Popular Science Monthly/Volume 2/April 1873/Applied Sanitary Science
By J. R. BLACK, M. D.
IN the intellectual field there are two distinct classes of laborers: the discoverers, or those who pursue science for its own sake; and the appliers, or those who seek to make the knowledge it confers useful, and so turn it into a direct source of profit to themselves, and, in a general way, to the public. The genius each displays differs from the other: the one being delighted in finding out and making his way into the unknown, while the pleasure of the other consists in seizing results, and putting them into shape, so that they may be servants to our will. The history of electricity strikingly displays these distinct aptitudes and pursuits. Volta, Franklin, Arago, and Faraday, were leading discoverers of the properties and laws of electricity. They cared far less about the every-day use which might be made of the newly-discovered force, than of gaining a complete insight into its nature, and of making it the means of unlocking other secrets of the natural world. On the other hand, Morse and Wheatstone thought only of electricity as a means to an end, or of reaching, through some ingenious contrivance, the means of rendering human communication, at distant points, practically instantaneous.
A knowledge of the leading facts upon which sanitary science is founded is, at least, as old as history itself. It antedates the time of Moses; many of the rules of hygiene having been taught by the Egyptian priests. But more especially within the past two centuries has the knowledge of the ways in which disease is produced, and may be avoided, been corrected and extended. It is within this period that the first attempt was made in Europe to establish quarantines. The sum of the precautions taken in London during the middle ages to guard against the ravages of the plague, was the isolation of infected houses, and putting a red cross on house-doors, on which were inscribed the words, "Lord, have mercy on us."
The physician of to-day, who has devoted half as much thought to the prevention of disease as to its cure, firmly believes in human ability to avoid nearly all the ills to which flesh is now subject. Given a good constitution, and the conditions of health or sickness are almost wholly in our own power. He believes this, and on precisely the same grounds that the geologist believes that fossils are not what was once universally believed, the primary result of the action of a plastic or creative force in Nature. A like belief exists in the popular mind in reference to health and longevity, though in a less positive form. Families known to be of good constitution, and of ancestry noted for their length of days, are not expected to be sickly and short-lived. When any member of such a family does become a permanent invalid, and likely soon to die, it is a familiar expression, and notoriously true, that he or she has abused the endowment inherited.
Passing over the evidence which has convinced those the most competent to judge in reference to the prevalence of disease—the physicians—to their conclusion, that if all possessed good constitutions, and lived as they ought to live, in accordance with hygienic law, there would be no disease, or next to none, and death would not come upon the human family through a morbid process, but by the only truly natural mode of dying—old age; the question arises, How do men come by good constitutions? Through a course of life by progenitors for several generations, precisely the opposite of that course which makes a bad constitution out of a good one. Any one who has attained to life's meridian will be able to recall examples of good constitutions converted into bad ones. Children, parents, and grandparents, in some families, often stand thus in regard to constitutions:
Grandparents scarcely know what sickness is, and die of old age;
This is the downward career of life-force, which almost every one has witnessed; the upward career being the result of a precisely opposite course. In place of abusing the constitution there is the most careful husbanding of its resources, and avoidance of all the causes which will impair its vigor. The purity and strength which such a course of conduct begets is transmitted; the child starts in the world on a higher plane of life-force than the parents did; and if the offspring continue to carry out the reformation thus inaugurated, the result will be to bring back the pristine vigor, health, and longevity, which an opposite course had destroyed.
