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diff --git a/12036-h/12036-h.htm b/12036-h/12036-h.htm new file mode 100644 index 0000000..c28963e --- /dev/null +++ b/12036-h/12036-h.htm @@ -0,0 +1,1081 @@ +<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"> + +<html> +<head> + <meta name="generator" content= + "HTML Tidy for Windows (vers 1st February 2004), see www.w3.org"> + <meta http-equiv="Content-Type" content= + "text/html; charset=UTF-8"> + + <title>The Project Gutenberg eBook of Hygeia, A City of Health, by Benjamin Ward Richardson</title> + <style type="text/css"> + <!-- + P { margin-top: .75em; + text-align: justify; + margin-bottom: .75em; + } + H1,H2,H3,H4,H5,H6 { + text-align: center; /* all headings centered */ + } + HR { width: 33%; + margin-top: 1em; + margin-bottom: 1em; + } + BODY{margin-left: 10%; + margin-right: 10%; + } + .linenum {position: absolute; top: auto; left: 4%;} /* poetry number */ + .note {margin-left: 2em; margin-right: 2em; margin-bottom: 1em;} /* footnote */ + .blkquot {margin-left: 4em; margin-right: 4em;} /* block indent */ + .pagenum {position: absolute; left: 92%; font-size: smaller;} /* page numbers */ + .sidenote {width: 20%; margin-bottom: 1em; margin-top: 1em; padding-left: 1em; font-size: smaller; float: right; clear: right;} + + .poem {margin-left:10%; margin-right:10%; text-align: left;} + .poem .stanza {margin: 1em 0em 1em 0em;} + .poem p {margin: 0; padding-left: 3em; text-indent: -3em;} + .poem p.i2 {margin-left: 2em;} + .poem p.i4 {margin-left: 4em;} + .poem .caesura {vertical-align: -200%;} + // --> + </style> +</head> + +<body> +<div>*** START OF THE PROJECT GUTENBERG EBOOK 12036 ***</div> + + <p>This file was produced from images generously made available + by the Bibliothèque nationale de France (BnF/Gallica) at + http://gallica.bnf.fr</p><br> + <br> + + <h1>HYGEIA</h1> + + <h2>A CITY OF HEALTH</h2> + + <h3>BY</h3> + + <h3>BENJAMIN WARD RICHARDSON M.D., F.R.S.</h3><br> + <br> + + <center> + 1876 + </center> + <hr style="width: 65%;"> + + <p>TO EDWIN CHADWICK, C.B.</p><br> + + <p>MY DEAR MR. CHADWICK,</p> + + <p><i>I wrote this Address with the intention of dedicating it to + you, as a simple but hearty acknowledgment by a sanitary student, + himself well ripened in the work, of your pre-eminent position as + the living leader of the sanitary reformation of this + century</i>.</p> + + <p><i>The favour the Address has received indicates notably two + facts: the advance of public opinion on the subject of public + health, and the remarkable value and influence of your services + as the sanitary statesman by whom that opinion has been so wisely + formed and directed</i>.</p> + + <p><i>In this sense of my respect for you, and of my gratitude, + pray accept this trifling recognition, and believe me to + be</i>,</p> + + <p><i>Ever faithfully yours</i>,</p> + + <p>B.W. RICHARDSON.</p> + <hr style="width: 65%;"> + <a name="PREFATORY_NOTE"></a> + + <h2>PREFATORY NOTE.</h2> + + <p>The immediate success of this Address caused me to lay it + aside for some months, to see if the favour with which it was + received would remain. I am satisfied to find that the good + fortune which originally attended the effort holds on, and that + in publishing it now in a separate form I am acting in obedience + to a generally expressed desire.</p> + + <p>Since the delivery of the Address before the Health Department + of the Social Science Congress, over which I had the honour to + preside, at Brighton, in October last, every day has brought some + new suggestion bearing on the subjects discussed, and the + temptation has been great to add new matter, or even to recast + the essay and bring it out as a more compendious work. On + reflection I prefer to let it take its place in literature, in + the first instance, in its original and simple dress.</p> + + <p>12 HINDE STREET, W.: <i>August</i> 18, 1876.</p> + <hr style="width: 65%;"> + <a name="HYGEIA_A_CITY_OF_HEALTH"></a> + + <h2>HYGEIA, A CITY OF HEALTH</h2><br> + + <p>We meet in this Assembly, a voluntary Parliament of men and + women, to study together and to exchange knowledge and thought on + works of every-day life and usefulness. Our object, to make the + present existence better and happier; to inquire, in this + particular section of our Congress:—What are the conditions + which lead to the pain and penalty of disease; what the means for + the removal of those conditions when they are discovered? What + are the most ready and convincing methods of making known to the + uninformed the facts: that many of the conditions are under our + control; that neither mental serenity nor mental development can + exist with an unhealthy animal organisation; that poverty is the + shadow of disease, and wealth the shadow of health?</p> + + <p>These objects relate to ourselves, to our own reliefs from + suffering, to our own happiness, to our own riches. We have, I + trust and believe, yet another object, one that relates not to + ourselves, but to those who have yet to be; those to whom we may + become known, but whom we can never know, who are the ourselves, + unseen to ourselves, continuing our mission.</p> + + <p>We are privileged more than any who have as yet lived on this + planet in being able to foresee, and in some measure estimate, + the results of our wealth of labour as it may be possibly + extended over and through the unborn. A few scholars of the past, + like him who, writing to the close of his mortal day, sang + himself to his immortal rest with the '<i>Gloria in + excelsis</i>,' a few scholars might foresee, even as that Baeda + did, that their living actual work was but the beginning of their + triumphant course through the ages,—the momentum. But the + masses of the nations, crude and selfish, have had no such + prescience, no such intent. 'Let us eat and drink, for to-morrow + we die!' That has been the pass, if not the password, with them + and theirs.</p> + + <p>We, scholars of modern thought, have the broader, and + therefore more solemn and obligatory knowledge, that however many + to-morrows may come, and whatever fate they may bring, we never + die; that, strictly speaking, no one yet who has lived has ever + died; that for good or for evil our every change from + potentiality into motion is carried on beyond our own apparent + transitoriness; that we are the waves of the ocean of life, + communicating motion to the expanse before us, and leaving the + history we have made on the shore behind.</p> + + <p>Thus we are led to feel this greater object: that to whatever + extent we, by our exertions, confer benefits on those who live, + we extend the advantage to those who have to live; that one good + thought leading to practical useful action from one man or woman, + may go to the virtue of thousands of generations; that one breath + of health wafted by our breath may, in the aggregate of life + saved by it, represent in its ultimate effect all the life that + now is or has been.