THE COMMON NATURE
OF
EPIDEMICS
AND THEIR RELATION TO CLIMATE AND CIVILIZATION.
ALSO REMARKS ON
CONTAGION AND QUARANTINE.
FROM WRITINGS AND OFFICIAL REPORTS
BY
SOUTHWOOD SMITH, M.D.,
PHYSICIAN TO THE LONDON FEVER HOSPITAL,
CONSULTING PHYSICIAN TO THE HOSPITAL FOR DISEASES OF THE SKIN,
“THE FATHER OF SANITARY REFORM,”
MEMBER OF THE GENERAL BOARD OF HEALTH, 1848–1854,
AUTHOR OF
“THE PHILOSOPHY OF HEALTH;” “THE DIVINE GOVERNMENT,” &C., &C.
EDITED BY
T. BAKER, ESQ.,
OF THE INNER TEMPLE, BARRISTER AT LAW, AUTHOR OF
“THE LAWS RELATING TO PUBLIC HEALTH, SANITARY, MEDICAL, PROTECTIVE;”
“THE LAWS RELATING TO BURIALS,” &C., &C.
PHILADELPHIA:
J. B. LIPPINCOTT & CO.
1866.
------------------------------------------------------------------------
INTRODUCTION.
The recent very serious outbreak of Epidemic disease among the cattle in
England may not unreasonably induce the fear that a human Epidemic is
approaching. Cholera has prevailed in Paris and several other places on
the Continent during the late autumn, and it is well known that the
former visitations of that terrible disease in this country have
appeared the year following similar attacks abroad. Moreover, human
epidemics in numerous instances have been preceded or accompanied by
extensive murrain among cattle.[1]
Footnote 1:
See pp. 7, 65, 110.
Never was a country guided through the perils of an Epidemic with
greater wisdom and energy than Great Britain during the Cholera of
1848–9. The master spirit on that occasion was Dr Southwood Smith. Long
previous to that time this great man had had a more extended experience
of the nature, causes, and treatment of Zymotic diseases than perhaps
any physician before or since. He had made them his special study, and
applied the great powers of his clear, reasoning, and philosophic mind,
to the discovery of their causes, and the best means of arresting their
progress.
Whilst occupying the post of responsibility as the chief medical adviser
of the nation in his capacity of Medical Member of the General Board of
Health, Dr Southwood Smith left behind him a set of official reports on
the subjects of Epidemics, Contagion, and Quarantine, which will never
die.
“The reports drawn up by Dr Southwood Smith,” writes Dean Peacock, “on
the proper precautions to be taken to meet the recent outbreaks of
cholera, have been of the most essential service wherever their
recommendations have been followed. If Dr S. Smith, however, had no
other claims on the lasting gratitude of the nation, I would refer to
his reports on quarantine, as quite sufficient to establish them. They
have contributed, more than any other publications on this subject, to
dissipate the gross and mischievous delusions upon which these
regulations are founded, and which are known to be so injurious to the
free commercial intercourse and prosperity of nations.”
After Dr Southwood Smith left office he gave us a concise summary of his
experience in two masterly lectures, now published, together with
extracts from his official Reports.
In times of distress it is only natural to look for the most efficient
help. Our herds only have extensively suffered of late, but we ourselves
may follow, and it is well to be prepared. Even with reference to the
causes and treatment of the Epizootic, the reasonings, facts, and
conclusions again brought forward in the following pages will apply. But
should the worst fears become realized, and an extensive human epidemic
follow, these writings will tell with greater force, and the nation will
be better prepared to meet the danger, for having calmly considered
beforehand the probability of its approach.
* * * * *
One ground of hope that we may escape a visitation of Cholera during the
coming summer, may be afforded by the remarkably tempestuous weather
which prevailed in December and January last.[2] The loss of the
steam-ship “London,” which foundered in the Bay of Biscay, with 226
souls, on the 11th January, and the still more remarkable fact, that
during the night of the 10th, out of 62 vessels riding at anchor in
Torbay, 41 either foundered or were dashed to pieces on the rocks;—these
were terrible calamities, and they were only the most striking examples
of the numerous wrecks and disasters which occurred in the course of the
late most tempestuous season;—but they afford a hope of escape from a
worse peril, viz. nations prostrated by disease and premature death.
T. B.
KINGSCOTE, WOKINGHAM,
_May, 1866_.
Footnote 2:
See p. 18.
------------------------------------------------------------------------
CONTENTS.
EPIDEMICS—
PAGE
Their Common Nature 1
Are all Fevers:—_e.g._ Plague, Sweating 2
Sickness, Cholera, &c.,
Rapidity of their Course 4
Warnings of their Approach 5
Periodicity of their Return 8
Are produced by the same Causes 10
Foul Air—Overcrowding 12
Attack Animals 7, 13, 16,
65, 110
Their Attendant Signs—Meteorology 17
Action of Air on the Blood 19
Theories of Epidemic Causes 23
Influence of Climate 25
Mortality within the Tropics 29
Their Relation to Civilization 33
State of England in the 14th Century 35
Improvements in the 15th Century 41
Prolongation of Life in the 17th and 45
18th Centuries
Disappearance of the Earlier Epidemics, 51
_e.g._ Jail Fever, Sweating
Sickness, Plague, Typhus-Gravior, &c.
