and "opinions" about the different diseases which are caused by drinking-water. All forms of malarial fevers have been ascribed to it ; also yellow, typhoid, and scarlet fevers, eiy- sipelas, diphtheria, cholera, dyspepsia, boils, goitre, ulcers, elephantiasis, diseases of the bones, diarrhoea, dysentery, calculi, bronchial catarrh, and the entozoic diseases. The statements, however, respecting its agency in the production of disease are so conflicting that Parkes f says, " The exact connection between impure water and disease does not stand on so precise an experimental basis as might be wished;" but he adds, "Apart from actual evidence, we are entitled to conclude that abundant and good water is a prime sanitary necessity." When we consider the devout "belief" of the EngUsh sanitarians regarding the infective * Parkes, Hygiene. f Hygiene. THE WATER. IO9 power of what they say is impure water, these admissions of Parkes, who seems to have carefully weighed the evi- dence, are all the more striking. The most acute German observers have never found any relation of water to disease. To use the words of the Massachusetts Board of Health, " The idea is essentially English." It is extremely doubtful whether there is any scientific proof that the water of any spring, well, pond, lake, or stream, which has been in use as potable water, ever caused in the human system a specific disease, or anything more than slight or temporary disorder, unless such water was contaminated, deliberately or accidentally, by some irritant poison. Marsh-water is accused of causing malaria ; but Professor Colin * cites portions of Italy and Algiers where marsh-water is drunk and no malaria follows. Marsh-water is largely drunk in Holland and Hungary, but it does not produce malaria. Surgeon-General Lawson says that in Florida, where it was used by the United States troops, malaria was less severe than in those military departments where the water-supply was from other sources. In 1 88 1 the work of draining Lake Okeechobee, in Florida, was commenced. Colonel J. M. Kreamer, the en- gineer, testifies that during its progress, extending over a period of four years, more than five hundred men were employed, — whites, — most of them unacclimated. They labored in the swamps summer and winter, a good deal of the time immersed to their waists ; they drank no other than marsh-water. Colonel Kreamer declares that during these years not a single case of malarial disease occurred among them. He says he conferred with medical men in advance, who counselled him regarding prophylactics ; that he sup- plied himself with them, but had no occasion for their use. It was prophesied that after these swamps were drained * Parkes. 10 no VAGARIES OF SANITARY SCIENCE. malarial disease would occur, but in a letter, dated May 2, 1 89 1, Colonel Kreamer says, "Residents living on the re- claimed lands are exempt from chills and fever. Settlers on these lands, who suffered from chills and fever annually in Kansas, have had no recurrence from this malady since locating in Florida ;" yet during all of these years they have continued to drink marsh- water. Rohe '^ says that, in his opinion, " the instances in which malarial fevers are due to drinking-water are very rare." The most puzzling, and at the same time the most ridicu- lous, disagreement exists among analysts of water. Dr. F. L. Phipson f says we possess no positive data whereby to condemn a sample of drinking-water, and cannot possess such data until physiological experiments have been made to prove when and why a given kind of water is bad or good. Our text-books for the last thirty years — EngHsh and foreign — have stated when the total impurities of a water should condemn it, but this is a mere assertion that has been copied from one book to another. Mr. Charles Ekin,J F.C.S., on Water Analysis, says, " A fair trial of the different processes leads to the conclusion that all are absolutely worthless, so far as distinguishing between organic matter that is innoxious is concerned." "As giving any indication of the wholesomeness of a water they are useless." Fox § relates that the water of the same well being analyzed by five different chemists of repute, the first opines that the water is of good quality ; the second, that it is surface-water and is bad; the third, that it contains so much organic matter as to be unfit for drinking ; the fourth, that it is a perfectly pure water; the fifth, that it is unusually pure. Fox tells also (p. 179) of two waters from neighboring * Hygiene, 1891. f Chemical News, 1879. \ Journal Franklin Institute, 1 880. \ Sanitary Examination of Water. THE WATER. Ill pumps which were examined by a health officer ; one was pronounced pure and the other quite unfit for use. He says the confidence of the people was somewhat shaken in their health officer when it was discovered that ''both pumps derived their water from one and the same well." Mr. Reuben Haines * says, " The most diverse opinions have occasionally been