How Plumbing Eradicated Disease, Not Vaccines
Plumbers Are the Unsung Heroes in the Fight Against Disease
Vaccines get all the glory, but most plumbers will gladly inform you that it was water infrastructure –modern sewage systems and clean water – that eradicated disease, and they’re right!
While medications are far trendier and are given all the accolades, accessible modern plumbing in fact removed the breeding grounds for illnesses, like polio, cholera, and typhoid. Any Pittsburgh plumber knows that the real heroes in the battle against this mass of these often-deadly afflictions were clean water and adequate sewage systems.
As a prime example, during the Middle Ages, it was the total lack of sanitation in urban areas filled with rats and other vermin that provided the perfect environment to spread disease. Life expectancy was no better than middle age and massive outbreaks of disease were quite commonplace, wiping out huge swathes of the population at once. The Black Plague alone killed 75 to 200 million people, around 1/3 of Europe’s population.
As another significant illustration of the origins of these deadly diseases, smallpox continued to infect Europe’s population until plumbing infrastructure became commonplace. Although modern sanitation ended this disease, the smallpox vaccine is given all the credit.
Even today, some countries are finally convincing its citizens that the habits of the past, such as using water sources as toilets, are to blame for widespread outbreaks of diseases that are relatively uncommon, if not eliminated entirely, in other countries.
How about Sanitation in Bygone Days?
If you were describing a bathroom before there were nice clean flushing toilets, antibacterial soap, and clean running water, you might be surprised. If there even was a bathroom or washroom before modern plumbing, you most often got a pitcher with water, some kind of chamber pot that was used as a toilet and a washbowl or stand. You used the chamber pot to do your business and then washed off with the pitcher and rinsed off your hands.
Now, where did the chamber pot go after you were done? Well, when in need of emptying, it was merely taken outside to the street or anywhere that was convenient and dumped. Over time, the contents would be washed down into the rivers – which were often the source of the community’s drinking water.
Not only were these sanitation practices abhorrent by modern standards, but they also led to outbreaks of deadly diseases like cholera and dysentery with few medical professionals of the time coming to the conclusion that the spread of disease was related to sanitation.
All it took to keep these diseases under control and prevent the premature deaths of thousands upon thousands of people was a sanitary way to use a bathroom.
Plumbing is Not as New as You Think
As we noted in a previous blog, the history of plumbing shows that sophisticated and reliable plumbing and waste management systems did exist prior to the Middle Ages. From the Indus Valley in Asia to the Greeks and later the Romans, we’ve discovered evidence of elaborate water distribution and wastewater management systems.
When the Roman Empire crumbled, however, sanitation became a lost art. Civilization paid the price: plague after plague struck areas of dense population.
(If you’re interested in reading a more in-depth history of modern plumbing, please refer to our previous blog on the history of plumbing.)
The Sanitary Battle of Britain
In the early-to-mid 1800s, the city of London had little in the way of water and infrastructure. The majority of the city’s population utilized town pumps and communal wells to obtain their drinking water.
Waste disposal, too, was far from adequate. Just like most Europeans, Londoners just dumped raw sewage and animal wastes into open pits known as “cesspools” or, even more horrifying, directly into the Thames River. Unfortunately, the same Thames River was also the primary source of drinking water for many Londoners.
It should be noted that the infant mortality rate during this time was quite high, from 25% to 70%.
Today, it’s well documented that cholera spreads through contaminated water and food and kills very quickly, often proving fatal within hours of the first symptoms of vomiting and diarrhea.
In 1854, London witnessed another outbreak of cholera where in Soho, a suburb of the city, it claimed the lives of 500 in only ten days.
Dr. John Snow, who lived near the affected area, was able to directly investigate what was causing the outbreak. Five years earlier, he had written a paper in which he expressed his thoughts that such diseases were able to travel through the city’s water. It was in the water, he argued.
His notion, though, flew in the face of the conventional “wisdom” of the time. In the 1850s, most medical professionals were of the opinion that a miasma, the noxious vapors from rotting organic matter, was the root cause of the majority of diseases.
Fortunately, Dr. Snow had the courage to believe something different, to attempt something different, believing he might see different results.
In time, he traced the cholera outbreak to the communal Broad Street pump. He plotted cholera cases on a map of Soho which shows that most of the victims drew their water from that specific pump. He then persuaded town officials to remove the pump handle and the cholera cases ceased immediately
Dr. Snow’s research was an early use of mapping, a procedure that has become popular now that computers enable the display and analysis of such data.
Historians credit Dr. Snow for advancing the modern germ theory of disease and laying the grounds of epidemiology. He is widely regarded as the father of epidemiology.
