clothing, the basis of which is wool, and of which there were imported
in 1801 seven millions of pounds; in 1844, sixty-three millions of
pounds. This enormous importation of foreign wool has not only not
diminished its home growth, but the increased demand for it has led to a
vast multiplication of the animals that yield it, and what is of equal
importance, has induced an extraordinary care in improving their breed;
so that the very means which have fed the steam-engine have fed the
people both with more plentiful and with better food; the steam-engine,
meanwhile, applied to these and to all manufacturing processes, being as
much a producer of food as the plough.[21]
Footnote 21:
Similar progress has been made in the manufacture of flax and silk as
of cotton and wool.
And the same is emphatically true of fuel, the main creator of all this
activity and of its astonishing results; this necessary of life being
now brought to the door of every family in three-fold abundance and at
one-half the price at which it could have been obtained at the
commencement of the century; while such is the demand for it in various
manufactures of vast magnitude, that one trade alone, that of iron,
consumes annually eight millions of tons—a trade which immediately and
powerfully facilitates the production both of food and of clothing.
Thus, like one of Nature’s beautiful adaptations, like that wonderful
cycle, for example, in which production, change, and reproduction go on
in an unvarying circle, the constant and abundant supply of one main
necessary of life furnishes the means of producing the others; while
these last are the immediate causes of the abundance of the first.
And what a busy hive does this country present at the present time! Out
of every thousand males twenty years of age in the kingdom, 836 are
directly employed in some active occupation contributing to the national
wealth; while the remaining 114 are by no means idle, for they are
engaged in some one of the professions.
Though the masses have not yet obtained their due share of the wealth
they create, and though there is a class which in relation to one
essential condition, to be stated immediately, civilization has scarcely
reached, or reached only to injure—with these exceptions, no doubt very
important ones—the evidence is indubitable that the entire body of
society, from its base to its apex, stands on an elevated table-land
which many centuries have been employed in raising and consolidating. I
have partly proved this by showing the general diffusion of the means of
healthful subsistence and the prolongation of life. I am now to prove it
by applying these facts to the subject more especially before us, the
decline and disappearance of epidemics.
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[22] the deaths were 1 in 25; in 1750, 1 in 21;[23] 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;
The abolition of the cess-pool, involving complete house drainage, an
abundant supply of water, and the immediate removal by it of all
refuse which it is capable of holding in suspension;
Means for the removal of house refuse not capable of suspension in
water.
And this is all. And what are the results of these few and simple
arrangements?
That the mortality among the inhabitants of these dwellings is less than
that of London generally, and far less than that of some of the filthy
and neglected localities in London, the Potteries of Kensington for
example; while the mortality among children under ten years of age, on
an average of three years, is one-half less than that of the nation
generally, and four times less than that of the Potteries;
That there has not been a single death from typhus, or any other form of
continued fever, among the adults in any of these buildings since
their establishment; and that during the two first visitations of
epidemic cholera, with the exception of two cases which occurred under
peculiar circumstances, there was no attack of cholera in any of these
buildings, while from four to six deaths from the pestilence occurred
in single houses in the immediate neighbourhood.
Such are the results of the first imperfect attempt at improvement;
which, remarkable as they are, are not more striking than the results of
neglect. Of the children born in the best part of a town one fifth die
before they attain the fifth year of age; of the children born in the
worst, one-half die before they attain their fifth year. The inhabitants
of the worst localities attain little more than one half of the age of
those who live in the best. Of 100,000 children born in Surrey, 75,423
attain the age of ten years; 52,000 live to the age of fifty; and 28,878
live to seventy. In Liverpool, out of 100,000 persons born, only 48,211
live ten years; 25,878 live fifty years; and 8373 live seventy years.
The probable duration of life in Surrey is 53 years; in Liverpool it is
26 years. Were the whole of the metropolis as healthy as the Model
Dwellings, there would be an annual saving in London of nearly 20,000
lives. But these lives are not saved; this number of persons is allowed
to perish every year, and they are as truly and as needlessly sacrificed
as if they were taken out on Bethnal-green and shot.
When we bear in mind the suffering which in every case accompanies this
waste of life, and the suffering which must inevitably follow it, and
remember that it is admitted that these dreadful evils are remediable
and preventible, it is difficult to suppress the natural feelings of
indignation and of sorrow, that in a country calling itself Christian
the application of the known remedies should be so long delayed.
