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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..6833f05 --- /dev/null +++ b/.gitattributes @@ -0,0 +1,3 @@ +* text=auto +*.txt text +*.md text diff --git a/12036-0.txt b/12036-0.txt new file mode 100644 index 0000000..c03da7e --- /dev/null +++ b/12036-0.txt @@ -0,0 +1,980 @@ +*** START OF THE PROJECT GUTENBERG EBOOK 12036 *** + +This file was produced from images generously made available by the +Bibliothèque nationale de France (BnF/Gallica) at http://gallica.bnf.fr + +HYGEIA +A CITY OF HEALTH + +BY + +BENJAMIN WARD RICHARDSON M.D., F.R.S. + +1876 + +[Illustration] + + + + +TO +EDWIN CHADWICK, C.B. + + +MY DEAR MR. CHADWICK, + +_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. + +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. + +In this sense of my respect for you, and of my gratitude, pray accept +this trifling recognition, and believe me to be, + +Ever faithfully yours_, + +B.W. RICHARDSON. + + + + +PREFATORY NOTE. + +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. + +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. + +12 HINDE STREET, W.: +_August_ 18, 1876. + + + + +HYGEIA, A CITY OF HEALTH + + +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? + +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. + +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 +'_Gloria in excelsis_,' 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. + +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. + +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. + +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. + +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. + + + +HEALTH AND CIVILISATION. + + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + + + +A CITY OF HEALTH. + + +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. + +Our city, which may be named _Hygeia_, has the advantage of being +a new foundation, but it is so built that existing cities might be +largely modelled upon it. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +It will repay us a minute of time to look at one of these model +hospitals. One is the _fac simile_ 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. + +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. + +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. + +The hospital is supplied on each side with ordinary baths, hot-air +baths, vapour baths, and saline baths. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + + + +RESULTS. + + +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. + +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. + +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. + +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. + +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 _régime_. +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. + +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. + + _By swift degrees the love of Nature works + And warms the bosom: till at last, sublimed + To rapture and enthusiastic heat, + We feel the present DEITY, and taste + The joy of GOD to see a happy world!_ + + + + + + + +End of the Project Gutenberg EBook of Hygeia, a City of Health +by Benjamin Ward Richardson + +*** END OF THE PROJECT GUTENBERG EBOOK 12036 *** 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> diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. 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You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Hygeia, a City of Health + +Author: Benjamin Ward Richardson + +Release Date: April 15, 2004 [EBook #12036] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK HYGEIA, A CITY OF HEALTH *** + + + + +Produced by Paul Murray, Sam and the Online Distributed Proofreading +Team. + + + + + +This file was produced from images generously made available by the +Bibliothèque nationale de France (BnF/Gallica) at http://gallica.bnf.fr + +HYGEIA +A CITY OF HEALTH + +BY + +BENJAMIN WARD RICHARDSON M.D., F.R.S. + +1876 + +[Illustration] + + + + +TO +EDWIN CHADWICK, C.B. + + +MY DEAR MR. CHADWICK, + +_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. + +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. + +In this sense of my respect for you, and of my gratitude, pray accept +this trifling recognition, and believe me to be, + +Ever faithfully yours_, + +B.W. RICHARDSON. + + + + +PREFATORY NOTE. + +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. + +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. + +12 HINDE STREET, W.: +_August_ 18, 1876. + + + + +HYGEIA, A CITY OF HEALTH + + +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? + +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. + +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 +'_Gloria in excelsis_,' 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. + +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. + +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. + +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. + +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. + + + +HEALTH AND CIVILISATION. + + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + + + +A CITY OF HEALTH. + + +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. + +Our city, which may be named _Hygeia_, has the advantage of being +a new foundation, but it is so built that existing cities might be +largely modelled upon it. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +It will repay us a minute of time to look at one of these model +hospitals. One is the _fac simile_ 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. + +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. + +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. + +The hospital is supplied on each side with ordinary baths, hot-air +baths, vapour baths, and saline baths. