SPEECH OF DR. OLIVER WENDELL HOLMES.
Reading edition
You will not ask for rhetoric or eloquence in the few remarks upon a vital subject to be offered you by a member of the silent profession. What could be so eloquent as the hollow voice which announces the Boston annual death-rate as being 26.18 against 23.7, that of the great paved nation of London; against 19.3, that of Philadelphia; and approaching that of our two unhealthiest cities, New York and New Orleans? This high death-rate has been shown to be largely due to the excessive mortality among infants and children under five years of age. The most fatal of the diseases which assail them is that destruction which wasteth at noonday, to which our American practitioners give the name of cholera-infantum. And this disease prevails chiefly, almost entirely, from June to October, the season when all out-of-door influences are most tempting and most needed. The weekly record of August and September is that of a pestilence. The destroying angel carries off the firstborn, and, oftener still, the last-born, out of almost every household in certain districts, as in the heaviest curse laid on Egypt. Thousands have fled the city, as they deserted London in the season of the plague; but thousands are left to follow in the funeral procession of those who were the hope of their households.
A considerable part of this mortality, it may be feared, is unavoidable. Our climatic influences are permanent factors, and must always count in the bills of mortality. But there are certain agencies which we can, to a great extent, control. We can and do submit the dwellings of our citizens to inspection and sanitary regulation; we can and shall provide our city with proper drainage; we can and do inspect the food in our market, and condemn it if unfit for use; we can and must secure for our citizens the influences of unroofed and unwalled Nature,—air, light, space for exercise and recreation, the natural birthright of mankind.
Of the uses of these larger breathing-spaces, which we call parks,—for the relief of the imprisoned dwellers in crowded streets, for the recreation of poor and rich alike, for the health of mind and body which they offer to all,—it seems almost needless to speak from the medical point of view; for all know what cities would be without open areas, where children can play in the shade, and old people warm themselves in the sun. I wish to call your attention to a single point intimately connected with the alarming fact of the excessive death-rate of which I have spoken. That point is the influence of the air they breathe on the health of children, with the bearing of this on the question before us.
If a child is found to have been starved to death in a cellar or an attic, a cry of horror is raised over it. If two or three wandering boys, as it happened the other day at Lowell, come upon some noxious roots, and, in obedience to their omnivorous instinct, devour them, and pay the forfeit, the whole country hears of it. If a family or two get hold of some ill-conditioned meat, and suffer for it, the groans of their colics are echoed all over the land. If a milkman misrepresents his honest cows by falsifying their product, the chemist detects him, and the press puts him in the pillory. If the Cochituate or Mystic water is too much like an obsolete chowder, up go all noses, and out come all manner of newspaper paragraphs from "Senex," "Tax-payer," and the rest. But air-poisoning kills a hundred where food-poisoning kills one. Let me relate a circumstance which happened in Ireland, to which circumstance, in all probability, I owe the pleasure of being listened to at this moment by some among our hard-working, adopted citizens who are before me.
When I say to you, meaning to speak the words of sober truth, that a single physician, by a single and simple measure, saved more lives than were lost at Waterloo by the British army and all its allies, leaving out the Prussians, you will suspect me of exaggeration, not very uncommon in public speakers. I will therefore intrench myself behind certain details which I have often before cited, but not in the presence of a gathering of this kind.
Dr. Robert Collins was Master, as it is called, of the great Dublin Lying-in Hospital, where the annual rate of births was between two and three thousand, from the year 1826 to 1833. A work of his, containing the results of his practice during his seven years of service, was published in Boston in 1841, by order of the Massachusetts Medical Society, for the use of its members. I consider him vouched for as authority, therefore, by men in whom you can put confidence. Dr. Collins makes the following statement:—
When his predecessor, Dr. Joseph Clarke, was in office, in the year 1784, he found that seventeen children in the hundred, nearly one in six, died within the first fortnight after birth, nineteen-twentieths of these of one particular disease peculiar to very early infancy. Looking for the cause of this frightful mortality, he thought he found it in a foul and vitiated state of the air of the hospital. So he had some openings of considerable size made in the ceiling of each ward, and three holes, of an inch in diameter, through each window at top: the doors, too, were perforated with numerous holes. In this way, a free circulation was secured, and so arranged, that the nurses could not control it; for some of the old-fashioned nurses would not have opened a window in the Black Hole at Calcutta, for fear the inmates should catch a cold.
What was the result of this simple proceeding? Why, the mortality fell, from seventeen in a hundred, down to between five and six; and Dr. Collins gives us the result up to his time in these words, "Thus, by his valuable suggestions, 16,371 lives have been saved, as, had the mortality of infants continued one in six to this day (1833), the number of children dying of the 131,227 (which is the total number born in the hospital) would be 21,871, as the hospital registry now shows." In the battle of Waterloo, the British and their allies lost 16,186 men; that is, 185 less than the great army of very light infantry saved from death by letting out the smoke of the battle of life, and letting in the sweet air of heaven, through the walls of the Dublin hospital.
