Can the Public Afford to Tolerate These Menaces?—The Financial Side of the Question—The Matter of the Public Health Necessity of Screening and Sterilization where No Sewers Exist

IT is a far cry from the privy council to the privy I vault, and still they are both Anglo-Saxon institutions dating from time immemorial, and both, as institutions, are very much alive and kicking in the 20th century. It would appear, however, that in England, the home of the privy council, that the privy vault was, comparatively speaking, very much eliminated or reduced to a state of innocuous desuetude by good sanitary methods. By the time we reach England’s death rate from typhoid fever we can very well say the same of ourselves, but not until then. Why we should speak of the private well and privy vault, strikes me as rather strange so far as the adjective is concerned. If there was really such a thing as a private well, or a private vault, or a privy well, or a privy vault, in the literal sense, I should not be reading this paper today. In fact, we find that the well and the vault are often so close together that there is a certain ineffable unity which produces a result to the community which is, so to speak, ineluctable.

Health and Disease Not Private Matters

The fact is that disease is not a private matter. Health is not a private matter. It is something that concerns the whole life of the community, and the neglect of which becomes a community liability, if not a scourge. One of the most serious preventable diseases we have to deal with is typhoid fever. It is a purely preventable disease, as the experience of our army on the Mexican border and in the cantonments, has shown beyond a doubt. Nevertheless, in 1916, in the 29 cities of over 200,000 population, Indianapolis was the worst sinner, in the number of reported cases per 100,000 population. Our rate in 1916 was 26.6, the highest on the list. In 1915 the rate was not so high, 12.3, and three cities, Columbus. New Orleans and Baltimore, were slightly higher, but in the five-year period, 1911-15, Indianapolis had an average rate ot 20.5. Only two cities were worse, New Orleans with 20.9 and Baltimore with 23.7.

A City Government Survey Report

I he survey report of the city government, prepared in 1917 for the Chamber of Commerce, by the Bureau of Municipal Research of New York, has this to say on the subject: “The main causes of this condition are undoubtedly the pollution of the stream by sewage and the large number of yard privies. It is understood that a sanitary commission has been appointed to deal with the former nuisance. I wo other sources of danger, namely, water and milk infection, are being eliminated by chlorination and filtration of city water and pasteurization of milk. The health department has not the power to compel householders to make sewer connections, even if sewers exist, or to prescribe a sanitary privy. It can, however, keep its information as to cesspools and unsanitary privies in a readily comprehensible form by carding this information and filing the cards by streets. It can also constantly agitate the question and insist that an ordinance be enacted making house connections with existing sewers compulsory upon orders from the board of health and requiring that in any future extension of sewers through built-up sections the sewer connections be made by the city and the cost be assessed upon the property owner and paid for by installments, as other assessments are paid.”

Statistics as to Typhoid

In 1917 there were 161 typhoid cases reported and 28 deaths; in 1918 there were 86 cases reported and 19 deaths. These statistics are not as accurate as they might be, even as to deaths for occasionally the case might develop into terminal pneumonia and death might be ascribed to this cause. It is fairly safe to say that there are ten times as many cases as there are deaths, which would make 280 cases in 1917, as against 161 reported, and 190 cases in 1918 as against 86 reported.

Menace of the Privy Vault

It is unnecessary for me to go into the causes of typhoid, they are perfectly well known. The existence of the disease in any strength, indicates that there are a number of human bogs about. Human filth transported from its place of deposit into the food of healthy people means typhoid.

It is estimated that there are 10,000 to 15,000 privy vaults in existence in the city of Indianapolis, many of these are on unsewered streets and the best that can be done is to see that they are screened and constructed in such a way as not to be accessible to flies, and not to be accessible to surface drainage, which causes soil pollution.

We are not the only city” with such sources of public infection. St. Louis, in 1915, still had 20,000 privies, or privy sinks, 80 per cent of which were on sewered streets. Philadelphia had 20,000, of which 10,000 had sewers accessible; Minneapolis had 17,000, Cincinnati 27,000. Toronto abolished 12,291 privy vaults in two years up to December, 1914; Philadelphia abolished 16,661 in two years. Worcester, Richmond, Va., Buffalo and Erie report no vaults, but they are the great exceptions.

One of the objections to the elimination of these obnoxious places is the expense involved either to connect them with sewers, or to place proper facilities in the interior of houses. This could be unquestionably worked out and installed just as gas or electric ranges are installed, in this case at the expense of the city, which would be repaid by the landlord over a period of months or years, as the case might be. We, in Indiana, have the Barrett Law, which furnishes us with the analogy for the carrying out of this health preventive campaign.

