Epidemic as indictment: when natural disasters reveal failures of public health

“ Thus the laws of health are disregarded; and when fever comes, it finds a wide field to work upon: in undrained and filthy streets and back-yards,—noisome, pestilential districts,—foul, uncleansed dwellings,—large populations ill-supplied with clean water and with pure air. There death makes fell havoc; many destitute widows and children have to be maintained out of the poor's-rates; and then we reluctantly confess to ourselves that Ignorance is Power. ”

“ Voyaging around the small, forgotten islands I groaned over dirt and flies and the ignorance of simple hygiene which spread yaws, dysentery and typhoid. General weakening from these diseases had made the people easy prey to the influenza epidemic of 1918, which swept away eight per cent of the population. What they needed most was proper soil sanitation, proper water supplies, and education in these necessities. So many deaths were unattended by a physician that it was difficult to estimate the mortality figures covering typhoid, for instance. ”

“ But another disease follows on the heels of cholera: typhoid fever is the inevitable result of an absolute disregard of all sanitary laws. The system of burial among the Persians is beyond expression evil. They think nothing of washing the bodies of the dead in a stream which subsequently runs through the length of the village, thereby poisoning water which is to be used for numberless household purposes, and in their selection of the graveyard they will not hesitate to choose the ground lying immediately above a kanat which is carrying water to many gardens and drinking-fountains. ”

“ We have no standards for safety. Our enemies are no longer Indians and wild animals. Those were the days of big things. Today is the day of the infinitely little. To see our cruelest enemies, we must use the microscope. Of all our dangers, that of uncleanness leads—uncleanness of food and water and air—uncleanness due to unsanitary production and storage, to exposure to street dust, or to cooking and serving of food in unclean vessels. Such conditions result not only in actual disease, but in lowered vitality and lessened work power. ”

“ Some of these disease-making things, too, are not plants but animals. Such, for example, is the minute creature that causes malaria; and another that makes the dreadful “sleeping sickness” that every year is killing thousands of wretched negroes in Africa, in spite of all that can be done to prevent it.
They get into our bodies in all sorts of ways. Some come in the dust, when we breathe dirty air. Some come in dirty water. Some, a great many, come in dirty food, on lettuce and celery that have been carelessly washed, and especially in dirty milk. ”

“ A brief mention, in the Press, of the lateness of the monsoon gives no sign of the anxiety with which many millions of people are regarding the approaching harvest. Water means life to the rice-fields, and a drought implies, not alone the failure of a staple crop, but famine, with disorder and starvation, disease and death, as its accompaniments. ”

“ In very wet weather the drains and ditches are flooded; in very dry, on the contrary, they are by the evaporation of the fluids rendered very offensive, and thus almost all our cases of malignant fever are situated amongst those dwellings; if the neighbourhood had been crowded with inhabitants the mischief would have been much greater; 83and even as it now is, it has been the cause of much fatality among the able-bodied men and women. ”

“ The chief diseases known to be carried by food, water, or milk are typhoid fever, paratyphoid, dysentery and other diarrhœal diseases, scarlet fever, diphtheria, septic sore throat, and tuberculosis. The sole problem here is to keep human and animal excretions out of food, water, and milk. Since thorough cooking kills disease germs, danger arises chiefly from raw foods. All fruits and vegetables eaten raw should first be thoroughly washed. ”

“ Women who had lost their husbands from the deadly cholera were staggering on without food or water, leading their children. The trail was lined with dead mules and cattle. Some said that five thousand had perished on the plains from cholera alone. In the middle of the desert, miles from anywhere, were the death camps, the wagons drawn in the usual circle, the dead animals tainting the air, every living human being crippled from scurvy and other diseases. ”

“ Treatment is in line of prevention only. Clean, pure fresh water, free of the eggs or the parasites, is necessary if the trouble is to be eradicated. The old ponds, ordinarily filled with stagnant water, should be drained. They harbor many bad parasites, and their harm is far beyond their value. When water for sheep and cattle is taken from pure streams or wells the trouble from liver flukes and other parasites is reduced to a minimum.
LOCKJAW. —This disease, very frequently called tetanus, is an infectious disease in which the body muscles are spasmodically contracted or stiffened. ”

