From Seventh Report of the Massachusetts State Board of Health. 
HEALTH OF BOSTON. 
1875- 
By F. E. OLIVER, M. D. 
WRIGHT & POTTER, STATE PRINTERS, 
BOSTON: 
79 Milk Street (corner of Federal). 
1876. HEALTH OF BOSTON. 
1 8 7 5. 
F. E. OLIVER, M. D.  1* 1 
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MAP OP BOSTON. 
SHOWING HEALTH DISTRICTS 
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Undrained and filled land. 
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M Xr~~*ZA VJL t -I X HEALTH OF BOSTON* 
The somewhat confused state of the registration department, aris- 
ing from contemplated changes in the mode and management of the 
mortality registration, has made it a little difficult to obtain an accu- 
rate estimate of the mortality of Boston for the past }Tear. As the 
only returns for the whole year are those of the registrar, these have 
been adopted, although not entirely accurate, the number of deaths 
registered by him for the last seven months of the year falling 
considerably short of that contained in the tables of the City Board 
of Health. 
It appears from the returns of the city registrar that the number 
of deaths in Boston, in 1875, was 8,954, this exceeding by eleven 
hundred the number recorded in the previous year, an increase that 
may be, in part, attributed to the unusual length and severity of 
the winter, together with extraordinary epidemic influences during 
the latter part of the year. With a population that may be fairly 
estimated at 342,000, we have accordingly a death-rate of 26.18 in 
the thousand living, which is an increase of 2.59 per thousand over 
* An attempt was made to compare the mortality of Boston during the 
past year with that of 1870, using for that purpose the census of 1875, and 
the “ health-districts” into which the city had been subdivided by the late Dr. 
Derby. It was found, however, that the records of the city registrar did not 
contain information of sufficient exactness to make it advisable to publish a 
report based upon those returns. 
For that part of the year during which the City Board of Health has pre- 
served the records, statistics of great value have been preserved in a manner 
to make them accessible and thoroughly to be relied upon, for the first time 
in the history of Boston. It was hoped that the erroneous results reached 
in the paper on the mortality of Boston could be rectified, by means of com- 
parison with the accurate records of the Board of Health. It was found, 
however, at a late day, that this was impossible within the limits of time 
allowed the writer, and the board regret to be compelled to withdraw a 
paper of value. The following report, originally prepared for the “ Health 
of Towns,” is commended by the board to that careful consideration which 
the reputation of the writer and its thorough research deserve. [Ed. 496 
STATE BOARD OF HEALTH. 
[Jan. 
that of 1874, and of 1.63 over the estimated mean death-rate of 
Boston. In the mortality tables of the City Board of Health for 
the seven months ending December 31, 1875, there are 79 more 
deaths recorded than appear in the returns of the registrar, which, 
added to those already quoted, give 9,033 as the whole reported 
mortality for the year, and a death-rate of 26.41 ; and for Boston, 
exclusive of the three recently annexed towns, 26.80 per thousand. 
By further excluding Roxbury and Dorchester, the death-rate rises 
to 28.32, which is not far from four per thousand above the mean 
death-rate for Boston previous to the annexation of these five towns. 
The high death-rate that has characterized Boston for some years 
past, is largely due, as is shown in the recent report on the Sanitary 
Condition of Boston, to the excessive mortality-among infants and 
children under five years of age, the mean death-rate under one far 
surpassing that of London, and almost equalling that of Liverpool, the 
most unhealthy of English cities. The year that has now closed is 
by no means an exceptional one in this respect, the death-rate of 
infants under one being somewhat above, although that of children 
under five falls a little below, the mean for the last four census years. 
The rate above five was also 2.7 per thousand above the mean for the 
same years, as also considerably above the mean decennial death- 
rate for London, as appears from the following table :— 
Deaths in Boston per 
THOUSAND LIVING. 
1*55. 
1865. 
1870. 
1875. 
Mean of the four 
Census years. 
London, mean of 
ten years—1851- 
1860. 
Under 1, 
265.5 
276.9 
275.8 
272.7 
Under 5, 
99.4 
99.2 
97.2 
86.8 
95.6 
78.0 
Over 5, . 
14.7 
15.6 
15.5 
18.8 
16.1 
16.6 
At all ages, . 
