The Board had daily evidence of the connection between decomposing matter from our sewers and disease, and the experience of the rest of the world confirmed that of Boston. London, Paris, Brussels, Hamburg, Dantzig, Frankfort-onthe-Main, and many other cities have had their sanitary condition so remarkably improved by better sewerage that Berlin, Stuttgart, Munich, St. Petersburg, and many others of the cities of Europe are fast following their examples.

In all these places, the cardinal principle is to get their sewage away, far out of reach, before putrefaction begins.

Striking as the experience of these cities has been, that of England has been equally so; and, as there are many fruitful lessons for us in it, the paper of Dr. George Buchanan is quoted at some length, although it has been often referred to here and in the various countries of Europe.*

*The accompanying table shows the most striking of the improvements which resulted from proper works of drainage, sewerage, and water supply.

The death-rate among infants, and from measles, scarlet fever and whoopingcough, has been reduced very considerably, but in about the same proportion as the total from all causes. The decrease in the prevalence of typhoid fever has been very motable. The death-rate from consumption had decreased in a marked degree, and, generally speaking, in proportion as drying of the soil had been accomplished by the sewers, thereby confirming the conclusions of Dr. Bowditch of this city.

Pulmonary Consumption.

ORGANIZATION OF THE COMMISSION.

At the first meeting of the Commission, April 23, 1875, they were addressed by His Honor Mayor Cobb, who stated that the subject of the sewerage of Boston was the most important which he had been called upon to consider. He referred to our high mortality, and to the fact that it was considered by a large part of our citizens,* and especially by physicians, to be in a great measure due to causes connected with our sewerage.†

Chelmsford is the only town in the list in which the general death-rate had increased. This is explained by the facts that the outfall of the sewer was badly constructed, and that the outflow of the sewage was so far obstructed as to cause backing up of the water into adjoining cellars and escape of the "mephitic vapors mephitic vapors" into the streets and houses.

The improvement would have appeared greater in Bristol, only a part of which had been well sewered, if it had been possible to calculate the death-rate for the precise area improved. In Penzance, the new sewers had just been completed, when the facts were collected.

In Rugby and Carlisle, where the improvement had not been great, there had been some backing up of the sewage and some escape of the sewer gases into the houses; and in Worthin, where the death-rate from typhoid fever had decidedly increased, the sewage flooded certain basements, and the foul gases escaped into the air. [Ninth Report of the Medical Officer of the Privy Council, London, 1867.]

The International Medical Congress at Vienna, in 1874, the German Public Health Association, and the Sanitary Association of the Lower Rhine, have unanimously confirmed the truth of Dr. Buchanan's conclusions, and are now urging them upon the cities of Germany.

* See Appendix B.

†The averages of the rates of mortality in Boston, since registration began, divided into periods of five years each, are as follows. For at least the first thirty years, the returns are quite inaccurate.

Comparing the averages of the death-rates per 1,000 of the largest ten American cities for the past ten years, we have the following figures:

This system of sewerage for Boston, he said, should be adapted to the wants of a growing city, should be comprehensive enough to include the whole metropolitan district, and should be capable of extension without material altera

There was no registration of deaths in Brooklyn, Cincinnati and San Francisco until 1866, and the returns of those cities are therefore computed for nine years. The rate of Chicago is very near that of Boston. In St. Louis and Cincinnati the returns for at least some of the years are very easily shown to be inaccurate. Philadelphia and San Francisco have much lower rates than Boston, and there is no reason to suppose that their statistics are far from the truth, as the following table shows:

In view of the enormous infant mortality of Chicago, their general death-rate of 20.31 per 1,000, returned in 1874, looks suspiciously low. It can hardly be that their deaths were all registered, unless it be that the estimate of the population was too high.

London, which has reduced its rate of mortality from 42 to 22 per 1,000 between 1690 and 1872, and which still has many of the difficulties to contend with which do not exist in a new city like Boston, has a smaller death-rate, as will be seen by the following figures:

It must be remembered that the average number of persons living on each acre of land in London is double that of Boston (including suburbs in both cases), and that fifteen-sixteenths of its water-supply, although filtered, comes from rivers, that from the Thames being polluted by the sewage of four cities, while the water-supply of Boston is probably not yet seriously contaminated by the sewage of Natick, although it might be difficult to say what the result would be in case of an outbreak of typhoid fever at that place.

The mortality was higher in London in the decade from 1860 to 1869, owing to the idleness and want and disease among the laboring classes caused by the "cotton famine" during our war.

In 1872, 1873 and 1874 the deaths per 1,000 in London were respectively 21.5, 22.5 and 22.5; while for the same years in Paris they were 21.9, 23.2, and 22.4. Pettenkofer, in commenting severely on the high death-rates in Germany in 1872, said that that of Munich should be reduced at least to 22 per 1,000, which certainly is not a high standard, and which had been more than attained in London in that year.

