Part 13

┌───────────────────────────────────────────────────┬────────┬────────┐ │ │ No. of │ Ratio. │ │ │Deaths. │ │ ├───────────────────────────────────────────────────┼────────┼────────┤ │Agents │ 12│1 in 49 │ │Bricklayers and builders │ 14│1 „ 39 │ │Cowkeepers, dairymen, and milkmen │ 8│1 „ 20 │ │Egg merchants │ 5│1 „ 6 │ │Fishmongers │ 11│1 „ 20 │ │Fruiterers and greengrocers │ 12│1 „ 28 │ │Jobmasters, livery-stable keepers │ 5│1 „ 37 │ │Oilmen │ 13│1 „ 46 │ │Paper-makers │ 2│1 „ 15 │ │Poulterers │ 3│1 „ 32 │ │Sail-makers │ 2│1 „ 30 │ │Turners │ 2│1 „ 50 │ │Ballast-heavers │ 7│1 „ 24 │ │Coal-porters and coalheavers │ 53│1 „ 32 │ │Dustmen and scavengers │ 6│1 „ 39 │ │Founders │ 10│1 „ 12 │ │Hawkers, etc. │ 67│1 „ 22 │ │Lithographers │ 3│1 „ 48 │ │Modellers │ 3│1 „ 41 │ │Polishers │ 4│1 „ 36 │ │Sailors, including Greenwich pensioners │ 299│1 „ 24 │ │Tanners │ 22│1 „ 39 │ │Weavers │ 102│1 „ 36 │ │ │ │ │ │Physicians, surgeons, & general practitioners │ 16│1 „ 265 │ │Magistrates, barristers, conveyancers, and │ 13│1 „ 375 │ │ attorneys │ │ │ │Merchants │ 11│1 „ 348 │ │Auctioneers │ 1│1 „ 266 │ │Saddlers │ 1│1 „ 250 │ │Brass-finishers │ 3│1 „ 318 │ │Coach-makers │ 16│1 „ 262 │ │Cork-cutters │ 2│1 „ 279 │ │Footmen and men-servants │ 25│1 „ 1572│ │Jewellers, goldsmiths, and silversmiths │ 6│1 „ 583 │ │Millwrights │ 2│1 „ 266 │ │Tallow-chandlers │ 2│1 „ 430 │ │Type-founders │ 1│1 „ 390 │ │Undertakers │ 2│1 „ 325 │ │Warehousemen │ 8│1 „ 472 │ │Watchmakers │ 11│1 „ 364 │ │Wheelwrights │ 8│1 „ 294 │ └───────────────────────────────────────────────────┴────────┴────────┘

There is one remarkable circumstance connected with Dr. Guy’s table. One master-brewer died of cholera, being 1 in 160 of the trade; but no brewer’s man or brewer’s servant is mentioned as having died of this malady, although these men must constitute a very numerous body in London. There must be a few thousands of them. I have, indeed, met with the deaths of two or three of these persons, in looking over the returns of some of the most fatal weeks in 1849; but the brewers’ men seem to have suffered very slightly both in that and the more recent epidemics. The reason of this probably is, that they never drink water, and are therefore exempted from imbibing the cholera poison in that vehicle.

The great prevalence of cholera along the course of rivers has been well known for a quarter of a century; and it meets with a satisfactory explanation from the mode of communication of the disease which I am inculcating. Rivers always receive the refuse of those living on the banks, and they nearly always supply, at the same time, the drinking water of the community so situated. It has sometimes been objected to the propagation of the disease by the water of rivers, that the epidemic travels as often against the stream as with it. The reply to this is, that people travel both against the stream and with it, and thus convey the malady from village to village and from town to town on the banks, whilst the water serves as a medium to propagate the disease amongst those living at each spot, and thus prevents it from dying out through not reaching fresh victims.

The principles I have laid down afford a satisfactory explanation of the circumstances, that absence of drainage promotes the prevalence of cholera, and that it flourishes better on a clay soil than on primitive rocks, sandstone, or gravel. Without drainage, the refuse of the population permeates the ground, and gains access to the pump-wells. Merthyr Tydvil, with 52,863 inhabitants, is entirely without drainage, and the people derive their supply of water from pump-wells. This place has suffered severely from cholera in every epidemic. In 1849 there were 1,682 deaths from this disease, being 234 to each 10,000 inhabitants,—a rate of mortality as high as in Hull and certain of the south districts of London, where the morbid poison of cholera was distributed by the steam-engines of the water companies. The primitive rocks, sandstone, and gravel, generally cause the purification of the water by the separation or oxidation of organic matters, whilst clay does not exert this salutary influence to the same extent.