</p> + + <p>At the close of a Parliamentary session, an uneventful leader + of a section of Parliament banters his more eventful rival, and + enlivening his criticism by a sneer at our Congress, challenges + the contempt of his rival, as if to draw it forth in the same + critical direction. Alas! it is too true that great congresses, + like great men, and even like Parliaments, do live sometimes for + many years and talk much, and seem to miss much and advance + little; so that in what relates to the mere present it were + wrong, possibly, to challenge the sally of the statesman who, + from his own helpless height, looked down on our weakness. But + inasmuch as no man knoweth the end of the spoken word, as that + which is spoken to-day, earnestly and simply, may not reappear + for years, and may then appear with force and quality of hidden + virtue, there is reason for our uniting together beyond the proof + of necessity which is given in the fact of our existence. + Perchance some day our natural learning, gathered in our varied + walks of life, and submitted in open council, may survive even + Parliamentary strife; perchance our resolutions, though no + sign-manual immediately grace them, are the informal bills which + ministers and oppositions shall one day discuss, Parliaments + pass, royal hands sign, and the fixed administrators of the will + of the nation duly administer.</p> + + <p>These thoughts on the future, rather than on the passing + influence of our congressional work, have led me to the simple + design of the address which, as President of this Section, I + venture to submit to you to-day. It is my object to put forward a + theoretical outline of a community so circumstanced and so + maintained by the exercise of its own freewill, guided by + scientific knowledge, that in it the perfection of sanitary + results will be approached, if not actually realised, in the + co-existence of the lowest possible general mortality with the + highest possible individual longevity. I shall try to show a + working community in which death,—if I may apply so common + and expressive a phrase on so solemn a subject,—is kept as + nearly as possible in its proper or natural place in the scheme + of life.</p><br> + + <h2>HEALTH AND CIVILISATION.</h2> + + <p>Before I proceed to this task, it is right I should ask of the + past what hope there is of any such advancement of human + progress. For, as my Lord of Verulam quaintly teaches, 'the past + ever deserves that men should stand upon it for awhile to see + which way they should go, but when they have made up their minds + they should hesitate no longer, but proceed with cheerfulness,' + For a moment, then, we will stand on the past.</p> + + <p>From this vantage-ground we gather the fact, that onward with + the simple progress of true civilisation the value of life has + increased. Ere yet the words 'Sanitary Science' had been written; + ere yet the heralds of that science (some of whom, in the persons + of our illustrious colleagues, Edwin Chadwick and William Fair, + are with us in this place at this moment), ere yet these heralds + had summoned the world to answer for its profligacy of life, the + health and strength of mankind was undergoing improvement. One or + two striking facts must be sufficient in the brief space at my + disposal to demonstrate this truth. In England, from 1790 to + 1810, Heberden calculated that the general mortality diminished + one-fourth. In France, during the same period, the same + favourable returns were made. The deaths in France, Berard + calculated, were 1 in 30 in the year 1780, and during the eight + years, from 1817 to 1828, 1 in 40, or a fourth less. In 1780, out + of 100 new-born infants, in France, 50 died in the two first + years; in the later period, extending from the time of the census + that was taken in 1817 to 1827, only 38 of the same age died, an + augmentation of infant life equal to 25 per cent. In 1780 as many + as 55 per cent. died before reaching the age of ten years; in the + later period 43, or about a fifth less. In 1780 only 21 persons + per cent. attained the age of 50 years; in the later period 32, + or eleven more, reached that term. In 1780 but 15 persons per + cent, arrived at 60 years; in the later period 24 arrived at that + age.</p> + + <p>Side by side with these facts of the statist we detect other + facts which show that in the progress of civilisation the actual + organic strength and build of the man and woman increases. As in + the highest developments of the fine arts the sculptor and + painter place before us the finest imaginative types of strength, + grace, and beauty, so the silent artist, civilisation, approaches + nearer and nearer to perfection, and by evolution of form and + mind developes what is practically a new order of physical and + mental build. Peron,—who first used, if he did not invent, + the little instrument, the dynamometer, or muscular-strength + measurer,—subjected persons of different stages of + civilisation to the test of his gauge, and discovered that the + strength of the limbs of the natives of Van Diemen's Land and New + Holland was as 50 degrees of power, while that of the Frenchmen + was 69, and of the Englishmen 71. The same order of facts are + maintained in respect to the size of body. The stalwart + Englishman of to-day can neither get into the armour nor be + placed in the sarcophagus of those sons of men who were accounted + the heroes of the infantile life of the human world.</p> + + <p>We discover, moreover, from our view of the past, that the + developments of tenacity of life and of vital power have been + comparatively rapid in their course when they have once + commenced. There is nothing discoverable to us that would lead to + the conception of a human civilisation extending back over two + hundred generations; and when in these generations we survey the + actual effect of civilisation, so fragmentary and overshadowed by + persistent barbarism, in influencing disease and mortality, we + are reduced to the observation of at most twelve generations, + including our own, engaged, indirectly or directly, in the work + of sanitary progress. During this comparatively brief period, the + labour of which, until within a century, has had no systematic + direction, the changes for good that have been effected are + amongst the most startling of historical facts. Pestilences which + decimated populations, and which, like the great plague of + London, destroyed 7,165 people in a single week, have lost their + virulency; gaol fever has disappeared, and our gaols, once each a + plague-spot, have become, by a strange perversion of + civilisation, the health spots of, at least, one kingdom. The + term, Black Death, is heard no more; and ague, from which the + London physician once made a fortune, is now a rare tax even on + the skill of the hardworked Union Medical Officer.</p> + + <p>From the study of the past we are warranted, then, in assuming + that civilisation, unaided by special scientific knowledge, + reduces disease and lessens mortality, and that the hope of doing + still more by systematic scientific art is fully justified.</p> + + <p>I might hereupon proceed to my project straightway. I + perceive, however, that it may be urged, that as mere civilising + influences can of themselves effect so much, they might safely be + left to themselves to complete, through the necessity of their + demands, the whole sanitary code. If this were so, a formula for + a city of health were practically useless. The city would come + without the special call for it.