The Sanitary Drainage of Houses and Towns

I.

IT is proposed in these papers to consider a subject which, one might almost say, was born — or reborn — but a quarter of a century ago, and which has contended with much difficulty in bringing itself to the notice of the public. Indeed, it is only within the past ten years that it has made its way in any important degree outside of purely professional literature.

Happily men, and women too, are fast coming to realize the fact that humanity is responsible for much of its own sickness and premature death, and it is no longer necessary to offer an apology for presenting to public consideration a subject in which, more than in any other, — that is, the subject of its own healthfulness and the cleanliness of its own living, — the general publie is vitally interested.

The evils arising from sanitary neglect are as old as civilization, perhaps as old as human life, and they exist about every isolated cabin of the newly settled country. As population multiplies, as cabins accumulate into hamlets, as hamlets grow into villages, villages into towns, and towns into cities, the effects of the evil become more intense, and in their appeal to our attention they are reinforced by the fact that while in isolated life fatal or debilitating illness may equally arise, in compact communities each case arising is a menace to others, so that a single centre of contagion may spread devastation on every side.

It is not enough that we build our houses on healthful sites, and where we have pure air and pure water; we must also make provision for preventing these sites from becoming foul, as every unprotected house-site inevitably must — by sheer force of the accumulated waste of its occupants.

Houses, even of the best class, which are free from sanitary objections are extremely rare. The best modern appliances of plumbing are made with almost no regard for the tendency of sewer-gas to find its way into living-rooms, and for other insidious but well known defects. So generally is this true, that it is hardly an exaggeration to say that unwholesomeness in our houses is practically universal. Hardly less universal is a curious sensitiveness on the part of the occupants of these houses to any suggestion of their short-comings.

Singularly enough, no one whose premises are subject to malarial influences seems willing to be told the truth with regard to them. No man likes to confess that his own well and his own cess-pool occupy the same permeable stratum in his garden; that the decaying vegetables in his cellar are the source of the ailments in his household; or that an obvious odor from his adjacent pigsty, or from his costly marble-topped wash-stand, has to do with the disease his physician is contending against.

That the imperfections of our own premises are a menace to our neighbors is a still more irritating suggestion, and such criticism seems to invade the domain of our private rights. Yet surely there can be no equitable or legal private right whose maintenance jeopardizes the well - being of others. It is not possible, in a closely-built town or compact neighborhood, for one to retain in his own ground (either on the surface or in a vault or cess - pool) any form of ordure or festering organic matter, without endangering the lives of his neighbors, through either the pollution of the common air or the poisoning of wells fed from strata underlying the whole ground and more or less tainted by household wastes. Even if he might be permitted to maintain a source of injury to his own family, his neighbors may well insist that he shall not endanger them.

It being important for all that each be made to live cleanly, and the requirements of all, so far as the removal of the wastes of life is concerned, being essentially of the same character, the question of drainage is one in which the whole public is interested, and should be decided and carried out by public authority, — so that all may have the advantage of the economy of organized work and the security of work well done.

The drainage question is essentially a question of health and life. Dr. George Derby stated the whole case when he said, “ The well are made sick and the sick are made worse for the simple lack of God’s pure air and pure water.”

Yet, neither this statement nor the most perfect modern development of the art of cleansing towns by water-carriage has the merit of novelty. Hippocrates gave as the cardinal hygienic formula, “ Pure air, pure water, and a pure soil,” and after all these centuries we know nothing to add to it. Our modern sewerage works are thus far only taking us back to the cleanly condition of the most prosperous ancient cities; only lifting us out of the slough of plague-causing filth that marked the darkest periods of the Middle Ages; only continuing the wholesome revival that the Mahometan Moors introduced among the unwashed Christians of Europe. It is a revival that has grown slowly, urged on by the harsh whip of disease and death. So late as the middle of the brilliant nineteenth century it had only begun to command the aid of the law, and as a subject of popular interest it can hardly yet be said to command the attention of even the more intelligent members of society.

Yet, when the subject is once considered, every thoughtful person must appreciate the fact that in seeking the advantages of civilized life we necessarily depend at every turn upon our fellow-men, and that in this communion we lay ourselves open to the consequences of the neglect of others, while we equally threaten others with the consequences of our own neglect. The influence of thoughtful persons cannot long be withheld from a movement whose object it is to popularize the knowledge of good and evil in the conduct of the daily life of the household and of the community, and to make the public at large insist that each shall so regulate his action as to secure the greatest safety for all.

Public sanitary improvement is not the affair of the philanthropist alone, nor is the interest of the individual satisfied when he has made his own immediate surroundings perfect. Everything that can affect the health of the poorest and most distant of our neighbors may affect us; and, practically, the spread of disease in closely-built towns is more often than not from the poorest classes upward, so that many a patient falling ill of contagious or infectious disease in the back slums of the city becomes the centre of a wide infection. The health of each is important to all, and all must join in securing it.

The great aim of all sewerage work is to secure to every member of the community his full supply of uncontaminated air, and, where wells are used, of pure drinking-water.

Referring to the lower quarters of the city of Boston, Dr. Derby asks us to consider “ what would be the effect upon the annual mortality in a community like Boston, if the wretched cellars and crystal palaces and rookeries and dens in which the extremely poor and improvident live could be depopulated, and their occupants transferred to well drained and lighted and ventilated buildings, of however cheap and simple construction; if all the foul fluids could be made quickly to depart by force of gravity through ventilated sewers; if all the foul solids could be removed without delay in carts provided with means for arresting putrefaction; if the blind alleys and narrow streets were opened to the admission of the air and of sunlight; if the old vaults were removed, the old cisterns torn down or filled, and the general principle of cleanliness in its broadest sense applied to air, water, and food.” The picture would have been complete, had he suggested the wellknown fact that the danger to the community from the class of diseases known as “pythogenic ” (born of putridity) is not confined to those who live amid these filthy surroundings, but that the very sewers with which the better houses are drained are too often subterranean channels for conveying poisonous gases from the places of their origin to quarters which, without this transmission, would remain free from contamination.

Self - preservation is the first law of our nature; but it is a law which we ignorantly and constantly disregard in laying our life and health at the mercy of the foul conditions of life prevailing among our neighbors.

