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.
[Sidenote: CAUSE OF INTERMITTENT FEVERS.]
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,”[39] 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[40] 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:[41] “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.[42]
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.
[Sidenote: MEASURES REQUIRED FOR THE PREVENTION OF CHOLERA.]
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.
5th. When a case of cholera or other communicable disease appears among
persons living in a crowded room, the healthy should be removed to
another apartment, where it is practicable, leaving only those who are
useful to wait on the sick.
6th. As it would be impossible to clean out coal-pits, and establish
privies and lavatories in them, or even to provide the means of eating a
meal with anything like common decency, the time of working should be
divided into periods of four hours instead of eight, so that the pitmen
might go home to their meals, and be prevented from taking food into the
mines.
7th. The communicability of cholera ought not to be disguised from the
people, under the idea that the knowledge of it would cause a panic, or
occasion the sick to be deserted.
British people would not desert their friends or relatives in illness,
though they should incur danger by attending to them; but the truth is,
that to look on cholera as a “catching” disease, which one may avoid by
a few simple precautions, is a much less discouraging doctrine than that
which supposes it to depend on some mysterious state of the atmosphere
in which we are all of us immersed and obliged to breathe.
The measures which can be taken beforehand to provide against cholera
and other epidemic diseases, which are communicated in a similar way,
are—
8th. To effect good and perfect drainage.
9th. To provide an ample supply of water quite free from contamination
with the contents of sewers, cesspools, and house-drains, or the refuse
of people who navigate the rivers.
10th. To provide model lodging-houses for the vagrant class, and
sufficient house room for the poor generally.
The great benefit of the model lodging-houses arises from the
circumstance that the apartments for cooking, eating, and sleeping, are
distinct, and that all the proper offices which cleanliness and decency
require are provided. The very poor who choose to avail themselves of
these institutions, suffer a rate of mortality as low as that of the
most opulent classes. The public washhouses, which enable poor persons
to wash the soiled linen of the sick or the healthy, without doing it in
the midst of the plates and dishes and provisions of the family, are
well calculated to prevent the spread of disease.
11th. To inculcate habits of personal and domestic cleanliness among the
people everywhere.
12th. Some attention should undoubtedly be directed to persons, and
especially ships, arriving from infected places, in order to segregate
the sick from the healthy. In the instance of cholera, the supervision
would generally not require to be of long duration.
In the autumn of 1853, certain German emigrants, on their way to
America, who had crossed the sea from Hamburgh and Rotterdam, where
cholera was prevailing, to the port of Hull, and had gone thence, by
rail, to Liverpool, were seized with cholera (some of them fatally) in
the latter town; and it is most likely to the well-regulated Emigrant’s
Home, in which these cases occurred, that the town of Liverpool owed its
freedom from the epidemic at that time. And a little medical
supervision, and the detention of some of the emigrants for a short time
in Liverpool, before their embarcation, would probably have prevented
the great mortality which occurred in some of the emigrant ships during
their passage to America.
The measures which are intended to prevent disease should be founded on
a correct knowledge of its causes. For want of this knowledge, the
efforts which have been made to oppose cholera have often had a contrary
effect. In 1849, for instance, the sewers of London were frequently
flushed with water,—a measure which was calculated to increase the
disease in two ways: first, by driving the cholera evacuations into the
river before there was time for the poison to be rendered inert by
decomposition; and second, by making increased calls on the various
companies for water to flush the sewers with,—so that the water which
they sent to their customers remained for a shorter time in the
reservoirs before being distributed. It should be remarked, also, that
the contents of the sewers were driven into the Thames by the flushing,
at low water, and remained flowing up the stream for four or five hours
afterwards. Flushing the sewers was not repeated during the recent
epidemic, but increased quantities of water were distributed by some of
the Companies, and at more frequent intervals, causing the water-butts
to overflow for hours together into the drains, and producing nearly the
same effect as flushing the sewers; in addition to which, the water in
the butts of the Southwark and Vauxhall Company’s customers was
prevented from settling, as it might have done if less frequently
disturbed.
