Part 4

George Higinbottom, an undertaker, was employed to remove in a shell the corpse of a woman who had died of typhus fever in the London Fever Hospital. In conveying the body from the shell into the coffin, he observed that his left hand was besmeared with a moisture which had oozed from it. He had a recent scratch on his thumb. The following morning this scratch was inflamed; in the evening of the same day he was attacked with a cold shivering and pain in his head and limbs, followed the next by other symptoms of severe fever; on the fourth day there was soreness in the top of the shoulder and fulness in the axilla; on the fifth the breast became swollen and efflorescent; on the seventh delirium supervened, succeeded by extreme prostration and coma, and death took place on the tenth day.

A lady in the country received a basket of fish from London which had become putrid on the road. In opening the basket she pricked her finger, and she slightly handled the fish. On the evening of this day inflammation came on in the finger, followed by such severe constitutional symptoms as to endanger life, and it was six months before the effects of this wound subsided and her health was restored.

Among many other cases, Mr. Travers gives the following, as displaying well the minor degrees of irritation, local and constitutional, to which cooks and others, in handling putrid animal matter with chapped and scratched fingers, are exposed:—A cook-maid practised herself on a stale hare, for the purpose of learning the mode of boning them, in spite of being strongly cautioned against it. A few days afterwards two slight scratches, which she remembered to have received at the time, began to inflame; one was situated on the fore-finger and the other on the ring-finger. This inflammation was accompanied with a dull pain and feeling of numbness, and an occasional darting pain along the inside of the fore-arm. The next day she was attacked with excruciating pain at the point of the fore-finger, which throbbed so violently as to give her the sensation of its being about to burst at every pulsation. The following morning constitutional symptoms came on; her tongue was white and dry; she had no appetite; there was great dejection of spirits and languor, and a weak and unsteady pulse. After suffering greatly from severe pain in the finger, hand, and arm, and great constitutional derangement and debility, the local inflammation disappeared in about three weeks, and she then began to recover her appetite and strength.

2. It is proved by indubitable evidence that this morbific matter is as capable of entering the system when minute particles of it are diffused in the atmosphere as when it is directly introduced into the blood-vessels by a wound. When diffused in the air, these noxious particles are conveyed into the system through the thin and delicate walls of the air vesicles of the lungs in the act of respiration. The mode in which the air vesicles are formed and disposed is such as to give to the human lungs an almost incredible extent of absorbing surface, while at every point of this surface there is a vascular tube ready to receive any substance imbibed by it and to carry it at once into the current of the circulation. Hence the instantaneousness and the dreadful energy with which certain poisons act upon the system when brought into contact with the pulmonary surface. A single inspiration of the concentrated prussic acid, for example, is capable of killing with the rapidity of a stroke of lightning. So rapidly does this poison affect the system, and so deadly is its nature, that more than one physiologist has lost his life by incautiously inhaling it while using it for the purpose of experiment. If the nose of an animal be slowly passed over a bottle containing this poison, and the animal happen to inspire during the moment of the passage, it drops down dead instantaneously, just as when the poison is applied in the form of a liquid to the tongue or the stomach. On the other hand, the vapour of chlorine possesses the property of arresting the poisonous effects of prussic acid; and hence when an animal is all but dead from the effects of this acid, it is sometimes suddenly restored to life by holding its mouth over the vapour of chlorine.

During every moment of life in natural respiration a portion of the air of the atmosphere passes through the air vesicles of the lungs into the blood, while a quantity of carbonic acid gas is given off from the blood, and is transmitted through the walls of these vesicles into the atmosphere. Now that substances mixed with or suspended in atmospheric air may be conveyed with it to the lungs and immediately enter into the circulating mass, any one may satisfy himself merely by passing through a recently painted chamber. The vapour of turpentine diffused through the chamber is transmitted to the lungs with the air which is breathed, and passing into the current of the circulation through the walls of the air vesicles, exhibits its effects in some of the fluid excretions of the body, even more rapidly than if it had been taken into the stomach.

Facts such as these help us to understand the production and propagation of disease through the medium of an infected atmosphere, whether on a large scale, as in the case of an epidemic which rapidly extends over a nation or a continent, or on a small scale, in the sick chamber, the dissecting room, the church, and the church-yard.