We roll up our eyes and stand aghast when contemplating the horrors of war; yet the mortality of war is trifling as compared with the mortality by preventable disease. England, in twenty-two years of continuous war, lost 79,700 lives; in one year of cholera she lost 144,860 lives.

We look idly on and see our population decimated by an infant mortality so great that its like among calves and colts would appall the farmer, and set the whole community energetically at work to discover a remedy.

It is estimated that for every person dying, twenty fall sick (Playfair estimates it at twenty-eight), and — to turn the argument in a direction best understood by many of our more influential neighbors — that every case of sickness costs on the average fifty dollars.

Dr. Stephen Smith says, “ Man is born to health and longevity; disease is abnormal, and death, except from old age, is accidental, and both are preventable by human agencies.”

Disease is not a consequence of life; it is due to an unnatural condition of living, — to neglect, abuse, or want.

Were any excuse needed for the constant reiteration of such truths as are known concerning the origin and spread of infectious diseases, it is to be found in the hope that by creating a public realization of the danger of sanitary neglect we may obviate the necessity that now seems to exist for the appearance of occasional severe epidemics, acting as scavengers and inducing the performance of sanitary duties whose continued neglect would lead to even more serious results.

Dr. Farmer speaks of pestilence as the angel “ with which it would seem it has pleased the Almighty Creator and Preserver of mankind ” to awaken the human race to the duty of self-preservation; plagues “not committing havoc perpetually, but turning men to destruction and then suddenly ceasing, that they may consider. As the lost father speaks to the family, and the slight epidemic to the city, so the pestilence speaks to nations.”

The death-rate in the healthiest broad districts in England may be fixed at about fifteen per thousand per annum, but taking the whole kingdom into consideration, the death-rate is thirty-five per thousand, over one fourth of the deaths being due to preventable diseases. It is estimated that eighteen deaths take place every hour which might have been prevented by proper precaution. In addition to this, account must be taken of the lowering of the tone of health of those who survive, and of the existence of a vast number of weakly persons who are a tax on the community, and who transmit an inheritance of physical weakness to their offspring. Infants are most susceptible to unhealthful influences, and one half of the population of Great Britain dies before attaining the age of five years.

An ordinary epidemic any modern community will bear almost with indifference. The few who know the close relation between the disease and its preventable cause will generally maintain their accustomed indifference until their own circle is attacked, and even then they are powerless to arouse the authorities to the necessary action. It is only when an outbreak of more than ordinary malignity occurs that even the sanitary authorities of most of our towns bestir themselves in the matter; but if the prevalence and the malignity be sufficient, there follows a most active cleansing of streets, purification of drains, and investigation of the private habits of the lower classes of the people.

Then only is such attention given to the most obvious duty not only of the sanitary authorities but of every man in the community, as, had it been exercised in advance, would have prevented every death and every case of sickness that has gone to swell the aggregate needed to attract public attention.

Nothing so arouses the alarm of a people as an epidemic of cholera, yet it is a singular fact that even during the most severe cholera epidemics the deaths from this disease are less than from many others which attract no attention and excite no apprehension. During the epidemic of 1849-50 there were 31,506 deaths from cholera in the United States. During the same period there were more than this number of deaths from other diseases of the intestinal canal, and more from fevers alone.

That a proper use of known sanitary appliances is competent to remove the causes of a large class of fatal diseases is hardly disputed, and it is clearly proven by experience here and abroad.

Mr. Baldwin Latham, in his excellent work on Sanitary Engineering, gives the following table, showing the effect on health of sanitary works in different towns in England: —

Name of Place. Population in 1861. Average Mortality per 1000 before Construction of Works. Average Mortality per 1000 since Completion of Works. Saving of Life per Cent. 1 Reduction of Typhoid Fever Rate per Cent. Reduction in Rate of Phthisis per Cent.
Banbury 10,238 23.4 20.5 12½ 48 41
Cardiff 32,954 33.2 22.6 32 40 17
Croydon 30,229 23.7 18.6 22 63 17
Dover 23,108 22.6 20.9 7 36 20
Ely 7,847 23.9 20.5 14 56 47
Leicester 68,056 26.4 25.2 48 32
Macclesfield 27,475 29.8 23.7 20 48 31
Merthyr 52,778 33.2 26.2 18 60 11
Newport 24,756 31.8 21.6 32 36 32
Rugby 7,818 19.1 18.6 10 43
Salisbury 9,030 27.5 21.9 20 75 49
Warwick 10,570 22.7 21.0 7 1/2 52 19

When the improvement of sewerage was actively undertaken in London some twenty-five years ago, it was found that the death-rate was so much reduced, in some of the worst quarters of the town, that if the same reduction could be made universal the annual deaths would be twenty-five thousand less in London, and one hundred and seventy - seven thousand less in England and Wales; or, by another view, that the average age at death would be forty-eight instead of twenty-nine, as it then was.

The early registration returns of England developed the fact that the prevalence of fatal diseases was in the case of some three times, of some ten or twenty times, and of others even forty or fifty times greater in certain districts than in others, and that these diseases raised the mortality of some districts from fifty to a hundred per cent. higher than that of other districts, the death-rate of the whole country being from thirty to forty per cent. above that of its healthiest parts.

The effect of sanitary improvement has been nowhere better shown than in the British navy, where in 1779 the deathrate was one in forty-two (this of ablebodied, picked men), and the sick were two in every five. In 1813, after the means and appliances of health had been furnished, the death-rate was one in one hundred and forty-three, and the sick two in twenty-one.

Less than a generation ago the idea prevailed that it was of doubtful propriety to ask why we are sick, and even at this day many believe that such an inquiry savors of irreligion. Happily this condition of otherwise intelligent minds is passing away.

