Part 3

§ 5. So far as observations have been made on the point (and the more those reported upon it are scrutinized, the less trustworthy they appear to be), workmen so exposed do not appear to be peculiarly subject to epidemics; many, indeed, appear to be exempted from them to such an extent as to raise a presumption that such emanations have on those “acclimated” to them an unexplained preservative effect analogous to vaccination. That one miasma may exclude, or neutralize, or modify the influence of another, would appear to be _primâ facie_ probable. But it is now becoming more extensively apparent that the same cause is productive of very different effects on different persons, and on the same persons at different times; as in the case mentioned by Dr. Arnott of the school badly drained at Clarendon Square, Somers’ Town, where every year, while the nuisance was at its height, and until it was removed by drainage, the malaria caused some remarkable form of disease; one year, extraordinary nervous affection, exhibiting rigid spasms, and then convulsions of the limbs, such as occur on taking various poisons into the stomach; another year, typhoid fever; in another, ophthalmia; in another, extraordinary constipation of the bowels, affecting similar numbers of the pupils. Such cases as the one before cited with respect to the depôt for animal matter in Paris, where the workmen suffered very little, whilst the people living near the depôt were “tormented with fevers,” are common. The effects of such miasma are manifested immediately on all surrounding human life (and there is evidence to believe they are manifest in their degree on animal life[4]), in proportion to the relative strength of the destructive agents and the relative strength or weakness of the beings exposed to them; the effects are seen first on infants; then on children in the order of their age and strength; then on females, or on the sickly, the aged, and feeble; last of all, on the robust workmen, and on them it appears on those parts of the body that have been previously weakened by excess or by illness. Whilst M. Parent Duchâtelet was looking for immediate appearances of acute disease on the robust workmen living amidst the decomposing animal effluvium of the Montfaucon, I have the authority of Dr. Henry Bennett for stating that he might have found that the influence of that effluvium was observable on the sick at half a mile distant. “When I was house surgeon at St. Louis,” says Dr. Bennett, “I several times remarked, that whenever the wind was from the direction of the Montfaucon, the wounds and sores under my care assumed a foul aspect. M. Jobert, the surgeon of the hospital, has told me that he has repeatedly seen hospital gangrene manifest itself in the wards apparently under the same influence. It is a fact known to all who are acquainted with St. Louis, that the above malady is more frequent at that hospital than at any other in Paris, although it is the most airy and least crowded of any. This, I think, can only be attributed to the proximity of the Montfaucon. Indeed, when the wind blows from that direction, which it often does for several months in the year, the effluvium is most odious.” As an instance of a similar influence of another species of effluvium, not observed by the healthy inhabitants of a district, it is stated that at a large infirmary in this country, when the piece of ornamental water, which was formerly stagnant in front of the edifice, had a greenish scum upon it, some descriptions of surgical operations were not so successful as at other times, and a flow of fresh water has been introduced into the reservoir to prevent the miasma.

The immediate contrasts of the apparent immunity of adults to conspicuous attacks of epidemics, may perhaps account for the persuasion which masters and workmen sometimes express, that they owe an immunity from epidemics to their occupation, and that the stenches to which they are exposed actually “purify” the atmosphere. Numbers of such witnesses have heretofore been ready to attest their conviction of the preservative effect, and even the positive advantages to health, of the effluvia generated by the decomposition of animal or of vegetable matter, or of the fumes of minerals, of smoke, soot, and coal gas. But though they do not peculiarly suffer from epidemics, it is usually found that they are not exempted. In a recent return of the state of health of some workmen engaged in cleansing sewers, whilst it appeared that very few had suffered any attack from fever, nearly all suffered bowel attacks and violent intestinal derangement. If the effects of such emanations invariably appeared in the form of acute disease, large masses of the population who have lived under their influence must have been exterminated. In general the poison appears only to be generated in a sufficient degree of intensity to create acute disease under such a conjunction of circumstances, as a degree of moisture sufficient to facilitate decomposition, a hot sun, a stagnant atmosphere, and a languid population. The injurious effects of diluted emanations are constantly traceable, not in constitutional disturbance at any one time; they have their effect even on the strong, perceptible over a space of time in a general depression of health and a shortened period of existence. This or that individual may have the florid hue of health, and may live under constant exposure to noxious influences to his sixtieth or his seventieth year; but had he not been so exposed he might have lived in equal or greater vigour to his eightieth or his ninetieth year. A cause common to a whole class is often, however, not manifest in particular individuals, but is yet visible in the pallor and the reduced sum of vitality of the whole class, or in the average duration of life in that class, as compared with the average duration of life of another class similarly situated, in all respects except in the exposure to that one cause.[5] The effects of a cause of depression on a class are sometimes visible in the greater fatality of common accidents. An excess of mortality to a class is almost always found, on examination, to be traceable to an adequate cause. From the external circumstances of a class of the population, a confident expectation may be formed of the sum of vitality of the class, though nothing could be separately predicated of a single individual of it. If the former vulgar notions were correct as to the salubrity of the stenches which prevail in towns, the separate as well as the combined results of these several supposed causes of salubrity must be to expel fevers and epidemics from the most crowded manufacturing districts, and to advance the general health of the inhabitants above that of the poorer rural population; but all such fallacies are dissipated by the dreadful facts on the face of the mortuary records showing a frequency of deaths, and a reduction of the mean duration of life, in proportion to the constancy and the intensity of the combined operation of these same causes.[6]

