Part 12

The construction of sewers in Paris dates from 1663, but the earliest of those still in use are not earlier than the beginning of this century. Before the great epidemic of cholera in 1832, the total length of sewers was not more than 21 miles. The sewers of Paris to-day aggregate over 750 miles in length, and constitute one of the sights of the city. According to Mason, "They may be inspected without charge on the first and third Wednesdays of each month in summer, by writing for a permit to the Prefect de la Seine. Descent is commonly made near the Madeleine by a substantial stairway of stone, and the boats awaiting the party at the foot of the steps are fully as large and quite as comfortable as Venetian gondolas.

The great sewer, which is tunnel-like in dimensions, being 16 feet high and 18 feet broad, is, on occasions of a visit, lighted with lamps alternately red and blue, and as these stretch away into the distance the effect is decidedly striking.

Under ordinary circumstances, the sewage confines itself to the center channel, but upon occasions rises above the sidewalk on either hand. The central channel is about 10 feet wide and 4 feet deep with a curved bottom, and a walk on either side. The boats with their loads of visitors are pulled by ropes in the hands of attendants who walk along the sidewalks. On either side of the sewer may be seen the large mains, carrying the city water supply, also the telegraph cables."

Reliable data concerning the construction of sewers were not obtainable in the United States until long after the close of the Civil War. In 1857, when Julius W. Adams was commissioned to prepare plans for sewering the city of Brooklyn, N. Y., which at that time covered an area of 20 square miles, a great proportion of which was suburban territory, the engineering profession was wholly without data of any kind to guide in proportioning sewers for the drainage of cities and towns. The half century intervening since that time, however, has seen the development of sanitary engineering and witnessed the installation of sewer system, rightly proportioned and properly designed, in almost every city, town and village in the United States, while text books on engineering contain all necessary data for their design and construction. It must not be inferred from the foregoing statement that sewers were unknown in the United States prior to the construction of the Brooklyn sewer system. There was one in Boston, for example, which dated from the seventeenth century, while the first comprehensive sewerage project was designed by E. S. Chesbrough, for the city of Chicago in 1855.

There was no great activity in sewer building in this country thirty years ago. Up to that time most of the cities were comparatively small, and no thought was given by the various municipalities to treating the combined sewage as a whole. The conditions were ripe, however, for some unusual event to crystallize public opinion and focus attention on the subject, and the event was furnished by the city of Memphis, Tennessee. Ever since 1740, Memphis had been known as a particularly unhealthful city, where the death rate was abnormally high, and epidemic after epidemic of cholera, yellow fever and other contagious diseases had scourged the inhabitants. So common had those events become, that they were accepted as incident to living in the locality, and were looked upon as special visitations which could not be avoided. Such was the state of affairs when an epidemic of yellow fever broke out in 1879, which caused a death list of 5,150, and was followed the succeeding year by a further death roll of 485, due to the scourge. Had the disease been confined within the boundaries of the city, it is possible that little would have been thought of the matter outside of the state of Tennessee. However, refugees, fleeing in all directions, carried the dread disease with them, until a strict quarantine—a shotgun quarantine—confined the infection to a certain circumscribed area. In the meantime, interference with railroad traffic, armed forces guarding the borders of neighboring states, together with the fear of the dread disease spreading all over the country, brought Congress and the public to a realization of the necessity for doing something to stamp out the disease. The most practical good accomplished by the agitation was the organization of a National Board of Health, a committee from which made a thorough examination of the sanitary conditions of Memphis. What the committee found in the way of filth was almost beyond belief. The city, they found, was honeycombed with cesspools and privy-vaults. Many of the cesspools and privy-vaults were under or in the cellars of houses, where they had been filled with accumulations and abandoned to fester and rot. Filth was everywhere—above ground and beneath the surface, in the house and out of doors. There was only one thing to do—give the city a good cleaning; and that was the only time in history, perhaps, when pressure from the outside forced an almost bankrupt city to observe the laws of decency and sanitation.

The various works which had been built up to this time to supply communities with water, had for their sole object the providing of an adequate supply so far as quantity is concerned, but gave little thought to the quality of the water, so long as it was clear and cold. The sewers or drains on the other hand were constructed solely to prevent a nuisance and with no definite knowledge that an unclean environment and polluted water were conducive to ill-health, while pure water and clean surroundings were conducive to the public health.

Some events were about to happen, however, which would awaken the public mind to the dangers of dirt, and that would usher in the present epoch of sanitation.