While we know, thus far, comparatively little of the exact causes of disease, our knowledge at least points to certain perfectly well-established truths. One of these is that man cannot live in an atmosphere that is tainted by exhalations from putrefying organic matter, without danger of being made sick — sick unto death. It is true that not all of those who live in such an atmosphere either fall sick or die from its effects; but it is also true that not all who go into battle are shot down. In both cases they expose themselves to dangers from which their escape is a matter of good fortune. Fewer would be shot if none went, into battle, and fewer would die of disease if none were exposed to poisoned air. Our adaptability is great, and we accustom ourselves to withstand the attacks of an infected atmosphere wonderfully well; but for all that, we are constantly in the presence of the danger, and though insensibly resisting, are too often insensibly yielding to it. Some, with less power to resist, or exposed to a stronger poison, or finally weakened by long exposure, fall sick with typhoid fever or some similar disease, that springs directly from putrid infection. Of these, a portion die; the community loses their services, and it sympathizes with their friends in mourning that, “ in the wisdom of a kind but inscrutable Providence, it has been found necessary to remove them from our midst.”

In this way we blandly impose upon Divine Providence the responsibility of our own short-comings. The victims of typhoid fever die, not by the act of God, but by the act of man; they are poisoned to death by infections that are due to man’s ignorance or neglect.

Pettenkofer states that, so far as the city of Munich is concerned, typhoid epidemics bear in their frequency or rarity a certain fixed relation to changes in the soil, which can only be surmised, but which correspond with the differences of elevation of the water-table, or line of saturation in the soil. The greatest mortality coincides with the lowest state of the water - table, and the least mortality with the approach of this to the surface of the ground.

Fifteen years’ observation showed that the prevalence of typhoid was indicated by the water-level in the wells. This careful investigator believes that the cause of the disease exists not in the water, but in the soil; that it is due to certain “organic processes” in the earth.

The English investigators say that when the water in the well is low its area of drainage is extended, and it draws typhoid poison from a greater distance.

Neither of these theories is inconsistent with the hypothesis that the disease is due to organic matter reaching the soil from house-drains, cess-pools, etc., and finally either carried into the well to poison the drinking-water to a degree that becomes apparent when, during drought, it is reduced to a small quantity and its impurities are concentrated, or else left in the soil after the withdrawal of the water, and there exposed in such quantities to the action of the permeating air that poisonous gases are generated by their decomposition.

It is very clear that no system yet applied has been so generally efficient in lessening and weakening the attacks of typhoid as the English system of water supply and impervious drainage, which gives drinking-water free from contamination, and leaves the air untainted by the decomposition of organic matters in the immediate vicinity of dwellings.

Whether the London theory or the Munich theory be correct, the general result of all investigations shows that typhoid fever stands in a certain relation to the amount of neglected filth permitted to poison water and air.

The Massachusetts Board of Health published in 1871 a copious report on the causes of typhoid as occurring in that State. It concludes that the propagation of the fever is occasioned by a poison “ as definite as that which causes vaccine disease; ” and divides the means of propagation under three heads: first, drinking-water made foul by the decomposition of any organic matter, whether animal or vegetable, and specially by the presence in such water of excrementitious matters discharged from the bodies of those suffering from typhoid fever; second, propagation by air contaminated by any form of filth and specially by privies, cess-pools, pig-sties, manure-heaps, rotten vegetables in cellars, and leaky or obstructed drains; third, emanations from the earth, occurring specially in the autumnal months and in seasons of drought.

So far as Massachusetts towns are concerned, the contamination of wells, though a prominent, was not found to be a preëminent cause; numerous instances show this to have been active, but other causes, such as foul drains, sewer-gas, etc., are more important. It appears that the attack is more frequently received through the lungs than through the intestines. While it may be necessary that a marked quantity of impurity should exist in drinking-water before it can do us harm, an extremely small proportion of impurity in air is greatly to be apprehended; for we drink but a comparatively small amount of water, while we inhale, every twentyfour hours, from one to two thousand gallons of air.

There is reason to suspect the poison to be sometimes, if not quite generally, odorless, and the danger seems to be the greatest where the natural process of decomposition is secluded from air and light. The decay of vegetables in dark and unventilated cellars, and of house wastes or street wash in unventilated sewers, are especially to be feared.

In the town of Pittsfield, when the Board of Health assiduously attended to the removal of all nuisances, there was a very decided falling off in the number of cases of typhoid fever.

Derby says, “ Whether the vehicle be drinking-water made foul by human excrement, sink drains, or soiled clothing, or air made foul in inclosed places by drains, decaying vegetables or fish, or old timber; or, in open places, by pig - sties, drained ponds or reservoirs, stagnant water, or accumulations of filth of every sort, — the one thing present in all these circumstances is decomposition.”

If anything has been clearly proven with reference to the whole subject, it is that nearly all of the causes of typhoid fever are strictly within human control.

Dr. Benjamin Rush, an eminent physician of the last century, was so satisfied that the means of preventing pestilential fevers are “as much under the power of human reason and industry as the means of preventing the evils of lightning or common fire,” that he looked for the time when the law should punish cities and villages “ for permitting any sources of malignant or bilious fevers to exist within their jurisdiction.”

No dense population can hope to escape recurrent pestilential diseases unless the inhabited area is kept habitually free from the dejections and other organic wastes of the population.

The instance of the “Maplewood” young ladies’ school, at Pittsfield, Massachusetts, has been so often quoted in sanitary writings during the past ten years, that it must seem almost an old story to those who are familiar with the literature of the subject; but it is at the same time such a striking instance of the possibilities of the evils with which we are contending, that it can never lose its interest, and it is to be hoped that it may always remain the worst instance of its sort in our country’s record.

The house was a large one, built of wood, closely surrounded by trees, with a foul barn-yard near it containing water in which swine wallowed, and emitting offensive odors. The cellar of the centre main building was used for storing vegetables, and its private closets connected by closed corridors with the main halls of the building. The kitchen drain opened eighty or ninety feet away from the building. The vaults of the private closets were shallow and filled nearly to the surface with semi-fluid material (they received the slops from the sleeping-rooms). The house seems to have been beset with danger on every side, and it was often necessary in the heat of summer to close the windows, to keep out offensive odors. The whole case was examined after the attack by Drs. Palmer, Ford, and Earle, of the Berkshire Medical College, and they took, so far as possible, the testimony of every member of the household and of the relatives of those who had died after being removed to their homes. Their investigation fixed the origin of the Maplewood fever (which was clearly marked typhoid) unquestionably upon the unhealthfulness of the air of the house, made impure by the causes above specified.

