CONDITIONS OF HEALTH IN CITIES. 
By J. L. KAINE. [Reprint from the Wisconsin State Board of Health Report for 1886.] 
CONDITIONS OF HEALTH IN CITIES. 
BY J. L. KAINE, MILWAUKEE. 
If certain men would only be considerate enough to die- 
just when they ought, the progress of sanitary science in 
popular esteem would be more rapid. There are members 
of the English parliament, for example, who live under the 
most insanitary conditions, and London barristers who are 
surrounded by the worst faults the sanitarian can imagine, 
and yet they are alive and well and even cheerful at 70. 
All about us are persons who ought, as a matter of con- 
science, to be decently dead and decomposed as a warning 
to all who neglect the laws of health, and yet they are per- 
niciously alive and obtrusively well. There are persons who 
live in houses that are notoriously lacking in all proper san- 
itary arrangements, and yet they keep so well they are 
ashamed to look a doctor in the face. And, on the other 
hand, there are persons who make themselves a common 
nuisance by their attention to the laws of health, and yet 
they go off at a ridiculously early age, instead of living to 
be 90, as an evidence of the virtue of sanitation. These 
facts are obstacles in the way of scaring men into a respect 
for the young science. These are some of the reasons why 
men contemplate the spectre of sewer-gas with serenity, 
and refuse to be agitated by a chemist's report on the pres- 
ence of disease germs in the drinking water. Because the 
science is young, it has many questions still in issue; and 
because there has been a considerable appearance of dogma- 
tism in sanitary teaching, and some sharp disagreements, 122 
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Conditions of Health in Cities. 
the average man will weary himself as little as possible 
with being virtuous in sanitary matters. Perhaps it is true 
that in this, more than any other science, theories have clone 
more than absolute and established facts to determine prin- 
ciples. The theories may all be sound enough, but there is 
not demonstrable evidence enough in all cases to convince 
anybody who prefers to doubt and whose self-interest lies 
in doubting. Besides, people do not distinguish between 
capable public sanitarians and individual hygienic cranks.. 
The field of personal hygiene is a clover field for cranks. 
There has never been a theory of personal hygiene advanced 
that has not been contradictory of some other theory, and 
foolish people, who practice whatever is preached, have a 
lively time of it-coming and going between new and old 
theories, like Mulligan's blanket which was forever going 
and coming between Mulligan and the pawnshop. Thus, 
after it is settled that one obtains fine ventilation by a fire- 
place, and after everybody has put in a fire place for health 
and sestbetic effect, a solemn person claiming to be an un- 
mitigated scientific being comes along and tells us we are 
poisoning ourselves all along of our fire-places. " Because," 
says he, " the fresh air in the room seeks the floor, being 
cold, and the draught of the fire-place draws it up the chim- 
ney, rather than the warm, polluted air." He happens to 
be a humbug, but how are people to know a solemn hum- 
bug from serious persons of science ? 
Nothing is certain in this world but bills, yet mankind is 
convinced that when a bullet strikes a man and he falls 
dead, there is a positive relation between the two facts. If 
we could see men drop dead after a whiff of sewer-gas, 
mankind would readily place sewer-gas and death in its re- 
lation of cause and effect. As it is, some fairly sound- 
minded but very inconvenient persons take the liberty to be 
disagreeable by asking for more positive evidence than has State Board of Health. 
123 
Conditions of Health in Cities. 
yet been furnished that sewer-gas is poisonous. The sani- 
tarians have no stock of instantaneous deaths to frighten 
people with, like the enthusiastic but somewhat confused 
anti-tobacco lecturer who told his hearers that a drop of 
nicotine on a dog's tail would kill a man. There are per- 
sons who maintain that living on the margin of an open 
city sewer is merely unpleasant to the pampered sense of 
smell and not at all deleterious to health, and that a little 
sewage in the drinking water is chiefly objectionable as an 
idea. There is a lack of unquestionable or at least unques- 
tioned evidence such as sustains the principles of most other 
sciences. 
