History of Sanitation

Mr. Whitehead's detailed investigation was not made until the spring of 1855, but in spite of this fact it supplied most interesting and important confirmatory evidence of Dr. Snow's theory that the Broad Street well was the source of the epidemic. Mr. Whitehead, moreover, went further than Dr. Snow, and endeavored to find out how the well came to be infected, why its infectious condition was so limited, as it appeared to have been, and to answer various other questions which occurred in the course of his inquiry. As a result, he concluded that the well must have been most infected on August 31st, that for some reason unknown a partial purification began on September 2d, and thereafter proceeded rapidly. There was some evidence that on August 30th the water was much less infected than on the 31st, so that its dangerous condition was apparently temporary only. He further discovered that in the house No. 40 Broad Street, which was the nearest house to the well, there had been not only four fatal cases of cholera contemporaneous with the epidemic, but certain earlier cases of an obscure nature, which might have been cholera, and that dejecta from these had been thrown without disinfection into a cesspool very near the well. On his reporting these facts in April, 1855, to the main committee, Mr. J. York, secretary and surveyor to the committee, was instructed to survey the locality and examine the well, cesspool and drains at No. 40 Broad Street. Mr. York's report revealed a startling condition of affairs. The well was circular in section, 28 feet 10 inches deep, 6 feet in diameter, lined with brick, and when examined contained 7 feet 6 inches of water. It was arched in at the top, dome fashion, and tightly closed at a level 3 feet 6 inches below the street by a cover occupying the crest of the dome. The bottom of the main drain of the house No. 40 Broad Street, lay 9 feet 2 inches above the water level, and one of its sides was distant from the brick lining of the well only 2 feet 8 inches. It was constructed on the old fashioned plan of a flat bottom, 12 inches wide, with brick sides rising about 12 inches high, and covered with old stones. As this drain had but a small fall or inclination outward to the main sewer, the bottom was covered with an accumulation of soil deposit about 2 inches thick, and upon clearing this soil away the mortar joints of the old stone bottom were found to be perished, as was also all the jointing of the brick sides, which had brought the brickwork into the condition of a sieve, and through which the house drainage water must have percolated for a considerable period.

Thus, therefore, from the charged condition of the cesspool, the defective state of its brickwork and also that of the drain, no doubt remains in my mind that constant percolation for a considerable period had been conveying fluid matter from the drains into the well; but lest any doubt should arise on this subject hereafter, I had two spaces of the brick stemming, 2 feet square each, taken out of the inside of the well, the first 13 feet deep from the level of the street paving, the second 18 feet deep, and a third was afterward opened still lower, when the washed appearance of the ground and gravel fully corroborated the assumption. In addition thereto, the ground was dug out between the cesspool and the well to 3 feet below the bottom of the former, and its black, saturated, swampy condition clearly demonstrated the fact, as did also the small furrowed appearance of the underlying gravel observed from the inside of the well, from which the fine sand had been washed away during the process of filtration. It was thus established as clearly as can be done by circumstantial evidence, that the great epidemic in St. James' Parish, Westminster, London, in 1854, was caused by the polluted water of the Broad Street well, which for a very few days was probably infected with cholera germs. It is much less clear how the well became infected, but it seems probable that the dejecta of a cholera patient found tolerably direct access to the well from the cesspool or drain of a house nearby. There is no evidence whatever that the germs multiplied in the well, but rather much evidence that they rapidly died out. It is repeatedly stated in the report that the water was preferred for drinking because it was cold, i. e., colder than the cistern water derived from public water supply and this condition would probably favor such dying out.

That the water had long been polluted there can be no doubt. There was evidence of this, and also some evidence that it was worse than usual at the time when it was probably infected. One consumer spoke of it as having been at the time offensive in taste and odor. It is instructive to note that mere pollution seems to have done no obvious harm. Specific infection, however, produced Asiatic cholera.

Mr. Whitehead in his singularly fair and candid report raises an interesting question, viz: Why, if an early and unrecognized case in the house in question brought about infection of the well, should not the four severer cases of undoubted cholera subsequently in the same house, with no known change in the drainage, have produced even greater disaster? This question remains unanswered, except that after the removal of the pump handle on the 8th of September access to the well was shut off, and during the intermediate week the well may have been avoided by the frightened people; or owing to illness less water may have been used in No. 40 Broad Street, so that the cesspool did not overflow, or some other condition unknown may have been changed."

