THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA PRESENTED BY PROF. CHARLES A. KOFOID AND MRS. PRUDENCE W. KOFOID VAGARIES^ OF SANITARY SCIENCE BY 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. LIBBIG. PHILADELPHIA J. B. LIPPINCOTT COMPANY 1893 COPYRIGHT, 1893, BY J. B. LIPPINCOTT COMPANY. PRINTED BY J. B. LIPPINCOTT COMPANY, PHILADELPHIA. THIS BOOK IS DEDICATED WITH PROFOUND RESPECT TO THE WORKINGMEN OF THE MEDICAL PROFESSION. CONTENTS. PAGE INTRODUCTORY 7 CHAPTER I. Sanitarians Ancient, Mediaeval, and Modern 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 CHAPTER VII. The Sewer-Gas 153 CHAPTER VIII. Cemeteries 181 CHAPTER IX. Public Funerals 205 !* 5 6 CONTENTS. CHAPTER X. PACK The Meat 215 CHAPTER XI. 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 INTR OD 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- INTR OD UCTOR Y. 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 1 2 INTR OD UCTOR Y. 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 public 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 1 4 INTR OD UCTOR Y. 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 '5 1 6 VAGAKIES 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 anything 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, MEDIEVAL, AND MODERN. I/ 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 VAG 'ARIES 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, MEDIEVAL, AND MODERN. 19 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 inefficacy 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 nose 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 life 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 fever. 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, MEDIAEVAL, AND MODERN. 2$ 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, 1886. 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 rilled 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 * 3 26 VAGARIES OF SANITARY SCIENCE. the sanitarians respecting the origin of epidemic disease. As sensitive to the public 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 public 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, 1888. 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 dilettanti 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 which 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 very 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 ngent 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 ORE A T SANITAR Y A WAKENING. 2$ 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. 3O 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. 31 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 SANITARY SCIENCE. and the medical officers appeared to comprehend it, and framed their answers to correspond to this aim. A very large majority took no notice whatever of the ignorance, poverty, 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," qualifying 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 everywhere ; but Dr. TufTnal states that " throughout the greater part of these counties comparatively few diseases can be found to arise from want of sanitary 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 fifty 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 privy, 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 daytime these houses are thronged with dirty, 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 f 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 inquiry * 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 per 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 ^ was sa ^ 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 like 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., 1848. 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 public mind such reassurance was in vain. The soil, too, of London had been absorbing filth tor 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 1 85 7 f the Thames was avast 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 GREAT SANITARY AWAKENING. 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., 1858. 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 of 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,f 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. 41 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 oh " 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, 1865. 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 off 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 licking 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 eggs 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 1 876 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 GREA T SANITAR Y A WAKENING. 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! 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 1891. 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 prer 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 GREAT SANITARY AWAKENING. 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. 5