The Congress of the Sanitary Institute of Great Britain was opened in
Newcastle on September 26. The inaugural public meeting was held in the
Town Hall. Prof. De Chaumont presided, in the place of the ex-President,
Lord Fortescue, and introduced Captain Galton, the new President.
The President commenced his inaugural address by thanking, in the name
of the Sanitary Institute of Great Britain, the Mayor and Corporation
of Newcastle for the invitation to visit this important industrial
metropolis of Northern England. The invitation, he said, was the more
satisfactory because Newcastle was advancing in the van of sanitary
improvement, and was thus proving the interest of this great city in
a subject which was contributing largely to the moral and material
progress of the nation. Of all the definite questions which were made
the subject of the instruction by congresses at the present time, there
was scarcely one which deserved a greater share of attention than that
which called that congress together--namely, the subject of the public
health.
Within the last half century the whole community had been gradually
awakening to the importance of a knowledge of the laws of health, and
the energies of some of the ablest intellects in the world had been
employed in investigating the causes of disease, and in endeavoring to
solve the problem of the prevention of disease. There was much that was
still obscure in this very intricate problem, but the new light which
was daily being thrown upon the causes of disease by the careful and
exact researches of the chemist and physiologist was gradually tending
to explain those causes and to raise the science of hygiene, or science
of prevention of disease, out of the region of speculation, and enable
it to take rank as one of the exact sciences. Long ago the careful
observation of facts had shown that the preservation of health required
certain conditions to be observed in and around dwellings, conditions
which, when neglected, had led to the outbreaks of epidemic disease from
the days of Moses to the present time. But while the results had been
patent, it was only in recent years that a clew had been obtained to the
occult conditions in air and water to enable their comparative healthful
purity to be distinguished.
The researches of Pasteur in respect to the forms of disease in French
vineyards opened a fruitful field of inquiry, and the theories of Dr.
Bastian on spontaneous generation gave rise to the beautiful series
of experiments by Tyndall on bacterian life. A large band of leading
scientific men, both in this country and over the whole world, were
devoting their energies to a knowledge of the recent theories on the
propagation of disease by germs. In a lecture on fermentation, Tyndall
remarked that the researches, by means of which science has recently
elucidated the causes of fermentation, have raised the art of brewing
from being an art founded on empirical observation--that is to say,
on the observation of facts apart from the principles which explain
them--into what may be termed an exact science.
In like manner, if recent theories on the propagation of disease by
germs were proved to be correct, and if the laws which govern the
propagation or destruction of those germs were known, the art of the
physician would be similarly raised. Upon these questions leading
scientific men all over the world were devoting their energies. Research
had shown that putrefaction was only another form of organized life, and
Tyndall had shown that in the moving particles of fine dust discovered
by a ray of light in a dark room the germs of low forms of life, which
would cause putrefaction, were ever present, and ready to spring into
life when a favorable "nidus" for the development of the organism was
provided.
Professor Lister had turned this knowledge to useful account in surgery
in causing the air to be filtered by means of a carbolic spray during
surgical operations, by which means germs or organisms in the air were
prevented from reaching the wounds, and from developing organisms, the
presence of which caused putrefaction or suppuration. This antiseptic
treatment, which had arisen from the observation of germs in the air,
had had a material influence on the art of surgery throughout the world.
The speaker then reviewed the declarations of physiologists regarding
the theories that some diseases arise from minute organisms in the
blood--Pasteur holding that the disease in silkworms was from this
cause; Dr. Davaine, that splenic fever in cattle arose thus; Dr. Klein
alleging that pig typhoid was due to an organism; Toussaint attributing
fowl cholera to a similar cause; Professor Koch attributing tubercular
disease to specific germs; Dr. Vandyke Carter contending that there was
a connection between the presence of bacillus spirillum and relapsing
fever; and Mr. Talamon claiming to have discovered that diphtheria was
due to an organism by means of which the virus could be conveyed from
human beings to animals, and _vice versa_.
Taking another branch of the same subject, the causes of zymotic
diseases being traced to controllable sources, he said: Drs. Klebs and
Crudelli allege that malarial fever arises from germs present in the
soil and which float over the air of marshes; and that by treating with
water the soil of a fever-haunted marsh of the Campagna the germs of
this organism could be washed out; and that the water containing the
organisms thus obtained, introduced into the circulation of a dog,
produced ague more or less rapidly, and more or less violent, according
to the numbers in which the organisms were present in the water.
