Page images
PDF
EPUB

it would seem, at first view, that the increased rapidity of travel would also disseminate more rapidly the scourges; and yet it has seemed to me the practical working is the reverse. Those familiar with the history of cholera among the Mohammedan pilgrims are aware that since the abolition of caravans, and the transportation of pilgrims by steamers, very many fewer cases of cholera occur at Mecca, and along the land route from Dejeddah. It is because all are kept, so to speak, in a certain lane, where they are under constant observation; their food and hygienic surroundings are more carefully regulated; and cases occurring can be promptly treated and guarded. The same is true of steamers bringing emigrants to this country. With competent medical officers, isolated hospitals, absolute cleanliness of attendants, and prompt disinfection of discharges, the disease should be limited to those who had contracted it before coming on board, and virtually suppressed by the time of their arrival at any one of our seaports.

This influence of steam-communication is more striking, though in a different way, with reference to yellow-fever. In the great majority of cases, the vessel is the means of transportation; and the particular place of preference for the poison is, as stated above, in the filth which accumulates in the bilge. In sugar and milado carrying vessels, this, in a tropical climate, soon develops fermentative action. Until within a few years, the commercial history of vessels trading with yellow-fever ports has been as follows: A European cargo is taken to Havana, discharged, and the vessel lies an indefinite time empty in an infected port, seeking a charter for some seaport in the United States. No particular precautions of cleanliness are taken, either as regards the vessel or the crew. In most cases the fever appears while lying in port. A cargo is at length obtained, which adds to the filth of the bilge already infected. A better nidus for the propagation of the poison could not be formed; and under a tropical sun, sealed hatches, and stagnant air, it intensifies with great rapidity. An experience of several years showed that the majority of cases brought to the port of New York were on vessels of this character. Within the past ten years a radical change has been going on, and steam-transportation has largely replaced sailing-vessels, and with it. there has been a large diminution in the number of the cases of yellow-fever. Steamers belong to regular lines, which make frequent and regular trips, remain but a short time in port, and are therefore rarely infected. Being of

[blocks in formation]

It could also be easily shown that the long antagonism between commerce and quarantine has entirely passed away. Instead of vessels riding an indefinite quarantine, our knowledge of the natural history of the two diseases tells us that the sooner a vessel is emptied, the less the danger of transmission of disease. Vessels, therefore, in quarantine, are returned to commerce sooner than if they went to dock, and discharged through the usual routine.

S. OAKLEY VANDERPOEL, M.D., LL.D.,
Professor of hygiene, medical department,
University of the city of New York.

HOW TO DEAL WITH YELLOW-FEVER.

In closing a report on the yellow-fever epidemic of 1873, made in response to a resolution of the U. S. senate, the present writer used the following language:

"It may finally be added, that, in the absence of other adequate cause, the gradual narrowing of the yellow-fever zone in the United States during the past fifty years—say, from the time when leases in New-York City frequently contained a provision for reducing the rate of rents in the event of a depression of business from the advent of cholera or yellow-fever may be fairly claimed for the sanitarian and his efforts; and that in such efforts lies all there is of promise for the future in dealing with yellowfever."

This was written before the brilliant results of the investigations of Pasteur and Koch had opened up the tempting field which Ferrán and Domingos Freire already claim to be successfully cultivating. It may be that these gentlemen have actually accomplished - the one for cholera, and the other for yellow-fever — what Jenner, Pasteur, and Koch have done for other diseases; and although this is not yet proven, and, in the nature of the case, will require considerable time to demonstrate, there is scientific ground for believing that immunity against these pestilences will eventually be secured through a process analogous to that by which vaccination has disarmed small-pox of its terrors. Until that desideratum is reached, however, the precautions which should be taken to provide against yellow-fever will

continue to be those indicated in the sentence above quoted.

[ocr errors]

Whatever the yellow-fever poison may ultimately prove to be, enough is already known of its characteristics and limitations to enable us to formulate specific measures of such precaution. For practical purposes, we are not concerned with the many theories regarding its origin, — whether it was first engendered during the horrors of the middle passage' in the hold of an African slaver, or in the putrefaction of the abundant marine life of the Sargossa Sea, or by the action of atmospheric forces peculiar to the equatorial Atlantic, or by the spontaneous development of a specific organism. It is sufficient to know that there is such a poison, and, 1°, that while it does not originate in this country, it may be conveyed from place to place; 2°, that it is a poison of considerable specific gravity, infecting the lowest stratum of the atmosphere, and possesses great tenacity, clinging to surfaces; 3°, that it flourishes amidst filth, under certain conditions of temperature and moisture; and, 4°, that the disease which it produces is essentially one of cities and crowded populations.