This Maplewood fever is one of the most fatal ever recorded. Of seventyfour resident pupils heard from, sixty-six, or nearly ninety per cent., had illness of some sort, and fifty-one, or nearly sixtynine per cent., had well-marked typhoid fever. Of the whole family of one hundred and twelve persons, fifty-six had typhoid fever, and of these fifty-six, sixteen died. These proportions applied to the eight thousand people living in Pittsfield would have given four thousand cases of typhoid fever within the space of a few weeks, and of these eleven hundred and forty would have died. The outbreak was, however, so entirely local that some physicians in Pittsfield had no cases, and others only two or three. The Maplewood fever was a sudden explosion. It broke up the school in a very short time, and the pupils scattered to their homes, where, under the influence of pure air, many recovered.

Dr. Palmer says of this epidemic, “ Before the investigation, the matter was spoken of as the act of a mysterious Providence, to whose rulings all must submit. Looking with the eye of science upon the overflowing cess-pools and reeking sewers as inevitable causes, and with the eye of humanity upon the interesting and innocent victims languishing in pain and peril or moldering in their shrouds, I could but regard such implications of Providence, though perhaps sincerely made, as next to blasphemy; especially when uttered by the agents who were to be held responsible; though the prayer of charity might have been, 1 Father, forgive them, they know not what they do.’ ”

A century ago epidemic diseases carried with them only calamity, not culpability; but now, when their occurrence is chargeable to willful ignorance or to wicked neglect, Dr. Rush’s prophecy should be fulfilled, and the law should hold the community responsible for every death permitted to occur from preventable disease within the area that it controls.

The sanitary reforms recommended by the examining physicians being carried out, Maplewood became, and still remains, free from malarial disease.

Dr. Anstie, in his Notes on Epidemics, after describing the fouling of wells by the escape of cess-pool matter, and the fouling of the interior air of houses by reason of imperfect drain-traps, says, “ In short, all observers arrived at the conclusion that it would be possible, by rendering our drinking-water absolutely pure, and by disinfecting our sewage at the earliest moment, entirely, or almost entirely, to suppress typhoid fever.”

Dr. Austin Flint says, “ Typhoid fever is very rarely if ever communicated by means of emanations from the bodies of patients affected with the disease. It does not spread from cases in hospitals to fellow-patients, nurses, and medical attendants. Isolated cases are numerous, occurring under circumstances which preclude the possibility of contagion. Its special cause may be a product of the decomposition of collections of human excrement.”

The agency of tainted water was enunciated by Canstatt, in Germany, in 1847, and many later medical writers have confirmed the theory.

Dr. Flint investigated an outbreak of typhoid fever in a village in Western New York, in 1843. No case of typhoid fever had ever been known in the county. The community numbered fortythree persons; twenty-eight of these were attacked with fever, and ten died. All of those affected obtained their drinking-water from a well adjoining the tavern; but one family, living in the midst of the infected neighborhood, owing to a feud with the tavern-keeper did not use this water and escaped infection. Two families lived too far away to use this well. This immunity on the part of the enemy of the tavern-keeper led to a charge that he had maliciously poisoned the well, a charge which led to a suit for slander and the payment of one hundred dollars damages. At this time the idea that typhoid fever might be communicated by infected drinking-water had not been advanced, but its truth receives strong confirmation from the fact that a passenger, coming from a town in Massachusetts where typhoid prevailed, and traveling westward in a stage-coach, having been taken ill, was obliged to stop at this tavern. Twenty-eight days after his arrival he died of typhoid fever, and thus, doubtless, communicated in some way to the water of this well the germs of the disease, which speedily attacked every family in the town, except the three which did not resort to it for their supply. Dr. Flint states it as his opinion that “ in typhoid fever the contagion is in the dejections, and this fever may be, and generally is, caused by a morbific matter produced in decomposing excrement from healthy bodies.” And he believes that “ the spontaneous occurrence of this disease is to be avoided by a complete precaution against the pollution of water or air by the dejecta from healthy persons.”

In the summer vacation of 1874, ten students from Oxford went on a reading party to a rural retreat in Cornwall, which was recommended as of undoubted healthfulness and of quiet seclusion. They fell into a fever trap. The water and the soil of this village were polluted until it equaled the worst slums of Liverpool. Detecting the sanitary shortcomings of their retiring-place, they beat a hasty retreat, but they carried with them the germs of the disease, and before many days six of the party were down with typhoid fever: one has since died.

The Local Government Board of England lately deputed Dr. Thorne to investigate an outbreak of typhoid at Brierly. He found that the spread of the fever was due to the poisonous dejecta of the patients. Wherever those dejecta went, poison and disease went also. The original case was in the person of a dairy-man, and was of a mild type; but it was followed by two other cases in the same house, and, by the tainting of the milk vessels, the infection was carried to thirty-eight houses in the village, in twenty-three of which the fever appeared. From these centres it spread by excremental contamination until nearly the whole village was attacked. Dr. Thorne “ wished it to be distinctly understood that he by no means attributed all the cases occurring to the use of milk from the infected dairy; for when once the disease was started another powerful means for distributing it came into operation; ” and he proceeds to show a very defective condition of the vaults and drains. His irresistible conclusion was that the outbreak had been due, primarily, to the use of milk from an infected dairy, and that bad drainage and bad disposal of excrement had done the rest.

During the autumn of 1874 there was an outbreak of typhoid fever in the town of Lewes, about four hundred and fifty cases occurring. The town is divided into three sections, each having its own water supply, and the disease was confined almost entirely to the division supplied by the Lewes Water-Works Company. This company furnished an intermittent supply of water, the head being turned on for three or four hours in the morning and for the same time in the afternoon. When the head is taken off, the pipes empty themselves, sucking in air at every opening. Examination showed that there were many waterclosets, some of them used by fever patients, which were supplied by pipes leading directly from the water-mains into the soil-pan, and that it was a common habit to leave the taps open so that the closets should be flushed whenever the water was turned on. There were leaks in some of the old mains, and many of these were laid in soil fouled with the overflow of vaults. In one case a leak was found in a water-main where it passed through a sewer. The lead service-pipes of houses were frequently honey-combed, especially in the immediate vicinity of vaults, and in one case a leak was found directly under a vault. In seeking for this while the water was subsiding in the mains, the opening was exposed, and the whole contents of the vault were sucked into the water-pipe. In short, on every occasion of the subsiding of the water supply, air was drawn in violently at every opening, and the pipes thus received air contaminated by closets and vaults, and air from within a public sewer, so that in some cases at least, particles of excrement were drawn in from closet pans. In one section of the town only sixty houses out of a total of four hundred and fifty-four were supplied by the waterworks company, and in this section, with the exception of two infants, every case of typhoid fever occurred in these sixty houses, to the total exclusion of the other three hundred and ninety-four. Even after the epidemic became rife, and there were many other means for its extension, it was found that twenty-seven per cent. of the town-water houses had been attacked, and only six per cent. of all the others.

