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HYGEIAA CITY OF HEALTH

BY

BENJAMIN WARD RICHARDSON M. D. , F. R. S. 

1876

[Illustration]

TOEDWIN CHADWICK, C. B. 

MY DEAR MR. CHADWICK, _I wrote this Address with the intention of dedicating it to you, asa simple but hearty acknowledgment by a sanitary student, himself wellripened in the work, of your pre-eminent position as the living leaderof the sanitary reformation of this century. 

The favour the Address has received indicates notably two facts: theadvance of public opinion on the subject of public health, and theremarkable value and influence of your services as the sanitarystatesman by whom that opinion has been so wisely formed and directed. 

In this sense of my respect for you, and of my gratitude, pray acceptthis trifling recognition, and believe me to be, Ever faithfully yours_, B. W. RICHARDSON. 

PREFATORY NOTE. 

The immediate success of this Address caused me to lay it aside forsome months, to see if the favour with which it was received wouldremain. I am satisfied to find that the good fortune which originallyattended the effort holds on, and that in publishing it now in aseparate form I am acting in obedience to a generally expresseddesire. 

Since the delivery of the Address before the Health Department of theSocial Science Congress, over which I had the honour to preside, atBrighton, in October last, every day has brought some new suggestionbearing on the subjects discussed, and the temptation has been greatto add new matter, or even to recast the essay and bring it out as amore compendious work. On reflection I prefer to let it take itsplace in literature, in the first instance, in its original and simpledress. 

12 HINDE STREET, W. :_August_ 18, 1876. 

HYGEIA, A CITY OF HEALTH

We meet in this Assembly, a voluntary Parliament of men and women, to study together and to exchange knowledge and thought on worksof every-day life and usefulness. Our object, to make the presentexistence better and happier; to inquire, in this particular sectionof our Congress:--What are the conditions which lead to the pain andpenalty of disease; what the means for the removal of those conditionswhen they are discovered? What are the most ready and convincingmethods of making known to the uninformed the facts: that many of theconditions are under our control; that neither mental serenity normental development can exist with an unhealthy animal organisation;that poverty is the shadow of disease, and wealth the shadow ofhealth?

These objects relate to ourselves, to our own reliefs from suffering, to our own happiness, to our own riches. We have, I trust and believe, yet another object, one that relates not to ourselves, but to thosewho have yet to be; those to whom we may become known, but whom we cannever know, who are the ourselves, unseen to ourselves, continuing ourmission. 

We are privileged more than any who have as yet lived on this planetin being able to foresee, and in some measure estimate, the results ofour wealth of labour as it may be possibly extended over and throughthe unborn. A few scholars of the past, like him who, writing to theclose of his mortal day, sang himself to his immortal rest with the'_Gloria in excelsis_, ' a few scholars might foresee, even as thatBaeda did, that their living actual work was but the beginning oftheir triumphant course through the ages, --the momentum. But themasses of the nations, crude and selfish, have had no such prescience, no such intent. 'Let us eat and drink, for to-morrow we die!' That hasbeen the pass, if not the password, with them and theirs. 

We, scholars of modern thought, have the broader, and therefore moresolemn and obligatory knowledge, that however many to-morrows maycome, and whatever fate they may bring, we never die; that, strictlyspeaking, no one yet who has lived has ever died; that for good orfor evil our every change from potentiality into motion is carried onbeyond our own apparent transitoriness; that we are the waves of theocean of life, communicating motion to the expanse before us, andleaving the history we have made on the shore behind. 

Thus we are led to feel this greater object: that to whatever extentwe, by our exertions, confer benefits on those who live, we extend theadvantage to those who have to live; that one good thought leading topractical useful action from one man or woman, may go to the virtueof thousands of generations; that one breath of health wafted by ourbreath may, in the aggregate of life saved by it, represent in itsultimate effect all the life that now is or has been. 

At the close of a Parliamentary session, an uneventful leader of asection of Parliament banters his more eventful rival, and enliveninghis criticism by a sneer at our Congress, challenges the contemptof his rival, as if to draw it forth in the same critical direction. Alas! it is too true that great congresses, like great men, and evenlike Parliaments, do live sometimes for many years and talk much, andseem to miss much and advance little; so that in what relates to themere present it were wrong, possibly, to challenge the sally ofthe statesman who, from his own helpless height, looked down on ourweakness. But inasmuch as no man knoweth the end of the spoken word, as that which is spoken to-day, earnestly and simply, may not reappearfor years, and may then appear with force and quality of hiddenvirtue, there is reason for our uniting together beyond the proof ofnecessity which is given in the fact of our existence. Perchance someday our natural learning, gathered in our varied walks of life, andsubmitted in open council, may survive even Parliamentary strife;perchance our resolutions, though no sign-manual immediately gracethem, are the informal bills which ministers and oppositions shallone day discuss, Parliaments pass, royal hands sign, and the fixedadministrators of the will of the nation duly administer. 

These thoughts on the future, rather than on the passing influenceof our congressional work, have led me to the simple design of theaddress which, as President of this Section, I venture to submit toyou to-day. It is my object to put forward a theoretical outline ofa community so circumstanced and so maintained by the exercise ofits own freewill, guided by scientific knowledge, that in it theperfection of sanitary results will be approached, if not actuallyrealised, in the co-existence of the lowest possible general mortalitywith the highest possible individual longevity. I shall try to showa working community in which death, --if I may apply so common andexpressive a phrase on so solemn a subject, --is kept as nearly aspossible in its proper or natural place in the scheme of life. 

