Bad Drains; and How to Test Them / With notes on the ventilation of sewers, drains, and sanitary fittings, and the origin and transmission of zymotic disease

Whilst making experiments and taking observations five years ago, to trace the origin and transmission of some cases of zymotic disease, I formed an opinion that the theory as regards the transmission of zymotic disease by contagion was to a certain extent an erroneous one.

I mentioned this to some of my medical acquaintances at the time, but as it was so opposite to the prevailing ideas, I was advised not to publish or hold out such opinions, as they were contrary to the theories accepted by the medical profession.

Now that these theories have been severely shaken, and in many cases reversed by medical men themselves, during the past year, I shall plead no excuse, but insert them for the guidance of those engaged in sanitary work.

The source of zymotic diseases may be traced to persons inhaling or taking into the system poisons from putrid sewage matter, and those poisons are conveyed into the body, either in the food they eat, the water they drink, or the air they breathe. Whether they are organic or inorganic, they poison the blood, which becomes more or less diseased, according to their density or vitality, or whether each of the zymotic diseases is produced by distinct organic germs grown and developed from putrid matter under different atmospheric influences, it matters not to my mind in proving the true method by which zymotic diseases are transmitted.

On the origin or source from which these diseases are produced, I do not think there are two opinions, viz. that of poisons from putrid matter, and the question to be solved is in what manner these poisons are conveyed into the system. To do this it will be necessary to quote some cases of zymotic disease and the circumstances which surrounded them.

In a small district, a girl thirteen years of age was taken with diphtheria, and in two days after the younger brother was taken and the other children appeared sickly. From investigation it was certain that the poison had not been conveyed into the system by food or water. The children generally took their meals in the kitchen, the door of which opened into the yard, which was about 10 feet long by 8 feet wide, in the corner of which was the W.C. I tested the atmosphere entering the room at the bottom of the doorway, and found that it contained poisonous matter, and on testing the closet and drains I found a hole 3 inches by ¼ inch in the closet trap. Here was the source of poison which produced the disease. The gas in the drain was confined between two traps and in contact with putrid sewage matter, and when it was removed no poison from any other source could be detected. The first child that was taken ill died, but the other recovered.

Now it is quite evident that the second child did not take the disease from the first, as it had not time to develop. The atmosphere of the room and the breath of the child were not as poisonous as the atmosphere of the kitchen in a line between the kitchen fire and the door, and it was on this line both children sat at their meals, and thus inhaled the poison with their food. Had the gases in the other drains of the district been of the same density as in this one, and similar leaks existed in the sanitary fittings, diphtheria would have spread, and by the popular theory its transmission would have been attributed to contagion from this family, which in face of the above facts would have been incorrect.

Another case. In a large town diphtheria broke out, and some hundreds were attacked and over two hundred died. The source of the disease was not in the food or water, and the only disease-producing poison that could be found was in the gas issuing from the sewer gratings and sanitary fittings. Schools were closed and the usual remedies used to prevent contagion, but all to no purpose. The sewers being of an easy gradient had silted, forming at intervals masses of putrid matter, and in the best houses, where the disease was most prevalent, poisons from the sewers were laid on to them by the badly-constructed drains and sanitary fittings. The authorities at last took the matter vigorously in hand, cleansed and sweetened the sewers as much as possible, and then the disease abated and died out. Had contagion been the means by which the disease was transmitted, it would have continued as it existed in the town under almost every kind of atmospheric temperature.

Here we have evidence showing that putrid matter did exist from which poisons were given off and their mode of transit into the body, but not the slightest evidence to prove the poison passed direct from one person to another.

These poisons in the gas can be destroyed by washing the gas in a chemical solution on leaving the grating, and since this has been done medical men have cured the disease by washing the throat in a similar solution.

Numbers of typhoid cases could be mentioned where poisons from putrid matter were conveyed into the system by water, milk, and impure food, but I have never heard of a case where the poison was detected leaving one person for another.

