In this state of things, we have another visitation of the Asiatic cholera. We are again admonished as to our duties as men and Christians. Once more we are awakened to a full knowledge of the fact, that thousands of our fellow creatures are perishing annually, victims to public neglect. The great bulk of our working classes are placed in a condition unfavourable to health—a condition that forbids the preservation of the ordinary decencies and moralities of life. There is a responsibility rests upon all who have influence or power—a responsibility which cannot be shaken off. The work of reform is not accomplished because we have got a legislative enactment and a Board of Health. Every town-council and all parish authorities must see to it that the present warning is not neglected, and that it is not permitted to pass away unimproved. It is a question involving many others of great moment; and experience has shown that they cannot be neglected without serious loss, nor without entailing upon us great physical and moral evils.
The history of the present visitation will be familiar to all readers. The general statements are absolutely appalling. In Albion Terrace, Wandsworth Road, seventeen persons died within a fortnight, in ten houses, of cholera. In one house no less than six persons died. This house was occupied by the Rev. Mr. Harrison, a dissenting minister: he had two relatives staying with him,—Mrs. Roscoe and Mrs. Edwards. Mrs. Roscoe was first attacked, and died; Mrs. Edwards, who attended upon her, was next seized; and on Mr. Harrison returning from the funeral of Mrs. Roscoe, he found his wife attacked by the same disease, and that lady expired the next morning. Mr. Harrison, overwhelmed by this terrible calamity, fled to Hampstead. On the morning of his departure Mrs. Edwards died, and the cook was attacked and died the same evening. On the following day the three bodies were interred at Kensall Green; and on the return of the mourners they found the nurse who had attended Mrs. Edwards dead, and a note informed them that Mr. Harrison had been attacked at Hampstead, and had died the same day. It is important to look at some of the facts brought out before the coroner’s jury. Mr. Harrison had stated before his death that he believed the attack had arisen from bad drainage and from bad water. Dr. Milroy stated, in his report, that in the house in which the epidemic had first broken out in that neighbourhood,—“The cellars were swarming with filth and maggots, amounting altogether to some cart-loads.” The verdict of the jury declared that the disease had first broken out “in a house where the drainage was very defective, and the water bad.”
In other places we find the same causes actively at work, producing cholera. The seizures have been mainly in the districts notorious for bad sanitary arrangements. In every case we find that the track of cholera has been identical with that of fever. In a report just published by the Board of Health ample evidence is supplied that the seats of fever are also the seats of cholera.
The first decided case in London occurred in a court that had been specially pointed out to the Sanitary Commissioners. In the town of Uxbridge four cases occurred last October, marked by the unequivocal characteristics of Asiatic cholera. One of the persons lived in a house notoriously insalubrious, and in which some cases of malignant fever had proved fatal. In relation to it the medical man had said, that if ever cholera visited Uxbridge, he believed the first case would be in that house. The conditions upon which cholera extends are everywhere the same. They establish most clearly the connection between a low sanitary condition and disease,—between filth and fever; and show that the two diseases, although rarely, if ever, found in the same district together, are twins from the same parent stock. They have, no doubt, a common origin.
One word on the attacks of typhus. How is it that we are stirred into activity by an invasion of cholera? that we feel so much alarm? It is proved that the mortality from attacks of cholera, during its visitation in 1831–2, was not greater altogether than the average annual mortality occasioned by typhus. The effects of the latter disease are still more serious than those of cholera. And yet we sit down with the latter, and become reconciled to its existence, because it is common and always with us. If the sanitary evils which have been proved to exist almost universally were removed, cholera and typhus would scarcely be known amongst us; and yet “the annual slaughter in England and Wales, from preventable causes of typhus, which attacks persons in the vigour of life, appears to be double the amount of what was suffered by the allied armies in the battle of Waterloo.” Every day, disease and death arise from the presence of filth, from bad water, or overcrowding. They are put down in the bills of mortality as deaths by typhus, scarlatina, consumption, &c.—the true report would be, poisoned by bad air, killed by public neglect. It would not be too much to say that they are sacrificed to the indolence, incapacity, or waywardness of the public authorities.
To justify this view of the case, I may quote, from the report just referred to, a passage in relation to Dumfries. This town had suffered most severely in 1832. I believe at that time the cholera attacked one-eleventh of the entire population, and destroyed one-seventeenth.
