DEATHS OCCURRING IN STATE INSTITUTIONS UNDER THE BOARD OF CONTROL FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1901.

* Data kindly furnished by the honorable Board of Control. -SECRETARY.

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VIII

MUNICIPAL SANITARY ENGINEERING

BY CHARLES FRANCIS, DANENPORT, CIVIL ENGINEER, IOWA STATE BOARD OF HEALTH

The need of sanitary engineering in this great section of our country, which we know as the middle west, is evidenced in many ways: So many in fact, that it would be futile to attempt enumeration, so that but a few of the most pronounced will be discussed here.

The immediate purpose of this paper is to call attention to the fact that the people-the public-the masses-whatever their name may be-are very indifferent to, if not profoundly ignorant of, the fundamental principles of sanitary science, and many of the primary rules of hygiene.

Moreover, this indifference or ignoronce is by no means confined to that large class of people who work with their hands, who have neither time nor inclination to think upon these things, and for whom the consideration of these matters is naturally (and rightly also) left to others.

This same carelessness in sanitary matters obtains very largely in what is called the better class"-those who have rather more money, and are supposed to work with their brains-who appear to be so fully occupied with business (which has come to mean merely the chase for the dollar) that they have no time to get acquainted with themselves or their environment.

Great statesmen have told us that this is a government of the people, by the people and for the people. In all the great crises through which our nation has passed, it has been the voice of the people that has shaped our course. The people, then, having such a heavy responsibility, should use every means to enlighten themselves in every direction, as far as possible, so as to be able to govern well.

Then political education is looked after very sharply. During political campaigns, those political leaders supposed to be best acquainted with great national questions, go about explaining why this or that policy should be adopted, and vast quantities of campaign literature" are circulated so that this great factor in our national safety and welfare "the voice of the people", may be intelligently declared.

Large sums of money are expended-campaign funds; and nothing is left undone to educate the people as to the policy which they should adopt to insure their prosperity and happiness.

Now the question arises, and it appears to be a reasonable one:-Why should this careful education of the people, and training of public thought be confined to politics; Why should not such vital questions as Public

Health, Municipal Sanitation, and other like matters affecting the people qnite as closely as politics receive similar attention?

These are plain questions and demand a plain answer, and we do not have to go very far to find it. It is this: There is no money in it. On the contrary, the study of these matters only discloses the fact that proper Sanitary methods are expensive, which means increased taxation, and "we are taxed enough now, goodness knows."

If the people would only treat these great questions relating to public health, as they do the public schools-and they are undoubtedly of equal importance—it would only be a short time before our sanitary systems would be in true scientific line, and we should all understand them and take the interest in them that they deserve.

The first rule of health is KEEP CLEAN; ourselves, our clothing, our dwellings, premises, barns, stables, alleys, and all that we have to do with. Everybody knows this, and most of the people live up to it.

When a community can afford it, a system of water supply is introduced. This necessitates a system of sewerage, by which the sewage is removed from the residences, etc., in the community. This sewerage system is carefully worked out by the engineer, who calculates with great pains, the proper dimensions of the sewers and their grades, so that they will all fit together and form a "sewerage system,” and so far everything is done in true scientific fashion.

But how many people have given a thought as to what shall be finally done with the sewage collected by this carefully prepared system, except that it shall be discharged into the neighboring stream below town?

If there be a stream near town there is no question as to the feasibility of constructing a system of sewerage; if there be no stream near by, it is very doubtful if a sewerage system is built, in fact it may be set down as a moral certainty that it will not be built, because there is no place to discharge the sewage. The stream is necessary to carry away the sewage. Never mind about the people living on the streams lower down, "let them take care of themselves, our sewage is carried away from us."

It seems necessary to state, in view of the almost universal custom (perhaps better to omit the almost) that attains in Iowa of discharging sewers into streams, that this method of disposing of sewage is wholly wrong and as it is entirely unnecessary in this section; it is very nearly criminal.

To show this, we have only to take one Iowa city and its sanitary methods as an example.

The city of Davenport, on the Mississippi river, has about 40,000 inhabitants, with a most excellent water supply taken from the river, and a very fair system of sewerage.

The sewage collected by this system is discharged into the river at various points on the water front, and the garbage is collected in the most approved form of iron carts, and dumped into the rlver by a very efficient dump boat.

These are the sanitary methods of all the cities or communities in Iowa where there is a system matic water supply and sewerage, systematic or sporadic, if the word may be permitted.

