  EPIDEMICS—
QUARANTINE—
CONTAGION—
APPENDIX.
OF EPIDEMICS. Some account of the structure and functions of the human frame, of the action of physical agents on this wonderful machinery, and of the principles which relate to Individual, as well as to Public Health, ought to form a part of elemental education. There is a growing conviction that the necessity for such knowledge is not restricted to the physician; that it is essential also to the educator, the mother, the nurse, and indeed to every one who would enjoy, together with the due development of his physical, intellectual, and moral nature, the full term of the boon of life. The main causes which shorten and embitter human life, as far as that unhappy result depends on the disturbance of health, are within our own control. There is the closest connection between the knowledge we have acquired of the physical conditions on which the life and health of individuals and communities depend, and on our command over those conditions. Every fact we have learnt respecting the great laws of nature, on our conformity to which our very existence depends, has taught us that the circumstances The character of Pestilence which gave it its great power and terror—that it walketh in darkness,—is its character no longer. Its veil has fallen, and with it its strength. A clear and steady light now marks its course from its commencement to its end; and that light places in equally broad and strong relief its antagonist and conqueror—Cleanliness. The term Epidemic has become a popular one. It is derived from two Greek words, which signify “upon the people—prevalent among the people”—diseases which, at one and the same time, prevail extensively among large masses of the people. Recently these diseases have received another name, which is also becoming familiar—“Zymotic,” from a Greek word, which signifies to “ferment,” as if the efficient cause of these diseases, whatever it may be, acts in the manner of a ferment. Epidemic diseases, though called by a common name, present great differences in their external characters. Plague, Yellow Fever, Cholera, Small-Pox, Typhus, Scarlet Fever, Influenza, present characters so definite and special, that they have been naturally regarded as distinct diseases, and they really are so different as to render it desirable, for many reasons, that each should be discriminated and denoted by its proper name. Amidst this great diversity in form, however, they present very striking resemblances, of which the following are generally recognized:— 1. Epidemics resemble each other in being all fevers. They all exhibit that particular assemblage of symptoms which from time immemorial it has been agreed to denote by the term Fever. The so-called Black Death of the 14th century was a fever—an aggravated form of the Oriental or Bubo-Plague; in which there occurred, in addition to the ordinary symptoms of that dreadful disease, effusions of black blood, forming black spots on the arms, face, and chest. From this circumstance it derived its name. These effusions on the external surface of the body were accompanied by profuse and mortal discharges from the internal organs. The Oriental Plague, the great devastator of Europe in former times, and still the scourge of some portions of it, is a fever characterized by specific glandular inflammation. The Sweating Sickness of the 15th and 16th centuries was a fever, with symptoms of acute rheumatism, attended with a foetid perspiration which poured from the body in streams. “Suddenly,” says Hollingshed, “a deadly burning sweat assailed their bodies and distempered their blood, and all, as soon as the sweat took them, yielded the ghost.” The Cholera of modern times is a fever, which appears in its true character when the first stroke of the disease does not prove fatal, and time is allowed for the full development of its successive stages. The common Epidemics of the day—Ordinary as distinguished from Extraordinary Epidemics—typhus, scarlet fever, small-pox, measles,—are so universally recognized as fevers that the popular notion of fever is derived from the external characters which these maladies present. 2. Epidemics resemble each other in the extent of their range. Ordinary diseases attack single individuals, and if, from season or other causes, several cases occur simultaneously, they are still isolated and scattered. They never prevail at the same time among several members of The great Epidemics of all ages have been strikingly characterized by their wide-spread course. The Black Death extended from China to Greenland, and desolated in its course Asia, Europe, and Africa. The Bubo-Plague of the middle ages often extended beyond its proper seat. In the 15th century it spread seventeen times over different European countries, and extended to the most distant northern nations. The Sweating Sickness prevailed simultaneously or in rapid succession over England, France, Germany, Prussia, Poland, Russia, Norway, and Sweden. “It extended,” say the chronicles of the day, “like a violent conflagration which spread in all directions; yet the flames did not issue from one focus, but rose up everywhere as if self-ignited.” The Influenza of the middle ages took a range which may be said to have been universal. In our own day we have seen the same disease attack almost every family, in nearly every city, town, and village; spread within a short period over the whole of Europe, and then extend through the vast continent of the New World. Cholera traverses the earth in zones, spreads with equal facility through tropical and polar regions, and attacks alike the seats of civilization and the huts of the slave and the savage. 3. Epidemics resemble each other in the rapidity of their course. Sometimes, indeed, they begin slowly, advance haltingly, and gather strength in silence. For some time they give so little indication of their power that the apprehension of their presence is very constantly regarded as a “false alarm.” Now and then, here and there, they strike a sudden and mortal blow; but it is only an individual In 1831, when Cholera first appeared in Cairo, it extended within the space of five days over the whole of Lower Egypt, desolating simultaneously all the towns and villages of the Delta. In 1832 it leaped at one bound from London to Paris, and when once there, spread in five days over thirty-five out of forty-eight quarters of the city. When Influenza broke out in London in 1847, it spread in one day over every part of the metropolis, and upwards of 500,000 persons suffered from the malady. 4. Epidemics resemble each other in giving distinct and unmistakeable warnings of their approach. These warnings consist of two events: first, the sudden outbreak and general spread of some milder epidemic; and, secondly, the transformation of ordinary diseases into diseases of a new type, more or less resembling the character of the extraordinary disease at hand. It is a very singular fact that both in the middle ages, and in modern times, the lesser Epidemic which has generally preceded and pre-announced the coming of the greater, is Influenza. The history of European Epidemics from the 14th century So again, on the second visitation of Cholera, in 1848, it was preceded, as we have just seen, by the universal Influenza of 1847. 3.It may be remarked that for some time prior to the Cattle Plague in the autumn of 1865, the disease called pleuro-pneumonia had extensively prevailed among the herds throughout the country. [Ed.] The second circumstance, and a most instructive one it is, premonitory of the advent of a great Epidemic, is a general transformation of the type of ordinary diseases into the characteristic type of the approaching pestilence. Sydenham gives a graphic description of such a transformation in the character of the fevers and inflammatory diseases prevailing in London some months before the outbreak of the Great Plague. He states that this change consisted in an approximation, in several striking features, of the general type of disease, to the distinguishing characters of the Pestilence which had not yet appeared, but was close at hand. In 1831, in the wards of the London Fever Hospital, I observed and recorded a precisely similar change in the general type of the fevers in London, six months before the first visitation of Cholera. Anterior to that period, fever in London, for a long series of years, had been essentially an acute, inflammatory disease, for which bloodletting 4.This was written in November, 1855. It is further very remarkable that the Professors of Veterinary Medicine and Surgery in London noted at the same time a similar change in the type of the diseases of the lower animals—horses, cows, sheep, and all domestic creatures;—a change requiring a similar modification of the remedies which they had been in the habit of using. 5. A further character of great Epidemics, partly arising from the last, is this:—they are actually present and in operation some time before they assume their distinct and proper form. Sometimes, indeed, the very first cases are most intense and characteristic, but at others they are scarcely to be distinguished from the severer attacks of ordinary disease of a like nature. Hence doubt is sometimes reasonably entertained of their true character. When at length increasing numbers leave no doubt of the actual presence of the dreaded malady, the first announcement of it is always received with incredulity and sometimes with resentment; and so it is that Epidemics always take a country by surprise—burst suddenly on an unprepared people, who wilfully shut their eyes against the plainest 6. Again, Epidemics resemble each other in the uniformity of their course. They present, with great regularity, periods of comparative quiescence and activity—periods of well-marked increase, culmination, and decrease. 