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How did historical peoples deal with choking?

How did historical peoples deal with choking?

These days, the use of the Heimlich Maneuver to deal with choking is so well-known that one might be surprised to learn that it was not invented until the 1970s, so this seemingly simple treatment is as much a product of the modern age as the home computer!

How did people deal with choking without the aid of modern knowledge of medicine and anatomy? For example, if I were in the Middle Ages, dining with my friend, and I started to choke on my food, what would he try in order to save my life?


Dealing with choking would have depended in part on what the obstruction was, where one was and who one was with. As even the surgical procedure tracheotomy can be traced back to ancient Egypt, it's implausible that people in ancient times had not also figured out simpler procedures such as thumping the afflicted person on the back, drinking water and attempting to remove the obstruction by using the fingers.

There were surgical instruments for extracting fish bones from the throat, and evidence that people endured it and survived, or simply died. Incantations, spells and prayers were also used in both ancient and medieval times, not to mention a variety of other methods such as putting bread in the ears.


ANCIENT EGYPT

In addition to tracheotomy, A Companion to Ancient Egypt notes that in the absence of "a sanctioned doctor or priest", for someone choking on a fish bone (for example),

At least two spells have survived that provide the remedy that included reciting a short religious invocation and swallowing a piece of cake to force the bone down the throat.


ANCIENT GREECE & ROME

In ancient Greece, Hippocrates cautioned against tracheotomy, fearing that the carotid artery would be damaged. Instead, he recommended tracheal intubation. Alexander the Great, though, apparently disagreed:

Homerus of Byzantium documented the story of Alexander the Great performing a tracheotomy with his dagger point to save one of his troops from asphyxiation. The soldier was said to be choking, on what we are uncertain, and the long-term outcome is also unsure.

Homeric incantations may also have been used by the Greeks as they were by the Romans (the origins of this practice are obscure), especially during the first four centuries AD.

Galen was said to have experimented with Homeric incantations himself, and to have found them effective in the treatment of a scorpion sting and for dislodging bones stuck in the throat.

Also,

a Roman-era recipe recommends that, when someone swallows a fish or bird bone, we should say "Come out in an upward or downward direction!"

Such commands were also used in Christian times, with reference to Lazarus and Jonah (of whale fame).

Pliny the Elder (AD 23 - 79) mentions a couple of 'cures' in his Natural History:

When a fish-bone happens to stick in the throat, it will go down immediately, if the person plunges his feet into cold water; but where the accident has happened with any other kind of bone, the proper remedy is to apply to the head some fragments of bones taken from the same dish. In cases where bread has stuck in the throat, the best plan is to take some of the same bread, and insert it in both ears.

He also mentions mint as a preventive:

It has the effect of preventing milk from turning sour, or curdling and thickening; hence it is that it is so generally put into milk used for drinking, to prevent any danger of persons being choked by it in a curdled state. It is administered also for this purpose in water or honied wine.


MEDIEVAL & EARLY MODERN PERIODS

Paul of Aegina (circa 625 to 690), a Byzantine physician, also deals with fish bones and 'other objects' getting stuck in the throat, mentioning removal with forceps (if the object can be seen) or inducing vomiting by sticking a finger or feather in the throat (if the object is deeper).

Bones stuck in the throat were obviously quite common as there was even a medieval patron saint, Saint Blaise, to pray to or to be invoked. This dates back to ancient times and is mentioned in The Book of Blessings (1625); Saint Blaise supposedly cured a boy with a bone stuck in his throat, though how he did it is unclear.

Gregory of Tours (circa 538 to 593 or 594) relates how he had a fish bone stuck in his throat for three days; neither coughing nor hawking (clearing the throat noisily). He attributes its eventual removal to a miracle, but adds

One thing only I know, that I so quickly perceived that I was cured that I thought that some one had put in his hand and pulled out the bone that hurt my throat.

Thus, we have evidence at least of the idea of removing a blockage using the hand.

A more scientific method was using surgical instruments to extract the offending object. The Arabic physician Al-Zahrawi (aka Abulcasis, 936 - 1013) was the first to

use lead for making some of the instruments. Since lead was soft, it was easy to curve and bend an instrument made out of it, during surgical operation. Probes and hooks, therefore, were also especially made of lead for the purpose of extracting fishbone from the throat.

Illustration of medieval Muslim surgical instruments taken from al-Zahrawi's Kitab al-Tasrif. Fifteenth century copy of an eleventh century manuscript.

Below is an engraving from 1600-01. Mortality on this procedure was high, though.

Source: A Brief History of Endotracheal Intubation


19th CENTURY

In A Practical Treatise on Foreign Bodies in the Air-passages (1854) by Samuel D. Gross, the author recounts a number of cases of choking. Remedies mentioned include inversion and inducing vomiting through the administration of an emetic. In at least one case the emetic didn't work and the patient died. He also notes a case where

On the 10th of May, 1846, a little boy… while playing with a hammer and some horseshoe nails, allowed one of the latter to slip into the windpipe. He was immediately seized with choking and violent cough. The cough for a time subsided, but soon returned with symptoms of slight pneumonia, which lasted a week. At the end of this period, as the boy was lying over a chair with his head downwards, a sudden clucking noise was heard, as if some substance had been thrown from the lungs up into the windpipe, and was at once followed by a paroxysm of suffocation, threatening instant destruction. Placed erect, the obstruction was removed, and he became better.

In another case, the father of a girl who had swallowed a cowdrie shell "thrust his finger down her throat" and that seemed to solve the choking problem. However, about a year later,

she was suddenly attacked by a violent spasmodic cough and sense of suffocation, followed by the forcible expulsion of the remnant of the shell, the animal substance of which had entirely disappeared.

In several instances the object was simply coughed or thrown up without any external inducement, though sometimes only after a considerable period of time. In another case, patting on the back was seen to worsen the patients condition.


The absence of someone able to perform a tracheotomy and the fact that hitting someone on the back doesn't always work (it can actually make the blockage worse) may well account for some of the less likely 'remedies' our ancestors came up with. It is also worth noting that, even today, people die from choking. In the case of major obstructions in the throat, professional help may be the only way to save someone's life and all our modern technology does not change one simple fact: a complete blockage of the windpipe has to be removed in a matter of minutes.


All highlighting is mine.


Historical revisionism

In historiography, the term historical revisionism identifies the re-interpretation of a historical account. [1] It usually involves challenging the orthodox (established, accepted or traditional) views held by professional scholars about an historical event or time-span or phenomenon, introducing contrary evidence, or reinterpreting the motivations and decisions of the people involved. The revision of the historical record can reflect new discoveries of fact, evidence, and interpretation, which then results in revised history. In dramatic cases, revisionism involves a reversal of older moral judgments.

At a basic level, legitimate historical revisionism is a common and not especially controversial process of developing and refining the writing of histories. Much more controversial is the reversal of moral findings, whereby what mainstream historians had considered (for example) positive forces are depicted as negative. Such revisionism, if challenged (especially in heated terms) by the supporters of the previous view, can become an illegitimate form of historical revisionism known as historical negationism if it involves inappropriate methods such as:

  • the use of forged documents or implausible distrust of genuine documents
  • attributing false conclusions to books and sources
  • manipulating statistical data
  • deliberately mis-translating texts

This type of historical revisionism can present a re-interpretation of the moral meaning of the historical record. [2] Negationists use the term "revisionism" to portray their efforts as legitimate historical inquiry. This is especially the case when "revisionism" relates to Holocaust denial.


A brief history of human filth: how did people try to keep clean in the past?

How did people through history keep clean? How did they deal with dirt, sweat and other bodily odours, and did they take baths? Historian Amanda Vickery explores the history of personal hygiene and human filth…

This competition is now closed

Published: March 2, 2020 at 2:45 pm

In the words of the anthropologist Mary Douglas, “Dirt is simply matter out of place.” The human history of dirt is the saga of our battle to control environmental filth and channel human waste out of sight, out of mind. Not that ‘dirtiness’ or ‘cleanliness’ are unchanging across time, space and cultures.

Filth undoubtedly has a fascinating past: from the godly cleanliness of 17th‑century Delft, to the triumphant introduction of carbolic acid as surgical antiseptic in 1860s Glasgow, the co-opting of hygiene to promote Nazi ideas of ‘racial cleansing’, to the slums of contemporary New Delhi. The definition and management of dirt determines civilisation.

Dirtiness is in the eye of the beholder. In Japanese homes, for example, visitors are asked to exchange their shoes for slippers at the threshold. Traipsing outdoor mud across clean floors is offensive. Moreover, the toilet is always separated from the bathroom. The western habit of combining the two is disgusting to Japanese sensibility.

The English have been harping on about cleanliness since the early modern period, but cleanliness now and cleanliness then mean different things. We moderns wage war on domestic ‘germs’ armed with chemical weapons, but a practical understanding of bacteria is comparatively recent. The Victorians blamed cholera on airborne miasma. A star exhibit in the 2011 Wellcome Collection exhibition ‘Dirt’ was the ghost map produced by a heretical doctor John Snow – plotting cholera deaths around contaminated water pumps in 1854.

For centuries, the only easily available disinfectant for splashing around was vinegar. It was ordering, tidying, dusting, polishing, rooting out bad smells, scenting, weekly laundry of linens and washing of hands and face that maintained the wholesome house and person.

Disguising muck was routine. “To hide the dirt, the boards of the dining room and most of the other floors in the town were made of a brown colour,” noticed an architect in Bath in 1749. But observers still knew filth when they smelt it. “The dirt and nastiness is beyond description,” complained Lady Mary Coke about some Paris lodgings in 1772. “Added to which the smell of cat’s dirt makes it almost insupportable.”

It seems strange that a people so keen on cleanliness were so unwilling to wash in water. Since the great plagues and the closing of public bathhouses, western Europeans believed that bathing was positively bad for you. Skin protected the body from putrefaction and disease. Toxins left the body as perspiration, menstrual blood, urine and faeces.

Submerging the body in water risked the re-entry of toxins through the pores and orifices. Yet you had to be seen to be clean. The solution was to change your body linens frequently. The linen chafing your skin absorbed the toxins you had excreted and could be fiercely washed even if the body could not. So a flourish of bright white linen at the neck and the sleeve publicised your hygiene. And because “Cleanliness is indeed next to Godliness,” as John Wesley preached, spotless linen exhibited virtue.

When we criticise those who ‘wash their dirty linen in public’, we remember this antique link between clean linen and purity. Joseph Lister introduced white lab coats and aprons – that could be boiled and starched – as the uniform of his brave new world of aseptic hygiene at Glasgow Royal Infirmary in the 1860s. Yet the white coat itself would be condemned as a carrier of infection, replaced with surgical scrubs.

The history of filth is no linear tale of science beating back slime over the centuries. The more successful our economies the more detritus we create. Faecal contamination of water is rife in the developing world and latent everywhere after disasters. Ultimately putrefaction awaits everyone.

“Golden lads and girls all must, as chimney-sweepers, come to dust.” Or as an inscribed bowl made in 1661, and excavated from a London sewer, reminds us: “You and I are earth”.

Amanda Vickery is a writer, presenter and historian. She is also professor of early modern history at Queen Mary, University of London.

This article was first published by BBC History Magazine in 2011


Contents

Choking is often caused by an object from outside the body, also called a foreign body, blocking the airway. [5] The object can block the upper or lower airway passages. [6] The airway obstruction is usually partial, but can also be complete. [6]

Among children, the most common causes of choking are food, coins, toys, and balloons. [5] In one study, peanuts were the most common object found in the airway of children evaluated for suspected foreign body aspiration. [7] Foods that pose a high risk of choking include hot dogs, hard candy, nuts, seeds, whole grapes, raw carrots, apples, popcorn, peanut butter, marshmallows, chewing gum, and sausages. [5] The most common cause of choking death in children is latex balloons. [5] Small, round non-food objects such as balls, marbles, toys, and toy parts are also associated with a high risk of choking death because of their potential to completely block a child's airway. [5]

Children younger than age three are especially at risk of choking because they explore their environment by putting objects in their mouth. [5] Also, young children are still developing the ability to chew food completely. [5] Molar teeth, which come in around 1.5 years of age, are necessary for grinding food. [5] Even after molar teeth are present, children continue developing the ability to chew food completely and swallow throughout early childhood. [5] In addition, a child's airway is smaller in diameter than an adult's airway, which means that smaller objects can cause an airway obstruction in children. Infants and young children generate a less forceful cough than adults, so coughing may not be as effective in relieving an airway obstruction. [5] Finally, children with neuromuscular disorders, developmental delay, traumatic brain injury, and other conditions that affect swallowing are at an increased risk of choking. [5]

In adults, choking often involves food blocking the airway. [8] Risk factors include using alcohol or sedatives, undergoing a procedure involving the oral cavity or pharynx, wearing oral appliances, or having a medical condition that causes difficulty swallowing or impairs the cough reflex. [8] Conditions that can cause difficulty swallowing and/or impaired coughing include neurological conditions such as strokes, Alzheimer's disease, or Parkinson's disease. [9] In older adults, risk factors also include living alone, wearing dentures, and having difficulty swallowing. [8]

Children and adults with neurological, cognitive, or psychiatric disorders may experience a delay in diagnosis because there may not be a known history of a foreign body entering the airway. [8]

When someone is choking, it is important to react quickly to save their life. In the worst cases, choking can lead to death. For these reasons' prevention is the best solution. [10] [11] [12]

Main prevention Edit

Choking can typically happen when large or abundant mouthfuls of food are poorly chewed and swallowed. This risk is minimized by adopting the discipline of cutting food into moderately sized pieces and chewing them completely without swallowing them whole first. If food can be chewed, it must be chewed, whatever it is, even if it is very soft or gelatinous, such as spreads and soft desserts.

