That personal cleanliness, and breathing pure air, should contribute to the health of individuals, or to any number of them collected into camps or cities, seems to be agreeable to reason and common sense; nevertheless we find that this has been denied, and even Dr. Canestrinus says that “in the plague of Lyons and Marseilles it was observed, that the most populous parts of these cities, where the streets were narrow and filthy, suffered less from the disease than those which were more airy and clean. At the time of the plague in London in the time of Charles II, the physicians advised that all the privies should be opened and exposed; the fetid odour from which having pervaded the city, the plague was stopped! Is it from this cause (the author asks) that the plague has seldomer visited Spain, the towns of which are intolerably offensive from their want of cleanliness?”[114]
This certainly seems a very strange doctrine, nevertheless the fact that Spain is but little subject to the plague seems undeniable, and as it is no less certain that the towns are excessively filthy, it would seem that cleanliness is not effectual in preventing it. But, however agreeable the smell of human excrements may be to the Spaniards, or to the English physicians in former times, it seems to be less so at present. “I am persuaded (says Dr. Ferriar) that mischief frequently arises from a practice common in narrow back streets of leaving the vaults of privies open. I have often observed that fevers prevail most in houses exposed to the effluvia of dunghills in such situations.” In Spain the opinion seems to have been but lately eradicated; for some years ago, an order having been issued by government that the streets of Madrid should be kept somewhat cleaner, the people were so much exasperated at being threatened with the loss of the savoury odour, that a rebellion had almost ensued, and the physicians declared the smell of human excrements to be the most wholesome thing in the world.[115]
That the confinement of human effluvia, along with heat and want of water, will produce a malignant fever, is certain from the example of the unfortunate people confined in the Black Hole at Calcutta. In this case the distemper seems to justify the opinion that plague may be artificially produced, perhaps more than any other upon record; for Dr. Ferriar informs us that it was attended with eruptions resembling those of the true plague. In this case, however, the confinement was beyond example in any situation which can be supposed incident to a city or camp. There is no country in the world where the inhabitants are equally numerous with those of the empire of China, its population at present being estimated by Sir George Staunton at three hundred and thirty-three millions, a number equal to one third of the supposed inhabitants of the whole globe; of consequence the cities must be immensely crowded with inhabitants; yet it remains free from plagues. Human effluvia therefore, in the most populous state in which mankind can exist in society, are not able to taint the atmosphere of a country or city. The following is Dr. Clark’s account of that celebrated empire: “The whole empire of China is represented to be extremely delightful; the soil rich, the air pure, and the industry of the inhabitants astonishing. As it produces every luxury and necessary of life, it is justly esteemed one of the most fertile countries in the world. As the Chinese prohibit emigration, and seldom or never engage in war, their country is extremely populous. Every river maintains a proportion of inhabitants adequate to the land, whose families live continually in boats, without having any other place of residence. Their number of people lays them under the necessity of carrying industry to the greatest height; for otherwise their country, fertile as it naturally is, would be insufficient to maintain the inhabitants. Every inch of land is cultivated; no forests nor woods, nor even a single tree, is suffered to obstruct the labours of the husbandman. Canals are cut every where to water the fields, and marshes are manured for the cultivation of rice. By these means health and plenty are, in a great measure, the portion of its inhabitants through all the seasons of the year. The only terrible and fatal diseases to which they seem to be subject are the small-pox and leprosy.”
But, though our author determines in general that the air of China is pure, this cannot apply to every part of it without exception. On the contrary he describes in the following manner Wampoa, a village about fourteen or sixteen miles below the city of Canton, on Canton river: “It is the usual station of all European ships in this river. On one side the land is low, marshy, and covered with water, forming swamps fit only for the cultivation of rice. The extent of these swamps is considerable; the tide rises high, and overflows great part of them; but the intersection of the rivers renders them more pure than they would otherwise be; and consequently the air is much healthier than one could expect from the unfavourable aspect.”
In like manner Canton city he says “is built on a very extensive plain, and is large and populous. Here the government allow the English, Dutch, French, Danes and Swedes separate factories on the banks of the river. The city, though paved, is very wet in rainy weather; and the water makes its way under the factories of the different nations every tide. The houses are built with bricks; the apartments are in general small, and not very lofty, and the ground stories are very damp. When the business of the season is over, the supercargoes remove to Macao, a Portuguese island, subject to the Chinese government. The city of Macao is situated on a rising ground; the whole island is dry, rocky and barren; it is, however, plentifully supplied with provisions by the Chinese; and, though the air is very sultry, yet it is tolerably healthy.”
From the preceding account it is plain, that the causes which operate in the production of plagues and epidemic diseases in other countries, though they exist in China, do not act there with equal efficacy. At Wampoa the marshes in the neighbourhood must, in the hot season, emit noxious effluvia as well as any where else, and there can be no certainty that the overflowing of the tide is sufficient to put a stop to their malignant influence. At Canton the water penetrates below the floors of the houses, and we have seen from Dr Fordyce[117] that in other countries the sprinkling of a floor with clean water, and the encampment of an army upon ground where water was found at a small depth below the surface, were sufficient to produce fevers; yet here it is not so. In this city also the inhabitants are numerous, and the apartments small; so that neither the perspiration of multitudes, nor the moist exhalations from water stagnating in the streets, nay, under the houses themselves, are able to produce the diseases in question. Again, at Macao the sultry heat of the air has as little effect as the rest.
