THE Sanitary Needs of Toledo, Ohio. A PAPER Read by mvi tation before the Social Science Club. By W. W. JONES, M. D., Toledo, Ohio. Toledo, Ohio, February to, 1885. W. W. Jones, M. D., Dear Sir : The Social Science Club very cordial- ly invites you to read a paper before it upon Friday evening, February 27th, upon the Sanitary Condition and Needs of Toledo in view of the" probable approach of cholera. The Club is composed of thirty men who are interested in all that belongs to the city, and upon a presentation of your subject, would probably be of help to your Medical Association in your work of reform. Hoping to receive a favorable answer, I am, Very Cordially Yours, Wm. H. Maher, Chairman Exc. Com. Toledo, Ohio, February nth, 1885. W. H. Maher, Esq., Chairman Exc Com. Social Science Club. Dear Sir : Your note of yesterday inviting me to read a paper before your Club on the 27th inst. , upon the "Sanitary Condition and Needs of Toledo in View of the Probably Approach of Cholera," is received. I will embrace the opportunity offered by your invitation to present some thoughts upon our municipal sanitation with regard to epidemics of cholera. The general subject is so vast, and involves so much that is unknown, that I may have to crave the induluence of your Club. My time is so much occupied that I may have to rely upon extemporaneous remarks rather than a written paper. Very Sincerely Yours W. W. Jones. The Sanitary Needs of Toledo IN VIEW OF THE PROBABLE APPROACH OF CHOLERA. READ BEFORE THE SOCIAL SCIENCE CLUB, FEB. 28th, 1885. DR. W. W. JONES. Gentlemen: Since yoa have invited me to say a few words upon 'the sanitary needs or Toledo in view of the probable approach of cholera," I may commence by saving that the "needs" within our control are such as will promote health and prevent disease under any and all circumstances, with, perhaps, the addition of some quarantine agencies on its near approacn and more rigid sanitary inspection of emigrants and freight connected with them, aiso for refuge stations where cases of cholera break out among them while in transit, so that they can be isolated from the healthy. PKSVENTION OF DISEASE, It is the modest pretense or sanitation that it prevents disease and mortality; hence its effects are not seen except in the good health of a people and the low rate of mortality which does not attract attention, and comes to be looked upon as the normal condition of the municipality. The causes of disease for the most part which it is the province of sanitation to prevent, are so obscure as to elude the vigilance of the wisest detective, but the conditions which favor malignancy, and promote its spread, when its invasion has occurred, are very generally believed to be known. These causes pertain to the individuality of the person, his idyosyncracies, temperament, constitution and his surroundings. The first part of this proposition lequires the study and discrimination of the physician to learn his particular tendencies to disease. The latter, those influences which are without, and surrounding him, and from which he cannot to a certain extent escape. It is these influences from without which make it necessary to organize a Sanitary Board and clothe its officers with extraordinary powers, in order that one careless or ignorant person may not be the means of bringing disease and death upon his innocent family or neighbors. Any one attempting to answer the question of TOLEDO'S NEEDS, In anticipation of any epidemic disease would enquire first of all: Have we a sanitary organization which is entrusted wita the power, and is equal to such an emergency? knowing that its success largely depends upon the knowledge, skill and fidelity of such a municipal organization. In our city we call this a Board of Health, created by a statute of the State, clothed with extraordinary powers, ' Legislative, Executive, Judicial and Ministerial, The complex functions bestowed upon this Board require for their intelligent fulfillment, the highest intellectual powers and attainments, coupled with a knowledge of what is known in very many of the sciences as applied to sanitation, as well as legal discrimination enough to avoid trespassing upon the jubt rights of others. The necessity for such a Board in cities is of somewhat recent origin, and is the outgrowth of progress in the human mind in its attempt to stay the mortality of epidemic disease. CONTBIBTJTING CAUSES. It is a well-settled fact that whatever conduces to disease in any form will in* crease the virulence of au epidemic which may prevail for the time being. In this city cases of sporadic cholera are sasn every year, and nearly all such cases are recognized by physicians as one of the forms of intermittent fever or ague. So in an epidemic of the same disease (cholera) many of the cases commence as an attack of that disease. Some of the causes which produce disease in summer are heat, and