CHAPTER X. - MALARIAL DISEASES.
So far as remote agricultural districts are concerned, it is not probable that the mere question of health would induce the undertaking of costly drainage operations, although this consideration may operate, in connection with the need for an improved condition of soil, as a strong argument in its favor. As a rule, "the chills" are accepted by farmers, especially at the West, as one of the slight inconveniences attending their residence on rich lands; and it is not proposed, in this work, to urge the evils of this terrible disease, and of "sun pain," or "day neuralgia," as a reason for draining the immense prairies over which they prevail. The diseases exist,—to the incalculable detriment of the people,—and thorough draining would remove them, and would doubtless bring a large average return on the investment;—but the question is, after all, one of capital; and the cost of such draining as would remove fever-and-ague from the bottom lands and prairies of the West, and from the infected agricultural districts at the East, would be more than the agricultural capital of those districts could spare for the purpose.
In the vicinity of cities and towns, however, where more wealth has accumulated, and where the number of persons subjected to the malarial influence is greater, there can be no question as to the propriety of draining, even if nothing but improved health be the object.
Then again, there are immense tracts near the large cities of this country which would be most desirable for residence, were it not that their occupancy, except with certain constant precautions, implies almost inevitable suffering from fever-and-ague, or neuralgia.
Very few neighborhoods within thirty miles of the city of New York are entirely free from these scourges, whose influence has greatly retarded their occupation by those who are seeking country homes; while many, who have braved the dangers of disease in these localities, have had sad cause to regret their temerity.
Probably the most striking instance of the effect of malaria on the growth and settlement of suburban districts, is to be found on Staten Island. Within five miles of the Battery; accessible by the most agreeable and best managed ferry from the city; practically, nearer to Wall street than Murray Hill is; with most charming views of land and water; with a beautifully diversified surface, and an excellent soil; and affording capital opportunities for sea bathing, it should be, (were it not for its sanitary reputation, it inevitably would be,) one vast residence-park. Except on its extreme northern end, and along its higher ridges, it has,—and, unfortunately, it deserves,—a most unenviable reputation for insalubrity. Here and there, on the southern slope also, there are favored places which are unaccountably free from the pest, but, as a rule, it is, during the summer and autumn, unsafe to live there without having constant recourse to preventive medication, or exercising unusual and inconvenient precautions with regard to exposure to mid-day sun and evening dew. There are always to be found attractive residences, which are deserted by[pg 210] their owners, and are offered for sale at absurdly low prices. There are isolated instances of very thorough and very costly draining, which has failed of effect, because so extensive a malarial region cannot be reclaimed by anything short of a systematic improvement of the whole.
It has been estimated that the thorough drainage of the low lands, valleys and ponds of the eastern end of the island, including two miles of the south shore, would at once add $5,000,000 to the market value of the real estate of that section. There can be no question that any radical improvement in this respect would remove the only obstacle to the rapid settlement of the island by those who wish to live in the country, yet need to be near to the business portion of the city. The hope of such improvement being made, however, seems as remote as ever,—although any one at all acquainted with the sources of miasm, in country neighborhoods, can readily see the cause of the difficulty, and the means for its removal are as plainly suggested.
Staten Island is, by no means, alone in this respect. All who know the history of the settlement of the other suburbs of New York are very well aware that those places which are free from fever-and-ague and malarial neuralgia, are extremely rare.
The exact cause of fever-and-ague and other malarial diseases is unknown, but it is demonstrated that, whatever the cause is, it is originated under a combination of circumstances, one of which is undue moisture in the soil. It is not necessary that land should be absolutely marshy to produce the miasm, for this often arises on cold, springy uplands which are quite free from deposits of muck. Thus far, the attention of scientific investigators, given to the consideration of the origin of malarial diseases, has failed to discover any well established facts concerning it; but there have been developed certain theories, which[pg 211] seem to be sustained by such knowledge as exists on the subject.
Dr. Bartlett, in his work on the Fevers of the United States, says:—"The essential, efficient, producing cause of periodical fever,—the poison whose action on the system gives rise to the disease,—is a substance or agent which has received the names of malaria, or marsh miasm. The nature and composition of this poison are wholly unknown to us. Like most other analogous agents, like the contagious principle of small-pox and of typhus, and like the epidemic poison of scarletina and cholera, they are too subtle to be recognized by any of our senses, they are too fugitive to be caught by any of our contrivances.