expressed in regard to the wholesomeness of the water-supply of a city by chemists of established reputation." Dr. J. A. Tanner, t in a lecture on water-analysis, gives a table of the analyses of twenty specimens of artificially- prepared waters containing sewage from different sources, dejecta from typhoid fever, and black-vomit from yellow- fever patients. Three of these samples were pronounced good by the three different processes of examination, — the combustion, the ammonia, and the permanganate. Eight of the twenty specimens were condemned, while in nine there was no agreement. Lake Drummond, which has always been in high repute among sea-captains for long voyages, and thereby proved beyond a doubt to be good, was pronounced by the three methods " impure," " foul," *' impure." Dr. Tanner says, " Viewing the subject impar- tially, it seems we must conclude that such examinations are as apt to condemn a good water as they are to commend it, and to commend an impure water when they should condemn it ; and that we know of no chemical method by which the ethereal-like substance causing disease when in water can be recognized at present. We are at sea, with an unreliable compass to guide us." Professor Mallet % says it is not pos- sible to decide on the wholesomeness of a water by the use of any of the processes of examination for organic matter. '^ Journal Franklin Institute, 1882. •^ Sanitarian, 1888. X National Board of Health Report, 1882. 112 VAGARIES OF SANITARY SCIENCE. Dr. C. G. Currier * says chemistry " affords us no sufficient test of the freedom of a water from the infectious principles which cause serious disease or which lessen the sum-total of the vital forces." In a report on the sanitary examina- tion of potable waters, Mr. Elwyn Waller f concludes that, in reviewing the methods of water-analysis, our knowledge of the whole matter falls very short of what is desirable. " The means of determining, even approximately, the safety of a water are at present extremely crude and unsatis- factory." Dr. Mace J says that chemical analysis furnishes little information respecting the character of a water, and often none at all. The inferior beings that breed and feed on azotized matters in water do no harm. The bacteriological examinations of water give no more satisfactory results. Dr. Link § showed that " the attempt to put forward bacteriological examination as a decisive criterion for the character of a water is devoid of a satis- factory basis." Dr. E. K. Dunham 1| concludes "that the bacteriological examination of water cannot, save under exceptional circumstances, pronounce a direct verdict as to the sanitary value of that water." Dr. T. M. Prudden \ says, *' It is already known that in some cases the results of chemical and biological analyses do not coincide." Louis Parkes ** says, " Chemical analysis is powerless to deal with those cases of infinitesimal pollution of a pure water." " Cultivation tests are equally powerless to cope with such cases." Though chemical analysis can in the majority of cases determine the amount of organic pollution, *' there is no possibility of ascertaining whether the water thus pol- luted is potent for evil, or whether it may not be entirely * Ameriean Journal Medical Sciences. f Ibid., 1883, % Annales d'Hygiene, 1888. \ Chemical News, 1886. 11 Medical Record, 1889. f Ibid., 1887. ** Practitioner, 1887. THE WATER. II3 harmless." " The only way of ascertaining the probable effects on the human system of drinking such water is for the operator to perform the experiment on his own person." C. E. Cassal* says that " in the present state of knowledge no chemical analysis would justify the assertion that a water was likely to cause a particular disease," and" no process of exam- ination whatever" will prove the noxious character of a water. " The counting of micro-organisms in some hands, even those of eminent persons, yields results which are wholly ludicrous." C. E. Pellew f says, with our present knowledge a satisfactory microscopic examination of water is " hardly possible, even for one thoroughly skilled in such investiga- tion," and " the question of the purity or impurity of a water cannot be satisfactorily settled by bacteriological tests alone." Yet with these humiliating confessions, publicly made, in the one hand, the sanitarians in official capacity— r and with an impudence which passes all comprehension — continue to offer with the other their farcical analyses of water, which are often made at the general expense, and solemnly parade them before the people as if they possessed a scientific value. On the strength of these analyses they have not only destroyed many valuable public water-sup- plies, but they have arbitrarily invaded the premises of private citizens, and ordered the closure of wells which have been proved by scores of years of experience to be healthful water-supplies. We are forced to the conclusion that there are no better tests for drinking-water than our first parents possessed ; and that the instincts, taste, and experience of a committee of farmers, mechanics, or intelligent housewives are more to be depended on in the selection of a public water-supply than are the so-called scientific tests of the sanitarians. * British Medical Journal, November 5, 1891. f Manual of Practical and Physical Chemistry, 1892. h 10* 114 VAGARIES OF SANITARY SCIENCE. There is no better way to ascertain the effect of so-called polluted water on the human system than by studying its influence on individuals and on large bodies of people. Emerich * drank for fourteen days from one to two pints of sewer-water which was disgusting to the eye, and which chemical analysis showed was highly polluted ; it contained refuse of blisters from human skin, pieces of salad, animal hairs, particles of excrement, and much other non-appe- tizing material. {Nicht gerade appetitliche Dinge mit sich) He drank this water while he was suffering from intestinal catarrh, and it had no unfavorable influence on the disease. Again, when he had a severe gastro-enteritis, though the disease had its course, it subsided while he continued to drink it. He gave the same to two of his patients (with their consent) who were suffering from diseases of the di- gestive organs ; the diseases were not aggravated. A large part — seven-eighths — of the people of London are supplied with water from the Thames and Lea. Only since 1852 has the law compelled the companies to filter it. It is declared that filtering is not competent to relieve it of its dangerous organic impurities. The sanitary literature of England is afire with accounts of the pollution of the drinking-water of London. In 1867 f Professor Frankland reports that it has received great quan- tities of putrescent matter; some of it is totally unfit for domestic use. In 1869 there is unquestioned evidence that the water is infected with animal matter; in 1870 it is ex- cessively nasty as to taste and smell, and the health of seamen and others on shipboard is in danger. In 1872 it is in a very filthy condition. In 1 874 the water of one of the companies is so nasty that it resembles "pea-soup." In 1875 seven out of eight companies in London are furnishing water from pestilent sources. It is still bad in 1882, and a * Handbuch der Hygeine. f London Lancet, THE WATER, II5 new idea is brought out ; Sanitary Science has made another "gigantic stride;" the chief danger from a water is now not from its usual, but its accidental, pollution. In 1885 * " it is difficult to keep from despair" on account of the dis- gusting pollution of the Thames. " It is a cesspool through- out its tidal regions," and in 1887 the Thames is in a " horrible and dangerous condition," and in the winter " it is fouler than ever." This year " the owners of house-boats, steam-launches, and other craft drain their sewage into the chief drinking-water supply of London." Mr. G. Phillips Bevan f at a meeting of the " Ballooii Society," in a lecture on the Thames and public health, said that instead of getting rid of our sewage, "it is churned backwards and forwards on us every day." When the essay was ended, a resolution was unanimously passed, " that in the opinion of this meeting the system adopted by the people of Kingston, Richmond, and adjoining districts, of drinking the water into which they put their sewage, is filthy, foul, and abominable, and barbarous in the extreme, and calls loudly for an immediate remedy." Dr. G. Vivian Poore,J President of the Section on Sanitary Science, at the twelfth meeting of the Sanitary Institute, stated that the public was becoming alive to the fact that causes which poisoned the surface-wells of London were equally poison- ing the Thames and the other sources of London water. " No thinking being could feel easy about the London water-supply." For it is impossible for the Thames to be pure. The whole of the sewage of all towns between Gloucester and London was emptied into it, and the great- est portion was drunk by the inhabitants of the metropolis. The Medical Press § says, " For years the condition of the Thames and Lea in every way proved the unfitness of these * London Lancet. f Builder, August 2, 18S4. \ Sanitary Record^ 1890. \ April, 1S91. Il6 VAGARIES OF SANITARY SCIENCE. rivers for drinking by the people of London," and Dr. Blax- all reports in the same journal (May, 1891), that the Thames drinking-water is fouled by excrementitious matter. A most remarkable coincidence, that during these forty years that the millions of people in London have been drinking this polluted water, the death-rate has never per- manently increased, and since 1880 has steadily declined, and especially from the class of diseases that polluted water is said to generate. London must have lost its sense of humor entirely, for there is no record that the town burst out laughing when it read in the Medical Times and Gazette of July 27, 1867, "It is notorious that just during the months when the or- ganic constituents of Thames water