Francis Lieber.

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ment of a bureau of vital statistics, whose reports and investigations have added moro
to the existing knowledge on the subject of the sanitary conditions of warfare than wag
ever before published. A hospital directory contained the names of 600,000 men who
passed through the military hospitals, and successfully answered 70 per cent of all
inquiries made after battles, or for missing friends or relatives. Soldiers' homes, estab-
lished by the commission, afforded food and shelter to as many as 2,000 soldiers per day
during the four years of the war. At as many as 600 out of the 700 battles and skir-
mishes of the war, the commission was represented by its agents and its benefits. More
than 4,500,000 meals and 1,000,000 nights' lodgings were supplied by this organization;
and $2,500,000 were collected by it of soldiers' pay. The quantity of stores supplied to
the soldiers after the battle of Gettysburg is almost incredible, and the details far too
numerous for statement here. The first call for funds by the commission was made
June 21, 1861; and up to Mar. 28, 1862, but little more than $50,000 had been contrib-
uted, mostly from Boston, New York, and Philadelphia. In Sept., 1862, its entire
receipts had reached the sum of $158,501. The magnificent gift by the state of Cali-
fornia of $100,000, made in the month last named, secured the commission from failure;
and being followed within two weeks by another donation from California of the same
amount, incited others to generous giving, and thenceforth there was no lack of money.
Early in 1864 a series of "sanitary fairs' was undertaken in the chief cities and towns
throughout the north, and these brought enormous sums to the treasury of the sanitary
commission.

The following table shows the money contribution to the U. S. Sanitary Commission,
from all sources, June 27, 1861, to Jan. 1, 1866:



Ill



Sanhlta.
Sanitary.



Maine $24,94843

New Hampshire 21,9:20 84

Vermont 3,521 17

Mass .chusetts 15,r..w KI

Massachusetts, Boston branch 106,396 60

Rhode Island 11,82396

Connecticut 8,41855

New England general 6,683 75

New York 229,3.871

New Jersey 20,741 25

Pennsylvania 12,73677

Delaware 775 00

Maryland 5,913 95

Disti-iet of Columbia 12,124 53

Virginia 703 GO

Ohio 16,049 50

Indiana 1,264 15

Illinois 4,342 50

Michigan 691 30

Wisconsin 91600

Iowa 13 50

Minnesota 6785

Kentucky 6,608 05

Louisiana 3,177 25

North Carolina 8 00

California 1,2*3,977 81

Nevada 107,642 96

Oregon 79,406 94

Washington Territory 20,918 92

Idaho Territory 5,301 31

Colorado Territory 1,025 00

Nebraska Territory 10 50

Vancouver's Island 2,19561

Sandwich Islands 17,955 51

Chili 5,376 79

Peru 2,00200

Buenos Ayres 18,412 85

Cuba 23 00

CostaRica 84 00



Canada $441 48

Newfoundland 150 00

Italy 50 00

Turkey 50 00

China 2,989 90

Japan 5,000 00

United States Army 1,738 30

United States Navy 199 00

Boston and New England Fair 50,000 00

Yonkers, N. Y 12,00000

Flushing, L. I., Fair 3,934 32

Brooklyn and Long Island Fair 305,513 83

Schuyler Co., N. Y., Fair 1,287 43

Albany, N. Y., Fair 80,000 00

Metropolitan, New York, Fair 1,184,487 72

Warwick, N. Y., Fair 1,432 73

Poughkeepsie, N. Y., Fair 10,192 27

Hornells ville, N. Y. , Fair 800 00

South Adams, N. Y., Fair 3,087 04

Baltimore Fair 40,23454

Wheeling, Va., Fair 2,500 00

Great Central Fair, Phila 1,035,398 96

Unknown sources 3,95226

Interest on United States Certificates. 37,771 71

Interest on deposits 1,923 63

Interest on deposits 3, 154 15

Receipts from Sanitary Bulletin 2,351 80

Contributions to Medical Fund 197 00

Proceeds from sales, furniture, etc. . . . 72,298 07

England 11,145 33

Scotland 74 75

France 3,55000

European branch (Paris) 13,372 72

London branch 36,790 42

Belgium 100 00

Germany 843 22

Total $4,924,480 99



After the war the entire collection of records, documents, correspondence, and other
papers of the U. S. sanitary commission were deposited in the Astor library, New York;
and some years later were formally placed in the possession of that institution, where
they remain. The board of direction of the sanitary commission comprised the follow-
ing gentlemen named by the medical bureau and the secretary of war: rev. Dr. Henry
W. Bellows, prof. Alexander D. Bache, prof. Wolcott Gibbs, Dr. Jeffries Wyman, Dr.
W. H. Van Buren, Dr. Samuel G. Howe, R. C. Wood, surgeon U. S. A. ; G. W. Cul-
him, U. S. A. ; A. E. Shiras, U. S. A. Mr. Fred. Law Olmsted filled the position of
general secretary of the commission during the first two years of its history, and to his
judgment, sagacity, and administrative ability may be fairly attributed much of its
Success.

