of Fever, as against Practical Means of Prevention. 149

of the public with speculations on contagion, and infection from the gaols as the original cause, and diverted attention from the means of prevention, cleansing and ventilation, the means by which, as will hereafter be shown, the pestilence was ultimately banished. The main error of those who have ascribed fever to destitution, appears to have been in adopting too hastily as evidence of the fact of destitution, such prima facie appearances as are noticed by Dr. Scott Alison, an error which non-professional experience may correct. In more than one instance where, in a district in which the demand for labour was still great, and the wages high, benevolent gentlemen have propounded similar doctrines, which, being at variance with the known state of the labourmarket, I have requested that the names of these fever cases might be given, that their antecedent circumstances might be examined, and the accuracy of the conclusions tested, by officers of experience in such investigations; but I think it right to state the names or means of inquiry have never been forthcoming. In general, medical practitioners and benevolent individuals are extremely liable to deceive themselves and to deceive others, by what they call the evidence of their own eyes. The occurrence of severe destitution is denied as a general cause of fever, not as a consequence. The evidence shows that the best means of preventing the consequent destitution are those which prevent the attacks of fever and other epidemics upon all classes of the community.

By an extract from a report of the late Dr. Currie, of Liverpool, given in the Appendix, it will be seen that at the time he wrote, 1797, when only 9500 of the population are reported to have lived in cellars, the proportion of fever cases was nearly the same as at present, when the cellar population has risen to 40,000; the disease has been almost as constant as the surrounding physical circumstances of bad ventilation, filth, and damp then pointed out as removable, and the disease has continued in every period of the prosperity of the town in its progress from a population of 77,000 to 223,000 in 1841. So the late Dr. Ferriar, of Manchester, when writing between 30 and 40 years ago, of the state of the population in periods of great prosperity, especially for hand-loom weaving, described the effect of the bad economy of the habitations much as they were described in the year 1829 by Dr. Kay, and as they are described in 1840 by Dr. Baron Howard. Dr. Ferriar, when he wrote to warn the labouring classes as to the choice of their dwellings, stated that—

"The custom of inhabiting cellars also tends to promote both the origin and preservation of febrile infection. But even in them the action of filth and confined air is always apparent when fevers arise. I have often observed that the cellar of a fever patient was to be known by a shattered pane, patched with paper or stuffed with rags, and by every external sign of complete dirtiness."

The false opinions as to destitution being the general cause of

fever, and as to its propagation, have had extensively the disastrous effect of preventing efforts being made for the removal of the circumstances which are proved to be followed by a diminution of the pestilence.

The opinion of the majority of the medical officers of the unions in England on this topic, acting in districts in every condition, might be expressed in the terms used by Dr. Davidson :

"It has already been shown that filth and deficient ventilation tend much to spread the contagion of typhus, being almost constant concomitants; and that while it generally affects the whole members, or the large proportion of a family among the lower orders, it rarely spreads in this manner among the better classes of society, who attend more to cleanliness and ventilation. It is quite obvious that an amelioration of the physical condition of the lower orders, in these particulars, would, in proportion as this was effected, diminish their chances of catching the contagion, which would not only operate in lessening directly its diffusion, but by reducing the number of its sources, must tend to lessen the actual quantity of this principle that might be generated in a given time.