·HINDV·DEAD·AT·BENARES·

"Who dies in the waters of the Ganges obtains Heaven"

From Stereograph, copyright by Underwood & Underwood, N. Y.

(See page iv)]

Synopsis of Chapter. Sanitary Awakening—Realization of the Danger of Unwholesome Water—Cholera in London Traced to the Broad Street Pump—An Historical Stink.

Truth is mighty and will prevail, but sometimes it is centuries before its voice can be heard and additional centuries before its language is understood. As early as 350 B. C., Hippocrates, the Father of Medicine, pointed out the danger of unsterilized water and advised boiling or filtering a polluted water supply before drinking. He further believed that the consumption of swamp water in the raw state produced enlargement of the spleen. Had his warning been heeded the lives of millions of people who were carried to untimely graves by the scourges of pestilence which swept over Europe, Asia and Great Britain, might have been saved. Some idea of the ravage caused by filth diseases can be gained by reviewing the mortality due to cholera in London during the epidemics of 1832, 1848, 1849, 1853 and 1854.

On account of its size and lack of sanitary provisions, the London of that period was the kind of place in which, with our present knowledge of disease, we would expect a plague to reach its height. Prior to 1700, the city of London had no sewers and was without water supply, except such as was obtained from wells and springs in the neighborhood. The subsoil of London we can readily believe was foul from cesspool leachings and from slops and household refuse deposited on the surface of the ground, so that water from the wells within the city limits, while cool perhaps and palatable, could not have been wholesome. Many public wells with pumps had been installed at certain intervals on the public highways, and an epidemic of cholera traced to one of these wells, was the means of pointing out the danger to public health, caused by an infected water supply, and of showing the channel by which the infectious matter from people suffering from intestinal diseases was transmitted to healthy individuals. The story is well told by Sedgwick: "One of the earliest, one of the most famous, and one of the most instructive cases of the conveyance of disease by polluted water, is that commonly known as the epidemic of Asiatic cholera connected with the Broad Street, London, well, which occurred in 1854. For its conspicuously circumscribed character, its violence and fatality, and especially for the remarkable skill, thoroughness and success with which it was investigated, it will long remain one of the classical instances of the terrible efficiency of polluted water as a vehicle of disease.

ASIATIC CHOLERA - AND - THE BROAD STREET PUMP. LONDON 1854.]

As a monument of sanitary research, of medical and engineering interest and of penetrating inductive reasoning, it deserves the most careful study. No apology therefore need be made for giving of it here a somewhat extended account.

The parish of St. James, London, occupied 164 acres in 1854, and contained 36,406 inhabitants in 1851. It was subdivided into three subdistricts, viz., those of St. James Square, Golden Square and Berwick Street. As will be seen by the map, it was situated near a part of London now well known to travellers, not far from the junction of Regent and Oxford Streets. It was bounded by Mayfair and Hanover Square on the west, by All Souls and Marylbone on the north, St. Anne's and Soho on the east, and Charing Cross and St. Martin's-in-the-Fields on the east and south.

In the cholera epidemics of 1832, 1848, 1849 and 1853, St. James' Parish suffered somewhat, but on the average decidedly less than London as a whole. In 1854, however, the reverse was the case. The inquiry committee estimated that in this year the fatal attacks in St. James' Parish were probably not less than 700, and from this estimate compiled a cholera death rate, during 17 weeks under consideration, of 220 per 10,000 living in the parish, which was far above the highest in any other district. In the adjoining sub-district of Hanover Square the ratio was 9; and in the Charing Cross district of St. Martin's-in-the-Fields (including a hospital) it was 33. In 1848-1849 the cholera mortality in St. James' Parish had been only 15 per 10,000 inhabitants.