There has recently been an investigation into the origin of an outbreak of “ filth fever ” in Over-Darwen, England, the origin of which for a long time eluded the careful search of the authorities. It was finally worked out by a sanitary officer dispatched from London. The first case was an imported one, occurring in a house at a considerable distance from the town. The patient had contracted the disease, came home, and died with it. On first inquiry it was stated that the town derived its water supply from a distance, and that the water was brought by covered channels and could not possibly have been polluted by the excreta from this case. Further examination showed that the drain of the closet into which the excreta of this patient were passed emptied itself through channels used for the irrigation of a neighboring field. The water-main of the town passed through this field, and although special precautions had been taken to prevent any infiltration of sewage into the main, it was found that the concrete had sprung a leak and allowed the contents of the drain to be sucked freely into the waterpipe. The poison was regularly thrown down the drain, and as regularly passed into the water-main of the town. This outbreak had a ferocity that attracted universal attention; within a very short period two thousand and thirty-five people were attacked, and one hundred and four died. The report of this investigation closes as follows: “If an inquest were held on every case of death from typhoid fever, as we have long contended there should be, a similar relation of fatal effect to preventable cause could nearly always be traced, and may always safely be presumed.”

Thus much attention has been given to the subject of typhoid fever because it is universally recognized as the typical pythogenic disease, and the most prominent of those which are believed to be entirely preventable by human agency.

Two other prevalent scourges, not ascribed to organic uncleanliness but connected with the question of soil-water removal, — consumption and fever and ague, — must have a prominent place in any discussion of sanitary drainage.

The scientific world has been quick to accept the suggestion of Dr. Bowditch, of Boston, that the genesis of pulmonary disease seems to be connected with excessive moisture arising either from a wet soil, from a clay subsoil, which is usually a cause of damp and cold, from springs breaking out near the site of the house, from sluggish drains, damp meadows, ponds of water, and other sources of fog and atmospheric moisture, or from too close sheltering by trees. To one or more of these causes it is now thought that we may ascribe the origin of a large proportion of the cases of that painful disease which, more than any other, characterizes New England.

Dr. Bowditch says, “ Private investigations in Europe and America have in these later times proved that residence on a damp soil brings consumption; and second, that drainage of the wet soil of towns tends to lessen the ravages of that disease.”

In 1865-66 the British government instituted an examination into the effect of drainage works on public health. Twenty-four towns sewered by the modern system were examined. “ It appeared that while the general death-rate had greatly diminished, it was most strikingly evident in the smaller number of deaths from consumption.” As Bowditch had pointed out, the drying of the soil as an incidental effect of sewerage had led to the diminution of this disease.

Those ailments which are caused by the influence of stagnant water or excessive wetness of the soil — consumption in its most fatal form being one of them — may be much alleviated by the simple removal of the drainage - water, through exactly the same process that is employed in farm drainage.

The connection of fever and ague with soil moisture and with the obstructed decomposition of vegetable matter in saturated ground or in moist air is almost universally recognized.

The improvement resulting from drainage is fully attested by wide areas in England where whole neighborhoods have been drained for farming purposes, and where, as a consequence, malarial diseases have entirely disappeared.

In the report of the Staten Island Improvement Commission (1871) it is stated that where the foundations of the dwelling and the land about it for a certain space have been thoroughly underdrained, and where considerable foliage interposes between such space and any exterior source of malaria, the liability to disease is greatly reduced, and there is little danger that fever and ague would be contracted by the inmates of such a house except by exposure outside their own grounds. An instance is cited where four adjoining farms, near Fresh Kills, were drained. Close to each of these farms there has been much malarial disease, but the seventy people living on them have had scarcely a symptom of it. In another quarter formerly very malarial, the occupants of which carried to other residences the disease there contracted, those who remained after the thorough drainage of the land have recovered, and have not suffered at all since; while those who moved to them after their drainage have lived there for years without injury. In this case as in the first, the neighborhood beyond the influence of the under-drains is still highly malarial.

Pulmonary diseases, especially the early stages of consumption; all continued fevers, especially typhoid fever; degenerative diseases, such as scrofula and cancer; and uterine diseases, both of tissues and of function, are stated by the Staten Island commissioners to become less severe with the natural or artificial reduction of the level of the groundmoisture.

The Secretary of the General Board of Health (England) published in 1852 Minutes of Information collected in respect to the drainage of the land forming the sites of towns, etc.

He says: “ When experienced medical officers see rows of houses springing up on a foundation of deep, retentive clay, inefficiently drained, they foretell the certain appearance among the inhabitants of catarrh, rheumatism, scrofula, and other diseases, the consequence of an excess of damp, which break out more extensively and in severer forms in the cottages of the poor, who have scanty means of purchasing the larger quantities of fuel and of obtaining the other appliances by which the rich partly counteract the effects of dampness. Excess of moisture is often rendered visible in the shape of mist or fog, particularly towards evening. An intelligent medical officer took a member of the sanitary commission to an elevated spot from which his district could be seen. It being in the evening, level white mists could be distinguished over a large portion of the district. ‘ These mists,’ said the officer, ‘ exactly mark out and cover the seats of disease for which my attendance is required. Beyond these mists, I have rarely any cases to attend but midwifery cases and accidents.’ Efficient drainage causes the removal, or at least a diminution of such mists, and a proportionate abatement of the disease generated or aggravated by dampness.