"But can this amelioration be effected to any appreciable extent; or, if effected, could it be maintained for any length of time? We fear that little permanent amelioration could be effected without a legislative enactment; for though our philanthropists are very active in their charities during the prevalence of an epidemic, it no sooner subsides than they relapse into a comparative quiescence, and our working population into their former habits of filth and intemperance. And the evil will continue to assail us so long as our cities contain so many narrow and filthy lanes, so long as the houses situated there are little better than dens or hovels, so long as dunghills and other nuisances are allowed to accumulate in their vicinity, so long as these hovels are crowded with inmates, and so long as there is so much poverty and destitution. Why, then, should we not have a legislative enactment that would level these hovels to the ground-that would regulate the width of every street that would regulate the ventilation of every dwellinghouse-that would prevent the lodging-houses of the poor from being crowded with human beings, and that would provide for their destitution? It may be said that this would interfere too much with the liberty of the subject, and no doubt it would be vehemently opposed by many interested persons. In place, however, of being an infringe ment on the liberty of the subject, it might rather be designated an attempt to prevent the improper liberties of the subject; for what right, moral or constitutional, has any man to form streets, construct houses, and crowd them with human beings, so as to deteriorate health and shorten life, because he finds it profitable to do so? As well ought the law to tolerate the sale of unwholesome food because it might be profitable to the retailer of it."

But the professional experience and weight of professional testimony on this subject is not confined to this country. In a report prepared under the superintendence of a commission of the Royal

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Academy of Medicine at Paris,* appointed to investigate the epidemics prevalent in France, similar general conclusions are announced upon similar evidence adduced, of which we select the following instance :-

"If an example," says the report, "be necessary to justify this placing of circumstances as cause and effect, we shall find one in the terrible epidemic which desolated the commune of Prades, in the department of Ariège, at the end of the year 1838. Out of 750 healthy and vigorous inhabitants of this commune 310 were attacked with the disease, and 95 died, thus the deaths were 1 in every 3 cases. The cause of this epidemic, violent and sudden in its nature, and which broke out in all points at once, is not less evident. It proceeded from a sewer, the receptacle of all the water from the neighbourhood, and of the filth which the water brought with it, and of the dead animals of the district. The hot, damp weather which preceded it no doubt augmented the activity of this focus of infection. The first persons attacked were the women employed in washing linen in this pestiferous pool, and the labourers working in the neighbourhood of it. This terrible epidemic recurred three times, which the invalids in their simplicity attributed to the influence of the moon, but which mainly depended upon the wind at certain periods passing over the infected pool, and bringing the miasma in the direction of their dwellings. If for want of sufficient description it is not possible to prove completely the similarity of the epidemic at Prades with the typhus fever, yet it may be inferred from the symptoms, viz. that when the skin was broken deep sores were formed, and that serous abscesses showed themselves in the lymphatic ganglions, that this disease was very similar to the ancient putrid and malignant fevers formerly described by authors, and which are entirely replaced in our nosology by the typhoid affection. The physicians of Ariège, in order to prove that the disease was not contagious, and to re-assure the inhabitants, lay in the beds from which the invalids had been removed."

Adverting to the local reports they have received, the Commissioners state-"These reports have awakened in us the sad conviction that many localities are quite devoid of even the most simple ideas on public health; the inhabitants live surrounded by marshes, drains, stagnant pools, manure heaps, without having the slightest idea of the dangers they are incurring. Indeed, many of them blindly speculate in these heaps of infection, increasing the manure which is to enrich their fields at the expense of their health, and often of their lives."

The Commissioners observe,-"Most of the improvements in public health have been brought about through the experience and science united in our large cities; so much so that now epidemics often come to us from the rural districts. These epidemics are generally much less fatal than formerly, but are still very prevalent even in the wealthiest and the most civilized depart

Rapport de la Commission des Epidémies de l'Académie Royale de Médecine pour l'année 1839 et un partie d' 1840. Par M. Brichetan, Secrétaire Rapporteur de la Commission.

ments. It would be an important problem to solve, what are the causes which produce these epidemics in the agricultural as well as in the manufacturing counties, as in ancient Normandy and Picardy. One cause is certainly the unhealthiness of the houses. The inhabitants of these districts are, in general, well fed, well clothed, but ill lodged. We are surprised to find in the midst of a fertile plain wide districts covered with luxuriant vegetation, villages buried in the ground, smothered with large trees, and cottages constructed without any art or plan, and almost entirely without windows." The Commissioners state, further," If you wish to have a robust and healthy people, you must have a care for their physical education, their houses, and their modes of living. Do not allow generation after generation to be depressed under the evil effects of recurring epidemics, which must eventually ruin the strongest constitutions, as is seen to be the case in marshy and ill-drained districts, where fevers, goitres, and scrofulas constantly prevail."

