An inquiry into the propagation of contagious poisons,

By the atmosphere : as…

The Project Gutenberg eBook of An inquiry into the propagation of contagious poisons, by the atmosphere
    
This ebook is for the use of anyone anywhere in the United States and
most other parts of the world at no cost and with almost no restrictions
whatsoever. You may copy it, give it away or re-use it under the terms
of the Project Gutenberg License included with this ebook or online
at www.gutenberg.org. If you are not located in the United States,
you will have to check the laws of the country where you are located
before using this eBook.

Title: An inquiry into the propagation of contagious poisons, by the atmosphere
        as also into the nature and effects of vitiated air, its forms and sources, and other causes of pestilence : with directions for avoiding the action of contagion, and observations on some means for promoting public health

Author: Somerville Scott Alison

Release date: February 3, 2025 [eBook #75284]

Language: English

Original publication: Edinburgh: MacLachlan, Stewart & Co, 1839

Credits: Richard Tonsing, Charlene Taylor, and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive/American Libraries.)


*** START OF THE PROJECT GUTENBERG EBOOK AN INQUIRY INTO THE PROPAGATION OF CONTAGIOUS POISONS, BY THE ATMOSPHERE ***





                               AN INQUIRY
                                INTO THE
                              PROPAGATION
                                   OF
                          CONTAGIOUS POISONS,
                           BY THE ATMOSPHERE;
                                AS ALSO
INTO THE NATURE AND EFFECTS OF VITIATED AIR, ITS FORMS AND SOURCES, AND
                      OTHER CAUSES OF PESTILENCE;
                                  WITH
            DIRECTIONS FOR AVOIDING THE ACTION OF CONTAGION,
                                  AND
         OBSERVATIONS ON SOME MEANS FOR PROMOTING PUBLIC HEALTH


                                    BY

                          S. SCOTT ALISON, M. D.

                                 TRANENT.

 “I have long thought that there is no subject on which a Physician could
  employ his time and ability more advantageously for the benefit of his
   fellow-creatures, than in the investigation of febrile Contagion, in
   order to ascertain the laws by which it is communicated, and by what
                means it may be prevented.”      HAYGARTH

                                EDINBURGH:
                        MACLACHLAN, STEWART & CO.;
                         LONDON, WHITTAKER & CO.
                                  1839.




          PRINTED BY NEILL AND CO., OLD FISHMARKET, EDINBURGH.




                                PREFACE.


The Author trusts that the importance and the accuracy of the facts
which have been detailed in the following Work may, in some measure,
counterbalance the many defects which will doubtless present themselves
to the reader.

The progress of the Work has been interrupted, on innumerable occasions,
by the unceasing labours incident to the life of a country medical
practitioner; and though many of the facts and arguments which have been
used, have long obtained the author’s attentive consideration, their
reduction to the present form has only now been accomplished during the
short intervals which he has seized, after the fatigues of the day had
been concluded.

The author relies with some confidence on that indulgence which he hopes
will be extended to the work of one who contributes, for useful
purposes, the results of his experience, derived from an intimate
knowledge of the condition, habits, health and diseases of the various
classes of the population of a considerable extent of country, of which
his situation has put him in possession.

                                                                S. S. A.


  TRANENT, _March 1839_.




                               CONTENTS.


                                 PART I.

 INTRODUCTION                                                     Page 1
 CHAP. I. Prevalence of Doctrine of Atmospheric Contagion, Injury
   to Patient, Attendants, and Visitors                                7
 CHAP. II. Medicine retarded—Forms of Contagion                       18
 CHAP. III. Historical Sketch                                         25
 CHAP. IV. The Absence of Sufficient Evidence of the Existence of
   Atmospheric Contagion                                              36
 CHAP. V. Contagious Poisons—Non-Solution in the Air—Results of
   Experiments                                                        40
 CHAP. VI. Contagious Poisons, compared with Yeast—Does that
   agent assume the Aeriform State?                                   50


                                PART II.

 CHAP. I. The Negation of Atmospheric Contagion from the History
   and Actual Observation of Disease                                  56
 CHAP. II. The Evidence drawn from Disease attacking the
   Relatives, Attendants, and Visitors of the Sick, in favour of
   Atmospheric Contagion, considered—Facts explained                  67
 CHAP. III. The argument drawn in favour of the Propagation of
   Disease by Atmospheric Contagion, from Disease appearing in
   previously Healthy Houses and Localities to which Persons
   sick, or lately so, have been removed                              86
 CHAP. IV. There is no evidence that Atmospheric Contagion
   travels, or is communicated from one place to another              89


                                PART III.

 CHAP. V. On Vitiated Air                                             96
 CHAP. VI. Air Vitiated by Admixture with Effluvia arising from
   the Decomposition of Vegetable Matter on the Surface of the
   Earth                                                             112
 CHAP. VII. Malignant Fever                                          126
 CHAP. VIII. General Diseased Condition of the Body, the Product
   of Malaria                                                        132
 CHAP. IX. Other causes of Pestilence—Famine—Unwholesome Food and
   Drink                                                             140
 CHAP. X. Causes of Pestilence continued—Cold, Want of Clothing,
   and Shelter—Depression of Mind—Influence of Weather, Climate,
   Habits, &c.                                                       152
 CHAP. XI. The Avoidance of Diseases marked with Palpable
   Contagious Poisons—The Limited Range of Action of Contagion       165
 CHAP. XII. The Prevention and Correction of Vitiated Air            172
 CHAP. XIII. The Prevention of Vitiated Air in connection with
   the Disposal of the Dead—Offals—Construction of Towns, Houses,
   Sewers, &c.                                                       190
 CHAP. XIV. Prevention of Disease by an Active and Cheerful State
   of Mind, Sufficient Clothing, and Wholesome Diet                  206




                            AN INQUIRY, &c.




                                PART I.




                             INTRODUCTION.


  “Les hommes sont bien malheureux! ils flottent sans cesse entre de
  fausses esperances et des craintes ridicules; et, au lieu de s’appuyer
  sur la raison, ils se font des monstres qui les intimident, ou des
  fantomes qui les seduisent.”

                                                            MONTESQUIEU.


The author of the following pages has been induced to lay before the
public the details of an investigation into Atmospheric Contagion, from
the following considerations.

_1st_, That there prevails among the public, and especially among the
relatives of the sick, much unnecessary alarm on that subject.

_2d_, That much injury is inflicted upon the poor patient, who is often
made to suffer great and cruel privations, from the neglect and
desertion of friends in a state of panic.

_3d_, That a great obstacle to the progress of Medical Science, is
raised up by the belief in the existence of Atmospheric Contagion.

_4th_, That there exists relative to that subject, much confusion, from
the misapplication of terms.

He has thought that these are important grievances, and that a little
labour would go far to remove them. He is satisfied, from the
investigation that is shortly to be detailed, that Atmospheric Contagion
has no existence; that consequently all the apprehension felt upon the
subject is groundless, and that the many painful measures which the
public adopt, for their security, are totally unnecessary.

On a subject, too, touching such important considerations as the
dreadful panic often experienced when pestilence is ravaging; the safety
and ease of mind of the public; the discharge of the most sacred offices
of kindness and consolation to their sick and dying fellow-men; and the
progress of medical science, he has felt that the public must take a
deep interest, and that he is warranted in treating it in a style fitted
for popular perusal.

It must be granted that the British nation, whose sympathy is not
confined among themselves, but exists for the various tribes of the
human race, civilized and savage, must willingly lend an ear to an
argument, whose object is, to shew that their own safety from
pestilence, does not require them to be placed in the painful and cruel
position, of withholding their aid from a suffering and helpless
fellow-creature; of disregarding the cries and the imploring and
eloquent looks of the dying; of forsaking the sick-bed of a father or a
brother, denying the tender and unpurchaseable offices of friendship,
and of ruthlessly breaking asunder the sacred bonds with which God has
wisely and indulgently joined us.

They, whose hearts are open to the appeal of the forlorn slave, must be
gratified to hear that they may perform the offices of humanity to their
sick relatives and friends, without, as has hitherto been thought,
subjecting themselves to the almost certain invasion of disease; that
they may watch the last moments of an expiring friend, minister to his
latest wants, and have the melancholy gratification of standing by him,
when about to make the last and most awful change that can overtake him.

It is expected that it will be shewn, that the sick-room is at all times
free of the poison with which it has been believed to be contaminated,
and that the atmosphere there, if attention is paid to ventilation, &c.
is almost as wholesome as that out of doors.

The air which the sick respire does become impure, but not on ordinary
occasions in a manner different, or with a greater virulence, than is
observed in the case of air in a small and close apartment, respired by
many persons closely huddled together.

The history of sick chambers presents no instance more dreadful than
that of the Black Hole of Calcutta, where so many perished of corrupted
or vitiated air.

The subject of infectious air touches directly upon the most important
interests of mankind, concerns intimately their safety, the duties of
man to man, and even the very affections of the heart.

As the subject at present stands, the public is awkwardly situated;
believing that they must either endanger their health, even their lives,
or allow their friends and relatives to perish unassisted.

The author thinks he is under no obligation to apologize for attempting
to shew, that the public may at once perform all the charities of life
to the sick, and avoid the action of a virulent poison. There can be
none necessary, and he even hopes that his inquiry may tend to obtain
for many, who are yet to be the victims of pestilence, that succour from
hands they love, which, alas! has been withheld from thousands.

It has not been usual to write speculative medical opinions in a popular
style, but the author is of opinion that an inquiry bearing on matters
so important, should be made known to those whom it most concerns,
certainly, the people; and he is convinced, that in a simple case of
evidence such as this, that they are qualified to decide, provided there
is a full and impartial leading of facts on both sides, and there be
absence of all technical terms and purely professional phrases. The
discussion will be conducted on plain and obvious principles, so that
the merits of the question may be appreciated, at once, by them and the
profession.

The public is already informed of much that relates to the animal
economy in health, through the assistance of many admirable works which
have been published within the last few years, and it is not unfair to
suppose that they may be interested in hearing, and likewise capable of
understanding, a case relative to disease.

The community is aware that Medicine is not now the subtle, hidden,
affectedly mysterious art, it was at no very remote date; and that its
present enlightened professors now seek not the assistance of darkness,
of silence, to disguise their ignorance and questionable views, or to
heighten the impression of the skill and cunning of their order.

Its study is now conducted openly, and its foundation, happily, is laid
upon principles established in nature that are as well known to the
unprofessional as to the professional man.

There is no wish to disguise matters from the public, and, were it
attempted, it could not possibly succeed.

The utmost care will be observed to lay the evidence impartially down,
plainly, and divested of technical phraseology; and, satisfied of the
general ability of the public to judge, the author will await their
decision with as much anxiety as that of the medical world.

It will afford the writer the return he most values, if, by his means,
less anxiety and apprehension are felt in future among the public on
occasions of disease; if those acting under a sense of duty are enabled
to discharge their humane offices with less feeling of danger; if the
patient remain unoppressed with alarm for the dear ministering friends
around him; if even one sufferer be spared the anguish of bearing wants
unanswered, and if in his last hours he is spared the bitterness of soul
he must experience, when deserted by those to whom, through life, he
looked for comfort and support.

The author has also been induced to publish his views upon vitiated air,
its nature, sources and effects, with directions for its prevention,
avoidance, and correction. Vitiated air has been confounded with
atmospheric contagion, has performed the greater part of the work of
death attributed to that agency, or supposed agency, and it has been it
that has been affected and controlled, when both non-professional people
and the medical world thought systems of quarantine, isolation, gens des
cordons, (contagion police,) and fumigations, were effecting the objects
for which they were established.

The immediate objects of these counteracting agents, the destruction of
contagion and contagious atmosphere, &c., could not be effected, since,
at least, the latter does not exist: but fortunately, though they could
not effect the objects immediately proposed, the ultimate ends have been
served, by their acting on many occasions upon the efficient causes of
disease, viz. vitiated air.

They were useful after the fashion of the medicine and charms in olden
times, used for the expulsion of evil spirits, devils, and the like,
which, by their natural action upon the functions of the body, corrected
derangements which were mistaken for the operations of these imaginary
beings. The Author has pointed out other causes of pestilence, and has
given some directions for their prevention, and for the preservation of
health.




                               CHAPTER I.
  PREVALENCE OF DOCTRINE OF ATMOSPHERIC CONTAGION, INJURY TO PATIENT,
                        ATTENDANTS AND VISITORS.


Atmospheric contagion, to which public attention is directed, has been
regarded for many ages as the cause of a great proportion of the
pestilence incident to the human race; and, at the present day, most of
the diseases which are wont to be widely spread, and to be very mortal,
are usually considered as depending on that agent, both by the
unprofessional and the medical world: indeed, so extended has been
thought its sphere of action, that it is suspected to be operating in
almost every case that occurs, of those diseases which usually attack
many at the same time; and, in nearly every instance, its existence is
positively inferred, where previous cases can be shewn to have been
prevailing, though at the distance of several miles.

It is a fact familiar to many, that, on the occasion of the late
prevalence of Cholera Morbus in the years 1831 and 1832, that infection,
through the medium of the air, was considered the most common cause of
the propagation of that scourge; and every mother is taught to regard
every case of scarlet fever, common fever, hooping-cough, and many such
disorders, as a very centre of infectious air that possesses qualities
subversive of the health of her children.

Ordinary conversation, too, marks well the common belief in the positive
injury that agent inflicts. In general, it seems a matter quite out of
the question to suppose, that the patient may have got his sickness from
the operation of other and distinct causes, as is sufficiently evident
from such common questions as these, “Had he visited any person ill of
the same complaint?”—“Where, and from whom, did he get the infection?”
and likewise from the ordinary replies, “He got it from a friend, at
whose house he called to inquire after his health,”—“He caught it when
passing through a street in which a person lay ill of the same
distemper.” Such inquiries and replies are made not only by the public,
but by the medical profession also, who are, in general, sufficiently
satisfied if such answers and solutions as those above be given. Were it
necessary to say more to prove the important position infection holds as
a cause of disease, and as the chief instrument of its propagation,
references might be made to thousands of instances, narrated, too, on
medical authority, where whole visitations of pestilence have been
attributed to its operation, and volumes might be filled with the most
skilful artifices, devised, and actually carried into execution, to
deprive the air of its invisible poison; but these steps are deemed
unnecessary here.

The belief in the doctrine of atmospheric contagion is hurtful to the
patient by its direct influence on his mind, and the gratification of
his wishes.

The patient laid on the bed of sickness, having many wants and occasions
for a thousand little offices, but being unable to assist himself,
generally desires, and, where apprehension does not cause desertion,
obtains the aid of good and gentle friends, whose very presence affords
a gratification to the sufferer which none can sufficiently value, who
have not, like him, felt its blessings. Their assistance and constant
presence is absolutely necessary to supply his several wants, and to
render a situation, often painful, and ever irksome, less acutely so.

But not more necessary is such assistance to the mitigation of the
sufferings of the body, and the soothing, the calming of a fevered mind,
than is it urgently wished for, and longed for by the patient, to whom
even the momentary absence of the ministering being from his bedside is
frequently the cause of much mental agitation and of pain.

But where, as we have often seen, the patient has still his senses left,
and dearly loves the objects around him, what must be the amount of that
bitterness of mental struggle going on in his breast, alternately
heaving with desire for their presence as his greatest comfort, and with
the alarm every amiable being must feel, lest those most dear to him
should fall the victims of their tenderness, and be cut down themselves,
in their holy endeavours to relieve his sufferings?

The apprehensions of the patient lest those kind and beloved friends
ministering to his wants, and nobly incurring on his account all the
risk of a dangerous situation, should unhappily derive from him, through
the medium of Atmospheric Contagion, the same disease,—are calculated to
produce a state of excitement highly injurious and directly opposed to
that calm and cheerful state of mind so favourable to his recovery. But
these apprehensions are often changed for the dreadful reality, and no
little mental suffering has been produced, and no trifling obstacle to
the convalescence of a patient has been raised up, by the intimation
that a dear friend has caught the pestilence from him, and has in
consequence been deprived of life.

The belief in the doctrine of Atmospheric Contagion is hurtful also to
the friends and attendants of the patient—by its naturally conveying the
impression that he is a centre of a poisonous agent, whose immediate
tendency is to propagate the distemper and diffuse itself through the
atmosphere, extending to it, its deleterious attributes, to be felt by
all who respire it.

The poison is said to diffuse itself in the air of the apartment; hence
it is believed, that entering into the apartment is tantamount to
destruction, or at least, is nothing less than exposure to an influence
of the most virulent and deadly quality.

It does not at the time signify to the attendants, the evidence on which
the doctrine rests. It is believed, and that is enough to cause the most
baneful effects upon the spirits, to inspire the worst apprehensions,
and has also, as is well known, produced those very effects they had
feared from its operation, has caused the increase of disease, nay,
death itself, and that not on one occasion only, but on many.

The most common causes of Pestilence, Plague, Putrid and low Fevers, and
Cholera, are mostly of a depressing nature, and, usually, the more they
partake of that character, they are the more effectual in their
operation. Famine is chiefly favourable to the sickness which is usually
coincident with it, from the depressed and feeble state of body it
produces; and an impure atmosphere is deleterious, chiefly from its
allowing the body to become less energetic, by withholding that vigour
and elasticity which the respiration of pure air imparts to the system
at large, and thence to the mind.

These are powerful depressing causes, but not more so than fear,
especially that kind that is deep and lasts long. Moral philosophers
rank Fear as one of the most depressing passions, and its
characteristics with the artist are paleness, contraction of the
features, the best and surest indication of a weakened circulation (of
blood) and diminution of vital power. The first are well aware of the
hurtful influence it imparts to the whole body, and narrate instances,
on excellent authority, where death, even immediate death, has been the
consequence, where the brain has had its functions impaired, and thus
imbecility induced; so that in short, they are accustomed to regard it
as one of the most powerful agents, applied both to the mind and body.

The Medical Philosopher, too, has frequent occasion to mark the great
depression of the powers of the body, the imperfect discharge of its
functions, and the general exhaustion consequent upon the long continued
operation of apprehension.

Be the apprehension of whatever nature, it is always detrimental—in a
ratio too, proportionate to its intensity, and its other contingent
circumstances. In the lesser degrees, it causes indigestion, flatus,
loss of appetite, headach, and often general restlessness, with feelings
of great discomfort.

It is found operating with great force, whether it arise from
apprehension of damnation in respect to a future state, of ruin in a
pecuniary point of view, or perhaps from what is most immediate and
striking in its effects, of catching the infection of pestilential
disease, which is the point with which we have most to do.

We have known many persons much affected with the fear of taking
infection, and allowing this to prey upon their spirits, who were among
the first attacked with pestilence; and if any weight is to be given to
our knowledge of the probable causes of disease, there is great reason
for concluding that those persons were the victims of their very fears,
more than of any other causes of a prejudicial character. It is often
impossible, with complete justice, to say decidedly that any one
influence has been the exclusive cause of disease, when there is room to
think there are, or may be many ready to operate; but, in many
instances, the relation has been so immediate, and so striking between
the known presence of depressing apprehension, and the supervention of
sickness, that there is no room left to doubt the propriety of placing
them in the relation of cause and effect. It must be familiar to many,
quite a common occurrence, and one of which we heard constantly during
the ravages of Cholera a few years ago, that persons took that disease
from mere fright, and of the attack having been very much encouraged by
its operation among the attendants, and more especially of those
believing in the existence of the infectious nature of the disease.

These facts, it is thought, will prove that the doctrine of Atmospheric
Contagion is calculated to excite much apprehension among the attendants
and visitors of one sick of pestilence, and to shew in what manner that
very apprehension is disposed to produce disease.

The attendant or visitor persuaded of the atmospherically contagious
character of the disease, must possess considerable fortitude to venture
at all into the presence of the patient, and even when once there, he
must possess more than common hardihood, who does not feel more or less
depressed with apprehension for that potent, and not the less imposing
agent, because invisible, which, like a drawn sword, hangs over him, and
threatens his existence.

By the belief in the doctrine of Atmospheric Contagion, the attendant
not only becomes, in general, exposed to one of the most common and
efficient causes of disease, viz. fear, but his offices are performed
more as a duty than as a gratification, which it is to a well disposed
mind, where no extraordinary danger is encountered, and he is thus
forced to make a sacrifice of his feelings, and the valued assurance of
security to a rigid sense of duty; but however much such conduct may
agree with morals, it is detrimental to health.

It is hurtful also to the patient, from its influencing so far those,
who, by relationship, by previous terms of friendship, and by duty, are
bound, by every moral obligation, to assist him, now helpless, sick, and
perhaps expiring,—as to forget their most sacred duties as to make them
disregard his forlorn situation, and indeed to induce them to fly from
and desert him; thus sacrificing every good principle and wholesome
consideration, (as they erroneously think) to make their own lives the
more secure.

Such contingencies are of frequent occurrence; and the result is, that
many unhappy persons are left to perish, their thirst unslaked, their
latest requests unheard, and their last moments unwitnessed. Parents
have been known to forsake their children, and the offspring their
parents, whom, at all hazards, they were bound to serve,—by every holy
affection, to assist the more diligently, the more they were pressed
with adversity.

But alas! the affections, the instincts of Nature, the dictates of
gratitude, have been thrown aside, and every thing fair and holy in the
human soul has been foully stained, in the almost universal wreck,
attendant on the course of pestilence.

The history of the cholera visitation affords many examples of perishing
persons deserted and left to the mercy of a cruel scourge; and we are
familiar with many instances which have come under our own charge, where
it has been found impossible to procure the attendance of relations, or
even the mercenary aid of hirelings, although extraordinary remuneration
has been offered.

Last winter, the father and mother of a family were seized with fever,
and their sole attendants were their infant children. There were several
relatives of the family not far off, but none, not even one, could be
persuaded to lend assistance. Their neighbours refused to hold any
communication; and, notwithstanding repeated and continued attempts by
the Author to induce those who make it their business to wait upon the
sick, the family had to struggle on, without the least attention being
paid, saving by the almost useless children, to their wants, to
cleanliness, and to the administration of the remedies.

It was truly a deplorable scene, such as made the Author reprobate that
cowardly desertion, and regret the operation of a doctrine so baneful,
and moreover so groundless. Yet we know not whether to blame most the
people or the doctrine. Did those see the scenes, the distress and
cruelty inflicted through the operation of infectious air, who believe
in it, and preach its avoidance; surely, did they possess one spark of
humanity, it could not fail to manifest itself, by causing them to
institute, or at least to listen to, an inquiry touching its evidence.

The medical attendants are not free from the hurtful operation of this
doctrine. If believers in infectious air, they are under a feeling of
apprehension which, perhaps with some, may not be strongly felt, on
account of the frequency of impunity from exposure; but with many it is
strongly felt, and influences their attendance on the sick, their
communication with them, and their own comfort and feeling of security.

Many instances are known—they are of very frequent occurrence—where the
physician, from apprehension, has failed to pay so many visits as were
necessary, or to remain with his patient sufficiently long to ascertain
his situation, and watch well the progress of the case. Cases are known
where patients have been looked at by their advisers, stationed at the
door, where it was impossible to ascertain the expression of the
countenance, the condition of the tongue, the state of the skin, not to
say any thing of that of the pulse.

We are acquainted with instances in which medical men have so acted
under the apprehension of taking infection, and where, too, they have
not felt they were doing any thing reprehensible, as was sufficiently
evident from the fact, that they themselves were the informants.

These facts prove that injury has been done to the patient from
insufficient care; and cases are not wanting, where medical men
themselves have taken disease, where the circumstances of the case
warranted the belief that fear was the chief, if not the only cause.
Many very cunningly-devised plans have been recommended for the adoption
of the physicians visiting patients labouring under infectious diseases,
such as standing in a current of air passing between windows, or doors
and windows,—keeping a handkerchief applied to the mouth and nose,
washing the mouth with water, &c. These are sometimes adopted, yet there
is room to think that, where a man of merely ordinary fortitude supposes
that he inspires an atmosphere holding in solution a very virulent, nay
deadly poison, that he will be anxious to make his visit as short as
possible, even though the preventives above mentioned be religiously
adopted.