Of course there is no argument in the fact that some men 
live long and keep an appearance of health amid insanitary 
surroundings. There are men who drink an inordinate 
quantity of whisky and manage to live long and in appar- 
ent good health, yet nobody pretends to deny the pernicious 
and destructive influence of whisky on body and mind. A 
man's ability to resist destructive influences is determined 
largely by his physical inheritance. He may be able to 
withstand injurious agencies that would make short work 
of another. Two persons in the same apparent condition 
may be exposed to small-pox contagion in exactly the same 
way and one may escape the disease; but nobody is foolish 
enough to affirm that the disease of the other is not due to 
the exposure. And it is to be considered that there is a 
steady process of weeding out those who are not equal to 
resisting the bad conditions of living. The least fit go early- 
one-tenth of all the children born into the world die during 
the first month. The process of weeding out the unfit goes 
on until only one in many tens of thousands of those born 
into the world reaches the age of three-score-and-ten, under 
which age nobody ought to die. The race constantly tends 
to accustom itself to its surroundings, and when the weak- 124 
Report of the 
Conditions of Health in Cities. 
est have all been disposed of, those who remain may be 
considered tough. It is probable that in the course of ages, 
the race might adapt itself to constantly increasing hard- 
ships, and eventually be able to live in an atmosphere that 
would now be instantly fatal; but in acquiring the condi- 
tions necessary to such endurance, only a small fraction of 
each succeeding generation would be able to survive the in- 
creasing difficulties. This is, in fact, the case now-only a 
small fraction of those born into this world survive the 
present conditions of living, for any proper length of time. 
It is not established that sewer-gas, for example, is pois- 
onous-no exhaustive and conclusive experiments have been 
made to that end. But there is a reasonable presumption, 
sustained by good evidence, amounting almost to a certainty 
and acceptable to the most intelligent men as conclusive, 
that it is poisonous. It is about as certain as anything can 
be without the most absolute proof, that typhoid fever and 
diphtheria owe their existence and virulence to filth. A 
man may be able to keep alive and in seemingly good health 
in an atmosphere tainted with sewer gas, but there is strong 
reason to believe that he will not be as much alive or in as 
actual health as if his air were pure. And there is strong 
reason to believe that persons with less power of resistence 
are either poisoned to death or into invalidism in varying 
degrees by the presence of sewer-gas; and that any person 
is made more susceptible to disease by breathing an air 
touched by the emanations from the sewers. There is no 
use asking why, if sewer-gas is so generally found in city 
houses, we are not all dead. We are all dead - all except 
a small fraction. Compared with the number who come into 
the world, the number of persons who live as long as men 
ought to live is ridiculously small. As a rule, we are all 
dead before 70. In laying down the rules of living, sani- 
tary science does not pretend to say that every man who State Board of Health. 
125 
Conditions of Health in Cities. 
neglects them shall surely die, but it does say that most 
men's chances of living are better when these rules are 
observed. 
About the only compensation for the trouble of living in 
a world of fog-horns and pianos and church-bells and con- 
certs, is freedom from sickness. A perfectly well man can- 
not be unhappy - no matter how the elections go or his 
own schemes miscarry, if the schemes of a per- 
fectly well man ever miscarry. The science which 
undertakes to point out how health may be main- 
tained, deserves to rank at the head of all sciences, for 
it really undertakes to point out how the worst evils of life 
may be eradicated. There is an enormous amount of dis- 
ease in the world, ranging from fatal sickness to the slight- 
est states of discomfort, and including all the conditions 
that make criminals and drunkards and other kinds of fools 
of men - the various states which impair the faculties and 
waste the energeries of the race. It is the conclusion of 
sanitary science that at least one-fourth of the cases of 
sickness can be prevented. This does not include disease 
due to inherited defects, the causes of which defects are also 
largely preventable. 