I feel confident, however, that by attending to the above-mentioned
precautions, which I consider to be based on a correct knowledge of the
cause of cholera, this disease may be rendered extremely rare, if indeed
it may not be altogether banished from civilized countries. And the
diminution of mortality ought not to stop with cholera. The deaths
registered under the name of typhus consist chiefly of the typhoid fever
mentioned above. Its victims are composed chiefly of persons of adult
age, who are taken away from their families and connections. In 1847
upwards of 20,000 deaths were registered in England from typhus, and in
1848 upwards of 30,000 deaths. It is probable that seven times as many
deaths have taken place from typhus as from cholera, since the latter
disease first visited England in 1831; and there is great reason to hope
that this mortality may in future be prevented by proper precautions,
resulting from a correct knowledge of the mode of communication of the
malady.
APPENDIX,
Containing the number of deaths from cholera registered in the four
weeks ending 5th August, 1854, together with the supply of water in
the houses in which the fatal attacks took place, in all the
sub-districts to which the water supply of either the Southwark and
Vauxhall or the Lambeth Company extends. (See Table VII, page 84.)
The registers of deaths are copied from the Weekly Returns of the
Registrar-General.
ST. SAVIOUR, SOUTHWARK. _Christchurch._
At 34, Charlotte Street, on 29th July, a stock-maker, aged 29, “Asiatic
cholera 18 hours”
_Lambeth._
At 45, Gravel Lane, on 1st August, the widow of a farmer, aged 48,
“cholera 12 hours”
_Southwark & Vauxhall._
At 1, Alpha Place, on 1st August, a barrister’s clerk, aged 57, “cholera
24 hours”
_Southwark and Vauxhall._
ST. SAVIOUR, SOUTHWARK. _St. Saviour._
At 1, Park Street, on 25th July, the wife of a labourer, aged 35,
“Asiatic cholera 14¹⁄₂ hours”
_Southwark & Vauxhall._
At 40, Bankside, on 25th July, the son of a locksmith, aged 5 years,
“cholera 12 hours”
_Southwark and Vauxhall._
At same house, on 26th July, the daughter of a locksmith, aged 9 yrs.,
“cholera 12 hours”
_Southwark and Vauxhall._
At same house, on 28th July, the daughter of a locksmith, aged 13 yrs.,
“cholera 12 hours”
_Southwark and Vauxhall._
At 97, Bridge Road, on 28th July, a hatter, aged 36, “Asiatic cholera 24
hours”
_Southwark and Vauxhall._
At 49, Great Guildford Street, on 29th July, a coal-porter, aged 44,
“cholera 12 hours”
_Southwark and Vauxhall._
At 20, Zoar Street, on 31st July, a female, formerly a domestic servant,
aged 79, “diarrhœa 2 days, cholera 12 hours”
_Southwark and Vauxhall._
At 22, America Street, on Aug. 1, the wife of an engine-driver, aged 38,
“cholera 12 hours”
_Southwark and Vauxhall._
At 5, Pleasant Place, August 1, the daughter of a coal-porter, aged 5
years, “Asiatic cholera 13 hours”
_Southwark and Vauxhall._
At 10, Castle Street, on 1st August, the son of an engineer, aged 7
years, “cholera 12 hours”
_Southwark and Vauxhall._
At 36, New Park Street, on 1st August, the son of an artist, aged 2
years, “Asiatic cholera 10¹⁄₂ hours”
_Thames water from the tank of a saw-mill._
At 54¹⁄₂, Great Guildford St., on 2nd Aug., a labourer aged 51, “Asiatic
cholera 47 hours”
_Southwark and Vauxhall._
At the same house, same day, the wife of a labourer, aged 48, “Asiatic
cholera 12¹⁄₂ hours”
_Southwark and Vauxhall._
At 2, Emerson Place, on 3rd August, the wife of an engineer, aged 30,
“cholera 2 days”
_Southwark and Vauxhall._
At 29, Norfolk St., on 2d Aug., the son of a labourer, aged 3 years,
“Asiatic cholera 12¹⁄₂ hours”
_Southwark and Vauxhall._
At 68, Great Guildford St., on 3rd Aug., the widow of a labourer, aged
40, “cholera 19 hours”
_Southwark and Vauxhall._
At 10, Castle Street, on 3rd August, the daughter of a labourer, aged 4
years, “cholera 12 hours”
_Southwark and Vauxhall._
At White Hart Inn Yard, on 3rd August, the wife of a porter, aged 49,
“cholera 14 hours”
_Southwark and Vauxhall._
At 22, America Street, on 3rd August, an engine-driver, aged 35,
“cholera 9 hours”
_Southwark and Vauxhall._
At 15, Essex Street, on 4th August, a packer, aged 65, “diarrhœa 4 days,
cholera 11 hours”
_Southwark and Vauxhall._
At 17, Southwark Square, on 3rd August, the wife of an engineer, aged
31, “diarrhœa 1 day, cholera 3 days”
_Southwark and Vauxhall._
At 31, York Place, 5th Aug., the daughter of a labourer, aged 5 yrs.