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + + + +RESULTS. + + +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. + +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. + +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. + +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. + +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 _régime_. +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. + +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. + + _By swift degrees the love of Nature works + And warms the bosom: till at last, sublimed + To rapture and enthusiastic heat, + We feel the present DEITY, and taste + The joy of GOD to see a happy world!_ + + + + + + + +End of the Project Gutenberg EBook of Hygeia, a City of Health +by Benjamin Ward Richardson + +*** END OF THIS PROJECT GUTENBERG EBOOK HYGEIA, A CITY OF HEALTH *** + +***** This file should be named 12036-8.txt or 12036-8.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/1/2/0/3/12036/ + +Produced by Paul Murray, Sam and the Online Distributed Proofreading +Team. + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Hygeia, a City of Health + +Author: Benjamin Ward Richardson + +Release Date: April 15, 2004 [EBook #12036] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK HYGEIA, A CITY OF HEALTH *** + + + + +Produced by Paul Murray, Sam and the Online Distributed Proofreading +Team. + + + + + + +</pre> + + <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> + + + + + + + +<pre> + + + + + +End of the Project Gutenberg EBook of Hygeia, a City of Health +by Benjamin Ward Richardson + +*** END OF THIS PROJECT GUTENBERG EBOOK HYGEIA, A CITY OF HEALTH *** + +***** This file should be named 12036-h.htm or 12036-h.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/1/2/0/3/12036/ + +Produced by Paul Murray, Sam and the Online Distributed Proofreading +Team. + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Hygeia, a City of Health + +Author: Benjamin Ward Richardson + +Release Date: April 15, 2004 [EBook #12036] + +Language: English + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK HYGEIA, A CITY OF HEALTH *** + + + + +Produced by Paul Murray, Sam and the Online Distributed Proofreading +Team. + + + + + +This file was produced from images generously made available by the +Bibliotheque nationale de France (BnF/Gallica) at http://gallica.bnf.fr + +HYGEIA +A CITY OF HEALTH + +BY + +BENJAMIN WARD RICHARDSON M.D., F.R.S. + +1876 + +[Illustration] + + + + +TO +EDWIN CHADWICK, C.B. + + +MY DEAR MR. CHADWICK, + +_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. + +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. + +In this sense of my respect for you, and of my gratitude, pray accept +this trifling recognition, and believe me to be, + +Ever faithfully yours_, + +B.W. RICHARDSON. + + + + +PREFATORY NOTE. + +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. + +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. + +12 HINDE STREET, W.: +_August_ 18, 1876. + + + + +HYGEIA, A CITY OF HEALTH + + +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? + +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. + +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 +'_Gloria in excelsis_,' 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. + +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. + +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. + +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. + +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. + + + +HEALTH AND CIVILISATION. + + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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 Eginaeta. 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. + +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. + + + +A CITY OF HEALTH. + + +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. + +Our city, which may be named _Hygeia_, has the advantage of being +a new foundation, but it is so built that existing cities might be +largely modelled upon it. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +It will repay us a minute of time to look at one of these model +hospitals. One is the _fac simile_ 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. + +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. + +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. + +The hospital is supplied on each side with ordinary baths, hot-air +baths, vapour baths, and saline baths. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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. + +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 depots. 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. + +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. + +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. + +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. + + + +RESULTS. + + +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. + +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. + +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. + +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. + +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 _regime_. +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. + +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. + + _By swift degrees the love of Nature works + And warms the bosom: till at last, sublimed + To rapture and enthusiastic heat, + We feel the present DEITY, and taste + The joy of GOD to see a happy world!_ + + + + + + + +End of the Project Gutenberg EBook of Hygeia, a City of Health +by Benjamin Ward Richardson + +*** END OF THIS PROJECT GUTENBERG EBOOK HYGEIA, A CITY OF HEALTH *** + +***** This file should be named 12036.txt or 12036.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/1/2/0/3/12036/ + +Produced by Paul Murray, Sam and the Online Distributed Proofreading +Team. + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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