Associate Professor of Applied Physiology
Yale University

Noah Webster wrote a book called a Brief History of Epidemic and Diseases. It was published at Hartford, Connecticut, in 1799. In gives his impression of a New England city of that time, a city like New Haven. He says, "Away, then, wit h crowded cities- the thirty foot lots and alleys the artificial reservoirs of filth, the hotbeds of atmospheric poison! Such are our cities-they are great prisons, built with immense labor to breed infection and hurry mankind prematurely to the grave." < /P>

That description certainly could not be applied to New Haven today. Obviously then, enormous changes have taken place in giving us the modern city. Whether you realize it or not, the most important of these changes has been the one brou ght about by sanitation and the measures of public health organization. Medical science has made the modern city possible, made it a healthier place to live than the open countryside. Under the influence of medical science the "crowded cities", as Noah We bster called them, have become the healthiest localities the world has ever known.

But unfortunately the changes brought about by medical science, although much more important than those derived from the advancement of invention and the material sciences, are not as obvious or striking. Thus when we compare the New Ha ven of today with the New Haven of fifty years ago, our attention is held by the material aspects of the changes. We see the tall brick and stone buildings that have replaced the low wooden structures, the paved streets that are filled with hurrying autom obiles where once went only went only horse-drawn wagons and carriages, and the homes and offices and factories lighted by electricity where formerly horse-drawn wagons and candles and lamps were used. But the changes brought about by medical science do n ot strike our minds forcibly, for its greatest contribution is a negative one, the absence of disease. Most of us are not concerned about disease when it is absent; it is only the presence of disease that holds our attention.

If New Haven today were to have suddenly the same prevalence of such diseases as typhoid fever and diphtheria as was the regular and normal occurrence among the people of New Haven fifty or a hundred years ago, then we would be impresse d forcibly with the tremendous advancement that has taken place in holding such diseases in check. If, then, under such circumstances the choice came to us of retaining the material advancements of modern civilization-the automobile, the tall building-the electric light- or being freed from the diseases, there can be little question which our choice would be. But fortunately we can have both the medical and the engineering advantages.

Sanitation and public health work have changed the life in our cities more than has any other single influence. But the measures employed in bringing about these medical changes are so commonplace to us now, so thoroughly accepted as a part of our regular life, that we fail to notice them or appreciate them. The fact that our city has a supply of pure water to every house, that it has an elaborate system of sewers, that provisions are made for garbage disposal, that milk and food are i nspected, and that infectious diseases are quarantined, does not strike us as unusual. Such things are a part of the life of any city just as is the police supervision or fire control. But these matters of disease prevention, so commonplace to us, were un known to the people of New Haven fifty or a hundred years ago.

One way to evaluate the importance of any factor in our lives is to consider what sort of conditions would result if it were removed but all others left unchanged. You can well imagine the disaster that might follow the abolition of our fire department and the disorganization that would result if police supervision were discontinued. Likewise you can imagine the discomfort that would result from the loss of electricity. If it were taken away, our city would be in darkness, automobiles w ould stop, the wheels in many factories would be still, and elevators and street cars would be useless. New Haven would go back fifty years to the pre-electric day, low buildings, oil lamps, and horse cars. The change would give us much inconvenience, but it would be of little consequence compared with the disaster that would result from the loss of the sanitary and public health control that keeps our city healthy.

Imagine New Haven without sewers, merely privies and cesspools, or without a supply of fresh water, only wells and cisterns, or without a system of garbage disposal, but, instead filth accumulating in backyards and vacant lots, or witho ut adequate quarantine of infectious diseases, merely a pest-house for severe cases of smallpox. It makes an unpleasant picture. We are inclined to think of New Haven of a hundred years ago as a charming colonial town, and we are inclined to assume that it had all of the sanitary improvements that it has today. But we would not have found it a charming city if we had lived here then. Instead, from our standards, we should have judged it a very unpleasant place indeed, one that answered to Noah Webster's description of cities in the times before sanitation made them safe and healthy places in which to live, "artificial reservoirs of filth-hotbeds of atmospheric poisons- great prisons- to breed infection and hurry mankind prematurely to the grave."

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