25.4 
23.6 
24.3 
26.1 
24.8 
23.7 
The diseases that have been most prevalent are phthisis, pneu- 
monia, and three diseases of the zymotic class,—scarlatina, diphthe- 
ria, and cholera infantum, to which be added typhoid fever. 
The mortality from phthisis, which was somewhat higher in the 
first and fourth quarters of the year, was less by seventeen than in the 
previous year ; the percentage of deaths to the whole mortality falling 
to 14.90, or 3.86 to the thousand living, which is less than the mean 
death-rate from this disease for the last ten years, and pretty nearly 
corresponds with the mean decennial death-rate throughout the 
State, and marking a still further decline in the mortality from this 
disease, which has for some years been steadily decreasing. The 1876.] 
HEALTH OF BOSTON. 
497 
highest number of deaths (five per thousand) was in the twenty-third 
district, which comprises the northern slope of Beacon Hill, including 
the narrow, crowded streets at its base lying between West Boston 
and East Cambridge bridges. The northern side of this hill is in- 
habited largely by a colored population, and from its northerly 
exposure, and the nature of the soil, is cold and damp. From the 
analysis of the mortality statistics given in the report of the Com- 
mission on the Sanitar}’ Condition of Boston, above referred to, it 
is shown that the high rate of mortality from phthisis is in a great 
measure due to the large Irish population, who show a marked pro- 
clivity to lung affections. 
The deaths from pneumonia numbered 666, or more than 100 
more than in 1874,’and 7.43 per cent, of the whole mortality. This 
disease was especially fatal in the first quarter of the }’ear, and its 
prevalence was probably due to the cold and prolonged winter; the 
average temperature for the first three months being 25.2, which 
is six degrees lower than during the same period in the previous 
year. The largest number of deaths was in district 23, where the 
death-rate was 2.3 per thousand. The lowest mortality was in 
district 28. 
The large mortality from scarlatina and diphtheria wras due to 
epidemic influences, not unaided by local causes, which will be 
alluded to below. The number of deaths from scarlatina was un- 
usually large, amounting to 530, or 5.91 per cent, of the whole 
mortality. It was especially fatal in districts 20, 21, 35, 39 and 42, 
where filth and foul air have for years been allowed to do their 
legitimate work unmolested. The highest rate of mortalit}- was in 
Brighton (district 45), where the death-rate was six in the thousand, 
not an i mprobable cause of which is suggested by one of our Brighton 
correspondents. 
The deaths from diphtheria gradually increased from 49 in the 
first three months of the year to 234 in the last quarter, amounting 
to 418 for the whole year, and making 4.66 per cent, of the entire 
mortality, and a higher death-rate from this diesase than ever before 
here recorded. The highest mortality was in districts 38 and 45. 
No deaths wrere reported from district 26. Deaths from mem- 
braneous croup, which was more prevalent than usual, are not 
included in this estimate. The death-rate from the latter disease 
was 0.64 per thousand, or 2.45 per cent, of the whole mortality, 
being nearly double the mean for the previous ten 3rears. 
There were 680 deaths from cholera infantum, which is one more 
than the number recorded in 1874. These occurred mostly from 
June to October, inclusive, the highest weekty number being in 
the first week in August. The districts where it mostly prevailed 498 
STATE BOARD OF HEALTH. 
[Jan. 
were those where it has been observed in previous 3rears,—in over- 
crowded parts of the city, exposed to every insanitary condition. 
No case was reported from district 28. 
The mortality from all the diarrhoeal diseases taken together, 
including the last mentioned, was 999, which is not far from one- 
ninth of the whole mortality for the }’ear. 
The deaths from typhoid fever were 225, or 2.51 per cent, of the 
whole mortalit}", the number reported for the last half of the year 
being nearly double that of the first six months. Man}1, of the cases 
are believed to have been imported from the countiy. 
The mortality from the prevalent zymotic diseases, taken together, 
mainly due to scarlatina, diphtheria and the diarrhoeal diseases, 
although not so high as in 1872, when the sfnall-pox proved so 
fatal, was considerably above the decennial death-rate from 1865 to 
1874, as will appear from the following table:— 
Comparative Mortality from Zymotic Diseases in 1875. 
