Medical papers have been written in this country and on the continent to show that the exposure of workmen to putrid emanations in the employment of sewer cleansing has no effect on the general health; and when the employers of the labourers engaged in such occupations are questioned on the subject, their general reply is, that their men “have nothing the matter with them:” yet when the class of men who have been engaged in the work during any length of time are assembled; when they are compared with classes of men of the same age and country, and of the like periods of service in other employments free from such emanations, or still more when they are compared with men of the same age coming from the purer atmosphere of a rural district, the fallacy is visible in the class, in their more pallid and shrunken aspect—the evidence of languid circulation and reduced “tone,” and even of vitality—and there is then little doubt of the approximation given me by an engineer who has observed different classes of workmen being correct, that employment under such a mephitic influence as that in question ordinarily entails a loss of at least one-third of the natural duration of life and working ability.
The usual comment of the employers on the admitted facts of the ill-health and general brevity of life of the inferior workmen engaged in such occupations is, “But they drink—they are a drunken set;” and such appears frequently, yet by no means invariably, to be the case. On further examination it appears that the exposure to the emanations is productive of nervous depression, which is constantly urged by the workmen as necessitating the stimulus of spirituous or fermented liquors. The inference that the whole of the effects are ascribable to the habitual indulgence in such stimuli is rebutted by the facts elicited on examination of other classes of workmen who indulge as much or more, but who nevertheless enjoy better health, and a much greater average duration of life. It is apt to be overlooked that the weakly rarely engage in such occupations, or soon quit them; and that, in general, the men are of the most robust classes, and have high wages and rather short hours of work, as well as stimulating food. A French physician, M. Labarraque, states in respect to the tanners, that, notwithstanding the constant exposure to the emanations from putrid fermentations, it has not been “remarked” of the workmen of this class that they are more subject to illness than others. A tanner, in a manual written for the use of the trade, without admitting the correctness of this statement, observes: “Whatever may be the opinion of M. Labarraque on this point, we do not hesitate to declare the fact that this species of labour cannot be borne by weakly, scrofulous, or lymphatic subjects.”[[3]]
§ 5. So far as observations have been made on the point (and the more those reported upon it are scrutinized, the less trustworthy they appear to be), workmen so exposed do not appear to be peculiarly subject to epidemics; many, indeed, appear to be exempted from them to such an extent as to raise a presumption that such emanations have on those “acclimated” to them an unexplained preservative effect analogous to vaccination. That one miasma may exclude, or neutralize, or modify the influence of another, would appear to be primâ facie probable. But it is now becoming more extensively apparent that the same cause is productive of very different effects on different persons, and on the same persons at different times; as in the case mentioned by Dr. Arnott of the school badly drained at Clarendon Square, Somers’ Town, where every year, while the nuisance was at its height, and until it was removed by drainage, the malaria caused some remarkable form of disease; one year, extraordinary nervous affection, exhibiting rigid spasms, and then convulsions of the limbs, such as occur on taking various poisons into the stomach; another year, typhoid fever; in another, ophthalmia; in another, extraordinary constipation of the bowels, affecting similar numbers of the pupils. Such cases as the one before cited with respect to the depôt for animal matter in Paris, where the workmen suffered very little, whilst the people living near the depôt were “tormented with fevers,” are common. The effects of such miasma are manifested immediately on all surrounding human life (and there is evidence to believe they are manifest in their degree on animal life[[4]]), in proportion to the relative strength of the destructive agents and the relative strength or weakness of the beings exposed to them; the effects are seen first on infants; then on children in the order of their age and strength; then on females, or on the sickly, the aged, and feeble; last of all, on the robust workmen, and on them it appears on those parts of the body that have been previously weakened by excess or by illness. Whilst M. Parent Duchâtelet was looking for immediate appearances of acute disease on the robust workmen living amidst the decomposing animal effluvium of the Montfaucon, I have the authority of Dr. Henry Bennett for stating that he might have found that the influence of that effluvium was observable on the sick at half a mile distant. “When I was house surgeon at St. Louis,” says Dr. Bennett, “I several times remarked, that whenever the wind was from the direction of the Montfaucon, the wounds and sores under my care assumed a foul aspect. M. Jobert, the surgeon of the hospital, has told me that he has repeatedly seen hospital gangrene manifest itself in the wards apparently under the same influence. It is a fact known to all who are acquainted with St. Louis, that the above malady is more frequent at that hospital than at any other in Paris, although it is the most airy and least crowded of any. This, I think, can only be attributed to the proximity of the Montfaucon. Indeed, when the wind blows from that direction, which it often does for several months in the year, the effluvium is most odious.” As an instance of a similar influence of another species of effluvium, not observed by the healthy inhabitants of a district, it is stated that at a large infirmary in this country, when the piece of ornamental water, which was formerly stagnant in front of the edifice, had a greenish scum upon it, some descriptions of surgical operations were not so successful as at other times, and a flow of fresh water has been introduced into the reservoir to prevent the miasma.
