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diff --git a/old/61029-0.txt b/old/61029-0.txt deleted file mode 100644 index 6b07b14..0000000 --- a/old/61029-0.txt +++ /dev/null @@ -1,5099 +0,0 @@ -Project Gutenberg's The Common Nature of Epidemics, by Thomas Southwood-Smith - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: The Common Nature of Epidemics - and their relation to climate and civilization - -Author: Thomas Southwood-Smith - -Editor: T. Baker - -Release Date: December 27, 2019 [EBook #61029] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK THE COMMON NATURE OF EPIDEMICS *** - - - - -Produced by Chris Curnow, Barry Abrahamsen, and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive) - - - - - - - - - - THE COMMON NATURE - - OF - - EPIDEMICS - - AND THEIR RELATION TO CLIMATE AND CIVILIZATION. - - - ALSO REMARKS ON - - CONTAGION AND QUARANTINE. - - - FROM WRITINGS AND OFFICIAL REPORTS - - BY - - SOUTHWOOD SMITH, M.D., - - PHYSICIAN TO THE LONDON FEVER HOSPITAL, - CONSULTING PHYSICIAN TO THE HOSPITAL FOR DISEASES OF THE SKIN, - “THE FATHER OF SANITARY REFORM,” - MEMBER OF THE GENERAL BOARD OF HEALTH, 1848–1854, - AUTHOR OF - “THE PHILOSOPHY OF HEALTH;” “THE DIVINE GOVERNMENT,” &C., &C. - - EDITED BY - - T. BAKER, ESQ., - - OF THE INNER TEMPLE, BARRISTER AT LAW, AUTHOR OF - “THE LAWS RELATING TO PUBLIC HEALTH, SANITARY, MEDICAL, PROTECTIVE;” - “THE LAWS RELATING TO BURIALS,” &C., &C. - - - PHILADELPHIA: - J. B. LIPPINCOTT & CO. - 1866. - - ------------------------------------------------------------------------- - - INTRODUCTION. - -The recent very serious outbreak of Epidemic disease among the cattle in -England may not unreasonably induce the fear that a human Epidemic is -approaching. Cholera has prevailed in Paris and several other places on -the Continent during the late autumn, and it is well known that the -former visitations of that terrible disease in this country have -appeared the year following similar attacks abroad. Moreover, human -epidemics in numerous instances have been preceded or accompanied by -extensive murrain among cattle.[1] - -Footnote 1: - - See pp. 7, 65, 110. - -Never was a country guided through the perils of an Epidemic with -greater wisdom and energy than Great Britain during the Cholera of -1848–9. The master spirit on that occasion was Dr Southwood Smith. Long -previous to that time this great man had had a more extended experience -of the nature, causes, and treatment of Zymotic diseases than perhaps -any physician before or since. He had made them his special study, and -applied the great powers of his clear, reasoning, and philosophic mind, -to the discovery of their causes, and the best means of arresting their -progress. - -Whilst occupying the post of responsibility as the chief medical adviser -of the nation in his capacity of Medical Member of the General Board of -Health, Dr Southwood Smith left behind him a set of official reports on -the subjects of Epidemics, Contagion, and Quarantine, which will never -die. - -“The reports drawn up by Dr Southwood Smith,” writes Dean Peacock, “on -the proper precautions to be taken to meet the recent outbreaks of -cholera, have been of the most essential service wherever their -recommendations have been followed. If Dr S. Smith, however, had no -other claims on the lasting gratitude of the nation, I would refer to -his reports on quarantine, as quite sufficient to establish them. They -have contributed, more than any other publications on this subject, to -dissipate the gross and mischievous delusions upon which these -regulations are founded, and which are known to be so injurious to the -free commercial intercourse and prosperity of nations.” - -After Dr Southwood Smith left office he gave us a concise summary of his -experience in two masterly lectures, now published, together with -extracts from his official Reports. - -In times of distress it is only natural to look for the most efficient -help. Our herds only have extensively suffered of late, but we ourselves -may follow, and it is well to be prepared. Even with reference to the -causes and treatment of the Epizootic, the reasonings, facts, and -conclusions again brought forward in the following pages will apply. But -should the worst fears become realized, and an extensive human epidemic -follow, these writings will tell with greater force, and the nation will -be better prepared to meet the danger, for having calmly considered -beforehand the probability of its approach. - - * * * * * - -One ground of hope that we may escape a visitation of Cholera during the -coming summer, may be afforded by the remarkably tempestuous weather -which prevailed in December and January last.[2] The loss of the -steam-ship “London,” which foundered in the Bay of Biscay, with 226 -souls, on the 11th January, and the still more remarkable fact, that -during the night of the 10th, out of 62 vessels riding at anchor in -Torbay, 41 either foundered or were dashed to pieces on the rocks;—these -were terrible calamities, and they were only the most striking examples -of the numerous wrecks and disasters which occurred in the course of the -late most tempestuous season;—but they afford a hope of escape from a -worse peril, viz. nations prostrated by disease and premature death. - - T. B. - -KINGSCOTE, WOKINGHAM, - - _May, 1866_. - -Footnote 2: - - See p. 18. - - ------------------------------------------------------------------------- - - CONTENTS. - - -EPIDEMICS— - - PAGE - - Their Common Nature 1 - - Are all Fevers:—_e.g._ Plague, Sweating 2 - Sickness, Cholera, &c., - - Rapidity of their Course 4 - - Warnings of their Approach 5 - - Periodicity of their Return 8 - - Are produced by the same Causes 10 - - Foul Air—Overcrowding 12 - - Attack Animals 7, 13, 16, - 65, 110 - - Their Attendant Signs—Meteorology 17 - - Action of Air on the Blood 19 - - Theories of Epidemic Causes 23 - - Influence of Climate 25 - - Mortality within the Tropics 29 - - Their Relation to Civilization 33 - - State of England in the 14th Century 35 - - Improvements in the 15th Century 41 - - Prolongation of Life in the 17th and 45 - 18th Centuries - - Disappearance of the Earlier Epidemics, 51 - _e.g._ Jail Fever, Sweating - Sickness, Plague, Typhus-Gravior, &c. - - Experience of the Model Dwellings 54 - - Sanitary Legislation and Works 57, 129 - - Epidemics are within Human Control 58 - - -QUARANTINE— - - Originated in the Belief that Epidemics 61 - spread exclusively by - Contagion - - Sanitary Measures the only Safeguards 63 - - Effects Attributed to Contagion 67 - - Inutility of Quarantine 71 - - Plague, Yellow Fever, Cholera, &c. 73 - - Mitigation of Disease by Migration, 75 - _e.g._ Tramps - - Sanitary Regulation of Ships 77 - - -CONTAGION— - - Cholera averted at Baltimore 79 - - Cholera averted at Newcastle Barracks 82 - - Yellow Fever in the _Eclair_ 84 - - Alleged Communication of Disease to Boa 96 - Vista, and Examination of - Evidence - - Alleged Importation of Disease by the 117 - _Dygden_ into Gibraltar, and - Examination of Evidence - - -APPENDIX. - - Sanitary Works accomplished under the 129 - Public Health Act - - ------------------------------------------------------------------------- - - - - - THE COMMON NATURE - - 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 which produce excessive sickness and -early death are preventible. - -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. - -This is as true of the great Epidemics of former times as of those which -prevail in our own. - -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 fœtid 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 -a family, or among the inhabitants generally of a court, street, or -town. Epidemics, on the contrary, derive their name from their attacking -large numbers at once. - -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 that falls. After a -considerable interval, perhaps at a great distance, another blow is -struck; and then one by one, another and another, until at last the fact -becomes too manifest to be doubted or denied, that two victims have been -seized in one family—several in the same street—three or four on the -same day, in distant parts of the town, or in the adjoining town, or it -may be in towns separated from each other by the distance of hundreds of -miles. At length the terror-stricken nation, startled from its fondly -cherished security, sees no place safe from the Plague. When, however, -the causes are intense, it may break forth quite suddenly, and spread -with astonishing rapidity. - -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 downwards, shows -that whenever a new Plague was at hand, destined to become truly -European, it was preceded by a sudden outbreak of Influenza, as general -as it was violent. This is exemplified with singular uniformity in the -Epidemics of the 16th century—the severest epidemic period on record. It -is most remarkable that in our own day the first visitation of Epidemic -Cholera was preceded by an outbreak of Influenza which resembled, in the -most minute particulars, the violent and universal Influenza that -ushered in the mortal Sweating Sickness Epidemic of 1517. - -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] - -Footnote 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 and -other depleting remedies were indispensable. At this period it ceased to -be an inflammatory disease; it became a disease of debility, in which no -one could think of bleeding; and so closely did the prevailing fever now -put on the general character of the approaching plague, which was as yet -six months distant, that the fever into which those Cholera patients -fell, who were not killed by the first stroke—the consecutive fever, as -it was afterwards called—could not be distinguished from the primary -fever in the wards of the Hospital when Cholera was at its height, which -had appeared there for the first time six months previously, and which -has never disappeared since.[4] - -Footnote 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 evidence, as if they would avert the event by -denying its existence. - -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 interval of -precisely eleven years. Such was its violence on this occasion, that the -historians of that day designate this period by the significant name of -the “Great Mortality.” It drove Henry VIII. from London, destroyed -several of the most distinguished persons of the Court, impressed the -nation, from the monarch to the peasant, with an awful feeling of the -uncertainty of life, continued its destructive course for its accustomed -period of six months, and then again disappeared. - -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 was sometimes fatal within twelve -hours, and frequently in two days, particularly when spitting of blood -or any other form of hœmorrhage was amongst the early symptoms. - -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 suffer? Suppose -these same hundred persons took a large dose of arsenic, or an over-dose -of chloroform, not only would not one in ten escape, but every -individual would certainly perish. - -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 the science of prevention, -the importance of which it is impossible to over-estimate. - -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 space allowed to -each prisoner ranges from 819 to 935 cubic feet. Not a single case of -cholera, nor even of diarrhœa, occurred among the prisoners in this -jail. - -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 diarrhœa 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:[5] results which prove the operation of a general law -of nature. I could adduce equally decisive examples of the action of -each of the principal external predisposing causes just enumerated. - -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. - -Footnote 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.] - -The moisture in the air of a crowded room may be condensed by ice. It -condenses indeed spontaneously on the walls and windows, and on all -surfaces, and may be collected in sufficient quantity for examination -and experiment. - -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] - -Footnote 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. It was so in -one particular building in which, during a local epidemic outbreak, -twelve persons were attacked with cholera, and four died. - -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, -and that they manifest themselves by unmistakeable signs. - -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] frogs, covering the face of the earth, and devouring every -green thing that the deluge of rain had left; and, as the sequence of -these antecedent conditions, dearth and famine, closing the long series -of the year’s calamities. Such, in all ages and countries, have been the -recognized portents and precursors of a coming year of pestilence. - -Footnote 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. - -Among other important facts, he has determined that there is—1. An -increased pressure of the atmosphere, greatest at the worst period of -the epidemic. - -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. - -7. An extraordinary stillness and stagnation of the air, both by day and -night. Sometimes in the low-lying districts not a breath could be -observed. Even when at more elevated stations the wind was moving with a -force of 1 lb 7 oz., the pressure was only ¼ lb in the heart of London. - -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. - -“The three epidemics,” says Mr Glashier, in summing up the results of -his inquiry, “were attended with a particular state of atmosphere, -characterized by a prevalent mist, thin in high places, dense in low. -During the height of the epidemic, in all cases, the reading of the -barometer was remarkably high, the atmosphere thick; and in 1849 and -1854 the temperature above its average. A total absence of rain, and a -stillness of air amounting almost to calm, accompanied the progress of -the disease on each occasion. In places near the river, the night -temperatures were high, with small diurnal range, with a dense torpid -mist and air charged with the many impurities arising from the -exhalations of the Thames, and adjoining marshes; a deficiency of -electricity, and, as shown in 1854, a total absence of ozone, most -probably destroyed by the decomposition of the organic matter with which -the air in these situations is so strongly charged. - -“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 courts, and within and about houses, and -over the heated surface of all foul water, decomposition goes on with -the utmost activity, and the products are poured into the stagnant air. - -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 nervous conducters, but a corresponding portion of -nervous tissue is used up; no muscular movement, no glandular secretion, -takes place without a proportionate waste of muscle and of gland. What -must be the amount of supply required to meet this waste, when -able-bodied men employed in their ordinary labour lose from 2 lbs. to 5 -lbs. and upwards of their weight twice a day.[8] Some physiologists of -eminence have estimated that in order to supply that waste, there passes -in the course of every 24 hours as much fluid through the thoracic -duct[9] as equals the whole quantity of blood in the body. - -Footnote 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._ - -Footnote 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 the system in respired air, must be too -minute to exert any serious influence upon the body. - -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 filth alone, epidemics break out and -spread; and so of the whole number. The removal of one of these causes, -therefore, or the removal of two or three of them, will not suffice for -safety; every one must be removed before there can be safety. - -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;[10] -that the prevalence of the predisposing causes in particular localities, -in certain intensities, is sufficient to produce local epidemic -outbreaks; that the prevalence of such causes in such intensities, -joined to some general conditions of the atmosphere, such as the -meteorological conditions which have been enumerated, particularly those -which favour the accumulation and concentration of the products of -organic decomposition, are all that is required to engender wide-spread -epidemics. Those who adopt this view contend that the existence of a -primary cause as a distinct and separate entity is not necessary to -account for the phenomena. - -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. - -Footnote 10: - - See Baltimore case, p. 78. - -It is urged that though we are unacquainted with the physical form or -chemical properties of this body, this is no reason why we should not -understand its force as a special agent in the production of disease, -just as we know the forces of other physical bodies, though not their -nature. - -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 -impure blood is charged, precisely the materials for taking on the -fermenting process. The advocates for this view think that the term -“_zymotic_” is not only the appropriate name of the whole of this class -of diseases, but that it also declares an interesting fact connected -with them. Whatever may be the truth with respect to these points, on -which at present we have no positive knowledge, one thing is certain, -that practically our concern is with the known causes,—the ascertained -conditions. These are palpable, definite, and capable of complete -removal and prevention. - -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. - -Minor but still important conditions are the nature of the soil, the -proportion of land that is cleared and under cultivation, the extent of -forests, lakes, and rivers, the prevailing winds, the electrical state -of the atmosphere, and so on. - -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, oaks, and beech trees afford no example; forming a -carpet of verdure, the dark tint of which augments the splendour of the -aërial light.” - -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] to which -they give a decided and often a highly offensive odour. - -Footnote 11: - - See note, p. 16. - -“On fixing our eyes on the tops of the trees,” describes Humboldt, “we -discovered streams of vapour wherever a solar ray penetrated and -traversed the dense atmosphere, exhaling, together with the aromatic -odour yielded by the flowers, the fruit, and even the wood, that -peculiar odour which we perceive in autumn in foggy seasons. It might be -said, that notwithstanding the elevated temperature the air cannot -dissolve the quantity of water exhaled from the surface of the soil and -of the vegetation.” - -“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 determined by -temperature. It is incapable of existing where the average range of the -thermometer is greater than from 76° to 86° of Fahrenheit, or where the -temperature varies more than from 5° to 10° night and day. Extreme heat -and moderate cold immediately stop it; nay, even the prevalence of a -cold wind for a few hours only. - -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 epidemics of our -own country. During the prevalence of Cholera it was observed over and -over again, that persons coming directly from the pure air of the -country into the infected part of a town, were seized with the disease. -The explanation is not obvious. It would seem, however, to be connected -with the suddenness of the shock on the system. Priestley found, that -after shutting up a mouse in a given quantity of air a considerable -time, it seemed to be weak, and to be slowly dying. If at this period he -put a fresh mouse into the same air, it instantly died. It seems as if -the system can bear a pestiferous atmosphere better when gradually than -when suddenly exposed to it. - -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, and most of -them on the evening parade, as if at once stricken down, and striving, -with the last efforts of gigantic strength, to resist a death-call that -would not be refused.” - -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 climes, and -only one, which appears capable of penetrating within the torrid zone, -and of committing greater ravages there than in lower temperatures, and -that is Small-pox. With this exception, the ordinary epidemics of -temperate climates do not enter the tropics, while, on the other hand, -the ordinary epidemics of the tropics every now and then decimate the -temperate regions. - -“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] in England against an amount of solar heat -of which its climate is insusceptible. Let them further be repeated in -the Schools of Medicine until the Professors become ashamed of imbuing -the minds of the young with prejudice and false belief, which, should -they ever visit warmer climates, may cause them to be eminently -mischievous in vexing the commerce and deeply and injuriously agitating -the public mind of whatever community may have received them.” - -Footnote 12: - - See Cases of the Eclair, Dygden, &c., _post._ - -Climate differs not only in different countries but in different parts -of the same country. The climate of the country is different from that -of the city. The climate of every city, town, and village, differs from -that of every other. The temperature, the moisture, and the other -meteorological conditions of different districts, nay, even of different -streets in the same town, vary to such a degree as to influence -materially their relative salubrity and the prevalence or absence of -particular classes of disease. These local climatic conditions and their -connection with prevalent diseases, have not as yet received due -attention: when they shall have received it—and they will receive it—a -new light will be shed on local epidemics. - - * * * * * - -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. - -Without the two first, there can be no security for life and property, -both of which must be placed in absolute and unquestionable safety -before a single step can be taken out of the lowest depth of barbarism. -Without the two last, none of the others can be acquired. These -conditions are therefore the basis of the pyramid of society. - -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. - -Immediately beyond the walls that encompassed the towns were large -stagnant ditches, which being the nearest receptacles for refuse, were -full of all sorts of decomposing filth. - -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 chiefly on salted beef, veal, and -pork, the price of which was one-half less than that of wheat in the -time of Henry VIII. - -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, disease, -and death. The phrase “starved by cold” expresses a more literal fact -than is commonly understood. Unhappily the circumstances which deprive a -population of the means of counteracting cold limit also the supplies of -food at their command, and the pressure of the twofold privation, want -of food and want of fuel, commonly occurs at the very season when both -these indispensable supports of life are most needed. Some conception -may be formed of the suffering to which our ancestors were exposed from -this cause, from the fact that their prejudice against the use of coal -as an article of fuel was such that a law was passed rendering it a -capital offence to burn it within the City, and there is a record in the -Tower importing that a person was tried, convicted, and executed for -this offence in the reign of Edward the First. It was not until the -reign of Charles the First that there was a regular supply of coals to -London. - -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 which have been enumerated, namely, in -the malarious state of the greater part of the kingdom, in the confined -space of the towns, in the deficiency and putrescency of the food, in -the inadequacy of the means of protection from cold, and in the -intemperance of the people. These were the true sources of the malignity -and mortality of the pestilences of that age. - -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 -service; and ships were seen driving about on the ocean and drifting on -shore, whose crews had perished to the last man. - -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 of two centuries, under the name of the “Dancing Mania.” It was -universally attributed to demoniacal possession, and its cure was -attempted by exorcism. It was one expression and outlet of the violent -passions of that time, imposture and profligacy playing principal parts -in this strange drama. - -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] - -Footnote 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! - -But in the midst of these terrible disorders, changes which had been in -silent operation during several centuries began to produce visible -results. The independent power of the nobles had been suppressed; the -feuds that raged between them, filling the country with disorder and -bloodshed, had been put down; the supremacy of the law had been -established; property and life had become more secure; industry had -taken a surprising start; the practical abolition of serfdom had been to -a large extent effected; and at last came the final breaking up of the -feudal system in the reign of Henry VII. by the passing of the law -authorizing the alienation of land. - -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 forging and riveting: that stupendous work, -which was not merely emancipation from spiritual bondage, but the -re-communication of the long-lost spirit of religion; the noble men who -achieved it being ever, even in their day of triumph, less intent on -demolishing the gorgeous edifice that had held the mind enthralled, than -on erecting a pure temple in which it might worship with sincerity and -freedom. - -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] - -Footnote 14: - - Macaulay’s History, Vol. I. Chap. III. - -In the next century the care of the Public Health became a recognized -and direct object of the Legislature and the Magistracy. Better -regulations were enforced in the metropolis for the removal of filth, -for the construction and extension of sewers, and for widening, paving, -and lighting the streets. In the middle of this century the Great Fire -(1666) consumed 13,000 houses and left an open space of upwards of a -square mile. This opportunity of improvement was not lost. Though in -rebuilding the city the same lines of streets were preserved, and the -streets were still kept much too narrow, yet there was some improvement -in the general plan, while the houses were built of better materials; -brick was substituted for wood and plaster, and the buildings were less -crowded and less projecting. - -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 collective circumstances that -make up national prosperity. In the interval between the seventeenth and -eighteenth centuries that sum grew into a highly important one. Of this -the proof is positive. - -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 the time of Mr Pitt, but must -have been slowly on the increase at least since the days of Queen Anne. - -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,[15] yet there are not -wanting evidences that the value of life continues progressively to -increase. It must necessarily continue to increase, because the main -conditions on which life and health depend have experienced, during the -whole of the present century, an expansion and improvement, on which no -former age presents a parallel. It will be sufficient to establish this -fact, to glance at what has been effected within this period in the -multiplication and diffusion of the three primary necessaries of -existence—food, clothing, and fuel. - -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.[16] - -Footnote 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. - -Footnote 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: - - - ┌──────┬────────────┬──────────┬──────────┐ - │ │ │ INCREASE │ ANNUAL │ - │YEARS.│POPULATION. │ Each │ RATE │ - │ │ │Decennial │ of │ - │ │ │ Period. │ Increase │ - │ │ │ │per cent. │ - ├──────┼────────────┼──────────┼──────────┤ - │ 1801 │ 10,917,433 │ │ │ - │ 1811 │ 12,424,120 │1,506,687 │ 1.274 │ - │ 1821 │ 14,402,643 │1,978,523 │ 1.489 │ - │ 1831 │ 16,564,138 │2,161,495 │ 1.408 │ - │ 1841 │ 18,813,786 │2,249,648 │ 1.279 │ - │ 1851 │ 21,121,967 │2,308,181 │ 1.186 │ - └──────┴────────────┴──────────┴──────────┘ - - -This increased production of food consists chiefly of grain, green -crops, and garden vegetables, countless in variety, and highly -nutritious and grateful, completely reversing the nature of the national -subsistence compared with that of former times, and giving to the masses -of the people a constant and unfailing supply, winter and summer, of -fresh vegetable nutriment. - -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 few years ago were wholly sterile, or -deemed incapable of producing wheat, now yield some of the finest grain -in England.[17] - -Footnote 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 of -surplus articles, which add to the sum of the general convenience, and -from that moment the community takes a start in the career of -improvement. From a comparison of occupations taken in 1831, it appears -that, at that time, the division of labour among the people was such -that one person raised nearly all the food of home production consumed -by four persons.[18] - -Footnote 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] while each power-loom, -superintended by an adult assisted by a child, completes weekly twenty -times the amount of work which the hand-loom is capable of producing. -The increase of production is of course enormous, and the effect is a -progressive cheapening of the articles manufactured, reducing the price -of some of them tenfold, and placing them within the reach of the -poorest classes:[20] articles of clothing not only conducive to health -through warmth, but almost equally so through cleanliness; for they are -almost all composed of such tissues and textures as favour and compel -frequent washing. - -Footnote 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. - -Footnote 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] - -Footnote 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 the means of producing the others; while -these last are the immediate causes of the abundance of the first. - -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, the prison, the -hospital, the school, and in short of every place in which any -considerable number of persons was assembled, and which when it once -broke out was as destructive as the plague—that terrible disease is -gone. - -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. - -Moreover several acute diseases which hardly come under the name of -Epidemics, such as Rheumatic Fever, Pneumonia, and Peripneumonia, are -much less frequent and fatal now than they were a century ago. - -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] the deaths were 1 in 25; in 1750, 1 in 21;[23] in -1801, 1 in 35; in 1810, 1 in 38; and in 1830, 1 in 45. - -Footnote 22: - - parliamentary Returns, 1811. - -Footnote 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 of the middle ages; and if -Typhus-gravior has disappeared, Typhus and its kindred diseases have -taken its place; and the Registrar-General constantly presents before -our eyes a faithful record of their ravages. - -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 centuries, -Cholera, in the middle of the 19th, found and exerted a power similar to -that which characterized the epidemics of the middle ages, and here -Typhus and its kindred diseases continually hold their undisputed reign: -houses whose unhealthfulness is increased by the only marks of the age -which attach to them, their brick construction and their glass windows; -those bricks and windows more effectually than the ancient wattles -excluding the external, and confining the internal air, and thereby -fostering the generation and spread of typhus. It is remarked by Dr -Macculloch, in his account of the Hebrides, that while the inhabitants -had no shelter but huts of the most simple construction which afforded -free ingress and egress to the air, they were not subject to fevers, but -when such habitations were provided as seemed more comfortable and -commodious, but which afforded recesses for stagnating air and -impurities, then febrile infection was generated. Houses in this state, -without ventilation, without the means of cleanliness, worse than the -huts of the savage, exist in great numbers in all our towns, and too -truly merit the name they have acquired of “fever nests.” - -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 free admission of light and air to each inhabited room; - -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 children born in Surrey, 75,423 -attain the age of ten years; 52,000 live to the age of fifty; and 28,878 -live to seventy. In Liverpool, out of 100,000 persons born, only 48,211 -live ten years; 25,878 live fifty years; and 8373 live seventy years. -The probable duration of life in Surrey is 53 years; in Liverpool it is -26 years. Were the whole of the metropolis as healthy as the Model -Dwellings, there would be an annual saving in London of nearly 20,000 -lives. But these lives are not saved; this number of persons is allowed -to perish every year, and they are as truly and as needlessly sacrificed -as if they were taken out on Bethnal-green and shot. - -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. - -Eleven towns, with a population of about half a million, have adopted -the powers of the Act in subsequent local acts. - -Works of drainage and water supply are completed, or are in an advanced -state, in 70 towns. - -Mortgages have been sanctioned— - - For drainage works nearly 1¾ - and water supply, millions - sterling; - - ──────────────────────────────────── - For private works of about £45,000; - drainage and water - supply, - ──────────────────────────────────── - For paving, street about £200,000; - improvements, &c., - -Making a total of nearly two millions sterling devoted to sanitary -improvement.[24] - -Footnote 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. - -On inspecting these works, I saw in the tenements occupied by the lowest -classes a high degree of cleanliness, wholesomeness, and comfort, and -heard from the inhabitants an expression of the greatest satisfaction. - -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; and -compared with some other children of their own class it has been -increased fourfold. - -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 to habits of self-restraint, thereby -dooming the man to the blankness and turbulence of ignorance and -intemperance. We equally neglect the sanitary condition of the people. -We make no provision for securing to the humblest classes, and they can -make none for themselves, the conditions that are essential to their -physical health, the loss of which to them involves and includes every -other. We thus neglect body and mind, and then the disorders and vices -which necessarily follow we endeavour to repress by punishments that -harden but never reform, neither trusting nor trying the influence of -gentleness, which our religion teaches us is stronger than ignorance, -stronger than crime, and can master both. It is this state of things -that places in danger the ark of civilization. - -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.] - - ------------------------------------------------------------------------- - - - - - QUARANTINE AND CONTAGION. - - [From First and Second Reports on Quarantine. See Introduction. ED.] - - -The object of quarantine is to prevent the introduction of epidemic -diseases from one country into another, and its regulations are based on -the assumption of the contagiousness of the diseases with which it -deals; it being supposed that such diseases are propagated by contact, -direct or indirect, of the unaffected with the affected. In accordance -with this view the preventive means adopted by quarantine consist of the -isolation of the sick or suspected, with whom it interdicts all -communication, whether by person or by articles deemed capable of -transmitting contagion. - -When quarantine was first established, the spread of epidemic diseases -exclusively or chiefly by contagion was a doctrine universally -received;[25] but during the last century a change has gradually taken -place in professional opinion in almost every country in Europe, -particularly in France, Russia, and Austria, as well as in America, with -respect at least to several of these diseases, chiefly by medical -officers, who, having had the charge of the health of fleets and armies -in different quarters of the globe, have been under the necessity of -studying the circumstances connected with the outbreak and spread of -formidable epidemics; and also by those who, having had the care of -hospitals and dispensaries in large cities, have been obliged to visit -the localities and abodes of the poorer classes, where these diseases -are always the most prevalent. - -Footnote 25: - - The wide difference between the qualifications of the accomplished - popular physician and the scientific investigator into the causes of - epidemic sickness was strikingly exhibited in the first outbreak of - Asiatic cholera in 1831, when the emergency required not merely a - knowledge of the practice of medicine, but the power also of applying - the philosophy of public health to the exigencies of the moment. How - were these exigencies provided for? - - A board, comprising all the most eminent and skilful physicians of the - day, was assembled in the College of Physicians, under the presidency - of Sir Henry Halford; and, after declaring, in opposition to the - unanimous opinion of the physicians of Bengal, “that no measures of - external precaution for preventing the introduction of the cholera - morbus by a rigorous quarantine have hitherto been found effectual,” - they issued the following official notification:— - - “To carry into effect the separation of the sick from the healthy, it - would be very expedient that one or more houses should be kept in view - in each town or its neighbourhood, as places to which every case of - the disease, as soon as detected, might be removed, provided the - family of the afflicted person consent to such removal; and, in case - of refusal, a conspicuous mark, ‘SICK,’ should be placed in front of - the house, to warn persons that it is in quarantine; and even when - persons with the disease shall have been removed, and the house shall - have been purified, the word ‘CAUTION’ should be substituted, as - denoting suspicion of the disease; and the inhabitants of such house - should not be at liberty to move out or communicate with other persons - until, by the authority of the local board, the mark shall have been - removed. - - “It is recommended that those who may fall victims to this most - formidable disease should be buried in a detached ground, in the - vicinity of the house that may have been selected for the reception of - cholera patients. By this regulation, it is intended to confine, as - much as possible, every source of infection to one spot: on the same - principle, all persons who may be employed in the removal of the sick - from their own houses, as well as all who may attend upon cholera - patients in the capacity of nurses, _should live apart_ from the rest - of the community. - - “Whenever objections arise to the removal of the sick from the - healthy, or other causes exist to render such a step not advisable, - _the same_ PROSPECT OF SUCCESS IN EXTINGUISHING THE SEEDS OF THE - PESTILENCE cannot be expected. Much, however, may be done, even in - these difficult circumstances, by following the _same principles of - prudence_, and by avoiding all unnecessary communication with the - public out of doors: all articles of food or other necessaries - required by the family _should be placed in front of the house, and - received by one of the inhabitants of the house after the person - delivering them shall have retired_. Until the time during which the - contagion of cholera lies dormant in the human frame has been more - minutely ascertained, it will be _necessary_, for the sake _of perfect - security_, that convalescents from the disease, and _those who have - had any communication with them_, should be kept under observation for - a period of _not less than twenty days_. - - “All intercourse with any infected town and the neighbouring country - must be prevented, by the best means within the power of the - magistrates, who will have to make regulations for the supply of - provisions. - - “Other measures of a more coercive nature may be rendered expedient - for the common safety, if unfortunately so fatal a disease should ever - show itself in this country, in the terrific way in which it has - appeared in various parts of Europe; and it may become _necessary to - draw troops or a strong body of police around infected places, so as - utterly to exclude the inhabitants from all intercourse with the - country_: and we feel sure that what is demanded for the common safety - of the state, will always be acquiesced in with a willing submission - to the necessity which imposes it.” - - This announcement by the English physicians of 1831 was published - throughout the land in the form of an Order of the King in Council. - But the strong good sense of the public averted many of the mischiefs - which these scientific advisers would have produced, had their - counsels been carried into execution. The preventive measures which - were eventually adopted by them consisted in prohibiting intercourse - between one town and another by sea, and permitting it by land; thus, - communication between London and Edinburgh by stage coach was - perfectly free and uninterrupted, while communication between those - capitals by sea was prohibited with such rigour that no interest, - however powerful, could procure an exemption. Francis Jeffrey—at this - time holding the high office of Lord Advocate of Scotland, and whose - influence, from his personal and official connections, was very - great—was unable to obtain permission for his faithful servant, in the - last stage of dropsy, to go from London to Leith by water, lest he - should carry with him to his native country, by that mode of - conveyance, not the dropsy, which he had—but the cholera, which he had - not. - - “You will be sorry,” writes Jeffrey to Miss Cockburn, “to hear that - poor old Fergus is so ill that I fear he will die very soon. I have - made great efforts to get him shipped off to Scotland, where he most - wishes to go; _but the quarantine regulations are so absurdly severe, - that, in spite of all my influence with the Privy Council_, I have not - been able to get a passage for him, _and he is quite unable to travel - by land_; he has decided water in the chest, and swelling in all his - limbs. The doctors say he may die any day, and that it is scarcely - possible he can recover.”