HEALTH AND CIVILISATION. 

Before I proceed to this task, it is right I should ask of the pastwhat hope there is of any such advancement of human progress. For, asmy Lord of Verulam quaintly teaches, 'the past ever deserves that menshould stand upon it for awhile to see which way they should go, butwhen they have made up their minds they should hesitate no longer, butproceed with cheerfulness, ' For a moment, then, we will stand on thepast. 

From this vantage-ground we gather the fact, that onward with thesimple progress of true civilisation the value of life has increased. Ere yet the words 'Sanitary Science' had been written; ere yetthe heralds of that science (some of whom, in the persons of ourillustrious colleagues, Edwin Chadwick and William Fair, are with usin this place at this moment), ere yet these heralds had summoned theworld to answer for its profligacy of life, the health and strength ofmankind was undergoing improvement. One or two striking facts mustbe sufficient in the brief space at my disposal to demonstrate thistruth. In England, from 1790 to 1810, Heberden calculated that thegeneral mortality diminished one-fourth. In France, during the sameperiod, the same favourable returns were made. The deaths in France, Berard calculated, were 1 in 30 in the year 1780, and during the eightyears, from 1817 to 1828, 1 in 40, or a fourth less. In 1780, out of100 new-born infants, in France, 50 died in the two first years; inthe later period, extending from the time of the census that was takenin 1817 to 1827, only 38 of the same age died, an augmentation ofinfant life equal to 25 per cent. In 1780 as many as 55 per cent. Diedbefore reaching the age of ten years; in the later period 43, or abouta fifth less. In 1780 only 21 persons per cent. Attained the age of 50years; in the later period 32, or eleven more, reached that term. In1780 but 15 persons per cent, arrived at 60 years; in the later period24 arrived at that age. 

Side by side with these facts of the statist we detect other factswhich show that in the progress of civilisation the actual organicstrength and build of the man and woman increases. As in the highestdevelopments of the fine arts the sculptor and painter place beforeus the finest imaginative types of strength, grace, and beauty, sothe silent artist, civilisation, approaches nearer and nearer toperfection, and by evolution of form and mind developes what ispractically a new order of physical and mental build. Peron, --whofirst used, if he did not invent, the little instrument, thedynamometer, or muscular-strength measurer, --subjected personsof different stages of civilisation to the test of his gauge, anddiscovered that the strength of the limbs of the natives of VanDiemen's Land and New Holland was as 50 degrees of power, while thatof the Frenchmen was 69, and of the Englishmen 71. The same orderof facts are maintained in respect to the size of body. The stalwartEnglishman of to-day can neither get into the armour nor be placed inthe sarcophagus of those sons of men who were accounted the heroes ofthe infantile life of the human world. 

We discover, moreover, from our view of the past, that thedevelopments of tenacity of life and of vital power have beencomparatively rapid in their course when they have once commenced. There is nothing discoverable to us that would lead to the conceptionof a human civilisation extending back over two hundred generations;and when in these generations we survey the actual effect ofcivilisation, so fragmentary and overshadowed by persistentbarbarism, in influencing disease and mortality, we are reduced to theobservation of at most twelve generations, including our own, engaged, indirectly or directly, in the work of sanitary progress. Duringthis comparatively brief period, the labour of which, until within acentury, has had no systematic direction, the changes for good thathave been effected are amongst the most startling of historical facts. Pestilences which decimated populations, and which, like the greatplague of London, destroyed 7, 165 people in a single week, have losttheir virulency; gaol fever has disappeared, and our gaols, once eacha plague-spot, have become, by a strange perversion of civilisation, the health spots of, at least, one kingdom. The term, Black Death, isheard no more; and ague, from which the London physician once made afortune, is now a rare tax even on the skill of the hardworked UnionMedical Officer. 

From the study of the past we are warranted, then, in assuming thatcivilisation, unaided by special scientific knowledge, reduces diseaseand lessens mortality, and that the hope of doing still more bysystematic scientific art is fully justified. 

I might hereupon proceed to my project straightway. I perceive, however, that it may be urged, that as mere civilising influences canof themselves effect so much, they might safely be left to themselvesto complete, through the necessity of their demands, the wholesanitary code. If this were so, a formula for a city of health werepractically useless. The city would come without the special call forit. 

I think it probable the city would come in the manner described, buthow long it would be coming is hard to say, for whatever great resultshave followed civilisation, the most that has occurred has been anunexpected, unexplained, and therefore uncertain arrest of the spreadof the grand physical scourges of mankind. The phenomena have beensuppressed, but the root of not one of them has been touched. Stillin our midst are thousands of enfeebled human organisms which only arecomparable with the savage. Still are left amongst us the bases of allthe diseases that, up to the present hour, have afflicted humanity. 

