Report on the sanitary conditions of the labouring population of Great Britain. A supplementary report on the results of a special inquiry into the practice of interment in towns. Made at the request of Her Majesty's principal secretary of state for the Home department online

from epidemics to their occupation, and that the stenches to which they
are exposed actually “purify” the atmosphere. Numbers of such witnesses
have heretofore been ready to attest their conviction of the
preservative effect, and even the positive advantages to health, of the
effluvia generated by the decomposition of animal or of vegetable
matter, or of the fumes of minerals, of smoke, soot, and coal gas. But
though they do not peculiarly suffer from epidemics, it is usually found
that they are not exempted. In a recent return of the state of health of
some workmen engaged in cleansing sewers, whilst it appeared that very
few had suffered any attack from fever, nearly all suffered bowel
attacks and violent intestinal derangement. If the effects of such
emanations invariably appeared in the form of acute disease, large
masses of the population who have lived under their influence must have
been exterminated. In general the poison appears only to be generated in
a sufficient degree of intensity to create acute disease under such a
conjunction of circumstances, as a degree of moisture sufficient to
facilitate decomposition, a hot sun, a stagnant atmosphere, and a
languid population. The injurious effects of diluted emanations are
constantly traceable, not in constitutional disturbance at any one time;
they have their effect even on the strong, perceptible over a space of
time in a general depression of health and a shortened period of
existence. This or that individual may have the florid hue of health,
and may live under constant exposure to noxious influences to his
sixtieth or his seventieth year; but had he not been so exposed he might
have lived in equal or greater vigour to his eightieth or his ninetieth
year. A cause common to a whole class is often, however, not manifest in
particular individuals, but is yet visible in the pallor and the reduced
sum of vitality of the whole class, or in the average duration of life
in that class, as compared with the average duration of life of another
class similarly situated, in all respects except in the exposure to that
one cause.[5] The effects of a cause of depression on a class are
sometimes visible in the greater fatality of common accidents. An excess
of mortality to a class is almost always found, on examination, to be
traceable to an adequate cause. From the external circumstances of a
class of the population, a confident expectation may be formed of the
sum of vitality of the class, though nothing could be separately
predicated of a single individual of it. If the former vulgar notions
were correct as to the salubrity of the stenches which prevail in towns,
the separate as well as the combined results of these several supposed
causes of salubrity must be to expel fevers and epidemics from the most
crowded manufacturing districts, and to advance the general health of
the inhabitants above that of the poorer rural population; but all such
fallacies are dissipated by the dreadful facts on the face of the
mortuary records showing a frequency of deaths, and a reduction of the
mean duration of life, in proportion to the constancy and the intensity
of the combined operation of these same causes.[6]

§ 6. The observations of the effects of such emanations on the general
health of classes of human beings have been corroborated by experiments
on animals.

§ 7. Another doctrine more extensively entertained than that above
noticed, is, that although putrid emanations are productive of injury,
they are not productive of specific disease, such as typhus. The medical
witnesses say, that they were exposed to such emanations in
dissecting-rooms, where bodies of persons who have died of small-pox,
typhus, scarlatina, and every species of disease, are brought; that they
pursued their studies in such places, and were unaware of typhus or
other disease having been taken by the students in them, though that
disease was frequently caught by students whilst attending the living in
the fever wards.[7]

The strongest of this class of negative evidence appears to be that of
undertakers, all of whom that I have seen state that neither specific
disease nor the propagation of any disease was known to occur amongst
them, from their employment. Neither the men who handle, or who
“coffin,” the remains; nor the barbers who are called in to shave[8] the
corpses of the adult males; nor the bearers of the coffins, although,
when the remains are in an advanced state of decomposition, the liquid
matter from the corpse frequently escapes from the coffin, and runs down
over their clothes, are observed to catch any specific disease from it,
either in their noviciate, or at any other time. When decomposition is
very far advanced, and the smell is very offensive, the men engaged in
putting the corpse into the coffin smoke tobacco; and all have recourse
to the stimulus of spirituous liquor. But it is not known that, by their
infected clothes they ever propagate specific disease in their families,
or elsewhere. Neither does this appear to be observed amongst the
medical men themselves.[9]

