Читать книгу A supplementary report on the results of a special inquiry into the practice of interment in towns - Edwin Chadwick - Страница 4

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To the Right Honourable Sir James Graham, Bart.,

&c., &c., &c.

Sir,

In compliance with the request which I have had the honour to receive from you, that I would examine the evidence on the practice of interment, and the means of its improvement, and prepare for consideration a Report thereon, I now submit the facts and conclusions following:—

It has been remarked, as a defect in the General Report on the evidence as to the sanitary condition of the labouring population, that it did not comprise any examination of the evidence as to the effects produced on the public health, by the practice of interring the dead amidst the habitations of the town population. I wish here to explain that the omission arose from the subject being too great in its extent, and too special in its nature, to allow of the completion at that time, of any satisfactory investigation in relation to it even if it had not then been under examination by a Committee of the House of Commons, whose Report is now before the public.

To obtain the information on which the following report is founded, I have consulted, as extensively as the time allowed and my opportunities would permit, ministers of religion who are called upon to perform funereal rites in the poorer districts: I have made inquiries of persons of the labouring classes, and of secretaries and officers of benefit societies and burial clubs, in the metropolis and in several provincial towns in the United Kingdom, on the practice of interments in relation to those classes, and on the alterations and improvements that would be most in accordance with their feelings: I have questioned persons following the occupation of undertaker, and more especially those who are chiefly engaged in the interment of the dead of the labouring classes, on the improvements which they deem practicable in the modes of performing that service: I have consulted foreigners resident in the metropolis, on the various modes of interment in their own countries: I have examined the chief administrative regulations thereon in Germany, France, and the United States: and I have consulted several eminent physiologists as to the effects produced on the health of the living, by emanations from human remains in a state of decomposition. I need scarcely premise that the moral as well as the physical facts developed in the course of this inquiry are often exceedingly loathsome; but general conclusions can only be distinctly made out from the various classes of particular facts, and the object being the suggestion of remedies and preventives, it were obviously as unbecoming to yield to disgusts or to evade the examination and calm consideration of those facts, as it would be in the physician or the surgeon, in the performance of his duty with the like object, to shrink from the investigation of the most offensive manifestations of disease.

§ 1. It appears that the necessity of removing interments from the midst of towns is very generally admitted on various considerations, independently of those founded on the presumed injurious effects arising from the practice to the public health. I believe an alteration of the practice is strongly desired by many clergymen of the established church, whose incomes, even with the probable compensation for the loss of burial dues, might be expected to be diminished by the discontinuance of intra-mural interments. Exemptions from a general prohibition of such interments are, however, claimed in favour of particular burial-grounds, situate within populous districts, of which grounds it is stated that they are not over-crowded with bodies, and of which it is further alleged that they have not been known, and cannot be proved, to be injurious to the public health.

The statements as to the innocuousness of particular graveyards are supported by reference to the general testimony of a number of medical witnesses of high professional position, by whom it is alleged that the emanations from decomposing human remains do not produce specific disease, and, further, that they are not generally injurious. The practical consequences of these doctrines extend beyond the present question, and are so important in their effects on the sanitary economy of all towns, as apparently to require that no opportunity should be lost of examining the statements of facts on which they are founded.

The medical evidence of this class has generally been given in answer to complaints made by the public, of the offensiveness, and the danger to health which arises from the practice of dissection in schools of anatomy amidst crowded populations. The chief fact alleged to prove the innocuousness of emanations from the dead is that professors of anatomy experience no injury from them. Thus, Dr. Warren, of Boston, in a paper cited by M. Parent Duchâtelet, states, that he has been accustomed all his life to dissecting-rooms, in which he has been engaged night and day. “It has sometimes happened to me,” he observes, “after having dissected bodies in a state of putrefaction, to have experienced a sort of weakness and the loss of appetite; but the phenomena were never otherwise than transient. During the year 1829, the weather being excessively hot, decomposition advanced with a degree of rapidity such as I have rarely witnessed: at that season the emanations became so irritating, that they paralyzed the hands, producing small pustules and an excessive itching, and yet my general health was in nowise affected.”

