Comparison of death-rates in Michigan from scarlet fever and small-pox before and since the State Board of Health was established, and from typhoid fever before and since its restriction was undertaken by the State Board. (Compiled from the State Department’s “Vital Statistics” of Michigan.)
The “Encyclopædia Britannica” asserts that two centuries ago the mortality of London was 80 per 1000, while now it is but a little over 20. In 1841, out of every 100,000 people in England, 30,000 would have died before reaching the age of 10, and one half would have died before they were 40 years old; in the decennium 1881–90, before 30,000 would have died out of each 100,000 some would have lived to be 17, and some would have lived to be 55 before one half of the number had departed into the unknown and the hereafter.
The figures of the statistician must be quoted again and again in the progress of the article, as no more tangible evidence can be given of the benefits resulting from improved methods of sanitation. Very early a coincidence was observed between the uncleanly and the death-rate. Neighborhoods where little or no care was taken to remove the refuse, where there were foul drains and a deficient water supply, were found to be the abodes of special forms of disease,—so much so, that these diseases soon received the name of “filth diseases.” Acting upon the suggestion, the gospel of cleanliness was preached and its practice enforced. There was a “redding up” in its eventuality as thorough as the cleansing of Santiago de Cuba in recent days. It did not take long to discover that decaying organic matter in some way was the offending body, and that this contaminated the water supply. Wells were condemned and public water supplies installed; means were sought to enable the cleansing to be constantly carried on, and sewers for house drainage followed or accompanied the water supply. In proportion as this has been thoroughly done has the death-rate from certain diseases diminished. During the last century the European armies were decimated by fever (typhus or relapsing) to such a degree that the work of the fell destroyer at Santiago was trifling in comparison. On into the present century, the great scourge of Great Britain was these same two fevers; so much so, that “the fever” meant the dread jail or typhus fever. It was imported into this country, and epidemics of “ship fever” were of frequent occurrence. Thus, as late as 1846, it was estimated that in Dublin alone there were 40,000 cases of fever, with a total in Ireland of 1,000,000 cases. There were 10,000 deaths in Liverpool, a city especially prone to the disease; while in Edinburgh one person out of every nine of the population was attacked, and one out of every eight of the sick died. Turning from this account to the medical returns of the war for the Union, there were reported only 1723 cases, with 572 deaths, to the office of the Surgeon General, and even these a very competent authority after careful investigation decided not to be instances of true typhus. Or turn to civil practice: the disease is found so seldom with us that it is not necessary to assign to it a column along with the other diseases in publishing the mortality returns by our health authorities. The deaths from fever in London during October, November, and December, 1898, were but 296. London has an estimated population of 4,504,766, and the “fever” in the report included typhoid, simple and ill-defined forms of fever, as well as typhus. This makes a death-rate of but 0.26 per 1000.
Had sanitary science no other trophy, its votaries could still boast of the great benefits to humanity brought about by their labors. This is but one of many; thus, scurvy, the great bane of the navy, is now a disease that few physicians have the misfortune to see, or patients to endure. Then that disease somewhat akin to typhus, and until within the memory of the fathers confounded with it, hence called typhoid fever, is likewise fast disappearing, more rapidly in cities than in rural communities however. The suppression of typhoid proceeds with equal step with the introduction of a public water supply in our towns, the adoption of the proper means to furnish this water unpolluted, and the proper removal of domestic waste through sewers, whose contents are so treated as to work no harm after they escape. Notwithstanding these great triumphs, if boasting is permissible, the sanitarian’s boast is rather that his science, which had its beginning, as we have seen, at the time when there was a great awakening of the national conscience in British politics for “the larger sympathy of man with man,” has broadened with the years of its growth; has endeavored to care for one’s brother so that his blood would not cry up from the ground; so that, after forty or fifty years had passed, a distinguished sanitarian could write with literal accuracy: “Whatever can cause, or help to cause, discomfort, pain, sickness, death, vice, or crime—and whatever has a tendency to avert or destroy, or diminish such cases—are matters of interest to the sanitarian; and the powers of science and the arts, great as they are, are taxed to the uttermost to afford even an approximate solution of the problems with which he is concerned.”[1] And the crowning glory of the science to-day is the care it bestows upon the weak, the ignorant, and the helpless; the efforts it makes to ameliorate every undesirable condition of society.
[1] Dr. J. S. Billings in Ziemssen’s Encyclopædia.
MAP SHOWING “REGISTRATION STATES” NOW AVAILABLE FOR THE MORTALITY STATISTICS OF THE TWELFTH U. S. CENSUS (1900).
Note.—States having immediate registration of deaths and requiring burial permits are black. The only additions to the list since the Census of 1890 are Maine (1891) and Michigan (1897).
It would be misleading to infer that all of these benefits have been brought about solely through the collection of vital statistics, although much of it would have been difficult without the knowledge furnished by these statistics. Workers in almost every branch of pure science have contributed to the progress,—the physicist, the meteorologist, the chemist, and by no means the least, the biologist. Indeed, with the more recent investigations, the culture tube of the biologist has almost revolutionized medicine and all that pertains to it.
Sanitary science seeks to accomplish two ends; it purposes to prevent disease and to promote public health. If it seeks to prevent disease, after the fashion of the oft-quoted cook-book, it must first secure the disease, or what is essentially the same thing, know what causes it. If the cause be known, and we can conquer the cause, we can prevent the disease. Thus a disease known as trichinæ spiralis, from the name of the parasite invading the body and causing sickness and death, is caused by eating pork infected by the trichinæ. We can certainly prevent trichinæ in persons by forbidding pork; but we also know that the trichinæ do not occur in all pork, and that their presence can be detected by the microscope. If, then, a sample from every slaughtered pig is submitted to the microscopist, the infected pork can be discovered. This is done in our large packing establishments, especially for that pork which is to be exported. Again, a thorough cooking will kill the trichinæ, even if present. Only the grossest carelessness, consequently, can account for a case of trichinæ, and, indeed, it is a very rarely occurring disease. This illustrates the importance of a knowledge of the cause of the disease, to enable one to devise a method for preventing it. In the study of disease causes, the biologist has been very successful during the past few years, and a number of our communicable diseases are demonstrated to be caused by the growth and development of bacteria. From this demonstration in the case of some, a general hypothesis has been formulated, which is useful as a working hypothesis, but by no means safe to call a theory as yet. This hypothesis is that all of our communicable diseases are caused by living organisms originating in one person and conveyed to another, where they begin to grow, to reproduce their kind and to perform their life functions. Hence all communicating diseases are infectious. Some of these infectious diseases, like measles or smallpox, are capable of direct communication from one person to another, rendering them contagious; others, like typhoid fever and cholera, are not contagious in this sense of the word. This is a very excellent distinction to make in the use of these much abused words.