This theory, no doubt, agrees with certain well-known facts. In a
tropical climate, if soil which has been long undisturbed, or the soil
of marshy ground, be turned up, intermittent fever is almost certain to
ensue. In illustration of this, I recollect that at Hong Kong the troops
were unhealthy, and a beautiful position on a peninsula exposed to the
most favorable sea-breezes was selected for a new encampment. The troops
were encamped upon this spot for some time to test its healthiness,
which was found to be all that could be desired. It was then resolved to
build barracks. As soon as the foundations were dug, fever broke out.
As an instance of this nearer home, I may mention that last winter at
Cannes, in the south of France, some extensive works adjacent to the
town were begun which required a large quantity of earth to be moved.
The weather was exceptionally warm; an outbreak of fever occurred among
the workmen, of whom fifteen died. This fever was attributed to the
turning up of the soil.
If a strong solution of quinine be let fall in the water containing
these organisms they at once die; the efficacy of quinine as a
preventive of this form of fever would therefore not be inconsistent
with this theory. Upon this subject the President called attention to
the view of Sir Joseph Fayrer, who acknowledged the importance of the
discovery if it should be confirmed, but considered that there was a
possibility that the results attributed to these influences might, to
some extent, be due to disturbance of the system in a body predisposed
to be deranged by peculiarity of constitution, climatic or other
influence of the nature of which we are ignorant, though it is
conceivable by analogy.
The marvelous facility of reproduction of various germs, as shown
by Pasteur in the case of chicken cholera, was dwelt upon; and the
President said that it would be a wonder how any higher form of life
could exist subject to the possibility of invasion by such countless
hosts of occult enemies were it not seen that the science of the
prevention of disease advanced quite as rapidly as our knowledge of the
causes. Holding that the attitude of the sanitarian, in regard to the
germ theory of diseases, as applied to all diseases of the zymotic
class, must be one of reserve, yet, he said, even if the views of those
who are prepared to accept the germ theory of disease to its fullest
extent were shown to be true, it seems to be certain that if the
invasion of these occult enemies present in the air is undertaken in
insufficient force, or upon an animal in sufficiently robust health,
they are refused a foothold and expelled; or, if they have secured a
lodgment in the tissues, they, so to speak, may be laid hold of, and
absorbed or digested by them.
In corroboration of this view, Professor Koch and others state that the
minor organisms of tubercular disease do not occur in the tissues of
healthy bodies, and that when introduced into the living body their
propagation and increase is greatly favored by a low state of the
general health. The President held that for the present sanitary
procedure was independent of these theories on the germ origin in
particular of zymotic disease; but gave the facts as worthy of
consideration, as indicating points for the direction of those who aimed
at preventing disease.
The President dealt with the important subject of isolation in the cases
of contagious zymotic diseases, and then, proceeding to discuss the
subject of epidemic diseases, said: Notwithstanding the numerous
experiments and the great efforts which have been made in recent times
to endeavor to trace out the origin of disease, the sanitarian has not
yet been able to lift up the veil which conceals the causes connected
with the occurrence of epidemic diseases. These diseases come in
recurring periods, sometimes at longer, sometimes at shorter intervals.
Animals, as well as the human race, are similarly affected by these
diseases of periodical recurrence; but why they prevail more in one year
than in another we are entirely ignorant. They appear to be subject to
certain aerial or climatic conditions.
Cholera affords an illustration of this. There is a part of India,
low-lying, water-logged, near the mouth of the Ganges, where cholera may
be said to be endemic. In certain years, but why we know not, it spreads
out of this district, and moves westward over the country; the people
are sedentary, and seldom leave home, but the cholera travels on. At
last it arrives on the borders of the desert, where there are no people,
and no intercourse, no alvine secretions, and no sewers, yet the
statistician sitting in Calcutta can tell almost the day on which the
epidemic influence will have crossed the desert. But it exercises
discrimination in its attacks, It will visit one town or village and
leave many others in the vicinity untouched. Similarly it will attack
one house and leave another. But it has been generally found that
the attacked house or village held out special invitation from its
insanitary condition. The same houses or the same localities will be
revisited in recurring epidemics, because the conditions remain the
same; remove those conditions, and at the next recurrence the locality
will escape. At Malta it was found that the same localities and houses
which yielded the majority of plague deaths there in 1813 yielded the
majority of the deaths in the cholera epidemics of 1839 and 1867, and
that in the intervals the same localities yielded the majority of cases
of small-pox, fever, and of an anthrax, a very special eruptive epidemic
attended by carbuncles. Hence, while we are unable either to account
for the cause or to prevent the periodic recurrence of epidemics, the
sanitarian has learnt that it is possible to mitigate the severity of
the visit; and that, whether these evils arise from the occult causes
to which I have alluded, or from other causes, pure air and pure
water afford almost absolute safeguards against most forms of zymotic
diseases.