Again, whilst it is stated by M. Duchâtelet that students who attend the dissecting-rooms are sometimes seriously injured, and even killed by pricks and cuts with the instruments of dissection, yet it is denied that they are subject to any illness from the emanations from the remains “other than a nausea and a dysentery for two or three days at the commencement of their studies.” Fevers the students of medicine are confessedly liable to, but he says it is only when they are in attendance on the living patients in the fever wards.

Sir Benjamin Brodie pointed out to me, that from the precautions taken, by the removal of such portions of the viscera as might be in an advanced state of decomposition, and from the ventilation of dissecting-rooms being much improved, the emanations from the bodies dissected are not so great as might be supposed; nevertheless, he observes:—

There is no doubt that there are few persons who during the anatomical season are engaged for many hours daily in a dissecting-room for a considerable time, whose health is not affected in a greater or less degree; and there are some whose health suffers considerably. I have known several young men who have not been able to prosecute their studies in the dissecting-room for more than three or four weeks at a time, without being compelled to leave them and go into the country. The great majority, however, do not suffer to that extent, nor in such a way as to cause interruption to their studies; and, altogether, the evil is not on a sufficiently large scale to attract much notice, even among the students themselves.

A writer on public health, Dr. Dunglison, maintains that “we have no satisfactory proof that malaria ever arises from animal putrefaction singly;” and as evidence of this position he adduces the alleged fact of the numbers of students who pass through their education without injury; yet he admits—

In stating the opinion that putrefaction singly does not occasion malarious disease, we do not mean to affirm that air highly charged with putrid miasmata may not, in some cases, powerfully impress the nervous system so as to induce syncope and high nervous disorder; or that, when such miasmata are absorbed by the lungs in a concentrated state, they may not excite putrid disorders, or dispose the frame to unhealthy erysipelatous affections. On the contrary, experiment seems to have shown that they are deleterious when injected; and cases are detailed in which, when exhaled from the dead body, they have excited serious mischief in those exposed to their action. According to Percy, a Dr. Chambon was required by the Dean of the Faculté de Médecine of Paris to demonstrate the liver and its appendages before the faculty on applying for his licence. The decomposition of the subject given him for the demonstration was so far advanced, that Chambon drew the attention of the Dean to it, but he was required to go on. One of the four candidates, Corion, struck by the putrid emanations which escaped from the body as soon as it was opened, fainted, was carried home, and died in seventy hours; another, the celebrated Fourcroy, was attacked with a burning exanthematous eruption; and two others, Laguerenne and Dufresnoy, remained a long time feeble, and the latter never completely recovered. “As for Chambon,” says M. Londe, “indignant at the obstinacy of the Dean, he remained firm in his place, finished his lecture in the midst of the Commissioners, who inundated their handkerchiefs with essences, and, doubtless, owed his safety to his cerebral excitement, which during the night, after a slight febrile attack, gave occasion to a profuse cutaneous exhalation.”

An eminent surgeon, who expressed to me his belief that no injury resulted from emanations from decomposing remains, for he had suffered none, mentioned an instance where he had conducted the post mortem examination of the corpse of a person of celebrity which was in a dreadful state of decomposition, without sustaining any injury; yet he admitted, as a casual incident which did not strike him as militating against the conclusion, that his assistant was immediately after taken ill, and had an exanthematous eruption, and had been compelled to go to the sea side, but had not yet recovered. Another surgeon who had lived for many years near a churchyard in the metropolis, and had never observed any effluvia from it, neither did he perceive any effects of such emanations at church or anywhere else; yet he admitted that his wife perceived the openings of vaults when she went to the church to which the graveyard belonged, and after respiring the air there, would say, “they have opened a vault,” and on inquiry, the fact proved to be so. He admitted also, that formerly in the school of anatomy which he attended, pupils were sometimes attacked with fever, which was called “the dissecting-room fever,” which, since better regulations were adopted, was now unknown.

§ 2. In proof of the position that the emanations from decomposing remains are not injurious to health at any time, reference is commonly made to the statements in the papers of Parent Duchâtelet, wherein he cites instances of the exhumation of bodies in an advanced stage of decomposition without any injurious consequences being experienced by the persons engaged in conducting them.