Experience of the Model Dwellings 54
Sanitary Legislation and Works 57, 129
Epidemics are within Human Control 58
QUARANTINE—
Originated in the Belief that Epidemics 61
spread exclusively by
Contagion
Sanitary Measures the only Safeguards 63
Effects Attributed to Contagion 67
Inutility of Quarantine 71
Plague, Yellow Fever, Cholera, &c. 73
Mitigation of Disease by Migration, 75
_e.g._ Tramps
Sanitary Regulation of Ships 77
CONTAGION—
Cholera averted at Baltimore 79
Cholera averted at Newcastle Barracks 82
Yellow Fever in the _Eclair_ 84
Alleged Communication of Disease to Boa 96
Vista, and Examination of
Evidence
Alleged Importation of Disease by the 117
_Dygden_ into Gibraltar, and
Examination of Evidence
APPENDIX.
Sanitary Works accomplished under the 129
Public Health Act
------------------------------------------------------------------------
THE COMMON NATURE
OF
EPIDEMICS.
------------------
Some account of the structure and functions of the human frame, of the
action of physical agents on this wonderful machinery, and of the
principles which relate to Individual, as well as to Public Health,
ought to form a part of elemental education. There is a growing
conviction that the necessity for such knowledge is not restricted to
the physician; that it is essential also to the educator, the mother,
the nurse, and indeed to every one who would enjoy, together with the
due development of his physical, intellectual, and moral nature, the
full term of the boon of life.
The main causes which shorten and embitter human life, as far as that
unhappy result depends on the disturbance of health, are within our own
control. There is the closest connection between the knowledge we have
acquired of the physical conditions on which the life and health of
individuals and communities depend, and on our command over those
conditions. Every fact we have learnt respecting the great laws of
nature, on our conformity to which our very existence depends, has
taught us that the circumstances which produce excessive sickness and
early death are preventible.
The character of Pestilence which gave it its great power and
terror—that it walketh in darkness,—is its character no longer. Its
veil has fallen, and with it its strength. A clear and steady light
now marks its course from its commencement to its end; and that light
places in equally broad and strong relief its antagonist and
conqueror—CLEANLINESS.
* * * * *
The term Epidemic has become a popular one. It is derived from two Greek
words, which signify “upon the people—prevalent among the
people”—diseases which, at one and the same time, prevail extensively
among large masses of the people.
Recently these diseases have received another name, which is also
becoming familiar—“Zymotic,” from a Greek word, which signifies to
“ferment,” as if the efficient cause of these diseases, whatever it may
be, acts in the manner of a ferment.
Epidemic diseases, though called by a common name, present great
differences in their external characters. Plague, Yellow Fever, Cholera,
Small-Pox, Typhus, Scarlet Fever, Influenza, present characters so
definite and special, that they have been naturally regarded as distinct
diseases, and they really are so different as to render it desirable,
for many reasons, that each should be discriminated and denoted by its
proper name. Amidst this great diversity in form, however, they present
very striking resemblances, of which the following are generally
recognized:—
1. Epidemics resemble each other in being all fevers. They all exhibit
that particular assemblage of symptoms which from time immemorial it has
been agreed to denote by the term Fever.
This is as true of the great Epidemics of former times as of those which
prevail in our own.
The so-called Black Death of the 14th century was a fever—an aggravated
form of the Oriental or Bubo-Plague; in which there occurred, in
addition to the ordinary symptoms of that dreadful disease, effusions of
black blood, forming black spots on the arms, face, and chest. From this
circumstance it derived its name. These effusions on the external
surface of the body were accompanied by profuse and mortal discharges
from the internal organs.
The Oriental Plague, the great devastator of Europe in former times, and
still the scourge of some portions of it, is a fever characterized by
specific glandular inflammation.
The Sweating Sickness of the 15th and 16th centuries was a fever, with
symptoms of acute rheumatism, attended with a fœtid perspiration which
poured from the body in streams. “Suddenly,” says Hollingshed, “a deadly
burning sweat assailed their bodies and distempered their blood, and
all, as soon as the sweat took them, yielded the ghost.”
The Cholera of modern times is a fever, which appears in its true
character when the first stroke of the disease does not prove fatal, and
time is allowed for the full development of its successive stages.
The common Epidemics of the day—Ordinary as distinguished from
Extraordinary Epidemics—typhus, scarlet fever, small-pox, measles,—are
so universally recognized as fevers that the popular notion of fever is
derived from the external characters which these maladies present.
2. Epidemics resemble each other in the extent of their range. Ordinary
diseases attack single individuals, and if, from season or other causes,
several cases occur simultaneously, they are still isolated and
scattered. They never prevail at the same time among several members of
a family, or among the inhabitants generally of a court, street, or
town. Epidemics, on the contrary, derive their name from their attacking
large numbers at once.