The immediate contrasts of the apparent immunity of adults to conspicuous attacks of epidemics, may perhaps account for the persuasion which masters and workmen sometimes express, that they owe an immunity from epidemics to their occupation, and that the stenches to which they are exposed actually “purify” the atmosphere. Numbers of such witnesses have heretofore been ready to attest their conviction of the preservative effect, and even the positive advantages to health, of the effluvia generated by the decomposition of animal or of vegetable matter, or of the fumes of minerals, of smoke, soot, and coal gas. But though they do not peculiarly suffer from epidemics, it is usually found that they are not exempted. In a recent return of the state of health of some workmen engaged in cleansing sewers, whilst it appeared that very few had suffered any attack from fever, nearly all suffered bowel attacks and violent intestinal derangement. If the effects of such emanations invariably appeared in the form of acute disease, large masses of the population who have lived under their influence must have been exterminated. In general the poison appears only to be generated in a sufficient degree of intensity to create acute disease under such a conjunction of circumstances, as a degree of moisture sufficient to facilitate decomposition, a hot sun, a stagnant atmosphere, and a languid population. The injurious effects of diluted emanations are constantly traceable, not in constitutional disturbance at any one time; they have their effect even on the strong, perceptible over a space of time in a general depression of health and a shortened period of existence. This or that individual may have the florid hue of health, and may live under constant exposure to noxious influences to his sixtieth or his seventieth year; but had he not been so exposed he might have lived in equal or greater vigour to his eightieth or his ninetieth year. A cause common to a whole class is often, however, not manifest in particular individuals, but is yet visible in the pallor and the reduced sum of vitality of the whole class, or in the average duration of life in that class, as compared with the average duration of life of another class similarly situated, in all respects except in the exposure to that one cause.[[5]] The effects of a cause of depression on a class are sometimes visible in the greater fatality of common accidents. An excess of mortality to a class is almost always found, on examination, to be traceable to an adequate cause. From the external circumstances of a class of the population, a confident expectation may be formed of the sum of vitality of the class, though nothing could be separately predicated of a single individual of it. If the former vulgar notions were correct as to the salubrity of the stenches which prevail in towns, the separate as well as the combined results of these several supposed causes of salubrity must be to expel fevers and epidemics from the most crowded manufacturing districts, and to advance the general health of the inhabitants above that of the poorer rural population; but all such fallacies are dissipated by the dreadful facts on the face of the mortuary records showing a frequency of deaths, and a reduction of the mean duration of life, in proportion to the constancy and the intensity of the combined operation of these same causes.[[6]]
§ 6. The observations of the effects of such emanations on the general health of classes of human beings have been corroborated by experiments on animals.
§ 7. Another doctrine more extensively entertained than that above noticed, is, that although putrid emanations are productive of injury, they are not productive of specific disease, such as typhus. The medical witnesses say, that they were exposed to such emanations in dissecting-rooms, where bodies of persons who have died of small-pox, typhus, scarlatina, and every species of disease, are brought; that they pursued their studies in such places, and were unaware of typhus or other disease having been taken by the students in them, though that disease was frequently caught by students whilst attending the living in the fever wards.[[7]]
The strongest of this class of negative evidence appears to be that of undertakers, all of whom that I have seen state that neither specific disease nor the propagation of any disease was known to occur amongst them, from their employment. Neither the men who handle, or who “coffin,” the remains; nor the barbers who are called in to shave[[8]] the corpses of the adult males; nor the bearers of the coffins, although, when the remains are in an advanced state of decomposition, the liquid matter from the corpse frequently escapes from the coffin, and runs down over their clothes, are observed to catch any specific disease from it, either in their noviciate, or at any other time. When decomposition is very far advanced, and the smell is very offensive, the men engaged in putting the corpse into the coffin smoke tobacco; and all have recourse to the stimulus of spirituous liquor. But it is not known that, by their infected clothes they ever propagate specific disease in their families, or elsewhere. Neither does this appear to be observed amongst the medical men themselves.[[9]]
§ 8. On the other hand, the undertakers observe such instances, as will be stated in their own words in a subsequent part of the report, where others have caught fever and small-pox, apparently from the remains of the dead, and they mention instances of persons coming from a distance to attend funerals, who have shortly afterwards become affected with the disease of which the person buried had died. Of the undertakers it is observed, that being adults, they were likely to have had small-pox. Dr. Williams, in a work stated to be of good authority, on the effects of morbid poisons, relates the case of four students infected with small-pox by the dead body of a man who had died of this disease, that was brought into the Windmill-street Theatre, in London, for dissection. One of them saw the body, but did not approach it; another was near it, but did not touch it; a third, accustomed to make sketches from dead bodies, saw this subject, but did not touch it; the fourth alone touched it with both his hands; yet all the four caught the disease. Sir Benjamin Brodie mentions cases which occurred within his own knowledge, of pupils who caught small-pox after exposure to the emanations in the dissecting-room from the bodies of persons who had died of that disease.
Dr. Copeland, in his evidence before the Committee of the House of Commons, adduced the following remarkable case, stated to be of fever communicated after death:—
About two years ago (says he) I was called, in the course of my profession, to see a gentleman, advanced in life, well known to many members in this house and intimately known to the Speaker. This gentleman one Sunday went into a dissenting chapel, where the principal part of the hearers, as they died, were buried in the ground or vaults underneath. I was called to him on Tuesday evening, and I found him labouring under symptoms of malignant fever; either on that visit or the visit immediately following, on questioning him on the circumstances which could have given rise to this very malignant form of fever, for it was then so malignant that its fatal issue was evident, he said that he had gone on the Sunday before (this being on the Tuesday afternoon) to this dissenting chapel, and on going up the steps to the chapel he felt a rush of foul air issuing from the grated openings existing on each side of the steps; the effect upon him was instantaneous; it produced a feeling of sinking, with nausea, and so great debility, that he scarcely could get into the chapel. He remained a short time, and finding this feeling increase he went out, went home, was obliged to go to bed, and there he remained. When I saw him he had, up to the time of my ascertaining the origin of his complaint, slept with his wife; he died eight days afterwards; his wife caught the disease and died in eight days also, having experienced the same symptoms. These two instances illustrated the form of fever arising from those particular causes. Means of counteraction were used, and the fever did not extend to any other members of the family.