“Asiatic cholera, 11¹⁄₂ hours”
_Southwark & Vauxhall._
At 50, Great Guildford Street, on 4th August, a baker’s shopwoman, aged
21, “Asiatic cholera”
_Southwark & Vauxhall._
At 10, Russell Place, on 5th August, the widow of a steam-boat stoker,
aged 38, “diarrhœa 4 weeks, Asiatic cholera 20 hours”
_Southwark and Vauxhall._
At 14, Keppel St., 31st July, the daughter of a cooper, aged 4 years,
“Asiatic cholera 12 hours”
_Southwark & Vauxhall._
At 3, Bank End, on 2nd August, a widow of a coach-trimmer, aged 73,
“Asiatic cholera 14 hours”
_Thames water from tank at Messrs. Barclay & Perkins._
ST. OLAVE, SOUTHWARK. _St. Olave._
At St. Thomas’s Hospital (from Grey Eagle Street, Spitalfields), on 27th
July, a labourer, aged 32, “rheumatism, cholera 20 hours”. This patient,
named John Moull, was admitted with rheumatism on 25th July. Water
supply of hospital
_Southwark and Vauxhall and pump-wells on the premises._
At 5, Marble Court, July 28, the son of a basket maker, aged 4 years,
“malignant cholera 12 hours”
_Southwark and Vauxhall._
At the same house, July 30, a stonemason’s daughter, aged 2 yrs.,
“choleraic diarrhœa 2 days”
_Southwark & Vauxhall._
At 3, Gimber’s Rents, July 31, a labourer’s daughter, 13 months,
“Asiatic cholera 7 hours”
_Southwark and Vauxhall._
At Guy’s Hospital, July 30, a dressmaker, aged 19, “cholera”; admitted
with cholera from 2, Port Place, Walworth Common
_Southwark and Vauxhall._
At 3, Gimber’s Rents, Aug. 1, a labourer’s daughter, 3 years, “Asiatic
cholera 48 hours”
_Southwark & Vauxhall._
On board the “Prince Cobourg”, Cotton’s Wharf, on August 2nd, a seaman,
aged 38, “Asiatic cholera 14 hours”
_Most likely Thames water._
At 5, Marble Court, August 1, the daughter of a basket maker, aged 1
year and 4 months, “cholera, congestion of brain”
_Southwark and Vauxhall._
At 6, Darley’s Buildings, August 2, the daughter of a labourer, 2 yrs.,
“Asiatic cholera 14 hrs.”
_Southwk. & Vauxhall._
At Guy’s Hospital, on August 1st, a sailor, aged 16, “cholera”; admitted
with cholera from a ship in the Thames
_Most likely Thames water._
At Guy’s Hospital, on 2nd August, a bookbinder, aged 30, “cholera”; was
taken ill in the train on his way from Portsmouth
_Water supply not ascertained._
At Guy’s Hospital, on 3rd August, the daughter of a block-turner, aged
11 yrs., “cholera”; admitted with cholera from 7, Mint Street,
Southwark.
