Originally published in The Leisure Hour (Religious Tract Society) vol.1 #12 (18 Mar 1852).
If we were to read in the morning papers that, in a village of two thousand inhabitants, twenty persons had been killed by the fall of a bridge, long known to be insecure by the magistrates, and had been all drowned in the deep pools of a stagnant stream, every one would be shocked at the catastrophe, would condemn the apathy of the public authorities, and perhaps raise a subscription for the bereaved families. If, instead of draining the stagnant pools, and erecting a secure viaduct, an insufficient bridge were, from motives of sordid economy, to be erected, and in the course of twelve months the same "accident" were to recur, and twenty persons once more to perish, the nation would be indignant, the magistrates would probably be struck off the commission of the peace, and the village would become a by-word for improvident folly. The day on which, in two successive years, the twenty faces, all familiar to the little community, had been laid, with pale and convulsed features, on the grass, amid the shrieks of surviving relatives, would, under the name of "Black Monday or Wednesday," be long recalled with a shudder of horror, and strangers who might visit the village would be conducted to the churchyard to gaze on these forty graves, as on some spectacle of wonder and awe. If, still, from some inherent defect, the bridge annually fell, and twenty persons were annually swept away, the inhabitants would abandon the place as one under the especial curse of God, and the village would be no more dwelt in for ever.
Yet in almost every village of two thousand inhabitants throughout Great Britain, twenty individuals perish annually from a want as easily supplied as that of a good bridge. They do not drop all at once into the dark waters; their faces, with the death-struggle convulsion on them, are not seen side by side, and their graves are scattered over all the village churchyard instead of being gathered up in dreary files in one part of it; but every twelvemonths as surely sees the sufferings and the graves, as if the victims had all perished in one sudden catastrophe, and had been followed to the churchyard by the whole of the peasantry, struck dumb with awe.
The numerous reports on public health, both by sanitary commissioners, and the large number of intelligent persons who, during the last ten or twelve years, have devoted their time to the subject, in various parts of this country, have at length issued in a "Summary of Experience on Disease," drawn up by William Lee, Esq., Superintending Inspector under the Public Health Act—a most important document, wherein is made manifest, by statistics unanswerable, that most villages of two thousand persons, and every two thousand persons in most towns, do really stand by and see twenty of their neighbours killed, who by proper exertions on their parts might be saved. If the method of this annual mortality were proved to be as infallible as drowning, and as easily remedied as building a stone bridge, there can be little doubt that every one, from the architect to the hodman of society, would come freely forward, and have the bridge finished off in the shortest possible space of time. By way of proving this to that portion of the public who choose to spend a leisure hour with us, we mean to say a few words on this most valuable "Summary of Experience on Disease," by Mr. Lee, and to offer a few suggestions which have occurred to us during its perusal.
Generally speaking, the mortality of towns is greater than that of the country, but not to the extent usually supposed, nor by any means inevitably so; for in the good parts of well-paved and drained towns the mortality is as low as in the most salubrious village. In the dirty undrained alleys and courts of small country towns and villages; nay, in isolated farm-houses and cottages where the family dwell on the floor, and have dunghills and other refuse decomposing around them; the mortality per cent. is, in our experience, quite as great as in the back streets of manufacturing towns; in some manufacturing and agricultural villages which we know of, even greater. For if the country people have fewer vicious habits, less absolute want, and more open air during the day, they have the floor below the surface of the soil, and the damp walls, which the town artisan usually escapes; while they frequently lack the good and ready medical advice which the hospital and the dispensary supply.
This similarity in the great mortality of the dirty undrained portions of both town and country dwellings, and the similarity in the small mortality of the clean dry parts of good country villages, and the clean well-drained portions of large towns, has not yet been sufficiently attended to, and is a circumstance of great practical importance. For the fact fixes the causes of death (in excess of the average) on the want of ventilation and cleanliness common to both places, in town and country; and shows that not all the wholesome influence of the
free country air can much lessen, nor all the depressing influences of town life much increase, the mortality allotted to man, provided his personal habits and the vicinity of his dwelling be in accordance with the common laws of health.