In speaking of the pure-water question, he remarked: Although there are
many theories as to how far water which has once been contaminated by
sewage may again after a time become fit to drink, I am disposed to
think that there has never been a well-proved case of an outbreak of
disease resulting from the use of drinking water where the chemist would
not unhesitatingly on analysis have condemned the water as an impure
source; and it appears probable that, whatever may be the actual causes
of certain diseases--i.e., whether germs or chemical poisons, the
_materies morbi_ which finds its way into the river at the sewage
outfall is destroyed, together with the organic impurity, after a
certain length of flow. He pressed that there should be no further delay
in bringing the Act for the Prevention of Pollution of Rivers into
operation, and in enforcing the provisions of the Acts. In regard to the
pollution of the air, he called attention to the fact that nearly fifty
years ago Mr. Edwin Chadwick impressed upon the community the evils
which were caused by the impure condition of the air in our towns owing
to the retention of refuse around houses. The speaker remarked that the
gases, which were the result of putrefaction, were offensive to the
smell, and some of them, such as sulphureted hydrogen, when present in
undue proportions in the air, would kill persons outright, or when those
gases were in smaller proportions in the air breathed by people, there
would be a lowered tone of health in the individuals exposed to them.
Continued exposure might lead to the development of other conditions,
which, in their turn, might lead to disease or death.
From this point the President proceeded to speak of the increased
toxical power of volatile compounds given off by neglected decomposed
matter, and was thence led to dwell upon the dangers arising from
decomposed substances in cesspools and in badly constructed drains.
There was no doubt, he said, that in the sewering of towns want of
experience in the construction of works had in some cases led to
deposits in the sewers, and evil consequences had ensued; but it might
be accepted as certain that in every case where the sewerage had been
devised on sound principles, and where the works had been carried
on under intelligent supervision, a largely reduced death-rate had
invariably followed.
Evidence of this fact he adduced from the history of Newcastle, for in
the ten years beginning in 1867 the death-rate was 27.6, while in the
ten years ending 1881 (during which there had been improved sewerage in
operation) the death-rate was only 23, while in 1881 it was only
21.7. He instanced the like results in Munich, where the entire fever
mortality sank from 24.2 in the period when there were no regulations
in regard to cleanliness to 8.7 when the sewerage was complete, at
Frankfort-on-the-Main, at Dantzic, and at Hamburg, where similar results
obtained of a heavy zymotic mortality previous to the sewering of the
cities, and a lighter mortality on the completion of the works.
These results were set forth in figures, and after dealing with
the beneficial results of purifying the air of towns by the rapid
abstraction of refuse matter, he passed on to review "other fertile
causes of mischief" in poisoning the air of towns, the chief of these
being horse manure, the dust of refuse, and smoke.
On this subject he quoted Dr. Angus Smith, who in his "Contributions to
the Beginnings of a Chemical Climatology," shows that the air in the
middle of the Atlantic Ocean, on the sea-shore, and on uncontaminated
open spaces, commands the greatest amount of oxygen; that at the tops of
hills the air contains more oxygen than at the bottom; and that places
where putrefaction may be supposed to exist are subject to a diminution
of oxygen.
For instance, a diminution of oxygen and an increase of carbonic acid is
decidedly apparent in crowded rooms, theaters, cowhouses, and stables.
It is well known that oxygen over putrid substances is absorbed, while
carbonic acid and other gases take its place; and hence all places near
or in our houses which contain impurities diminish the oxygen of the
air. The average quantity of oxygen in pure air amounts to 21 parts out
of 100. In impure places, such, for instance, as in a sleeping-room
where the windows have been shut all night, or in a lecture-theater
after a lecture, or in a close stable, the oxygen has been found to be
reduced to as little as 20 parts in 100.
That is to say, a man breathing pure air obtains, and he requires, 2,164
grains of oxygen per hour. In bad air he would, if breathing at the same
rate, get little over 2,000 grains of oxygen an hour--that is, a loss
of 5 per cent.; and this diminished quantity of oxygen is replaced with
other, and in almost all cases, pernicious matters. The oxygen is the
hard-working, active substance that keeps up the fire, cooks the food,
and purifies the blood; and, of course, as the proportion of oxygen in
the air breathed diminishes, the lungs must exert themselves more to
obtain the necessary quantity of oxygen for carrying on the functions of
life. If the air is loaded with impurities the lungs get clogged, and
their power of absorbing the oxygen that is present in the air is
diminished. An individual breathing this impure air must therefore do
less work; or, if he does the same amount of work, it is at a greater
expense to his system.