Upon these characteristics must be based the precautions to be enforced, and first with regard to communication with places where the disease is endemic. A quarantine of absolute exclusion is demonstrably impracticable, owing mainly to the many facilities which steam enables commerce to command. Much, however, may be done in this direction by a quarantine of inspection and sanitation. To this end it is necessary, that, within the geographical limits where yellow-fever may become epidemic in the United States, a system of sanitary supervision over personal and commercial intercourse with places where the disease exists endemically be established and maintained during the season when the atmospheric conditions necessary to its epidemic spread obtain in this country.

This would dictate specifi

cally that such supervision over commerce with South-American ports lying north of 22° south, with the West Indies and the Bahamas, and with the east coast of Mexico, should begin in April at the Gulf and South-Atlantic ports, and in May at ports north of 32° or 33° north, and should continue until the close of October and September respectively.1

1 Of a hundred and seventy-four epidemics, of which the date of beginning has been accurately recorded, three began in May in places south of latitude 33° north, but none earlier than June in places north of Charleston (32° 46′ north): four began as late as October in the former, but none later than September in the lat ter. Hence south of Charleston the danger scason begins in April, and ends in October: north of Charleston it begins in May, and ends in September.

The supervision should consist of an inspection of every vessel arriving from the region specified, and of treatment, which will vary, 1°, with the actual sanitary condition of the vessel, her cargo, belongings, and personnel, including in the sanitary condition the facts as to age, material, and previous yellow-fever history; 2°, with the sanitary status of the port of departure; and, 3°, with the climatic and other conditions of the port of arrival. Within the limits assigned to this paper, it is not possible to enter into the details of this treatment. They are well understood by practical sanitarians, and their sufficiency has been demonstrated by the inspection services of the National board of health and the Sanitary council of the Mississippi valley, as well as in the quarantine practice of the port of New York and elsewhere; while a practical test of their value for the protection of the port of New Orleans is now being made by the Louisiana state board of health. The characteristics of the poison, as set forth in the second and third propositions, will indicate what methods of treatment by disinfection and cleansing are necessary.1

But no matter how perfect such a system of sanitary quarantine may be made, there is always the risk of the poison being introduced through some unsuspected, and therefore unguarded, channel. To meet this risk leads to further consideration of the third proposition, that the poison flourishes amidst filth.

Whether the disease is in its indigenous

1 Assuming that yellow-fever is "due to a specific cause which is capable of growth and reproduction," and which is transportable, not only by adhesion to surfaces, but in the air from an infected locality; and that the "growth and reproduction of this cause [i.e., the yellow-fever poison] is connected with the presence of filth, in the sanitary sense of that word, including decaying organic matters and defective ventilation," it follows that closed vehicles, compartments, or receptacles, and articles or masses of material capable of retaining air motionless in meshes, folds, webs, or interstices, are dangerous as contagion-carriers in proportion as their character, use, or structure prevents or retards aeration, and in proportion as such articles or materials furnish organic matter liable to decay: hence an empty boxcar, or the unventilated hold of a vessel in ballast, may be the means of introducing the poison by transporting infected atmos. phere... [extract from a "Memorandum for the classification of articles of merchandise for quarantine purposes," drawn up by the writer, and adopted by the Sanitary council of the Mississippi valley, April 21, 1881].

It will be seen from the above that the disinfection necessary for yellow-fever is essentially different from that laid down by the recent International sanitary conference at Rome as suffi cient for cholera. In the report of the committee of that conference on the question of disinfection, and which embraces such eminent men as Koch, Sternberg, and Proust, it is specifi cally stated that disinfection of merchandise and of the mails is unnecessary;' while, of atmospheric disinfection, no mention whatever is made in the report. That these are both essential for yellow-fever, is, in the opinion of the writer, beyond question. His personal experience during the epidemics of 1878-79 alone notably, that on the relief-boat Chambers, in connection with the infection of Lieut. Benner and others is to him conclusive on this point.

