Part 4

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 sewer opposite Mr. Post’s house, that he had a pump, the water from the well attached to which had been very good, and used for domestic purposes; but that, since a burying-ground was formed above his house, the water in his well had become of so disagreeable a flavour as to prevent its being used as heretofore: and he was in hopes that the extra depth of our sewer would relieve him from the drainage of the burying-ground, to which he attributed the spoiling of his water.”

Professor Brande states that he has “frequently found the well-water of London contaminated by organic matters and ammoniacal salts,” and refers to an instance of one well near a church-yard, “the water of which had not only acquired odour but colour from the soil;” and mentions other instances of which he has heard, as justifying the opinion, that as “very many of these wells are adjacent to church-yards, the accumulating soil of which has been so heaped up by the succession of dead bodies and coffins, and the products of their decomposition, as to form a filtering apparatus, by which all _superficial_ springs must of course be more or less affected.” Some of the best springs in the metropolis are, fortunately, of a depth not likely to be considerably affected by such filtration. In Leicester, and other places, I have been informed of the disuse of wells near church-yards, on account of the perception of a taint in them. The difficulty of distinguishing by any analysis the qualities of the morbific matter when held in solution or suspension in water, in combination with other matters in towns, and the consequent importance of the separate examination already given to those qualities, may be appreciated from such cases as the following, which are by no means unfrequent. In the instance of the water of one well in the metropolis, which had ceased to be used, in consequence of an offensive taste (contracted, as was suspected, from the drainage of an adjacent church-yard), it was doubted whether it could be determined by analysis what portion of the pollution arose from that source, what from the leakage of adjacent cesspools, and what from the leakage of coal-gas from adjacent gas-pipes. In most cases of such complications, the parties responsible for any one contributing source of injury are apt to challenge, as they may safely do, distinct proof of the separate effect produced by that one. Popular perceptions, as well as chemical analysis, are at present equally baffled by the combination, and complaints of separate injuries are rarely made. If, therefore, the combined evil is to remain until complaints are made of the separate causes, and their specific effects on the health, and until they can be supported by demonstration, perpetual immunity would be ensured to the most noxious combinations.