“ Hence it is that the vicinity of towns and the banks of the tanks and water courses are reeking with filth of the worst description, which is of necessity washed into the public water supply with every rainfall. Add to this the misery of pilgrims, then poverty and disease and the terrible crowding into the numerous towns which contain some temple or shrine, the object of their devotion, and we can see how India has become and remains the hotbed of the cholera epidemic." In the United States official report the horrors incident upon the pilgrimages are detailed with appalling minuteness. ”

“ What society with one consent pronounces filth—the evacuations of the human body—is not only washed into the Thames, and the land so deprived of a vast amount of nutriment, but the tide washes these evacuations back again, with other abominations. The water we use is derived almost entirely from the Thames, and therefore the water in which we boil our vegetables and our meat, the water for our coffee and tea, the water brewed for our consumption, comes to us, and is imbibed by us, impregnated over and over again with our own animal offal. ”

“ In the cases in which the cholera poison gains access to a limited supply of drinking water, such as a tank or pumpwell, the outbreak it occasions is always sudden, violent, and limited; but when a river is the medium of the propagation of the disease, its progress is more gradual and extended, being diffused amongst the whole population using the water. ”

“ Bold science — not impious, — far from it, bold only in its determined search for truth, and modest ever — has pushed home some searching questions concerning water contamination, and infection of different sorts, which begin to throw much light on its diffusion, and will, before long, I think, make cholera visitations in India as few and far between as they are now in Europe.
These are the fair realms of study and usefulness medicine opens up to you. ”

“ If we know that stagnant water breeds mosquitoes and that they are likely to carry disease, we can, disliking that anticipated result, take steps to avert it. Since we do not anticipate results as mere intellectual onlookers, but as persons concerned in the outcome, we are partakers in the process which produces the result. ”

“ The grocer and milkman may sell to you bad food, the town may furnish impure water, churches and schools may injure your health by failing to supply fresh air in their buildings. More than a hundred thousand people were made very sick last year through the use of water poisoned by waste matter which other persons carelessly let reach the streams and wells. Many of the sick died of the fever caused by this water. [Pg 11] Although it cannot be said that we are engaged in real war, yet we are surely killing one another by our thoughtless habits in scattering disease. ”

“ While wholesale river-pollution from any source is utterly inadmissible on any sanitary grounds, so infinitesimal pollution by dilute sewage, indirectly discharged into the water-course, is equally dangerous, and attended with sure though more remote fatal results, "especially if human excreta he present in any form whatever." ”

“ The man is dead, is killed, is murdered—but we cannot fix responsibility. Can we arrest for murder the poor mother who is caring for her boy sick with typhoid fever; just because she empties slops on a watershed that feeds a little brook, that feeds a river, that feeds a city—and thousands die of that widespread disease? ”

“ Frosted or indigestible feed, and, above all, green succulent vegetables in a frozen state, have proved effective factors, and filthy, stagnant water is dangerous. Low condition in the dam and plethora have in opposite ways caused abortion, and hot, relaxing stables and lack of exercise strongly conduce to it. The exhaustion of the sire by too frequent service, entailing debility of the offspring and disease of the fetus or of its envelopes, must be recognized as a further cause. ”

“ War can not compare with the campaigns of disease and death waged by this most filthy of all insects. In our recent strife with Spain we lost a few lives in battle, but we lost many more in hospitals due to contagious diseases, in the transmission of which this pest played a most important part.
The fly is dangerous on account of its filthy habits. It breeds in filth, feeds on filth in open closets, slop-barrels, on the streets and in back alleys and then comes into the house and wipes this germ-laden filth on our food or on the hands or even in the mouths of helpless babies. ”

