# Popular Science Monthly/Volume 37/August 1890/Sanitary Work in Great Disasters

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* SANITARY WORK IN GREAT DISASTERS.
By G. G. GROFF, M. D., LL. D.,
PRESIDENT OF THE PENNSYLVANIA STATE BOARD OF HEALTH.
THE suggestions offered in this paper are derived from the experience of the past summer at Johnstown, Pa., and in the other flooded regions of the State, where a large share of the organization of the sanitary measures fell to the writer. Although one ninth of the inhabitants of the devastated district perished and were buried in the débris, along with thousands of domestic animals; and although typhoid fever, measles, and diphtheria existed in the district before the calamity, they never spread to any great extent, and certainly never became epidemic.
The region was a peculiarly difficult one in which to conduct sanitary relief. Along a narrow mountain valley for twenty miles were scattered some twenty-eight towns and villages, forming Johnstown. Of these, twenty were devastated by the flood, which left almost every village isolated from the others, all bridges and roads being destroyed, as also all horses and vehicles of the inhabitants, thus rendering communication extremely difficult or impossible. The members of the State Board of Health were unacquainted with the geography of the region, and with the local physicians, as well as with those who volunteered their services. There were no disinfectants on hand, and the whole appropriation of the Board for sanitary purposes was but two thousand dollars for the whole year. When, therefore, on June 1, 1889, representatives of the State Board of Health of Pennsylvania reached the desolated Conemaugh Valley, to do what could be done to prevent the occurrence and spread of disease among the exhausted and stricken survivors, the best estimates that could be hastily secured showed that ten thousand human beings, one thousand horses, one thousand cows, together with a great number of hogs, dogs, chickens, cats, etc., were drowned and buried in the débris at Johnstown, and in the drift-piles down the river, while ten thousand sufferers were without shelter, wet, hungry, and distracted. There were slime, mud, carcasses of domestic animals, and human bodies everywhere.
"No pen has yet fully described the condition that existed the next day after the waters of the South Fork Lake had swept the valley. The pen will never picture the desolation that existed, or tell of the difficulties that confronted the inhabitants of the stricken valley. The homes that were not swept away were left in the most unsanitary condition imaginable. The flood in many localities reached a height of thirty feet. This water contained ​or was heavily laden with débris and every kind of filth, and whatever this water touched it contaminated. As a result, every house in the flooded district was filled to the second floor, in most cases, with offensive matter. In many cases dead animals were found in parlors, and scores of dead horses were removed from dwellings and business stands. Everything was covered with mud. There was not a place where the flood touched that man could lay his head with safety."
The State work began June 1st and ended October 12th. The result at Kernville, a ward of Johnstown, is a truthful index for the whole district. "With the concentration of twenty-five hundred people in three hundred and eighty houses, all subjected to intense mental strain by reason of the calamity and the radical changes in their habits of living, it is very gratifying to know that during the continuance of the Board's operations not a case of infectious disease developed in the district which should be attributed to bad sanitary condition." In the past history of national disasters we do not read of such gratifying results, but dire pestilence has too often followed great earthquakes, floods, fires, famine, and the disasters of war.
There are several measures not strictly sanitary, but most necessary, to which the sanitarian should give heed before his own special work occupies his attention. If the officers of the district have been lost, or in any way rendered inefficient, a strong government must be at once organized, and the district placed under efficient police control, that lawlessness and anarchy do not prevail. At Johnstown the people named a "dictator," who decided all questions of government and kept the region in order. The distress which lawlessness produces must not be tolerated. The organization of relief corps to succor the injured and dying, and to organize temporary hospitals, should receive next the attention of the sanitarian. So soon as the government is assured, and temporary relief is progressing satisfactorily, he may advise the proper committee as to what will be needed in the way of food, clothing, shelter, and medical stores. These will be required in large quantities; but in the United States, at least, we can safely rely upon the country at large to supply these things promptly. For shelter, tents can be had from the State Governors by applying to them.
