and enjoyed herself at home. A single visit to one of these spendthrift families, who are in the receipt of good wages, would convince any one that their persons and houses might be far more orderly, clean, and comfortable, were they but half trained to the tastes and habits of household industry, sobriety, and economy."

The more closely the investigation as to the causes of epidemic disease is carried the more have the grounds been narrowed on which any presumption can be raised that it is generally occasioned by extreme indigence, or that it could be made generally to disappear simply by grants of money.

In the great mass of cases in every part of the country, in the rural districts and in the places of commercial pressure, the attacks of disease are upon those in full employment, the attack of fever precedes the destitution, not the destitution the disease. There is strong evidence of the existence of a large class of persons in severe penury in some places, as in Glasgow, being subject to fever, but the fever patients did not, as a class, present evidence of being in destitution in any of the places we examined. Dr. William Davidson, the senior physician of the Glasgow Royal Infirmary, who has written a Treatise on the Sources and Propagation of Continued Fevers, for which the prize instituted by Dr. Thackeray, of Chester, was unanimously awarded at the annual meeting of the Provincial Medical and Surgical Association, states in that treatise, when speaking of the influence of delicacy of constitution as a predisposing cause of fever,

"We have kept a record of the physical habit of the patients admitted into the Glasgow Fever Hospital from May 1st to November 1st, 1839, and the following were the divisions adopted :

"1. Moderate, by which is meant a person having an ordinary quantity of muscle and cellular substance.

"2. Full or plethoric, having an extra quantity of adipose texture or of blood.

"The whole of these 429 cases were characterized by the typhoid eruption, and will therefore be considered as decided cases of typhus. It appears from this table that there were only 10 cases in an emaciated or unhealthy condition; and almost all of them, as far as could be as

Workmen in full Employment and ordinary Health. 145

certained, were engaged in their ordinary occupations at the time of their seizure. The spare and unhealthy, when added together, only form about 17 per cent. of the whole number."

He gives two tables of the proportionate numbers of persons admitted, during the year 1839, into the Glasgow Fever Hospital, whose persons were clean or filthy :—

"These two tables show that, among 611 cases admitted as continued fever, there were 340 filthy and 271 clean, or about 55 per cent. filthy; that among 395 cases of eruptive typhus, there were 245 filthy and 150 clean, or about 62 per cent. filthy; and that among 48 cases of febricula there were 14 filthy and 34 clean, or about 29 per cent. filthy.",

Amongst the fever patients are found a larger proportion of the highly intemperate than appear to be usually found amongst the labouring classes.

Dr. Davidson, in remarking on the influence of intemperance on fever, adduces the following table to show the proportion of temperate and intemperate individuals who were admitted into the Glasgow Fever Hospital from November 1st, 1838, to November 1st, 1839, whose habits could be ascertained with more or less certainty. He states that the eruptive cases only are included :— Temperate. A little Intemperate. Intemperate.

Typhus (MALES) 125
Typhus (FEMALES)

76

51
8

73

30

I have been informed that those were classed as 66 temperate" who never indulged in strong liquors to the extent of inebriety; those a "little intemperate" who now and again, perhaps at long intervals, drank to intoxication; and those as " intemperate" who were habitually so-who drank whenever they could get ardent spirits.

He adds,

"In the Glasgow Fever Hospital there occurred 81 deaths from eruptive typhus in individuals whose habits were ascertained, and 34 of these were reported as intemperate, 19 a little intemperate, and 28 temperate. In Dr. Craigie's table of the deaths in 31 fever cases that occurred in the Edinburgh Royal Infirmary, there were 15 stated to be irregular or dissipated; only two regular; the habits of the remainder are not stated. "It is also a singular fact, which has been noticed by several writers, that fever is more fatal among the higher than among the lower classes. Dr. Braken states, in reference to the fever which prevailed at Waterford during the years 1817-18-19, that it would be difficult to adjust the rates of mortality in the upper classes, but it seems probable that one-fourth, or perhaps one-third of all those persons who were attacked with fever fell victims to its power.'