In towns, typhus and other fevers, and drink, are the chief parents of pauperism; in the country it is the same—rheumatism, small-pox, scarlet fever, and, in a few places yet, ague, adding to the miserable brood. The parents of typhus and very many of the other infectious and endemic fevers issuing in pauperism are, even in country villages and farm-houses, bad air, and filth in a decomposing state. We have known fever and small-pox spread as rapidly and virulently in a village as in the back streets of a large town; and, near dirty farm-yards, have known fatal typhus linger though the freshest of mountain breezes were playing around, and streams like crystal were flowing near.
We said, that if the causes of this excessive mortality were as manifest to the public as the breaking down of a rickety bridge, they would at once remedy the mischief. When these causes shall become visible, palpable to all, as they now are to many, the laissez-faire, or let-alone, philosophy of ignorance, and the fatalism philosophy of laziness and folly, will be abandoned. Gradually the knowledge of the preventible nature of very much of this mortality is becoming diffused amongst the people; and in proportion as this knowledge shall become general, the better philosophy of fore-thought, founded on experience, will become the law of the public mind on the subject of the public health. But it will not be till the majority of the people—or, rather, of the thinking portion of them, (a small but influential minority indeed)—shall come to see the merits of this question, that its solution will become easy.
At present, so far as we are advanced in the inquiry, the chief question with the public is, as it has long been the question with medical men and other intelligent sanitary reformers, is it lawful for any man, under any pretence, to oppose public cleanliness and abundance of fresh air and water? Should any one, anywhere, be allowed to cherish and harbour miasm and fomites, those invisible Thugs of society? If a man may not harbour a pig in his garret, is he to harbour a confluent small-pox? If he may not have a drunken fight in his cellar, is he to be allowed to have a putrid or delirious fever up-stairs? We think, as society can punish, by very summary methods, the sale of diseased flesh in the shambles, it ought also to arrest the distribution of a deadly atmosphere; that it is quite as great and as easily preventible a crime to scatter the infection of typhus as sulphuric acid; and that no man should be permitted to have an open sewer any more than a savage bull-dog going at large. The sooner the thinking portion of the public, and especially the thinking portion of the working classes, examine these questions, the nearer will the remedy be; for their discussion can lead to no other result than that a deep and solemn religious duty lies before them in regard to the public health.
Out of a number of districts embracing a population of 600,000 persons inhabiting country towns, villages, hamlets, and isolated houses, Mr. Lee found the average annual mortality to be scarcely more than eleven to a thousand. These were the most healthy populations in England. But as there can be no doubt that many deaths, from preventible causes, occurred in these country districts, he concludes, we think justly, that the average mortality of England, under favourable circumstances of ventilation and drainage, should not be more than ten in a thousand. Yet in many towns and villages the mortality is twice, even sometimes three times, as great as this; and it is a melancholy fact, that in very large sections of the population the number of deaths from DIRT is as great as those from inevitable causes. In a small beautifully situated country town, within a mile of the place where we write, the deaths have averaged, for many years past, twenty-two in the thousand; yet, with a little exertion, it might become one of the cleanest, neatest, and healthiest, as it is one of the most beautifully situated, little towns in the whole of the country. Typhus, small-pox, measles, scarlet fever, and cholera, have their tales of death and sorrow to tell in this lovely land, amid gushing streams and mountain breezes, as well as in St. Giles' and Wapping; and the worn look and wasted spirits resulting from foul air, and the use of the stimulants to which the depression it produces tempts, are as visible here as in the Cowgate of Edinburgh. And many are the fair villages and towns throughout England which, with equal advantages of situation, have similar tales of sorrow to tell.