Thus it is universally known that, when the atmosphere is infected with the matter of small-pox, this disease is produced with the same and even with greater certainty than when the matter of small-pox is introduced by the lancet directly into a blood-vessel in inoculation.

It is equally well known that, when the air is infected by particles of decomposing vegetable and animal matter, fevers are produced of various types and different degrees of intensity; that the exhalations arising from marshes, bogs, and other uncultivated and undrained places, constitute a poison chiefly of a vegetable nature, which produces principally fevers of an intermittent or remittent type; and that exhalations accumulated in close, ill-ventilated, and crowded apartments in the confined situations of densely-populated cities, where little attention is paid to the removal of putrefying and excrementitious matters, constitute a poison chiefly of an animal nature, which produces continued fever of the typhoid character. There are situations in which these putrefying matters, aided by heat and other peculiarities of climate, generate a poison so intense and deadly, that a single inspiration of the air in which they are diffused is capable of producing almost instantaneous death; and there are other situations in which a less highly concentrated poison accumulates, the inspiration of which for a few minutes produces a fever capable of destroying life in from two to twelve hours. In dirty and neglected ships, in damp, crowded, and filthy gaols, in the crowded wards of ill-ventilated hospitals filled with persons labouring under malignant surgical diseases or bad forms of fever, an atmosphere is generated which cannot be breathed long, even by the most healthy and robust, without producing highly dangerous fever.

3. The evidence is just as indubitable that exhalations arise from the bodies of the dead, which are capable of producing disease and death. Many instances are recorded of the communication of small-pox from the corpse of a person who has died of small-pox. This has happened not only in the dwelling-house before interment, but even in the dissecting room. Some years ago five students of anatomy, at the Webb-street school, Southwark, who were pursuing their studies under Mr. Grainger, were seized with small-pox, communicated from a subject on the dissecting-table, though it does not appear that all who were attacked were actually engaged in dissecting this body. One of these young men died. There is reason to believe that emanations from the bodies of persons who have died of other forms of fever have proved injurious and even fatal to individuals who have been much in the same room with the corpse.

The exhalations arising from dead bodies in the dissecting room are in general so much diluted by admixture with atmospheric air, through the ventilation which is kept up, that they do not commonly affect the health in a very striking or marked manner; and by great attention to ventilation, it is no doubt possible to pursue the study of anatomy with tolerable impunity. Yet few teachers of anatomy deny that without this precaution this pursuit is very apt to injure the health, and that, with all the precaution that can be taken, it sometimes produces such a degree of diarrhœa, and at other times such a general derangement of the digestive organs, as imperatively to require an absence for a time from the dissecting room and a residence in the pure air of the country. The same statements are uniformly made by the professors of Veterinary anatomy in this country. The result of inquiries which I have personally made into the state of the health of persons licensed to slaughter horses, called knackers, is, that though they maintain their health apparently unimpaired for some time, yet that after a time the functions of the nutritive organs become impaired, they begin to emaciate, and present a cadaverous appearance, slight wounds fester and become difficult to heal, and that upon the whole they are a short-lived race.

The exhalations arising from dead bodies interred in the vaults of churches, and in church-yards, are also so much diluted with the air of the atmosphere, that they do not commonly affect the health in so immediate and direct a manner as plainly to indicate the source of these noxious influences. It is only when some accidental circumstances have favoured their accumulation or concentration in an unusual degree, that the effects become so sensible as obviously to declare their cause. Every now and then, however, such a concurrence of circumstances does happen, of which there are many instances on record; but it may suffice for the present to mention one, the particulars of which I have received from a gentleman who is known to me, and on the accuracy of whose statements I can rely.