It is right however to acknowledge that something has been done, and is
in progress, for the improvement of the sanitary condition of the
people. The principle is admitted that it is the duty of the Legislature
to deal with this matter, and the first systematic legislative effort to
bring about a better state of things has been made.
The Public Health Act is in operation, and the general and proper
application by local authorities of the powers it confers would place
every part of every town in Great Britain in as good a sanitary
condition, at least, as that of the Model Dwellings.
Up to the present time (1855) there are under this Act 196 towns,
containing a population of upwards of 2¼ millions. In about 50 of these
towns, however, nothing has yet been done.
Eleven towns, with a population of about half a million, have adopted
the powers of the Act in subsequent local acts.
Works of drainage and water supply are completed, or are in an advanced
state, in 70 towns.
Mortgages have been sanctioned—
For drainage works nearly 1¾
and water supply, millions
sterling;
────────────────────────────────────
For private works of about £45,000;
drainage and water
supply,
────────────────────────────────────
For paving, street about £200,000;
improvements, &c.,
Making a total of nearly two millions sterling devoted to sanitary
improvement.[24]
Footnote 24:
This has been since greatly increased: see Appendix, p. 129. [ED.]
It is difficult at present to give the average cost of these combined
and complete sanitary works; but the total expense for public and
private works of drainage and water supply for houses of from £10 to £20
per annual rental, may be taken at 4d. per week per house.
The great obstacle to sanitary progress is the fear of rates, not so
much on the part of the poor, who gladly pay for the improvements, but
on the part of the owners of small tenements, by whom chiefly opposition
is raised to the application of this Act.
In the town of Alnwick, public and private works of sewerage and
drainage have been completed. There have been laid down about twenty
miles of sewers and drains, and seventeen miles of apparatus for water
supply, at a total cost, for the combined works, of 4d. per week per
house for the term of thirty years; after the expiration of which period
the cost of the works, both principal and interest, will have become
liquidated, and the only expense thereafter will be for maintenance.
On inspecting these works, I saw in the tenements occupied by the lowest
classes a high degree of cleanliness, wholesomeness, and comfort, and
heard from the inhabitants an expression of the greatest satisfaction.
We have as yet no certain knowledge of the extent to which such works
are capable of preventing sickness and lengthening life. But the most
perfect drainage, combined with the most ample supply of water, will not
alone secure for the public health all which it is practicable to
accomplish. There must also be provision for the better construction of
the houses of the poor; for the prevention of overcrowding; for street
ventilation and cleansing, and for the exclusion from the neighbourhood
of human dwellings of filth-creating animals and of noxious trades. When
all this is done, as it might be done, and as it would be done were
there a general perception of the crying evils it would remedy,
Epidemics would disappear, the more formidable of them immediately, and
all of them, I believe, in the end.
From the whole of these facts and observations we see—
1. That Epidemics are under our own control; we may promote their
spread; we may prevent it. We may secure ourselves from them. We have
done so. We have banished the most formidable. Those that remain are not
so difficult to be conquered as those that have been vanquished. The
causes of Typhus are more completely under our control than those of
Intermittent. We have banished Intermittent. We may put an end to
Typhus. We have actually done so. We have encompassed the Model
Dwellings by a barrier which neither typhus, nor even cholera, nor any
of the other causes of excessive sickness and premature mortality have
been able to pass. To the residents within that barrier the chance of
life has been almost doubled; to their children it has been doubled; and
compared with some other children of their own class it has been
increased fourfold.
2. We see that Epidemics are not made by a Divine law the necessary
condition of man’s existence upon earth. The boon of life is not marred
with this penalty. The great laws of nature, which are God’s ordinances
in their regular course and appointed operation, do form and give off
around us, products which are injurious to us; but He has given us
senses to perceive them, and reason to devise the means of avoiding
them, and epidemics arise and spread because we will not regard the one,
nor use the other.
3. We see that there are circumstances which render it doubtful whether
civilization has yet attained a point that places it beyond the danger
of retrogression. States in some respects of higher civilization than
our own have relapsed into barbarism. There is indeed one circumstance
which may give us hope; there is one humanizing principle which is now
at least recognized and in partial operation, of which there is no trace
in any nation of antiquity. I mean the principle of kindness as a
governing influence, distinguished from the principle of brute force.
