USA > Massachusetts > Middlesex County > Somerville > Report of the city of Somerville 1879 > Part 14
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After a further exposure of eighteen hours, the cow's milk and the Swiss milk were found to be coagulated, while the farinaceous and prepared foods were in a high state of putrefaction. The human milk, however, still gave an alkaline reaction, and appeared almost unchanged." - Fourth Report of Boston Board of Health. It will be seen from these experiments, the great superiority of the human milk over all other kinds of food. Next in order comes cow's milk, and then Swiss (condensed) milk; after these, the farinaceous foods.
The bacterial theory of diarrheal infection is strongly main-
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tained by eminent medical authority. Infusions of vegetable or animal substances become, in a short time after exposure to the air, turbid, and are found to contain an immense number of minute organisms called bacteria. The same infusions in sealed fla-ks which have been exposed to a high temperature undergo no change, owing to the destruction of the bacteria. These are the agents of decomposition, and without their presence there will be no change in organic matters. These organisms are found in immense numbers in air and water, and in decomposing substances they reproduce themselves with great rapidity. If the views already expressed are held in mind, it will be seen that the bac- terial theory will readily account for the great prevalence of diarrhæal diseases in the summer months and in sections of the city where insanitary conditions prevail. In such places are to be found' all the conditions favorable to decomposition of organic substances ; and it is highly probable that the artificial food pre- pared for infants in those places subject to atmospheric impurities from causes already named, has entered on the stage of decomposi- tion before being used. Add to this the fact that without the greatest care being taken in washing bottles, tubes, etc., we shall have in them putrefying substances, which will lend their evil influence in bringing about this change. Taking this view of the cause of these diseases, it will be seen that something can be done to lessen their number. As impure air and improper food are the primal causes, our efforts must be directed toward the purifying of one, and diffusing among the people a knowledge of the danger attending the use of the other.
We should not wait until the heat of the summer is upon us before we begin to remove any or all the causes which render the air impure. We should carefully inquire into the condition of our privies, and see that their contents are frequently removed. Cess- pools and drains should be examined to see that there is no danger of their rendering the air impure. Cesspools at the best are necessary evils, and their use should be discontinued as soon as it is possible to connect the house-drainage with a public sewer. Mothers cannot be compelled to nurse their children; but it is hoped that when they fully understand the importance of their doing so, they will cheerfully supply the only proper food to their infants.
Although it is not possible to demonstrate beyond doubt the pre- cise manner in which filth causes or predisposes to a certain class
236
of diseases, the presumption that it does so is further strengthened by the effects on health of an improvement in the sanitary condi- tion of towns and cities. If we can show a diminution in the death-rate from diarrhœal diseases, diphtheria, typhoid fever, and consumption, the inference is plain, that in some way these dis- eases are intimately related to such conditions of our surroundings ; there is no escape from such a conclusion. On the other hand, if it could be shown that in spite of all that had been done to in- troduce sewers, remove privies and cesspools and filth of all kinds, these diseases were as prevalent as formerly, our proposition would fall to the ground. But sufficient proof is at hand to warrant the belief that filth and disease are found together, and that by the removal of the former we materially diminish the prevalence of the latter. Dr. Buchanan instituted an inquiry as to the effects of sanitary improvements in certain English towns These consisted mainly in measures for the removal of decomposing organic mate- rial, thereby rendering air and water purer, widening and cleaning streets, improving the conditions of lodging and tenement houses, improved sewerage, etc. The following results were noticed : -
Towns.
Death-rate before construction of works.
Death-rate after construction of works.
Reduction of Typhoid Fever per cent.
Reduction of Phthisis (Consumption) per cent.
Banbury
23 4
20.5
48
41
Cardiff
33.2
22.6
40
17
Croydon
23.7
18.6
63
17
Dover
22.6
20.9
36
20
Ely
23.9
20.5
56
47
Leicester
26.4
25.2
48
32
Macclesfield
29.8
23.7
48
31
.
Merthyr
33 2
26.2
60
11
Newport
31.8
21.6
36
32
Rugby
19.1
18.6
10
43
Salisbury
27.5
21.9
75
49
Warwick
22.7
21.0
52
19
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The average reduction of typhoid-fever rate, almost one half, is a remarkable showing. It will be observed that the scourge of our New England States, consumption, was reduced in these towns about thirty per cent.
" Two hundred years ago the death-rate of London was 80 per thousand ; under the influence of sanitary improvements, it has now been reduced to 21} per thousand, in spite of the enormous growth of the town and the great crowding to which many of its people are still subjected." - Waring, "Sanitary Drainage of Houses and Towns "
" It is a well-settled fact that in localities where drainage has from any cause been imperfect, the people are more or less affected with fevers and diseases of a kindred character; but where ample drainage is afforded, it is evident that the disease subsides with the extension of drainage." - Dr. Lyster, article on "Influence of Drainage," Third Report State Board of Health of Michigan.