_Southwark and Vauxhall._
At St. Thomas’s Hospital, supposed from Red Cross Street, Southwark, on
31st July, a charwoman, aged 50, “cholera”
_Water supply not ascertained._
At St. Thomas’s Hospital, from (28) Cole Street, Dover Road, on 2nd
August, a cab-driver, aged 40, “cholera”; admitted with cholera
_Southwark and Vauxhall._
At St. Thomas’s Hospital, from (1 Star Place) Star Corner, Bermondsey,
on 3rd August, a baker, aged 27, “cholera”; admitted with cholera.
_Southwark and Vauxhall._
At 10, Tattle Court, on 4th August, a labourer, aged 46, “Asiatic
cholera 12 hours”
_Southwark and Vauxhall._
At 11, Green Bank, on 4th August, the daughter of a pavior, aged 3
years, “Asiatic cholera 18 hours.”
_Southwark & Vauxhall._
At 24, Mellor Street, on 3rd August, a butcher, aged 73, “cholera 18
hours”
_Southwark and Vauxhall._
At 194, Tooley Street, Aug. 5th, the son of a railway porter, aged 16
months, “cholera”
_Southwark and Vauxhall._
ST. OLAVE, SOUTHWARK. _St. John, Horsleydown._
At 8, Charles Street, July 20, a carman, aged 42, “diarrhœa 3 days,
Asiatic cholera 22 hours”
_Southwark & Vauxhall._
At 19, Bermondsey St., July 26, a labourer’s daughter, aged 5 yrs.,
“cholera Asiatica 4¹⁄₂ hours”
_Southwark & Vauxhall._
At 4, Abdy Street, on 29th July, a corn-turner, aged 60, “Asiatic
cholera, with premonitory diarrhœa, 18 hours”
_Southwark and Vauxhall._
At 12, Bermondsey Street, July 29, a railway porter, aged 34, “malignant
cholera 12 hours”
_Southwark & Vauxhall._
At 5, Gibbon’s Rents, July 29, wife of a railway porter, aged 39,
“malignant cholera 16 hours”
_Southwark & Vauxhall._
At 18, Parish Street, July 29, a carpenter’s labourer, aged 19,
“diarrhœa 4 days, cholera 3 days”
_Southwark & Vauxhall._
At the Union Workhouse, on 30th July, a labourer, aged 40, “Asiatic
cholera 24 hours”; admitted with cholera from 4, Bethel Place, Vine Yard
_Southwark and Vauxhall._
At the Union Workhouse, on 31st July, an apprentice to the sea, aged 16,
“Asiatic cholera 36 hours”; admitted with cholera from on board ship
_Most likely Thames water._
At 5, Bethel Place, July 30, the wife of a corn-turner, aged 35,
“Asiatic cholera 4 hours”
_Southwark and Vauxhall._
At the same house, Aug. 1, daughter of a corn-turner, aged 1 year,
“Asiatic cholera 3 days”
_Southwark and Vauxhall._
At 8, Gibbon’s Rents, Aug. 1, the wife of a carpenter, aged 32, “Asiatic
cholera 12 hours”
_Southwark and Vauxhall._
At 6, Gordon Terrace, on 1st August, the daughter of a coal-porter, aged
2 years and 7 months, “Asiatic cholera 4 hours”
_Southwark and Vauxhall._
At the Union Workhouse, on 1st August, a slater, aged 56, “Asiatic
cholera 24 hours”; admitted with cholera from 4, Magdalen Court, Tooley
Street
_Southwark & Vauxhall._
At the Union Workhouse, on 3rd August, the wife of a labourer, aged 30,
“Asiatic cholera 4 days”; admitted with cholera from 4, Bethel Pl., Vine
Yd.
_Southwark & Vauxhall._