If in 1883 a person had stated that cholera was not contagious, they would have been ridiculed, yet the principal physician and those in charge of the cholera hospitals of Paris last year, certified to the representative of one of our daily papers that cholera was not contagious. The cholera epidemic of last year proves that cholera poisons are produced by heat and atmospheric influences on putrid matter, and circumstances favour the theory that they are inorganic, and when inhaled into the system poison the organisms of the blood to such an extent as to produce the disease. Cases of cholera broke out in different parts of the Continent at the same date, clearly showing that contagion had nothing to do with producing or transmitting the disease. In England our ports were jealously watched to prevent any case from being landed. Had a case been landed, the excreta from that one case might, when mixed with the sewage of a large town, have been the means of spreading the disease through the whole district, as miles of sewers are so laid that poisons in the gases can be effectually distributed through the district in a very short time. Open ventilation to sewers would greatly assist this, and especially when the gases in the drains and the fresh air admitted into them were of a high temperature. It is very improbable that cases if imported would break out in two towns at the same time, or that the poison could be conveyed in the atmosphere which divides us from the Continent.

Fortunately, when the continental outbreak was known, the authorities in the metropolis and other towns used disinfectants on all known putrid matter, and especially at the sewer gratings. This was an expensive process, but it had the effect of preventing the atmospheric influences (which were similar to those on the Continent) from developing the poison to a vitality necessary to give the disease.

It would be an excellent preventive if the authorities of towns would thoroughly examine every part of their districts, and know for a certainty whether in their sewers, cesspits, vaults, or dust-bins there existed putrid matter, or gases from them similar to those which produced the disease on the Continent. The expense of such an examination and for remedying the evils cannot be an excuse for not doing this work, as the monetary loss experienced by the residents of those continental towns and cities by the outbreak was enormous. What the loss would be to the residents of the metropolis if a cholera epidemic were to occur, it is difficult to imagine, and yet in many of the districts cholera-producing elements exist from which in all probability the heat and atmospheric influences experienced during several weeks of excessive dry weather during the summer months will produce poisons of a similar vitality to those produced on the Continent during the past year.

Previous to the cholera epidemic, small-pox was very prevalent in London, and I very carefully noted the cases as they were reported, and visited the districts where the disease was most prevalent, for the purpose of testing the nature of the gases in the sewers, and observing how the sewers and sanitary fittings were constructed.

In many of these districts, and especially those of Homerton, Hackney, Bow, and Bromley, the drains are so laid and the fittings so constructed that a supply of sewer gas is pumped into the houses, and it is impossible for persons to live in the houses of these districts without inhaling gases that have been for a long time in contact with sewage matter.

Whether the small-pox poison is an organic one (which I believe it is), and is produced from a collection of matter in a high state of decomposition, with or without being mixed with the excreta of persons suffering from the disease, or whether it is of an inorganic nature, the poison is derived from this source rather than from the impurities thrown off through the skin of persons suffering from the disease. As a proof of this, as soon as the cholera broke out last year on the Continent, almost every gulley and grating in the metropolis where sewer gas passes was charged more or less with a disinfectant, which minimised the poison in the gas. The result was that small-pox abated in an epidemic form although the temperature of the atmosphere increased.

The disinfectants so placed could not, naturally, affect the gas in branch drains to houses, or putrid matter in various parts of the sewers, or if it had, judging from its beneficial effects at the outlets, small-pox would have disappeared.

If contagion were the means by which this disease was distributed, disinfectants at sewer gratings would not have prevented the disease continuing in an epidemic form.

Take the adjoining districts of Fulham and Putney. During the epidemic, the gases from the sewer gratings in the Fulham district were more dense than those at Putney. Fulham had many cases of small-pox, but Putney none, although persons from each district were in daily contact with each other; but the houses were not connected by the same system of sewers.

It must not be thought that I wish to advance the theories of the anti-vaccinationist. I have had my children vaccinated because it is the law, and in the opinion of medical men a preventive against the disease, but viewing the change of medical opinion with reference to cholera during last year, and comparing tests and observations that have been made, they will soon be convinced that vaccination is a futile remedy to use with a view of stamping out the disease.

At present the question is (with medical men) one of theory, but ere long I am certain that they will take a more practical view of the case and definitely fix the origin of this disease and its distribution.

Previous to vaccination being introduced, putrid matter in vaults, cesspits, and drains was allowed to reach a higher state of putrefaction, and thus the poisons from them became more virulent and produced the disease of a more virulent type.