Dr. Brownell, of Utica, Macomb County, writes : -
" Malarial diseases here have been gradually diminishing. I have seen the time when full seventy-five per cent of all sickness had its origin in malaria. This change is due, in my judgment, in no small degree, to the artificial drainage which has been carried out in this portion of the State. I am fully convinced, from the experience and observation obtained during twenty-two years' practice in the profession of medicine, in a locality where artificial drainage was and is largely necessary in order that the land should be fit for agricultural purposes, that the authorities and people have been and will be amply repaid for all the trouble and expense in the work of drainage, by the good that has grown, and will con- tinue to grow out of it, to the public health alone." - Second Report Michigan Board of Health.
Commenting on the report for the quarter ending December, 1857, of the Registrar-General of England, Dr. Beale says : -
" As an instance of the saving of life which has been caused by the progress of civilization and of hygiene, we may mention London ; the annual mortality of which, two centuries ago, was 50 per thousand, its inhabitants living only 20 years on an average.
" The yearly death-rate was
Per thousand.
1660 to 1679
1681 to 1690
. 42.1
. 80
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Per Thousand.
1746 to 1755
.35 5
1846 to 1855
24.9
1871.
22.6
" The annual death-rate is now only 24 per thousand, and the mean duration of life 42 years Even within the past few years, a great decline has taken place in the death-rate of many places in England, which have had the benefit of , anitary improvements."
" 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 25,000 less in London, and 177,000 less in England and Wales ; or by another view, that the average age at death would be 48, instead of 21 as it then was."- Waring, " Sanitary Drainage of Houses and Towns."
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 under- drained, 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 ex- posure outside their own house. . . Pulmonary diseases especially the early stages of consumption ; all continual fevers. especially typhoid fever and uterine diseases, both of tissue and of function, are stated by the Staten Island Commission to become less severe with the natural or artificial reduction of the level of the ground moisture." - Ibid.
The late Dr. George Derby (First Annual Report Massachusetts Board of Health) wrote : -
" There is much in the records of consumption in Massachusetts during the past few years to encourage the hope that private and public hygiene are already anticipating and averting its ravages.
· Comparing the first group of five years with the last group of five years, it is seen that the annual gain in each 100,000 of the population is 54 lives. This gives as the actual saving of life in the last five years 3,440 persons, or 688 in each year."
The diminution of the consumption death-rate in the twelve English towns already referred to, subsequent to the improvements
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in their sewerage, taken in connection with the statements of Dr. Derby, and a host of other instances of a like nature, seem to con- firm the proposition of Dr. Bowditch, that " a residence on or near damp soil, whether that dampness be inherent in the soil itself, or caused by percolation from adjacent ponds, rivers, meadows, marshes, or springy soils, is one of the primal causes of consump- tion in Massachusetts, probably in New England, and possibly in other portions of the globe. Consumption can be checked in its career, and possibly, nay, probably prevented, in some instances, by attention to this law."
It will be seen from these extracts from the writings of men well qualified to judge, that in cities, sanitary improvements result in a diminution of their death-rates; that attention to the sanitary condition of towns, more particularly to the condition of privies and cesspools, and instituting measures for subsoil drainage, is attended by a gratifying diminution of typhoid fever and consump- tion ; and that as we recognize the law of contagion, the diminu- tion of small-pox, scarlet fever. and diphtheria will be observed.