§ 8. On the other hand, the undertakers observe such instances, as will
be stated in their own words in a subsequent part of the report, where
others have caught fever and small-pox, apparently from the remains of
the dead, and they mention instances of persons coming from a distance
to attend funerals, who have shortly afterwards become affected with the
disease of which the person buried had died. Of the undertakers it is
observed, that being adults, they were likely to have had small-pox. Dr.
Williams, in a work stated to be of good authority, on the effects of
morbid poisons, relates the case of four students infected with
small-pox by the dead body of a man who had died of this disease, that
was brought into the Windmill-street Theatre, in London, for dissection.
One of them saw the body, but did not approach it; another was near it,
but did not touch it; a third, accustomed to make sketches from dead
bodies, saw this subject, but did not touch it; the fourth alone touched
it with both his hands; yet all the four caught the disease. Sir
Benjamin Brodie mentions cases which occurred within his own knowledge,
of pupils who caught small-pox after exposure to the emanations in the
dissecting-room from the bodies of persons who had died of that disease.

Dr. Copeland, in his evidence before the Committee of the House of
Commons, adduced the following remarkable case, stated to be of fever
communicated after death:—

About two years ago (says he) I was called, in the course of my
profession, to see a gentleman, advanced in life, well known to many
members in this house and intimately known to the Speaker. This
gentleman one Sunday went into a dissenting chapel, where the
principal part of the hearers, as they died, were buried in the
ground or vaults underneath. I was called to him on Tuesday evening,
and I found him labouring under symptoms of malignant fever; either
on that visit or the visit immediately following, on questioning him
on the circumstances which could have given rise to this very
malignant form of fever, for it was then so malignant that its fatal
issue was evident, he said that he had gone on the Sunday before
(this being on the Tuesday afternoon) to this dissenting chapel, and
on going up the steps to the chapel he felt a rush of foul air
issuing from the grated openings existing on each side of the steps;
the effect upon him was instantaneous; it produced a feeling of
sinking, with nausea, and so great debility, that he scarcely could
get into the chapel. He remained a short time, and finding this
feeling increase he went out, went home, was obliged to go to bed,
and there he remained. When I saw him he had, up to the time of my
ascertaining the origin of his complaint, slept with his wife; he
died eight days afterwards; his wife caught the disease and died in
eight days also, having experienced the same symptoms. These two
instances illustrated the form of fever arising from those
particular causes. Means of counteraction were used, and the fever
did not extend to any other members of the family.

Assuming that that individual had gone into a crowded hospital with
that fever, it probably would have become a contagious fever. The
disease would have propagated itself most likely to others, provided
those others exposed to the infection were predisposed to the
infection, or if the apartments where they were confined were not
fully ventilated, but in most cases where the emanations from the
sick are duly diluted by fresh air, they are rendered innocuous. It
is rarely that I have found the effects from dead animal matter so
very decisive as in this case, because in the usual circumstances of
burying in towns the fetid or foul air exhaled from the dead is
generally so diluted and scattered by the wind, as to produce only a
general ill effect upon those predisposed; it affects the health of
the community by lowering the vital powers, weakening the digestive
processes, but without producing any prominent or specific disease.

Mr. Barnett, surgeon, one of the medical officers of the Stepney Union,
who has observed the symptoms observable in those persons who are
exposed to the emanations from a crowded grave-yard, thus describes
them:—

They are characterized by more or less disturbance of the whole
system, with evident depression of the vital force, as evinced
throughout the vascular and nervous systems, by the feeble action of
the heart and arteries, and lowness of the spirits, &c. These
maladies, I doubt not, if surrounded by other causes, would
terminate in fever of the worst description. The cleanliness, &c.,
of the surrounding neighbourhood, perhaps, prevents this actually
taking place.