It is helpful to have some liquid available to drink to make swallowing easier (before the choke is completed). Eating in handfuls (it can happen with foods as popcorn, different peeled nuts, etc.), requires chewing with more control than normal, and not exceeding in the amounts that enter the mouth. To swallow well, it is recommended that the neck is in a normal position, straight for the eater's body, with the head looking forward, being seated or standing up (never lying or too reclined).

Dangerous foods Edit

The foods that produce the most complicated choking are those whose shape adapts to the shape of the pharynx or trachea: hot dogs and sausages, bananas, food in blocks, etc. It is easier to choke on foods that dry the mouth (overcooked meat, sponge cake, cold pizza, etc.), which require the help of drinking liquid, or to be accompanied of purees or sauces. It is also easier to choke on foods that are tough (meat of octopus or cuttlefish, major size animals, some reptiles, etc.), they may need to be eaten together with something that helps the teeth to grind them (as loaf bread), or any concrete way to be prepared or cooked.

Groups at risk Edit

Some population groups have a higher choking risk, as: the elderly, the children, the disabled (physically or mentally), people under the effects of alcohol or drugs, people who have taken medications that seriously reduce the ability to salivate or react, patients with difficulties to swallow (dysphagia), suicidal people, epileptics, people on the autism spectrum, individuals with disorders such as pica that lead them to consume inedible objects, etc. They may require more assistance to feed themselves and it may be necessary to supervise them while they eat. If they are unable to chew properly, their food can not be hard nor tough. If they have difficulty eating normally, it is not recommended to give them food that may cause issues, or to separate it into very small pieces. In cases where a person is unable to safely eat, food can be supplied by feeding syringes that pour a liquid content into the patient's mouth. If the problem is that they have taken any medication or substance that reduces saliva, they cannot eat solid food until their salivation is restored.

In babies and children Edit

All little children require care in eating. They must learn to chew their food completely to avoid choking. Feeding them while they do another activity (when they run, play, laugh, etc.) increases the risk of choking. Caregivers can supervise children while eating or playing. [13] Providers such as pediatricians and dentists can provide information to parents and caregivers about what food and toys are appropriate by age to prevent choking. [5] The American Academy of Pediatricians recommends waiting until 6 months of age before introducing solid foods to infants. [14] Caregivers can avoid giving children, when they are younger than 5 years-old, foods that pose a high risk of choking such as hot dog pieces, bananas, cheese sticks, cheese chunks, hard candy, nuts, grapes, marshmallows or popcorn. [13] Later, when they are accustomed to these foods, it is normal to give them split into small pieces. For example: if they are going to eat hot dogs, it is possible to split the sausage lengthwise, sliced, or both. And the same in the case of bananas, grapes, grains, etc. Parents, teachers, childcare providers and other caregivers for children are advised to be trained in choking first-aid and cardiopulmonary resuscitation (CPR). [5]

Children can put small objects into their mouths (deflated balloons, marbles, small pieces, buttons, coins, button batteries, etc.), which could lead to the child swallowing or choking on them. When babies choke on deflated balloons or plastic bags (as the sacks for wrapping the dirty diapers, the nappy sacks, which are a sort of bag sometimes dangerously placed near the babies), [15] it produces a complicated obstruction that would require it to be directly removed with the fingers, if it is visible. To prevent children from swallowing things, it is needed to take precautions on their environment by placing dangerous objects out of their reach. Besides, they must be supervised, paying enough attention to what they do. It is necessary to teach the children to avoid putting things into their mouths. They may try to eat small pieces of toys. Toys and games may indicate on their packages the ages for which they are safe. In the US, manufacturers of children's toys and products are required by law to apply appropriate warning labels to their packaging. [5] However, toys that are resold may not be marked with warning labels. [5] Caregivers can try to prevent choking by considering the features of a toy (such as size, shape, consistency, small parts) before giving it to a child. [5] Children's products that are found to pose a choking risk can be taken off the market. [5]

The symptoms of choking include:

  • Difficulty or inability to speak or cry out.
  • Inability or difficulty in breathing. Labored breathing, including gasping or wheezing, may be present.
  • Violent and largely involuntary coughing, gurgling, or vomiting noises may be present.
  • More serious choking victims will have a limited (if any) ability to produce these symptoms since they require at least some air movement.
  • The person may begin clutching the throat, mouth, or attempting to induce vomiting by putting fingers down the throat.
  • The person's face turns blue (cyanosis) from lack of oxygen if breathing is not restored.
  • The person may become unconscious if breathing is not restored.

The time a choking victim is still alive and without brain damages [16] can vary. But, typically:

  • Brain damage can happen when the victim remains without air for three minutes approximately (it is variable).
  • Death can happen if breathing is not restored in six to ten minutes (varies depending on the victim). But life can be extended some more by using cardiopulmonary resuscitation (CPR) on the unconscious victims of choking (see more details further below).

Choking is treated with several different procedures, which form the airway management. This consist in basic techniques available for first aiders and more advanced techniques available for health professionals.

Basic treatment (First-Aid) Edit

Basic treatment of choking includes a few non-invasive techniques to help remove foreign bodies from the airways.

For a conscious choking victim, most protocols recommend encouraging the victim to cough, followed by hard back slaps and, if none of these things work, abdominal thrusts (Heimlich maneuver, see details further below) or chest thrusts (see details further below). Most modern protocols, including those of the American Heart Association and the American Red Cross, recommend alternating series of back slaps and series of thrusts seeking a better effect.

Besides, it is mandatory that somebody calls to the emergency medical services if choking is not being solved, and continues first-aid.

If the choking victim loses consciousness, a cardiopulmonary resuscitation (CPR) is recommended. [17]

First-aid methods against choking include the following:

Cough Edit

If the choking individual is conscious and coughing, the American Red Cross recommends encouraging the individual to stay calm and continue coughing freely, and it may be easier to take air through the nose to refill the lungs. If the person choking is unable to cough or if coughing is not effective, the American Red Cross recommends to move onto other methods, detailed below. [18]

Back blows (back slaps) Edit

Many associations, as the American Red Cross and the Mayo Clinic, recommend the use of back blows (back slaps) to aid in the rescue of choking victims. This technique starts by bending the choking victim forward as much as possible, even trying to place their head lower than the chest, to avoid the risk of the slaps driving the object deeper into the person's throat (that is a rare complication, but possible). The bending is in the back, while the neck should not be excessively bent. Back blows are performed by delivering forceful slaps with the heel of the hand on the victim's back, between the shoulder blades. [19] [20]

The back slaps push behind the blockage, to dislodge the foreign object. In some cases, the physical vibration of the action may cause enough movement of the object to assist the patient in clearing the airway.

Abdominal Thrusts (Heimlich Maneuver) Edit

Abdominal thrusts [21] are performed with the rescuer standing behind the choking victim. The rescuer closes his skillful hand, grasps it with the other hand, and presses forcefully inwards and upwards with both hands on the area located between the chest and the belly button of the victim. The pressure is not focused directly against the ribs, to avoid breaking any of them. If the first thrust does not solve the choking, it can be repeated several times.

Usage of abdominal thrusts is not recommended in infants under 1 year of age due to risk of causing injury there are adapted techniques for babies (see more details further below), and, when the children are too big for them, they require normal abdominal thrusts (according to their bodies). Abdominal thrusts should not be used when the patient's abdomen presents problems to receive them, such as when the victim is pregnant or has excessive size then, chest thrusts are advised (see more details further below).

In the case of choking alone, abdominal thrusts are one of the possibilities that can be tried on oneself (see more details further below).

The purpose of abdominal thrusts is to create a pressure capable to expel the object lodged upwards in the airway, relieving the obstruction. This method was discovered by Dr. Henry Heimlich in 1974, so it is referred to as "The Heimlich Maneuver." Dr. Henry Heimlich claimed that his maneuver was better than the back blows, arguing that back blows could cause the obstruction to become more deeply lodged in the victim's airway. That claim started a debate [22] into the medical community, that ended up with the recommendation of alternating both techniques, but making the patient to bend the back before receiving the slaps. [23] [19] [20] So the Heimlich Maneuver itself uses only abdominal thrusts, but is also part of anti-choking protocols that include the back blows (back slaps) technique.

Chest thrusts Edit

When abdominal thrusts cannot be performed on the victim (in case of pregnant or too obese victims, and others) chest thrusts are advised instead. [24]

Chest thrusts are performed with the rescuer standing behind the choking victim. The rescuer closes his skillful hand and grasps it with the other hand. This can produce several kinds of fists, but any of them can be valid if it can be placed on the chest of the victim without sinking the knuckle too painfully. Keeping the fist with both hands, the rescuer uses it to press forcefully inwards on the lower half of the chest bone (approximately), but not in the very endpoint (which is the xiphoid process). It can be noted, as a general reference, that, when the victim is a woman, the zone of pressure of the chest thrusts would be normally upper than the level of the breasts. The pressure is not focused against the xiphoid process, to avoid breaking it. If the first thrust does not solve the choking, it can be repeated several times.

"Five and Five" strategy Edit

The American Red Cross recommends a protocol of alternating five back blows and five abdominal thrusts for conscious choking victims until the object blocking the airway is dislodged. For pregnant or too obese victims, the protocol is the same, but chest thrusts are advised instead of the abdominal ones. If the victim becomes unconscious, basic CPR is recommended. [18] Emergency services should be called if such a situation arises.

The Red Cross does not specifically refer to its choking victim protocol as the "Five and Five Technique", and it differs from the Heimlich Maneuver since it includes administering back blows to the victim, contrary to Dr. Heimlich's procedure which specifically omitted back blows and was based only on his technique.

Anti-choking devices Edit

Since 2015, several anti-choking devices were developed and released to the market. The design of these devices is based in a vacuum mechanical effect, with no need of batteries or electric current. They usually present an attached mask, in order to make a vacuum from the patient's nose and mouth. The current models of anti-choking devices are quite similar: a direct plunger tool (LifeVac), [25] or a vacuum syringe (backward syringe) that keeps the tongue in place by inserting a tube in the mouth (Dechoker). [26] Some other mechanical models are in development, such as Lifewand, [27] which makes the vacuum by direct pressure against patient's face using a button. According to a 2020 systematic review of the effectiveness of these three devices, "There are many weaknesses in the available data and few unbiased trials that test the effectiveness of anti-choking suction devices resulting in insufficient evidence to support or discourage their use. Practitioners should continue to adhere to guidelines authored by local resuscitation authorities which align with ILCOR recommendations." [28]

Unconscious victims Edit

A choking victim that becomes unconscious requires to be caught then, and placed lying on a surface. That surface would not be too hard or too soft and would be appropriated for the victim's anatomy (it is possible to put a layer of something above the floor and place the victim on it).

Also, it is mandatory that someone calls to the emergency medical services (in case of this has not been done yet).

While they come, the unconscious choking victim should receive a cardiopulmonary resuscitation (CPR) that is like the CPR for any other non-breathing patient. Babies (infants under 1 year old) require a special adaptation of the procedure (described further below). In the rest of cases, it is provided a normal cardiopulmonary resuscitation (CPR) for choking victims.

This CPR is a cycle that alternates series of compressions with series of breaths. Each compressions series applies around 30 compressions on the lower half of the chest bone. The chest compressions of cardiopulmonary resuscitation (CPR) produce coincidentally the same anti-choking effect than the chest thrusts technique, so the CPR itself could expel the object. So, at the end of each compressions series, the rescuer has to look for the obstructing object, and try to remove it, mainly using a finger sweeping when the object is already visible (which is the difference between CPR in choking victims and normal CPR). If the object has not appeared, it is applied a series of 2 rescue breaths: pinching the victim's nose and puffing air inside of the mouth. And, at the end of the breaths series, it is recommended the addition of tilting the victim's head up or down and give 2 extra breaths, trying that the air could find an entrance through the blockage. The cycle repeats continuously. If the object is expelled and followingly removed, CPR must continue until the victim recovers breathing. [29]

An anti-choking device can unblock the airway on unconscious victims, but not necessarily can take the obstructing object out of the mouth (it may need a manual removal). Anyway, the victim will require cardiopulmonary resuscitation (CPR) after that, in the manner that has been described above, but only alternating the 30 compressions and the 2 rescue breaths.