The great Epidemics of all ages have been strikingly characterized by
their wide-spread course. The Black Death extended from China to
Greenland, and desolated in its course Asia, Europe, and Africa.
The Bubo-Plague of the middle ages often extended beyond its proper
seat. In the 15th century it spread seventeen times over different
European countries, and extended to the most distant northern nations.
The Sweating Sickness prevailed simultaneously or in rapid succession
over England, France, Germany, Prussia, Poland, Russia, Norway, and
Sweden. “It extended,” say the chronicles of the day, “like a violent
conflagration which spread in all directions; yet the flames did not
issue from one focus, but rose up everywhere as if self-ignited.”
The Influenza of the middle ages took a range which may be said to have
been universal. In our own day we have seen the same disease attack
almost every family, in nearly every city, town, and village; spread
within a short period over the whole of Europe, and then extend through
the vast continent of the New World.
Cholera traverses the earth in zones, spreads with equal facility
through tropical and polar regions, and attacks alike the seats of
civilization and the huts of the slave and the savage.
3. Epidemics resemble each other in the rapidity of their course.
Sometimes, indeed, they begin slowly, advance haltingly, and gather
strength in silence. For some time they give so little indication of
their power that the apprehension of their presence is very constantly
regarded as a “false alarm.” Now and then, here and there, they strike a
sudden and mortal blow; but it is only an individual that falls. After a
considerable interval, perhaps at a great distance, another blow is
struck; and then one by one, another and another, until at last the fact
becomes too manifest to be doubted or denied, that two victims have been
seized in one family—several in the same street—three or four on the
same day, in distant parts of the town, or in the adjoining town, or it
may be in towns separated from each other by the distance of hundreds of
miles. At length the terror-stricken nation, startled from its fondly
cherished security, sees no place safe from the Plague. When, however,
the causes are intense, it may break forth quite suddenly, and spread
with astonishing rapidity.
In 1831, when Cholera first appeared in Cairo, it extended within the
space of five days over the whole of Lower Egypt, desolating
simultaneously all the towns and villages of the Delta.
In 1832 it leaped at one bound from London to Paris, and when once
there, spread in five days over thirty-five out of forty-eight quarters
of the city.
When Influenza broke out in London in 1847, it spread in one day over
every part of the metropolis, and upwards of 500,000 persons suffered
from the malady.
4. Epidemics resemble each other in giving distinct and unmistakeable
warnings of their approach. These warnings consist of two events: first,
the sudden outbreak and general spread of some milder epidemic; and,
secondly, the transformation of ordinary diseases into diseases of a new
type, more or less resembling the character of the extraordinary disease
at hand.
It is a very singular fact that both in the middle ages, and in modern
times, the lesser Epidemic which has generally preceded and
pre-announced the coming of the greater, is Influenza.
The history of European Epidemics from the 14th century downwards, shows
that whenever a new Plague was at hand, destined to become truly
European, it was preceded by a sudden outbreak of Influenza, as general
as it was violent. This is exemplified with singular uniformity in the
Epidemics of the 16th century—the severest epidemic period on record. It
is most remarkable that in our own day the first visitation of Epidemic
Cholera was preceded by an outbreak of Influenza which resembled, in the
most minute particulars, the violent and universal Influenza that
ushered in the mortal Sweating Sickness Epidemic of 1517.
So again, on the second visitation of Cholera, in 1848, it was preceded,
as we have just seen, by the universal Influenza of 1847.[3]
Footnote 3:
It may be remarked that for some time prior to the Cattle Plague in
the autumn of 1865, the disease called _pleuro-pneumonia_ had
extensively prevailed among the herds throughout the country. [ED.]
The second circumstance, and a most instructive one it is, premonitory
of the advent of a great Epidemic, is a general transformation of the
type of ordinary diseases into the characteristic type of the
approaching pestilence. Sydenham gives a graphic description of such a
transformation in the character of the fevers and inflammatory diseases
prevailing in London some months before the outbreak of the Great
Plague. He states that this change consisted in an approximation, in
several striking features, of the general type of disease, to the
distinguishing characters of the Pestilence which had not yet appeared,
but was close at hand.
In 1831, in the wards of the London Fever Hospital, I observed and
recorded a precisely similar change in the general type of the fevers in
London, six months before the first visitation of Cholera. Anterior to
that period, fever in London, for a long series of years, had been
essentially an acute, inflammatory disease, for which bloodletting and
other depleting remedies were indispensable. At this period it ceased to
be an inflammatory disease; it became a disease of debility, in which no
one could think of bleeding; and so closely did the prevailing fever now
put on the general character of the approaching plague, which was as yet
six months distant, that the fever into which those Cholera patients
fell, who were not killed by the first stroke—the consecutive fever, as
it was afterwards called—could not be distinguished from the primary
fever in the wards of the Hospital when Cholera was at its height, which
had appeared there for the first time six months previously, and which
has never disappeared since.[4]
Footnote 4:
This was written in November, 1855.