The influence of smoky town air on health is to some extent illustrated
by the fact that the death-rate of twenty-three manufacturing towns,
selected chiefly for their smoky character, averaged 21.9 per 1,000 in
1880; while the rural districts in the counties of Wilts, Dorset, and
Devon, excluding large towns, averaged 17.7 per 1,000; and the deaths
from the principal zymotic diseases in the towns were more than double
those in the rural districts.
The President quoted the experiments of Mr. Aitkin, of Edinburgh, on the
creation of fogs--that the vapor of water injected into air, from which
particles had been strained out, was not visible; whereas as soon as
foreign matter, such as dust, or smoke, or fumes, and especially
fumes of sulphur, were introduced, the aqueous vapor condensed on the
particles, and became visible as fog, and pointed out the fact that the
barbarous method which we adopt for burning coal in this country adds to
the dust the fumes which necessarily result from combustion, as well as
a quantity of soot and tarry matter, a soot which assists in forming the
black canopy which it is the fashion in England to consider the proper
attribute of a large town.
He quoted the opinions of eminent scientific men to show that it was
possible, under proper methods of burning coal, to lessen the intensity
of fogs, and so to lessen materially the causes of ill-health,
terminating in fatal disease of those subject to them. In dealing with
the wide subject of the "general effect of sanitary conditions upon
health," he gave some remarkable facts showing that sanitary work had
reduced the death-rate of the European army in India from 60 per 1,000
to 16 per 1,000; that the deaths from tubercular disease in the army at
home used to be 10 per 1,000--the sum total now of the total deaths from
all causes in a time of peace--a reduction due to the improved hygienic
conditions under which soldiers now live; that the death-rate in a
certain part of Newcastle (now removed) used to be 54 per 1,000, and of
the entire borough 26.1 so lately as seven years ago, while now it was
21.8; that in parts of London, where the people were ill-lodged and
crowded, as in parts of Limehouse, Whitechapel, Aldgate, and St.
Giles's, the death-rates were 50 per cent. above the death-rates in more
open parts of the same districts, and that when proper dwellings were
erected the death-rates fell from 50 in the 1,000 to not more than 20
per 1,000. He then spoke of the advantage arising to the health of the
population generally by the new dwellings for artisans.
He remarked that these improved dwellings "afford accommodation to a
population per acre as dense as, and in most cases even denser than,
that afforded by the buildings which they replaced. Within limits it is
not the density of population which regulates the health. But if a dense
population is spread over the surface or close to the surface of the
ground, by which means all movement of air is prevented, and if there
are numerous corners in which refuse is accumulated, it will be
difficult to prevent disease. Dr. Angus Smith's experiments show that
while there is less oxygen and more carbonic acid in the eastern and
in the more crowded parts of London, yet in open spaces the amount of
oxygen rises and the carbonic acid diminishes very considerably; and
that we are exposed to distinct currents of good air in the worst, and
equally to currents of bad air in the best atmosphere, in towns like
Manchester.
Dr. Tyndall showed that where there is quiescence in the air the
tendency of his sterilized infusions to produce organisms was increased.
The conclusion from all these experiments is to show the importance of
laying out the general plan of dwellings in a town so that currents of
air shall be able to flow on all sides with as little impediment as
possible, by which means the air will be continually liable to renewal
by purer air. The dwellings which have been constructed in the place of
the very defective dwellings condemned by the medical officers of health
in various parts of London specially illustrate the importance of this
question of the circulation of air. These dwellings replace those in
which the normal mortality was as much as 33, 44, and 50 per 1,000. But
these improved dwellings provide ample space all round the blocks
of building, so that air can flow round and through them in every
direction, and so that there are no narrow courts and hidden corners for
the accumulation of refuse. The mortality in the new dwellings is as low
as 13 per 1,000 in some, and does not rise above 20 per 1,000 in any of
them, and upon an average of years it may be taken at from 14 to 16
per 1,000. It is to this point that I specially desire to draw
attention--namely, that these facts prove the possibility of bringing
down the death-rate of the class of population which inhabits this sort
of accommodation to rates varying from 15 to 16 per 1,000. I say of the
class of population, because habits and mode of life have an important
influence on health and on longevity.
