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Plagues & Epidemics The
first epidemic of a waterborne disease probably was caused by an infected caveman
relieving himself in waters upstream of his neighbors. Perhaps
the entire clan was decimated, or maybe the panicky survivors packed up their gourds and
fled from the "evil spirits" inhabiting their camp to some other place. As
long as people lived in small groups, isolated from each other, such incidents were
sporadic. But as civilization progressed, people began clustering into cities. They shared
communal water, handled unwashed food, stepped in excrement from casual discharge or
spread as manure, used urine for dyes, bleaches, and even as an antiseptic. As
cities became crowded, they also became the nesting places of waterborne, insect-borne,
and skin-to-skin infectious diseases that spurted out unchecked and seemingly at will.
Typhus was most common, reported Thomas Sydenham, England's first great physician, who
lived in the 17th century and studied early history. Next came typhoid and relapsing
fever, plague and other pestilential fever, smallpox and dysentery's - the latter a
generic class of disease that includes what's known as dysentery, as well as cholera. The
ancients had no inkling as to the true cause of their misery. People believed divine
retribution caused plagues and epidemics, or else bad air, or conjunction of the planets
and stars, any and all of these things. Ignorance
Ain't Bliss!
How else to explain healthy people suddenly falling dead within hours and soldiers struck
down with no signs of wounds? What else would cause such excruciating deaths, accompanied
by delirium or hallucination, the body wracked by yellow or green or black vomit or
excreta; or covered with obscene black boils, terrible red rashes or ghastly blue pallor?
Why else would such sickness remain for months, then leave suddenly and not reappear till
years later? Or perhaps it was replaced by a plague more deadly. Hypocrites,
the "Father of Medicine" who lived around 350 B.C., recommended boiling water to
filter out impurities---those particles that pollute its sweet taste, mar its clarity or
poison the palate. He
was onto something, but his advice pertained only to what the observer could taste, touch,
smell or see with the naked eye. The "what you see is what you get" approach was
about the extent of scientific water analysis until the late 1800s. That
invisible organisms also thrive and swim around
in a watery environment was beyond imagination until a few centuries ago, and their
connection with disease wasn't established till a scant 100 years ago. Although the
microscope was invented in 1674, it took 200 years more for scientists to discover its use
in isolating and identifying specific microbes of particular disease. Only then could
public health campaigns and sanitary engineering join forces in eradicating ancient and
recurring enteric diseases, at least in developed countries of the world. Cleaning
Up: From
archeology we learn that various ancient civilizations began to develop rudimentary
plumbing. Evidence has turned up a primitive flushing water closet used by the fabled King
Minos of Crete back around 1700 B.C. The Sea Kings of Crete were renowned for their
extravagant bath rooms, running hot and cold water systems, and fountains constructed with
fabulous jewels and workings of gold and silver. Just
a few months ago, a colorful public latrine dating to the 4th century B.C. was unearthed
on the Aegean island of Amorgos. The 7'x 5' structure resembles a little Greek temple.
Topped with a stone roof, the interior walls decorated in red, yellow and green plaster,
it served a gymnasium a short distance away. The building accommodated four people seated
on two marble benches. Running water flushed the wastes away, probably along an open ditch
at the users' feet. Ancient
water supply and sewerage systems---along with various kinds of luxury plumbing for the
nobility---also have been discovered in early centers of civilization such as Carthage,
Athens and Jerusalem as well. But it was the Roman Empire of biblical times that reigns
supreme, by historical standards, in cleanliness, sanitation and water supply. The
Romans built huge aqueducts conveying millions of gallons of water daily, magnificent
public baths and remarkable sewer systems---one of which, the Cloaca Maxmia, is still in
use. Rome spread its plumbing technology throughout many of its far-flung territories as
well. Yet,
while we may rightfully marvel at the Roman legacy in plumbing, it should be noted that
they were motivated primarily by concerns of esthetics, comfort and convenience. They
understood very well that bringing fresh water to the masses and disposing of waste made
for a more pleasant way of life, but there is little evidence they understood the
connection with disease control. Bursting
Rome's Bubble:
In fact, the magnificence great city-state diminishes quite a bit when its plumbing
systems come under closer scrutiny. Rome
sprang up in haphazard fashion, a town of crooked, narrow streets and squalid houses. In
its heyday, Rome had a population of over one million, and waste disposal was a definite
problem. The