—_Cockburn’s Life of Jeffrey_, p. 247. - - These examples are not adduced for the purpose of casting obloquy on - Sir Henry Halford, Dr Maton, and the other eminent physicians their - colleagues, who vainly attempted to reduce to practice in the - nineteenth century, the standard but obsolete doctrines taught, almost - universally, in the medical schools in the country; but solely for the - purpose of displaying the state of the science of Public Health in the - year 1831–2, as far as the physicians of highest reputation and - largest practice may be taken as its exponents.—_Origin and Progress - of Sanitary Reform, by T. Jones Howell._ - -The consideration of the common properties of pestilence, under whatever -form or name it may occur, has led to the general conclusion that the -true safeguards against pestilential diseases are not quarantine -regulations, but sanitary measures—that is to say, measures which tend -to prevent or remove certain conditions, without which pestilential -diseases appear to be incapable of existing. - -The whole machinery of quarantine is based on the assumption that by an -absolute interdiction of communication with the sick, either by the -person or by infected articles, it can prevent the introduction of -epidemic disease into an unaffected community. - -But this assumption overlooks the essential condition on which epidemic -disease depends, namely,—the presence of an epidemic atmosphere, without -which it is now generally admitted that no contagion, whether imported -or native, can cause a disease to spread epidemically. Allowing, -therefore, to contagion all the influence which any one supposes it to -possess, and to quarantine all the control over it which it claims, -there remains the condition, the primary and essential condition, which -confessedly it cannot reach, namely, the epidemic atmosphere. - -Experience affords evidence that the influence of an epidemic atmosphere -may exist over thousands of square miles, and yet affect only particular -localities. The cases of cholera which have occurred in numerous and -widely distant parts of England and Scotland mark the presence of the -epidemic influence; yet over this extended area cholera has fixed itself -and prevailed as an epidemic only in very few places. Why has it -localized itself in these particular places? Probably because it has -there found conditions of a specific kind, either local or personal, or -both. It follows that our true course is to make diligent search for all -localizing circumstances, and to remove them, so as to render the -locality untenantable for the epidemic. But quarantine makes no such -search, and leaves all localizing conditions untouched and unthought of. - -Hence the signal failure of quarantine as a means of prevention, with -reference at least to the most prevalent epidemics, in all the nations -of Europe in which it has been tried in modern times; and hence the -general relaxation, and in some instances the total abandonment, of the -system of quarantine, with reference to several diseases against which -it was formerly rigidly enforced, and the growing distrust in the -supposition that measures of this kind really afford protection against -the introduction of any epidemic disease into any country. - -The influence of great epidemics is not limited to human beings; it -extends to all classes of domestic animals. - -It is stated by Dr Thomas Lesslie Gregson, who was at Alexandria during -the prevalence of the great plague of 1836, on duty there as -surgeon-in-chief to the Naval, Military, and Civil Hospital, that cattle -were attacked with decided symptoms of plague some time before the -disease broke out among the human species. “Before the disease broke -out,” he says, “a number of the Pacha’s oxen were seized with a malady, -of which above one hundred died in a few days. I was sent to investigate -and report on this epidemic. On examination I found gastroenterite in -the most intense degree; so much so, that I have found extensive -gangrene in oxen that have only been observed ill twelve hours. They had -also large buboes. This I reported plague, and caused them to be -interred deeply.” - -Quarantine is based on the assumption that epidemic diseases depend upon -a specific contagion; but the question of contagion has no necessary -connection with that of quarantine. The real question is whether -quarantine can prevent the extension of epidemic diseases, whatever may -be their nature, whether contagious or not. If it can, it is valuable -beyond price; if it cannot, it is a barbarous encumbrance, interrupting -commerce, obstructing international intercourse, periling life, and -wasting, and worse than wasting, large sums of the public money. - -But if the power of protecting the country from the introduction and -spread of disease, whether contagious or otherwise, claimed by -quarantine, be really possessed by it, this must be proved by other -considerations than those which establish the contagiousness of disease; -it is a mere matter of evidence and experience, and consequently the -disputed point of contagion should be placed entirely out of view in -this discussion, and the whole question should be argued on the broad -ground whether or not quarantine is a public security, or is capable of -affording practically any useful result. - -There is indeed one point of view in which it may be proper, and even -necessary, to consider the question of contagion with relation to that -of quarantine. Assuming the existence of contagion, if it can be proved -that quarantine, instead of affording any protection against contagion, -absolutely fosters it, then the stronger the proof of contagion the more -decisive the argument presented by it against quarantine; and it will be -shown hereafter that this is the true and the only relation in which -contagion stands to this question. - -There is no more reason why the controversy on contagion should -complicate the question of quarantine than why it should continue to -encumber the general subject of the removable causes of disease, from -which efforts have long been made to disentangle it. - -The discussion whether epidemic diseases arise and spread from contagion -or from common or specific poisons generated in the localities in which -these pestilences first break out, has nothing whatever to do with -quarantine, the sole inquiry with reference to this question being -whether, however epidemic diseases arise, quarantine can prevent their -introduction into a country or arrest their progress when there. - -Few will question that the progress of the opinion of observers in -Europe during the last half-century has been steadily towards a material -modification, if not an entire abandonment, of the doctrine of contagion -with reference to the majority of epidemic diseases, taking the word -contagion in its strict sense, that is, the communicability of disease -exclusively by contact: direct, that is, with the body or breath of an -infected person; or indirect, with something which an infected person -has touched. - -Cholera may be taken as an example of the diseases of the epidemic -class. When cholera first invaded Europe in 1831,[26] the belief in its -contagious nature was almost universal, and in this country in -particular there was scarcely a medical man who did not entertain this -conviction; but as in India, where this disease is known, the belief in -its contagious nature is universally abandoned, so in Europe it -gradually diminished in proportion as opportunities of observing the -disease increased; and now in Russia, Poland, Prussia, France, Belgium, -and England, the contrary view, with few exceptions, is maintained. - -Footnote 26: - - See note p. 61. - -There has been much confusion of terms in respect to the use of the -words contagion and non-contagion. Professional men have avowed their -belief of the contagiousness of typhus, and stated that they had -experienced it in their own persons. When asked for the evidence on -which the belief was founded, they have usually related some -circumstances showing, not the contagiousness, but the infectiousness of -the disease. Contagion is a term applicable to a different set of -circumstances. According to the hypothesis of contagion, no matter how -pure the air, no matter what the condition of the fever ward, if the -physician only feels the pulse of the patient, or touches him with the -sleeve of his coat, though he may not catch the disease himself, he may -communicate it by a shake of the hand to the next friend he meets; or -that friend, without catching it himself, may give it to another; or if -the physician wash and fumigate his hand, but neglect the cuff of his -coat, he may still convey the deadly poison to every patient whose pulse -he feels during the day. If this were so, the track of a general -practitioner who attended one patient labouring under a specific -epidemic disease would be marked by the seizure of the rest of his -patients; if it were true of cholera and typhus, the members of the -General Board of Health must have fallen by these diseases, who from -morning until night received inspectors that came from places where -these epidemics were rife; and if any disease of common occurrence -really possessed such powers of communication and diffusion, it is -difficult to conceive how it is that the human race has not been long -since extinguished.[27] To assume the method of propagation by touch, -whether by the person or of infected articles, and to overlook that by -the corruption of the air, is at once to increase the real danger, from -exposure to noxious effluvia, and to divert attention from the true -means of remedy and prevention. It is not in human power to take from -any disease the property of contagion, if this property really belongs -to it; but it is in our power to guard against and prevent the effects -of any contagion, however intense; and it is equally in our power to -avoid communicating to common disease an infectious character, and -aggravating it into pestilence. - -Footnote 27: - - In January, 1866, the members of the Aberdeenshire Cattle Plague - Association being much interested in the question as to how the - disease could possibly have reached Pitmillan, Fovernan, no suspicious - communication by beast or otherwise having taken place with the farm - for weeks, Mr Hay, veterinary surgeon, inspector for the county, gave - the following explanation of the matter in a letter to Mr Barclay, the - hon. secretary:—“I am happy to be able to satisfy the public mind as - to how the disease was brought to Pitmillan. About Christmas Mr Fraser - got from Mr Duncan, flesher, Aberdeen, a quantity of beef rolled up in - packsheet, which had apparently paid several visits to London round - carcases, and doubtless mingled there with many of its kind from - various places of the kingdom. After being removed from the beef at - Pitmillan, this packsheet was thrown aside for some time, when one of - the servant girls took and used it (unwashed) as an apron for a - considerable period before the first cow got bad, and was carrying the - kail in it to the cow after she was taken ill. You see by this that we - are liable to get the disease at any time. Tons of packsheet return - weekly by railway, and no surer agent could be employed to bring - rinderpest to the country.” The secretary having some doubt about the - guilt of the packsheet (which however, was gravely accused in both - Houses of Parliament), reported his opinion that the contagion was - conveyed by the wind! [ED.] - -If indeed the emanations thrown off from the living body formed -permanent and powerful poisons, like miasms connected with the products -of decomposition, and if they were, like such products, capable of being -conveyed unchanged to great distances, we should be able to live only in -solitude; we could never meet in society, for we should poison each -other; the first symptom of illness would be the signal for the -abandonment of the sick, and we should be compelled by a due regard to -self-preservation to withhold from persons afflicted with disease every -kind and degree of assistance that required personal attendance. - -Happily, we are not so constituted, and the evidence that has been -adduced of the narrowness of the sphere even of the most virulent -contagion, shows the groundlessness of the alarm sometimes entertained -respecting this dreaded agent, while it points to the certain means of -destroying it. The London Fever Hospital is separated from the Small-Pox -Hospital only by the space of between thirty and forty feet, and the -windows of the wards of both establishments are immediately opposite -each other: yet there is no instance of the communication of small-pox -to the typhus patients, nor of typhus to the small-pox patients; nor of -either disease to the convalescent, or to the official inmates of the -adjoining establishment. There does not appear to be a single instance -on record, in any country, of the extension of infection beyond the -walls of an hospital, or even of a lazar-house, so as to injure in any -manner the nearest inhabitants. - -But though it appears that modern experience and research have shed -considerable light on the origin and progress of epidemic diseases, yet -there are still some circumstances connected with their propagation -which the present state of our knowledge does not enable us to -understand, and which therefore appear to us as difficulties. - -These cases are sometimes termed exceptional; but they are only -apparent, not real, exceptions; as in all other departments of human -research, they are merely indications of the imperfection of our -knowledge, and advancing science will unquestionably one day so -elucidate these very exceptions, as to render them additional -confirmations of the true conditions. - -In the present state of popular opinion it has been deemed requisite to -enter into this detailed consideration of the general subject of -contagion, because it appears that in proportion as undue weight is -attached to this dreaded agent the effect is mischievous; since, “it -diverts attention from the true source of danger, and the real means of -protection, and fixes it on those which are imaginary; creates panic; -leads to the neglect and abandonment of the sick; occasions great -expense for what is worse than useless; and withdraws attention from -that brief but important interval between the commencement and the -development of disease, during which remedial measures are most -effective in its cure.” - -It is also necessary to examine the questions of contagion and -quarantine apart from each other, because there are points of obscurity, -and therefore grounds for controversy, which, in the present state of -our knowledge, may be reasonably considered as belonging to the former, -that do not attach to the latter. The inquiry with reference to -quarantine, indeed, is simple, and lies in a narrow compass. The sole -question to be determined is, whether or not it accomplishes, or is -capable of accomplishing, its professed object, and this is a mere -question of evidence and experience. - -The object of quarantine is to prevent the introduction of epidemic -diseases from one country into another, and the agency which it employs -for this purpose is the isolation of the sick; the detention of, and the -placing under inspection for a given period, persons who come from an -infected country or district, though they may not be actually sick; and -the purification of articles of commerce presumed to be capable of -imbibing and conveying pestilential virus, before such articles are -landed and dispersed. - -It appears that facts and observations place beyond all reasonable doubt -the utter inutility of this system. - -If there be any truth in the preceding representation, that epidemic -diseases are universally and inseparably connected with an epidemic -atmosphere, the question is at once decided. Quarantine can exercise no -more control over this epidemic atmosphere than over the electricity and -temperature of the common atmosphere, and the direction and force of the -wind. - -If it be true that epidemic diseases, such, for example, as influenza -and cholera, traverse the globe in determinate courses or zones, and -often spread from country to country, and through the vast populations -of their great cities, in single weeks, and even days, it must be futile -to array such a machinery as that of quarantine, that is to say, a -vessel placed at the entrance of one or two seaport towns, a line of -soldiers guarding a few miles of the frontier, of a particular country -against morbific agents, which pursue their course like the blight that -destroys the vegetation of a country in a night, and which extend their -influence over the greater part of the habitable globe. - -If it be true that the epidemic influence precedes the actual outbreak -of epidemic disease—that that epidemic influence is present in a -country, creating a predisposition or susceptibility to disease before -the epidemic appears in its true and recognized form,—quarantine must be -futile, because, before it takes its precautions or erects its barriers, -such as they are, the epidemic is already in the country busy in action, -vitiating the blood of the most susceptible of the population, and -preparing the way for its general attack. - -If it be true, as ancient and modern authorities are agreed, that, -without the essential preliminary of an epidemic atmosphere on the spot, -foreign contagion is inert, and that, unless both concur, no pestilence -ensues, quarantine under any circumstances must be useless; for in the -absence of an epidemic atmosphere it must be useless, because then no -disease will spread beyond the individual affected; and with the -presence of an epidemic atmosphere it must be useless, because then the -disease will spread wherever the infected atmosphere goes and finds -favouring conditions. - -If the preceding principle be true, it must be futile to place vessels -coming from infected countries in quarantine, unless those vessels are -capable of bringing with them an epidemic atmosphere, and unless -quarantine can control such an atmosphere when imported; and the -uselessness of this procedure will be placed in a still stronger light -when recent experience as to the comparative insusceptibility of -Europeans, though resident on the spot, to plague itself is -considered.