The existing calendar of diseases, studied in connection with theclassical history of the diseases written for us by the longestunbroken line of authorities in the world of letters, shows, inunmistakable language, that the imposition of every known malady ofman is coeval with every phase of his recorded life on the planet. Nomalady, once originated, has ever actually died out; many remain aspotent as ever. That wasting fatal scourge, pulmonary consumption, isthe same in character as when Coelius Aurelianus gave it description. The cancer of to-day is the cancer known to Paulus Eginæta. The BlackDeath, though its name is gone, lingers in malignant typhus. The greatplague of Athens is the modern great plague of England, scarlet fever. The dancing mania of the Middle Ages and the convulsionary epidemicof Montmartre, subdued in their violence, are still to be seen insome American communities, and even at this hour in the New Forestof England. Small-pox, when the blessed protection of vaccination iswithdrawn, is the same virulent destroyer as it was when the ArabianRhazes defined it. Ague lurks yet in our own island, and, albeit thephysician is not enriched by it, is in no symptom changed from theague that Celsus knew so well. Cholera, in its modern representationis more terrible a malady than its ancient type, in so far as we haveknowledge of it from ancient learning. And that fearful scourge, the great plague of Constantinople, the plague of hallucination andconvulsion which raged in the Fifth Century of our era, has inour time, under the new names of tetanoid fever and cerebro-spinalmeningitis, been met with here and in France, and in Massachusettshas, in the year 1873, laid 747 victims in the dust. 

I must cease these illustrations, though I could extend them fairlyover the whole chapter of disease, past and present. Suffice it if Ihave proved the general propositions, that disease is now as it was inthe beginning, except that in some examples of it it is less virulent;that the science for extinguishing any one disease has yet tobe learned; that, as the bases of disease exist, untouched bycivilisation, so the danger of disease is ever imminent, unless wespecially provide against it; that the development of disease mayoccur with original virulence and fatality, and may at any moment bemade active under accidental or systematic ignorance. 

A CITY OF HEALTH. 

I now come to the design I have in hand. Mr. Chadwick has manytimes told us that he could build a city that would give any statedmortality, from fifty, or any number more, to five, or perhaps somenumber less, in the thousand annually. I believe Mr. Chadwick to becorrect to the letter in this statement, and for that reason I haveprojected a city that shall show the lowest mortality. I need not saythat no such city exists, and you must pardon me for drawing upon yourimaginations as I describe it. Depicting nothing whatever but what isat this present moment easily possible, I shall strive to bringinto ready and agreeable view a community not abundantly favouredby natural resources, which, under the direction of the scientificknowledge acquired in the past two generations, has attained avitality not perfectly natural, but approaching to that standard. Inan artistic sense it would have been better to have chosen a smalltown or large village than a city for my description; but as the greatmortality of States is resident in cities, it is practically betterto take the larger and less favoured community. If cities could betransformed, the rest would follow. 

Our city, which may be named _Hygeia_, has the advantage of beinga new foundation, but it is so built that existing cities might belargely modelled upon it. 

The population of the city may be placed at 100, 000, living in 20, 000houses, built on 4, 000 acres of land, --an average of 25 persons toan acre. This may be considered a large population for the spaceoccupied, but, since the effect of density on vitality tells onlydeterminately when it reaches a certain extreme degree, as inLiverpool and Glasgow, the estimate may be ventured. 

The safety of the population of the city is provided for againstdensity by the character of the houses, which ensures an equaldistribution of the population. Tall houses overshadowing the streets, and creating necessity for one entrance to several tenements, are nowhere permitted. In streets devoted to business, where thetradespeople require a place of mart or shop, the houses are fourstories high, and in some of the western streets where the houses areseparate, three and four storied buildings are erected; but on thewhole it is found bad to exceed this range, and as each story islimited to 15 feet, no house is higher than 60 feet. 

The substratum of the city is of two kinds. At its northern andhighest part, there is clay; at its southern and south-eastern, gravel. Whatever disadvantages might spring in other places from aretention of water on a clay soil, is here met by the plan that isuniversally followed, of building every house on arches of solidbrickwork. So, where in other towns there are areas, and kitchens, andservants' offices, there are here subways through which the air flowsfreely, and down the inclines of which all currents of water arecarried away. 

The acreage of our model city allows room for three wide main streetsor boulevards, which run from east to west, and which are the mainthoroughfares. Beneath each of these is a railway along which theheavy traffic of the city is carried on. The streets from north tosouth which cross the main thoroughfares at right angles, and theminor streets which run parallel, are all wide, and, owing to thelowness of the houses, are thoroughly ventilated, and in the day arefilled with sunlight. They are planted on each side of the pathwayswith trees, and in many places with shrubs and evergreens. All theinterspaces between the backs of houses are gardens. The churches, hospitals, theatres, banks, lecture-rooms, and other public buildings, as well as some private buildings such as warehouses and stables, stand alone, forming parts of streets, and occupying the position ofseveral houses. They are surrounded with garden space, and add notonly to the beauty but to the healthiness of the city. The largehouses of the wealthy are situated in a similar manner. 

The streets of the city are paved throughout with the same material. As yet wood pavement set in asphalte has been found the best. It isnoiseless, cleanly, and durable. Tramways are nowhere permitted, thesystem of underground railways being found amply sufficient for allpurposes. The side pavements, which are everywhere ten feet wide, areof white or light grey stone. They have a slight incline towards thestreets, and the streets have an incline from their centres towardsthe margins of the pavements. 

From the circumstance that the houses of our model city are based onsubways, there is no difficulty whatever in cleansing the streets, no more difficulty than is experienced in Paris. That disgrace toour modern civilisation, the mud cart, is not known, and even thenecessity for Mr. E. H. Bayley's roadway moveable tanks for mudsweepings, --so much wanted in London and other towns similarlybuilt, --does not exist. The accumulation of mud and dirt in thestreets is washed away every day through side openings into thesubways, and is conveyed, with the sewage, to a destination apart fromthe city. Thus the streets everywhere are dry and clean, free alike ofholes and open drains. Gutter children are an impossibility in a placewhere there are no gutters for their innocent delectation. Instead ofthe gutter, the poorest child has the garden; for the foul sight andsmell of unwholesome garbage, he has flowers and green sward. 