So much for what air alone can do for children. Now, it is not the "nine-day fits" of that hospital in its unventilated condition which kills our poor children in the hot months, but that other disease of infancy, which to name is like sounding a funeral knell in the ears of many a parent. This one malady, more than any other, gives Boston its place on the black list of unhealthy towns. All parents having young children leave the city during the worst part of the sickly season, if they have the means of so doing. Our best streets look as Defoe tells us London streets looked during the Great Plague. But thousands of families must remain; and we are bound to do what we can for them in their dearest interests,—the lives of their children.
With regard to cholera-infantum,—the deadly scourge of which I have spoken,—the testimony of experience shows that change of air, even temporary, often effects the cure of which the apothecary, who "pestles a poisoned poison behind his crimson lights," cannot bring about with his drugs, though the wisest of physicians had written the prescription. This point is so important, and bears so directly, not only on the necessity of park-spaces, but upon their distribution so as to bring them within reach of all the crowded and unhealthy districts as far as possible, that I shall borrow a few sentences, enforcing it, from writers recognized as authorities on the diseases of children.
"Even in cases in which a removal to a healthy and airy situation in the country is impracticable," says Dr. Condie of Philadelphia, long and well known by his writings, "much benefit may be derived from carrying the patient frequently into the open air in a carriage, or in the arms, or, when its residence is near a large river, sailing it daily in an open boat." And Dr. John Bell of the same city says, "The restorative effects of fresh air in cholera-infantum are strikingly evinced in the relief procured by many hundreds of children every summer in Philadelphia, by their simply crossing and recrossing the River Delaware in steamboats once or twice a day. New life is restored to the little beings, who, on leaving their homes in the city, seemed almost exanimate, and in the last stage of incurable exhaustion." Dr. James Stewart of New York, in his treatise on the diseases of children, and our own honored patriarch of the profession, the late Dr. James Jackson, in his letters to a young physician, speak in similar terms of the great advantage of change of place and of air. The "aquatic jaunts" recommended by Dr. Stewart, and spoken of as so efficacious by Dr. Bell, are among the advantages to be secured by the plan proposed by our Park Commissioners. I wish twenty tons of little children could be shipped every fine summer day for a good sail.
There is one particular region which I will mention as like to be specially benefited by the plan referred to,—a region which would get the advantages of the fresh air coming over the wide estuary of Charles River without the expense and trouble of taking boats. The narrow and crowded streets of the northern slope of Beacon Hill, and a wide region extending northward from it, are inhabited by the very class most exposed to cholera-infantum and diseases of that nature. Having lived for many years in Charles Street, where I am no longer an owner, I had occasion to learn the incomparable comfort and delight to be got in a hot summer's day, when the wind is from the southwest, by turning the corner of Charles and Cambridge Streets, and getting into the current of air cooled by passing over the water. Some of the poor mothers with sick children had found out where to bring them for relief; and I often thought, if there were an open green filling up that corner, with shade trees and seats, what a priceless sanatorium it would be to all that suffering quarter of the city! The proposed green margin, beginning at Leverett Street, and extending along the river, will meet this very want; and this is only one locality of many which will thus turn its natural advantages to account.
I have preferred to insist on a single point rather than to expatiate on a larger number. But I trust that the eloquence of others will enforce and illustrate the innumerable advantages our city will derive from the only chain she would submit to,—a chain of pleasure-grounds all around her. The Bostonian has looked up at the gilded dome of the State House, and down at the reflection of his own features in the Frog Pond, long enough. Our city has always been a centre; and it must not act as if it considered itself a mere feeder. We must provide ourselves with the complete equipment, not of a village community, not of a thriving town, but of a true metropolis, large enough for a citizen of the world to live in without feeling himself provincialized, and not too large for one honest mayor like our own to handle. The marrow-bones of the past are pretty well cleared out, or will be before the Centennial year is over, and we must not be content to live on them for another century. The Old Elm got enough of it,—grew discontented, and started on its travels for wider quarters, but, unfortunately, stumbled and fell. Let us take the hint, and plant a thousand acres with young elms and all other trees of the forest, where the hillsides are not already clad in foliage; so that the children of coming generations may bless our memory, not only for all the happiness they have had in their shadow, but for saving more lives to the country than were lost in any one of the battles which scarred and crippled their fathers. [Applause.]
The President. Gentlemen, you have been addressed by two of the learned professions. It follows, as a matter of course, that you will now be addressed by one from the third, the most important and most respected of all. I am happy to introduce to you the Rev. Dr. Neale, the oldest settled pastor of the city of Boston. [Applause.]