SANITARY SCIENCE IN THE UNITED STATES.
The following is an abstract of a paper on the Present and Future of Sanitary Science in the United States, read by Professor Albert R. Leeds, of the Stevens Institute of Technology, before the New York Academy of Sciences at their meeting, November 11th, 1878:
Sciences, such as the one under consideration, that have in them a side largely practical, are sure of a welcome in our midst. The study of the laws of public health grew into prominence in this country during the war, when the Sanitary Commission undertook to supervise the camps and hospitals. Sanitary associations were then formed in many States and smaller communities, and these have led to the establishment of State and city boards of health, clothed to a greater or less degree with executive functions. Every epidemic has been the cause of wider dissemination of sanitary knowledge by the daily press. The yellow fever plague, by which more than twelve thousand people have perished, has thoroughly aroused public interest. During its continuance the papers were full of homilies on private and public hygiene, the people everywhere sent aid and sympathy to the afflicted, and a lady offered to defray the expenses of a scientific commission of sanitary experts to inquire into the cause and prevention of the scourge. The proper execution of sanitary laws depends on the free and intelligent co-operation of individuals much more than on the influence of a strong central authority. A general health department at Washington could not legislate pure air, pure water, and pure food into use throughout the nation. The people themselves, in each community, must be educated to demand these requisites of health and to secure them in their own way.
I. Vital Statistics.—The first "Bill of Mortality" in New York city extended from November 1st, 1801, to January 1st, 1803. In it people are said to have died of "flux," "hives," "putrid fever," "breaking out," "stoppage," "fits," of "rash," and, by way of contrast, of "lingering illness." This rude beginning gradually led to the organization of the Metropolitan Board of Health, whose first report was made in 1866. Their second report showed a decrease of 3,152 deaths, mainly in districts where the greatest amount of sanitary work had been done. Valuable illustrations of the relation between damp houses and consumption were obtained by constructing maps of certain wards, on which every death from phthisis for several years was noted opposite each house. It was found that the disease was most fatal in the lowest levels, in rainy seasons, and in crowded localities.
The registration of marriages continued so defective that a writer on the subject declares it would be impossible for a large portion of the adult native population of the United States to prove by any legal document that they have a right to the name they bear, or that their parents were ever married. The mortality returns of 1871 were probably nearly perfect, and their very accuracy told against New York city, whose death rate was 28.6 per thousand, while St. Louis reported 17, Rochester 16, Buffalo 14, and Jersey City 7 per thousand. To secure accuracy in the returns of marriages and births, etc., more stringent legislation will be necessary.
In New Jersey the State Sanitary Association has conclusively shown the utter worthlessness of the State vital statistics. They memorialized the legislature, and caused the passage of a law which gives to New Jersey one of the best systems of registration yet devised. It owes its excellence to the following features, which should be universally copied:
1. Burial Permits are issued only after registry has been made by a properly qualified person; and
2. The returns are made to an expert, who collates them and deduces practical lessons from them.
II. Registration of Disease.—A large class of diseases may be prevented from becoming epidemic if their existence is known in time. For this purpose the boards of health should be invested with power and provided with means to investigate, reform, and, if necessary, to punish delinquency. Yet in the face of so practical a requirement little more is annually appropriated for the Board of Health of New Jersey than for the pay of two policemen.
III. State Sanitary Legislation.—The agitation for sanitary reform caused by the yellow fever should not be allowed to die out with the pressure of the calamity that aroused it. It should continue until every State that has been the seat of yellow fever, year after year, has as efficient a health code as Massachusetts and Michigan. The necessity of educating the people before it is possible to secure the requisite legislation will cause a considerable period of time to elapse before all the States have laws in accordance with modern knowledge. Probably no community takes the trouble to protect itself until it has actually suffered. To the distress of London the world owes the report of the Royal Commissions on water supply and the pollution of rivers, still the best repertory of the best knowledge on the subject. The manufactories of England have made it necessary for the government to take cognizance of aerial impurities. Similarly in this country the pollution of the Passaic has caused inquiries to be set on foot in the same direction.*
*See Report to Board of Public Works of Jersey City, by Professors Wurtz and Leeds; also, Analyt. Beiträge aus dem Laboratorium des Stevens Institute of Technology, by Professor Leeds, in Zeitschr. fur Anal. Chem. 1878.
An attempt was made to deprive the inhabitants of New York of their public parks, and to occupy them with buildings devoted to military and other purposes; but the people had already been sufficiently educated up to an appreciation of their sanitary value not to permit it. Dr. Seguin eloquently advocated the improvement of the parks, to make them not only pleasure grounds, but places of æsthetical and practical out-door education of the public school children.