SANITARY SCIENCE, known also under the names of PREVENTIVE MEDICINE, STATE
^IEDICIXE, HYGIENE, and PUBLIC HEALTH, has been variously defined by different
writers.* Dr. Mapothe.r's is perhaps as good a definition as any. In the first of his
Lectures on Public Health he describes this science as "an application of the laws of
physiology and general pathology to the maintenance of the health and life of com-
munities, by means of those agencies which are in common and constant use." This
department of science received so strong an impulse, about a quarter of a century ago,
fi-om the labors of Southwood Smith, Edwin Chadwick, Lyon Playfair, and others, that
man)' persons regard it as of modern origin ; and doubtless to a great extent they are
right; but on fuming back to the records of early history, we almost invariably find evi-
dence that the health of the general population was a subject of legislation. The Mosaic
code of laws the most ancient on record contains minute directions for the cleanliness
of the person, the purification of the dwelling and the camp, the selection of healthy and
the avoidance of unwholesome food (pork, for example, which in hot countries is more
commonly found to harbor parasites than in temperate climates, and blood, which is
the most putrescible part of the animal), the seclusion of persons with contagious
disorders, the regulation of sexual intercourse at certain periods, and various other
points bearing on the physical well-being of the Jewish nation. The Greeks and
Romans, although not, like the Jews, making hygiene a part of their religious duties,
were far from neglecting it. "The laws of Lycurgus," says Dr. Gairdner, "are not
wanting in very pointed enactments on sanitary matters; nn'd the importance attached
by all the Greek republics, and in the Platonic ideal polity, to physical culture, is too
well known to require remark. The Roman people, poor and apparently rude as it was
in its origin, yet found time amidst its military occupations to construct the cloaca
maxima as an indestructible and stupendous memorial of its attention to the drainage
and sewerage of the city at a very early period of its history. At a later period aque-
ducts were made to cover miles upon miles of the surrounding plain, and their splendid

* As the state of sanitary science, both in principles and practice, is substantially what it was when
this exhaustive account of the subject was written by the late Dr. Day, the article has been .allowed
to stand without any material alteration.



i I o
Sanitary.

ruins, sti'l partly used for their original purpose, attest the munificence and the abun-
dance with which the first of sanitary requisites was supplied to the imperial city."
Public Health in Relation to Air and Water, 1862, p. 6. Moreover, we know enough of
the construction of the private houses and public buildings of the Romans to see that
they recognized the necessity for free ventilation and good drainage. When the
archiatri populares, or state-physicians, were first appointed in the Roman empire, is
not certainly known. Their mode of election is described in the Theodosian and Jus-
tinian codes. There were ten of them in the largest towns, one to each district or sub-
division; seven in towns of the second order, and five in the smaller ones. They
collectively formed a college, whose duty it was to attend to the public health, and they
,may be regarded as the earliest type of our "general medical council." Gradually,
however, as Christianity spread, an utter misconception of doctrine led to the neglect
of all care of the human body. While the monks and friars devoted themselves to
good works, feeding the hungry, clothing the naked, and instituting hospitals, they
entertained no idea of the possible prevention of disease. They never attempted to
impress upon their followers the importance of drainage, ventilation, pure and abun-
dant water, etc. ; but when an epidemic arose it was supposed to be a manifestation of
God's special anger, and it would have been impossible to make them understand that it
was the natural result of a prolonged disregard of the laws of nature. Those who
have read dean Stanley's graphic Memorials of Thomas d Becket will be inclined to wonder
whether those who adopted such penances as his could ever be free from cutaneous
disorders. The state of the towns in England in the 13th c. is so clearly described by
Mr. Brewer in his introduction to the Monumenta Franciscana, that we should have been
glad to have extracted it, if our space had permitted. Those who have not access to the
valuable series in which Mr. Brewer's work is included, will find a sufficient quotation
from it in Dr. Gairduer's interesting volume on Air and Water, pp. 44-47. In another
work in the same series the Liber Albus, edited by Mr. Riley much important infor-
mation regarding the general sanitary state of London in the medieval times may also
be found. In addition to the causes of disease indicated by these writers, such as the
absence of drainage, the accumulation of filth, bad ventilation, insufficient and often
unwholesome water, inattention to personal cleanliness, etc., must also be noticed the
ordinary food in those times. The common vegetables of our own day, excepting the
cabbage, were only slowly introduced from the time of Henry VIII. As turnips were
not then used as a winter-food for oxen and sheep, these animals were with difficulty
kept alive during the season when grass was scanty, and were therefore killed and salted
in the beginning of the cold weather; and during several months, game and river-fish
were the only kinds of fresh> animal food. Macaulay, in his celebrated third chapter on
"The State of England in 1683," observes that, at that time, meat, although cheaper
than in former times, was still so dear that hundreds of thousands of families scarcely
knew the taste of it; that bread such as is now given to the inmates of work-houses was
then seldom seen even on the trencher of a yeoman pr of a shopkeeper; and that the
great majority of the natives lived almost entirely on rye, barley, and oats. Many
important facts of a similar nature are also recorded' in Froude's History of England.