Several of the cases of death among medical men, which have been
unhesitatingly attributed to infectious air, the Author is convinced,
from his knowledge of particular circumstances, and from the known
tendency of fear, have arisen from depression, in consequence of that
passion.

The prejudicial operation of the doctrine of infectious air has been
proved in reference to the patient himself, _1st_, From his apprehension
for the safety of others ministering to him; _2d_, From the neglect and
desertion of friends and others; _3d_, From the insufficient medical
treatment which his case frequently obtains.

It has been proved in reference to friends and attendants, who are often
in consequence in a state of apprehension, favouring the invasion of
disease; and in relation to the first, who are made to regard one of the
most delightful offices as a duty of imminent peril.

It is hurtful both to patient and friend, by forbidding that intercourse
which, but for the danger in question, would be so delightful and
consoling to both.

It tends to the commission of crimes of no trifling character, the
desertion of kindred and of friends, the hardening and debasing of the
heart, and the general corruption of the finest sentiments that bind and
ornament society.

It has led to deeds not the least dark in the page of human history.

It takes much from the efficiency of medicine, and has been the frequent
cause of much evil to its professors.

For all those reasons, it is an important subject, and demands patient
investigation.

Surely a case has been made out to shew how important are its effects,
and how much evil might be avoided were it proven, as is proposed to be
done, that Atmospheric Contagion has no existence. That is all, that is
desired to be shewn from what precedes, and we would on no account wish
the amount of mischief it inflicts to be thought as put forward as an
argument against its entity, which would be absurd.




                              CHAPTER II.
                 MEDICINE RETARDED—FORMS OF CONTAGION.


The progress of medical science has been much impeded by the operation
of the doctrine of atmospheric contagion. From the earliest periods the
practitioners of medicine have been in the habit of attributing a very
great proportion of the worst forms of disease to that agent; and the
consequence has been that little attention has been paid to the
investigation of the most difficult, and not the least important
department, that of the efficient and ordinary causes of disease.

It was almost a necessary consequence of the possession of such an
instrument, ready on all occasions, to solve the problems offered by the
occurrences of disease, that no inquiry would be made into those
circumstances by which might be detected those influences that conduce
to its production. There was ever at hand an agent whose existence all
were alike ready to concede, which was amply sufficient to explain the
origin and propagation of pestilence.

That being the case, medical men had no inducement to make
investigations, and from one generation to another they have gone on in
the old way, attributing much to that agency, and leaving uninquired
into, with few exceptions, the actual springs of diseased action.

Until very lately little was known of the relation between disease and
such important matters as these,—the state of the atmosphere, the
severities of the weather, and its other contingent circumstances, the
quality of the food and drink, clothing, habits, climate, and the like.

These most important matters received very little consideration, and
although much has lately been done to shew their influence in the origin
and propagation of disease; yet they are not regarded as so efficient in
that respect as they ought to be, and the reason of it is, that the
common application of atmospheric contagion to the explanation of the
problem, by the vast majority of medical practitioners, puts a stop to
the scrutiny which would detect their relation. The fact undoubtedly is,
that, in respect to some diseases, little is known, among those
intrusted with their treatment, of their causes. This situation of
affairs is dangerous, and were physicians to adopt the extravagant
measures, which the doctrine of atmospheric contagion suggests, there is
a risk that, armed with weapons of so powerful a nature as our medicines
are, and moreover, applied to so delicate and nicely strung a machine as
the human body, their interference might become downright tampering, and
dangerous in the extreme.

But the blame does not lie so much with the present generation of
practitioners. It is more the fault of the science than of its present
professors.

That doctrine has been taught them, as on established and well
authenticated principle. They have too readily confided in the accuracy
of their predecessors, and taken for ascertained, that which was only
supposititious. Still the public injury is the same, be that as it may;
and would the profession perform efficiently its important duties, and
deserve that confidence so necessary for the full operation of the art,
they would, without delay, inquire into the merits of this case, and
turn to the investigation of the causes of disease, the many facts and
principles, revealed by the late rapid progress of the sciences.

For the judicious and efficient treatment of disease, a knowledge of its
causes is necessary. The disorders being ascertained, the first
consideration in reference to the treatment is the cause or causes, and
according as the information partakes of certainty or uncertainty, so
the propriety of the measures is sure or doubtful.

Without a knowledge of the causes, sure or probable, our efforts are, in
some cases, like random blows made in the dark, they may or may not
strike the object. It is in general only when the causes are known, more
or less, particularly, that medical treatment can be said to rest on a
sure and philosophical basis, and to promise the full amount of benefit
the art can afford.

For many years the investigation of Atmospheric Contagion has occupied
the Author, anxious only to ascertain its actual merits, and to be
guided by the result, free of prejudice or bias.

The result has been, that from the actual, constant, and minute
observation of disease, from an enlarged inquiry into the circumstances
coincident therewith, of the pestilential character of many agencies,
and a careful comparison with every agent or form in nature with which
we are acquainted, bearing any resemblance to what Atmospheric Contagion
must be, if it have an existence at all; that where other hurtful
influences are operating, Atmospheric Contagion is needlessly called in
to account for their effects, and that it (_i. e._ Atmospheric
Contagion) has no existence, properly considered, in the light of an
atmosphere holding in solution a specific contagious poison.

Before commencing the argument, it is proposed to notice shortly its
history, and the opinions held at this day respecting its nature and
qualities.

But as these opinions are very various and conflicting, and as,
moreover, from the general confusion of terms, the reader will almost
unavoidably become perplexed and unable to understand the merits of the
case as treated here or by others, the Author proposes to explain,
before going further, what is meant or ought to be meant by contagion,
and by contagious air. He is not aware that any plain and uniform method
or arrangement of the principles in question is in common use, though
some physicians, as will appear in the historical sketch that is to
follow, have reduced contagion to two or three distinct kinds, and thus
divested the subject of much of its perplexing clashing of terms. They
have given fixed meanings to some terms formerly used by all, and even
at present by most, with too great latitude.

We will consider, _1st_, Contagion.

That term is, and with propriety may be, used to denote that property,
which matter eliminated in a body suffering under disease, has of
producing the same disease when applied to another in a state of health,
as the matter of small-pox.

Contagion is also used, and will be employed here, to denote the matter
itself which we have just defined.

Thus it appears that contagion is used to signify both the property of
the matter and the matter itself. This should be understood, as
confusion may lead to great misconception. In the same way, the term
“heat” is used to denote caloric itself, and also its property.

Contagion, signifying the matter itself, is said to act in different
shapes, but here medical men divide. According to those on whose
authority most reliance is to be placed, they are the following—three in
number:—

_1st_, By the direct application to the body of palpable contagious
matter.

_2dly_, By the application to the body of clothes, and the like,
impregnated with contagious matter.

_3dly_, By the application to the body of air holding in solution,
contagious matter.

To contagion acting in the first-mentioned manner, has almost
universally been applied the title, by distinction, Contagion, or
immediate contagion; but in order to promote perspicuity, we shall call
it Contactual or Palpable Contagion.

To contagion acting in the second-mentioned manner, has been applied the
term Fomites (impregnated clothes), but we shall call it Fomitic
Contagion.

To contagion acting in the third-mentioned manner, many terms have been
applied indiscriminately, Contagion, Infection, Contagious Miasm,
Infectious Air, &c. &c.; but to preserve distinctness, and to shew its
relation to the other modes, we shall apply to it the title Atmospheric
Contagion.

With Atmospheric Contagion, the third mode in which contagion acts, has
been confounded by many, air holding in solution, or having commingled
with it, gases or impurities, not producing exclusively one disease, as
contagious matter does; but productive of deranged health—or at least
hurtful to life.

Air thus tainted, has also been called Contagious, Infectious, &c. &c.;
but as it is widely different, for the reason mentioned, they should not
be confounded; and in order to prevent any accidental confusion, we
shall term it vitiated, or, simply, impure air.

There is yet another pestiferous principle called Marsh Miasm, which has
sometimes, but less frequently, been confounded with the third mode in
which contagion acts, viz. atmospheric contagion. They are very
different: the former is confined to marshy lands, and produces
exclusively disease of an intermittent character.

Of the first mode in which contagion is said to act, contactual or
palpable contagion, there is the most positive proof. That is a settled
point capable of demonstration.

Of the second, viz. fomitic contagion, there seems to be no good room to
doubt. It is consistent with our knowledge, on points of a like nature,
to admit the possibility of its existence; and there is evidence of
pretty good character, that contagion does act in that shape, though we
are disposed to think that it is not the cause of pestilence so often as
is generally understood.

It is to the third mode, viz. atmospheric contagion, that we object. We
question its existence for these reasons, _first_, That in the whole
course of its history, it fails to supply us with sufficient evidence
thereof; _secondly_, That its supposed career is not marked with the
same uniformity of effect, and constancy of character, cognisable among
other powerful agents, but appears rather to be regulated by no fixed
laws; _thirdly_, That the phenomena of disease do not go to shew that it
is dependent on atmospheric contagion, the occurrence and dissemination
of which, moreover, it could not explain.

We are further disposed to deny its existence at all, for this reason,
that its admission is opposed to the testimony of direct observation and
of experiments instituted for the purpose.




                              CHAPTER III.
                           HISTORICAL SKETCH.


In the Old Testament, frequent allusion is made to contagion,
particularly in Leviticus, where directions are given for the
expurgation, from the system, of that principle; for the isolation of
persons possessed of it; and the cleansing of garments therewith
infected.

The earliest Grecian historians make reference to it, and Thucydides, in
his History of the Plague, attributes some occurrences in its career, to
the operation of that principle.

Dr Winterbottom[1] writes thus, of an ancient physician—“Aratæus says,
that the miserable patients (those ill of Elephantiasis), were banished
into deserts, or to the top of mountains, where the kindness of their
friends occasionally attended their distresses; though perhaps they were
more frequently deserted.”

Footnote 1:

  Dr Winterbottom on Sierra Leone.

Cælius Aurelianus, a noted physician, says—“Some advise that a person
labouring under this disease, should be turned out of town, if a
stranger, or if an inhabitant, be banished to some distant part; others
advise the patient to be totally abandoned.”

These expressions relate to contagion generally.

Atmospheric contagion is not specified, though perhaps even then, it may
have been thought to exist.

As already said, later physicians thought that contagious diseases were
propagated in three different ways, _1st_, by actual contact with the
matter or virus itself; _2dly_, by fomites, or by contact with clothes
tainted with it; and, _3dly_, by infection, or by air holding it in
solution.

But it is to contagion, as diffused through the air, that the
observations that are to follow are directed. So we shall, for the
present at least, dismiss the other two modes of its action, that by
contact, and that by fomites or tainted clothes, with the expression of
our belief in their existence, as modes of the propagation of disease.

In 1777, Dr Haygarth, an English physician, began to investigate the
laws that regulate the action of contagious poisons, and for the first
time they obtained a scientific examination, and became the subject of
experiment, if, perhaps, are excepted the labours of Lind, whose
observations appeared about the same time.

Dr Haygarth believed in the propagation of disease through the direct
application of contagious matter, such, for instance, as that of
small-pox; but of this none have expressed any doubt worthy of notice;
for the fact is well known, and often witnessed, by inoculation for
small-pox and cow-pox.

At the time at which Dr Haygarth wrote, very vague and extravagant
notions were held on the subject of contagious poisons diffused in the
air—of air holding in solution contagious poison, or, as we have
determined to call it—Atmospheric Contagion.

It was believed to extend itself to great distances, and there to
develope its powers.

His opinions on the subject were, at the time of their publication,
quite original; and as they are such as are usually held, to this day,
by most intelligent practitioners, the most important will be
transcribed here.

In a letter to Dr Percival, on the prevention of infectious diseases,
published in 1801, Dr H. says—“I have long thought that there is no
subject on which a physician could employ his time and ability more
advantageously for the benefit of his fellow-creatures, than in the
investigation of febrile contagion, in order to ascertain the laws by
which it is communicated, and by what means it may be prevented. It is
well known to be the cause of very extensive destruction in the army,
the navy, and in large towns.”

“In 1777 I began to ascertain, by clinical observations, (_i. e._
observations made at the bedside of a patient,) according to what law
the small-pox infection, and, in 1780 and 1781, according to what law
the febrile infection, is propagated.”—“I found that the pernicious
effects of small-pox miasms (that is, airs or vapours) were limited to a
very narrow sphere. In the open air, and in moderate cases, I discovered
that the infectious distance does not exceed half a yard.”—“Hence it is
probable that, even when the distemper is malignant, the infectious
influence extends to but a few yards from the poison.”—“I soon also
discovered, that the contagion of fevers was confined to a much narrower
sphere.”

“You will recollect, my dear friend, that at this time (1781) my
attention was much engaged in the investigation of the nature of the
small-pox poison. I was struck with the difference of the periods in
those two maladies during which the infection remains in a latent state,
that is, the interval of time which elapses between the patient’s
exposure to the pestilential influence and the commencement of the
fever. In the typhus, this period appeared to be much longer than in
small-pox.”

The period between the exposure to what is considered infection, and the
period of the manifestation of disease, certainly does vary in different
distempers. In those in which palpable contagious poisons are produced,
and where they are palpably applied to the system, the interval is
known, and seldom varies; but in those where a palpable poison is not
recognised, or where it is said to act exclusively through the air, it
is found that the interval is sometimes short, sometimes long, and
manifests none of that precision almost always observed in reference to
the first class of diseases.

Dr Haygarth again says, “When the room of a patient ill of an infectious
fever is spacious, airy, and clean, few or none of the most intimate
attendants will catch the disease.”

“Among the middle and higher ranks of society in Chester and its
neighbourhood, during a period of thirty-one years, I scarcely recollect
a single instance of the typhus fever being communicated to a second
person, not even during the epidemics of 1783 and 1786, which excited a
general alarm in that city, Fresh air and cleanliness were the only
means which I employed to prevent infection. Doors and windows were kept
open as far as the season, and other circumstances, would permit.
Curtains were drawn to exclude the light, but not the free circulation
of air. All clothes, utensils, &c. used by the patient were immersed in
a vessel of cold water immediately, and, when taken out of it, carefully
washed. The floors were kept clean, and vinegar was sometimes, but not
always, employed to sprinkle. It was thought to be more easy to remove
than to correct the poison.”

Dr Haygarth deserves much credit for his judicious treatment, and by it
he had the satisfaction of seeing much public good effected. His
principles are yet acted upon with the very best effects; but it will be
shewn, at a more advanced part of this work, that the check put to the
progress of disease, was rather to be attributed to the removal of an
atmosphere loaded with unwholesome emanations, than to any power those
steps or measures had, of rendering innocuous, by dilution, a specific
contagious poison.

Dr Haygarth continues—“The whole evidence which I have been able to
collect, incontestibly leads to this very important conclusion, that
febrile infection extends but to a very narrow sphere from the person.

“It appears highly improbable that the typhus infection should ever be
communicated in the open air, by the common intercourse of society;
because visitors, and even attendants, with very few exceptions, escape
the fever, when exposed to it, in even the same chamber, if clean, airy,
and spacious.

“The quantity of miasms (unwholesome or poisonous air) respired in the
latter, is incomparably more than it can be in the former situation. It
is not, however, intended to be asserted that such an event is
impossible, if a person on purpose, or by some rare accident, were to
breathe the air which immediately issues from a patient, or from clothes
fully impregnated with the poison.

“During my long attention to this inquiry, not a single instance ever
occurred to prove that persons liable to the small-pox could associate
in the same chamber with a patient in the distemper, without receiving
the infection.

“We have no certain knowledge in what manner infectious fevers are
received into the body. According to the most plausible conjecture they
appear to be communicated by poisonous vapours, which issue from the
breath, or the insensible perspiration, or the excretions of a patient
in the distemper. These miasms are probably taken into the body by the
absorbents of the mouth, nostrils, lungs, stomach, or skin.”

Under the able investigation of Dr Haygarth, the doctrine of infection
has been deprived of much of its extravagant character. Under his
examination it is found losing that widely extended range of action, and
that extreme virulence, that had hitherto marked its history.

Dr Bateman, in his excellent work on contagious fever, after alluding to
a prevalent opinion, that contagious poison is capable of diffusion in
the air, says, “To one acquainted with the evidence which has been
adduced relative to the properties of contagion, these opinions, and the
terrors connected with them, appear equally unfounded and absurd, as are
all creations of an over-excited imagination magnified by prejudice and
alarm—for it has been proved, beyond the possibility of a doubt, by the
concurrent testimony of a multitude of the ablest practitioners, who
have had every opportunity of investigating the fact, and by all the
experience which the establishment of fever boards and houses of
recovery has afforded the means of accumulating, that no contagion
whatever is communicable, even to the distance of a few feet, through
the medium of the free and open atmosphere, and consequently that
residence in a district where fever prevails is free from all danger.
Nay, it has been further proved on the same undeniable evidence, that
the house and even the apartment, occupied by the sick, may be rendered
perfectly innocuous, the contagion being disarmed of its activity and
virulence by dilution with pure air,” &c.

Dr Bateman gives the following facts—

“All the patients admitted into the London House of Recovery are
transported in a litter by two others employed by the institution,
enveloped in their uncleanly and tainted apparel. Yet the porters who
have been daily occupied for the last eighteen months in conveying this
double source of contagion, often the distance of two or three miles,
and assisting them in and out of the litter, have never received the
infection.

“Neither have the washerwomen, employed during the period of my
attendance, (sixteen years) on the House of Recovery, occupied almost
constantly in washing the apparel brought in by the patient, as well as
the bed-linen, often much soiled by their excretions, and the cloths
used by the patients in the house, ever been affected with the fever.”

Dr Patrick Russell, whose work on the plague is so well known, is the
next writer to whose observations reference will be made. His personal
observation of much contagious disease, and his high character, entitle
his observations to much weight. They will amply shew, how the question
before us has gained with the advancement of medical science. Some are
subjoined.

“In the first place, the various and vague application of the term
contagion has been the source of confusion. In foreign languages, as
well as in English, it has sometimes been used for the plague itself,
sometimes as synonimous with infections; sometimes for the virulent
effluvia issuing from the sick, or from substances infected, and
sometimes as a property common to various diseases.”

He is of the decided opinion, that plague is communicated, by contact of
the body, with the poison, which is properly understood by the word
contagion. He says—“The second mode of contagion is by the medium of the
air. The effluvia arising from the diseased, received into the ambient
air, form a pestiferous atmosphere, more or less impregnated with these
effluvia, as it recedes from their source. That contagion is thus
communicated in the chamber of the sick, appears from persons being
infected without touching the diseased body, or any thing in the room
that may be supposed to harbour infection.

“To what distance the tainted atmosphere extends is not yet known, but
recent facts render it probable that the effluvia, when once transmitted
into the air, are soon dispersed, blended with the common mass, or
otherwise suffer such alteration as render them innocuous at no great
distance from their source. It is probable, also, that those effluvia
arise, in an active state, to no great height in the atmosphere.”

He adds, that the contagion by fomites, that is, impregnated clothes, is
the most extensive in its operation; and that it spreads disease, not
only in all quarters of a town, but also to remote regions. He asserts
that the plague is conveyed into different streets, remote from one
another, by the Jewish salesmen, and that he has known Armenian
washerwomen infected by tainted linen. The infectious air of plague,
according to him, when it adheres to substances not exposed to free
ventilation, and closely packed, retains its vigour for along time, and
in that state is transported to other countries: and he held it as
proven that it retains its activity in a three months’ voyage from the
coast of Syria to Marseilles.

He is disposed to think that the contagion of plague, rarely remains in
the system longer than ten days, and that more danger is to be
apprehended from the baggage of passengers who enter into lazarettoes,
than from their persons.

To Dr Joseph Adams we are indebted for an excellent treatise on animal
poisons, one that is much valued for the information and clear views it
contains. The following is an extract from the work in question.

“By contagion I would understand those diseases with the origin of which
we are now unacquainted, but which at present can only be propagated by
contact with a person, or matter from a person under similar disease.
Contagious diseases, which it is now our business to consider, may be
divided into chronic and acute, of the former are the itch, and several
others. These are for the most part incurable by the unassisted powers
of the constitution. The acute of which are the small-pox, and many
other exanthemata, (these are those diseases accompanied with fever)
marked with a peculiar eruption, and that attack only once, such as
measles, and scarlet fever produce a critical fever, which ceases with
the disease.

“The chronic may attack a person as often as he is exposed to the
exciting cause, the acute, for the most part, leave the constitution no
longer susceptible of their operation.”

After pointing out the modes of communication of contagious diseases by
contact and by fomites, he says, “Infectious diseases, on the contrary,
may be traced in their origin, and do not require for their production
matter similar to their effects, but may at any time be generated by
crowding together the sick or wounded of any description. Of this kind
are the hospital, prison, or ship-fever, camp dysentery, and some
peculiarly malignant ulcers. Though these diseases, when formed, may
produce their like in others, yet we can always trace their origin to
causes different from their effects.”

From the London Cyclopædia the following extract is taken.

“There does not appear to be any distinction commonly made between
contagious and infectious diseases.”

This extract proves how much confusion there exists, with the terms
infectious and contagious. Here they are said to be used synonimously,
and in that of Dr Bateman just quoted, a great distinction is drawn.

Such are a few of the facts connected with the history of contagion,
which are most worthy of notice, in a work of this kind.

This sketch will afford some idea of the most rational views which have
been, and still are, held on the subject; and of the light in which it
is at present regarded by the medical world.

It is feared that the extracts which have been given, may appear too
copious, but it has been thought highly proper, that the opinions of
those justly considered, the greatest authorities on the subject, should
be given: and that they might not be misunderstood, they have been, for
the most part, presented verbatim.




                              CHAPTER IV.
   THE ABSENCE OF SUFFICIENT EVIDENCE OF THE EXISTENCE OF ATMOSPHERIC
                               CONTAGION.


  Ponderable bodies are endowed with common or general properties, and
  likewise with particular or secondary properties.

                                                               MAGENDIE.


The properties of atmospheric contagion, under its various titles, have
been noted in the preceding chapter. They have been attributed to it, by
the most eminent writers on the subject, and are such as are assented
to, by most medical men of the present day.

Its origin, the sphere of its activity, and the means by which it may be
destroyed or neutralized, have there been alluded to. In the extracts
given, and in the current medical literature of the present time, it is
spoken of, as an agent of whose existence there is the utmost assurance.

The reader who has not already thought upon the subject for himself, but
has, as is almost universally done, in reference to this agent, taken
the whole case, as one fully ascertained, and settled upon fixed
principles, will doubtless be surprised to hear, that it is the decided
opinion of a member of the medical profession, that the doctrine of
atmospheric contagion presents no sufficient evidence of its truth; that
he is in possession of facts connected with the occurrence of disease,
which render it probable, that other and efficient causes of disease
have been thrown aside, to make room for that agency, and that he is
convinced, from the results of experiments on contagious poisons, and
from a minute inquiry into their nature, that it (that is, atmospheric
contagion) does not exist. Perhaps he should regret that he has not been
able to see the question in the same light as his brethren. He has felt
unwilling to espouse singular opinions; he has therefore been patient in
the inquiry, and it has been only from the consideration, that a great
medical truth was concerned, that the progress of the science might
possibly, thereby, be promoted, and that the comfort of the patient, and
the ease of mind, of the public, might be advanced, that he has been
induced to lay his opinions before the world.


Regarded as a physical agent, atmospheric contagion has never been
detected, and its presence has been inferred merely from the observation
of what have been supposed its effects. It has certainly never been
unequivocally manifested to any of the external senses. It has never
been seen combined with the atmosphere, precipitated from it, or
attracted therefrom, to solid bodies.

It might be supposed, however, from common parlance, that it has often
made itself known to the sense of smell; but while nothing certainly
proves that the impressions made on the nasal organ arise from
atmospheric contagion, many circumstances induce at once the belief,
that they proceed from common impurities.

The atmosphere in a sick chamber sometimes certainly has an odour, but
it is certainly more logical to attribute this to the presence of
impurities, whose presence there is no room to doubt, than to an agent
whose existence under any circumstances has never been proven.

