Part 34

A third case occurred a few days ago. A medical certificate was presented to me of the death of a man from disease of the heart and aneurism of the aorta. He was driven in a cab to the door of a medical practitioner in this neighbourhood, and was found dead. He might have died from poison, and, without the questions put on the occasion of registering the cause of death, the case might have passed without notice. There was not in this case, as in others, any evidence to show that death was occasioned by unfair means, but the causes were obscure and unsatisfactory, and I felt it to be my duty to have them investigated by the coroner.

But for anything known, you may have passed cases of murder?—Certainly; and there is at present no security against such cases. The personal inspection of the deceased would undoubtedly act as a great security.

In the course of your practice, have you had occasion to believe that evil is produced by the retention of the corpse?—Yes; I can give an instance of a man, his wife, and six children, living in one room, in Draper’s Buildings. The mother and all the children successively fell ill of typhus fever: the mother died; the body remained in the room. I wished it to be removed the next day, and I also wished the children to be removed, being afraid that the fever would extend. The children were apparently well at the time of the death of the mother. The recommendation was not attended to: the body was kept five days in the only room which this family of eight had to live and sleep in. The eldest daughter was attacked about a week after the mother had been removed, and, after three days’ illness, that daughter died. The corpse of this child was only kept three days, as we determined that it should positively be removed. In about nine days after the death of the girl, the youngest child was attacked, and it died in about nine days. Then the second one was taken: he lay twenty-three days, and died. Then another boy died. The two other children recovered.

By the immediate removal of the corpse, and the use of proper preventive means, how many deaths do you believe might have been prevented?—I think it probable that the one took it from the other, and that if the corpse of the first had been removed the rest would have escaped; although I, of course, admit that the same cause which produced the disease of the mother might also have produced it in the children. I believe that, in cases of typhus, scarlatina, and other infectious diseases, it frequently happens that the living are attacked by the same disease from the retention of the body.

Have you had occasion to observe the effects of cesspools in your district?—Yes, and that they are very injurious to the health. In the states of the weather when offensive emanations arise from the cesspools and drains, I have often heard people complain of headache, giddiness, nausea, languor, and an indisposition for exertion of any kind; and I have known a walk or a ride in the open air to remove those symptoms, but in an hour or two after their return home they have found themselves as bad as before. Their sleep brings them little or no refreshment; in truth, they have inhaled, during the whole of the night, the noxious atmosphere, which is very depressing, and will fully account for their rising, as they often say, as tired as when they went to bed. As an example, I may mention the case of a compositor, residing in Draper’s Buildings—a narrow, confined, and filthy place, where there was always a disgusting stench in every house. He was the subject of disordered stomach and liver, which might have been induced by his night-work and intemperance: the stinking hole in which he resided contributed its share towards it, without doubt. This man remained at home for a week, when he was getting better, but had scarcely any appetite. I advised him to walk in Finsbury Circus two or three times a-day, as long as he could without fatigue; and on several occasions, when he returned to his dinner, he said, “Now, if I had had my dinner in Finsbury Circus I could have eaten a hearty one, but now I do not seem to care anything about it.” I believe that if I had entered that man’s house with a good appetite for a dinner, and had remained there for an hour, that I should have cared no more about eating than he did,—which I attribute to the nauseating and depressing effects of the effluvia from the cesspools, drains, and general filthiness of the place.

Are you aware whether this state of things arose from the cesspools or the state of the sewers?—I conceive the worst have been cesspools; but the drains, if they open, are just as bad. I was called upon to visit a patient living in a court in Whitecross Street, ill of typhus fever; in the centre of it was a gully-hole, which was untrapped and smelt horribly. The fever went through the whole of that court. I gave it as my opinion at the time, that the case I visited was occasioned by the gully-hole, and that the fever would go through the court, which it did.

Have you perceived the present state of the drains in the city of London?—At times they smell very strongly, which scarcely any one can fail to notice; but I have heard country-people complain of them at times when they have not attracted any particular notice from me.

Are you aware that decomposing matter is allowed to accumulate in them?—Yes; very recently they took up the refuse in our street, Old Broad Street; it smelt very badly, and it was black and horribly filthy.

How long before had the sewer been cleansed?—I do not know. I do not remember its having been cleansed, before the last September, since I have been there, which is about nine years.