At the conclusion of this inquiry, and whilst engaged in the preparation of the report, I was favoured by Dr. Forbes with the copy of a report by Dr. V. A. Riecke, of Stuttgart. “On the Influence of Putrefactive Emanations on the Health of Man,” &c., in which the medical evidence of this class is closely investigated. In reference to the statements of Parent Duchâtelet on this question, Dr. Riecke observes—

When Parent Duchâtelet appeals to and gives such prominence to the instance of the disinterments from the churchyard of St. Innocens, and states that they took place without any injurious consequences, although at last all precautions in the mode of disinterring were thrown aside, and that it occurred during the hottest season of the year, and therefore that the putrid emanations might be believed to be in their most powerful and injurious state, I would reply to this by asking the simple question, what occasion was there for the disinterment? Parent Duchâtelet maintains complete silence on this point; but to me the following notices appear worthy of attention. In the year 1554, Houlier and Fernel, and in the year 1738, Lemery, Geoffroy, and Hunaud, raised many complaints of this churchyard; and the two first had asserted that, during the plague, the disease had lingered longest in the neighbourhood of the Cimetière de la Trinité, and that there the greatest number had fallen a sacrifice. In the years 1737 and 1746 the inhabitants of the houses round the churchyard of St. Innocens complained loudly of the revolting stench to which they were exposed. In the year 1755 the matter again came into notice: the inspector who was intrusted with the inquiry, himself saw the vapour rising from a large common grave, and convinced himself of the injurious effects of this vapour on the inhabitants of the neighbouring house.^[1] “Often,” says the author of a paper which we have before often alluded to, “the complexions of the young people who remain in this neighbourhood grow pale. Meat sooner becomes putrid there than elsewhere, and many persons cannot get accustomed to these houses.” In the year 1779, in a cemetery which yearly received from 2000 to 3000 corpses, they dug an immense common grave near to that part of the cemetery which touches upon the Rue de la Lingerie. The grave was 50 feet deep, and made to receive from 1500 to 1600 bodies. But in February, 1780, the whole of the cellars in the street were no longer fit to use. Candles were extinguished by the air in these cellars; and those who only approached the apertures were immediately seized with the most alarming attacks. The evil was only diminished on the bodies being covered with half a foot of lime, and all further interments forbidden. But even that must have been found insufficient, as, after some years, the great work of disinterring the bodies from this churchyard was determined upon. This undertaking, according to Thouret’s report, was carried on from December, 1785, to May, 1786; from December, 1786, to February, 1787; and in August and October of the same year: and it is not unimportant to quote this passage, as it clearly shows how little correct Parent Duchâtelet was in his general statement, that those disinterments took place in the hottest seasons of the year. It is very clear that it was exactly the coldest seasons of the year which were chosen for the work; and though in the year 1787 there occurs the exception of the work having been again begun in August, I think it may be assumed that the weather of this month was unusually cold, and it was therefore thought the work might be carried on without injurious effects. It does not, however, appear to have been considered safe to continue the work at that season, since the report goes on to state that the operations were again discontinued in September.

Against those statements of Parent Duchâtelet, as to the innocuousness of the frequent disinterments in Père La Chaise, statements which are supported by the testimony of Orfila and Ollivier, in regard to their experience of disinterments, I would here place positive facts, which are not to be rejected. “I,” also remarks Duvergie, “have undertaken judicial disinterments, and must declare that, during one of these disinterments at which M. Piedagnel was present with me, we were attacked with an illness, although it was conducted under the shade of a tent, through which there was passing a strong current of wind, and although we used chloride of lime in abundance, M. Piedagnel was confined to his room for six weeks.” Apparently, Duvergie is not far wrong when he states his opinion that Orfila had allowed himself to be misled by his praiseworthy zeal for the more general recognition of the use of disinterments for judicial purposes, to understate the dangers attending them, as doubtless he had used all the precautions during the disinterments which such researches demand: and to these precautions (which Orfila himself recommended) may be attributed the few injurious effects of these disinterments. It, however, deserves mentioning, that, if Orfila did undertake disinterments during the heat of summer, it must have been only very rarely; at least, amongst the numerous special cases which he gives, we find only two which took place in July or August, most of the cases occurred in the coldest season of the year. I cannot refrain from giving, also, the information which Fourcroy gained from the grave-diggers of the churchyard of St. Innocens. Generally they did not seem to rate the danger of displacing the corpses very high: they remarked, however, that some days after the disinterment of the corpses the abdomen would swell, owing to the great development of gas; and that if an opening forced itself at the navel, or anywhere in the region of the belly, there issued forth the most horribly smelling liquid and a mephitic gas; and of the latter they had the greatest fear, as it produced sudden insensibility and faintings. Fourcroy wished much to make further researches into the nature of this gas, but he could not find any grave-digger who could be induced by an offered reward to assist him by finding a body which was in a fit state to produce the gas. They stated, that, at a certain distance, this gas only produced a slight giddiness, a feeling of nausea, languor, and debility. These attacks lasted several hours, and were followed by loss of appetite, weakness, and trembling. “Is it not very probable,” says Fourcroy, “that a poison so terrible that when in a concentrated state, it produced sudden death, should, even when diluted and diffused through the atmosphere, still possess a power sufficient to produce depression of the nervous energy and an entire disorder of their functions? Let any one witness the terror of these grave-diggers, and also see the cadaverous appearance of the greatest number, and all the other signs of the influence of a slow poison, and they will no longer doubt of the dangerous effects of the air from churchyards on the inmates of neighbouring houses.”

