Part 13

It is now exactly two centuries, short of ten years, since the visitation of the Great Plague of 1665—that terrible disease which ravaged England for the space of 1249 years: for it is first heard of in English history in the year 430, and the last year in which its name appears in the Bills of Mortality is 1679; that terrible disease which not only maintained undiminished power over this vast space of time, but which sometimes recurred twenty times in one century—that terrible disease is gone. It cannot be supposed that it has worn itself out, for it still frequently returns with its ancient malignity to Constantinople, Alexandria, Smyrna, and other Eastern States.

Petechial or Jail fever, the fatal scourge of the ship, the prison, the hospital, the school, and in short of every place in which any considerable number of persons was assembled, and which when it once broke out was as destructive as the plague—that terrible disease is gone.

Intermittent fever, which in the middle of the fifteenth century and long afterwards recurred like the plague periodically but more frequently, and which often raged as universally, which was sometimes so mortal that the living could hardly bury the dead, and which spared not even the throne, for James I. and Oliver Cromwell both died of ague contracted in London—that formidable disease is gone. Ague, it is true, still exists in the fenny and marshy places which yet remain in England, and we occasionally see a case contracted there in the wards of the London Fever Hospital, but I have not seen a single case of ague contracted in London for upwards of a quarter of a century.

Remittent fever is also gone, scurvy is gone, rickets is gone, malignant sore throat is gone, typhus-gravior is gone, and if small-pox is not gone it is entirely the consequence of our own apathy and folly.

No less remarkable is the gradual decline and the ultimate cessation of certain forms of bowel-complaint of a very painful nature, the very names of which have long disappeared both from medical and popular language. In the 17th century the deaths from two of these diseases alone registered in the Bills of Mortality under two separate titles, were never less than 1000 annually, and in some years they exceeded 4000; but from having been 1070 in the year 1700, they decreased through each successive decade of that century in the following remarkable progression: 770, 706, 350, 150, 110, 80, 70, 40, 20; and they have so entirely disappeared during the 19th century, that, as I have just said, their very names are no longer in use.

Moreover several acute diseases which hardly come under the name of Epidemics, such as Rheumatic Fever, Pneumonia, and Peripneumonia, are much less frequent and fatal now than they were a century ago.

All this time there has been a continually decreasing mortality. In 1700 the estimated mortality of England and Wales was 1 in 39; in 1750 it was 1 in 40; in 1801 it was 1 in 44; in 1810 it was 1 in 49; in 1820 it was 1 in 55, and in 1830 it was 1 in 58.

In London in 1700 the deaths were 1 in 25; in 1750, 1 in 21; in 1801, 1 in 35; in 1810, 1 in 38; and in 1830, 1 in 45.

Footnote 22:

parliamentary Returns, 1811.

Footnote 23:

It is conceived that the remarkable increase of the mortality in the middle of this century was mainly caused by the abuse of spirituous liquors, which was checked about that time by the imposition of high duties.—Sir Gilbert Blane’s Dissertations.

The diminishing number of those who are born merely to die exhibits the decrease of mortality in a still more striking point of view. The estimated mortality of persons under twenty years of age in London in 1780 was 1 in 76; in 1801 it was 1 in 96; in 1830 it was 1 in 124; in 1833 it was 1 in 137; not much more than one-half the proportion who died under twenty half a century ago.

The contrast between the mortality of former times and of the present is seen in the mortality of London in 1685 and in 1830. In the first period the deaths were 1 in 23; in the second they were 1 in 45, little more than one-half. Truly therefore has it been said, that the salubrity of London in the nineteenth century and of London in the seventeenth is far greater than the difference between London in an ordinary season and London in the cholera.

But still we have had Cholera. In less than a quarter of a century we have had three visitations of this dreadful disease, which exhibits the essential characters of a pestilence of the middle ages; and if Typhus-gravior has disappeared, Typhus and its kindred diseases have taken its place; and the Registrar-General constantly presents before our eyes a faithful record of their ravages.

This is too true. We still have epidemics—and why? Because in all our towns there are large portions of the people who live in a state essentially the same as that which existed in the middle ages. The conditions are similar; the results are similar.

It is this unhappy class of people that form the exception to the general progress of the nation to which I have adverted.

These wretched places and their inhabitants do not obtrude themselves on the public eye. They are not seen in our common thoroughfares, nor in our splendid streets and squares. They are not known. The medical man knows them, the minister of religion knows them, the relieving officer knows them, a few dispensers of voluntary charity know them. They are not known to any one else.

Let me then describe one.

It is a small room, say twelve feet square; an inner room; no chimney, no window that will open, no inlet for fresh air, no outlet for foul air. There, on a miserable bed, lies a woman ill of typhus fever; a child at her side on the same bed is dying of that fever; a child already dead of it is stretched out on a table at the bed-side.

I could not breathe the air of that room. I could not remain in it long enough to write a prescription for the poor patients. As I was writing it at the street-door I shivered and felt sick. I knew that I had taken fever. I passed through a very severe form of it. I could take you to hundreds of such houses in every part of London; to hundreds of courts and lanes wholly consisting of such houses.

In such houses, with the conditions of the 15th and 16th centuries, Cholera, in the middle of the 19th, found and exerted a power similar to that which characterized the epidemics of the middle ages, and here Typhus and its kindred diseases continually hold their undisputed reign: houses whose unhealthfulness is increased by the only marks of the age which attach to them, their brick construction and their glass windows; those bricks and windows more effectually than the ancient wattles excluding the external, and confining the internal air, and thereby fostering the generation and spread of typhus. It is remarked by Dr Macculloch, in his account of the Hebrides, that while the inhabitants had no shelter but huts of the most simple construction which afforded free ingress and egress to the air, they were not subject to fevers, but when such habitations were provided as seemed more comfortable and commodious, but which afforded recesses for stagnating air and impurities, then febrile infection was generated. Houses in this state, without ventilation, without the means of cleanliness, worse than the huts of the savage, exist in great numbers in all our towns, and too truly merit the name they have acquired of “fever nests.”

I once took a distinguished statistician of France to some of these places in London, and showed him the sick with typhus lying in their wretched beds; for the sick with typhus may be seen there every day of every year. After the painful inspection he exclaimed—“England is indeed adorned with a splendid mantle, but under it are concealed the greatest horrors.”

Determined that this eminent person should see both sides of the picture, I next took him to the Model Dwellings.

What are the Model Dwellings? Small plots of civilization cultivated in the midst of a wide waste of barbarism.

In what does their civilization consist? In very simple matters.

The subsoil drainage of the site of the building;

The free admission of light and air to each inhabited room;