The evidence that supports the principles raised by sani- 
tarians is good enough for practical purposes. In a house 
where there is typhoid fever or diphtheria, may be found a 
break in the drain pipe or a lack of traps in the closets, and 
the skeptic may object that as almost all houses are equally 
defective, the evidence as to causation is not conclusive; but 
the study of disease germs is leading to results that sustain 
the sanitarian's view. It ought to be good evidence that 
hygiene is capable of saving life, when a reduction of death 
rate invariably follows the enforcement of what are consid- 
ered sanitary conditions; but again it is urged that improve- 
ment in the methods of treating disease may be responsible 126 
Report of the 
Condition of Health in Cities. 
for the lower mortality. The sanitarian knows, however, 
that there are also fewer cases of sickness for medical 
science to treat. That vaccination has almost destroyed 
small pox as an epidemic disease is positive. There has 
been no advance in the medical treatment of the black- 
death, which destroyed forty millions of lives in Europe in 
one long course, or of the plague, yet these diseases are now 
almost unknown in Europe, where some of the worst of 
insanitary conditions have been abolished. The cholera 
has tried in vain, so far, to effect a landing in England 
since special efforts have been made to overcome the condi- 
tions believed to be favorable to the disease. Leprosy has 
been almost destroyed in Norway since the application of 
preventive measures. In Berlin, since the improvement of 
the sewerage system and the abolition of cess-pools and 
vaults, the death-rate from typhoid fever has been reduced 
one-half, and in Brussels to one-fourth. In London, where 
there are now no cess-pools, the death-rate from typhoid 
fever is 26, and from diphtheria 18 per 100,000 of population; 
while in Paris, where cess-pools still exist, the death rate 
from typhoid fever is 70, and from diphtheria 75 per 100,000. 
Sanitarians in England assumed that typhoid fever had its 
origin in poisoned air and poisoned water, and their serious 
fight against it on this line began in 1869. In twelve years 
the death rate from this disease was reduced 46 per cent 
and there was an almost equal reduction in the number of 
cases of typhoid fever illness. In the general death-rates of 
that country, a striking change has taken place in the last 
ten years - a reduction in the number of deaths of 750,00U 
as compared with previous periods. Everywhere and al- 
ways the institution of what are regarded as sanitary con- 
ditions in barracks, is followed by a marked reduction in 
the sick-rate of soldiers. Twenty years ago the percentage 
of deaths among the British soldiers in India, was 69 per State Board of Health. 
127 
Condition of Healtn in Cities. 
1,000 annually. Sanitarians have been allowed full swing 
there, and now the percentage is only 18 per 1,000. The dis- 
appearance of intermittent fever has followed proper drain- 
age all over the Northern states. 
It is good evidence in support of the doctrines of sanitar- 
ians when certain diseases attack many persons subject to 
the same alleged special causes and do not attack others un- 
der the same general condition but with the special causes 
absent. In the State Reform School at Morganza, Pa., re- 
cently, there were twenty three cases of continued fever, of 
which the first fifteen occurred among the inmates of a 
particular building, into the sleeping room of which sewer- 
gas could find its way, while the other eight cases were dis- 
tributed among five other buildings. In the Pittsburg 
epidemic of two hundred cases, all the original cases were 
confined to two parts of a district through both of which 
ran a sewer having twenty-nine untrapped street drops, and 
which sewer was choked with a mass of filth from one to 
three feet deep. The typhoid fever epidemic at Plymouth, 
Pa., was traced to the dejections of a single tpyhoid-fever 
patient. In innumerable instances typhoid-fever epidemics 
have been found to be due to the use of contaminated well 
water, persons not using it escaping the disease until af- 
fected through contact with the sick. We have had a re- 
cent case of this kind in Racine county. 
There is no reasonable doubt that if the public would ap- 
ply such laws as sanitarians are agreed about, there would 
be an immense saving in human life and in the time and 
money now lost through sickness. The conditions of health 
in cities involve only fresh air and wholesome water. Given 
these, which a man cannot provide for himself, and given 
the exercise of some control over th« character of the food 
supply, a man can take care of the other conditions himself 128 
Report of the 
Condition of Health in Cities. 
- he can keep a clean skin and be temperate and take ex- 
ercise. 
THE AIR WE BREATHE. 
Perhaps the greatest speech ever delivered in the House 
of Commons was by Sir Isaac Newton. He never made but 
one, but this deserves to go thundering down the ages, for 
it involves the welfare of the human race more than the 
fervid orations of Burke and Fox. Sir Isaac Newton arose 
from his seat and asked a man in the gallery to open a 
window. 