About the finger sweeping in unconscious victims Edit

In unconscious victims of choking, the American Medical Association advocates sweeping the fingers across the back of the throat to attempt to dislodge airway obstructions. [30] However, many modern protocols recommend against the use of the finger sweep. Red Cross procedures specifically direct rescuers not to perform a finger sweep unless an object can be clearly seen in the victim's mouth due to the risk of driving the obstruction deeper into the victim's airway. Other protocols suggest that if the patient is conscious they will be able to remove the foreign object themselves, or if they are unconscious, the rescuer should simply place them in the recovery position as this allows (to a certain extent) the drainage of fluids out of the mouth instead of down the trachea due to gravity. There is also a risk of causing further damage (for instance inducing vomiting) by using a finger sweep technique. There are no studies that have examined the usefulness of the finger sweep technique when there is no visible object in the airway. Recommendations for the use of the finger sweep have been based on anecdotal evidence. [17]

In special populations Edit

Babies (under 1 year old) Edit

For babies (infants under 1 year old), the American Heart Association recommends [31] some adapted procedures that have been developed. Children that are already too big for the babies' procedures require the normal first-aid techniques against choking, according to their bodies' size.

First aid for babies' alternate cycles of back blows (5 back slaps) followed by chest thrusts (5 chest compressions, that are adapted), as it is described next:

In the back blows maneuver, the rescuer slaps on the back of the baby. It is recommended that the baby receive them being slightly leaned upside-down. There exist some manners to achieve that:

In the most depicted one, the rescuer sits down on any seat with the baby. The rescuer supports the baby with a forearm and its respective hand. The baby's head must be carefully held with that hand, usually by the jaw. Then the baby's body (supported in that manner) can be leaned upside-down along the rescuer's thighs and receive the slaps.

As an easier alternative, the rescuer can sit on a bed or sofa, or even the floor, carrying the baby. Next, the rescuer would support on the lap the baby's body, to make the upside-down leaning (at the right or at the left). Then the slaps would be applied.

If the rescuer can not sit down, they could try to do the maneuver at a low height and over a soft surface. Then, as in the first manner, the rescuer would support the baby with a forearm and the hand of that side, holding the baby's head with that hand, usually by the jaw. The baby's body would be leaned in that position, to receive the slaps.

In the chest thrusts maneuver, the baby's body is placed lying on a surface. Then the rescuer does the compressions on the chest bone, pressing with only two fingers on its lower half (the nearer to the abdomen). Abdominal thrusts are not recommended in children less than 1 year, because they can cause liver damage. [31]

The back blows and chest thrusts are alternated in cycles of 5 back blows and 5 chest compressions, until the object comes out of the infant's airway or until the infant becomes unconscious. [31]

If the infant becomes unconscious, it is mandatory that someone calls to the emergency medical services (in case this has not been done yet). While they come, the American Heart Association [31] recommends starting a cardiopulmonary resuscitation (CPR), which must be adapted to babies. In that procedure, the baby is placed face up on a horizontal surface (preferably not too hard or too soft). The baby's head must be in straight position, looking frontally (tilting too much a baby's head backwards can close the access to the trachea). Then it is applied a cycle of alternating chest compressions and rescue breaths. The chest compressions are adapted: the rescuer presses 30 times with only two fingers in the lower part of the chest bone. At the end of the compressions, the rescuer looks into the mouth searching if the obstructing object has come out (because of the effect of the compressions) and, if it is visible, attempts to extract it (mainly using a finger sweeping). If the object is not visible, the rescue breaths are applied. They are also modified: the rescuer's mouth puffs air covering the baby's mouth and nose at the same time. The cycle repeats continuously.

If the object is extracted, the cardiopulmonary resuscitation continues until the baby's breath is successfully recovered or until medical services arrive.

Pregnant or too obese people Edit

The American Heart Association recommends the chest thrusts rather than the abdominal thrusts for pregnant or too obese persons who are choking. [17] Chest thrusts are performed in a similar way to the abdominal thrusts, but with the hands placed on the lower part of the choking victim's chest, at the lower half of the breast bone (sternum), rather than over the middle of the abdomen, as in the traditional abdominal thrusts. Strong inward thrusts are then applied. [19] As a reference, in women, the zone of pressure of the chest thrusts (the lower half of sternum) would be normally upper than the level of the breasts. The chest thrusts can be alternated with back blows (back slaps), which are applied on the back of the victim when it is very bent forward.

Disabled people in wheelchair Edit

If the choking victim is a disabled person and is using a wheelchair, the first-aid procedure is quite similar than in the case of the other victims. The difference is in trying to apply the techniques directly, while the victim is still seated on the wheelchair. [32] Besides, the presence of an anti-choking device at hand can be especially useful when a disabled person is near. But the first-aid techniques without devices are also possible:

The back blows (back slaps) can be used after bending forward the back of the victim very much, as much as possible. To perform the abdominal thrusts (Heimlich maneuver), the back of the victim must be bent too, and the rescuer must get behind the wheelchair. Then, the rescuer can embrace the victim's abdomen from behind and up, leaning over the top of the wheelchair's backrest. If this is too difficult, the rescuer can get down to embrace the victim's abdomen and the wheelchair's backrest all together. The same can be tried from a side or in another way. Finally, the rescuer must apply the sudden inward and upward pressures on the abdomen. It must be remembered that, if the victim can not receive abdominal thrusts (this is the case of the pregnant or too obese people), chest thrusts must be used instead. They are applied while the victim is in the wheelchair too but making sudden inward pressures on the lower part of the chest bone against the wheelchair's backrest and the rescuer's body. If there are difficulties for this, the same maneuver can be tried from a side or in another way.

Due to the additional difficulties in helping to the disabled, it is convenient to avoid placing them in too narrow and encased spaces at the mealtimes. The opened spaces give an easier access to them for the rescuers.

Self-treatment Edit

Some of the first-aid techniques can be applied on oneself, so they can be useful in the case of choking when alone. On the other hand, having a modern anti-choking device nearby is one of the best, and most realistic, options to solve choking. But trying first-aid techniques on oneself, by hand and without any device, is also possible:

The abdominal thrusts (Heimlich Maneuver) can be self-applied with the hands: making a fist, grasping it with the other hand, and pressing forcefully, inwards and upwards, with both of them on the area located between the chest and the belly button. It can be repeated as many times as needed. This serves as a substitute for the thrusts made with the hands by another person. One study showed that these self-administered abdominal thrusts were just as effective as those performed by another person, although obese individuals were not included in the study. [33] Another manner of self-administration of this maneuver requires positioning of one's own abdomen over the border of an object: a chair, railing, or countertop, and driving the abdomen upon the border with sharp, upward thrusts. It is possible to try to fall on the border to increase pressure.

Other variation of the self-administration of abdominal thrusts (Heimlich Maneuver) consist in pressing the own belly, inwards and upwards, with an appropriated object.

When a problem makes impossible to receive pressures on the belly, it is possible to try to apply the chest thrusts on oneself, despite it would be more difficult. The chest thrusts would be self-applied making a fist, grasping it with the other hand, and pressing inwards forcefully on the lower half of the chest bone. They can be repeated as many times as needed. Making attempts to cough until achieving it can also clear the airway.

Alternatively, multiple sources of evidence suggest that one of promising approaches for self-treatment during choking could be applying the head-down (inverse) position. [34] [35] [17] To make that position, it is possible to put the hands on the floor and then place the knees on an upper seat (as on a bed, a sofa, or an armchair).

Advanced treatment Edit

There are many advanced medical treatments to relieve choking or airway obstruction. These include inspection of the airway with a laryngoscope or bronchoscope and removal of the object under direct vision. Severe cases where there is an inability to remove the object may require cricothyrotomy (emergency tracheostomy). Cricothyrotomy involves making an incision in a patient's neck and inserting a tube into the trachea in order to bypass the upper airways. [36] The procedure is usually only performed when other methods have failed. In many cases, an emergency tracheostomy can save a patient's life, but if performed incorrectly, it may end the patient's life.

Choking is the fourth most common cause of unintentional injury-related death in the US. [3] Many episodes are not reported because they are brief and resolve without seeking medical attention. [5] Among reported events, the majority of episodes (80%) occur among children younger than age 15, with fewer episodes (20%) among age 15 and older. [3] The death rate from choking is low at most ages but increases starting around age 74. [3] Choking due to a foreign object resulted in 162,000 deaths (2.5 per 100,000) in 2013, compared to 140,000 deaths (2.9 per 100,000) in 1990. [37]


'That could have been me': The people Derek Chauvin choked before George Floyd

They describe an officer quick to use force and callous about their pain.

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This article was published in partnership with The Marshall Project, a nonprofit news organization covering the U.S. criminal justice system, and The New York Times. Sign up for The Marshall Project’s newsletter, or follow them on Facebook or Twitter.

Story by Jamiles Lartey and Abbie VanSickle | The Marshall Project

Nearly three years before the Minneapolis police officer Derek Chauvin knelt on George Floyd as he cried that he couldn’t breathe last May, Zoya Code found herself in a similar position: handcuffed facedown on the ground, with Chauvin’s knee on her.

The officer had answered a call of a domestic dispute at her home, and Code said he forced her down when she tried to pull away.

“He just stayed on my neck,” Code said, ignoring her desperate pleas to get off. Frustrated and upset, she challenged him to press harder. “Then he did. Just to shut me up,” she said.

Last week, a judge in Minnesota ruled that prosecutors could present the details of her 2017 arrest in their case against the former officer, who was charged with second-degree unintentional murder in Floyd’s death.

Code’s case was one of six arrests as far back as 2015 that the Minnesota attorney general’s office sought to introduce, arguing that they showed how Chauvin was using excessive force when he restrained people by their necks or by kneeling on top of them — just as he did in arresting Floyd. Police records show that Chauvin was never formally reprimanded for any of these incidents, even though at least two of those arrested said they had filed formal complaints.

Of the six people arrested, two were Black, one was Latino and one was Native American. The race of two others was not included in the arrest reports that reporters examined.

Discussing the encounters publicly for the first time in interviews with The Marshall Project, three people who were arrested by Chauvin and a witness in a fourth incident described him as an unusually rough officer who was quick to use force and callous about their pain.

The interviews provide new insight into the history of a police officer whose handling of Floyd’s arrest, captured on video, was seen around the world and sparked months of protests in dozens of cities.

Chauvin, who was fired, has said through his attorney that his handling of Floyd’s arrest was a reasonable use of authorized force. But he was the subject of at least 22 complaints or internal investigations during his more than 19 years at the department, only one of which resulted in discipline. These new interviews show not only that he may have used excessive force in the past, but that he had used startlingly similar techniques.

All four people who told of their encounters with Chauvin had a history of run-ins with law enforcement, mostly for traffic and nonviolent offenses. Code’s arrest occurred on June 25, 2017. Chauvin’s lawyer, Eric J. Nelson, did not respond to a request for comment, but in a court filing said the officer acted properly in the case, responding to “a violent crime in a volatile situation.” He said that “there was nothing unreasonable or unauthorized about Mr. Chauvin’s actions.”

Code’s mother had accused her of trying to choke her with an extension cord, according to the arrest report. Code said in an interview that her mother was swinging the cord around, and that she merely grabbed hold of it.

She said she had left the house to cool off after the fight and when she returned, Chauvin and his partner had arrived. In the prosecutors’ description of the arrest, based on Chauvin’s report and body-camera video, Chauvin told Code she was under arrest and grabbed her arm. When she pulled away, he pulled her to the ground face first and knelt on her. The two officers then picked her up and carried her outside the house, face down.

There, prosecutors said, Chauvin knelt on the back of the handcuffed woman “even though she was offering no physical resistance at all.”

Code, in an interview, said she began pleading: “Don’t kill me.”

At that point, according to the prosecutors’ account, Chauvin told his partner to restrain Code’s ankles as well, though she “was not being physically aggressive.” As he tied her, she said, she told the other officer, “You’re learning from an animal. That man — that’s evilness right there.”

Chauvin’s partner in that arrest declined to comment. Misdemeanor domestic assault and disorderly conduct charges filed against Code were ultimately dropped.