After having strenuously asserted the general innocuousness of such emanations, and the absence of foundation for the complaints against the anatomical schools, Parent Duchâtelet concludes by an admission of their offensiveness, and a recommendation in the following terms:—

“Instead of retaining the ‘debris’ of dissection near the theatres of anatomy, it would certainly be better to remove them every day: but as that is often impracticable, there ought, on a good system of ‘assainissement,’ to be considered the mode of retaining them without incurring the risk of suffering from their infection.”

After describing the mode of removing the “debris,” he concludes—

“Thus will this part of the work be freed from the inconveniences which accompanied and formed one of the widest sources of ‘infection,’ and of the disgust which were complained of in the theatres of anatomy.”

§ 3. The statements of M. Duchâtelet respecting the innocuousness of emanations from decomposing animal and vegetable remains, observed by him at the chantiers d’équarrissage, or receptacle for dead horses, and the dépôts de vidange, or receptacle of night soil, &c., at Montfaucon, near Paris, are cited in this country, and on the continent, as leading evidence to sustain the general doctrine; but as it is with his statements of the direct effects of the emanations from the grave-yards, so it is with relation to his statements as to the effects of similar emanations on the health of the population; the facts appear to have been imperfectly observed by him even in his own field of observation. In the Medical Review, conducted by Dr. Forbes, reference is made to the accounts given by Caillard of the epidemic which occurred in the vicinity of the Canal de l'Ourcq near Paris in 1810 and subsequent years:—

In the route from Paris to Pantin (says he), exposed on the one side to the miasmatic emanations of the canal, and on the other, to the putrid effluvia of the voiries, the diseases were numerous, almost all serious and obstinate. This disastrous effect of the union of putrid effluvia with marsh miasmata, was especially evident in one part of this route, termed the Petit Pont hamlet, inhabited by a currier and a gut-spinner, the putrid waters from whose operations are prevented from escaping by the banks of the canal, and exposed before the draining to the emanations of a large marsh. This hamlet was so unhealthy, that of five-and-twenty or thirty inhabitants I visited about twenty were seriously affected, of whom five died.

In the carefully prepared report on the progress of cholera at Paris, made by the commission of medical men, of which Parent Duchâtelet was a member, it is mentioned, as a singular incident, that in those places where putrid emanations prevailed, “le cholera ne s'est montré ni plus redoutable ni plus meurtrier que dans autres localities.” Yet the testimony cited as to this point is that of the Maire, “whose zeal equalled his intelligence,” and he alleges the occurrence of the fact of the liability to fevers which M. Duchâtelet elsewhere denies.

“I have also made some observations which seem to destroy the opinions received at this time, as to the sanitary effect of these kinds of receptacles; for,

“1st. The inhabitants of the houses situated the nearest to the depôt, and which are sometimes tormented with fevers, have never felt any indisposition.”

§ 4. To prove the innocuousness of emanations from human remains on the general health, evidence of another class is adduced, consisting of instances of persons acting as keepers of dissecting rooms, and grave-diggers, and the undertakers’ men, who it is stated have pursued their occupations for long periods, and have nevertheless maintained robust health.

