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LETTER TO THE EDITOR Dear Sir: Lord Ashby used Bramah's water closet as a classic case to illustrate his text on environmental pollution [I]. He quotes the mortality rate for typhoid, which increased from 52.7 per 100,000 to 99.5 in Newark, New Jersey, between 1880 and 1890 although sewage mileage almost doubled. William Farr had already written in 1874 ofthe effect ofincreased water supply and the increase in disease following the construction of sewers: Another example is offered by the drainage of towns. In London the fatal refuse which had been retained in the houses was conveyed by water into the drains and into the Thames; and this was an advance on the previous state of things; but the sewers were charged with impurities; they put houses by their effluvia in communication with each other, and poured zymotic elements into the waters which were distributed by companies to the houses of both the wealdiy and the indigent. And even at the present hour the sewage is pumped into the Thames, which it pollutes and obstructs, instead of being distributed over the land to which it belongs. The same difficulty in disposing of sewage is encountered in all English towns. He gave further examples in the famous supplement to the 35th Annual Report of the Registrar-General [2, p. 134]. Farr was Superintendent of the Statistical Department of the Registrar General 's Office, England, from 1839 to 1880 and was responsible for a vast and detailed literature of the statistics of Victorian England, including the censuses of 1851, 1861, and 1871. Among the pitfalls of reform he noted that: 1. "Deaths from small-pox in London, compared with the deaths from all othercauses, and also the absolute mortality, increased considerably when inoculation became common after Lady Montague brought back small-pox inoculation to England." 2."Mortality ofthe patients [with smallpox] in the hospital was double the mortality by the disease outside." 3."Vaccination diminished the chances of taking smallpox . . . and reduced the danger of its attacks. But, density of population increasing, other zymodc principles appeared to find in its absence freer scope: . . . mortality by scarlet fever rose from 88 to 97 . . . increasing one and a half times as much as the mortality by smallpox decreased." 4."Out of pity for poor children Foundling hospitals were erected, but the babies nearly all perished, and a greater number than ever were abandoned. Had diese hospitals succeeded the race ofchild-abandoning men must have been multiplied." And so on [2]. Environmental risks and benefits have long been with us. Permission to reprint a letter printed in this section may be obtained only from the author. 674 J LettertotheEditor Farr was born in 1807. He studied medicine in Paris and attended lectures by Pierre-Charles Alexandre Louis, considered the father ofmodern epidemiology. Among others influenced or taught by Louis were Oliver Wendell Holmes and Semmelweis. Farr was a friend of Florence Nightingale and John Snow, whose work on cholera rested in part on information about the South London water companies collected by Farr [3]. Fair's work on cholera illustrates other aspects of our concern with the environment. He believed that the cholera flux from patients was infective and might contain millions of living molecules; however, he called these living molecules, germs, vibrios, cholera particles, living molecules, and zymotic molecules in following sentences [2, p. 368]. He related cholera mortality to elevation and derived a formula to establish a general rule that "the mortality of cholera is inversely as the elevation of the people assailed above the sea level" [2, p. 347]. This rule was more in keeping with the theories of the German Pettenkofer that cholera was a soil-borne disease [4] than with the ideas of Snow and, later, Koch. In epidemiology, as everywhere, coincident events are not necessarily causal. references 1.Ashby, E. Reflections on the costs and benefits of environmental pollution. Perspect. Biol. Med. 23:7, 1979. 2.Humphreys, N. A. (ed.). Vital Statistics: A Memorial Volume ofSelectionsfrom the Reports and Writings of William Farr. London: Sanitary Institute, 1885. 3.Snow, J. Snow on Cholera. Reprint. New York: Hafner, 1965. 4.Howard-Jones, N.Br. Med. J...

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