Following closely on the heels of the report of the Cholera Inquiry Commission came an event, which, though fraught with no danger, nevertheless did more to call attention of people in general and lawmakers in particular to the necessity for sanitary surroundings and the danger of polluted water supply, than had all the epidemics of cholera and typhoid fever which had preceded. This event was one of the most famous stinks recorded, if not the most famous, and arose from the Thames in London in 1858 and 1859. The following account of this historic stink is by Dr. Budd.[7]

"The need of some radical modification in the view commonly taken of the relation which subsists between typhoid fever and sewage was placed in a very striking light by the state of the public health in London during the hot months of 1858 and 1859, when the Thames stank so badly. The late Dr. McWilliam pointed out at the time, in fitting and emphatic terms, the utter inconsistency of the facts with the received notion of the subject. Never before had nature laid down the data for the solution of a problem of this kind in terms so large, or wrought them out to so decisive an issue. As the lesson then taught us seems to be already well nigh forgotten, I may perhaps be allowed to recall some of its most salient points.

The occasion, indeed, as has already been hinted, was no common one. An extreme case, a gigantic scale in the phenomena, and perfect accuracy in the registration of the results—three of the best of all the guarantees against fallacy—were combined to make the inductions sure. For the first time in the history of man, the sewage of nearly three millions of people had been brought to seethe and ferment under a burning sun, in one vast open cloaca lying in their midst. The result we all know. Stench so foul we may well believe had never before ascended to pollute this lower air. Never before at least had a stink risen to the height of an historic event. Even ancient fable failed to furnish figures adequate to convey a conception of its thrice-Augean foulness. For many weeks the atmosphere of Parliamentary committee rooms was only rendered barely tolerable by the suspension before every window of blinds saturated with chloride of lime, and by the lavish use of this and other disinfectants. More than once, in spite of similar precautions, the law courts were suddenly broken up by an insupportable invasion of the noxious vapor. The river steamers lost their accustomed traffic, and travelers pressed for time often made circuit of many miles rather than cross one of the city bridges.

For months together the topic almost monopolized the public prints. Day after day, week after week, the Times teemed with letters filled with complaint, prophetic of calamity or suggesting remedies. Here and there a more than commonly passionate appeal showed how intensely the evil was felt by those who were condemned to dwell on the Stygian banks. At home and abroad the state of the chief river was felt to be a national reproach. "India is in Revolt, and the Thames Stinks," were the two great facts coupled together by a distinguished foreign writer to mark the climax of a national humiliation. But more significant still of the magnitude of the nuisance was the fact that five million pounds in money were cheerfully voted by a heavily-taxed community to provide the means for its abatement. With the popular views as to the connection between epidemic disease and putrescent gases, this state of things naturally gave rise to the worst forebodings.

Members of Parliament and noble lords, dabblers in sanitary science, vied with professional sanitarians in predicting pestilence. If London should happily be spared the cholera, decimation by fever was at least a certainty. The occurrence of a case of malignant cholera in the person of a Thames waterman, early in the summer, was more than once cited to give point to these warnings, and as foreshadowing what was to come. Meanwhile the hot weather passed away; the returns of sickness and mortality were made up, and, strange to relate, the result showed not only a death rate below the average, but as the leading peculiarity of the season, a remarkable diminution in the prevalence of fever, diarrhœa and the other forms of disease commonly ascribed to putrid emanations."

