Read Ebook: Hygeia a City of Health by Richardson Benjamin Ward

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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.

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 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 dep?ts. 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.

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.

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