In another report made on the proceedings of the Conseil de Salubrité, the diseases prevalent amongst the population in the towns is adverted to "We must be like the men so well painted by the Psalmist, to reject such evidence-eyes have they, and see not. How shall we explain, or rather to what shall we attribute the difference that is remarked between the mortality of one quarter and that of another quarter of the same town; of one street and that of another street of the same quarter or of the same village; or, lastly, the difference that is observed in this respect between the houses of the same street and those houses which are completely isolated? Misery, it is replied to us, is the cause. Yes, without doubt, misery is a powerful cause; but it is so especially when it is driven back into the most insalubrious quarters, streets, and houses; when it lives habitually in the midst of filth and dirt, that is to say, in the midst of an infected atmosphere; and when there is no misery, or when it exists in the same degree in the quarters, in the villages, in the streets, and in the houses with which the comparison is made; and, stronger still, when poverty is met with precisely there where there is the least mortality; in what is to be found the cause of this difference, if it is not in the insalubrity of the dwelling-places?"

The report on the local epidemics concludes by earnestly recommending to the government-"That sanitary measures be adopted by means of which the constitution of the people may be renewed, and their longevity increased. If this recommendation be fulfilled, we may then hope to see the condition of some of the departments ameliorated, in which now the population is so degenerated that the men seem to diminish in size each time they are measured for the conscriptions."

Evidence on the mismanagement of expenditure in respect to supplies of food, on mismanagement also in respect to clothing

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and fuel by the labouring classes, might be added to complete the view of the principal causes of disease prevalent amongst them, but these do not come within the immediate scope of the present inquiry, which has been directed chiefly to the investigation of the evils affecting their sanitary condition, that come within the recognized provinces of legislation or local administration.

The information on the means for the prevention of epidemic disease arising in the common lodging-houses maintained for the accommodation of trampers and vagrants, might also have been considered in connexion with the subject of the effects of overcrowding and filth which they strongly exemplify; but it appeared most convenient to consider them apart, from the exposition of what may be termed the indigenous evils that afflict the settled inhabitants of the labouring class.

I would now submit for consideration, 1st, the total expense of the present state of things, so far as a proximate view of it can be obtained, on the health, strength, and life of the lower classes of the population. 2d, a proximate view of the pecuniary expense of such partial remedies as are at present applied or applicable to alleviate the consequences of these preventible diseases.

IV.

COMPARATIVE CHANCES OF LIFE IN DIFFERENT CLASSES OF
THE COMMUNITY.

Very dangerous errors arise from statistical returns and insurance tables of the mean chances of life made up from gross returns of the mortality prevalent amongst large classes, who differ widely in their circumstances. Thus we find, on inquiry into the sanitary condition of the population of different districts, that the average chances of life of the people of one class in one street will be 15 years, and of another class in a street immediately adjacent, 60 years. In one district of the same town I find, on the examination of the registries, the mortality only 1 out of every 57 of the population; and in another district 1 out of every 28 dies annually. A return of the average or the mean of the chances of life, or the proportions of death in either instance, would and does lead to very dangerous errors, and amongst others to serious misapprehensions as to the condition of the inferior districts, and to false inferences as to the proper rates of insurance. With the view of arriving at some estimate of the comparative extent of the operation of the chief causes of sickness and mortality proved to be prevalent, amidst the different classes of society, in the towns where the sanitary inquiries have been made; I have obtained the following returns from the clerks of the several unions acting as superintendent registrars. These returns have, as far as practicable, been corrected by particular local inquiry, and are submitted as the best approximations that can readily be obtained. In all districts, and especially in the manufacturing districts, there is some migration of labourers which would, for the obtainment