§ 6. The observations of the effects of such emanations on the general health of classes of human beings have been corroborated by experiments on animals.

§ 7. Another doctrine more extensively entertained than that above noticed, is, that although putrid emanations are productive of injury, they are not productive of specific disease, such as typhus. The medical witnesses say, that they were exposed to such emanations in dissecting-rooms, where bodies of persons who have died of small-pox, typhus, scarlatina, and every species of disease, are brought; that they pursued their studies in such places, and were unaware of typhus or other disease having been taken by the students in them, though that disease was frequently caught by students whilst attending the living in the fever wards.[7]

The strongest of this class of negative evidence appears to be that of undertakers, all of whom that I have seen state that neither specific disease nor the propagation of any disease was known to occur amongst them, from their employment. Neither the men who handle, or who “coffin,” the remains; nor the barbers who are called in to shave[8] the corpses of the adult males; nor the bearers of the coffins, although, when the remains are in an advanced state of decomposition, the liquid matter from the corpse frequently escapes from the coffin, and runs down over their clothes, are observed to catch any specific disease from it, either in their noviciate, or at any other time. When decomposition is very far advanced, and the smell is very offensive, the men engaged in putting the corpse into the coffin smoke tobacco; and all have recourse to the stimulus of spirituous liquor. But it is not known that, by their infected clothes they ever propagate specific disease in their families, or elsewhere. Neither does this appear to be observed amongst the medical men themselves.[9]

§ 8. On the other hand, the undertakers observe such instances, as will be stated in their own words in a subsequent part of the report, where others have caught fever and small-pox, apparently from the remains of the dead, and they mention instances of persons coming from a distance to attend funerals, who have shortly afterwards become affected with the disease of which the person buried had died. Of the undertakers it is observed, that being adults, they were likely to have had small-pox. Dr. Williams, in a work stated to be of good authority, on the effects of morbid poisons, relates the case of four students infected with small-pox by the dead body of a man who had died of this disease, that was brought into the Windmill-street Theatre, in London, for dissection. One of them saw the body, but did not approach it; another was near it, but did not touch it; a third, accustomed to make sketches from dead bodies, saw this subject, but did not touch it; the fourth alone touched it with both his hands; yet all the four caught the disease. Sir Benjamin Brodie mentions cases which occurred within his own knowledge, of pupils who caught small-pox after exposure to the emanations in the dissecting-room from the bodies of persons who had died of that disease.

Dr. Copeland, in his evidence before the Committee of the House of Commons, adduced the following remarkable case, stated to be of fever communicated after death:—

About two years ago (says he) I was called, in the course of my profession, to see a gentleman, advanced in life, well known to many members in this house and intimately known to the Speaker. This gentleman one Sunday went into a dissenting chapel, where the principal part of the hearers, as they died, were buried in the ground or vaults underneath. I was called to him on Tuesday evening, and I found him labouring under symptoms of malignant fever; either on that visit or the visit immediately following, on questioning him on the circumstances which could have given rise to this very malignant form of fever, for it was then so malignant that its fatal issue was evident, he said that he had gone on the Sunday before (this being on the Tuesday afternoon) to this dissenting chapel, and on going up the steps to the chapel he felt a rush of foul air issuing from the grated openings existing on each side of the steps; the effect upon him was instantaneous; it produced a feeling of sinking, with nausea, and so great debility, that he scarcely could get into the chapel. He remained a short time, and finding this feeling increase he went out, went home, was obliged to go to bed, and there he remained. When I saw him he had, up to the time of my ascertaining the origin of his complaint, slept with his wife; he died eight days afterwards; his wife caught the disease and died in eight days also, having experienced the same symptoms. These two instances illustrated the form of fever arising from those particular causes. Means of counteraction were used, and the fever did not extend to any other members of the family.

