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

vesicles into the atmosphere. Now that substances mixed with or
suspended in atmospheric air may be conveyed with it to the lungs
and immediately enter into the circulating mass, any one may satisfy
himself merely by passing through a recently painted chamber. The
vapour of turpentine diffused through the chamber is transmitted to
the lungs with the air which is breathed, and passing into the
current of the circulation through the walls of the air vesicles,
exhibits its effects in some of the fluid excretions of the body,
even more rapidly than if it had been taken into the stomach.

Facts such as these help us to understand the production and
propagation of disease through the medium of an infected atmosphere,
whether on a large scale, as in the case of an epidemic which
rapidly extends over a nation or a continent, or on a small scale,
in the sick chamber, the dissecting room, the church, and the
church-yard.

Thus it is universally known that, when the atmosphere is infected
with the matter of small-pox, this disease is produced with the same
and even with greater certainty than when the matter of small-pox is
introduced by the lancet directly into a blood-vessel in
inoculation.

It is equally well known that, when the air is infected by particles
of decomposing vegetable and animal matter, fevers are produced of
various types and different degrees of intensity; that the
exhalations arising from marshes, bogs, and other uncultivated and
undrained places, constitute a poison chiefly of a vegetable nature,
which produces principally fevers of an intermittent or remittent
type; and that exhalations accumulated in close, ill-ventilated, and
crowded apartments in the confined situations of densely-populated
cities, where little attention is paid to the removal of putrefying
and excrementitious matters, constitute a poison chiefly of an
animal nature, which produces continued fever of the typhoid
character. There are situations in which these putrefying matters,
aided by heat and other peculiarities of climate, generate a poison
so intense and deadly, that a single inspiration of the air in which
they are diffused is capable of producing almost instantaneous
death; and there are other situations in which a less highly
concentrated poison accumulates, the inspiration of which for a few
minutes produces a fever capable of destroying life in from two to
twelve hours. In dirty and neglected ships, in damp, crowded, and
filthy gaols, in the crowded wards of ill-ventilated hospitals
filled with persons labouring under malignant surgical diseases or
bad forms of fever, an atmosphere is generated which cannot be
breathed long, even by the most healthy and robust, without
producing highly dangerous fever.

3. The evidence is just as indubitable that exhalations arise from
the bodies of the dead, which are capable of producing disease and
death. Many instances are recorded of the communication of small-pox
from the corpse of a person who has died of small-pox. This has
happened not only in the dwelling-house before interment, but even
in the dissecting room. Some years ago five students of anatomy, at
the Webb-street school, Southwark, who were pursuing their studies
under Mr. Grainger, were seized with small-pox, communicated from a
subject on the dissecting-table, though it does not appear that all
who were attacked were actually engaged in dissecting this body. One
of these young men died. There is reason to believe that emanations
from the bodies of persons who have died of other forms of fever
have proved injurious and even fatal to individuals who have been
much in the same room with the corpse.

The exhalations arising from dead bodies in the dissecting room are
in general so much diluted by admixture with atmospheric air,
through the ventilation which is kept up, that they do not commonly
affect the health in a very striking or marked manner; and by great
attention to ventilation, it is no doubt possible to pursue the
study of anatomy with tolerable impunity. Yet few teachers of
anatomy deny that without this precaution this pursuit is very apt
to injure the health, and that, with all the precaution that can be
taken, it sometimes produces such a degree of diarrhœa, and at other
times such a general derangement of the digestive organs, as
imperatively to require an absence for a time from the dissecting
room and a residence in the pure air of the country. The same
statements are uniformly made by the professors of Veterinary
anatomy in this country. The result of inquiries which I have
personally made into the state of the health of persons licensed to
slaughter horses, called knackers, is, that though they maintain
their health apparently unimpaired for some time, yet that after a
time the functions of the nutritive organs become impaired, they
begin to emaciate, and present a cadaverous appearance, slight
wounds fester and become difficult to heal, and that upon the whole
they are a short-lived race.

The exhalations arising from dead bodies interred in the vaults of
churches, and in church-yards, are also so much diluted with the air
of the atmosphere, that they do not commonly affect the health in so
immediate and direct a manner as plainly to indicate the source of
these noxious influences. It is only when some accidental
circumstances have favoured their accumulation or concentration in
an unusual degree, that the effects become so sensible as obviously
to declare their cause. Every now and then, however, such a
concurrence of circumstances does happen, of which there are many
instances on record; but it may suffice for the present to mention
one, the particulars of which I have received from a gentleman who
is known to me, and on the accuracy of whose statements I can rely.