are at their highest, diarrhoea is at its lowest ; and vice versa!' In the Chemical News^ Professor Tidy, in his report to the society of medical officers of health, says, " I have diligently com- pared and considered the death-rates, and also, as far as possible, the causes of death, in different parts of the metrop- olis supplied by the Thames water, the Lea, and the water from the chalk-wells of the Kent Company, respectively. I have failed to discover any difference worth noting in the death-rate, or any evidence whatever that any special class of diseases has been prevalent from drinking the water of the Thames and Lea, or absent from the use of chalk-water ; indeed, what difference there exists is in favor of the Thames and Lea waters over that of the chalk-wells." Professor Tidy t says that in 1879 the water in the Thames showed a larger amount of organic matter on account of floods ; " yet, notwithstanding this, the death-rate in London for 1879 i^ the lowest on record." Professor Tidy says that while he admitted that disease might have been produced by impure or polluted water, it is seen from an examination of statis- * 1878. f Chemical News y 1880. THE WATER, l\y tics that the death-rate of towns in which water is obtained from wells is practically identical with that in towns sup- plied by rivers ; and that in London, as regards mortality, there is very little to choose between districts with the water from the chalk-wells and those supplied by river-water. In the Chemical News, 1883, Messrs. Crookes, OdUng, and Tidy say, " Taking a series of years, and relying solely upon the water analyses supplied to the Registrar-General, it does with singular perversity happen that the years in which the metropolitan rate of mortality is exceptionally high are the years in which the proportion of organic im- purities in the water is relatively low ; while the years in which the metropolitan rate of mortality is exceptionally low are the years in which the proportion of organic im- purities in the water is relatively high." In the years 1869-70-71, in each of which there was the exceptionally high rate of mortality of over twenty-four per thousand, the mean proportion of organic impurity in the Thames water was represented by nine hundred and twelve ; while in 1872-80-81, in each of which there was the exceptionally low rate of mortality of considerably less than twenty-two per thousand, the mean proportion of organic impurity in the Thames was represented by the number eleven hundred and seventy-one; the proportion in 1868, with its mortality of 23.5, being represented by the number one thousand. M. Hueppe, in a report* to the International Hygienic Congress at Vienna, said that after comparing the figures of morbidite and mortality by typhoid fever and cholera in cities provided with eau potable and sufficient sewerage, with those from cities not so provided, it was impossible to de- cide oui ou non whether drinking-water had any influence on the propagation of contagious diseases. In 1839 the city of Boston petitioned the General Court * Annales d' Hygiene. Il8 VAGARIES OF SANITARY SCIENCE. for power * to introduce water. Though no positive cases of disease were adduced as having been caused by the use of native water, notwithstanding its proverbially bad repu- tation, the physicians of the town seemed to concur that the introduction of a plentiful supply of pure soft water would be a good thing for the public health. In i844,t Dr. Walter Channing made a plea for pure water in Boston. He says it is not pure now and is unfit for use ; it is insufficient in quantity, and great inconvenience and danger are the re- sults. " An abundant supply," he adds, " promotes health and longevity and as surely tends to diminish or prevent pauperism." In Boston, previous to 1848,^ wells and privies were about equally numerous and in close proximity ; but the suppression of wells had Httle to do in lessening typhoid fever. " Our Lowell correspondent speaks of a well used by at least a hundred families, containing fifty-two grains of inorganic matter and twenty-five grains of organic resi- due to the gallon ; and yet the people using it seem to be even less liable to typhoid fever than those using water of a better quality." "Old Boston previous to 1848 was riddled with wells and privies side by side, all over its limited and very crowded territory. The water must have been continually charged with the products of decompo- sition." The report says here is a test on a grand scale. " There is a diminution of typhoid fever, but in no striking degree." In the eighth report of the Massachusetts Board of Health is an account of an investigation into the causes of diphtheria in Gloucester in 1876-77. The wells were sus- pected and the waters of thirty-four of them were examined. They were so filthy that Professor Nichols, who analyzed them, exclaimed, with surprise, " Do people actually drink * Boston Medical and Surgical Journal, 1839. f Ibid. % Second Report