Over 450,000 Die From Preventable Causes

About a million and a half persons die annually in the United States, probably 25 per cent to 33 per cent die from preventable causes. From 35,000 to 50,000 die anually of typhoid fever, from 400,000 to 500,000 are prostrated by this dread disease. Let us compare this with the figures ot other countries:

*Excerpts from a paper read before the annual convention of the American Water Works Association at Buffalo June 9 to 13, 1919.

This comparison shows very plainly where we stand in the matter of public cleanliness. Bridgeport, in 1910, was the only American city having a death rate from typhoid of less than 5 per 100,000. Can we afford, as a nation, to permit the economic loss from sickness which runs from $1,500,000,000 to $2,000,000,000 a year, to continue. In 1908 Dr. Ditman wrote, “The cost of typhoid fever each year in sickness and death throughout America amounts to many million dollars. The sickness and death from this cause in this city and in Philadelphia, Scranton and Pittsburgh, during a single year, represent an economic loss to those cities of $3,750,000; such epidemics with their resulting losses, are startling in an age which considers itself enlightened.”

Typhoid Disease of Uncivilization

Typhoid is the disease of uncivilization. As Sedgwick says, “Defective sanitation is but another name for defective civilization.” The average rate from typhoid throughout the United States per 100,000 is 22. In Indiana as a whole, it is 40. The average for a ten-year period is 944.

With 30,000 deaths per year from typhoid the yearly loss is easily $150,000,000. It is just as stupid for us to permit this loss to continue as it is to permit our tremendous fire losses to continue, but just so long as ignorance and indifference create this disease politic, we shall continue to have it. According to Dr. Morgan, of the City Board of Health, the number of private wells is 308 and of privy vaults 664 within the mile square in this city (Indianapolis). You will probably be startled to ascertain the number of each, but this is based on a sanitary survey recently made and shows conclusively that we are sitting on a volcano so far as typhoid is concerned. As Lawrence Veiller, secretary of the National Housing Association, says, “How profitable is it for a city to spend vast sums of money to insure a supply of pure water to its inhabitants, and at the same time to allow barbarous privy vaults, sinks of iniquity, to drain their contents into private wells, still used by ‘conservative citizens’, who cling to them with startling tenacity.”

When you stop to consider that during the epidemic of 1916, at the rate of $300 as an average cost of medical care per case, it cost the citizens of Indianapolis in the vicinity of $250,000. Without attempting to estimate the economic loss to industry, one can readily grasp the financial significance of further temporizing with middleage sanitary facilities.

Right Kind of Ordinance Needed

This condition can be eliminated by the right kind of an ordinance, which, once backed by an enlightened public opinion, will go through without any difficulty. “There never was a reform in administration in this world,” says Elihu Root, “which did not have to make its way against the strong feeling of good, honest men concerned in existing methods of administration, and who saw nothing wrong. It is no impeachment of a man’s honesty, his integrity, that he thinks the methods that he is familiar with and in which he is engaged are all right. But you cannot make any improvement in this world without over-riding the satisfaction that men have in things as they are, and of which they are a contented and successful part.” Mr. Root here states admirably the position of those who want to stand pat in health matters, and want to stand pat in this matter of privy vaults, because it involves a few of their dollars.

War Deaths Only Twice Annual Typhoid Loss

Have we not learned, among other things, in this war that human lives come before dollars, that we are spiritual beings first and human beings second? We must become as interested in the conservation of human life, at least as interested as we are in the conservation of animal life, and surely in a great agricultural state like this, we do not neglect our stock. Human life seems so cheap after a great war when 7,000,000 men fell that others may live in freedom. Surely after this tremendous drain on the world’s stock of humanity we can leave no stones unturned to preserve what the war has left intact, and fortunately we, in the United States, suffered almost no loss as compared to our annual loss from preventable disease. Our total deaths in this war was only twice our annual loss from typhoid.

In closing, let me quote from a statement of the Minneapolis Civic and Commerce Association, substituting the word Indianapolis for Minneapolis:

“A new spirit is developing in industry, a spirit of a realization that all industry suffers through the misfortune of any factor. The employer fails to prosper as his men fail to prosper. Bad housing for the workmen means bad business for the one who hires. In the light of this spirit, the primary question is not “What can the tenant afford?” it is “What can Indianapolis afford?” If we are to develop in Indianapolis the highest type of civilization, if industry is to thrive permanently, if art and music are to serve their highest purpose, we must first recognize as an essential prerequisite to the realization of these high ideals, the providing of a home life for every family, rich or poor, that shall insure to them their inalienable right to sanitation, safety, ventilation, privacy, sunlight, space, and beauty.”

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