The examination of persons engaged in processes exposed to miasma from decomposing animal remains in general only shows that habit combined with associations of profit often prevents or blunts the perceptions of the most offensive remains. Men with shrunken figures, and the appearance of premature age, and a peculiar cadaverous aspect, have attended as witnesses to attest their own perfectly sound condition, as evidence of the salubrity of their particular occupations. Generally, however, men with robust figures and the hue of health are singled out and presented as examples of the general innocuousness of the offensive miasma generated in the process in which they are engaged. Professor Owen mentions an instance of a witness of this class, a very robust man, the keeper of a dissecting room, who appeared to be in florid health (which however proved not to be so sound as he himself conceived), who professed perfect unconsciousness of having sustained any injury from the occupation, and there was no reason to doubt that he really was unconscious of having sustained or observed any; but it turned out, on inquiry, that he had always had the most offensive and dangerous work done by an inferior assistant; and that within his time he had had no less than eight assistants, and that every one had died, and some of these had been dissected in the theatre where they had served. So, frequently, the sextons of grave-yards, who are robust men, attest the salubrity of the place; but on examining the inferiors, the grave-diggers, it appears, where there is much to do, and even in some of the new cemeteries, that as a class they are unhealthy and cadaverous, and, notwithstanding precautions, often suffer severely on re-opening graves, and that their lives are frequently cut short by the work.^[2] There are very florid and robust undertakers; but, as a class, and with all the precautions they use, they are unhealthy; and a master undertaker, of considerable business in the metropolis, states, that “in nine cases out of ten the undertaker who has much to do with the corpse is a person of cadaverous hue, and you may almost always tell him whenever you see him.” Fellmongers, tanners, or the workmen employed in the preparation of hides, have been instanced by several medical writers as a class who, being exposed to emanations from the skins when in a state of putrefaction, enjoy good health; but it appears that all the workmen are not engaged in the process when the skins are in that state, and that those of them who are, as a class, do experience the common consequences. The whole class of butchers, who are much in the open air and have very active exercise, and who are generally robust and have florid health, are commonly mentioned as instances in proof of the innocuousness of the emanations from the remains in slaughter-houses; but master butchers admit that the men exclusively engaged in the slaughter-houses, in which perfect cleanliness and due ventilation are neglected, are of a cadaverous aspect, and suffer proportionately in their health.

Medical papers have been written in this country and on the continent to show that the exposure of workmen to putrid emanations in the employment of sewer cleansing has no effect on the general health; and when the employers of the labourers engaged in such occupations are questioned on the subject, their general reply is, that their men “have nothing the matter with them:” yet when the class of men who have been engaged in the work during any length of time are assembled; when they are compared with classes of men of the same age and country, and of the like periods of service in other employments free from such emanations, or still more when they are compared with men of the same age coming from the purer atmosphere of a rural district, the fallacy is visible in the class, in their more pallid and shrunken aspect—the evidence of languid circulation and reduced “tone,” and even of vitality—and there is then little doubt of the approximation given me by an engineer who has observed different classes of workmen being correct, that employment under such a mephitic influence as that in question ordinarily entails a loss of at least one-third of the natural duration of life and working ability.

The usual comment of the employers on the admitted facts of the ill-health and general brevity of life of the inferior workmen engaged in such occupations is, “But they drink—they are a drunken set;” and such appears frequently, yet by no means invariably, to be the case. On further examination it appears that the exposure to the emanations is productive of nervous depression, which is constantly urged by the workmen as necessitating the stimulus of spirituous or fermented liquors. The inference that the whole of the effects are ascribable to the habitual indulgence in such stimuli is rebutted by the facts elicited on examination of other classes of workmen who indulge as much or more, but who nevertheless enjoy better health, and a much greater average duration of life. It is apt to be overlooked that the weakly rarely engage in such occupations, or soon quit them; and that, in general, the men are of the most robust classes, and have high wages and rather short hours of work, as well as stimulating food. A French physician, M. Labarraque, states in respect to the tanners, that, notwithstanding the constant exposure to the emanations from putrid fermentations, it has not been “remarked” of the workmen of this class that they are more subject to illness than others. A tanner, in a manual written for the use of the trade, without admitting the correctness of this statement, observes: “Whatever may be the opinion of M. Labarraque on this point, we do not hesitate to declare the fact that this species of labour cannot be borne by weakly, scrofulous, or lymphatic subjects.”^[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.

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:—