water supply of Rome was obtained from ground water and rain water, and in many cases
these mixed together. The lowlands of the countryside were swampy marshes which developed
into malarial wastelands. The Romans developed underground channels to drain the natural
swamps and secure water for irrigation and drinking. Nonetheless, a particular region
known as the Pontine Marshes were all but uninhabitable during the summertime, until
drained during the regime of Benito Mussolini (some 40,000 Italians died in a 16th century
malaria epidemic). A
luxury toilet in the private houses of the well-to-do was a small, oblong hole in the
floor, without a seat---similar to toilets that prevail in the Far East and other sections
of the world even today. A vertical drain connected the toilet to a cesspool below. The
great Roman spas accommodated hundreds and even thousands of bathers at a time. But
without filtration or circulation systems, the bathers basked in germ-ridden water and the
huge pools had to be emptied and refilled daily. In
public latrines, a communal bucket of salt water stood close by in which rested a long
stick with a sponge tied to one end. The user would cleanse his person with the spongy end
and return the stick to the water for the next one to use. The stick later evolved into
the shape of a hockey stick, and the source for the expression "getting hold of the
wrong end of the stick." It also provided an excellent medium for passing along
bacteria and the assorted diseases they engendered. Running
water for the latrine either was supplied by stone water tanks or else by an aqueduct
patterned after the graceful, curved arches made famous by the Roman engineers. Those
water experts knew that covering water keeps it cool from the sun and helps prevent the
spread of algae. Imperfect
though their plumbing knowledge may have been, the Roman Empire still did an admirable job
assuring public cleanliness and, inadvertently, health. Rome employed administrators known
as aediles to oversee various public works,
including coliseum games and the police. They also were in charge of seeing that streets
got swept of garbage and streams cleared of visible pollution and debris. Decline
& Fall: Though
the Roman Empire would last until the 6th century A.D., its fall was preceded by centuries
of gradual decay, conflict and unrest. Ironically,
some historians suggest that the Roman plumberi
(plumbers) may have played a significant role in the downfall due to their extensive use
of lead. So
prized was the craftsmanship of these plumberi
that in lieu of present-day status symbols like a Rolls Royce or Porsche, our Roman
ancestors boasted of lead pipes in their houses, especially those imprinted with the
plumber's name (usually female, by the way), and that of the building owner. Lead
poisoning is at least a plausible explanation for the dementia of Roman emperors such as
Caligula and Nero, and for a general weakening and demoralization of the populace at
large. However, the case for massive lead poisoning is far from proven, and water piping
was hardly the only source of lead contamination. The widespread use of lead cooking
utensils and goblets probably was more harmful than its use in plumbing. Whatever
the causes, over time there was a noticeable deterioration in the moral values, dignity
and physical character of Roman society. Symbolic of this general decline, by the time of
Augustus Caesar in 14 A.D., the once authoritative aediles
collected the waste only at state-sponsored events. During
the final century of Roman domination, there was a succession of earthquakes, volcanic
eruptions and disease epidemics. Soon afterwards, rampaging vandals and other barbaric
tribes completed the breakdown of Western civilization, as they systematically leveled and
defiled the great Roman cities and their water systems. Then
came a thousand years of medieval squalor. A thousand years of sicknesses and plague of
unbridled virulence, fanned by fleas and mosquitoes, excrement and filth, stagnant and
contaminated water of every description. Age
Of Disease:
The typical peasant family of the aptly-named Dark Ages lived in a one-room, dirt-floor
hovel, with a hole in the thatched roof to let out the smoke of the central fire. The
floor was strewn with hay or rushes, easy havens for lice and vermin. Garbage accumulated
within. If they were lucky, the family had a chamber pot, though more likely they relieved
themselves in the corner of the hovel or in the mire and muck outside. Water
was too precious to use for anything except drinking and cooking, so people rarely bathed.
Heck, they barely changed clothes from one season to another, wearing the same set every
day, perhaps piling on more rags for warmth. These
are the conditions which spawned the infamous Black Plague, killing an estimated one third
of the European population. Although not directly related to bad plumbing, the plague
serves as the most striking example of misery caused by poor sanitation in general, and
the ignorance of people in controlling the outbreak. The
first of several waves hit England in 1348, caused by flea bites spread by insects that
dwelled on host black rats. They, in turn, fed on the garbage and excrement of the masses.
