§ 213. In an important paper which Dr. Calvert Holland has written “On the Diseases of the Lungs from mechanical causes,” he gives an account of the physical and moral condition of the cutlers’ dry grinders of Sheffield, whose case may be cited not only as further exemplifying the large evils, § 200, which, in the absence of protective public arrangements, will pass without complaint from the immediate sufferers, but as showing the advantages derivable from any arrangements which bring large classes of cases within one intelligent view, i. e. before an officer of health, in presenting clearly common causes of evil, and in suggesting means of prevention, which in single cases or smaller groups of cases might not have challenged attention or justified any confident conclusions as to the remedies available.
It is known that the steel and stone dust arising in the processes of grinding cutlery, is peculiarly injurious to the class of workpeople engaged in it, and that those who continue at the work are generally cut off before they are thirty-five or forty-five years of age. Formerly the same workmen completed several processes in the making of knives, of which processes grinding was only one. At that time the “grinders’ disease” was very little known, and the men lived to about the average age, and were considered the most respectable class of the Sheffield workmen. As the manufacture advanced the labour became subdivided, and one class of workmen were wholly occupied with the destructive process of grinding. Whether their numbers were kept down by the excessive mortality, or a monopoly were maintained by the destructive effects of the process, wages were so high as to allow them to play during a part of the week. Then arose that avidity for immediate and reckless enjoyment, common to all uneducated minds under the perception of a transient existence. When trade was good they would only work a part of the week; they spent the remainder in the riot and the dissipation characteristic of soldiers after a siege. Many of them each kept a hound, and had it trained by a master of the hunt, and their several hounds formed a pack with which they hunted lawlessly, and poached over any grounds within their reach. The grinders pack is still kept up amongst them. They became reckless in their marriages. “The more destructive the branch of work,” says Dr. Holland, “the more ignorant, reckless, and dissipated are the workmen, and the effects may be traced in the tendency to marry, and generally at exceedingly early ages.” He further observes of one class of them, that amongst them “nature appears not only precocious but extremely fruitful.” Their short and improvident career is attended by a proportionately large amount of premature and wretched widowhood and destitute orphanage.
This one class of cases was brought fortuitously under the observation of Dr. Holland, and he has done what a competent officer of health could scarcely have omitted to attempt to do,—to devise means of prevention and reclaim their execution.
One benevolent inventor proposed the adoption of a magnetic guard, or mouth-piece, the efficiency of which consisted in the attraction of the metallic particles evolved in the process of grinding. But the dust to which the grinder was exposed consisted of the gritty particles of the stone as well as of the metallic particles of the instruments ground, and if the invention had been adopted, it would still have left the men exposed to the gritty particles. It was not, however, adopted, nor does it appear that any efficient preventive would be voluntarily adopted by these reckless men. Dr. Holland invented another mode, which acts independently of the men, and which is very simple, and, it is confidently stated, that after a trial of some years, it has proved equal to the complete correction of the evil. It consists of an arrangement by which a current of air, directed over the work, carries from the workman clear out of the apartment all the gritty as well as all the metallic particles. The expense of the apparatus would scarcely exceed the proportion of a sovereign to each grinder. But it is not adopted; and Dr. Holland is in the position of an officer of health, on behalf of mothers and children, to reclaim authoritative intervention and the interests of society to arrest the suicidal and demoralizing waste of life. Having consulted his experience on the advantages of such an office as that in question to the working classes, he speaks in strong and confident terms of the benefits to be derived from it:—
Perhaps in no manufacturing community is human life, in large classes of men, so shortened or accompanied with such an amount of suffering or wretchedness as in this town, in connection with certain staple manufactures. Were the legislature to interfere and enforce the correction of the evils, by a system of ventilation, which is neither difficult nor expensive to put in operation, the duties of this officer, if directed to the superintendence of this system, would save numerous lives and prevent an incalculable amount of misery. At present, in consequence of these evils, a majority of the artisans is killed off from twenty-five to thirty-five years of age, and numbers annually leaving widows and children in great destitution, and, in most cases, dependent on the parish. The evils are not inseparably connected with the occupation; they admit of redress. An officer of health, by maintaining the system of ventilation in efficient operation, would save numerous lives, would create a better tone of mind among the artisans—for wretchedness is closely allied with ignorance and immorality—would diminish the high rate of mortality amongst the young under five years of age—left by the premature death of the parent unprovided for, and lastly, would greatly relieve the parish funds. The officer, having the power to remove at once any case of fever from a densely populated locality, as well as to enforce measures of prevention, such as the removal of accumulated filth, stagnant pools of water, or the correction of any other local circumstances, would perform duties which would redound considerably to the advantage of the community.
§ 214. In confirmation of the views of the benefits derivable to medical science from such arrangements as those proposed, § 211, various instances might be adduced besides the last cited, § 213, and that already given in the General Report, p. 355, of the discoveries made, on an examination of 1000 cases, by M. Louis, on the nature of consumption, now generally recognized as presenting facts at variance with all ancient and previous modern opinions: but in respect of the views there stated, as to the great public importance of well-ascertained medical statistics, I submit the high confirmation derivable from the following statement contained in the recently published outlines of pathology and practice of medicine, by Dr. W. Pulteney Alison, fellow and late president of the College of Physicians at Edinburgh, and professor of the practice of medicine in the University of Edinburgh:—
“The living body,” he observes, “assumes, in many cases, different kinds of diseased action, varying remarkably in different periods of life, without any apparent or known cause; but in the greater number of cases it is generally believed that certain circumstances in the situation or condition of patients, before diseases appear, can be assigned with confidence as their causes. The efficacy of these, however, is seldom established in any other way than simply by the observation that persons known to be exposed to their influence become afflicted with certain diseases in a proportion very much greater than those who are not known to be so exposed.
“This kind of evidence is in many individual cases very liable to fallacy, in consequence of the great variety of the circumstances capable of affecting health, in which individuals are placed, and of the difficulty of varying these so as to obtain such observations, in the way of induction or exclusion, as shall be decisive as to the efficacy of each. Hence the importance of the observations intended to illustrate this matter being as extensively multiplied as possible; and hence also the peculiar value, with a view to the investigation of the causes of diseases, of observations made on large and organized bodies of men, as in the experience of military and naval practitioners. All the circumstances of the whole number of men whose diseases are there observed, are in many respects exactly alike; they are accurately known to the observer, and are indeed often to a certain degree at his disposal; they are often suddenly changed, and when changed as to one portion of the individuals under observation, they are often unchanged as to another; and therefore the conditions necessary to obtaining an experimentum crucis as to the efficacy of an alleged cause of disease are more frequently in the power of such an observer than of one who is conversant only with civil life.
“But when the necessary precautions as to the multiplication of facts, and the exclusion of circumstances foreign to the result in question, are observed, the efficacy of the remote causes of disease may often be determined statistically, and with absolute certainty; and the knowledge thus acquired as leading directly to the prevention of disease, is often of the greatest importance, especially with a view to regulations of medical police. And if the human race be destined, in future ages, to possess greater wisdom and happiness in this state of existence than at present, the value of this knowledge may be expected to increase in the progress of time; because there are many diseases which the experience of ages has brought only partially within the power of medicine, but the causes of which are known, and under certain circumstances may be avoided; and the conditions necessary for avoiding them are in a great measure in the power of communities, though at present beyond the power of many of the individuals composing these.
“There are, indeed, various cases, of frequent occurrence, in which the study of the remote causes of disease is as practically important as anything that can be learnt as to their history, or the effects of remedies upon them. This is particularly true of epidemic diseases, and of diseases to which a tendency is given by irremediable constitutional infirmities.”