Some years since a vault was opened in the church-yard (Stepney),
and shortly after one of the coffins contained therein burst with so
loud a report that hundreds flocked to the place to ascertain the
cause. So intense was the poisonous nature of the effluvia arising
therefrom, that a great number were attacked with sudden sickness
and fainting, many of whom were a considerable period before they
recovered their health.

The vaults and burial ground attached to Brunswick chapel,
Limehouse, are much crowded with dead, and from the accounts of
individuals residing in the adjoining houses, it would appear that
the stench arising therefrom, particularly when a grave happens to
be opened during the summer months, is most noxious. In one case it
is described to have produced instant nausea and vomiting, and
attacks of illness are frequently imputed to it. Some say they have
never had a day’s good health since they have resided so near the
chapel-ground, which, I may remark, is about five feet above the
level of the surrounding yards, and very muddy—so much so, that
pumps are frequently used to expel the water from the vaults into
the streets.

The bursting of leaden coffins in the vaults of cemeteries, unless they
are watched and “tapped” to allow the mephitic vapour to escape, appears
to be not unfrequent. In cases of rapid decomposition, such instances
occur in private houses before the entombment. An undertaker of
considerable experience states:—

“I have known coffins to explode, like the report of a small gun, in
the house. I was once called up at midnight by the people, who were
in great alarm, and who stated that the coffin had burst in the
night, as they described it, with ‘a report like the report of a
cannon.’ On proceeding to the house I found in that case, which was
one of dropsy, very rapid decomposition had occurred, and the lead
was forced up. Two other cases have occurred within my experience of
coffins bursting in this manner. I have heard of similar cases from
other undertakers. The bursting of lead coffins without noise is
more frequent. Of course it is never told to the family unless they
have heard it, as they would attribute the bursting to some
defective construction of the coffins.”

The occurrence of cases of instant death to grave-diggers, from
accidentally inhaling the concentrated miasma which escapes from
coffins, is undeniable. Slower deaths from exposure to such miasma are
designated as “low fevers,” and whether or not the constitutional
disturbances attendant on the exposure to the influence of such miasma
be or not the true typhus, it suffices as a case requiring a remedy,
that the exposure to that influence is apt to produce grievous and fatal
injuries amongst the public.

§ 9. Undertakers state that they sometimes experience, in particularly
crowded grave-yards, a sensation of faintness and nausea without
perceiving any offensive smell. Dr. Riecke appears to conclude, from
various instances which are given, that emanations from putrid remains
operate in two ways,—one set of effects being produced through the lungs
by impurity of the air from the mixture of irrespirable gases; the other
set, through the olfactory nerves by powerful, penetrating, and
offensive smells. On the whole, the evidence tends to establish the
general conclusion that offensive smells are true warnings of sanitary
evils to the population. The fact of the general offensiveness of such
emanations is adduced by Dr. Riecke also as evidence of their injurious
quality.

Another circumstance which must awaken in us distrust of putrid
emanations, is the powerful impression they make on the sense of
smell. It certainly cannot be far from the truth to call the organ
of smell the truest sentinel of the human frame. “Many animals,”
observes Rudolphi, “are entirely dependent on their sense of smell
for finding out food that is not injurious; where their smell is
injured they are easily deceived, and have often fallen a sacrifice
to the consequent mistakes.” Amongst all known smells, there is,
perhaps, no one which is so universally, and to such a degree
revolting to man, as the smell of animal decomposition. The roughest
savage, as well as the most civilized European, fly with equal
disgust from a place where the air is infected by it. If an instinct
ever can be traced in man, certainly it is in the present case: and
is instinct a superfluous monitor exactly in this one case? Can
instinct mislead just in this one circumstance? Can it ever be, that
the air which fills us with the greatest disgust, is the finest
elixir of life, as Dumoulins had the boldness to maintain in one of
his official reports. Hippolyte Cloquet, in his Osphrestologie has
attempted to throw some light on the effect of smell on the human
frame, and though we must entirely disregard many of the anecdotes
which he has blended into his inquiry, yet the result remains firmly
proved that odours in general exert a very powerful influence on the
health of men, and that all very acutely impressing smells are
highly to be suspected of possessing injurious properties.