During the 18th c. many important steps were taken for the improvement of the pub-
lic health. Under a proper system of dnina<re, ague became eradicated from exten-
sive fenny districts; and with a knowledge of the therapeutic properties of cinchona
bark and arsenic, we can cut short the disease when it appears. Scurvy* was all but
blotted out of the list of diseases that proved most fatal to our sailors; and vaccina-
tion," incomparably the greatest discovery yet made in this department of science, was
the crowning achievement of the century.-)- The first outbreak of cholera in this coun-
try in 1832, lamentable as it was in itself, was productive of much benefit in directing
the public mind to the all-important subject of the prevention or repression of dis-
ease. It was impossible to ignore the fact that, while the poor, dwelling in un venti-
lated and undrained hovels, fell victims to this new and ill-understood disease in
thousands, the middle and higher classes were comparatively safe. All investigations
into the dwellings and domestic habits of the lowest class pf the population revealed
a condition of things of which the general public had no conception. A new poor-
law was consequently passed in 1834, and a commission was appointed to investigate and
report upon its working. The Report on the Sanitary Condition of the Laboring Pbpu-
lation of Great Britain, published in 1842, and mainly treating of the sanitary sf-'^c o/
the poor and of the character of their dwellings, may be regarded, as pro' o<iirdner}
well observes, as "the true starting-point of modern sanitary legislation.'' A ''health
of towns commission," which was soon after appointed, gave in two valuable reports in
1844 and 1845: and subsequently a metropolitan sanitary commission published reports
in the years 1847 and 1848. These reports will form a lasting memorial of the laborj

* We regret to state that during the last few years scurvy Js again becoming prevalent in the mer-
cantile service, and occasionally among navvies engaged at places where good food was not easily
attainable. In both cases, it may alwavs be traced to neglect of due dietetic precautions.

t And yet, in consequence of vaccination being either neglected or imperfectly performed, ro less
than 51,034 persons died in fJreat Britain from small-pox in the ten years, 185f>-65. In the yr-ar 1*64
alone, the deaths were 9,425. On this subject, see sir James Y. Simpson's "Proposal to stamp out
Small-pox, etc.," in the Medical Times ana Gazette for Jan. 4, 1808.

i Public Health in Relation to Air and Water, p. IT.



Sanitary.

of ^lr Chadwick <and his able co-operators. Nor, in this rapid glance at the histoiy of
solitary science, can the name of Dr. William Farr be omitted, who again to quote
Dr. G, lii-iiner's words "found the facts of this science in a state of almost hopeless
a-i I ai.ulesa confusion, and lias not only added immensely to their number and value,
but has brought into them light, harmony, order, and, for the first time in the history
of the science, a determinate mot-hod, and an approach to scientific exactness." By hist
system of calculating death-rates he has placed an easy and useful method at the ser-
vice of his professional brethren, while, by the formation of life-tables, he has greatly
facilitated the operations of life-assurance.

We now pass on to the consideration of the most important sanitary agents, begin-
ning with Aiu. Under this head we have to consider (1) the amount of air necessary
for the full performance of the respiratory process; (2) the means of ascertaining when
air is impure, or, if impure, what substances are mixed with it: (3) the means of purify-
insr contaminated air; and (4) the* diseases due to deficiency in the quantity, and altera-
tions in the quality of the air.