Mr. Hutchinson, surgeon, Farringdon-street, was called on Monday
morning, the 15th March, 1841, to attend a girl, aged 14, who was
labouring under typhus fever of a highly malignant character. This
girl was the daughter of a pew-opener in one of the large city
churches, situated in the centre of a small burial ground, which had
been used for the interment of the dead for centuries, the ground of
which was raised much above its natural level, and was saturated
with the remains of the bodies of the dead. There were vaults
beneath the church, in which it was still the custom, as it had long
been, to bury the dead. The girl in question had recently returned
from the country, where she had been at school. On the preceding
Friday, that is, on the fourth day before Mr. Hutchinson saw her,
she had assisted her mother during three hours and on the Saturday
during one hour, in shaking and cleansing the matting of the aisles
and pews of the church. The mother stated, that this work was
generally done once in six weeks; that the dust and effluvia which
arose, always had a peculiarly fœtid and offensive odour, very
unlike the dust which collects in private houses; that it invariably
made her (the mother) ill for at least a day afterwards; and that it
used to make the grandmother of the present patient so unwell, that
she was compelled to hire a person to perform this part of her duty.
On the afternoon of the same day on which the young person now ill
had been engaged in her employment, she was seized with shivering,
severe pain in the head, back, and limbs, and other symptoms of
commencing fever. On the following day all these symptoms were
aggravated, and in two days afterwards, when Mr. Hutchinson first
saw her, malignant fever was fully developed, the skin being burning
hot, the tongue dry and covered with a dark brown fur, the thirst
urgent, the pain of the head, back, and extremities severe, attended
with hurried and oppressed breathing, great restlessness and
prostration, anxiety of countenance, low muttering delirium, and a
pulse of 130 in the minute.

In this case it is probable that particles of noxious animal matter
progressively accumulated in the matting during the intervals
between the cleansing of it; and that being set free by this
operation and diffused in the atmosphere, while they were powerful
enough always sensibly to affect even those who were accustomed to
inhale them, were sufficiently concentrated to produce actual fever
in one wholly unaccustomed to them, and rendered increasingly
susceptible to their influence by recent residence in the pure air
of the country; for it is remarkable that miasms sometimes act with
the greatest intensity on those who habitually breathe the purest
air.

The miasms arising from church-yards are in general too much diluted
by the surrounding air to strike the neighbouring inhabitants with
sudden and severe disease, yet they may materially injure the
health, and the evidence appears to me to be decisive that they
often do so. Among others who sometimes obviously suffer from this
cause, are the families of clergymen, when, as occasionally happens,
the vicarage or rectory is situated very close to a full
church-yard. I myself know one such clergyman’s family, whose
dwelling-house is so close to an extremely full churchyard, that a
very disagreeable smell from the graves is always perceptible in
some of the sitting and sleeping rooms. The mother of this family
states that she has never had a day’s health since she has resided
in this house, and that her children are always ailing; and their
ill health is attributed, both by the family and their medical
friends, to the offensive exhalations from the church-yard.

Dr. Lyon Playfair states as follows in his communication—

There are two kinds of changes which animal and vegetable matters
undergo, when exposed to certain influences. These are known by the
terms of “decay” and “putrefaction.” Decay, properly so called, is a
union of the elements of organic matter with the oxygen of the air;
while putrefaction, although generally commencing with decay, is a
change or transformation of the elements of the organic body itself,
without any necessary union with the oxygen of the air. When decay
proceeds in a body without putrefaction, offensive smells are not
generated; but if the air in contact with the decaying matter be in
any way deficient, the decay passes into putrefaction, and putrid
smells arise. Putrid smells are rarely if ever evolved from
substances destitute of the element nitrogen.

Both decaying and putrefying matters are capable of communicating
their own state of putrefaction or of decay to any organic matter
with which they may come in contact. To take the simplest case, a
piece of decayed wood, a decaying orange, or a piece of tainted
flesh is capable of causing similar decay or putrefaction in another
piece of wood, orange, or flesh. In a similar manner the decaying
gases evolved from sewers occasion the putrescence of meat or of
vegetables hung in the vicinity of the place from which they escape.
But this communication of putrefaction is not confined to dead
matter. When tainted meat or putrescent blood-puddings are taken as
food, their state of putrefaction is frequently communicated to the
bodies of the persons who have used them as food. A disease
analogous to rot ensues, and generally terminates fatally. Happily
this disease is little known among us, but it is of very frequent
occurrence in Germany.

The decay or putrefaction communicated by putrid gases or by
decaying matters does not always assume one form, but varies
according to the organs to which their peculiar state is imparted.
If communicated to the blood it might possibly happen that fever may
arise; if to the intestines, dysentery or diarrhœa might result; and
I think it might even be a question worthy of consideration, whether
consumption may not arise from such exposure. Certainly it seems to
do so among cattle. The men who are employed in cleaning out drains
are very liable to the attacks of dysentery and of diarrhœa; and I
recollect instances of similar diseases occurring among some
fellow-students, when I attended the dissecting-rooms.