DISEASES. 
1875. 
Mean for 
ten years. 
Choleiia Infantum, 
. Deaths per 1,000, . 
/1.98 
1.92 
Per cent, of mortality, . 
\ 7.59 
7.81 
Diarriiceal Diseases, Deaths per 1,000, . 
/ 0.93 
1.03 
Per cent, of mortality, . 
\ 3.56 
4.19 
Scarlatina, 
. Deaths per 1,000, . 
/1.55 
0.93 
Per cent, of mortality, . 
\ 5.91 
3.85 
Diphtheria, 
. Deaths per 1,000, . 
f1.22 
0.21 
Per cent, of mortality, . 
\ 4.66 
0.86 
Measles, 
. Deaths per 1,000, . 
/0.18 
0.13 
Per cent, of mortality, . 
\ 0.70 
0.52 
Whooping-cough, 
. Deaths per 1,000, . 
/ 0.08 
0.20 
Per cent, of mortality, . 
\ 0.32 
0.82 
Typhoid Fever, . 
. Deaths per 1,000, . 
f 0.65 
0.66 
Per cent, of mortality, . 
\ 2.51 
2.64 
It is to a few diseases of this class, as has been shown by the 
able report above referred to, that is largely due (he high death- 
rate of Boston for many years past. More than one-fourth part of 
the entire mortality the last year is attributable to these diseases; 
and, as they are believed to be especially promoted by insanitary 
conditions peculiar to certain localities, the testimony of physicians 
was requested as to how far they were able to trace the influence of 
these conditions in the cases that had fallen under their observation. 
The circular addressed to them contained the following questions :— 
1. Have diphtheria, scarlet fever, and typhoid fever been, in your 1876.] 
HEALTH OF BOSTON. 
499 
experience, more prevalent or not during the past year than in the 
preceding year or years ? 
2. Have you had reason to regard these diseases as due to defect- 
ive drainage or the presence of sewer-gases in the particular local- 
ity where they have appeared, or in its immediate vicinity? 
3. Has cholera infantum been especially prevalent during the 
past summer, and what were the insanitary influences that seemed 
to you to promote it, or the three above-named diseases, whether 
in connection with locality, absence of sunlight, defective drainage, 
overcrowding, or insufficient water-supply, etc.? 
4. Please give the localities, including street and number, where 
you have had cases of the above diseases, and where they have been 
most prevalent? 
Of the physicians who replied to the above questions, there are many 
who were unable to perceive any connection between these diseases 
and the conditions referred to. B37 far the largest number, however, 
including many of wide experience, regarded their influence on 
diphtheria and tj-phoid fever as unquestionable. How far such 
influences affected the development of scarlet fever, there seems to 
be a more equal division of opinion. The fact that this disease 
not unfrequently occurred in places where no local cause could be 
assigned, may be readily explained by its communicability, and 
the constitutional proneness that exists in some individuals to 
zymotic diseases. 
The following are quotations from the letters referred to, so far 
as our limits will allow :— 
Diphtheria.—Dr. Bickford, of Charlestown (district 46), after 
mentioning the alarming prevalence of diphtheria, says, that “ nearly 
every case that I have seen, has occurred in houses with defective 
drainage which, in this district, is fearfully bad in all houses which 
have been built from twenty to forty years, or more. They were laid 
on planks which have become decayed and broken away, allowing the 
drain to become clogged and the cellars to become filled with the 
fluids from sinks and water-closets.” 
Dr. Campbell, of East Boston, writes, that “ the most malignant 
cases of diphtheria and scarlet fever occurred in localities where the 
drainage is imperfect, although not entirely confined to those places.” 
“ I have, for a year past,” says Dr. Cheever, “ had recurrent (many 
times) cases of sore throat in a family of children, in Montgomery 
Street, which have wholly ceased since a defect in the soil-pipe was 
discovered and remedied.” “ I have just lost a patient (three months 
old) after five days’ sickness of an obscure character, but pointing to 
some obstruction of the throat, and death from exhaustion, in East 
Chester Park, where sewer-gas is a daily nuisance in the wash-bowls, 500 
STATE BOARD OF HEALTH. 
