CHAPTER I THE NEW SANITATION
HE conservation of national resources is a term
which is gradually coming to include human life as well as timber and coal. Needless waste of national vitality is taking its place among the wrongs which are of national concern. Conservation of human life is to be accomplished in large part through the practice of sani- tary measures. To be effective in the best sense, this practice must be carried on with the least possible ex- penditure of time, effort, and money. If, with intelligence and skill, one housekeeper can do the work of ten health officers or one dollar accomplish as much as ten dollars in the hands of a sanitary inspector, the larger expendi- ture is sheer waste and the net result in conservation is so much the smaller.
It is, therefore, well worth while for those interested in the promotion of public and private health occasion= ally to survey the field of sanitary practice and to learn whether the methods in use are in accord with the advance of science, or whether modern theory calls for changes in practice in the interests of effective and economical re- sults. This is particularly true of housekeepers, for, on the whole, the sanitation of the home is in their keeping, and as the famous sanitarian, Dr. B. W. Richardson, said, “If in the centers called home the foundations of
1
ROUSE SANITATION
the science of health are laid, the rest on a larger scale will necessarily follow.”
The idea of considering the house as a unit of health is essentially modern. It was, indeed, an impossible one until the knowledge was available which has been acquired in recent years. The fact that it is so generally accepted today shows that our views have changed materially in respect to two points, viz., the relation of private to public tights and the causation of disease.
In the first place, a man’s house is no longer considered his castle, to use as he pleases regardless of the welfare of other people. Modern sanitary law greatly abridges the rights of the householder in recognizing that his possession involves obligations to his neighbors and can- not be used in a way which may prove harmful to them.
In the second place, ideas in regard to disease have undergone radical change. The early Christian view was that disease was caused by the wrath of God or the malice of Satan, or by a combination of both. Since the source of disease was supernatural, it was considered irreligious
“to use natural means for combating it. Methods of cure
were logically based on the two ideas of striving to appease the divine anger which had been aroused because ef sin and of eluding the malice of Satan. On the one hand, help was sought by prayer, visits to shrines, pil- grimages, gifts to the church, and similar practices reputed to be effective in renewing divme favor; on the other hand, the malice of Satan was to be thwarted by the persecution and murder of his supposed emissaries, especially Jews and witches. The proof that the Jews were particularly chosen for this office lay in the fact
THE NEW SANITATION 3
that they were remarkably free from disease. It is now known that their rigid adherence to the Mosaic code of sanitation, which was to them a religious duty, was the true explanation of their exemption.
In consequence of these views, measures which in modern times would be called sanitary reform were looked upon as impious. Even to the present day, phrases linger in popular speech which express the old view, as, for example, after an epidemic of a contagious disease lead- ing to much loss of life, the explanation is still sometimes offered that the disaster was “due to an inscrutable Providence,” “a divine visitation,” “the result of natural sin,” or “the rebuke of God.”
Such influences greatly delayed the progress of scien- tific thought, for any attempt at another explanation met with opposition and ridicule, reénforced by religious fervor and fanaticism. But the onward march of knowl- edge could not be permanently stopped. Facts gradually accumulated whose antagonism to the established theory aroused questionings. It became clear, fo1 instance, that pestilence was not limited to heretical countries or to “ ungodly people.
In time, many forms of disease were seen to be in some way connected with uncleanliness, and that there , was some connection between the spread of disease and the water supply became evident. John Wesley’s dictum, “Cleanliness next to Godliness,” expressed the new idea from which results have already come which have greatly affected society. The impetus to hygienic research came largely through the practical efforts of Sir Edwin Chad- wick, properly called “the father of sanitary reform.”
4 HOUSE SANITATION
The modern science of bacteriology, a marvel in the rapidity of its development, has contributed in an extraor- dinary measure to men’s knowledge of ways in which many kinds of disease are caused, spread, and controlled.
A change of view on the part of the clergy has natur- ally followed close upon this new knowledge. It is said that after a bishop had issued a call to prayer to ward off cholera, one clergyman refused on the ground that it would be blasphemous to seek help from prayer, con- sidering the filthy condition of the streets, and he urged the members of his church to clean up the town. Fast- ing, penance, and prayer are now recognized as ineffec- tive substitutes for obedience to the divine law in the physical realm.
As science has been reénforced by rational and active practical effort, several diseases, such as cholera, typhus, and plague, have almost disappeared. Many other dis- eases, it has been proved, can be controlled to a great extent and perhaps ultimately exterminated. Tubercu- losis is a noteworthy example.