Mr. Hutchinson, surgeon, Farringdon-street, was called on Monday morning, the 15th March, 1841, to attend a girl, aged 14, who was labouring under typhus fever of a highly malignant character. This girl was the daughter of a pew-opener in one of the large city churches, situated in the centre of a small burial ground, which had been used for the interment of the dead for centuries, the ground of which was raised much above its natural level, and was saturated with the remains of the bodies of the dead. There were vaults beneath the church, in which it was still the custom, as it had long been, to bury the dead. The girl in question had recently returned from the country, where she had been at school. On the preceding Friday, that is, on the fourth day before Mr. Hutchinson saw her, she had assisted her mother during three hours and on the Saturday during one hour, in shaking and cleansing the matting of the aisles and pews of the church. The mother stated, that this work was generally done once in six weeks; that the dust and effluvia which arose, always had a peculiarly fœtid and offensive odour, very unlike the dust which collects in private houses; that it invariably made her (the mother) ill for at least a day afterwards; and that it used to make the grandmother of the present patient so unwell, that she was compelled to hire a person to perform this part of her duty. On the afternoon of the same day on which the young person now ill had been engaged in her employment, she was seized with shivering, severe pain in the head, back, and limbs, and other symptoms of commencing fever. On the following day all these symptoms were aggravated, and in two days afterwards, when Mr. Hutchinson first saw her, malignant fever was fully developed, the skin being burning hot, the tongue dry and covered with a dark brown fur, the thirst urgent, the pain of the head, back, and extremities severe, attended with hurried and oppressed breathing, great restlessness and prostration, anxiety of countenance, low muttering delirium, and a pulse of 130 in the minute.

In this case it is probable that particles of noxious animal matter progressively accumulated in the matting during the intervals between the cleansing of it; and that being set free by this operation and diffused in the atmosphere, while they were powerful enough always sensibly to affect even those who were accustomed to inhale them, were sufficiently concentrated to produce actual fever in one wholly unaccustomed to them, and rendered increasingly susceptible to their influence by recent residence in the pure air of the country; for it is remarkable that miasms sometimes act with the greatest intensity on those who habitually breathe the purest air.

The miasms arising from church-yards are in general too much diluted by the surrounding air to strike the neighbouring inhabitants with sudden and severe disease, yet they may materially injure the health, and the evidence appears to me to be decisive that they often do so. Among others who sometimes obviously suffer from this cause, are the families of clergymen, when, as occasionally happens, the vicarage or rectory is situated very close to a full church-yard. I myself know one such clergyman’s family, whose dwelling-house is so close to an extremely full churchyard, that a very disagreeable smell from the graves is always perceptible in some of the sitting and sleeping rooms. The mother of this family states that she has never had a day’s health since she has resided in this house, and that her children are always ailing; and their ill health is attributed, both by the family and their medical friends, to the offensive exhalations from the church-yard.

Dr. Lyon Playfair states as follows in his communication—

There are two kinds of changes which animal and vegetable matters undergo, when exposed to certain influences. These are known by the terms of “decay” and “putrefaction.” Decay, properly so called, is a union of the elements of organic matter with the oxygen of the air; while putrefaction, although generally commencing with decay, is a change or transformation of the elements of the organic body itself, without any necessary union with the oxygen of the air. When decay proceeds in a body without putrefaction, offensive smells are not generated; but if the air in contact with the decaying matter be in any way deficient, the decay passes into putrefaction, and putrid smells arise. Putrid smells are rarely if ever evolved from substances destitute of the element nitrogen.

Both decaying and putrefying matters are capable of communicating their own state of putrefaction or of decay to any organic matter with which they may come in contact. To take the simplest case, a piece of decayed wood, a decaying orange, or a piece of tainted flesh is capable of causing similar decay or putrefaction in another piece of wood, orange, or flesh. In a similar manner the decaying gases evolved from sewers occasion the putrescence of meat or of vegetables hung in the vicinity of the place from which they escape. But this communication of putrefaction is not confined to dead matter. When tainted meat or putrescent blood-puddings are taken as food, their state of putrefaction is frequently communicated to the bodies of the persons who have used them as food. A disease analogous to rot ensues, and generally terminates fatally. Happily this disease is little known among us, but it is of very frequent occurrence in Germany.

The decay or putrefaction communicated by putrid gases or by decaying matters does not always assume one form, but varies according to the organs to which their peculiar state is imparted. If communicated to the blood it might possibly happen that fever may arise; if to the intestines, dysentery or diarrhœa might result; and I think it might even be a question worthy of consideration, whether consumption may not arise from such exposure. Certainly it seems to do so among cattle. The men who are employed in cleaning out drains are very liable to the attacks of dysentery and of diarrhœa; and I recollect instances of similar diseases occurring among some fellow-students, when I attended the dissecting-rooms.

