Numbers of typhoid cases could be mentioned where poisons from putrid matter were conveyed into the system by water, milk, and impure food, but I have never heard of a case where the poison was detected leaving one person for another.
If in 1883 a person had stated that cholera was not contagious, they would have been ridiculed, yet the principal physician and those in charge of the cholera hospitals of Paris last year, certified to the representative of one of our daily papers that cholera was not contagious. The cholera epidemic of last year proves that cholera poisons are produced by heat and atmospheric influences on putrid matter, and circumstances favour the theory that they are inorganic, and when inhaled into the system poison the organisms of the blood to such an extent as to produce the disease. Cases of cholera broke out in different parts of the Continent at the same date, clearly showing that contagion had nothing to do with producing or transmitting the disease. In England our ports were jealously watched to prevent any case from being landed. Had a case been landed, the excreta from that one case might, when mixed with the sewage of a large town, have been the means of spreading the disease through the whole district, as miles of sewers are so laid that poisons in the gases can be effectually distributed through the district in a very short time. Open ventilation to sewers would greatly assist this, and especially when the gases in the drains and the fresh air admitted into them were of a high temperature. It is very improbable that cases if imported would break out in two towns at the same time, or that the poison could be conveyed in the atmosphere which divides us from the Continent.
Fortunately, when the continental outbreak was known, the authorities in the metropolis and other towns used disinfectants on all known putrid matter, and especially at the sewer gratings. This was an expensive process, but it had the effect of preventing the atmospheric influences (which were similar to those on the Continent) from developing the poison to a vitality necessary to give the disease.
It would be an excellent preventive if the authorities of towns would thoroughly examine every part of their districts, and know for a certainty whether in their sewers, cesspits, vaults, or dust-bins there existed putrid matter, or gases from them similar to those which produced the disease on the Continent. The expense of such an examination and for remedying the evils cannot be an excuse for not doing this work, as the monetary loss experienced by the residents of those continental towns and cities by the outbreak was enormous. What the loss would be to the residents of the metropolis if a cholera epidemic were to occur, it is difficult to imagine, and yet in many of the districts cholera-producing elements exist from which in all probability the heat and atmospheric influences experienced during several weeks of excessive dry weather during the summer months will produce poisons of a similar vitality to those produced on the Continent during the past year.
Previous to the cholera epidemic, small-pox was very prevalent in London, and I very carefully noted the cases as they were reported, and visited the districts where the disease was most prevalent, for the purpose of testing the nature of the gases in the sewers, and observing how the sewers and sanitary fittings were constructed.
In many of these districts, and especially those of Homerton, Hackney, Bow, and Bromley, the drains are so laid and the fittings so constructed that a supply of sewer gas is pumped into the houses, and it is impossible for persons to live in the houses of these districts without inhaling gases that have been for a long time in contact with sewage matter.
Whether the small-pox poison is an organic one (which I believe it is), and is produced from a collection of matter in a high state of decomposition, with or without being mixed with the excreta of persons suffering from the disease, or whether it is of an inorganic nature, the poison is derived from this source rather than from the impurities thrown off through the skin of persons suffering from the disease. As a proof of this, as soon as the cholera broke out last year on the Continent, almost every gulley and grating in the metropolis where sewer gas passes was charged more or less with a disinfectant, which minimised the poison in the gas. The result was that small-pox abated in an epidemic form although the temperature of the atmosphere increased.
The disinfectants so placed could not, naturally, affect the gas in branch drains to houses, or putrid matter in various parts of the sewers, or if it had, judging from its beneficial effects at the outlets, small-pox would have disappeared.
If contagion were the means by which this disease was distributed, disinfectants at sewer gratings would not have prevented the disease continuing in an epidemic form.
Take the adjoining districts of Fulham and Putney. During the epidemic, the gases from the sewer gratings in the Fulham district were more dense than those at Putney. Fulham had many cases of small-pox, but Putney none, although persons from each district were in daily contact with each other; but the houses were not connected by the same system of sewers.