The earliest incident in which prosecutors said Chauvin used excessive force took place on Feb. 15, 2015, when he arrested Julian Hernandez — a carpenter who was on a road trip to Minneapolis to see a band at the El Nuevo Rodeo nightclub. Chauvin worked as an off-duty security officer there for almost 17 years.

The arrest report filed by Chauvin said Hernandez tried to leave the club through the wrong door, and Chauvin stopped him and escorted him down a stairwell. Hernandez said in an interview that he had been drinking, but felt like Chauvin was pushing him down the stairs.

Outside, Hernandez said, “things escalated.”

Chauvin’s report said that Hernandez tried to turn around as he was preparing to handcuff him, so he pushed him away “by applying pressure toward his Lingual Artery” at the top of the neck.

Hernandez said the officer told him “you just need to leave,” and he remembered thinking that he was trying to leave but was not being allowed to do so. As Chauvin pushed him into a wall and grabbed him by the throat, Hernandez recalled thinking, “You’re choking me.”

Hernandez said he tried to sue the department, but no lawyer would take his case so he let it go. He was charged with disorderly conduct, but under a court agreement he avoided punishment by staying out of trouble for a year, records show.

Nelson, the officer’s lawyer, said in a court filing that there was no evidence that Chauvin acted improperly in “dealing with a resistant, aggressive arrestee by himself.”

Under the judge’s order, only Code’s arrest, among the six cases showing what may have been excessive force, can be used at Chauvin’s trial. Prosecutors also sought to include two additional cases they said showed just the opposite — that Chauvin knew how to use reasonable force to properly restrain a person.

The judge’s order will allow them to use one of those cases: an incident in which the police department commended Chauvin and other officers for taking lifesaving steps in placing a restrained, suicidal man on his side so he could breathe. Chauvin even rode with the man to the hospital, according to prosecutors.

According to the attorney general’s office, the arrest showed that Chauvin knew how important it was to avoid breathing problems in detainees. When he did not put Floyd in a similar side position, prosecutors contend, he understood that it could jeopardize his life.

Chauvin’s lawyer objected to any of the previous arrests being admitted at his trial, which is set to begin in March. He argued that Chauvin’s actions “were not crimes,” but rather part of Chauvin’s job as an officer, and that a police supervisor at each arrest scene reviewed his use of force and concluded that it comported with department standards.

The Minneapolis Police Department did not respond to queries about past complaints against Chauvin. Critics say the department has a long history of accusations of abuse, but never fully put in place federal recommendations to implement a better system of tracking complaints and punishing officers. Only a handful over the years have faced firing or serious punishment.

In another case prosecutors highlighted to try to establish a pattern of excessive force, a man said he landed in the hospital overnight after an encounter with Chauvin. The man, Jimmy Bostic, had made a purchase at the Midtown Global Market in April 2016 and was waiting for a ride when private security guards asked him to leave. A different shop owner had accused him of panhandling, the arrest report said. Bostic argued, and Chauvin was called in.

Chauvin escorted Bostic outside, writing in the arrest report that Bostic had threatened to spit on the owner.

“I closed distance with” Bostic, Chauvin wrote, “and secured his neck/head area with my hands.”

Bostic said in an interview that as Chauvin and the private security guards attempted to put him in cuffs, he yanked his arm back.

“The next thing I felt was arms just wrapped around my neck,” he said. “I started telling him, ‘Let go, I’m having trouble breathing. I have asthma. I can’t breathe.’”

Chauvin’s lawyer, in a court filing, said the officer “acted reasonably” and followed police policy in restraining Bostic, who he said was refusing orders and making threats.

After he was released from police custody at the scene, Bostic said, emergency medical workers took him to a hospital. Suffering from an asthma attack, he said, he stayed for over a day. A disorderly conduct charge against him was ultimately dropped.

“Looking back on Floyd, that could have been me,” said Bostic, who is now in state prison on an unrelated burglary conviction. “And I would no longer be alive right now to even tell my story.”

Monroe Skinaway, a 74-year-old Minneapolis resident, was a chance witness to another incident prosecutors cited that occurred in March 2019. He said in an interview that he had called the police after he spotted his grandson’s stolen car parked at a South Minneapolis gas station.

As he answered police questions about the car, Skinaway said, he saw a young man wandering nearby, asking officers to give him a ride. Skinaway said the man seemed “off.”

The man, named in the arrest report as Sir Rilee Peet, 26, followed one officer to his squad car. After Peet refused to take his hands out of his pockets, the officer tried to grab him, and they scuffled, the police report said.

That is when the other officer, identified in the report as Chauvin, sprayed Peet with Mace. Chauvin restrained him by the neck and pinned him facedown on the ground by kneeling on his lower back, according to the prosecutors’ description of body-camera video.

Skinaway said he remembers seeing the officer on top of Peet, but also something not mentioned in Chauvin’s account in the arrest report. Skinaway said the officer put Peet’s head, face down, in a rain puddle. Other officers were present as well, he said.

“He said, ‘I can’t breathe — can I just put my head up?’” Skinaway said. “And they just held his face in the water, and I couldn’t see a purpose for that.”

Skinaway said he was about seven feet away as he watched Peet struggle for air, bubbles surfacing as he tried to breathe. He estimated that the officer kept Peet in the puddle for two to three minutes. Whenever Peet managed to turn his head for air, Skinaway said, the officer grabbed him by his long hair and put his head back in the water.

When he spoke by phone with a reporter, Skinaway said he did not know the officer’s name or that there was a connection with the Floyd case, but the details he described match those noted in the police report and prosecutors’ account.

Chauvin’s lawyer, Nelson, said in a court filing that the officer had acted according to police policy. “It was after midnight in South Minneapolis, and a man who refused to remove his hands from his pockets repeatedly approached the officers after being told not to,” he said. The filing said Peet’s actions had created concern for the officers’ safety.

Peet was arrested on charges of misdemeanor obstruction of the legal process and disorderly conduct, but it is unclear from court records what happened to the charges. The records show Peet has a history of court-ordered treatment for mental illness. In a phone call, Peet told a reporter that he did not recall the encounter.

Some of those whom Chauvin arrested said that learning the same officer had been involved in Floyd’s death made them regret they had not pushed harder to hold the officer and the department accountable.

“I don’t have nothing against cops, I got relatives that are cops,” said Hernandez, the carpenter arrested at the nightclub. “But he should have never been on the force that long.”


Contents

During the Neolithic era, humans dug the first permanent water wells, from where vessels could be filled and carried by hand. Wells dug around 6500 BC have been found in the Jezreel Valley. [2] The size of human settlements was largely dependent on nearby available water.

A primitive indoor, tree bark lined, two-channel, stone, fresh and wastewater system appears to have featured in the houses of Skara Brae, and the Barnhouse Settlement, from around 3000 BCE, along with a cell-like enclave in a number of houses, of Skara Brae, that it has been suggested may have functioned as an early indoor Latrine. [3] [4] [5] [6] [7]

Wastewater reuse activities Edit

Wastewater reuse is an ancient practice, which has been applied since the dawn of human history, and is connected to the development of sanitation provision. [8] Reuse of untreated municipal wastewater has been practiced for many centuries with the objective of diverting human waste outside of urban settlements. Likewise, land application of domestic wastewater is an old and common practice, which has gone through different stages of development.

Domestic wastewater was used for irrigation by prehistoric civilizations (e.g. Mesopotamian, Indus valley, and Minoan) since the Bronze Age (ca. 3200-1100 BC). [9] Thereafter, wastewater was used for disposal, irrigation, and fertilization purposes by Hellenic civilizations and later by Romans in areas surrounding cities (e.g. Athens and Rome). [10] [11] [12]

Ancient Americas Edit

In ancient Peru, the Nazca people employed a system of interconnected wells and an underground watercourse known as puquios.

Ancient Near East Edit

Mesopotamia Edit

The Mesopotamians introduced the world to clay sewer pipes around 4000 BCE, with the earliest examples found in the Temple of Bel at Nippur and at Eshnunna, [13] utilised to remove wastewater from sites, and capture rainwater, in wells. The city of Uruk also demonstrates the first examples of brick constructed Latrines, from 3200 BCE. [14] [15] Clay pipes were later used in the Hittite city of Hattusa. [16] They had easily detachable and replaceable segments, and allowed for cleaning.

Ancient Persia Edit

The first sanitation systems within prehistoric Iran were built near the city of Zabol. [13] Persian Qanats and ab anbars have been used for water supply and cooling.

Ancient Egypt Edit

The c. 2400 BCE , Pyramid of Sahure, and adjoining temple complex at Abusir, was discovered to have a network of copper drainage pipes. [17]

Ancient East Asia Edit

Ancient China Edit

Some of the earliest evidence of water wells are located in China. The Neolithic Chinese discovered and made extensive use of deep drilled groundwater for drinking. [ citation needed ] The Chinese text The Book of Changes, originally a divination text of the Western Zhou dynasty (1046 -771 BC), contains an entry describing how the ancient Chinese maintained their wells and protected their sources of water. [18] Archaeological evidence and old Chinese documents reveal that the prehistoric and ancient Chinese had the aptitude and skills for digging deep water wells for drinking water as early as 6000 to 7000 years ago. [ citation needed ] A well excavated at the Hemedu excavation site was believed to have been built during the Neolithic era. [19] The well was caused by four rows of logs with a square frame attached to them at the top of the well. Sixty additional tile wells southwest of Beijing are also believed to have been built around 600 BC for drinking and irrigation. [19] [20] Plumbing is also known to have been used in East Asia since the Qin and Han Dynasties of China. [21]

Indus Valley Civilization Edit

The Indus Valley Civilization in Asia shows early evidence of public water supply and sanitation. The system the Indus developed and managed included a number of advanced features. A typical example is the Indus city of Lothal (c. 2350 BCE). In Lothal all [ citation needed ] houses had their own private toilet which was connected to a covered [ citation needed ] sewer network constructed of brickwork held together with a gypsum-based mortar that emptied either into the surrounding water bodies or alternatively into cesspits, the latter of which were regularly emptied and cleaned. [22]

The urban areas of the Indus Valley civilization included public and private baths. [ citation needed ] Sewage was disposed through underground drains built with precisely laid bricks, and a sophisticated water management system with numerous reservoirs was established. In the drainage systems, drains from houses were connected to wider public drains. Many of the buildings at Mohenjo-daro had two or more stories. Water from the roof and upper storey bathrooms was carried through enclosed terracotta pipes or open chutes that emptied out onto the street drains. [23]

The earliest evidence of urban sanitation was seen in Harappa, Mohenjo-daro, and the recently discovered Rakhigarhi of Indus Valley civilization. This urban plan included the world's first urban sanitation systems. Within the city, individual homes or groups of homes obtained water from wells. From a room that appears to have been set aside for bathing, waste water was directed to covered drains, which lined the major streets.

Devices such as shadoofs were used to lift water to ground level. Ruins from the Indus Valley Civilization like Mohenjo-daro in Pakistan and Dholavira in Gujarat in India had settlements with some of the ancient world's most sophisticated sewage systems. [ citation needed ] They included drainage channels, rainwater harvesting, and street ducts.

Stepwells have mainly been used in the Indian subcontinent.

Ancient Mediterranean Edit

Ancient Greece Edit

The ancient Greek civilization of Crete, known as the Minoan civilization, was the first civilization to use underground clay pipes for sanitation and water supply. [24] Their capital, Knossos, had a well-organized water system for bringing in clean water, taking out waste water and storm sewage canals for overflow when there was heavy rain. It was also one of the first uses of a flush toilet, dating back to the 18th century BC. [25] The Minoan civilization had stone sewers that were periodically flushed with clean water. [ citation needed ] In addition to sophisticated water and sewer systems they devised elaborate heating systems. The Ancient Greeks of Athens and Asia Minor also used an indoor plumbing system, used for pressurized showers. [26] The Greek inventor Heron used pressurized piping for fire fighting purposes in the City of Alexandria. [27] The Mayans were the third earliest civilization to have employed a system of indoor plumbing using pressurized water. [28]

An inverted siphon system, along with glass covered clay pipes, was used for the first time in the palaces of Crete, Greece. It is still in working condition, after about 3000 years. [ citation needed ]

Roman Empire Edit

In ancient Rome, the Cloaca Maxima, considered a marvel of engineering, discharged into the Tiber. Public latrines were built over the Cloaca Maxima. [29]

Beginning in the Roman era a water wheel device known as a noria supplied water to aqueducts and other water distribution systems in major cities in Europe and the Middle East.