Assuming that that individual had gone into a crowded hospital with that fever, it probably would have become a contagious fever. The disease would have propagated itself most likely to others, provided those others exposed to the infection were predisposed to the infection, or if the apartments where they were confined were not fully ventilated, but in most cases where the emanations from the sick are duly diluted by fresh air, they are rendered innocuous. It is rarely that I have found the effects from dead animal matter so very decisive as in this case, because in the usual circumstances of burying in towns the fetid or foul air exhaled from the dead is generally so diluted and scattered by the wind, as to produce only a general ill effect upon those predisposed; it affects the health of the community by lowering the vital powers, weakening the digestive processes, but without producing any prominent or specific disease.

Mr. Barnett, surgeon, one of the medical officers of the Stepney Union, who has observed the symptoms observable in those persons who are exposed to the emanations from a crowded grave-yard, thus describes them:—

They are characterized by more or less disturbance of the whole system, with evident depression of the vital force, as evinced throughout the vascular and nervous systems, by the feeble action of the heart and arteries, and lowness of the spirits, &c. These maladies, I doubt not, if surrounded by other causes, would terminate in fever of the worst description. The cleanliness, &c., of the surrounding neighbourhood, perhaps, prevents this actually taking place.

Some years since a vault was opened in the church-yard (Stepney), and shortly after one of the coffins contained therein burst with so loud a report that hundreds flocked to the place to ascertain the cause. So intense was the poisonous nature of the effluvia arising therefrom, that a great number were attacked with sudden sickness and fainting, many of whom were a considerable period before they recovered their health.

The vaults and burial ground attached to Brunswick chapel, Limehouse, are much crowded with dead, and from the accounts of individuals residing in the adjoining houses, it would appear that the stench arising therefrom, particularly when a grave happens to be opened during the summer months, is most noxious. In one case it is described to have produced instant nausea and vomiting, and attacks of illness are frequently imputed to it. Some say they have never had a day’s good health since they have resided so near the chapel-ground, which, I may remark, is about five feet above the level of the surrounding yards, and very muddy—so much so, that pumps are frequently used to expel the water from the vaults into the streets.

The bursting of leaden coffins in the vaults of cemeteries, unless they are watched and “tapped” to allow the mephitic vapour to escape, appears to be not unfrequent. In cases of rapid decomposition, such instances occur in private houses before the entombment. An undertaker of considerable experience states:—

“I have known coffins to explode, like the report of a small gun, in the house. I was once called up at midnight by the people, who were in great alarm, and who stated that the coffin had burst in the night, as they described it, with ‘a report like the report of a cannon.’ On proceeding to the house I found in that case, which was one of dropsy, very rapid decomposition had occurred, and the lead was forced up. Two other cases have occurred within my experience of coffins bursting in this manner. I have heard of similar cases from other undertakers. The bursting of lead coffins without noise is more frequent. Of course it is never told to the family unless they have heard it, as they would attribute the bursting to some defective construction of the coffins.”

The occurrence of cases of instant death to grave-diggers, from accidentally inhaling the concentrated miasma which escapes from coffins, is undeniable. Slower deaths from exposure to such miasma are designated as “low fevers,” and whether or not the constitutional disturbances attendant on the exposure to the influence of such miasma be or not the true typhus, it suffices as a case requiring a remedy, that the exposure to that influence is apt to produce grievous and fatal injuries amongst the public.

§ 9. Undertakers state that they sometimes experience, in particularly crowded grave-yards, a sensation of faintness and nausea without perceiving any offensive smell. Dr. Riecke appears to conclude, from various instances which are given, that emanations from putrid remains operate in two ways,—one set of effects being produced through the lungs by impurity of the air from the mixture of irrespirable gases; the other set, through the olfactory nerves by powerful, penetrating, and offensive smells. On the whole, the evidence tends to establish the general conclusion that offensive smells are true warnings of sanitary evils to the population. The fact of the general offensiveness of such emanations is adduced by Dr. Riecke also as evidence of their injurious quality.