The least knowledge of the physiology of breathing is 
convincing as to the importance of pure air. All the vital 
processes depend upon the exchange of carbonic acid for 
oxygen in the lungs. Shut off the supply of oxygen en- 
tirely and the candle of life flickers and goes out. Shut it 
off in a measure and the process goes on imperfectly. To 
whatever degree the air is vitiated, to that degree the func- 
tions of life are disturbed. In this matter the conclusions 
of science are unquestioned. There are no skeptics here, 
and yet impure air continues to be the leading cause of 
of death, for consumption is essentially a disease of bad air. 
It is not because men do not know better, that bad air is 
breathed. At a meeting of the Paris Academy of Sciences, 
some years ago, it was decided that the hall in which the 
scientific men met was the worst ventilated in the city; and 
it was shown that every member had known it for ten 
years. And yet it was an evil that could be corrected in 
one week. There is hardly a doubt that much of the criti- 
cism directed against legislators should be directed against 
the bad air of the legislative halls, instead. 
It isn't becoming, even if it were possible, for a man to 
wear a clothes-pin on his nose to escape breathing a vitia- 
ted atmosphere. He is bound to suck it in and get what State Board of Health. 
129 
Conditions of Health in Cities. 
oxygen there is in it. The general atmosphere of a city is 
vitiated to some degree, and that of houses to a still greater 
degree. On the measure of dilution of specific poisons in 
pure air depends their effect on people. All cities increase 
in size and there is a constant increase in the measure of 
corruption of the air through the emanations from the 
sewers, and particularly from open sewers and vaults, from 
cemeteries, from slaughtering-houses, meat-shops, soap-fac- 
tories, stables and the like; the air is corrupted by coal 
gases, the putrefaction of vegetables and the gases from 
damp soils. It has been shown that in the spring, when the 
ground is wet, the atmosphere of a crowded cemetery is a 
deadly poison. Air from such a cemetery injected under 
the skin of pigeons produces all the symptoms of typhoid 
fever, and death results in a few hours. The corruption of 
the general atmosphere is not serious as compared with that 
of buildings, except when infective elements are involved 
and except in particular localities. But it is certain that 
the best health cannot be maintained in the city atmosphere 
of the present. Children taken from the streets of WajIK 
sail to the country, with no great change in the matter of 
food, gained enormously in weight and strength from the 
better air. A typical case was a boy of eleven, who gained 
eight pounds in four weeks and whose muscular strength 
increased from forty-five to eighty, as tested by the dyna- 
mometer. A Babylonian or an Andalusian of the old time 
would refuse to live in one of our cities. Because the death- 
rate of a city with an open sewer is not larger than that of 
other cities, is not conclusive evidence that the air is not 
dangerously polluted by the emanations. Every city has 
its own special causes of disease as well as its own special 
conditions of health. A city with an open sewer as a cause 
of disease, may be so situated as to climate and natural con- 
ditions of surface drainage as to offset the statistical results 130 
Report of the 
Conditions of Health in Cities. 
of an open sewer. That a city which is free, by natural 
conditions of situation and climate, from zymotic diseases, 
should present a death-rate not materially lower than that 
of other cities less favorably situated, is evidence of special 
and avtifical causes of disease. In the use of the modern 
facilities for moving about in a city, people escape the worst 
effects of localized poisons and are often simply not at their 
best physically and mentally as a consequence of the degree 
of poisoning they undergo. Decent air implies a good sew- 
erage system, which few cities have. 
But for the beneficence of bricks and the blunders of 
builders, most of us would be dead as smelts. Prof. Petten- 
kofer has shown that houses breathe through their walls, as 
men breathe through their skins. Pie has made a tube by 
means of which the flame of a candle can be blown almost 
out through a brick or a piece of mortar. We try to build 
houses air-tight, but rarely succeed. The only way by 
which air can be kept out of a brick house is by building 
on damp soil from which the bricks can absorb moisture 
and so become impervious to air. Every brick will absorb 
a pound of water, and a house with damp walls will fatten a 
graveyard with the victims of consumption and enteric 
fevers. Dampness is deadly. It not only keeps out fresh 
air, but it nourishes the seeds of disease. In the mud houses 
of Glasgow, which are always damp, are found the con- 
firmed victims of rheumatism and rickets', and the bandy- 
legged children whose bones are too weak to sustain the 
body without bending. A damp cellar is just about as good 
a thing as Death can ask for. A musty house has its pores 
stopped by moisture. Builders help humanity a good deal 
by failing to make windows and doors air-tight. The air a 
house gets by its own methods of breathing helps dilute 
the poison of sewer and cellar gases and makes them less State Board of Health. 