While the historical stink of the Thames was without apparent effect on the public health, the nuisance caused was so great and the fear engendered was so real, that much good was the immediate result. One of the most lasting and far reaching benefits was the appointment by Parliament of a Rivers Pollution Commission, to study into and devise ways for the prevention of pollution of streams, lakes and water-sheds, from which public water supplies are obtained. In addition to this, the stink stimulated inquiry into the sources of infection in cases of epidemic diseases, and means for preventing the spread of disease, with such success, that as early as 1866 it was decided that cholera was a water-borne disease and that the cause of infection, whatever it was, could be destroyed by heat. This is evidenced by the signs the local sanitary authorities caused to be issued during the epidemic of Asiatic cholera in 1866:

Following this, the Rivers Pollution Commission[8] of 1868 went on record as authority for the statement that "the existence of specific poison capable of producing cholera and typhoid fever is attested by evidence so abundant and strong as to be practically irresistible. These poisons are contained in the discharges from the bowels of persons suffering from these diseases." So it was that close observation and rigid inquiry discovered the truths that discharges from bowels of persons suffering from intestinal diseases contain the specific poison of the disease; that these discharges, mixed with the sewage of cities, often found their way into water supplies, and thus caused an epidemic of the same disease, and that boiling of water before drinking would destroy the infection, thus rendering it harmless. These truths stand to-day and the same means of prevention are resorted to in time of danger that were recommended during the epidemic of cholera in London in 1866. We know now, however, thanks to the investigations of Louis M. Pasteur, that all that class of disease which he designated as zymotic, are caused by little microscopic vegetation which gain lodgment in the body where they grow, multiply and thrive at the expense of the host; and knowing the specific cause of a disease makes it more easy to fight to prevent and to cure.

CHAPTER IX

On the river Elbe, some miles from the sea, there are three cities adjoining and forming in appearance one large city of 800,000 inhabitants, the combined sewage of which is discharged into the river Elbe. The water supply to the city of Hamburg, a free German city, with a population of 640,400, is derived from the Elbe above where the sewage is discharged into the river but not sufficiently far away to escape contamination from a recision of polluted water at flood tide. This water after some imperfect sedimentation passes direct to the consumer without filtration. The supply of water to Wandsbeck, a city of 20,000 population, is obtained from a lake which is unexposed to contamination and is filtered before being delivered to the mains. The supply to Altona, on the other hand, a Prussian city of 143,000 inhabitants, is obtained from the river Elbe at a point about 8 miles below where it receives the combined sewage of the three cities, with their population of over 800,000. It will thus be seen that the source of supply to Altona is the worst of the three. This most grossly polluted supply, however, is filtered with exceeding care before delivery to the consumers, and to this fact is attributed the freedom from cholera that visited Hamburg in 1892. The story is well told by Dr. Thorne, medical officer of the London Local Government Board.[9]

"The different behavior of Hamburg and Altona as regards cholera is extremely interesting. The two towns adjoin; they are practically one city. The division between the two is no more obvious than that between two densely peopled London parishes, and yet a spot map indicating the houses which were attacked with cholera, which was shown to me by Professor Koch, points out clearly that whereas the disease prevailed in epidemic form on the Hamburg side of the boundary line, that line running in and out among the streets and houses and at times passing diagonally through the houses themselves, formed the limit beyond which the epidemic, as such, did not extend. The dots on one side of the dividing line were proof of the epidemicity of cholera in Hamburg, their comparative absence on the Altona side of it was proof of the absence of the epidemic in Altona. To use Professor Koch's own words: 'Cholera in Hamburg went right up to the boundary of Altona and then stopped. In one street, which for a long way forms the boundary, there was cholera on the Hamburg side, whereas on the Altona side was free from it, and yet there was one detectable difference, and one only, between the two adjacent areas—they had different water services.' Professor Koch has collected certain proofs which he regards as crucial on this point, and Dr. Reincke has supplied me with a small plan in support of the contention. At one point close to and on the Hamburg side of the boundary line between Hamburg and Altona, is a large yard, known as the Hamburger-Platz. It contains two rows of large and lofty dwellings, containing 72 separate tenements and some 400 people, belonging almost wholly to those classes who suffered most from cholera elsewhere in Hamburg. But while cholera is shown by the spot map to have prevailed all around, not a single case occurred among the many residents of this court during the whole epidemic. And why? Professor Koch explains that owing to local difficulties, water from the Hamburg mains could not easily be obtained for the dwellings in question, and hence a supply had been laid in from one of the Altona mains in an adjacent street. This was the only part of Hamburg which received Altona water, and I am informed that it was the only spot in Hamburg in which was aggregated a population of the class in question, which escaped the cholera. At the date of my visit to Hamburg, a notice board was affixed at the entrance to this court. It stated that certain tenements were to let; but, above all, in large type, and as an inducement to intending tenants, was the announcement that the court was not only within the jurisdiction of Hamburg, with the privileges still attaching to the old Hanseatic cities, but that it had a supply of Altona water.