Since the latter part of 1848, when I first arrived at my present conclusions respecting the mode of communication of cholera, I have become more and more convinced that many other diseases are propagated in the same way.

When the plague visited this country, it was most fatal in London, York, Winchester, and certain other towns having a river of fresh water passing through them. It resembled cholera also in being twice as fatal in the districts on the south of the Thames as in those on the north. The following passage from Stow’s “Survey”, published in 1633, shows the way in which Southwark was supplied with water about the time of the great visitations of plague: “Southwark useth chiefly the water of the Thames, that falls into a great pond at St. Mary Overies, that drives a mill called St. Saviour’s Mill, the owner whereof is one Mr. Gulston. The revenue thereof is supposed by some to be worth 1,300l. a year.”

Although some of the lower parts of the City were supplied with water from the Thames, at the latter part of the sixteenth and throughout the seventeenth century, yet the greater part of London north of the Thames was supplied by fountains and conduits, conveying spring water from a distance. The following quaint but poetic account of the conduits of London cannot fail to be interesting: “As nature, by veins and arteries, some great and some small, placed up and down all parts of the body, ministereth blood to every part thereof; so was that wholesome water, which was necessary for the good of London, as blood is for the good and health of the body, conveyed by pipes, wooden or metalline, as by veins, to every part of this famous city.... They were lovely streams indeed that did refresh that noble city, one of which was always at work pouring out itself when the rest lay still. Methinks these several conduits of London stood like so many little but strong forts, to confront and give check to that great enemy, fire, as occasion should be. There, methinks, the water was intrenched and in-garrisoned. The several pipes and vehicles of water that were within these conduits, all of them charged with water, till by turning of the cock they were discharged again, were as so many soldiers within these forts, with their musketry charged, ready to keep and defend these places. And look how enemies are wont to deal with these castles, which they take to be impregnable, and despair of every getting by them,—that is, by attempting to storm them by a close siege: so went the fire to work with these little castles of stone, which were not easy for it to burn down (witness their standing to this day); spoiled them, or almost spoiled them, it hath for the present, by cutting off those supplies of water which had vent to flow to them, melting those leaden channels by which it had been conveyed, and thereby, as it were, starving those garrisons which it could not take by storm. As if the fire had been angry with the poor old tankard-bearers, both men and women, for propagating that element which was contrary to it, and carrying it upon their shoulders, as it were, in state and triumph, it hath even destroyed their trade, and threatens to make them perish by fire who had wont to live by water.”

Dr. Farr makes the following remarks on the plague, in his report on the cholera of 1848–9: “It is endemic in the Delta of the Nile, and periodically decimates the population of Cairo and Alexandria.... It grows gradually less fatal up the Nile, and is less frequent and destructive in Upper than in Lower Egypt, in the high lands and in the desert, than on the low lands on the shores of the Mediterranean.” Speaking of Cairo, he says: “Through the midst of it passes the Great Canal, into which the sewers are discharged over carrion, excretion, and mud. At the yearly overflow of the Nile, its waters, filling this canal, are distributed over the city, and drunk by its wretched inhabitants.”

The plague resembles cholera in being much promoted by crowding and want of personal cleanliness. The natives of Gurhwal, a province in the north-west of British India, in which the plague has been present for the last thirty years, believe that it may be transmitted from one place to another in articles of diet, such as a jar of ghee.

Yellow fever, which has been clearly proved by Dr. M’William and others to be a communicable disease, resembles cholera and the plague in flourishing best, as a general rule, on low alluvial soil, and also in spreading greatly where there is a want of personal cleanliness. This disease has more than once appeared in ships sailing up the river Plate, before they have had any communication with the shore. The most probable cause of this circumstance is, that the fresh water of this river, taken up from alongside the ship, contained the evacuations of patients with yellow fever in La Plata or other towns.

It was long ago observed, that dysentery was apparently propagated by the drinking of water containing excrementitious matters. The frequent appearance of this disease in Millbank prison, when the Thames water was used, is a confirmation of this; and Dr. Bryson has lately related a number of instances where both dysentery and fever seemed to be occasioned by the water of the Yangtse-Kiang, the Canton river, and other rivers of China. What very much confirms this view of the case, is, that nearly all the patients were afflicted with great numbers of intestinal worms (lumbrici); for it cannot be supposed that the worms could proceed from malaria, miasmata, or any of the causes which are frequently believed to occasion dysentery and fever. The eggs of the lumbrici were no doubt contained in great numbers in the water of the densely populated Chinese rivers.