“ After houses built in the manner described have been inhabited for some time, and especially if crowded, fevers of a typhoid type are added to the preceding list of diseases, in consequence of emanations from privies and cess-pools. The poisonous gases, the product of decomposing animal and vegetable matter, are mixed with the watery vapor arising from excessive damp (such vapors being now recognized as the vehicle for the diffusion of the more subtle noxious gases), and both are inhaled night and day by the residents of these unwholesome houses. A further consequence of the constant inhalation of these noxious gases, which have an extremely depressing effect, is inducing the habitual use of fermented liquors, ardent spirits, or other stimulants, by which a temporary relief from the feeling of oppression is obtained.”

In the English Sanitary Report for 1852 the following propositions are laid down: —

1. Excess of moisture, even on lands not evidently wet, is a cause of fogs and damps.

2. Dampness serves as the medium of conveyance for any decomposing matter that may be evolved, and adds to the injurious effect of such matter in the air; in other words, the excess of moisture may be said to increase or aggravate excess of impurities in the atmosphere.

3. The evaporation of the surplus moisture lowers temperature, produces chills, and creates or aggravates the sudden and injurious changes of temperature by which health is injured.

The copious evidence taken by the Metropolitan Sanitary Commission, in 1848, concerning the effect of ordinary agricultural land-drainage, as practiced in England, upon the improving healthfulness of men and animals and upon climate, resulted in the production of a vast amount of evidence of the most telling character, to review which, even briefly, would be impossible in this limited space; but it clearly showed that all the benefits that the advocates of land - drainage have claimed for it had already been fully sustained by English experience.

The agricultural drainage of the land in and about the sites of towns, and the soil-drainage which is usually effected, even where no especial provision is made for it, by the ordinary works of sewerage, has fully demonstrated the sanitary benefit arising from the removal of stagnant water, or water of saturation, from the soil. The earth acts upon foul organic matters much in the same way that charcoal would do, having, though in less degree, the same sort of capacity for condensing within its pores the oxygen needed to consume the products of organic decomposition. But no soil can act in this way so long as its spaces are filled with water, and in order to make it an efficient disinfectant it is necessary to withdraw its surplus moisture and thus admit atmospheric air within its pores.

It is now generally believed that in addition to the many other evils of excessive soil-moisture, its effect in rendering a dwelling-house cold and unwholesome is especially marked in encouraging the formation of tubercles in consumptive subjects; and the various forms of malarial fever, neuralgia, influenza, dysentery, and diseases of the bowels, are thought to be aggravated by excess of moisture in the soil immediately about human habitations.

During the past thirty or forty years very large contiguous areas have been drained in England for agricultural purposes, and an invariable result of the improvement has been a great decrease of malarial diseases, such as fever and ague and neuralgia. The vast fen-lands of Norfolk, Lincolnshire, and Cumberlandshire were formerly the seat of very wide-spread diseases of a malarial type. Since the drainage of the fens these diseases have become comparatively rare and mild in form ; and it is asserted with regard to England generally, that such diseases “ have been steadily decreasing both in frequency and severity for several years; and this decrease is attributed in nearly every case mainly to one cause, —improved land-drainage.”

The well-known Mr. James Howard, of Bedford, England, says, “ In my own county, ague and fever thirty or forty years ago were very common in certain villages; since draining has been carried out the former has quite disappeared, and the latter has greatly decreased.”

So far as the question of social prosperity is concerned, it is quite proper to consider the financial aspects of the question of health. The body politic has perhaps no compassion for the sufferings of the poor invalid or the bereaved mourner, but it has a quick and a vital interest in everything affecting its worldly prosperity, and the deepest foundation of its worldly prosperity lies in the strength and efficiency of its members.

Dr. Boardman, of Boston, in the sixth annual report of the Massachusetts Board of Health, enters into a calculation, based on numerous data, which seem to be sufficiently proved.

In the metropolitan district, including Boston, the average loss of time from sickness for each individual is twentyfour days in the year. In the western district, including Berkshire County, the loss is about fourteen days; and the average for the whole State is nearly seventeen days for each member of the population. This was in 1872; a similar computation for the previous eight years shows an average of fourteen days for each person. Calculating the cost of nursing, medical attendance, etc., and the loss of time to persons of a productive age, he finds that the loss to the State from the sickness of working people alone is over fifteen million dollars; and the same computation for the entire population would amount to nearly forty million dollars.

Assuming that out of the nineteen persons in every thousand who die annually in the whole State of Massachusetts, four might be saved by the avoidance of preventable diseases, — and this is certainly very low, for it may be reasonably assumed that eleven per thousand is the natural death-rate, or the lowest that can be attained, — the following saving to the State would result: the annual mortality being 26,619 with a death-rate of nineteen per one thousand, it would be, with a death-rate of fifteen per thousand, 21,015, or an annual saving of 5604 lives. Good grounds are given for assuming that every death represents a total of 730 days of sickness and disability; the aggregate saving from sickness therefore would be 4,090,920 days, which would amount to $8,181,840, or for the working population alone $3,190,916, which latter sum would represent the interest on more than fifty million dollars. The practical question then which the commonwealth should consider is whether an investment of fifty million dollars in the improvement of the sanitary condition of its population, and in their enlightenment as to means for preserving health, would result in a reduction of the death-rate from nineteen to fifteen. If it would do so, then the investment would be a profitable one. That it might do this, and even more, is proven by English experience, and no one can doubt it who will give even casual attention to the degree to which human life, in even our best communities, whether in town or country, is hourly endangered by the unwholesome conditions under which it exists.

In every household in which a pronounced case of typhoid occurs, it may fairly be assumed that the value of the whole family to themselves and to the community is distinctly lessened; and the large proportion of “ debilitated and weakly ” persons found in all our communities are but half-way victims struggling against the assaults of foul air and contaminated water. Their lives are permanently dulled by a malaria they are in part able to withstand.

In this ever-waged battle there are wounded as well as killed; and in England it is recognized that “ convulsions ” and many attacks of nervous ailments are marks of excremental poisoning.

There are several diseases which are now known to indicate more or less definitely unfavorable sanitary arrangements, and as the knowledge of hygiene extends, other diseases are being added to the list. Nervous toothache, neuralgia, scarlet fever, cholera, dysentery, diphtheria, cerebro - spinal meningitis, and consumption are among those which are either generated by foul air or foul water, or which are made worse because of unhealthy surroundings.