At Johnstown the people did not like tents, preferring any kind of houses, and suffered great inconvenience from overcrowding rather than go into the tents. There were two forms of ready-made houses used—one, familiarly known as "Oklahomas," were of two sizes: the smaller, eighteen by ten feet, with one room, and a larger, eighteen by twenty-four feet, with two rooms; and the Hughes house, which was larger and better built, consisting of ​four rooms. When tents or temporary houses arrive, the proper location of these should be decided by the sanitary officer in charge. These preliminaries having received attention, the work proper of the sanitary officer begins:
1. The supply of disinfectants should be ordered at once. This order should cover all that will be needed while the emergency lasts, and is necessarily larger in summer than in winter. It was found at Johnstown that the moral effect of a large supply of disinfectants was very great and for good. In ordering disinfectants it is well to provide that what is not needed may be returned to the manufacturers. Pure chemicals and those easy of application are the best.
2. The region should be divided into convenient districts, and each placed under a local physician as sanitary inspector. At Johnstown the local physicians named one of their own number as health officer, and he nominated to the State Board of Health the inspectors, and this plan worked very well'. Inspectors are also needed for the camps of citizens and laborers, for the morgues and burial-places. These inspectors should all make a daily report in writing, stating the exact sanitary condition of their districts, and in these reports they should also state any need of food, clothing, shelter, or medical stores. So long as is necessary, the inspectors should give their whole time to their duties.
3. The burial of the dead needs early attention. In summer, this must be hastened if the number be very large; in winter, more time for identification can be given. If the number of dead is very large, and the distress of the survivors too great to permit of accurate identification, bodies should be buried in their clothes, so that identification can be made out at some future time, when the bodies may be lifted for reburial. Very careful and accurate descriptions of the bodies should always be taken before burial. If possible, the bodies should be brought to one point for identification. At Johnstown, for ten days, a large proportion of the bodies were embalmed, but if buried in their clothes this is not necessary. Great care should be taken to number the graves as the bodies were numbered at the morgue, so that when lifted the record may be found to be correct.
4. The water-supply of the district should be inspected at once, and frequently while the emergency continues. Wells and springs had better be closed if any other water is available. Impure drinking-water must not be tolerated for a moment in these emergencies. Chemical analyses should be made frequently.
5. One or more hospitals for contagious diseases should be established at once, and every case of such disease, as it arises, should be transferred to these hospitals, there to remain until all ​danger of spreading the disease is over. This is a point of great importance, and its neglect may result in grave disaster.
6. For the convenience of the survivors and of the laborers who may be brought to the place, it will be necessary for the health authorities to see that public privies, or closets, are erected. These should be placed where most convenient. They should be examined by inspectors of the different districts, and should be under the charge of a careful and reliable foreman, who will daily disinfect them. No foul odors should ever be permitted to arise from these places.
7. If the free discharge from the sewers is impeded by débris, these should be opened at once, so that water may be discharged through them freely. In the case of floods it will very frequently be found that the mouths of the sewers have been silted shut. These should be opened. The escape of foul gases from sewers at such a time is not to be permitted.
8. There is always, in time of disasters, danger of the people becoming panic-stricken from fear of a pestilence arising, and in our times well-meaning but ignorant persons are very liable to convey messages to the daily press which tend to excite and distress the survivors. To prevent any panic in this way, the State Board of Health found it necessary to issue occasionally "health bulletins," which stated the exact condition of the public health in the devastated district. These bulletins were printed and posted throughout the whole region, and they were thought to do much good. They were founded on the daily reports received from the sanitary inspectors, from the other physicians in the district, and from the hospitals. In addition to these "health bulletins," the people may be greatly aided by issuing "circulars of information." These circulars describe in the plainest language the proper ways to disinfect the premises, to clean them up, and about what should be eaten, and those things which will best tend to preserve health in the midst of unfavorable conditions. These circulars of information should be placed in each house throughout the district as often as may be deemed necessary.
9. It may, in some cases, be desirable to partially or wholly depopulate the devastated district. This may be done by laying out a town of tents, and then requiring the people to remove from their homes into it. Such a town should be laid out as a military camp, and should be under the same regulations as are military camps. At Johnstown, a partial depopulation only was attempted. The State furnished free transportation to all women and children who desired to go elsewhere to their friends for a few weeks or months, and all were urged to go for a short time. For several weeks, also, transportation was given the men who ​applied for the same. In this way the population was largely reduced.
10. If the distress of the survivors is very great, it may be necessary for the sanitary officers to assist the inhabitants in the disinfecting and cleansing of their homes. At Johnstown some thirteen hundred cellars were cleansed by the State, and the débris was removed from the streets and lots, wherever it was found to contain the bodies of human beings and animals in numbers sufficient to endanger the public health. This work of cleansing the district can only be considered the work of the State so long as the district is in a condition to be denominated a public nuisance. When this ceases, the work of the State must also cease.