London became largely deserted. The King and Queen and other rich people fled to the
countryside. The poor were the greatest sufferers. Panic,
death and despair followed the abandonment of farms and towns. Wrote William of Dene, a
monk of Rochester in Kent, England, "Men and women carried their own children on
their shoulders to the church and threw them into a common pit. From these pits such an
appalling stench was given off that scarcely anyone dared to walk beside the cemeteries,
so marked a deficiency of labors and workmen that more than a third of the land in the
whole realm was left to." So
bad was the "Black Death," the Great Fire of London in 1666 can be viewed as a
blessing in disguise. Though it killed thousands of people, the holocaust also consumed
garbage, muck and black rats, effectively ending the plague. Camp
Killers:
Bad plumbing was merely one of many sanitation factors that gave rise to the Black Death.
Other scourges are more directly related to human waste. Dysentery is one that has left an
indelible mark on history. Characterized
by painful diarrhea, dysentery is often called an army's "fifth column."
Identified as far back as the time of Hippocrates and before, it comes in various forms of
infectious disorders and is said to have contributed to the defeat of the Crusaders. Wrote
the eminent English historian, Charles Creighton: "The Crusaders of the 11th - 13th
centuries were not defeated so much by the scimitars of the Saracens as by the hostile
bacteria of dysentery and other epidemics." The
summer of the first Crusade in 1099 was extraordinarily hot as the ill-prepared and
rag-tag "army" of men and camp followers went to war with little more than the
clothes on their backs---confident that the Lord would provide for their needs in such a
holy cause. They denuded the land of trees and bushes in the quest for nourishment.
Hampered by lack of fresh water and contaminated containers, they trudged along to their
destiny, relieving themselves along the wayside or in the fields. Dysentery
hit the women and children first, and then the troops. More than 100,00 died plus almost
2,500 German reinforcements whose bodies remained unburied. Typhus
fever is another disease born of bad sanitation. It has come under many headings,
including "jail fever" or "ship fever," because it is so common among
men in pent-up, putrid surroundings. Transmitted by lice that dwell in human feces, the
disease is highly contagious. Napoleon
lost thousands of his men to typhus in Russia---as did the Russians who caught it from the
enemy. Many historians believe that Napoleon would have won were it not for the might of
his opponents "General Winter, General Famine and General Typhus." French
ships were notorious for their filthy and fever-ridden sailors. One such French squadron
left its soiled clothing and blankets behind near Halifax, Nova Scotia, when they returned
to Europe in 1746, thinking they could dispel their own plague. Their infected blankets
wiped out a nation of Indians. Typhoid
fever, a slightly different ailment than typhus, involves a Salmonella bacillus that is
found in the feces and urine of man. The symptoms are so similar to typhus that the two
were not differentiated until 1837. Prince
Albert died from typhoid in 1861. His wife, Queen Victoria, had built-in immunity because
of a previous siege. Good thing, because she is said to have prostrated herself in grief
across the dead body of her beloved husband. Ten
years later, Victoria's son, Edward, almost died from the disease. A plumber traced the
contamination to the lines of a newly-installed water closet and fixed the problem.
Edward, the Prince of Wales, was very grateful to the plumber. Word spread of this episode
and is thought to have hastened the acceptance of the indoor water closet in England. By
the time of the Boer War in 1899-1901, anti-typhoid inoculation was available. By then,
typhoid fever was recognized as a waterborne disease, and that the germ could be killed by
filtering and boiling water. Far from home in South Africa, the undisciplined British
troops succumbed to the hot climate and drank straight from the rivers. Of 400,000 troops,
43,000 contracted typhoid. Closer
to home, typhoid raged on in colonial New York and Massachusetts. It reappeared for the
last time in epidemic form in America in the early 1900s, compliments of the celebrated
Typhoid Mary. Mary
Mallon was a cook for the moneyed set of New York State; her specialty was homemade ice
cream. Officially, she infected 53 people---with three deaths---before she was tracked
down. Unofficially, she is blamed for some 1,400 cases that occurred in 1903 in Ithaca,
where she worked for several families. Never sick herself, it took a lot of persuasion by
authorities to convince her that she was a carrier of the disease. Health authorities
quarantined her once, let her go, then quarantined her for the rest of her life when
another outbreak occurred. The
Cholera Story:
The bad news is that another waterborne disease, cholera, has proven one of history's most
virulent killers. The good news is that it was through cholera epidemics that
epidemiologists finally discovered the link between sanitation and public health, which
provided the impetus for modern water and sewage systems. With
20th-century smugness, we know cholera is caused by ingesting water, food or any other
material contaminated by the feces of a cholera victim. Casual contact with a contaminated
chamber pot, soiled clothing or bedding, etc., might be all that's required. The
disease is stunning in its rapidity. The onset of extreme diarrhea, sharp muscular cramps,
vomiting and fever and then death---all can transpire within 12-48 hours. In
the 19th century cholera became the world's first truly global disease in a series of
epidemics that proved to be a watershed for the history of plumbing. Festering along the
Ganges River in India for centuries, the disease broke out of Calcutta in 1817 with
grand-scale results. India's
traditional, great Kumbh festival at Hardwar in the Upper Ganges triggered the outbreak.