“Knowing,” say the Commissioners, “that little sanitary improvement had been effected in the interval, and consequently that the inhabitants must be in as great danger as before, we called the attention of the authorities to the special regulations of the Board. To our recommendations the parochial board paid no regard. The disease, meantime, went on committing its former ravages. Thus, within the first twenty-nine days after its outbreak, there occurred 269 deaths out of a population of 10,000. No efforts being made on the part of the local authorities to check this great mortality, it appeared to us that this was a case requiring a stringent enforcement of the regulations of the Board, and we sent one of our medical inspectors (Dr. Sutherland) to organise a plan of house-to-house visitation, to open dispensaries for affording medical assistance by night as well as by day, and to provide houses of refuge for the temporary reception of persons living in filthy and overcrowded rooms, where the disease was prevailing, and who, though not yet attacked, were likely to be the next victims. The result of the adoption of these measures was, that, on the second day after they were brought into operation, the attacks fell from 27, 38, and 23 daily, to 11; on the fifth day they diminished to eight; on the ninth day no new case occurred, and in another week the disease nearly disappeared.”
Surely, there was great want of knowledge or culpable neglect, on the part of the local authorities, in this case. In other cases similar conduct has been displayed. It appears we have yet to learn that the care of the public health is a branch of social economics; that it involves more than mere pecuniary considerations. We have not summed up the evils of this immense pressure of disease when we have estimated the number of those attacked, or the number of those who die. The money cost, though heavy, is a mere trifle to the various afflictions that follow in the dark train. Neither does the bodily suffering—the physical pain—complete the amount of evil. The more we look at it, the more intense does the feeling of awe and sorrow become. We find, as we look abroad on the face of society, a fearful retribution for sins of neglect, and for opportunities unemployed. We find ample proof that the ordinations of Divine Providence cannot be violated with impunity:—if we sever the links of duty and of kindness which unite us to our fellow-men, we cannot separate ourselves from the guilt, the suffering, and the loss, such alienation may induce.
I must present some of these evils in detail. I begin with the lowest—the pecuniary loss. We have to estimate the unnecessary deaths, the unnecessary sickness, the number of funerals, the burthens upon every charity, and that upon the poor-rate. The fever-tax is the heaviest of all taxes. And yet a much larger sum is annually spent in sustaining a number of palliative expedients, than would suffice to support a machinery of prevention. It is laid upon us, sometimes by the neglect, sometimes by the false economy of local authorities. They have only one object—to keep down the rates. However obvious the improvement, it is met by the question—“How much will it cost?” Short-sighted economy! The question ought to be—“How much suffering and sickness will it prevent?” The largest sum that could by possibility be required to carry out all the needful schemes of sanitary improvement, are far exceeded by the sums now expended in various ways, and which are entailed upon us by the presence of disease, and the poverty it produces.
The moral evils far exceed any pecuniary loss, and outweigh any amount of physical suffering. The various epidemic diseases generally attack persons in the vigour of life. This is, especially, the case with typhus, which is, as Dr. Guy terms it, our “pet epidemic,” and which we nurse “with as much care as if we loved it.” How many widows and orphans are thus thrown destitute upon the world? How many thousands of poor children are cast, homeless and friendless, upon the streets, furnishing supplies for that great fund of juvenile depravity of which we have lately heard so much? These wretched children crowd our thoroughfares, miserable and abject. They soon acquire the irregular habits of the class among whom they are thrown. Let the candid mind calculate the cost. How much in poor-rates? how much in alms? how much to public institutions? And then let us ask how many of them become depredators and thieves—punishing society for its neglect—punishing, by preying upon its property—punishing, by spreading abroad the contagion of disease and of vice—and punishing, by the cost of prisons, police, bridewells, penitentiaries, and all the other appliances to repress crime? The reports from some places are of the most painful description, as respects the great number of orphans made by the present visitation of cholera. If this applies to an occasional visit of cholera, it applies with ten-fold force to typhus. I know, at this moment, three different families suffering under this affliction. In two of the cases, the mother is left to struggle with a large family; in the other case, both parents were taken off by fever within a fortnight of each other. The children are in the workhouse.