7. They further resemble each other in the manner of their migration. They advance by leaps. On breaking out in a locality they soon come to their height, decline, and disappear. Then they attack another locality; here they pass through precisely the same process as before, and proceed to a third, fourth, or fifth district, and so on. Sometimes indeed they localize themselves on the same spot for a considerable period, and then several places may be simultaneously affected; but for the most part a large city may be regarded as a cluster of towns, through the several districts of which epidemics advance as if they were proceeding from one town or village to another. Hence the duration of an epidemic in a place is generally proportionate to its size. The several localities attacked being visited in succession, a space of time is required to spread through the whole of them proportionate to the magnitude of the town. 8. Epidemics resemble each other in the periodicity of their return. On its first visitation (1485) the Sweating Sickness spread over the whole of England in the course of one year, when it disappeared. After an interval of twenty years it broke out a second time quite suddenly (1505); revisited nearly all the seats of its former ravages, and again disappeared at the end of six months. On its third visitation (1517), after an interval of eleven years, it again finished its course within six months. Its fourth visitation (1528) was repeated after a further From this to its fifth and last visitation, twenty-three years elapsed (from 1528 to 1551.) It then broke out with unmitigated fury, spread once more over the whole of England, ceased within six months, and from that period has never reappeared in any country. The Oriental Plague of the middle ages returned with a like periodicity; and so it does at the present day in the countries in which it maintains its ancient reign. It recurs with much regularity about every ten years. The Fever Epidemics of the metropolis return pretty constantly about every ten or twelve years. The Irish Typhus Epidemics have recurred nearly decennially for the last 150 years. Epidemic Cholera, on its first visitation, ravaged Great Britain for a period of fifteen months. It then wholly ceased; after an interval of sixteen years it again broke out, and pursued its former course for the same exact period of fifteen months, and then ceased. Within the brief interval of only five years, it last year (1854) accomplished its third visitation. It now protracted its stay for a period of seventeen months; coming sooner and staying longer. 9. Again, Epidemics resemble each other in the brevity of the space that intervenes between the attack and death. The Black Death was often fatal on the first day of the attack—generally on the third or fourth. In England it The violent inflammatory fever which characterized the Sweating Sickness, generally ran its course in a few hours; in severe cases, indeed, the crisis was always over within a day and night, but it often proved fatal in six hours. In our own day we have witnessed many instances in which Epidemic Cholera was fatal within twelve hours. I have known several in which the fatal event followed in ten hours, the patient having been within an hour of the dreaded attack in apparent health. In all great epidemics the protraction of the disease beyond three or four days is a favourable omen. One of the objects in the treatment of the sick is to gain time. If Nature’s first violent effort to expel the enemy that has taken possession of the system, does not destroy life, the vital powers rally, and the frame often survives the storm. 10. Lastly, Epidemics resemble each other in being produced by the same causes. The whole tenor of experience shows that whatever produces an especial liability to one epidemic, produces a similar liability to every other. The Causes of epidemics, as of all other diseases, are divided into two classes,—the predisposing and the primary. The predisposing causes are those circumstances which bring the body into a fit state for the action of the primary. The primary cause is the agent which directly and immediately excites the disease. If a number of persons, in an ordinary state of health, say a hundred, are exposed to the primary cause of any epidemic—to the poison of Cholera for example—probably not more than ten would be seized with the disease. Why do the ninety escape? The poison, by the supposition, encompasses and acts upon all alike: why do ten only It is conceived that the primary cause cannot take effect unless the system be in a state of susceptibility to its action; that there is in the body an innate power of resistance to all noxious agents of this kind, rendering it, when in full vigour, invulnerable to them; that there are certain circumstances which weaken or destroy this resisting power, and which even impart to the body a peculiar susceptibility to the influence of such agents—and these circumstances are called predisposing causes. The predisposing causes of epidemics may be divided into two classes—External and Internal. The external are those which vitiate the atmosphere; the internal are those which more immediately vitiate the blood. The vitiators of the atmosphere include overcrowding, filth, putrescent animal and vegetable matters of all kinds, exhalations from foul cesspools, sewers, rivers, canals, ditches, marshes, swamps, &c. Causes of this class are also called localizing, because they favour the generation and spread of epidemics in the localities in which they abound. The causes which more immediately act from within are those which either directly introduce pernicious matters into the interior of the body, in the shape of foul water or putrescent food; or which indirectly accumulate noxious matters within the system, by impairing the action of the excretory or depurating organs whose office it is to maintain the blood in a state of purity, by removing out of the system substances which having served their purpose have become useless and pernicious. The earnest attention which has been recently directed to the first class of causes has led to an advancement in To give only one illustration of the action of a predisposing cause, I select as my example, Overcrowding. The Statistical Society of London some time ago appointed a Committee of its Council to make a house-to-house examination of the parish of Marylebone, with a view to ascertain how many families in the parish occupied a single room as a living and sleeping room. In the course of this inquiry, one of the examiners came to a house in which there was one remarkable room. It was occupied not by one family only, but by five. A separate family ate, drank, and slept in each of the four corners of this room; a fifth occupied the centre. “But how can you exist,” said the visitor to a poor woman whom he found in the room (the other inmates being absent on their several avocations), “how can you possibly exist?” “Oh, indeed, your honour,” she replied, “we did very well until the gentleman in the middle took in a lodger.” I see every day in the wards of the Fever Hospital the consequence of taking in such lodgers. An epidemic shows it not more truly, but more strikingly. Within the walls of an establishment for pauper children at Tooting, in 1849, there were crowded 1395 children. Little more than one hundred cubic feet of breathing space was allowed for each child, 500 being the smallest compatible with safety. One night Cholera attacked sixty-four of these children; 300 were attacked in all. Within a week 180 perished. In the Workhouse of Taunton there were 276 inmates. In some of the rooms the breathing space was not more than sixty-eight cubic feet. Cholera swept away 60 of these inhabitants in less than a week. In the County Jail of this same town, the breathing The town’s people also escaped, while in the overcrowded workhouses, 22 per cent. of the total number of the inhabitants were swept away. In the village of East Farleigh, near Maidstone, 1000 persons were assembled for hop-picking. They were lodged in sheds, and had about eighty cubic feet for breathing space: in a few days diarrhoea became universal among them: ninety-seven were attacked with cholera, and forty-six died. In the same village, at the same time, under another employer who had provided proper accommodation for his labourers, there was a complete immunity from the epidemic. I could add cases of the like kind without number. I could show that animals are affected by this cause of disease no less than men; that horses overcrowded in stables die of glanders; dogs in overcrowded kennels die of distemper; sheep overcrowded in ships, even during a short passage from one country to another, die in great numbers of febrile diseases: It has been often said that we cannot tell the difference between the air of the mountain-side and that of the crowded hospitals and fever-nests of towns. If it were so, it would be sufficient to say, Life is a more delicate test than Chemistry. But it is not so. The impurities in these pernicious places can be detected by chemical analysis, and examined as readily as the constituents of the atmosphere itself. 5.It has been alleged that the Cattle Plague owed its existence to these among perhaps other kindred causes, and human Epidemics have frequently been preceded or accompanied by a murrain among Cattle. See p. 7, and Boa Vista fever, pot. [Ed.] If a portion of this deposit be put on a piece of platinum and burnt, a strong odour of organic substance is given off, and a quantity of charcoal remains. If the deposit be allowed to stand for a few days, it forms a solid, thick, glutinous mass, having a strong odour of animal matter. If examined by a microscope, it is seen to undergo a remarkable change. First of all, it is converted into a vegetable growth, and this is followed by the production of multitudes of animalcules,—a decisive proof that it must contain organic matter, otherwise it could not nourish organic beings. 6.See the interesting experiments of Dr Angus Smith, on the Air and Water of Towns, “Report of the British Association for the Advancement of Science,” p. 16, et seq. At every expiration the lungs pour a portion of organic matter into the surrounding atmosphere; at every moment the skin does the same. This matter is the dead portion of the body, which it is one of the special offices of these depurating organs to remove out of the living system as useless and pernicious. It is indeed pernicious, for it is an animal poison, more concentrated in this than in any other form of excrementitious matter, since in other excretions the noxious particles, in their transmission out of the body, are diluted with other substances, but as they issue from the lungs and skin, they are in a great degree undiluted. Ventilation and cleanliness prevent this matter from accumulating, and render it innoxious. But it collects in large quantities on the furniture and walls of dirty houses, and is the main cause of the disagreeable smell of the rooms in which it abounds. In some instances the walls are coated with it. From recent chemical and microscopical examinations of the air of some crowded and filthy localities in the metropolis, it appears as a general result, that decomposing organic matter is always contained in such air,—the never-failing presence of animalcules testifying its existence, and their number and size indicating its amount. Imagine the state of the atmosphere in the dormitories of the Tooting children: in the sixty-eight cubic feet of breathing space of the inmates of the Taunton Workhouse; in the eighty cubic feet of the Kentish hop-pickers; in the four corners and centre of the five-family room. Conceive the state of the atmosphere in this room at night; all the members of the several families, collected; every breath of external air