“ The dirt sticks to his feet, and the disease germs stick to the dirt; for a fly is not nearly so much smaller than an elephant as a disease germ is smaller than a fly.
Then the fly tracks over our food or falls into our milk. He may carry a million germs on his body, and every time he puts down one of his six feet he plants at least one. In forty-eight hours this single one may have grown to sixteen thousand. Then some boy or girl eats the food and is sick; or some baby drinks the milk and dies.
XLI
The Great War The hardest battle we have to fight is with these living diseases. ”

“ Infection usually occurs by the ingestion of water or food contaminated by such germs, and it has been shown with a great degree of probability that such contamination frequently results from the transportation of infectious material from the surface of the ground, from shallow pits, etc., by flies, which after visiting the most filthy places, may alight upon a beefsteak or fall into the milk jug in a well-ordered kitchen. ”

“ When flies are responsible, there are little neighborhood epidemics, extending in short leaps from house to house, without reference to water supply or anything else in common. But when water is at fault the disease follows its use wherever it may go.... Epidemics spread by flies tend to follow the direction of prevailing warm winds, as though the fly, wandering outdoors after contact with the source of infection, had drifted with the wind, but nothing of the sort is perceptible in the case of water-borne disease. ”

“ I have been reading about the fly, in the newest science-book. In that book he is called "the most dangerous animal and the most murderous that exists upon the earth, killing hundreds of thousands of men, women and children every year, by distributing deadly diseases among them." ”

“ One fly produces fifty-two billions of descendants in 60 days in June and July, and they go and crawl over sick people and wade through pus, and sputa, and foul matter exuding from sores, and gaum themselves with every kind of disease-germ, then they go to everybody's dinner-table and wipe themselves off on the butter and the other food, and many and many a painful illness and ultimate death results from this loathsome industry. Mamma, they murder seven thousand persons in New York City alone, every year -- people against whom they have no quarrel. ”

“ The third mode of infection, by contact, the more or less direct transfer from person to person, is by far the most important factor in the spread of communicable disease in temperate climates. Malaria is our only important insect-borne disease. Typhoid may sometimes be spread by flies and often by water or milk—diphtheria and scarlet fever and tuberculosis and tonsilitis, sometimes by milk. On the other hand, diphtheria and scarlet fever and tuberculosis and, in cities with good water supplies, even typhoid fever, are all more commonly transmitted by contact than in any other way ”

“ At first, while there was yet water on the hillsides and food in the wallets, the host toiled on with only the pitiless summer sun for foe; then, as the little streamlets grew rarer, the dry, dark crags pressed closer, and the food was failing, the misery began. Misery past imagining! for if it is terrible for one mortal to suffer and go out in agony, what is it when hundreds of thousands suffer? when horses and mules are falling like flies by the roadway; when men and women trudge onward like dogs, with their tongues hanging from their mouths ”

“ Filth, that's what war is, and dirty diseases lying in wait for decent men. And cold, cold day and night, cold that brutalizes, that degenerates you till you would sell your soul, your mother's soul to be warm again. And mud, not clean country mud, but filth, and up to your eyes and beyond, horrible infected mud splashing upon the emergency bandage you are trying to put on a wound. And the wounded ... see here, when the newspapers speak complacently of the superb artillery preparation which after three days of cannon-duel silences the enemy's batteries, do you know what that means to me? ”

“ On one drop of blood a day it grows almost to the size of a pin and develops jaws as steely strong as wire-cutters. Multiply these blood-drops by a hundred, by a thousand, and watch the pale anemia that lays the sufferer open to the first epidemic that comes along.
In infected districts the health physician’s job was routine diagnosis and routine treatment. When we had to treat and survey whole villages and tribes within a limited time we gathered as many as we could into an audience and lectured them in whatever language they happened to speak. ”

“ The evil is becoming worse and worse as a larger [Pg 8] and larger population crowds into these subdivided dwellings, there, perforce almost, to fall into habits lower than those of the beasts. It is well known that drunkenness, disease, and degradation are the results of a deficient water supply. It is more difficult to estimate statistically the broken health and hearts of the female water-carriers. There is an economy of water and a most prodigal expenditure of human suffering. ”