The effects produced by decaying emanations will vary according to the state of putrefaction or decay in which these emanations are, as well as according to their intensity and concentration. Thus it occurs frequently that persons susceptible to contagion may be in the vicinity of a fever patient without acquiring the disease. I know one celebrated medical man who attends his own patients in fever without danger, but who has never been able to take charge of the fever-wards in an infirmary, from the circumstance of his being unable to resist the influence of the contagion under such circumstances. This gentleman has had fever several times. This shows that the contagion of fever requires a certain degree of _concentration_ before it is able to produce its immediate effects. A knowledge of this circumstance has induced several infirmaries (the Bristol infirmary, for example) to abolish altogether fever-wards and to scatter the fever cases indiscriminately through the medical wards. Owing to this distribution, cases in which fever is communicated to other patients or nurses in the infirmary are very unfrequent, although they are far from being so in those hospitals where the fever cases are grouped together.

I consider that the want of attention to the circumstance of the concentration of decaying emanations is a great reason that the effects of miasmata in producing fever is still a _questio vexata_. Thus there may be many church-yards and sewers evolving decaying matter, and yet no fever may occur in the locality. Some other more modified effect may be produced, according to the degree of concentration of the decaying matter, such as diarrhœa or even dysentery; or there may be no perceptible effects produced, although the blood may still be thrown into a diseased state which will render it susceptible to any specific contagion that approaches. It must be remembered that decaying exhalations will not always produce similar effects, but that these will vary not only according to the concentration, but also according to the state of decomposition in which the decaying matters are.

The rennet for making cheese is in a peculiar state of decay, or rather is capable of a series of states of decay, and the flavour of the cheese manufactured by means of it varies also according to the state of the rennet. Just so with the diseases produced by the peculiar state or concentration of decaying matters or of specific contagions. When the Asiatic cholera visited this country many of the towns were afflicted with dysentery before the cholera appeared in an unquestionable form. In like manner the miasmata evolved from church-yards may produce injurious effects which may not be sufficiently marked to call attention until they assume a more serious form by becoming more concentrated. But notwithstanding the absence of marked effects, it is extremely probable that constant exposure to miasmata may produce a diseased state of the blood. Thus I had occasion to visit and report upon, amongst other matters, the state of slaughter-houses in Bristol. These are generally situated in courts, very inefficiently ventilated, as all courts are. I remarked that the men employed in the slaughter-houses had a remarkably cadaverous hue, and this was participated in a greater or less degree by the inhabitants of the court. So much was this the case, that in a court where the smells from the slaughter-house were so offensive that my companion had immediately to retire from sickness, I immediately singled out one person as not belonging to the court from a number of people who ran out of their houses to inquire the object of my visit. The person who attracted my attention from her healthy appearance compared with the others, had entered this court to pay a visit to a neighbour.

§ 11. That conclusions respecting such immensely important effects can only be established by reasonings on facts frequently so scattered over distant times and places as to require much research to bring them together; that those conclusions are still open to controversy, and have hitherto been maintained only by references to statements of distant observations, whilst regularly sustained examinations of the events occurring daily in our large towns might have placed them beyond a doubt; may be submitted as showing the necessity of some public arrangements to ensure constant attention, and complete information on these subjects, as the basis of complete measures of prevention.

§ 12. The conclusions, however, which appear to be firmly established by the evidence, and the preponderant medical testimony, are on every point, as to the essential character of the physical evils connected with the practice of interment, so closely coincident with the conclusions deduced from observation on the continent, that from Dr. Riecke’s report (and to which a prize was awarded by an eminent medical association), in which the preponderant medical opinions are set forth, they may be stated in the following terms:—

“The general conclusions from the foregoing report may be given as follows:

“The injurious effect of the exhalations from the decomposition in question upon the health and life of man is proved by a sufficient number of trustworthy facts;

“That this injurious influence is by no means constant, and depends on varying and not yet sufficiently explained circumstances;

“That this injurious influence is manifest in proportion to the degree of concentration of putrid emanations, especially in confined spaces; and in such cases of concentration the injurious influence is manifest in the production of asphyxia and the sudden and entire extinction of life;

“That, in a state less concentrated, putrid emanations produce various effects on the nerves of less importance, as fainting, nausea, head-ache, languor;

“These emanations, however, if their effect is often repeated, or if the emanations be long applied, produce nervous and putrid fevers; or impart to fevers, which have arisen from other causes, a typhoid or putrid character;

“Apparently they furnish the principal cause of the most developed form of typhus, that is to say, the plague (_Der Bubonenpest_). Besides the products of decomposition, the contagious material may also be active in the emanations arising from dead bodies.”