Had contagious matter the power of diffusing an odour through the air,
it is probable, that would be constantly the same, in all cases of the
same disease, and that each disease would have its own peculiar odour:
but this correspondence is not found.

It is not desired to prove, that atmospheric contagion does not exist,
because it cannot be detected by the senses.

Many agencies exist, which, under ordinary circumstances, are beyond the
cognizance of the external senses; but in general they make themselves
manifest to one, or other, under some conditions. The electricity of the
air is neither seen nor felt under ordinary circumstances; but that
agent is capable of being collected from the atmosphere in such
quantities as are cognizable to the eye. Now, under any manner of
circumstances, contagion has never been recognised by the senses—and it
has never been detected by chemical experiments.

It is surely not unfair to expect, that, if a contagious poison, a
palpable matter such as is contained in a small-pox pustule, is
transformed to the vaporic state, or taken into the atmosphere, that the
air so impregnated will be marked by some qualities, beyond those of
simple, pure air. Perhaps air in which it is disseminated should have an
odour, and perhaps that odour should be of a peculiar kind, in each
disease. Should it not also be marked by some effects, constant and
uniform, upon the human body, such as mark the career of such like
agents in a palpable form, when applied either immediately, as by touch,
or mediately, as by fomites? Perhaps it may not be deemed unreasonable
to expect, that atmospheric contagion, did it exist, would produce its
peculiar effects, as constantly, or nearly so, as a palpable contagious
poison. But how different is the fact. If a hundred persons not formerly
vaccinated, have the palpable contagion of cow-pox matter inserted under
the skin, the probability is, that, if the matter is good, and the
operation is skilfully done, 90 or 95 will be duly affected with the
specific effects; whereas, when a hundred persons are exposed to the
atmosphere of fever, and when these persons, too, have not before had
the disease, perhaps not one, or at most not above two or three will
take the distemper, unless the air has become extremely vitiated; and
then the probability is, that it is so, not in consequence of the
presence of specific contagious virus, but of gross impurities, and the
consumption of the more vital parts, as in the case of the Black Hole of
Calcutta, where putrid fever attacked all who survived their
confinement, certainly not from the action of contagious poison.




                               CHAPTER V.
   CONTAGIOUS POISONS—NON-SOLUTION IN THE AIR—RESULTS OF EXPERIMENTS.


  Animal substances are the results of still more delicate processes,
  and of a more refined organization (than vegetables); and the balance
  of affinities, by which they exist, is disturbed by still slighter
  causes.

                                                                  HENRY.


For the present, the argument drawn from the actual observation of the
origin and propagation of disease, against the doctrine of atmospheric
contagion, will be waived, and it is proposed here, before going
farther, to inquire, whether the case may not be settled by a reference
to the history of analogous agents, and to the results of experiment.

It is proposed here to inquire if it is likely, judging from their
chemical constitution, that palpable contagious poisons, such as the
matter of small-pox, may be disseminated through the air, without
chemical changes being effected upon them, that must be destructive of
their peculiar properties.

The palpable contagious poisons are products of the blood, formed
therefrom, by the nicest processes. They partake of the nature common to
all animal products; are, like them, prone to putrefaction,—and, like
them, are of a very compound nature.

They are animal products: now it is a well known fact that almost all
animal products are fixed—that is, incapable of being volatilized or
disseminated in air, unchanged in chemical constitution.

Gelatin or animal jelly; albumen, or what is much the same, the white
part of an egg; fibrin or muscular fibre, and the like, are never known
to be in the vaporic state, or commingled with the air. They are
incapable of assuming the aeriform state, not in virtue of a character
peculiar to them, but on account of that nature they share in common
with almost all animal principles, which precludes the possibility of
their being volatilized. No experiment has ever been made which can show
that the principles specified may be diffused through the air.

When exposed to the air for even a short period, decomposition takes
place, and their original nature is totally subverted.

Their elements are held together by affinities too feeble to admit of
their particles being separated by air, without new combinations being
formed.

If heat be applied to them, immediate destruction takes place; if they
be kept moist, and in merely a moderate temperature, putrefaction or
fermentation, in the proper sense of the terms, occurs; if carefully
dried and exposed to the atmosphere, they remain little altered, for a
considerable time; but at length fundamental changes, though operating
slowly, entirely change their nature.

It cannot be shewn that contagious poisons are less animalized than the
products alluded to.

Is it ascertained that contagious poisons, unlike other proximate animal
principles, enter into the aeriform state?

Putting aside the loose and rash statements current upon the subject, as
unworthy of notice, there can be no doubt that, in the whole history of
those poisons, no fact is known, that can legitimately be held as
proving, that they possess such a property, or of giving the idea any
degree of countenance.

On the other hand, many facts are known, which are adequate for the
refutation of these statements, and that are sufficient to put the case
beyond a doubt.

Small-pox propagates by a contagious poison, eliminated from the blood,
and found in the pox or pustule.

It is known to every one that it affects, by contact, hence the practice
of inoculation, which is nothing more than the inserting, under the
skin, a little of that agent, a practice which has been in use among the
negroes of Africa, since, or before, the introduction of the doctrines
of Mahomet.

Many physicians, perhaps almost all, believe that it, the poison, may be
diffused through the air, and in that situation produce its wonted
effects; but evidence is submitted to shew, how questionable that is:
and it is conclusive, as far as negative evidence can go.

The following experiment was performed by Dr O’Ryan of Lyons.[2] The
force of its results, and their tendency, cannot be overlooked.

Footnote 2:

  O’Ryan, Sur les Fievres.

“A dish containing lint saturated with matter taken from the natural and
the inoculated small-pox, was placed upon a table, whose diameter was
three feet, and children who never had the disease, and never were
inoculated or vaccinated, were placed around it, and kept there for some
considerable time; yet none of them were seized with the disease.”

“He also exposed children within two feet of a child affected at the
time with the inoculated small-pox, for an hour daily, for fourteen
days. None of the children were affected, and all were successfully
inoculated two months afterwards.”

We are acquainted, too, with many cases of small-pox, where the houses
in which they were, were visited by many persons, some of whom had not
been vaccinated, or inoculated, and yet the disease did not spread to
them; and in those instances, where the distemper did spread, only some,
and not all, who were liable, were affected, as would have been the
case, had the matter been inserted under the skin.

Perhaps, in reference to this contagious matter and to others, it may be
said that they were not favourably situated for acting. Heat, moisture,
and the passing to and fro, of air, must certainly assist the assumption
of the aeriform state; and a more favourable opportunity cannot be
obtained, than the contagious matter of small-pox pustules has, in the
mouth of the patient, where it almost always is observed. That situation
is perhaps even more favourable than that of the matter operated on by
Dr O’Ryan. Yet it is known, (and we are prepared to shew cases) that
persons liable to the disease have breathed in the same apartment, and
have not taken the distemper. We know, too, of many cases, where persons
have been attacked under such circumstances, but that has probably
arisen from actual contact with the matter, or exposure to those general
and widely-spread influences productive of that pestilence, that
undoubtedly exist. But it is not necessary for our purpose, that all
should escape, but, that any should not suffer. It is enough that those
who escape, are more, in proportion, than those who resist the action of
the palpable poison, when inserted into the system by inoculation.

With respect, also, to the disease produced by the insertion of cow-pox
matter, or, in other words, by vaccination, as it is called; nobody ever
heard of it being propagated through the air. It is feared that it would
be a very inefficient mode of vaccinating, to bring the child to be
vaccinated, into an atmosphere, to which was exposed an arm with a
cow-pox. He who would propose such a plan would be laughed at by every
old woman; and what is held as so absurd and ridiculous in respect to
cow-pox, cannot be very wise in reference to small-pox, plague, scarlet
fever, and the like. There are other diseases, too, which undoubtedly
are propagated by palpable contagious poisons. Yet were any person
affected with them, to whisper, that a contagious atmosphere had been
the occasion, they would be held as using no small liberty with the
credulity of the medical adviser.

There is yet another palpable contagious matter to which reference must
be made,—that of itch. The only known way by which that disease can be
propagated, from one to another, is by palpable or contactual contagion.

Many medical men are in the daily practice of seeing and examining such
cases, yet they seldom or never are affected with it. Any caution
directed against the operation of that contagion, is addressed
exclusively to contact, never to the atmosphere.

The plague, according to the very best authorities, is undoubtedly
marked by the elimination of a matter capable of producing the same
pestilence, when applied in a palpable form, to the body of another. The
plague has been produced intentionally by inoculation, and may be
propagated at pleasure.

Dr Patrick Russell was satisfied, from the observation of much of that
pestilence, that the atmospheric contagion did not extend the distance
of four feet; and there is much room to think that, if he had extended
his inquiry farther, that had he been aware how unusual it is for a
proximate animal principle, as contagious matter, to take on the
aeriform state, he would have arrived at the conclusion, that it did not
only not exist, at the distance of four feet from the patient, but that
it did not exist at all. Had he gone that length, he would not have
created any more difficulties, to be explained away, than were made by
laying down for it, such a limited range of operation, for there would,
it seems, be little difficulty, in general, in discovering, that persons
who had approached so near as four feet to the patient, had come in
contact either with the sick himself, or the matter of the sores
attached to clothes or other bodies.

We know of no facts capable of proving that the matter of plague is
diffusible through the air; and the very evidence of Dr Russell, which
was used by him to prove the limited range of atmospheric contagion, may
be used to lend countenance to the position, that it does not exist at
all.

The evidence was this:—Dr Russell was in the practice, at Aleppo, of
examining plague sores from a window four feet from the patient, yet he
suffered not from that pestilence.

Scarlet Fever is a disease universally held to be one of those
propagated by a contagious principle.

It is commonly believed that a contagious poison is eliminated in the
course of this disease, similar to that of small-pox.

Its history is marked by this remarkable feature, peculiar to acute
contagious diseases, of attacking the same individual only once; and the
disease is accompanied by a peculiar eruption, which may, without
impropriety, be supposed to contain the said contagious poison. This
eruption is uniform in the time of its appearance, its duration, and
decay, like the other eruptions of other contagious diseases. On all
these accounts, the Author is disposed to assent to its possession of
the contagious poison;—and that will be taken for granted.

Connected with this view, is an observation made by Dr Sidey, of
Edinburgh, in a paper contained in a late Number of the Edinburgh
Medical and Surgical Journal, on Scarlatina, as lately prevalent in that
town. It is to this effect, that he found that the disease, when
characterized by a distinct eruption, attacked several members of a
family more frequently, than when it wanted that symptom.

We will inquire whether persons exposed to an atmosphere containing one
sick of that disease, take that distemper as uniformly, as those take
the respective diseases of those palpable contagious poisons which may
be inserted under the skin.

During a most severe and mortal visitation of that disease in Tranent
and its surrounding country, which lasted from about the end of January
to the 20th October 1836, many cases occurred, where brothers and
sisters of children suffering under that malady, living in the same
apartment, but not sleeping together, remained free of any attack
whatever at the time.

Had the poison been capable of diffusion in the atmosphere, the air
would have become highly contagious, and as persons were constantly
inhaling it, and among them some liable to the disease, it would
certainly have manifested its peculiar pestiferous influence upon them.

But the result was different, and the person exposed at that time
remained quite free of it; and in the course of time, varying from weeks
to several months after, went through the disease in the ordinary
manner. These cases have been carefully noted and preserved.

But the Author was anxious to ascertain, by other means, whether that
disease was capable of propagation by atmospheric contagion; and
opportunities were not wanting.

It occurred that the matter of ulcers, in the throat, might possibly
contain the contagious poison, and might be made the subject of
experiment.

The following is a case in which the experiment was made.

The patient, a boy eight years old, had been exposed about three months
before, constantly, to an atmosphere in which a younger brother, ill of
scarlet fever, was breathing.

He had the precursory fever, and the tonsils and uvula (the parts at the
back of the mouth) were almost covered with ash-coloured spots and
suppurating ulcers.

A piece of linen, fixed to the extremity of a probe, was rubbed freely
over the ulcers. The linen impregnated with matter and the secretions,
was, within an hour or two of its being taken, exposed to the free
action of the air of a small apartment, where it remained for ten days,
without producing any effect, upon several persons, a good deal in the
room; and among them, two children, one aged two, and the other fourteen
years, who had not had scarlet fever. They respired the air occasionally
and for a considerable time, on the several days.

The temperature was various. During the day being about 60° Fahr., and
40° during the night. The linen readily became dry, but was repeatedly
moistened with water.

This experiment goes to shew, that the matter of the ulcers of scarlet
fever is incapable of propagating the disease, through the medium of the
air.

But scarcely any better nidus could be formed, for the dissemination of
the matter, of the ulcers, through the atmosphere, than the sores
themselves, the very place where it is eliminated; and cases have been
referred to, where persons have respired an atmosphere thus liable to be
acted on, with the most complete impunity.

It is not ascertained that the contagious poison is eliminated at the
sores in the throat, but such seems probable, seeing that the sores are
as essential and constant as the eruption itself.

Experiments might have been multiplied, but that has appeared
unnecessary, as it is hoped that enough has been done to shew that the
contagious poisons which have undergone our examination, are incapable
of assuming the aeriform state, and, as it must seem probable, that in a
point so important, they will all coincide, even those which have not
been treated of here.

Their chemical constitution, as before remarked, prevents their assuming
that state. Dr Henry of Manchester remarks, when pointing out the
distinctive characters of animal and vegetable bodies, that “Animal
substances are the results of still more delicate processes, and of a
more refined organization, and the balance of affinities by which they
exist is disturbed by still slighter causes;” and again says, “Instead
of passing through the vinous and the acetous fermentation, they are
peculiarly prone to undergo putrefaction.”

Thus, then, this great law, ascertained and settled beyond a doubt, and
the results of our observations on the causes of diseases styled
contagious, and of experiments on the palpable contagious poisons
themselves, are opposed to the admission of this doctrine, and when we
recall to memory the slender evidence, nay, the absence of any evidence
at all, the conclusion almost necessarily is, that atmospheric contagion
does not, and cannot exist.

With what justice may we now join with De Lolme, when he says—“There is
a very essential consideration to be made in every science, though
speculators are very apt to lose sight of it, which is, that in order
that things may have existence, that they must be possible.”




                              CHAPTER VII.
   CONTAGIOUS POISONS, COMPARED WITH YEAST—DOES THAT AGENT ASSUME THE
                            AERIFORM STATE?


Lest the evidence we have laid before the reader should not be so
satisfactory and conclusive as it has been deemed by us, the details and
results of some investigation into yeast will now be given.

It occurred to us, that it would be useful, in our inquiry respecting
contagious poisons, to ascertain whether or not yeast was capable of
producing its wonted effects through the medium of the air, if, in
short, it was capable of taking on the vaporic state. We were led to
this inquiry from the consideration, that it and contagious poisons
presented points of resemblance of the most important nature, and that
the history of the one might elucidate that of the others.

Yeast is the only other inanimate substance, besides the contagious
poisons, with which we are acquainted, which has the property of
producing a substance in every respect like itself, in short, of
reproduction.

Like the contagious poisons, too, it is the result of a great and active
process, which, like them, it can again produce in other materials.

Fermentation may be likened to contagious disease, and, indeed, it is
not the first time contagious disease has been likened to fermentation.
These diseases produce contagious poisons,—fermentation produces yeast,
and again, these agents produce their respective processes.

Bodies in general, which have undergone the action at least of the
active contagious poisons, are not liable to be again affected by them;
so vegetable bodies, which have undergone fermentation, by means of
yeast, are not liable to be again acted upon by a second application.

It is important to know if yeast is capable of assuming the aeriform
state.

It is a complex substance, being compound in its chemical constitution.
Did we find that it was, then it might seem probable that contagious
poisons (putting out of consideration the evidence already given), might
possibly be so disseminated also. It runs readily into putrefaction, and
in a short time loses its power of producing its peculiar effects, that
is, fermentation.

Knowing this, we were inclined to believe that it could not get into the
atmosphere otherwise than in a decomposed state, and, therefore, could
not act through that medium.

The question was put to a most intelligent brewer, conversant with its
common qualities, and the unhesitating answer was immediately given,
that it could act through the air.

Here we could not help marking the striking similarity in the bearing of
the brewer, with the confidence with which medical men speak of the like
property of contagious poisons—the marked taking for granted _what_ was
opposed in both instances, to the obvious evidence of chemistry, and
_what_ might be so readily tested by experiment.

He was of opinion, that if fermentation were going on in a tub in an
apartment where there was a quantity of wort (liquid ready for
fermentation), to which no yeast had been added, that that process would
be excited from the yeast in the fermenting tub, producing its influence
through the medium of the atmosphere, in short, by being dissolved in
it.

As that opinion did not tally with our opinions on chemical affinity,
recourse was had to experiment.


                           _1st_ EXPERIMENT.

A quantity of wort, to which no yeast had been added, was put into a
wide mouthed vessel, and suspended in the mouth of a large tub,
containing ale in an active state of fermentation. The vessel was
allowed to remain three days, and at the end of that time no more
appearance of fermentation was detected, than a very slight display of
frothy bubbles in the middle, nothing more than we were assured by the
brewer, was wont to appear from spontaneous fermentation.

A blind devotion to his opinion might have induced the brewer to
attribute to the yeast acting through the medium of the air, what was
quite spontaneous, and if he had done so, how like his case would have
been to that of some medical men, who unwittingly attribute to
atmospheric contagion, what is spontaneous or dependent on other
agencies.

From this experiment it appears that yeast is incapable of solution in
the air, and of producing through that medium its peculiar effects.

But to make the result still more certain, another experiment was
performed.


                            _2d_ EXPERIMENT.

A wide mouthed vessel, containing a quantity of water, was suspended
over some liquor, in a state of active fermentation, for the purpose of
absorbing any gas or yeast, in a state of vapour proceeding from it. It
was kept there two days, and then examined. Its taste was somewhat
altered, and it had acquired a slight odour much resembling that of
yeast, probably from the absorption of gas. It was thought, that if this
water had become impregnated with yeast, that that circumstance would be
rendered manifest, by producing fermentation, when added to a quantity
of wort; and to determine the question, the following trial was made.

Two jugs half filled with wort, free from yeast, were placed in an
apartment whose atmosphere was favourable to fermentation. To one was
added the water which had been suspended over the fermenting tub, and to
the other an equal quantity of pure water. They were then put aside, and
secured from interference. At the end of three days they were examined.
The wort to which had been added the water taken from over the
fermenting tub, presented on its surface a few frothy bubbles, but not
the slightest appearance of yeast.

The wort, to which pure water had been added, presented an appearance
identically the same, having a few frothy bubbles on its surface, but
not any other, the most trifling sign of fermentation.

Similar experiments were made at a distillery, where the facilities for
their success were said to be even greater than at the brewery, and they
were marked with precisely similar results.

Thus, then, it appears, as the result of experiment, that yeast is
incapable of assuming the vaporic or aeriform state.

This inquiry will perhaps appear to many remote and unconnected with the
proper subject of these pages, and, hence, that it is altogether
superfluous; but we think differently, and are of opinion, that an
accurate knowledge of that agent is calculated to be of the utmost use
in forwarding the formation of a just estimate of the habitudes of the
contagious poisons, which it resembles in several very important points.

It is, as before stated, the only other substance belonging to the
inanimate world, whose immediate and most prominent property is that of
propagating a substance identically the same—of producing, through a
peculiar and uniform process, an agent possessed again of all its
properties.

Some other agents may be said, under some circumstances, to propagate
themselves, but it is in a very remote way, and by no means by that
direct and uniform operation which marks the propagation of contagious
poisons and yeast, which is obviously as well defined as germination
among animal and vegetable bodies.

_Heat_, under some circumstances, does cause the production or evolution
of heat, but that is rather an accidental circumstance, brought about
remotely by the chemical operation produced, and would have taken place
whatever had been the cause of that process, and is not the result of an
immediate and particular property.

Vitiated air also is calculated much in the same way to reproduce
itself; but, instead of being in virtue of a quality possessed by the
palpable contagious poisons, vitiated air of itself produces disease,
and a common result of disease is vitiated or impure air.

The close analogy subsisting between yeast and the palpable contagious
poisons, it is hoped, has been fully made out; and though it is not
permitted, by the rules of logic, positively to determine, that the laws
which regulate the action of the one, necessarily hold with the other
agents; yet, where there is no evidence of a contrary nature, the
closeness of the connection lends countenance to the idea.

That analogy seems remarkably strong when it is considered, that both
yeast and the palpable contagious poisons produce their peculiar effects
only once upon the same object.

Many instances are known where the palpable contagious poisons have
produced their peculiar effects more than once, but these deserve rather
to be held as exceptions to the general law than as a proof against its
existence.




                                PART II.




                               CHAPTER I.
   THE NEGATION OF ATMOSPHERIC CONTAGION FROM THE HISTORY AND ACTUAL
                        OBSERVATION OF DISEASE.


  Ce qu’il y’a d’extraordinaire c’est que ceux qui fatiguent leur raison
  pour lui faire rapporter de certains événements à des vertus occultes
  n’ont pas un moindre effort à faire pour s’empêcher d’en voir la
  véritable cause.

                                                            MONTESQUIEU.


It has been attempted, in the preceding part of this work, to prove, on
general principles, and by a reference to analogous objects, that
atmospheric contagion cannot exist; but, lest that object should appear
unaccomplished, and that the data are insufficient for the conclusion
proposed, it is purposed to test the merits of the question by the
consideration of the history and phenomena of disease.

Those circumstances, connected with the appearance and propagation of
disease, on which the doctrine of atmospheric contagion rests, will be
inquired into, and their weight and importance duly ascertained. This
inquiry will be prosecuted as if no such investigation as the preceding
had been made, and as if the existence of that agency was not
irreconcilable with well ascertained laws; and, for the sake of
argument, the possibility of its existence will be conceded.

The facts in the history of disease, which are held as lending
countenance to the doctrine of atmospheric contagion—of proving its
existence, are, chiefly, the general prevalence of disease at one and
the same time among the members of the same family, of the inhabitants
of the same town, district, and country,—its affecting the visitors and
attendants of the sick,—and its observation in places hitherto healthy,
shortly after communication with those ravaged with the distemper. These
facts cannot be denied; and all that can be done is to weigh their
value, as proofs of the existence of atmospheric contagion, and the
first mentioned will occupy our attention.


THE EVIDENCE DRAWN FROM THE WIDELY SPREAD AND SIMULTANEOUS PREVALENCE OF
        DISEASE, IN FAVOUR OF ATMOSPHERIC CONTAGION, CONSIDERED.

The widely-spread prevalence of disease at the same time among the
inhabitants of a country or district, is almost invariably held as
affording proof of the presence and operation of atmospheric contagion.

The ravages of pestilence, rapid, wide, and deadly, are noticed in the
histories of all nations, and at intervals they have been experienced
during the long period of the existence of the world; and the
destruction of whole armies, and the annihilation of entire nations,
prove how widely spread its operation has sometimes been.

Did the circumstance of disease being widely spread prove its
propagation by atmospheric contagion, then the matter were at rest; but
the propriety of such an inference is questionable.

Let it be supposed that there is prevailing, in a district of country,
disease to a great amount, that is to say, many cases of the same
distemper.

That single circumstance proves nothing in reference to atmospheric
contagion, more than to any other probable cause of disease. It shews,
merely, that there is in wide operation some cause or causes of
sickness; and it is totally unwarrantable to conclude that one agency,
more than another, is the efficient cause, without further information
directly bearing on the subject.

It is with the knowledge of the single fact, and in total ignorance of
others, or with total blindness to them, that atmospheric contagion is
pronounced to be the active agent.

Now it is not the peculiar property, the exclusive prerogative of that
principle, to cause disease; at least, that character has not been
openly sought by its advocates, though the tone of common conversation,
and of medical writings on the subject, would seem to imply that it had
been tacitly granted.

That cannot be conceded. Many other agencies are known to be productive
of sickness, and have, on many occasions, induced pestilence of a deadly
character, that has ravaged in no despicable limits.

