What the diseases which prevail with such fatality in the uncleaned tenant-houses are for the most part preventable, we have the most undoubted evidence. That smallpox is preventable is known to every school-boy, and yet that loathsome disease to-day A Town That
Was Immune prevails throughout all the tenant-house districts of New York, without the slightest restraint on the part of our local authorities. Typhus is to-day ravaging the homes of the poor without “let or hindrance,” and yet cleanliness and pure air are sure preventives. Of this truth these reports furnish many examples.
The fever-nest—West Thirty-third Street—is one of a row of tenant-houses five stories high, and contains 16 families. It was in a filthy condition, without Croton water, waste-pipes stopped, sinks overflowing and emitting offensive odors; fever had prevailed all winter, nearly every person in the house having had an attack, four having died. It was never inspected by a city official. The owner was induced to clean the house, and from that date not a case of fever has occurred. The inspector who reports this case very justly adds: “If, when the first case of fever occurred in this building, the owner had been compelled to put it in a good sanitary condition, six human lives would undoubtedly have been saved, besides a great amount of sickness.”
PLAN OF A REAR CUL-DE-SAC FEVER-NEST, 1865
Cholera infantum and diarrhoeal affections are found in their greatest intensity where putrescible animal matter and domestic filth exist. Remove these causes, or remove the patients from the neighborhood, and these diseases generally disappear at once. Diphtheria is found to be most intense in the vicinity of unclean stables. It is, therefore, with great propriety, that the entire class of zymotic diseases are now called “filth and foul air” diseases by the English sanitary writers. Remove the filth and foul air, and these diseases disappear as effect follows cause.
But while it is admitted that the streets of a town may be cleaned, the condition of the poor improved, and diseases, under the most favorable circumstances, prevented, it may be doubted whether the sanitary condition of populous towns can be Can Populous Towns
Be Improved? materially changed, and the death-rate greatly reduced. Yet in England, where sanitary science is enthusiastically cultivated, there is not only no doubt that large towns can be thus improved, but that the mortality of London itself may be no greater than that of the country.
Already, indeed, the London Times boasts “that the average of health throughout the City of London is higher than the average of health throughout all England, taking town and country together. The mortality in all England is at the rate of 22.8 in every 1,000 of the population; in the City of London it is at the rate of 22.3 for every 1,000 inhabitants! The improvement has been progressive; it has been slow, but steady and sure. Gradually the mortality has decreased, until the yearly death roll of 3,763 has been reduced to 2,904 within a period of nine years, during which the city has been under the rule of the Sanitary Commission. The deaths this year—22.3 per 1,000, or one in every forty-five of the inhabitants—are nine per cent below the general average, and represent a saving of 286 lives. And secondly, this gratifying result has been obtained in the face of obstacles which seemed to be almost insurmountable.”
Liverpool affords a striking example of the power of sanitary measures, rigidly enforced to improve the public health. It was formerly the most unhealthy city of England, being the very home of typhus, smallpox, and allied preventable diseases. But it adopted vigorous measures of reform, improving its poorer districts, and the death-rate has fallen eight in 1,000. Macclesfield, Salisbury, and many other English towns have had their mortality reduced 8, 10, and 15 in 1,000 by the vigorous prosecution of sanitary improvements. All the populous towns of that country are moving in this reform, and, as a result, the general death-rate of towns is approximating that of the country.
The Health Officer of London announced that cleanliness would preserve a town from the visitations of epidemics. But there must be cleanliness of the streets, cleanliness of the Cleanliness Preserves
from Epidemics courts, cleanliness of the apartments, and cleanliness of the person. On the approach of the cholera in 1849 the town of Worcester, England, determined to test the theory, and set vigorously to work and cleaned the town thoroughly, removing everything of an offensive nature, and adopting the most stringent regulations against the accumulation of filth about or within the homes of the people. The result was that this “destroyer” of unclean cities made a Passover with the people of Worcester, for on every lintel and door-post was written—Cleanliness, Cleanliness. Not a house was entered, and the town was saved in the midst of the most frightful desolation.
New Orleans is another striking example of the value of civic cleanliness. Since, by military regulations, it is kept constantly in a cleanly condition, it has had no visitation of its old enemy, yellow fever.