[Jan. 
and where, in summer, the Roxbury Canal, quite adjacent, has been 
unparalleled in vileness.” Dr. Cheever also mentions “a case of 
slow7 and recurrent pneumonia in an infant who, during its sickness, 
was suddenly seized with vomiting its milk. The milk was prepared 
and kept in an open bowl, set into the water of the wash-bowl to 
keep it cool. Over this played a stream of sewer-gas from the 
overflow pipe—very perceptible; vomiting ceased when the food 
w as removed, the overflow hole puttied up, and the bowl kept full 
of water.” 
Dr. Edes states that “ the typhoid cases and the diphtheritic 
croup that he had seen, occurred in a badly drained district.” 
Dr. Hastings “ has noticed more diphtheria and typhoid fever in 
parts of the city where drainage is imperfect.” 
Dr. Blood, of Charlestown (district 46), says: “In regard to 
diphtheria and typhoid fever, I believe the cause of all the cases that 
I have seen, without exception, to be defective drainage, the pres- 
ence of sewer-gases being noticeable in or about the houses where 
the cases occurred.” “ 1 would not speak so strongly in regard to 
the cause of scarlet fever.” 
Dr. J. B. Ayer mentions cases as occurring at Portland Street (144), 
where the common sinks contained a great deal of refuse, and often 
emitted offensive odors. “ In Myrtle Street (121), where the odors 
from the cesspools in the yard were very offensive, and the cellars 
so foul, that the tenants threatened to leave.” “ In Porcelain Place, 
where the cesspool occasionally sends up offensive odors ; also offen- 
sive at high water.” 
Other cases are mentioned where no odors were noticeable, or 
where no inquiry was made as to their existence. 
Dr. Nichols, of Roxbur}7, states that in his experience, “ these 
diseases were decidedly more numerous, and the results less favora- 
ble in those districts imperfectly drained, or subject to the action of 
sew7er-gases, or the emanations from the so-called midden-vaults.” 
“ I have noticed,” says Dr. Osgood, “for many years, that the 
above diseases have been much more severe in consequence of these 
gases, and in some cases, I believe, they were caused entirely by 
them.” 
Dr. Whittier attributes these diseases to “ both defective drainage 
and the presence of sewer-gases.” A paper was read by Dr. 
Whittier before the Society for Medical Observation, in October last, 
which gives four cases of this disease, where these influences were 
unmistakable in their effects. 
The following extract is from a letter of Dr. Goss, of Roxbury :— 
“ I was called to see, some time in January, a child who was 
suffering from this disease, in Williams Street, where a child had 1876.] 
HEALTH OF BOSTON. 
501 
died of supposed diphtheria,—not a very severe case. Later in the 
year, the father had a severe attack of pneumonia, but recovered ; 
still later, a child was taken with the same disease, and died. The 
mother, who was confined in September, had a tedious convalescence 
from pelvic cellulitis and other complications. This house is situated 
in what was formerly a marsh, or a part of a territory comprised in 
the Roxbury Flats. It is far below the level of the street, with no 
proper facilities for drainage, and water is standing, much of the 
time, under the house. I cannot affirm that the unfavorable location 
of the dwelling had anything to do with the cases of disease occur- 
ring therein, but am convinced that this, and many others in its 
vicinity, are built where habitations should not have been permitted 
until proper arrangements had been made for drainage.” 
Dr. C. D. Homans remarks that he has found no special cause for 
the few cases that he has seen, but “ the drainage is defective every- 
where.” 
Dr. Hyndman says: “ I have had no reason to attribute the 
disease to either of the above-named causes.” He subsequently 
states that his practice chiefly lies in the “ north part of the city.” 
Scarlet Fever.—Dr. J. B. Ayer mentions cases of this disease in 
Cusson Place (2), where the drains empty into the water-closets on 
each floor, and are often very offensive in summer. “ In Cambridge 
Street (193), where the odors from the drains were ver}’ offensive 
through the summer and early part of the fall; often most intoler- 
able. In Anderson Street and Bridge Court, where the water often 
rises in the cellar, but without odor.” 
Dr. Bush states that “ the cases of this disease that he had seen 
occurred in crowded houses, in Middlesex Street, a part of the city 
that is considered well drained, so far as the street is concerned, but 
the pipes in the house were insufficient for the amount of work re- 
quired of them, so that parts of the houses were in a foul condition.” 