Lastly, in Pekin, the capital, the population and the crowd are immense. According to Sir George Staunton,[118] the city is about one third larger than London; but, as he supposes[119] it to contain three millions of inhabitants, the population must be twice and a third-part as great as that of London in proportion to its bulk. “The low houses of Pekin (says he) seem scarcely sufficient for so vast a population; but very little room is occupied by a Chinese family, at least by the middling and lower classes of life. In their houses there are no superfluous apartments. A Chinese dwelling is generally surrounded by a wall six or seven feet high. Within this enclosure, a whole family of three generations, with all their respective wives and children, will frequently be found. One small room is made to serve for the individuals of each branch of the family, sleeping in different beds, divided only by mats hanging from the ceiling. One common room is used for eating.”
Where diseases are prevalent, circumstances of the kind just mentioned would certainly be urged as evident causes of them; but in China we see that something disarms such causes of their power. People, however, seldom want a salvo for any thing. “The crowds of people, at Pekin (says our author) do not prevent it from being healthy. The Chinese indeed live much in the open air, increasing or diminishing the quantity of their apparel according to the weather. The atmosphere is dry, and does not engender putrid diseases; and excesses productive of them are seldom committed.” But, if the dry air at Pekin contributes to the health of the people, why does not the moist air of Canton produce diseases? Besides, in this empire there are multitudes of people who live entirely upon the water, in a kind of houses constructed upon junks, employed in carrying grain from place to place, or for other purposes.[120] Sir George Staunton computes the number of inhabitants on a branch of a single river to be no less than an hundred thousand. What then must they be throughout the whole empire! Yet these people, though continually exposed to moisture, as well as to an almost inconceivably crowded situation, are yet no more subject to epidemics than others. Our author does not specify the excesses which produce disorders. Intemperance in drinking no doubt is one of them; but Dr. Patrick Russel expressly says, that he never saw an instance of the plague being brought on by intemperance.
Lastly, with regard to living in the open air, Mr. McLean has ascribed to the vicissitudes of this element the principal if not the only cause of epidemics. “A fact worthy of notice (says he) is, that aged persons and children are both seldomer and less severely attacked by epidemics and pestilential disorders than the young and middle aged, and women seldomer and less severely than men. Now, if contagion was the source of these diseases, the case would be exactly reversed. Old people, women and children, being more in the way of contagion, would be more frequently and more severely attacked. But the young and middle aged, being more exposed to the vicissitudes of the atmosphere, the principal source of those diseases, they are consequently more severely attacked. It has been a puzzling question to solve why old people and children are less exposed to plague, &c. but the solution will be no longer difficult if it should be proved that these diseases are always produced by certain states or vicissitudes of the atmosphere, together with the application of other powers co-operating in the production of indirect debility.” In the country we speak of, however, this solution fails in a manner almost as evident as can be imagined. “The removal of the embassy, (says Sir George Staunton) was a disappointment to several persons belonging to it, who had made arrangements for passing the winter at Pekin. Judging of its temperature by the latitude of the place, a few minutes under 40° north, they were not aware of the violent effect of the great range of high Tartarian mountains, covered perpetually with snow, upon that capital, where the average degree of the thermometer is under twenty in the night during the winter months, and even in the day time is considerably below the freezing point. The usual inhabitants were guarded against cold, not only by habit, but by an increase of clothing in proportion to its intenseness, consisting of furs, woollen clothes and quilted cottons. They are not accustomed to the presence of fire. They have no chimneys, except to kitchens in great hotels. Fires, on which Englishmen chiefly depend against suffering by the sharpness of the atmosphere, could not well answer that purpose in houses which are so constructed as to admit the external air almost on every side. Stoves are, however, common in large buildings. These stoves are situated frequently under the platforms on which the inhabitants sit in the day time, and rest at night. The worst weather experienced in that capital might be considered as mild by the Tartars, coming from a climate still more rude; but other foreigners are said to feel themselves less comfortable at Pekin in the winter than in the summer, though the heat is then raised to the opposite extreme. In both they seem to require a seasoning. Several individuals of the embassy fell ill during their stay; and all did not recover. The human frame seems calculated for the hottest rather than the coldest atmosphere, and to exist at the equator rather than the pole.”
Here we are involved in difficulties much greater than before. It appears that even the fine climate of China is healthful only to its own inhabitants. They can bear the vicissitudes of the air, which Europeans cannot. The prevention of plagues or mortal diseases then must consist in some mode of living by which people can accommodate themselves to the country which they inhabit, and without which every other precaution will be ineffectual. The diseases with which the attendants of the ambassador were seized could not be owing to any slovenliness or dirtiness in their lodgings or food, or to want of apparel; nor were they more exposed to the inclemencies of the air than others; only they were in a strange country, where that inexplicable constitution of the elements acted upon them in a manner different from what it did on the natives, and, while it was friendly to the latter, proved pernicious to the former. But there was a time when even China was as unhealthy as other countries; for the great plague in 1346 began in the northern part of it. We have seen, in a former section, that this was preceded by the most dreadful and violent wars throughout the whole Asiatic continent. Since the cessation of these violent wars the Chinese have staid at home, and applied themselves to the arts of peace, particularly to agriculture, which they have carried, we may say, to its utmost perfection. This seems therefore to be the true method of removing all those local causes which produce epidemics, or at least of preventing them from doing hurt; and, without attention to the natural duties and occupations of man, it is to be feared that all artificial modes of prevention will be found not only precarious but ineffectual.