minor ones are included. Everywhere and at all periods of history
the theory of ethics has widely differed from practical conduct. The
race conflict which is taking place in France as the result of the
Dreyfus trial, more than a century after the emancipation of the Jews
before the law was proclaimed, is a late illustration of this fact.
To this, the corruption and failure of justice which recent exposures
have revealed in the highest circles of republican France add peculiar
significance. As already stated, the broad outlines established in
precept remain unchanged, and it is in their logical application that
lie all present growth and future hope.
To trace, even in sketchy outline, the debit and credit account of
modern ideas upon the various subjects involved in the above mentioned
issues would be a serious undertaking. A chapter must be devoted
to each nation, for the moral progress of each differs as does its
besetting sin. Moreover, every shade of opinion must be weighed and
considered. Inherited traditional views are, in each modern mind,
hopelessly interwoven with the new articles of a code of morals which
public opinion is even now evolving from contemporary conditions. “Each
of us,” says Edmond Schérer, “belongs to two civilizations, that which
is coming and that which is going; and as we are accustomed to the
first, we are poorly placed to judge or enjoy the latter.”
There never was an epoch when the struggle for existence was fiercer
and when earthly possessions were more keenly prized. But despite the
many survivals which still point to a semi-barbaric inheritance of
selfishness descended through millenniums, a decided moral gain may, on
the whole, be placed to the credit of our era. With the decrease of the
sum total of ignorance, not only among the lower but among the upper
classes, the sum total of well-doing and well-being has immeasurably
increased.
The sympathy for suffering is more widespread than it has ever been.
No middle-aged person can fail to note the rapid change which has
taken place in the public mind with regard to the general treatment
not only of children, but of animals. The present mode of dealing with
school children according to their individual capacity, the trust in
their honor which governs their relation to the teacher, the absence
of any corporal punishment, form a recent departure in education well
calculated to produce the best moral results.
The improvement of modern methods in relief work as well as in the
treatment of vice—now viewed more in the light of a pathological
condition than in that of a sin—must make this a memorable epoch
in the ethical history of humanity. No branch of civilization has
undergone greater change in modern times both in theory and practice
than public and private charity. To-day the humanitarian endeavors
to lift up the fallen and the needy, and almsgiving on the part
of the well-to-do is fast becoming relegated to the category of a
self-indulgence which is not to be encouraged. The distinction between
the old methods and the new is given in the formula that “henceforth
the chief test of charity will be the effect upon the recipient.”
Any relief calculated to undermine self-reliance and independence is
discouraged by those who have in view the prevention of our moral ills
rather than their relief.
[Illustration: CAPTAIN ALFRED DREYFUS.]
Indeed, the new school preaches scientific charity as against emotional
charity. What it may have lost in impulse it has more than made up in
effectiveness. The attempt to teach the needy to help themselves, the
work of college settlements and of the organized efforts in the poorest
and most neglected districts of large cities, with a view to fostering
by personal contact and example habits of thrift and self-respect where
those virtues are most lacking, are among the truest if more homely
glories of the closing century.
Verily, never was a more thoughtful effort made everywhere to mitigate
the cruel distinctions of race and sex, of wealth and poverty, and
to “harmonize the social antagonisms” of modern life. Never was so
much consideration given to the betterment of humanity, nor was the
aggregate of earnestness so great.
In our more robust intellectual world the tree is judged by its fruit,
and acts tell, not creed. The principle that well-doing, unless it
is disinterested, forfeits its claim to the highest respect of men,
is growing in strength, whilst the feeling is gaining ground among
the thoughtful that in the development of personality may be found a
sufficient motive for the exercise of virtue, and that character, not
reward, _being_ not _having_, are the highest aims.
If we resume the moral progress of the nineteenth century, allowing
for its inconsistencies, carefully weighing its negative and positive
results, and taking as a balance what is original in its contribution
to the ethical development of the human race, we will find that this
contribution mainly lies in the direction of tolerance and of altruism.
This altruism is distinct from the charity of St. Vincent, which
sacrificed self in a loving attempt to relieve individual distress.
Such pure sacrifice, admirable as it is, is not only narrow in its
scope, but because of its austerity must fail to survive in the
struggle for existence. Modern altruism aims at removing the main cause
of individual distress, and spends itself in educational efforts, in
which the well-doer finds happiness in the consciousness of usefulness.
It is also unlike the socialism of Condorcet, which reached down in an
endeavor to make all institutions subservient to the interests of the
poorer and most numerous classes, for it aims at lifting these to the
highest possible plane. The mountain summits are not to be lowered, but
the valleys are being filled. To raise the people, to build up, not to
tear down, is the avowed end of all modern moral effort, and must ever
stamp the humanitarian struggles of the present age as distinct from
those of the eighteenth and preceding centuries.