2 Intercommunication with Mexico by rail, for example, suggests one mode which as yet has not been provided against; although an extension of the system of sanitary supervision to railroad intercourse is entirely feasible, as has been shown during the past few years by the operations of the inspection services above referred to.

home, or imported, the testimony is uniform that epidemics of yellow-fever have their starting-points in the lowest, filthiest quarters of seaport towns, than which nothing can be filthier or more disgusting. It can hardly be necessary to dwell upon this point. With the improvement in the water-side precincts of New York, Philadelphia, and other NorthAtlantic seaports, yellow-fever has ceased to be the devastating pestilence which it was in the days of Benjamin Rush. In those days the purlieus of such cities were little better than they now are in the towns and cities of the Spanish main, where it still rages. In the latter, it is true, there is always present the added factor of a favoring condition of temperature; and, less constantly, this also affects our Gulf and South-Atlantic seaports. But this of itself should be an additional incentive to securing the best attainable sanitary condition. Foul drains, filthy streets, reeking gutters, neglected cloacae, excremental accumulations, decomposing garbage, rotting fruit and vegetables, the drainage of sugar and molasses casks, the wonder to the sanitarian, as he views such scenes for the first time under the tropical rays of a summer sun, is not that yellow fever occasionally occurs, but that pestilence in some form is not always present. In the endemic home of yellow-fever, sanitation' is an unknown term; and, in the degree that its import is ignored along our Gulf and SouthAtlantic coasts, the disease finds favorable conditions for establishing itself whenever its poison is introduced.

[ocr errors]

An obvious precaution is suggested by the fourth proposition, that yellow-fever is a disease of cities and crowded populations.1 As a rule, it is limited not only to cities, but to sharply defined quarters of cities. The great specific gravity of the poison, and its property of clinging to surfaces, are shown in this limitation of extension. Frequently its rate of progress may be mathematically defined, so many feet per day, independent of any recognized influence, except a perpendicular obstacle. A board fence has been known to stop its progress, as in Mobile; or a bluff bank to hold it at bay for weeks, as in Memphis. Not only do the higher portions of a city suffer less than the lower, other things being equal, but the upper stories of individual houses are safer than the lower. Yellow-fever is essentially a local disease, its existence depending upon par

1 Its occasional extension to small places, and even to plantations and isolated houses, does not affect the general accuracy of this proposition. Such extension occurs only during widespread and virulent epidemics, when, it may be inferred, the specific poison is generated in such quantity and intensity as to be the more readily transplanted from place to place.

[ocr errors]

ticular circumstances of place: hence, when the disease manifests itself in a locality, the imperative duty of the sanitary authority is to remove from the infected place (be it house, street, ward, or quarter) all those susceptible to it, - to depopulate the infected district, if it tends to become epidemic, by removal to camp, if only a few miles distant, as was done with such satisfactory results in Memphis during the epidemics of 1878 and 1879, and repeatedly before that time in the U. S. army. The cordon sanitaire may be employed to prevent people from going into an infected district; but with the present resources of sanitary science, and definite knowledge of this disease, its use to prevent escape from such a district is a barbarism of the same character as the old-time quarantine of detention.

In a word, the precautions to be taken against yellow-fever are the same as those which common sense and experience have shown to be adequate against the other exotic infective diseases: to wit, a thorough system of sanitary supervision and control of intercourse, both by sea and land, for the exclusion of the specific poison; and, supplementing possible (if not inevitable) defects in this, the destruction of the conditions necessary to the life and activity of the poison by general and local sanitary effort within our own territory. F. W. REILLY.

CHICAGO-RIVER POLLUTION.

It is worthy of note that the first sanitary regulation made by the authorities of the town of Chicago had reference to the protection of the river from pollution. Nov. 7, 1833, the town trustees declared it to be unlawful" to throw or put into the Chicago River, within the limits of the town, any dead animal or animals, under a penalty of three dollars for every offence." More than half a century later, the problem of establishing and maintaining an inoffensive condition of this stream still demands the attention of the sanitarian. A glance at the topography of the region will facilitate comprehension of the problem, and