SMALL-POX. VACCINATION. - At the present time these subjects are receiving more than the usual amount of attention. The re- appearance of small-pox in this country, and the opposition to vaccination in some parts of Germany and England, seem to me sufficient reason for devoting a little space to their consideration. It is claimed that vaccination is the cause of many skin diseases, scrofula, cancer, and even death. In standard medical works allu- sion is made to the fact that when the vaccine vesicles are fully formed, an eruption occasionally makes its appearance on some portions of the body of the child ; but it is of short duration, and the child afterwards enjoys its previous good health. In the case of scrofulous children in whom the disease had not previously shown itself, it would be unjust to regard vaccination as its cause. There is no well-attested case on record of a healthy child, vacci- nated with pure vaccine virus, developing any blood disease after its performance. As a means of preventing the spread of small- pox in a community, the importance of vaccination cannot be over- estimated. It is a noticeable fact that in the present century there have been, in each epidemic of small-pox, a relatively larger number of mild cases of that disease (varioloid) than there were previous to the introduction of vaccination. A glance at the history of small- pox in the eighteenth century, and a comparison with the epidem- ics of that disease in the present century, will show the very great
240
value of vaccination. " In England, in the seventeenth and eight- teenth centuries, seven to nine per cent of all deaths were attrib- utable to small-pox." - Ziemssen. Out of every 1,000 deaths in England in the half-century from 1750 to 1800, there were 96 deaths from small-pox, and of every 1,000 in the half-century from 1800 to 1850 (since the introduction of vaccination) there were only 35 deaths. As stated by Aitkens, there were during 91 years previous to inoculation (the insertion of small-pox virus into some part of the body) 65 distinct and well-marked epidemics of small- pox, which is equal to a ratio of 71.4 epidemics in 100 years. In 63 years during the practice of inoculation there were 53 epidemics, a ratio of 84 in 100 years. In 55 years since the introduction of vaccination, there were only 12 epidemics of small-pox, a ratio of 24 in 100 years. In England and Wales, at the end of the last century, 3.000 per million of the population died annually of small- pox, while the average yearly deaths from 1841 to 1853 from this disease were 3'14, and in the succeeding 10 years the average fell to 171. Vaccination was introduced into Sweden in 1801, and was made compulsory in 1810. In the 15 succeeding years, small- pox entirely disappeared. During the 12 preceding years upwards of 3,000 persons died of the disease in Copenhagen. Previous to the introduction of vaccination into Sweden the annual death-rate from small-pox was 2,050 for every million of its inhabitants. The early history of small pox in America shows the fearful rav- ages of this disease in unprotected communities. There was no small-pox in America previous to its discovery by Columbus. It was brought from Europe, and in 1517 the disease first made its appearance in San Domingo. A few years later, in one of the Spanish expeditions from Cuba to Mexico, a negro who was cov- ered with the pustules of small-pox was landed on the Mexican coast. The disease spread from him ; and in a very short time, according to Robertson, three and one half millions of the peo- ple died from the disease in that country. It was introduced into Iceland in 1707, when 16,000 persons - more than a fourth of the population - fell victims to the disease.
As showing the protective property of recent vaccination, one instance may be cited : " Among 10,000 children vaccinated at Brussels from 1865 to 1871, and living afterwards amidst the ter- rible epidemic which raged there in 1870 and 1871, there is not known a single instance of an attack of small-pox."
When vaccination was first introduced, it was claimed by its
241
advocates that it was a sure preventive' of small-pox But this claim was not well founded, for vaccinated persons have taken the disease when it prevailed as an epidemic. Its protective influence diminishes after a certain number of years, and the consequent necessity for revaccination has been recognized and insisted on by the profession. The length of time during which vaccination pro- tects the individual is variously estimated at from eight to twelve years. This should be borne in mind when the disease is prevail- ing as an epidemic, and all persons who have not been vaccinated within twelve years should be revaccinated. It is generally believed by the medical profession that in vaccination and revacci- nation we have the means of prevention of that loathsome disease, small-pox.
TYPHOID FEVER. - The production of this disease is considered by some writers to be due to the presence of a " germ," derived from the body of a person sick with the disease. These " germs" pass off from the patient in the discharges from the bowels, and, thrown into privies, enter the system through the use of well-water which has been contaminated by them. The air is also credited with being the carrier of this poison, and persons exposed to the exhalations from privies which have received the dejections from typhoid patients are liable to take the disease. Liebermeister says, " In general we can say that the disposition of any locality to an epidemic of typhoid fever depends largely upon the extent to which the inhabitants breathe or drink the contents of their privies. The greater the chances of this are, so much the greater are the probabilities that the introduction of an imported case of typhoid will produce an epidemic."
Other writers, while not denying the " germ " theory, claim that the disease is frequently caused by the use of drinking water made foul by the decomposition of organic matter, vegetable or animal, by the air loaded with exhalations from foul privies, cesspools, manure heaps, obstructed drains, etc. The late Dr. George Derby, in the Second Annual Report of the Massachusetts Board of Health, says, "The single continuous thread of probability which we have been able to follow in this inquiry leads uniformly to the decom- position of organized (and chiefly vegetable) substances, as the cause of typhoid fever as it occurs in Massachusetts."
The following account of an epidemic of typhoid fever due to the use of contaminated drinking water is taken from Waring's work on " Sanitary Drainage, etc." : ---
16
242
" There has recently been an investigation into the origin of an outbreak of typhoid 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 water pipe. 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, 2,035 people were attacked, and 104 died."
