Hygeia, a City of Health Part 1

Hygeia, a City of Health.

by Benjamin Ward Richardson.

TO EDWIN CHADWICK, C.B.

MY DEAR MR. CHADWICK,

_I wrote this Address with the intention of dedicating it to you, as a simple but hearty acknowledgment by a sanitary student, himself well ripened in the work, of your pre-eminent position as the living leader of the sanitary reformation of this century.

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

In this sense of my respect for you, and of my grat.i.tude, pray accept this 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 for some months, to see if the favour with which it was received would remain. I am satisfied to find that the good fortune which originally attended the effort holds on, and that in publishing it now in a separate form I am acting in obedience to a generally expressed desire.

Since the delivery of the Address before the Health Department of the Social Science Congress, over which I had the honour to preside, at Brighton, in October last, every day has brought some new suggestion bearing on the subjects discussed, and the temptation has been great to add new matter, or even to recast the essay and bring it out as a more compendious work. On reflection I prefer to let it take its place in literature, in the first instance, in its original and simple dress.

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

HYGEIA, A CITY OF HEALTH

We meet in this a.s.sembly, a voluntary Parliament of men and women, to study together and to exchange knowledge and thought on works of every-day life and usefulness. Our object, to make the present existence better and happier; to inquire, in this particular section of our Congress:--What are the conditions which lead to the pain and penalty of disease; what the means for the removal of those conditions when they are discovered? What are the most ready and convincing methods of making known to the uninformed the facts: that many of the conditions are under our control; that neither mental serenity nor mental development can exist with an unhealthy animal organisation; that poverty is the shadow of disease, and wealth the shadow of health?

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 those who have yet to be; those to whom we may become known, but whom we can never know, who are the ourselves, unseen to ourselves, continuing our mission.

We are privileged more than any who have as yet lived on this planet in being able to foresee, and in some measure estimate, the results of our wealth of labour as it may be possibly extended over and through the unborn. A few scholars of the past, like him who, writing to the close of his mortal day, sang himself to his immortal rest with the '_Gloria in excelsis_,' a few scholars might foresee, even as that Baeda did, that their living actual work was but the beginning of their triumphant course through the ages,--the momentum. But the ma.s.ses 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 has been the pa.s.s, if not the pa.s.sword, with them and theirs.

We, scholars of modern thought, have the broader, and therefore more solemn and obligatory knowledge, that however many to-morrows may come, and whatever fate they may bring, we never die; that, strictly speaking, no one yet who has lived has ever died; that for good or for evil our every change from potentiality into motion is carried on beyond our own apparent transitoriness; that we are the waves of the ocean of life, communicating motion to the expanse before us, and leaving the history we have made on the sh.o.r.e behind.

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

At the close of a Parliamentary session, an uneventful leader of a section of Parliament banters his more eventful rival, and enlivening his criticism by a sneer at our Congress, challenges the contempt of 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 even like Parliaments, do live sometimes for many years and talk much, and seem to miss much and advance little; so that in what relates to the mere present it were wrong, possibly, to challenge the sally of the statesman who, from his own helpless height, looked down on our weakness. But inasmuch as no man knoweth the end of the spoken word, as that which is spoken to-day, earnestly and simply, may not reappear for years, and may then appear with force and quality of hidden virtue, there is reason for our uniting together beyond the proof of necessity which is given in the fact of our existence. Perchance some day our natural learning, gathered in our varied walks of life, and submitted in open council, may survive even Parliamentary strife; perchance our resolutions, though no sign-manual immediately grace them, are the informal bills which ministers and oppositions shall one day discuss, Parliaments pa.s.s, royal hands sign, and the fixed administrators of the will of the nation duly administer.

These thoughts on the future, rather than on the pa.s.sing influence of our congressional work, have led me to the simple design of the address which, as President of this Section, I venture to submit to you to-day. It is my object to put forward a theoretical outline of a community so circ.u.mstanced and so maintained by the exercise of its own freewill, guided by scientific knowledge, that in it the perfection of sanitary results will be approached, if not actually realised, in the co-existence of the lowest possible general mortality with the highest possible individual longevity. I shall try to show a working community in which death,--if I may apply so common and expressive a phrase on so solemn a subject,--is kept as nearly as possible 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 past what hope there is of any such advancement of human progress. For, as my Lord of Verulam quaintly teaches, 'the past ever deserves that men should stand upon it for awhile to see which way they should go, but when they have made up their minds they should hesitate no longer, but proceed with cheerfulness,' For a moment, then, we will stand on the past.