Do you remember to have perceived the smell from the sewers before the last September?—Yes; there is a gully-hole near my own house from which there was constantly an offensive smell: it was much worse after a thaw in winter, or a shower of rain in summer. A neighbour living two doors from me being more annoyed by it than I, made great efforts, and at length succeeded in getting it trapped; and I have not since perceived any smell from it, though I observe it now in other places. The gully-holes are trapped now in most of the respectable streets, but in the bye and poor streets they are not trapped.

From the evidence which has come before you, have you any doubt that the existing state of sewers in the City are the latent cause of much disease and death?—I have not the least doubt of it in the world.—A great deal of active disease, which creeps on gradually and insidiously, may be traced to that cause.

In the poorer districts, in what state is the surface-cleansing of the streets?—Even the best streets are very badly cleansed, but in the poorer streets of the city the cleansing is very bad indeed—horribly bad! Take Duke’s Place, for example; you will see cabbage-stalks and rotten oranges that have been thrown away, and they often remain there for several days. We do not get our streets swept oftener than once a-week.

If there were a perfect system of drainage and cleansing in the city, do you think that the health and the duration of life of the inhabitants would be extended?—I think there would be a considerable extension.

What is the physical condition of the children born in London of parents who are natives of the rural districts, as compared with the physical condition of children who are born in the country of parents of the same class?—The children born and bred up in London are more frequently of small stature and have slender limbs, are deficient in stamina and powers of endurance, are of irritable frames and prone to inflammatory attack, than children born and bred up in the country. An impure atmosphere is immeasurably more injurious to children than adults. Children also suffer more from want of opportunities of exercise in the open air. The beneficial effects of pure air and exercise on children who have been born and pent up in London are most marked: a weakly child, and which, if kept in London, would perhaps always continue weakly, would most likely become strong and healthy if sent into the country. I cannot doubt that children born of healthy parents, and bred up in the country, would be more robust and stronger than children born of the same class of parents and bred up in London, and that this difference may be justly ascribable to atmospheric influence.

When children are weakly, what is the effect on the temper and character?—The temper and character of weakly children are generally found to correspond with, and are most probably derived from, the character of their constitution: their temper is quick and irritable, their passions ardent, their perception keen, and their imagination predominant over their judgment.

You are speaking, of course, of the general characteristics of individuals as specimens of the population brought up under such circumstances?—Yes, of persons coming under my own observation.

Have you, as Registrar of Deaths, noticed the larger proportion of infant mortality in the city?—There is, I conceive, all over the kingdom, a large proportion of infant deaths; but I have no doubt that a considerable proportion of the excess of infant deaths in London is ascribable to atmospheric influences.

It appears, from the Mortuary Registration, that of deaths in the city of London, about one-half are deaths of children under ten years of age; whilst in a rural district, take the county of Hereford for example, only one-third of the deaths are deaths of children.

Do you conceive it probable that this different rate of infant mortality is to be traced chiefly to the difference of the atmospheric influence, the average age of all of the labouring classes being, in Herefordshire, 39 years, whilst in the City of London the average age of the deaths of all the labouring classes is only 22 years?—I am decidedly of opinion that a greater proportion of the excess of infant mortality in London, and the reduced duration of life, are ascribable to atmospheric impurity.

If all cesspools were removed, and water-closets substituted; if water were introduced into the houses of the poorest classes; if the sewers were regularly flushed weekly, or oftener, so as to prevent accumulations of deposit and the escape of miasma, such as you have described; if the carriage and foot pavements were more frequently and completely cleansed; if these several public duties were performed with practicable efficiency, can you express a confident opinion that decrease and premature deaths would be considerably diminished?—I am quite confident that the adoption of such measures would not only diminish disease of every kind, but greatly improve the moral as well as the physical condition of the inhabitants.

No. 4. THE PROPORTIONS OF DEATHS AND FUNERALS PREVENTIBLE BY SANITARY MEANS.

_Henry Blenkarne_, Esq., South West District Surgeon of the City of London Union.

Have you in your district perceived any effects resulting from interments in the parochial burying places?—I have no cognizance of any bad effects resulting from those interments. The first twenty years of my life I lived close to a burial-ground, and never was aware or heard of any prejudicial consequences arising. I may observe, however, that when a relation of mine has attended the church she has been enabled to perceive whenever a vault underneath the church has been opened. She has said, “I feel they have opened a vault;” and on inquiry it has turned out to have been so.