It will be seen, from what has been already told, that in this ourmodel city there are no underground cellars, kitchens, or other caves, which, worse than those ancient British caves that Nottinghamstill can show the antiquarian as the once fastnesses of her savagechildren, are even now the loathsome residences of many millions ofour domestic and industrial classes. There is not permitted to be oneroom underground. The living part of every house begins on the levelof the street. The houses are built of a brick which has the followingsanitary advantages:--It is glazed, and quite impermeable to water, sothat during wet seasons the walls of the houses are not saturated withtons of water, as is the case with so many of our present residences. The bricks are perforated transversely, and at the end of each thereis a wedge opening, into which no mortar is inserted, and by which allthe openings are allowed to communicate with each other. The walls arein this manner honeycombed, so that there is in them a constant bodyof common air let in by side openings in the outer wall, which aircan be changed at pleasure, and, if required, can be heated from thefiregrates of the house. The bricks intended for the inside wallsof the house, those which form the walls of the rooms, are glazed indifferent colours, according to the taste of the owner, and arelaid so neatly, that the after adornment of the walls is consideredunnecessary, and, indeed, objectionable. By this means those mostunhealthy parts of household accommodation, layers of mouldy paste andsize, layers of poisonous paper, or layers of absorbing colour stuffor distemper, are entirely done away with. The walls of the roomscan be made clean at any time by the simple use of water, and theceilings, which are turned in light arches of thinner brick, or tile, coloured to match the wall, are open to the same cleansing process. The colour selected for the inner brickwork is grey, as a rule, that being most agreeable to the sense of sight; but various tastesprevail, and art so much ministers to taste, that, in the houses ofthe wealthy, delightful patterns of work of Pompeian elegance are soonintroduced. 

As with the bricks, so with the mortar and the wood employed inbuilding, they are rendered, as far as possible, free of moisture. Seasand containing salt, and wood that has been saturated with sea water, two common commodities in badly built houses, find no place in ourmodern city. 

The most radical changes in the houses of our city are in thechimneys, the roofs, the kitchens, and their adjoining offices. Thechimneys, arranged after the manner proposed by Mr. Spencer Wells, areall connected with central shafts, into which the smoke is drawn, and, after being passed through a gas furnace to destroy the free carbon, is discharged colourless into the open air. The city, therefore, atthe expense of a small smoke rate, is free of raised chimneys and ofthe intolerable nuisance of smoke. The roofs of the houses are butslightly arched, and are indeed all but flat. They are covered eitherwith asphalte, which experience, out of our supposed city, has provedto last long and to be easily repaired, or with flat tile. Theroofs, barricaded round with iron palisades, tastefully painted, makeexcellent outdoor grounds for every house. In some instances flowersare cultivated on them. 

The housewife must not be shocked when she hears that the kitchens ofour model city, and all the kitchen offices, are immediately beneaththese garden roofs; are, in fact, in the upper floor of the houseinstead of the lower. In every point of view, sanitary and economical, this arrangement succeeds admirably. The kitchen is lighted toperfection, so that all uncleanliness is at once detected. The smellwhich arises from cooking is never disseminated through the rooms ofthe house. In conveying the cooked food from the kitchen, in houseswhere there is no lift, the heavy weighted dishes have to be conveyeddown, the emptied and lighter dishes upstairs. The hot water fromthe kitchen boiler is distributed easily by conducting pipes into thelower rooms, so that in every room and bedroom hot and cold water canat all times be obtained for washing or cleaning purposes; and as onevery floor there is a sink for receiving waste water, the carrying ofheavy pails from floor to floor is not required. The scullery, whichis by the side of the kitchen, is provided with a copper and all theappliances for laundry work; and when the laundry work is done at homethe open place on the roof above makes an excellent drying ground. 

In the wall of the scullery is the upper opening to the dust-binshaft. This shaft, open to the air from the roof, extends to the binunder the basement of the house. A sliding door in the wall opens intothe shaft to receive the dust, and this plan is carried out on everyfloor. The coal-bin is off the scullery, and is ventilated into theair through a separate shaft, which also passes through the roof. 

On the landing in the second or middle stories of the three-storiedhouses there is a bathroom, supplied with hot and cold water from thekitchen above. The floor of the kitchen and of all the upper storiesis slightly raised in the centre, and is of smooth, grey tile; thefloor of the bath-room is the same. In the living-rooms, where thefloors are of wood, a true oak margin of floor extends two feet aroundeach room. Over this no carpet is ever laid. It is kept bright andclean by the old-fashioned bees'-wax and turpentine, and the air ismade fresh and is ozonised by the process. 

Considering that a third part of the life of man is, or should be, spent in sleep, great care is taken with the bed-rooms, so that theyshall be thoroughly lighted, roomy, and ventilated. Twelve hundredcubic feet of space is allowed for each sleeper, and from the sleepingapartments all unnecessary articles of furniture and of dress arerigorously excluded. Old clothes, old shoes, and other offensivearticles of the same order, are never permitted to have residencethere. In most instances the rooms on the first floor are made thebed-rooms, and the lower the living-rooms. In the larger housesbed-rooms are carried out in the upper floor for the use of thedomestics. 