From this vantage-ground we gather the fact, that onward with the simple progress of true civilisation the value of life has increased.

Ere yet the words 'Sanitary Science' had been written; ere yet the heralds of that science (some of whom, in the persons of our ill.u.s.trious colleagues, Edwin Chadwick and William Fair, are with us in this place at this moment), ere yet these heralds had summoned the world to answer for its profligacy of life, the health and strength of mankind was undergoing improvement. One or two striking facts must be sufficient in the brief s.p.a.ce at my disposal to demonstrate this truth. In England, from 1790 to 1810, Heberden calculated that the general mortality diminished one-fourth. In France, during the same period, the same favourable returns were made. The deaths in France, Berard calculated, were 1 in 30 in the year 1780, and during the eight years, from 1817 to 1828, 1 in 40, or a fourth less. In 1780, out of 100 new-born infants, in France, 50 died in the two first years; in the later period, extending from the time of the census that was taken in 1817 to 1827, only 38 of the same age died, an augmentation of infant life equal to 25 per cent. In 1780 as many as 55 per cent. died before reaching the age of ten years; in the later period 43, or about a fifth less. In 1780 only 21 persons per cent. attained the age of 50 years; in the later period 32, or eleven more, reached that term. In 1780 but 15 persons per cent, arrived at 60 years; in the later period 24 arrived at that age.

Side by side with these facts of the statist we detect other facts which show that in the progress of civilisation the actual organic strength and build of the man and woman increases. As in the highest developments of the fine arts the sculptor and painter place before us the finest imaginative types of strength, grace, and beauty, so the silent artist, civilisation, approaches nearer and nearer to perfection, and by evolution of form and mind developes what is practically a new order of physical and mental build. Peron,--who first used, if he did not invent, the little instrument, the dynamometer, or muscular-strength measurer,--subjected persons of different stages of civilisation to the test of his gauge, and discovered that the strength of the limbs of the natives of Van Diemen's Land and New Holland was as 50 degrees of power, while that of the Frenchmen was 69, and of the Englishmen 71. The same order of facts are maintained in respect to the size of body. The stalwart Englishman of to-day can neither get into the armour nor be placed in the sarcophagus of those sons of men who were accounted the heroes of the infantile life of the human world.

We discover, moreover, from our view of the past, that the developments of tenacity of life and of vital power have been comparatively rapid in their course when they have once commenced.

There is nothing discoverable to us that would lead to the conception of a human civilisation extending back over two hundred generations; and when in these generations we survey the actual effect of civilisation, so fragmentary and overshadowed by persistent barbarism, in influencing disease and mortality, we are reduced to the observation of at most twelve generations, including our own, engaged, indirectly or directly, in the work of sanitary progress. During this comparatively brief period, the labour of which, until within a century, has had no systematic direction, the changes for good that have been effected are amongst the most startling of historical facts.

Pestilences which decimated populations, and which, like the great plague of London, destroyed 7,165 people in a single week, have lost their virulency; gaol fever has disappeared, and our gaols, once each a plague-spot, have become, by a strange perversion of civilisation, the health spots of, at least, one kingdom. The term, Black Death, is heard no more; and ague, from which the London physician once made a fortune, is now a rare tax even on the skill of the hardworked Union Medical Officer.

From the study of the past we are warranted, then, in a.s.suming that civilisation, unaided by special scientific knowledge, reduces disease and lessens mortality, and that the hope of doing still more by systematic 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 can of themselves effect so much, they might safely be left to themselves to complete, through the necessity of their demands, the whole sanitary code. If this were so, a formula for a city of health were practically useless. The city would come without the special call for it.

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

The existing calendar of diseases, studied in connection with the cla.s.sical history of the diseases written for us by the longest unbroken line of authorities in the world of letters, shows, in unmistakable language, that the imposition of every known malady of man is coeval with every phase of his recorded life on the planet. No malady, once originated, has ever actually died out; many remain as potent as ever. That wasting fatal scourge, pulmonary consumption, is the same in character as when Coelius Aurelia.n.u.s gave it description.