That the whole human race is one family, that the people of every
colour, clime, language, government, and faith, are one brotherhood, and
that the same law of love which is the bond of the union, strength, and
happiness of a single family, is equally binding on the universal family
of mankind, are the fundamental and distinguishing principles of our
religion; and in proportion to our conformity in our private and public
life to the spirit of these divine principles, advancement in
civilization is certain; relapse into barbarism is impossible. But as
yet there is no such conformity. We neglect the education of the people,
quarrelling about the mode, and postponing the thing. We devote to a
life of absorbing labour the child and the youth ungrounded in the
elements of knowledge, untrained to habits of self-restraint, thereby
dooming the man to the blankness and turbulence of ignorance and
intemperance. We equally neglect the sanitary condition of the people.
We make no provision for securing to the humblest classes, and they can
make none for themselves, the conditions that are essential to their
physical health, the loss of which to them involves and includes every
other. We thus neglect body and mind, and then the disorders and vices
which necessarily follow we endeavour to repress by punishments that
harden but never reform, neither trusting nor trying the influence of
gentleness, which our religion teaches us is stronger than ignorance,
stronger than crime, and can master both. It is this state of things
that places in danger the ark of civilization.
Lastly, we see the first step that must be taken to elevate the people:
nay, even to bring them within the pale of the civilization already
attained. We must improve their sanitary condition. Until this is done,
no civilizing influence can touch them. The schoolmaster will labour in
vain; the minister of religion will labour in vain; neither can make any
progress in the fulfilment of their mission in a den of filth. Moral
purity is incompatible with bodily impurity. Moral degradation is
indissolubly united with physical squalor. The depression and discomfort
of the hovel produce and foster obtuseness of mind, hardness of heart,
selfish and sensual indulgence, violence, and crime. It is the Home that
makes the man; it is the home that educates the family. It is the
distinction and the curse of Barbarism that it is without a home: it is
the distinction and the blessing of Civilization that it prepares a home
in which Christianity may abide, and guide, and govern.
[The foregoing is from the Edinburgh Lectures. See Introduction. ED.]
------------------------------------------------------------------------
QUARANTINE AND CONTAGION.
[From First and Second Reports on Quarantine. See Introduction. ED.]
The object of quarantine is to prevent the introduction of epidemic
diseases from one country into another, and its regulations are based on
the assumption of the contagiousness of the diseases with which it
deals; it being supposed that such diseases are propagated by contact,
direct or indirect, of the unaffected with the affected. In accordance
with this view the preventive means adopted by quarantine consist of the
isolation of the sick or suspected, with whom it interdicts all
communication, whether by person or by articles deemed capable of
transmitting contagion.
When quarantine was first established, the spread of epidemic diseases
exclusively or chiefly by contagion was a doctrine universally
received;[25] but during the last century a change has gradually taken
place in professional opinion in almost every country in Europe,
particularly in France, Russia, and Austria, as well as in America, with
respect at least to several of these diseases, chiefly by medical
officers, who, having had the charge of the health of fleets and armies
in different quarters of the globe, have been under the necessity of
studying the circumstances connected with the outbreak and spread of
formidable epidemics; and also by those who, having had the care of
hospitals and dispensaries in large cities, have been obliged to visit
the localities and abodes of the poorer classes, where these diseases
are always the most prevalent.
Footnote 25:
The wide difference between the qualifications of the accomplished
popular physician and the scientific investigator into the causes of
epidemic sickness was strikingly exhibited in the first outbreak of
Asiatic cholera in 1831, when the emergency required not merely a
knowledge of the practice of medicine, but the power also of applying
the philosophy of public health to the exigencies of the moment. How
were these exigencies provided for?
A board, comprising all the most eminent and skilful physicians of the
day, was assembled in the College of Physicians, under the presidency
of Sir Henry Halford; and, after declaring, in opposition to the
unanimous opinion of the physicians of Bengal, “that no measures of
external precaution for preventing the introduction of the cholera
morbus by a rigorous quarantine have hitherto been found effectual,”
they issued the following official notification:—