During the epidemic the deaths in the several cities were:

That infectious matter was communicated to the Elbe water from Hamburg is not in any way a hypothesis. Cholera germs had been as a fact found in the Elbe water. They were found a little below the place where the Hamburg main sewer flows into the Elbe. They were also found in one of the two Altona basins into which the water flowed before filtration."

No more striking example could be found, demonstrating on a large scale the efficiency of filtration as a preventive of water-borne diseases than that of the cholera epidemic of Hamburg in 1892, yet, at the present writing, there are people holding public offices throughout the United States who do not believe in the value of filtration as a public prophylactic, or who are so indifferent as not to advocate its adoption. Nor is this disbelief confined to public officials; many there are outside of public office who have made no study of sanitation and cannot believe that merely passing water downward through sand will purify it, and for the benefit of those who wish to be better informed, the story of the Hamburg epidemic of cholera, together with the part played by filters in saving Altona from a worse visitation, cannot be too often told.

It is but natural that, suspicion having once fallen on water as a source or vehicle of disease, means would be adopted not only to properly sterilize water before delivering it to the public, but, furthermore, to select the source of supply where there was least danger of contamination from filth. By this time public water supplies had progressed to such a stage that but few towns, cities or villages of any importance were without a municipal plant. Further, most cities of any importance had a more or less complete system of sewers, and the filth from these sewers was discharging freely, and in the crude state, into the streams and rivers of the realm. Such a condition of affairs could not last long without causing a nuisance, as well as becoming a menace to the health of the commonwealth, and it was not long before the problem was discussed of purifying the sewage before discharging it into streams and rivers. In Great Britain, the pollution of streams was felt more keenly than in America. The population along the rivers in Great Britain is quite dense, and the rivers, which are comparatively small, are used as sources of supply for the different municipalities along the banks, so that some means had to be devised to prevent the people up stream from polluting and perhaps infecting it for those lower down. So early as 1840, this matter forced itself on the attention of Parliament, and in 1843, a royal commission, the Health of Towns Commission, was appointed to inquire into the present state of large towns and populous districts. This was followed in 1857 by the Sewage of Towns Commission, a royal commission appointed to inquire into the best means of distributing the sewage of towns, and in 1865 by the Rivers Pollution Commission, a royal commission appointed to inquire into the best means of preventing the pollution of rivers.

Progress was not at a standstill during this time, however, but, on the contrary, chemical precipitation of sewage and purification by the application to land were striving with each other for supremacy. Up to that time, the important part that bacteria play in the reduction of organic matter was not understood, and instead of affording every advantage for the decomposition and fermentation of organic matter under the least objectionable conditions, the principal efforts of those interested in the problem were to prevent or put off as long as possible the septic action of sewage. It was not until so late as the year 1880 that attention was turned toward the possibility of the micro-organisms in sewage. In that year Dr. Mueller took out a patent endeavoring to utilize the micro-organism in sewage for the purpose of purification. According to Dr. Mueller's views, "The contents of sewage are chiefly of organic origin, and in consequence of this an active process of decomposition takes place in sewage through which the organic matters are dissolved into mineral matters, or, in short, are mineralized, and thus become fit to serve as food for plants. To the superficial observer, however, it is chiefly a process of digestion, in which the various, mostly microscopically small, animal and vegetable organisms utilize the organically fixed power for their life purpose.

"The decomposition of sewage in its various stages is characterized by the appearance of enormous numbers of spirilla, then of vibrios (swarming spores) and, finally, of moulds. At this stage commences the reformation of organic substance with the appearance of chlorophyl-holding protococcus."