The effects produced by decaying emanations will vary according to
the state of putrefaction or decay in which these emanations are, as
well as according to their intensity and concentration. Thus it
occurs frequently that persons susceptible to contagion may be in
the vicinity of a fever patient without acquiring the disease. I
know one celebrated medical man who attends his own patients in
fever without danger, but who has never been able to take charge of
the fever-wards in an infirmary, from the circumstance of his being
unable to resist the influence of the contagion under such
circumstances. This gentleman has had fever several times. This
shows that the contagion of fever requires a certain degree of
_concentration_ before it is able to produce its immediate effects.
A knowledge of this circumstance has induced several infirmaries
(the Bristol infirmary, for example) to abolish altogether
fever-wards and to scatter the fever cases indiscriminately through
the medical wards. Owing to this distribution, cases in which fever
is communicated to other patients or nurses in the infirmary are
very unfrequent, although they are far from being so in those
hospitals where the fever cases are grouped together.

I consider that the want of attention to the circumstance of the
concentration of decaying emanations is a great reason that the
effects of miasmata in producing fever is still a _questio vexata_.
Thus there may be many church-yards and sewers evolving decaying
matter, and yet no fever may occur in the locality. Some other more
modified effect may be produced, according to the degree of
concentration of the decaying matter, such as diarrhœa or even
dysentery; or there may be no perceptible effects produced, although
the blood may still be thrown into a diseased state which will
render it susceptible to any specific contagion that approaches. It
must be remembered that decaying exhalations will not always produce
similar effects, but that these will vary not only according to the
concentration, but also according to the state of decomposition in
which the decaying matters are.

The rennet for making cheese is in a peculiar state of decay, or
rather is capable of a series of states of decay, and the flavour of
the cheese manufactured by means of it varies also according to the
state of the rennet. Just so with the diseases produced by the
peculiar state or concentration of decaying matters or of specific
contagions. When the Asiatic cholera visited this country many of
the towns were afflicted with dysentery before the cholera appeared
in an unquestionable form. In like manner the miasmata evolved from
church-yards may produce injurious effects which may not be
sufficiently marked to call attention until they assume a more
serious form by becoming more concentrated. But notwithstanding the
absence of marked effects, it is extremely probable that constant
exposure to miasmata may produce a diseased state of the blood. Thus
I had occasion to visit and report upon, amongst other matters, the
state of slaughter-houses in Bristol. These are generally situated
in courts, very inefficiently ventilated, as all courts are. I
remarked that the men employed in the slaughter-houses had a
remarkably cadaverous hue, and this was participated in a greater or
less degree by the inhabitants of the court. So much was this the
case, that in a court where the smells from the slaughter-house were
so offensive that my companion had immediately to retire from
sickness, I immediately singled out one person as not belonging to
the court from a number of people who ran out of their houses to
inquire the object of my visit. The person who attracted my
attention from her healthy appearance compared with the others, had
entered this court to pay a visit to a neighbour.

§ 11. That conclusions respecting such immensely important effects can
only be established by reasonings on facts frequently so scattered over
distant times and places as to require much research to bring them
together; that those conclusions are still open to controversy, and have
hitherto been maintained only by references to statements of distant
observations, whilst regularly sustained examinations of the events
occurring daily in our large towns might have placed them beyond a
doubt; may be submitted as showing the necessity of some public
arrangements to ensure constant attention, and complete information on
these subjects, as the basis of complete measures of prevention.

§ 12. The conclusions, however, which appear to be firmly established by
the evidence, and the preponderant medical testimony, are on every
point, as to the essential character of the physical evils connected
with the practice of interment, so closely coincident with the
conclusions deduced from observation on the continent, that from Dr.
Riecke’s report (and to which a prize was awarded by an eminent medical
association), in which the preponderant medical opinions are set forth,
they may be stated in the following terms:—

“The general conclusions from the foregoing report may be given as
follows:

“The injurious effect of the exhalations from the decomposition in
question upon the health and life of man is proved by a sufficient
number of trustworthy facts;

“That this injurious influence is by no means constant, and depends on
varying and not yet sufficiently explained circumstances;

“That this injurious influence is manifest in proportion to the degree
of concentration of putrid emanations, especially in confined spaces;
and in such cases of concentration the injurious influence is manifest
in the production of asphyxia and the sudden and entire extinction of
life;

“That, in a state less concentrated, putrid emanations produce various
effects on the nerves of less importance, as fainting, nausea,
head-ache, languor;

“These emanations, however, if their effect is often repeated, or if the
emanations be long applied, produce nervous and putrid fevers; or impart
to fevers, which have arisen from other causes, a typhoid or putrid
character;

“Apparently they furnish the principal cause of the most developed form
of typhus, that is to say, the plague (_Der Bubonenpest_). Besides the
products of decomposition, the contagious material may also be active in
the emanations arising from dead bodies.”

