the person who permits his neighbour’s atmosphere to be contaminated by any filth ... is worse than a highway robber. The latter robs us of property, the former of life.
Similarly, Simon in England was teaching that “in order to the prevention of Filth Diseases, the prevention of filth is indispensable”; and that there was need for local authorities “to introduce for the first time, as into savage life, the rudiments of sanitary civilization.”
The crude generalization that filth causes disease perhaps persisted too long, and the value of Snow’s investigation in 1855 of the outbreak of Cholera in the area of supply of the Broad Street pump was perhaps too slowly appreciated. The influence of Von Pettenkofer’s theories on the relation between subsoil conditions and Cholera was largely responsible for this delay; but already in 1856 Simon had accepted the importance of water infection, giving as his general conclusion that
under the specific influence which determines an epidemic period, fecalised drinking water and fecalised air equally may breed and convey the poison (of Cholera).
Still it will be noted there persisted the notion of aerial convection of the contagia of cholera and enteric fever, in addition to their convection by dirt, by flies, or the more common contamination of hands or feet or food by faecal matter; but the importance of water supplies was beginning to be appreciated. Already in 1883 local authorities in England and Wales had outstanding loans for waterworks amounting to twenty-nine million and for sewerage amounting to fifteen million pounds sterling, while between 1883 and 1912 they expended out of rates and by means of loans one hundred and thirty-one millions for waterworks and eighty-nine millions sterling for sewerage.
Although we realise now the greater importance of control of excreta from persons specifically infected, we must agree with Simon that communally
Nowhere out of Laputa could there be serious thought of differentiating excremental performances into groups of diarrhœal and healthy.... It is excrement, indiscriminately, that must be kept from fouling us with its decay.... It is to be hoped that ... for a population to be thus poisoned by its own excrement, will some day be deemed ignominious and intolerable.
And it is still opportune to draw attention to the terrible responsibility incurred by local authorities when they distribute a general supply of water to the inhabitants of their area without taking every possible precaution against contamination. The conveniences and advantages of public water supplies “are countervailed by dangers to life on a scale of gigantic magnitude”; and sanitary history, in the calamitous experience of Lincoln, Maidstone, and Worthing and of Lowell and other towns and districts, has given remarkable illustrations of the need for eternal vigilance.
Typhoid Fever
With the differentiation of typhoid fever from typhus fever by Gerhard in Philadelphia in 1837, and by Stewart and W. Jenner in Great Britain in 1849, it became possible to associate the former with excremental, the latter with respiratory filth, “the non-removal of the volatile refuse of the human body.” The question still remained whether typhoid fever was producible by “emanations from decomposing organic matter,” whether it was “often generated spontaneously by faecal fermentation,” as contended by Murchison, who in 1858 proposed the name “pythogenic fever” for typhoid fever; or whether as indicated by the remarkable observations of William Budd of Bristol, the introduction of specific infection from a typhoid patient was needed to start a local outbreak. Gradually it became clear that specific contamination was necessary to start an outbreak or even to cause a single case of this disease, and between 1870 and 1880 a number of water-borne outbreaks were traced. It also gradually became evident that, however objectionable or even noxious might be the gaseous emanations from leaky drains or sewers, they did not cause typhoid fever or diphtheria. Hence the statement, for instance, of Oliver Wendell Holmes in 1862 (quoted for its historical interest by Dr. Sedgwick) that “the bills of mortality are more obviously affected by drainage than by this or that method of practice,” which expressed universal opinion when it was written, is now known to be accurate only when specific matter from drains contaminates milk or water supplies, or causes infection by actual contact.