About the same time, December, 1881, the account of Mouras's automatic scavenger was published in France. Mouras had been working and experimenting along the same lines as Dr. Mueller, and the result was an apparatus consisting of a closed vessel or vault, with a water seal which rapidly changed excrementatious matter into a homogeneous fluid, only slightly turbid, and holding the solid matters in suspension in the form of scarcely visible filaments. The principle claimed for his automatic scavenger by Mouras was that animal dejecta within themselves contained all the principles of fermentation necessary to liquefy them.

The teachings of Dr. Mueller and Mouras went unheeded for a long time, on account of the chemical processes then in vogue. It was maintained by those who were supposed to know, that lime and other antiseptic substances were particularly valuable in sewage purification, because they destroyed living organisms, such as bacteria, which give rise to putrefaction and fermentation. They contended that if all the organisms could be destroyed, that sewage would be rendered unobjectionable. So conditions stood when in January, 1887, Mr. Dibden read a paper before the Institute of Civil Engineers, in which he pointed out that the very essence of sewage purification was not the destruction of bacterial life, but the resolution of organic matter into other combinations by the agency of the micro-organisms. He pointed out, further, that a septic and not an antiseptic action was what was wanted, consequently any process which arrested the activity of the bacteria was the reverse of what was desired. Dibden's paper had the effect of turning investigation in the right direction, but a world of experimenting on a practical scale would be necessary before the practice of sewage purification could be established on a safe, sound and scientific footing. It remained for the Massachusetts State Board of Health to conduct those investigations, and so thoroughly was it accomplished that the records of their experiments furnish the basis for sewage purification practice in the United States. The experiments have been carried on since 1887, and the thoroughness and value of these investigations can be judged by the fact that during one period of twenty-two months four thousand chemical examinations were made in addition to the microscopic examinations.

Following the historic investigations of the Massachusetts State Board of Health, numerous engineers and investigators commenced applying to practice the principles there laid down, and with such good results that there are upwards of 200 purification plants in the United States to-day, and in Pennsylvania alone plans are under way at the present time for over one hundred sewage disposal works. Such a showing is encouraging, and leads to the hope that within a decade no city of any importance within the States will be pouring impurified sewage into public streams or lakes.

Up to within the last quarter century no thought was given in the United States to the disposal or destruction of the grosser particles which make up the waste of a large city, nor was provision made at sanatoria, hospitals and like institutions for the destruction of materials which might prove infectious; yet, no less important than the removal of sewage by water carriage is the systematic collection and subsequent destruction of all matter of no value which might prove a vehicle of disease, if a clean, sanitary environment is to be maintained. The necessity for such removal and destruction was first felt in hospitals, sanatoria, barracks and camps, where many people are brought together under unusual circumstances, and infective matter is liable to accumulate, thereby proving a menace to the community. It is not surprising, therefore, that the desirability of destroying such accumulated wastes was first brought home to the medical staff connected with military service, and that the medical authorities should be connected with the British army.

The first garbage destructor, or garbage furnace, of which there is any record, was constructed about 1860, at Gibraltar, for the exclusive destruction by fire of all waste matter from the British garrison. In the United States, likewise, it was at the army posts where the need for waste destructors was first felt, and in 1885 Lieutenant H. I. Reilly, U. S. A., built the first American garbage furnace at Governor's Island, New York Harbor. From that time on, the value of garbage destructors became more widely known, and within recent years the need for a sanitary and convenient method for disposing of waste matters has been occupying the attention of those in charge of institutions devoted to the care of the sick, infirm, feeble, and to the control of the criminal. In addition to the superintendents of hospitals, prisons, sanatoria and asylums, those in charge of medical schools and laboratories, hotels, business houses and municipalities have given the matter much consideration, and at the present time most of the large cities of the United States have constructed garbage destructors, or are seriously considering the step, while the principal hospitals, hotels, department stores, medical colleges and public institutions throughout the country have already installed destructors. Likewise, garbage destructors have been constructed at all of the United States Government army posts.