excluded; the windows, and perhaps even the chimney, carefully fastened up. This stagnant and poisoned air, breathed over and over again by every individual for seven or eight hours continuously; respiration, the special and admirable apparatus which nature has constructed for purifying the blood, thus made the very means of corrupting it. I have known from two to three cases of typhus produced nightly, for a fortnight together, in a room of this description, by sleeping in it for a single night! Can we wonder at the generation of typhus in such a room in ordinary seasons! Can we wonder at the spread and the havoc of an epidemic in it in epidemic seasons? But besides the contamination of the air by external causes, it is conceived that the atmosphere itself undergoes natural changes which predispose it to the development and spread of epidemics. From time immemorial, the popular belief has been that such changes do take place, Among such signs may be reckoned,—a disturbance of the regular and ordinary condition of the atmosphere; an inversion of the seasons—summer in winter, and winter in summer; long-continued drought succeeded by torrents of rain, causing rivers to overflow, and the seed to rot in the earth; cloud, mist, fog, favouring excessive dampness, under the influence of which spring up inordinate growths of the lower species of plants, producing mouldiness, and the blood-spots, and other coloured vegetation that adhere to houses, and household furniture, and wearing apparel, and personal ornaments, and the person itself; under which also, fostered by a steadily elevated temperature, spring into being and activity, myriads of the lower tribes of animals—locusts, caterpillars, flies, 7.During the autumn following the extraordinary summer of 1865, and in which the Cattle Plague appeared, there was a very marked preponderance of insect life as compared with ordinary seasons. It is asserted by Mr Mc Dougall, of Manchester, that no case of this plague is known to have occurred where his disinfectant, which arrests decomposition, had been freely applied to and about the cattle. [Ed.] And there is truth in this. It is quite certain that such atmospheric changes do take place, and prepare the way for pestilence. It is quite certain that there is an epidemic meteorology. This epidemic condition of the atmosphere is at length coming within the range of science. The first step towards this result, which promises to be of the highest practical value, we owe to the well-devised and patient observations of Mr Glashier, continued through the three recent Cholera epidemics. 2. An increased density of the atmosphere, not arising from an increase of watery vapour; for, 3. The quantity of water in the air was 1/20th less than the average, at the same time that the mean weight of a cubic foot of air was 2 grains above the average. 4. An unusual alternation of heat and cold, yet the heat predominating to such an extent that in particular localities it rose as much as from 2° to 8° above the average. These excesses were most striking at night, particularly in the parts of London on a level with the Thames, where the night temperatures ranged from 7°, 8°, 9°, and 10° above the temperature of the country, and even of the suburban districts. These temperatures were highest, especially the night ones, when the mortality was greatest; and the mortality was greatest where the temperatures were highest. 5. A remarkable increase above the average in the temperature of the water of the Thames. From a long series of observations it had been found that the normal temperature of the Thames is 51.7°. During the prevalence of the epidemic it rose to 60°, 66°, and once to 70°. At this temperature the “simmering” water must have poured enormous quantities of vapour into the surrounding atmosphere; not the pure vapour of water, for that cannot arise from a river which is the recipient of the foul contents of all the sewers and cesspools of the metropolis. In some instances there was an excess of 20° of the temperature of the water above that of the air. For twenty-eight continuous nights during the height of the epidemic, the average excess exceeded 16.5°. 6. An unusual prevalence of haze, mist, and fog; the fog being sometimes so dense that London could not be discerned from Greenwich. Wind is the ventilator of nature. Artificial ventilation, as far as it is successful, is an imitation of nature’s process. It is stated on undoubted authority (Maitland’s History of London) that for several weeks before the Great Plague broke out in London, there was an uninterrupted calm, so that there was not sufficient motion of the air to stir a vane. Baynard, a contemporary physician, confirms this fact. The like circumstance is mentioned by Diemerbroeck in giving an account of the plague at Nimeguen. At the period when the last plague visited Vienna, according to Sir Gilbert Blane, there had been no wind for three months. The terrific outbreak of the cholera at Kurrachee was preceded for some days by such a stagnation of the atmosphere that an oppression scarcely to be endured affected the whole population. It is obvious that calms must favour the accumulation and concentration of effluvia from every source from which they arise. 8. A general deficiency in the tension of common positive electricity. 9. A deficiency of one fourth of the rain-fall for the year. During 118 consecutive days there was scarcely any rain, and not a single drop for 18 days at the period of the highest mortality. 10. A total absence of ozone at all the stations near the river, while at stations of high elevation it was of general occurrence. These observations relate particularly to the epidemic of 1854, which was more carefully watched than the two former; but the results are similar for each. “In both 1849 and 1854, the first decline of the disease was marked by a decrease in the readings of the barometer, and in the temperature of the air and water; the air, which previously had for a long time continued calm, was succeeded by a strong S. W. wind, which soon dissipated the former stagnant and poisonous atmosphere.” We knew before that such influences were in operation, but they had not been weighed and measured. We now know definitely something of an epidemic atmosphere, and the information obtained is most significant; for it shows that the several meteorological changes that take place during the prevalence of an epidemic concur to produce a heavy, warm, moist, and stagnant atmosphere, with disturbed electricity: conditions highly favourable to the decomposition of organic matter. Under the influence of such an atmosphere, over the moist and warmed surface of every filthy place, over the entire mass of all accumulations of filth in streets, lanes, and Against such products the human body has no defence. The lungs admit whatever is brought to them—poisonous and salubrious substances alike. They are guarded by none of those protective contrivances which we see in some other parts of the body. Whatever is capable of suspension in the respired air passes with it directly into the current of the circulation, and when once there, is carried with astonishing rapidity into the very substance of the vital organs. From the quantity of air which the lungs receive, some conception may be formed of the amount of obnoxious matter which may be introduced into the system through these portals. At each inspiration there enter the lungs of an ordinary-sized person about 20 cubic inches of air. There are 20 respirations in a minute: 400 cubic inches of air must therefore enter in one minute; 14 cubic feet in one hour, and 366 cubic feet, or 36 hogsheads, in one day. To meet this the heart sends into the lungs at each contraction two ounces of blood; there are 75 pulsations in a minute, during which 150 ounces are propelled into the lungs; a quantity which gives 562 pounds in one hour and 24 hogsheads in 24 hours. The main purpose for bringing these enormous quantities of air and blood together, with such velocity, is to provide for the enormous waste which is caused by the rapid and unceasing mutation of organic matter. The activity of an organ is sustained at the expense of the matter of which it is composed. No thought passes through the mind, but an equivalent portion of the substance of the brain is consumed; no nervous current flows along the 8.See Experiments on the daily loss of weight sustained by workmen employed in gas-works.—Philosophy of Health, 11th Edit. p. 284, et seq. 9.The tube which conveys the debris of the body, together with the nutritious part of the food,—both measures of change or waste. The results of the highly interesting experiments recently made by Professor Graham on the part taken by the active agent in all these processes—organic membrane, of which the organic cell is the type, demonstrates that all the phenomena known as Endosmose and Exosmose depend on a chemical action involving the destruction of organic membrane. In this process chemical action is set up dependent upon active chemical agents, neutral substances being inoperative. Out of this chemical action a new force is induced, the Osmotic force; a purely chemical being converted into an equivalent mechanical force, which is made subservient to the essential phenomena of organic and animal life: a vis motrix, a force which is to the extra-vascular movements of the body, what the contraction of the heart is to the vascular. In a frame so constructed, any particles contaminating the circulating fluid most rapidly pervade and contaminate every part of the system. It has been sometimes imagined that the quantity of matter suspended in the atmosphere and conveyed into One single puncture of the finger, so small as not to be visible without the aid of a lens, has introduced into the system a sufficient quantity of putrid matter to cause death with the most violent symptoms. A few drops of the liquid matter obtained by a condensation of the air of a foul locality, introduced into the vein of a dog, is stated to have produced death with the usual phenomena of typhus fever. It is certain that on the introduction into the body of an inappreciable portion of the matter of cow-pox, or of small-pox, those specific forms of fever are produced. From these and similar facts it is inferred, that when putrescent or decomposing organic matter is introduced into the blood it acts as a poison and produces the phenomena of fever, and that all the predisposing causes of epidemics act in this way—by overcharging the blood with the products of decomposing organic matter. Strictly speaking, however, all that we really know is this—that where certain conditions exist, epidemics break out and spread; that where those conditions do not exist, epidemics do not break out and spread; and that where those conditions did exist, but have been removed, thereupon