“ A great portion of each town is elevated nearly 200 feet above the river, and some parts are nearly 300 feet high; yet the Water Company supplies all these districts, and all were severely visited by the cholera, which on this occasion spared no class of the community. In the districts which are most crowded, the mortality was greatest, the deaths being much more numerous in the parishes which contained a great number of tenements consisting of a single room, than in those which consisted chiefly of houses 107occupied by one family. ”

“ Ignorance of hygienic principles, absence of bathrooms, poor ventilation, unscreened doors and windows, and impure water and milk are among the causes of disease.
There is as much need of pure air, pure water, and pure food in the country as in the city, and the danger from disease is no less menacing. ”

“ If we live in a city, we [Pg 35] take into our lungs and throat millions of the germs of these diseases every day. Therefore the one hope that is left is to keep ourselves in such a condition of health that the army of our bodies shall be able to destroy these germs. When the blood is in a healthy condition, the white cells are numerous, powerful, and active, but when the blood flows stagnantly, or when it is impoverished, then the white cells are few and the forces of disease obtain a foothold.
Healthy men can go through many epidemics with impunity. ”

“ In all cases, some particular living and growing thing breaks through into the blood, or gets a foothold somewhere in the body, and begins to poison it. Then the invaders and the blood cells fight it out—and the best man wins.
There is a disease called anthrax which attacks various animals, ourselves and the birds among the number. A hen, for example, fighting anthrax, will almost always win, if it is kept warm. The lymph cells fight better when the blood is hot. But if the hen’s feet are kept in cold water, then the anthrax wins. The cool blood gives it the advantage. ”

“ For the misery that they grow up in, for the filth of their food, for the lack of covering, their faces are yellow, and all their bodies of the color of earth. They tremble with cold, and for leaness they stagger in walking. They go weeping and sighing, and full of sadness, and all misfortunes are joined to them; though they stay by afire, they find little heat. ”

“ Pig-sties are very injurious; slaughter-houses are equally hurtful: the smells from both excite typhus fever, and cause ill health. Frederick the Great said, that one fever was more fatal to him than seven battles. Disease, and even death, is often the consequence of our own negligence. Wash your rooms and passages at least once a week; use plenty of clean water; but do not let your children stay in them while they are wet—it may bring on croup or inflammation of the chest. ”

“ We do not now burn our patients on the soles of the feet, tie ligatures round their limbs, or have recourse to other senseless barbarities; for we find that simpler and more rational methods are of greater avail, more or less according to the period of the epidemic attack, and the promptitude with which the remedies are applied. But we have learned that local causes have a potent influence, and that cleanliness, good air, pure water, and free ventilation, are all powerful opponents of cholera. ”

“ Not more than two hundred years of research have made us masters where we were slaves; masters of distance, of the air, of the water, of the bowels of the earth, of many of the most dreaded aspects of disease and suffering. Only for forty years have we practiced antisepsis; only for sixty years have we had anesthetics; yet life to-day is well-nigh inconceivable without them. And all of this has been accomplished without any forethought on the part of the acknowledged rulers and leaders of mankind or any save the most trumpery and uncertain provision for research. ”

“ Each of these great cities carries for many miles the pure distillate of the hills to its million of inhabitants. It has cost much in pounds sterling, though not more than if each family had a pump in its backyard. On the other hand, think of the disease and suffering and death prevented, enteric fever almost gone where thousands would have died of it, and tens of thousands been debilitated, and these of the best of the citizens, for disease is no eliminator of the unfit. ”

“ With the universal construction of smooth and non-absorbent roads and the use of oil instead of water for sprinkling, the quantity of dust in the air will be reduced. As a consequence a number of diseases which are frequently transmitted by dust will be decreased and storm waters will be more easily cared for. (2) The horse will gradually disappear from our streets. With it the number of house flies and stable flies will be diminished; human lives will be saved and much added to health and comfort. Contact infections of those engaged in the care of horses will also become rare. ”