[Since the preparation of this note, there has been published the Report on the Sanitary Condition of Boston by a medical commission consisting of Drs. Charles E. Buckingham, Calvin Ellis, Richard M. Hodges, Samuel A. Green and Thomas B. Curtis. The whole subject has been treated in such a masterly and exhaustive manner that we refer to it for details that would not be in place here, contenting ourselves with a simple brief extract. They state "that the death-rate of Boston, compared with her own past death-rates, or with those of the generality of great cities, can hardly be called excessive; but that her sanitary condition is, nevertheless, only fair, inasmuch as a considerable proportion of mortality takes place which is due to remediable causes.' The italics, except the last, are ours.]

tion in its plan; especially in view of the fact that there is every reason to believe that twenty years hence the city will contain a population of at least 900,000.

The Commission report the following results of their investigations, and the conclusions at which they have arrived. The appointment of a Park Commission will make it unnecessary for us to discuss that question except in as far as it may be intimately connected with any proposed change in

our sewers.

PRESENT CONDITION OF THE SEWERS.

While Boston was a city of about seven hundred acres, the lines of drainage were short, the grades were sharp, the sewage at its points of discharge was so much diluted in a vast volume of water as to render it practically innocuous, and the emanations from it were mixed with so many times their bulk of the purest air that they could not have contaminated our atmosphere to a serious extent.

The growth of the city in various directions, and the reclamation of land from the sea, however, have necessitated the extension of a plan which was suited to the wants of the time, as far as the knowledge of the principles of sewerage then known allowed it to be so, but which is entirely inadequate to our present needs.

The filling-in of the old mill pond necessitated the extension of the sewers of that district to discharge into the canal; and, upon closure of the canal, the sewers were intercepted by a main which now discharges on both sides of the city, very irregular in grade, and whose two outlets are materially higher than its central point at Haymarket square, thereby causing obstructions in that whole drainage area. No dispensary physician who has had that district can have failed to notice the deleterious influences of such conditions upon the health of people who are absolutely powerless to help themselves.

The South bay district contains so many old covered wharves and stone walls, and has been filled in with such bad material, that the tide actually ebbs and flows in some parts of it; and, although the drainage may be much improved by a different plan of sewerage, the soil there can never be such as to justify the use of the cellars as tene

ments.

When the sewage of Boston Neck was discharged at a low point in the closed basin, formed by the Mill Dam and the Cross Dam (now Parker street), the cellars were quite dry, although often put too deep. But when the odors from

this closed basin became so offensive as to necessitate its connection with the Charles river to keep it flushed and clean, the sewers had to be discharged on the south side of the city into the South bay; and the cellars were flooded during storms at high water, inasmuch as tide-gates were necessarily used to keep the sewers, and consequently many of the cellars, from inundation at every tide.* This rendered the raising of the Church-street and the Suffolk-street districts necessary, at the cost of several million dollars. Raising the area below Dover street made the cellars in this street still more subject to floodings than before, being the lower point; and when Dover street itself was raised Milford and Dwight streets beyond it suffered a similar increase of trouble.

Near Berlin street, and at several points on the southerly side of the city, the drainage is so imperfect, on account of the low grade, as to forbid the use of the land, as at present, for dwelling-houses.

The filling-in of the area below Charles street has removed the nuisance which existed there a few rods farther west, and it is to be regretted that better material had not been used in the process. A tight, impervious wall (like the Mill Dam) also should have been placed outside all the houses beyond Beacon and Charles streets, so as to prevent the soil from being soaked by each tide.

Finally, the Back hay proper has been filled in with the best of material, generally speaking, but at a grade and of an extent such as to make large tide-locked sewers at slight grades and of great length necessary.

In all, we have many hundred acres of this low, flat land, and just in proportion as we have extended such territory for residences, just so far have we been creating difficulties for ourselves which other cities are unfortunate enough to have had from the beginning, and which some of them have met and are meeting at great cost, and by the employment of the highest engineering skill.

THE SEWERS THEMSELVES.

In the limited time of eight months the Commission have not been able to examine in detail the whole of the one

* A great deal of the difficulty here is explained by the following extract from City Document No. 14, 1850, a report in respect to the drainage of the Back bay, by Messrs. Rogers, Chesbrough and Parrott: "As the law now stands, any proprietor of land may lay out streets at such level as he may deem to be for his immediate interest, without municipal interference; and when they have been covered with houses, and a large population are suffering the deplorable consequences of defective sewerage, the Board of Health is called upon to accept them, and assume the responsibility of applying a remedy" [p. 6].