It is further very remarkable that the Professors of Veterinary Medicine
and Surgery in London noted at the same time a similar change in the
type of the diseases of the lower animals—horses, cows, sheep, and all
domestic creatures;—a change requiring a similar modification of the
remedies which they had been in the habit of using.
5. A further character of great Epidemics, partly arising from the last,
is this:—they are actually present and in operation some time before
they assume their distinct and proper form. Sometimes, indeed, the very
first cases are most intense and characteristic, but at others they are
scarcely to be distinguished from the severer attacks of ordinary
disease of a like nature. Hence doubt is sometimes reasonably
entertained of their true character. When at length increasing numbers
leave no doubt of the actual presence of the dreaded malady, the first
announcement of it is always received with incredulity and sometimes
with resentment; and so it is that Epidemics always take a country by
surprise—burst suddenly on an unprepared people, who wilfully shut their
eyes against the plainest evidence, as if they would avert the event by
denying its existence.
6. Again, Epidemics resemble each other in the uniformity of their
course. They present, with great regularity, periods of comparative
quiescence and activity—periods of well-marked increase, culmination,
and decrease.
7. They further resemble each other in the manner of their migration.
They advance by leaps. On breaking out in a locality they soon come to
their height, decline, and disappear. Then they attack another locality;
here they pass through precisely the same process as before, and proceed
to a third, fourth, or fifth district, and so on. Sometimes indeed they
localize themselves on the same spot for a considerable period, and then
several places may be simultaneously affected; but for the most part a
large city may be regarded as a cluster of towns, through the several
districts of which epidemics advance as if they were proceeding from one
town or village to another. Hence the duration of an epidemic in a place
is generally proportionate to its size. The several localities attacked
being visited in succession, a space of time is required to spread
through the whole of them proportionate to the magnitude of the town.
8. Epidemics resemble each other in the periodicity of their return.
On its first visitation (1485) the Sweating Sickness spread over the
whole of England in the course of one year, when it disappeared.
After an interval of twenty years it broke out a second time quite
suddenly (1505); revisited nearly all the seats of its former ravages,
and again disappeared at the end of six months.
On its third visitation (1517), after an interval of eleven years, it
again finished its course within six months.
Its fourth visitation (1528) was repeated after a further interval of
precisely eleven years. Such was its violence on this occasion, that the
historians of that day designate this period by the significant name of
the “Great Mortality.” It drove Henry VIII. from London, destroyed
several of the most distinguished persons of the Court, impressed the
nation, from the monarch to the peasant, with an awful feeling of the
uncertainty of life, continued its destructive course for its accustomed
period of six months, and then again disappeared.
From this to its fifth and last visitation, twenty-three years elapsed
(from 1528 to 1551.) It then broke out with unmitigated fury, spread
once more over the whole of England, ceased within six months, and from
that period has never reappeared in any country.
The Oriental Plague of the middle ages returned with a like periodicity;
and so it does at the present day in the countries in which it maintains
its ancient reign. It recurs with much regularity about every ten years.
The Fever Epidemics of the metropolis return pretty constantly about
every ten or twelve years.
The Irish Typhus Epidemics have recurred nearly decennially for the last
150 years.
Epidemic Cholera, on its first visitation, ravaged Great Britain for a
period of fifteen months. It then wholly ceased; after an interval of
sixteen years it again broke out, and pursued its former course for the
same exact period of fifteen months, and then ceased.
Within the brief interval of only five years, it last year (1854)
accomplished its third visitation. It now protracted its stay for a
period of seventeen months; coming sooner and staying longer.
9. Again, Epidemics resemble each other in the brevity of the space that
intervenes between the attack and death.
The Black Death was often fatal on the first day of the attack—generally
on the third or fourth. In England it was sometimes fatal within twelve
hours, and frequently in two days, particularly when spitting of blood
or any other form of hœmorrhage was amongst the early symptoms.
The violent inflammatory fever which characterized the Sweating
Sickness, generally ran its course in a few hours; in severe cases,
indeed, the crisis was always over within a day and night, but it often
proved fatal in six hours.
In our own day we have witnessed many instances in which Epidemic
Cholera was fatal within twelve hours. I have known several in which the
fatal event followed in ten hours, the patient having been within an
hour of the dreaded attack in _apparent_ health.
In all great epidemics the protraction of the disease beyond three or
four days is a favourable omen. One of the objects in the treatment of
the sick is to gain time. If Nature’s first violent effort to expel the
enemy that has taken possession of the system, does not destroy life,
the vital powers rally, and the frame often survives the storm.
10. Lastly, Epidemics resemble each other in being produced by the same
causes. The whole tenor of experience shows that whatever produces an
especial liability to one epidemic, produces a similar liability to
every other.
The Causes of epidemics, as of all other diseases, are divided into two
classes,—the predisposing and the primary. The predisposing causes are
those circumstances which bring the body into a fit state for the action
of the primary. The primary cause is the agent which directly and
immediately excites the disease.