Within the parish itself, the disease in 1854 was very unequally distributed. In the St. James Square district, the cholera mortality was only 16 per 10,000, while in the Golden Square district it was 217 and in the Berwick Street district 212. It was plain that there had been a special cholera area, a localized circumscribed district. This was eventually minutely studied in the most painstaking fashion as to population, industries, previous sanitary history, meteorological conditions and other general phenomena common to London as a whole, with the result that it was found to have shared with the rest of London a previous long continued absence of rain, a high state of temperature both of the air and of the Thames, an unusual stagnation of the lower strata of the atmosphere, highly favorable to its acquisition of impurity, and although it was impossible to fix the precise share which each of the conditions enumerated might separately have had in favoring the spread of cholera, the whole history of that malady, as well as of the epidemic of 1854 and indeed of the plague of past epochs, justifies the supposition that their combined operation, either by favoring a general impurity in the air or in some other way, concurred in a decided manner, last summer and autumn (1854) to give temporary activity to the special causes of that disease. The inquiry committee did not, however, rest satisfied with these vague speculations and conclusions, but as previously shown in the history of this local outbreak, the resulting mortality was so disproportioned to that in the rest of the metropolis and more particularly to that in the immediately surrounding districts, that we must seek more narrowly and locally for some peculiar conditions, which may help to explain this serious visitation.

Accordingly special inquiries were made within the district involved in regard to its elevation of site, soil and subsoil, including an extended inquiry into the history of a pest field said to have been located within this area in 1665, 1666, to which some had attributed the cholera of 1854; surface and ground plan; streets and courts; density of population; character of the population; dwelling houses; internal economy as to space, light, ventilation and general cleanliness; dust bins and accumulations in yards, cellars and areas; cesspools, closets and house drains; sewers, their water flow and atmospheric connection; public water supply and well water supply. No peculiar condition or adequate explanation of the origin of the epidemic was discovered in any of these, even after the most searching inquiry, except in the well water supply. Abundant general defects were found in the other sanitary factors, but nothing peculiar to the cholera area, or if peculiar, common to those attacked by the disease, could be found excepting the water supply.

At the very beginning of the outbreak, Dr. John Snow, with commendable energy, had taken the trouble to get the number and location of the fatal cases, as is stated in his own report:

"I requested permission, on the 5th of September, to take a list, at the general register office, of the deaths from cholera registered during the week ending the 2nd of September, in the subdistricts of Golden Square and Berwick Street, St. James' and St. Anne's, Soho, which was kindly granted. Eighty-nine (89) deaths from cholera were registered during the week in the three subdistricts, of these only six (6) occurred on the first four days of the week, four occurred on Thursday, August 31, and the remaining 79 on Friday and Saturday. I considered therefore that the outbreak commenced on the Thursday, and I made inquiry in detail respecting the 83 deaths registered as having taken place during the last three days of the week.

On proceeding to the spot I found that nearly all the deaths had taken place within a short distance of the pump in Broad Street. There were only ten deaths in houses situated decidedly nearer to another street pump. In five of these cases the families of the deceased persons told me that they always sent to the pump in Broad Street, as they preferred the water to that of the pump which was nearer. In three other cases the deceased were children who went to school near the pump in Broad Street. Two of them were known to have drunk the water and the parents of the third think it probable that it did so. The other two deaths beyond the district which the pump supplies, represent only the amount of mortality from cholera that was occurring before the eruption took place.

With regard to the 73 deaths occurring in the locality belonging, as it were, to the pump, there were 61 instances in which I was informed that the deceased persons used to drink the water from the pump in Broad Street, either constantly or occasionally. In six (6) instances I could get no information, owing to the death or departure of every one connected with the deceased individuals; and in six (6) cases I was informed that the deceased persons did not drink the pump water before their illness.

The result of the inquiry consequently was that there had been no particular outbreak or increase of cholera in this part of London, except among the persons who were in the habit of drinking the water of the above mentioned pump well.

I had an interview with the Board of Guardians of St. James' Parish on the evening of Thursday, 7th of September, and represented the above circumstances to them. In consequence of which the handle of the pump was removed on the following day.

The additional facts that I have been able to ascertain are in accordance with those related above, and as regards the small number of those attacked, who were believed not to have drunk the water from the Broad Street pump, it must be obvious that there are various ways in which the deceased persons may have taken it without the knowledge of their friends. The water was used for mixing with spirits in some of the public houses around. It was used likewise at dining rooms and coffee shops. The keeper of a coffee shop which was frequented by mechanics and where the pump water was supplied at dinner time, informed us on the 6th of September that she was already aware of nine of her customers who were dead."

On the other hand, Dr. Swan discovered that while a workhouse (almshouse) in Poland Street was three-fourths surrounded by houses in which cholera deaths occurred, out of 525 inmates of the workhouse, only five cholera deaths occurred. The workhouse, however, had a well of its own in addition to the city supply, and never sent for water to the Broad Street pump. If the cholera mortality in the workhouse had been equal to that in its immediate vicinity, it would have had 50 deaths.