Popular Science Monthly/Volume 4/February 1874/Sanitary Science and Public Instruction




YOU are well aware that it is not by virtue of any special claims as an investigator in sanitary science, or as a student in it to any great extent, that I now address you. But, when I was invited to speak, it seemed a good opportunity to make one more point in behalf of certain great, manly studies in our system of public instruction, and especially in our institutions for advanced instruction, and therefore an opportunity not to be neglected.

The generations that come after us will doubtless wonder at what this age has done, but I think they will wonder far more at what it has not done. There will be wonder at discoveries, inventions, reforms—at all our conquests in the realms of mind and matter; but I think the wonder will grow when notice is taken of the utter neglect, in great systems of education, of the most important subjects which occupy us, either for material purposes or for mental and moral advancement. Look, first, at the neglect of political studies. Here is a great Republic, dependent, as all confess, upon the knowledge of those who live beneath its sway. And yet you may go from one end of the country to the other and hardly find the slightest provision for any real instruction in Political Science, whether it be in political economy or political history. If, during the war of our rebellion, any thoughtful American wished to find out what that history was in which the germs of that great struggle were planted and developed, he had to go for such knowledge to the public lecture-room of Laboulaye at Paris, or the private lecture-room of Neumann at Berlin.

The case is still worse in regard to that great class of studies comprehended under the designation of Social Science. Every year our national Legislature and some forty State and Territorial Legislatures, and a vast number of county and town boards, are brought face to face with the most vital social problems. They are called upon to make great expenditures for the prevention and cure of pauperism, for the repression and punishment of crime, for the treatment of lunatics of various sorts, for the care of idiots of various grades, for the special treatment of inebriates, for the cure of the sick in hospitals, for general measures of prevention, as regards epidemics, and yet no one will gainsay my assertion that on no subject are our Legislature, and all our various public bodies, so utterly blind as on this. If we look at the result of this as regards expenditure, the case is bad enough. The amount annually expended in all our States for this purpose is enormous. The only approach which we have to the palaces of the Old World are in the various hospitals and prisons and asylums of the New. I can speak of this want of knowledge from personal experience. I can stand in the confessional on this subject. It has been my lot more than once to vote on such appropriations in a legislative body. I remember especially one case where the Legislature of this State was called upon to establish a great asylum, at vast expense, for a certain class of lunatics. The case was very pressing. A careful report from a commission showed that some provision of this sort must be made. A bill was passed, the buildings were erected, and yet, when all was done, we were assured by an expert, who had no interest one way or the other in the matter, that all our well-meant benevolence had, perhaps, resulted in almost as much evil as good, and that the whole institution was a failure as regards the immediate purposes for which it was erected. The simple cause for this was that in that whole Legislature, in the lower House, in the upper House, in the Executive Department, there was not one person who had ever given any close attention to subjects of this kind, and we had been obliged to trust entirely to those who could give us scraps of information, no matter how crude. But, if the immediate results are unfortunate, the remote results are still more so.

If any one wishes to see what vicious methods of dealing with great social questions will produce, he has only to look at the great harvest of evil which England is now reaping from seed sown 300 years ago, especially as regards the treatment of her pauper and criminal classes. I have said that there is no provision for thorough instruction. The reason is twofold. The first is the reluctance of educators to take up new subjects of study, or, at least, to present them thoroughly. But the other and far more effective reason is the fact that we have so few institutions for advanced education which have the means to make provision for such teaching. The last report of the Commissioners of Education at Washington shows that we have in this country about 400 establishments calling themselves colleges or universities. You may count on your fingers all those which really have any claim to either title. In obedience to the demands of sect or of locality, we have gone on multiplying institutions insufficiently endowed, wretchedly wanting in every thing necessary to scientific investigation, until we have now hardly three or four in possession of the means to present any new subject of study involving any outlay for investigation or for demonstration. The time has come when such provision should be made. Whether it is to be made by the munificence of private individuals, or by State endowments, is not here the question.