To facilitate communication between the kitchen and the entrance-hall, so that articles of food, fuel, and the like may be carried up, ashaft runs in the partition between two houses, and carries a basketlift in all houses that are above two stories high. Every heavy thingto and from the kitchen is thus carried up and down from floor tofloor and from the top to the basement, and much unnecessary labouris thereby saved. In the two-storied houses the lift is unnecessary. Aflight of outer steps leads to the upper or kitchen floor. 

The warming and ventilation of the houses is carried out by a commonand simple plan. The cheerfulness of the fireside is not sacrificed;there is still the open grate in every room, but at the back ofthe firestove there is an air-box or case which, distinct from thechimney, communicates by an opening with the outer air, and by anotheropening with the room. When the fire in the room heats the ironreceptacle, fresh air is brought in from without, and is diffusedinto the room at the upper part on a plan similar to that devised byCaptain Galton. 

As each house is complete within itself in all its arrangements, thosedisfigurements called back premises are not required. There is a widespace consequently between the back fronts of all houses, which spaceis, in every instance, turned into a garden square, kept in neatorder, ornamented with flowers and trees, and furnished withplaygrounds for children, young and old. 

The houses being built on arched subways, great convenience existsfor conveying sewage from, and for conducting water and gas into, thedifferent domiciles. All pipes are conveyed along the subways, andenter each house from beneath. Thus the mains of the water pipe andthe mains of the gas are within instant control on the first floor ofthe building, and a leakage from either can be immediately prevented. The officers who supply the commodities of gas and water haveadmission to the subways, and find it most easy and economical to keepall that is under their charge in perfect repair. The sewers of thehouses run along the floors of the subways, and are built in brick. They empty into three cross main sewers. They are trapped for eachhouse, and as the water supply is continuous, they are kept wellflushed. In addition to the house flushings there are special openingsinto the sewers by which, at any time, under the direction of thesanitary officer, an independent flushing can be carried out. Thesewers are ventilated into tall shafts from the mains by means of apneumatic engine. 

The water-closets in the houses are situated on the middle andbasement floors. The continuous water-supply flushes them withoutdanger of charging the drinking water with gases emanating from thecloset; a danger so imminent in the present method of cisterns, whichsupply drinking as well as flushing water. 

As we walk the streets of our model city, we notice an absence ofplaces for the public sale of spirituous liquors. Whether this be avoluntary purgation in goodly imitation of the National TemperanceLeague, the effect of Sir Wilfrid Lawson's Permissive Bill and mostpermissive wit and wisdom, or the work of the Good Templars, we neednot stay to inquire. We look at the fact only. To this city, as tothe town of St. Johnsbury, in Vermont, which Mr. Hepworth Dixon hasso graphically described, we may apply the description Mr. Dixon haswritten: 'No bar, no dram shop, no saloon defiles the place. Nor isthere a single gaming hell or house of ill-repute. ' Through all theworkshops into which we pass, in whatever labour the men or womenmay be occupied, --and the place is noted for its manufacturingindustry, --at whatever degree of heat or cold, strong drink isunknown. Practically, we are in a total abstainers' town, and a manseen intoxicated would be so avoided by the whole community, he wouldhave no peace to remain. 

And, as smoking and drinking go largely together, as the two practiceswere, indeed, original exchanges of social degradations between thecivilised man and the savage, the savage getting very much the worstof the bargain, so the practices largely disappear together. Pipe andglass, cigar and sherry-cobbler, like the Siamese twins, who couldonly live connected, have both died out in our model city. Tobacco, by far the most innocent partner of the firm, lived, as it perhapsdeserved to do, a little the longest; but it passed away, and thetobacconist's counter, like the dram counter, has disappeared. 

The streets of our city, though sufficiently filled with busy people, are comparatively silent. The subways relieve the heavy traffic, andthe factories are all at short distances from the town, except thosein which the work that is carried on is silent and free from nuisance. This brings me to speak of some of the public buildings which haverelation to our present studies. 

It has been found in our towns, generally, that men and women whoare engaged in industrial callings, such as tailoring, shoe-making, dressmaking, lace-work and the like, work at their own homes amongsttheir children. That this is a common cause of disease is wellunderstood. I have myself seen the half-made riding-habit that wasultimately to clothe some wealthy damsel rejoicing in her morning rideact as the coverlet of a poor tailor's child stricken with malignantscarlet fever. These things must be, in the ordinary course of eventsunder our present bad sanitary system. In the model city we havein our mind's eye, these dangers are met by the simple provision ofworkmen's offices or workrooms. In convenient parts of the town thereare blocks of buildings, designed mainly after the manner of thehouses, in which each workman can have a work-room on payment of amoderate sum per week. Here he may work as many hours as he pleases, but he may not transform the room into a home. Each block is underthe charge of a superintendent, and also under the observation of thesanitary authorities. The family is thus separated from the work, and the working man is secured the same advantages as the lawyer, the merchant, the banker now possesses: or to make the parallel morecorrect, he has the same advantage as the man or woman who works in afactory, and goes home to eat and to sleep. 