With this we may claim an increase in individual freedom, and a
perceptible tendency to a logical and ever broadening conception, not
only of the rights, but of the duties of citizenship; to a more honest
recognition of the place assigned by expediency to evil in the social
and business intercourse of a practical life; to a growing scorn of
casuistry, and to a stronger faith in the reality of right and of
abstract truth as they are revealed in every thinking man’s heart, and
the uniformity of which is reflected in the public conscience.
PROGRESS OF SANITARY SCIENCE
BY CHARLES McINTIRE, A.M., M.D.,
_Lecturer on Sanitary Science, Lafayette College, Easton, Pa._
Since blessings brighten as they take their flight, it may be difficult
to realize how much of our present happiness and comfort depend upon
the constantly abiding benefactions brought about by the progress of
Sanitary Science in the present cycle. The proper care of the body
and the prevention of disease, rather than its cure, have occupied
the minds of men from the dawn of history. Moses is the author of a
well-digested code of hygiene, and erudite scholars can find hints of
the proper conservation of health in the Egyptian papyri. Hippocrates
wrote about the prevention as well as the cure of disease; indeed,
all along the course of time the master minds of medicine attempted
the solution of many of the problems of Sanitary Science as eagerly
as they sought for the _elixir vitæ_ or for the universal solvent.
Notwithstanding all this, one can truthfully say that sanitation could
not be fairly termed Sanitary Science until its rules of procedure
began to be formulated with more or less exactness upon careful
experiment and accurately recorded observation. Sanitary science,
as such, could not begin to be until pathology (a knowledge of the
morbid processes of disease) and etiology (a study of the causation
of disease) had builded upon a scientific foundation. Before this all
deductions were from experience, and had no other reason than the
seeming helpfulness of the procedure; after this, as fast as the facts
were demonstrated, deductions were made that determined a procedure
which would of a certainty accomplish the purpose. In the olden times,
during an epidemic of a contagious disease, tar barrels were burned in
the streets,—and not without some benefit. At the present, the room,
with its contents, can be disinfected with a certainty of destroying
every atom of contagion.
This difference must be kept in mind when comparing the old with the
new, and the true reason of the great advance be recognized as due to
the spirit of scientific investigation, which began in the latter part
of the last century with the employment of instruments of precision
in research, and which has developed so wonderfully up to the present
that the experimental psychologist measures the minute portion of time
it takes to form a thought. At the same time, it must be kept in mind
that the sciences which furnish sanitary science much of its material
are progressing and, because progressing, changing; that the conditions
desired to be removed are prevailing, and the necessity of overcoming
them urgent. Not in every case has the sanitarian fully demonstrated
and laid down scientifically accurate data on which to base his method
of procedure. Hence it happens that even now sanitary empiricism must
needs be mingled with sanitary science, and the mingling is sometimes
as much of a motley as the dress of the court fool of the Middle Ages.
Since sanitary science had its origin during the present century,
it will be helpful to assign a definite period for its birth. Not
that any one would have the temerity to dogmatically assert that the
science came into being at a fixed date, but rather to fix a period
of time when the conditions working through the ages were so shaped
that, perforce, the problems of sanitation would thereafter be treated
more in a scientific and less in an empirical method than before. This
time is associated with the beginning of the reign of Queen Victoria
of England, since the first Act of Parliament for the registration of
births, marriages, and deaths was passed in 1837, and the beginning
made of accurately gathering information which is to the sanitarian
what the pulse is to the physician. With his fingers on this tell-tale
of the flow of the heart-blood of the nation, he is enabled to
determine whether disease is above or below the normal, the character
of the disease that abounds, and its whereabouts. Knowing where to find
any disease in excess, he can study the conditions and surroundings,
comparing them with other places, whether afflicted in like manner or,
more favored, free from the disease. By means of these vital statistics
he can compare year with year, and tell with a degree of exactness
heretofore impossible whether any disease is increasing or decreasing;
he can lay his returns by the side of the figures of the meteorologist
and learn if the weather has any influence on the death-rate; he can
follow the results of his efforts to improve the condition of the
people and vindicate his expenditure of the public money by pointing
to the reduced mortality rate. It may seem to be a gruesome task for
every physician in the land to send to the proper official a notice
of each death and of each patient suffering from a disease apt to be
communicated to some one else; and almost ghoulish for the officer
to sit at his desk, day after day, and catalogue and tabulate these
returns. But it is only a modern version of the old riddle of Samson,
out of the bitter came forth the sweet; for without this, much of the
progress of sanitary science would be well-nigh impossible.
The act adopted in Great Britain has been modified and improved upon
since then, and in the United States many of our cities and some of our
States have been engaged in a similar effort. As yet we have no central
bureau or collecting office for the nation; nor is this necessary, if
each State would do its duty, or, at least, the general government in
that event need only tabulate the returns of each of the States. The
effort is now making, under the auspices of the American Public Health
Association, to secure a uniform method of registration in all offices
collecting vital statistics, by which the same name will be given to
the same disease and the same facts recorded in each return made.