Mr. Chadwick and Dr. Richardson obtained some statistics for
Westminster, for the use of a committee of the Society of Arts, which
indicate the very different conditions of health to which the different
classes of population are subject. It appeared from these statistics
that out of one hundred deaths of the first class, or gentry, six were
those of children in their first year, and nine of children within
their fifth year; while out of one hundred deaths of the wage classes
twenty-two are those of children in their first year, and thirty-nine
within their fifth year. If we take the average duration of life of all
who have died of the first class, men, women, and children, we find that
they have had an average of fifty-five years and eight months of life;
while of the wage classes they have had a mean of only twenty-eight
years and nine months. And if we take the average duration of life of
those who have escaped the earlier ravages of death up to twenty years
of age, the males who have died of the first class have had sixty-one
years of life, while of the wage class the males have had only
forty-seven years and seven months. Moreover, of the first class in
Westminster, the proportion who have attained the old age, and died
of natural causes, is 3.27 per cent., but of the wage classes only a
fraction, or two-thirds per cent., did so. I have obtained similar
returns for this town. It was considered desirable, for the purpose of
this return, to divide the population into the following five classes:
First, gentry and professional men; second, tradesmen and shopkeepers;
third, shipwrights, chain and anchor smiths, iron forge laborers, etc.,
fourth, seamen, watermen, fishermen, etc.; fifth, other wage clashes
and artisans; and each of these classes represents distinct sanitary
conditions and habits of life. The healthiest class is that of the
seamen, watermen, and fishermen. The mean age at death of all who died
of that class, men, women, and children, is thirty-seven years, as
compared with thirty five years for gentry and professional men; while
the mean age of shipwrights, chain and anchor makers, and iron forge
laborers is only twenty-two years. The President considered that these
points gave much food for reflection. He then touched upon the important
question of the effect of occupation upon health, and remarked: If we
take the professional and merchant class, who attend at their offices
during the daytime, we may be sure that, as a rule, they are placed
in unhealthy surroundings during that time, and in many cases have to
breathe during their hours of work as bad an atmosphere as that in which
the wage classes work. He also quoted returns showing that the great
mortality among the tradesmen class in Westminster was explained from
the fact that the best rooms in the houses in which they live were let
for lodgings, the tradesmen contenting themselves with living in the
basements or back premises, which were frequently unhealthy. He looked
for great improvements in the health of the wage classes by the
construction of improved dwellings; but, he confessed, in many cases
workmen required to be taught to attend to precautions devised for their
health.
On the subject of sickness caused by insanitary conditions, he quoted
the remark of an East London clergyman that the "poor go on living in
wretched places, but have much ill-health." He showed from Mr. Burdett's
figures that the London voluntary hospitals and dispensaries cost nearly
£600,000 a year to administer--an expenditure incurred mainly for the
purpose of "patching up" the wretched poor who had been injured by bad
drainage, want of ventilation and the like; and he urged that it might
be safely assumed preventive measures would bring down the death-rate of
the wage class to one-half, reducing also the sickness rate in at least
a similar proportion. By means of this item alone the wage-earning power
of the industrious classes would be enlarged by some millions of pounds,
and their comfort correspondingly increased. There would also, he
contended, be other distinct economies, for there would be less need for
much of the accommodation in prisons, reformatories, and workhouses
now needed from evils incident to unhealthy circumstances and crowded
dwellings.
He dwelt upon the economic advantages of sanitary measures generally,
dealing first with the subject of the conversion of sewage into manure,
and then, in relation to the provision of healthful dwellings, such as
those of the Metropolitan Association for Improving the Dwellings of the
Industrial Classes, he showed that the cost of such dwellings had been
about £1,900,000 for 11,000 persons. By the saving in life and health,
through the continuance in earning power of men, whose lives would
otherwise have been cut short, he estimated that the expenditure of the
£1,900,000 for the 11,000 persons, by the addition often years' earning
power to the heads of families, brought in a return of £4,600,000, and
urged these facts as showing the pecuniary advantages accruing to the
nation from sanitary improvements which led to decreased death and
sickness rates. On the one hand, he said, insanitary dwellings and
insanitary conditions of life engendered sickness, entailed poverty, and
fostered crime, while improved dwellings insured improved health, and by
affording a security for the more continuous earning of wages created
the possibility of a comfortable home. Advanced sanitarians had long
preached these doctrines, and he was happy to think that they were at
last beginning to hear some results, and in those results he saw the
means of developing morality, contentment, and happiness among the
people.
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