When we hear of 70,000 persons perishing annually in Great Britain from consumption, we listen with pity and awe, and call it "the English disease," as if that peculiarly were our foe. But what is that compared to the mortality from typhus and its kindred diseases? In every million of inhabitants, probably less, we lose as many every year as consumption takes away from the whole population; and the misery which results from the preventible disease is many times greater, in proportion to the numbers carried off, than in this "incurable" disease of the chest. Typhus strikes the father and mother, and leaves the helpless family behind; or it undermines the constitutions of the poor, leaves them unfitted for toil, and an easy prey to future maladies, while consumption takes chiefly the young, gives them leisure to prepare for the solemn change, and does not so often leave pauperism behind it.
We have been astonished throughout life to find how large a portion of really worthy and even sensible people, look upon disease, and especially the great pestilences which sweep over society, as being inevitable and irremediable as death itself, and think it presumptuous, nay, impious, to strive for the extinction of these scourges of our race. The enlightenment of the Tweed-side farmer, who, having always been accustomed to winnow his corn in a suitable wind, and wait for that patiently, considered the winnowing machine as a mere blasphemous invention for raising the wind, has been often paralleled during the last half-century; and it is only the other day that a learned professor of the Edinburgh University had to publish various pamphlets, well fortified by Greek and Hebrew, to defend the use of chloroform in relieving agony, from the popular outcry which was raised against it, as impiously annulling the primeval curse upon all the daughters of Eve. We trust, however, there are few of our readers who thus survey the boundless goodness of God through the tunnel of prejudice, and see no beam but that which reaches their own dim optics in the dark passage along which they grope. Certainly there will be none among those who shall well employ their "leisure hours."
Many eminent medical men believe that typhus fever and its kindred contagious maladies do not necessarily exist on the earth, any more than ague or drunkenness. The evidence of very many of the witnesses quoted by Mr. Lee, who had practised largely among the poor, goes to establish the belief. Those who have not had the observation forced on them by a large experience of typhus, will, perhaps, doubt the truth of it; but, startling as it may seem to say that half a million of deaths annually in Great Britain might be prevented, a close examination of the medical statistics given in Mr. Lee's tables, will show that the estimate is, in all probability, correct. Other diseases have been driven from the country, when their causes were discovered—plague, for example, and ague, and there seems no reason why typhoid fevers should form any exception. Fifty years ago, no farm servant or other stranger came to reside within some miles of the place wherein these remarks are written, without suffering from ague:—"Every body," say the country people, "had to go through a six weeks' shake." The last woman who suffered from it is now sixty years of age, and there has not been a case of true indigenous ague known for a quarter of a century or more.
In the old wards of the Edinburgh Infirmary, at the close of the last century, physicians and nurses were continually taking small-pox from the patients; but on the establishment of new well-ventilated wards, these cases among the attendants entirely disappeared. Drainage has driven the ague from this district, and ventilation saved the lives of the officers and nurses of the Edinburgh Infirmary. Innumerable instances have been recorded of late years, wherein an open sewer, or cesspool, or ditch, which for a long series of years had generated infectious disease, had, on being closed, ceased to produce any noxious effects. It has, indeed, become quite impossible for any one who will spend a few hours in examining into the evidence, to resist the conviction that typhus fever, and its kindred diseases, are as much the consequence of filth, as ague is of marsh miasma, or intoxication of deep drinking. It will, no doubt, be more difficult to apply the remedy to a town or village, than to a marsh with a ready outlet; but the method of cure is as clear in the one case as in the other, and all the obstacles will disappear by degrees when this truth is generally acknowledged.
How strange that truths so evident and simple should lie so long wrapped up in mystery, and that we should only now be arriving at the perception of them! The Almighty Disposer has said to all, in accents ever audible and clear: "This refuse of life, if you place it in the soil, shall cover the earth with verdure, beauty, and abundance; if you allow it to remain about your dwellings, it shall generate pain, disease, and death;" and we are only now beginning to listen to, believe, and obey the eternal law.