[28] - -Footnote 28: - - Dr W. H. Burrell, Deputy Inspector-general of Hospitals, who was three - years Principal Medical Officer at Malta, presented, in 1852, to the - General Board of Health, an elaborate examination on the plague which - had formerly raged in that island. The following are the conclusions - to which he had arrived:— - - “1. There is no evidence to prove, or even to render it probable, that - the plague was introduced either into Malta in 1813 or into Gozo in - 1814 by importation. - - “2. There is every reason to believe that the plague existed in Malta - at the time of the arrival of the ship supposed to have introduced the - disease; and that in Gozo the first case (a stranger) contracted the - disease from local causes, which enhanced by quarantine, produced it - in others. - - “3. The lower orders, and those occupying the lowest, most crowded, - and worst ventilated dwellings, furnished the great majority of cases; - which decreased in proportion with improvement in these respects. - - “4. As this discriminative preference of the disease to attack certain - classes, living in certain localities, never obtains to the same - extent with diseases arising from a specific contagion, it is more - than probable that the causes engaged in the generation of the plague - are not constant, but variable and accidental; its initial cause, the - peculiar atmospheric constitution, having no power to develop the - disease, unassisted by season and local conditions. - - “5. The transmissibility of plague from person to person out of the - noxious atmosphere in which it originated—the only certain test of - such a power—has not been proved by the four instances, during - thirty-eight years, in which it is alleged to have been communicated - to persons employed by the Quarantine Department of Malta, carbuncular - affections being endemic among the population of this island. - - “6. Quarantine restrictions enforced by the penalties of _corporal - punishment_ and _death_, and seconded by the greatest dread of contact - with suspected persons or things, among the panic-struck populations - of Malta and Gozo, utterly failed to arrest the progress of plague; on - the contrary, where these restrictions were carried to their utmost - limits by an absolute power, there the disease persisted longest, and - the mortality was greatest.” - - “All these circumstances,” says the French Dr Chervin, speaking of the - restrictions and cruelties of quarantine, “are calculated to fill with - horror the breast of every feeling and honest man; and we are really - obliged to offer violence to ourselves in not giving vent to our - indignation against the partisans of contagion, who yet desire to - continue to defend their erroneous opinions, and who, to this day, - have used all their efforts to make obscure and disfigure the subject, - to the great detriment of truth;—who have never ceased to deceive - governments, which think it their duty, with regard to this disease - [Yellow Fever], to surrender themselves to the judgment and knowledge - of medical men,—who have never ceased to describe it as contagious, - and have induced those authorities to adopt, with respect to it, the - most false and contrary measures, and to neglect the suitable, - prophylactic, and _preservative_ means, and others which might have - put an end to the disastrous epidemics of this disease;—thus it is - they have always acted contrary to truth, to the interest of - governments and of humanity.” - - “I am of opinion,” says Dr Reece, of New York, “that the oppressive - features of our quarantine system should be reckoned among the relics - of barbarism which an enlightened Legislature should make haste to - abrogate for the sake of our character as a people. There is no - pretext for the perpetuation of a system founded in ignorance, and - fruitful only in public and private injustice, cruelty, and wrong.” - - “Cholera,” says Professor Caldwell, of America, “though a fatal - scourge to the world, will, through the wise beneficent dispensation - under which we live, be productive of consequences favourable alike to - science and humanity. Besides being instrumental in throwing much - light on the practice of physic, it will prove highly influential in - extinguishing the belief in pestilential contagion, and bringing into - disrepute the quarantine establishments that have hitherto existed.” - -If the great practical truth, taught by modern investigation and -experience, be, that the only real security against any kind and degree -of epidemic disease is an abundant and constant supply of pure air, the -prevention of overcrowding, and the dispersion of the sick; and if, as -is generally agreed, confinement in a foul atmosphere can convert common -fever into pestilence, and ventilation and dispersion can dissipate any -contagion, then quarantine must be not only useless but pernicious, -since the invariable effect of quarantine as hitherto practised in all -countries has been the congregation and confinement of the sick, and of -those who, though not actually sick, are suspected to have in them the -seeds of disease, requiring only a few days or hours for their -development,—the congregation and confinement of such persons in a -limited space, often in a filthy ship and an unhealthy locality, and -always under circumstances calculated to excite apprehension and -alarm—conditions in the highest degree favourable to the generation and -spread of disease: it follows that quarantine, instead of guarding -against and preventing disease, fosters and concentrates it, and places -it under conditions the most favourable that can be devised for its -general extension; and therefore must not only fail to accomplish its -object, but tend to produce the very calamity which it endeavours to -prevent. - - * * * * * - -The principal ground on which objection is made to the continuance of -quarantine is that the fundamental principle on which it is based is -fallacious, and that the only means of preventing the origin and spread -of epidemic disease is the adoption of sanitary measures. Substitution -of sanitary measures for quarantine restrictions would render the -importation of any disease from one country into another in the highest -degree improbable. - -There has been and continues to be a popular impression of the -importation or the contagiousness of disease, created by the frequent -occurrence of epidemic diseases amongst itinerant classes of the -population. Seeing the occurrence of such diseases amongst those who -travel, it is an easy and apparently a natural inference that the -diseases are carried by them. Thus, the low tramps’ lodging-houses in -our towns were in the Sanitary Report shown to be throughout the country -the worst of fever-nests in each place; but they were also shown at the -same time to be the places where there was the most overcrowding and the -greatest filth. With a stationary population, with the same overcrowding -and filth, it may be confidently pronounced that the disease would be -worse. When by bad weather the tramps are detained and kept stationary, -it is worse. The tramping about from town to town and in the open -air—the movement which to superficial observation imports the disease—in -reality mitigates it. From what we have already said, it is consistent -with this general statement that tramps infected with fever in one place -may carry it with them and spread infection in another place amongst -classes of persons predisposed by the like habits and conditions, as was -exemplified in the spreading of the Pali plague. Of late times the poor -Irish emigrants are said to have imported fever into this country; they -are represented, for example, to have imported fever into Liverpool; but -the description of the places where the fever burst out, and the -overcrowding in them, displayed fever-nests sufficient to have produced -fatal results on the most robust of the stationary populations. “In one -small cellar with no window,” a gentleman, who ministered to the wants -of the poor people who had crept for shelter into damp uninhabited -houses, and who, it was stated, fell a victim to the contagious nature -of the fever, found “eighteen persons in fever, lying on wet dirty -straw. In one house he counted eighty-one, in another sixty-one, in -every stage of fever, on straw in the corners.” It would be surprising -if the poor Irish had not imported fever into the lower districts of -towns, when, as in Glasgow, they have added 10,000 annually to the -already overcrowded and wretched population of that city; just as the -miserable refugees from the infected villages of Ragpootana carried the -pestilence into the close, filthy, and already overcrowded huts of the -neighbouring villages. But the conditions in which the Irish emigrants -have arrived, and have been crowded together in the towns as well as on -shipboard, are just the conditions in which fevers arise amidst -stationary populations; and, we may confidently state, would have been -worse had the particular class of migrants been stationary. - -The like delusion as to the _importation_ of disease is created by the -appearance of fever amongst the migrants at sea. It is important that -the universal effects of overcrowding, filth, and atmospheric impurity -should be known and discriminated in all cases. It will be seen that -they produce their effects at sea as well as elsewhere. It appears to be -most important also to display the facts as to the common existence of -the conditions of fever in ships themselves as at present regulated; and -that, if properly regulated, instead of being fever-nests or “the means -of importation” of the disease, a voyage in the open sea would become a -sure means of arresting any such disease. Epidemic disease is often more -severe in ships when stationary in port than when sailing, and with them -the passage in fair weather when overcrowding is avoided is a means of -mitigation. - -The sanitary regulation of the ships themselves—a measure of the utmost -importance to the seafaring classes of the community—would accomplish -far more than could be hoped for or pretended to be accomplished by any -known system of quarantine, and would have, moreover, a beneficial -effect upon popular opinion by removing the fallacious appearances which -favour the belief in imported disease, while they divert attention from -the true causes of disease, the removable and preventible causes that -exist on the spot. - -The basis of sanitary legislation is the evidence that has been -accumulated in relation to the whole of the epidemic, endemic, and -contagious diseases, and the latest opinions of medical authorities with -reference to them. It having been shown by indubitable evidence that the -prevalence and mortality of typhus, scarlatina, cholera, and every other -epidemic disease, are uniformly in proportion to the low sanitary -condition of the population, the Legislature has decided on attempting -to check the prevalence of these diseases by laying the foundation of -sanitary improvement.[29] It appears that the measures adopted by the -Legislature with this view should be consistently carried out and -applied to the dwellings of all classes of the population whether on -land or at sea. In the larger vessels in which well-directed care has -been exercised, the general ill-health has been reduced below the -average ill-health of populations of the like ages on shore; but from -the evidence which has been brought from witnesses at the ports, medical -men well acquainted from long practice in the mercantile marine, it -appears that the _general_ condition of merchant-vessels, and of the -forecastle in which common seamen are, for the most part, lodged, -renders them in effect cellar-dwellings, just as dark, foul, and -unventilated, as the filthy, unaired, and dismal cellars on shore with -which the Legislature has endeavoured to deal. It appears also that -typhus and other epidemic diseases do break out at sea in these movable -cellars, just as they do in the cellars of the dirtiest courts on shore; -and were it not that seamen work in a purer external atmosphere, that -they are below decks comparatively for short intervals only, and that in -general they are men at the most robust periods of life, it is probable -that epidemic disease would be still more frequent among them; an -inference supported by the fact that whenever passengers, emigrants, and -others are, owing to stormy weather, much confined to the berths below, -some form of malignant disease is almost sure to break out. - -Footnote 29: - - See pp. 57, 129, works executed after this was written. [ED.] - - * * * * * - -There are not wanting instances in which the energetic adoption of such -measures as were available, particularly the enforcement of all -practicable means of cleansing, and the resolute removal of nuisances, -warded off Cholera to a very great extent, even under circumstances in -which a formidable attack appeared inevitable; and perhaps it may serve -for encouragement and guidance to direct attention to one or two of such -examples.[30] - -Footnote 30: - - The two following examples are taken from “Results of Sanitary - Improvement,” by Dr Southwood Smith, 1854. [ED.] - -One of the most remarkable of these occurred at Baltimore, during the -prevalence of epidemic cholera in America, in 1849. - -The population of that city was about 149,000 souls. The site of the -town is naturally salubrious, and parts of it are well built; but the -districts near the river occupied by the poorer classes are low and -damp, and liable to remittent and intermittent fevers, and, therefore, -predisposed to cholera. - -In the spring of 1849, the pestilence, which had attacked with great -violence several neighbouring towns, appeared to be close upon the city. -A general conviction prevailed, both among the authorities and the -citizens, that uncleanliness had much to do with the development and -spread of the disease; they therefore spared neither money nor labour to -purify the city, and they gave the execution of the cleansing operations -to experienced and energetic officers, who performed the work so -vigorously, that it was generally admitted that never before had the -town been in so clean a state, or so thoroughly purified, as during the -summer months of the year 1849. - -About the middle of June, while cholera was prevailing at New York, -Cincinnati, and other places, north and west of Baltimore, diarrhœa -broke out, and became general over the whole city, accompanied by -another symptom which was universal, affecting even those who had no -positive attack of diarrhœa; namely, an indefinable sense of oppression -over the whole region of the abdomen, seldom amounting to pain, but -constantly calling attention to that part of the body. - -“At that time,” says the medical officer of the city, “I felt assured -that the poison which produced cholera pervaded the city; that it was -brooding over us; that we were already under its influence, and I -anticipated momentarily an outbreak of the epidemic. In about two weeks, -however, from the commencement of this diarrhœa, and the prevalence of -the uneasy sensation which accompanied it, these symptoms began to -subside, and in a short time they wholly disappeared. Simultaneously -with their disappearance, cholera broke out at Richmond, and other towns -south of Baltimore. I then felt assured that the fuel necessary to -co-operate with this poison did not exist in our city: that the cloud -had passed over us and left us unharmed.” - -No case of cholera was reported to the Board of Health or other -authorities of the town as having occurred during this time; but on -close examination, it was ascertained that four deaths had taken place -from the disease in its most virulent form. - -That the cholera poison had really pervaded the city, was appallingly -evinced by an event which occurred in its immediate vicinity. - -The Baltimore almshouse is situated about two miles from the city, on -sloping ground, remarkable for its beauty and salubrity, in immediate -contiguity with the country-seats of several of the wealthy families of -the town. It is surrounded by a farm of upwards of 200 acres, belonging -to the establishment, for the most part under cultivation. The building -is capable of accommodating between 600 and 700 inmates. An enclosure of -about five acres, surrounded by a wall, adjoins the main building upon -its north side. In the rear of this north wall is a ravine, which at one -point approaches the wall to within about nine feet. This ravine is the -outlet for all the filth of the establishment. It is dry in summer, but -retentive of wet after rain. The space between the wall and the bed of -the ravine is not under tillage, but is overgrown with a rank, weedy -vegetation, common in rich waste soils. The physician of the -establishment, under the same apprehension of an outbreak of cholera as -had prevailed in Baltimore, had taken the same precautions against the -disease, and had placed the establishment itself in a state of -scrupulous cleanliness. - -On the first of July cholera attacked one of the inmates. On the seventh -a second attack occurred. This was followed in rapid succession by other -seizures, and within the space of one month 99 inmates of the -establishment had perished by cholera. - -Within the building and grounds the most diligent search failed to -discover anything that could account for this outbreak; but on examining -the premises outside the northern wall, there was found a vast mass of -filth, consisting of the overflowings of cesspools, the drainage from -pigsties, and the general refuse of the establishment. “In short,” says -the medical officer, “the whole space included between the ravine and -the wall, upon its north side, was one putrid and pestilential mass, -capable of generating, under the ardent rays of a Midsummer sun, the -most poisonous and deadly exhalations.” - -During the greater part of the time that this outbreak continued, a -slight breeze set in pretty steadily from the north, conveying the -poisonous exhalations from behind the north wall directly over the -house. - -The first persons attacked were those who happened to be particularly -exposed to the air blowing from the north side of the building. - -On the male side of the house there was no protection from the ravine. -The female side was partially protected by three rows of trees. The -residents on the women’s side were more numerous than on the men’s, but -the attacks were considerably less. - -Among the paupers, those who slept in apartments exposed to the north -were attacked, those not so exposed generally escaped. - -In the basement story of a building, opening directly to the north, and -close to a spot which received the contents of one of the cesspools, 17 -lunatics were lodged, all of whom were attacked, and all died. - -Eight medical students were attached to the establishment, of whom four -occupied apartments with a northern exposure, and four were lodged in -rooms with a southern exposure. The four whose rooms were exposed to the -north were attacked, the four whose rooms were not thus exposed escaped. - -The manager, also, who slept in a room above that of the students -looking to the north, was attacked: his family, whose rooms looked to -the south, escaped. - -Men, after some difficulty and delay, were employed to remove the filth -and drain the ravine, the whole surface of which, after having been -thoroughly cleansed by a stream of water, was thickly covered with lime, -over which was put a deep stratum of earth. The men employed in this -work were attacked with cholera, as were some of the several inmates of -the almshouse who had been dispersed throughout Baltimore, but the -disease did not spread to any other persons in the city. From the 25th -of July, the day on which the drainage was completed, the disease -suddenly declined from 11 the day previous, to 3, and, by the 9th of -August, had entirely disappeared. - - * * * * * - -In the case of Baltimore, and the Baltimore almshouse, a neglected spot -was severely visited by the pestilence, while, by well-directed -exertion, an entire city escaped. In our own country an instance has -lately occurred (1854) in which, by similar exertion, a particular spot -escaped, while a populous town was devastated by the plague. - -No town in Great Britain has ever been so severely visited by cholera as -Newcastle, yet the garrison of Newcastle has wholly escaped. - -The barracks in which the garrison of Newcastle is quartered are -situated about three-quarters of a mile from the centre of the town. In -houses at distances varying from 20 to 200 yards of the barrack gates, -numerous deaths from cholera took place, and in a village 250 yards from -the barracks the pestilence prevailed to a frightful extent for many -days, numbering one or more victims in almost every cottage. - -On the outbreak of the pestilence in the town, the medical officers of -the garrison, with the sanction and assistance of their superior -officers, exerted themselves with great promptitude and energy to carry -into effect all the means at their command, calculated to lessen the -severity of an attack from which they could not hope altogether to -escape. The sewers, drains, privies, and ashpits were thoroughly -cleansed; all accumulations of filth were removed; the spots where such -filth had been collected were purified; the freest possible ventilation -was established day and night in living and sleeping rooms; overcrowding -was guarded against; the diet of the residents was, as far as -practicable, regulated; the men were strictly confined to barracks after -evening roll-call, and were forbidden to go into the low and infected -parts of the town; amusements were encouraged in the vicinity of the -barracks; every endeavour was made to procure a cheerful compliance with -the requirements insisted on, without exciting fear; and there was a -medical inspection of the men twice, and of the women and children, once -daily. - -The influence of the epidemic poison upon the troops was demonstrated by -the fact that among 519 persons, the total strength of the garrison, -there were 451 cases of premonitory diarrhœa, of which 421 were among -the 391 men, irrespective of the officers, women, and children, the -attacks being in some instances obstinate, and recurring more than once. -Yet such was the success of the judicious measures which had been -adopted, that no case of cholera occurred within the barracks during the -whole period of the epidemic; and every case of diarrhœa was stopped -from passing on to the developed stage of the disease: while in -Newcastle there were upwards of 4000 attacks, and 1543 deaths.