If a number of persons, in an ordinary state of health, say a hundred,
are exposed to the primary cause of any epidemic—to the poison of
Cholera for example—probably not more than ten would be seized with the
disease. Why do the ninety escape? The poison, by the supposition,
encompasses and acts upon all alike: why do ten only suffer? Suppose
these same hundred persons took a large dose of arsenic, or an over-dose
of chloroform, not only would not one in ten escape, but every
individual would certainly perish.
It is conceived that the primary cause cannot take effect unless the
system be in a state of susceptibility to its action; that there is in
the body an innate power of resistance to all noxious agents of this
kind, rendering it, when in full vigour, invulnerable to them; that
there are certain circumstances which weaken or destroy this resisting
power, and which even impart to the body a peculiar susceptibility to
the influence of such agents—and these circumstances are called
predisposing causes.
The predisposing causes of epidemics may be divided into two
classes—External and Internal. The external are those which vitiate the
atmosphere; the internal are those which more immediately vitiate the
blood.
The vitiators of the atmosphere include overcrowding, filth, putrescent
animal and vegetable matters of all kinds, exhalations from foul
cesspools, sewers, rivers, canals, ditches, marshes, swamps, &c. Causes
of this class are also called _localizing_, because they favour the
generation and spread of epidemics in the localities in which they
abound.
The causes which more immediately act from within are those which either
directly introduce pernicious matters into the interior of the body, in
the shape of foul water or putrescent food; or which indirectly
accumulate noxious matters within the system, by impairing the action of
the excretory or depurating organs whose office it is to maintain the
blood in a state of purity, by removing out of the system substances
which having served their purpose have become useless and pernicious.
The earnest attention which has been recently directed to the first
class of causes has led to an advancement in the science of prevention,
the importance of which it is impossible to over-estimate.
To give only one illustration of the action of a predisposing cause, I
select as my example, _Overcrowding_.
The Statistical Society of London some time ago appointed a Committee of
its Council to make a house-to-house examination of the parish of
Marylebone, with a view to ascertain how many families in the parish
occupied a single room as a living and sleeping room. In the course of
this inquiry, one of the examiners came to a house in which there was
one remarkable room. It was occupied not by one family only, but by
five. A separate family ate, drank, and slept in each of the four
corners of this room; a fifth occupied the centre.
“But how can you exist,” said the visitor to a poor woman whom he found
in the room (the other inmates being absent on their several
avocations), “how can you possibly exist?”
“Oh, indeed, your honour,” she replied, “we did very well until the
gentleman in the middle took in a lodger.”
I see every day in the wards of the Fever Hospital the consequence of
taking in such lodgers. An epidemic shows it not more truly, but more
strikingly.
Within the walls of an establishment for pauper children at Tooting, in
1849, there were crowded 1395 children. Little more than one hundred
cubic feet of breathing space was allowed for each child, 500 being the
smallest compatible with safety. One night Cholera attacked sixty-four
of these children; 300 were attacked in all. Within a week 180 perished.
In the Workhouse of Taunton there were 276 inmates. In some of the rooms
the breathing space was not more than sixty-eight cubic feet. Cholera
swept away 60 of these inhabitants in less than a week.
In the County Jail of this same town, the breathing space allowed to
each prisoner ranges from 819 to 935 cubic feet. Not a single case of
cholera, nor even of diarrhœa, occurred among the prisoners in this
jail.
The town’s people also escaped, while in the overcrowded workhouses, 22
per cent. of the total number of the inhabitants were swept away.
In the village of East Farleigh, near Maidstone, 1000 persons were
assembled for hop-picking. They were lodged in sheds, and had about
eighty cubic feet for breathing space: in a few days diarrhœa became
universal among them: ninety-seven were attacked with cholera, and
forty-six died. In the same village, at the same time, under another
employer who had provided proper accommodation for his labourers, there
was a complete immunity from the epidemic.
I could add cases of the like kind without number. I could show that
animals are affected by this cause of disease no less than men; that
horses overcrowded in stables die of glanders; dogs in overcrowded
kennels die of distemper; sheep overcrowded in ships, even during a
short passage from one country to another, die in great numbers of
febrile diseases:[5] results which prove the operation of a general law
of nature. I could adduce equally decisive examples of the action of
each of the principal external predisposing causes just enumerated.
It has been often said that we cannot tell the difference between the
air of the mountain-side and that of the crowded hospitals and
fever-nests of towns. If it were so, it would be sufficient to say, Life
is a more delicate test than Chemistry. But it is not so. The impurities
in these pernicious places can be detected by chemical analysis, and
examined as readily as the constituents of the atmosphere itself.
Footnote 5:
It has been alleged that the Cattle Plague owed its existence to these
among perhaps other kindred causes, and human Epidemics have
frequently been preceded or accompanied by a murrain among Cattle. See
p. 7, and Boa Vista fever, _pot._ [ED.]
The moisture in the air of a crowded room may be condensed by ice. It
condenses indeed spontaneously on the walls and windows, and on all
surfaces, and may be collected in sufficient quantity for examination
and experiment.