The proposition to which I shall speak especially is this: that provision should be made for instruction in Human Physiology, Hygiene, and Sanitary Science, in all departments of public instruction in our public schools, by providing fundamental instruction, especially in the simple principles of physiology and hygiene; in colleges and universities, by presenting this general instruction in a more extended way, and by promoting investigation; in medical colleges, by giving more special instruction in matters relating to public and international hygiene; and that, in our departments of engineering and polytechnic and technological schools, especial provision should be made for instruction in sanitary engineering.

In regard to the first of these provisions, that for popular instruction, few probably are aware of the need of them. Take, for example, the revelation made within the past year, at the outbreak of yellow fever in a Southern city. Two things in relation to that revealed very clearly the evils of which I speak: First, the cause assigned to the disease shows the utter want of sanitary knowledge in the people at large; and, secondly, the real cause, since revealed, shows the absolute blindness to the simplest principles of sanitary science on the part of those immediately concerned. When the yellow fever broke out at Shreveport, it was telegraphed all over the country that it was caused by the removal of the obstructions in the river above the city. That statement went all over the country unchallenged. So far as I know, no one thought of expressing doubt publicly as to the statement that the yellow fever was caused by a more plentiful supply of water at the wharves of that city—the fact being that this would conduce rather to the removal of the causes of the disease than to the prevention of them. At last came information as to the real cause, and it was found that in that hot climate men had been allowed to heap up the material in which disease-germs arise abundantly; that the simplest truths of sanitary science had been ignored, and that the consequence was perfectly simple and natural.

But it is not merely in such outstanding parts of the nation that such ignorance exists. It is spread throughout our own country districts, even the most enlightened districts, and you will find prevailing in many of our country towns traditions and superstitions in regard to this matter that are most surprising. You will find some of these things which are known to be absolutely deadly considered on the whole as healthful. Strange as it may seem, you may hear people who take the papers, who are supposed to be within reach of the great sources of information—you may hear such people, I say, maintaining that, after all, the emanations of the cesspool are rather conducive to health than to disease; that their fathers lived and throve in such an atmosphere, and that, therefore, it has a healthy influence. I can point you to an exceedingly pleasant village which I have sometimes to visit, where, with a plentiful supply of water, there is an absolute want of any system of sewerage. Typhoid and typhus go zigzag through that town every year or two, making victims, yet you can't induce the people of that village to believe that their unsewered condition has any thing to do with it.

But it is not merely in the country districts that this state of things has existed. Up to a very recent period at least this same ignorance was manifested in a very surprising degree in this metropolis. It is now about five years since, with two other members of our State Senate, I visited this city, and sat in the Commission for examining into certain branches of the city administration, and especially into the conduct of that branch which had the care of the public health. The state of things revealed was such as could only exist under a great and wide-spread ignorance on the part of citizens of the first principles of Sanitary Science. To give an idea of this ignorance, let me recall, as nearly as I can, a little episode in the investigation: It happened that the late Judge Whiting, who had charge of the investigation on the part of the Citizens' Association, put on the stand a young physician, who testified that the Health Officers, or Wardens, or Inspectors, were men utterly ignorant of the first principles relating to the public health which they were appointed to preserve. In order to refute this, the head of the Health Department at the time brought on the stand, in perfect good faith, several of these Health Officers. Toward the close of the examination of the first (one) of these gentlemen, Judge Whiting asked this question: "Did you have a case of small-pox in your ward?" and he answered, "Yes, sir." Judge Whiting: "Did you visit the patient?" Witness: "No, sir." Judge Whiting: "Why not?" Witness: "For the same reason that you would not; that I was afraid of taking it myself." Judge Whiting: "Did the family have any care?" Witness: "Yes, sir; they were 'highjinnicks' (hygienics); they doctored themselves." As the other witnesses came in, Judge Whiting used this as a sort of test question—as a sort of key to unlock the system, and show the utter ignorance that prevailed in every department of it. Every witness was asked: "Well, have you any 'highjinnicks' in your ward?" Some of the witnesses thought they had; some thought they had not; some thought they "had them pretty badly;" some thought they had them in some parts of the ward, some thought they had them in other parts of the ward. At last the Judge asked a witness, who had been answering his question in this way: "Do you know what the word 'highjinnicks' means?" and he replied: "Yes, sir, I do; it means a bad smell arising from dirty water." Of course the exhibition was vastly amusing, but, after all the guffaw was over, a sad after-thought necessarily came to every thinking man as to the condition of the great metropolis which allowed all its dearest material interests to be placed in such hands as this. It may be said that this was the result of a political system, but it was not. Had there been a tithe of the instruction which should have prevailed—of that simple knowledge that should have existed on this subject—such a thing would have been impossible, no matter what the political exigencies or arrangements were.