Dr. Derby says, “ That an obscure internal cause — which, in our ignorance of its nature, is called a proneness of disposition to receive the poison — is necessary for its development does not affect the truth of the fact that without filth the disease is not born. . . . The improvement of public health as expressed by that unerring guide, the death-rate, corresponds with all the means by which air and water are kept free from pollution.”

Typhoid fever is the most conspicuous type of the class of zymotic diseases, all of which are clearly pythogenic, and none of which can originate under conditions fit for proper human habitation.

A fertile soil or an impervious subsoil is especially favorable to typhoid poisoning; while deep gravel or sand, well drained and offering free access to the air, are the least so. Rock near the surface is bad in the same way that a clay subsoil is bad.

As a rule, new residents in an unhealthy locality are more subject to disease than those who have become accustomed to the unfavorable influence; yet when typhoid contagion appears, it attacks first those whose systems have been debilitated by the insidious influences of foul air or water.

One naturally argues from circumstances with which he is most familiar, and as I have given more especial attention to the sanitary short-comings of my own town, I take it as an example, believing, however, that its interior arrangements are not less favorable than those of the average of our prosperous country places, and recognizing the important fact that its position (on a neck of land hardly a mile wide and sloping in one direction to the Atlantic Ocean and in the other to Narragansett Bay, without a hill or a forest to intercept the free-blowing winds from every quarter) makes Newport naturally a perfectly salubrious town. The population in 1870 was 12,521, the larger number living in a compactly built district facing the west and drained into a deep cove of Narragansett Bay. At the north and at the south the land is flat, but nearly all of it lies high enough for tolerable drainage. It is underlaid with stratified rock, and has a heavy clay subsoil interrupted by fissures of gravel sloping similarly to the surface of the ground.

There is no public water supply, and probably a large majority of the population drink water from wells only, although there are many filtering cisterns. Nearly all the houses of well-to-do people have the usual plumbing arrangements, which discharge into cisterns or into cess-pools in the ground. Some of these drain themselves through the gravel streaks of the subsoil, and a very few are absolutely tight, so that they require hand emptying. A rude sort of sewerage has been attempted here and there, laid without system and constructed apparently without the least reference to the well-known requirements of all town drains.

These sewers have the advantage of being at every opening so noisomely offensive that persons living near them are warned by the odor to keep their windows closed when the wind comes from a certain direction, and passers-by do not loiter in their vicinity. There is less insidious sewer poisoning here, as the exhalations are blazoned to the dullest sense. Usually where a sewer is available, the private cess - pool overflows into it, but in a great majority of cases the removal is by hand, with carts trundling into the country and making winter days and summer nights more than hideous.

If the best winds of heaven did not blow almost constantly through our streets, we should probably be as badly off as a country town can be, but apparently this free ventilation will for some time continue to stave off the epidemic that awaits us, and which alone probably (here as elsewhere) will be able to secure the needed reform.

With these advantages and disadvantages Newport had a death-rate in 1863 of 34.16 per thousand (even supposing the population not to have increased between 1863 and 1870); a death-rate in 1873 of 25.76 per thousand, and an average death-rate for eleven years ending 1873 of 21.05 per thousand.

The town of Worthing, on the south coast of England, is probably more nearly like Newport in its climate, population, and uses than any other sea-coast town with which it can be compared. Like Newport, Worthing is more or less a resort for invalids and persons seeking a beneficial change of air, but unlike Newport it has an excellent and abundant supply of pure water, and its drainage is said to be perhaps the most complete in Great Britain, every cess-pool and surface drain having been suppressed and a main sewer emptying into the sea two miles away. The sanitary effect of this difference is shown by the fact that Worthing has the lowest death-rate ever recorded— 14.5 per thousand (during the second quarter of 1874 it was only 12.9 per thousand); and a death-rate of 14.5 means an average longevity of nearly sixty-nine years for the whole population. It is probably as nearly certain as any such speculation can be, that could Newport have the simple advantage of a pure water supply and the perfect drainage that could so easily be given it, its average death-rate could be reduced to that of Worthing, causing us an annual saving of nearly one third of its deaths, with the enormous amount of costly and wearying illness and of debility and inefficiency that these deaths imply. Viewed in another light, could the questionable reputation under which Newport now suffers be replaced by one like that of Worthing, it would lead to such a growth of “ stranger ” population in summer and in winter as would gladden the hearts and overflow the coffers of all its eager army of purveyors.

Nor are our cities better provided with sanitary appliances than our smaller towns. Even Boston, which congratulates itself on its refinement and civilization, is assiduously planting the seeds of future trouble.

The newer parts of the city, especially the district toward the mill-dam, may serve as a very good illustration of what it is possible to do in the way of providing unfit habitations. The annoyances caused by the imperfect sewerage of this district have long been a ground of complaint even among persons who would accept the ordinarily defective drainage of higher-lying town - districts as quite satisfactory.

In this case the remedy though radical is simple, and it would be much less costly than would be supposed by those who are not acquainted with the artificial pumping system largely in use in England. Indeed, this district is especially well adapted for such drainage, for the reason that all its houses are occupied by a class who use water very liberally, so that there need be no fear that there would not be an ample flow to remove all solid matter reaching properly made drains.

All street - wash and the rain - water falling on the roofs, court - yards, etc. (beyond what would be needed for occasional flushing of the house sewers), may be removed by surface gutters or by a system of shallow drains discharging into Massachusetts Bay, and flushed, whenever needed, by water admitted to a flushing reservoir from Charles River. The house drainage itself should be disposed of through an independent system of small sewers laid at least three feet below the level of the lowest cellars, collected at one point and lifted by steam power into a sewer leading to Massachusetts Bay.

Nothing but the fact that it is surrounded by wide stretches of water and great areas of unoccupied land could account for the preservation of the city in a state of even tolerable healthfulness, in the face of the circumstance that the water system is only partially introduced, and that fully one half of its night-soil, or about five thousand cords per annum, is still removed by carts; and it should be borne in mind that this five thousand cords is only what has been retained in the vaults after enormous volumes of its liquid parts have soaked away into a soil covered with a dense population.