The isolated fact itself of disease being widely extended in the absence
of particulars, after proving that some cause existed, should
legitimately go to create a suspicion, that the cause or causes which
had produced the first cases, and acted as the ordinary springs of the
malady, were continuing to operate on other individuals. Such would be
known to be capable of producing the effect observed, for the
satisfactory reason, that it or they had already accomplished it. How
much more wise, under such circumstances, it would be to suspect the
continuance of that influence with the continuance of effects
identically the same as it or they had already produced, than to call in
a principle whose only evidence of existence was the presence of
effects, the same as had been only a short time before produced by a
different agency, and of whose removal or absence there was not a
particle of proof.

But a little inquiry will, on most occasions, elicit the fact, that some
pestiferous influences exist; and it will, in general, be soon enough to
pronounce on the probable causes of a distemper after that investigation
has been made.

Disease in general, unconnected with alterations in the texture of the
organs, is neither more nor less than a derangement of the functions
performed by the body; and as it partakes of a general or local
character, so the disease is either local or general; and, as it relates
to functions, more or less important, so it is more or less dangerous.

It must be obvious, that a machine so nicely balanced, so complicated
and so exquisitely wrought as the human body, must be liable, on many
occasions, to have its operations impeded and deranged; and, although
sometimes said to be a little world of itself, still, it is dependent on
surrounding agencies. It requires a pure atmosphere for respiration,
food to supply the waste it continually suffers, and drink to appease
thirst, and to take the place of the fluids that are constantly draining
from it.

The human body is necessarily brought in contact with the external
world; and many are the injuries it suffers therefrom, both directly and
remotely.

The derangements of the functions of the body are in general owing to
circumstances of an unwholesome character, for the most part relating to
food, drink, the various steps in nutrition, the atmosphere, its
temperature, dryness, moistness, purity, &c. &c., and chemical and
mechanical agents, to whose action the body is exposed.

Were it not for the operation of unfavourable circumstances of the
nature specified, a body in health, were no special interposition of the
Almighty hand made, would go on in the healthy performance of its
functions, till the frailty and decay, incident to old age, would
overtake it.

In general those diseases which are observed to prevail to a great
extent, and over a large tract of country at the same time, are so
uniformly coincident with circumstances of an unwholesome tendency,
connected with those agencies above referred to, that they appear at
once to the candid and unprejudiced inquirer, to stand in the relation
of cause and effect. Surely it should cause no difficulty, nor occasion
any necessity for the calling in a principle, atmospheric contagion,
without any other evidence, that those effects are occasionally found
not confined to one spot merely, but are seen developed in an extended
sphere—for, assuredly, it can require no extraordinary effort of the
mind to conceive that the agent acting and causing disease in one place,
or individual case, may with equal force, and with a like result, act in
many situations, and in respect to many persons.

The presence of certain operations in several situations by no means
proves that they have reproduced themselves.

Day-light is manifest in many countries, within certain latitudes at the
same hour, but it has never been suggested that this circumstance in one
of them has been propagated by that of another, through any occult
principle, or whatever else such an agency may be called.

Had the case not presented at once, and in so direct and striking a
manner, a sufficient cause for the effects observed, then we doubt not,
that, perhaps, individuals would relieve themselves of any present
difficulty, and attribute what they could not readily explain, to the
operation of a principle having as little evidence of its entity as
atmospheric contagion itself. But the sun is too glorious, too
resplendent an object to be overlooked, and its effects are too
immediate, to permit the possibility of the most unreflecting, not
marking its relation as cause to the effect observed.

But, unfortunately, the relation between widely spread diseases or
epidemics, as they are called, and circumstances connected with the
agencies before referred to, is not so striking—though it is as close.
There is no object so bright to draw the same attention to it, and to
proclaim it from east to west, from the dawn of morning till the fall of
evening, like that luminary dispersing light as he appears to traverse
the heavens.

Yet there is room to believe that the presence of epidemics is always
accompanied, or shortly preceded, by circumstances, which, though by
reason of their less striking character, and less immediate operation,
are sometimes overlooked or neglected, yet do exist, and, were inquiry
made by those able for the purpose, doubtless would be found.

In most of the epidemics recorded, some such agencies or circumstances
were in operation. They were known to be so—and in almost all that have
come under our own observation, and they have neither been few nor
carelessly noted—there have, on nearly every occasion, been found the
influences to which we allude.

We are led to believe an agent to be the cause of an effect when the one
follows upon the operation or presence of the other, uniformly, and on
every occasion, when the latter bears some relation in its amount to the
force and length of duration of the former—and when the effect ceases
with the removal of the agent. Such a close connection, as subsists in
that case, entitles the former or agent to be held as the cause of the
effect observed.

For those very reasons day-light is said to be the effect of the sun
that comes with it, remains with it, and goes with it.

Let us see if the same connection holds with disease and those agencies
and circumstances we have cursorily referred to.

Those agencies and circumstances, relating to food, drink, air, heat,
contagious matter, &c. &c. are known to present themselves, and with
them are presented diseases. They are known to remain, and with them are
known to continue diseases. They are known to disappear, and with them
all the world knows diseases disappear also.

These being the causes of epidemic or widely spread disease, as such a
connection proves, it is altogether superfluous to admit the operation
of atmospheric contagion, whose existence has never been known, but by
the very circumstances which it is said to bring about.

It is surely most unwise, when we see disease arising with the existence
of unwholesome circumstances, such as scarcity of food, unwholesome
quality of it, great vicissitudes of weather, uncommon conditions of the
atmosphere, want of sufficient clothing or incommensurate with the
severities of the season, the operation of depressing passions, and the
like,—growing with their intensity—extending where they extend—abating
where they decrease—and finally disappearing when they disappear—to
refuse to grant the relation as cause and effect, and to plunge into the
tide of difficulties such ill-timed incredulity creates, with nothing
but the appearance, nothing but the assurance, of an object to grasp at.

In general, such a connection can be made out between the existence of
wide-spread disease and such circumstances.

If, in respect to some diseases, so intimate a connection cannot be
observed, the probability is, that it is the obscurity connected with
these subjects, the less direct way in which they operate and the remote
time at which their effects may be experienced on the body, that are the
occasion of the difficulty. The human body, unlike mere inanimate
matter, has the power of withstanding, at least for a time, the
operation of unwholesome influences, if not very virulent; and it is
only natural to allow, that, in respect to a machine so complicated,
affected by so many agencies, and standing in so many relations, there
will be less complete directness of operation, than with simple or
inanimate substances, and more variety in the amount and duration of the
effect.

On these accounts, the indications of the case are less direct and
obvious, and it should cause no great surprise, that being considered,
and the fact of the imperfect state of our knowledge on the varieties of
the agencies referred to, being kept in mind, that the causes of disease
cannot at all times be completely and satisfactorily ascertained.

Our knowledge of the derangements of health, from the operation of these
agencies, on some of which we are dependent, and with others of which we
are constantly brought in contact, is fast increasing, and the relation
between the former and the varieties in the latter is becoming clear and
precise. There is, therefore, reason to hope that difficulties which now
baffle us, will soon be explained away, and that much of that mist that
has long overhung the causes of pestilence, will soon be dissipated.

Certain circumstances produce certain uniform effects, and in every
instance where they are operating, their effects will be produced,
provided no agency is acting adequate to neutralize them. Not one hill
only, in northern latitudes, has its summit whitened with snow, nor does
sterility mark a few spots only in the immense deserts of Africa and
Asia.

The same features are spread far and wide. They owe their existence to
agencies acting in immense spheres corresponding with their own.

The sphere of those circumstances connected with the agents so often
referred to, that produce disease, is sometimes large, and no
astonishment need be felt, if that of disease is also large, since a
relation ever holds between the extent of a cause and its effects.

It would certainly be ample time to call in the assistance of
atmospheric contagion to account for the propagation of disease, when
its sphere or circle is found to be positively eccentric of that of
those circumstances alluded to.

But we are satisfied that such a contingency is of very rare occurrence,
and even when it is said to exist, we shall require some undoubted
assurance that the non-correspondence is not the result of ignorance of
the extent of these hurtful circumstances, rather than the actual
absence of relation between them.

It is not our intention at present to enlarge on the causes of disease,
yet we maintain, that such a relation as that referred to, will in
almost every instance be made out, if candid and efficient inquiry be
instituted; so that, even granting that atmospheric contagion exists,
there can be no room for its operation. And we are of opinion, that if,
in some extraordinary instance, no such relation can be detected, the
progress which every department of science is making will in time
achieve what may not be accomplished at present.

The history of nations and the records of medicine shew, that,
coincident with epidemic sickness, there have, for the most part, been
noticed certain circumstances operating which were prejudicial to the
welfare of the human body. For example, famine, bad or unwholesome food,
great and long continued droughts, great rains followed by intense heat,
sudden vicissitudes of weather, dissipation, irregularities, depressed
state of mind, insufficient clothing and fuel, and unwholesome water.

These, and many similar circumstances known to prevail in the haunts of
pestilence, must exert a great, a very powerful, influence on the human
body, and, when the question of the probable causes of its diseases is
mooted, it argues a strange and discreditable blindness to obvious
facts, to overlook the part which they must exert in their production;
and a strong and dangerous partiality to a questionable principle, to
attribute the whole calamity to atmospheric contagion.




                              CHAPTER II.
THE EVIDENCE DRAWN FROM DISEASE ATTACKING THE RELATIVES, ATTENDANTS, AND
       VISITORS OF THE SICK, IN FAVOUR OF ATMOSPHERIC CONTAGION,
                      CONSIDERED—FACTS EXPLAINED.


Few points have been held so conclusive of the existence of atmospheric
contagion, as the circumstance of the attendants and visitors of the
sick being attacked with the same distemper, during, or shortly after,
their communication.

It is vain to deny, that where a person is ill of a disease, such as
fever, that those about him, the members of his family, his attendants,
and his visitors, are sometimes attacked with the same distemper.

Such is a common occurrence, but common as it is, it cannot prove that
the efficient cause is atmospheric contagion.

Were it established that atmospheric contagion existed in that
individual disease, and in that individual case, then it might be
admitted that the circumstance did lend some countenance to the
supposition, and should perhaps entitle the case to examination.

But it has never been shown that that principle positively exists. There
is, as has already been observed, no proof, saving that drawn from the
very circumstances for which it is called in to account.

Thus it is entitled to no exclusive respect.

Here is then an agency, of whose existence there is no evidence of a
sufficient nature, and here there is reason to believe that the same
circumstances are operating widely, and upon the relatives, the
attendants, and visitors of the sick, which have already produced the
disease in those visited.

These circumstances, in general, are ascertained to be acting upon these
individuals, and where they cannot, from their obscure nature, be
recognised, there is reason, from the very circumstance of the sick
having been affected, to conclude that they are operating, though
perhaps in an insidious way. Now, a question arises, whether it is
wisest to attribute the prevalence of disease among those holding
communication with the sick, to the operation of atmospheric contagion,
or to those circumstances and agencies which caused the disease
originally, and which there is room to believe are exerting their
influence over them also.

It has been said in the preceding chapter, that, during the prevalence
of widely spread or epidemic disease, there are generally found
circumstances of an unwholesome tendency, favouring its career, and that
the range of their action corresponds with that of pestilence. That
being the case, as it undoubtedly is, it would be proper, before
admitting the operation of atmospheric contagion, to shew that no such
circumstances were in operation. An inquiry would be necessary; and
their presence being proven, it would not be short of imbecility to
attribute to that agency, effects such as are wont to follow their
action. It would be to call in a principle whose existence has never
been proven, and which, therefore, must be held as at least doubtful, to
account for phenomena, the ordinary results of circumstances present,
which would indeed be absurd.

Before the operation of atmospheric contagion could with propriety be
entertained, it behoved to shew that those circumstances which induced
disease in the visited, were not operating with those holding
communication with them.

But in all those cases in which atmospheric contagion is held as acting,
no attempt is made to prove such absence, and the belief in its presence
is not the less strong because these circumstances can be proved to be
present.

It is a self-evident truth that some agency or agencies, totally
independent of atmospheric contagion must have been in operation, and
acting as the cause of disease in the first case or cases that occurred.
For this ample reason, that, for atmospheric contagion to exist at all,
it is obviously necessary that disease pre-existed, since it is the
product of disease, and of disease only.

Thus, then, it is proved, that some causes, totally independent of
atmospheric contagion, produce the first cases of an epidemic, or widely
spread disease. Now, there is no evidence that these same causes are not
operating upon those who visit the sick, and in absence of any facts to
the contrary, and of the operation of an equally active and undoubted
agent, there is justice in thinking it probable that they are acting,
more especially if the self-same results are manifested—and this may,
with safety, be done, even when direct testimony cannot be
obtained—which is very seldom entirely the case.

The causes of the disease being widely extended, and the visited patient
being ill from the operation of forces shared in common with many, it is
only fair to conclude that as relatives, attendants, and visitors are
like the great mass of people thus operated upon—that they, _cæteris
paribus_, are as likely to be affected with the prevalent disease, as
those who are suffering were previous to its invasion.

They do suffer, but not in general in a greater proportion than other
persons having no communication, and similarly situated in other
respects.

It would be ample time to look for the operation of some other agency in
addition to those commonly experienced, when the portion of the
community, holding communication with the sick, is affected with disease
in a greater proportion than that portion having none.

Now, with a few exceptions, it is the result of much patient
investigation, not only into the experience of others, but of many
epidemics we have had the most ample means of noting, that, in general,
in respect to diseases held to be propagated by atmospheric contagion,
those who have communication with the sick, do not suffer in a greater
proportion than those who keep apart, but remain in the sphere in which
the agencies and circumstances are operating, which produced the first
cases.

These exceptions are—

   _1st_, The relations and inmates of the same house inhabited by one
            sick of fever.

    _2d_, Those receiving disease from actual contact with the palpable
            contagious matter, or by contactual contagion.

    _3d_, Those persons, through the operation of fear, and from
            depression of mind, affected with disease, as fever,
            cholera, &c.

   _4th_, The attendants in fever institutions, &c.

These exceptions will meet with a little consideration, in order to shew
in what manner, and wherefore, those persons are seized in greater
proportion, and to prove that it is not in consequence of atmospheric
contagion.

This statement is important, and is made cautiously, and only after the
most detailed examination, and unprejudiced weighing of evidence.

The facts which have led to that conclusion might be detailed, but, as
they would occupy much room, and perhaps prove uninteresting to the
general reader, they will be withheld, however, to be produced, if any
sufficient objections be made.

That statement is contrary to common belief, which attributes disease in
a much greater proportion to those communicating with the sick, than to
those keeping apart; but that is not of much consequence, since implicit
reliance is not to be placed upon the opinions on that subject, held
either by the public or the medical profession.

On the whole, disease does affect, in a greater ratio, those who
communicate with the sick, than those who do not, the instances which we
excepted being included. But the difference, on the whole, is very
trifling, at least much less than is usually supposed.

One of the reasons that the difference is thought to be much more than
is actually the case, is, that every case of a visitor or attendant
being affected with disease, after or during communication, is bruited
about, and becomes the subject of much gossip; while that of hundreds,
equally exposed, who escape, is treated very judiciously with silence.
There is no impartial hearing of evidence. All that is heard is taken in
favour of one side, and instead of an opinion being formed from the
whole bearings of the case, one is got up on partial statements, which,
however, as it agrees with preconceived notions, answers very well.

But that is not the way in which a case so important should be treated.
Be it hoped that medical men, at least, will take more enlarged views,
when their own reputation and the public weal are at stake.

The partial statements remind us strongly of the self-deception of which
many persons are the dupes, in respect to fortune-telling and the
solving of dreams. Every instance of the divination of the
fortune-teller, or the solution of a dream, having any, the most
far-fetched, correspondence with the future history of the individual,
is stored up in the memory, and adduced as undeniable evidence of the
truth of those dark arts, however much a thousand facts may cry out
against them as vile impositions. The prognostications must, of
necessity, be right sometimes, in much the same manner as Louis the 14th
declared those astrologers must at some time be correct, who were
constantly foretelling his death.

We now proceed to inquire into the circumstances which cause disease to
attack those having communication with the sick, in a greater proportion
than is observed to hold with those apart from them, yet living in the
sphere of the epidemic causes, that is, generally speaking, in the same
locality.


_Exception 1st_, The greater proportion in which relatives and others
inhabiting the same house with one sick of disease, are attacked, we
would explain in this manner:—

_1st_, The relatives, if inhabiting the same locality, are, like others,
liable to the disease.

They are suffering in general under depression from apprehension of
losing a dear friend.

They are, perhaps, under an apprehension that they themselves may be
affected with the same distemper. They may have a dread of atmospheric
contagion, or, as is often the case, may have a presentiment of fatal
sickness.

They are irregular in the time of taking diet—have often no appetite—are
deprived of their night’s rest—maintain long and anxious watchings—and
are in general in that feverish state of mind that precludes the
possibility of taking due rest.

They are deprived of their wonted exercise in the open air, and of that
elasticity of mind and body which it imparts.

They respire an atmosphere, though not contagious, often, and especially
in the houses of the poor, deprived of its oxygen or more important
principle, and tainted with the admixture of adventitious vapours or
gases arising from the excretions, and perhaps the fermenting of
impurities often found collected on the skin.

It would be wonderful, where there is a widely-spread disposition to
disease, say to fever, if members of the same family, inhabiting the
same house, in which one of them lay ill of that distemper, did not take
ill, seeing how much they are exposed to it.

Nor is it to be thought extraordinary that relatives living in the same
locality, but in different houses, or even in different villages, should
take the disease also after visiting the house of a sick friend. What
has been stated will sufficiently explain that occurrence.

Here it will perhaps be permitted to make a slight digression to mention
a fact which has given much credit to the doctrine of atmospheric
contagion,—the simultaneous invasion of fever among relatives, living
together, in different houses, in different villages, and in very
different parts of the country. We are aware of several extraordinary
instances, where from ten to twenty of the same family were ill, at the
same time, of fever, several of whom were living far apart.

It is in vain to think of atmospheric contagion being the cause.
Possibly that notion might be entertained in reference to those living
together, and having communication,—but cannot possibly apply to those
in remote and different parts of the country. We know of instances where
a family has been seized with fever in our village, and members of the
same, living at great distances, forty and sixty miles, have suffered
the same distemper at or nearly at the same time, without any
communication having subsisted, either by person, by packets, or by
letter.

These extraordinary circumstances speak of something more than
atmospheric contagion. That could not possibly have extended to those
relatives who had no communication; and it is remarkable that, in those
instances, disease did not go as with the other members of the
community, attacking at leisure, now this, now that one, but almost on
the same day, many different members of the same family.

We have sometimes thought, from the consideration of such circumstances,
that there is something like a community of disposition causing members
of the same family to be similarly affected by like agents, more than
subsists between men who are unconnected:—something like an
idiosyncrasy, which goes to make them suffer after the same fashion.

There are such things as family characters, family idiosyncracies,
family dispositions, family peculiarities of bodily conformation, and
family temperaments; and may there not exist some family disposition, to
be similarly affected by like circumstances?

The case appears well worthy of philosophical inquiry, something beyond
the untenable puerilities of Mesmerians.


_2d Exception._—Visitors and attendants are liable to increase their
ordinary chance of taking the prevalent distemper, by touching the body
or clothes of the sick, when he labours under a disease marked by a
palpable contagious poison. Though the poison cannot be diffused through
the air, it may, and sometimes does, act by contact, which we call
contactual or immediate contagion. That, of course, can operate in those
diseases only in which a palpable poison is eliminated. Those diseases
are in this country chiefly small-pox, chicken-pox; the plague, if it
can now be said to be a disease of this country; the itch; and, as is
commonly believed, measles, scarlet fever, &c. &c.

Though the propagation of these diseases may take place from contact
with their peculiar contagious matters, we are disposed to think, that,
at least with most of them, especially the latter, the cases which occur
in that way are very few.

It is sometimes difficult to produce disease, even when the skin is cut,
and the matter is then introduced. That step sometimes fails in respect
to cow-pox matter, even when fresh; and small-pox matter we have known
to be in contact with the tips of the finger for a minute or so, in
innumerable cases, as in feeling the pulse, and no disease has followed.
Women affected with small-pox bear healthy children.

Almost the only diseases which we are disposed to think are propagated
by contact with the person or clothes of the sick, are small-pox,
chicken-pox, scabies, plague, &c. They all possess palpable matters in
abundance.

Many instances are known to us, where children have got small-pox, and
of grown-up people who have got itch, from sleeping with those sick of
these distempers, and thus coming in contact with them closely, and for
some time; and where they have not been seized with them, when only
breathing the same atmosphere used by those sick.

Thus visitors and attendants may get disease by contact with palpable
contagious matter, that is, by contactual contagion, and by touching
clothes impregnated with the same, that is, by fomitic contagion, which
they would not have taken, had they merely been respiring the air used
by the patients.


_3d Exception._—The visitors, and those in general holding communication
with the sick, are also liable to be affected more with disease than
others who remain free of it, on account of the sorrow usually felt on
all occasions of public calamities, and particularly of very mortal
pestilence, and more especially experienced in all its acuteness, in the
silent sick-room of a friend.

Among the scenes our professional duties call us to witness, there is,
perhaps, none so touching as the sorrow-striken countenances of friends,
directed to the sick, nay, perhaps the deathbed of one they love; and we
have noted the unspeakable sorrow then felt, the deep anguish then
experienced, and the silence more touching than eloquence that reigns
throughout the sick-room, as an awful contemplation, truly indicative of
a depression that is calculated to throw its sufferers into the same
situation which they so much deplore in others.

That sorrow attendant on such calamities, and that was so well marked,
when cholera lately assailed the nations of the earth, throws into the
shade almost every other form, sinks deep into the soul, and enervates
every principle of life. It gives a pall to every taste, a disregard to
all enjoyment, deprives the unhappy victim of that serenity and
composure so favourable to health, and, on the contrary, imparts a
restlessness to body and mind, until at length his system becomes a very
nidus of disease.

None who have attentively watched the course of widely-spread disease,
can doubt that that sorrow, so generally experienced on those occasions,
is an active instrument, and a strong abettor of the original epidemic
influences. It must be obvious to them, that those strong and
deeply-felt emotions, with which man contemplates his relatives, his
neighbours, aye, his very race, falling around him,—feeling, too, that
he is in the midst of danger, and can do nothing for his security,—must
produce a withering influence on the most vital functions of the body,
and prove the immediate cause of disease.

Under such circumstances, when disease manifests itself, it certainly
cannot be wise to disregard the part they must enact in the production
of the effect observed, and to attribute the whole, or nearly the whole,
to the operation of atmospheric contagion, which has already been shewn
to be without sufficient evidence of its existence, in any one case, or
in any one disease.

The visitors, also, are exposed to the action of an atmosphere, which,
as it is sometimes impure, is liable to be hurtful.


_4th Exception._—That of the attendants in Fever Institutions. It has
often been remarked, that in some fever institutions the nurses and
medical clerks resident in the house, are attacked with fever in a much
greater ratio than holds with the population around. The difference has
been seen on some occasions to be very great, and from information
collected on the subject, we are disposed to think, on some occasions,
and in reference to some institutions at least, that the statement is
correct. That fact has been attributed to atmospheric contagion; and we
shall proceed to inquire if it is not more likely that it is dependent
on other circumstances which are operating, and that are known to be
adequate for the effect observed.

The history of the Royal Infirmary of Edinburgh, and of Queensberry
House, an institution for the reception of fever patients, shews that on
some occasions almost all the clerks and nurses waiting upon those
affected with fever, have been seized with it also.

And it would appear to be owing to some agency peculiar to fever
patients or their wards; for in regard to the first-mentioned
institution, it is ascertained that it is with those attendants only,
who wait upon those patients, that the greater amount of sickness is
experienced. Those attendants exclusively occupied in the surgical wards
being attacked in no greater proportion than those unconnected with the
institution.

This is certainly an important fact, and one on which the advocates of
atmospheric contagion are wont to place no small weight. Did that
principle exist, there is perhaps no fact in the whole history of
medicine, on which we would place more reliance in proving its
operation, for it is self-evident that nothing relating to the general
unwholesomeness of the institution can be entitled to much activity in
this case, for any insalubrious tendency of its situation, of the soil
on which it stands, or emanations therefrom, and of the general economy
and discipline, cannot be confined in their operation to one apartment
or ward, cannot possibly be experienced in the fever wards only.