In most towns throughout the kingdom the laundry system is dangerousin the extreme. For anything the healthy householder knows, theclothes he and his children wear have been mixed before, during, andafter the process of washing, with the clothes that have come from thebed or the body of some sufferer from a contagious malady. Some of themost fatal outbreaks of disease I have met with have been communicatedin this manner. In our model community this danger is entirely avoidedby the establishment of public laundries, under municipal direction. No person is obliged to send any article of clothing to be washed atthe public laundry; but if he does not send there he must have thewashing done at home. Private laundries that do not come under theinspection of the sanitary officer are absolutely forbidden. Itis incumbent on all who send clothes to the public laundry from aninfected house to state the fact. The clothes thus received are passedfor special cleansing into the disinfecting rooms. They are speciallywashed, dried and prepared for future wear. The laundries areplaced in convenient positions, a little outside the town; theyhave extensive drying grounds, and, practically, they are workedso economically, that homewashing days, those invaders of domesticcomfort and health, are abolished. 

Passing along the main streets of the city we see in twenty places, equally distant, a separate building surrounded by its own grounds, --amodel hospital for the sick. To make these institutions the best oftheir kind, no expense is spared. Several elements contribute to theirsuccess. They are small, and are readily removable. The old idea ofwarehousing diseases on the largest possible scale, and of making itthe boast of an institution that it contains so many hundred beds, is abandoned here. The old idea of building an institution so thatit shall stand for centuries, like a Norman castle, but, unlike thecastle, still retain its original character as a shelter for theafflicted, is abandoned here. The still more absurd idea of buildinghospitals for the treatment of special organs of the body, as if thedifferent organs could walk out of the body and present themselves fortreatment, is also abandoned. 

It will repay us a minute of time to look at one of these modelhospitals. One is the _fac simile_ of the other, and is devoted to theservice of every five thousand of the population. Like every buildingin the place, it is erected on a subway. There is a wide centralentrance, to which there is no ascent, and into which a carriage, cab, or ambulance can drive direct. On each side the gateway are the housesof the resident medical officer and of the matron. Passing down thecentre, which is lofty and covered in with glass, we arrive attwo sidewings running right and left from the centre, and formingcross-corridors. These are the wards: twelve on one hand for male, twelve on the other for female patients. The cross-corridors aretwelve feet wide and twenty feet high, and are roofed with glass; Thecorridor on each side is a framework of walls of glazed brick, arched over head, and divided into six segments. In each segment isa separate, light, elegant removable ward, constructed of glass andiron, twelve feet high, fourteen feet long, and ten feet wide. Thecubic capacity of each ward is 1, 680 feet. Every patient who is illenough to require constant attendance has one of these wards entirelyto himself, so that the injurious influences on the sick, which arecreated by mixing up, in one large room, the living and the dying;those who could sleep, were they at rest, with those who cannotsleep, because they are racked with pain; those who are too nervousor sensitive to move, or cough, or speak, lest they should disturbothers; and those who do whatever pleases them:--these bad influencesare absent. 

The wards are fitted up neatly and elegantly. At one end they openinto the corridor, at the other towards a verandah which leads to agarden. In bright weather those sick persons, who are even confined tobed, can, under the direction of the doctor, be wheeled in their bedsout into the gardens without leaving the level floor. The wards arewarmed by a current of air made to circulate through them by theaction of a steam-engine, with which every hospital is supplied, andwhich performs such a number of useful purposes, that the wonder is, how hospital management could go on without the engine. 

If at any time a ward becomes infectious, it is removed from itsposition and is replaced by a new ward. It is then taken to pieces, disinfected, and laid by ready to replace another that may requiretemporary ejection. 

The hospital is supplied on each side with ordinary baths, hot-airbaths, vapour baths, and saline baths. 

A day sitting-room is attached to each wing, and every reasonablemethod is taken for engaging the minds of the sick in agreeable andharmless pastimes. 

Two trained nurses attend to each corridor, and connected with thehospital is a school for nurses, under the direction of the medicalsuperintendent and the matron. From this school, nurses are providedfor the town; they are not merely efficient for any duty in thevocation in which they are always engaged, either within the hospitalor out of it, but from the care with which they attend to their ownpersonal cleanliness, and the plan they pursue of changing everygarment on leaving an infectious case, they fail to be the bearers ofany communicable disease. To one hospital four medical officers areappointed, each of whom, therefore, has six resident patients underhis care. The officers are called simply medical officers, thedistinction, now altogether obsolete, between physicians and surgeonsbeing discarded. 

The hospital is brought, by an electrical wire, into communicationwith all the fire-stations, factories, mills, theatres, and otherimportant public places. It has an ambulance always ready to be sentout to bring any injured persons to the institution. The ambulancedrives straight into the hospital, where a bed of the same height onsilent wheels, so that it can be moved without vibration into a ward, receives the patient. 

The kitchens, laundries, and laboratories are in a separate block atthe back of the institution, but are connected with it by the centralcorridor. The kitchen and laundries are at the top of this building, the laboratories below. The disinfecting-room is close to theengine-room, and superheated steam, which the engine supplies, is usedfor disinfection. 

The out-patient department, which is apart from the body of thehospital, resembles that of the Queen's Hospital, Birmingham, --thefirst out-patient department, as far as I am aware, that ever deservedto be seen by a generous public. The patients waiting for adviceare seated in a large hall, warmed at all seasons to a proper heat, lighted from the top through a glass roof, and perfectly ventilated. The infectious cases are separated carefully from the rest. Theconsulting rooms of the medical staff are comfortably fitted, thedispensary is thoroughly officered, and the order that prevails is soeffective that a sick person, who is punctual to time, has never towait. 

The medical officers attached to the hospital in our model city areallowed to hold but one appointment at the same time, and that for alimited period. Thus every medical man in the city obtains the equaladvantage of hospital practice, and the value of the best medical andsurgical skill is fairly equalised through the whole community. 