epidemics cease. We call those conditions Causes, Predisposing or Localizing Causes, but how they act, whether by accumulating decomposing organic matter in the blood, or in what other way, we have no certain knowledge. One further fact however is ascertained, that where any one of these predisposing causes is present, epidemics break out and spread just as readily as when all are present together. Where there is overcrowding alone, for example, epidemics break out and spread. Where there is decomposing This we know; all beyond this is conjecture, but as to the most probable of these conjectures, some who have thought on this subject believe that the preponderance of evidence justifies the conclusion that the predisposing causes may themselves become efficient causes; that instances in which they actually do so, are constantly passing before our eyes; that it is practicable to manufacture fever and even epidemic fever to any amount by placing a population under certain known conditions; that it is practicable to prevent the outbreak of epidemics altogether by placing the population under certain other conditions; The more common opinion however is, that joined to the predisposing causes there must always be present a primary cause, having a distinct existence, capable of travelling from one part of the globe to another; capable of spreading over any space however extended, or of confining itself to any space however small—a district, a street, a house, a room. 10.See Baltimore case, p. 78. The existence of such a body being assumed, it is conceived that it exists not in a gaseous but in a liquid state. It is supposed that it cannot exist in a gaseous state because a gas is readily diffused and dissipated; because when organic matter is reduced to a gaseous state, it has passed from the organic into the inorganic kingdom, and there is no evidence that the elementary bodies belonging to this kingdom are capable of producing any form of fever; and because there is indubitable evidence that organic matter in a recent state of putrescence—the more recent the more potent—is capable of producing the most deadly forms of fever. From these considerations it is conjectured that the primary cause, whatever it be, is some subtle fluid which has not wholly lost its organic composition, and that it consists of particles of extreme minuteness, capable of attaching itself to the surfaces of other bodies, and even of increasing under favourable circumstances. It is further thought that this body is not equally diffused through the atmosphere, but is only partially distributed, and that this accounts for the local distribution of epidemics, and for their occasional absence from places which apparently present all the conditions favourable to their development. Lastly, the opinion is gaining ground, that this body acts in the manner of a ferment. It is urged in favour of this view, that a ferment being an azotized substance in a state of putrefactive alteration, the body in question must find, in the decomposing organic compounds with which Overcrowding, for example, we can prevent; the accumulation of filth in towns and houses we can prevent; the supply of light, air, and water, together with the several other appliances included in the all-comprehensive word Cleanliness, we can secure. To the extent to which it is in our power to do this, it is in our power to prevent epidemics. The human family have now lived together in communities more than six thousand years, yet they have not learnt to make their habitations clean. At last we are beginning to learn the lesson. When we shall have mastered it, we shall have conquered epidemics. Our duties, then, and our hopes in this respect, I shall proceed to show. The principal constituents of the atmosphere maintain their equilibrium steadily over the whole surface of the globe. There is scarcely any difference in the relative proportion of its oxygen and nitrogen in the torrid zone and in the arctic regions. Whatever influence the atmosphere may have on climate must consequently depend on something adventitious to it and not in anything forming a part of it. Possibly therefore that something may be, in some degree, under human control. The main constituents of climate are temperature and moisture, and these are the climatic conditions that exercise the greatest influence on epidemics. The temperature is highest where the sun’s rays are vertical, or nearly so; where the sky is cloudless; where the day is longest; and where there is the smallest difference between the fervid noon-tide heat and the temperature of the short night. The moisture is greatest where in addition to all the other sources of humidity there are periodical rains. In the countries subject to these rains, the entire extent of the level and low land is often covered a foot deeper with water than before the rain set in. Elevated temperature and excessive moisture are combined in tropical countries; and they are concentrated in those parts of the tropics in which there are extensive forests having an undergrowth of luxuriant vegetation; in which the tides of the ocean penetrate deeply into the interior of the land, and mix with the waters of the rivers; and in which the rivers constantly overflow their banks and form marshes and swamps. In tropical countries there are tracts such as these that extend in unbroken continuity hundreds of leagues. The western coast of Africa (the Bight of Benin) presents an unbroken area of upwards of 100,000 square miles, consisting of one vast alluvial and densely-wooded forest, irrigated by Atlantic tides, and intersected by numerous rivers and creeks, whose muddy banks are constantly overflowed. In describing a tropical forest, Humboldt says, “Under the bushy, deep, green verdure of trees of stupendous height and size, there reigns constantly a kind of half daylight, a sort of obscurity, of which our forests of pines, With this luxuriance of vegetation is combined a corresponding abundance of animal life. The earth and air teem with living creatures. “The mould,” observes the same distinguished traveller, “contains the spoils of innumerable quantities of reptiles, worms, and insects. Wherever the soil is turned up we are struck with a mass of organic substances, which by turns are developed, transformed, and decomposed. Nature in these climates appear more active, more fruitful, we might say more prodigal of life.” The air is still more alive than the land. Insects fill the lower strata of the atmosphere to the height of fifteen or twenty feet, like a condensed vapour. It is estimated that a cubic foot of air is often peopled by a million of winged insects, which contain a caustic and venomous liquid, several species being nearly two lines (1.8) long. When two persons who have their home in these regions meet in the morning, the first questions they address to each other are, “How did you find the zancudoes during the night?” “How are we to-day for the mosquitoes?” An ancient form of Chinese politeness, showing the ancient state of that country, was—“Have you been incommoded in the night by serpents?” It appears that there are still inhabited places in which the Chinese compliment on the serpents might be added to that of the mosquitoes. Proportionate to this prodigality of organic life is the amount of organic decomposition, the products of which are poured into the atmosphere and suspended in the surrounding vapour and fog, 11.See note, p. 16. “At the distance of several miles from the coast,” says Dr Daniell, in describing the western shores of Africa, “the peculiar odour arising from swampy exhalations and the decomposition of vegetable matter is very perceptible, and sometimes even offensive. The water also is frequently of a dusky hue, with leaves, branches, and other vegetable debris floating on the surface, brought down from the interior by innumerable narrow channels that empty their turbid streams into the open ocean.” It is under these climatic conditions that the worst forms of epidemics are engendered: the most sudden in their attack, the most rapid in their development, the most general in their prevalence, and the most mortal. The form of the epidemic prevalent in any particular district is dependent on the physical characters of the immediate neighbourhood. Thus intermittents prevail chiefly in marshy and swampy districts: remittents also chiefly there, though not exclusively; while in other localities other forms arise approximating to the continued type of temperate climates. For the most part these epidemics are strictly endemic, and are confined to the particular regions in which they are engendered. They never pass the limit of the equatorial or tropical zone. Yellow Fever, one of the most common and destructive of these diseases, is still more restricted in its range, being confined within a definite line In other instances these epidemics pass beyond the regions in which they are produced, and sometimes extend to all the other quarters of the globe. The Black Death, the range of which we have seen, was engendered in China; the Cholera of our own day, generated in the delta of the Ganges, the great source and centre of Indian epidemics, ravaged that country long before it directed its course to Europe. When these tropical epidemics advance into more temperate climes, they lay aside nothing of their nature; they lose but little of their power. Wherever they go they decimate the populations which they attack. One remarkable peculiarity of some of these epidemics is, that natives of the region in which they prevail are for the most part unsusceptible to them. This is true however only of particular forms of pestilence. Some of them acknowledge no acclimation. Cholera, for example, attacks equally natives and new comers. On the other hand, yellow fever rarely attacks the natives who reside permanently within its zone. Its chief victims are strangers who have recently arrived within its sphere, particularly the inhabitants of northern climates. The susceptibility to its influence appears to be strictly proportionate to the degree of northern latitude from which the stranger has arrived, and the shortness of the interval that has passed since he left the European for the Equatorial regions. We see something of the same kind in the wide-spread I do not know that I can give a more vivid picture of a tropical epidemic than that which is afforded by the outbreak of Cholera in the 86th regiment at Kurrachee in June, 1846. On this occasion the atmosphere was very peculiar,—damp, hot, stagnant, and oppressive. Not a breath of air was stirring. A few isolated cases of cholera had occurred for some days. The utmost alarm was excited in the minds of experienced persons, who felt certain that an epidemic was at hand. Their fears were too fully realized. On the night of the 15th, upwards of 40 