If a portion of this deposit be put on a piece of platinum and burnt, a
strong odour of organic substance is given off, and a quantity of
charcoal remains. If the deposit be allowed to stand for a few days, it
forms a solid, thick, glutinous mass, having a strong odour of animal
matter. If examined by a microscope, it is seen to undergo a remarkable
change. First of all, it is converted into a vegetable growth, and this
is followed by the production of multitudes of animalcules,—a decisive
proof that it must contain organic matter, otherwise it could not
nourish organic beings.[6]
Footnote 6:
See the interesting experiments of Dr Angus Smith, on the Air and
Water of Towns, “Report of the British Association for the Advancement
of Science,” p. 16, _et seq._
At every expiration the lungs pour a portion of organic matter into the
surrounding atmosphere; at every moment the skin does the same. This
matter is the dead portion of the body, which it is one of the special
offices of these depurating organs to remove out of the living system as
useless and pernicious.
It is indeed pernicious, for it is an animal poison, more concentrated
in this than in any other form of excrementitious matter, since in other
excretions the noxious particles, in their transmission out of the body,
are diluted with other substances, but as they issue from the lungs and
skin, they are in a great degree undiluted. Ventilation and cleanliness
prevent this matter from accumulating, and render it innoxious. But it
collects in large quantities on the furniture and walls of dirty houses,
and is the main cause of the disagreeable smell of the rooms in which it
abounds. In some instances the walls are coated with it. It was so in
one particular building in which, during a local epidemic outbreak,
twelve persons were attacked with cholera, and four died.
From recent chemical and microscopical examinations of the air of some
crowded and filthy localities in the metropolis, it appears as a general
result, that decomposing organic matter is always contained in such
air,—the never-failing presence of animalcules testifying its existence,
and their number and size indicating its amount.
Imagine the state of the atmosphere in the dormitories of the Tooting
children: in the sixty-eight cubic feet of breathing space of the
inmates of the Taunton Workhouse; in the eighty cubic feet of the
Kentish hop-pickers; in the four corners and centre of the five-family
room.
Conceive the state of the atmosphere in this room at night; all the
members of the several families, collected; every breath of external air
excluded; the windows, and perhaps even the chimney, carefully fastened
up. This stagnant and poisoned air, breathed over and over again by
every individual for seven or eight hours continuously; respiration, the
special and admirable apparatus which nature has constructed for
purifying the blood, thus made the very means of corrupting it. I have
known from two to three cases of typhus produced nightly, for a
fortnight together, in a room of this description, by sleeping in it for
a single night! Can we wonder at the generation of typhus in such a room
in _ordinary_ seasons! Can we wonder at the spread and the havoc of an
epidemic in it in _epidemic_ seasons?
* * * * *
But besides the contamination of the air by external causes, it is
conceived that the atmosphere itself undergoes natural changes which
predispose it to the development and spread of epidemics. From time
immemorial, the popular belief has been that such changes do take place,
and that they manifest themselves by unmistakeable signs.
Among such signs may be reckoned,—a disturbance of the regular and
ordinary condition of the atmosphere; an inversion of the seasons—summer
in winter, and winter in summer; long-continued drought succeeded by
torrents of rain, causing rivers to overflow, and the seed to rot in the
earth; cloud, mist, fog, favouring excessive dampness, under the
influence of which spring up inordinate growths of the lower species of
plants, producing mouldiness, and the blood-spots, and other coloured
vegetation that adhere to houses, and household furniture, and wearing
apparel, and personal ornaments, and the person itself; under which
also, fostered by a steadily elevated temperature, spring into being and
activity, myriads of the lower tribes of animals—locusts, caterpillars,
flies,[7] frogs, covering the face of the earth, and devouring every
green thing that the deluge of rain had left; and, as the sequence of
these antecedent conditions, dearth and famine, closing the long series
of the year’s calamities. Such, in all ages and countries, have been the
recognized portents and precursors of a coming year of pestilence.
Footnote 7:
During the autumn following the extraordinary summer of 1865, and in
which the Cattle Plague appeared, there was a very marked
preponderance of insect life as compared with ordinary seasons. It is
asserted by Mr Mc Dougall, of Manchester, that no case of this plague
is known to have occurred where his disinfectant, which arrests
decomposition, had been freely applied to and about the cattle. [ED.]
And there is truth in this.
It is quite certain that such atmospheric changes do take place, and
prepare the way for pestilence. It is quite certain that there is an
epidemic meteorology. This epidemic condition of the atmosphere is at
length coming within the range of science. The first step towards this
result, which promises to be of the highest practical value, we owe to
the well-devised and patient observations of Mr Glashier, continued
through the three recent Cholera epidemics.
Among other important facts, he has determined that there is—1. An
increased pressure of the atmosphere, greatest at the worst period of
the epidemic.
2. An increased density of the atmosphere, not arising from an increase
of watery vapour; for,
3. The quantity of water in the air was 1/20th less than the average, at
the same time that the mean weight of a cubic foot of air was 2 grains
above the average.
