Part 3
§ 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 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.