IV. Ventilation.—It would be a great step in the interests of sanitary science if builders, vestrymen, and school or hospital trustees could be persuaded that their offices did not make them temporary authorities on ventilation, and that they had best intrust this matter to specialists who have fought their way into successful practice.
It appears that both the system of ventilation by aspiration and that by propulsion have had great successes and great failures. Many authorities have declared in favor of mechanical ventilation, yet in most institutions where fans had been introduced they are now standing still. In Roosevelt Hospital, New York, they ran their fan backwards for months and then stopped it.
V. Physical Education.—Instruction in hygiene and physical exercise as a part of the college curriculum was first successfully accomplished at Amherst College, and has now had a trial of nearly twenty years. The importance attached to it is shown by the fact that only distinguished members of the medical profession are appointed as professors, and that they have the same rank as the rest of the faculty. Their first duty is to know the physical condition of every student and to see that the laws of health are not violated. In case of sickness, the students are given certificates to excuse them from attendance and are put in the way of obtaining suitable treatment. The records kept are of great interest. All the classes are required to attend the gymnastic exercises four times a week. For a full account see Professor Hitchcock's report on Hygiene at Amherst College to the American Public Health Association. The excellent results of this feature—it can no longer be regarded as an experiment—recommend its introduction in all our colleges and public schools.
VI. Health Resorts.—The number of people who leave the cities in the summer to visit the seashore, the mountains, and the country is annually increasing. A healthful village is often changed to a center of pestilence merely by such an influx of strangers, the ordinary means of removing offal, etc., being no longer adequate. The town of Bethlehem, N. H., became so popular by reason of its pure air that several thousand hay fever patients sought relief there in 1877. The consequence was insufficient drainage; but as the inhabitants understood their interests, this defect was at once remedied.
The sea shore of New Jersey from Sandy Hook to Cape May is becoming an almost continuous city, and harbors a multitude of visitors every summer. Those whose interest it is to retain this patronage cannot have it too strongly impressed upon them to preserve their healthfulness by introducing cemented cisterns, by causing garbage to be removed daily, and by encouraging local boards of health.
VII. Illuminating Gas not only withdraws from the air of our rooms a considerable amount of oxygen, but fills them with noxious products of combustion. All this may be avoided in the future by the introduction of the electric light.
VIII. Sanitary Surveys.—Dr. Bowditch has shown that a thousand deaths from consumption in Massachusetts are due to a wet and retentive soil, and this fact alone will show the importance of sanitary surveys of the country, such as that made of Staten Island by Professors Newberry and Trowbridge, who determined the influence of the surface soil, of the underlying rock, its porosity, its bedding and its joints, upon the drainage and upon the local climate and health. A similar survey of Hudson county, New Jersey, has been recently made by L. B. Heard, C.E.
IX. Composition of the Atmosphere.—The English government has been obliged to appoint the celebrated Dr. Angus Smith to examine the effects of atmospheric contamination. In Philadelphia there is scarcely a house front that is not disfigured by the stain of magnesia and lime salts, caused by acid vapors in the atmosphere.
A discussion followed, which was introduced by Mr. Collingwood, who remarked that the problem of the sewage of cities was still far from being solved. Though the recent experiments in England on utilizing sewage for agricultural purposes by filtration and otherwise were reported to be successful, we had only dodged the question in this country. Our sewage is still emptied into rivers to poison the water of cities further down their course. When the country becomes more thickly settled, this will answer no longer.
It was also stated that while gas in large chandeliers could be made an effective means of ventilation, there was another objection to its use in the fact that the soil of the city was everywhere impregnated with it from leaky mains, thus causing poisonous exhalations and an insufferable odor whenever the ground was opened. Attention was also called to the evil effects of the system of tenement houses, which led to an unfavorable comparison of the health and morality of New York with those of cities like Philadelphia and Cleveland, that abound in small homes.
Dr. Minor attributed disease to what Richardson calls "ultra-microscopic molecular aggregates," which always exist in the air, but take hold of us only when our vitality is reduced to a certain point. It has been shown that decay is absolutely impossible in vessels from which they are excluded. But for them the earth would now be heaped with the undecomposed remains of animals and vegetables. According to this view, the future efforts of sanitary science must be simply in the direction of learning how to protect ourselves against the "ultra-microscopic molecular aggregates."
C. F. K.