</p> + + <p>I think it probable the city would come in the manner + described, but how long it would be coming is hard to say, for + whatever great results have followed civilisation, the most that + has occurred has been an unexpected, unexplained, and therefore + uncertain arrest of the spread of the grand physical scourges of + mankind. The phenomena have been suppressed, but the root of not + one of them has been touched. Still in our midst are thousands of + enfeebled human organisms which only are comparable with the + savage. Still are left amongst us the bases of all the diseases + that, up to the present hour, have afflicted humanity.</p> + + <p>The existing calendar of diseases, studied in connection with + the classical history of the diseases written for us by the + longest unbroken line of authorities in the world of letters, + shows, in unmistakable language, that the imposition of every + known malady of man is coeval with every phase of his recorded + life on the planet. No malady, once originated, has ever actually + died out; many remain as potent as ever. That wasting fatal + scourge, pulmonary consumption, is the same in character as when + Coelius Aurelianus gave it description. The cancer of to-day is + the cancer known to Paulus Eginæta. The Black Death, though + its name is gone, lingers in malignant typhus. The great plague + of Athens is the modern great plague of England, scarlet fever. + The dancing mania of the Middle Ages and the convulsionary + epidemic of Montmartre, subdued in their violence, are still to + be seen in some American communities, and even at this hour in + the New Forest of England. Small-pox, when the blessed protection + of vaccination is withdrawn, is the same virulent destroyer as it + was when the Arabian Rhazes defined it. Ague lurks yet in our own + island, and, albeit the physician is not enriched by it, is in no + symptom changed from the ague that Celsus knew so well. Cholera, + in its modern representation is more terrible a malady than its + ancient type, in so far as we have knowledge of it from ancient + learning. And that fearful scourge, the great plague of + Constantinople, the plague of hallucination and convulsion which + raged in the Fifth Century of our era, has in our time, under the + new names of tetanoid fever and cerebro-spinal meningitis, been + met with here and in France, and in Massachusetts has, in the + year 1873, laid 747 victims in the dust.</p> + + <p>I must cease these illustrations, though I could extend them + fairly over the whole chapter of disease, past and present. + Suffice it if I have proved the general propositions, that + disease is now as it was in the beginning, except that in some + examples of it it is less virulent; that the science for + extinguishing any one disease has yet to be learned; that, as the + bases of disease exist, untouched by civilisation, so the danger + of disease is ever imminent, unless we specially provide against + it; that the development of disease may occur with original + virulence and fatality, and may at any moment be made active + under accidental or systematic ignorance.</p><br> + + <h2>A CITY OF HEALTH.</h2> + + <p>I now come to the design I have in hand. Mr. Chadwick has many + times told us that he could build a city that would give any + stated mortality, from fifty, or any number more, to five, or + perhaps some number less, in the thousand annually. I believe Mr. + Chadwick to be correct to the letter in this statement, and for + that reason I have projected a city that shall show the lowest + mortality. I need not say that no such city exists, and you must + pardon me for drawing upon your imaginations as I describe it. + Depicting nothing whatever but what is at this present moment + easily possible, I shall strive to bring into ready and agreeable + view a community not abundantly favoured by natural resources, + which, under the direction of the scientific knowledge acquired + in the past two generations, has attained a vitality not + perfectly natural, but approaching to that standard. In an + artistic sense it would have been better to have chosen a small + town or large village than a city for my description; but as the + great mortality of States is resident in cities, it is + practically better to take the larger and less favoured + community. If cities could be transformed, the rest would + follow.</p> + + <p>Our city, which may be named <i>Hygeia</i>, has the advantage + of being a new foundation, but it is so built that existing + cities might be largely modelled upon it.</p> + + <p>The population of the city may be placed at 100,000, living in + 20,000 houses, built on 4,000 acres of land,—an average of + 25 persons to an acre. This may be considered a large population + for the space occupied, but, since the effect of density on + vitality tells only determinately when it reaches a certain + extreme degree, as in Liverpool and Glasgow, the estimate may be + ventured.</p> + + <p>The safety of the population of the city is provided for + against density by the character of the houses, which ensures an + equal distribution of the population. Tall houses overshadowing + the streets, and creating necessity for one entrance to several + tenements, are nowhere permitted. In streets devoted to business, + where the tradespeople require a place of mart or shop, the + houses are four stories high, and in some of the western streets + where the houses are separate, three and four storied buildings + are erected; but on the whole it is found bad to exceed this + range, and as each story is limited to 15 feet, no house is + higher than 60 feet.</p> + + <p>The substratum of the city is of two kinds. At its northern + and highest part, there is clay; at its southern and + south-eastern, gravel. Whatever disadvantages might spring in + other places from a retention of water on a clay soil, is here + met by the plan that is universally followed, of building every + house on arches of solid brickwork. So, where in other towns + there are areas, and kitchens, and servants' offices, there are + here subways through which the air flows freely, and down the + inclines of which all currents of water are carried away.</p> + + <p>The acreage of our model city allows room for three wide main + streets or boulevards, which run from east to west, and which are + the main thoroughfares. Beneath each of these is a railway along + which the heavy traffic of the city is carried on. The streets + from north to south which cross the main thoroughfares at right + angles, and the minor streets which run parallel, are all wide, + and, owing to the lowness of the houses, are thoroughly + ventilated, and in the day are filled with sunlight. They are + planted on each side of the pathways with trees, and in many + places with shrubs and evergreens. All the interspaces between + the backs of houses are gardens. The churches, hospitals, + theatres, banks, lecture-rooms, and other public buildings, as + well as some private buildings such as warehouses and stables, + stand alone, forming parts of streets, and occupying the position + of several houses. They are surrounded with garden space, and add + not only to the beauty but to the healthiness of the city. The + large houses of the wealthy are situated in a similar manner.