So much for the need of popular enlightenment on this subject. Look, now, at a higher range. It is only a few years since the country was startled by the outbreak of a malignant type of fever in one of the leading boarding-schools in New England. The result was, that several ladies from the most respectable families in the country lost their lives. The school had always been considered an admirable one. It was under the charge of a principal and instructors in every way worthy of their calling; but an investigation by competent persons showed that causes of zymotic disease lurked at every corner of the edifice, and that the only wonder was that the disease had not come earlier and spread even wider.

Look now at the want of special and technical instruction. It is little over ten years since the International Commission on Quarantine Matters sat in Paris. They did a great and noble work, but their labors have taken no such hold upon the policy of various States as they ought to have taken. What is the reason of this? There are admirable sanitarians in our own country and in others. We have several of whom the country may justly be proud; but the difficulty is, that our institutions have not given us enough of them to create and spread a healthy public opinion on this subject. One or two, or half a dozen, cannot, in so great a country as this, accomplish so great a work, and especially they cannot if they are burdened with the laborious duty of a metropolitan physician. There is a great want of special instruction in our medical colleges in public hygiene—hygiene in its relation to quarantine matters, in regard to the prevention of epidemics, in regard to sanitary provision for the wants of great cities and districts. Again, if you go into any of our interior States, you will find that any thing like a thorough or carefully-thought-out or wrought-out system of sewerage is a very rare exception to a very wide-spread rule. Nothing can be more inadequate than the system of sewerage of nine-tenths of our cities; and, indeed, until recently, the city of New York, with all its magnificent provision of water-supply, and in spite of its splendid position for drainage, was very improperly provided for in this respect. So much for the want of these different branches of instruction in this great science, and now as to the remedy which I would propose.

First, as regards Public Schools, I would make provision for simple instruction in the elements of Physiology and Hygiene, either by the use of some short and plain text-book, or, what is still better, by lectures from some competent resident physician. I confess that I greatly prefer the latter method. Not only theory, but experience, leads me to prefer it. Were it not that we have made a very great mistake in our systems of public instruction, by severing our common-school instruction from advanced instruction, we should by this time have a body of teachers in our common schools abundantly able to lecture to the pupils without a text-book. I trust the time will come when provision will be made just as thoroughly for advanced instruction as for primary and common-school instruction, when all will be connected together; when the present illogical separation that exists, under which primary and common-school education is provided for by the State, and advanced education is left very inadequately provided by various religious denominations, will be done away with. But at present we have comparatively few teachers in our public schools who are competent, without text-books, to teach a subject of this kind; therefore it is that I would have provision made, in our larger schools especially, for lectures by resident physicians. That the interest of pupils can be roused in this way I know, for I have seen it fully tried. It is one of those subjects in which, with a little care, the great body of school-children can be greatly interested, and this without the slighest detriment to other subjects. The very change of method will make them come back to other subjects of study with renewed vigor.