Massachusetts Board of Health. THE WATER. IIQ these waters ?" The ammonia in them varied from 0.0037 to 2.35 ; the albuminoid ammonia from 0.0040 to 0.0723 ; inorganic residue from 3.20 to 198.9; organic residue from 0.6 to 10.7; total solid residue from 3.48 to 205.4; chlorine from 0.70 to 55.04 in 100,000 parts. The professor says that no one of these waters is fit for drinking, and some show evidences of very great pollution. To eighteen of them, it is distinctly said, no illness could be referred. In a house supplied by one there has been much illness, " a large part of which, however, can be traced to very wet cellars and inability to provide the comforts of life." In seven households there had been illness where the water had been used from seven of these wells ; of the re- mainder, no mention is made of their having caused sick- ness. " Of the worst specimens (Nos. 22 and 6), both as valuable for manure as the sewage taken from the Pittsfield sewers. No. 22 is from a well which has been dug for a century and used by three families, who are always well." " A family of robust children, types of health, have been brought up on No. 6, without any illness that could be fairly traced to the use of the water." " As regards diph- theria in connection with these thirty-four specimens of water, the worst cases occurred where the best water was used." The conclusion arrived at was that the water did not cause the epidemic of diphtheria in Gloucester in " The thirty-four samples of well-water probably repre- sent fairly the wells used for drinking purposes in Glouces- ter." " No. 7 is worth twice as much for manure as ordinary sewage," but " the use of the water has not been shown to have caused any illness." The condition of fifteen wells that were near cemeteries in different parts of Massachusetts is detailed in the sixth report of the Massachusetts Board of Health. Five of these had drains and privies within fifty feet; they were 120 VAGARIES OF SANITARY SCIENCE. from thirty to forty, and one was a hundred years old. Of none was there any mistrust that the water had caused dis- ease. Only one of the fifteen was suspected. These waters when analyzed showed great pollution, — chlorine as high as 13.20 in 100,000 parts, and total solids as high as 138.60. It will be remembered that both the well- and pubHc-supply of Newport, also its ice, were grossly polluted ; yet the death-rate was not augmented thereby. In 1 88 1 Boston's water was examined by Professor Edes, who said, " It contains pollution seventy per cent, above the limit of health ;" he found it " abounding in decomposing organic matter." Some of it, Dr. Barnes says, was the color of good coffee. In the tank in his own house, Dr. Barnes found a mud deposit three-fourths of an inch deep, that was very offensive when removed. Dr. Minot considered "the water-supply of Boston a disgrace to the city, and a source of danger to the health of the community." Professor Leeds, who examined the water of towns on the Hudson and elsewhere, said that Boston's supply was the worst of all, and was " absolutely dangerous." Dr. Bowditch had to give up drinking it, or bathing in it, without filtration. Yet the Massachusetts Board of Health * say, " For months a very large portion of the water-supply of the city was wholly unfit for any household use." It adds, " Nor does the use of this water appear to have had a noticeable effect upon the death-rate of the city or upon the health of the inhabitants." If we seek for something more than this gen- eral avowal in the vital statistics of Boston, we find that the average annual proportion of zymotic to total mortality in that city for the preceding ten years was 28.40 per cent. ; and the proportion of infant to total mortality for the same time was 40.75 per cent. ; while during the year that the three hundred and fifty thousand people of Boston were [S81. THE WATER. 121 drinking water polluted seventy per cent, above the healthy standard, "abounding in decomposing organic matter," "absolutely dangerous," and "wholly unfit for any house- hold use," the proportion of zymotic mortahty declined to 26.87, and the infant mortality (a still more sensitive test) declined to 36.75 per cent. It must not be forgotten that if any citizen of Boston had possessed a well supplying such water, the Board of Health would have forcibly entered his premises and closed it. If he had resisted the invasion he would have been arrested, fined, and imprisoned as an enemy of the public health. The National Board of Health * reports on the sanitary condition of Baltimore. Though pumps have been mostly discarded in that city, yet water from them is used in the first district on two hundred premises. The report adds, " The comparative immunity of the people from disease under the most trying sanitary conditions is extremely remarkable, but should not lead us to the conclusion that filth and bad water are conducive to health." Seven families used water from an old pump which must have been pol- luted