men were seized with cholera in its severest form; in two days more 256 were attacked, of whom 131 were already dead. “The floors of the hospital,” says Dr Thom, the surgeon of the regiment, “were literally strewed with the livid bodies of men labouring under the pangs of premature dissolution. Many were brought in with the cold and clammy damp of death; as if sudden obstruction of every vital function had taken place, and the fountains of life had been arrested by an invisible but instantaneous shock. It was indeed a sight never to be forgotten, to behold the powerful frames of the finest men of a fine corps, who had that morning been in apparent good health, In describing a river on the west coast of Africa, Dr Daniell says—“When I visited it, I found two vessels moored a short distance from its mouth, one of which within the space of five months had buried two entire crews, a solitary person alone surviving. The other, which had arrived at a much later period, had been similarly deprived of one-half of its men, and the remainder were in such a debilitated condition as to be incapable of undertaking any active or laborious duty. Immediately before, another vessel had sailed from this port in such a deplorable state as to be solely dependent on the aid of Kroomen to perform the voyage.” In the statistical report of Sir Alexander Tulloch it is stated, that out of 1658 white troops sent out to military stations on the western coast of Africa, 1271 perished from climatic diseases; while of the 387 who remained to be sent home, 17 died on their passage; 157 were reported as incapable of further service; and 180 as qualified only for garrison service; thus leaving only 33 out of 1658 men who were fit for active service. As we pass out of the torrid zone a remarkable change takes place in the general character of epidemics. They lose more and more of their intermittent type, and become either remittent or continued. The remittent keeps its hold over the southern part of Europe, and continually breaks out in the form of Yellow Fever. As we proceed northward out of the yellow fever zone, that disease wholly disappears, and typhus and its kindred maladies take its place; typhus commencing precisely at the point where yellow fever ends. There is, indeed, one of the ordinary diseases of temperate “In these our latitudes,” says Dr William Fergusson, “cold and fatigue, and sorrow and hunger, will generate fever anywhere; but every region, every climate, will exhibit its own form of fever. With us it is Typhus; in the warmer countries of Europe, Remittent; in the upper Mediterranean, Plague; in the Antilles and Western Africa, Yellow Fever; this last being restricted to particular localities, temperatures, and elevation. While typhus fever goes out when you enter the tropics, it is there that yellow fever commences; the pure epidemic of a hot climate that cannot be transported or communicated upon any other ground. Places, not persons, constitute the rule of its existence. Places, not persons, comprehend the whole history, the etiology of the disease. Places, not persons! Let the emphatic words be dinned into the ears of the Lords of the Treasury, of Trade and Plantations, until they acquire the force of a creed, which will save them hereafter from the absurdity of enforcing a quarantine 12.See Cases of the Eclair, Dygden, &c., post. I pass now to Civilization. We have no sufficient knowledge of the state of the people and of their diseases, in any of the civilized nations of antiquity, to trace the relation between them. The authentic history of periods, comparatively near to our own time, as far as concerns the diseases of the people, goes scarcely further back than the 14th century. The first great epidemic, to which I have so often called attention, occurred in that century, and we have reliable evidence, both of the phenomena attending this plague and the condition of the people at that time. I assume this period therefore as my starting-point. I take a civilized community to be one in which there exist— 1. A sovereign authority. 2. Laws incorruptibly administered. 3. Physical comfort generally diffused. 4. Intellectual development and activity generally diffused. 5. Recognition of the fundamental principles of religion and morality. Taking these then as the essential constituents of civilization, and applying them as a test to Great Britain, we shall see that at the commencement of the 14th century England was in a state of barbarism, since every one of these elements was wanting, although the foundation of political and social institutions containing the germs of liberty and progress had been already laid. Practically, however, at that period there was no sovereign authority, for the king had no sufficient power to maintain order, to protect the rights and liberties of the people, or to defend his own throne against armed men nominally his subjects; while the lord of every feudal castle exercised a more perfect sovereignty over his vassals than the so-called monarch over the nation. Every town was a fortress, and every house in which it was safe to dwell a castle, the inmates of which, like people in a garrison, constantly held themselves prepared to resist attack, from which they were never secure. They slept with arms at their side. Marauders openly encamped on the public roads for the plunder of the wayfarer, which often ended in his murder. Few persons ventured to travel alone, and none without the reasonable apprehension that they might never return alive. Scarcely a third part of the area of the kingdom was under cultivation. The remainder consisted of moor, forest, and fen. Vast tracts were under water during the greater part of the year, and at other times formed morasses, marshes, and swamps. The streets were narrow, unpaved, undrained, uncleansed, and unlighted. There was no provision for the removal of the town refuse. Gutters were formed at the sides of the streets, as in Bethnal Green and the neglected parts of all our towns at the present time, into which the inhabitants threw the refuse of their houses; forming in dry weather a semi-fluid mass of corrupting animal and vegetable matter, and in rainy weather black turbid rivulets which ultimately poured their contents into some water-course. The houses were mean and squalid, built of wood and wattles, thatched with straw, without chimneys, the windows without glass, the floors without boards, the furniture of the rudest description; the use of linen was scarcely known; common straw formed the king’s bed. “The floors,” says Erasmus, writing two centuries later, “generally are made of nothing but loam, and are strewed with rushes, which being constantly put on fresh, without a removal of the old, remain lying there, in some cases for twenty years; with fish bones, broken victuals, the dregs of tankards, and impregnated with other filth underneath, from dogs and men.” Contemporary writers concur in representing the offensive odour of decaying straw and rushes as universal in the houses. There was no knowledge of the art of collecting, preserving, and storing fodder. The animals for winter food were slaughtered in autumn, and their flesh salted or smoked. It was only during three months of the year, from Midsummer to Michaelmas, that any fresh animal food, excepting game and river fish, was tasted even by the nobles of the land. The common people subsisted There were no fresh vegetables. As late as the 18th century salads were sent from Holland for the table of Queen Caroline. Sir John Pringle, writing in the middle of the last century, states that his father’s gardener told him that in the time of his grandfather cabbages were sold for a crown a-piece. It was not until towards the close of the 16th century (1585) that the potato was first brought to England, where it was limited to the garden for at least a century and a half after it had been planted by Sir Walter Raleigh in his own garden. It was first cultivated as a field crop in Scotland so recently as the year 1752. For many centuries England remained in the condition of country in which no more subsistence is produced than is barely sufficient for the necessities of the people. Consequently every year of scarcity became a year of famine, and such years, about one in ten, occurred for ages with great regularity, and often equalled in their terrible results the worst famines of antiquity. In a cold climate fuel is nearly as important as food, for which indeed it is a substitute. A large portion of our daily food is used up in supporting that internal fire by which the heat of the human body in every climate, and under every variety of external temperature, is maintained at the 98th degree of Fahrenheit. The greater the loss of heat by cooling, the greater the amount of heat which the body itself must generate to maintain its temperature at this elevated point. This demand for additional heat cannot be supplied without additional quantities of food, and unless these supplies are afforded, the substance of the body itself, its very tissues and organs, are consumed; a process which cannot be continued long without exhaustion, The habits of the people increased the force of these privations. Intemperance was a national vice. Excessive carousing at home, or days and nights spent in taverns, was the usual practice among all classes, and the physical and moral evils resulting from the custom were neither redeemed nor lessened by the epithet which these habitual convivialities appear to have conferred upon the nation of “Merrie England.” Caius, indeed, one of the most celebrated physicians of the sixteenth century, couples Germany and the Netherlands with England in this common reproach. “These three nations,” he says, “destroy more meats and drynkes without all order, convenient time, reason, and necessitie, than all other countries under the son, to the great annoyance of their bodies and wittes.” This condition of the country and this mode of life themselves constitute the most powerful causes of epidemics; and an extraordinary concurrence and concentration of these causes are manifested in the combination of the circumstances We have no reliable evidence of the actual mortality produced by these terrible diseases; for no physician has left such an account of the epidemics of which he was an eye-witness as enables us to determine it, and there was no Registrar-General to fill up the momentous columns included in his death-roll. We can therefore only take the statements of the time as we find them. According to the accounts of contemporary writers, the Black Death swept away, within the space of four years, a fourth part of the population of Europe. Some towns in England are stated to have lost two-thirds of their inhabitants, and it is computed that one-half of the entire population of the country perished. Of the Sweating