Have you observed any evil effects following the practice of the long retention of the corpse in the house amidst the living?—Yes, I have observed effects follow, but I cannot say produced by them, though they were perhaps increased by them. In those cases which I have had where there has been a succession of cases of fever in the same family, after a death it has generally occurred that the parties affected have complained two or three days before that they felt very unwell. Generally this has been the case. I have, in such instances, ordered them medicine immediately. Since the Union has been established we have immediately removed all fever cases to the Fever Hospital.

The retention of the corpse amidst the living, under such circumstances, must aggravate the mortality, must it not?—There cannot be a moment’s doubt about it.

What, from the observations in your district, has been the actual state of the sewerage, and cleansing dependent upon it, as the cleansing of the cesspools?—There has been great improvement in the city of London by the improvement of the sewerage, in so far as it has removed the cesspools. When you went into a respectable house formerly, you could, in the city, tell the state of the weather by the smell from the cesspools. Where water-closets are substituted, the health of the inhabitants has undoubtedly been improved. In the poorer neighbourhoods, where they have still cesspools, they are still very bad. I constantly tell them, if you get rid of that nasty cesspool you’ll get well and keep well; it is of no use my giving you physic until that is done. Where there have been deposits accumulating in the sewers, and the drains have been choked up, the effect has been just the same as if there had been cesspools.

You are aware that in respect to sewerage it is the practice to allow deposits to accumulate in the sewers, and then, when the private drains are stopped up, to open the sewer and get out the deposit by means of buckets, and remove it in carts?—Yes, I am.

Have you seen any illness result from this practice?—I cannot state a case, though I have no doubt of its highly injurious effects; but can decidedly speak to illness arising from the accumulations. The illness is just the same as from cesspools: a low depressing nervous fever, most like that which is described to be the form of the jungle fever. In November or December last, they were taking up the deposits from the sewers near Broken Wharf, in Upper Thames-street: the stench from it was quite sufficient to have produced any fever: it was not within my district, and I do not know what were the effects. Fortunately there was clear weather, and the wind blew towards the river.

Have you any doubt that the removal of such refuse, as well as the accumulation, must be attended with danger to life?—Yes; if any person in a state of mental or bodily depression were exposed to such an influence, it would produce low fever; it would be dangerous in proportion as it was stagnant.

In passing through the city, have you been assailed with smells from gully-holes?—Only yesterday, in passing through the city, the smells from many of the gully-holes were very offensive; and several medical friends agree with me in attributing extremely prejudicial consequences as arising from this cause.

The following case is related on the authority of Dr. Good, as having occurred within the city of London, and is mentioned by Mr. Fuller, in a letter from a surgeon who has paid great attention to the influence of sewerage, and who adduces the facts of the case in evidence that typhus may be produced by the miasma from sewers:—“Soon after the closing of the Parliamentary Committee, I learned, from the late Dr. Hope, the particulars of a case which, to my mind, has completely proved the production of typhus fever from it, and was so much in the character of an _experimentum crucis_, that I did not consider it necessary to prosecute the inquiry any further. The case is as follows:—“A family in the city of London, who had occupied the same house for many years, enjoying a good state of health, had a nursery-maid seized with typhus fever; the young woman was removed from the house and another substituted in her place. In a short time the new nurse-maid was attacked with typhus fever, and was also sent away. A few weeks after one of the children was seized with the same fever: an inquiry was now instituted by the medical man in attendance, in order to ascertain, if possible, the cause of this frequent recurrence of typhus fever, when the following facts were brought to light:—The nursery was situated on the upper floor but one of the house, and about a fortnight or three weeks before the first case of fever occurred, a sink was placed in the corner of the nursery for the purpose of saving the labour of the servants; this was found to communicate with the common sewer, and to be quite open, or untrapped; they ordered it immediately to be effectually trapped, and then no other case of fever occurred, although it continued to be occupied as before; and, when I learned the case, more than a twelvemonth had passed.””

Have you met with cases analogous to the one here stated?—I have met with several such cases. I know of an instance where a room in an old house had an offensive stench, and the health of the person living in it was always bad. A stench was perceived in the room, which it was guessed might arise from the decay of dead rats in the wainscot. The party went to much expense to pull down the wainscot, when it was found that there was an opening which communicated with the cesspool below. The hole was properly cemented and stopped up, and the room has since that time become quite habitable and healthy; and where I have directed the cesspools to be emptied, as the predisposing cause, the general result has been that the sick have immediately got well. From my knowledge of the local causes I can predicate, with certainty, what will be the general effect on the health in the case of removal of the parties.