</p> + + <p>The streets of the city are paved throughout with the same + material. As yet wood pavement set in asphalte has been found the + best. It is noiseless, cleanly, and durable. Tramways are nowhere + permitted, the system of underground railways being found amply + sufficient for all purposes. The side pavements, which are + everywhere ten feet wide, are of white or light grey stone. They + have a slight incline towards the streets, and the streets have + an incline from their centres towards the margins of the + pavements.</p> + + <p>From the circumstance that the houses of our model city are + based on subways, there is no difficulty whatever in cleansing + the streets, no more difficulty than is experienced in Paris. + That disgrace to our modern civilisation, the mud cart, is not + known, and even the necessity for Mr. E.H. Bayley's roadway + moveable tanks for mud sweepings,—so much wanted in London + and other towns similarly built,—does not exist. The + accumulation of mud and dirt in the streets is washed away every + day through side openings into the subways, and is conveyed, with + the sewage, to a destination apart from the city. Thus the + streets everywhere are dry and clean, free alike of holes and + open drains. Gutter children are an impossibility in a place + where there are no gutters for their innocent delectation. + Instead of the gutter, the poorest child has the garden; for the + foul sight and smell of unwholesome garbage, he has flowers and + green sward.</p> + + <p>It will be seen, from what has been already told, that in this + our model city there are no underground cellars, kitchens, or + other caves, which, worse than those ancient British caves that + Nottingham still can show the antiquarian as the once fastnesses + of her savage children, are even now the loathsome residences of + many millions of our domestic and industrial classes. There is + not permitted to be one room underground. The living part of + every house begins on the level of the street. The houses are + built of a brick which has the following sanitary + advantages:—It is glazed, and quite impermeable to water, + so that during wet seasons the walls of the houses are not + saturated with tons of water, as is the case with so many of our + present residences. The bricks are perforated transversely, and + at the end of each there is a wedge opening, into which no mortar + is inserted, and by which all the openings are allowed to + communicate with each other. The walls are in this manner + honeycombed, so that there is in them a constant body of common + air let in by side openings in the outer wall, which air can be + changed at pleasure, and, if required, can be heated from the + firegrates of the house. The bricks intended for the inside walls + of the house, those which form the walls of the rooms, are glazed + in different colours, according to the taste of the owner, and + are laid so neatly, that the after adornment of the walls is + considered unnecessary, and, indeed, objectionable. By this means + those most unhealthy parts of household accommodation, layers of + mouldy paste and size, layers of poisonous paper, or layers of + absorbing colour stuff or distemper, are entirely done away with. + The walls of the rooms can be made clean at any time by the + simple use of water, and the ceilings, which are turned in light + arches of thinner brick, or tile, coloured to match the wall, are + open to the same cleansing process. The colour selected for the + inner brickwork is grey, as a rule, that being most agreeable to + the sense of sight; but various tastes prevail, and art so much + ministers to taste, that, in the houses of the wealthy, + delightful patterns of work of Pompeian elegance are soon + introduced.</p> + + <p>As with the bricks, so with the mortar and the wood employed + in building, they are rendered, as far as possible, free of + moisture. Sea sand containing salt, and wood that has been + saturated with sea water, two common commodities in badly built + houses, find no place in our modern city.</p> + + <p>The most radical changes in the houses of our city are in the + chimneys, the roofs, the kitchens, and their adjoining offices. + The chimneys, arranged after the manner proposed by Mr. Spencer + Wells, are all connected with central shafts, into which the + smoke is drawn, and, after being passed through a gas furnace to + destroy the free carbon, is discharged colourless into the open + air. The city, therefore, at the expense of a small smoke rate, + is free of raised chimneys and of the intolerable nuisance of + smoke. The roofs of the houses are but slightly arched, and are + indeed all but flat. They are covered either with asphalte, which + experience, out of our supposed city, has proved to last long and + to be easily repaired, or with flat tile. The roofs, barricaded + round with iron palisades, tastefully painted, make excellent + outdoor grounds for every house. In some instances flowers are + cultivated on them.</p> + + <p>The housewife must not be shocked when she hears that the + kitchens of our model city, and all the kitchen offices, are + immediately beneath these garden roofs; are, in fact, in the + upper floor of the house instead of the lower. In every point of + view, sanitary and economical, this arrangement succeeds + admirably. The kitchen is lighted to perfection, so that all + uncleanliness is at once detected. The smell which arises from + cooking is never disseminated through the rooms of the house. In + conveying the cooked food from the kitchen, in houses where there + is no lift, the heavy weighted dishes have to be conveyed down, + the emptied and lighter dishes upstairs. The hot water from the + kitchen boiler is distributed easily by conducting pipes into the + lower rooms, so that in every room and bedroom hot and cold water + can at all times be obtained for washing or cleaning purposes; + and as on every floor there is a sink for receiving waste water, + the carrying of heavy pails from floor to floor is not required. + The scullery, which is by the side of the kitchen, is provided + with a copper and all the appliances for laundry work; and when + the laundry work is done at home the open place on the roof above + makes an excellent drying ground.</p> + + <p>In the wall of the scullery is the upper opening to the + dust-bin shaft. This shaft, open to the air from the roof, + extends to the bin under the basement of the house. A sliding + door in the wall opens into the shaft to receive the dust, and + this plan is carried out on every floor. The coal-bin is off the + scullery, and is ventilated into the air through a separate + shaft, which also passes through the roof.</p> + + <p>On the landing in the second or middle stories of the + three-storied houses there is a bathroom, supplied with hot and + cold water from the kitchen above. The floor of the kitchen and + of all the upper stories is slightly raised in the centre, and is + of smooth, grey tile; the floor of the bath-room is the same. In + the living-rooms, where the floors are of wood, a true oak margin + of floor extends two feet around each room. Over this no carpet + is ever laid. It is kept bright and clean by the old-fashioned + bees'-wax and turpentine, and the air is made fresh and is + ozonised by the process.