The Roman Empire had indoor plumbing, meaning a system of aqueducts and pipes that terminated in homes and at public wells and fountains for people to use. Rome and other nations used lead pipes while commonly thought to be the cause of lead poisoning in the Roman Empire, the combination of running water which did not stay in contact with the pipe for long and the deposition of precipitation scale actually mitigated the risk from lead pipes. [30] [31]

Roman towns and garrisons in the United Kingdom between 46 BC and 400 AD had complex sewer networks sometimes constructed out of hollowed-out elm logs, which were shaped so that they butted together with the down-stream pipe providing a socket for the upstream pipe. [ citation needed ]

Nepal Edit

In Nepal the construction of water conduits like drinking fountains and wells is considered a pious act. [32]

A drinking water supply system was developed starting at least as early as 550 AD. [33] This dhunge dhara or hiti system consists of carved stone fountains through which water flows uninterrupted from underground sources. These are supported by numerous ponds and canals that form an elaborate network of water bodies, created as a water resource during the dry season and to help alleviate the water pressure caused by the monsoon rains. After the introduction of modern, piped water systems, starting in the late 19th century, this old system has fallen into disrepair and some parts of it are lost forever. [ citation needed ] Nevertheless, many people of Nepal still rely on the old hitis on a daily basis. [ citation needed ]

In 2008 the dhunge dharas of the Kathmandu Valley produced 2.95 million litres of water per day. [34]

Of the 389 stone spouts found in the Kathmandu Valley in 2010, 233 were still in use, serving about 10% of Kathmandu's population. 68 had gone dry, 45 were lost entirely and 43 were connected to the municipal water supply instead of their original source. [35]

Islamic world Edit

Islam stresses the importance of cleanliness and personal hygiene. [36] Islamic hygienical jurisprudence, which dates back to the 7th century, has a number of elaborate rules. Taharah (ritual purity) involves performing wudu (ablution) for the five daily salah (prayers), as well as regularly performing ghusl (bathing), which led to bathhouses being built across the Islamic world. [37] [38] Islamic toilet hygiene also requires washing with water after using the toilet, for purity and to minimize germs. [39]

In the Abbasid Caliphate (8th-13th centuries), its capital city of Baghdad (Iraq) had 65,000 baths, along with a sewer system. [40] Cities of the medieval Islamic world had water supply systems powered by hydraulic technology that supplied drinking water along with much greater quantities of water for ritual washing, mainly in mosques and hammams (baths). Bathing establishments in various cities were rated by Arabic writers in travel guides. Medieval Islamic cities such as Baghdad, Córdoba (Islamic Spain), Fez (Morocco) and Fustat (Egypt) also had sophisticated waste disposal and sewage systems with interconnected networks of sewers. [ citation needed ] The city of Fustat also had multi-storey tenement buildings (with up to six floors) with flush toilets, which were connected to a water supply system, and flues on each floor carrying waste to underground channels. [41]

Al-Karaji (c. 953–1029) wrote a book, The Extraction of Hidden Waters, which presented ground-breaking ideas and descriptions of hydrological and hydrogeological perceptions such as components of the hydrological cycle, groundwater quality, and driving factors of groundwater flow. He also gave an early description of a water filtration process. [42]

Post-classical East Africa Edit

In post-classical Kilwa plumbing was prevalent in the stone homes of the natives. [43] [44] The Husani Kubwa Palace as well as other buildings for the ruling elite and wealthy included the luxury of indoor plumbing. [44]

Medieval Europe Edit

There is little record of other sanitation systems (apart of sanitation in ancient Rome) in most of Europe until the High Middle Ages. Unsanitary conditions and overcrowding were widespread throughout Europe and Asia during the Middle Ages. This resulted in pandemics such as the Plague of Justinian (541–542) and the Black Death (1347–1351), which killed tens of millions of people. [45] Very high infant and child mortality prevailed in Europe throughout medieval times, due partly to deficiencies in sanitation. [46]

In medieval European cities, small natural waterways used for carrying off wastewater were eventually covered over and functioned as sewers. London's River Fleet is such a system. Open drains, or gutters, for waste water run-off ran along the center of some streets. These were known as "kennels" (i.e., canals, channels), and in Paris were sometimes known as “split streets,” as the waste water running along the middle physically split the streets into two halves. The first closed sewer constructed in Paris was designed by Hugues Aubird in 1370 on Rue Montmartre (Montmartre Street), and was 300 meters long. The original purpose of designing and constructing a closed sewer in Paris was less-so for waste management as much as it was to hold back the stench coming from the odorous waste water. [47] In Dubrovnik, then known as Ragusa (Latin name), the Statute of 1272 set out the parameters for the construction of septic tanks and channels for the removal of dirty water. Throughout the 14th and 15th century the sewage system was built, and it is still operational today, with minor changes and repairs done in recent centuries. [48] Pail closets, outhouses, and cesspits were used to collect human waste. The use of human waste as fertilizer was especially important in China and Japan, where cattle manure was less available. However, most cities did not have a functioning sewer system before the Industrial era [ citation needed ] , relying instead on nearby rivers or occasional rain showers to wash away the sewage from the streets [ citation needed ] . In some places, waste water simply ran down the streets, which had stepping stones to keep pedestrians out of the muck, and eventually drained as runoff into the local watershed. [ citation needed ]

In the 16th century, Sir John Harington invented a flush toilet as a device for Queen Elizabeth I (his godmother) that released wastes into cesspools. [49]

After the adoption of gunpowder, municipal outhouses became an important source of raw material for the making of saltpeter in European countries. [50]

In London, the contents of the city's outhouses were collected every night by commissioned wagons and delivered to the nitrite beds where it was laid into specially designed soil beds to produce earth rich in mineral nitrates. The nitrate rich-earth would be then further processed to produce saltpeter, or potassium nitrate, an important ingredient in black powder that played a part in the making of gunpowder. [51]

Classic and early modern Mesoamerica Edit

The Classic Maya at Palenque had underground aqueducts and flush toilets the Classic Maya even used household water filters using locally abundant limestone carved into a porous cylinder, made so as to work in a manner strikingly similar to Modern ceramic water filters. [52] [53]

In Spain and Spanish America, a community operated watercourse known as an acequia, combined with a simple sand filtration system, provided potable water.

Sewage farms for disposal and irrigation Edit

“Sewage farms” (i.e. wastewater application to the land for disposal and agricultural use) were operated in Bunzlau (Silesia) in 1531, in Edinburgh (Scotland) in 1650, in Paris (France) in 1868, in Berlin (Germany) in 1876 and in different parts of the USA since 1871, where wastewater was used for beneficial crop production. [54] [55] In the following centuries (16th and 18th centuries) in many rapidly growing countries/cities of Europe (e.g. Germany, France) and the United States, “sewage farms” were increasingly seen as a solution for the disposal of large volumes of the wastewater, some of which are still in operation today. [56] Irrigation with sewage and other wastewater effluents has a long history also in China and India [57] while also a large “sewage farm” was established in Melbourne, Australia, in 1897. [58]

Sewer systems Edit

A significant development was the construction of a network of sewers to collect wastewater. In some cities, including Rome, Istanbul (Constantinople) and Fustat, networked ancient sewer systems continue to function today as collection systems for those cities' modernized sewer systems. Instead of flowing to a river or the sea, the pipes have been re-routed to modern sewer treatment facilities.

However, until the Enlightenment era, little progress was made in water supply and sanitation and the engineering skills of the Romans were largely neglected throughout Europe. This began to change in the 17th and 18th centuries with a rapid expansion in waterworks and pumping systems.

The tremendous growth of cities during the Industrial Revolution quickly led to terribly overpolluted streets, which acted as a constant source for the outbreak of disease. [59]

People wealthy enough to enjoy 19th century flush toilets often had the political power to allow them to drain into public sewers and the practice became the norm as indoor plumbing became more common, based on large-scale supply networks such as the Croton Aqueduct in New York.

As cities grew in the 19th century concerns were raised about public health. [60] : 33–62 As part of a trend of municipal sanitation programs in the late 19th and 20th centuries, many cities constructed extensive sewer systems to help control outbreaks of disease such as typhoid and cholera. [61] : 29–34

Initially these systems discharged sewage directly to surface waters without treatment. [62] Later, cities attempted to treat the sewage before discharge in order to prevent water pollution and waterborne diseases. During the half-century around 1900, these public health interventions succeeded in drastically reducing the incidence of water-borne diseases among the urban population, and were an important cause in the increases of life expectancy experienced at the time. [63]

Early techniques involved land application of sewage on agricultural land. [62] The use of the land treatment systems continued into the nineteenth/twentieth century in central Europe, USA, and other locations all over the world, but not without causing serious public health concerns and negative environmental impacts. During the 1840s and 1850s, this practice resulted in disastrous spread of waterborne diseases like cholera and typhoid. [64] However, when the water supply links with these diseases became clear, engineering solutions were implemented that include the development of alternative water sources using reservoirs and aqueduct systems, relocation of water intakes, and water and wastewater treatment systems. [65]

In the late 19th century some cities began to add chemical treatment and sedimentation systems to their sewers. [66] : 28 Most cities in the Western world added more expensive systems for sewage treatment in the 20th century, after scientists at the University of Manchester discovered the sewage treatment process of activated sludge in 1912. [67]

Storm and sanitary sewers were necessarily developed along with the growth of cities. By the 1840s the luxury of indoor plumbing, which mixes human waste with water and flushes it away, eliminated the need for cesspools. The odor was considered the big problem in waste disposal and to address it, sewage could be drained to a lagoon, or "settled" and the solids removed, to be disposed of separately. This process is now called "primary treatment" and the settled solids are called "sludge."

Liverpool, London and other cities, UK Edit

As recently as the late 19th-century sewerage systems in some parts of the rapidly industrializing United Kingdom were so inadequate that water-borne diseases such as cholera and typhoid remained a risk.

From as early as 1535 there were efforts to stop polluting the River Thames in London. Beginning with an Act passed that year that was to prohibit the dumping of excrement into the river. Leading up to the Industrial Revolution the River Thames was identified as being thick and black due to sewage, and it was even said that the river “smells like death.” [68] As Britain was the first country to industrialize, it was also the first to experience the disastrous consequences of major urbanisation and was the first to construct a modern sewerage system to mitigate the resultant unsanitary conditions. [ citation needed ] During the early 19th century, the River Thames was effectively an open sewer, leading to frequent outbreaks of cholera epidemics. Proposals to modernize the sewerage system had been made during 1856 but were neglected due to lack of funds. However, after the Great Stink of 1858, Parliament realized the urgency of the problem and resolved to create a modern sewerage system. [69]

However, ten years earlier and 200 miles to the north, James Newlands, a Scottish Engineer, was one of a celebrated trio of pioneering officers appointed under a private Act, the Liverpool Sanitory Act by the Borough of Liverpool Health of Towns Committee. The other officers appointed under the Act were William Henry Duncan, Medical Officer for Health, and Thomas Fresh, Inspector of Nuisances (an early antecedent of the environmental health officer). One of five applicants for the post, Newlands was appointed Borough Engineer of Liverpool on 26 January 1847.

He made a careful and exact survey of Liverpool and its surroundings, involving approximately 3,000 geodetical observations, and resulting in the construction of a contour map of the town and its neighbourhood, on a scale of one inch to 20 feet (6.1 m). From this elaborate survey Newlands proceeded to lay down a comprehensive system of outlet and contributory sewers, and main and subsidiary drains, to an aggregate extent of nearly 300 miles (480 km). The details of this projected system he presented to the Corporation in April 1848.

In July 1848 James Newlands' sewer construction programme began, and over the next 11 years 86 miles (138 km) of new sewers were built. Between 1856 and 1862 another 58 miles (93 km) were added. This programme was completed in 1869. Before the sewers were built, life expectancy in Liverpool was 19 years, and by the time Newlands retired it had more than doubled.

Joseph Bazalgette, a civil engineer and Chief Engineer of the Metropolitan Board of Works, was given responsibility for the work. He designed an extensive underground sewerage system that diverted waste to the Thames Estuary, downstream of the main center of population. Six main interceptor sewers, totaling almost 100 miles (160 km) in length, were constructed, some incorporating stretches of London's 'lost' rivers. Three of these sewers were north of the river, the southernmost, low-level one being incorporated in the Thames Embankment. The Embankment also allowed new roads, new public gardens, and the Circle Line of the London Underground.

