Francis Lieber.

Library of universal knowledge. A reprint of the last (1880) Edinburgh and London edition of Chambers' encyclopaedia, with copious additions by American editors (Volume 13) online

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erected three mortuaries: and a mortuary chapel for the Roman Catholics has been hnilt partlyat the
expense of Mr. Hutcheson, a Protestant gentleman, and partly by subscription. (Stewart, op. cit..
p. 74.)



out the- powers conferred on them by the diseases prevention act, 1855, and the public
health act, 1858. Unfortunately, however, it requires some comparatively rare and
startling disease, as yellow fever, plague, cholera, or cattle-disease, to stir That august
body into activity; while typhus, typhoid, and small-pox may ravage our crowded towns
and undrai.ied villages, and cany oil' their thousands of victims, unless in very extreme
cases, to which the public press may have called attention. (Of the half million deaths
that occur annually in England, more than 0,000 are, due to typhus and typhoid;* while
in England and Scotland, more than 5,000 persons annually i'all victims to small pox.f)
By the sanitary act, 1806, the home secretary is empowered to interfere, if Le see fit, on
complaint made to him of the default of any local authority. It is sincerely to he hoped
that he will unsparingly put forth the power intrusted to him.

Passing from what has, and what has not, been done by government, let us consider
what are the duties of local authorities, and how they discharge them. On this subject,
Dr. Stewart, gives us much information in his pamphlet already referred to. To such an
extent has non-interference prevailed that, except in London, the 5 appointment of medi-
cal officers of health, and even of inspectors ol nuisances, is optional. He ascertained
that of 570 places under the local government act, 1858, and the public healih act, 1848,
with populations varying from 214 to 200.000, 50 Lave no inspectors of nuisances, 153
have each one; while in 347 one man holds the double or treble offices of i-urveyor,
inspector, and collector. In the metropolitan districts, with a population of a Love
3,000,000, the sanitary force is most unequally divided, for, while 2 subdistricts, with a
population of 4,000 and 10.000 respectively, have the services of one inspector, St.
MaVyleboue and St. Pan eras, with respective populations of 163,000 and 211,000, have
each of 'hem only two.

A few words on the duties, qualifications, and position of the medical officer of
health, will rind a titling place here.}: liis duti<s and qualifications are thus laid down
in an instructional mii.uleof the general board of health, dated Dec. 20, 1855: "He will
make himself familiar wiih the general features of the place, with its previous sanitary
state, and with its i xisting provisions for health viz., the levels, inclinations, soil, wells,
and watt-r-springs; with its meteorological peculiarities; with its burial-grounds, slaughter-
houses, lodging-boiiFes. etc. ; he will see to the general healthiness of his district, inquire
into the cleanly and water proof condition of houses, examine the drinking-water, and
observe whether diseased meat or s'dulterate'd articles of food are exposed for sale; and
will report weekiy and annually to th<; local board." These are but a few of his duties,
for the proper performance of which (as the minute goes on to add) special qualifications
in science are reqi'irc-d. " The^e lie in pathology, including vital statistics, in chemistry,
a 1 d in natural philosophy." For these accomplishments, the town of Aberdare offers
8Ad. ?i day, or 12 guineas n year, for looking after the health of its 85,000 inhabitants;
while Paisley gives 20 foi the sanitary superintendence of a population of 48,000.
Fifty pounds is a common salaiV. except in the metropolis; the most liberal salaries are
350 at Pirkcnhead and Hackney, ,400 at St. JVIan lebone, 500 at Edinburgh and Leeds,
600 at London (proper), while Liverpool has nobly raised the salary to 1000. Surely
500, 600, and 1000 are not too much for Edinburgh, London, and Liverpool to pay,
in order to secure the services of such men as Littlcjohn, Letheby, and Trench. Dr.
Russell, th" medical sanitary officer for Gi.isirow, has 600 a year; and Dr. Gaird net, one
of the first of our living hygeists, is retained as consulting officer at 100 a year. Not
only is the medical officer's salary dependent on the caprices of the local board, who
may dismiss him at pleasure, but, as Dr. Stewart truly observes, "the very efficiency
with which he performs his duties may be an unpardonable sin in the eyes of a majority
of his masters. His statements of facts may touch the interests of some, his suggestions
of remedies may excite the displeasure of others; and if the soundness of his position
cannot, be assailed by reasoning, passion may suggest as it has before nqw suggested a
reduction of salary or a threat of dismissal, as likely to bring the offender to his senses."
Not only is this disgraceful form of pressure brought to bear directly on the medical
officer of health, but indirectly on. those who have the power of electing or dismissing
him. An amusing incident of this nature is mentioned in Dr. Stewart's pdmphlet.
When Dr. Robinson was appointed officer of health for Leeds, he found that he had to
grapple with unparalleled privy abominations, piggeries by hundreds, numerous slaughter-
houses, tin- gigantic smoke-nuisance, and an average death-rate of 30 in 1000. The battle
between science and filth was prolonged and terrific, and the piggeries were made ihe
battle-field. The pig-owners, taking alarm at Dr. Robinson's energy, formed themselves
into a "pig protection society," summoned ward-meetings, and commenced an active
canvass, for the p'trpoxe of turning out of the council all who woidd not pledge them-
selves to vote for Dr. Robinson's dismissal. The case, after being twice heard before the
magistrates, who declared that the pigs were n nuisance, and must be removed, was
finally settled 0:1 appeal by the recorder, who gave an order, not for the eviction of the
pigs, but for the daily removal of the manure, for the due enforcement of which a