"As always happens in such cases and under similar circumstances, in the absence of positive knowledge, we have been abundantly supplied with conjecture and speculation; what observation has failed to discover, hypothesis has endeavored and professed to supply. It is quite unnecessary even to enumerate the different substances to which malaria has been referred. Amongst them are all of the chemical products and compounds possible in wet and marshy localities; moisture alone; the products of animal and vegetable decomposition; and invisible living organisms. * * * * Inscrutable, however, as the intimate nature of the substances or agents may be, there are some few of its laws and relations which are very well ascertained. One of these consists in its connection with low, or wet, or marshy localities. This connection is not invariable and exclusive, that is, there are marshy localities which are not malarious, and there are malarious localities which are not marshy; but there is no doubt whatever that it generally exists."
In a report to the United States Sanitary Commission, Dr. Metcalfe states, that all hypotheses, even the most[pg 212] plausible, are entirely unsupported by positive knowledge, and he says:—
"This confession of ignorance still leaves us in possession of certain knowledge concerning malaria, from which much practical good may be derived.
"1st. It affects, by preference, low and moist localities.
"2d. It is almost never developed at a lower temperature than 60° Fahrenheit.
"3d. Its evolution or active agency is checked by a temperature of 32°.
"4th. It is most abundant and most virulent as we approach the equator and the sea-coast.
"5th. It has an affinity for dense foliage, which has the power of accumulating it, when lying in the course of winds blowing from malarious localities.
"6th. Forests, or even woods, have the power of obstructing and preventing its transmission, under these circumstances.
"7th. By atmospheric currents it is capable of being transported to considerable distances—probably as far as five miles.
"8th. It may be developed, in previously healthy places, by turning up the soil; as in making excavations for foundations of houses, tracks for railroads, and beds for canals.
"9th. In certain cases it seems to be attracted and absorbed by bodies of water lying in the course of such winds as waft it from the miasmatic source.
"10th. Experience alone can enable us to decide as to the presence or absence of malaria, in any given locality.
"11th. In proportion as countries, previously malarious, are cleared up and thickly settled, periodical fevers disappear—in many instances to be replaced by the typhoid or typhus."
La Roche, in a carefully prepared treatise on "Pneumonia; its Supposed Connection with Autumnal Fevers," recites[pg 213] various theories concerning the mode of action of marsh miasm, and finds them insufficient to account for the phenomena which they produce. He continues as follows:—
"All the above hypotheses failing to account for the effects in question, we are naturally led to the admission that they are produced by the morbific influence of some special agent; and when we take into consideration all the circumstances attending the appearance of febrile diseases, the circumscribed sphere of their prevalence, the suddenness of their attack, the character of their phenomena, etc., we may safely say that there is nothing left but to attribute them to the action of some poison dissolved or suspended in the air of the infected locality; which poison, while doubtless requiring for its development and dissemination a certain degree of heat, and terrestrial and atmospheric moisture, a certain amount of nightly condensation after evaporation, and the presence of fermenting or decomposing materials, cannot be produced by either of these agencies alone, and though indicated by the chemist, betrays its presence by producing on those exposed to its influence the peculiar morbid changes characterizing fever."
He quotes the following from the Researches of Dr. Chadwick:—
"In considering the circumstances external to the residence, which affect the sanitary condition of the population, the importance of a general land-drainage is developed by the inquiries as to the cause of the prevalent diseases, to be of a magnitude of which no conception had been formed at the commencement of the investigation. Its importance is manifested by the severe consequences of its neglect in every part of the country, as well as by its advantages in the increasing salubrity and productiveness wherever the drainage has been skillful and effectual."
La Roche calls attention to these facts:—That the acclimated residents of a malarious locality, while they are less subject than strangers to active fever, show, in their physical and even in their mental organization, evident indications of the ill effects of living in a poisonous atmosphere,—an evil which increases with successive generations, often resulting in a positive deterioration of the race; that the lower animals are affected, though in a less degree than man; that deposits of organic matter which are entirely covered with water, (as at the bottom of a pond,) are not productive of malaria; that this condition of saturation is infinitely preferable to imperfect drainage; that swamps which are shaded from the sun's heat by trees, are not supposed to produce disease; and that marshes which are exposed to constant winds are not especially deleterious to persons living in their immediate vicinity,—while winds frequently carry the emanations of miasmatic districts to points some miles distant, where they produce their worst effects. This latter statement is substantiated by the fact that houses situated some miles to the leeward of low, wet lands, have been especially insalubrious until the windows and doors on the side toward the source of the miasm were closed up, and openings made on the other side,—and thenceforth remained free from the disease, although other houses with openings on the exposed sides continued unhealthy.
