No. 4 The Proportions of Deaths and Funerals Preventible by Sanitary Means
Henry Blenkarne, Esq., South West District Surgeon of the City of London Union
Have you in your district perceived any effects resulting from interments in the parochial burying places?—I have no cognizance of any bad effects resulting from those interments. The first twenty years of my life I lived close to a burial-ground, and never was aware or heard of any prejudicial consequences arising. I may observe, however, that when a relation of mine has attended the church she has been enabled to perceive whenever a vault underneath the church has been opened. She has said, “I feel they have opened a vault;” and on inquiry it has turned out to have been so.
Have you observed any evil effects following the practice of the long retention of the corpse in the house amidst the living?—Yes, I have observed effects follow, but I cannot say produced by them, though they were perhaps increased by them. In those cases which I have had where there has been a succession of cases of fever in the same family, after a death it has generally occurred that the parties affected have complained two or three days before that they felt very unwell. Generally this has been the case. I have, in such instances, ordered them medicine immediately. Since the Union has been established we have immediately removed all fever cases to the Fever Hospital.
The retention of the corpse amidst the living, under such circumstances, must aggravate the mortality, must it not?—There cannot be a moment’s doubt about it.
What, from the observations in your district, has been the actual state of the sewerage, and cleansing dependent upon it, as the cleansing of the cesspools?—There has been great improvement in the city of London by the improvement of the sewerage, in so far as it has removed the cesspools. When you went into a respectable house formerly, you could, in the city, tell the state of the weather by the smell from the cesspools. Where water-closets are substituted, the health of the inhabitants has undoubtedly been improved. In the poorer neighbourhoods, where they have still cesspools, they are still very bad. I constantly tell them, if you get rid of that nasty cesspool you’ll get well and keep well; it is of no use my giving you physic until that is done. Where there have been deposits accumulating in the sewers, and the drains have been choked up, the effect has been just the same as if there had been cesspools.
You are aware that in respect to sewerage it is the practice to allow deposits to accumulate in the sewers, and then, when the private drains are stopped up, to open the sewer and get out the deposit by means of buckets, and remove it in carts?—Yes, I am.
Have you seen any illness result from this practice?—I cannot state a case, though I have no doubt of its highly injurious effects; but can decidedly speak to illness arising from the accumulations. The illness is just the same as from cesspools: a low depressing nervous fever, most like that which is described to be the form of the jungle fever. In November or December last, they were taking up the deposits from the sewers near Broken Wharf, in Upper Thames-street: the stench from it was quite sufficient to have produced any fever: it was not within my district, and I do not know what were the effects. Fortunately there was clear weather, and the wind blew towards the river.
Have you any doubt that the removal of such refuse, as well as the accumulation, must be attended with danger to life?—Yes; if any person in a state of mental or bodily depression were exposed to such an influence, it would produce low fever; it would be dangerous in proportion as it was stagnant.
In passing through the city, have you been assailed with smells from gully-holes?—Only yesterday, in passing through the city, the smells from many of the gully-holes were very offensive; and several medical friends agree with me in attributing extremely prejudicial consequences as arising from this cause.
The following case is related on the authority of Dr. Good, as having occurred within the city of London, and is mentioned by Mr. Fuller, in a letter from a surgeon who has paid great attention to the influence of sewerage, and who adduces the facts of the case in evidence that typhus may be produced by the miasma from sewers:—“Soon after the closing of the Parliamentary Committee, I learned, from the late Dr. Hope, the particulars of a case which, to my mind, has completely proved the production of typhus fever from it, and was so much in the character of an experimentum crucis, that I did not consider it necessary to prosecute the inquiry any further. The case is as follows:—“A family in the city of London, who had occupied the same house for many years, enjoying a good state of health, had a nursery-maid seized with typhus fever; the young woman was removed from the house and another substituted in her place. In a short time the new nurse-maid was attacked with typhus fever, and was also sent away. A few weeks after one of the children was seized with the same fever: an inquiry was now instituted by the medical man in attendance, in order to ascertain, if possible, the cause of this frequent recurrence of typhus fever, when the following facts were brought to light:—The nursery was situated on the upper floor but one of the house, and about a fortnight or three weeks before the first case of fever occurred, a sink was placed in the corner of the nursery for the purpose of saving the labour of the servants; this was found to communicate with the common sewer, and to be quite open, or untrapped; they ordered it immediately to be effectually trapped, and then no other case of fever occurred, although it continued to be occupied as before; and, when I learned the case, more than a twelvemonth had passed.””
Have you met with cases analogous to the one here stated?—I have met with several such cases. I know of an instance where a room in an old house had an offensive stench, and the health of the person living in it was always bad. A stench was perceived in the room, which it was guessed might arise from the decay of dead rats in the wainscot. The party went to much expense to pull down the wainscot, when it was found that there was an opening which communicated with the cesspool below. The hole was properly cemented and stopped up, and the room has since that time become quite habitable and healthy; and where I have directed the cesspools to be emptied, as the predisposing cause, the general result has been that the sick have immediately got well. From my knowledge of the local causes I can predicate, with certainty, what will be the general effect on the health in the case of removal of the parties.