131 
Conditions of Health in Cities. 
deadly. Dampness and sewer-gas together make busy un- 
dertakers. 
Hardly any houses with sewer connections are entirely 
free from sewer-gas. How sewer-gas gets in is plain enough. 
There are at least a score of cheap books on house-draining 
and plumbing, one of which every man should have. A 
man who lives in a house, who has a wife and children 
whose health depends upon proper sanitary conditions, can- 
not afford to be ignorant on this subject or to trust to the 
plumber. It is better to pay half a dollar or so, for such a 
book, than to pay a hundred times as much to doctors and 
undertakers. The man who builds a house without know- 
ing what measures to take against dampness, or who isn't 
able to superintend the selection and putting-in of pipes and 
traps and ventilators, offers a premium for the most destruct- 
ive diseases. An old French poem recites that Death once 
held a competitive examination among his agents, including 
war and famine and pestilence, and the highest prize went 
to intemperance. In this day he would probably bestow 
the chief honor on those who poison the air and the water. 
It is a lamentable fact that comparatively few householders 
know anything about the connection of their house drains 
with the sewers. The worst conditions may commonly be 
overcome easily and cheaply. 
The literature of school hygiene is extensive, and no ex- 
cuse exists for a single insanitary condition about a school- 
house. Yet it is a fact that many city school buildings are 
defective. The Spartans used to send their children into the 
mountains to struggle against the weather and wild ani- 
mals, considering them fit to live only if they were able to 
live against these hardships. That is less inhuman than the 
sending of children into damp or poorly ventilated build- 
ings to pore for an excessive number of hours over books, 
the pages of which are badly lighted. While there has been 132 
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Conditions of Health in Cities. 
a general improvement in the sanitary conditions of school 
buildings, many of them are still overcrowded, particularly 
in the primary rooms. It is moderate to demand 500 cubic 
feet of air space for every pupil, which would limit the 
number in a room forty feet square by twelve feet high to 
about thirty-six pupils. The half-day system would rem- 
edy much of the fault of overcrowding of the rooms as 
well as overcrowding of the brains. 
THE WATER WE DRINK. 
The modern Perseus is the sanitarian and health is his 
Andromeda. The dragon he has to fight is not a monster 
of hideous mien, but a microscopic creature more terroriz- 
ing than a thousand dragons. The bacillus, the disease-germ, 
is the true terror of mankind. The American likes to deal 
with big things-his Washington monument overtops all 
others in the world, his statue of Liberty makes the Colos- 
sus a pigmy, but he is downed by the microscopic bacillus 
which comes to him in the air he breathes, but more fre- 
quently in the water he drinks. 
If there is one thing above all others the public should 
demand of its agents it is good water-a water that is cer- 
tainly wholesome, free from sewage, free from animalcules, 
whether animal or vegetable and whether living or dead-a 
water at no season of the year or in periods of epidemics 
liable to propagate disease. This means water absolutely 
without the possibility of sewage contamination. No 
amount of water can sufficiently dilute sewage to make 
any particle harmless-dilution can only diminish the 
chances of getting the harmful particle in any particular 
glass of water. The minute germs that constitute the nox- 
ious part of sewage are held in mechanical suspension and 
not in solution. When chance carries them into the par- 
ticular glass of water a person drinks, they do their fatal 
work as well as if they had never floated for miles in water. State Board of Health. 
133 
Conditions of Health in Cities. 
Great is the power of little things. A thousandth part 
of yeast, a minute fungus, when added to a vat of sweet 
wort, converts the whole into an intoxicating drink. Some 
of the smaller animalcules found in water are not more 
than the thirty thousandth part of an inch in size, and yet 
one microscopic entozoa which finds its way into the blood 
will multiply there in thousands. The Damascus sore, 
which has killed thousands in the East, is due to a minute 
vegetable cell. The fungus of the foot disease of India, is 
conveyed into the blood through the drinking water. The 
record of the wells of Hurd war, from which the cholera 
epidemics have sprung, makes the destructive record of the 
whisky distillery seem tame. 