(1) The Jirxt question can be answered both by calculation and experiment. By cal-
culation, Dr. Parkes finds that 2,082 cubic ft. of air must be supplied per head per
hour, so to dilute the products of respiration and transpiration from the sound body,
as to keep the air always pure and fresh (see his Manual of Practical Hygiene. 1804,
p. 65). From numerous experiments in which the outflow of air was measured, and
the carbonic acid simultaneously determined, he found that at least 2,000 cubic ft. per
hour must be given to keep the carbonic acid at its normal level of .5 or .3 in ^000
volumes, and to remove the odor humanus or fetid smell of animal matter. Gen.
Morin, in his Ripport de la Commission snr le GhaUffiige et In Ventilation fa* Bd'iniens du
Palais de Justice, 1860, gives results in close accordance with those of Parkcs, assigning
the following as the relative hourly amounts of fresh air (expressed in cubic feet.) per
head in temperate climates: in barracks, at 1059 by day, and 2,118 by night; in work-
shops, prisons, and theaters, 2.118; in schools, 1059; and in hospitals, 2,825, increased
to 4,238 during the hours of dressing the surgical cases, and 5,650 during epidemics.*
In mines, if it is wished to keep up the greatest energies of the men, 6,000 ft. of air per
hour must be allowed. It may be incidentally mentioned that a horse requires 2,460
ft. per hour at the least. It is difficult to lay down any rules regarding the amount of
fresh air required in sickness. The vitiation of the air by the products of combustion
of gas, candles, lamps, etc., must not be overlooked. For every cubic foot of g,is that is
burned, 1800 cubic ft. of air are required to keep the air pure, unless tl^e gaseous prod-
ucts are carried off in a special channel, such as is now frequently attached to gas-
fittings. A pound of oil burned in a lamp may be regarded as equivalent to 10 cubic
ft. of gas, so far as the deterioration of the air is concerned. (For these facts we are
indebted to Dr. Parkes.)

(2) The composition of pure air is sufficiently d?sc.ribed in ATMOSPHETVS. Tho
impurities in air may 1)3 divided into: (a) suspended matters, (6) gaseous substances,
and (c) special impurities. Amongst suspended matter* are, according to Pasteur and
others, numerous and universal germs of organic brings, both animal and vegeta-
ble, as of vibriones, bacteria, and monads; pollen, spores of fungi, mycoderm*,
mucedones, etc. Minute particles of finely comminuted inorganic matter arc also
often taken up by currents of air, and remain in suspension. These are proba-
bly altogether harmless. The works of man more seriously affect the air In a hygi-
enic point of view. Particles of coal and of half-burned carbon (smuts), starch-c'elU
(from bakeries and bread), and, when certain trades are carried on, cotton fibers, hairy
particles of wool, of stone, of iron, etc., nv.iy, when constantly inhaled, give rise to the
production of special disease* of the lungs and stomach. In the air of bully-kept hos-
pital wards, pus-cells and epithelial cells are often to be detected. Most physicians now
believe that the specific poisons of small-pox, scarlet fever, and measles, which are
derived from the skin and mucous membrane, consist of molecular organic matter,
which, although as yet undetected, must pass into the air; and the same remark applies
to the so-called germs of typhoid fever (see the article on TYPHUS AND TYPHOID FEVERS)
and cholera, which are thrown off by the intestinal mucous membrane, and subsequently
become dried and capable of aerial suspension. Amongst gaseous matters, which merely
pass into the atmosphere either from natural causes or manufactories, are various com-

pounds of carbon, sulphur, chlorine, nitrogen, and phosphorus, with oxygen and
hydrogen, which it is unnecesary here to enumerate. Besides the gases formed by the
union of the above-named elements, we must notice organic vapor from decomposing
animal matters and sewers, which last has been found by Odling to be carbo-ammoni-
acal. Amongst special -impu ntie, those caused by respiration are the most important.
An adult man, under ordinary conditions, gives off, in 24 hours, from 12 to 16 cubic ft.
of carbonic aci.l by the lungs, and a certain additional quantity, not determined, by the
skin. Watery vapor, ranging from 25 to 40 ounces, also passes off daily from the skin
and lungs, together with an undetermined quantity of organic matter, which is partly
suspended (a-; particles of epithelium, etc.), and partly made up of organic vapor. This
vapor, when collected and condensed from a large volume of respired air, is found to

* The older observers fixed the necessary quantity of fresh air far too low: Peelet thought 215 ft.
sufficient; Arago. 353 ft. ; and Dr. Reid, 600 ft. per hour.

U. K. XIII. 8



Sanitary.