by a privy ; but, in spite of this, " no sickness or death" had occurred /or a year. At another point, eight, at another, four, and at another, three families were all using " bad" or " very bad" water from wells, close to privies in bad condition ; yet the inspectors could not find that a single case of disease, except one of consumption, had occurred for a twelvemonth in any of these families. In the Connecticut Board of Health Report for 1885 is a paper by Dr. Wolfe on " Sanitary Examination of Drinking- Water." The Bridgeport water is polluted by animal and vegetable matter ; New Haven's water is polluted by vege- table decomposition. The supply of Hartford coming from Brandy Brook is so contaminated that it is unfit for public * 1880. F II 122 VAGARIES OF SANITARY SCIENCE. use. The people of Hartford are drinking the drainage from one of the filthiest swamps in New England. Such a water is a " vera causa of diarrhoea, dysentery, and malarious diseases." New Britain's supply is similar to that of Hart- ford. Yet that year, in the same book, Hartford reports, in " Health of Towns," malaria as decreasing, and makes no mention of diarrhoea and dysentery ; New Britain makes a similar report ; in New Haven the malaria is less than the average, and dysentery here in an epidemic form had not been known for thirty years. Surgeon McKee, U.S.A., reports * that the water in the tank at the garrison in San Francisco, which contains twenty- seven thousand gallons, and which was supposed to be secure from pollution, had for some weeks a bad odor and a sickening, nauseous taste. An investigation disclosed that a polecat had crawled into the tank through the overflow- pipe and had been drowned. The carcass was in an ad- vanced stage of decomposition, and must have been there some months, for fragments of the rotting body were float- ing in all directions. The water had been drunk by eighty people, — men, women, and children. Dr. McKee looked for the development of some " filth-disease," but no serious results followed. After the tank was cleaned some persons complained of " a sense of goneness" and a loss of appetite ! The doctor says this occurrence is opposed to the theory that diseases originate in filth ; and he asks, " Might not this have been almost too acute and overpowering to have at- tained a lodgement, when a milder poison would have been more insinuating and permanent ?" , In the seventh report of the New York State Board of Health is the story of the Jamestown water. It is supplied partly by driven- wells and partly from the outlet of Chau- tauqua Lake, which is contaminated by sewage. The board * New York Medical Journal, November 3, 1883. THE WATER. 1 2$ reports that it is " a menace, and one affecting the life and health of the inhabitants." Of seven samples taken in December, 1886, all were grossly polluted. Nine affidavits declared that Jamestown's water was unfit for use ; five of these were made by doctors. One physician testified that he had seen it " loaded with decaying and putrid animal and vegetable matters," and that it was offensive to sight and smell. Many other citizens say it is not acceptable to the community. Only one physician attributes any disease to its use. The water company had a good deal of property at stake, and they made a gallant fight to protect it. Seven physi- cians swear that since the introduction of this water there has been a less amount of zymotic disease, and that it has not and does not endanger the security of life and health where it is used. Mr. Hall swears that he never heard or knew of any disease, illness, or death caused by it ; others testify to the same effect. Statistics of deaths which oc- curred at Jamestown before and after its use are shown, which prove the diminution of zymotic ailments. The water- works were established in 1882. In 1883 there were 11 deaths from typhoid fever. " 1884 " " 3 " " «« « " 1885 " " 2 " « « « «« 1886 " « o « to August 15. In 1883 there were 4 deaths from scarlet fever. " 1884 " " 2 " «* *' " " 1885 " " I " " " '< " i886 " " o " " " « The records of vital statistics and other evidence showed that " while the city has been rapidly increasing in popu- lation, the number of deaths from this class of (zymotic) diseases has been no less rapidly diminishing." 