Next, as to instruction in our Colleges and Universities. I would have instruction in physiology and hygiene more advanced, systematic, and thorough. Those who have read Herbert Spencer's work on "Education," no matter what they may think of some minor ideas, must have been greatly struck by that part in which he gives his estimate of the comparative value of different branches of knowledge. Among those which should be placed first he names Human Physiology. The reason is very simple. Human Physiology is simply the study of a machine which we are to run, nay, which is to run us for threescore years and ten. Certainly it is a study which falls very directly to us. The study of hygiene naturally comes in connection with it, and it was in obedience to this idea that, in framing the general course of instruction for the Cornell University, careful provision for physiology and hygiene was made. An extensive series of models was purchased, diagrams from Paris and London were obtained, and what was far better, a young professor, who had already begun to obtain a reputation not only as a close investigator, but as an impressive lecturer, was set at the work. The result has been most satisfactory. I am persuaded that study of this kind forms an admirable relief from other studies, pursued in a different way, and for a different purpose. In this case, the study of Physiology and Hygiene has been made very thorough. Frequent and close examinations have been demanded, and it has been made not merely a study for information, but a study for discipline. And here let me say that, as a starting-point for scientific studies, the study of Hygiene and of Sanitary Science seems to me to have great value. It is not, perhaps, the best point theoretically from which to start, but practically it has been found to be as good as any other.

Next, as to instruction in our Medical Colleges, I speak here with great diffidence, for there are those about me more competent to discourse on this subject than I am. I am well aware that all the effective knowledge that is given to sanitary science in the country, so far as its advanced branches are concerned, is now given in the medical colleges. But it seems to me that not yet is sufficient place given for good instruction in Public Hygiene—sufficient study of that kind which gives to town authorities, county authorities, State authorities, the national authority, a body of experts who can be relied upon in various public emergencies, or, indeed, for ordinary care of public health.

Next, as to instruction in Departments of Engineering, and in our Scientific, Polytechnic, and Technological institutions. Within the past twenty-five years there has been created a science of Sanitary Engineering. I say within the past twenty-five years, although I know that engineering, even in ancient times, had frequent reference to sanitary considerations. Any one who has walked along the Tiber at Rome, as far as the mouth of the Cloaca Maxima, is well aware of that; but it is within the past twenty-five years that the science has been placed on solid foundations. Vital statistics have shown the effects of the introduction of sunlight, of pure water, and air, into our dwellings and cities, and engineering has shown us the best methods of introducing them. Any one who will take up the recent work on this subject by Mr. Baldwin Latham will see what great conquest has here been made. The statistics show that, of seven leading towns and districts in England, such as Croydon, Ely, Salisbury, and others, where careful and thorough modes of sewerage prevail, the percentage of deaths has been reduced from forty to twenty per cent. I also see, from calculations made on the basis of Dr. Allen's tables, that there is a saving to these districts pecuniarily. Taking into view the fact that, for every death prevented, about twenty cases of disease are prevented, I will say that, judged even from a cold financial point of view, the result has been magnificent. What the result would be by good modes of sanitary engineering may be judged from the statement in Dr. Lionel Beales's book on "Disease Germs," which is, that by a good system of sewerage 100,000 lives might be saved annually in England.

But I am aware of the opposition that will be made to any attempt to introduce these studies. First, it will be said that there is little material in this subject for advanced instruction, and that we know very little regarding the causes or the nature of diseases. That is partly true and partly not true. Unquestionably, the true theory of disease is yet to be wrought out, although every thing leads us to suppose that science is at last upon the right track; but, unquestionably, in relation to the germ of disease, great conquests are yet to be made, and it is a matter of great satisfaction to me, and, I doubt not, to all of you, that one of the most careful of American investigators is to speak on that subject this evening.[2] So, too, the relations of ozone to various diseases is a matter in which conquests are still to be made. There are multitudes of questions yet to be solved, but still many have been solved already. And a very great conquest was made when it was found that zymotic diseases had relation to physical causes, and that the causes were ascertainable and removable. So, too, we have made conquests, as I have stated already, in sanitary engineering. There is material for study. We have made great advances in the study of vital statistics—there is another object of study. I think that this objection, feeble as it is at present, should rapidly become more feeble as science advances, and it can have but little weight among thoughtful men.