Such are some of the elementary truths forced upon the attention by everyday experience on the great problem of obliterating sickness and death by disease. As has been stated, these elements of sanitary science have long been known. But in spite of this, and of the facts that this science has of late been purged of many errors, and its bearings and capabilities greatly extended, disease, deformity, decrepitude, and untimely death, prevail almost as much as ever. Where, then, is the weak point in sanitary science? Is it in the imperfection of the science itself, or is it in its applications? Reverting to the history of electrical discovery and its applications, will give us aid in solving the question. We have seen that the discovery of the great truths about the electrical force employed one class of scientific experts, and applying these truths employed another class of scientific experts. Now, we have had in abundance the discoverers of the truths of sanitary law, but we have not, nor can we have, as in electricity, experts who can carry out for the advantage of all, the benefits which hygienic law is capable of conferring. There cannot be, in sanitary matters, ingenious contrivances, by which a certain class of men can manipulate health and long life into their fellow-beings. Its truths, if applied at all, must be mainly applied by those who desire its benefits; or every one must apply the science for himself or herself, else nearly all the knowledge there may be on the subject will be as if it were not. Here we have plainly before the mind the great and peculiarly weak point, so far as the practical benefits are concerned, which this science may be capable of conferring. To make it profitable and useful, or, in other words, to make it an applied science in a community, that community must be made, one and all, experts in its knowledge and in its applications.
This last consideration should lead educators to bestow a preëminent importance to a thorough course of instruction in hygiene. It is all well enough for the young to learn more or less about the philosophy of electricity and magnetism, but, as the great majority of them in after-life will make very little, if any, use of this knowledge, its importance practically dwindles to very small proportions. Wholly different is it in the case of sanitary science. Every one can make of it in after-life most important, and ultimately momentous uses, not occasionally, but during every day and hour of life. And, if thus applied, its benefits would transcend those of any other branch of knowledge; it would tend to make man a master of himself, of his pains, deformities, and mortal afflictions.
We have said that the applications of sanitary science must be made mainly by the individual members of society. This is true of the kind of air breathed, of the food and drinks partaken, of the clothing worn, etc., etc. But where human beings are clustered together, their sanitary relations are so intimate that it becomes absolutely necessary for the general good to define and regulate some sanitary matters by law, which each member of a community cannot, as an individual, regulate for himself. It is not possible, for example, for one in a densely-populated place, to enforce regulations for a supply of wholesome water, for carrying off to a safe distance all the refuse and noxious matters of a great city, or to protect himself from the presence of persons suffering from infectious diseases. It is here plainly the duty of the State to exercise supervision for the general good, and to protect all, as far as may be possible, against evils which a few persons may fight against in vain. There is absolutely no difference, except in the matter of will, between the danger of allowing a person who has a mania for putting poison into the drinking-water of a city, by which many perish, and one who puts the poison of small-pox into the air of a city by which hundreds are slain. In the former case, even if it were the work of an idiot, or of an irresponsible person, and if he were known to be travelling over the country, liable at any moment to enter a city, would not the officers of the law be considered exceedingly derelict in duty if they did not carefully guard against his entrance? And, if such a class of persons were in a city infecting others with their mania, would not all applaud the law and the efforts of its officers in securely confining them where they could do no harm, taking from them the means by which they injured and destroyed the lives of others? This is precisely what ought to be done with every one in a densely-populated place laboring under an infectious or contagious disease. When out of a city, such dangerously-affected persons should be watchfully excluded until cured of their disorder; and, when in, a cordon should be placed around them, so that the community would be in no danger; all the while carefully stamping out with disinfectants the means or the germs by which disease and death are carried from house to house.
It should for these reasons be a maxim with the law-making power to protect the health and lives of the people, whenever individual effort is powerless or insufficient; and, moreover, to provide that pure air, wholesome drink and food, should be made possible to every inhabitant of a town or city. If the refuse matter and excreta of a city are not promptly and carefully removed; if the streets are not of the proper width, and regularly cleansed; if houses are allowed to be so constructed that effective ventilation is impossible; if the water-supply is insufficient, or tainted with organic matter; and if persons are allowed free entrance, suffering with dangerous infectious diseases, and no well-directed efforts are made to destroy the noxious matters thus introduced, misery, disease, and a fearful rate of mortality, will be the normal results. The few who make diligent efforts to apply the rules of sanity are powerless in removing the obvious causes of the prevailing misery and death-gloom, and, like Lot, for safety, must flee the city.