4. An unusual alternation of heat and cold, yet the heat predominating
to such an extent that in particular localities it rose as much as from
2° to 8° above the average. These excesses were most striking at night,
particularly in the parts of London on a level with the Thames, where
the night temperatures ranged from 7°, 8°, 9°, and 10° above the
temperature of the country, and even of the suburban districts. These
temperatures were highest, especially the night ones, when the mortality
was greatest; and the mortality was greatest where the temperatures were
highest.
5. A remarkable increase above the average in the temperature of the
water of the Thames. From a long series of observations it had been
found that the normal temperature of the Thames is 51.7°. During the
prevalence of the epidemic it rose to 60°, 66°, and once to 70°. At this
temperature the “simmering” water must have poured enormous quantities
of vapour into the surrounding atmosphere; not the pure vapour of water,
for that cannot arise from a river which is the recipient of the foul
contents of all the sewers and cesspools of the metropolis. In some
instances there was an excess of 20° of the temperature of the water
above that of the air. For twenty-eight continuous nights during the
height of the epidemic, the average excess exceeded 16.5°.
6. An unusual prevalence of haze, mist, and fog; the fog being sometimes
so dense that London could not be discerned from Greenwich.
7. An extraordinary stillness and stagnation of the air, both by day and
night. Sometimes in the low-lying districts not a breath could be
observed. Even when at more elevated stations the wind was moving with a
force of 1 lb 7 oz., the pressure was only ¼ lb in the heart of London.
Wind is the ventilator of nature. Artificial ventilation, as far as it
is successful, is an imitation of nature’s process. It is stated on
undoubted authority (Maitland’s History of London) that for several
weeks before the Great Plague broke out in London, there was an
uninterrupted calm, so that there was not sufficient motion of the air
to stir a vane. Baynard, a contemporary physician, confirms this fact.
The like circumstance is mentioned by Diemerbroeck in giving an account
of the plague at Nimeguen. At the period when the last plague visited
Vienna, according to Sir Gilbert Blane, there had been no wind for three
months. The terrific outbreak of the cholera at Kurrachee was preceded
for some days by such a stagnation of the atmosphere that an oppression
scarcely to be endured affected the whole population. It is obvious that
calms must favour the accumulation and concentration of effluvia from
every source from which they arise.
8. A general deficiency in the tension of common positive electricity.
9. A deficiency of one fourth of the rain-fall for the year. During 118
consecutive days there was scarcely any rain, and not a single drop for
18 days at the period of the highest mortality.
10. A total absence of ozone at all the stations near the river, while
at stations of high elevation it was of general occurrence.
These observations relate particularly to the epidemic of 1854, which
was more carefully watched than the two former; but the results are
similar for each.
“The three epidemics,” says Mr Glashier, in summing up the results of
his inquiry, “were attended with a particular state of atmosphere,
characterized by a prevalent mist, thin in high places, dense in low.
During the height of the epidemic, in all cases, the reading of the
barometer was remarkably high, the atmosphere thick; and in 1849 and
1854 the temperature above its average. A total absence of rain, and a
stillness of air amounting almost to calm, accompanied the progress of
the disease on each occasion. In places near the river, the night
temperatures were high, with small diurnal range, with a dense torpid
mist and air charged with the many impurities arising from the
exhalations of the Thames, and adjoining marshes; a deficiency of
electricity, and, as shown in 1854, a total absence of ozone, most
probably destroyed by the decomposition of the organic matter with which
the air in these situations is so strongly charged.
“In both 1849 and 1854, the first decline of the disease was marked by a
decrease in the readings of the barometer, and in the temperature of the
air and water; the air, which previously had for a long time continued
calm, was succeeded by a strong S. W. wind, which soon dissipated the
former stagnant and poisonous atmosphere.”
We knew before that such influences were in operation, but they had not
been weighed and measured. We now know definitely something of an
epidemic atmosphere, and the information obtained is most significant;
for it shows that the several meteorological changes that take place
during the prevalence of an epidemic concur to produce a heavy, warm,
moist, and stagnant atmosphere, with disturbed electricity: conditions
highly favourable to the decomposition of organic matter.
Under the influence of such an atmosphere, over the moist and warmed
surface of every filthy place, over the entire mass of all accumulations
of filth in streets, lanes, and courts, and within and about houses, and
over the heated surface of all foul water, decomposition goes on with
the utmost activity, and the products are poured into the stagnant air.
Against such products the human body has no defence. The lungs admit
whatever is brought to them—poisonous and salubrious substances alike.
They are guarded by none of those protective contrivances which we see
in some other parts of the body. Whatever is capable of suspension in
the respired air passes with it directly into the current of the
circulation, and when once there, is carried with astonishing rapidity
into the very substance of the vital organs.
From the quantity of air which the lungs receive, some conception may be
formed of the amount of obnoxious matter which may be introduced into
the system through these portals.