The intercepting sewers, constructed between 1859 and 1865, were fed by 450 miles (720 km) of main sewers that, in turn, conveyed the contents of some 13,000 miles (21,000 km) of smaller local sewers. Construction of the interceptor system required 318 million bricks, 2.7 million cubic metres of excavated earth and 670,000 cubic metres of concrete. [70] Gravity allowed the sewage to flow eastwards, but in places such as Chelsea, Deptford and Abbey Mills, pumping stations were built to raise the water and provide sufficient flow. Sewers north of the Thames feed into the Northern Outfall Sewer, which fed into a major treatment works at Beckton. South of the river, the Southern Outfall Sewer extended to a similar facility at Crossness. With only minor modifications, Bazalgette's engineering achievement remains the basis for sewerage design up into the present day. [71]

In Merthyr Tydfil, a large town in South Wales, most houses discharged their sewage to individual cess-pits which persistently overflowed causing the pavements to be awash with foul sewage. [72]

Paris, France Edit

In 1802, Napoleon built the Ourcq canal which brought 70,000 cubic meters of water a day to Paris, while the Seine river received up to 100,000 cubic meters of wastewater per day. The Paris cholera epidemic of 1832 sharpened the public awareness of the necessity for some sort of drainage system to deal with sewage and wastewater in a better and healthier way. Between 1865 and 1920 Eugene Belgrand lead the development of a large scale system for water supply and wastewater management. Between these years approximately 600 kilometers of aqueducts were built to bring in potable spring water, which freed the poor quality water to be used for flushing streets and sewers. By 1894 laws were passed which made drainage mandatory. The treatment of Paris sewage, though, was left to natural devices as 5,000 hectares of land were used to spread the waste out to be naturally purified. Further, the lack of sewage treatment left Parisian sewage pollution to become concentrated downstream in the town of Clichy, effectively forcing residents to pack up and move elsewhere. [47]

The 19th century brick-vaulted Paris sewers serve as a tourist attraction nowadays.

Hamburg and Frankfurt, Germany Edit

The first comprehensive sewer system in a German city was built in Hamburg, Germany, in the mid-19th century. [66] : 2 [73] : 43 [74]

In 1863, work began on the construction of a modern sewerage system for the rapidly growing city of Frankfurt am Main, based on design work by William Lindley. 20 years after the system's completion, the death rate from typhoid had fallen from 80 to 10 per 100,000 inhabitants. [66] [73] : 43 [75]

United States Edit

The first sewer systems in the United States were built in the late 1850s in Chicago and Brooklyn. [73] : 43

In the United States, the first sewage treatment plant using chemical precipitation was built in Worcester, Massachusetts, in 1890. [66] : 29

Sewage treatment plants Edit

At the end of the 19th century, since primary treatment still left odor problems, it was discovered that bad odors could be prevented by introducing oxygen into the decomposing sewage. This was the beginning of the biological aerobic and anaerobic treatments which are fundamental to wastewater processes.

As pollution of water bodies became a concern, cities attempted to treat the sewage before discharge. [76] In the late 19th century some cities began to add chemical treatment and sedimentation systems to their sewers. [66] : 28 In the United States, the first sewage treatment plant using chemical precipitation was built in Worcester, Massachusetts in 1890. [66] : 29 Most cities in the Western world added more expensive systems for sewage treatment in the early 20th century, after scientists at the University of Manchester discovered the sewage treatment process of activated sludge in 1912. [67] During the half-century around 1900, these public health interventions succeeded in drastically reducing the incidence of water-borne diseases among the urban population, and were an important cause in the increases of life expectancy experienced at the time. [63]

Toilets Edit

With the onset of the industrial revolution and related advances in technology, the flush toilet began to emerge into its modern form. It needs to be connected to a sewer system though. Where this is not feasible or desired, dry toilets are an alternative option.

Water supply Edit

An ambitious engineering project to bring fresh water from Hertfordshire to London was undertaken by Hugh Myddleton, who oversaw the construction of the New River between 1609 and 1613. The New River Company became one of the largest private water companies of the time, supplying the City of London and other central areas. [77] The first civic system of piped water in England was established in Derby in 1692, using wooden pipes, [78] which was common for several centuries. [79] The Derby Waterworks included waterwheel-powered pumps for raising water out of the River Derwent and storage tanks for distribution. [80]

It was in the 18th century that a rapidly growing population fueled a boom in the establishment of private water supply networks in London. The Chelsea Waterworks Company was established in 1723 "for the better supplying the City and Liberties of Westminster and parts adjacent with water". [81] [82] The company created extensive ponds in the area bordering Chelsea and Pimlico using water from the tidal Thames. Other waterworks were established in London, including at West Ham in 1743, at Lea Bridge before 1767, Lambeth Waterworks Company in 1785, West Middlesex Waterworks Company in 1806 [83] and Grand Junction Waterworks Company in 1811. [84]

The S-bend pipe was invented by Alexander Cummings in 1775 but became known as the U-bend following the introduction of the U-shaped trap by Thomas Crapper in 1880. The first screw-down water tap was patented in 1845 by Guest and Chrimes, a brass foundry in Rotherham. [85]

Water treatment Edit

Sand filter Edit

Sir Francis Bacon attempted to desalinate sea water by passing the flow through a sand filter. Although his experiment did not succeed, it marked the beginning of a new interest in the field.

The first documented use of sand filters to purify the water supply dates to 1804, when the owner of a bleachery in Paisley, Scotland, John Gibb, installed an experimental filter, selling his unwanted surplus to the public. [86] [87] This method was refined in the following two decades by engineers working for private water companies, and it culminated in the first treated public water supply in the world, installed by engineer James Simpson for the Chelsea Waterworks Company in London in 1829. [88] [89] This installation provided filtered water for every resident of the area, and the network design was widely copied throughout the United Kingdom in the ensuing decades.

The Metropolis Water Act introduced the regulation of the water supply companies in London, including minimum standards of water quality for the first time. The Act "made provision for securing the supply to the Metropolis of pure and wholesome water", and required that all water be "effectually filtered" from 31 December 1855. [90] This was followed up with legislation for the mandatory inspection of water quality, including comprehensive chemical analyses, in 1858. This legislation set a worldwide precedent for similar state public health interventions across Europe. [91] The Metropolitan Commission of Sewers was formed at the same time, water filtration was adopted throughout the country, and new water intakes on the Thames were established above Teddington Lock. Automatic pressure filters, where the water is forced under pressure through the filtration system, were innovated in 1899 in England. [86]

Water chlorination Edit

In what may have been one of the first attempts to use chlorine, William Soper used chlorinated lime to treat the sewage produced by typhoid patients in 1879.

In a paper published in 1894, Moritz Traube formally proposed the addition of chloride of lime (calcium hypochlorite) to water to render it "germ-free." Two other investigators confirmed Traube's findings and published their papers in 1895. [92] Early attempts at implementing water chlorination at a water treatment plant were made in 1893 in Hamburg, Germany, and in 1897 the city of Maidstone, England, was the first to have its entire water supply treated with chlorine. [93]

Permanent water chlorination began in 1905, when a faulty slow sand filter and a contaminated water supply led to a serious typhoid fever epidemic in Lincoln, England. [94] Dr. Alexander Cruickshank Houston used chlorination of the water to stem the epidemic. His installation fed a concentrated solution of chloride of lime to the water being treated. The chlorination of the water supply helped stop the epidemic and as a precaution, the chlorination was continued until 1911 when a new water supply was instituted. [95]

The first continuous use of chlorine in the United States for disinfection took place in 1908 at Boonton Reservoir (on the Rockaway River), which served as the supply for Jersey City, New Jersey. [96] Chlorination was achieved by controlled additions of dilute solutions of chloride of lime (calcium hypochlorite) at doses of 0.2 to 0.35 ppm. The treatment process was conceived by Dr. John L. Leal and the chlorination plant was designed by George Warren Fuller. [97] Over the next few years, chlorine disinfection using chloride of lime were rapidly installed in drinking water systems around the world. [98]

The technique of purification of drinking water by use of compressed liquefied chlorine gas was developed by a British officer in the Indian Medical Service, Vincent B. Nesfield, in 1903. According to his own account, "It occurred to me that chlorine gas might be found satisfactory . if suitable means could be found for using it. The next important question was how to render the gas portable. This might be accomplished in two ways: By liquefying it, and storing it in lead-lined iron vessels, having a jet with a very fine capillary canal, and fitted with a tap or a screw cap. The tap is turned on, and the cylinder placed in the amount of water required. The chlorine bubbles out, and in ten to fifteen minutes the water is absolutely safe. This method would be of use on a large scale, as for service water carts." [99]

U.S. Army Major Carl Rogers Darnall, Professor of Chemistry at the Army Medical School, gave the first practical demonstration of this in 1910. Shortly thereafter, Major William J. L. Lyster of the Army Medical Department used a solution of calcium hypochlorite in a linen bag to treat water. For many decades, Lyster's method remained the standard for U.S. ground forces in the field and in camps, implemented in the form of the familiar Lyster Bag (also spelled Lister Bag). This work became the basis for present day systems of municipal water purification. [ citation needed ]

Fluoridation Edit

Water fluoridation is a practice that has been carried out since the early 20th century for the purpose of decreasing tooth decay.

Trends Edit

The Sustainable Development Goal 6 formulated in 2015 includes targets on access to water supply and sanitation at a global level. In developing countries, self-supply of water and sanitation is used as an approach of incremental improvements to water and sanitation services, which are mainly financed by the user. Decentralized wastewater systems are also growing in importance to achieve sustainable sanitation. [100]

A basic form of contagion theory dates back to medicine in the medieval Islamic world, where it was proposed by Persian physician Ibn Sina (also known as Avicenna) in The Canon of Medicine (1025), the most authoritative medical textbook of the Middle Ages. He mentioned that people can transmit disease to others by breath, noted contagion with tuberculosis, and discussed the transmission of disease through water and dirt. [101] The concept of invisible contagion was eventually widely accepted by Islamic scholars. In the Ayyubid Sultanate, they referred to them as najasat ("impure substances"). The fiqh scholar Ibn al-Haj al-Abdari (c. 1250–1336), while discussing Islamic diet and hygiene, gave advice and warnings about how contagion can contaminate water, food, and garments, and could spread through the water supply. [102]

Long before studies had established the germ theory of disease, or any advanced understanding of the nature of water as a vehicle for transmitting disease, traditional beliefs had cautioned against the consumption of water, rather favoring processed beverages such as beer, wine and tea. For example, in the camel caravans that crossed Central Asia along the Silk Road, the explorer Owen Lattimore noted, "The reason we drank so much tea was because of the bad water. Water alone, unboiled, is never drunk. There is a superstition that it causes blisters on the feet." [103]

One of the earliest understandings of waterborne diseases in Europe arose during the 19th century, when the Industrial Revolution took over Europe. [104] [105] Waterborne diseases, such as cholera, were once wrongly explained by the miasma theory, the theory that bad air causes the spread of diseases. [104] [105] However, people started to find a correlation between water quality and waterborne diseases, which led to different water purification methods, such as sand filtering and chlorinating their drinking water. [104]

Founders of microscopy, Antonie van Leeuwenhoek and Robert Hooke, used the newly invented microscope to observe for the first time small material particles that were suspended in the water, laying the groundwork for the future understanding of waterborne pathogens and waterborne diseases. [106]

In the 19th century, Britain was the center for rapid urbanization, and as a result, many health and sanitation problems manifested, for example cholera outbreaks and pandemics. This resulted in Britain playing a large role in the development for public health. [107] Before discovering the link between contaminated drinking water and diseases, such as cholera and other waterborne diseases, the miasma theory was used to justify the outbreaks of these illnesses. [107] Miasma theory is the theory that certain diseases and illnesses are the products of "bad airs". [108] The investigations of the physician John Snow in the United Kingdom during the 1854 Broad Street cholera outbreak clarified the connections between waterborne diseases and polluted drinking water. Although the germ theory of disease had not yet been developed, Snow's observations led him to discount the prevailing miasma theory. His 1855 essay On the Mode of Communication of Cholera conclusively demonstrated the role of the water supply in spreading the cholera epidemic in Soho, [109] with the use of a dot distribution map and statistical proof to illustrate the connection between the quality of the water source and cholera cases. During the 1854 epidemic, he collected and analyzed data establishing that people who drank water from contaminated sources such as the Broad Street pump died of cholera at much higher rates than those who got water elsewhere. His data convinced the local council to disable the water pump, which promptly ended the outbreak.

