Revealing Data: Sewers and other Amenities

By Ashley Bowen ~

Ilfracombe, a seaside town in southwest England, in the early summer…

Is the most inviting, when the orchards are pink with apple-blossom, the trees and hedgerows are decked in their freshest livery of green, when the tall grass waves gracefully by the goldcups, and thousands of silvery daises glitter beside the blue speed-wells, while the scented honeysuckle and briar-roses are unfolding, and the blue sky overhead is flecked with breezy cloudlets…. a glorious temple where Nature needs no priest of AEsculapius to interpret her ritual, but, face to face with her votaries, freely bestows large gifts of health and healing.

Tourist pamphlet or medical tract?

Marketing Health Resorts in the Age of Germ Theory

From 1888 to 1895, the Bristol Medico-Chirurgical Journal (BMCJ) published a semi-regular series of articles about “Health Resorts in the West of England and South Wales.” It makes sense that local physicians’ interest in the healing properties (and possible financial opportunities) associated with the nearby sea and spring waters made it into this particular journal. These articles shared journal space such articles as “Some Surgical Aspects of Carcinoma” and “Notes on Disinfection.” Descriptions of health resorts and the healing properties of various spring waters, though not exactly old fashioned in the late 19th century, certainly feel dated when viewed next to items on x-rays and new pharmaceutical treatments.

Thanks to the Medical Journal Backfiles Digitization Project, an ongoing joint effort between the National Library of Medicine and the Wellcome Collection, researchers now have easy and free access to full runs of historical medical journals. To investigate how the rise of the germ theory and scientific medicine in the late 19th century coexisted with older notions around healing, I skimmed the table of contents of issues of medical journals published in the 1880s to identify articles that might speak to this moment of transition. That, plus a little bit of luck, is how I found this series on health resorts in the BMJC.

In the 1870s and 1880s, leading researchers like Robert Koch and Louis Pasteur demonstrated that specific microorganisms caused specific diseases. Their insights ushered in a new approach to disease prevention that focused on the individual body and the eradication of specific germs. Experts still looked to climate as a factor in the spread of disease and development of treatment regimens but increasingly as one factor among many.

The physicians who wrote about local health resorts drew on climate data, something physicians had collected for generations, but interpreted the air temperature, water composition, and civic infrastructure in ways that bridged older and newer ways of understanding the relative healthiness of a place. These authors employ “the iron logic of inexorable figures” when they reprint climate data collected from different almanacs and nearby observation stations. However, none of the authors present that data without providing their own gloss on the average temperature, rainfall total, or relative humidity of their preferred resort town. Writing in March 1889, Dr. Alfred J. H. Crespi explains that Bournemouth’s “bright climate is one of its chief advantages, and rightly so… For a British health-resort, Bournemouth is greatly favored, and has many attractions for invalids who cannot go abroad to winter.”

Scientific insights into the chemical composition of water also provided an important data source for physicians making the case for their local health resort. Dr. John Beddoe acknowledges that some claims about the local water “we now regard as having been imaginary or fictitious” while simultaneously pointing out that there was empirical evidence for mineral water’s positive effects on cases of diabetes and dyspepsia. Claims about the water’s health now needed patient reports and laboratory analysis to make them credible.

If insights from the laboratory supported health resorts medical claims with ease, engineering occupied a more complex position in the resort town. The profession’s standing improved with better knowledge of specific pathogens even as it remained secondary to medicine. On one hand, some physicians worried that urbanization would destroy the healthy climate of resort towns. Beddoe observed that:

Clifton has ceased to be a watering-place: it is hardly even an invalid-resort: it is the West-end of Bristol… The average annual depth of rain has increased from about 30 to 34 inches; while the atmosphere, always dry… has become drier still, possibly, as Dr. Burder suggest, partly from the extension of buildings and pavements. On the other hand, the growth of Bristol tends to deteriorate the atmosphere.

On the other hand, physicians promoted the excellent transportation, sewer, and sanitation, initiatives in their towns. Excellent train lines (or at least improved roads) were, after all, essential to getting the invalid to any spa town. And when selecting a resort, invalids increasingly concerned themselves as much with the sewerage as the climate. The medical officer for Weston-super-Mare observed that, “the first questions usually asked in these latter years of the nineteenth century, when everybody, more or less, is educated up to a high standard of hygienic knowledge, are: Is the town well drained? And is there a good water supply?” Both of these questions, of course, he could answer in the affirmative for his town. Other physicians writing in this series also mentioned the excellent sewer systems alongside more typical resort attractions—shops, theaters, and the ocean views.

Medical journals may not be the typical place to look for a vacation destination, but while germ theory shared intellectual and journal space with older theories, medical journals like the Bristol Medico-Chirurgical Journal would continue to describe and promote health resorts. Well into the 20th century, the healing properties of springs and the seashore’s climate would attract medical men, invalids, and pleasure seekers.

We hear about data every day. In historical medical collections, data abounds, both quantitative and qualitative. In its format, scope, and biases, data inherently contains more information than its face value. This series, Revealing Data, explores how, by preserving the research data of the past and making it publicly available, the National Library of Medicine (NLM) helps to ensure that generations of researchers can reexamine it, reveal new stories, and make new discoveries. As the NLM becomes the new home of data science at the National Institutes of Health (NIH), Circulating Now explores what researchers from a variety of disciplines are learning from centuries of preserved data, and how their work can help us think about the future preservation and uses of the data we collect today.

Ashley Bowen, PhD is a guest curator for the Exhibition Program in the History of Medicine Division of the National Library of Medicine.