At each inspiration there enter the lungs of an ordinary-sized person
about 20 cubic inches of air. There are 20 respirations in a minute: 400
cubic inches of air must therefore enter in one minute; 14 cubic feet in
one hour, and 366 cubic feet, or 36 hogsheads, in one day. To meet this
the heart sends into the lungs at each contraction two ounces of blood;
there are 75 pulsations in a minute, during which 150 ounces are
propelled into the lungs; a quantity which gives 562 pounds in one hour
and 24 hogsheads in 24 hours.
The main purpose for bringing these enormous quantities of air and blood
together, with such velocity, is to provide for the enormous waste which
is caused by the rapid and unceasing mutation of organic matter. The
activity of an organ is sustained at the expense of the matter of which
it is composed. No thought passes through the mind, but an equivalent
portion of the substance of the brain is consumed; no nervous current
flows along the nervous conducters, but a corresponding portion of
nervous tissue is used up; no muscular movement, no glandular secretion,
takes place without a proportionate waste of muscle and of gland. What
must be the amount of supply required to meet this waste, when
able-bodied men employed in their ordinary labour lose from 2 lbs. to 5
lbs. and upwards of their weight twice a day.[8] Some physiologists of
eminence have estimated that in order to supply that waste, there passes
in the course of every 24 hours as much fluid through the thoracic
duct[9] as equals the whole quantity of blood in the body.
Footnote 8:
See Experiments on the daily loss of weight sustained by workmen
employed in gas-works.—_Philosophy of Health_, 11th Edit. p. 284, _et
seq._
Footnote 9:
The tube which conveys the debris of the body, together with the
nutritious part of the food,—both measures of change or waste.
The results of the highly interesting experiments recently made by
Professor Graham on the part taken by the active agent in all these
processes—organic membrane, of which the organic cell is the type,
demonstrates that all the phenomena known as Endosmose and Exosmose
depend on a chemical action involving the destruction of organic
membrane. In this process chemical action is set up dependent upon
active chemical agents, neutral substances being inoperative. Out of
this chemical action a new force is induced, the _Osmotic_ force; a
purely chemical being converted into an equivalent mechanical force,
which is made subservient to the essential phenomena of organic and
animal life: a _vis motrix_, a force which is to the extra-vascular
movements of the body, what the contraction of the heart is to the
vascular.
In a frame so constructed, any particles contaminating the circulating
fluid most rapidly pervade and contaminate every part of the system.
It has been sometimes imagined that the quantity of matter suspended in
the atmosphere and conveyed into the system in respired air, must be too
minute to exert any serious influence upon the body.
One single puncture of the finger, so small as not to be visible without
the aid of a lens, has introduced into the system a sufficient quantity
of putrid matter to cause death with the most violent symptoms.
A few drops of the liquid matter obtained by a condensation of the air
of a foul locality, introduced into the vein of a dog, is stated to have
produced death with the usual phenomena of typhus fever.
It is certain that on the introduction into the body of an inappreciable
portion of the matter of cow-pox, or of small-pox, those specific forms
of fever are produced.
From these and similar facts it is inferred, that when putrescent or
decomposing organic matter is introduced into the blood it acts as a
poison and produces the phenomena of fever, and that all the
predisposing causes of epidemics act in this way—by overcharging the
blood with the products of decomposing organic matter.
Strictly speaking, however, all that we really know is this—that where
certain conditions exist, epidemics break out and spread; that where
those conditions do not exist, epidemics do not break out and spread;
and that where those conditions did exist, but have been removed,
thereupon epidemics cease.
We call those conditions Causes, Predisposing or Localizing Causes, but
how they act, whether by accumulating decomposing organic matter in the
blood, or in what other way, we have no certain knowledge.
One further fact however is ascertained, that where any one of these
predisposing causes is present, epidemics break out and spread just as
readily as when all are present together.
Where there is overcrowding alone, for example, epidemics break out and
spread. Where there is decomposing filth alone, epidemics break out and
spread; and so of the whole number. The removal of one of these causes,
therefore, or the removal of two or three of them, will not suffice for
safety; every one must be removed before there can be safety.
This we know; all beyond this is conjecture, but as to the most probable
of these conjectures, some who have thought on this subject believe that
the preponderance of evidence justifies the conclusion that the
predisposing causes may themselves become efficient causes; that
instances in which they actually do so, are constantly passing before
our eyes; that it is practicable to manufacture fever and even epidemic
fever to any amount by placing a population under certain known
conditions; that it is practicable to prevent the outbreak of epidemics
altogether by placing the population under certain other conditions;[10]
that the prevalence of the predisposing causes in particular localities,
in certain intensities, is sufficient to produce local epidemic
outbreaks; that the prevalence of such causes in such intensities,
joined to some general conditions of the atmosphere, such as the
meteorological conditions which have been enumerated, particularly those
which favour the accumulation and concentration of the products of
organic decomposition, are all that is required to engender wide-spread
epidemics. Those who adopt this view contend that the existence of a
primary cause as a distinct and separate entity is not necessary to
account for the phenomena.