In addition to the hospital building is a separate block, furnishedwith wards, constructed in the same way as the general wards, for thereception of children suffering from any of the infectious diseases. These wards are so planned that the people, generally, send sickmembers of their own family into them for treatment, and pay for theprivilege. 

Supplementary to the hospital are certain other institutions of akindred character. To check the terrible course of infantile mortalityof other large cities, --the 76 in the 1, 000 of mortality under fiveyears of age, homes for little children are abundant. In these thedestitute young are carefully tended by intelligent nurses; so thatmothers, while following their daily callings, are enabled to leavetheir children under efficient care. 

In a city from which that grand source of wild mirth, hopeless sorrowand confirmed madness, alcohol, has been expelled, it could hardly beexpected that much insanity would be found. The few who are insane areplaced in houses licensed as asylums, but not different in appearanceto other houses in the city. Here the insane live, in smallcommunities, under proper medical supervision, with their own gardensand pastimes. 

The houses of the helpless and aged are, like the asylums, the same asthe houses of the rest of the town. No large building of pretentiousstyle uprears itself for the poor; no men badged and badgered aspaupers walk the place. Those poor who are really, from physicalcauses, unable to work, are maintained in a manner showing thatthey possess yet the dignity of human kind; and that, being worthpreservation, they are therefore worthy of respectful tenderness. Therest, those who can work, are employed in useful labours, which payfor their board. If they cannot find work, and are deserving, they maylodge in the house and earn their subsistence; or they may live fromthe house and receive pay for work done. If they will not work, they, as vagrants, find a home in prison, where they are compelled to sharethe common lot of mankind. 

Our model city is of course well furnished with baths, swimmingbaths, Turkish baths, playgrounds, gymnasia, libraries, board schools, fine-art schools, lecture halls, and places of instructive amusement. In every board-school drill forms part of the programme. I need notdwell on these subjects, but must pass to the sanitary officers andoffices. 

There is in the city one principal sanitary officer, a duly qualifiedmedical man elected by the Municipal Council, whose sole duty it is towatch over the sanitary welfare of the place. Under him, as sanitaryofficers, are all the medical men who form the poor law medical staff. To him these make their reports on vaccination and every matterof health pertaining to their respective districts; to him everyregistrar of births and deaths forwards copies of his registrationreturns; and to his office are sent, by the medical men generally, registered returns of the cases of sickness prevailing in thedistrict. His inspectors likewise make careful returns of all theknown prevailing diseases of the lower animals and of plants. To hisoffice are forwarded, for examination and analysis, specimens of foodsand drinks suspected to be adulterated, impure, or otherwiseunfitted for use. For the conduction of these researches the sanitarysuperintendent is allowed a competent chemical staff. Thus, under thiscentral supervision, every death, every disease of the living world inthe district, and every assumable cause of disease, comes to light andis subjected, if need be, to inquiry. 

At a distance from the town are the sanitary works, the sewage pumpingworks, the water and gas works, the slaughter-houses and the publiclaboratories. The sewage, which is brought from the town partly byits own flow and partly by pumping apparatus, is conveyed away towell-drained sewage farms belonging to, but at a distance from, thecity where it is utilised. 

The water supply, derived from a river which flows to the south-westof the city, is unpolluted by sewage or other refuse, is carefullyfiltered, is tested twice daily, and if found unsatisfactory issupplied through a reserve tank, after it has been made to undergofurther purification. It is carried through the city everywhere byiron pipes. Leaden pipes are forbidden. In the sanitary establishmentare disinfecting rooms, a mortuary, and ambulances for the conveyanceof persons suffering from contagious disease. These are at all timesopen to the use of the public, subject to the few and simple rules ofthe management. 

The gas, like the water, is submitted to regular analysis by the staffof the sanitary officer, and any fault which may be detected, andwhich indicates a departure from the standard of purity framed by theMunicipal Council, is immediately remedied, both gas and water beingexclusively under the control of the local authority. 

The inspectors of the sanitary officer have under them a body ofscavengers. These, each day, in the early morning, pass through thevarious districts allotted to them, and remove all refuse in closedvans. Every portion of manure from stables, streets, and yards isin this way removed daily, and transported to the city farms forutilisation. 

Two additional conveniences are supplied by the scientific work ofthe sanitary establishment. From steam-works steam is condensed, anda large supply of distilled water is obtained and preserved in aseparate tank. This distilled water is conveyed by a small maininto the city, and is supplied at a moderate cost for those domesticpurposes for which hard water is objectionable. 

The second sanitary convenience is a large ozone generator. By thisapparatus ozone is produced in any required quantity, and is made toplay many useful purposes. It is passed through the drinking waterin the reserve reservoir whenever the water shows excess of organicimpurity, and it is conveyed into the city for diffusion into privatehouses, for purposes of disinfection. 

The slaughter-houses of the city are all public, and are separatedby a distance of a quarter of a mile from the city. They are easilyremovable edifices, and are under the supervision of the sanitarystaff. The Jewish system of inspecting every carcase that is killed isrigorously carried out, with this improvement, that the inspector is aman of scientific knowledge. 

All animals used for food, --cattle, fowls, swine, rabbits, --aresubjected to examination in the slaughter-house, or in the market, ifthey be brought into the city from other depôts. The slaughter-housesare so constructed that the animals killed are relieved from the painof death. They pass through a narcotic chamber, and are brought to theslaughterer oblivious of their fate. The slaughter-houses drain intothe sewers of the city, and their complete purification daily, fromall offal and refuse, is rigidly enforced. 