Besides the houses of the labouring classes, are there many houses of the middling classes in your district in the city of London that are provided with cesspools?—Many houses that I go into are provided with cesspools. I mentioned the other day to a lady that I should never be enabled to keep her well so long as there was a cesspool in the house; I told her that the expense of continued medical attendance would pay for a communication with the common sewer and better cleansing.

Are you aware that a new practice has arisen of preventing the accumulation of deposits in the sewers, by flushes of water, which remove all deposits weekly, and so far prevent the year’s accumulation and corruption of deposits in the sewers. If this system were enforced in the city, have you any doubt as to the extensive prevention of disease and mortality which would be thereby effected amongst all classes?—Certainly it would be a great boon, in a sanitary point of view, to the population of the city of London. I am so much convinced of this, that in my own house I put a stick under the handle of the water-closet, so as to have a continued flow or flush of water for some length of time; this I do to remove any accidental accumulation. Of course the flushing of the common sewers would have the same effects.

Besides the accumulations in the sewers, is there at this time no decomposing refuse from the defective cleansing of the courts and bye-streets, and poorer districts?—Yes; in the poorer districts there is accumulation. In one court, for example, called Harrow-court, Thames-street, where there is almost always low fever, there is always dirt and filth, and I am constantly exhorting the people to remove the filth; but the great difficulty with the poor people is commonly how to get the water. There is a court in Cornhill which a man was cleansing the other day by applying a hose to the water-cock (which is used in case of fire), in order to cleanse the pavement. An officer belonging to the water company coming by, said, “If I see you doing that again, I shall indict you.”

Are you aware that the streets are swept oftener than weekly in the city of London?—My impression is—not oftener.

It has been proposed that water should be laid on, and kept at high pressure in the streets, so as to enable the courts and alleys, the foot and the carriage pavements, to be washed daily by means of a hose attached to the water-pipes. This, which has been proposed for protection against fire, as well as for cleansing the streets more completely, has, I am informed, been done in Philadelphia. If the system were carried out in the city of London, what do you conceive would be the effect on the health of the population in the poorer districts?—I should certainly say that it would tend greatly to prolong life amongst the population.

From the mortuary registries it appears that the average duration of life among the professional persons and gentry in the city of London, who live in better cleansed and ventilated houses, and better cleansed streets, is, on the average of the whole class, about 43 years, and 6 per cent. of the deaths are deaths from epidemic disease; whilst among the labouring classes the proportion of deaths from epidemic disease is 19 per cent., and the average age of all who die is only 22 years. With such sanitary regulations as are under the public control of the public authorities, to what extent do you think it probable the duration of life amongst the labouring classes may be extended?—So far as I can judge, without examination of the particular cases, I should say that the average might be extended one-half at the least.

The majority of the cases of epidemic diseases may decidedly be ascribed to the want of cleanliness and ventilation. On looking over the mortuary registry of the deaths occurring in Upper Thames-street and the district attached to it, I find the causes of death most frequently registered are “low fever,” “low fever,” occurring one after the other. This recurrence of low fever corresponds with my experience of sickness, which so often assumes the character of low typhoid nervous depression. The medicine I use in the greatest quantity is ammonia, as an active diffusive stimulus. For all classes this medicine is in constant use. In damp weather we have always much increase of this illness: the dampness produces a depression which lays them open to the atmospheric poison.

Have you had instances where better cleansing has taken place and illness diminished?—Yes; for example, in Ireland-yard, containing a large number of families of coal-heavers and others, a place which I never was out of from continued illnesses: the yard has been much better cleansed, the houses put in better order, and now there is very little illness there. I know for a fact, that in the neighbourhood of London-wall, where recently great improvements have taken place in the sewerage and ventilation, disease has greatly diminished, especially _low fever_. Formerly they had a sewer which used to be stopped up and overflowed; they have had of late a new sewer, which now works better; they have no stink or stench in the kitchens, as formerly, and they have nothing of the same kind of disease going on there that they used to have before.

Are the houses in Ireland-yard occupied by the same inhabitants?—Just by the same class. The habits of coal-heavers are reputed to be none of the best in respect to general cleanliness or temperance.

Have you observed any alteration in their habits?—Not in the least.

Have you observed what is the personal condition of the natives of London?—The real cockney is generally of stunted growth.

Have you observed whether the children born in London of parents who have come from the rural districts are as tall or as strong as the parents?—Generally shorter children, though some of them are as tall, but all are of comparatively weakly constitutions; they are particularly predisposed to strumous disease. I have been so impressed with the effect of children living in a London atmosphere, that I have been anxious to send them out of it when possible.