extreme oscillations from heat to cold, impure water supply, poor or defective food, overcrowded and poorly ventilated apartments, animal and vegetable filth, defective drainage and escape of noxious gases which contaminate the atmosphere. Some of these causes require for their inspection and finding-out, a class of men with more knowledge and fidelity than is usually found in the ordinary sanitary policeman and inspector. While a man may be a very good policeman to watch over your property and protect your person, he may be so illy qualified to observe causes of disease as 10 tread over them without notice. In ordinary times when health is the normal condition and disease the exception, a street commissioner may perform the duty of health officer and sanitary inspector, and the functions of a Board of Health may be exercised by persons elected for other duties without exciting any just comment. But when an epidemic like cholera invades a community, there comes a frienzied demand for that kind of help upon which reliance can be placed that all will be done which skill and knowledge can accomplish. OTJE WHOLE BEWEBAGE SYSTEM needs to be inspected and its defects remedied. Many years ago it was discovered that the catch basins leading into the sewers of the lower part ol the city had their traps originally built wrong side up, and I have heard complaints every year since, of their effensivecess by residents and people who bave been compelled to pass them. We all know that sewer gasses may breed the worst pestilential diseases, and that when once set np in a family may spread to widely separate parts of a city, through infection, transported by friends and acquaintances, and can not be easily stamped out except by the strong force, •which is by law reposed in a board of health. MY OBSEBVATION AND EXPEEIENCE "WITF CHOLEEA in this country has convinced me that it is not contagious, as that term is used in connection with smallpox, measles, mumps, and, perhaps, whooping cough in children, but that its spread is greatly due to that undefined and undetermined influence of mind upon mind, which is more felt than seen, and which disturbes the individual by its depressant action upon his mental and nerve force. Many years ago, during our cholera epidemics, I used to see illustrations of this in the Irish emigrants whom I used to be called to attend, who, when asked what was the matter, used to repjy, "Och, Doctor, I am sick at the heart." Though this was a somewhat apt illustration of homesickness, yet when pushed a little f nrther, coupled with the fear of some invisible foe who is to be escaped from, it becomes a panic. The history of our country is full of instances where panics caused by the prevalence of epidemic disease, have blasted the prospects of towns and cities for whole generations. Say what you will of miasma, of germe and other influences which are the potent factors in causing ordinary disease, they exercise less influence in the production and spread of cholera, than those just alluded to as affecting nerve force. Every surgeon in the late war knows that it was the scourge of the army. Every physician of extensive observation has seen its blighting effects and will concur in the statement that it is the first thing to be watched for .« the bedside, and its failure most to be dreaded. People repose confidence in an army in proportion to the perfection of its organization and the firmness, intelligence and experience of its commanding officers. So will a people have confidence in a Board of Health in proportion as it is made up* of those best qualified to grapple with the intricate problems of sanitation. CHOLEBA IN 1849. In 1849 when the cholera epidemic first appeared in this city, (for we were scarcely a hamlet in 1832 and 1834 en its previous advent in the country), the Common Council organized a sanitary force consisting of a Board of Health, aided by three or four of our best citizens in each precinct of the city, whose duty it was to call to their aid such nursing and medical skill as they required for the benefit of any who needed it, and also act as a committee for house to house visitation. A cro n of laurel should ornament the brows of those men if living, and the highest honors be paid to their memory if dead, for they carried us safely over the pestilence, without as much as a stampede of persons or business. The grass never grew on our paved or other streets, as in a sister city from a human panic, and we are now enjoying theieward which accrued from the courage and fearless exposure of those men who battled the scourge of 1849 in this city. I notioe beside me as your honorble chairman, Hon. Richard Mott, one of those fearless men of whom I speak. EPIDEMIC PANICS. The more ignorant, superstitious and poor the population of a city, the more liable it is to become panicky and suffer from an epidemic. An illustration of this happened on the