The Triumph of Sanitary Science

But by those standing in the higher places of thought some glimpses of scientific truth had already been obtained, and attempts at compromise between theology and science in this field began to be made, not only by ecclesiastics, but first of all, as far back as the seventeenth century, by a man of science eminent both for attainments and character - Robert Boyle. Inspired by the discoveries in other fields, which had swept away so much of theological thought, he could no longer resist the conviction that some epidemics are due - in his own words - "to a tragical concourse of natural causes"; but he argued that some of these may be the result of Divine interpositions provoked by human sins. As time went on, great difficulties showed themselves in the way of this compromise - difficulties theological not less than difficulties scientific.

To a Catholic it was more and more hard to explain the theological grounds why so many orthodox cities, firm in the faith, were punished, and so many heretical cities spared; and why, in regions devoted to the Church, the poorer people, whose faith in theological fetiches was unquestioning, died in times of pestilence like flies, while sceptics so frequently escaped. Difficulties of the same sort beset devoted Protestants; they, too, might well ask why it was that the devout peasantry in their humble cottages perished, while so much larger a proportion of the more sceptical upper classes were untouched. Gradually it dawned both upon Catholic and Protestant countries that, if any sin be punished by pestilence, it is the sin of filthiness; more and more it began to be seen by thinking men of both religions that Wesley's great dictum stated even less than the truth; that not only was "cleanliness akin to godliness," but that, as a means of keeping off pestilence, it was far superior to godliness as godliness was then generally understood.

The recent history of sanitation in all civilized countries shows triumphs which might well fill us with wonder, did there not rise within us a far greater wonder that they were so long delayed. Amazing is it to see how near the world has come again and again to discovering the key to the cause and cure of pestilence. It is now a matter of the simplest elementary knowledge that some of the worst epidemics are conveyed in water. But this fact seems to have been discovered many times in human history. In the Peloponnesian war the Athenians asserted that their enemies had poisoned their cisterns; in the Middle Ages the people generally declared that the Jews had poisoned their wells; and as late as the cholera of 1832 the Parisian mob insisted that the water-carriers who distributed water for drinking purposes from the Seine, polluted as it was by sewage, had poisoned it, and in some cases murdered them on this charge: so far did this feeling go that locked covers were sometimes placed upon the water-buckets. Had not such men as Roger Bacon and his long line of successors been thwarted by theological authority, - had not such men as Thomas Aquinas, Vincent of Beauvais, and Albert the Great been drawn or driven from the paths of science into the dark, tortuous paths of theology, leading no whither, - the world to-day, at the end of the nineteenth century, would have arrived at the solution of great problems and the enjoyment of great results which will only be reached at the end of the twentieth century, and even in generations more remote. Diseases like typhoid fever, influenza and pulmonary consumption, scarlet fever, diphtheria, pneumonia, and la grippe, which now carry off so many most precious lives, would have long since ceased to scourge the world.

Still, there is one cause for satisfaction: the law governing the relation of theology to disease is now well before the world, and it is seen in the fact that, just in proportion as the world progressed from the sway of Hippocrates to that of the ages of faith, so it progressed in the frequency and severity of great pestilences; and that, on the other hand, just in proportion as the world has receded from that period when theology was all-pervading and all-controlling, plague after plague has disappeared, and those remaining have become less and less frequent and virulent.

The recent history of hygiene in all countries shows a long series of victories, and these may well be studied in Great Britain and the United States. In the former, though there had been many warnings from eminent physicians, and above all in the seventeenth and eighteenth centuries, from men like Caius, Mead, and Pringle, the result was far short of what might have been gained; and it was only in the year 1838 that a systematic sanitary effort was begun in England by the public authorities. The state of things at that time, though by comparison with the Middle Ages happy, was, by comparison with what has since been gained, fearful: the death rate among all classes was high, but among the poor it was ghastly. Out of seventy-seven thousand paupers in London during the years 1837 and 1838, fourteen thousand were suffering from fever, and of these nearly six thousand from typhus. In many other parts of the British Islands the sanitary condition was no better. A noble body of men grappled with the problem, and in a few years one of these rose above his fellows - the late Edwin Chadwick. The opposition to his work was bitter, and, though many churchmen aided him, the support given by theologians and ecclesiastics as a whole was very far short of what it should have been. Too many of them were occupied in that most costly and most worthless of all processes, "the saving of souls" by the inculcation of dogma. Yet some of the higher ecclesiastics and many of the lesser clergy did much, sometimes risking their lives, and one of them, Sidney Godolphin Osborne, deserves lasting memory for his struggle to make known the sanitary wants of the peasantry.

Chadwick began to be widely known in 1848 as a member of the Board of Health, and was driven out for a time for overzeal; but from one point or another, during forty years, he fought the opposition, developed the new work, and one of the best exhibits of its results is shown in his address before the Sanitary Conference at Brighton in 1888. From this and other perfectly trustworthy sources some idea may be gained of the triumph of the scientific over the theological method of dealing with disease, whether epidemic or sporadic.

In the latter half of the seventeenth century the annual mortality of London is estimated at not less than eighty in a thousand; about the middle of this century it stood at twenty-four in a thousand; in 1889 it stood at less than eighteen in a thousand; and in many parts the most recent statistics show that it has been brought down to fourteen or fifteen in a thousand. A quarter of a century ago the death rate from disease in the Royal Guards at London was twenty in a thousand; in 1888 it had been reduced to six in a thousand. In the army generally it had been seventeen in a thousand, but it has been reduced until it now stands at eight. In the old Indian army it had been sixty-nine in a thousand, but of late it has been brought down first to twenty, and finally to fourteen. Mr. Chadwick in his speech proved that much more might be done, for he called attention to the German army, where the death rate from disease has been reduced to between five and six in a thousand. The Public Health Act having been passed in 1875, the death rate in England among men fell, between 1871 and 1880, more than four in a thousand, and among women more than six in a thousand. In the decade between 1851 and 1860 there died of diseases attributable to defective drainage and impure water over four thousand persons in every million throughout England: these numbers have declined until in 1888 there died less than two thousand in every million. The most striking diminution of the deaths from such causes was found in 1891, in the case of typhoid fever, that diminution being fifty per cent. As to the scourge which, next to plagues like the Black Death, was formerly the most dreaded - smallpox - there died of it in London during the year 1890 just one person. Drainage in Bristol reduced the death rate by consumption from 4.4 to 2.3; at Cardiff, from 3.47 to 2.31; and in all England and Wales, from 2.68 in 1851 to 1.55 in 1888.

What can be accomplished by better sanitation is also seen to-day by a comparison between the death rate among the children outside and inside the charity schools. The death rate among those outside in 1881 was twelve in a thousand; while inside, where the children were under sanitary regulations maintained by competent authorities, it has been brought down first to eight, then to four, and finally to less than three in a thousand.

In view of statistics like these, it becomes clear that Edwin Chadwick and his compeers among the sanitary authorities have in half a century done far more to reduce the rate of disease and death than has been done in fifteen hundred years by all the fetiches which theological reasoning could devise or ecclesiastical power enforce.

Not less striking has been the history of hygiene in France: thanks to the decline of theological control over the universities, to the abolition of monasteries, and to such labours in hygienic research and improvement as those of Tardieu, Levy, and Bouchardat, a wondrous change has been wrought in public health. Statistics carefully kept show that the mean length of human life has been remarkably increased. In the eighteenth century it was but twenty-three years; from 1825 to 1830 it was thirty-two years and eight months; and since 1864, thirty-seven years and six months.