No system of filtration can purify water containing the 
noxious germs of sewage, and no practicable measure of 
dilution can render them harmless. A single cholera stool 
in any body of water used for domestic purposes, may ex- 
tend the disease indefinitely. The dejections of a typhoid- 
fever patient were emptied into a running stream miles 
away from the town of Plymouth, Pa., last year. This 
water was used for domestic purposes, and in one month 
there were 1,200 cases of the disease in the town, with 120 
deaths. In a Dublin hospital, forty cases of typhoid fever 
were traced to the dejections of typhoid-fever patients 
emptied into the water twenty-five miles up. Any economy 
that stops short of absolute certainty in the matter of whole- 
some water is reckless extravagance - extravagance in the 
waste of human life and strength. A water actually pol- 
luted in some degree may have no apparent bad effect upon 
a community in ordinary periods, though no one can say it 
does not do actual harm, but in a period of cholera or 
typhoid epidemic it will almost certainly become the means 
of extending the disease. Any system of sewage removal 
that gives room for a reasonable suspicion of contaminating 134 
Report of the 
Conditions of Health in Cities. 
the supply of domestic water, should be abolished at what- 
ever cost. Unhappily, chemical analysis cannot always tell 
us of the danger in water. There are noxious qualities that 
escape the utmost researches of the chemist. When he 
finds salt above a few grains to the gallon in water, he can 
say with positiveness that there is contamination from sew- 
age, for nearly all the salt used for domestic purposes passes 
out with the sewage and is inseparable from it; but he can- 
not always tell when water is free from all contamination. 
In a city, well water is never well water, but sick water. 
Pump-water may be put aside at once as unfit for domestic 
use. The fact that it is sometimes used without apparent 
evil is of no consequence. In a city, no well can escape 
pollution from surface and soil impurities and such polluted 
water is one of the most frequent means of propagating dis- 
ease. In periods of epidemic, the chances that anybody 
using such water will escape are few. In a London cholera 
season, 600 deaths were traced directly to the use of pump- 
water that had been apparently harmless before. Taste and 
color are not tests of water. First-class drinking water 
should not contain more than a grain of organic matter to 
the gallon, yet some clear waters, pleasing to the taste, con- 
tain ten times that amount. 
The yearnings of the stomach are the inspiration of all 
human endeavor. Until a man's stomach is satisfied, there 
is no recognition of the Humanities. As a man is fed, so 
will he think and so will he be. A man's ancestors deter- 
mine the maximum of health and of sense he may have, 
but within the limits of this restriction he is largely what 
his food makes him. There may be murder in a mince pie 
or a poem in a leg of mutton. " (Test la soupe que fait le 
soldat," say the French. There is an intimate relation be- 
tween meat and morality. A man with indigestible food in 
THE FOOD WE EAT. State Board of Health. 
135 
Conditions of Health in Cities. 
his stomach is not a free moral agent. Digestion depends 
upon what we eat and a man's views of life depend upon 
his digestion. If the characters of men are to be improved, 
the quality of their food must be looked after. 
The literature of the subject of food is so extensive and 
handy, that there seems to be no excuse for pointing out 
the most serious faults in the food supply of cities. The 
chief evils the municipality can be asked to remedy are the 
sale of diseased meats, stale vegetables and fruits, and the 
milk of unhealthy cows. Diseased cows are brought into 
the large markets almost daily. Outbreaks of typhoid fever 
and other infectious diseases have been traced to sick cows. 
Disease germs have been found in milk and traced to water 
used for its adulteration. At least it is reasonable to insist 
that if our milk is to be watered it shall be with good 
water. It is impracticable, with present means of inspec- 
tion, to undertake to prevent many of the present adulter- 
ations of food articles; and we can only protest against the 
roasting and grinding up of old boots and shoes to be 
mixed with pepper. This may be only a prejudice, but it is 
widespread enough to deserve respect. 