[31] - -Footnote 31: - - Results of Sanitary Improvement by Dr Southwood Smith, 1854. - - * * * * * - -The case of the “Eclair,” and the history of the Epidemic Fever which -occurred at Boa Vista in 1845, have been declared by high medical -authority to afford “conclusive evidence that Yellow Fever is sometimes -imported.” It will therefore be necessary to make a careful examination -of the circumstances relative to this Epidemic. - -It has been affirmed, and generally credited, that unusual effort has -been made to ascertain the facts of this case under circumstances more -than commonly favourable to the discovery of the truth. Two official -Reports respecting it, drawn up after personal inspection on the spot, -have indeed been presented to Parliament—one by Dr McWilliam, and the -other by Dr King; and several official notices of these reports have -been published; but the evidence on which these two Reports were founded -was not collected until some time after the cessation of the epidemic. -The statements of witnesses, for the most part poor and ignorant, many -of whom had a direct interest in establishing the importation of the -disease by a British ship, have been admitted implicitly, even with -respect to dates and circumstances not of recent occurrence, and without -due examination of the credibility of their testimony; and on all -material points the reporters have arrived at directly opposite -conclusions. - -On a review and comparison of the whole of the statements which have -been made with respect to this case, it appears that the steam-ship -“Eclair,” with a crew of 140 officers and men, proceeded in 1844 to the -coast of Africa, and was stationed for upwards of four months (130 days) -at the island of Sherboro, with a view to blockade the eastern outlet of -the passage at Shebar. This place is considered one of the most -unhealthy on the African coast; vessels remaining near the island very -rarely escaping an outbreak of Yellow Fever on board. The land is -represented as low lying, some parts being marshy, and the rest thickly -wooded, and abounding in rank vegetation. - -According to the account of the surgeon of the “Eclair,” Mr Maconchy, -the ship on this occasion was anchored at the mouth of the river, in -position where she “was surrounded with filthy-looking river water, -urged backwards and forwards by the tides through extensive tracts of -mangrove bushes.” The fresh water used on board was also bad, holding in -solution a quantity of offensive vegetable matter, which produced in -some of the crew attacks like mild cholera. The men, in parties of from -30 to 40, were often sent up the river on boating expeditions, where -they remained for seven or eight days at a time exposed, “whether they -slept on board or ashore, perhaps after a hard day’s labour, to all the -exciting causes of fever, and a tainted nocturnal atmosphere, in the -rainy season, heavy weather having set in, and the men constantly -getting as wet as possible.” - -The danger of this boating service is thus stated by Dr King:— - -“The duty in boats up African rivers involves considerable risk at any -time of the year, but it can never be practised in the rainy season -without endangering the health and lives of all who are employed, and -such were evidently the sad consequences of the boat expeditions of the -‘Eclair.’” - -The crew, according to Mr Maconchy, in addition to this dangerous -service, and the dreariness and monotony of the situation, were exposed -to another depressing agency, “from seeing the prizes of other ships -passing frequently to Sierra Leone, whilst they considered themselves -out of the reach of such good fortune.” - -Another cause was probably in operation even at this time, namely, the -foul condition of the ship, as will hereafter appear. - -Under these circumstances, fever broke out on board the ship, and proved -fatal to ten of the crew; eight of the ten deaths being considered by -the medical officers as directly consequent on the boating expeditions. -Though there were other and severe cases of sickness on board, these -deaths appear to include the whole of the ship’s mortality during her -stay at Sherboro, a period, as has been stated, of above four months. - -In the month of July the “Eclair” left this station, returned to Sierra -Leone, and anchored in the harbour, where she appears to have remained -13 days. This happened to be the rainy season. The crew went on shore, -where several of them remained at night unable to reach the ship from -being in a state of helpless intoxication. - -The consequences were soon apparent. While the ship remained in the -harbour, fever again broke out on board with great violence, and -continued without intermission during this and the following month. In -this sickly state she again left Sierra Leone, proceeded northward in -company with another ship, the “Albert,” and anchored in the Gambia on -the 10th of August “(one of the most unhealthy months at that place),” -where she remained until the 15th. All this time, the fever steadily -increasing, she arrived on the 21st of August at Boa Vista. She had now -lost, since leaving Sherboro, 13 more of her crew, making in all, from -the first outbreak of the disease at Sherboro, 37 attacks and 23 deaths; -that is, 1 in 6 of the crew had died. - -On anchoring in the harbour of Boa Vista, pratique was at once offered -to her commander, Captain Estcourt, but he replied that he could not -think of accepting it until he had communicated the state of his vessel -to the authorities on shore. After some deliberation the -Governor-General consented to the landing of the ship’s company, in the -hope that the formidable disease, by which so many had already perished, -and so many others were still placed in imminent danger, might be -checked. Accordingly the crew, both the healthy and the sick, were sent -to a Fort on an islet a mile distant from the town (Porto Sal Rey), and -the officers were lodged in the town itself. This took place on the 31st -of August. - -The hope of benefiting the crew by the change of their quarters from the -ship to the land was not realized. On the contrary, the sickness -continued to increase with so much virulence that, at the end of the -third week after the arrival of the ship at Boa Vista, no fewer than 60 -fresh cases were added to the sick list, and some deaths took place -nearly every day. - -In this state of things a consultation of the medical officers was held -on the condition of the crew, the result of which was a recommendation -that the ship should immediately proceed to Madeira, and if the fever -received no check, that she should go on to England. In conformity with -this advice, the whole of the crew, the sick as well as the healthy, -were forthwith re-embarked, and the ship sailed from Boa Vista on the -following day, namely, the 13th of September. - -The sequel to this sad narrative shows that no improvement took place -during the passage of the “Eclair” to Madeira, where she was refused -pratique. She therefore proceeded next day on her voyage to England, and -anchored off the Isle of Wight, at the Motherbank, on the 28th of -September, having lost, since sailing from Boa Vista, 12 more of her -crew. Thus in the short space of 37 days, that is, from the time when -she anchored at Boa Vista on the 21st of August, till her arrival at the -Motherbank on the 28th of September, there occurred no less than 90 -attacks and 45 deaths, including the death of her excellent and devoted -captain. - -On her arrival in England the ship was put in quarantine, and remained -under the direction of the Privy Council until the 31st of October. - -On the day following her arrival, Dr Richardson proposed that the sick -should be immediately removed to a wing of Haslar Hospital, to be -appropriated exclusively for them; stating, that in his opinion, if the -sick were placed in well-ventilated wards, with fresh bedding, and the -other means of cleanliness afforded by an hospital, there would be no -further risk to the attendants than would occur in wards set apart for -cases of typhus fever. - -To this advice, Sir William Pym objected, and instead of allowing the -removal of the sick, he ordered the vessel, with the whole of her crew, -to proceed from the Motherbank to the Foul Bill Quarantine Station at -Standgate Creek, which place she did not reach until the afternoon of -the 2nd of October, that is, four days after her arrival at the -Motherbank, where they remained six days more before their removal into -another vessel. Thus were all on board detained close prisoners in a -pestilential atmosphere on the shores of their native land; their -anticipations that at length they should quit the scene of such terrible -sufferings, and of so many horrors, their hopes of life and health, -totally destroyed. The consequence was, that within these ten days, five -more deaths took place, nor was it until the Lords of the Admiralty -declared their conviction that the only means of preserving the lives of -the survivors of the crew would be the entire removal of every -individual from this ill-fated ship, that they were permitted to quit -it. Their removal took place on the 8th of October, after which event -two more deaths occurred, one of them being that of the pilot who took -the vessel from the Motherbank to Standgate Creek.[32] - -Footnote 32: - - A striking contrast to this treatment of the crew of the “Eclair” is - exhibited in the case of Her Majesty’s frigate, the “Arethusa,” which - recently (Feb. 14, 1852) arrived at Plymouth from Lisbon, having on - board cases of small-pox. Instead of putting the ship in quarantine, - and confining the healthy in the same poisonous atmosphere with the - sick, wiser counsels on this occasion prevailed, and more humane - measures were adopted. On the advice of Dr Rae, Inspector of the Royal - Naval Hospital, the sick, twelve in number, were immediately removed - to that establishment, and of these two died, without any - communication of the disease. - -As already stated, official inquiries were directed to be made into the -causes of this extraordinary mortality, from which it appears:— - -That there was nothing peculiar in the disease itself. The medical and -other officers of the ship, as well as the medical and other officers at -Boa Vista, that is, all competent witnesses who actually saw the -disease, concur in stating that it was nothing more than an aggravated -form of the common endemic fever of the African coast; a view which is -decisively confirmed by the original description of the disease in the -medical journal of the ship, and by post-mortem examination. - -In opposition to this generally-received opinion, however, Sir William -Pym promulgated a statement that, in addition to the common African -fever, the celebrated _nova pestis_ of Dr Chisholm had been introduced -into the vessel by a passenger taken on board at Sierra Leone; this -disease being, as he represents, a fever _sui generis_, known by the -name of the African, Bulam, Yellow, or Black Vomit Fever, attacking the -human frame but once, and differing from the common remittent fever in -being highly contagious. - -That the doctrine on which Sir William Pym’s assertion rests met with -little countenance from medical authorities is apparent from the -statement of Sir William Burnett, who says:— - -“The whole of this, as regards the peculiar properties of the disease, -called by Sir William Pym, Bulam, &c., is a gratuitous assumption on his -part, and, in my opinion, has no foundation in fact; and in my view of -this part of the subject I am supported by nineteen-twentieths of the -medical officers of both services, who are of opinion with myself that -the more ardent form of Yellow Fever is a mere modification of the -bilious remittent so extensively known all over the tropical regions.” - -He adds: “The fever which prevailed in the ‘Eclair’ was unquestionably a -remittent fever, originating in marsh miasmata, and the exposure of the -men in boats during rainy weather.” - -Dr King and Dr Stewart, in official Reports upon this case, state their -concurrence with Sir William Burnett. Dr McWilliam, on the other hand, -is of opinion that the disease, though primarily an endemic remittent of -the African coast, became, from a series of causes, exalted into a -concentrated remittent or Yellow Fever, and in that manner acquired new -and peculiar properties, not primarily and essentially belonging to it. - -With reference to this latter opinion, it may be observed that the -Governor-General of the Cape de Verd Islands affirms, that not one of -those who with a view to escape the pestilence emigrated to the -different islands of the Archipelago, had the disease, or communicated -it to others. According to the view of Dr McWilliam, therefore, this -disease must have been of a very singular character, for in its origin -at Shebar, it was not contagious, at Boa Vista it became contagious, -while in the other islands of the Archipelago, wherever the sick or the -uninfected fled, it again laid aside its contagious character, and did -not spread to a single individual. - -All the inquirers and reporters agree in stating that among the causes -which concurred in communicating to this disease so extraordinary a -degree of prevalence and mortality, the more important were the -following:— - -The employment of the crew uninterruptedly for an unusual length of -time, including the sickly season, in a peculiarly unhealthy situation, -and dangerous local duty. - -The exposure of men, whose systems were impregnated with the seeds of -disease imbibed in this unhealthy locality, to the risks of unrestricted -liberty on shore, in the atmosphere of Sierra Leone, during the rainy -season; one consequence of which freedom being their “inordinate -indulgence in ardent spirits of the worst description.” - -And subsequently, at Boa Vista, the confinement of the crew, the sick as -well as the uninfected, in a place still more crowded, filthy, and -unventilated than their quarters on board, instead of their dispersion -in a pure atmosphere. - -Some conception may be formed of the unfavourable circumstances under -which the crew were placed at the Fort, from the account which, on -personal inspection, Dr King gives of its sanitary condition, who states -that from the absence of all means of cleansing, from the actual -accumulation of filth, and from the impossibility under any -circumstances of obtaining a free circulation of pure air, owing to the -plan of the building, the atmosphere which the sick, the convalescent, -and the healthy were compelled to breathe, day and night, must have been -polluted and deleterious in the extreme; and that into a space incapable -of affording sufficient accommodation for 50 men, upwards of 100, -including the sick, were huddled together under a most oppressive heat, -the thermometer ranging from 81° to 86°. This description is confirmed -by the testimony of Dr Almeida, who states that having been requested by -the Governor-General to go to the Fort and see the sick, “he found them -so extremely crowded that he could hardly pass between them.” - -The influence of such conditions in conducing to the virulence and -spread of the disease has been already exemplified in what has been -stated under the head “Localizing Causes;” but it must be added, that -the crew had here also access to ardent spirits, in which both the sick -and the uninfected indulged to still greater excess even than at Sierra -Leone. - -“It is with great regret,” says Sir William Burnett, “I have now to -state on the best information, that while in this situation means were -found to supply the sick as well as others with enormous quantities of -ardent spirits, which were drunk with avidity and produced the most -deleterious effects; indeed, I have reason to believe that some were -absolutely killed by it as if by poison. Had there not been a fever -already in existence, the intense heat (86° of Fahrenheit), the nature -of the soil, and this dreadful intoxication together, would have been -fully sufficient to have produced it, and one of the worst kind too, in -which irritability of the stomach and dark-coloured vomiting would have -been conspicuous symptoms.” - -The actual result, as stated by Dr McWilliam, was that the accession to -the sick-list and the mortality became much greater at this time than -they had been at any previous period, and that from an endemic remittent -of the African coast, the disease became exalted into a concentrated -remittent or Yellow Fever. - -Indubitable evidence further shows that, in addition to all these causes -of disease, the crew when on board were constantly inhaling a poison -generated in the ship itself. On a superficial examination the ship may -have appeared clean, and Sir William Pym positively asserts that she was -so; but there is conclusive evidence that this appearance was -fallacious. - -From the records of the Medical Department of the Navy have been -extracted the following decisive statement with reference to this point, -by Captain Simpson, late of the “Rolla:”— - -“In June, 1845, being then in command of the ‘Rolla,’ I went on board -the ‘Eclair’ off Shebar River. Commander Estcourt reported to me that he -had sent a boat up the Sherborough River, and that the crew, during -night, were exposed to heavy rain and much lightning, and were sick: -some deaths had occurred on board. In the early part of July I went to -Sierra Leone for supplies; the ‘Eclair’ was there; the vessel was -anchored close to the shore; and I advised her Commander to move her -further out, which he did. There seemed much excitement amongst the -crew; some liberty had been given them, and drunkenness and sickness -were the consequence. Wood was received on board for fuel in lieu of -coals. This wood was green, as I understood at Sierra Leone, and very -unhealthy to burn.” - -This fact is substantiated by the log of the “Eclair,” which shows that -from July 16th to the 19th inclusive, the crew were employed at Sierra -Leone in wooding. - -The influence of a quantity of greenwood recently taken on board a ship -navigating the tropical seas, in producing destructive fever, is shown -in the most striking manner by the history of the “Regalia,” and by that -of the “Vestal.”[33] - -Footnote 33: - - For these cases see the Second Report on Quarantine, pp. 64, 299. - -Further evidence will be found in the Medical Department of the Navy to -show “that the hold of the ‘Eclair’ was in a pestiferous state;” and Dr -King states, that long after the people left the ship in England, and -when the engines were removed, mud, some inches deep, was found under -the flooring. - -“I should scarcely have noticed the above circumstance,” he says, “but -for some remarkable occurrences which took place in the same vessel at a -subsequent period, which confirmed me in the opinion I had previously -formed that the origin and continuance of the fever on board depended -solely on local causes. - -“The ‘Rosamond,’ formerly the ‘Eclair,’ was commissioned at Woolwich on -the 5th of November, 1846, for the Cape of Good Hope station, but none -of the former crew rejoined the ship. During the time of fitting out, -four cases of typhus fever occurred, and were sent to the hospital, -where two of them died, but it is necessary to mention that typhus was -prevalent at Woolwich at the time. The steamer left England for the Cape -on the 23rd of February, 1847. Three days after sailing, one of the men -was affected with slight febrile symptoms, and he continued more or less -indisposed for a number of days, but occasionally felt so well that he -returned to his work. After the ship entered the tropics, however, the -disease began to assume a new and alarming character; and when off the -Island of St Nicholas, and almost in sight of Boa Vista, the man died, -having had for two days previous black vomit and other characteristic -symptoms of Yellow Fever. Within a few days afterwards the ‘Rosamond’ -arrived at Ascension, where I was then stationed; and Commander Foot -having communicated to Captain Hutton, the superintendent of the island, -every particular respecting the illness and death of the seaman, I was -ordered, with Dr Sloane, the surgeon of the hospital, to make a report -on the case, and at the same time to suggest measures for the benefit of -the ship without endangering the health of the people on the island. -Having obtained from Dr Slight, surgeon of the ‘Rosamond,’ every -information relative to his late patient, we stated our opinion that the -disease the man died from was sporadic Yellow Fever. * * * On the -following morning I went on board with the view of learning something to -enable me to form an opinion as to the sanitary condition of the ship, -and for the purpose also of inspecting the sick, as the surgeon informed -me he had then a suspicious case, with symptoms of a low kind of fever. -I had barely time to take a cursory view of the after parts of the ship, -when my attention was called to the patients, who were all mustered in -the steerage, and I found the man the doctor had alluded to in such a -precarious state that I recommended him to be sent on shore immediately. -The only other severe case was that of a supernumary lad, who was taken -ill the same morning, but the indications of a low malignant fever were -so apparent even at that early stage, as to induce me to express my -opinion to the surgeon that he would not probably survive 24 hours. As -it was most desirable to prevent a panic among the ship’s company, I -went on shore to consult with Captain Hutton, and make arrangements for -their reception. * * * The patients themselves attributed their illness -to foul air in the forepart of the ship; one of them said he suffered so -much from an abominable stench in the boatswain’s storeroom, that he -represented the circumstance and obtained permission to cut a hole in -the floor, which exposed to view a considerable quantity of soft mud, -and five or six buckets full of it mixed with decayed shavings, and -emitting an offensive odour, were removed at the time. - -“It appears then, that besides an unusual number sleeping in the -fore-cockpit, some of them at least had been exposed to a morbific -miasma, exhaled from a festering mass of filth in the bottom of that -part of the ship. The quantity of mud, no doubt, was small in comparison -with what had accumulated when the vessel arrived at Spithead from the -coast of Africa, yet the malaria eliminated from that small and -circumscribed focus was equally virulent in its operation, and produced -the same disease in a few who were placed within the sphere of its -influence.” - -Such is a brief narrative of the circumstances connected with this ship -and her crew. - -But it has been alleged that while the landing of the crew of the -“Eclair,” at Boa Vista, afforded no benefit to the ship’s company, it -inflicted a grievous evil on the inhabitants of the island; that several -individuals in contact, or close proximity with the sick, became -affected