"Drs. Barker and Cheyne, in their historical account of the Irish epidemic, state that, in every part of the country, fever was reported to have been much more fatal amongst the upper than the lower classes.' To what is this difference of mortality, so generally remarked by experienced hospital physicians, to be attributed, and

L

which in Ireland seemed to be very remarkable, namely, in the lower classes about one in twenty-three cases, and in the upper classes one in three or four generally, but in other places about one in seven? Can the difference in the mode of living account for this anomaly? as the first live very much on potatoes, while the others use a larger or smaller proportion of animal food; and the lower classes almost everywhere in this country use less animal food and stimulating dishes than those who are more wealthy and in a higher sphere of society."

In remarking on the supposed influence of fear and the depressing passions in producing fever, Dr. Davidson, however, remarks:

"The influence of fear and the depressing passions has also been considered as very powerful in predisposing persons to be affected with typhus contagion. There can be no doubt that fear has a tendency to produce a temporary depression of the physical powers; but, as has been already shown, there is no proof that persons of a naturally spare or weak habit of body, who are generally very sensitive, are more liable to fever than those of an ordinary constitution; this opinion must also be considered hypothetical. Indeed the facts, as far as our inquiries have enabled us to judge, seem to prove that the apprehension of fever, more particularly when it is not epidemic, is very rarely felt until the person is actually seized with the disease; for some cannot recollect of a single circumstance by which they could be exposed to contagion; and a considerable number of those who had undoubtedly been exposed to it were only made aware of the fact when it had been elicited by cross-examination. We are quite aware that cases may be brought forward of sensitive individuals who have been seized with fever soon after visiting a person labouring under the disease; but as this fact can be opposed with at least an equal number of persons who were destitute of fear, and yet caught it after an exposure to contagion, no conclusion whatever can be drawn from them. It must be observed, however, that though there is no proof that persons who are naturally weak in body or of a sensitive disposition are more susceptible of fever than those who are naturally vigorous and robust, yet that, during famine or commercial distress, poverty, by depressing the mind and lowering the physical status from insufficient aliment, does powerfully predispose a community to become affected with fever. This has been already shown in a former part of the essay, and has been again alluded to in order that the distinction might be made between an individual of naturally weak mental and physical stamina, and one who has been reduced to that state by deficient nutriment."

There appears to be little evidence on one side or the other in support of this last hypothesis, other than such as that cited from Dr. Davidson himself; but it is to be observed that the wet or bad seasons, which suspend agricultural industry and much labour in the towns, is usually of a character of itself to predispose to discase, if not to produce it; and that it does propagate it amongst all classes, high and low, in proportion to their exposure to it. It appears to be highly probable that the privation attendant on the stoppage of work, by diminishing the means for

Disease in Periods of Manufacturing Distress.

147

the purchase of fuel, of soap, &c., and in various ways by inducing lax habits of life, may increase the amount of exposure to and loss from the all-pervading cause.

The preponderant evidence given on this subject by the great majority of the medical officers in England who are accustomed to visit the labouring classes in their own dwellings, is however of the tenor of the following from the medical officer of the Whitechapel union acting in Spitalfields parish.

Mr. Byles, the medical officer of the Whitechapel union:"What is the number of cases you have had to visit during the year 1841 as a medical officer ?—I think the number of cases I have had to visit during each year since the commencement of the Union has been upwards of 2,000 cases of various disease, of which 1,400 were cases out of the workhouse.

"Has the present winter been unhealthy ?-I do not think it has; there has been an increase of fever cases during the last month. The number of cases is, however, still below the average of 1838.

"Is there not, however, unusual distress in your district, comprehending Spitalfields and a portion of Whitechapel ?-Yes, there is: I believe that more than half the looms are out of work.