Edwin Chadwick, in particular, played a key role in Britain's sanitation movement, using the miasma theory to back up his plans for improving the sanitation situation in Britain. [107] Although Chadwick brought contributions to developing public health in the 19th century, it was John Snow and William Budd who introduced the idea that cholera was the consequence of contaminated water, presenting the idea that diseases could be transmitted through drinking water. [107]

People found that purifying and filtering their water improved the water quality and limited the cases of waterborne diseases. [107] In the German town Altona this finding was first illustrated by using a sand filtering system for its water supply. [107] A nearby town that didn't use any filtering system for their water suffered from the outbreak while Altona remained unaffected by the disease, providing evidence that the quality of water had something to do with the diseases. [107] After this discovery, Britain and the rest of Europe took into account to filter their drinking water, as well as chlorinating them to fight off waterborne diseases like cholera. [107]


Seventies Homes

Example of a home from our Property for sale in the 1970's
1963 New Homes Lowell Massachusetts
large tree wooded plots, colored bath and kitchen fixtures, full basement Formica kitchen 3 bedrooms From $15,500
Electrical Home Goods
As technology improved the range and sophistication of home appliances offered much greater freedom and uses including "Time Saving Devices", plus as you can see for the second example some items had a 70's look and feel all of their own. But Color TV's still have a long way to go The Latest and Cinema Screen Color TV costing close to $800 in todays money about $4,000. Not included on these examples but can be found on the page are the latest music playing devices including an Eight Track Tape Player and an example of a solid-state Three Speed Record deck and speakers.
From Our 1970's Home Appliances Page
Homes and Furniture From The Seventies
It is interesting looking at the furniture and fixtures you might find in a home from each decade, below are just two examples I found interesting from the more than 20 we have included on our
Home furnishing examples with descriptions and Prices Page


From Our 1970's Home Furnishing Page


Contents

In the State of Wu of China, steel was first made, preceding the Europeans by over 1,000 years. [4] The Song dynasty saw intensive industry in steel production, and coal mining. No other premodern state advanced nearly as close to starting an industrial revolution as the Southern Song. [5] [6] The want of potential customers for products manufactured by machines instead of artisans was due to the absence of a "middle class" in Song China which was the reason for the failure to industrialize. [7]

Western historians debate whether bloomery-based ironworking ever spread to China from the Middle East. Around 500 BC, however, metalworkers in the southern state of Wu developed an iron smelting technology that would not be practiced in Europe until late medieval times. In Wu, iron smelters achieved a temperature of 1130 °C, hot enough to be considered a blast furnace which could create cast iron. [8] [9] [10] At this temperature, iron combines with 4.3% carbon and melts. As a liquid, iron can be cast into molds, a method far less laborious than individually forging each piece of iron from a bloom.

Cast iron is rather brittle and unsuitable for striking implements. It can, however, be decarburized to steel or wrought iron by heating it in air for several days. In China, these ironworking methods spread northward, and by 300 BC, iron was the material of choice throughout China for most tools and weapons. A mass grave in Hebei province, dated to the early 3rd century BC, contains several soldiers buried with their weapons and other equipment. The artifacts recovered from this grave are variously made of wrought iron, cast iron, malleabilized cast iron, and quench-hardened steel, with only a few, probably ornamental, bronze weapons.

During the Han dynasty (202 BC–220 AD), the government established ironworking as a state monopoly (yet repealed during the latter half of the dynasty, returned to private entrepreneurship) and built a series of large blast furnaces in Henan province, each capable of producing several tons of iron per day. By this time, Chinese metallurgists had discovered how to puddle molten pig iron, stirring it in the open air until it lost its carbon and became wrought iron. (In Chinese, the process was called chao, literally, stir frying.) By the 1st century BC, Chinese metallurgists had found that wrought iron and cast iron could be melted together to yield an alloy of intermediate carbon content, that is, steel. [11] [12] [13] According to legend, the sword of Liu Bang, the first Han emperor, was made in this fashion. Some texts of the era mention "harmonizing the hard and the soft" in the context of ironworking the phrase may refer to this process. Also, the ancient city of Wan (Nanyang) from the Han period forward was a major center of the iron and steel industry. [14] Along with their original methods of forging steel, the Chinese had also adopted the production methods of creating Wootz steel, an idea imported from India to China by the 5th century. [15]

The Chinese during the ancient Han Dynasty were also the first to apply hydraulic power (i.e. a waterwheel) in working the inflatable bellows of the blast furnace. This was recorded in the year 31 AD, an innovation of the engineer Du Shi, prefect of Nanyang. [16] Although Du Shi was the first to apply water power to bellows in metallurgy, the first drawn and printed illustration of its operation with water power came in 1313, in the Yuan dynasty era text called the Nong Shu. [17] In the 11th century, there is evidence of the production of steel in Song China using two techniques: a "berganesque" method that produced inferior, heterogeneous steel and a precursor to the modern Bessemer process that utilized partial decarbonization via repeated forging under a cold blast. [18] By the 11th century, there was also a large amount of deforestation in China due to the iron industry's demands for charcoal. [19] However, by this time the Chinese had figured out how to use bituminous coke to replace the use of charcoal, and with this switch in resources many acres of prime timberland in China were spared. [19] This switch in resources from charcoal to coal was later used in Europe by the 17th century.

The economy of the Song dynasty was one of the most prosperous and advanced economies in the medieval world. Song Chinese invested their funds in joint stock companies and in multiple sailing vessels at a time when monetary gain was assured from the vigorous overseas trade and indigenous trade along the Grand Canal and Yangzi River. [20] Prominent merchant families and private businesses were allowed to occupy industries that were not already government-operated monopolies. [21] [22] Both private and government-controlled industries met the needs of a growing Chinese population in the Song. [21] [22] Both artisans and merchants formed guilds which the state had to deal with when assessing taxes, requisitioning goods, and setting standard worker's wages and prices on goods. [20] [23]

The iron industry was pursued by both private entrepreneurs who owned their own smelters as well as government-supervised smelting facilities. [24] [25] The Song economy was stable enough to produce over a hundred million kg (over two hundred million lb) of iron product a year. [26] Large scale deforestation in China would have continued if not for the 11th-century innovation of the use of coal instead of charcoal in blast furnaces for smelting cast iron. [19] Much of this iron was reserved for military use in crafting weapons and armoring troops, but some was used to fashion the many iron products needed to fill the demands of the growing indigenous market. The iron trade within China was furthered by the building of new canals which aided the flow of iron products from production centers to the large market found in the capital city. [27]

The annual output of minted copper currency in 1085 alone reached roughly six billion coins. [28] The most notable advancement in the Song economy was the establishment of the world's first government issued paper-printed money, known as Jiaozi (see also Huizi). [28] For the printing of paper money alone, the Song court established several government-run factories in the cities of Huizhou, Chengdu, Hangzhou, and Anqi. [29] The size of the workforce employed in paper money factories was large it was recorded in 1175 that the factory at Hangzhou employed more than a thousand workers a day. [29]

The economic power of Song China heavily influenced foreign economies abroad. The Moroccan geographer al-Idrisi wrote in 1154 of the prowess of Chinese merchant ships in the Indian Ocean and of their annual voyages that brought iron, swords, silk, velvet, porcelain, and various textiles to places such as Aden (Yemen), the Indus River, and the Euphrates in modern-day Iraq. [30] Foreigners, in turn, affected the Chinese economy. For example, many West Asian and Central Asian Muslims went to China to trade, becoming a preeminent force in the import and export industry, while some were even appointed as officers supervising economic affairs. [31] [32] Sea trade with the Southeast Pacific, the Hindu world, the Islamic world, and the East African world brought merchants great fortune and spurred an enormous growth in the shipbuilding industry of Song-era Fujian province. [33] However, there was risk involved in such long overseas ventures. To reduce the risk of losing money on maritime trade missions abroad, the historians Ebrey, Walthall, and Palais write:

[Song era] investors usually divided their investment among many ships, and each ship had many investors behind it. One observer thought eagerness to invest in overseas trade was leading to an outflow of copper cash. He wrote, 'People along the coast are on intimate terms with the merchants who engage in overseas trade, either because they are fellow-countrymen or personal acquaintances. [They give the merchants] money to take with them on their ships for purchase and return conveyance of foreign goods. They invest from ten to a hundred strings of cash, and regularly make profits of several hundred percent'. [34]

Some historians such as David Landes and Max Weber credit the different belief systems in China and Europe with dictating where the revolution occurred. The religion and beliefs of Europe were largely products of Judaeo-Christianity, Socrates, Plato, and Aristotle. Conversely, Chinese society was founded on men like Confucius, Mencius, Han Feizi (Legalism), Lao Tzu (Taoism), and Buddha (Buddhism). The key difference between these belief systems was that those from Europe focused on the individual, while Chinese beliefs centered around relationships between people. [ citation needed ] The family unit was more important than the individual for the large majority of Chinese history, and this may have played a role in why the Industrial Revolution took much longer to occur in China. There was the additional difference as to whether people looked backwards to a reputedly glorious past for answers to their questions or looked hopefully to the future. [ citation needed ] Further scholarship, such as that of Joel Makyr suggests that one of the main driving forces that led to Europe industrializing sooner than China was a culture of interstate competition. Because China was the regional hegemonic power there was no large threat from the 17th century onwards. In Europe, where there was no clear hegemonic power, the power struggle created a competition model which allowed for economic, cultural, and technological progress that was unseen in China. Other factors include a Chinese culture of status-quo stability, meaning that revolutionary new ideas which called into question the historical or cultural narrative of China were largely suppressed, meaning there was little space for innovation comparable to Europe. [35] Although this view may supplement a larger narrative, it is by no means definitive and is only one piece of the multi-faceted phenomena of why China experienced industrialization later in its history compared to Western nations. [ citation needed ] [ editorializing ]

The English school Edit

By contrast, there is a historical school which Jack Goldstone has dubbed the "English school" which argues that China was not essentially different from Europe, and that many of the assertions that it was are based on bad historical evidence. [36]

Mark Elvin argues that China was in a high-level equilibrium trap in which the non-industrial methods were efficient enough to prevent use of industrial methods with high initial capital. Kenneth Pomeranz, in the Great Divergence, argues that Europe and China were remarkably similar in 1700, and that the crucial differences which created the Industrial Revolution in Europe were sources of coal near manufacturing centers, and raw materials such as food and wood from the New World, which allowed Europe to expand economically in a way that China could not. [37]

Some have compared England directly to China, but the comparison between England and China has been viewed as a faulty one, since China is so much larger than England. A more relevant comparison would be between China's Yangtze Delta region, China's most advanced region, the location of Hangzhou, Nanjing and contemporary Shanghai, and England. This region of China is said to have had similar labor costs to England. [38] According to Andre Gunder Frank, "Particularly significant is the comparison of Asia's 66 percent share of world population, confirmed above all by estimates for 1750, with its 80 percent share of production in the world at the same time. So, two thirds of the world's people in Asia produced four-fifths of total world output, while one-fifth of world population in Europe produced only a part of the remaining one-fifth share of world production, to which Europeans and Americans also contributed." [39] China was one of Asia's most advanced economies at the time and was in the middle of its 18th-century boom brought on by a long period of stability under the Qing dynasty.

Industrialization of China did occur on a significant scale only from the 1950s. Beginning in 1953 Mao introduced a 'Five Year Plan' reminiscent of Soviet industrialization efforts. This five-year plan would signify the People's Republic of China first large scale campaign to industrialize. Drawing heavily from Soviet success, the plan was characterized by intense collectivization and economic centralization. Soviet assistance was crucial in this undertaking, China “received the most advanced technology available within the Soviet Union, and in some cases this was the best in the world”. [40] Several thousand Soviet Technical advisors went on to oversee and guide 156 industrial projects. Soviet assistance during this stage constituted about half of industrial production and development. [1] Because of Soviet assisted development, agricultural and industrial output value grew from 30% in 1949 to 56.5% in 1957, and heavy industry saw similar growth from 26.4% to 48.4%. [41] Therefore, the Soviet assistance in kickstarting industrialization was a key component in the larger process of Chinese industrialization, and economic development as a whole. The Maoist Great Leap Forward (simplified Chinese: 大跃进 traditional Chinese: 大躍進 pinyin: Dàyuèjìn ) was the plan used from 1958 to 1961 to transform the People's Republic of China from a primarily agrarian economy by peasant farmers into a modern communist society through the process of agriculturalization and industrialization. Mao Zedong anticipated agriculture and industry (shorthand 'grain and steel') as the foundations of any economic progress or national strengthening. [42] Thus, The Great Leap forward heavily relied on and lent attention to these two sectors to establish a strong economic base from which further developments could originate. Ideological motivations for this transformation are widely varied. Chinese experience of foreign occupation had widespread effects on the national mentality, compelling leaders to establish a strong, autonomous and self sufficient state. A primary factor however was Cold War cultural, and economic competition with the West. Hearing of the Soviet Union's plan to surpass the United States in industrial output, Mao Zedong claimed "Comrade Khrushchev has told us, the Soviet Union 15 years later will surpass the United States of America. I can also say, 15 years later, we may catch up with or exceed the UK." [43] Mao Zedong based this program on the Theory of Productive Forces. The Great Leap Forward ended in catastrophe, high volumes of resources were directed to the industrial projects of the campaign. When the industrial projects failed to produced the expected output, there was a lack of resources including tools, farming equipment and infrastructure upon which the agricultural sector was relying upon. In conjunction with widespread drought towards the end of the period, a widespread famine occurred. The overall result of the Great Leap Forward was an actual, albeit temporary, shrinking of the Chinese economy. However, from 1952 to 1978 GDP per capita grew at an average rate of 3.6%, outpacing inflation. Another trend from The Great Leap Forward, was the steady decline of those employed in the agricultural sector, as the industrial sector grew. Furthermore, as China began to rely more heavily on industrial output, the value added to the GDP by agriculture also declined, going from 70% in 1952, to 30% in 1977. [44] During this time period several notable industries within China experienced significant growth in their annual production: annual steel production grew from 1.3 million tons to 23 million tons, coal grew from 66 million tons to 448 million tons, electric power generation increased from 7 million to 133 billion kilowatt-hours, and cement production rose from 3 million to 49 million tons per year. [2] [3]