§ 13. Such being the nature of the emanations from human remains in a
state of decomposition, or in a state of corruption, the obtainment of
any definite or proximate evidence of the extent of the operation of
those emanations on the health of the population nevertheless appears to
be hopeless in crowded districts. In such districts the effects of an
invisible fluid have not been observed, amidst a complication of other
causes, each of a nature ascertained to produce an injurious effect upon
the public health, but undistinguished, except when it accidentally
becomes predominant. The sense of smell in the majority of inhabitants
seems to be destroyed, and having no perception even of stenches which
are insupportable to strangers, they must be unable to note the
excessive escapes of miasma as antecedents to disease. Occasionally,
however, some medical witnesses, who have been accustomed to the smell
of the dissecting-room, detect the smell of human remains from the
grave-yards, in crowded districts; and other witnesses have stated that
they can distinguish what is called the “dead man’s smell,” when no one
else can, and can distinguish it from the miasma of the sewers.

In the case of the predominance of the smell from the grave-yard, the
immediate consequence ordinarily noted is a head-ache. A military
officer stated to me that when his men occupied as a barrack a building
which opened over a crowded burial-ground in Liverpool, the smell from
the ground was at times exceedingly offensive, and that he and his men
suffered from dysentery. A gentleman who had resided near that same
ground, stated to me that he was convinced that his own health, and the
health of his children had suffered from it, and that he had removed, to
avoid further injury. The following testimony of a lady, respecting the
miasma which escaped from one burial-ground at Manchester, is adduced as
an example of the more specific testimony as to the perception of its
effects. This testimony also brings to view the circumstance that in the
towns it is not only in surface emanations from the grave-yards alone
that the morbific matter escapes.

You resided formerly in the house immediately contiguous to the
burying-ground of —— chapel, did you not?—Yes I did, but I was
obliged to leave it.

Why were you so obliged?—When the wind was west, the smell was
dreadful. There is a main sewer runs through the burying-ground, and
the smell of the dead bodies came through this sewer up our drain,
and until we got that trapped, it was quite unbearable.

Do you not think the smell arose from the emanations of the sewer,
and not from the burying-ground?—I am sure they came from the
burying-ground; the smell coming from the drain was exactly the same
as that which reached us when the wind was west, and blew upon us
from the burying-ground. The smell was very peculiar; it exactly
resembled the smell which clothes have when they are removed from a
dead body. My servants would not remain in the house on account of
it, and I had several cooks who removed on this account.

Did you observe any effects on your health when the smells were
bad?—Yes, I am liable to head-aches, and these were always bad when
the smells were so also. They were often accompanied by diarrhœa in
this house. Before I went there, and since I left, my head-aches
have been very trifling.

Were any of the other inmates of the house afflicted with illness?—I
had often to send for the surgeon to my servants, who were liable to
ulcerated sore throats.

And your children, were they also affected?—My youngest child was
very delicate, and we thought he could not have survived; since he
came here he has become quite strong and healthy, but I have no
right to say the burying-ground had any connexion with his health.

§ 14. In the course of an examination of the Chairman and Surveyor of
the Holborn and Finsbury Division of Sewers, on the general management
of sewers in London, the following passage occurs:—

“You do not believe that the nuisance arises in all cases from the
main sewers? (Mr. Roe)—Not always from the main sewers. (Mr.
Mills)—Connected with this point, I would mention, that where the
sewers came in contact with church-yards, the exudation is most
offensive.

“Have you noticed that in more than one case?—Yes.

“In those cases have you had any opportunities of tracing in what
manner the exudation from the church-yards passed to the sewer?—It
must have been through the sides of the sewers.

“Then, if that be the case, the sewer itself must have given
way?—No; I apprehend even if you use concrete, it is impossible but
that the adjacent waters would find their way even through cement;
it is the natural consequence. The wells of the houses adjacent to
the sewers all get dry whenever the sewers are lowered.

“You are perfectly satisfied that in the course of time
exudations very often do, to a certain extent, pass through the
brick-work?—Yes; it is impossible to prevent it.

“Have you ever happened to notice whether there was putrid matter in
all cases where the sewer passed through a burial-ground?—The last
church-yard I passed by was in the parish of St. Pancras, when the
sewer was constructing. I observed that the exudation from it into
the sewer was peculiarly offensive, and was known to arise from the
decomposition of the bodies.

“At what distance was the sewer from the church-yard where you found
that?—Thirty feet.”

Mr. Roe subsequently stated—

“Mr. Jacob Post, living at the corner of Church-street, Lower Road,
Islington, stated to our clerk of the works, when we were building a