Reference has been made to the fact that there is often less danger from impure well-water than from impure air, and some of the Massachusetts investigations indicate that in that State contaminated wells are not a very prominent source of infection. At the same time, the fouling of well-water by organic impurities is a very frequent source of fatal disease, and probably the reason why it does not appear relatively more serious in Massachusetts is that so much of the soil of that State is of a light character to a very great depth, there being less lateral movement of excessive soilmoisture than where strata of hardpan, or impervious soil, and seams in stratified rocks are more prevalent.

The reason why well-water is often bad and unwholesome is, in plain English, because sink-drains and vaults empty their foul contents into it. A well may be good for a long time and subsequently become poisoned, because the soil lying between the source of the impurity and the well itself has a certain amount of cleansing power. While this is effective, every impurity is withheld, but by degrees the soil becomes foul farther and farther on, until at last there is no grain of uncorrupted earth to stand between the sink and our only source of the pure water without which we cannot live in health.

The well is in effect a deeper drain, toward which the water from the surrounding earth finds its way, and in time, as impurities will follow water to any outlet unless the filter that holds them back remains always active, the foulness of the earth within the drawing range of the well is carried into the water, which it renders unfit for human use.

In 1847 typhoid fever broke out nearly at once in the thirteen houses of a single terrace in Clifton, England, which took their drinking-water from a certain well. Other houses in the same terrace escaped entirely, and it was found on investigation that in every house supplied from the well in question the disease was severe, while in no other house of the terrace did it appear. The infected houses were considerably scattered, and the only connecting link between the inmates was the use of the same drinking-water.

A very striking case in point which occurred in Williamstown, Massachusetts, was well and skillfully investigated. A house-drain became choked, and its contents mingled with those of a field-drain that was near a well. The season was wet, the ground was thoroughly saturated, and surface water oozed into the well. The house was a boarding-house, with from thirty to thirty-five persons, mostly students, at table. Within two weeks most of the boarders were affected, and twenty or more of the students fell sick. At this time there was one case of typhoid fever in town, and this patient had been removed from his lodgings in the college to this boarding-house, where, probably by means of the escape of his dejections from the imperfect drain, his disease was communicated through the water of the well to all or nearly all of those who drank the water unboiled. Those who drank no cold water escaped: but a family in an adjoining house supplied from the same well were attacked, except one member who habitually drank no cold water. All who drank that water unboiled had the disease; all who avoided it in that state escaped.

Dr. Stephen Smith describes a visit to a country clergyman, a former schoolmate, who told him of a family, five of the members of which had died, while another was then fatally sick with typhoid fever; and he had not thought of attributing it to anything else but a “ visitation of Providence.” An investigation showed that during a busy harvest the valve of the pump had got out of order, and there being no time to replace it, water had been taken from a brook which received, higher up, surface water and the drainage from several barn-yards. Of the entire family but two escaped attack, and they had not used the water.

The Broad Street pump in London is now famous in the annals of epidemics. During the cholera visitation in 1848-49, it killed five hundred persons in a single week. And many of the better classes, who fled the town and went to reside five miles farther up the Thames, were there attacked with cholera, it being found that they had been in the habit of sending to the Broad Street pump for their tea-water.

Having been instrumental in introducing the dry-earth system of sewerage into this country, it is proper for me to say here that my faith in the ability of that system to accomplish all that it has ever promised remains unabated, and that, under circumstances where its application is practically feasible, I should never recommend water sewerage; yet, in the present state of its development, it is so inapplicable to a large majority of cases, or so distasteful to a mass of persons whose necessities demand immediate relief, that, without in any way receding from its advocacy, I freely acknowledge that the practical good which is to come of early sanitary reform is to be sought through other means.

The drawback, so far as towns are concerned, lies in the inability of this system to deal satisfactorily with copious amounts of water. Twenty-five gallons of waste running from a kitchen sink would require for its absorption from four hundred to five hundred pounds of earth. Still, earth sewerage can be perfectly depended on in village and rural establishments where there is a sufficient amount of lawn or garden to absorb the waste by underground irrigation; such irrigation beginning at a point sufficiently far from the house or the well. Disposed of in this way, and made to feed a vigorous vegetation, all of the liquid waters of the house may be safely treated in a small lawn or garden.

The evidence as to the sanitary completeness of this system is all as conclusive as the following recent report from a very unhealthy quarter: Before 1868, dysentery and fever were very prevalent in the convict-prison of Labuan, Borneo, and the old system of water-closets and cess-pits was abolished, earth-closets being substituted. Hereupon the sickness and mortality declined. In 1870 a great mortality broke out among the troops of the station, and a government inquiry developed the fact that in the barracks, where the earth system had been neglected, thirty per cent. of the troops died per annum; the deaths in the prison, where it had been assiduously used, amounted to but two per cent. In Sierra Leone, where the commanding officer had taken efficient measures to provide earthclosets for the troops, the health of the officers and men was maintained “at the very time when fever and dysentery were carrying off twenty per cent. per annum of the European population residing in the town.”

A novel system of sewerage by pneumatic action, invented a few years ago by a Dutch engineer named Liernur, has been introduced on a large scale in parts of Amsterdam, Leyden, and other towns of Holland, and is now being much discussed by those interested in sanitary matters in England. The accounts given of the success of this method, of the entire absence of odor in all its processes, and of the complete saving for agricultural use of almost every part of the household waste, indicate that it is most efficient, economical, and admirable. It has just been adopted for the entire sewerage of St. Petersburg, where it is to be introduced at a cost of over twenty million dollars.

It has been attempted, in this preliminary paper, to bring within the scope of a magazine article some of the leading considerations which make the subject of sanitary drainage seem well worthy of more attention at the hands of the public than it has thus far received. It seemed advisable to offer such an introduction to the later articles of this series, — which will treat more particularly of the better methods of dealing with such of the wastes of human life in and about dwelling-houses, whether isolated or in towns, as lead to the evils herein referred to; and of the safest means for removing from inhabited town-areas the accumulated waste of its individual houses.

George E. Waring, Jr.

  1. It is to be remembered that even this great saving of life has been effected by works that are very far from perfect.