Dr. Fisher mentions a house in Fabin Street where there were 
three cases and two deaths, and where “ the surroundings are not as 
wholesome as they should be.” 
Dr. Morrill states that he has had cases of scarlet fever “ which 
seemed to point directly to bad drainage as the only cause, this 
existing both in the exact locality of the disease, and in its imme- 
diate vicinity.” 
Dr. Street attributes this disease, as well as diphtheria, “ to de- 
fective drainage, more than to any other cause beyond the control of 
the tenants.” 
Dr. Giddings, of Brighton, in allusion to the remarkable preva- 
lence of scarlet fever in that district, where it has proved far more 
fatal than in any other portion of the city, says: “ I am unable to 502 
STATE BOARD OF HEALTH. 
[Jan. 
account satisfactorily for the outbreak of scarlet fever. We have 
no system of drainage, and cases have occurred with as much fre- 
quency in localities where elevation, slope, and soil would favor the 
disposition of extraneous matters, as in those where the surroundings 
would seem to favor and perpetuate the poison. There is one fact 
worthy of note, which may furnish an hypothesis by which we may 
account for the production of this disease. There is a low, flat piece 
of land (a sort of semi-meadow) lying along the south line of the 
Boston & Albany Railroad in Allston. During the fall of 1874 a 
large amount of compost from a slaughter-house was spread over 
this low land, and, for a time, for the distance of a mile or more, 
according to the direction of the wind, the most pungent and sick- 
ening and offensive odors prevailed. From that time to the present, 
scarlatina has prevailed, with an occasional case of diphtheria. I 
am forced to believe that, from this compost spread over this low 
land, the poison of scarlatina and diphtheria originated, and has 
been continued, by the diffusion of the poisonous gases and the 
principle of contagion.” 
Dr. Marion, of Brighton, states that he has seen scarlet fever in 
nearly every street in the district. “ The epidemic began here in 
December, 1874, and raged through the winter months. Through 
the spring and summer there were only isolated cases. In Septem- 
ber, 1875, it commenced again, and continued to increase till Janu- 
ary, when it seemed to be at its height. Since then it has been 
gradually disappearing. In the winter of 1874-75 it was confined 
mostly to the more elevated portions of the town; during the past 
winter mostly to Allston ; North Beacon Street might be considered 
the dividing line,—scarlet fever raging south of it in 1874-75, and 
north of it in 1875-76. During the year I attended one hundred 
and fourteen cases ; of these sixty-three were of Irish parentage.” 
It will be noticed that the date of the outbreak of scarlet fever 
corresponds with that given by Dr. Giddings. 
Typhoid Fever.—Dr. J. B. Ayer reports a case of typhoid fever 
in the rear of Spring Street (21), where the cesspool was under the 
privies, and where the odor in summer was strong enough to require 
the closing of the windows. 
Dr. Belt, of South Boston, thinks that most cases “ can be traced 
to defective drainage from houses to the street.” 
Dr. Blodgett thinks that the absence of any subterranean drain in 
a small, sunless court, was an important factor in the causation of 
the disease. 
Dr. Minot mentions a case of this disease “ in a boy eleven }’ears 
old ; one of obscure disease, with symptoms of nervous and physical' 
prostration, lasting several months ; and two or three cases of slight 1876.] 
HEALTH OF BOSTON. 
503 
indisposition, all occurring in the same familj’, which were supposed 
to be caused by sewer-gases escaping from a defect at the junction 
of the soil-pipe with the house-drain, discovered after the house was 
vacated.” 
Dr. Shattuck reports several cases “ which appeared to be due to 
defective drainage.” 
Dr. Tarbell states that about one-fourth of the cases of typhoid 
fever that have come under his observation could be traced directly 
to some local origin ; one-fourth only indirectly, and in the remain- 
ing half there could certainly be no such cause assigned. 
Dr. Walker, of South Boston, mentions “ two severe cases, which 
occurred among the attendants at the lunatic hospital, both of which 
were attributed to exposure to a foul drain while cleaning and re- 
pairing it.” 
