To return, however, after this somewhat lengthy digression, to the question of dust and its bacterial properties, we have learnt enough to enable us to realise that the movement for the migration of the working-classes from crowded streets to rural districts, in which Mr. George Cadbury has played so practical and important a part in the creation of his model village, with its gardens and open spaces, some five miles from the city of Birmingham, is, if only bacterially considered, a very real barrier against the dissemination of disease, for the denser the population, the greater will be the crowd of bacteria, and the greater the chance of pathogenic varieties being present amongst them. Again, we know that sunshine is one of the most potent germicides with which nature has provided us;[2] and it requires no effort of the imagination to realise how, in the gloomy back courts and crowded tenements of our great smoke-laden cities, bacteria succeed in obtaining a firm hold on their surroundings, and, in the shape of spores, attaining an undesirable and hoary old age, in which they are in some cases almost indestructible. Fräulein Dr. E. Concornotti has shown that this is no figment of fancy only, for she has recently made a special and very elaborate study of the distribution of pathogenic or disease bacteria in air, searching for them in the most varied surroundings, such as prisons, schools, casual wards, etc., with the result that, out of forty-six experiments in which the character of the bacteria found was tested by inoculation into animals, thirty-two yielded organisms which were pathogenic. Dr. Concornotti concludes her valuable memoir by stating that her investigations proved conclusively that the dirtier or more slumlike the surroundings, the greater was the frequency with which she found bacteria associated with disease in the air.
Messrs. Valenti and Terrari-Lelli have quite recently been able fully to endorse these statements in the results they have obtained in their systematic study of the bacterial contents of the air in the city of Modena. In their report they state that the narrower and more crowded the streets, the greater was the number of bacteria present in the air, and the more frequently did they meet with varieties associated with septic disease.
Numerous detailed investigations have also been made of the bacterial contents of the dust in hospitals. That cases of infection arising within hospital precincts are of no uncommon occurrence may be gathered from the observations made by Lutand and Hogg, who report no fewer than 2,294 such cases having arisen in the space of six years in certain Paris hospitals, whilst Solowjew records 1,880 cases as occurring in the space of four and a half months in the St. Petersburg city hospital. Solowjew made a special study of the bacterial contents of dust collected in hospitals, and states that 41·8 per cent. of the samples examined contained disease germs. The degree of infection possessed by dust in such surroundings must, of course, depend upon the degree of cleanliness which characterises the management of any particular institution; and such investigations as the above can only help to emphasise the immense importance of common cleanliness and the reasonableness of taking every precaution possible in the disinfection of utensils, etc.
Some years ago Messrs. Carnelley, Haldane, and Anderson carried out an elaborate series of investigations on the air of dwelling-houses in some of the poorest parts of Dundee. The samples were taken during the night, between 12.30 a.m. and 4.30 a.m., and in their report the authors state that the one-roomed tenements were mostly those of the very poor; "sometimes as many as six or even eight persons occupied the one bed," whilst in other cases there was no bed at all. As regards the number of bacteria present in the air in these one-roomed houses, an average of several examinations amounted to sixty per quart; in two-roomed houses it was reduced to forty-six, and in houses of four rooms and upwards only nine micro-organisms in the same volume of air were discovered.
On comparing the mortality statistics with the composition of the air of dwelling-houses of different dimensions, the authors arrive at the following conclusions: "That, as we pass from four-roomed to three-, two-, and one-roomed houses, not only does the air become more and more impure, as indicated by the increase in the carbonic acid and organic matter, and more especially of the micro-organisms, but there is a corresponding and similar increase in the death-rate, together with a marked lowering of the mean age at death."[3]
Mention may also here be made of the investigations made by these gentlemen on the air of Board schools, which showed that in those buildings where mechanical ventilation was used the carbonic acid gas was three-fifths, the organic matter one-seventh, and the micro-organisms less than one-ninth of what was found in schools ventilated by the ordinary methods. In commenting upon this series of investigations, the authors write: "When we come to consider that the children who attend average Board schools for six hours a day are during that time subjected to an atmosphere containing on an average nearly nineteen volumes of carbonic acid per 10,000, and a very large proportion of organic matter, and no less than 155 micro-organisms at least per quart, we need not be surprised at the unhealthy appearance of very many of the children. It must also be borne in mind that many of them are exposed for nine hours more to an atmosphere which is about five times as impure as that of an ordinary bedroom in a middle-class house. They are thus breathing for at least fifteen hours out of the twenty-four a highly impure atmosphere. The effects of this are often intensified, as is well known, by insufficient food and clothing, both of which must render them less capable of resisting the impure air. The fact that these schools become, after a time, habitually infected by bacteria renders it probable that they also become permanent foci of infection for various diseases, and particularly, perhaps, for tubercular disease in its various forms."
Further practical evidence of the manner in which the general death-rate for certain diseases is influenced by the conditions under which the poor are housed is afforded by statistics which have been collected at Glasgow. In the case of zymotic diseases, whereas the death-rate in tenements consisting of one or two rooms was 4·78 per 1,000, it fell to 2·46 in those of three or four rooms, and to 1·14 per 1,000 in those of five rooms and upwards. Again, in the case of acute diseases of the lungs, the death-rate was as high as 9·85 in the smallest tenements, and but 3·28 in the largest.
Of great interest are the certified mortality statistics of phthisis in the British Army in the period 1830-46 and 1859-66 respectively; in the former it was 7·86 per 1,000, whilst in the latter period it had fallen to 3·1, this important difference being coincident with an increased cubic space per head in the barracks.
Such facts as these, if only fully realised, should surely serve to stimulate municipal and other local authorities to provide decent and wholesome accommodation for the poor. It has been recently estimated that in London the total number of persons living in tenements of one to four rooms is 2,333,152, and of these nearly half a million live the life of the one-room tenement of three to a room and upwards. In the stirring words of Mr. John Burns, M.P.: "At least a million of people who live thus on wages that barely sustain decent life, are but prisoners of poverty, whose lot in life is but a funeral procession from the cradle to the grave … for these, as soon as practicable, better homes should be provided at once in the interest of physique, of morals, of industrial efficiency, and municipal health."
Yet, despite all these facts and the overwhelming evidence which has been collected on the dire results which follow in the wake of overcrowding and insanitary dwellings, we find a prominent magistrate in one of our great industrial cities publicly expressing himself as follows at a municipal banquet: "The Town Council sometimes attempted too much. For instance, they had been far too anxious to get quit of the slums. Now slums, in his opinion, were one of the necessities of all large towns, and it was impossible in the present state of civilisation to dispense with slums unless they could take the people living in them, who were not fit to live anywhere else, and drown them wholesale, as would have been done in the time of the French Revolution."