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To householders of the 21st century, periodically dismantling and boiling drainage pipes sounds like neurosis, if not pathologic obsession with hygiene. But for citizens of Dr Harvey's day, beset on all sides by warnings of the dangers posed by the microorganisms recently demonstrated by medical scientists to cause the most acute diseases, it seemed that one could not be too careful. Drain pipes, after all, were the source of “sewer gas,” vile germ-laden air that presumably seeped into the house through faulty, filthy plumbing and sickened and sometimes killed its inhabitants. “The waste pipe of the house,” a leader of New York City's public health establishment explained in 1898, is “smeared from top to bottom with the foulest organic matter, putrefying often under the worst conditions,” making it “the worst enemy of those who live in modern houses.”1(pp32,63) “Sewer-gas,” another New York physician maintained, “is to-day killing more persons every year than the yellow fever in its worst periods of epidemic, and so long as water-closets are allowed to exist it will continue to kill.”2(p102) So common were such dire pronouncements up to the beginning of the 20th century, even stoic New Englanders, a public health officer joked, feared sewer gas “perhaps more than they did the Evil One.”3(p50) Sewer gas is a telling demonstration of the power of old ways of thinking to mutate and adapt to new scientific circumstances. That the fumes of human waste could bring disease and death to those who inhaled them was an intuitive belief that had been tightly embraced since antiquity. It was a major component of the miasma theory developed by Galen, the great medical authority of the Roman Empire, who blamed outbreaks of epidemic disease on an atmosphere poisoned by the vapors of decomposing organic matter, be it feces, garbage, or corpses. Before the germ theory, miasma (polluted air) offered a more satisfactory explanation of epidemiologic phenomena than any other interpretation available and, indeed, served as the basis for the sanitary reform movement of the mid-1800s that brought about the establishment of modern public health programs. As sanitary reform's leader, London's Edwin Chadwick, put it, “all smell is disease.”4(p298) Yet, if all smells were bad, human waste was regarded as the worst of the lot. London physician and health officer John Simon was typical of sanitary reformers in singling out feces as the source of “extreme injury.” “It requires very little medical knowledge,” Simon began the first of his numerous annual reports on public health in London, “to understand that animals will scarcely thrive in an atmosphere of their own decomposing excrements.” Most Londoners, however, were confined within just such an atmosphere, the cesspits that received their evacuations being “actually within the four walls of the inhabited house; the latter reared over it, as a bell-glass over the beak of a retort, receiving and sucking up incessantly the unspeakable abomination of its volatile contents.”5(pp3-5) Consequently, the progress of sanitary reform and the advance of public health seemed to depend as much on plumbers as physicians, and the science of sanitary engineering that emerged as a discipline in the second half of the 1800s was dedicated above all to designing drainage systems and “sewer traps” that prevented the reflux of noxious air from sewers back into houses.6(p187),7 Excerpts from The Transactions of the Medical Society of the State of California 1898 HOME SANITATION By Louise Harvey, MD Los Angeles, Cal It would seem a fitting time for us to turn our attention to the sanitary condition of our own homes, and see if some improvements could not be made. That there is room for improvement is evident to every practicing physician.... To the drainage of the house too much attention cannot be paid. The plumbing is best placed entirely outside of the main part of the house, and separated from it by an air space into which the sunshine and air have free access.... Many people are obliged to live in houses where the lavatories are enclosed in the main part of the house, or, as Dr Price puts it, “in enlarged water-closets.” To these people we would say that much may be done to obviate their contaminative influence, first by keeping the plumbing in perfect condition; second, by keeping the bowls and traps clean, and third, by ventilation.... Every householder should have a plan of his house drainage in order to facilitate the finding of faulty pipes or joints. The drain from the ice chest should not have any connection with the sewer or drip through the floor under the house. The ice-box and the waste pipe should be kept perfectly clean with hot water and soap. It would be a good plan to have the waste pipe jointed and removable so that it could be boiled. The introduction of medical bacteriology in the 1870s and 1880s rang miasma's death knell, but the theory did not die without a struggle. Rather, it passed through a long stage of denial, hope for survival being sustained by sewer gas. After all, sewers enclosed the refuse of the human bowel, evacuations that, medical science had discovered, could teem with typhoid, cholera, and other microbes. Surely air that rose from sewers and toilet drains to infiltrate the living quarters above could carry the virtually weightless germs in its ascent. Further, common experience demonstrated that the inhalation of stench made a person feel ill, so a sewer's fumes must lower the resistance of the body to germ invasion even as it introduced germs into it. Smell was still disease, but now doubly malevolent, being both predisposing factor and vector. The smell of the sewer had yet another dimension of viciousness, for it invaded only those houses with indoor toilets, which in the late 19th century meant the homes of society's more affluent, productive members (who, despite their wealth, often balked at investing in the newer drainage systems). Hitherto, smell and disease had been thought of as the province of the poor in their garbage-filled tenements; now it was the mansion that harbored the seeds of destruction. The homes of the rich might seem “to lack nothing to promote comfort, enjoyment, and health,” a writer in the North American Review observed in 1883; but in truth, they were “mere whited sepulchers, and their luxurious inmates are exposed to constant risk of disease and death”8(pp173-174) (quoted by Tomes, whose book is a superb examination of the American public's reception of and reaction to the early germ theory9(p48)). Not even the highest house in the land was immune. When President James Garfield was shot in 1881 and taken to the White House to be treated, his steady decline over the following weeks at last came to be blamed not on the assassin's bullet still lodged in his back, but to the executive mansion's obsolete plumbing system. A “well-known plumber” told a New York newspaper that “the real trouble” in Garfield's case “is sewer gas,” while the Sanitary Committee of the Master Plumbers of New York offered to outfit the White House with sewer traps at no charge. Instead, the president was moved from Washington, DC, to his summer home in New Jersey, despite physicians' fears that he could not survive the journey; he died in New Jersey less than 2 weeks later. His successor, Chester Arthur, refused to move into the White House, having been made nervous by authoritative statements that, until its plumbing was reconstructed to eliminate sewer gas, “the White House will be behind our better class of tenement-houses.” Arthur even went so far as to lobby Congress to tear down the White House and erect a sewer gas-proof replica in its stead, but though the Senate approved $300,000 for the project, the House of Representatives would not concur, and the new President had to settle for a plumbing overhaul of the old building.9(pp68-75) Sewer gas anxiety was a fertile field for health hucksters, who marketed all manner of devices guaranteed to eradicate the mephitic air. Such was the Germicide, a unit installed above the toilet to periodically dispense the disinfectant zinc chloride into the toilet water and spray antibacterial thymol into the air every time the toilet lid was lifted or lowered. The Germicide offered absolute protection against “the insidious foe that stealthily enters our homes and destroys our happiness”9(p80)—and for only $15. Sewer gas did at last succumb to science, being discarded by the medical profession as the source of disease during the first decade of the 20th century. The dean of the American public health establishment, Providence, Rhode Island's Charles Chapin, summed up the change in his 1910 classic The Sources and Modes of Infection: “Though I began my public-health work with a fairly strong belief in the danger” of typhoid, diphtheria, and other infections from sewer fumes, “it is no longer a plausible hypothesis.”10(p229) Nevertheless, although sewer gas flourished, this “contaminative influence,” as Harvey called it, was the source of considerable uneasiness for both physicians and the public— and equally considerable income for plumbers.
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