MODERN & RECENT PLVMBING FIXTVRES

No history of sanitation would be complete without touching upon the plumbing fixtures in buildings, and showing the marked progress along these lines within the last quarter of a century. It is only a little over a century and a quarter since the first English patent was granted for a water closet. That was in the year 1775, and was issued to Alexander Cummings, who, strange to say, was a watchmaker. This closet was the first one patented which had what is known as a trap to contain water for a seal. Three years later a patent was issued to Joseph Bramah, inventor of the hydraulic press, for a water closet with a valve at the bottom. Little progress was made in the improvement of water closets during the next half century, and when in the year 1833 the first American patent was taken out the art had not advanced very far. Indeed, it might be said that until the time of the filing of the application for the Fraim and Neff patent, for a siphon closet, that a real cleanly and sanitary type of closet was not on the market.

Bath tubs and lavatories have improved as much in appearance in the time that has elapsed as have water closets. The earliest bath tubs of which we have any knowledge were hewn out of marble. Later, when bath tubs came into rather extensive use in the United States, they were made of wood, lined with either sheet zinc or sheet copper, tinned on one side, and it is only within comparatively recent years that porcelain enameled tubs came into use, and that solid porcelain tubs were manufactured in this country. Open plumbing was unheard of twenty-five years ago and in its stead plumbing fixtures were concealed as much as possible by encasing them in woodwork of more or less ornate designs; at that time the lavatories were all made of marble, and of this material fully 90 per cent. of the lavatories were made up to about the year 1902. About that time, porcelain enameled and solid porcelain lavatories commenced taking the lead and worked a complete revolution in the design of these fixtures. Indeed, so sudden and complete was the change that inside of a year the marble-top lavatories were driven as completely from the market as though they never existed, and, outside of old work, they are as much a curiosity to-day as an old pan closet.

With the perfecting and cheapening of plumbing fixtures came an increased demand for their use, and the attention of public-minded citizens turned to means for providing the people less favored with worldly riches with means for cleansing the person and apparel. Liverpool, England, was the first of modern cities to establish public bath houses. The first bath in that city was established in 1828, and is known as the Pierhead. It contains eleven private baths, two vapor baths, one douche, one plunge 46 x 27 feet, one plunge 40 x 27 feet, and two small private plunges. In all, Liverpool has at the present time nine public baths.

Birmingham, England, was next in point of time. It now has five bath houses, the first of which was built on Kent Street, and opened May 12, 1851. In this establishment a Turkish bath can be had for a shilling.

London, England, follows on the heels of Birmingham, with eleven bath houses, the first of which was erected in 1854. At present municipal London has invested over $2,500,000 in public baths and laundry establishments, which cost $550,000 annually to maintain.

Provisions for free public baths were made in New York in 1870 by the erection of two floating baths. These bath houses, however, could only be used during warm weather, so could not be considered, in the full sense of the word, bathing establishments. The New York Association for Improving the Condition of the Poor, realizing this and the lack of public bathing facilities, undertook to supply the deficiency as far as possible, and in 1891 opened the first real public bath house in the United States, at 9 Centre Market Place. Yonkers, N. Y., however, claims the credit of being the first city in the United States to establish a municipal bath house, supplied with hot and cold water, open all the year round, and maintained at the public expense.

The example set by a few cities has not been without effect, and other cities in the United States have followed the lead. It is noticeable, however, that it is only in the Eastern cities that public bath houses are built and maintained at the city's expense. According to the "Report on Public Baths and Comfort Stations," Buffalo, Boston, Philadelphia, Newark and Trenton each have one public bath house and Chicago has three. Since the publication of that report, however, many cities both in the East and in the West have built public bath houses and many have built, are building, or have planned to build, public comfort stations. Indeed, the standard by which the advancement of cities will be judged in the near future is, "What have they done for the comfort and welfare of the citizens?" And among the visible evidences of what they have done, standing foremost will be the public bath houses, public comfort stations, and last, but not least, public wash houses.

Events of to-day become history of to-morrow, and no history would be complete without recounting contemporaneous facts and events. So it is with sanitation; no history of that subject would be complete without illustrating a few of the plumbing fixtures in use at the time the record was written. We of the present age believe, as did those of a generation ago, that we have almost attained perfection in the manufacture of plumbing fixtures; but have we, or will succeeding generations look back upon what we consider good as we do upon the fixtures in vogue in the early 70's? This we do not know nor can we foresee. Time alone will tell.