Dr. J. C. Walker mentions “ a case of this disease on Highland 
Park Avenue, wrhere the location was high. The patient had not 
been into the country, and the disease seemed to be one arising from 
defective drainage. There was no sewer-drainage in the street.” 
Cholera Infantum. A very large proportion of the cases reported 
are believed to have been due to one or more of the causes mentioned 
in the following extracts from the letters of our correspondents :— 
1. “Long-continued and excessive heat, acting on children who 
have been nourished on artificial food, in crowded and badly venti- 
lated rooms, exposed to decaying animal and vegetable matters, bad 
drainage, putrefying excrement, and water contaminated with putres- 
cent animal matter, especially soakage from privies. 
2. “ Olfal thrown out of tenement-houses, being allowed to remain 
and decompose.” 
3. “ Very hot weather in conjunction with unsuitable food and con- 
taminated air. Absence of sunlight, defective drainage, and over- 
crowding, as also privies and swill-pails.” 
4. “ Overcrowded, dark, badly drained houses.” 
5. “ Overcrowding, absence of sunlight, improper food, improper 
clothing, want of cleanliness, bad sewerage and carelessness in the 
removal of refuse matter.” 
6. “ Errors in diet (of 200 nursing-bottles carefulty examined, but 
20 were proved free from fungi).” 
7. “ A filthy house.” 
8. “ Defective drainage, locality, overcrowding, in so far as this 
also implies filth ; absence of sunlight.” 
9. “ Overcrowding and improper feeding.” 
10. “ Defective drainage, defects in water-closets, and stagnant 
water, as in open lots.” 
11. “Exhalations from filth-water.” 504 
STATE BOARD OF HEALTH. 
[Jan. 
12. “ Exposure to the heat of a cooking-stove in rooms in the 
second and third story.” 
13. “Teething infants fed artificially, bad food, and overcrowd- 
ing in streets and courts deficient in light and air.” 
14. “ Bad drainage and improper food.” 
The localities where the above diseases principally prevailed are 
the same that have long been noted for high mortality rates. Those 
especially mentioned are districts 20, 21, 22, and 23, corresponding 
to the old wards 1, 2, 3, and part of 4 ; districts 29 and 30 to ward 
7, which comprises the South Cove territory and parts of South 
Boston ; and districts 35, 39, and 42, comprising wards 10, 13, and 
15; also district 45, or Brighton, where scarlet fever proved so 
fatal. Many of these districts contain either a dense population, 
crowded into dark, narrow streets, or are characterized by low, wet 
or ill-drained land; and the inhabitants are largely composed of 
foreigners whose habits and proclivities especially predispose them 
to diseases of the zymotic class. The insanitary influence of new- 
made land is not apparent, as the highest death-rate reported (31 
per thousand) was in district 21, which is upon the original soil, 
while the healthiest district, 28, is one, the larger part of which, a 
few years since, was covered by the waters of the Back Bay. 
The above testimony is less important as showing a connection 
between certain insanitary conditions and a dangerous and fatal 
class of diseases, now generally recognized, than as pointing out 
the results of defective sanitation at our own doors, and the urgent 
necessity of such sanitary measures as in many foreign cities have 
proved so effectual. With a mortality as reported for the past year 
of 1,200 above the average mortality, that average itself being con- 
siderably above the normal death-rate of Boston, as shown by the 
report above referred to, and with all the facts and recommendations 
of two commissions before them, an unenviable responsibility rests 
upon the city authorities, should the warning pass unheeded. 
The number of deaths in public institutions was 907, or not far 
from one-tenth of the whole mortality. 
In connection with this subject, it would be amiss not to mention, 
however briefly, the recent reports of the two commissions just 
alluded to, one on the Sanitary Condition of Boston, and the other 
upon the Sewerage of Boston, appointed a year ago or more, under 
the auspices of the City Board of Health. The publication of these 
papers, drawn up with admirable care and ability, may be said to 
mark an era in the sanitar}' history of Boston, for it cannot be 
doubted that the suggestions contained in them will receive that 
attention which the character of the commissioners and the impor- 
tance of the subject entitle them to. 1876.] 
HEALTH OF BOSTON. 