* According to Dr. W. Bndd. typhoid alone is the rnuse of from 15.000 to 20,000 deaths in England.

t For data on this subject, see the foot-not** to p. ~.

tOn this subject Dr. Letheby has published nn excellent memoir, which will be found in the ^ff(Ji-
ecil Press nnd Circular for August 7 and 14. 18ti7: and Dr. Rummy's pddress On State Medicine in
Great Britain and Ireland (Lond. 1867), may also be consulted with advantage.



separate inspector would be required for every pig-sty! Under these conditions, is a
medical officer of health fairly encouraged to discharge his proper dulies?

Tlie next points to which we shall direct attention are the NUMBER OK DEATHS occur-
ring annually in England and Wales, and the CAUSES OF THESE DEATHS; and we shall
then proceed to inquire how far the deaths from some of our most fatal diseases might
have been prevented l>y due attention to sanitary measures. We learn from the twenty-
eighth annual report or the registrar-general of births, deaths, ami man-iaux-sin England,
which was published in 1867, and gives the results for the year 1N65, the following
statistical facts, which bear more or less closely on our subject. The population of
England, the births, deaths, and excess of births over deaths, are tabulated from ihe year
1833, when the system of registration came in force: and from this table we extract the
numbers for 183 J, 1848, 1838. and for 1861-65 inclusive:

Yeai-s ending Dec. 31.

population in
middle of year.

(exclusive of


of bir.hs.

1833 ..



342 760






1 13,226


19 471 291


449 05(5

205,825 '







20 ^30 -il r


43(i 566

276 * '8






180 1


740 "J75

45 531

2 14 744







From these figures, we learn, inter alia, that in a quarter of a century the population has
added 5,090,000 to its strength, and that there is a steady increase (with occasional excep-
tions) in the annual number of births and deaths, and in the excess of the former; the num-
ber of births having increased during that period 46 per cent, and that of deaths 43 per
cent. The following is an abstract of Dr. Farr's letter to the registrar general on the causes
of death in England in 1865: In every 1000 deaths. 381 of the population fell before local
diseases, 235 were struck down by. zymotic diseases, 182 by constitutional diseases, 160
by developmental diseases, and 36 died violent deaths; the remaining 6 were deaths
from causes not ascertained. Local diseases the inflammations and functional diseases
of organs carried o:f 184,877 persons in England, causing 9 of the 23 deaths per 1000 of
the living. It is the deaths from diseases of the vital organs that swell this number so
high 23.273 deaths from 'heart diseases, nearly as many (21, 774) from diseases of the
digestive organs, more than thrice as many (63,953) from diseases of the respiratory
organs so essential to life, and a number nearly as large as this last (60,234) from diseases
of the nervous system. Tiie number of deaths in England ascribed to bronchitis has
rapi.lly increased: it was but 21,538 in 1856. had advanced to 32,346 in 1800, and in 188.5
reached 33,438. Softening of the brain is another disease that has increased rapidly of
late years, and in 1835 was fatal to l'J5l males and 627 females: these deaths would for-
merly have been classed under paralysis and other heads. The deaths from diseases of
the nervous system include 26,723 from convulsions, occurring chiefly in children.
Among the raivr deaths from local diseases, 5 are referred to fright, 3 to irrief, and 4o to
melancholy. The second most fatal class of diseases the zymotic (epidemic and cm-
tagious) is swelled chiefly by fevers and by diarrheal disease. It swept from life in
England 113,948 persons in 1865, the majority of them young children under 5 years of
age. The deaths by cholera in England' in 1865 were '1291"; by diarrhea, 23,531. The
deaths by fever typhus, typhia, and typhinia* which were 13,012 in the year 1860,
rose to 23,03i in 18J5. and five-tenths of "them were registered among four-tenths of the
population. The deaths from scarlatina were 17,700, and from diphtheria, 4,145. The
deaths attributed to syphilis rose to 1647; 437 persons' died from intemperance, and 612
from delirium tremeii*; 74 from privation; 19 from hydrophobia; 4 from glanders, for
horses as well as dogs communicate some of their diseases to men. Worms are put
down *8%ie cause of death in 153 cases, one of which is ascribed to trichina xpimli*.
The third class of deaths is from constitutional diseases, diathetic or tubercular, which
were fatal to 83.504 persons in 1865. These diseases have this in common with the
zymotic, that they are diffusive; and human tubercle is, even when introduced by inocu-
lation, capable of inducing tubercular deposits in the organs of animals. The preva-
lence of phthisis in the armies of Europe is considered to be probably due in part to tiie
inhalation of expectorated tubercular matter, dried, broken up into dust, and Moating in
fae air of close barracks. Dr. Farr remarks that to test this may be difficult, but the