</p> + + <p>Considering that a third part of the life of man is, or should + be, spent in sleep, great care is taken with the bed-rooms, so + that they shall be thoroughly lighted, roomy, and ventilated. + Twelve hundred cubic feet of space is allowed for each sleeper, + and from the sleeping apartments all unnecessary articles of + furniture and of dress are rigorously excluded. Old clothes, old + shoes, and other offensive articles of the same order, are never + permitted to have residence there. In most instances the rooms on + the first floor are made the bed-rooms, and the lower the + living-rooms. In the larger houses bed-rooms are carried out in + the upper floor for the use of the domestics.</p> + + <p>To facilitate communication between the kitchen and the + entrance-hall, so that articles of food, fuel, and the like may + be carried up, a shaft runs in the partition between two houses, + and carries a basket lift in all houses that are above two + stories high. Every heavy thing to and from the kitchen is thus + carried up and down from floor to floor and from the top to the + basement, and much unnecessary labour is thereby saved. In the + two-storied houses the lift is unnecessary. A flight of outer + steps leads to the upper or kitchen floor.</p> + + <p>The warming and ventilation of the houses is carried out by a + common and simple plan. The cheerfulness of the fireside is not + sacrificed; there is still the open grate in every room, but at + the back of the firestove there is an air-box or case which, + distinct from the chimney, communicates by an opening with the + outer air, and by another opening with the room. When the fire in + the room heats the iron receptacle, fresh air is brought in from + without, and is diffused into the room at the upper part on a + plan similar to that devised by Captain Galton.</p> + + <p>As each house is complete within itself in all its + arrangements, those disfigurements called back premises are not + required. There is a wide space consequently between the back + fronts of all houses, which space is, in every instance, turned + into a garden square, kept in neat order, ornamented with flowers + and trees, and furnished with playgrounds for children, young and + old.</p> + + <p>The houses being built on arched subways, great convenience + exists for conveying sewage from, and for conducting water and + gas into, the different domiciles. All pipes are conveyed along + the subways, and enter each house from beneath. Thus the mains of + the water pipe and the mains of the gas are within instant + control on the first floor of the building, and a leakage from + either can be immediately prevented. The officers who supply the + commodities of gas and water have admission to the subways, and + find it most easy and economical to keep all that is under their + charge in perfect repair. The sewers of the houses run along the + floors of the subways, and are built in brick. They empty into + three cross main sewers. They are trapped for each house, and as + the water supply is continuous, they are kept well flushed. In + addition to the house flushings there are special openings into + the sewers by which, at any time, under the direction of the + sanitary officer, an independent flushing can be carried out. The + sewers are ventilated into tall shafts from the mains by means of + a pneumatic engine.</p> + + <p>The water-closets in the houses are situated on the middle and + basement floors. The continuous water-supply flushes them without + danger of charging the drinking water with gases emanating from + the closet; a danger so imminent in the present method of + cisterns, which supply drinking as well as flushing water.</p> + + <p>As we walk the streets of our model city, we notice an absence + of places for the public sale of spirituous liquors. Whether this + be a voluntary purgation in goodly imitation of the National + Temperance League, the effect of Sir Wilfrid Lawson's Permissive + Bill and most permissive wit and wisdom, or the work of the Good + Templars, we need not stay to inquire. We look at the fact only. + To this city, as to the town of St. Johnsbury, in Vermont, which + Mr. Hepworth Dixon has so graphically described, we may apply the + description Mr. Dixon has written: 'No bar, no dram shop, no + saloon defiles the place. Nor is there a single gaming hell or + house of ill-repute.' Through all the workshops into which we + pass, in whatever labour the men or women may be + occupied,—and the place is noted for its manufacturing + industry,—at whatever degree of heat or cold, strong drink + is unknown. Practically, we are in a total abstainers' town, and + a man seen intoxicated would be so avoided by the whole + community, he would have no peace to remain.</p> + + <p>And, as smoking and drinking go largely together, as the two + practices were, indeed, original exchanges of social degradations + between the civilised man and the savage, the savage getting very + much the worst of the bargain, so the practices largely disappear + together. Pipe and glass, cigar and sherry-cobbler, like the + Siamese twins, who could only live connected, have both died out + in our model city. Tobacco, by far the most innocent partner of + the firm, lived, as it perhaps deserved to do, a little the + longest; but it passed away, and the tobacconist's counter, like + the dram counter, has disappeared.</p> + + <p>The streets of our city, though sufficiently filled with busy + people, are comparatively silent. The subways relieve the heavy + traffic, and the factories are all at short distances from the + town, except those in which the work that is carried on is silent + and free from nuisance. This brings me to speak of some of the + public buildings which have relation to our present studies.</p> + + <p>It has been found in our towns, generally, that men and women + who are engaged in industrial callings, such as tailoring, + shoe-making, dressmaking, lace-work and the like, work at their + own homes amongst their children. That this is a common cause of + disease is well understood. I have myself seen the half-made + riding-habit that was ultimately to clothe some wealthy damsel + rejoicing in her morning ride act as the coverlet of a poor + tailor's child stricken with malignant scarlet fever. These + things must be, in the ordinary course of events under our + present bad sanitary system. In the model city we have in our + mind's eye, these dangers are met by the simple provision of + workmen's offices or workrooms. In convenient parts of the town + there are blocks of buildings, designed mainly after the manner + of the houses, in which each workman can have a work-room on + payment of a moderate sum per week. Here he may work as many + hours as he pleases, but he may not transform the room into a + home. Each block is under the charge of a superintendent, and + also under the observation of the sanitary authorities. The + family is thus separated from the work, and the working man is + secured the same advantages as the lawyer, the merchant, the + banker now possesses: or to make the parallel more correct, he + has the same advantage as the man or woman who works in a + factory, and goes home to eat and to sleep.