114



be nitrogenous, and has a very fetid smell. Here there is a most powerful source of
vitiation, regarding which numerous chemical analyses have been made; for details
regarding which we may refer to Parkes, op. cit. pp. 70-77; Gaird-er, op. cit,. p. 6^; and
Mapother's Lecture* on Public Health, 2d ed., pp. 40-61. '1 here is a condition of the
atmosphere to which various observers, and especially Pasteur, have directed attention,
which/requires a passing remark. It is what may lie termed the fermentaiive condition,
and depends upon the universal presence in the air of countless germs of vegetables and
infusoria. It is possible that this atmospheric condition may be concerned in some of
the zymotic diseases. Dr. Salisbury, an American physician, endeavors to show that
the poison of measles is due to a fungus which grows on rotten straw ; another American
physician. Dr. Flint, "has almost fully demonstrated that the t-pores of pahnella cause
ague." iflapother, op. cit., p. 441, etc. The presence of a chule>':t-f align?, which has
been recently proved to exist in the evacuations of all cholera patients, gives, as will be
seen from Mr. Simon's report of the Weimar conference,* a hint as to the probable
cause of that disease. Bearing on the same subject is the fact, lately noticed by Davame,
that the splenic apoplexy of sheep is owing to the presence of bacteria in the blood, and
that sheep, rabbits, and horses can be inoculated by transferring into their circulation.
the bacteria, which are extremely thin rod-like organisms, varying in length from ^fa
to, ^55 of an inch. The same observer iris just found (as we learn from the " Parisian
Medical Intelligence," in the Lancet for Jan. 4, 1868) that bacteria -.ire to be .found in all
carbuncular diseases of any form whatever; that the supervensiou of the.-c hale beings
in the spleen, the lungs, and the blood precedes the occurrence of morbid phenomena;
and that the carbuncular blood ceases to be contagious as soon as the bacteria have dis-
appeared; and hence he feels justified in regarding them as (he cause of carbuncle.
Another French observer, M. Poulet, has just detected myriads of infusoria (iitv/iiis
teiino and others) in the breath exhaled in whooping-cough. If one contagion.-, disease
can be proved to be connected with the germs occurring in the air, it is almost, a cer-
tainty that similar diseases must arise from corresponding causes.

(3) The natural means of purifying the atmosphere are diffusion, oxidation, the action
of winds, and the fall of rain. In cases where the air is specially impure, as in
Bick-rooms where there are contagious cases, the agents commonly known as di.xinftct-
a&(q.v.), or deodorants, are employed. Amongst the noiidn of this class are rham al
(see \\OOD-CHARCOAL), dried earth, and the carbolatcs of lime and magnesia. Amongst
the liquids, those in highest reputation are Condi/' sjluid] (consisting of an alkaline per-
manganate, which at once decomposes ammoniac;*! coinpoundo, and destroys organic
matter rapidl}') and carbolic acid: whilst nmon^t the cases or w pew* Which are the
most powerful means of purifying the atmosphere, next to ventilation mny be espe-
cially mentioned chlorine, nitrous acid, and sulphurous acid; of these, says Dr. Parkes,
the nitrous acid is probably tl~e most powerful, b:it it is useful to employ all three
alternately, or even together. It must be recollected that nil the-^e agents are mere
auxiliaries to ventilation, the primary importance of which must never be. forgotten.

(4) Abundant experience confirms the view which might have been a priori inferred
from the study of the physiology of respiration (q.v.), that the, breathing of impure air
must be incompatible with perfect health. The special impurities wlreh are worthy of
notice as being causes of disease, or of an impaired state of health, are arranged by Dr.
Parkes as follows: (a) Suspended matters; (b) Gaseous matters; (c) Impurities from sev-
eral substances always co-existing.

(a) Tie suspended matters which are known to occasion disease in various trades are
very numerous. Thackrnh, in his well-known work on The Effects of Art*. Trade*, and
Professions on Health, published in 1832. gives the following list of workmen who were
injuriously affected by the dust of their trades: Corn-millers maltsters, tea-men, coffee-
roasters, snuff-makers, paper-makers, flock-dressers, feather-dressers, shoddy-grinders,
weavers of coverlets, weavers of harding, dressers of hair, hatters employed in the bow-
ing department, dressers of colored leather, workers in flax, dressers of hemp, sonic
workers in wood, ware-orinders, masons, colliers, iron-miners, lead-miners, guilders of
metals, file-cutters, machine-makers, makers of fire-arms, and button-makers. To ihis
list must be added colliers, who suffer from lung-disease in ill-ventilated mines; potters,
especially the class called flat-prcssers, in whem emphysema is so common that it is
known as "the potters* asthma;" the china-scourers, who all, sooner or later, become



Online LibraryFrancis LieberLibrary of universal knowledge. A reprint of the last (1880) Edinburgh and London edition of Chambers' encyclopaedia, with copious additions by American editors (Volume 13) → online text (page 26 of 203)