124 VAGARIES OF SANITARY SCIENCE. A sanitary inspection of the city of Allegheny in 1885* found the water-supply grossly polluted by slaughter-houses, bone-boiling and soap-factories, besides " six sewers were found discharging their noisome contents, under the burning September sun, directly into the river above the mouth of the influent-pipe." There are also piles of garbage '' fester- ing on the river-bank." " The committee returned from this tour filled with amazement at the fact that with all these multiplied and horrible sources of pollution, the water sup- plied the city of Allegheny should, except when thick during freshets, be a not unpalatable and, so far as indicated by the average low rate of mortality in the city, a not unwholesome beverage." In an official report,t Elwyn Waller, chemist, of New York City, says of the Croton water that it has a bad taste and odor, described as filthy ; a green-grass color ; and, on standing, a green-grass scum rises to the surface. The cause was attributed to decomposing fish, sewage, and other poisonous material. Although it continued in this filthy state for six weeks, no cases of illness were assigned to it. The same condition was present in 1859, i^ 1^73* ^^<^ ^^ 1874. When these impurities were most abundant and most unpleasant to eye and taste, the water was not un- wholesome. The waters of sixty other places in different parts of the country were examined ; all of them stank and were dis- agreeable to the taste and disgusting to the eye, and the odor was described as " fishy," " woody," " like cucumbers," ** like dead fish," " musty." One had the odor of a horse- pond, three were distinctly classed of a pig-sty odor, and some had the smell of putrid fish. The bottoms of some of the reservoirs were filled with decaying stumps and veg- etables. This state was present generally in summer, and * Pennsylvania Board of Health Report, 1885. f i^^'- THE WATER. 12$ lasted from six weeks to five months. In some of these places the water was so filthy that it had to be abandoned. Here were sixty cities, with populations varying from five thousand to one million two hundred thousand, drinking this filthy water, which is classed as " impure" and *' dan- gerous" by the sanitarians ; yet this report concludes that the filthy conditions of these waters " never as yet proved deleterious to the health of any community where they have occurred, as far as any records go." Dr. Griffin * says, " Several years ago a former incumbent of the Department of Health caused to be removed all pumps from the city, in the hope that the number of cases of typhoid annually occurring would be diminished. It has been supposed that the saturated soil had polluted the water, and that the drinking from the wells and pumps during the warm summer weather was in a great measure responsible for the increasing number of typhoid cases which made their appearance in the fall. Their removal, however, has not exercised any apparent effect in diminishing the number of those attacked, as the average has remained about the same during a series of years after, as before, this sanitary im- provement.^* (Italics ours.) Bouchardat f says the well-waters of old cities like Paris contain the products of organic decomposition, and, besides, organic matter incompletely decomposed. They are so dis- agreeable that they cannot be used as potable waters ; but the bakers and brewers use them, and pretend that they favor panification and the fabrication of beer. In spite of the repugnance one feels at their use, he says, " No fact has come to his knowledge to prove that they are noxious." Bou- chardat, in his " Conclusions," p. 197, designates as potable waters all of those natural waters which are agreeable to drink ; and declares that the only way to pronounce on their * Report of Brooklyn Board of Health, 1889. f Trait6 d' Hygiene. II* 126 VAGARIES OF SANITARY SCIENCE. salubrity is to observe their effect on the health of people who have long used them. The history of the Croton water-supply and its relation to the public health of New York is without a parallel in the pages of sanitary literature. In 1885 it received * the drainage of 20,000 persons, 1879 dwellings, 602 barns, 9453 cows, 1224 horses, 1501 pigs, and, besides, grist-, saw-, and cider-mills, condensed-milk factories, cemeteries, and slaugh- ter-houses drained into it. During freshets, which often overflow the river-banks, " all privy-vaults within that range are overflowed and washed out" into the stream. In 1888 it was shown that 25,000 people and 33,000 domestic ani- mals drain into this supply, besides the drainage from the roads. The cemeteries add to the danger. The editor of the Sanitarian says, ** The subsoil currents which penetrate the coffins take up everything that is soluble during the process of putrefaction and convey it into the water-courses at all seasons." " What," he asks, " are the sixty-two deaths of the Park Place disaster, in comparison with the daily stream of disease and death among the million and a half of people of the city consequent upon neglect to protect the water-supply ?" ^'The recent chemical analyses have startled the City Board of Health by the discovery of nitrites, — the indubitable evidence of animal putref action'' Then follow more italics. " The putrefaction of human dead bodies on the Croton Valley water-shed sufficiently accounts for the presence of nitrites in the water, independent of the other six thousand one hundred and forty-six special nuisances and the surface filth of thirty-three thousand domestic animals." " Will the people of New York be longer content to drink such an infusion ?" A special inspection made by the Board of Health in *5amV