But an occurrence of this kind is apt to be too readily received and
made the ground of many inferences. In itself it certainly is a strong,
a cogent fact, and such as naturally leads the mind to believe, that, as
some very potent agency is at work, it may be that of atmospheric
contagion, which in alleged activity is surpassed by none.

Before proceeding to explain the occurrence, on principles very
different from atmospheric contagion, it is right to say that it is such
as does not occur in connection with all such institutions; and that, if
the case which has been stated, proves it is likely such a principle as
contagion is present in these institutions, that others of a directly
opposite nature, and as much to the purpose, can be produced to shew,
granting the possibility, that it is not present in other institutions,
much larger.

By physicians of the first eminence, such occurrences as that referred
to in connection with the Royal Infirmary of Edinburgh, are held as
decisive proof of the operation of contagious atmosphere.

Dr Alexander Tweedie, a physician of London, and one justly eminent,
after mentioning the self-same cause, goes on to say, in a sufficiently
assured tone,—“No statement more conclusive, as to the contagious nature
of fever, need be adduced: and if such facts will not lead to
conviction, the mind of such a sceptic must be strangely constructed
indeed.”

The case had been made much stronger, and would have stood inquiry much
better, had Dr Tweedie shewn, that the occurrence he treats of was not
solitary or uncommon, but was such as is wont to be observed in all like
institutions.

He should have known, that it is not from extraordinary, nor even from
unique cases alone, that knowledge is to be obtained, nor laws deduced,
of the ordinary characters, and action of disease. It is dangerous to
deduce inferences, and construct laws, from the knowledge of one
circumstance, and where, too, many can be obtained bearing on the case.

Let us see if this occurrence holds with other establishments. We will
find that it by no means always holds.

Dr Bateman, who saw much of fever, and gave it much of his active
consideration, in his excellent Treatise on Contagious Fever,
says,—“During the fourteen years, in the course of which I have almost
daily been in contact with persons labouring under contagious fever, not
only myself, but all the nurses have been preserved from infection, with
one exception, down to the period of the present epidemic” (in the
London House of Recovery).[3]

Footnote 3:

  Bateman on Contagious Fever, p. 154. 1818.

Similar cases of exemption might be given, but it seems unnecessary to
say more here.

But though Dr Bateman’s evidence in a manner meets the case recorded,
connected with the Royal Infirmary of Edinburgh, yet it does not
disprove its correctness; and we proceed to explain what has been held
as only to be explained by the presence of atmospheric contagion.

But though the case could not at present be explained, we deny that one
such circumstantial piece of evidence should outweigh the many facts,
and the results of reasoning, that have been laid before the reader, and
that are yet to follow.

When evidence is contradictory, it is well to ascertain on which side it
preponderates; and even when it is nicely balanced, which is not the
case here, it should be tested by a reference to general principles.
That was done in the first part of this work, and the reader cannot have
forgotten the result.

We are disposed to think, that the great prevalence of fever among the
nurses and resident medical attendants of fever institutions, and fever
wards in general hospitals, which does occasionally occur, is, in no
small degree, owing to the particularly great contamination of the
atmosphere, which is liable to take place from the peculiarly strong
tendency there is in the body of those labouring under fever, especially
of the low or typhoid character, to run to putrescence.

The body, it is ascertained, so afflicted, is particularly prone to
putrefaction, as is sufficiently attested by the presence of black spots
upon the surface, sordes upon the teeth and gums, and the general
appearance of corruption, often sufficiently manifest.

The secretions and excretions are marked at first by a putrid character,
and in a short time they are in an active state of putrefaction. In that
state, chemical changes take place, gases are evolved, such as nitrogen,
hydrogen, carbureted hydrogen, phosphureted hydrogen, singly and
combined, forming for instance ammonia, which is a combination of
hydrogen and nitrogen: they become mingled with the atmosphere, and
impart to it pestiferous qualities.

In fever, the body is much more prone to run into the state of
putrefaction, than when in health, or even when affected with merely
local disease. The whole system is then affected, the whole functions
are deranged, the decayed parts of the blood and solids are not removed,
nor are they corrected by admixture with new and purer elements obtained
from the products of digestion. The correcting influence of exercise is
lost, and likewise the assistance it gives to the due performance of the
various secretions; and it need not cause surprise that a body so
situated, for days and weeks, becomes at length prone to putrefaction.

It will perhaps be argued, that the same corruption or contamination of
the air is as likely to take place in the surgical wards, where patients
are kept having sores, &c. But in those wards, in general, there is not
the same amount of tendency to putrefaction. Their health is often
excellent, their functions are often not at all deranged, and their
bodies, in general, are not more prone to putrefaction than those in
health.

There are, to be sure, a multitude of sores and the like, but, as long
as they are healthy, and the matter is good, there is no risk of their
injuring the air, provided they are kept tolerably clean.

Healthy matter is a bland and innocent fluid, not more prone to
putrefaction than healthy blood. When healthy, matter may be present in
an apartment or ward in abundance, without the least injury being felt
by those respiring the atmosphere in the room in which it is contained,
as the history of surgical hospitals amply proves.

But as soon as matter, by any means, becomes of a bad character, acrid,
fretting, unkind, and prone to putrefaction, then it sends forth gases,
and perhaps, compound agents, produced by their combination, which
mingle with the atmosphere, impart to it most virulent properties, and
thus produce havoc among the various patients, as great, as well marked,
and as dreadful as those sometimes observed among the attendants of
fever patients, from the supposed operation of what has been considered
atmospheric contagion.

Wounds are much connected with the state of the general health. Where
that, by any means, is affected in a serious manner, the wound takes on
an unhealthy aspect, and the matter, which before was bland, becomes
acrid and irritating. If the body is affected with a putrid taint, then
the matter takes on the same, and from the emanations spoken of, disease
spreads around the ward.

That dreadful disease, called hospital gangrene, was some years ago a
common affection in military hospitals, from effluvia, and inattention
to ventilation; and it was common to observe healthy wounds taking on a
sphacelating character, from such causes. Sir John Pringle says, “I have
seen instances of it (hospital fever), beginning in a ward, where there
was no other cause, but one of the men having a mortified leg.”[4]

Footnote 4:

  Sir John Pringle on Diseases of the Army, p. 288.

There are other circumstances of a hurtful character, operating in
general upon the young gentlemen who fill the offices of clerks, and
upon the nurses, in these establishments, which we doubt not co-operate
with the other circumstances mentioned, in producing the extraordinary
amount of disease sometimes observed among them. But of these which will
readily suggest themselves to all, it is unnecessary to say much in this
place.

It is in the fever wards principally that contagious atmosphere is
apprehended.

The young gentlemen officiating as clerks are generally arrived at the
most important part of their course of study. They are in preparation
for their examination before the colleges, and are often in consequence
in a very feeble state of health—which, if not always marked with actual
sickness, is often sufficiently indicated by worn out and emaciated
systems, and by complexions of a very sallow or sickly colour. They are
thus predisposed to fever. The nurses waiting upon fever patients are
subject to more fatigue and more interruptions to their rest, on account
of the great attention which those under their care require, than the
same class of persons are exposed to, who belong to the surgical wards.




                              CHAPTER III.
     THE ARGUMENT DRAWN IN FAVOUR OF THE PROPAGATION OF DISEASE BY
  ATMOSPHERIC CONTAGION, FROM DISEASE APPEARING IN PREVIOUSLY HEALTHY
  HOUSES AND LOCALITIES TO WHICH PERSONS SICK, OR LATELY SO, HAVE BEEN
                                REMOVED.


A case of an apparently strong nature is made out in favour of the
propagation of disease by atmospheric contagion, when a person labouring
under sickness or lately recovered from it, is removed into a house or
locality in which the same malady shortly manifests itself. It is often
held conclusive; we hold it otherwise.

Such a case is known to take place, and we have observed it in our own
practice—but that is not entitled to be considered conclusive. It should
be shewn, if that inference is at all to be arrived at, that the
occurrence is so frequent that the probability is precluded of
attributing the phenomena observed to the ordinary causes of disease,
that the number who thus suffer is greatly more in proportion than holds
among the population generally, and that, in short, those thus visited
by the sick are affected in a greater ratio than holds with the general
community, as ascertained by an observation of the whole course of the
disease or epidemic.

We know that the appearance of disease among those visited by the
sick, or those lately recovered, does not always happen. We ourselves,
scarcely recovered of typhus fever, have visited and lived with a
family at a distance, and no such thing as propagation has
occurred—and hundreds of other cases are within our knowledge. We
have, after making calculations on the subject, considering both those
cases, where disease did occur and where it did not, that, generally
speaking, those visited by convalescents, or even patients, suffer in
a proportion very little greater, if at all greater, than those having
no such intercourse—compared of course with the very many cases that
are wont to occur in a widely spread epidemic.

Yet, though the general proportion may not be much affected, still we
are ready to admit that a case does now and then occur, where disease is
shortly observed after the admittance of a sick person in a house or
locality, and where the effect is so marked, so immediate and so general
among those exposed, that we are compelled to admit that there is room
for thinking, that the patient is somehow or other, in some degree at
least, the occasion of the catastrophe.

It is sometimes observed that servant girls, affected with typhus fever,
are in that state sent to their homes, and that disease shortly affects
their brothers and sisters, but before such cases can be held as proving
the existence of atmospheric contagion, there should be a strong
assurance that the agencies of a most unwholesome character, known to
exist in such cases, are inert, and that they which have on other
occasions, without assistance, produced of themselves the distemper
observed, have been altogether impotent and inactive.

Their case produces the usual effect, demands the exertion of night
watching, spoken of already, as favourable to the accession of disease,
and their house or apartment, close and confined as it usually is in
that rank of life, becomes the abode of many unwholesome influences, and
among others, of an atmosphere, deprived in a great degree of its more
essential part, and loaded, too, with foreign gases, and even perhaps
with chemical compounds of a virulent character, the products of
putrefaction. If disease spreads much among those thus exposed, it seems
fair to attribute the occurrence to these agencies known to be present,
and known to be favourable to the production of sickness, and not to
atmospheric contagion, as is almost universally done.

The case of disease appearing in a house previously healthy, after
receiving one just recovered of disease, which it is by the way
consonant with our experience to say, is much more rare than the other,
or that of persons actually ill,—is occasionally noticed, and the
explanation, perhaps, is, that the clothes may retain impurities
acquired during the course of disease, and may on this occasion shew
their activity.




                              CHAPTER IV.
     THERE IS NO EVIDENCE THAT ATMOSPHERIC CONTAGION TRAVELS, OR IS
                COMMUNICATED FROM ONE PLACE TO ANOTHER.


The question of the communication of atmospheric contagion from one
place to another has almost universally, on occasions of pestilence,
been much agitated, in respect to individual diseases, but seldom in a
comprehensive way, embracing all diseases. We propose to inquire
generally into the facts which are held to prove the principle of
dissemination from one place to another—whether contagious atmosphere is
transmitted from one country to another, from one town to another, and
from hamlet to hamlet.

In the many works written by medical men on occasions of great epidemic
disease, descriptive of the character of the prevalent distemper, there
almost universally appear the most minute accounts of the route pursued
by contagion, both fomitic and atmospheric, down to the noting of the
very road, the very street or alley by which it reached a town—and of
the manner in which it arrived, whether on the rags of a tattered
beggar, or seated in a stage-coach.

The line of its progression is taken from the observation of disease,
and from that alone. Wherever disease appears, there it is said that
contagion has been carried or conveyed; and as a proof of that position,
it is gravely maintained, that disease invariably breaks out where there
are houses, and where communication is likely to be going on in some way
or other. This most extraordinary fact proves what must certainly be
thought not less extraordinary, that it appears in the abodes and
habitations of men. But where else is disease, we would ask, to manifest
itself, if among men at all, if not where alone they are to be
found?—surely not among deserts uninhabitable, or on the frosty summit
of an iceberg?

It is true that in the course of an epidemic, such as the cholera, one
country suffers before another; but there is no alternative to such a
course if they are not to be simultaneously affected. And it signifies
nothing that communication subsists between them. One part of a country,
too, is ravaged first, then another, and so on—one town then another—one
part of a town, and after it another part.

But it is evident, that if disease is to begin at all, it must begin
somewhere, and if all parts are not to be seized on the same instant,
that one will have precedence of another, and so on. Springing and
propagating, from whatever causes, that character must hold, and surely
it is wrong to hold a feature common to the effects of many causes as
decisive evidence of the operation of one, and of one only.

The harvests of Europe begin in one country, sooner than in another. In
many, harvest is earlier than in England, but it is never surmised that
when that process begins in the latter country, that it is through the
mediation of some such influence as contagion. It begins in England,
too, it might be shewn, in places having communication with foreign
countries. Nay, it might also be proven that the parts in which it in
general commences are at the coast, where it is well known ships are
wont to appear.

Were such an insane supposition made, the most obvious facts would
necessarily be laid aside; but such gross blindness would not, we are
satisfied, be much greater, than when the process of diseased action,
marked out in an epidemic, is attributed to contagious atmosphere alone.

In the case of the harvest, it would argue a forgetfulness of the object
held in view when the seed was sown,—in that of disease, an ignorance of
the effects to be expected from the sowing of the seeds of pestilence
(the exposure to the common epidemic influences alluded to above), in
the first, an insensibility to the influence of climate, intensity of
sun’s rays, the quality of the soil, &c.:—And in the other, a blindness
to the operation of circumstances not less potent, such as the time of
application of the causes, the condition of the body, and the presence
or absence of moral adjuvants.

It has universally held with all epidemic sickness, that parts of a
country have been attacked in succession—that one town is visited after
another, and one part of a town before another, whether the prevailing
distemper have or have not been said to depend on contagion.

There is nothing extraordinary in the fact that all persons who are to
suffer, do not become affected on one and the same day. Far from proving
that any thing of the nature of contagion has been in operation, it only
proves what may so readily be admitted, or at once readily understood,
that all and sundry the inhabitants of a vast tract of country,
inhabiting parts having different climates more or less mild, having
different situations, some on the banks of rivers, some along the coast,
some inland, some on boggy and some on dry soil; having different
occupations, different houses, wearing different dresses, having
different habits, different pursuits, different diet, different
recreations, and perhaps having constitutions differing in aptitude to
be acted upon, may not be all ready for the manifestation of disease on
one and the same day, but may attain to that point at times
corresponding with the operation of so many different circumstances.

In vegetation, which on the whole is much more simple than living animal
organization, there is a gradation in the time at which its various
individuals become ripe. The same grain is ripe in some districts weeks
before it is ready in others, and even in the same farm, though the seed
had been sown on the same day. Thus, by observing that the gradual
development of disease over a country is the result of the varying
activity and time of action of the epidemic influences, and perhaps of
some condition of the body, varying in forwardness—it becomes
unnecessary to have recourse to atmospheric contagion. It is unnecessary
to repeat here what has been said relative to the operation of
unwholesome agencies to account for the wide range of disease—over a
country.

It is often said, as decisive proof of disease spreading by contagion,
that a beggar, or some poor person left a town affected with disease,
and entered another hitherto healthy—and that afterwards disease
manifested itself there also.

In the first place, would not sickness have occurred notwithstanding?
Its supporters say, not likely, when the effect followed, or immediately
on the communication; but we reply, that communication took place before
without any such immediate result, and that in all probability it had
been going on freely all along, whatever regulation and hinderances
might have been adopted.

It seems madness to think of stopping all communication with towns, in a
free country such as this, where human intercourse is going on without
interruption throughout the entire empire, or, indeed, anywhere at all,
tolerably inhabited, or where commerce subsists.

It is in vain to endeavour to shew that opportunities for the
transmission of contagious atmosphere have not occurred. The case
involves an impossibility, for do not a thousand means of communication
suggest themselves to the mind of the reader? The atmosphere itself,
currents, winds, water, streams, &c.,—animals,—such as rats, mice,
winged insects, &c. &c., which cannot be prevented from operating. We,
therefore, leave this case, perhaps to the efforts of the advocates of
quarantine regulations, who possibly may arrive at a happier result, and
we proceed to the opposite case, where disease fails to spread, where
communication does take place.

The advocates of contagion prove, where a disease appears in a town,
that communication has taken place. That statement, as the reverse, can
never be proven, is easily affirmed; and its insignificance corresponds
with the facility with which it can be proven. Of course, it is obvious,
that such a fact proves very little, either in reference to contagion or
anything else.

We are prepared to prove, that communication has subsisted on many
different occasions, without any unusual amount of sickness taking
place. We know of many instances where disease has been prevailing in a
town or village, which has failed to manifest itself in another at a
short distance, although daily unrestrained communication was held.

At the end of the year 1835, and the beginning of the year 1836 the
scarlet fever prevailed in Edinburgh to a great extent; and although
great traffic was constantly going on between that town and Tranent, by
means of foot-passengers, numerous carts and coaches, passing to and
fro, daily, still that distemper failed to make its appearance in the
latter town till the 20th of January, the day on which the first case
was noticed.

That case did not occur at the point where the greatest thoroughfare
subsists, but at one, the most remote from it.

Typhus fever has been prevailing, to a great extent, in Edinburgh, for
many weeks past, but that disease has failed to make its appearance in
Tranent (ten miles distant), although the road is constantly crowded
with carriages, with vast numbers of carts conveying coals from that
village to the capital, and with passengers both on horse and foot. It
has not made its appearance, although several of the inhabitants of
Tranent have lately lost relatives who have died of that disease, both
in Edinburgh and Leith; and although a woman just recovered from that
distemper, and come from the Royal Infirmary, has taken up her abode in
this village.

Small-pox appeared about six weeks ago, simultaneously in two very
filthy localities in Tranent, and it has been confined to them, although
the most free communication has subsisted with other parts of the
village, and it has failed to spread to the hamlets and farm-steadings
around, notwithstanding the relatives of some of those labouring under
that disease have travelled through the country, seeking charity.

We propose to close this part of the work. Much has been said in order
to prove the position, that the doctrine of atmospheric contagion gains
no support from the actual character of disease, no countenance from the
ungarbled history of its career.

Arguments in favour of our views might have been drawn from the fact,
that diseases said to be propagated by contagion, do not manifest
themselves in all parts of the globe to which the poison would be likely
to be taken, as they undoubtedly would do, were they dependent on the
operation of one single object, such as contagious matter; and also from
the consideration that those diseases, with whose causes we are
intimately acquainted, by reason of their immediate operation, or of
their being otherwise obvious, such as inflammation and wounds, are
never said to be dependent on such an agency; but it is feared in the
endeavour to be explicit, we have already been tiresome.




                               CHAPTER V.
                            ON VITIATED AIR.


The question of air holding in solution, an animal contagious matter,
eliminated in the body of a sick person, and capable of producing the
same disease, when inhaled by another, has hitherto occupied our
attention.

It is now our design to treat of vitiated air, that is, an atmosphere
deprived of part of its more essential principle, viz. oxygen gas, or
tainted with the admixture of effluvia or gaseous products, from
putrefying animal bodies, both living and dead, and from corrupting
vegetable matter.

It is one of the most common, and most widely spread causes, of the most
virulent and widely prevalent diseases, to which humanity is subject.

The importance of the atmosphere to the animal economy, is so very
great, and its derangements so very hurtful to health, that it appears
that a few observations respecting it may be useful to some
non-professional readers. It may enable them to understand better the
observations that are to follow on its vitiation.

The atmosphere is a fluid of an elastic nature, encompassing the globe,
occupying the space comprehended from its surface, to the distance of
twenty or thirty miles therefrom. It possesses weight, and it is by this
property that water rises in pumps, and that mercury is sustained in the
barometer. It is in constant motion, going, as it does, with the globe
itself, revolving on its axis, and rushing, in counter streams, from the
tropics to the poles, and from the poles to the tropics.

That portion nearest the sun becomes rarefied and lightened with the
heat which it acquires:—it then rushes, by virtue of its comparative
lightness, to the poles, and that in temperate regions presses forward
to occupy its place.

By means of this motion, the temperature of the earth is kept pretty
uniform, and it is corrected of any impure taint it may acquire.

The atmosphere is composed of two gases, oxygen and nitrogen, a small
quantity of watery vapour, and a fraction of carbonic acid gas, or fixed
air.

Oxygen is the agent on which its more active properties depend. The
other component, viz. nitrogen, serving to dilute it.

They are united in the proportion of about seventy-seven of nitrogen by
volume, and twenty-one of oxygen, the rest being made up of watery
vapour, and carbonic acid gas.

The atmosphere supports combustion,—oxygen gas being the essential
agent. During combustion, it is consumed, and at the end of the process,
it will be found wanting,—the other gas being undiminished.

This may be seen, at least the diminution in the volume of air, by
burning a candle in a large wide mouthed bottle, inverted over coloured
water. As it continues to burn, the water ascends in the bottle, and
occupies the place of the oxygen consumed.

Atmospheric air supports respiration, a process essential to the
continuance of life. Oxygen gas here, too, is the agent on which it
depends. Air, which has been once respired, is found to be deprived of
part of its oxygen, from ten to twelve per cent.

Air, deprived of oxygen, or even deprived of a small portion of it, is
unfit for respiration. A mouse, put into a vessel containing air, which
has been robbed of that fluid, dies immediately. Put into one containing
pure air, it breathes well at first, but, as the oxygen gets less, its
breathing becomes laboured, it is convulsed, and shortly dies.

The air is concerned, besides, in a thousand operations, constantly
going on at the surface of the earth. It gives up a portion of its
component parts in an immense number, and in a considerable proportion
receives bodies foreign to its constitution.

By one set of operations, it is deprived of its oxygen, and becomes
vitiated by the admixture of deleterious principles. By others, again,
its oxygen is restored, and the impurities removed; so that between two
opposite forces, it is in general kept in a wholesome condition.

An immense number of bodies on the surface of the earth, are constantly
attracting to themselves the oxygen of the air; some become what is
called oxydized, as the metals, the dull incrustation which is found
upon them after long exposure to the air, being an oxide, or a
combination of the metal, and the oxygen of the air. Some bodies become
acids, as the various vegetable juices which form their respective
acids, by combination with the oxygen of the atmosphere.

During fermentation, the oxygen is absorbed, and carbonic acid is
evolved. During putrefaction, oxygen is taken up also. There are many
operations, too, connected with the arts, in which that fluid is
abstracted from the air. The very soil is constantly acting on the
atmosphere, and is, indeed, one vast and extended laboratory, where
chemical processes, on a large scale, are going on without interruption.
The putrefaction of the animal and vegetable materials, used as manure,
is much promoted by free exposure to the air; hence one of the
advantages of ploughing the land so universally adopted. The very nature
of the soil is greatly altered by that process, and much of that change
depends not only on the chemical processes just spoken of, but upon the
action of the air itself, on the essential particles of the clod. From
the surface of newly turned up soil, it is understood by intelligent
agriculturists, that much gaseous or elastic vapour is evolved; and we
have heard it observed by intelligent ploughmen, that one of the most
delightful things is the air which arises from newly ploughed fields in
the morning. It is said that it imparts an invigorating, and wholesome
sensation throughout the body, and from thence to the mind.

All those processes we referred to, abstract from the atmosphere its
most essential part, the oxygen gas. Did that process of abstraction go
on without its being counterbalanced by others, imparting that principle
to supply the place of that abstracted, then the atmosphere in the
course of time would become unfit to support combustion or flame,—unfit
to support animal respiration; and the consequence would be, that the
surface of the earth would soon be uninhabitable, would soon be a
lifeless desert. Such would be the inevitable consequence.

But a wise and a good Creator has prevented the occurrence of that
catastrophe. He has so ordered it, that one department of nature shall
correct the bad tendencies of the other;—he has placed a weight at the
opposite end of the balance, to counterpoise and balance the glorious
work of his hand. Animal life is met by vegetable life: their results
are made to neutralize those of each other, and with a wisdom truly the
Father’s, found in his works alone, he has made the apparently hurtful
consequence of animal life, the very means for the maintenance of the
life of vegetation. The results of the function of respiration so
necessary to animals, are highly useful to vegetables. Those products
that are hurtful are absorbed by the leaves of plants, which are
analogous to our lungs or breathing apparatus, and the oxygen consumed
by animals is replaced by the evolution of a large quantity of that
principle.