The festival lasts three months, drawing pilgrims from all over the country. Those from
the Lower Bengal brought the disease with them as they shared the polluted water of the
Ganges and the open, crowded camps on its banks. When the festival was over, they carried
cholera back to their homes in other parts of India. There
is no reliable evidence of how many Indians perished during that epidemic, but the British
army counted 10,000 fatalities among its imperial troops. Based on those numbers, it's
almost certain that at least hundreds of thousands of natives must have fallen victim
across that vast land. When
the festival ended, cholera raged along the trade routes to Iran, Baku and Astrakhan and
up the Volga into Russia, where merchants gathered for the great autumn fair in
Nijni-Novgorod. When the merchants went back to their homes in inner Russia and Europe,
the disease went along with them. Cholera
sailed from port to port, the germ making headway in contaminated kegs of water or in the
excrement of infected victims, and transmitted by travelers. The world was getting smaller
thanks to steam-powered trains and ships, but living conditions were slow to improve. By
1827 cholera had become the most feared disease of the century. The
Laughter Died:
It struck so suddenly, a man could be in good health at daybreak and be buried at
nightfall. A New Yorker in 1832 described himself pitching forward in the street "as
if knocked down with an axe. I had no premonition at all." The
ailment seemed capable of penetrating any quarantine of harbor or city. It chose its
victims erratically, with terrifying suddenness and with gross and grotesque results. Acute
dehydration turns victims into wizened caricatures of their former selves. The skin
becomes black and blue, the hands and feet drawn and puckered. The German poet Heinrich
Heine described an outbreak in Paris in a letter to a friend: "A
masked ball in progress ... suddenly the gayest of the harlequins collapsed, cold in the
limbs, and underneath his mask, violet blue in the face. Laughter died out, dancing ceased
and in a short while carriage-loads of people hurried from the Hotel Dieu to die, and to
prevent a panic among the patients were thrust into rude graves in their dominoes [long,
hooded capes worn with a half-mask]. Soon the public halls were filled with dead bodies,
sewed in sacks for want of coffins ... Long lines of hearses stood in queue ..." The
worldwide cholera epidemic was aided by the Industrial Revolution and the accompanying
growth of urban tenements and slums. There was little or no provision at all for cesspools
or fresh water supplies. Tenements rose several stories high, but cesspools were only on
the ground floor with no clear access to sewers or indoor running water. It didn't make
much difference, because until the 1840s a sewer was simply an elongated cesspool with an
overflow at one end. "Night men" had to climb into the morass and shovel the
filth and mire out by hand. In most cases, barrels filled with excrement were discharged
outside, or contents of chamber pots flung from open windows---if there were any---to the
streets below. Water
hydrants or street pumps provided the only source of water, but they opened infrequently
and not always as scheduled. They ran only a few minutes a day in some of the poor
districts. A near riot ensued in Westminster one Sunday when a water pipe that supplied 16
packed houses was turned on for only five minutes that week. Cholera
first hit England through the town of Sunderland, on October 26, 1831. One William Sproat
died that day from the disease, though nobody wanted to admit it. Merchants and officials
found plenty of reasons to rationalize away a prospective 40-day maritime quarantine of
the ports. England
was reaping the profits of the Industrial Revolution and a quarantine of ships would be
catastrophic for the textile industry. At any rate, the medical profession held that
cholera wasn't contagious. Public health administration was in its infancy, and so
disorganized that the leading doctor didn't know there were two infected houses only a
short distance away from each other. He learned of the "coincidence" three
months later. The
American Experience:
American hygiene and sanitation were not much better. Cholera spread through immigrants
from the infected countries, Ireland in particular, whose masses were fleeing the poverty
and despair of the potato famine. Those who could scrape together three pounds for passage
left for North America. Life
aboard an immigrant ship was appalling as ship owners crowded 500 passengers in space
intended for 150. Infected passengers shared slop buckets and rancid water. The
contagion spread as soon as the immigrants landed. In one month, 1,220 new arrivals were
dead in Montreal. Another 2,200 died in Quebec over the summer of 1832. Detroit
became another focal point of cholera. Instead of drawing fresh water from the Detroit
River, people used well water. The land was low and it was much more convenient. But
outhouses placed at odd locations soon contaminated those wells, and cholera spread
quickly. Cholera
entered New York through infected ships. City people started clogging the roads in an exit
to the countryside. On June 29, 1832, the governor ordered a day of fasting and prayers -
the traditional response by government to treating the disease. After July 4, there was a
daily cholera report. Quarantine
regulations which sought to contain towns and cities in upper New York, Vermont and along
the Erie Canal met with little success. Immigrants leaped from halted canal boats and
passed through locks on foot, despite the efforts by contingents of armed militia to stop
them. Some
doctors flatly declared that cholera was indeed epidemic in New York, but more people
sided with banker John Pintard that this "officious report" was an
"impertinent interference" with the Board of Health. The banker incredulously
asked if the physicians had any idea what such an announcement would do to the city's
business. Visitors
were struck by the silence of New York's streets, with their unaccustomed cleanliness and
strewn with chloride of lime (the usual remedy for foul-smelling garbage). Even on
Broadway, passers-by were so few that a man on horseback was a curiosity. One young woman
recalled seeing tufts of grass growing in the little-used thoroughfares. Big
news was unfolding in England then, but no one realized the significance. Steadfast
Ignorance:
The eminent Dr. John Snow demonstrated how cases of cholera that broke out in a district
of central London could all be traced to a single source of contaminated drinking water.