Sickness, Bacon says it “destroyed infinite persons;” Stowe “a wonderful number;” and other writers reckon the deaths in the places attacked by thousands. Similar representations are given of the ravages of the Plague, of the Petechial Fever, and even occasionally of Intermittent Fever; and the substantial correctness of these statements is confirmed by entries in parish registers still extant, which tell the story of the local outbreaks of those days with graphic and touching simplicity. During some of the worst of these visitations, contemporary writers concur in stating that the living were insufficient to bury the dead; business was suspended; the courts of law were closed; the churches were deserted for want of a sufficient number of clergy to perform the We can form no adequate conception of the terror inspired by these events. We have seen alarm in our own day, but then it bordered on maniacal despair. It seemed as if the last judgment had come upon the world, and men abandoned alike their possessions and their friends. The rich gave up their treasures and laid them at the foot of the altars; neighbour abandoned neighbour; parents their offspring, and brothers their sisters. “If” says one of the chroniclers, “in a circle of friends any one only by a single word happened to bring the plague to mind, first one and then another of the company was seized with a tormenting anguish; certain that they were attacked with a mortal sickness, they slunk away home, and there soon yielded up the ghost.” These fearful forms of pestilence were accompanied by moral epidemics more appalling than the physical. Of these the two following may serve as examples:— Vast assemblages of men and women formed circles hand in hand, dancing, leaping, shouting, insensible to external impressions; some seeing visions and spirits whose names they shrieked out; others in epileptic convulsions with foaming at the mouth; all continuing to make the most violent muscular exertions for hours together, until they fell to the ground in a state of exhaustion. Lookers-on were seized with an uncontrollable impulse to join in these wild revels. Peasants left their ploughs, mechanics their workshops, servants their masters, boys and girls their parents, women their domestic duties, and men their business, thus to spend days and nights; these infatuated crowds passing furiously through streets, along highways, over fields, and from town to town. This madness pervaded the least barbarous countries of Europe for upwards More pernicious than this madness was the mania of cruelty, an especial manifestation of which was the ferocious persecution of the Jews, who were put to death by hundreds and thousands, under the accusation that they had poisoned the wells. At Basle a number of this nation, whose European history proves them to have been everywhere amongst the most inoffensive of the people, were enclosed in a wooden building and burnt with it. At Strasburg two thousand were burnt alive. Whoever showed them compassion and endeavoured to protect them were put upon the rack and burnt with them. In numerous instances these unhappy people, driven to despair, assembled in their own habitations, to which they set fire and consumed themselves with their families. The noble and the mean bound themselves by an oath to extirpate them from the face of the earth by fire and sword. In England this relentless cruelty took particularly the shape of burning innocent people under the name of witches; an infatuation which pervaded all classes from the highest to the lowest, affording a melancholy exemplification of the close alliance between credulity and cruelty. 13.The number of wretched beings condemned and executed for this imaginary crime at the Assizes of Suffolk and Essex alone, in the year 1646, amounted to two hundred. Dr Zachary Gray affirms that he had seen an authentic account of persons who had so suffered in the whole of England, amounting to from three to four thousand. So late as the year 1697 seven persons, three men and four women, were burnt at Paisley for this alleged crime. We seldom sufficiently consider how near we are to those times of dreadful superstition and cruelty! How short a period it is since the light of a brighter day dawned upon us! About the middle of the fifteenth century improvements in the condition of the people, which had been gradually effected by these changes, were accelerated by a succession of events that gave an extraordinary impulse to the human mind, just aroused from the long and deep sleep of the middle ages—that dark night which was now passing away. Among the most memorable of these was the invention of printing, which the three immortal masters of the art had now completed (1436–1442), giving untiring and undying wings to thought;— The diffusion over the West of Europe of the remains of a former civilization, by the dispersion of the treasures of classical art, literature, and science, which before Constantinople fell into the hands of barbarians (1453) had been confined within the walls of that city;— The cessation of the long and disastrous struggle between the East and the West, by the expulsion of the Moors from Spain (1492);— The discovery of the New World;— And lastly, the Reformation, that stupendous work which with giant strength burst asunder the chain which consummate skill and supreme power had spent ages in The time when the foundation was laid for this intellectual and spiritual renovation was also that of the commencement of physical improvement. The towns being no longer fortresses, it became unnecessary to maintain their fortifications. Walls were thrown down; stagnant moats were filled up; broader streets were opened; more convenient houses were erected. Forests were cleared; marshes and swamps were drained; more land was brought under cultivation; more vegetable matter was produced; the art of collecting, storing, and preserving fodder was discovered. Fresh meat became the food of the people during a longer period of the year; in the course of two centuries the length of that period had doubled, and at last such food was in use the whole winter. The products of growing art and manufacture superseded the beds of straw and displaced the floors of rushes. Famines ceased. There has been no recurrence of famine in England since the middle of the 15th century (1448). The proportion of people in the enjoyment of moderate competence rapidly increased. It is computed that in the 16th century the number of small freeholders realizing a clear income of between £60 and £70 a-year amounted with their families to one-seventh of the whole population, and that the number of persons who tilled their own land was greater than the number of those who farmed the land of others. 14.Macaulay’s History, Vol. I. Chap. III. The spirit of improvement thus awakened exerted itself with increased effect during the whole of the eighteenth century. Agriculture, which was now rapidly advancing, had created a demand for town refuse, the fertilizing property of which began to be perceived; so that all manner of offensive substances were regularly carried away to the fields, to the great increase of the cleanliness of the streets. At the same time many of the narrower streets were widened, the houses were entirely taken down and rebuilt, and in this operation slate was universally substituted for thatch, and brick for timber. The pavement also, which had long been the reproach of London, was improved. Population in the mean time rapidly increased, less by the relative increase of the number of births than by the proportionate decrease of the deaths, and this notwithstanding the occasional occurrence of severe pestilence. The result of the whole was an increase in the length of life. An increase in the length of life is an expression and a measure of the sum of comfort experienced from the whole It happened that in the year 1693 a loan was raised for the service of the State by the method of Tontine, and that another was contracted by the same method in the year 1790; the interval being almost exactly a century. The term Tontine is derived from the name of the originator of this scheme of life annuity, the principle of which is this. The person who advances £100 is at liberty to name any life he pleases, during the existence of which he draws a certain annuity; and as the shares of the dead nominees are distributed among the living ones, the annuity continually increases till the last survivor gets the whole income. A comparison of the experience between two Tontines gives the exact measure of the effect produced on the duration of life, by such changes in the social condition of the people as may have occurred in the interval between them. A person of the male sex (for there is a considerable difference in the results in the two sexes), living in 1793, compared with a male living in 1690, at fifteen years of age, had gained an expectation of life of nearly ten years; at twenty years of age, nine years and a half; at twenty-five years of age, upwards of eight years; at thirty years of age, upwards of seven years, and so on. Or the gain in the expectation of life may be stated more correctly in years, thus: Take for example a man at the age of 30, in 1693 his expectation of life would have been 26.665; in 1790 it would have been 33.775 years. On this evidence Mr Finlaison justly observes that civilization could not have increased by a single leap in We may then fairly conclude, that in the interval between the close of the 17th and 18th centuries human life gained an addition equivalent to a fourth part of its whole term. What has it gained in the succeeding century? What has been the increase in the value of life in this first half of the century in which we ourselves have lived? Though unfortunately we can appeal to the results of no renewed tontine to enable us to answer this question with exactness, Such has been the increased production of food during the present century, that the quantity now raised maintains ten millions more human beings than existed at its commencement; for on the first enumeration of the people in 1801 the population of Great Britain was eleven millions; in 1851, it was twenty-one millions. 15.Considering that there appears to be no objection in principle to the method of raising a loan by Tontine, and that the scheme is a popular one, it seems highly desirable that we should continue this means of measuring with positive exactness the results of our advancing civilization. 16.According to Mr Rickman, from the best information that can be obtained from Doomsday Book, the population of England in the time of William the Conqueror was 1½ millions. In the reign of Edward the Third (1377), when a poll-tax was imposed on all persons of both sexes above fourteen, it was 2½ millions. In the reign of Queen Elizabeth, at the period of the Spanish Armada, it was 4 millions. According to Mr Finlaison, at the close of the 16th century it was somewhat under 5 millions two hundred thousand. According to Mr Rickman, on a computation founded on the return of Baptisms, as stated in the Abstract of Parish Registers, it was in 1700, 5½ millions; in 1750, 6½ millions; and in 1770, 7½ millions. The first actual enumeration was made in 1801. The following table exhibits the rate of increase in the population of Great Britain from that time up to the enumeration in 1851:
