During every moment of life in natural respiration a portion of the air of the atmosphere passes through the air vesicles of the lungs into the blood, while a quantity of carbonic acid gas is given off from the blood, and is transmitted through the walls of these vesicles into the atmosphere. Now that substances mixed with or suspended in atmospheric air may be conveyed with it to the lungs and immediately enter into the circulating mass, any one may satisfy himself merely by passing through a recently painted chamber. The vapour of turpentine diffused through the chamber is transmitted to the lungs with the air which is breathed, and passing into the current of the circulation through the walls of the air vesicles, exhibits its effects in some of the fluid excretions of the body, even more rapidly than if it had been taken into the stomach.
Facts such as these help us to understand the production and propagation of disease through the medium of an infected atmosphere, whether on a large scale, as in the case of an epidemic which rapidly extends over a nation or a continent, or on a small scale, in the sick chamber, the dissecting room, the church, and the church-yard.
Thus it is universally known that, when the atmosphere is infected with the matter of small-pox, this disease is produced with the same and even with greater certainty than when the matter of small-pox is introduced by the lancet directly into a blood-vessel in inoculation.
It is equally well known that, when the air is infected by particles of decomposing vegetable and animal matter, fevers are produced of various types and different degrees of intensity; that the exhalations arising from marshes, bogs, and other uncultivated and undrained places, constitute a poison chiefly of a vegetable nature, which produces principally fevers of an intermittent or remittent type; and that exhalations accumulated in close, ill-ventilated, and crowded apartments in the confined situations of densely-populated cities, where little attention is paid to the removal of putrefying and excrementitious matters, constitute a poison chiefly of an animal nature, which produces continued fever of the typhoid character. There are situations in which these putrefying matters, aided by heat and other peculiarities of climate, generate a poison so intense and deadly, that a single inspiration of the air in which they are diffused is capable of producing almost instantaneous death; and there are other situations in which a less highly concentrated poison accumulates, the inspiration of which for a few minutes produces a fever capable of destroying life in from two to twelve hours. In dirty and neglected ships, in damp, crowded, and filthy gaols, in the crowded wards of ill-ventilated hospitals filled with persons labouring under malignant surgical diseases or bad forms of fever, an atmosphere is generated which cannot be breathed long, even by the most healthy and robust, without producing highly dangerous fever.
3. The evidence is just as indubitable that exhalations arise from the bodies of the dead, which are capable of producing disease and death. Many instances are recorded of the communication of small-pox from the corpse of a person who has died of small-pox. This has happened not only in the dwelling-house before interment, but even in the dissecting room. Some years ago five students of anatomy, at the Webb-street school, Southwark, who were pursuing their studies under Mr. Grainger, were seized with small-pox, communicated from a subject on the dissecting-table, though it does not appear that all who were attacked were actually engaged in dissecting this body. One of these young men died. There is reason to believe that emanations from the bodies of persons who have died of other forms of fever have proved injurious and even fatal to individuals who have been much in the same room with the corpse.
The exhalations arising from dead bodies in the dissecting room are in general so much diluted by admixture with atmospheric air, through the ventilation which is kept up, that they do not commonly affect the health in a very striking or marked manner; and by great attention to ventilation, it is no doubt possible to pursue the study of anatomy with tolerable impunity. Yet few teachers of anatomy deny that without this precaution this pursuit is very apt to injure the health, and that, with all the precaution that can be taken, it sometimes produces such a degree of diarrhœa, and at other times such a general derangement of the digestive organs, as imperatively to require an absence for a time from the dissecting room and a residence in the pure air of the country. The same statements are uniformly made by the professors of Veterinary anatomy in this country. The result of inquiries which I have personally made into the state of the health of persons licensed to slaughter horses, called knackers, is, that though they maintain their health apparently unimpaired for some time, yet that after a time the functions of the nutritive organs become impaired, they begin to emaciate, and present a cadaverous appearance, slight wounds fester and become difficult to heal, and that upon the whole they are a short-lived race.
The exhalations arising from dead bodies interred in the vaults of churches, and in church-yards, are also so much diluted with the air of the atmosphere, that they do not commonly affect the health in so immediate and direct a manner as plainly to indicate the source of these noxious influences. It is only when some accidental circumstances have favoured their accumulation or concentration in an unusual degree, that the effects become so sensible as obviously to declare their cause. Every now and then, however, such a concurrence of circumstances does happen, of which there are many instances on record; but it may suffice for the present to mention one, the particulars of which I have received from a gentleman who is known to me, and on the accuracy of whose statements I can rely.
Mr. Hutchinson, surgeon, Farringdon-street, was called on Monday morning, the 15th March, 1841, to attend a girl, aged 14, who was labouring under typhus fever of a highly malignant character. This girl was the daughter of a pew-opener in one of the large city churches, situated in the centre of a small burial ground, which had been used for the interment of the dead for centuries, the ground of which was raised much above its natural level, and was saturated with the remains of the bodies of the dead. There were vaults beneath the church, in which it was still the custom, as it had long been, to bury the dead. The girl in question had recently returned from the country, where she had been at school. On the preceding Friday, that is, on the fourth day before Mr. Hutchinson saw her, she had assisted her mother during three hours and on the Saturday during one hour, in shaking and cleansing the matting of the aisles and pews of the church. The mother stated, that this work was generally done once in six weeks; that the dust and effluvia which arose, always had a peculiarly fœtid and offensive odour, very unlike the dust which collects in private houses; that it invariably made her (the mother) ill for at least a day afterwards; and that it used to make the grandmother of the present patient so unwell, that she was compelled to hire a person to perform this part of her duty. On the afternoon of the same day on which the young person now ill had been engaged in her employment, she was seized with shivering, severe pain in the head, back, and limbs, and other symptoms of commencing fever. On the following day all these symptoms were aggravated, and in two days afterwards, when Mr. Hutchinson first saw her, malignant fever was fully developed, the skin being burning hot, the tongue dry and covered with a dark brown fur, the thirst urgent, the pain of the head, back, and extremities severe, attended with hurried and oppressed breathing, great restlessness and prostration, anxiety of countenance, low muttering delirium, and a pulse of 130 in the minute.
In this case it is probable that particles of noxious animal matter progressively accumulated in the matting during the intervals between the cleansing of it; and that being set free by this operation and diffused in the atmosphere, while they were powerful enough always sensibly to affect even those who were accustomed to inhale them, were sufficiently concentrated to produce actual fever in one wholly unaccustomed to them, and rendered increasingly susceptible to their influence by recent residence in the pure air of the country; for it is remarkable that miasms sometimes act with the greatest intensity on those who habitually breathe the purest air.
The miasms arising from church-yards are in general too much diluted by the surrounding air to strike the neighbouring inhabitants with sudden and severe disease, yet they may materially injure the health, and the evidence appears to me to be decisive that they often do so. Among others who sometimes obviously suffer from this cause, are the families of clergymen, when, as occasionally happens, the vicarage or rectory is situated very close to a full church-yard. I myself know one such clergyman’s family, whose dwelling-house is so close to an extremely full churchyard, that a very disagreeable smell from the graves is always perceptible in some of the sitting and sleeping rooms. The mother of this family states that she has never had a day’s health since she has resided in this house, and that her children are always ailing; and their ill health is attributed, both by the family and their medical friends, to the offensive exhalations from the church-yard.