* In the National Returns, all cases of fever aro set down as typhus, which is thus made to include
pure typhus, with blood-spots (petechice) on the skin, which is exceedingly fatal imore than 20 per cent
of the cases in the London fever hospital proving fatal), is generated in crowded populations, and ia
very infectious: tifphia or t>ipho>d fever, which i; endemic, is characterized byan eruption of rose-red
the skin, and by ulceration of 1'eyer's glands, and is usually generated by the intestinal evacu-


orij^n and propagation of the most fatal of all human diseases deserves full investiga-
tion. The inquiry should also extend to eancc-r aiul the other constitutional diseases,
among which should perhaps he included diabetes. Among the deaths troni cons.itu-
tional di.sea. - es may be noted gout, as increasing every year. Gout is live times as com-
mon in men as in women, and is very rarely Fatal under 85 years of age. To it, 801
deaths were attributed in 1865. Unlike gout, dropsy is most "fatal to women; and the
substitution of dropsy in women for gout in men after the age of 45 is worthy the atten-
tion of pathologist*. Cancer is more tiiau twice as fatal to women as it is to men. The
mortality by all constitutional diseases is rather le*s than it was in the de-cade I850-/i9r
end this- is partly due to the decrease of the number (,f deaths referred to phthisis; siiil
these deaths reached f)o, 7;j4 in 1865, the greater part of them occurring in ad'ilts: and
more than half the deaths of young women between 20 and 25 were caused by phthisis.
The fourth class of diseases the ciffimtopmentaJ. were fatal to 77,806 persons in Kngland
in 18o5: 8.7SM infants born alive died from being premature; and other 22.4o6 died of
debility be Sore they were a year old. Besides 1383 deaths by puerperal fever, and 2,490
ascribi d to childbirth, 490 women died of spec i lie diseases complicated by parturition.
The deaths by ordinary diseases of the 560,000 enceinte women, constantly existing in
the population of England, could not be entirely distinguished from the deaths of other
women of the saint: age; of course they were subject to the same diseases as others, but
probably the class of mothers belongs to what, in a certain sense, the insurance oftices
call select lives. The* list of developmental diseases closes with the deaths, of 28,709
persons from old age, 154 of the men and 402 of the women being of the age of 95 and
upward. Thus we reach the last class of deaths the 17,;>74 persons who were destroyed
by fin/.'itf tlit/t*; 15,2152 by accident or negligence, 443 under circumstances bringing
the case under the legal denomination of homicide, 1392 by suicide, (J on the scaffold,
and the remaining 301 not classed. These are the several ways in which 4'JO.*J09 persons
died in England in 1805.