The whole subject involves only a question of closer in- 
spection-larger appropriations for the inspection of meats 
and vegetables and milk and for the training of capable in- 
spectors. There is no doubt that the infant mortality of 
cities might be enormously reduced by a close inspection of 
the milk supply, and still further by the attention of medi- 
cal men to the subject of infants' food. But the hygienic 
education of mothers would doubtless give the most fruit- 
ful results. 
WHAT SHALL BE DONE WITH SEWAGE ? 
The city of Milwaukee is under indictment to-day, a bill 
being found by a grand jury, for maintaining an open sewer, 
or in other words, for using the city rivers as receptacles of 136 
Report of the 
Conditions of Health in Cities. 
sewage, to the danger of the people. It is a wholesome 
finding, even if it has no other practical result than to 
stand as a protest against the criminality of allowing sew- 
age to course its sluggish way through the rivers into the 
lake where, according to the evidence of both chemists and 
microscopists, it pollutes the supply of water used for do- 
mestic purposes. The grand jury justly says " that any sys- 
tem which allows the sewage to be deposited in the rivers 
and carried forward into the lake through the harbor is 
hazardous, because of the liability of imparting to the water 
supply the germs of deadly disease." This covers the whole 
case. A single case of typhoid fever or of diphtheria in 
the city of Milwaukee is evidence of a public crime. The 
thousands of deaths annually from preventable diseases in 
any city tell of official neglect, of the failure to dispose of 
the sewage properly, of the refusal to provide ample funds 
and facilities for sanitary inspection. 
Plans for disposing of the sewage of cities are innumera- 
ble and a few are practicable. But of all plans, unquestion- 
ably the worst from every point of view, is the pouring of 
the excreta and waste of hundreds of thousands of people 
and thousands of households, and slaughtering houses and 
noxious establishments of all kinds, into a river which 
crawls through the city and empties its awful mass into a 
body of water in such a way that any part of the noxious 
matter can be drawn into the pipes which supply the city 
with water. Undoubtedly the simplest, cheapest and best 
way to dispose of the sewage of a city situated as Milwau- 
kee, without any present demand for refuse as a soil fertil- 
izer, is to empty it into the lake. But to do this with safety 
involves the intercepting sewer system advocated by sani- 
tary engineers. More than all, it involves the removal of 
the intake for the water supply to a point absolutely beyond 
the possibility of sewage contamination. The essential State Board of Health. 
137 
Conditions of Health in Cities. 
thing is prompt removal of sewage before decomposition 
takes place. 
Probably it is only a question of time when the germ the- 
ory of disease will be abundantly established, and when por- 
ous sewers, with surface ventilation, of a size to take care 
of storm water, and subject to the retention of sewage 
in process of putrefaction, will be universally abandoned, 
and when sewage pipes and surface-drainage pipes will be 
laid separately. But an earlier and more certain change 
will be the construction of pumping works for the prompt 
emptying of sewers and the removal of water intakes to a 
point of absolute safety. 
One astounding fact is the apparent indifference of life- 
insurance companies to questions of public health. While 
their terms are based upon the probable duration of life as 
established under the present insanitary conditions, which 
allows them an ample security against an excess of losses 
over receipts, there is no doubt that a general improvement 
in public sanitary conditions would increase the number of 
acceptable risks enormously and lead to an immense increase 
in the number of insured by the diminished cost of insur- 
ance. Sanitary science ought to find its strongest support 
among life-insurance companies. 
The number of causes which impair the health of a com- 
munity is vast, including not only air, water, food, drug and 
other adulterations, but also ignorance and neglect of the 
first laws of personal sanitation. But the remedy lies for 
all in a more efficient system of inspection, a higher sense 
of duty among legislators and officials, and a better system 
of sanitary instruction. Indeed, the last includes all and 
the one remedy may be said to be proper practical hygienic 
instruction in public schools and the establishment of de- 
partments of preventive medicine in medical colleges. It 
is to the physician that people look for whatever measure 138 
Report of the 
Conditions of Health in Cities. 
of protection they are to have from insanitary conditions. 
As a rule, the physician is as innocent of proper instruction 
on the subject of public hygiene as any other class, includ- 
ing the plumber.