east side of the river in the year 1854. That suburb of Toledo was not at that time attached to the city, and contained only about one hundred and fifty people. Cholera had been prevailing in the city since the sth of May, (the first cases having been brought from Galena on the Mississippi river) when suddenly about the 4th or sth of July cholera broke out in that hamlet and in twenty-four hours every house, with a very few exceptions, was deserted. Over twenty deaths had occurred during this time, and as I traversed its streets in the evening, twenty-four hours after its advent, I counted a dozen COFFINS FILLED WITH VICTIMS ABAN- DONED UPON THE SIDEWALK.. Scarcely a light to be seen in the houses, they had been abandoned and their occupants had fled to the farms in the rear, and the towns up the river, where the tales they tsld and the panics they created caused the death of hundreds of people. The picturesque and thrifty town of Perrysburg lost many of its most prominent citizens. Early in tbe course of tue epidemic, Dr. Robertson, one of the best physicians of that town sent for me and when I reached his bedside about 11 o'clock in the evening, he was dying. I can never forget the words be addressed me, "Doctor, I have said much about the want of skill of you doctors of Toledo, because you fail to cure cholera, and let so many people die when there was no need of it. I wish now to say that I take it all back. I have seen and treated it, and my patients have all died. lam dying myself from it, and have no wish to live longer, you can do me no good, the town is full of cases of that disease; go with Dr. Peck and see if you can do tnun any good." I worked the balance of tbe night among the terrorstricken inhabitants making house visitations with Dr. Peck, and returned to the bedside of my medical friend at the dawn of day, but his eyes had meantime been closed in death. FIEST CASK OF CHOLEBA IN 1854. The following extracts from my clinical note book of the first case of cholera occurring here in 1854 illustrate the depressing influence generally found accompanying cases of cholera: "Miss ' t aged 20. Arrived in this city on the atternoon of May 8, 1854, in company with an uncle, William H. Hall, Esq., an attorney of this city, from Galena, 111. Hhd been where cholera prevailed on the Mississippi river, and a lady had died of it at a hotel in Galena, where they had stopped. She told me that she had been considerably alarmed on the way here, and was afraid she would have it, and it had greatly worried and prostrated her. "I first saw her at 9a. m., May 4. She had no percsptible pulse' at the wrist, extremities, tongue and skin cold; voice husky; fingers and lips blue; had had watery discharges every few minutes since 2 a. in., with occasional vomiting and cramps in the muscles of the extremities; died at 12:30 m." WHAT A BOARD OF HEALTH SHOULD BE. In the organization of a Board of Health, it is not necessary or desirable that it should be made up exclusively of physicians or sanitarians. An attorney who can guide the Board amid the pitfalls of legal opposition, an engineer who understands the best means of overcoming those physical causes which promote and spread disease, and the sagacious property owner whose pecuniary interest prompts him to act for the best interest of himself and others like him, are as indispensible as the most accomplished sanitarian. All the numbers of this Board should be imbued with that zeal for the cause of humanity which belongs to the just and fearless, and having this accomplishment, petty or partizan schemes will find no favor in its councils, and no fears need be entertained that its individual members will not soon acquire (if they had it not before) the sanitary knowledge which will enable them to accomplish the expectations in their ap point vent. The sanitary need of Toledo, as well as every other city, whether in times of health or sickness, prosperity or adversity, is "a live Board of Health," such as the statutes of the state contemplate The original forms for their appointment by our municipal code have been changed from time to time to suit the changing phases presented in the life of the different municipalities, their exigencies and their needs, and the views of legislators for the time being. These changes have principally related to the appointment of members of such boards. In some cities these appointments are made by the council, in others elected by the people. In our own, its functions are exercised by a police board. All of these modes of appointment at one time or another have been found to be so objectionable as to invite change. HOW CONSTITUTED. My own opinion is that the nearer you can get the appointing power to individual responsibility, the nearer perfection such an organization will approach. If asked my plan, I would say put the ap« appointing power in the mayor or presiding resident judge of