The cancer of to-day is the cancer known to Paulus Eginaeta. The Black Death, though its name is gone, lingers in malignant typhus. The great plague of Athens is the modern great plague of England, scarlet fever.

The dancing mania of the Middle Ages and the convulsionary epidemic of Montmartre, subdued in their violence, are still to be seen in some American communities, and even at this hour in the New Forest of England. Small-pox, when the blessed protection of vaccination is withdrawn, is the same virulent destroyer as it was when the Arabian Rhazes defined it. Ague lurks yet in our own island, and, albeit the physician is not enriched by it, is in no symptom changed from the ague that Celsus knew so well. Cholera, in its modern representation is more terrible a malady than its ancient type, in so far as we have knowledge of it from ancient learning. And that fearful scourge, the great plague of Constantinople, the plague of hallucination and convulsion which raged in the Fifth Century of our era, has in our time, under the new names of tetanoid fever and cerebro-spinal meningitis, been met with here and in France, and in Ma.s.sachusetts has, in the year 1873, laid 747 victims in the dust.

I must cease these ill.u.s.trations, though I could extend them fairly over the whole chapter of disease, past and present. Suffice it if I have proved the general propositions, that disease is now as it was in the beginning, except that in some examples of it it is less virulent; that the science for extinguishing any one disease has yet to be learned; that, as the bases of disease exist, untouched by civilisation, so the danger of disease is ever imminent, unless we specially provide against it; that the development of disease may occur with original virulence and fatality, and may at any moment be made active under accidental or systematic ignorance.

A CITY OF HEALTH.

I now come to the design I have in hand. Mr. Chadwick has many times told us that he could build a city that would give any stated mortality, from fifty, or any number more, to five, or perhaps some number less, in the thousand annually. I believe Mr. Chadwick to be correct to the letter in this statement, and for that reason I have projected a city that shall show the lowest mortality. I need not say that no such city exists, and you must pardon me for drawing upon your imaginations as I describe it. Depicting nothing whatever but what is at this present moment easily possible, I shall strive to bring into ready and agreeable view a community not abundantly favoured by natural resources, which, under the direction of the scientific knowledge acquired in the past two generations, has attained a vitality not perfectly natural, but approaching to that standard. In an artistic sense it would have been better to have chosen a small town or large village than a city for my description; but as the great mortality of States is resident in cities, it is practically better to take the larger and less favoured community. If cities could be transformed, the rest would follow.

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

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

The safety of the population of the city is provided for against density by the character of the houses, which ensures an equal distribution 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 the tradespeople require a place of mart or shop, the houses are four stories high, and in some of the western streets where the houses are separate, three and four storied buildings are erected; but on the whole it is found bad to exceed this range, and as each story is limited to 15 feet, no house is higher than 60 feet.

The substratum of the city is of two kinds. At its northern and highest part, there is clay; at its southern and south-eastern, gravel. Whatever disadvantages might spring in other places from a retention of water on a clay soil, is here met by the plan that is universally followed, of building every house on arches of solid brickwork. So, where in other towns there are areas, and kitchens, and servants' offices, there are here subways through which the air flows freely, and down the inclines of which all currents of water are carried away.

The acreage of our model city allows room for three wide main streets or boulevards, which run from east to west, and which are the main thoroughfares. Beneath each of these is a railway along which the heavy traffic of the city is carried on. The streets from north to south which cross the main thoroughfares at right angles, and the minor streets which run parallel, are all wide, and, owing to the lowness of the houses, are thoroughly ventilated, and in the day are filled with sunlight. They are planted on each side of the pathways with trees, and in many places with shrubs and evergreens. All the inters.p.a.ces 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 of several houses. They are surrounded with garden s.p.a.ce, and add not only to the beauty but to the healthiness of the city. The large houses 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 is noiseless, cleanly, and durable. Tramways are nowhere permitted, the system of underground railways being found amply sufficient for all purposes. The side pavements, which are everywhere ten feet wide, are of white or light grey stone. They have a slight incline towards the streets, and the streets have an incline from their centres towards the margins of the pavements.