If modern systems of drainage and sanitary arrangements were the means of preventing this high state of putrefaction, and of reducing the disease to a milder form, perfecting these arrangements should be the means of stamping it out altogether and rendering vaccination useless.

Unless it can be proved that poisons given off through the skin and from the lungs of persons suffering from the disease are as virulent as those from putrid matter alone, or from the excreta from those suffering from the disease, the theory of contagion^[2] cannot be entertained.

Many medical men will say that the facts to prove that small-pox is transmitted by contagion are so positive that there is no chance of disputing them.

Let us examine two cases to support this theory.

Small-pox is prevalent, say, in the north of London; a man is in business there from seven to eight hours each day, but his home is in the S.W. district. He is taken ill, and remains at home, calling in his medical attendant, who on his second visit pronounces it a case of small-pox, and orders his removal to the hospital. In a few days other members of the family are taken and removed, and similar cases occur in the neighbourhood.

The theory of the medical man would be that his first patient had contracted his disease in his place of business in the N.W. district and had conveyed it to the S.W. district, distributing it in the neighbourhood in which he lived. This is only theory, and the only thing the medical man has to rely on to prove his case is, that the man first taken was engaged three-fourths of each day where small-pox was prevalent. Against this theory, assume that the disease originated by the whole of these persons inhaling poisons from putrid matter in their own locality or at their own doors, or in their homes, but that the atmospheric influences to develop the poison was a few days longer completing its work in the S.W. district than in the north. Then test the sanitary conditions of both localities, and you will find similar matter producing poisons. These are facts that will support this view of the case, as well as the following evidence which cannot be contradicted. When sewage matter is allowed to remain in bulk undisturbed, and in connection with a system of sewers, it forms retorts for the generation of these poisons, and they are conveyed for miles in drains by atmospheric and other influences; and where these people lived the gases would probably be discharged with a greater facility than at any other point.

Take another case. A man leaves London for the country, and a day or two after his arrival he is taken ill with small-pox. There is no system of drains to the house in which he is located. People living in this and other houses are affected with the disease, and the medical officer of health in his report states that the disease was conveyed from London to the district by this man. He was certainly the first one affected, and at first sight this case appears to be conclusive in favour of contagion, for if he did not contract the disease in London and bring it into the country how was it that he was first affected?

It is certain that putrid matter from which the poisons are derived exists in villages similar to that in towns, consequently the poisons are there, and medical men agree that when a person leaves one locality for another, for what is commonly called a change of air, the system undergoes a change. This change had such an effect on the system of this man that the poison from the putrid matter of the village had a greater effect on him and poisoned the blood more quickly, than on those who were inhaling the poison during its various stages of development: but when it was fully developed by atmospheric influences the disease appeared in those other persons who were in contact with the poison.

The action of sewer poison on the system is similar to that experienced by persons taking cold. Persons occupied in rooms which have an equal temperature, or are not subjected to cold chilly winds, take colds and contract all sorts of complaints on being exposed to currents of cold air even for a short time. The draught from a window only, when a cold stream of air is playing upon it, will do this: the blood is chilled, hence the cold, fever, or one of the many complaints follow; but on persons used to exposure it has no effect. In the same way sewer poisons act on those who suddenly inhale them, only the blood becomes poisoned instead of chilled; but on those who are in constant contact with them they have not such an effect, yet on these persons the effect of them can be traced.

The medical profession have hitherto placed too much reliance on isolation as the sole means of stamping out this disease.

The Metropolitan Asylums Board have had ample means at their disposal since 1867 to test the soundness of this theory, yet after spending something like 480,000l. per annum, small-pox has increased 100 per cent. since that date! This fact alone is sufficient evidence to prove that other means than those of isolation must be used to effectually stamp out this disease.

It is of little use to have elaborate arrangements in hospitals and camps to minimise the effects on persons who have taken the disease, and at the same time allow the source from which it emanates to remain undisturbed. I admit that it is a question too complicated to be exhaustively dealt with in a work on the testing of drains and sanitary fittings, but it is inserted to show what a power those who are engaged in designing or executing sanitary works hold for good or evil in affecting the health of the community.

Experience proves that ninety-nine zymotic cases out of every hundred are caused through imperfect sanitary works and appliances.