Besides the houses of the labouring classes, are there many houses of the middling classes in your district in the city of London that are provided with cesspools?—Many houses that I go into are provided with cesspools. I mentioned the other day to a lady that I should never be enabled to keep her well so long as there was a cesspool in the house; I told her that the expense of continued medical attendance would pay for a communication with the common sewer and better cleansing.
Are you aware that a new practice has arisen of preventing the accumulation of deposits in the sewers, by flushes of water, which remove all deposits weekly, and so far prevent the year’s accumulation and corruption of deposits in the sewers. If this system were enforced in the city, have you any doubt as to the extensive prevention of disease and mortality which would be thereby effected amongst all classes?—Certainly it would be a great boon, in a sanitary point of view, to the population of the city of London. I am so much convinced of this, that in my own house I put a stick under the handle of the water-closet, so as to have a continued flow or flush of water for some length of time; this I do to remove any accidental accumulation. Of course the flushing of the common sewers would have the same effects.
Besides the accumulations in the sewers, is there at this time no decomposing refuse from the defective cleansing of the courts and bye-streets, and poorer districts?—Yes; in the poorer districts there is accumulation. In one court, for example, called Harrow-court, Thames-street, where there is almost always low fever, there is always dirt and filth, and I am constantly exhorting the people to remove the filth; but the great difficulty with the poor people is commonly how to get the water. There is a court in Cornhill which a man was cleansing the other day by applying a hose to the water-cock (which is used in case of fire), in order to cleanse the pavement. An officer belonging to the water company coming by, said, “If I see you doing that again, I shall indict you.”
Are you aware that the streets are swept oftener than weekly in the city of London?—My impression is—not oftener.
It has been proposed that water should be laid on, and kept at high pressure in the streets, so as to enable the courts and alleys, the foot and the carriage pavements, to be washed daily by means of a hose attached to the water-pipes. This, which has been proposed for protection against fire, as well as for cleansing the streets more completely, has, I am informed, been done in Philadelphia. If the system were carried out in the city of London, what do you conceive would be the effect on the health of the population in the poorer districts?—I should certainly say that it would tend greatly to prolong life amongst the population.
From the mortuary registries it appears that the average duration of life among the professional persons and gentry in the city of London, who live in better cleansed and ventilated houses, and better cleansed streets, is, on the average of the whole class, about 43 years, and 6 per cent. of the deaths are deaths from epidemic disease; whilst among the labouring classes the proportion of deaths from epidemic disease is 19 per cent., and the average age of all who die is only 22 years. With such sanitary regulations as are under the public control of the public authorities, to what extent do you think it probable the duration of life amongst the labouring classes may be extended?—So far as I can judge, without examination of the particular cases, I should say that the average might be extended one-half at the least.
The majority of the cases of epidemic diseases may decidedly be ascribed to the want of cleanliness and ventilation. On looking over the mortuary registry of the deaths occurring in Upper Thames-street and the district attached to it, I find the causes of death most frequently registered are “low fever,” “low fever,” occurring one after the other. This recurrence of low fever corresponds with my experience of sickness, which so often assumes the character of low typhoid nervous depression. The medicine I use in the greatest quantity is ammonia, as an active diffusive stimulus. For all classes this medicine is in constant use. In damp weather we have always much increase of this illness: the dampness produces a depression which lays them open to the atmospheric poison.
Have you had instances where better cleansing has taken place and illness diminished?—Yes; for example, in Ireland-yard, containing a large number of families of coal-heavers and others, a place which I never was out of from continued illnesses: the yard has been much better cleansed, the houses put in better order, and now there is very little illness there. I know for a fact, that in the neighbourhood of London-wall, where recently great improvements have taken place in the sewerage and ventilation, disease has greatly diminished, especially low fever. Formerly they had a sewer which used to be stopped up and overflowed; they have had of late a new sewer, which now works better; they have no stink or stench in the kitchens, as formerly, and they have nothing of the same kind of disease going on there that they used to have before.
Are the houses in Ireland-yard occupied by the same inhabitants?—Just by the same class. The habits of coal-heavers are reputed to be none of the best in respect to general cleanliness or temperance.
Have you observed any alteration in their habits?—Not in the least.
Have you observed what is the personal condition of the natives of London?—The real cockney is generally of stunted growth.
Have you observed whether the children born in London of parents who have come from the rural districts are as tall or as strong as the parents?—Generally shorter children, though some of them are as tall, but all are of comparatively weakly constitutions; they are particularly predisposed to strumous disease. I have been so impressed with the effect of children living in a London atmosphere, that I have been anxious to send them out of it when possible.
Does not defective cleansing, as causing atmospheric impurity, not only tend to produce disease and shorten the duration of life, but depress the physical condition of the population?—Decidedly.