This increased production of food is mainly of home growth, for the supply of wheat from foreign sources would scarcely suffice to afford to each person two gallons of flour annually. This increased production has been obtained partly by a progressive increase in the quantity of land brought under cultivation, which now amounts for the United Kingdom to upwards of 40,000,000 of acres, by far the greater part of which is employed in the production of human food; and partly by the employment of capital in the improvement of the soil, by which large tracts that a 17.“In 1821 almost the only grain produced in the Fens of Cambridgeshire consisted of oats; since then, by draining and manuring, the capability of the soil has been so changed that these fens now produce some of the finest wheat that is grown in England; and this more costly grain now constitutes the main dependence of the farmers in a district where 14 years ago its produce was scarcely attempted.”—Porter’s Progress of the Nation. This increased fertility of the soil renders it more healthy by diminishing its moisture and raising its temperature. One cubic foot of water in the process of evaporation deprives three millions of cubic feet of air of one degree of temperature. An undrained field growing rushes has a permanent temperature from four to six degrees lower than an adjoining field drained and growing wheat. By draining and manuring, by throwing down fences, by removing trees, by clearing underwood, and by promoting the free aËration of the soil, the temperature of large tracts of land in the north of England has been permanently raised three degrees. Thus that very culture of the earth, by which it is made to yield the largest amount of food, increases its salubrity as an abode for man, and lessens at their source the main causes of epidemics. This increased production has been obtained by a proportionally small addition to labour; for while the quantity of land brought under cultivation, and its produce, have been increasing at a rate of which there is no similar example in any age or country, the relative number of persons employed in agriculture has been as steadily decreasing. As long as the labour of a man applied to the cultivation of the soil is capable of producing only a bare subsistence for himself, there can be no advance in civilization. But when two men can produce subsistence for three, the labour of the third can be set free for the production 18.Porter’s Progress of the Nation, Chap. III. Were the remaining three idle? Mediately or immediately they were engaged in producing clothing, or fuel, or machinery, economizing the production of both; and busily and well they worked. In number they exceed one million and a half. Taking into account the accessory occupations, indeed, no fewer than one million two hundred thousand are employed on one single material alone, namely cotton. For these workers, at the beginning of the century, there were imported yearly 56 millions of pounds of cotton: at present the annual importation of it exceeds 550 millions of pounds. These workers in 1820 were assisted in their operations by fourteen thousand power-looms; at present they are assisted by three hundred thousand power-looms, besides twenty-five millions of spindles; 19.Return to the House of Commons by the Factory Inspectors, of the Number of Cotton, Woollen, Worsted, Flax, and Silk Factories subject to the Factories Acts in the United Kingdom, page 21. 20.The cheapness of some of these ornamental as well as useful fabrics is calculated to excite astonishment. A yard of platt net is worth from 20s. to £5; a yard of plain net may be bought for one shilling. Gigantic strides have been made at the same time in another article of clothing, the basis of which is wool, and of which there were imported in 1801 seven millions of pounds; in 1844, sixty-three millions of pounds. This enormous importation of foreign wool has not only not diminished its home growth, but the increased demand for it has led to a vast multiplication of the animals that yield it, and what is of equal importance, has induced an extraordinary care in improving their breed; so that the very means which have fed the steam-engine have fed the people both with more plentiful and with better food; the steam-engine, meanwhile, applied to these and to all manufacturing processes, being as much a producer of food as the plough. 21.Similar progress has been made in the manufacture of flax and silk as of cotton and wool. And the same is emphatically true of fuel, the main creator of all this activity and of its astonishing results; this necessary of life being now brought to the door of every family in three-fold abundance and at one-half the price at which it could have been obtained at the commencement of the century; while such is the demand for it in various manufactures of vast magnitude, that one trade alone, that of iron, consumes annually eight millions of tons—a trade which immediately and powerfully facilitates the production both of food and of clothing. Thus, like one of Nature’s beautiful adaptations, like that wonderful cycle, for example, in which production, change, and reproduction go on in an unvarying circle, the constant and abundant supply of one main necessary of life furnishes And what a busy hive does this country present at the present time! Out of every thousand males twenty years of age in the kingdom, 836 are directly employed in some active occupation contributing to the national wealth; while the remaining 114 are by no means idle, for they are engaged in some one of the professions. Though the masses have not yet obtained their due share of the wealth they create, and though there is a class which in relation to one essential condition, to be stated immediately, civilization has scarcely reached, or reached only to injure—with these exceptions, no doubt very important ones—the evidence is indubitable that the entire body of society, from its base to its apex, stands on an elevated table-land which many centuries have been employed in raising and consolidating. I have partly proved this by showing the general diffusion of the means of healthful subsistence and the prolongation of life. I am now to prove it by applying these facts to the subject more especially before us, the decline and disappearance of epidemics. It is now exactly two centuries, short of ten years, since the visitation of the Great Plague of 1665—that terrible disease which ravaged England for the space of 1249 years: for it is first heard of in English history in the year 430, and the last year in which its name appears in the Bills of Mortality is 1679; that terrible disease which not only maintained undiminished power over this vast space of time, but which sometimes recurred twenty times in one century—that terrible disease is gone. It cannot be supposed that it has worn itself out, for it still frequently returns with its ancient malignity to Constantinople, Alexandria, Smyrna, and other Eastern States. Petechial or Jail fever, the fatal scourge of the ship, Intermittent fever, which in the middle of the fifteenth century and long afterwards recurred like the plague periodically but more frequently, and which often raged as universally, which was sometimes so mortal that the living could hardly bury the dead, and which spared not even the throne, for James I. and Oliver Cromwell both died of ague contracted in London—that formidable disease is gone. Ague, it is true, still exists in the fenny and marshy places which yet remain in England, and we occasionally see a case contracted there in the wards of the London Fever Hospital, but I have not seen a single case of ague contracted in London for upwards of a quarter of a century. Remittent fever is also gone, scurvy is gone, rickets is gone, malignant sore throat is gone, typhus-gravior is gone, and if small-pox is not gone it is entirely the consequence of our own apathy and folly. No less remarkable is the gradual decline and the ultimate cessation of certain forms of bowel-complaint of a very painful nature, the very names of which have long disappeared both from medical and popular language. In the 17th century the deaths from two of these diseases alone registered in the Bills of Mortality under two separate titles, were never less than 1000 annually, and in some years they exceeded 4000; but from having been 1070 in the year 1700, they decreased through each successive decade of that century in the following remarkable progression: 770, 706, 350, 150, 110, 80, 70, 40, 20; and they have so entirely disappeared during the 19th century, that, as I have just said, their very names are no longer in use. All this time there has been a continually decreasing mortality. In 1700 the estimated mortality of England and Wales was 1 in 39; in 1750 it was 1 in 40; in 1801 it was 1 in 44; in 1810 it was 1 in 49; in 1820 it was 1 in 55, and in 1830 it was 1 in 58. In London in 1700 22.parliamentary Returns, 1811. 23.It is conceived that the remarkable increase of the mortality in the middle of this century was mainly caused by the abuse of spirituous liquors, which was checked about that time by the imposition of high duties.