with the same kind of fever; that from these individuals the -malady spread to others with whom they came in contact, and from these -again to others, as from so many centres of contagion, until the disease -became general over the island, thus affording a positive instance of -the importation of epidemic disease. The alleged facts on which these -representations rest are the following:— - -It is stated, that during the occupancy of the Fort by the crew, there -was a small Portuguese guard stationed there; that this guard was -several times relieved; that at the time when the “Eclair” left the -island, the guard consisted of one negro and two European soldiers; -that within three days after the sailing of the “Eclair” both -Europeans were attacked with fever similar to that from which the crew -of the “Eclair” had suffered; that the negro soldier, who, with his -comrade—the man sent from Boa Vista to nurse the two Europeans—on -returning from the small island to Porto Sal Rey, had been—“as a -matter of precaution”—“restricted for [‘about 8’ or] 17 days to the -occupation of a small hut at the northern end” of the town, was -afterwards attacked,—though not confined to bed until the day -following his return to barracks; and that a woman (Anna Gallinha), -who lived next door to this hut, was the first person who was attacked -with fever in the town. It is further stated that a man (Pathi), who -had been a labourer on board the “Eclair,” was also attacked with -fever, according to one account, on the day after the “Eclair” sailed; -but according to another account, on the third day after that event. - -Such are the alleged facts, and the only ones bearing directly on the -communication of a specific contagion by the crew of the “Eclair,” -collected by Dr M‘William by personal inquiries on the spot; and these, -in his opinion, present a chain of evidence sufficient to establish a -positive instance of the importation of epidemic disease. - -With reference, however, to these inquiries, it has been already stated -that they were not instituted until several months after the departure -of the “Eclair” from Boa Vista;—the only regular practitioner on the -island (Dr Kenny) who could have given authentic and trustworthy -information respecting the nature and progress of the disease, had -died;—the witnesses examined by Dr M‘William, poor and ignorant, gave -their evidence, hearsay and otherwise, in the loosest possible -manner;—their statements as to dates and occurrences, alleged to have -happened several months before the inquiry took place, were received -implicitly, without examination into the correctness of their answers -and the credibility of their testimony;—all the witnesses of this class -appear to have spoken under the influence of the strongest feeling of -self-interest, with a view to establish a claim to pecuniary -compensation should they be able to make out a case against the -“Eclair,” in which expectation they were not disappointed, since the sum -of £1000 was eventually granted by Great Britain for the benefit of the -inhabitants;—and to this motive may probably be ascribed the highly -coloured and exaggerated statements put forth by these people on the -re-appearance of fever in the following year. - -Taking the facts, however, precisely as they are represented in the -Report of Dr M‘William, they do not, as the proof of the allegation in -question requires, present a clear and palpable chain of evidence, -connecting as cause and effect the fever of the ship with the epidemic -on shore; but, on the contrary, there is not a single link undoubtedly -connecting the one with the other. - -Take the first case forming what is represented as the first link in -this presumed chain, the seizure with fever of the two guards at the -Fort. Two European soldiers lately arrived in the colony, and therefore -peculiarly predisposed to an attack of endemic fever, go from Boa Vista, -which at that time was healthy, to a confined, unventilated, -overcrowded, and filthy spot on another island, where fever was raging -to such a degree that within the space of three weeks there had occurred -no less than 60 attacks and 33 deaths, in a crew consisting on the -arrival of the ship of 117 officers and men. There is in this no -evidence of the propagation of disease by a specific contagion; on the -contrary, it is the ordinary production of disease by its ordinary -cause, namely, exposure to a polluted atmosphere, the pollution being, -in this instance, excessive from overcrowding; from accumulation of -filth; from foul and offensive privies; from the impossibility of the -admission of fresh air, owing to the construction of the building, and -from the intense and oppressive heat, the thermometer ranging from 81° -to 86° of Fahrenheit. The seizure of two men with fever under such -circumstances is precisely analogous to the attack of persons, -previously healthy, with typhus, who take up their abode in the crowded -and filthy courts and alleys of English towns. - -Take the next link in the chain, the attack of the negro soldier. The -circumstances respecting this man, being precisely the same as those -relating to the two other guards, the same answer would have sufficed -for both, but according to the testimony of the man himself, his illness -was very slight, and his companion who was sent to lodge with him at the -hut in Porto Sal Rey, had no illness at all during the whole time of -their seclusion. - -The third link in the chain is the presumed fact, that a woman (Anna -Gallinha), who lived next door to the hut in which these two men had -been confined, was seized with fever soon after they had left it, and -that she was the first person attacked, at least whose illness attracted -public attention, in the town of Porto Sal Rey. Dr King states, that on -a personal examination of the soldier who had experienced the slight -attack of fever, he said that during the seventeen days that he and his -companion were confined to the hut, “they had no communication with any -one.” Dr M‘William, on the other hand, affirms that Gallinha was a -frequent visitor at the hut, and, indeed, cooked for the men. Supposing -Dr M‘William’s account to be the correct one, it is surely more -reasonable to attribute the attack of Gallinha to the local causes to -which she was exposed, and which Dr M‘William admits were sufficient to -account for her illness, than to contagion derived from a man whose -illness was so slight that it had not confined him to his bed for a -single day, and which was incapable of infecting his companion who was -constantly with him night and day. - -“By the time Anna Gallinha was taken ill,” says Dr M‘William, “much rain -had fallen; the weather had become more hot, and, in short, there now -(but not before this) existed the recognized elements for malarious -evolution.” - -“In that part of the town called Beira, or Pao de Varella,” reports Dr -King, “where Anna Gallinha and the soldiers resided, the houses are of -the lowest description, and the people who occupy them are generally -very poor and destitute; there is a large pool of stagnant salt and -fresh water immediately behind; but to windward of this part of the -town, and still nearer to the houses, there is a locality which is -resorted to by many of the people when obeying the calls of nature; and -the exhalations from the one, and the effluvia from the other, are blown -by the north winds in the direction of Beira.” - -A similar description of this locality is given by Dr M‘William,— - -“In the upper portion of the town,” he says, “which is called Pao de -Varella, the houses are in general mere hovels, rudely built, and much -crowded together, and with few exceptions dirty. They are occupied by -the lowest classes. From the total absence of any police laws the -streets here are also very filthy.” - -Here then were present in full force, as is admitted, the ordinary -localizing causes of fever; to which it is more consistent to refer this -case, than to an extraordinary and foreign cause. - -But at this point the presumed chain of evidence stops; the chain is -suddenly snapped; there is no further link traceable; there is nothing -really connecting the illness of Gallinha with the next cases, or with -the general spread of the disease which rapidly followed, and we need -hardly state, that in order to prove the spread of a pestilence by -contagion, communication, either direct or indirect, must be proved to -have existed between all the persons attacked.[34] - -Footnote 34: - - The widow of the next victim (Affonso) denied his having had - communication with Gallinha; and Dr Almeida “found about 20 people - sick” in Porto Sal Rey only three or four days after Gallinha’s death. - It is evidently more rational to ascribe these numerous attacks to - epidemic influence, which it is admitted was now present, than to - contact with this woman, for the fact of which there is in truth not a - shadow of evidence. - -For the only other case of fever that is stated to have occurred shortly -after the sailing of the “Eclair,” namely, that of the labourer (Pathi) -who had been employed on board the ship, will scarcely be considered as -affording an additional link; since admitting that this man contracted -his fever while employed on board the “Eclair,” his case would be merely -one of infection from going on board a foul ship, a generally recognized -cause of fever:— - -“Whenever,” says Dr Stewart, “fever has prevailed much in ships on the -West India and African stations, strangers going on board of those ships -have been particularly liable to its attack; but on sending fever cases -from those ships to the hospitals and private houses on shore, it has -not been found that the disease extended from them.” - -But as in the locality of the dwelling of Gallinha, so in the district -in which this man lived, there were local causes abundantly sufficient -to account for the endemic origin of his disease. He resided in Rabil, -one of the hamlets in the neighbourhood of Moradinha, at some distance -from Porto Sal Rey. Of this locality Dr King says:— - -“If there is one spot more than another in the whole island where, from -its physical peculiarities, endemic fever might be expected to begin -first, and end last, that locality is Moradinha, and the villages in its -vicinity, in one of which Pathi resided.” - -It may be observed further, that whatever may have been the cause of -this man’s fever, it is admitted, that for three weeks at least it was -communicated to no one else in the house at Moradinha, where he was -attacked, and remained for eight days, and not to any one else in that -neighbourhood for 11 weeks; that his illness was extremely slight, and -that on his return to his own house no disease broke out for some time -in his family. According to Dr M‘William, the first member of his family -that was attacked was one of his children, who was taken ill “on the -tenth or eleventh day” after his return, the illness of this child being -gradually followed by that of two other children. But Dr King affirms -that these children were not taken ill until “about a month” after their -father’s return, and that it was not until the succeeding month (the -middle of November) that his wife was seized, “when the disease was -general throughout the island.” It is also particularly to be observed, -that a child in another family at Rabil, having no communication with -the family of Pathi, died about the same time as Pathi’s first child, -and that the disease broke out at least as early at Rabil as at Porto -Sal Rey. - -Lastly, it may be urged in opposition to the opinion that the contagion -was communicated by the crew of the “Eclair,” that the small island on -which the sick were landed and to which they were confined was a mile -distant from the town of Porto Sal Rey, and that on reference to the map -attached to Dr M‘William’s report, it is obvious that the North-east -trade wind must (according to the theory of Sir William Pym, as applied -to the Neutral Ground at Gibraltar in 1828) have dispersed the contagion -if in existence, or carried it in a contrary direction from Porto Sal -Rey. - - * * * * * - -For a more minute examination of the cases of the guards at the Fort, -and of Pathi and others, as presented by Dr M‘William, we refer to the -Note of Dr Browne, Appendix No. III. (p. 306),[35] who has there shown -the real value of these cases, considered as links forming a chain of -circumstantial evidence. - -Footnote 35: - - _Vide_ the Report itself. - -The authentic facts attending the intercourse of the ship’s company with -the inhabitants of the island, afford further evidence that no infection -could have been communicated by the former to the latter. Thus, it is -admitted that Captain Estcourt, the commander of the ship, went directly -from the infected vessel to reside with Mr Macaulay, the judge: no -infection was communicated to Mr Macaulay, or any part of his family. - -The officers of the gun-room—midshipmen, warrant, and engineer—on -disembarking from the ship, took a house for themselves and their -servants in the town, and mixed unreservedly with the inhabitants: no -infection was communicated to any individual with whom they had -intercourse. - -The crew obtained or took leave to pay frequent visits from the small -island to the town of Porto Sal Rey, where, according to Dr M‘William, -they resorted chiefly to the house of one Georgio, who kept a spirit -store; the only consequence of which visit, considered by Dr M‘William a -remarkable one, appears to have been that this man (and “shortly -afterwards” two females who associated with them) was attacked with -headache and general fever on the evening of the day he was visited by -the “Eclair’s” people; a result which admits of a more obvious solution -than the communication of febrile contagion on the part of persons who -were themselves in perfect health. - -The soiled linen of the officers and crew having been brought on shore -on the first arrival of the vessel, was immediately given out to be -washed to the washerwomen of Porto Sal Rey, and the careful search made -after these women, brought to light no fewer than seventeen persons who -were so employed. - -“The soiled clothes,” says Dr King, “linen, cotton, and flannel, which -had accumulated in the officers’ cabin from the time of their departure -from Sierra Leone, were contained in at least 12 bags, which were taken -on shore at Porto Sal Rey the same evening the ship arrived, and -distributed next morning (22nd August) to the washerwomen of the town. -Now, if the disease possesses the power of reproduction, its poison must -[according to general opinion] have been as certainly communicated -through the medium of _fomites_ as by direct contact with the sick on -board or at the fort; yet none of the washerwomen nor any in their -families were attacked with fever until November, showing an interval of -70 days after exposure to the infection.” - -That it was not from any want of susceptibility to the influence of -febrile poison that these women escaped the danger of this exposure to -_fomites_ was proved by subsequent events; for during the progress of -the epidemic, all of these women, according to Dr McWilliam, with only -one exception, were attacked with the prevailing fever; two between six -and seven weeks after the sailing of the “Eclair;” five, two months; -two, three months; three, four months; and one, five months afterwards. - -“None of the deaths,” says Dr M‘William, “took place until fever was -general in Porto Sal Rey, so that in none of these cases can the -occurrence of the fever be fairly attributed to infectious matter -conveyed by the linen.” - -The Guards at the Fort were many times relieved, and the soldiers were -sent direct from the small island to their barracks in Porto Sal Rey, -without conveying any disease to their comrades. On one occasion two -soldiers who are stated to have lived in a room next to that in which -the sick of the “Eclair” were lodged, on being taken ill, were conveyed -at once to the barracks, yet they infected no one in their quarters. - -From a list drawn up by Dr King, of the names of the islanders who were -engaged as labourers on board the “Eclair,” it appears that there were -in all 63 persons employed in coaling, watering, and cleansing the ship. -These men appear to have had unrestricted communication with the ship’s -crew. According to Dr M‘William, the whole of these labourers went to -their respective homes every night, except those from Estacia and the -Eastern villages, who generally slept at Porto Sal Rey. None of these -men were themselves attacked with fever, excepting one (Pathi) whose -case has been already considered; none of them communicated fever either -to their own families or to the persons with whom they lodged in the -town, yet subsequent events proved that they as well as the washerwomen -were sufficiently susceptible subjects, since, during the progress of -the epidemic, the greater part of them were attacked by the disease; -none, however, within a month after the departure of the “Eclair;” a few -within two months, but the majority not until four or five months -afterwards. - -That the geographical position of the Cape de Verd Islands places them -within the legitimate domain of Yellow Fever, and that this disease is -no stranger to these islands, is admitted on all hands. According to Dr -M‘William, - -“The north-western part of the island, where Porto Sal Rey is situated, -is low and flat, and almost wholly occupied by sand, which, blown up -from the north-western shore through the water-courses, and other -hollows, accumulates in mounds twenty and thirty feet high, which are -drawn about and shifted by any little variation of the direction of the -wind.” - -On the flat between Porto Sal Rey and the village of Rabil, which is -about four miles to the southward of Porto Sal Rey, Dr M‘William states -that there is a point where the sea, when the waves are high— - -“Breaks over the elevated beach, and penetrates through the shingle, so -as to accumulate, and run inland in the form of a narrow creek, from 200 -to 300 yards from the sea-shore. During the rainy season, this, in -common with the other flats on the island, is inundated to a -considerable extent, as is evident from the appearance of the soil in -those places not covered with sand, as well as by the presence of a rude -raised causeway, which the people have constructed over part of the -hollow flat, to render it passable during the rains. * * * Near the town -is a hollow flat, spread over an area of about a mile, with the same -soil and subsoil as that in the town. The central part of this area is -occupied by a salt pan, which contains not less than 300 troughs, each a -foot deep, and about thirty feet square, into which the salt water is -poured, there to evaporate and form salt. During and for some weeks -after the rainy season, the whole of this space is more or less -inundated. * * * The water is left to stagnate on the Rabil side, and as -it dries up during the hot weather, little alluvial islets are from time -to time exposed, which the people avail themselves of to raise a small -crop of corn. Indeed the greater part of the ravine, from Rabil -downwards, is in a state of rude cultivation, and contains large green -fœtid pools, with all kinds of decomposing matter, the effluvia from -which was most offensive when I was there in May, 1846.” - -Experience has shown, that such a condition of sandy soil is as fruitful -a source of endemic and malignant fever as a marsh or swamp. Dr Lind, -who wrote nearly a century ago, expressly notices the unhealthiness of -Boa Vista, particularly during the rainy season, stating that, -“strangers who arrive here at this season are liable to be visited by a -general sickness,” and instances its white sand as a mark of an -unhealthy locality. Dr Fergusson confirms the correctness of this -indication of insalubrity. - -“That sandy soils,” he says, “should, in malarious climates, prove as -productive of aggravated remittent fever as the swamp, has never been -sufficiently explained. Certain it is, however, that they do so, in a -marked and prominent degree. The Alemtejo and Algarve of -Portugal—regions, I may say, altogether of sand—are the most prolific of -fever of any in the Peninsula.” - -Another instance is found in the unhealthiness of Vera Cruz, which is -spoken of by McCulloch in the following words:— - -“It is said to be the original seat of the Yellow Fever.” [Bulama?] “The -city is well built and the streets clean, but it is surrounded by -sand-hills and ponds of stagnant water, which, within the tropics, are -quite enough to generate disease. The inhabitants and those accustomed -to the climate are not subject to this formidable disease; but all -strangers, even those from the Havannah and the West India Islands are -liable to the infection. No precautions can prevent its attack, and many -have died at Xalapa, on the road to Mexico, who merely passed through -this pestilential spot.” - -Dr King states, that if ever endemic fever derives its origin from a -vitiated and malarious state of the atmosphere, Boa Vista abounds with -the elements for its production. Among these he enumerates swamps and -pools of stagnant water, in the immediate vicinity of Porto Sal Rey, and -over the whole district of Rabil; patches of rich alluvial soil near the -other villages, the recognized sources of noxious exhalations; the -wretched food of the lower classes, and still more, the polluted -atmosphere which they breathe in their crowded and ill-ventilated -abodes, and the general disregard of cleanliness in their houses and -streets, “a combination of morbid causes,” he says, “which would produce -malignant fevers in any part of the world.” - -The relative position of Boa Vista to the African coast would further -naturally lead to the expectation that it must be subject to diseases of -the same character, and no one disputes that this is the case. The -residents of the island, military, medical, and civil, concur in stating -that endemic, bilious remittent fever, prevails there more or less every -year; that there is no season in which it does not carry off several of -the inhabitants, and that it often prevails epidemically. - -“The testimony of the most intelligent men in the island,” says Dr King, -“including Dr Almeida, Senor Baptista (the Consul’s agent), the Mayor of -Rabil, the Judge of Fundas Figieras, and the Judge at Old Town, removes -every doubt as to the fact that fever prevails to a certain extent, and -carries off several of the inhabitants in the months of November and -December every year; and this endemic fever, which recurs annually, and -which Dr Almeida calls the bilious remittent, does not always present -the same mild aspect and character; on the contrary, it is well known -that in certain years the disease was epidemical, and in comparison with -other seasons, very fatal.” - -Dr M‘William records the fact, that such epidemic seasons occurred and -proved unusually mortal in the years 1821–2, in 1827, and in 1833. - -It is most material to a right understanding of this whole subject to -observe, that a Yellow Fever Epidemic had broken out at this very time -in an adjoining island, St Jago. It is stated by Dr Stewart, in his -Report in the Admiralty Correspondence, that “in the adjoining island at -Porto Praya, there was Yellow Fever whilst the ship was at Boa Vista.” -Captain Simpson states that it recurred in the following year at Porto -Praya; “is common there at times and quite endemic.” - -That co-incident with the presence of the “Eclair” at Boa Vista one of -these epidemic seasons was impending, was declared by the usual -indications, which in warm climates precede and accompany such -visitations. These premonitory signs on this occasion were a great fall -of rain at an unaccustomed season; the consequent accumulation of large -quantities of stagnant water in and about the towns and villages; the -occurrence of extraordinary heat; the prevalence of light winds with -frequent calms rendering the weather extremely sultry and oppressive; -the appearance of sporadic cases of fever of more than common intensity; -the almost simultaneous outbreak of pestilence amongst cattle and other -domestic animals; and the visitation in greater numbers than common of -destructive insects.