§ 10. I beg leave on this particular topic to submit the facts and
opinions contained in communications from two gentlemen who have paid
close and comprehensive attention to the subject.

Dr. Southwood Smith, who, as physician to the London Fever Hospital, and
from having been engaged in several investigations as to the effects of
putrid emanations on the public health, must have had extensive means of
observation, states as follows:—

1. That the introduction of dead animal matter under certain
conditions into the living body is capable of producing disease, and
even death, is universally known and admitted. This morbific animal
matter may be the product either of secretion during life or of
decomposition after death. Familiar instances of morbific animal
matter, the result of secretion during life, are the poisons of
small-pox and cow-pox, and the vitiated fluids formed in certain
acute diseases, such as acute inflammations, and particularly of the
membranes that line the chest and abdomen. On the examination of the
body a short time after death from such inflammations, the fluids
are found so extremely acrid, that even when the skin is entirely
sound, they make the hands of the examiner smart; and if there
should happen to be the slightest scratch on the finger, or the
minutest point not covered by cuticle, violent inflammation is often
produced, ending, sometimes within forty-eight hours, in death. It
is remarkable, and it is a proof that in these cases the poison
absorbed is not putrid matter, that the most dangerous period for
the examination of the bodies of persons who die of such diseases is
from four to five hours after the fatal event, and while the body is
yet warm.

That the direct introduction into the system of decomposing and
putrescent animal matter is capable of producing fevers and
inflammations, the intensity and malignity of which may be varied at
will, according to the putrescency of the matter and the quantity of
it that is introduced, is proved by numerous experiments on animals;
while the instances in which human beings are seized with severe and
fatal affections from the application of the fluids of a dead animal
body to a wounded, punctured, or abraded surface, sometimes when the
aperture is so minute as to be invisible without the aid of a lens,
are of daily occurrence. Though this fact is now well known, and is
among the few that are disputed by no one, it may be worth while to
cite a few examples of it, as specimens of the manner in which the
poison of animal matter, when absorbed in this way, acts; a volume
might be filled with similar instances.

The following case is recorded by Sir Astley Cooper:—Mr. Elcock,
student of anatomy, slightly punctured his finger in opening the
body of a hospital patient about twelve o’clock at noon, and in the
evening of the same day, finding the wound painful, showed it to Sir
Astley Cooper after his surgical lecture. During the night the pain
increased to extremity, and symptoms of high constitutional
irritation presented themselves on the ensuing morning. No trace of
inflammation was apparent beyond a slight redness of the spot at
which the wound had been inflicted, which was a mere puncture. In
the evening he was visited by Dr. Babington, in conjunction with Dr.
Haighton and Sir Astley Cooper; still no local change was to be
discovered, but the nervous system was agitated in a most violent
and alarming degree, the symptoms nearly resembling the universal
excitation of hydrophobia, and in this state he expired within the
period of forty-eight hours from the injury.

The late Dr. Pett, of Hackney, being present at the examination of
the body of a lady who had died of peritoneal inflammation after her
confinement, handled the diseased parts. In the evening of the same
day, while at a party, he felt some pain in one of his fingers, on
which there was a slight blush, but no wound was visible at that
time. The pain increasing, the finger was examined in a stronger
light, when, by the aid of a lens, a minute opening in the cuticle
was observed. During the night the pain increased to agony, and in
the morning his appearance was extremely altered; his countenance
was suffused with redness, his eyes were hollow and ferrety; there
was a peculiarity in his breathing, which never left him during his
illness; his manner, usually gay and playful, was now torpid, like
that of a person who had taken an excessive dose of opium, he
described himself as having suffered intensely, and said that he was
completely knocked down and had not the strength of a child, and he
sunk exhausted on the fifth day from the examination of the body.