—Sir Gilbert Blane’s Dissertations. The diminishing number of those who are born merely to die exhibits the decrease of mortality in a still more striking point of view. The estimated mortality of persons under twenty years of age in London in 1780 was 1 in 76; in 1801 it was 1 in 96; in 1830 it was 1 in 124; in 1833 it was 1 in 137; not much more than one-half the proportion who died under twenty half a century ago. The contrast between the mortality of former times and of the present is seen in the mortality of London in 1685 and in 1830. In the first period the deaths were 1 in 23; in the second they were 1 in 45, little more than one-half. Truly therefore has it been said, that the salubrity of London in the nineteenth century and of London in the seventeenth is far greater than the difference between London in an ordinary season and London in the cholera. But still we have had Cholera. In less than a quarter of a century we have had three visitations of this dreadful disease, which exhibits the essential characters of a pestilence This is too true. We still have epidemics—and why? Because in all our towns there are large portions of the people who live in a state essentially the same as that which existed in the middle ages. The conditions are similar; the results are similar. It is this unhappy class of people that form the exception to the general progress of the nation to which I have adverted. These wretched places and their inhabitants do not obtrude themselves on the public eye. They are not seen in our common thoroughfares, nor in our splendid streets and squares. They are not known. The medical man knows them, the minister of religion knows them, the relieving officer knows them, a few dispensers of voluntary charity know them. They are not known to any one else. Let me then describe one. It is a small room, say twelve feet square; an inner room; no chimney, no window that will open, no inlet for fresh air, no outlet for foul air. There, on a miserable bed, lies a woman ill of typhus fever; a child at her side on the same bed is dying of that fever; a child already dead of it is stretched out on a table at the bed-side. I could not breathe the air of that room. I could not remain in it long enough to write a prescription for the poor patients. As I was writing it at the street-door I shivered and felt sick. I knew that I had taken fever. I passed through a very severe form of it. I could take you to hundreds of such houses in every part of London; to hundreds of courts and lanes wholly consisting of such houses. In such houses, with the conditions of the 15th and 16th I once took a distinguished statistician of France to some of these places in London, and showed him the sick with typhus lying in their wretched beds; for the sick with typhus may be seen there every day of every year. After the painful inspection he exclaimed—“England is indeed adorned with a splendid mantle, but under it are concealed the greatest horrors.” Determined that this eminent person should see both sides of the picture, I next took him to the Model Dwellings. What are the Model Dwellings? Small plots of civilization cultivated in the midst of a wide waste of barbarism. In what does their civilization consist? In very simple matters. The subsoil drainage of the site of the building; The abolition of the cess-pool, involving complete house drainage, an abundant supply of water, and the immediate removal by it of all refuse which it is capable of holding in suspension; Means for the removal of house refuse not capable of suspension in water. And this is all. And what are the results of these few and simple arrangements? That the mortality among the inhabitants of these dwellings is less than that of London generally, and far less than that of some of the filthy and neglected localities in London, the Potteries of Kensington for example; while the mortality among children under ten years of age, on an average of three years, is one-half less than that of the nation generally, and four times less than that of the Potteries; That there has not been a single death from typhus, or any other form of continued fever, among the adults in any of these buildings since their establishment; and that during the two first visitations of epidemic cholera, with the exception of two cases which occurred under peculiar circumstances, there was no attack of cholera in any of these buildings, while from four to six deaths from the pestilence occurred in single houses in the immediate neighbourhood. Such are the results of the first imperfect attempt at improvement; which, remarkable as they are, are not more striking than the results of neglect. Of the children born in the best part of a town one fifth die before they attain the fifth year of age; of the children born in the worst, one-half die before they attain their fifth year. The inhabitants of the worst localities attain little more than one half of the age of those who live in the best. Of 100,000 When we bear in mind the suffering which in every case accompanies this waste of life, and the suffering which must inevitably follow it, and remember that it is admitted that these dreadful evils are remediable and preventible, it is difficult to suppress the natural feelings of indignation and of sorrow, that in a country calling itself Christian the application of the known remedies should be so long delayed. It is right however to acknowledge that something has been done, and is in progress, for the improvement of the sanitary condition of the people. The principle is admitted that it is the duty of the Legislature to deal with this matter, and the first systematic legislative effort to bring about a better state of things has been made. The Public Health Act is in operation, and the general and proper application by local authorities of the powers it confers would place every part of every town in Great Britain in as good a sanitary condition, at least, as that of the Model Dwellings. Up to the present time (1855) there are under this Act 196 towns, containing a population of upwards of 2¼ millions. In about 50 of these towns, however, nothing has yet been done. Works of drainage and water supply are completed, or are in an advanced state, in 70 towns. Mortgages have been sanctioned—
Making a total of nearly two millions sterling devoted to sanitary improvement. 24.This has been since greatly increased: see Appendix, p. 129. [Ed.] It is difficult at present to give the average cost of these combined and complete sanitary works; but the total expense for public and private works of drainage and water supply for houses of from £10 to £20 per annual rental, may be taken at 4d. per week per house. The great obstacle to sanitary progress is the fear of rates, not so much on the part of the poor, who gladly pay for the improvements, but on the part of the owners of small tenements, by whom chiefly opposition is raised to the application of this Act. In the town of Alnwick, public and private works of sewerage and drainage have been completed. There have been laid down about twenty miles of sewers and drains, and seventeen miles of apparatus for water supply, at a total cost, for the combined works, of 4d. per week per house for the term of thirty years; after the expiration of which period the cost of the works, both principal and interest, will have become liquidated, and the only expense thereafter will be for maintenance. We have as yet no certain knowledge of the extent to which such works are capable of preventing sickness and lengthening life. But the most perfect drainage, combined with the most ample supply of water, will not alone secure for the public health all which it is practicable to accomplish. There must also be provision for the better construction of the houses of the poor; for the prevention of overcrowding; for street ventilation and cleansing, and for the exclusion from the neighbourhood of human dwellings of filth-creating animals and of noxious trades. When all this is done, as it might be done, and as it would be done were there a general perception of the crying evils it would remedy, Epidemics would disappear, the more formidable of them immediately, and all of them, I believe, in the end. From the whole of these facts and observations we see— 1. That Epidemics are under our own control; we may promote their spread; we may prevent it. We may secure ourselves from them. We have done so. We have banished the most formidable. Those that remain are not so difficult to be conquered as those that have been vanquished. The causes of Typhus are more completely under our control than those of Intermittent. We have banished Intermittent. We may put an end to Typhus. We have actually done so. We have encompassed the Model Dwellings by a barrier which neither typhus, nor even cholera, nor any of the other causes of excessive sickness and premature mortality have been able to pass. To the residents within that barrier the chance of life has been almost doubled; to their children it has been doubled; 2. We see that Epidemics are not made by a Divine law the necessary condition of man’s existence upon earth. The boon of life is not marred with this penalty. The great laws of nature, which are God’s ordinances in their regular course and appointed operation, do form and give off around us, products which are injurious to us; but He has given us senses to perceive them, and reason to devise the means of avoiding them, and epidemics arise and spread because we will not regard the one, nor use the other. 3. We see that there are circumstances which render it doubtful whether civilization has yet attained a point that places it beyond the danger of retrogression. States in some respects of higher civilization than our own have relapsed into barbarism. There is indeed one circumstance which may give us hope; there is one humanizing principle which is now at least recognized and in partial operation, of which there is no trace in any nation of antiquity. I mean the principle of kindness as a governing influence, distinguished from the principle of brute force. That the whole human race is one family, that the people of every colour, clime, language, government, and faith, are one brotherhood, and that the same law of love which is the bond of the union, strength, and happiness of a single family, is equally binding on the universal family of mankind, are the fundamental and distinguishing principles of our religion; and in proportion to our conformity in our private and public life to the spirit of these divine principles, advancement in civilization is certain; relapse into barbarism is impossible. But as yet there is no such conformity. We neglect the education of the people, quarrelling about the mode, and postponing the thing. We devote to a life of absorbing labour the child and the youth ungrounded in the elements of knowledge, untrained Lastly, we see the first step that must be taken to elevate the people: nay, even to bring them within the pale of the civilization already attained. We must improve their sanitary condition. Until this is done, no civilizing influence can touch them. The schoolmaster will labour in vain; the minister of religion will labour in vain; neither can make any progress in the fulfilment of their mission in a den of filth. Moral purity is incompatible with bodily impurity. Moral degradation is indissolubly united with physical squalor. The depression and discomfort of the hovel produce and foster obtuseness of mind, hardness of heart, selfish and sensual indulgence, violence, and crime. It is the Home that makes the man; it is the home that educates the family. It is the distinction and the curse of Barbarism that it is without a home: it is the distinction and the blessing of Civilization that it prepares a home in which Christianity may abide, and guide, and govern. [The foregoing is from the Edinburgh Lectures. See Introduction. Ed.] |
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