How plumbing prevents disease

Before plumbing, disease was rife – and it spread fast.

One major problem was that, as the Roman Empire fell (and it was the Romans who pioneered plumbing systems), people turned against their inventions, believing that getting wet actually caused illness. This contempt and fear persisted throughout the Dark Ages, and although some Europeans defied local customs by bathing, they did so against great protest. It’s reported that when Queen Elizabeth bathed, her servants entered a state of panic, as they genuinely thought she would get ill and die.

Then there was the issue of the facilities available. We may now be accustomed to certain standards for our toilets around the world, but a flushable toilet and fresh running water are relatively new concepts, and still remain a luxury for some.

Here, we look at diseases that proved to be preventable with an efficient plumbing system in place.

Bubonic plague in Europe

In past times, indoor bathroom facilities consisted of a pitcher and a commode, and all human waste was thrown into the street.

The lack of sanitation meant that urban areas filled with rodents, and disease spread quickly. The bubonic plague (commonly referred to as the Black Death) notoriously killed up to an estimated 200 million1 people in this way, and as it peaked in Europe, up to a third of the European population was completely wiped out.

With the introduction of modern bathroom plumbing featuring flush toilets and clean water supplies, human infection is now rare, with the last epidemic occurring in America in the early 1900s.

Cholera in London, England

In the 1800s, European infant mortality rates were extremely high at between 25% and 70%. A huge factor was that in the first half of the century, densely populated areas such as London didn’t have the sanitation methods to prevent regular outbreaks of diseases like cholera. People would share a communal well to get their drinking water and they would dump waste into open pits called cesspools, or directly into the River Thames.

Cholera spreads easily through contaminated water and foods, and it kills extremely quickly, often proving fatal within hours of the first signs of infection, vomiting or diarrhoea.

In 1854, yet another outbreak struck Europe, with over 500 deaths in London’s Soho alone. Dr. John Snow traced the outbreak back to a pump in Broad Street and persuaded officials to remove the pump handle, which was a difficult task because doctors of the time believed disease was in the air, not in the water. Of course, once the water supply was cut off, the cholera outbreak abruptly seized, and Dr. Snow became renowned as the father of epidemiology.

Typhoid fever in Chicago, USA

Chicago’s population grew from a mere 350 in 1835 to more than 60,000 in 1850. Sadly, the city’s water infrastructure wasn’t set up to cope with such large-scale population growth and typhoid fever spread.

The majority of the city’s sewage was directed to the Chicago River and flowed directly back into Lake Michigan, which provided drinking water for its residents. Unsurprisingly, a cycle of disease ensued.

It took years to correct, but in the early 1900s Chicago modernised its water system and reversed the flow of many rivers and streams. Typhoid fever instances plummeted as a result.

Polio in India

India is the second most populous country in the world with an estimated population of 1.2 billion, yet its sanitisation standards fall behind much of the industrialised nations. Currently, 96 million Indians do not have access to clean drinking water and 780 million do not have a toilet, hence open defecation is common in rural areas.

The life-threatening disease Polio thrives in faecal matter and is easily transmitted via human waste. Although polio vaccinations have considerably reduced the amount of polio cases in India, the vaccine is controversial due to its high rate of injury and death in thousands of people who caught NPAFP after receiving the vaccine.

Therefore more emphasis must be placed in overhauling India’s sanitisation facilities, as the pattern is easy to see; in areas with poor sanitation, polio is common, and in areas with good sanitation, polio is scarce.

Dysentery in Rwanda

The Rwandan refugee camps set up in Zaire in 1994 struggled with outbreaks of dysentery, which at its peak was killing up to 2,000 people per day.

Human waste was building up near to the places where people cooked and ate, causing disease to spread, but once UN officials brought in purified water and encouraged refugees to use outhouses for defecation, the incidences of dysentery rapidly declined.

Sanitation prevents disease by removing the cause of transmission

The Greeks and Romans created elaborate systems of aqueducts, baths and drainage, but when the Roman Empire crumbled and sanitation became a lost art, society paid the ultimate price.

Vaccines may often take all the credit, but it’s important to remember that plumbers are fighting disease and saving lives too. Furthermore, as increasing numbers of people choose to forego vaccinations in light of concerns over aluminium and mercury content, the value of a sanitary plumbing system has never been so high.

1 Lusaka Times, 2015. How plumbing (NOT VACCINES) eradicated disease. [Online] Available at: https://www.lusakatimes.com/2015/08/25/how-plumbing-not-vaccines-eradicated-disease/. [Accessed 26th August 2015].

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