As political stability was gradually restored following the Cultural Revolution of the late 1960s, a renewed drive for coordinated, balanced development was set in motion under the leadership of Premier Zhou Enlai. To revive efficiency in industry, Chinese Communist Party committees were returned to positions of leadership over the revolutionary committees, and a campaign was carried out to return skilled and highly educated personnel to the jobs from which they had been displaced during the Cultural Revolution. Universities began to reopen, and foreign contacts were expanded. Once again the economy suffered from imbalances in the capacities of different industrial sectors and an urgent need for increased supplies of modern inputs for agriculture. In response to these problems, there was a significant increase in investment, including the signing of contracts with foreign firms for the construction of major facilities for chemical fertilizer production, steel finishing, and oil extraction and refining. The most notable of these contracts was for thirteen of the world's largest and most modern chemical fertilizer plants. During this period, industrial output grew at an average rate of 11 percent a year. [2] [3]

At the milestone Third Plenum of the National Party Congress's 11th Central Committee which opened on December 22, 1978, the party leaders decided to undertake a program of gradual but fundamental reform of the economic system. [45] They concluded that the Maoist version of the centrally planned economy had failed to produce efficient economic growth and had caused China to fall far behind not only the industrialized nations of the West but also the new industrial powers of Asia: Japan, South Korea, Singapore, Taiwan, and Hong Kong. In the late 1970s, while Japan and Hong Kong rivaled European countries in modern technology, China's citizens had to make do with barely sufficient food supplies, rationed clothing, inadequate housing, and a service sector that was inadequate and inefficient. All of these shortcomings embarrassed China internationally.

The purpose of the reform program was not to abandon communism but to make it work better by substantially increasing the role of market mechanisms in the system and by reducing—not eliminating—government planning and direct control. The process of reform was incremental. New measures were first introduced experimentally in a few localities and then were popularized and disseminated nationally if they proved successful. By 1987 the program had achieved remarkable results in increasing supplies of food and other consumer goods and had created a new climate of dynamism and opportunity in the economy. At the same time, however, the reforms also had created new problems and tensions, leading to intense questioning and political struggles over the program's future. [ citation needed ] [46]

The first few years of the reform program were designated the "period of readjustment," during which key imbalances in the economy were to be corrected and a foundation was to be laid for a well-planned modernization drive. The schedule of Hua Guofeng's ten-year plan was discarded, although many of its elements were retained. The major goals of the readjustment process were to expand exports rapidly overcome key deficiencies in transportation, communications, coal, iron, steel, building materials, and electric power and redress the imbalance between light and heavy industry by increasing the growth rate of light industry and reducing investment in heavy industry.

In 1984, the fourteen largest coastal cities were designated as economic development zones, including Dalian, Tianjin, Shanghai, and Guangzhou, all of which were major commercial and industrial centers. These zones were to create productive exchanges between foreign firms with advanced technology and major Chinese economic networks. [47]

China has continued its rise as an industrial power through the present day. It is now the leading industrial power in the world in terms of output, in 2016 producing $4.566 trillion worth of industrial yield. [48] This rapid increase, is in large part attributed to a number of factors. Opening sectors of the industrial economy to foreign investment and privatization, the introduction of the stock market in Shanghai, increasing export markets, outsourcing of manufacturing into China, and the entry of China into the World Trade Organization. [49]

While Chinese industrial output is still dominant in the world, it had been subjected to slowdowns and stagnation. Declining in the late 1990s, it reached its low point of 7% in 1998 (industrial output index) and reached 23% in 2004. Since then, it has largely declined and stagnated in the 2010s hovering between 5-10%. Much of this downturn can be attributed to lower demand as a response to the Chinese stock market crash. In response, in 2016 China announced its plans to downsize its steel and coal industries and layoff 15% of the respective industries workforce. [50] Part of this larger trend can be attributed to China's movement away from heavy industry, and movement into light industry such as producing consumer goods for the world market. China has also seen growth in other sectors such as construction, technology, finance, and energy which can also be attributed to the decline and reliance on industry as an economic sector. [51]

Like previous industrialization campaigns, Chinese industrialization brought modern economic development and a general increase in quality of life for many of its citizens, [52] while also introducing a variety of environmental implications that can be felt locally, and on a global scale. [53] Severe pollution, dehydration of waterways, widespread deforestation, and some of the highest levels of air pollution in the world are just a few of China's cost of its rapid industrialization and modernization. From 1985 to 2008, the quantities of energy production grew by 203.9%, while the energy consumption increased by 271.7%. Along with those increases, the emissions of industrial wastewater, gas and solid waste have undergone massive growth. Environmental accidents all over the country have also increased in recent years. “It is reported that the number of environmental disasters in 2010 was as double as that of 2009, and there were 102 accidents in the first half of 2010.” [54]

Air pollutants Edit

CO2 Edit

China faces a problem with air quality as a consequence of industrialization. China ranks as the second largest consumer of oil in the world, and "China is the world’s top coal producer, consumer, and importer, and accounts for almost half of global coal consumption.”, [55] as such their CO2 emissions reflect the usage and production of fossil fuels. As of 2015, China has been ranked the number one CO2 contributor holding 29% of the global CO2 emission emissions. [56] In 2012, the World Resources Institute figured the total global carbon emission to be 33.84 billion tons where China contributed to 9.31 billion. [57] In particular, biomass forest burning and shrubland, grassland, and crop residue fire burning are some of the most important contributors to China's CO2 emission. [58] Agriculture is also another top contributor to carbon emission in China representing 17% of the total emissions. [59] And, China's steel industry has accounted for 44% of the total CO2 emissions. China's industries are not the only determinate of air pollution China's growing population has increased heavy traffic and power generation. Altogether, China's growing infrastructure has created 3.28 billion tons of industrial waste from 2013 to 2016. [57] On a local level, China has implemented a pollution warning system that notifies citizens of the day to day air quality and potential health effects. The highest warning: red, indicates an unsuitability for all outdoor activity because of health risks. Certain measures have been adopted to curb the production of smog and haze within China such as temporary vehicle bans. Additionally as smog and haze threats grow, the Chinese Ministry of Environmental Protection has called upon the steel producing cities of Linyi and Chengde to curb pollution from a result of the steel industry, by enforcing environmental laws or by closing down some thirteen offender's factories. [60]

Water pollutants Edit

Haui River Basin Within the Shandong Province Case Study Edit

The Haui River Basin is located between the Yangtze River and the Yellow River and contains 42 counties. The Haui River Basin within Shandong covers an area of 4.71 X 10^4 km 2 including the Nansi Lake Basin and Yishi River Basin. [61]

With the growing infrastructure from industrialization, urbanization, and the growth of megacities in China, there are numerous pollutants that are decreasing the water quality and have contaminated many groundwater aquifers. A study on the causes of pollutants on the Haui River Basin within the Shandong province analyzed which of these industries caused the most wastewater to determine the direct effects of industrialization in the HRBSP. Different industries that emit these pollutants in the region were classified into different levels for their environmental impact. Coal, papermaking, and construction material were classified as high-energy-consumption/low-output value/high-pollution industries. Textiles, petrochemicals, and electric power were classified as high-energy-consumption/ high-output value/high pollution industries. Lastly, medical manufacturing and mechanical scores were classified as low-energy-consumption/high-output value/low-pollutant industries. The study concluded that the top contributors to water pollutants were the food processing industry, 23.55% COD and 26.05% NH3-N, the papermaking industry, 28.47% COD and 18.72% NH3-N, and the petrochemical industry, 15.34% COD and 25.52% NH3-N. [61]

Since 2010, China's Prevention and Control of Water Pollution and the Eleventh Five-Year Plan of the Haui River Basin have set water quality requirements to level III meaning the water quality is clean enough for human consumption and recreation. Because the Haui River Basin includes four-prefecture-level cities, Zaozhuang, Jinan, Linyi, and Heze, there is high pressure for meeting the required water quality standards. Of the 27 monitoring sites in this case study, the Haui River Basin's water quality was graded IV, where water quality is not suitable for human consumption or recreation, at 10 monitoring sites and graded V, where water quality it extremely polluted and unsuitable for any use, in the Xiangzimio region. [62] Even though the water quality at these sites have slightly improved, the Eastern Route of the South-to-North Water Division Project, who manages the water quality of the Haui River Basin, are still in their developing stages and have struggled to maintain a balance between industrialization and water quality due to the rate of China's growing industrial activities. [61]

Desertification Edit

Desertification remains a serious problem, consuming an area greater than the area used as farmland. Over 2.95 million hectares, or 57% of its territory, had been affected by desertification. [63] Although desertification has been curbed in some areas, it is still expanding at a rate of more than 67 km 2 every year. 90% of China's desertification occurs in the west of the country. Approximately 30% of China's current surface area is considered desert. China's rapid industrialization could cause this area to drastically increase. The Gobi Desert to the north currently expands by about 950 square miles (2,500 km 2 ) per year. [64] The vast plains in northern China used to be regularly flooded by the Yellow River. However, overgrazing and the expansion of agricultural land could cause this area to increase.

Health risks Edit

Pollutants emitted into the air and water by China's rapid industrialization has brought major health concerns. The anthropogenic activities in China have decreased food safety and antibiotic resistance and have increased resurging infectious diseases. Air pollution, alone, is directly linked to increased risk of lung cancer, breast cancer, and bladder cancer and has already led to more than 1.3 million premature deaths in China [57] and linked to 1.6 million deaths a year - 17% of all annual Chinese deaths. 92% of Chinese have had at least 120 annual hours of unhealthy air determined by EPA standards. As the World Health Organization states hazardous air is more deadly than AIDS, malaria, breast cancer, or tuberculosis, than Chinese air quality is especially problematic because of the scale at which it occurs. [65]

While farmable land in China is slim to begin with, the Ministry of Land and Resources reported that China has contaminated 33.3 million hectares of farmland that cannot be used for any constructive purpose. Consequently, China is faced with increased exposure to new pathogens that threaten public health as a result migrating wildlife from these dead zones. [57]


Who was the man in the lead burrito?

In 2010, archaeologists from the University of Michigan uncovered a mysterious, 1,000-pound lead coffin buried in the city of Gabii. Clearly, someone had gone to huge lengths to give this person an elaborate burial, securing their earthly remains in a sheet of lead folded carefully into a coffin in a shape that gave it the nickname "lead burrito." Nicola Terrenato of the University of Michigan (via Science Daily) said lead coffins were rare and that one that heavy would have cost a fortune. Guesses as to who was buried inside ranged from a gladiator or a soldier of some renown to a big wig in the religious world. Exciting, right? Researchers were planning on using noninvasive techniques like thermography to see what artifacts had been buried with the body and learn more about the person.

Unfortunately for them (and anyone else who's curious), the contents of the lead burrito didn't help solve the mystery at all. There was absolutely nothing buried with him, and the only thing researchers learned was that the remains belonged to an adult man who was buried about the time Nero was ruling. Beyond that, we have no idea why this massive but singular display of wealth and standing was made during his burial.


No rights

As non-citizens, Rohingya people lack basic rights within Myanmar and are considered stateless. Though Myanmar recognizes 135 distinct ethnic groups, the Rohingya are not one of them. Myanmar refuses to recognize the term as one that refers to the region’s Muslim minority.

When Myanmar became a military state in 1962, the Rohingya became victims of state-sponsored persecution. During “Operation King Dragon,” Burmese military forces targeted the Rohingya people, and were accused of human rights abuses including rape, destruction of houses and villages, and mass arrests. Rohingya people began fleeing to nearby Bangladesh in huge numbers. Another targeted campaign, “Operation Clean and Beautiful Nation,” pushed another 200,000 people out of the country.

Today, the Rohingya are considered illegal immigrants by Myanmar, and are not recognized under the law. Rohingya people cannot access social services or education, and their movement outside of Rakhine State is closely restricted. Myanmar has also imposed strict regulations on birth control and marriage, only allowing Rohingya in some townships in Rakhine State to have two children and restricting the marriages of some Rohingya.