This will cause a little confusion at first in those offices where
statistics have been tabulated for a number of years, but the advantage
will be so great as to fully repay any inconvenience at the first. If
we desire to obtain the full benefits from the advance of sanitary
science, we must see to it that in every State there is an efficient
bureau of vital statistics, whether under the supervision of the State
Board of Health or some other department of the State. The absence
of such a bureau reflects upon the intelligence of the people or the
integrity of the law-making power.
Are there tangible results to warrant so sweeping an assertion? is a
fair question, since at the time of the preparation of the census of
1890 New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut,
New York, New Jersey, and Delaware were the only States collecting
vital statistics, and since then but Maine and Michigan have been
added. Before quoting figures, it must be premised that even now the
returns only approximate accuracy; they were much more inaccurate at
the first, and before the general registration was undertaken most
of the statements are merely estimates, after the fashion of the
geographer who gives the number of inhabitants in China, where a census
never has been taken. It may happen that the benefits are not as great
as the figures seem to show, but after making all allowance there is
great improvement.
[Illustration: LIVES SAVED BY PUBLIC-HEALTH WORK.
_Comparison of death-rates in Michigan from scarlet fever and
small-pox before and since the State Board of Health was
established, and from typhoid fever before and since its
restriction was undertaken by the State Board. (Compiled from the
State Department’s “Vital Statistics” of Michigan.)_
]
The “Encyclopædia Britannica” asserts that two centuries ago the
mortality of London was 80 per 1000, while now it is but a little over
20. In 1841, out of every 100,000 people in England, 30,000 would have
died before reaching the age of 10, and one half would have died before
they were 40 years old; in the decennium 1881–90, before 30,000 would
have died out of each 100,000 some would have lived to be 17, and some
would have lived to be 55 before one half of the number had departed
into the unknown and the hereafter.
The figures of the statistician must be quoted again and again in the
progress of the article, as no more tangible evidence can be given of
the benefits resulting from improved methods of sanitation. Very early
a coincidence was observed between the uncleanly and the death-rate.
Neighborhoods where little or no care was taken to remove the refuse,
where there were foul drains and a deficient water supply, were found
to be the abodes of special forms of disease,—so much so, that these
diseases soon received the name of “filth diseases.” Acting upon the
suggestion, the gospel of cleanliness was preached and its practice
enforced. There was a “redding up” in its eventuality as thorough as
the cleansing of Santiago de Cuba in recent days. It did not take
long to discover that decaying organic matter in some way was the
offending body, and that this contaminated the water supply. Wells were
condemned and public water supplies installed; means were sought to
enable the cleansing to be constantly carried on, and sewers for house
drainage followed or accompanied the water supply. In proportion as
this has been thoroughly done has the death-rate from certain diseases
diminished. During the last century the European armies were decimated
by fever (typhus or relapsing) to such a degree that the work of the
fell destroyer at Santiago was trifling in comparison. On into the
present century, the great scourge of Great Britain was these same two
fevers; so much so, that “the fever” meant the dread jail or typhus
fever. It was imported into this country, and epidemics of “ship fever”
were of frequent occurrence. Thus, as late as 1846, it was estimated
that in Dublin alone there were 40,000 cases of fever, with a total
in Ireland of 1,000,000 cases. There were 10,000 deaths in Liverpool,
a city especially prone to the disease; while in Edinburgh one person
out of every nine of the population was attacked, and one out of every
eight of the sick died. Turning from this account to the medical
returns of the war for the Union, there were reported only 1723 cases,
with 572 deaths, to the office of the Surgeon General, and even these
a very competent authority after careful investigation decided not to
be instances of true typhus. Or turn to civil practice: the disease
is found so seldom with us that it is not necessary to assign to it
a column along with the other diseases in publishing the mortality
returns by our health authorities. The deaths from fever in London
during October, November, and December, 1898, were but 296. London has
an estimated population of 4,504,766, and the “fever” in the report
included typhoid, simple and ill-defined forms of fever, as well as
typhus. This makes a death-rate of but 0.26 per 1000.