The literature relating to periodical fevers contains nothing else so interesting as the very ingenious article of Dr. J. H. Salisbury, on the "Cause of Malarious Fevers," contributed to the "American Journal of Medical Science," for January, 1866. Unfortunately, while there is no evidence to controvert the statements of this article, they do not seem to be honored with the confidence of the profession,—not being regarded as sufficiently authenticated to form a basis for scientific deductions. Dr. Salisbury claims to have discovered the cause of malarial fever in the spores of a very[pg 215] low order of plant, which spores he claims to have invariably detected in the saliva, and in the urine, of fever patients, and in those of no other persons, and which he collected on plates of glass suspended over all marshes and other lands of a malarious character, which he examined, and which he was never able to obtain from lands which were not malarious. Starting from this point, he proceeds, (with circumstantial statements that seem to the unprofessional mind to be sufficient,) to show that the plant producing these spores is always found, in the form of a whitish, green, or brick-colored incrustation, on the surface of fever producing lands; that the spores, when detached from the parent plant, are carried in suspension only in the moist exhalations of wet lands, never rising higher, (usually from 35 to 60 feet,) nor being carried farther, than the humid air itself; that they most accumulate in the upper strata of the fogs, producing more disease on lands slightly elevated above the level of the marsh than at its very edge; that fever-and-ague are never to be found where this plant does not grow; that it may be at once introduced into the healthiest locality by transporting moist earth on which the incrustation is forming; that the plant, being introduced into the human system through the lungs, continues to grow there and causes disease; and that quinia arrests its growth, (as it checks the multiplication of yeast plants in fermentation,) and thus suspends the action of the disease.
Probably it would be impossible to prove that the foregoing theory is correct, though it is not improbable that it contains the germ from which a fuller knowledge of the disease and its causes will be obtained. It is sufficient for the purposes of this work to say that, so far as Dr. Salisbury's opinion is valuable, it is,—like the opinion of all other writers on the subject,—fully in favor of perfect drainage as the one great preventive of all malarial diseases.
The evidence of the effect of drainage in removing the cause of malarial diseases is complete and conclusive. Instances of such improvement in this country are not rare, but they are much less numerous and less conspicuous here than in England, where draining has been much more extensively carried out, and where greater pains have been taken to collect testimony as to its effects.
If there is any fact well established by satisfactory experience, it is that thorough and judicious draining will entirely remove the local source of the miasm which produces these diseases.
The voluminous reports of various Committees of the English Parliament, appointed to investigate sanitary questions, are replete with information concerning experience throughout the whole country, bearing directly on this question.
Dr. Whitley, in his report to the Board of Health, (in 1864,) of an extended tour of observation, says of one town that he examined:—
"Mr. Nicholls, who has been forty years in practice here, and whom I was unable to see at the time of my visit, writes: Intermittent and remittent are greatly on the decline since the improved state of drainage of the town and surrounding district, and more particularly marked is this alteration, since the introduction of the water-works in the place. Although we have occasional outbreaks of intermittent and remittent, with neuralgic attacks, they yield more speedily to remedies, and are not attended by so much enlargement of the liver or spleen as formerly, and dysentery is of rare occurrence."
Dr. Whitley sums up his case as follows:—
"It would appear from the foregoing inquiry, that intermittent and remittent fevers, and their consequences, can no longer be regarded as seriously affecting the health of the population, in many of the districts, in which those diseases were formerly of a formidable character.[pg 217] Thus, in Norfolk, Lincolnshire, and Cambridgeshire, counties in which these diseases were both frequent and severe, all the evidence, except that furnished by the Peterborough Infirmary, and, in a somewhat less degree, in Spaulding, tends to show that they are at the present time, comparatively rare and mild in form."
He mentions similar results from his investigations in other parts of the kingdom, and says:—
"It may, therefore, be safely asserted as regards England generally, that:—
"The diseases which have been made the subject of the present inquiry, 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;" again:
"The change of local circumstances, unanimously declared to be the most immediate in influencing the prevalence of malarious diseases, is land drainage;" and again:
"Except in a few cases in which medical men believed that these affections began to decline previously to the improved drainage of the places mentioned, the decrease in all of the districts where extensive drainage has been carried out, was stated to have commenced about the same time, and was unhesitatingly attributed to that cause."
A select Committee of the House of Commons, appointed to investigate the condition and sanitary influence of the Thames marshes, reported their minutes of evidence, and their deductions therefrom, in 1854, The following is extracted from their report:
"It appears from the evidence of highly intelligent and eminent gentlemen of the medical profession, residing in the neighborhood of the marshes on both sides of the[pg 218] Thames below London Bridge, that the diseases prevalent in these districts are highly indicative of malarious influences, fever-and-ague being very prevalent; and that the sickness and mortality are greatest in those localities which adjoin imperfectly drained lands, and far exceed the usual average; and that ague and allied disorders frequently extend to the high grounds in the vicinity. In those districts where a partial drainage has been effected, a corresponding improvement in the health of the inhabitants is perceptible."
In the evidence given before the committee, Dr. P. Bossey testified that the malaria from salt marshes varied in intensity, being most active in the morning and in the Summer season. The marshes are sometimes covered by a little fog, usually not more than three feet thick, which is of a very offensive odor, and detrimental to health. Away from the marshes, there is a greater tendency to disease on the side toward which the prevailing winds blow.