There are many facts which indicate that one at least of the continued fevers—the typhoid fever with ulceration of the small intestines—is also propagated in the same way as cholera. Dr. Jenner called my attention some time ago to an instance occurring at the village of North Boston, Erie County, N.Y., in which typhoid fever was probably communicated to a number of families by the contamination of the water of a well which they used. The epidemic which prevailed so extensively at Croydon two years ago was of this character, as was verified by a Committee of the Epidemiological Society, of which Drs. Sankey, Jenner, and A. P. Stewart were members. Mr. Carpenter, of Croydon, has lately shown very ably that this epidemic was connected with the pollution of the pump-wells of the town, owing to the disturbance of the ground, and of many old cesspools during the drainage operations of the Local Board of Health. The Board had supplied the town with good water from a deep well in the chalk, but the population had a prejudice against it and persisted in resorting to the water of the shallow pump-wells. In the autumn of last year diarrhœa was very prevalent in Croydon, and Mr. Carpenter found that this also was caused by the impure water of the pump-wells. Nine-tenths of the people of Croydon were drinking the new water supplied by the Board of Health, but, out of thirty-two patients with diarrhœa who came under the notice of Mr. Carpenter, twenty-five were drinking well-water entirely, five drank water from both sources, and the other two could not decidedly say that they had not drank well-water.

Intermittent fevers are so fixed to particular places that they have deservedly obtained the name of endemics. They spread occasionally, however, much beyond their ordinary localities, and become epidemic. Intermittent fevers are undoubtedly often connected with a marshy state of the soil; for draining the land frequently causes their disappearance. They sometimes, however, exist as endemics, where there is no marshy land or stagnant water within scores of miles. Towards the end of the seventeenth century, intermittent fevers were, for the first time, attributed by Lancisi to noxious effluvia arising from marshes. These supposed effluvia, or marsh miasmata, as they were afterwards called, were thought to arise from decomposing vegetable and animal matter; but, as intermittent fevers have prevailed in many places where there was no decomposing vegetable or animal matter, this opinion has been given up in a great measure; still the belief in miasmata or malaria of some kind, as a cause of intermittents, is very general. It must be acknowledged, however, that there is no direct proof of the existence of malaria or miasmata, much less of their nature.

That preventive of ague, draining the land, must affect the water of a district quite as much as it affects the air, and there is direct evidence to prove that intermittent fever has, at all events in some cases, been caused by drinking the water of marshes. In the “General Report of the Poor Law Commissioners on the Sanitary Condition of Great Britain,” Mr. Wm. Blower, surgeon, of Bedford, states that typhus and ague, which had long infested the village of Wootton, near Bedford, had been much diminished by digging a few wells, and obtaining good water. He also states that, in the neighbouring parish of Houghton, almost the only family which escaped ague, at one time, was that of a respectable farmer who used well-water, whilst all the other families had only ditch water.

M. Boudin relates a very marked instance in which intermittent, and apparently also remittent, fever were caused by drinking marsh water. It is as follows:—

“In July 1834, 800 soldiers, all in good health, embarked on the same day in three transports at Bona, in Algeria, and arrived together at Marseilles; they were exposed to the same atmospheric influences, and were, with one essential difference, supplied with the same food, and subjected to the same discipline. On board one of the vessels were 120 soldiers: of these, 13 died on the passage, from a destructive fever, and 98 more were taken to the military hospital of the lazaretto at Marseilles, presenting all the pathological characters proper to marshy localities. On seeing the physiognomy of these patients, altogether so unusual for Marseilles, one would have said that the Gulf of Mexico, the Delta of the Ganges, and the marshes of Senegal and of Holland, had supplied passengers to this ship. In short, by the side of a simple intermittent, there was a pernicious fever. On an inquiry being instituted, it was ascertained that on board the affected ship the water supplied for the soldiers, owing to the haste of the embarkation, had been taken from a marshy place near Bona; whilst the crew, not one of whom was attacked, were supplied with wholesome water. It further appeared that the nine soldiers who had escaped had purchased water of the crew, and had consequently not drunk the marsh water. Not a single soldier or sailor of the other two transports, who were supplied with pure water, suffered.”