Sixteen years later, Snow would win a 30,000 franc prize by the Institute of France for
his theory that cholera was waterborne and taken into the system by mouth. But
Snow's original work received little attention from the medical profession. He was
attacked at the weakest point---that he could not identify the nature of the
"poison" in the water. By
the end of the first cholera epidemic, the relationship between disease and dirty,
ill-drained parts of town was rather well established. This should have spurred sanitary
reform. But little action followed. An
out-of-sight, out-of-mind syndrome developed when the first epidemic ended. The learned Edinburgh Medical and Surgical Journal at one point
declared they would review no more books on the subject “because of the multitude of
books which have recently issued from the press on the subject of cholera, and our
determination to no longer try the patience of our readers." When
the second cholera epidemic hit England in 1854, Snow described it as "the most
terrible outbreak of cholera which ever occurred in this kingdom." At least it
provided him with an opportunity to test his theory. By
charting the incidence of the disease, he showed that over 500 cases occurred within 10
days over a radius of some 250 yards centered on London's Broad Street. He looked for some
poison which he believed came from the excreta of cholera patients and swallowed by the
new victims. A common factor was their use of water that had been polluted with sewage.
Snow had traced the pipelines of various water companies and showed that one was infected
by cholera. By
the methodical process of elimination, he proved his point: A workhouse in that area had
its own private well, and there were only 5 deaths among its 535 inmates. A brewery on
Broad Street likewise never used the water from the Broad Street pump, and it had no cases
among its 70 workers. The
actual discovery of the comma-shaped bacillus of cholera was made by the German Dr. Robert
Koch in 1876. Through microscopic examination, he ascertained that "excrement may
contain cholera bacteria a good while after the actual attack of the disease." Final
Obstacles:
Cholera was always the worst where poor drainage and human contact came together. This of
course was apt to be in crowded slums. So
at first, those on top of the social heap could reassure themselves that pestilence
attacked only the filthy, the hungry and the ignorant. When the cholera epidemic first hit
Paris, there were so few deaths outside of the lower classes, that the poor regarded the
cholera epidemic as a poison plot hatched by the aristocracy and executed by the doctors.
In Milwaukee, efforts to apply basic health measures were thwarted by rag-pickers and
"swill children" who saw the removal of offal and garbage from the streets as a
threat to their livelihood. As one newspaper editorialized, "It is a great pity if
our stomachs must suffer to save the noses of the rich." The immunity enjoyed by the wealthy was short-lived, however, the open sewers of the poor sections eventually leached into the ground and seeped into wells, or ran along channels into the rivers that supplied drinking water for whole towns and cities. Once the rich and the movers and shakers of society began to get sick, government reform began. Thus
it happened that most municipal water mains and sewer systems got built in the late 19th
century in America. Public health agencies got formed and funded. Building codes and
ordinances got passed and enforced. The
superstitions of the ages had finally run their course. Mankind began to understand that
the evil spirits causing its woes were microscopic creatures that could be defeated by
plumbers and sanitary engineers. Plumbers
finally got to show their stuff in a way that had not been seen since the days of the
Roman Empire.
Thank You to P & M magazine for sharing the important history of plumbing BET YOU NEVER THOUGHT ABOUT YOUR PLUMBING THAT WAY BEFORE. YOU WILL NOW.
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