Dr. James Stewart testified that the effect of malaria was greatest when very hot weather succeeds heavy rain or floods. He thought that malaria could be carried up a slope, but has never been known to descend, and that, consequently, an intervening hill affords sufficient protection against marsh malaria. He had known cases where the edges of a river were healthy and the uplands malarious.
In Santa Maura and Zante, where he had been stationed with the army, he had observed that the edge of a marsh would be comparatively healthy, while the higher places in the vicinity were exceedingly unhealthy. He thought that there were a great many mixed diseases which began like ague and terminated very differently; those diseases would, no doubt, assume a very different form if they were not produced by the marsh air; many diseases are very difficult to treat, from being of a mixed character[pg 219] beginning like marsh fevers and terminating like inflammatory fevers, or diseases of the chest.
Dr. George Farr testified that rheumatism and tic-doloreux were very common among the ladies who live at the Woolwich Arsenal, near the Thames marshes. Some of these cases were quite incurable, until the patients removed to a purer atmosphere.
W. H. Gall, M. D., thought that the extent to which malaria affected the health of London, must of course be very much a theoretical question; "but it is very remarkable that diseases which are not distinctly miasmatic, do become much more severe in a miasmatic district. Influenzas, which prevailed in England in 1847, were very much more fatal in London and the surrounding parts than they were in the country generally, and influenza and ague poisons are very nearly allied in their effects. Marsh miasms are conveyed, no doubt, a considerable distance. Sufficiently authentic cases are recorded to show that the influence of marsh miasm extends several miles." Other physicians testify to the fact, that near the Thames marshes, the prevalent diseases are all of them of an aguish type, intermittent and remittent, and that they are accompanied with much dysentery. Dr. John Manly said that, when he first went to Barking, he found a great deal of ague, but since the draining, in a population of ten thousand, there are not half-a-dozen cases annually and but very little remittent.
The following Extract is taken from the testimony of Sir Culling Eardly, Bart.:
"Chairman:—I believe you reside at Belvidere, in the parish of Erith?—Yes.—Ch.: Close to these marshes?—Yes.—Ch.: Can you speak from your own knowledge, of the state of these marshes, with regard to public health?—Sir C.: I can speak of some of the results which have been produced in the neighborhood, from the condition of the marshes; the neighborhood is in one[pg 220] continual state of ague. My own house is protected, from the height of its position, and a gentleman's house is less liable to the influence of malaria than the houses of the lower classes. But even in my house we are liable to ague; and to show the extraordinary manner in which the ague operates, in the basement story of this house where my men-servants sleep, we have more than once had bad ague. In the attics of my house, where my maid-servants sleep, we have never had it. Persons are deterred from settling in the neighborhood by the aguish character of the country. Many persons, attracted by the beauty of the locality, wish to come down and settle; but when they find the liability to ague, they are compelled to give up their intention. I may mention that the village of Erith itself, bears marks of the influence of malaria. It is more like one of the desolate towns of Italy, Ferrara, for instance, than a healthy, happy, English village. I do not know whether it is known to the committee, that Erith is the village described in Dickens' Household Words, as Dumble-down-deary, and that it is a most graphic and correct description of the state of the place, attributable to the unhealthy character of the locality."
He also stated that the ague is not confined to the marshes, but extends to the high lands near them.
The General Board of Health, of England, at the close of a voluminous report, publish the following "Conclusions as to the Drainage of Suburban Lands:—
"1. Excess of moisture, even on lands not evidently wet, is a cause of fogs and damps.
"2. Dampness serves as a medium for the conveyance of any decomposing matter that may be evolved, and adds to the injurious effects of such matters in the air:—in other words the excess of moisture may be said to increase or aggravate atmospheric impurities.
"3. The evaporation of the surplus moisture lowers the temperature, produces chills, and creates or aggravates the sudden and injurious changes or fluctuations by which health is injured."
In view of the foregoing opinions as to the cause of malaria, and of the evidence as to the effect of draining in removing the unhealthy condition in which those causes originate, it is not too much to say that,—in addition to the capital effect of draining on the productive capacity of the land,—the most beneficial sanitary results may be confidently expected from the extension of the practice, especially in such localities as are now unsafe, or at least undesirable for residence.
In proportion to the completeness and efficiency of the means for the removal of surplus water from the soil:—in proportion, that is, to the degree in which the improved tile drainage described in these pages is adopted,—will be the completeness of the removal of the causes of disease. So far as the drying of malarious lands is concerned, it is only necessary to construct drains in precisely the same manner as for agricultural improvement.
The removal of the waste of houses, and of other filth, will be considered in the next chapter.