In general it may be said, that for the river cities, there is and can be no other source of water supply than the rivers upon which they are situated. It would seem to be reasonable to say the least that these cities should endeavor.

to keep their sources of water supply as clean and free from pollution as possible.

There are quite enough of what we may call natural pollutions of rivers (which call for considerable attention in the way of settling basins and filters) without pouring our sewage into them.

Sewage may be disposed of in a natural and proper manner without injury or cause of complaint to our neighbors, and our water sources preserved against pollution out here in the west with but comparatively small cost, if it be done now.

Every year of delay increases the cost by a large percentage, and we are very imprudent, unbusiness like, not to say criminally foolish, to wait for the time (which is as sure to come as the sunrise) when we shall, by federal and state laws, be compelled to keep our sewage out of any stream or water course which may be used as a source of water supply.

Continuing our illustration, suppose that the city of Davenport should acquire 120 acres of land as near the river as might be,. Let. we will say, sixty acres of this area be, by grading and tiling, converted into great filters, say eight of them of seven and one-half acres each, this would give each filter one day's work and seven days rest.

Now, this filtering area of sixty acres would dispose of and purify completely the sewage of 60,000 people for an indefinite time.

The effluent from these filter beds would be very nearly perfectly pure water, better and safer to drink than that now furnished and used in most cities, and no harm is done to anybody.

The other sixty acres should be held until the growth of the city demands their services, or in the mean time, might be used as a sewage farm, that is a farm or kitchen garden irrigated by sewage-a most profitable form of horticulture. The sale of the products of the great sewage farms near Berlin in Prussia, brings revenue enough to pay all the expenses of the maintainance of their great system (which includes eleven pumping stations in the city), the interest on the cost of construction, and the annual contribution to the sinking fund.

A scheme of sewage disposal, of this sort is perfectly feasable for Davenport, and in fact for all our Iowa cities. Land, suitable for such purposes, is to be had near every one of them and it is not too expensive now, and in view of the fact that this system, which is known as "Intermittent downward filtration," is one of the best known methods of sewage disposal it is very strange indeed that it has not been adopted here.

Moreover if Davenport disposed of her sewage in this way, she would be in a position to demand that the cities above her on the Mississippi river should cease from polluting her water supply with their sewage.

If the city of St. Louis employed this system of disposing of her sewage, her case against Chicago would be immensely strengthened. As it is, she has no case because she is doing to the cities below her on the river, just what Chicago is doing to her.

Some of the details of construction of the large filters mentioned above and also the discussion of the question of the reduction of garbage will be the subject of a future paper.

IX

MODES OF INFECTION AND NOTES ON DISIN

FECTION

BY ELI GRIMES, M. D., DES MOINES, BACTERIOLOGIST STATE BOARD

OF HEALTH

How the cause of disease gets into the human body is a most important question. If we knew the means by which the various disease producing agencies enter the body we could to a great extent prevent disease. We will not enter into a technical discussion of this question, but note briefly some of the simple facts that experiment and observation have demonstrated.

Let us notice first that all diseases are of external origin, that is, due to some cause taken or acting from without. This is very apparent in such diseases as smallpox, scarlet-fever, measles, etc.; as after an exposure to the disease a definite time elapses and the disease appears. In many diseases such as typhoid fever or malaria the canditions are more obscure owing to the remotness of the cause, but that they are of external origin there is no doubt. While it is evident that all infectious diseases are of external origin, the non-contageous likewise depend on conditions outside the body for their conception. Even the so-called hereditary diseases owe their origin to injurious circumstances under which the body or its parent, usually both, is placed. It is a physiological impossibility for the healthy body to become diseased, except from extrinsic causes.

In order to understand clearly the way by which diseases are contracted we must understand something of disease producing agents. Among the known causes of disease bacteria are the most important. The great diseases, tubercuolsis, typhoid fever, cholera, bubonic pest, diphtheria, and many others are due to bacteria, while malaria in all its forms is due to an organism which belongs to the animal kingdom, Bacteria are vegetable and are classed with the lowest and simplest forms of plant growth. The laity and and popular press regard bacteria as animal life, this is false, for in all their manifestations they are distinctly vegetable.

The distribution of bacteria, their dissemination, and constant presence are peculiarties due to their size. They take rank as the smallest thing that lives. To say that a certain bacterium is one twenty-five thousandth of an inch in diameter conveys no definite idea of actual size. Many are but onehalf this size, i. e. one-fifty thousandth of an inch in diameter. If we reduce this to terms of comparison we find very astonishing results. A box one cubic inch in capacity would hold 125,000,000,000,000 of the smaller bacteria, which if placed side by side like beads on a string would make a