</p> + + <p>In most towns throughout the kingdom the laundry system is + dangerous in the extreme. For anything the healthy householder + knows, the clothes he and his children wear have been mixed + before, during, and after the process of washing, with the + clothes that have come from the bed or the body of some sufferer + from a contagious malady. Some of the most fatal outbreaks of + disease I have met with have been communicated in this manner. In + our model community this danger is entirely avoided by the + establishment of public laundries, under municipal direction. No + person is obliged to send any article of clothing to be washed at + the public laundry; but if he does not send there he must have + the washing done at home. Private laundries that do not come + under the inspection of the sanitary officer are absolutely + forbidden. It is incumbent on all who send clothes to the public + laundry from an infected house to state the fact. The clothes + thus received are passed for special cleansing into the + disinfecting rooms. They are specially washed, dried and prepared + for future wear. The laundries are placed in convenient + positions, a little outside the town; they have extensive drying + grounds, and, practically, they are worked so economically, that + homewashing days, those invaders of domestic comfort and health, + are abolished.</p> + + <p>Passing along the main streets of the city we see in twenty + places, equally distant, a separate building surrounded by its + own grounds,—a model hospital for the sick. To make these + institutions the best of their kind, no expense is spared. + Several elements contribute to their success. They are small, and + are readily removable. The old idea of warehousing diseases on + the largest possible scale, and of making it the boast of an + institution that it contains so many hundred beds, is abandoned + here. The old idea of building an institution so that it shall + stand for centuries, like a Norman castle, but, unlike the + castle, still retain its original character as a shelter for the + afflicted, is abandoned here. The still more absurd idea of + building hospitals for the treatment of special organs of the + body, as if the different organs could walk out of the body and + present themselves for treatment, is also abandoned.</p> + + <p>It will repay us a minute of time to look at one of these + model hospitals. One is the <i>fac simile</i> of the other, and + is devoted to the service of every five thousand of the + population. Like every building in the place, it is erected on a + subway. There is a wide central entrance, to which there is no + ascent, and into which a carriage, cab, or ambulance can drive + direct. On each side the gateway are the houses of the resident + medical officer and of the matron. Passing down the centre, which + is lofty and covered in with glass, we arrive at two sidewings + running right and left from the centre, and forming + cross-corridors. These are the wards: twelve on one hand for + male, twelve on the other for female patients. The + cross-corridors are twelve feet wide and twenty feet high, and + are roofed with glass; The corridor on each side is a framework + of walls of glazed brick, arched over head, and divided into six + segments. In each segment is a separate, light, elegant removable + ward, constructed of glass and iron, twelve feet high, fourteen + feet long, and ten feet wide. The cubic capacity of each ward is + 1,680 feet. Every patient who is ill enough to require constant + attendance has one of these wards entirely to himself, so that + the injurious influences on the sick, which are created by mixing + up, in one large room, the living and the dying; those who could + sleep, were they at rest, with those who cannot sleep, because + they are racked with pain; those who are too nervous or sensitive + to move, or cough, or speak, lest they should disturb others; and + those who do whatever pleases them:—these bad influences + are absent.</p> + + <p>The wards are fitted up neatly and elegantly. At one end they + open into the corridor, at the other towards a verandah which + leads to a garden. In bright weather those sick persons, who are + even confined to bed, can, under the direction of the doctor, be + wheeled in their beds out into the gardens without leaving the + level floor. The wards are warmed by a current of air made to + circulate through them by the action of a steam-engine, with + which every hospital is supplied, and which performs such a + number of useful purposes, that the wonder is, how hospital + management could go on without the engine.</p> + + <p>If at any time a ward becomes infectious, it is removed from + its position and is replaced by a new ward. It is then taken to + pieces, disinfected, and laid by ready to replace another that + may require temporary ejection.</p> + + <p>The hospital is supplied on each side with ordinary baths, + hot-air baths, vapour baths, and saline baths.</p> + + <p>A day sitting-room is attached to each wing, and every + reasonable method is taken for engaging the minds of the sick in + agreeable and harmless pastimes.</p> + + <p>Two trained nurses attend to each corridor, and connected with + the hospital is a school for nurses, under the direction of the + medical superintendent and the matron. From this school, nurses + are provided for the town; they are not merely efficient for any + duty in the vocation in which they are always engaged, either + within the hospital or out of it, but from the care with which + they attend to their own personal cleanliness, and the plan they + pursue of changing every garment on leaving an infectious case, + they fail to be the bearers of any communicable disease. To one + hospital four medical officers are appointed, each of whom, + therefore, has six resident patients under his care. The officers + are called simply medical officers, the distinction, now + altogether obsolete, between physicians and surgeons being + discarded.</p> + + <p>The hospital is brought, by an electrical wire, into + communication with all the fire-stations, factories, mills, + theatres, and other important public places. It has an ambulance + always ready to be sent out to bring any injured persons to the + institution. The ambulance drives straight into the hospital, + where a bed of the same height on silent wheels, so that it can + be moved without vibration into a ward, receives the patient.</p> + + <p>The kitchens, laundries, and laboratories are in a separate + block at the back of the institution, but are connected with it + by the central corridor. The kitchen and laundries are at the top + of this building, the laboratories below. The disinfecting-room + is close to the engine-room, and superheated steam, which the + engine supplies, is used for disinfection.</p> + + <p>The out-patient department, which is apart from the body of + the hospital, resembles that of the Queen's Hospital, + Birmingham,—the first out-patient department, as far as I + am aware, that ever deserved to be seen by a generous public. The + patients waiting for advice are seated in a large hall, warmed at + all seasons to a proper heat, lighted from the top through a + glass roof, and perfectly ventilated. The infectious cases are + separated carefully from the rest. The consulting rooms of the + medical staff are comfortably fitted, the dispensary is + thoroughly officered, and the order that prevails is so effective + that a sick person, who is punctual to time, has never to + wait.