[36] - -Footnote 36: - - See note, p. 16. - -These prognostications were so manifest as to excite the attention and -alarm of the intelligent classes of residents. The Governor-General -states:— - -“Great falls of rain took place at a very advanced period of the season, -which remained stagnant.” - -The British Consul says:— - -“Up to the month of October, extraordinary heat and the fall of a large -quantity of rain had been experienced, events which were surprising to -the oldest inhabitants.” - -The British Judge says:— - -“Stagnant water had settled in great quantity at the back of the town, -to which was joined great heat in the weather.” - -Dr King says:— - -“The information received on the island in 1846, fully corroborated what -is stated in the above extracts, the periodical rains, contrary to what -usually happens, did not set in till late in September. In October, -November, and December the winds were light and variable, with frequent -calms, and the weather became in consequence extremely sultry and -oppressive. The grass and green crops were nearly destroyed by the long -previous drought, and what little appeared after the rains was devoured -by the locusts, which visited the island in greater numbers this year -than was ever known to be the case before.” - -Though Dr M‘William, on his inspection of the island with a view to -ascertain the true cause of the pestilence, took no notice of any of -these premonitory signs of its approach, Sir William Burnett was fully -aware of their signification, and calls special attention to one of the -most important of them in his Report to the Lords of the Admiralty. - -“I beg to lay before their Lordships,” he says, “an extract of a letter -from the Governor-General of the Cape de Verd Islands, and likewise -extracts of letters from Mr Macaulay and the British Consul, residents -on the island of Boa Vista, distinctly showing the very remarkable state -of the weather preceding the attack of the inhabitants of the island, -which very important circumstance in a case of this kind I regret to -observe Dr M‘William has omitted to take any particular notice of.” - -The event foreshadowed by these occurrences rapidly followed. As early -as the middle of September a few cases of unusually malignant fever -broke out, but, as has been already stated, the first case that -attracted public attention occurred on the 12th of October; a few others -followed during the remainder of this month; a still greater number -broke out in the beginning of November, and the epidemic came to its -height in the latter half of November, continuing to prevail throughout -December, and recurring for several months in the following year. - -As in epidemic outbreaks in general, so in this instance, individual or -sporadic cases occurred some time before the appearance of the epidemic -in its true and proper form. On minute inquiry, it was discovered that -one if not two cases occurred as early as the 14th of September (Pathi), -another on the 20th of September (Roque), and a third on the 21st of -September (Agostinho): no other cases, at least none that attracted -attention, appeared to have occurred until the one already mentioned -(Gallinha), on the 12th of October. These sporadic cases all occurred in -the ordinary localities of epidemic disease, and among individuals -belonging to the classes that usually furnish its first and chief -victims. - -At Boa Vista, in addition to other proofs of the presence of a stagnant -and pestilential atmosphere, there was the evidence derived from the -prevalence of unusual sickness and mortality among domestic animals. - -“That the common air,” says Dr King, “which was inhaled by every living -thing on the island was in an epidemic condition in the months of -October, November, and December of both years, is sufficiently -demonstrated by the simultaneous occurrence of universal sickness and -great mortality among the cattle (including horses, cows, mules, -donkeys, and goats) at the very time that fever was raging among the -inhabitants. And, further, there was this remarkable coincidence, that -after an interval of some months and the disappearance of the disease -both in man and beast, the same fever broke out again in the towns and -villages about the rainy season of the following year, and was again -accompanied by the same murrain among the cattle, which in the two -seasons proved fatal to two-thirds of the whole stock of the island.” - -These considerations afford all the evidence which the nature of the -case admits of, that the sickness which affected the island on this -occasion arose, not from the landing of the sick of the “Eclair,” but -from climatic and endemic causes. - -To sum up the whole of this case, then, it appears that the evidence in -favour of the allegation that fever was imported into Boa Vista by the -“Eclair,” amounts to this: that four men, not of the ship’s crew, were -attacked with fever while performing military service in a locality in -which no fewer than 60 of the crew themselves were seized; that one man -not of the ship’s crew who worked as a labourer on board the ship “about -eight” or “two” days, had a slight attack of fever, while 62 men also -not of the ship’s crew, and who also in like manner worked as labourers -on board the ship a longer time, were wholly unaffected; and that a -month after the sailing of the vessel, a woman was attacked with fever -who happened to be a next-door neighbour to two of the soldiers who had -served on duty at the Fort—one of whom was unaffected, and the other not -even confined to bed—simultaneously with the children of the labourer -(Pathi) who resided in one of the dirtiest localities of the island. - -Against such evidence, if evidence it can be called, must be weighed the -following countervailing considerations:— - -It is admitted that the “Eclair” had been exposed on the coast of -Africa to the causes which usually develope epidemic fever in that -country; that intensity was given to those causes by circumstances -which occurred at Sierra Leone, where she took in green wood as fuel, -and where her men went on shore during the rainy and sickly season, -and indulged in the unlimited use of ardent spirits; that her hold was -in a pestiferous condition, and that a quantity of putrid mud had -collected between her timbers. It is proved that the fever which broke -out under these circumstances was the common endemic African coast -fever, which, it is admitted, is not contagious, and which is assumed -to have become contagious on this particular occasion, expressly to -account for its alleged importation. It is admitted that on the -landing of the ship’s crew at Boa Vista, though the men mixed freely -with the islanders,—though the officers lodged in the town,—and -though, when some of them became sick, they were nursed by the -inhabitants,—there was no communication of the disease in a single -instance. It is admitted that of seventeen washerwomen who washed the -linen of the officers and crew, not one became infected, although all -these women, except two, suffered severely from the disease at -subsequent periods after the epidemic became general. It is admitted -that with the exception of one case, which has been proved on inquiry -to have been no real exception, 87[37] labourers worked on board or in -the neighbourhood of the ship daily, and returned to their homes at -night, without taking any precautions,—without becoming themselves -infected,—and without communicating infection to any individual of -their families;—though, like the washerwomen, the greater part of -these men suffered severely when the epidemic became general. It is -admitted that the Cape de Verde Islands are within the Yellow Fever -zone, and are liable to frequent and severe outbreaks of epidemic -fever. It is admitted that the physical and social conditions of Boa -Vista are eminently those which are found by universal experience to -localize epidemic diseases whenever an epidemic influence is present. -It is admitted that the “Eclair” arrived at Boa Vista at the season of -the year when endemic fevers usually prevail. It is admitted that at -the very time of her arrival, Yellow Fever was actually prevailing at -Porto Praya, in the island of St Jago, into which it is not alleged -that the disease had been introduced by importation. It is admitted -that some time before the outbreak of the epidemic, the atmospheric -and other conditions which usually precede and accompany the -development of epidemic disease, were so manifest as to attract -general attention. It is proved that sporadic cases of the disease -appeared, as is usual, some time before the presence of the epidemic -was declared in its distinct and recognized form. It is admitted that -the epidemic influence extended to animals as well as man, a mortal -epizootic disease prevailing over the whole of the island at the same -time. It is proved that the epidemic did not break out until about a -month or six weeks after the “Eclair,” with all her crew, healthy and -sick, had left the island. It is admitted that a similar epidemic -appeared among men and animals the following year, not imported, but -entirely of local origin. - -Footnote 37: - - The aggregate number of the lists furnished by Dr M‘William. - -A consideration of these circumstances has satisfied most of those who -have inquired into the case, that the arrival of the “Eclair” at Boa -Vista with fever among her crew, and the occurrence of a similar disease -on the island, were mere coincident events, and that the appearances -which might at first view have given some colour to the notion of -importation were fallacious. - -Among those who arrived at these conclusions were—The Governor-General, -who says:— - -“The disease was perfectly endemic. Not one of those who emigrated to -the different islands of the Archipelago had the disease or communicated -it to others. It did not make its appearance till a month after the -departure of the steamer.... The disease had its origin in the great -falls of rain which took place at a very advanced period of the season, -and which remained stagnant in the neighbourhood of the place.” - -Mr Rendall, the Consul, who says:— - -“The competent officers of the ‘Eclair’ at all times pleaded that the -fever which had appeared and rested on board was nothing more than the -‘common African coast fever;’ the opinion of the medical men on the spot -continued to be that the fever was merely the common African fever, and -that no danger existed of its spreading among the people.” - -Mr Macaulay, the Judge, who says:— - -“So long an interval had elapsed between the departure of the ‘Eclair’ -and the appearance of the first serious case of fever in the town, that -we were all disposed in the first instance to attribute it, as well as -the general sickness of the place, rather to stagnant water, which had -settled in great quantity at the back of the town, joined with the great -heat of the weather and the dirty state of the streets. The ‘Eclair’ had -left Boa Vista nearly a month before any case of fever exhibited itself -in the town.... No injury whatever had resulted from the unrestricted -intercourse which had subsisted during the whole of the ‘Eclair’s’ stay -in the harbour, between the officers and men (not in the hospital at the -fort) and their friends on shore.” - -Captain Simpson, who says:— - -“If I give my opinion on the fever that was on board the ‘Eclair,’ I -should say it commenced at Shebar: and it was to be expected that men -being exposed in boats to night duty during the rains, would be sickly; -that it was likely to be much increased at Sierra Leone by the long -continuance of the vessel there, and the men having leave to go on shore -during this season, when this place is so very unhealthy, and seamen -always so incautious; the occupation of the ‘Eclair’s’ officers and -ship’s company on board the ‘Albert’ in clearing the holds, at all times -a very dangerous work in the Tropics; and the use of green wood for -fuel. In fact, I should have been very much surprised if the ‘Eclair’ -had not been sickly.” - -Sir William Burnett, who, in reporting on the case to the Lords of the -Admiralty, says:— - -“After a careful perusal of the papers he (Dr M‘William) has sent, I am -compelled to say that I cannot conscientiously arrive at the conclusion -the Doctor has done, namely, that the fever was occasioned by -intercourse with the ‘Eclair.’” - -Sir William Burnett adds, with reference to the general question of -importation:— - -“With respect to the importation of the disease into various places, -except in one instance, and that even is surrounded with doubts (I mean -that of Her Majesty’s sloop ‘Bann’), I entirely disbelieve it. Both the -surgeons of Bermuda Hospital most distinctly deny on two occasions that -the epidemic which prevailed in 1843 was imported or contagious; I have -also caused the medical reports of Jamaica Hospital for more than twenty -years to be examined; and though hundreds of patients with yellow fever -in all its most appalling forms, including black vomit, &c., have been -treated in that establishment, not one of the medical officers in charge -of the hospital have ever hinted at the disease being contagious; and if -it be needful I can cite numerous other instances.” - -As to the apprehension that the crew of the “Eclair” might have imported -the disease into England, he says:— - -“I have no hesitation in declaring my firm belief that the sick men of -the ‘Eclair’ when that ship arrived at the Motherbank, might have been -landed at Haslar Hospital and placed in the well-ventilated wards of -that establishment without the public health suffering in the smallest -degree. It is a fact well known, and of the truth of which I can give -the most satisfactory proof, that during the autumn of every year -merchant-ships arrive in our harbours loaded with the produce of the -coast of Africa, having perhaps lost great part, nay in some instances -the whole, of their crew by the fever of the country; or some are still -labouring under fever when the ship arrives in the Thames, and are sent -to the hospital in that state; yet no instance is known of any infection -having been produced by such procedure; in fact it is perfectly certain -that it never did take place.” - -Dr King, who says:— - -“The inhabitants in general are firmly persuaded that the fever was -imported by the ‘Eclair’ and afterwards spread throughout the island by -contagion from one person to another. I have taken considerable pains to -trace out and discover the supposed morbid concatenation, but in vain. -It becomes, therefore, a duty to express my opinion decidedly, that -there is no satisfactory proof of the disease having been propagated by -contagion, or from a specific poison which is said to emanate from the -bodies of the sick, the dying, or the dead.” - -The case of the “Eclair,” as has been already stated, is the one on -which the greatest reliance is placed in proof of the importation of -epidemic disease. - - * * * * * - -It is needful to advert to one instance more of alleged importation; -namely, the introduction of the Yellow Fever epidemic of 1828 into the -Garrison of Gibraltar by the ship “Dygden.” This case has been more -rigorously examined than any other, and on that account it exhibits a -better specimen than can usually be obtained of the manner in which the -evidence for these cases is commonly got up. - -The most positive assertions having been made that this epidemic was -introduced into Gibraltar by a ship from the Havannah, the “Dygden,” the -then Secretary of State for the Colonies, Sir George Murray, appointed a -Special Commission to inquire into the facts of the case; consisting of -the Judge Advocate, the Colonial or Civil Secretary, the Captain of the -Port, and head of the quarantine department, the Town Major, or head of -the police, the Principal Medical Officer of the garrison, and a Staff -Surgeon. It was the desire of Sir George Murray that the Governor should -act as president, on the ground that “as the proposed investigation is -merely to ascertain a fact, it may be more properly accomplished by the -careful examination of impartial witnesses than by the application of -scientific research;” but Sir George Don, “not finding himself equal to -the task,” appointed, by desire of the Secretary of State, conveyed in a -subsequent despatch, the British Superintendent of Quarantine, Sir -William Pym, to preside in his place. - -The facts alleged and attempted to be established before the Board with -a view to prove that this epidemic was imported by the ship “Dygden” -were, that this ship had arrived from the Havannah with Yellow Fever on -board; that while in quarantine in the bay, she was visited from the -garrison by a family of the name of Fenic, and that the first cases of -the epidemic occurred in this family. - -The first witness called to prove this alleged visit to the ship was a -woman of the name of Villalunga, who stated that she lived in the yard -of Fenic’s house; that Fenic was a cigar-maker, that she assisted him in -making cigars, that she heard the boy (Fenic’s son) say that he, his -sister, and his father had been on board the ship in the bay on Sunday, -the day before the boy was taken ill, and that the boy told her that -they had been on board “to eat, drink, and make merry,” and “that his -father had sold tobacco on board the ship.” - -The next witness brought forward was a child Caffiero, 11 years old, who -stated that he was in the habit of playing with the two Fenics: that he -lived very near them; that he played with them _every day before their -death_, and that he saw them _every_ day when they were sick in bed. - -On these statements the Judge Advocate, Mr Howell, observes:— - -“The only evidence which up to this period (April 10th) had been given -to connect the illness in Fenic’s family with a visit on ship-board, is -the hearsay tale told by Villalunga, nor did she give to Fenic and his -two children any companion in their alleged Sunday excursion.” * * - -“Eight days after his examination above mentioned, the boy Caffiero -re-appears as a witness (viz., April 18th) with a story entirely new, -and which, if credible, would be extremely material; because he affects -to speak of facts which had before rested on the hearsay evidence of -Villalunga, but of which facts Caffiero now, after the lapse of eight -days, represents himself to have been an eye-witness. On this his -re-appearance, however, he carefully abstains from giving any date, -either day of the week, or month, or even season of the year. This -cautious avoiding of dates may not unfairly be attributed to the -variance between himself and Villalunga, in their respective journals of -the illness of Fenic’s children. Caffiero now says, ‘I knew Salvo and -Catalina Fenic, and went on board ship with them; _I do not recollect_ -the day. We went on board a three-masted ship. _I do not recollect_ to -what nation it belonged. We remained on deck and did not go below. We -remained on board about one hour. Fenic, the father, took us on board; -he rowed the boat himself; he ate and drank on board, and then brought -_a bundle of clothes on shore_.’ - -“Until this time, neither he nor Villalunga said anything about a bundle -of clothes. - -“This boy’s second evidence thus proceeds:—‘I did not understand the -language of the people on board the ship; they appeared to speak like -Jews or Moors. I did not go on board more than once. When we landed on -the wharf, the Maltese,’ _i.e._ Fenic, ‘_gave me some money, a -pistoreen, and told me not to say anything to anybody about our having -been on board_.’ - -“The effect which this was designed to produce is obvious, viz., that -the ship visited was in quarantine, and Fenic, the Maltese, was -conscious that he had committed an offence against the quarantine laws -which rendered it necessary for his own safety that he should bribe this -boy to secrecy. This story is full of incongruities; it is not probable -that a man should select for his Sunday excursion, to eat, drink, and -make merry, a ship in quarantine; it is more improbable still that Fenic -should gratuitously place himself in extreme peril, by taking with him -(to be witnesses of his offence) children of the artless ages of 10, 11, -and 13, on an expedition which, in his own judgment, as demonstrated by -his own act, he is convinced exposes him to severe punishment. - -“But with regard to the ship ‘Dygden,’ I find that she had already -received pratique, and had been admitted to free intercourse with the -shore, on the 6th of August, _four days previously to the alleged visit -of Fenic_, the date of which, notwithstanding Caffiero’s loss of memory -on his second examination, had already been ascertained by Villalunga to -have been Sunday, August 10th, on which day Fenic, therefore, could -commit no crime by going on board; and the story of the bribe and -injunction to secrecy resolves itself into a clumsy and ill-disguised -attempt at giving a colour of guilt to a fabulous occurrence which, even -if it had been real, would have been guiltless. - -“His second evidence concludes thus:—‘My mother was a washerwoman, and -washed for a black woman who lived next her. Fenic’s wife refused to -wash the bundle of clothes that he brought ashore; he offered them to my -mother, who also refused them; he then gave them to an Englishwoman: I -knew her: _she is dead: I do not know her name, nor where she lived_.’ I -find by my notes that he added, ‘This occurred during last winter,’ -although the words are not entered upon the minutes. He was then asked, -‘What season of the year was it that you were on board of ship?’ To -which he cautiously replied, ‘It was either summer or winter, I -believe.’ - -“Evidence such as this, and given as I saw it given, bears on its face -every character of falsehood; and disbelieving as I do this boy’s whole -story, and at the same time considering his extreme youth, the testimony -given by him has upon my mind the further operation of tainting with -more than suspicion all the other evidence proceeding from the same -class of witnesses, which consisted chiefly of hearsay in conversation -with persons who had since died; because it would seem that this child -must have been an instrument in the hands of some one of maturer age.” - -The suspicion attached to the second appearance of this child is -confirmed by a similar re-appearance of Villalunga, who, after sixteen -days’ absence from the Board, on the 24th of April, again presents -herself as a witness. She now remembers that Mrs Fenic had asked her to -wash some clothes; that she did not wash them, being herself indisposed; -but that she was told by Mrs Fenic that she put these clothes out to be -washed. - -Mr Howell thus comments on this second appearance of Villalunga:— - -“I have observed that Caffiero added to his original testimony so much -as to give to it a new character altogether; I now observe that six days -after Caffiero’s amended testimony, and sixteen days after her own -original examination, the woman Villalunga comes back with a new story, -of which, singularly enough, the principal point is made to coincide -with the alterations and emendations in the evidence of Caffiero.” - -On an examination of the surviving member of the Fenic family, the widow -of Fenic himself, it appears that she gave a positive denial to this -alleged visit of her husband and children to the ship. - -“She was at my desire,” says Mr Howell, “particularly reminded that the -duty which she owed to society required her to disclose everything that -she knew; and from the ingenuous manner in which her evidence was given, -I am led to believe that she spoke the truth. - -“She declared that she did not know the cause of her children’s -illness:—‘They were attended by Dr Lopez, who is dead, and who said they -had a tabardillo and indigestion, _caused by eating green figs_. He did -not say what was the cause of the tabardillo. My husband was a -cigar-maker; but he did not go on board ship either to buy tobacco or to -sell cigars. Neither my husband nor my children went into the bay at any -time during last summer or autumn. I know this: because if they had -gone, they would have told me, and they did not tell me.’ Nor, indeed, -is it to be supposed that the children would not have told their mother, -and that the husband would not have told his wife, that which all of -them are declared to have communicated so freely to other people.” - -On being cited before a Public Notary at Gibraltar (November 14th, -1829), this witness still more particularly deposed— - -“That it was utterly untrue that her husband went on board any ship in -the bay at any time last summer; that on account of his age and -infirmity, he had not been in a boat for ten years past; that she is -equally certain that her two children never went on board any boat or -ship; that, with respect to the boy Caffiero, neither she nor any of her -family knew anything about him; and that his story of having gone on -board the ship with her husband and her two children, ‘is a made-up -falsehood.’” - -Mr Howell sums up the result of his examination of the evidence adduced -before the Board respecting the Fenic family in the following words:— - -“Having thus examined in detail the evidence adduced to connect the -illness of Salvador Fenic (the alleged first case of the epidemic) with -the ‘Dygden,’—and no other vessel has been pointed at,—I find not only -that it completely fails to make out even a _primâ facie_ case, but -also, from the whole complexion of the evidence, I am convinced that the -story of Fenic’s visit to that vessel on the 10th of August is, from -beginning to end, a fabrication.” - -Apparently in anticipation of a failure to connect the illness in -Fenic’s family with a foreign source, much testimony was given before -the Board derived, as is stated by Mr Howell, “through channels most -impure,” about instances in which foul clothes are supposed to have been -brought ashore by sailors arriving from the Havannah, in the early part -of the epidemic, and which foul clothes infected the washerwomen. - -After showing at some length the discrepancies and contradictions which -proved the whole testimony adduced on this point to be utterly -worthless, Mr Howell says:— - -“Here I leave the journals of washerwomen, and the tattle of their -gossips, remarking this fatal objection to each washing-tub anecdote, -however circumstantial, that _not one of them goes back so far as to -precede_, and therefore to account for, _the alleged first case of the -epidemic_, namely, that of Salvador Fenic, who, as we are told, fell ill -_on the 11th of August_, and upon whose single case, therefore, the -proof of importation rests. And if the attempt to connect the illness of -Salvador Fenic with a foreign source be, as I hold it to be, a complete -failure, how is the illness of the boy Caffiero to be accounted for? And -to what is to be ascribed the illness of Mr Martin’s child on August -16th, a case quite as early as that of Caffiero, and which has not been -attempted to be traced to importation? not one of the washing-tub cases -being anterior either to that of Mr Martin’s child or to that of -Caffiero, both of which are unquestioned cases of the epidemic.” - -It was essential to the proof of the connection of the “Dygden” with the -outbreak of the epidemic, to establish the fact of the existence of -Yellow Fever on board the ship. No proof of this appears to have been -adduced. On the contrary, the captain of the ship declares that no such -disease existed on board; the head of the Quarantine Department, after -an official examination into the fact, affirms that there is no evidence -whatever to disprove the truth of the captain’s statement, and the -Quarantine Medical Officer, after “a minute inspection of the captain -and crew,” states that he “found them all in perfect health.” - -“I have minutely inspected the captain and crew,” he says, “whom I found -in perfect health. The reason for putting this ship in quarantine for 40 -days was, that two men died on the passage. It is now 66 clear days -since the first man died, and 61 since the death of the last, and -nothing like disease has since appeared, nor have I the most distant -reason to apprehend danger to the public health from any circumstances -connected with the ‘Dygden.’” - -Mr Howell calls special attention to this report of the medical -officer:— - -“This report,” he says, “was written, as it strikes me, under -circumstances which entitle it to much consideration. This ship had been -officially pointed out to him (as the Medical Officer of Quarantine) as -being strongly suspected. The responsibility of his office was thus -brought fully before his eyes, and he had _then_ no motive for making a -false report of his inspection of the ‘Dygden’s’ master and crew, -because the epidemic had not at that period commenced. If he had -observed any reasonable grounds for suspicion, he had only to fall in -with the rumour, and recommend that none of the persons or susceptible -articles on board should be permitted to land. The conduct and -declarations, therefore, of Dr Hennen, as a responsible public officer, -under such circumstances, when, if he erred at all, it would probably be -on the side of _over caution_, I hold to be most material.” - -Such is a fair specimen of the evidence adduced on this occasion to -establish a positive case of importation. It breaks down at every point. -There is complete failure in the proof that Yellow Fever existed on -board the ship; there is complete failure in the proof that there was -the slightest connection between the ship and any persons on shore; and -there is even failure in the proof that the individuals who are alleged -to have introduced the disease were really affected with a malady of the -same nature as the epidemic that subsequently prevailed. - -The Judge Advocate thus states the conclusion at which he arrived after -a careful examination of the proceedings of the Commission:— - -“I am of opinion that the evidence brought forward has totally failed to -prove that the late epidemic disease was introduced from any foreign -source, either by the Swedish ship ‘Dygden’ or by any other means; and I -am further of opinion that the late epidemic had its origin in -Gibraltar.” - -Medical observers on the spot, not members of the Board, but who -carefully watched its proceedings, it is believed, without any -exception, arrived at the same conclusion. Thus Dr T. Smith sums up the -result of his examination of the subject in the following words:— - -“That it was not imported I think every candid man will admit who has -deliberately weighed the evidence given on the subject before the Board -of Commissioners, and the facts I have stated. Every endeavour to -establish the importation doctrine has failed, and both the Colonial -Secretary, Sir George Murray, and Sir James McGrigor, Director-General -of the Army Medical Department, I have heard, are convinced there is not -the slightest ground for such a belief; but, on the contrary, that there -is every reason to suppose the disease owed its origin to causes within -the walls of the garrison.” - -Several comments were made by those who paid attention to the subject at -the time, on the manner in which this investigation was conducted, which -appear to deserve notice. - -Complaints were made that the result of the inquiry was prejudged. In -proof of this it was found that the President of the Board, a few days -before it held its first meeting, addressed to the military secretary of -the garrison an official letter in which, among other observations -directly tending to a prejudgment of the case, he affirms, that “the -fever in question has often been traced to importation, and against this -source _only_ must we look for its prevention.” - -It appears further that before the meeting of the Board an official -intimation of the views and wishes of the local authorities was -promulgated in the Government Gazette, into which nothing is admitted -but by authority, in the following words:— - -“The scourge from which we have been by Divine Providence just delivered -must be an exotic of some kind. It is in its origin independent of -everything inherent in the soil which we inhabit, incapable of existing -among us during the winter months, and totally distinct from and -unconnected with the Remitting and Intermitting Fever, which may be said -to be unknown in this garrison.” - -“Two causes,” observes Mr Howell, “concurred to operate injuriously upon -the proceedings of the Board: _First_, the conviction universally -prevalent among the _civil_ population of Gibraltar, that the prosperity -of that community would be undermined if it should be proved that the -epidemic had been generated on the spot, because of the prohibitions and -restrictions which it was anticipated would in that case be inflicted -upon its commercial intercourse with other places. Hence the notion that -not only the last epidemic, but that all its predecessors had been -imported from some foreign country was not only anxiously supported by -the unanimous voice of the civil community, but it was with equal -unanimity believed that a different doctrine would be fatal to the -commercial prosperity of the place. From this feeling of self-interest -it is to be admitted that the _military_ were exempt, a distinction -between the two classes which ought to be taken into account in -estimating the value of the evidence taken by the Board, and more -especially the evidence of the medical practitioners. - -“The _second_ cause operating injuriously upon this inquiry was the -publication, in the official government newspaper (into which nothing is -admitted except by official authority), on January 12, 1829, of an -article authoritatively announcing that the late epidemic had been -imported into Gibraltar, and denouncing as void of common sense any -person who should hold a different opinion. This official notification -of the feelings of the local Government (preceding as it did by only 12 -days the appointment of the Board of Inquiry) could hardly fail to -encourage evidence on one side, and discourage evidence on the other.” - -Complaints were also made that there was a partial selection of -witnesses. - -“It always appeared most extraordinary and ‘unjustifiable,’” says Dr -Gillkrest, “that on this kind of inquiry, which was intended by the -Secretary of State to be so beneficial to the interests of humanity, the -Superintendent of Quarantine, as president, should have assumed the -right in several instances of selecting the witnesses, which obviously -prejudiced the question, and by which much of the truth was intercepted. - -“Several medical officers of the garrison who had much experience -respecting the progress of the epidemic, were either not examined at -all, or only in a very imperfect manner. I was among the latter, being -surgeon to the 43rd Regiment, and present during the whole epidemic. -After a very limited examination, I officially informed the President, -by letter, that I had much to state; but, like others, I was not called -afterwards. - -“From what I felt due to the service of which I had been a member for so -many years, as well as the cause of truth, I was induced to protest -against such proceedings, which protest will, I presume, be found with -the documents connected with the inquiry forwarded from Gibraltar to the -Colonial Office in London.” - -Complaints were further made of the mode of collecting the evidence -adopted on this occasion, which was such as to excite the suspicion of -some of the members of the Commission, and to lead eventually to their -condemnation of it, and their repudiation of the Report which was -founded upon it.[38] - -Footnote 38: - - _See_ Letter of Sir George Murray, and reply of Colonel Chapman, the - Civil Secretary, p. 274;—also Report of Judge Howell, Second Report on - Quarantine of the General Board of Health, Appendix II., pp. 245, 273. - - ------------------------------------------------------------------------- - - - - - APPENDIX. - - -A return of the Sanitary Works carried out in those towns to which the -Public Health Act has been applied, was laid on the table of the House -of Commons, on the 12th of April last, and ordered to be printed (No. -176, Session 1866). In view of the threatened Epidemic, however, the -unusual labour cast upon the Local Government Office,—now charged with -the superintendence of Local Boards of Health,—must render it improbable -that time can be found to examine the proof of this important return -before the end of the Session. - -At this still early period in the progress of Sanitary Reform, any such -return must be manifestly imperfect; yet it will probably be found that -ten times the sum mentioned in the text[39] is already known to have -been expended on these works; and previous returns show that about a -million and a half sterling has, in addition, been laid out in the -provision of Extramural Cemeteries. - -Footnote 39: - - See p. 57. - -The effect of these measures, in reducing the mortality of the -population, cannot of course be calculated at present with any degree of -accuracy; because no statistics of this nature can be reliable, unless -based upon an average of many years. It will, nevertheless, be -exceedingly interesting to watch the results of these improvements in -the civilization of England; improvements which have been, perhaps, -mainly effected by the labours of Dr Southwood Smith. - -That such Sanitary appliances are not yet all that could be wished in -many of our larger towns, is abundantly exhibited by the following -extract from the Quarterly Report of the Registrar-General for January, -February, and March, 1866. - -“If the map of England were shaded to represent the rates of mortality -of last quarter in the registration districts, the eye, travelling from -the lighter south to the darker north, would be instantly drawn to a -spot of portentous darkness on the Mersey; and the question would be -asked whether cholera, the black death, or other plague, imported with -bales of merchandise, had been lately introduced into its busy and -populous seaport. Happily this has not been the case; but fever, -probably developed or aided by the mild and damp atmosphere of the -season, and by overcrowding in an increasing population, has been busy -and fatal in Liverpool, and in other towns of the same county and of -Yorkshire. The annual mortality of the borough of Liverpool in the three -months was excessive, and demands immediate and earnest consideration; -it rose to 4.593 per cent. This implies that if this death-rate were -maintained for a year, 46 persons out of 1000 in the population would -die in that time, or 15 more than died in Glasgow, its northern rival, -19 more than in London. The mortality in the city of Manchester, though -far less than that of Liverpool, was higher than in any other of the 13 -selected towns of the United Kingdom; it was 3.742 per cent.; and that -of Leeds was hardly less.” - - - THE END. - - - - - ------------------ - - JOHN CHILDS AND SONS, PRINTERS. - - ------------------------------------------------------------------------- - - - - - ● Transcriber’s Notes: - ○ Missing or obscured punctuation was silently corrected. - ○ Typographical errors were silently corrected. - ○ Inconsistent spelling and hyphenation were made consistent only - when a predominant form was found in this book. - ○ Text that was in italics is enclosed by underscores (_italics_). - - - - - - - -End of the Project Gutenberg EBook of The Common Nature of Epidemics, by -Thomas Southwood-Smith - -*** END OF THIS PROJECT GUTENBERG EBOOK THE COMMON NATURE OF EPIDEMICS *** - -***** This file should be named 61029-0.txt or 61029-0.zip ***** -This and all associated files of various formats will be found in: - http://www.gutenberg.org/6/1/0/2/61029/ - -Produced by Chris Curnow, Barry Abrahamsen, and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive) - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. 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