During sunshine, plants, especially in water, give out a large quantity
of that principle, as may be seen by putting grass leaves into a jar
filled with water, and exposing them to sunshine. Bubbles of air soon
appear, and collect at the top of the jar; they are oxygen gas.

The evolution of oxygen gas in sunshine, is the chief means with which
we are acquainted, by which the chemical equipoise of the atmosphere is
maintained, against the operations constantly going on, to which we
alluded.

These observations relate to the chemical composition of the air,
considered as one great whole.

There are many situations in which it becomes not only deprived of its
oxygen in part, but becomes vitiated by admixture with foreign bodies or
vapours, most detrimental to health, in short, most pestiferous. But,
before pointing out the manner in which it becomes so tainted, and its
unwholesome consequences, we would here point out the use of the
atmosphere. By the act of respiration, air is carried into the lungs; it
acts upon the blood brought there in large quantities, and spread out in
innumerable vessels, forming a sort of network. The blood, upon its
arrival at the lungs, is dark, grumous, and unfit for the maintenance of
life, and the nutrition of the body; but, under the action of the air,
it becomes florid or crimson, has changes wrought upon it, by which it
is fitted to perform its various and important functions.

This chemical process gives a crimson and florid hue to the old blood of
the system, and imparts a colour and other qualities to the fluid
brought from the bowels, the result of digestion, which give it the
character of blood. It gives to that fluid the last preparation before
being converted into blood.

The heat of the body, which is above that of the surrounding atmosphere,
is maintained by the chemical changes which occur between the mass of
blood in the lungs, and the air to which it is there exposed. There is a
constant generation of heat, which is diffused along with the blood
throughout the whole system,—to supply the place of that which is ever
being abstracted by surrounding bodies, among which exists a constant
tendency to preserve an equilibrium of temperature.

When the atmosphere is vitiated, it is reasonable to suppose, that the
changes in the blood passing through the lungs will not take place in
their wonted integrity, and that, among other results, a diminution of
the vital heat of the body may be experienced.

Vitiated air admits of division into different kinds:—

_1st_, Into air simply deprived more or less of its oxygen.

_2d_, Into air holding in solution, or having mingled with it, effluvia
from animal bodies, living and dead.

_3d_, Into air holding in solution, or having mingled with it, noxious
gases or effluvia arising from decomposing vegetable matter.

Vitiated air, of every kind, is unwholesome and favourable to the
invasion of disease.

Vitiated air has been coexistent with many of the most appalling
visitations of disease, which have befallen man since the creation of
the world. It delights in the production of the most formidable
distempers, such as are marked with extreme debility and proneness to
the putrefactive character.

The plague, in its various visitations, from the time of its prevalence
in Athens, as described by Thucydides and Lucretius, down to the period
when it last raged in England, viz. in the year 1665, has been observed
to be coincident, for the most part, with circumstances proving the
existence of vitiated air: and at this day the most mortal diseases
prevail, where foul air exists, whether that arises from this or that
source.

The atmosphere becomes vitiated, when great numbers of men in health are
crowded together in apartments too close and confined to admit of a
sufficient supply of pure air for the perfect maintenance of
respiration. In this case, the vitiation is effected by the abstraction
of the oxygen of the atmosphere, the exhalation of carbonic acid gas,
and the dissemination of effluvia which arise from the bodies of those
who are confined.

The immediate effects of confinement to an atmosphere thus vitiated are,
oppressed breathing, sense of great anxiety and suffering, fixedness of
the eyes, and torpor, which gradually increases to insensibility; and
the miserable sufferer dies bereft of sense and motion, from
suffocation.

When the atmosphere is not so impure as to cause immediate death,
disease of a putrid character, for the most part takes place. Typhus
fever attacked those persons who survived the memorable struggle in the
black hole of Calcutta.

A low form of fever used to commit great havoc in jails and other places
of confinement, where prisoners were wont to be crowded together in
great numbers, from the atmosphere being deprived of its more vital
part, and being loaded with unwholesome emanations arising from the
filthy persons, and clothes of those confined.

This disease is called “Jail Fever,” and manifests a peculiarly
malignant character.

In hospitals crowded with wounded soldiers, but otherwise in health,
where sufficient ventilation cannot be maintained, the same distemper
makes its appearance, and is there denominated “Hospital Fever.”

In besieged towns and in camps, where the inmates are exposed to the
offensive and unwholesome effluvia, commonly experienced in such
situations, the same putrid disease prevails, and goes under the name of
“Camp Fever.”


     AIR VITIATED WITH EFFLUVIA FROM BODIES IN A STATE OF DISEASE.

Air vitiated with effluvia from bodies in a state of disease, and their
excretions, has been variously denominated.

By some it has been styled “Contagious Air;” by some “Infectious Air;”
and, when it is in connection with fever, “Febrile Miasm or Contagion.”

Vitiated air of this kind differs from that referred to above, in this
particular, that it arises from bodies in a state of disease.

Both forms of vitiated air produce, or assist to produce, disease of the
same character; but as the latter form not only goes to produce disease,
but arises from disease also, it has been considered to be analogous to
the contagious poisons, such as those of small-pox, cow-pox, and the
like.

From the circumstance of this vitiated air arising from persons in
disease, and assisting in the propagation of the same malady, it has all
along been regarded as a specific contagious animal poison in an
atmospheric menstruum; and thus has been created the perplexing and
entangled web of confusion and vagueness that has been wove around the
principles, viz. contagious poisons, and vitiated air arising from
effluvia from persons in disease, and from their excretions.

From this circumstance, these principles, viz. specific contagious
poisons, and vitiated air arising from persons in disease, have been
erroneously classed together, and a supposed analogy has been created.

But these principles are widely different in their nature, and in the
laws by which they are regulated.

The specific contagious poisons produce the same diseases as those with
which the bodies, whence they arose, were affected, and them only; and
their operation is marked by uniform effects, observing stated and
unvarying periods. Vitiated air, of the kind under examination, though
it arises from persons in a state of disease, and is sometimes known to
operate in the production or propagation of the same distemper, does not
always induce disease, does not induce that disease only, whence it
sprung, but various others; and, in short, its effects are not uniform,
and do not observe stated and unvarying periods.

The specific contagious poisons produce their peculiar diseases, as
their proper and only effects, without the cooperation of other
influences; but vitiated air, when the same disease extends, whence it
arose, cannot be said to be causing its proper, only, and peculiar
effects, as the same disease does not invariably follow its action. In
general, the effluvia which proceed from a sick person, where they prove
hurtful, cause the same distemper as that with which he is affected; for
instance, the effluvia arising from a person affected with typhus fever,
produce that disease again:—but that is not always the case, and an
instance will be presently detailed, where the effluvia which proceeded
from a body dead of one disease, produced another of a very different
nature.

The reason that the presence of vitiated air is generally attended with
the same disease as that with which the body is affected, whence it
sprung, is, that there is existing at the time, a disposition to that
particular malady: and the vitiated air only gives it form by acting as
an ordinary exciting cause upon individuals prepared for its invasion.

It appears probable that vitiated air, unlike the palpable contagious
poisons, assists in the production of that disease only which is
prevailing, or to which there exists a disposition from the operation of
other agencies; and it appears probable that vitiated air, whether it
arises from persons affected with this or that disease, will, within
certain limits, produce one disease as readily as another, the required
particular disposition being present; for instance, that the effluvia
from a small-pox patient will induce small-pox or typhus fever,
according as there exists a disposition to the one disease or the other,
and _vice versa_.

The effluvia arising from newly opened graves have been often productive
of putrid fever.

The following case will shew that effluvia arising from the remains of a
person who died of consumption of the lungs, and not of small-pox,
produced that disease, viz. small-pox. When that case occurred,
small-pox was prevailing, and doubtless, had there been existing at the
time a disposition to putrid fever, that disease, and not small-pox,
would have been induced by the effluvia which arose from the grave.

In September 1834, Peter Macawley, about twenty-eight years of age,
gardener and grave-digger, was employed in the churchyard of Tranent.
While busily digging a grave, he unexpectedly struck a coffin with his
spade, and broke it open. The coffin contained the remains of an old
woman, who had died of consumption of the lungs, and who had been
interred about fourteen months.

There immediately issued from the coffin the most offensive effluvia,
which threatened suffocation, and made him feel very unwell.

He proceeded home, and continued throughout the night very poorly,
giddy, and uncomfortable. He rose next morning, and although no better,
proceeded to the churchyard, gave some directions, and returned home,
feeling giddy and unsteady. He was put to bed, and passed a very
uncomfortable night.

Called in next morning to prescribe for him, I found him to be affected
with severe pain of head, great heat and sweating of skin, and great
quickness of pulse. He complained of thirst, could take no food, and was
occasionally delirious. On the third day of his illness, pimples
appeared over the whole surface of the body, which gradually becoming
larger, assumed the form of small-pox. The pocks or pustules did not
mature or fill with matter in the usual way, but continued throughout to
be flat, and assumed a dark blue or inky colour.

His strength fast declined,—he became very low,—muttered incoherently to
himself, and symptoms of a putrid character supervening, and the
energies of the system fast failing, he died insensible about the
twelfth day of his illness, of the worst form of immature, putrid,
confluent small-pox I had ever witnessed.

He was a powerful, well-formed, and laborious man, was in good general
health up to the moment of his being affected in the grave,—and it was
not ascertained that he had been in a situation to receive infection
from any other source.

Vitiated air arising from persons in a state of disease, is found in
those situations only where the apartment is close and confined, where
the person and clothes are allowed to remain in a state of impurity,
where the secretions and excretions are left to ferment; and, in short,
where no attention is paid to cleanliness, the removal of respired air,
and the introduction of a fresh atmosphere. The production of vitiated
air is thus only occasional, while, in the contagious diseases, the
specific poisons are produced in every case of their respective
diseases, and were they capable of being diffused in the atmosphere,
there would be present as constantly an atmospheric contagion.

When vitiated air is produced, its removal can readily be accomplished,
as daily experience, and the testimony of Dr Haygarth, given at the
beginning of this work, amply prove.


          AIR VITIATED WITH EFFLUVIA FROM DEAD ANIMAL MATTER.

There is still another source whence effluvia of a pestiferous nature
arise. Dead animal matter, during putrefaction, exhales gases which
taint the atmosphere, and render it unwholesome.

When these materials are exposed to heat and moisture, the decomposition
is rapid, and the air becomes more obviously tainted than when that
process is retarded by cold, breezy weather, and some other
circumstances. When the decomposition takes place in the open air, and
when that is kept in motion, the quantity of decomposing materials not
being very great, the bad effects are not so serious.

When, however, buried along with a sufficient quantity of atmospheric
air, to allow of the play of the chemical affinities, and kept there a
considerable time, if they be exhumed previous to their total digestion
or complete assimilation with surrounding objects, effluvia are exhaled,
having the most intolerable stench, causing instant sickness, faintness,
and giddiness, and eventually producing disease.

“Thus, we are told by Fourcroy, that in some of the burial-grounds of
France, whose graves are dug up sooner than they ought to be, the
effluvium from an abdomen, (belly), suddenly opened by the stroke of the
mattock, strikes so forcibly upon the grave-digger, as to throw him into
a state of asphyxy, if close at hand; and if at a little distance, to
oppress him with vertigo, fainting, nausea, loss of appetite, and
tremors for many hours: whilst numbers of those who live in the
neighbourhood of such cemeteries labour under dejected spirits, sallow
countenances, and febrile emaciation.”[5]

Footnote 5:

  Good’s Study of Medicine, vol. ii. page 65.

Instances are likewise known where graves containing human bodies, long
dead of plague, upon being opened, have emitted effluvia, which have
produced typhus fever among the workmen.

It is probable that, in general, the effluvia arising from dead animal
materials, undergoing decomposition in the ordinary way, are the common
results of the putrefactive fermentation,—carbonic acid gas, hydrogen,
nitrogen, &c.

These gases form various combinations; carbonic acid gas and hydrogen
gas forming carburetted hydrogen, an inflammable gas, the same as is
used for the purpose of illumination, and which cannot support
respiration. Hydrogen unites with nitrogen, and forms ammonia, or spirit
of hartshorn, which is volatile, and imparts a strong odour to the
atmosphere, such as is experienced in stables and byres, producing
sneezing and watering of the eyes.

Hydrogen, at its extrication, sometimes carries with it a portion of
phosphorus, already contained in the decomposing body, and becomes
phosphuretted hydrogen, a gas which ignites spontaneously in the
atmosphere, the same that is sometimes observed in churchyards under the
title of corpse-lights.

Hydrogen sometimes also unites with sulphur, and the combination is
called sulphuretted hydrogen, a gas readily discovered by its offensive
odour,—which it imparts to many very useful mineral waters.

These gases are discovered, not only in an atmosphere exposed to
decomposing dead animal materials, but are also found in that atmosphere
containing numbers of men in health, closely crowded together, and
persons suffering putrid diseases, where no attention is paid to
cleanliness and the removal of impurities.

A body affected with putrid disease is more liable to decomposition than
one in health; and the secretions and excretions are more prone to
putrefaction, and the emission of effluvia or gases.

Some facts are known, which shew that bodies, in some forms of low or
malignant disease, both before and after death, possess a virulence,
never found in bodies in health, or affected with disease of a
non-malignant character. The worst consequences have followed wounds in
the dissection of bodies recently dead of typhus fever; the
introduction, under the skin, of the fluid contained in the petechiæ or
black spots common in that disease, and even the washing of bandages and
clothes employed in cases of mortification and the like.

In such diseases, the body becomes a very centre of contamination and
virulence; its fluids become acrid and poisonous; and on the surface of
the body, fluids are elaborated, which are productive of the most
malignant and pestiferous effects. Whether these fluids, those virulent
secretions, are ever diffused in the air, and impart to it their deadly
properties, is a point of much interest, but one which cannot be
entertained here.




                              CHAPTER VI.
 AIR VITIATED BY ADMIXTURE WITH EFFLUVIA ARISING FROM THE DECOMPOSITION
            OF VEGETABLE MATTER ON THE SURFACE OF THE EARTH.


It is not only from such sources as those already treated of, that
effluvia or gases arise, to contaminate the atmosphere, and to spread
disease among men and beasts. Effluvia likewise spring from the
putrefaction of vegetables; and, in many instances, from circumstances
favourable to their development and action, they so vitiate the
atmosphere, that its respiration induces some of the most virulent
diseases, and, where the effects are not so serious, a state of slow
sickness and great suffering is often the lot of the sufferer, during
the whole course of his miserable existence. The situations of these
effluvia will shortly be pointed out, along with the respective diseases
incident to them.

But let us for a moment consider the changes on which these effluvia
depend. Putrefaction of vegetable matter is one of the many wise
provisions which the Almighty has instituted for the accomplishment of
his comprehensive plan of the creation.

The surface of the earth is covered with vegetation, to supply man with
food, and likewise to support the various animals placed below him in
the scale of creation, so necessary to his comfort and existence. They
are consumed, and, by means of digestion, become component parts of
animals; and when these, in their turn, die, they go down to the earth,
whence they originally sprung.

Mixed there, with other matters composing the soil, the carcasses of
animals afford nourishment to vegetation again, and once more they are
found as the component principles of vegetable forms. Thus the animal is
constantly supplying food to the vegetable world, which, in its turn,
supplies food to the other again.

In life, we found them performing functions useful to each other, and
mutually correcting their unwholesome effects; in death, they are no
less useful: the one is converted into the other.

All animated creation is the scene of endless changes, and is the object
of successive transformations. ’Tis one mighty circle, of a thousand
parts, constantly revolving,—one part occupying now this, now that
place,—and each taking the place of that next it, till at length it
completes the entire circle; and even then the race is not yet run, the
revolution must be performed again and again, to the very end of time.

The immediate agency by which these wonderful changes are effected, is
putrefaction. We have alluded to it shortly, in connection with man in
health, in disease, and in death.

We have now to speak of putrefaction in connection with dead vegetable
matter, in marshy situations, &c., where it is the occasion of much
disease.

There is no reason to believe that it was the design of the Almighty,
that the process of putrefaction, which is so essential to the great
plan of successive races of animals and vegetables, should be the active
engine of pestilence, which it is in many situations.

That is not the necessary consequence of putrefaction; and when it does
occur, it is rather the effect of accidental circumstances. Under
ordinary circumstances, where putrefaction goes on, as among vegetables
moderately moist, exposed to currents of air, and mixed up with the
soil, as in the various processes of agriculture, no bad results are
experienced.

But when vegetation is allowed to go on year after year, without being
cropped, where, as it ripens, it withers and dies; and when it dies, is
allowed to accumulate and putrefy, where there is much moisture, much
solar heat, and little motion of the air, where, perhaps, other
circumstances are operating, favourable to rapid decomposition, effluvia
are wont to ascend and vitiate the atmosphere.

Such a vitiated atmosphere has acquired various appellations, according
to the place in which it has been observed, and according to the effects
or diseases it produces.

But, under whatever name it passes, its origin is the same, namely,
decomposing vegetable matter on the surface of the earth, perhaps, in
some situations, mixed more or less with dead animal matter.

It is decomposing vegetable matter which produces the yellow fever of
the West Indies, the jungle fever of India, the deadly pestilential
fever of the coast of Africa, the ague in this country and in many
others, the cretinism of Switzerland, the pellagra of Milan, the
unwholesome condition of humanity in many parts of Italy, and especially
in the country surrounding Rome, or the Campagna of Rome, as it is
called. The decomposition, however, takes place under circumstances
somewhat different, and hence the difference in the results of its
action.

These effects are attributed to the decomposition of vegetable matter;
but there is room to think that, along with that, there is combined no
very insignificant proportion of matter of an animal nature.

It may safely be inferred, that wherever there is vegetation, there
animals are found also; and it is well known that vast numbers of many
kinds of animals live wherever decomposition is taking place, especially
if the situation is warm and sheltered. The carcasses of these animals
will be added to the vegetable matter, and add to the common mass of
corruption.

That matter in swamps, and in unwholesome situations, said to be purely
vegetable, is then a compound of animal and vegetable origin; and these
effluvia arise, not from vegetable decomposition only, but from both
dead animal and vegetable substances in a state of putrefaction.

There is little known of the composition of these effluvia. We are most
conversant with their situations, and their effects upon health. In
different situations, they produce different diseases. But no known
facts entitle us positively to say that their composition is different.
It is a remarkable fact, but one well ascertained, that the atmosphere,
in all parts of the world, in all climates, and in all situations, is
much the same in its chemical composition. It manifests the same general
physical characters in all situations, whether healthy or pestilential,
and the nicest investigations have detected nothing in an atmosphere
known to be pestilential, that is not found in the most wholesome.

However, there is much reason to think, that this circumstance is owing,
not to the absence of hurtful gases, but to the comparative
insignificance of their volume beside that of the atmosphere itself, so
vast in its dimensions.

Medical men have been disposed to think that effluvia which cause one
disease, say the yellow fever, are not the same as that which cause
another, say the fever of the coast of Africa. The only reason offered
is the difference of the diseases; but that is not enough to prove that
the effluvia are different in their nature. Different effects, or
effects so modified as to appear very different, are the results of the
same cause on many occasions. The smoke of tobacco will make one person
feel comfortable, another merry, another sick, another faint, and so on;
but it would be unfair, from these differences in the effects, to
pronounce that tobacco-smoke was in all these cases different in its own
nature.

We are satisfied that the effluvia or gases arising from marshy or
unwholesome soil, are the same, generally speaking, in all situations,
whatever disease is produced; and that the difference in the results is
to be attributed to the varying circumstances under which they act,—for
instance, the constancy or inconstancy of their operation, their greater
or less intensity, the greater or less degree of concomitant moisture
and heat, the greater or less amount of motion of the air,—the sheltered
situation of human habitations,—the condition of the body, its
predispositions from native country and the like, and the individual
being accustomed or unaccustomed to the action of effluvia.

Gases are known to arise from the marshy grounds mentioned, where animal
and vegetable matter is putrefying, from the fact, that the
neighbourhood of swamps is most unwholesome, the inhabitants and
visitors almost uniformly suffering, because unwholesome effluvia are
invariably known to emanate where animal and vegetable matter is thus
corrupting, and because the gases themselves may be seen rising in
bubbles out of putrid water, containing dead animal and vegetable matter
in a state of corruption.

These bubbles contain gases the very same as are disengaged when animal
and vegetable matter are putrefying among water. They are nearly the
same as proceed from merely animal matter dead and putrefying, not
incorporated with the soil, viz. carburetted hydrogen, or inflammable
gas, carbonic acid gas, or fixed air, and sometimes a little
phosphuretted and likewise sulphuretted hydrogen.

These gases are sometimes appreciable to the organ of smell. Carburetted
hydrogen is very strong, and is perceptible in many situations where
there is much corruption going on; for instance, at the meadow-ground
between the Dairy, on the Portobello road, and Comely Green, near
Edinburgh, where the stench is so strong as to prove most offensive to
passengers on the road. The source is the corrupting animal and
vegetable materials, in the foul water conducted from Edinburgh, and
made to overflow the ground, for the purposes of irrigation.

In such situations, it is not uncommon to observe lights floating along
during the night, and superstition has not failed to make them represent
evil spirits. They are known by the name of “Will o’ Wisp” and “Jack o’
Lantern;” and have, on many occasions, proved objects of no slight dread
to many ignorant persons. The lights are merely ignited carburetted
hydrogen gas,—the same kind of gas as that used for lighting our shops
and houses.

The gas is ignited, perhaps, by the rising to the surface of the putrid
water, of a bubble of phosphuretted hydrogen, which, as was before
observed, burns the moment it comes in contact with the atmosphere.

Other products of an aeriform kind may be evolved also, but we have no
direct evidence of their existence,—but an atmosphere, loaded with
vapours of the kind mentioned, is enough to account for the production
of the observed disease, in all its varied forms, when there is
conjoined with it other unwholesome agencies. In some countries, the
pestilential air is present throughout the year, for instance, in the
country around Rome, in the fens of Lincolnshire, where ague is seldom
absent; in others it is periodical, chiefly confined to the hot and
rainy seasons, as in India and in the West Indies, where fevers prevail
to a great extent; and in others, again, it is observed only when the
wind blows from a particular direction.

These effluvia are conveyed to a distance by currents, and produce their
peculiar effects, more or less, upon almost all they encounter. The
malaria at Rome is carried by the wind into the city, by the channels
most open to its entrance; and those parts, it is said by medical men
who reside there, that are most exposed to the wind blowing off the
adjacent marshy grounds, are most unhealthy. It is for that reason that
the suburbs are more unwholesome than the interior of that city, where
the wind does not find ready access, on account of the obstacles offered
to its course by the high buildings. The high houses and streets thus
act as a barrier against the entrance of the pestilence, and it is even
said that the narrowest streets there, are the most healthy, as they
shut out the pestilential vapour.

An obstacle of the same kind is offered by hills which interrupt the
course of winds carrying with them vapours from marshy grounds. In the
West Indies, where the yellow fever commits such frightful ravages, many
instances are known where a town or district retains its health, from
the shelter which a hill affords against the visitation of a wind that
has loaded itself with deadly miasms, while sweeping over a marsh or
swamp. It is the practice of those residing in those countries, not only
to remove from the swamps, but also from those points to which the wind
blows after passing over them.

Inattention to that consideration has led to the loss of much human
life, and to the fruitless expenditure of much money in the erection of
houses, barracks, and the like, which, after completion, have been found
to be totally uninhabitable, from the pestilential vapours carried to
them by the winds. In illustration of the influence of winds, we submit
the following interesting extract from Dr Good’s Study of Medicine. He
has been speaking of effluvia from animal matter. “But the foul and
stinking Harmattan,” (a pestilential wind) “when it rushes from the
south-east upon the Guinea coast, loaded with vegetable exhalations
alone, with which it impregnates itself while sweeping over the immense
uninhabitable swamps and oozy mangrove thickets of the sultry regions of
Benin, triumphs in a still more rapid and wasteful destruction; so much
that Dr Lind informs us, that the mortality produced by this
pestilential vapour in the year 1754 or 1755 was so general, that in
several negro towns, the living were not sufficient to bury the dead;
and that the gates of Cape Coast Castle were shut up for want of
sentinels to perform duty. Blacks and whites falling promiscuously
before this fatal scourge.”