Follow-up: A bit later, the outbreak was said to have been traced back to a woman cleaning a dirty diaper in the well. Many years after, it was theorized that the mother had emptied the baby’s diarrhea into the cesspool next to the well and the cesspool’s wall was decayed, so the sewage was seeping into the well.
The City of Chicago Fights Disease with Modern Plumbing
The Industrial Revolution powered rapid population growth in the city of Chicago during the 1800s. Not surprisingly, the city’s water infrastructure wasn’t intended to handle such a rapid rise in population.
At the time, the city was dealing with a variety of diseases but had encountered an exceptionally high rate of typhoid fever. As in London, the source of the infection was eventually traced to the city’s water distribution and sanitation systems.
The majority of the city’s sewage was being directed to the Chicago River, which flowed right back into Lake Michigan, the source of the city’s drinking water. Of course, this contaminated Chicago’s drinking water, producing a perpetual cycle of disease.
It took years to solve the problem, but by the early 1900s, Chicago had upgraded its water infrastructure. They also reversed the flow of several rivers and streams and, as a consequence, the number of incidences of typhoid fever, as well as other infectious diseases, plummeted.
Cholera Strikes NYC
On a Sunday in July 1832, a crowd of New Yorkers gathered in City Hall Park for the bad news – the cholera epidemic had reached its peak.
Out of a population of some 250,000 persons at the time, 3,500 were killed by this latest outbreak. Again, the source of the disease could be traced to the city’s deplorable sanitation conditions. Likewise, medical professionals had yet to recognize the role that germs played in the spread of these deadly diseases.
This particular outbreak did, however, boost support among city officials to build an aqueduct system to bring clean water to the city. Eventually, this also led to phasing out of private and community wells that were often infected with human and animal waste.
Several years later, city officials removed more than 20,000 pigs to the outer reaches of the city. A similar effort years earlier incited riots, but with the cholera epidemic having taken its toll on the city’s inhabitants, this time, the public obeyed the ordinance.
Finally, following up the work of Dr. Snow in London, city officials created a Board of Health with medical professionals given the authority to clean up the city. As an example, inspectors were empowered to burn the clothing of people who had just died from diseases such as cholera. They cleaned out the filth, spread lime and educated survivors in proper sanitation habits.
Cities had discovered that epidemics were the result of poor water distribution and wastewater systems and that it was their obligation to prevent and manage it.
While most of the “western world” has achieved a level of sophistication in combatting outbreaks of these deadly diseases, it’s not necessarily the case in many parts of Asia and Africa.
The Deadly Truth about Dirty Water
Even today, more than 1.5 million deaths worldwide each year can be connected to waterborne diseases. Dirty water accommodates numerous parasites and bacteria that trigger diarrheal illnesses resulting in death because of the acute dehydration that follows.
Unfortunately, many of these illnesses target the very young in developing countries due to unsafe water, inadequate sanitation and the lack of basic hygiene. Cholera, typhoid fever, and dysentery are commonplace in developing countries throughout Africa and Asia where people live each day without the benefits of modern plumbing.
These fatal diseases initiate a cruel cycle that is hastened because they trigger rampant outbreaks of diarrhea. This only exacerbates the problem as it eventually pollutes the water table. In some regions, rivers and other sources of water are repeatedly used as toilets or become contaminated by the runoff from nearby fields and forests.
Only with considerable investment in public sanitation will these areas ever wipe out these diseases and prevent unnecessary deaths.
Several Asian countries have actually begun to launch hard-hitting educational programs to foster better sanitation habits among its citizens. Along with this has come government-funded water filters, toilets and inexpensive toilet kits for people to make their own latrines in their homes.
India may have experienced a significant reduction in polio in recent years due to widespread immunization campaigns, but, in reality, those numbers don’t include regions where sanitary facilities and the removal of waste are non-existent. Such outbreaks in those areas often go unreported. Until the entire country is successfully dealing with poor sanitation and long-established cultural habits, typhoid, cholera and polio will continue to spread.
We know that vaccination programs are far more successful in reaching the masses than the monumental task of trying to provide water filters and toilets, but without modern plumbing, many diseases are still being caught and spread by poor sanitation habits.
The challenge is monumental, and the statistics are overwhelming. Some 780 million Indians do not have a toilet, and 96 million have no access to potable drinking water. Just the simple task of burying the waste left in the fields would be somewhat of an improvement.
This may come as a surprise to some. But even in the United States today, plumbing that is not in perfect working order can trigger such illnesses as Legionnaires’ disease and giardia.
We’re so accustomed to the comfort of modern-day plumbing in the U.S. that we just take it for granted. Truth is, while the pharmaceutical companies may hog the glory for the eradication of certain diseases in the U.S. and other advanced countries, their vaccines would be far less effective if there were merely a sanitary method of transporting and disposing of waste.