Another circumstance which must awaken in us distrust of putrid emanations, is the powerful impression they make on the sense of smell. It certainly cannot be far from the truth to call the organ of smell the truest sentinel of the human frame. “Many animals,” observes Rudolphi, “are entirely dependent on their sense of smell for finding out food that is not injurious; where their smell is injured they are easily deceived, and have often fallen a sacrifice to the consequent mistakes.” Amongst all known smells, there is, perhaps, no one which is so universally, and to such a degree revolting to man, as the smell of animal decomposition. The roughest savage, as well as the most civilized European, fly with equal disgust from a place where the air is infected by it. If an instinct ever can be traced in man, certainly it is in the present case: and is instinct a superfluous monitor exactly in this one case? Can instinct mislead just in this one circumstance? Can it ever be, that the air which fills us with the greatest disgust, is the finest elixir of life, as Dumoulins had the boldness to maintain in one of his official reports. Hippolyte Cloquet, in his Osphrestologie has attempted to throw some light on the effect of smell on the human frame, and though we must entirely disregard many of the anecdotes which he has blended into his inquiry, yet the result remains firmly proved that odours in general exert a very powerful influence on the health of men, and that all very acutely impressing smells are highly to be suspected of possessing injurious properties.

§ 10. I beg leave on this particular topic to submit the facts and opinions contained in communications from two gentlemen who have paid close and comprehensive attention to the subject.

Dr. Southwood Smith, who, as physician to the London Fever Hospital, and from having been engaged in several investigations as to the effects of putrid emanations on the public health, must have had extensive means of observation, states as follows:—

1. That the introduction of dead animal matter under certain conditions into the living body is capable of producing disease, and even death, is universally known and admitted. This morbific animal matter may be the product either of secretion during life or of decomposition after death. Familiar instances of morbific animal matter, the result of secretion during life, are the poisons of small-pox and cow-pox, and the vitiated fluids formed in certain acute diseases, such as acute inflammations, and particularly of the membranes that line the chest and abdomen. On the examination of the body a short time after death from such inflammations, the fluids are found so extremely acrid, that even when the skin is entirely sound, they make the hands of the examiner smart; and if there should happen to be the slightest scratch on the finger, or the minutest point not covered by cuticle, violent inflammation is often produced, ending, sometimes within forty-eight hours, in death. It is remarkable, and it is a proof that in these cases the poison absorbed is not putrid matter, that the most dangerous period for the examination of the bodies of persons who die of such diseases is from four to five hours after the fatal event, and while the body is yet warm.

That the direct introduction into the system of decomposing and putrescent animal matter is capable of producing fevers and inflammations, the intensity and malignity of which may be varied at will, according to the putrescency of the matter and the quantity of it that is introduced, is proved by numerous experiments on animals; while the instances in which human beings are seized with severe and fatal affections from the application of the fluids of a dead animal body to a wounded, punctured, or abraded surface, sometimes when the aperture is so minute as to be invisible without the aid of a lens, are of daily occurrence. Though this fact is now well known, and is among the few that are disputed by no one, it may be worth while to cite a few examples of it, as specimens of the manner in which the poison of animal matter, when absorbed in this way, acts; a volume might be filled with similar instances.

The following case is recorded by Sir Astley Cooper:—Mr. Elcock, student of anatomy, slightly punctured his finger in opening the body of a hospital patient about twelve o’clock at noon, and in the evening of the same day, finding the wound painful, showed it to Sir Astley Cooper after his surgical lecture. During the night the pain increased to extremity, and symptoms of high constitutional irritation presented themselves on the ensuing morning. No trace of inflammation was apparent beyond a slight redness of the spot at which the wound had been inflicted, which was a mere puncture. In the evening he was visited by Dr. Babington, in conjunction with Dr. Haighton and Sir Astley Cooper; still no local change was to be discovered, but the nervous system was agitated in a most violent and alarming degree, the symptoms nearly resembling the universal excitation of hydrophobia, and in this state he expired within the period of forty-eight hours from the injury.

The late Dr. Pett, of Hackney, being present at the examination of the body of a lady who had died of peritoneal inflammation after her confinement, handled the diseased parts. In the evening of the same day, while at a party, he felt some pain in one of his fingers, on which there was a slight blush, but no wound was visible at that time. The pain increasing, the finger was examined in a stronger light, when, by the aid of a lens, a minute opening in the cuticle was observed. During the night the pain increased to agony, and in the morning his appearance was extremely altered; his countenance was suffused with redness, his eyes were hollow and ferrety; there was a peculiarity in his breathing, which never left him during his illness; his manner, usually gay and playful, was now torpid, like that of a person who had taken an excessive dose of opium, he described himself as having suffered intensely, and said that he was completely knocked down and had not the strength of a child, and he sunk exhausted on the fifth day from the examination of the body.