iNow lei us ece how many of the above diseases are more or less preventable, and
how far we have already been successful in diminishing them. There are parts of Eng-
land in which, for each 1000 person* living, there die annually only 15;* while then; are
other pans that, of each 1000 persoin-. ;)0 or moref die annually. The 15 and the ;i() are
said to be the respective death-rates of these places. The average London death-rate is
21; and the most common death rate in country districts and small towns through all
England arid Wales is 20. The registir.r general's return, published in Jan., 1868, show-
ing the annual r;:t;: of mortality in the hirgc towns of the United Kingdom for the year
1807, enables a c-ompari.-on to be rnnde of the death-rates in the last three years H.65
being tlicfirsl year of the publication of these results. Thus the average annual rate of mor-
tality per 1000 persons living in the great cities in each of the years 1865, 180(5. and 1867
respectively, v/as a> follows: Birmingham, which is one of the healthiest, pites in the
kingdom. 25. 24. and 24: the density of population (persons to an acre) 1n 18(>7 was 44.
Hull. 27, 24. and 25; density, 30. Bristol, 24, 25, and 23; density, 35. Edinburgh; 28,
27, and 27; density, 40. Dublin. 26, 28, and 27; density, 33. Salford, 29, 29, and 29;
density. 22. Glasgow. 33, 30, and 29; density, 87. Manchester, 33, 32. and 31: density,
81. feeds, 31, :. and 27: density, 11. Liverpool. 36, 42, and 30; density, 96. The
annual mi rta'ity in Sheffield, in each of the years 1806 and 1867, was 28 and '25, density.
10. In NewcsisUe-on-Tyne the annual mortality in 1806 ami 1867 respectively was
32 and 81. The results for London in each of the three years 1865-67 respectively were,
annual mortality per 1000 of population, 25, 26. and 23;' density, 40. In comparing tha
rate of mortality in one town with that of another, it should be borne in mind that of
the English towns, Bristol, Leed^, and Liverpool have each a medical health officer.
Birmingham, Hull, Salford, Manchester, Sheffield, and Tsewcastle-on-Tyne have
no medical health officer; but most of these towns,' however, have benefited from
the dlieacy of hygienic measures. It is obvious that if, by sanitary precautions,
we could reduce all the death-rates to 15, or even to 20, an enormous saving of
human life would result | In the year 18G5 Mr. Simon suggested that the time
was come for attempting to ascertain the amount of benefit to the public health
that, had been derived from the works of sanitary improvement especially of
drainage and water-supply that had been already completed, and he was author-
ized to institute the inquiry, wirh the assistance of Dr. Buchanan as an inspector.
The result of the inquiry, which relates to 24 towns, with an aggregate population of

* In an article on " Pnlilio F^lth," in the Qitirterlt/ Journal nf Sciencr for Jan., 1POR. it in sfnfcd
that at Sundown, in tli" i->\^ of Wh^hf. whie'i is thoroiiL-Mv drained and well supplied with rnire water.

river I.reni.. H'>re, out of an entire population of 1000, there were 70 deaths in 1' (i~, mainly from
epidemic typhoid.

t We have already mentioned that, the death-rate at Liverpool not very long ago reached TO; sea
also the preceding noto.

t As in ih.> year 1 w <',.->. the population of England was 00.n30.04C, while the deaths were 400.900: the
peneral death-rate for that year is 5.4. If this rate could have been reduced to 15, the number of lives
thus saved in that year would have amounted to 17(>.o24!

Twe.ntv-flve to AMIS were visited, but we havo omitted Ottery St. Mary, because it seems to have
yielded no information.

U. K. XIII. 9


more tl.iui 600,000 persons, is now published, and \ve shall gire a brief abstract of the
resulis which have been obtained. The numerical results are given in the accompanying
table, page 131. where A shows at each place in the list what diih-iviK-e there has been. since
sanitary wor:\s were established, iu the i/enerai deiit : t - rnte in 10.000 of the population,
this number being taken imtvad of llOO to obtain more r.ccuive numerical results. B
gives the general death-rates of A. minus the inconstant nee which has been
exer.ed by the chief infantile epidemics; and similarly E gives il.e means of eliminating
from A the influence of the cholera epidemics of 1848=-49, 1851. aial IboG. The columns
(J to G inclusive are for comparing the quantities of particular kinds of deaths caused in
each of the places in the two compared periods. Puch ''special death-rates." used with
caution, yield the most useful of all conclusions as to chalices wrought in the public