But there is another class of objections which are more constantly made—the same objections that have been made to every change in the curriculum of study, from the days of Erasmus until now, and to any liberty in the choice of studies. Those objections are on the score of Discipline and Culture. I remember once that, when this objection was made in the presence of the late Horace Greeley, he cried out, "Discipline! I hate the word." Nor was this exclamation unnatural. Few words have done more harm to the progress of education than this. I am the last to say any thing against what is now known as the older system of education, or of classical education in general. I prize it; I love it; but, if there were no other argument to show that it is by no means the only mode of discipline or study, the return made by the Commissioners of the English Government, after their examination of the English public schools, is certainly proof on this point. It is there shown that seventy per cent, of the students under the old system, carried out as it is to its very highest point, failed to make any worthy use of their advantage.

What are disciplinary studies? I maintain simply that they are those which for any reason whatever a man takes hold of, and which take hold of him. It matters not whether the study be in obedience to natural tastes, or whether it be forced upon the student. This is the thing—that the study be taken hold of, and that it take hold of the mind of the person studying. Now, in our primary instruction, the studies which I here advocate take hold of great numbers of pupils; take hold of them by virtue of their being a relief from other studies—by virtue of their appealing to natural objects. Any teacher will bear me out in saying that, as regards pupils of an early age, there is no difficulty in this respect. As regards colleges and universities, there are but two things on which we can rely to make studies take hold upon the minds of students, and to receive thorough attention. The first is, love for them on the part of the student. The other is, their value to the student as regards his direct aims and purposes in life. We cannot in colleges and universities do what was formerly done in England—take the student and whip him. We have to trust to one or the other of these two classes of incentives. Now, the number is considerable of those who, from one motive or the other, would take up this great subject of study. All would not do it; the majority, probably, would not do it; but, if an opportunity were offered, I am satisfied that from every college and every university would go out a body of men not only well instructed in the great principles which underlie sanitary matters, but well disciplined in the obtaining of such instruction.

And now, as to the other branch of the objection—the objection on the score of Culture.

I prize all literary study as highly as any person ought, but yet I maintain that there is, after all, a higher culture. The very ideal, the very god of literary culture, is Goethe; and yet, splendid as he was, there is a higher culture which he lacked, even from a purely earthly point of view. I maintain that, in the studies I now urge, there comes a culture of high purpose, a culture of thought for our fellow-men, a culture involving the idea of duty, which certainly is worth any other sort of culture.

And, if any one objects that these studies are based upon Physiology, which has led man into dangerous paths, that it is, in fact, an unsafe study, I would simply point to these words, uttered so long ago, and from which, certainly, these objectors will make no appeal: "The fear of the Lord is the beginning of wisdom." There is a great truth in these words. We all feel them. But what is that truth? what is that fear? Is it the mere selfish fear which the African native feels for the madness of his fetish? Is it the mere groveling fear which the Turkish slave feels for the tyranny of the satrap placed over him? Certainly not. The only wholesome fear is that fear based not on mystic dread of tyranny, but fear to violate those great laws by which the Divine power which maintains and regulates this universe governs all. That is the fear which lies at the beginning of wisdom, and among those studies, calculated to impress upon us the existence of laws, the violation of which is followed by penalties strictly imposed, stand foremost those to which this Association is now so worthily devoting its attention—studies sure to make the earth more beautiful; sure to make mankind more reverent and noble.

  1. Read at the recent meeting of the American Public Health Association.
  2. President Barnard, of Columbia College, presented a paper on "The Germ Theory of Disease in its Relations to Hygiene."