your Common Pleas Court, whose reputation would be at stake in. appointing fit advisors in life and healtb. Such a plan may at first strike one as being objectionable. While I admit that it may occasionally prove so, yet all other plans so far tried in this Srate, have been found wanting in one municipality or another, and sometimes in attempting to better them theyhave made them worse. A knowledge and history of the sanitary legislation of the state, shows that some has had its birth in supposed partisan necessities, much in needed reform, and more in a desire to improve the physical and organic welfare of the people. Some of its wisest and most efficient provisions for preserving the health of the people and of tne State (and which I have never noticed in the laws of other States) have emanated from sanitaries of this city, and yet we have never had a special sanitary club to aid, or spur each other on in the business of preserving and propagating the knowledge of how to preserve healtb, which the most obtuse must admit is worthy of the highest aims to which the individual can aspire. A knowledge of this science, the most important for the happiness and moral good of the race, is not even taught in its elements, in the public schools. A moiety of this knowledge would deliver our people from the imposture practiced upon them by the innumerable horde of quacks who infest our cit? and State only to sponge out the life blood from a confiding people. "Life is short and Art is long." Apply the latter to sanitary science and some appreciation of the magnitude of the subject may be perceived. The ever changing phases of human life in the individual, in the community and in the nation, from its infancy, to maturity and decline, the subtle influences which produce disease, blast the hopes and bring sorrow and pain such as n.akes life a burden unto very many of our race, agencies which affect innocent children, meture age and embitter the decline of life, are all comprised in a knowledge of Sanitary Science. Only the first steps in the long ladder to the goal for which boards of health are organized, can be trod in one generation, and one may reasonably fear that a glimpse within the veil where the day is all sunshine will never be permitted to mortal eyes. Few men can appreciate the benefits to be derived from an efficient sanitary organization in both city and country, and yet all men ought to realize it when medical bills are presented. This city furnishes support to more than one hundred physicians and their families, when they have any. It is safe to say that their least average cost to the people per annum is $l,ooo,making an outlay of 100,-000 for medical services, besides supporting forty retail drug stores, not to speak of the hosts of traveling and other quacks whose advertisements crowd the newspaper columns and bill boards to the detriment of respectable reading matter. Seeing the indifference which exists even among our most intelligent people in regard to life and health, there is great danger that philanthropists and sanitarians will lose heart and give up the self-imposed task of urging measures which are of the most vital consequence, not only to this, but of unborn generations. Many years ago, a duty was imposed upon me by the Ohio State Medical Society of visiting and urging upon the General Assembly of the State the propriety of establishing a State Board of Health. While the members of the Legislature heard me patiently and seemed t > acquiesce in my views, I found upon sending detectives to ascertain what they really thought about it, that their answer was, "That fellow wants an office." Satiated with disgust at the obtuseness of these Legislators, and thoroughly convinced that to be one of them, even if I could, would be degrading by mere association, I resolved to return to my own city and spend what influence I possessed among a people who could appreciate honest effort for its own sake, and whose estimate of the benefits of sanitation was not limited by the desire to promote this or that man to a political office. Thanking you, gentlemen of the club, for the coartesy you have extended in askiog me to address you, allow me to express the hope that a new interest may be awakened in the city that shall result in lasting benefit. As is the custom with the Association the reading of the paper was followed by a general discussion upon the points brought out. The doctor's views were heartily endorsed, and upon motion a committee consisting of Dr. W. W. Jones, Hon. Gaido Marx, Wm. Baker, Esq., and Hon. Richard Mott were appointed to prepare a bill for presentation to the Legislature providing for a Board of Health independent of the Police Board. After thanking Dr. Jones for his address, and the announcement of the subject for the next meeting — "The Benefits Arising From City Parks," by Wm. Baker — the meeting was brought to a close.— Toledo Bee,