The buildings, sheds, and styes for domestic food-producing animalsare removed a short distance from the city, and are also under thesupervision of the sanitary officer; the food and water supplied forthese animals comes equally, with human food, under proper inspection. 

One other subject only remains to be noticed in connection with thearrangements of our model city, and that is the mode of the disposalof the dead. The question of cremation and of burial in the earthhas been considered, and there are some who advocate cremation. Forvarious reasons the process of burial is still retained. Firstly, because the cremation process is open to serious medico-legalobjections; secondly, because, by the complete resolution of the bodyinto its elementary and inodorous gases in the cremation furnace, thatintervening chemical link between the organic and inorganic worlds, the ammonia, is destroyed, and the economy of nature is therebydangerously disturbed; thirdly, because the natural tendencies of thepeople lead them still to the earth, as the most fitting resting-placeinto which, when lifeless, they should be drawn. 

Thus the cemetery holds its place in our city, but in a form muchmodified from the ordinary cemetery. The burial ground is artificiallymade of a fine carboniferous earth. Vegetation of rapid growth iscultivated over it. The dead are placed in the earth from the bier, either in basket work or simply in the shroud; and the monumentalslab, instead of being set over or at the head or foot of a raisedgrave, is placed in a spacious covered hall or temple, and recordssimply the fact that the person commemorated was recommitted to earthin those grounds. In a few months, indeed, no monument wouldindicate the remains of any dead. In that rapidly-resolving soil thetransformation of dust into dust is too perfect to leave a trace ofresiduum. The natural circle of transmutation is harmlessly completed, and the economy of nature conserved. 

RESULTS. 

Omitting, necessarily, many minor but yet important details, I closethe description of the imaginary health city. I have yet to indicatewhat are the results that might be fairly predicted in respect to thedisease and mortality presented under the conditions specified. 

Two kinds of observation guide me in this essay: one derived fromstatistical and sanitary work; the other from experience, extended nowover thirty years, of disease, its phenomena, its origins, its causes, its terminations. 

I infer, then, that in our model city certain forms of disease wouldfind no possible home, or, at the worst, a home so transient as notto affect the mortality in any serious degree. The infantile diseases, infantile and remittent fevers, convulsions, diarrhoea, croup, marasmus, dysentery, would, I calculate, be almost unknown. Typhusand typhoid fevers and cholera could not, I believe, exist in thecity except temporarily, and by pure accident; small-pox would bekept under entire control; puerperal fever and hospital fever would, probably, cease altogether; rheumatic fever, induced by residencein damp houses, and the heart disease subsequent upon it, wouldbe removed. Death from privation and from purpura and scurvy wouldcertainly cease. Delirium tremens, liver disease, alcoholic phthisis, alcoholic degeneration of kidney and all the varied forms ofparalysis, insanity, and other affections due to alcohol, wouldbe completely effaced. The parasitic diseases arising from theintroduction into the body, through food, of the larvae of theentozoa, would cease. That large class of deaths from pulmonaryconsumption, induced in less favoured cities by exposure to impureair and badly ventilated rooms, would, I believe, be reduced so as tobring down the mortality of this signally fatal malady one third atleast. 

Some diseases, pre-eminently those which arise from uncontrollablecauses, from sudden fluctuations of temperature, electrical storms, and similar great variations of nature, would remain as active asever; and pneumonia, bronchitis, congestion of the lungs, and summercholera, would still hold their sway. Cancer, also, and alliedconstitutional diseases of strong hereditary character, would yet, asfar as I can see, prevail. I fear, moreover, it must be admitted thattwo or three of the epidemic diseases, notably scarlet fever, measles, and whooping cough, would assert themselves, and, though limitedin their diffusion by the sanitary provisions for arresting theirprogress, would claim a considerable number of victims. 

With these last facts clearly in view, I must be careful not to claimfor my model city more than it deserves; but calculating the mortalitywhich would be saved, and comparing the result with the mortalitywhich now prevails in the most favoured of our large English towns, Iconclude that an average mortality of eight per thousand would be themaximum in the first generation living under this salutary _régime_. That in a succeeding generation Mr. Chadwick's estimate of a possiblemortality of five per thousand would be realised, I have no reasonabledoubt, since the almost unrecognised, though potent, influence ofheredity in disease would immediately lessen in intensity, and thehealthier parents would bring forth the healthier offspring. 

As my voice ceases to dwell on this theme of a yet unknown city ofhealth, do not, I pray you, wake as from a mere dream. The detailsof the city exist. They have been worked out by those pioneers ofsanitary science, so many of whom surround me to-day, and speciallyby him whose hopeful thought has suggested my design. I am, therefore, but as a draughtsman, who, knowing somewhat your desires andaspirations, have drawn a plan, which you in your wisdom can modify, improve, perfect. In this I know we are of one mind, that though theideal we all of us hold be never reached during our lives, we shallcontinue to work successfully for its realisation. Utopia itself isbut another word for time; and some day the masses, who now heed usnot, or smile incredulously at our proceedings, will awake to ourconceptions. Then our knowledge, like light rapidly conveyed from onetorch to another, will bury us in its brightness. 

 _By swift degrees the love of Nature works And warms the bosom: till at last, sublimed To rapture and enthusiastic heat, We feel the present DEITY, and taste The joy of GOD to see a happy world!_