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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 *** |