So loaded is the air on some occasions with these pestilential vapours,
that they attach themselves to whatever objects they meet, houses, the
sides of hills, and woods, through which they pass along with the wind,
and so completely has a wood stripped the currents of their baneful
accompaniments, that they have been respired after with no injury
whatever.

Trees are found to give great shelter and salubrity to towns in this
way, acting as they do as so many sieves retaining impurities.

It is understood that the effluvia arising from putrefying vegetable
matters ascend high in the atmosphere under the influence of the solar
rays, and spread far and wide, and that at night during the cold they
fall with the dew to the ground again, and impart to it and to those
exposed to its action, much virulence. The ground is there known to be
extremely unwholesome, and those who have been compelled by want, by
sickness, while travelling, overtaking them, or by being benighted, to
lie down with nothing but the soil for a couch, and with no shelter from
the vapours and dew that falls at night, save the sky itself, have felt
this pestilential influence: on the morrow they awake distressed,
parched, and affected with headach, and the usual symptoms of malignant
fever.

With the close of day or the setting of the sun, the pestilential vapour
falls and envelopes the country and the habitations of men with a deadly
mantle—and it is then unsafe to venture into the open air in many of the
finest countries of the world.

The pestilential effects of exposure to these night dews and vapours
have, on many occasions, been experienced by soldiers encamping in the
open grounds, and our gallant countrymen on foreign service are wont to
yield in fearful numbers to a foe, merciless and unsparing.

But it is not in swampy grounds only that these vapours arise, for there
is reason to think that in those places where sickness is constant, and
where no such dampness of ground is observed, that decomposition of
animal and vegetable matter is going on some depth below the surface,
and that the extricated gases issue through the soil. This is rendered
almost certain, by the fact which has sometimes been observed, that the
most dangerous and sickly season is, when the ground is parched and rent
with heat, permitting the exhalations generated below to ascend into the
atmosphere. Instances of this occurred among our soldiers in the
Peninsular war—the season, marked with the greatest prevalence of
disease, the common result of vitiated air, being that when the soil was
most rent with heat.

In some parts of Italy, it is remarked by that eminent physician and
philosopher, Dr James Johnstone, in his admirable volume, entitled the
Diary of a Philosopher, which, by the way, is a work of rare virtue, in
so much as it is replete, not only with accurate medical knowledge, but
with reflections in literature and the fine arts such as prove an
intimacy with polite learning not always found, that fever and that
general unwholesome state of body, observed in districts infested with
vitiated air, prevail where inquiry has discovered no appearance of
unusual dampness and corruption of the soil. He thinks that streams of
putrid water, containing animal and vegetable materials, that have sunk
down from the surface, in some part of their course are making their way
at a little depth, and that when the soil, parched with excessive heat
and drought, becomes rent, as it commonly does, the emanations
previously confined rush out by the channels now presented by these
fissures, and deal their deadly effects around.

Such an explanation seems to me highly probable, and deserving of more
inquiry. Connected with this subject, the following facts may be
interesting, and assist in forming an estimate of the probability of the
truth of that explanation.

In mines, as well as on the surface of the earth, changes are constantly
going on; and as in the latter situation the animal, vegetable, and
mineral components of the soil are decomposing, so the minerals in the
former are giving out some of their component parts and abstracting
oxygen, &c. in turn from the atmosphere.

In mines some of the fossils attract oxygen from the air, but the chief
process by which the atmosphere becomes vitiated there, is by the
evolution of gases from the minerals. In coal pits the principal gases
emitted are carbonic acid gas, commonly known as fixed air, which will
support neither animal life nor combustion, as proved by the disastrous
results on men having been confined in it, and by the extinction of
light when immersed therein, and carburetted hydrogen gas, known as
fire-damp, which cannot support respiration, and which takes fire when
brought in contact with a light. These gases are the results of chemical
changes going on in the minerals, in the same way as the gases before
alluded to attend the decomposition of animal and vegetable substances.

These gases arise not only from the minerals exposed to view at the
various surfaces, as the roof, sides, and pavement of coal pits, but
issue also from the unworked minerals in the interior, by fissures or
cracks in the various strata, produced by the violence used in detaching
the minerals.

These fissures extend in the course of the beds, or strata, and are
often scarcely visible, but are sometimes so wide as to admit the
finger. It is probable that they sometimes extend a considerable way
into the solid minerals.

In general, from these fissures there is constantly issuing streams of
gas, of a nature varying with the character of the minerals, but for the
most part they are such as have been mentioned. In the mines of Great
Britain, when the atmosphere above is much agitated, as by the
prevalence of southerly winds, and more especially if the violence
amounts to what is termed a storm, the gases pour out in prodigious
quantities, making a rushing noise, and filling the pit and excavated
parts. The pit then becomes so full as to interfere with the operations
of the men, who are frequently, for their safety, obliged to retire. In
this case the atmosphere is lightened, and the pressure it is constantly
exerting on all bodies with which it comes in contact is diminished, and
the consequence is, that the gases rush out, under the circumstances
already mentioned. It is known, that, during the prevalence of stormy
weather, the mercury in a barometer falls; it is for a like reason, the
weight upon it being less. Not only the gases issue from their caverns
when the air is thus lightened, but water contained in fissures in the
floor or pavement of mines rises also, sometimes to the amount of an
inch or two, and it is no uncommon thing to see the extrication of
vapour from a little collection of water on the floor, such as takes
place when water is boiling, a movement which it very much resembles.

These facts shew that it is not improbable that pestilential vapours,
ordinarily passing under the soil, may be extricated when fissures are
present. It may happen that effluvia may be prevented from issuing even
when fissures exist in the soil, from an increase in the weight of the
atmosphere, and in this way may be explained the occasional
disappearance of pestilence with a change of weather, not unfrequently
remarked in some tropical countries.

During the prevalence of strong north, north-east, and north-west winds,
blowing with considerable violence the currents in mines are
reversed—for, instead of gases issuing from the fissures and crannies,
currents of atmospheric air pour into them. These currents may be felt
with the hand, and the ear can detect the rushing sound; a flame applied
to a fissure is immediately drawn in, shewing the direction of the
current. These facts illustrate the influence which the state of the
atmosphere has upon terrestrial vapours.

As has been already observed, the exhalations from the soil obtain
different names from the effects they are wont to produce. When they
produce intermittent fever or ague, they are termed marsh miasms. When
they produce the various forms of malignant fever, such as the yellow,
the bilious fever of India, and the coast of Africa, simply pestilential
effluvia—and when they induce general bad health and degeneracy of the
inhabitants of a country, they are styled malaria, an Italian expression
signifying bad air.

As the subject appears one which may interest the general reader, it is
proposed to add a few observations on the diseases which are caused by
air vitiated with effluvia from the soil.




                              CHAPTER VII.
                            MALIGNANT FEVER.


A vast proportion of the most virulent diseases to which the human race
is subject in almost all parts of the world, but more especially in
tropical regions, is produced by the action of effluvia arising from
decomposing dead animal and vegetable matter on the surface of the
earth, and incorporated with the soil. These effluvia are the immediate
instrument by which thousands of our fellow men are annually deprived of
existence, the career of the young and the robust is abruptly stopped,
never again to be renewed. Malignant fever is the disease, by which
death is occasioned from these effluvia; and this fever assumes forms,
characters, and titles, various and manifold. It ravages in almost every
country within the tropics, and in many situations it annually commits
the most dreadful havoc—cutting down so rapidly that the ordinary forms
of burial cannot be observed. Whole communities suffer, the inhabitants
of a particular tract of country are sometimes almost extirpated, and to
visit some countries is almost to incur death from pestilence, so near
to certain is attack, and its destructive character is so uniform.

The average duration of life in many countries is extremely low, chiefly
on account of the wasteful career of that scourge, under its various
characters and designations; and it is not saying too much that there
the number of deaths is four times as great as occurs in our own happy
country.

In those regions in which malignant fever prevails so much, almost every
inhabitant at one period of his life, sooner or later, is afflicted with
it. If he survive he is more fortunate than thousands of those who lived
beside him; but his health is often deteriorated, he is often deprived
of that vigour and elasticity both of mind and body, which spring from a
sound constitution, and he not unfrequently lingers under the sufferings
of chronic disease till his life is gradually though slowly exhausted;
unless, indeed, as often happens, it is suddenly terminated by a fresh
attack of the active pestilence.

“Almost every territory in which it (malignant fever) has committed its
ravages has given it a new name. It is as gorgeously arrayed with titles
as the mightiest monarch of the East. From the depredations it has
committed in the West Indies, and on the American coast, it has been
called the St Domingo, Barbadoes, Jamaica, and American fever; and from
its fatal visitations on the Guinea Coast, and its adjoining islands,
the Bulam fever. In British India it is distinguished by the name of
Jungle fever, and still farther to the east by that of Mal de Siam.
Nearer home, in the lowlands of Hungary, and along the south of Spain,
it is called the Hungarian or the Andalusian pestilence. From its rapid
attack on ships’ crews, that are fresh to its influence, the French
denominate it Fievre Matelotte, (fever of sailors) as the Spanish and
Portuguese call it vomito Prieto or black vomit, from the slaty or
purplish and granular suburra (grounds) thrown up from the stomach in
the last stage of the disease; while, as its ordinary source is moist
lands, it has frequently been named Paludal Fever.”[6]

Footnote 6:

  Good’s Study of Medicine, vol. ii. p. 145.

This fever is severe with new settlers in these countries. Persons
visiting places in which it is endemic, during its severity almost
necessarily suffer, but sometimes they escape with a slight attack, in
which case they are said to have had a “seasoning fever.” The
pestilential vapours may be carried to a great distance, by winds and
currents. Instances have already been given where districts are
immediately rendered unhealthy upon the visitation of a wind which has
passed over an unhealthy swamp at a distance. Many instances are also
well known where ships, riding at the distance of a league from an
unhealthy coast, have had their crews affected with the distemper, on
the vapours being sent among them by the wind coming off that direction.
The British navy is, alas, too familiar with instances of ships being
visited by that pestilence when lying off the coast of Africa, where,
too, no direct communication had been maintained. The most appalling
mortality occurs in these cases; it is not unusual during the short
period a ship remains on that station for the whole officers and crew to
be swept away in one general tide of death, and it not unfrequently
happens that, after the short space of three years, the ordinary time of
service, that when a ship returns to England, she has not a hand on
board she carried out—but is manned with a crew that has succeeded one
which had, in its turn, taken the place of that which danced in joy, and
looked all gallantry, only a few short months before, when with hearty
huzzas they left their native land, and committed themselves to their
bark and to the buoyant billows. At the time of the expedition to
Walcheren a disastrous state of health prevailed among the soldiery in
Holland, in consequence of vitiated air and other forcible
adjuvants;—the pestilential vapours which arose from the soil were borne
by the winds to the ships riding at a distance, and there fever failed
not to manifest itself with its usual severity.

The actual amount of mortality produced by pestilential effluvia from
the soil has never been accurately calculated in those countries where
they are most severe. No bills of mortality or registers of deaths are
kept, as in this country, in connection at least with the natives. But
enough is known to shew that the amount is prodigious.

Tables are kept of the deaths occurring among the soldiers belonging to
this country, serving on foreign stations, and they amply shew that the
mortality is frightfully greater in those countries infested with these
effluvia, and with the diseases which these effluvia are wont to excite,
than at home—and as they are the chief agency of an unwholesome
character, known to prevail in these regions, it is not unfair to
attribute to them, in a general manner at least, a very great proportion
of the excessive mortality.

The following extract, from an official return, will shew the greater
mortality among the military when serving in the British Colonies than
when stationed at home—

  _Official return of the mortality among officers and soldiers in the
    several British Colonies, chiefly for the seven years from 1820 to
    1826, shewing the annual deaths out of ten thousand men._

 Great Britain (1824 and 1826), out of 10,000 there died per annum,  144
 Mauritius,                                                          240
 Madras Civil Service in 1820,                                       600
 Ceylon, soldiers on the island,                                    1328
 West Indies,                                                        701

Such is the fearful mortality which occurs among our soldiers stationed
in some of our colonies, where effluvia of a pestilential character
exhale from the ground. In Ceylon, where terrestrial effluvia are known
to prevail, the number of deaths of our soldiers is more than nine times
that which occurs among those who are stationed in Great Britain.

The immediate cause of that frightful mortality is the malignant fever,
the chief agent in whose production, again, is the pestilential
atmosphere, rendered such by terrestrial effluvia, and not by the
presence of specific contagious poisons, as defined at page 105,
assisted, perhaps, by other hurtful influences, such as, the intemperate
habits which new comers in those colonies frequently adopt, the great
heat of the climates, operating with particular force upon those
accustomed to the more temperate climate of England.

This pestilential fever, the product of effluvia from the soil, commits
such mortality among our gallant soldiery, as throws into insignificance
the carnage attendant on active warfare, as renders that, even in the
field of battle, comparatively of little moment.

Men in action may fall fast around; whole lines, nay columns of living
humanity, its boldest samples, in one brief moment may be hewn down;
still, as such carnage can last but a few hours of the day only, or, if
protracted, a few days at most, the work of death is inconsiderable,
compared with that effected by pestilential effluvia in many situations,
operating both night and day, from day to day, and from year to year,
unceasingly.




                             CHAPTER VIII.
    GENERAL DISEASED CONDITION OF THE BODY, THE PRODUCT OF MALARIA.


The inhabitants of countries infested with malaria, or vitiated air,
when they have been spared the more acute forms of disease, or have
recovered from them, are generally the victims of a miserable state of
health, compared with which many conceive that death itself would be
preferable.

The body loses its vigour and aptitude for exertion, becomes weak,
disabled, sluggish, and impotent; the appetite fails: the limbs refuse
to carry their burden aptly so called, and they become swollen and
dropsical. The mind becomes lethargic and unfit for exertion, and the
unhappy sufferer, who is insensible to whatever gratifies his more
highly favoured fellow-men, becomes often weary of existence, a burden
to himself, and an object of pity to others, who are accustomed to
regard the activity, the cheerfulness, and graceful lineaments of
health.

Thousands are so afflicted; and the number of those who thus have their
existence embittered,—who are deprived of the manifold enjoyments which
our condition can afford, and whose lives are prematurely terminated,—is
even greater than that of those who die of the more violent and more
speedily mortal distempers which are induced by vitiated air.

“A glance at the inhabitants of malarious countries or districts, must
convince even the most superficial observer, that the range of disorders
produced by the poison of malaria is very extensive. The jaundiced
complexion, the tumid belly, the stunted growth, the stupid countenance,
the shortened life, attest that habitual exposure to malaria, saps the
energy of every bodily and mental function, and drags its victim to an
early grave. A moment’s reflection must shew us, that ague and fever,
two of the most prominent features of the malarious influence, are as a
drop of water in the ocean, when compared with the other less obtrusive,
but more dangerous, maladies that silently but effectually disorganize
the vital structures of the human fabric, under the operation of this
deleterious and invisible poison.”[7]

Footnote 7:

  Johnson’s Diary of a Philosopher.

Such is the general state of health of the inhabitants of many parts of
the world; but it is chiefly in some parts of “fair Italy,” whose
celebrated blue skies invite, whose luxuriant vegetation delights, whose
gay and extensive prospects ravish, and whose classic associations charm
the ecstatic spectator,—where humanity acquires that degenerate
character, and that hideous aspect, which it assumes as if on purpose to
mark the contrast between the gay revelry of vegetation, and the
revolting degeneracy of mortality.

The resident in Italy can scarcely escape entirely the action of
malaria; if he survive or escape the more immediate and more violent
effects, those just described are, in the course of time, almost sure to
manifest themselves.

Many of our countrymen make their residence in Italy, invited by its
sky, its sun, its fertility, its ancient monuments, and stirring
associations, and they not unfrequently prolong their stay so much as to
imbibe the seeds of general bad health, which, though it may not
develope itself at the time, will manifest itself at some future day.
The malaria of Italy, like that of some other countries, sometimes acts
slowly, and does not produce its effects, until the sufferer is again
resident in his native country. Assailed with general decay, he is at a
loss to know its cause, happening, too, at a time, when he had expected
that his general health would have been more than ever established by
his residence in a warmer climate, and under a clearer sky. It is a
remarkable feature in the general bad health thus produced, that it is
marked with periodical alternations of activity and repose, or with
aggravations and remissions.


                               CRETINISM.

Cretinism, by which is meant a degenerate state of body, and an imbecile
state of mind, which occurs for the most part in the valleys of
Switzerland, and among the hollows of the Alps and the Pyrenees, and
that is in a great measure the product of vitiated air, emanating from
the swampy valleys and basins, which contain animal and vegetable
materials, powerfully acted upon by the direct and reflected rays of a
burning sun.

From the mountains there pour many streams into the valleys or troughs
beneath, and, as the water is seldom completely carried off, it there
forms an excellent or very favourable nidus for the putrefaction of
animal and vegetable remains.

It is said, by those who have attentively observed the miserable
population in these regions, that they form the most humiliating picture
of humanity. The body presents the most loathsome condition, and the
mind is removed only a step from idiocy itself.

The unwholesome tendency of these terrestrial vapours is materially
increased by the almost incredible filth in which the inhabitants keep
their persons, clothes, houses, and streets, the effluvia of which alone
are almost intolerable and most offensive.

The general degeneracy of the body is frequently accompanied with a
large swelling at the front of the neck, which gets the name of
“Goitre,” and which is known in England under the appellation of
“Derbyshire Neck.”

Cretinism has prevailed in Switzerland for many centuries, and has been
likewise noticed among the mountains of China.

Cretinism is thus ably described by Dr James Johnson: “The stature is
seldom more than from four to five feet, often much less;—the head is
deformed in shape, and too large in proportion to the body;—the skin is
yellow, cadaverous, or of a mahogany colour, wrinkled, sometimes of an
unearthly pallor, with unsightly eruptions;—the flesh is soft and
flabby;—the tongue is large, and often hanging out of the mouth;—the
eyes red, prominent, watery, and frequently squinting;—the countenance
void of all expression, except that of idiotism or lasciviousness;—the
nose flat;—the mouth large, gaping, slavering;—the lower jaw
elongated;—the belly pendulous;—the limbs crooked, short, and so
distorted as to present anything but a waddling progression;—the
external senses often imperfect, and the Cretin deaf and dumb;—the _tout
en semble_ of this hideous abortion of nature presenting the traits of
premature old age. The Cretins are voracious, and addicted to low
propensities. To eat and sleep form their chief pleasures. Hence we see
them, between meals, basking in nonchalance on the sunny sides of the
houses, insensible to every stimulus that agitates their more
intelligent fellow-creatures.”

Before closing this sketch of the effects of malaria in Italy, a table
of the annual decrement of life is submitted, which will shew the
fearful mortality of that country over that of England, the
disproportion against the former country being owing, in a very great
degree, to the contamination of the atmosphere, caused by the effluvia
which arise from the soil.

  In Rome, 1 out of every 25 persons dies annually, or a 25th part of
      the whole population.

  In Naples, 1 out of every 28 persons dies annually, or a 28th part of
      the whole population.

  In England, 1 out of every 60 persons dies annually, or a 60th part of
      the whole population.

Thus, in England, the mean term of life is more than double what it is
in Rome or Naples; and thus, while it takes 60 years to extinguish a
generation in England, the brief period of 25 years completes the same
work at Rome.


                      INTERMITTENT FEVER, OR AGUE.

Intermittent fever, more familiarly known as ague, is also a common
product of air which is vitiated with effluvia arising from the soil.

That disease was much more prevalent some years ago in England than it
is at present, where it is almost confined to Lincolnshire, and some of
the low grounds and meadows of Kent and Essex, through which the Thames
flows.

It is unnecessary to mention the symptoms of ague, as they are
familiarly known. Convalescents are very liable to relapses, and many of
those who have recovered from the more violent symptoms, are frequently
affected, throughout the whole term of life, with very troublesome
complaints, which arise from what is vulgarly known as ague cake, which
is an enlargement of the spleen, an organ which lies near the stomach.

Ague is very prevalent in the West Indies, America, Holland, and other
countries which are much covered with wood, are ill drained, and liable
to be periodically inundated. This disease displays none of the
virulence of the malignant remittent fever already noticed, yet affects
vast numbers in its peculiar localities, and not unfrequently leads to
mortal results.

The whole population of those fens and swamps in which ague is endemic,
is generally affected at some period of existence, scarcely one person
escaping.

The effluvia which produce that disease are sometimes carried to a
considerable distance, and there induce their peculiar distemper; and
instances are well known, where effluvia have been conveyed to high
grounds, where they have attacked the inhabitants, while those in the
immediate neighbourhood of the source of these vapours, have escaped for
the time.

Ague is a much milder disease than the remittent fever, which springs
from the same general source, viz. terrestrial effluvia, and which
prevails in the East and West Indies, and on the coast of Africa.

When and where intermittent fever only is produced, it would appear that
the effluvia from the soil are less virulent and concentrated, and
perhaps their activity is modified or tempered by a proportionately
great quantity of watery vapour combined with them in the atmosphere, by
the climate of the country, and by the constitution of the people.

In this country, even so lately as half a century ago, ague or
intermittent fever prevailed to a considerable extent, but is now almost
unknown.

In East Lothian many of the old inhabitants remember ague as being a
common disease in that county. At present it is there unknown.

In respect to this disease particularly, the health of the population of
England has greatly improved, and it is well ascertained that the
gratifying fact is chiefly owing to the country having been cleared of
its superabundant wood, which prevented the land being readily dried,
and which interfered with the due action of the winds, and to the speedy
removal of water from the surface of the earth by draining, which is now
so universally adopted. By draining, the water which formerly formed a
receptacle for the decomposition of animal and vegetable remains, is now
carried off, and with it the opportunity it afforded for the extrication
of unwholesome vapours.




                              CHAPTER IX.
      OTHER CASES OF PESTILENCE—FAMINE—UNWHOLESOME FOOD AND DRINK.


The operation of vitiated air in the production of disease is often very
much assisted by the presence of other prejudicial influences.

It has been frequently remarked that one stroke of misfortune seldom
comes alone, and that observation holds with striking force in reference
to the causes of disease. One cause of disease produces another, which
in its turn generates another, and so on, till the tendencies to, and
the excitants of, pestilence, are so strong and so numerous, that whole
communities are affected, one after another.

It not unfrequently happens that the predisposing source of some of the
most severe visitations of the most virulent distempers, is the want of
food, which generally depends on the exorbitant prices of provisions,
raised either by the arbitrary regulations of rulers, or by comparative
scarcity.

The total or almost total want of food is calculated to bring about,
very shortly, a mortal result, from exhaustion or from sinking of the
powers of the system.

When food is not withheld altogether, but is only given in sparing
quantity, in an amount insufficient for the maintenance of the body in
vigour, a condition of the system is induced, in which the functions are
imperfectly performed, in which the blood and the various humours become
universally prone to morbid change, and in which there arises a great
tendency to disease of a low or asthenic character.

If, under such privation, vitiated air be present, whether arising from
men in health, but uncleanly or crowded in close apartments; from the
clothes, or excretions of the sick; or from terrestrial effluvia; it
will give form to disease, will act as a spark amid fuel, and will
shortly convert any predisposition to sickness that may exist into
reality itself.

In those suffering under scarcity of food, there is generally
experienced great depression of mind, which is hurtful in itself and
injurious by preventing sufficient exertions for the maintenance of
cleanliness: there is an inability to procure requisites for the
purpose, and when, perchance, they are obtained, there is too often too
much apathy or supineness to admit of their being used.

That miserable individual who is famishing, who is so unfortunate as to
hear his helpless children call for bread, which he, alas, cannot give,
who himself is exhausted and sinking with want, is seldom found to be
very solicitous about cleanliness.