Mr. Grainger, who quotes the above circumstance in his Appendix to the Report on Cholera, also says: “Dr. Evans, of Bedford, related to me an equally well-marked instance. A few years ago, he was staying at Versailles, with his lady, when they both became affected with the ague, and, on inquiry, the following facts were disclosed. The town of Versailles is supplied with water for domestic purposes from the Seine, at Marli. At the time in question, a large tank, supplying one particular quarter, was damaged, and the mayor, without consulting the medical authorities, provided a supply of water, consisting of the surface-drainage of the surrounding country, which is of a marshy character. The regular inhabitants would not use this polluted water; but Dr. and Mrs. Evans, who were at an hotel, drank of it unwittingly, and it was also used by a regiment of cavalry. The result was, that those who drank the water suffered from intermittent fever of so severe a type, that seven or eight of the soldiers, fine young men, died on one day, Sept. 1, 1845. On a careful investigation it was ascertained that those only of the troops who had drunk the marsh water were attacked; all the others, though breathing the same atmosphere, having escaped, as did also the townspeople.”

In all the instances I have just quoted, the cause of ague, whatever it may be, was swallowed with the water, not inhaled with the air; and on questioning two patients, ill with this complaint, in St. George’s Hospital, after harvesting in Kent, they told me that they had often been obliged to drink water from the ditches. The disease of the liver and spleen, to which persons are subject after attacks of intermittent fever, also confirms the view that its material cause enters the system by the alimentary canal, and not by the lungs; and it is of importance to remark, that Hippocrates observed, that drinking stagnating waters caused hard swellings of the spleen.

Whether the unknown cause of ague has been produced in the system of a previous patient, like the pus of small-pox and the eggs of tape-worm, or whether it has been produced externally, there is, at present, no sufficient evidence to show. In the case first supposed, the disease would be a communicable one, in the second it would not.

There is one circumstance which seems to indicate that the specific cause of intermittent fevers undergoes a development or multiplication within the system of the patient,—it is, that a period of dormancy, or incubation, has been observed, in many cases, between the visit to the unhealthy locality and the illness which followed; for, as I have already remarked, every poisonous or injurious substance causes symptoms as soon as it has been absorbed in sufficient quantity.

The communication of ague from person to person has not been observed, and supposing this disease to be communicable, it may be so only indirectly, for the materies morbi eliminated from one patient may require to undergo a process of development or procreation out of the body before it enters another patient, like certain flukes infesting some of the lower animals, and procreating by alternate generations.

The measures which are required for the prevention of cholera, and all diseases which are communicated in the same way as cholera, are of a very simple kind. They may be divided into those which may be carried out in the presence of an epidemic, and those which, as they require time, should be taken beforehand.

The measures which should be adopted during the presence of cholera may be enumerated as follows:—

1st. The strictest cleanliness should be observed by those about the sick. There should be a hand-basin, water, and towel, in every room where there is a cholera patient, and care should be taken that they are frequently used by the nurse and other attendants, more particularly before touching any food.

2nd. The soiled bed linen and body linen of the patient should be immersed in water as soon as they are removed, until such time as they can be washed, lest the evacuations should become dry, and be wafted about as a fine dust. Articles of bedding and clothing which cannot be washed, should be exposed for some time to a temperature of 212° or upwards.

3rd. Care should be taken that the water employed for drinking and preparing food (whether it come from a pump-well, or be conveyed in pipes) is not contaminated with the contents of cesspools, house-drains, or sewers; or, in the event that water free from suspicion cannot be obtained, it should be well boiled, and, if possible, also filtered.

Works are in progress for supplying a great part of London with water from the Thames, obtained, like that of the Lambeth Company, above Teddington Lock. Although this is not the best possible source for supplying a large town, it is a great improvement on the practice of many of the water companies; and the water, owing to filtration, and especially to its detention in large reservoirs, will probably be quite salubrious: at all events it will be much safer than that of the shallow pump-wells of London, which are fed from very polluted sources. It is very desirable that the handles of nearly all the street-pumps of London and other large towns should be fastened up, and the water used only for such purposes as watering the streets. A proper supply of water for the shipping in the Thames is much wanted. Water acquires a flat taste by being boiled; but if it is filtered after it becomes cold, it gets re-aerated, and the flat or vapid taste is entirely removed.

4th. When cholera prevails very much in the neighbourhood, all the provisions which are brought into the house should be well washed with clean water, and exposed to a temperature of 212° Fahr.; or at least they should undergo one of these processes, and be purified either by water or by fire. By being careful to wash the hands, and taking due precautions with regard to food, I consider that a person may spend his time amongst cholera patients without exposing himself to any danger.