With a private and public hygiene thoroughly understood and effectively maintained, there is not an intelligent physician in our land who would not acknowledge that the result would be to diminish the prevalence of disease at least one-half, and to send the average expectation of life, at a bound, up a decade of years.
Taking into consideration the fact that it is within the power of sanitary regulations to prevent yellow fever, as was shown in New Orleans while under occupancy during the late war by the Union forces for more than two years, where over 100,000 unacclimated soldiers were stationed, or passed through the city, without a single case of the disease originating there; that it is possible to stamp out the germs of Asiatic cholera and small-pox, and say, "Thus far shalt thou go, and no farther;" and taking into consideration that the average duration of life has been extended during the past two centuries from nineteen to thirty-one years, by a slow appreciation and imperfect application of sanitary law alone; taking these, and many other facts of a like character, into consideration, it does not seem too much to say that it is within the power of any one with a moderately good constitution to say whether he will choose to cut short his days and die the violent death of disease, or whether he will extend the powers of his body to their normal limits, and so die from the effects of old age, or from the gradual wearing out of the most imperfect organ of his body.
Pecuniarily, the results of properly-applied sanitary law would be immensely successful; the cent of prevention would be more than worth the dollar of cure. It is estimated that from a half to three-fourths of the inhabitants of our principal cities are sick some time during each year of ordinary salubrity. The loss of time which thereby results, the expense of nurses and medicines, and, above all, the permanent impairment of the health and shortening of life which thereby ensue, are fruitful sources of the worst misery and the deepest indigence. These conditions become, in turn, the great nurseries for crime, and for filling our poor-houses, asylums, hospitals, and penitentiaries. During the years when an epidemic scourges a city, its business becomes for the time paralyzed, and a serious check is put upon its growth and prosperity.
But, more than these, sickness throughout the United States supports in comparative affluence, at least, 75,000 persons with their families. The physicians and dentists amount in round numbers, according to the last census, to 55,000, and the druggists, pharmaceutists, and patent-medicine venders, to about 20,000 more. Add to all this the munificent charities maintained for those who are directly or indirectly sufferers from the effects of preventable diseases, such as the deaf, the blind, the insane, and the imbecile asylums, and the aggregate outlay for avoidable evils assumes enormous proportions.
In reference to health and sickness, the civilization of the nineteenth century presents this remarkable spectacle: millions of dollars annually spent, indescribable torments and anguish endured from an evil which it is possible, but never seriously attempted, to remove. The dark shadow of a barbarous ignorance yet overspreads the popular mind, that sickness is somehow produced by evil causes, whose dreadful attacks we may patiently watch and fight with drugs, but whose ultimate destruction belongs alone to the gods. The danger of an attack by some dreadful disease is yet looked upon with a feeling akin to superstition, not with the calm confidence of security which a thorough knowledge of cause and effect alone can bestow. Slowly, oh, how slowly! does the human mind awaken to the truth that in this, as in every thing else pertaining to the natural world, nothing happens by chance, nothing of arbitrary will, but all is subject to immutable law. This truth once fully recognized and acted upon, man would exhibit the same power and success in subduing in his own body the one great obstacle to his weal, as he has shown in subduing the obstacles to his weal in the external world, and he will then become the most healthy instead of the most sickly of beings.
The proper means for accelerating such a hygienic reformation consists in making it possible for all to become experts in the application of the science of life. In effecting this, the State has the two great requisites in its own hands: first, to educate and train the youth of our country so that they may realize the importance, and be enabled to apply, sanitary science for themselves; and, second, to make it possible, wherever there is a dense population, for every one to carry the laws of hygiene into effect, and to protect the people against those who have disregarded its injunctions, and so have become focii for multiplying and disseminating the seeds of infectious diseases.