11. So soon as the disinfectants arrive, the sanitary officer must see to their proper distribution and instruct the people as to their proper use. At Johnstown, each sanitary inspector in charge of a district was authorized to open one or more depots, in places most convenient for the inhabitants of his district, in which depots disinfectants were stored. Large placards were then printed and posted over each district, telling the inhabitants where they could obtain disinfectants, and urging them to go and obtain supplies of the same. Circulars of information were given to all who applied, as also oral information, explaining how to use each disinfectant. The result was, that people came by the hundreds and carried the disinfectants to their homes, using them with good effect. These stations should be kept open just so long as the district is in a bad sanitary condition. Reference may be made here to the mode of using some of the more common disinfectants. The débris formed of the broken houses and forest trees, together with carpets, bedding, and household effects which had become worthless, were, at Johnstown, destroyed by fire, along with the bodies of the domestic animals. For fully three weeks immense fires were burning at Johnstown, formed of the débris and in these fires hundreds of animals were cremated. In the case of a great flood, those articles which it is desirable to burn may be water-soaked, as was the case at Johnstown. Cremation in such cases may be hastened by the addition of petroleum, though at Johnstown a large donation of tar and rosin, made by the citizens of Wilmington, K C, was used to aid in the combustion of these wet substances. The rosin was found to have very advantageous properties when applied to the cremation of carcasses. It appeared to destroy the unpleasant odors arising from the burning flesh, and in place gave out an agreeable balsamic fragrance. It also burned with great heat, hastening combustion, and could not be extinguished by heavy rains. By using rosin liberally, and adding driftwood, there was no trouble in entirely destroying the domestic animals with a single firing. The ​tar was not so valuable in this work as the rosin. Large quantities of quicklime were used at Johnstown, and found to be very valuable for drying the cellars and, absorbing unpleasant odors. The people were advised to whitewash their cellars and homes a number of times, as the lime was believed to be very beneficial. Chloride of lime was used also in sprinkling in the cellars and about the houses. The Board of Health also furnished in solution bromine, chloride of lime, carbolic acid, and Quibbells's disinfectant. These were applied by means of sprinkling-cans. So soon also as the streets were cleared of the débris, two sprinkling-carts were set running. These used a solution of disinfectants, which had a good effect upon the general atmosphere, and an excellent moral effect, maintaining the confidence of the people. At times, the workmen who are cleaning up the district will imagine that they detect foul odors, and that it is dangerous for them to work without a liberal use of disinfectants. In these cases the presence of a laborer with a sprinkling-can, applying a solution of disinfectants, produces a very reassuring effect. Disinfectants should be freely used about the morgues and in every place where it can be hoped that they will do good. In this connection it may be stated, to the credit of the manufacturers of disinfectants, that, without knowing the means of the Board of Health to pay them, they promptly filled all orders for their supplies without a moment's questioning.
12. That the district may be entirely within the control of the sanitarian, it is important that, as soon as possible, a house-to-house inspection or survey be made of all the houses which are occupied in the district. This survey should be carefully recorded on blanks prepared for the purpose, and should state whether the house is occupied by owner or tenant, the number of rooms, number of families, the adult males, the adult, females, and children under five years of age. It should also state the condition of the cellar, kitchen, and living-rooms. The water-supply should be examined and reported upon, as to source, condition, and amount. The drainage of the premises should be carefully looked into. The privy or water-closet should receive a minute inspection. The surveyor should examine the condition of the yard and stable, and the streets and alleys about the house. Note should also be made of any present sickness in the house, and of the existence of any contagious disease in the house during or within six months preceding. If any deaths have occurred within the house in a year, record should be made of them. With all these points before the Board of Health, if the survey has been made with care, it will not be difficult for the Board to maintain good health in the devastated district—certainly not if they have the confidence of the survivors. If the devastated district ​is situated upon a stream, as was the case at Johnstown, it will be necessary for the Board of Health to watch that no cause of disaster to regions below is overlooked. It may be necessary to patrol the river below and open drift-piles *and burn the carcasses of domestic animals. If the stream is the water-supply for towns or cities below, at the earliest possible moment it must be placed in a condition not to carry disease to such places.
In a word, in a great national disaster, the Board of Health must be prepared to meet each and every emergency as it may arise.