George Higinbottom, an undertaker, was employed to remove in a shell
the corpse of a woman who had died of typhus fever in the London
Fever Hospital. In conveying the body from the shell into the
coffin, he observed that his left hand was besmeared with a moisture
which had oozed from it. He had a recent scratch on his thumb. The
following morning this scratch was inflamed; in the evening of the
same day he was attacked with a cold shivering and pain in his head
and limbs, followed the next by other symptoms of severe fever; on
the fourth day there was soreness in the top of the shoulder and
fulness in the axilla; on the fifth the breast became swollen and
efflorescent; on the seventh delirium supervened, succeeded by
extreme prostration and coma, and death took place on the tenth day.

A lady in the country received a basket of fish from London which
had become putrid on the road. In opening the basket she pricked her
finger, and she slightly handled the fish. On the evening of this
day inflammation came on in the finger, followed by such severe
constitutional symptoms as to endanger life, and it was six months
before the effects of this wound subsided and her health was
restored.

Among many other cases, Mr. Travers gives the following, as
displaying well the minor degrees of irritation, local and
constitutional, to which cooks and others, in handling putrid animal
matter with chapped and scratched fingers, are exposed:—A cook-maid
practised herself on a stale hare, for the purpose of learning the
mode of boning them, in spite of being strongly cautioned against
it. A few days afterwards two slight scratches, which she remembered
to have received at the time, began to inflame; one was situated on
the fore-finger and the other on the ring-finger. This inflammation
was accompanied with a dull pain and feeling of numbness, and an
occasional darting pain along the inside of the fore-arm. The next
day she was attacked with excruciating pain at the point of the
fore-finger, which throbbed so violently as to give her the
sensation of its being about to burst at every pulsation. The
following morning constitutional symptoms came on; her tongue was
white and dry; she had no appetite; there was great dejection of
spirits and languor, and a weak and unsteady pulse. After suffering
greatly from severe pain in the finger, hand, and arm, and great
constitutional derangement and debility, the local inflammation
disappeared in about three weeks, and she then began to recover her
appetite and strength.

2. It is proved by indubitable evidence that this morbific matter is
as capable of entering the system when minute particles of it are
diffused in the atmosphere as when it is directly introduced into
the blood-vessels by a wound. When diffused in the air, these
noxious particles are conveyed into the system through the thin and
delicate walls of the air vesicles of the lungs in the act of
respiration. The mode in which the air vesicles are formed and
disposed is such as to give to the human lungs an almost incredible
extent of absorbing surface, while at every point of this surface
there is a vascular tube ready to receive any substance imbibed by
it and to carry it at once into the current of the circulation.
Hence the instantaneousness and the dreadful energy with which
certain poisons act upon the system when brought into contact with
the pulmonary surface. A single inspiration of the concentrated
prussic acid, for example, is capable of killing with the rapidity
of a stroke of lightning. So rapidly does this poison affect the
system, and so deadly is its nature, that more than one physiologist
has lost his life by incautiously inhaling it while using it for the
purpose of experiment. If the nose of an animal be slowly passed
over a bottle containing this poison, and the animal happen to
inspire during the moment of the passage, it drops down dead
instantaneously, just as when the poison is applied in the form of a
liquid to the tongue or the stomach. On the other hand, the vapour
of chlorine possesses the property of arresting the poisonous
effects of prussic acid; and hence when an animal is all but dead
from the effects of this acid, it is sometimes suddenly restored to
life by holding its mouth over the vapour of chlorine.

During every moment of life in natural respiration a portion of the
air of the atmosphere passes through the air vesicles of the lungs
into the blood, while a quantity of carbonic acid gas is given off
from the blood, and is transmitted through the walls of these