I am not sufficiently informed of the morbility statistics of African cities to appreciate the full weight of reasonings based upon their alleged comparative salubrity; the occasional scattered returns which I have seen from a few of them show death-rates ranging from 30 to over 40 per 1,000. But I am free to admit, on general principles, that it is less dangerous to let organic matter decompose fully exposed to atmospheric oxygen than to store it in unventilated receptacles to form sulphureted and carbureted compounds, or to saturate an undrained soil with it. It is to be remembered that few, if any, sewage substances are suspected of pathogenic power while in their fresh solid or liquid state: the products of their subsequent chemical changes are what we have to fear; and if these products be liberated al fresco as fast as they are formed, they are diluted to homœopathic insignificance by the surrounding air. Of the two evils, therefore, the Africo-Hibernian practice of throwing house refuse promiscuously upon the surface is preferable to the American village method of fostering and festering it in cumulative concentration.
As regards the allegation that "the young men at work in the fields were more frequently attacked (by typhoid fever) than the females, who were generally engaged in domestic duties in or about the house," it may be observed: First, that agricultural laborers do not spend all their time in the fields, but sleep in rooms from which, as a class, they carefully exclude all ventilation; second, that, for some unexplained reason, enteric fever seems to have a selective affinity for robust young males. It is an affair of common observation that, under apparently precisely similar conditions, fragile women may resist the infection to which strong men succumb.
Facts, however, are more forcible than words, and I therefore subjoin a few examples of coincidences which have very much the air of causes and consequences. I have excluded instances where water-pollution could be supposed to bear a part, and also those where careful inquiry did not seem to eliminate the possibility of immediate or mediate importation of contagium from a pre-existing case. And let me, at the outset, deprecate the Liebermeisterian criticism that if an adynamic fever with peculiar temperature curve, abdominal symptoms, etc., be not directly traceable to a preceding patient, it is not true typhoid, but only something otherwise indistinguishable from it; or that, without evidence of contagion, a pseudo-membranous angina with grave constitutional depression is not genuine diphtheria, though a remarkably good imitation of the real article. Grant only that there are diseases—call them what you will—which closely resemble the regulation nosological types, that people sometimes die of them, and that they are intimately associated with the eating, drinking, or breathing of filth-products, and I shall, for the present, leave the question of diagnosis to be begged by whosoever cares for it.
I. Typhoid.—Large country house with numerous "conveniences." Two "pan closets" on second floor; one in a small windowless hall-apartment, the other in a bath-room adjoining a bed-chamber; basin and bath-wastes led into trap of water-closet; leaden soil-pipe not continued above the line of fixtures, communicating directly with cesspool, and badly corroded at bends of closet-traps. Servants' pan-closet in basement with foul and leaky "retainer;" kitchen and laundry wastes on same horizontal branch, constantly liable to siphonage. Frequent illnesses of minor grade prevailed in this household until the whole plumbing system was reconstructed on a proper plan, since when the inmates have enjoyed excellent health.
II. Typhoid.—Small house in village street. Under the cellar runs the ill-covered channel of a former brook, which receives the sewage of several adjoining tenements. The house-refuse is discharged into this foul trench through an open untrapped conduit in the basement.
III. Typhoid.—Cottage of better class. No plumbing fixtures except kitchen sink, which discharges untrapped into an obstructed and very foul drain; leaching privy-pit on higher ground than the basement, which, with the foundation walls, is uncemented, affording ingress to ground-atmosphere.
IV. Diphtheria.—Elegant mansion, regarded by owner and "practical plumber" as a model of sanitary construction. Soil-pipe extended above roof, but without ventilation at its foot. Materials and workmanship good. On a lateral branch was a down-stairs water-closet into the trap of which the kitchen waste discharged, and into the dip of the running-trap of this horizontal soil-pipe, in the basement, and within a few feet of the furnace, was inserted a servants' hopper-closet without any flushing fixture; excremental matter being, of course, thus retained in the trap a great part of the time, and its decomposition favored by the admixture of hot water from the kitchen. When the water from the boiler was set running, the steam arose freely from this hopper.
V. Diphtheria.—Handsome country-seat. Plumbing work recently overhauled and declared perfect by the plumber. Three foul pan closets and numerous other "conveniences," all leading to unventilated cesspool. In the bedroom occupied by the patient the "safe-waste" from a stationary basin was carried into the soil-pipe, constituting a direct inlet from the cesspool.
VI. Diphtheria.—Presumably "first class" residence. Kitchen and laundry wastes carried from basement into privy-vault, which was filled to above the level of the pipes.
VII. Typhoid? (two irregular cases).—Cottage in good neighborhood. Bath and basin wastes discharging into trap of foul pan-closet with "putty-joints." Two inch tin pipe inserted, with leaky slip-joint, into bend of water closet trap, and carried with several angles to roof; no other ventilation of soil-pipe, which connects with leaching cesspool. Cellar riddled with rat-burrows (indicating probable connection with some old drain), and airbox of furnace made of loosely jointed boards, so as to convey the cellar air to upper part of house.