Had sanitary science no other trophy, its votaries could still boast
of the great benefits to humanity brought about by their labors. This
is but one of many; thus, scurvy, the great bane of the navy, is now a
disease that few physicians have the misfortune to see, or patients to
endure. Then that disease somewhat akin to typhus, and until within the
memory of the fathers confounded with it, hence called typhoid fever,
is likewise fast disappearing, more rapidly in cities than in rural
communities however. The suppression of typhoid proceeds with equal
step with the introduction of a public water supply in our towns, the
adoption of the proper means to furnish this water unpolluted, and the
proper removal of domestic waste through sewers, whose contents are
so treated as to work no harm after they escape. Notwithstanding these
great triumphs, if boasting is permissible, the sanitarian’s boast is
rather that his science, which had its beginning, as we have seen, at
the time when there was a great awakening of the national conscience
in British politics for “the larger sympathy of man with man,” has
broadened with the years of its growth; has endeavored to care for
one’s brother so that his blood would not cry up from the ground; so
that, after forty or fifty years had passed, a distinguished sanitarian
could write with literal accuracy: “Whatever can cause, or help to
cause, discomfort, pain, sickness, death, vice, or crime—and whatever
has a tendency to avert or destroy, or diminish such cases—are matters
of interest to the sanitarian; and the powers of science and the
arts, great as they are, are taxed to the uttermost to afford even an
approximate solution of the problems with which he is concerned.”[1]
And the crowning glory of the science to-day is the care it bestows
upon the weak, the ignorant, and the helpless; the efforts it makes to
ameliorate every undesirable condition of society.
[1] Dr. J. S. Billings in _Ziemssen’s Encyclopædia_.
[Illustration: MAP SHOWING “REGISTRATION STATES” NOW AVAILABLE FOR THE
MORTALITY STATISTICS OF THE TWELFTH U. S. CENSUS (1900).
NOTE.—States having immediate registration of deaths and requiring
burial permits are _black_. The only additions to the list since the
Census of 1890 are Maine (1891) and Michigan (1897).]
It would be misleading to infer that all of these benefits have been
brought about solely through the collection of vital statistics,
although much of it would have been difficult without the knowledge
furnished by these statistics. Workers in almost every branch of
pure science have contributed to the progress,—the physicist, the
meteorologist, the chemist, and by no means the least, the biologist.
Indeed, with the more recent investigations, the culture tube of the
biologist has almost revolutionized medicine and all that pertains to
it.
Sanitary science seeks to accomplish two ends; it purposes to _prevent_
disease and to _promote_ public health. If it seeks to prevent disease,
after the fashion of the oft-quoted cook-book, it must first secure the
disease, or what is essentially the same thing, know what causes it.
If the cause be known, and we can conquer the cause, we can prevent
the disease. Thus a disease known as _trichinæ spiralis_, from the
name of the parasite invading the body and causing sickness and death,
is caused by eating pork infected by the trichinæ. We can certainly
prevent trichinæ in persons by forbidding pork; but we also know
that the trichinæ do not occur in all pork, and that their presence
can be detected by the microscope. If, then, a sample from every
slaughtered pig is submitted to the microscopist, the infected pork
can be discovered. This is done in our large packing establishments,
especially for that pork which is to be exported. Again, a thorough
cooking will kill the trichinæ, even if present. Only the grossest
carelessness, consequently, can account for a case of trichinæ, and,
indeed, it is a very rarely occurring disease. This illustrates the
importance of a knowledge of the cause of the disease, to enable one
to devise a method for preventing it. In the study of disease causes,
the biologist has been very successful during the past few years, and
a number of our communicable diseases are demonstrated to be caused by
the growth and development of bacteria. From this demonstration in the
case of some, a general hypothesis has been formulated, which is useful
as a working hypothesis, but by no means safe to call a theory as yet.
This hypothesis is that all of our communicable diseases are caused by
living organisms originating in one person and conveyed to another,
where they begin to grow, to reproduce their kind and to perform their
life functions. Hence all communicating diseases are infectious. Some
of these infectious diseases, like measles or smallpox, are capable
of direct communication from one person to another, rendering them
contagious; others, like typhoid fever and cholera, are not contagious
in this sense of the word. This is a very excellent distinction to make
in the use of these much abused words.
The biologist has rendered sanitary science great service not only
in discovering the causes of certain diseases, but also by aiding
to determine the nature of the disease in any outbreak. It makes a
vast difference if a given case is one of true diphtheria or not,
or of Asiatic cholera or not, and often the symptoms alone are not
conclusive. Here the biologist comes to our aid, as is seen so often
in cases of supposed diphtheria. A portion of the throat secretion is
sent him under such precautions that no bacteria from the outside can
possibly contaminate. With this secretion he stabs or inoculates a
jelly composition which he has placed in a test-tube, stuffs a wad of
absorbent cotton in the mouth of his tube and puts it in a warm chamber
or incubator. If there are any microbes present, they will begin to
grow, and the expert biologist can tell the bacteria from its manner of
growth as readily as the gardener can distinguish between his radishes
and lettuce when they sprout in the spring, and in this way is able
to report the nature of the germs. If he is in doubt, he carries his
cultivation further and employs other tests to prove his observation.
[Illustration: LABORATORY OF THE UNIVERSITY OF PENNSYLVANIA.]