"Do you not find that fever attacks in greatest number those who are out of work?—On the contrary, the greatest number of the cases of fever we have are those who fall ill during the time they are in employment. I think they are more attacked when in work, when the windows are closed, and there is no ventilation. Many of them are obliged to work with closed windows, to keep out the moist air, and prevent the dust blowing upon their work. When they are out of work, they are more out of doors looking after work, more in the open air, and that very exercise may be the means of keeping them in health. This observation applies to the weavers. I find that they have generally less fever when they are out of work. The reverse, I think, holds as respects out-door labourers, such as those who work at the docks. When they are out of work, they stand about waiting in the cold, and when cold, they generally take cheap gin, and no food: they catch cold, and on going to their close filthy habitations, their cold is apt to generate fever.

"There was an unusual amount of fever prevalent in Spitalfields and Whitechapel, was there not; in the year 1838 ?—Yes, there was; in the proportion, perhaps, of more than two to one of the present amount. My last account for the year ending Lady-day, 1842, was about 250 fever cases; it has been as high as high as 800.

"Did it prevail proportionately amongst the weavers ?—Yes, I believe it did.

"Was there any marked or unusual distress at that period?- Not that I remember.

"Do you find in the course of your experience that the diminution of food is followed by fever?-Not as a general cause, I should say. If these two persons, casually exposed to the contagion of fever, the ene in full vigour, and with a full stomach, the other with an empty stomach, the person with the empty stomach would be the most obnoxious to its influence. In my experience, however, intemperance is a much more frequent antecedent to fever than destitution or want of food.

"Have you ever observed that habits of intemperance are created by distress of mind?-Such cases may occur, but I have not observed them, and I think it does not operate as a general cause.

"What are the chief remedies which your experience in this district would lead you to recommend for the prevention of fever and contagious diseases? The promotion of cleanly habits amongst the poor; the promotion of sewerage and drainage; having proper supplies of water laid on in the houses; the removal of privies from improper situations. I could point out in our neighbourhood many houses, and some courts, that ought to be pulled down as wholly unfit for human habitation.

"What is the personal state of the labouring classes in your district?-Generally extremely filthy. I have said that I could almost smell from what street a man came who came to my surgery: I do not think the poor themselves are conscious of it, but the smell to other persons must be extremely offensive. I certainly think that the want of personal cleanliness, and of cleanliness in their rooms, and the prevalence of fever, stand in the relation of cause and effect.

"Your colleague has pointed out that the want of proper and convenient supplies of water is an antecedent to the filth and the fever. Does your experience enable you to concur with him?-My experience entirely agrees with his on that point."

The late Dr. Cowan, of Glasgow, and the great majority of the medical officers, assign the foremost place to these physical agencies as antecedents to fever.

The medical controversy as to the causes of fever; as to whether it is caused by filth and vitiated atmosphere, or whether the state of the atmosphere is a predisposing cause to the reception of the fever, or the means of propagating that disease, which has really some other superior, independent, or specific cause, does not appear to be one that for practical purposes need be considered, except that its effect is prejudicial in diverting attention from the practical means of prevention.

Dr. Bancroft, one of the controversialists cited by Dr. Davidson, observes,

"That fever often exists in them" (gaols)" cannot be denied; but this circumstance can afford no evidence of its being generated therein, any more than the multiplication of vermin in such places could demonstrate the spontaneous generation of these and other insects by the nastiness which favours the deposition and hatching of their eggs."

Taking the controversy at this point, and admitting the force of this statement, the decision upon it will not alter the practical value of cleanliness, or of its protective effects in prevention, whether it remove an original or only a predisposing cause.

Yet it cannot but be regretted that the enlightened force of the professional opinion should sustain any diminution from an apparent want of unanimity on so important a question as the necessity of removing these causes, whether original or predisposing: that, for example, whilst the fleets were ravaged by fever and disease, men of high standing should have occupied the attention