The causes which more immediately act from within are those which either directly introduce pernicious matters into the interior of the body, in the shape of foul water or putrescent food; or which indirectly accumulate noxious matters within the system, by impairing the action of the excretory or depurating organs whose office it is to maintain the blood in a state of purity, by removing out of the system substances which having served their purpose have become useless and pernicious.
The earnest attention which has been recently directed to the first class of causes has led to an advancement in the science of prevention, the importance of which it is impossible to over-estimate.
To give only one illustration of the action of a predisposing cause, I select as my example, Overcrowding.
The Statistical Society of London some time ago appointed a Committee of its Council to make a house-to-house examination of the parish of Marylebone, with a view to ascertain how many families in the parish occupied a single room as a living and sleeping room. In the course of this inquiry, one of the examiners came to a house in which there was one remarkable room. It was occupied not by one family only, but by five. A separate family ate, drank, and slept in each of the four corners of this room; a fifth occupied the centre.
“But how can you exist,” said the visitor to a poor woman whom he found in the room (the other inmates being absent on their several avocations), “how can you possibly exist?”
“Oh, indeed, your honour,” she replied, “we did very well until the gentleman in the middle took in a lodger.”
I see every day in the wards of the Fever Hospital the consequence of taking in such lodgers. An epidemic shows it not more truly, but more strikingly.
Within the walls of an establishment for pauper children at Tooting, in 1849, there were crowded 1395 children. Little more than one hundred cubic feet of breathing space was allowed for each child, 500 being the smallest compatible with safety. One night Cholera attacked sixty-four of these children; 300 were attacked in all. Within a week 180 perished.
In the Workhouse of Taunton there were 276 inmates. In some of the rooms the breathing space was not more than sixty-eight cubic feet. Cholera swept away 60 of these inhabitants in less than a week.
In the County Jail of this same town, the breathing space allowed to each prisoner ranges from 819 to 935 cubic feet. Not a single case of cholera, nor even of diarrhœa, occurred among the prisoners in this jail.