505 
The first-mentioned report includes a careful analysis of the mor- 
tality statistics, showing that the death-rate, which has been 
thought for some years past to be excessive, is due, in a great meas- 
ure, to the large mortality among infants and children, as well 
as the large foreign element, especially Irish, in our population. 
Nearly two-thirds (58.4 per cent.) of the aggregate population, it 
is shown, are composed of foreigners and their offspring, of which 
large proportion two-thirds again (64-6 per cent.) are Irish, who are 
peculiarly prone to those diseases which act so large a part in 
swelling our mortalit}7 lists. Among these may be mentioned 
phthisis, pneumonia, Bright’s disease, and certain zymotic diseases 
suggestive of defective sanitation, and appropriately termed “ filth- 
diseases,” the latter including cholera infantum, the diarrhoeas, and 
typhoid fever. That portion of the second chapter treating upon 
the Influence of Nationality upon mortality is of especial interest, as 
is also the third chapter upon the “ Nature and causes of the dis- 
eases which occasion our excessive mortality.” In allusion to the 
sanitary needs of Boston, a more complete and accurate system of 
registration is recommended, and such sanitary measures as shall 
more effectually counteract the morbific causes that occasion one- 
fifth of all the deaths that take place, and which are shown to be 
removable. The most important of these measures is suggested in 
the following paragraph, which we quote at length :— 
“ The prevention of filth-infection, in its various forms, constitutes, with- 
out any doubt, the greatest and most urgent sanitary need of Boston. The 
attainment of this end imperatively calls for the adoption of energetic meas- 
ures designed to prevent all possible contamination of our air, water and 
food, by the putrefying organic matters of all kinds which constitute ‘ filth.’ 
Dirt has been defined as ‘matter out of place’; so the filth, of which we 
speak, is but sewage out of place. When confined within its proper channels, 
and therein, constantly undergoing rapid removal, sewage is harmless, 
and does not deserve the opprobrious epithet which it incurs under opposite 
conditions; namely, when stagnating without, or even within, its channels; 
then poisonous vapors are generated and given off, which convey filtli- 
iufection in all its forms. 
“ By no other means can the purification of our city from filth be encom- 
passed, than by the rapid and continuous removal from our midst of all refuse 
matters, such as constitute sewage, comprising solid and liquid excrements, 
foul household waters, etc., etc. Any reliance upon ‘ disinfectants,’ as a 
means of public sanitation, would be but a delusion and a snare.” 
The appointment of the Commission on Sewerage was in compli- 
ance with a request of the City Board of Health. It had long 
been believed that there is a direct connection between decomposing 
matter and disease, and the experience of foreign cities had shown 
that, with an improved system of sewerage, sickness and mortality 506 
STATE BOARD OF HEALTH. 
[Jan. 76. 
had much diminished. It was thought that the time had come when 
Boston should have a system of drainage commensurate with the 
necessities of a great and growing city. “ The evil of the present 
system of sewerage chief!}7 arises,” says the report, “ from additions 
being constantly made to the territory of the city, and from the 
sewers being necessarily extended through these low districts, and 
on flat grades, without a definite, comprehensive system.” Many of 
them are insufficient for the work required, and others are so low 
that they cannot be emptied even at low tide. In other cases, there 
are no tide-gates, the sewers lie low, and the soil is incompletely 
drained, the cellars are often wet, and the sewer-gases are driven 
into the houses by the rise of the tide. It is also stated that 
“ twenty millions of gallons of sewage are discharged daily at differ- 
ent points, completely skirting the city, and polluting the atmosphere 
throughout most of its length and breadth.” The plan suggested 
by the commission is to carry the sewage far out into deep water, 
where its discharge will be remote from dwellings, by two enormous 
sewers extending from a point near Cottage Farm Station to the 
sea, on either side of the city ; one to run in a south-easterly direc- 
tion through the south part of Boston to Moon Island, and the other 
north-easterly through Cambridge, Charlestown, Chelsea, and Win- 
throp to its outlet at Point Shirley. It was proved, by experiment, 
that sewage discharged at these points would not return with the 
tide. With this system there is a constant and uninterrupted flow 
of the sewage from the time it enters the sewers until its discharge 
at the outlets.* 
* See the map facing page 232; for the “health-districts,” see the map 
facing page 512.