From the table, which is fraught with the most valuable information, in the most
condensed form, we learn that, omitting the influence of choleia, iheiv has been a
diminution in the death-rate in all but five cases, where the rate has been stationary. In
four of the towns viz., Cardiff. Newport (Mon ), Macclesfield. and Croydoiv the reduc-
tion amounted to 24, 23, 20, and 13^ percent. With regard to I he C'mttnjioux dixeuxex,
m<iil-j.o.c, which is capable of being rooted out by an ellicieiit system of vaccination, is
not noticed i.e;v, and typhuitfccir h is scarcely occurred in the towns selected for inquiry.
The lime has haruly come for estimating the effect of works of cewe-age and watcr-.-up-
ply upon measles, scarlatina, and whooping-cough, inasmuch as epidemics of those dis-
eases may revolve in long Me-axlex nndieftvopi'jig-wvg/i ;ecin, however, to have
slightly declined. Typhoid has very much diminished with the ample supply of good
water, and the puriliealiou of the atmosphere from decomro-i/.g or-anic n. alter, by the
abolition of cess-pools, by draining, etc. In Salisbury. S.ra'ford, <. roydon, and Mer-
thyr the annual death-rate from typhoid has diminished 75, (i7, 63, and 60 per cent
respectively; and m all the towns except three there was more or less diminuiion. In
these exceptional cases it was found that sewage gases were, by a defect of the outfall
arrange. nent, forced into the house-*.* Diarrhea appeal's to have been reduced by purifica-
tion of air and water. Removal of subsoil water has not affected it. While' in three
towns the death-rate from this disease has been diminished 50 per cent or more, in Ash by
it has increased 100, and in Rugby 200 per cent. These anomalous resulis are ascribed
to the prevalence of the disease in the respective work-Ii'>usos Cholera ^;/,.V;///V'.\ appear,
says Dr. Buchanan, to have been rendered practically harmless i;i tin- towns examined,
as rn.-iy be seen by the comparison of the death-rates per 10,000 in the three last'

184S-49. ir-54. ISG6.

Merthyr. 207 K4 20

Cardiff 208 06 loj^

. Almvick .205

\ . Salisbury...; 180 UU

Newport 112 1M) 12

Brymnawr. 100

, ^Pulmonary phthisis has diminished in certain of the towns, and the diminution seems
due. to the drying of the soil, which has in most cases accompanied the laying of main
sewers; and the greater the influence of the sewerage in drying the subsoil is. so much, the
greater is the diminution of the death-rate from this disease. At Salisbury it is 40 per
cent of its former rate; at Ely, 47; at Rugby. 43; at Banbury, 41; ar.d at Worthing, 36.
Failure to reduce consumption is most observable cither where the soil already contained
little water, or where the town water p-issing by the surface or in superficial drains
the deep drainage consisted of impervious pipes, laid down in compact channels, so that
no extensive drainage of water could occur either through or alongside of them. !t does
not seem that the sewerage of towns, by the removal of excreta and house slops, has
acted lo reduce the amount of their death rate by consumption. Diteaxcs of ttte fungt
other than consumption have undergone no regular reduction. Dr. Buchanan concludes
this most valuable report with the observation that the progress made by the inhabit-
ants of most of the towns in decency, cleanliness, self-respect, and morality was at the
lca<l as striking as the improvement in their health, measured by the mortality returns.
In various articles on special disorders, as scurvy, sm:-.ll-pos. and typhoid fever, we
have, pointed out how completely they are under the control ofsauilaiy or dietetic meas-
ure*. In his excellent chapter "On the Prevention of Diseases in the Army," Dr.
Parkes gives the. following list of diseases, with the methods to be adopted for their pre-
vention viz. : (1) Spc.o'Jic Disenwx paroxysmal fevers, yellow fever, cholera, typhus
cxanthematus, bubo plague, typhoid fever, relapsing fever, bilious nmittent fever, erup-
tive fevers, erysipelas, hospital gangrene; and (2) Nonspecific Dit-eaws dysentery and

* Worthing Is the town in which the increase of fever is greatest, ami this need not excite surprise
when \ve leant that on the skle of the water-tower of the town is a shed containing the < ngine which
performs the double duty of distributing the water to the houses and the sewage to the land. To
enable this t:o be effected there are two wells within 50 fwt of one another, sunk in a porous soil, one
for the reception of the sewage and the other for the drinking-water. Moreover, the water-well is in
bad condition, and the water-supply is neither constant nor sufficiently abuudnnt. See the article
"Seaside Drainage Worthing," in The, Af<di,-al Pres* and Circular. Dec. 4, 18G7. Xu arrangement
tor tb propagation of typhoid could have been more ingeiii^i.sly de\i:ied!





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Online LibraryFrancis LieberLibrary of universal knowledge. A reprint of the last (1880) Edinburgh and London edition of Chambers' encyclopaedia, with copious additions by American editors (Volume 13) → online text (page 30 of 203)