[blocks in formation]

and the St. Lawrence River. The site of the city was once covered twenty feet or more by the waters of Lake Michigan, whose western rim, at no very remote period of geologic time, was some eight or nine miles west of its present position with reference to the city of Chicago. The recession of the lake resulted in the formation of a series of sand-dunes or ridges, with intervening ponds and lagoons, which gradually filled up with the humus of peat-producing vegetation. This formation was the original site of the city, with an average elevation of only twelve feet above the lake, and much of it being so low as to be subject to overflow, even by the ordinary variation of the lake under the influence of north and northeast winds. Through this low, flat, swampy plain there eventually cut its way to the lake a narrow, sluggish stream, the present Chicago River. Forking about a mile and a half from its present mouth, its north branch runs in a direction generally parallel with the lake shore for a distance of some twenty miles; while its south branch, after running due south for about two miles, tends sharply to the south-west for a mile or more, and then divides into two smaller branches, the western one of which is separated from the Des Plaines River by a narrow 'divide' of only a few feet elevation. In seasons of high water, this divide' was formerly obliterated by the flow of the Des Plaines into Lake Michigan, and for several years an artificial communication has existed between these two streams through the so-called 'Ogden ditch.' In 1848 the Illinois and Michigan canal was completed, connecting this south branch of the Chicago River with the Illinois River at La Salle, ninety-six miles south-west; and in 1871 the summit-level of the canal, twenty-six miles long, had been lowered from twelve feet above, to eight feet and a half below, the ordinary level of Lake Michigan: so that, theoretically, the Chicago River now rises in Lake Michigan, and empties into the Mississippi through the Illinois and Michigan canal and the Illinois River. The primary object of the construction of this canal was purely commercial, but it has since become one of the most important factors in the sanitary welfare of the city.

As the cholera epidemic of 1849-50 led directly to the introduction of lake-water, and the

The highest point above the level of Lake Michigan, for fifteen miles north, is only thirty-eight feet; and south-east for the same distance, only twenty-three feet. Directly south of the city, the surface is almost level, the highest point within sixteen miles being only twenty-two feet. Southwest for ten miles the highest point is only ten feet, where, at the Summit, the waters of the St. Lawrence run north-east, and those of the Mississippi south-west. From the Summit there is a gradual descent, until the ground is lower than the surface of the lake.

foundation of what is, in some respects, now the most magnificent system of water-supply in the world, so the repeated epidemics of cholera and dysentery led to the adoption, in 1856, of a system of sewerage, which, within twentyfour years thereafter, had furnished more linear feet of sewers per capita of population than in any other of the large cities of the Union. For fourteen years (1843-56 inclusive1) the average annual death-rate of the city had been 37.91 per thousand, probably the highest of any city in the United States; during the first fifteen years of sewer-construction (1856-70), the average annual death-rate was reduced to 23.97 per thousand; while, from 1871 to 1884 inclusive, the average has still further fallen to 21.40 per thousand. And although there have been marked fluctuations from year to year, -rising to 32.22 in 1866, and falling to 16.49 in 1878, on the whole, there is, as I have shown in a table published elsewhere, a striking correlation between the annual death-rate and the number of feet of sewers per capita year by year, independent of all other influ

ences.

[ocr errors]

2

But while the sewerage of the city has been one of the most important agencies in this reduction of the death-rate, it has necessarily added to the pollution of the river and its branches, and from time to time has affected the purity of the water-supply. To such proportions did this evil speedily attain, that in July, 1860, only four years after the system was adopted, the sewerage commissioners recommended that the canal be deepened and enlarged, so as to create a constant current from the lake into the Illinois River, as a measure indispensable to the protection of the health of the city. The recommendation was not heeded at the time; and for some years thereafter, Mr. Chesbrough, the sewerage engineer, continued to urge, as a practical measure of temporary relief, the construction of covered canals or aqueducts from the lake, with apparatus for forcing lake-water through them into the north and south branches respectively, and so to create a current from the river into the lake, pending the construction of a system of intercepting sewers or the deepening of the canal, both of which measures he had ably discussed from time to time, from the year 1855.

[ocr errors]

Meanwhile the volume of sewage and of offal from the slaughter-houses and other sources, pouring into the river, continued to increase with alarming rapidity; and although the foul

1 Certificates of causes of death were first required in 1841, but records were not begun until June 1, 1851.

The sanitary problems of Chicago, past and present.'

ness was occasionally mitigated by the action of the pumps at Bridgeport, raising water from the south branch into the canal as needed for navigation, it was not until the spring of 1865 that it was finally decided to deepen the canal, as had been recommended in 1860. A remarkable epidemic of erysipelas, which prevailed exclusively along the south branch and main river in 1863, and which was obviously caused by the unspeakable filth of these streams, had undoubtedly much to do in securing this decision; but the efficiency of this mode of relief had been incidentally shown by the action of the pumps at the head of the canal. The work was begun in the fall of 1865, and completed in July, 1871; but even before it was completed, the water-supply, taken from a point about one-fourth of a mile from the shore, had been so often affected by the current from the river, that a tunnel under the lake, running out two miles farther, was constructed, for the purpose of getting the supply from beyond the area of river-pollution.