Liebermeister gives the following account of an epidemic due to the use of water infected with the poison of the disease : -
"EPIDEMIC IN SOLOTHURN IN 1865. - In a locality supplied by a certain aqueduct during the period between Aug. 15 and Sept. 15, a number of persons were attacked with typhoid fever; 82 of these cases are classified with their names. Almost all the houses supplied with water from this aqueduct contained cases of typhoid ; while other houses near and between these, but with a different water supply, escaped entirely. In the barracks which were sup- plied from the aqueduct, numerous cadets and instructors, col- lected from ten different cantons, were attacked with the disease. The disease commenced fourteen days after their moving into the bar- racks ; in eleven days 32 were attacked, and the school being then given up, after its dismissal 10 more were attacked. Out of 100 persons, 42 were attacked with severe typhoid, and 8 died. At the same time the disease appeared among the other dwellers in the barracks, although before that time there had never been a case of typhoid there. It was found on examination that a brook which passed through the court of the lunatic asylum Rosegg, and
243
received its sewerage, ran into the aqueduct. In the asylum was a nurse who had recently come from a typhoid locality. This woman was taken sick with typhoid fever about the middle of July, and died Aug. 8. The clothes of this patient were washed in the wash-house of the asylum by order of the director, and many soiled clothes were even soaked in the brook itself. After the middle of August the epidemic appeared throughout the entire locality supplied by the aqueduct."
In the paper on typhoid fever in Massachusetts, by the late Dr. Derby, and already referred to, are to be found the views of the leading medical men of the State. A few of these will suffice for my present purpose. One correspondent says, "We may con- sider the practical facts presented in this connection to be these : that quantities of decomposing matter, whether from pigsties, privies, vegetables in cellars, or decomposing leaves of newly cleared land, combined with dampness and deficient ventilation, may be among the causes of typhoid fever." Another writes, " Whenever I have had several cases of typhoid fever in one house or neighborhood, I have usually found what I considered the cause, - either a wet cellar with decaying vegetables, or a sink-drain running into a pool near the house for the purpose of making compost." Another says, " According to my observation, putrid air from decaying vegetable matter and foul sink-drains, with poorly ventilated sleeping-rooms, constitute the most frequent cause of typhoid fever." Murchison gives several instances of out- breaks of typhoid, when, in his opinion, there had been no previous pollution of air or water with the dejections of fever patients. He claims that the spontaneous origin of these cases in emanations from sewers, and in contaminated drinking water, was proved to a certainty. The practical lesson to be derived from these extracts is, in my opinion, that we should carefully guard our water supply. from all possible sources of contamination, and remove from our midst as soon as possible the contents of our privies. Whichever theory of the disease we accept, - the " germ " theory or the spon- taneous origin of the disease, - we are forced to the conclusion that we have it in our power to prevent the disease. Granting the truth of the "germ" theory, if proper precautions are taken to disinfect the discharges from the bowels, before they are thrown into water-closets or privies, it will not be possible for them to cause the production of another case. If we accept the sponta- neous origin of the disease from decomposing animal or vegetable
244
substances, the mode of prevention will suggest itself to all thoughtful persons.
It has been demonstrated that man is an active agent in the production of disease, and that it is possible to remove many of its causes and lessen its prevalence by an observance of well- known laws. But many persons die yearly who are not responsi- ble for the diseases of which they die. The parents of these persons were the subjects of disease, the tendency to which was transmitted to their offspring through the influence of heredity. Many of the deaths ascribed to such causes as teething, convul- sions, diarrhœal diseases, marasmus, etc., are of children born with impaired organizations or with a tendency to disease derived from their parents.
Prominent among the diseases that are transmitted through the influence of heredity are consumption, syphilis, scrofula, and insanity. Consumption is regarded by medical and non-medical writers as a disease that is frequently transmitted through the influence of heredity ; yet despite this knowledge, we frequently see persons who are subjects of that disease, and apparently with- out any thought of the result, marrying. In the Fourth Annual Report of the Massachusetts Board of Health there is an instruc- tive paper by Dr. Bowditch on some of the " Causes or Antece- dents of Consumption." It contains a series of questions sent to the medical correspondents of the board, and the replies received. He says that in answer to the question, " Is consumption caused or promoted by hereditary influences?" two hundred and five cor- respondents replied in the affirmative, one in the negative, and four did not reply. Commenting on these replies he says, " Coming, as these returns do, not from theorists, but from physicians who see families grow up and die under their own care, this result, though perhaps not unexpected by some readers, - certainly not by myself, - is very significant. If we can ever have faith in medical testi- mony, every parent- and still more, every one preparing by mar- riage to become a parent - should consider himself as forewarned by the above table. Still further, will not the State feel obliged at some future time to restrain the marriage of persons liable to breed consumption, even if it be considered improper and contrary to liberty at present to interfere with or prevent any such marriage, however inevitably it may be destined to produce a consumptive, wretched progeny?" When we consider how frequently the fea- tures, the form of the body, the tone of the voice, the expression
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