As sanitary science has developed, light has been thrown on a good many obscure points, and views con- cerning other points, especially the real significance of uncleanliness, have had to be materially altered. As a re- sult, there is need of many changes in sanitary practive. This is shown by the increasing use of such terms as “The New Public Health,” “Profitable and Fruitless Lines of Endeavor in Public Health Work,” “Public Health Fallacies,” and “Sources and Modes of Infec- tion,” which are becoming familiar through the teachings of progressive and scientific sanitarians.
THE NEW SANITATION 5
The pith of the matter is thus stated by Dr. H. W. Hill in a series of illuminating articles on “The Control of Infectious Diseases”: “The old sanitation was concerned ¥ with the environment, the new is concerned with the individual, and finds the sources of infectious disease in man himself rather than in his surroundings.” Dr. Hill pictures “the old ideas that slum dwellers live like pigs and therefore invoke the coming of smallpox, scarlet fever, typhoid fever, and diphtheria. If these diseases invaded the homes of well-to-do, a pin hole in the plumb- ing accounted for diphtheria, rotten potatoes in the cellar for typhoid, manure piles for cholera, ground air for malaria, impure water for yellow fever. Tuberculosis was considered hereditary and bubonic plague could be banished by improved ventilation.”
Dr. Hill also points out that “the old-style sanitary inspector usually condemned everything in sight, from the garbage pail at the back door to the plumbing in the bath- room. But what availed it that the garbage pail was emptied every day or a vent pipe placed on the bath water waste pipe, if the milkman delivered scarlet-fever infected milk or an unrecognized case of measles sat next the children at school?”
Modern sanitarians are urging that public funds / appropriated for sanitary measures should be expended in such a way as to prevent the spread of disease. The mistaken idea should be abandoned that everything which tends toward comfort, beauty, good order, and even in- directly toward health, such as street cleaning, garbage disposal, and smoke prevention, belongs to the health de- partment. Dr. C. V. Chapin, in his work on “The Sources
6 HOUSE SANITATION
and Modes of Infection,” states his belief that such municipal improvements belong no more to the health officials than do “free transfers, cheaper commutation tickets, lower prices for coal, less shoddy in clothing, or more rubber in rubbers—all good things in their way and tending towards comfort and health.”
The housekeeper should understand that a broken bed-spring, a worn-out stove, a tumble-down chair, or even more offensive rubbish in a vacant lot near her house, is not a menace to health and is not a concern of sanitary officials. If these objects are offensive to her and the standard of municipal housekeeping is not very high, her complaint should be remedied by an appeal to a private agency, such as a Municipal Art League. Instances could be multiplied to show that the housekeeper needs to be well informed as to advances in sanitary knowledge,im order to direct her efforts intelligently and effectively.
A few illustrations of interest to the housekeeper will show changes in sanitary theory which have been abun- dantly and conclusively proved. In nearly every case popular opinion and sanitary enactment, as well as, too frequently, expert practice, have lagged far behind in making readjustments, and thus lead to waste in every kind of expenditure. The statements are made in brief and positive form, and together with others will be con- sidered more fully in later chapters. -
Night air is purer than day air, and should be admitted freely to the house.
Gases from marshes do not cause malaria.
The quality of the air in the breathing zone is more important than the general air of the room.
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“carbonic acid”
The quantity of carbon dioxide or is not a measure of the unhealthfulness of air.
Ordinary variations in the normal gaseous constitu- ents of air produce no apparent effects. +
High “humidity, combined with high temperature, produces the discomfort ordinarily attributed to “bad air,” and is unhealthful.
Ordinary buildings and rooms ventilate themselves to a considerable extent. A small house needs comparatively less provision for change of air than a large building.
Air from properly constructed sewers is not harmful.”
Sunlight cannot be depended on for disinfection or as a substitute for cleanliness. Its value is physiological, psychical, and chiefly moral.
Actual light rather than window area should be the measure of the efficiency of room lighting.
Odors are not harmful physically, but when un- pleasant should be eliminated by cleansing methods rather than by ventilation.
Disinfection as ordinarily practiced, especially by amateurs, is practically valueless.
The housekeeper must not be misled by the new sanitation into the belief that the means at her command for promoting the health of her household have almost reached the vanishing point, since ground, air, and plumb- ing have lost so many of their terrors. On the contrary, the implications in the modern views, if fully understood and intelligently acted upon, give her greater opportuni- ties than she has ever had and lay upon her still heavier responsibilities. This new phase of house sanitation, d which trenches closely upon personal hygiene, needs more
8 HOUSE SANITATION
attention than it is receiving and will be discussed in later chapters. Health depends in part on freedom from infection. The probability of obtaining that freedom will be greatly increased by maintaining the body at a high state of vigor or “vitality,” as it is popularly called. This implies the promotion of all agencies which have to do with physical well-being, as well as with the control of sources of infection; and in so far as such agencies are made use of within the house, they belong properly to, house sanitation,