Relying upon the deepening of the canal to establish and maintain a cleansing current from the lake through the river, the pumps at Bridgeport were removed when the 'deep cut' was completed, notwithstanding which there was for some time a decided improvement in the condition of the river. Gradually, however, the increased sewage-production of the rapidly growing city, a diminution of flow through the canal due to various causes, and the fluctuations of the lake-level, indicated the necessity for further effort. In 1871 the construction of the Ogden ditch' was begun; and after its completion another factor was added to the problem, a factor which acquired additional importance, when the dam and floodgate intended to regulate the flow through the ditch were broken down, and became inoperative. The Des Plaines pours through this ditch into the south branch a volume often greater than the entire capacity of the canal. Every cubic foot of this water reduces by so much

[ocr errors]

1 The lake is highest in July and August, and lowest in December and January, the average fluctuation being about three fect. Occasionally it is much greater than this: for example, on one occasion in February, 1875, the stage of water at the head of the canal was only five feet and eleven-hundredths, while for a short time in April, 1877, it was fourteen feet. Local rains on the watershed of the south branch, or on the area drained by the summit-level of the canal, or high water in the Des Plaines pouring into the south branch through the Ogden ditch,' - all operate, to a greater or less extent, in the same way that a low lake-level does; that is, the current in the south branch and main river is suspended or reversed, and, instead of flowing off through the canal, the sewage is carried into the lake in dangerous proximity to the in-take of the water-supply at the crib.' This condition obtains every spring for varying periods, and during the spring just closed it was frequently observed. local rain on the 2d of this month (June) created a current from the river, which continued for several days, the effect being perceptible for some distance beyond the crib,' until counteracted by north-east winds.

A

the inflow of the lake through the main river and south branch into the canal, and thus causes a concentration of the pollution.

In 1881, after careful study of all the conditions, I urged the re-establishment of the pumping-works at Bridgeport, recommending that their capacity be made sixty thousand cubic feet per minute, and subsequently pointed out the necessity for the re-establishment of the dam at the 'Ogden ditch.' An appropriation was promptly made for the pumping-works, and these were completed late in the fall of 1883; but thus far they have not pumped over thirty-five to forty thousand cubic feet per minute. Within a short time an appropriation has also been made for the repair of the dam.1

At the present time the fouling of the river and its branches from the blood, offal, and wastes of the slaughtering and packing establishments and their subsidiary industries, has been materially reduced by the utilization of much which was formerly considered worthless, and consequently was thrown into the river or upon the surrounding prairies. On the other hand, the volume of sewage proper has increased with the growth of the population and the extension of the sewered area, until a daily sewage-production, which may be roughly estimated at from forty-five to fifty million gallons, is now poured into the river and its branches. With the exclusion of the waters of the Des Plaines River from the canal, and the continuous operation of the pumping-works, this sewage need never be allowed to find its way into the lake, except for a short time during the spring thaws, or as the result of unusual rainfalls; and these exceptional occurrences will not then entail serious consequences, owing to the permanently improved condition of the river and its branches, resulting from the continuous removal of the sewage, and the cleansing effect of the steady influx of lake-water.

It should be stated that provision is made for the purification of the north branch of the river, as originally suggested by Mr. Chesbrough, through a conduit from the lake, with pumps capable of pouring eighteen thousand cubic feet of water per minute into the branch at Fullerton Avenue. To prevent this from creating a current into the lake through the

1 When this is completed, it may be necessary to convey the flood-waters of the Des Plaines to Lake Michigan, at some point north of the city, in order to obviate the danger of inundating the town of Joliet by fresbets from a watershed of some twelve hundred square miles. This, however, and the treatment of local areas, are matters of detail which present no features not easily mastered; as, for instance, the fork of the south branch which runs near the Union stockyards, now a foul cesspool. To bring this within the general system requires that an ade quate volume of lake-water be poured continuously into the head of the fork, washing its contents, properly diluted, into the south branch, to be thence pumped into the canal.

« PreviousContinue »