</p> + + <p>The medical officers attached to the hospital in our model + city are allowed to hold but one appointment at the same time, + and that for a limited period. Thus every medical man in the city + obtains the equal advantage of hospital practice, and the value + of the best medical and surgical skill is fairly equalised + through the whole community.</p> + + <p>In addition to the hospital building is a separate block, + furnished with wards, constructed in the same way as the general + wards, for the reception of children suffering from any of the + infectious diseases. These wards are so planned that the people, + generally, send sick members of their own family into them for + treatment, and pay for the privilege.</p> + + <p>Supplementary to the hospital are certain other institutions + of a kindred character. To check the terrible course of infantile + mortality of other large cities,—the 76 in the 1,000 of + mortality under five years of age, homes for little children are + abundant. In these the destitute young are carefully tended by + intelligent nurses; so that mothers, while following their daily + callings, are enabled to leave their children under efficient + care.</p> + + <p>In a city from which that grand source of wild mirth, hopeless + sorrow and confirmed madness, alcohol, has been expelled, it + could hardly be expected that much insanity would be found. The + few who are insane are placed in houses licensed as asylums, but + not different in appearance to other houses in the city. Here the + insane live, in small communities, under proper medical + supervision, with their own gardens and pastimes.</p> + + <p>The houses of the helpless and aged are, like the asylums, the + same as the houses of the rest of the town. No large building of + pretentious style uprears itself for the poor; no men badged and + badgered as paupers walk the place. Those poor who are really, + from physical causes, unable to work, are maintained in a manner + showing that they possess yet the dignity of human kind; and + that, being worth preservation, they are therefore worthy of + respectful tenderness. The rest, those who can work, are employed + in useful labours, which pay for their board. If they cannot find + work, and are deserving, they may lodge in the house and earn + their subsistence; or they may live from the house and receive + pay for work done. If they will not work, they, as vagrants, find + a home in prison, where they are compelled to share the common + lot of mankind.</p> + + <p>Our model city is of course well furnished with baths, + swimming baths, Turkish baths, playgrounds, gymnasia, libraries, + board schools, fine-art schools, lecture halls, and places of + instructive amusement. In every board-school drill forms part of + the programme. I need not dwell on these subjects, but must pass + to the sanitary officers and offices.</p> + + <p>There is in the city one principal sanitary officer, a duly + qualified medical man elected by the Municipal Council, whose + sole duty it is to watch over the sanitary welfare of the place. + Under him, as sanitary officers, are all the medical men who form + the poor law medical staff. To him these make their reports on + vaccination and every matter of health pertaining to their + respective districts; to him every registrar of births and deaths + forwards copies of his registration returns; and to his office + are sent, by the medical men generally, registered returns of the + cases of sickness prevailing in the district. His inspectors + likewise make careful returns of all the known prevailing + diseases of the lower animals and of plants. To his office are + forwarded, for examination and analysis, specimens of foods and + drinks suspected to be adulterated, impure, or otherwise unfitted + for use. For the conduction of these researches the sanitary + superintendent is allowed a competent chemical staff. Thus, under + this central supervision, every death, every disease of the + living world in the district, and every assumable cause of + disease, comes to light and is subjected, if need be, to + inquiry.</p> + + <p>At a distance from the town are the sanitary works, the sewage + pumping works, the water and gas works, the slaughter-houses and + the public laboratories. The sewage, which is brought from the + town partly by its own flow and partly by pumping apparatus, is + conveyed away to well-drained sewage farms belonging to, but at a + distance from, the city where it is utilised.</p> + + <p>The water supply, derived from a river which flows to the + south-west of the city, is unpolluted by sewage or other refuse, + is carefully filtered, is tested twice daily, and if found + unsatisfactory is supplied through a reserve tank, after it has + been made to undergo further purification. It is carried through + the city everywhere by iron pipes. Leaden pipes are forbidden. In + the sanitary establishment are disinfecting rooms, a mortuary, + and ambulances for the conveyance of persons suffering from + contagious disease. These are at all times open to the use of the + public, subject to the few and simple rules of the + management.</p> + + <p>The gas, like the water, is submitted to regular analysis by + the staff of the sanitary officer, and any fault which may be + detected, and which indicates a departure from the standard of + purity framed by the Municipal Council, is immediately remedied, + both gas and water being exclusively under the control of the + local authority.</p> + + <p>The inspectors of the sanitary officer have under them a body + of scavengers. These, each day, in the early morning, pass + through the various districts allotted to them, and remove all + refuse in closed vans. Every portion of manure from stables, + streets, and yards is in this way removed daily, and transported + to the city farms for utilisation.</p> + + <p>Two additional conveniences are supplied by the scientific + work of the sanitary establishment. From steam-works steam is + condensed, and a large supply of distilled water is obtained and + preserved in a separate tank. This distilled water is conveyed by + a small main into the city, and is supplied at a moderate cost + for those domestic purposes for which hard water is + objectionable.</p> + + <p>The second sanitary convenience is a large ozone generator. By + this apparatus ozone is produced in any required quantity, and is + made to play many useful purposes. It is passed through the + drinking water in the reserve reservoir whenever the water shows + excess of organic impurity, and it is conveyed into the city for + diffusion into private houses, for purposes of disinfection.</p> + + <p>The slaughter-houses of the city are all public, and are + separated by a distance of a quarter of a mile from the city. + They are easily removable edifices, and are under the supervision + of the sanitary staff. The Jewish system of inspecting every + carcase that is killed is rigorously carried out, with this + improvement, that the inspector is a man of scientific + knowledge.