VIII. Typhoid? (continued fever)—Cottage on high ground. Offensive pan-closet on bedroom floor. Soil-pipe relieved by angular galvanized vent. But carried without other ventilation or trapping to cesspool on lower ground. Kitchen and laundry wastes untrapped and led to a row of buried barrels which were filled with a most malodorous mess, the water being allowed to soak into the soil as best it might.
IX. Diphtheria.—House without plumbing fixtures. Cellar loosely paved with bricks, and saturated with soakage from several privy-vaults on much higher ground and close in the rear; the fæcal-smelling semi-liquid filth actually oozing up between the bricks when they were stepped upon.
X. Diphtheria.—Cottage alleged by the owner, and innocently believed by the tenant, to be "one of the best plumbed houses in the county." Pan closet in a decadent and offensive condition, with untrapped bath waste and insufficiently trapped basin waste led into its seal. Short vent from bend of closet trap to outside of wall, with orifice closed during winter "to prevent water pipes from freezing;" soil-pipe thus without ventilation at top or bottom. Butler's pantry sink connected by tin pipe with earthenware drain, which was badly laid and composed of different sized pipes. Some distance beyond the junction of the soil pipe and wastes, this drain was tapped by a "ventilating" pipe carried into a chimney flue, with an occasional down-draught. Kitchen waste opening directly into an unventilated cesspool. All lead pipes of poorest quality.
XI. Diphtheria.—Country farm-house. No plumbing. Uncemented cellar; living room in wing built directly upon the earth. Overflowing privy-vault within twenty feet and on higher ground, the soakage and surface washing from which had permeated the soil around and under the building.
XII. Diphtheria.—Large and handsome house. Sanitary arrangements satisfactory to plumber. Pan-closet with insufficient flush. Two-inch tin vent from bend of soil-pipe carried with various angles into cold chimney flue. Running under the whole length of the basement was an eight inch earthenware drain receiving the soil-pipe and the wastes from different fixtures; its large caliber and slight grade precluded proper flushing, and it was thickly coated with refuse and chilled grease. Into its upper end was inserted the overflow from a tightly covered cistern, so that the only ventilation of the entire house-drainage system was through the rain-water leader, close to a "mansard" bedroom window.
XIII. Typhoid?—Two small houses of the poorer class, situated on a road at the foot of a steep declivity. No plumbing. Two privy-vaults, a pig-pen, and an indescribably filthy cow stable just behind and above them, from which the washings were traceable into their cellars.
I could extend the list by scores of illustrations of rural house-defects: soil-pipes disjointed from their outlet drains and discharging their sewage under basement floors; cesspools "backing-up" into kitchen sinks or laundry tubs, or pouring a reflux tide through "overflow" pipes into drinking water cisterns; ingenious devices of every sort to deprive the gases from pent-up filth of any escape, save into the dwelling. And these among the "wealthier residents," whose surroundings are commonly supposed to be above suspicion. As regards the unplumbed poor, their chances of inhaling filth-polluted air or imbibing filth contaminated water are often enhanced by inadequate cubic space and faulty construction within doors, and ignorant neglect of the very rudiments of hygiene in the environment; their cellars and wells being sunk in soil saturated with putrescent refuse. In the intermediate agricultural or mechanic class similar conditions frequently exist, their potency for evil depending chiefly upon the porous or retentive character of the soil; precautions to exclude the ground atmosphere from cellars or basements are seldom found; cesspools and privy-vaults are close at hand; and it is a common thing for a couple of adults and two or three children to sleep in a "stuffy" unventilated room with not more than 1,000 or 1,500 cubic feet among them.
From a sanitary point of view it matters little whether the gases from decomposing sewage escape from sodden soil or from a foul sewer; their nature is alike in either case, and the aggregate dose may be even larger in the former instance. But when, and why, and how, they, or any of them, exert their most deleterious influences, are questions which it is impossible to answer in the present state of our knowledge. It is an indisputable fact that people may for a long while be exposed to them without pronounced manifestations of "filth disease"—although such people, in my experience, are seldom thoroughly well, even if not specifically ill. But sooner or later an apparent qualitative change may take place, and an acute zymosis declare itself. I have elsewhere suggested the part that may be borne in this complicated problem by a "personal factor," or temporarily altered individual susceptibility;[7] but it seems necessary also to assume an alteration in the external conditions; and such alteration is explained by many etiologists on the hypothesis of the importation or evolution of specific pathogenic micro-organisms. That certain varieties of schizophytes are associated with some of the acute infections is beyond doubt; that in a few, such "microdemes" are the conveyers,[8] if not the causes, of the infection seems proved; but it must be remembered that in the diseases chiefly under consideration no characteristic bacteroidal forms have been defined. In typhoid fever, Klebs describes a bacillus where Letzerich finds only micrococci; according to Wood and Formad, the micrococcus of diphtheria is just like that of the ordinary buccal mucus; indeed, nearly all of the acutest infectious diseases are attributed to these ubiquitous micrococci, indistinguishable from each other in most instances, and divided into species solely on the score of their assumed physiological effects. Admitting all that the most ardent advocates of the germ theory can claim for it, there are at least three possible ways in which filth and fungi may be connected.
1. Taking the view of Naegeli and others as regards the mutability of the bacteria, it is conceivable that the common "scavenger" microphytes may acquire pathogenic properties by successive generations of development amid the products of certain decomposing substances. In favor of this conception may be cited the seemingly gradual intensification of "filth poisoning" in numerous instances; sore throats of a less septic type forerunning outbreaks of diphtheria; diarrhœal derangements preceding enteric fever; and, furthermore, Koch has found both bacillus-spores and micrococci in surface soils, the latter organisms preponderating where the earth is subjected to excremental soakage.
2. Or, accepting the specific classification of the schizomycetes, it may be supposed that some pathogenic germs obtain favorable intermediate conditions for their development and multiplication in these products of decomposition; a supposition almost necessary if the specific-germ theory be applied to enteric or choleraic discharges.