</p> + + <p>All animals used for food,—cattle, fowls, swine, + rabbits,—are subjected to examination in the + slaughter-house, or in the market, if they be brought into the + city from other depôts. The slaughter-houses are so + constructed that the animals killed are relieved from the pain of + death. They pass through a narcotic chamber, and are brought to + the slaughterer oblivious of their fate. The slaughter-houses + drain into the sewers of the city, and their complete + purification daily, from all offal and refuse, is rigidly + enforced.</p> + + <p>The buildings, sheds, and styes for domestic food-producing + animals are removed a short distance from the city, and are also + under the supervision of the sanitary officer; the food and water + supplied for these animals comes equally, with human food, under + proper inspection.</p> + + <p>One other subject only remains to be noticed in connection + with the arrangements of our model city, and that is the mode of + the disposal of the dead. The question of cremation and of burial + in the earth has been considered, and there are some who advocate + cremation. For various reasons the process of burial is still + retained. Firstly, because the cremation process is open to + serious medico-legal objections; secondly, because, by the + complete resolution of the body into its elementary and inodorous + gases in the cremation furnace, that intervening chemical link + between the organic and inorganic worlds, the ammonia, is + destroyed, and the economy of nature is thereby dangerously + disturbed; thirdly, because the natural tendencies of the people + lead them still to the earth, as the most fitting resting-place + into which, when lifeless, they should be drawn.</p> + + <p>Thus the cemetery holds its place in our city, but in a form + much modified from the ordinary cemetery. The burial ground is + artificially made of a fine carboniferous earth. Vegetation of + rapid growth is cultivated over it. The dead are placed in the + earth from the bier, either in basket work or simply in the + shroud; and the monumental slab, instead of being set over or at + the head or foot of a raised grave, is placed in a spacious + covered hall or temple, and records simply the fact that the + person commemorated was recommitted to earth in those grounds. In + a few months, indeed, no monument would indicate the remains of + any dead. In that rapidly-resolving soil the transformation of + dust into dust is too perfect to leave a trace of residuum. The + natural circle of transmutation is harmlessly completed, and the + economy of nature conserved.</p><br> + + <h2>RESULTS.</h2> + + <p>Omitting, necessarily, many minor but yet important details, I + close the description of the imaginary health city. I have yet to + indicate what are the results that might be fairly predicted in + respect to the disease and mortality presented under the + conditions specified.</p> + + <p>Two kinds of observation guide me in this essay: one derived + from statistical and sanitary work; the other from experience, + extended now over thirty years, of disease, its phenomena, its + origins, its causes, its terminations.</p> + + <p>I infer, then, that in our model city certain forms of disease + would find no possible home, or, at the worst, a home so + transient as not to affect the mortality in any serious degree. + The infantile diseases, infantile and remittent fevers, + convulsions, diarrhoea, croup, marasmus, dysentery, would, I + calculate, be almost unknown. Typhus and typhoid fevers and + cholera could not, I believe, exist in the city except + temporarily, and by pure accident; small-pox would be kept under + entire control; puerperal fever and hospital fever would, + probably, cease altogether; rheumatic fever, induced by residence + in damp houses, and the heart disease subsequent upon it, would + be removed. Death from privation and from purpura and scurvy + would certainly cease. Delirium tremens, liver disease, alcoholic + phthisis, alcoholic degeneration of kidney and all the varied + forms of paralysis, insanity, and other affections due to + alcohol, would be completely effaced. The parasitic diseases + arising from the introduction into the body, through food, of the + larvae of the entozoa, would cease. That large class of deaths + from pulmonary consumption, induced in less favoured cities by + exposure to impure air and badly ventilated rooms, would, I + believe, be reduced so as to bring down the mortality of this + signally fatal malady one third at least.</p> + + <p>Some diseases, pre-eminently those which arise from + uncontrollable causes, from sudden fluctuations of temperature, + electrical storms, and similar great variations of nature, would + remain as active as ever; and pneumonia, bronchitis, congestion + of the lungs, and summer cholera, would still hold their sway. + Cancer, also, and allied constitutional diseases of strong + hereditary character, would yet, as far as I can see, prevail. I + fear, moreover, it must be admitted that two or three of the + epidemic diseases, notably scarlet fever, measles, and whooping + cough, would assert themselves, and, though limited in their + diffusion by the sanitary provisions for arresting their + progress, would claim a considerable number of victims.</p> + + <p>With these last facts clearly in view, I must be careful not + to claim for my model city more than it deserves; but calculating + the mortality which would be saved, and comparing the result with + the mortality which now prevails in the most favoured of our + large English towns, I conclude that an average mortality of + eight per thousand would be the maximum in the first generation + living under this salutary <i>régime</i>. That in a + succeeding generation Mr. Chadwick's estimate of a possible + mortality of five per thousand would be realised, I have no + reasonable doubt, since the almost unrecognised, though potent, + influence of heredity in disease would immediately lessen in + intensity, and the healthier parents would bring forth the + healthier offspring.</p> + + <p>As my voice ceases to dwell on this theme of a yet unknown + city of health, do not, I pray you, wake as from a mere dream. + The details of the city exist. They have been worked out by those + pioneers of sanitary science, so many of whom surround me to-day, + and specially by him whose hopeful thought has suggested my + design. I am, therefore, but as a draughtsman, who, knowing + somewhat your desires and aspirations, have drawn a plan, which + you in your wisdom can modify, improve, perfect. In this I know + we are of one mind, that though the ideal we all of us hold be + never reached during our lives, we shall continue to work + successfully for its realisation. Utopia itself is but another + word for time; and some day the masses, who now heed us not, or + smile incredulously at our proceedings, will awake to our + conceptions. Then our knowledge, like light rapidly conveyed from + one torch to another, will bury us in its brightness.</p> + + <div class="poem"> + <div class="stanza"> + <p><i>By swift degrees the love of Nature works</i></p> + + <p><i>And warms the bosom: till at last, sublimed</i></p> + + <p><i>To rapture and enthusiastic heat,</i></p> + + <p><i>We feel the present DEITY, and taste</i></p> + + <p><i>The joy of GOD to see a happy world</i>!</p> + </div> + </div> + +<div>*** END OF THE PROJECT GUTENBERG EBOOK 12036 ***</div> +</body> +</html> |