A mother so situated will, in her misery, amid her actual sufferings,
and with the dark yet immediate prospect of further hardships, forget
the necessity or disregard its call; of removing impurities from her
hut, of retaining the persons and clothes of her family clean—and of
washing the furniture, the walls and floor of her pestilence-haunted
cabin.

In such a situation, cleanliness is neglected and impurities of all
kinds accumulate which emit effluvia, to add to the number of the causes
of gradual death impending over a family thus situated.

Let a case be supposed in which disease makes its appearance in
obedience to the summons of so many forces, and let the malady be of a
low or putrid character, and the patient dangerously ill. This family is
unable from depression of mind, and from that exhaustion attendant upon
actual want, to give him the requisite attention and assistance, and
neither the means of cure are administered, nor is a suitable diet
afforded. Effluvia arise, and no means being adopted to remove them,
they become highly concentrated, and prove the immediate exciting cause
of disease among all around who may be prepared by the operation of
other favouring influences for that consummation. The occurrence of
typhus fever among the labouring classes of this country, which is
observed every winter, but more especially on those occasions when
provisions, the necessaries of life, are high in price, when employment
is with difficulty obtained, and when the wages are low, sufficiently
attests the fact that scanty food is a powerful cause of disease, and
one of a widely extended range of action. It is invariably in those
years when there is least correspondence between the severity or
inclemency of the season, the price of provisions and the means of the
labourer that typhus fever commits most havoc. I have had occasion to
note the prevalence of an unusual amount of disease, and amongst other
forms, that of fever, in winters following partial failures of the
crops, and the most satisfactory evidence has been afforded that a large
proportion of the sickness was the consequence of high prices, and
consequent scanty and insufficient food.

Such great prevalence of disease can be readily accounted for, when it
is known that the ordinary amount of the wage of the day labourer does
not exceed nine or ten shillings per week. I have heard labourers of the
most sober and frugal habits affirm, that if their whole wage were spent
in the purchase of oat meal for porridge, and of bread, that there would
not be more of those provisions than would barely satisfy their children
and themselves.

A scanty and unwholesome diet induces a bad and acrimonious state of the
fluids, and leads to many diseases, and among others, to scurvy, which
was long a frightful pestilence among our sailors.

Where there exists that tendency to scrophula, which is common in this
climate, the relaxing influence of a poor and scanty diet is
particularly hurtful, and proves the exciting cause of that hideous
disease in all its frightful forms. Scrophula is much connected with a
sluggish state of certain organs called glands. These organs are found
in all parts of the body, and in health vary in size from that of a
pin’s head to that of a bean, but in scrophulous subjects they are found
much larger, the smaller being often more than the size of a pea, and
the larger being equal to a hen’s egg.

Glands are congeries of vessels in which fluids of various kinds are
elaborated, and it is partly from these fluids or those from which they
are formed, stagnating in their vessels, owing to want of vital action,
that the swelling arises, which is always found in scrofulous subjects.

That sluggish disposition of these parts is generally connected with a
languid and lax state of the general system, which is liable to be
greatly increased by whatever diminishes the vigour of the body. Few
circumstances are better calculated to produce that effect than
insufficient food, and hence it is that those diseases whose foundation
is a scrophulous taint, are so much promoted in times of scarcity, and
among individuals accustomed to a liberal diet when accidentally placed
on scanty fare.

Instances are known where persons have become affected with weak eyes,
with tenderness, watering and disposition to ulceration in these organs,
immediately upon being put on spare and poor diet, and where a liberal
supply of nutritious food has proved an almost immediate cure. That
affection of the eyes was a form of scrophula, and fortunate it was for
them that the form in which that disease manifested itself was not more
dangerous. They had much reason to be thankful that the injury was
capable of cure, and was not irremediable, as it has been in many
instances, where the first intimation of the bad consequences of a
scanty and insufficient diet has been decided and incurable consumption
of the lungs.

When the glands which assume the scrofulous action are those of the
lungs, and when they become the seat of the formation of matter,
pulmonary consumption is said to be produced, a disease which annually
carries off a great proportion of the adult population of this country.

Consumption of the lungs, or pulmonary consumption, is a common
affection among those who subsist on scanty and insufficient food, and
is frequently observed with dogs and other animals whose sustenance is
small and precarious. Scrophula manifests itself in other forms, not
less severe and extremely loathsome—in running sores on the neck and
other parts, in swellings of the joints, and in various wasting diseases
of the bones and their coverings.

In the various forms which this disease assumes, the blood and the
different humours of the body become unhealthy and often acrimonious.
The milk of nurses who are tainted with that habit is unwholesome, and
when they are made to subsist on scanty and insufficient diet, it
becomes poor, less nutritious, and positively injurious—and instead of
being bland and white, it often appears watery and yellowish, and is
irritating and acrimonious.

Food of an unwholesome or vitiated quality is also injurious, and has on
many occasions proved to be the cause of much disease. Plants as well as
animals are subject to disease, and food when obtained from such sources
is highly unwholesome and detrimental to health.

The flesh of animals which have laboured under disease, has, on many
occasions, done much harm, and is liable to be much more injurious than
flesh which is merely putrid from being too long kept. Flesh merely
putrid much more seldom proves hurtful, as, long before it can be very
pernicious, it becomes so offensive that it cannot be consumed.
Moreover, food which has acquired a slight taint, is more easily
digested, its fibres become less tense, less hard, and more easily
divided and dissolved in the stomach.

But the most important injuries of the kind have arisen from the use of
diseased grain. On the Continent the rye sometimes becomes diseased, and
the grain throws out a fungus somewhat like the spur of a cock. Rye thus
deteriorated, when used for food, has produced disease of a very serious
character. Persons who partake of it suffer great pain of stomach, fiery
heat in the extremities, and very violent convulsions. This spurred rye
produces mortification of the extremities, of a very remarkable nature.

The late celebrated surgeon, Mr Pott, thus describes these affections.
“At the extremity of one or more of the small toes, in more or less
time, it passes on to the foot or ankle, and sometimes to a part of the
leg, and in spite of all the aid of physic and surgery, most commonly
destroys the patient. It is very unlike to the mortification from
inflammation, or to that from external cold. In its severer attacks,
however, the constitution seems to be generally contaminated, the mind
and body become equally debilitated, there is great irritability and a
tendency to convulsive action.”

Rye thus diseased produces another distemper, which partakes of the
nature of typhus fever and that of plague: it is called by the French
“Mal des ardens,” and is generally considered one of the worst forms of
the pest. That disease is marked by the most virulent character, and
has, on many occasions, committed the most fearful ravages. It commences
with a sensation of burning, prostration of strength, delirium, and
vehement headach; a bad form of erysipelas attacks the skin, ending in
suppuration, matter forms in the armpits and groins, and these symptoms
almost invariably terminate in death. There is good reason to believe
that the fungus or cock-spur is the product of disease in the plant. It
is about the size of a cock-spur, is coffee-coloured, and may be readily
detected when the farmer is disposed to use his eyes.

In this country, wheat which has been blighted or infected with the
parasitic plant called mildew; has sometimes produced very bad effects,
not unlike the severe burning at stomach, and the mortification which
supervene on the use of spurred rye on the Continent. Not long ago,
several families living in England were nearly destroyed by their using
some diseased grain, which a farmer, knowing it to be bad, had sold at a
reduced price. Other plants are sometimes known to be attacked with
disease, and in that state are ascertained to inflict much mischief. The
potato is more particularly injurious when its quality is bad.

Plants, like animals, may be affected with disease, and may be most
unwholesome, without exhibiting any very marked signs of their morbid
condition.


                                 DRINK.

Drink is as essential as food itself, to the maintenance of the health
of man. Thirst is no less urgent than hunger itself, and it often
happens that it must be satisfied when the calls of the appetite for
food are unheard. Drink of a wholesome quality is highly salubrious, and
conduces much to maintain the blood, and the various humours in a
healthy condition. Water is the only beverage with which Providence has
directly supplied his creatures, and is, under ordinary circumstances,
the liquid of all others the best adapted to their use.

Pure water is refreshing, cooling, and dilutes the blood, which, without
some diluent, would become too thick to move readily along its
containing vessels, to perform aright its manifold duties, and to
accomplish its numerous purposes in the animal economy. Water taken into
the stomach goes to supply that very considerable part of the mass of
blood which is constantly earned off in the shape of sensible and
insensible perspiration, and of other secretions, and to correct the
tendency in that vital fluid, to become irritating and acrimonious from
the formation and accumulation of various salts.

In order that the deleterious action of some liquids may be the more
readily understood, we will inquire how drink, which is taken into the
stomach, is there disposed of.

One of the chief objects which is obtained from the use of drink, is the
dilution and mollifying of the blood; and in order that this important
purpose may be effected, it is necessary that they be brought in contact
and mixed with each other.

Water, or any watery beverage, being received into the stomach, many
thousand vessels open their mouths upon the walls of that organ, and
imbibe the contained liquid, in virtue of a vital action which they
possess. The liquid is soon sucked up, and is carried by the veins and
the absorbent vessels into the general circulation, there to be mixed
and incorporated with the mass of blood. It has been popularly thought,
that there exists a direct communication between the stomach and the
kidneys, by which the contents of the former are conveyed to the latter
organs; and that supposition probably arose from the fact, that the
kidneys have an immediate increase of duty after copious drinking; and
that fluids having a peculiar and strong odour have been detected,
discharged, very soon after their reception into the stomach.

However, there is no direct communication between these organs, and all
liquids which are taken into the stomach must be passed through the
general circulation before they can reach the kidneys; and thus it is
worthy to be observed, that liquids which are possessed of deleterious
properties, have an ample field for their operation.

It is rare that any bad effects follow the use of moderately cold water
in a state of purity, and any instances in which injury has followed,
may, with perfect propriety, be regarded as depending on accidental
circumstances.

It sometimes happens, that water free of impurities, cannot be obtained,
and that, what is highly impure is taken into the stomach. Many nations
are occasionally subject to the privation of pure water, and are
compelled to have recourse to the tainted waters of sluggish rivers, of
almost stagnant rivulets, and putrefying lakes; and the consequence is,
that their health suffers, and that the invasion of disease is much
promoted.

The inhabitants of Switzerland, and of several other countries, are
supplied on some occasions, with no other water than that which is
obtained from snow, and the prevalence of goitre among the Swiss, has
been attributed by some physicians to that circumstance.

But man is not satisfied with this excellent beverage—water—which is
ever at hand, and to be obtained without a price.

While yet little advanced in the knowledge of the arts, man discovered
that the various juices with which the various fruits of the earth
abound, afforded, during fermentation, a liquor which possessed
properties such as strongly recommended it to his use. These juices,
after fermentation, prove exhilarating and intoxicating, and all the
nations of the world have their respective wines or intoxicating
beverages. This liquor, which is the product of fermentation, gives to
these juices their peculiar character. It is called spirits of wine, is
colourless, and is lighter than water.

The liquors in which that active agent resides, when taken in small
quantities, quicken the circulation of the blood, render more acute the
perceptions, and augment the heat of the body. When these liquors are
taken more copiously, the circulation becomes violently affected, the
face flushes, and the blood is sent to the head, with too great
velocity, and in too great abundance.

At first the mind is stimulated, but there gradually ensue sleep,
stupor, and privation of sense and motion, which may continue even unto
death. Several cases, in which death took place in this way from
drinking to excess, are detailed in Mr Watson’s excellent work on
homicide. But when the quantity which is taken is insufficient to
produce the last-mentioned effects, but is often repeated, it frequently
happens that disease, more or less acute, attacks some of the more
important organs of the body, as the stomach, liver, kidneys, brain,
heart, and the general nervous system.

The diseases which follow the long continued excessive use of liquors,
containing spirits of wine, vary in their nature, but, on the whole,
they prove highly dangerous, interfere with the performance of some of
the most important functions, and often lead directly to a mortal
result.

Where death is not the immediate consequence of the diseased condition
of these organs, symptoms arise which make the course of life run
bitterly along, the general system breaks up, the miserable victim
presents in vivid colours, the signs of premature decay, the accession
of acute and mortal sickness is greatly favoured, and the intellectual
faculties are impaired.

Many melancholy instances are known of soldiers at the sacking of
conquered towns, who, indulging in wine and other spirituous liquors to
great excess, have died in vast numbers, both immediately, and more
slowly, through the operation of disease, which had been induced by too
deep potations, by too long protracted carousing, and by that exposure
to those influences favourable to the developement of disease, to which
excess never fails to lead.

“Some thousands of soldiers covered the great square and the adjoining
streets (of Moscow), but they lay extended and stiff in front of the
magazines of brandy which they had broken open, and from which they had
drawn death, expecting to derive from them life.”[8]

Footnote 8:

  Segur’s Expedition to Russia.

The habit of indulging to excess in spirituous liquors, when it does not
directly induce pestilence, assuredly lays those who are its victims,
particularly open to its invasion, and is, therefore, entitled to be
regarded as a very important agent in the great tragedy of life which is
enacting.




                               CHAPTER X.
       CAUSES OF PESTILENCE CONTINUED—COLD, WANT OF CLOTHING, AND
 SHELTER—DEPRESSION OF MIND—INFLUENCE OF WEATHER, CLIMATE, HABITS, &C.


Few of the primary causes of pestilence among large bodies of men are so
powerful or so extended in the range of their action, as extreme and
long continued cold, want of sufficient clothing and shelter, and
depression of the mind.

Coincident with many of the epidemics which are wont to prevail in this
country, these circumstances are almost, without exception, found to be
present; and if they are not admitted to be considered as the sole and
exclusive causes of the prevalent disease, it is proved that they are
co-agents or adjuvants of the very first importance.

Much of the continued fever which infests the poorer classes of our
countrymen, and almost all the pleurisies, colds, and consequent
consumptions, which prevail more or less among the various ranks every
winter, are in a very great degree dependent on the extreme cold of the
season which suddenly sets in, and against which the dress of the
inhabitants of these islands is insufficient to provide. The labouring
classes suffer much, more particularly from the action of cold and the
inclemency of the weather. They are generally very scantily clothed,
nay, they are sometimes scarcely covered, and the consequence is, that
the cold makes a strong and lasting impression, the circulation on the
surface is suddenly impeded, the perspiration is checked, and the whole
fabric involuntarily shivers. Now these are the very first symptoms of
fever, and unless the constitution is possessed of stamina to remove
those symptoms without loss of time, and to establish the circulation in
its vigour again upon the surface of the body, that disease, or some
other, will undoubtedly be established.

When a body thus affected with cold is placed in a warm situation, there
supervenes an excitement or reaction, which is marked by increased force
of the circulation, and with redness and heat of the skin, a condition
which is often experienced by persons who go immediately to the fire
when newly arrived from a journey in the cold. When that reaction
ceases, and is followed by a sense of coldness and by shivering, which
again is succeeded by reaction, fever, in its proper sense, is
established, and will assume a character of violence, lowness, or
malignity, according to circumstances.

The clothes, the house, and the diet of the working man, are
insufficient to protect him against the action of the cold, and to
resist its operation when once it has fastened upon him; and thus it is,
that to comparative want and to many privations, there is so often
conjoined so much disease.

But it is in vain to expect any other result as long as our most
deserving labouring population is worked in an inordinate degree,—so
long as they labour beyond what their limited energies will, with
impunity, permit—so long as they are often unable to obtain a diet
sufficient for the maintenance, even of an idle person, and so long as
their very breasts, from very want of clothing, are literally open and
exposed to the fiercest blast that blows, and to the most searching and
chilling rain that falls from Heaven.

Observe the industrious labourer at his work; behold his powers are
taxed to the utmost, his energies, his capabilities, are put upon the
stretch, and the entire fabric, God’s most complicated and most delicate
creation, is actually labouring and heaving with protracted exertion.
His blood distils the dew of labour, and his clothes, such as they are,
are moistened with perspiration bursting from a thousand pores.

It frequently happens, that the labour of the poor man being over,
sorely fatigued, too exhausted even to enjoy the consciousness that his
hour of rest has arrived, with a heavy and unwieldy gait and hanging
head, he seeks his comfortless abode, his scanty board, his dreary,
dark, scarcely furnished apartment, with its faint and glimmering
embers.

He swallows his spare repast and falls asleep at his fireside, but
having no change of clothes, and those which he has on being wet with
perspiration or with rain, are allowed to dry upon him. In the mean time
the heat of the fire proves sufficient to create a steam on the side
next it, and the house of course being open to the wind, currents of
air, chillingly cold, pervade the apartment, and strike upon that side
of the poor inmate which is most remote from the fire, and thus he of a
thousand misfortunes and privations is actually steamed on one side, and
perished with cold on the other. Persons placed in such a situation can
scarcely, for any length of time, escape disease, and it is consonant
with my knowledge to say, that the condition of a great proportion of
the labouring classes is not one tittle better. Fever and many other
diseases will continue to assail our labouring population as long as
their food is insufficient, as long as they are barely covered during
the inclement season, and as long as their habitations scarcely own a
roof or a door, as long as the wind and rain enter at a thousand
crevices; and while the cheerful and salubrious light of heaven is
denied admittance by the old hats, bunches of straw, and rubbish which
so frequently, in the absence of glass, fill up the space originally
intended for a window. Yes, so long as every energy is exerted, and
every moment that can be cheated from rest, to obtain that wherewith a
supply of the necessaries of life may be procured, and when every other
consideration sinks and gives way to the more pressing wants of nature,
will disease prevail.

Such is the destitution among many of the labouring class, and the vast
amount of disease which prevails among them, is the necessary
consequence.

The following facts illustrate well the influence which scanty food,
insufficient clothing, and the privations attendant upon poverty, exert
in the production of disease.

During the last three months (10th February 1839), the fishermen and
potters living in Prestonpans, have been in a very destitute condition,
the former, partly from the very boisterous weather which has prevented
their going regularly to sea, and the latter from the closure of the
potteries at which they were employed. During that time, these two
classes of people have been suffering much from fever, about ten of
their number having died in that short period; while the people,
amounting to 750, including children, connected with Prestongrange
colliery, who are well employed, well paid, and well fed, though
inhabiting the same locality, and the houses stretching from Prestonpans
to Musselburgh Links, have been almost entirely free of that disease,
fever having affected two of those families only, in the course of the
same time; and while fever is still prevailing extensively among the
potters and fishermen, the people connected with the colliery have been
entirely free of that disease since about the 7th of last December. On
these facts I am well informed, being the medical attendant of the
colliery.

Let us mark the operation of the same or similar circumstances upon
soldiers; the consequences of exposure to cold, to the inclemency of the
weather, of the want of sufficient clothing, and of habitations, among
young and robust men, employed in the most active and spirit stirring
occupations, connected with the most kindling and heart-rousing
anticipations, and flushed with the glory and honour of victory.

Let the case be that of Napoleon’s Grand Army in Russia, perhaps the
most remarkable recorded in human history, and that, perhaps, will equal
any that will yet mark the future career of man, in the total
discomfiture, in the unspeakable sufferings, in the awful destruction of
human life, and, in short, in the triumph of nature over humanity,
which, from beginning to end, attended the disastrous retreat of that
mighty congregation of France’s bravest sons.

Let the case be that of the retreat of the Grand Army from Moscow,
which, alas, was one horrid series of unprecedented disasters, of wreck
upon wreck, whose course was one prolonged deathbed—one white, one
snow-white shroud—one extended grave, which barely spared enough to
convey the fatal tidings, and which received heroes by thousands, valour
and all that is ennobling in the mass, which monuments can never
note,—and broken hearts and broken ties, those of husband, of father,
and of comrade, for which tears have flowed, but which tears can never
bind again.

“At every step he (the Emperor) saw his soldiers, stricken by cold,
extenuated by hunger and fatigue, falling half dead into the hands of
the Russian cavalry.

“Around these (their bivouacs) hunger and cold rivetted those wretched
sufferers. It was impossible to tear them away.

“Above sixty thousand men well clothed, well fed, and completely armed,
attacked eighteen thousand half naked, ill armed, famished men,
encumbered by more than fifty thousand stragglers, sick and wounded. For
two days the cold and misery were so intense that the old guard lost a
third, and the young guard one-half of their effective men.

“It was indeed but the shade of an army, but it was the shade of a grand
army. It felt itself conquered by nature alone.

“Under these circumstances, the elements appeared more hostile to us
than the Russians themselves. Their climate did its part—if they had
done theirs.”

In that disastrous retreat there was a most extraordinary accumulation
of influences powerfully destructive of health. There was extreme cold,
that of an intensely cold climate, there was an insufficiency of food
and of clothing, and there was a want of proper habitations,—the
wretched sufferers lying almost naked around their fires in the open
air, perhaps enjoying the partial protection of a shed, a ruin, or a
stable, and sometimes seeking shelter in the carcasses of horses. But
there was also present another influence, highly prejudicial to health,
and equal of itself to a considerable proportion of the fearful amount
of disease which prevailed, and that was depression of mind.

Depression of mind conveyed a withering influence to the hearts of the
bold victors of a thousand actions, and paralyzed the whole energies of
the system. Here it acted on a gigantic scale, and its work of death,
yes, of death itself, was not less prodigious.

The humiliation, the mortifications, and the heart-rending misfortunes
of which these once victorious but now unhappy men were the prey, could
not but induce a state of mind, which, of all other circumstances, must
have been the most favourable to the invasion of disease. Daily
experience demonstrates that disease is much favoured by the presence of
circumstances, such as are referred to in the following passages.

“That grand army, which, in the course of the preceding twenty years,
had marched in triumph through all the capitals of Europe, now, for the
first time, reappeared, mutilated, disarmed, and fugitive in one of
those (Konigsberg) which its glory had reduced to the greatest
abasement. Its inhabitants hastened into the streets, as we passed
along, to observe and reckon our wounds, and to estimate by the number
and the extent of our misfortunes, the foundation on which they might
build their hopes: we were forced to regale their eager and delightful
eyes with our miseries; to submit to pass under the yoke of their
delight, and, dragging our squalid and miserable forms in full review
before their detested scrutiny, to march under the almost insupportable
weight of calamity which the hatred of the spectators beheld even with
transport.”[9]

Footnote 9:

  Segur’s Expedition to Russia.

The very knowledge and observation of mental distress and bodily
suffering creates a depression of mind, and sickness arising therefrom
spreads among the spectators, although, in other respects, they are
comfortably situated, and have abundance of clothing and wholesome food.

Segur further relates:—“Consternation took possession of the soldiers of
Marshal Victor, though unbroken in numbers and in spirits, after having
given way to their customary acclamations on beholding their Imperial
commander, when, instead of the grand column which was to achieve the
conquest of Moscow, they perceived behind Napoleon, only a band of
spectres, covered with rags, women’s pelisses, bits of carpet, or with
dirty cloaks scorched and burnt by the fire of the bivouacs, and with
feet wrapped in the most wretched tatters.”

Depression of mind favours the accession of many diseases. This was
noticed when the prevalence of fever was under observation.

It has been remarked by Citois, that the colic of Devonshire and Poutou
attacks more particularly those families who are suffering under that
calamity.

Disease frequently makes its first appearance when friends and relatives
assemble to pay the last marks of respect at the funeral of the
departed. I am acquainted with several instances in which, shivering,
tremors, and sense of great debility, have suddenly supervened in men in
perfect health upon the “lifting” of the corpse, and upon the “lowering”
into the grave, moments in which the hearts of many would seem to
threaten to melt away, and in which they have proved to be the primary
symptoms of fever; the other more violent and more dangerous
characteristics being duly developed. A man, named Stevenson, died at
Tranent last winter; the friends were assembled in the house to attend
the funeral; his brother arrived from a distance, just as the body was
about to be lifted, went into the apartment, apprehended he smelt
infection, and instantly felt very ill. After having gone to the
churchyard, and returned home, he was immediately attacked with
sickness, which assumed the form of fever, and he died in the course of
a few days.

The following statement, made by Dr Paris, illustrates well, how
depression of mind, by affecting the system, promotes the action of
poison:—

“A patient had been taking mercurial medicine, and using frictions for a
considerable period, without any apparent effect; under these
circumstances, he was abruptly told that he would fall a victim to his
disease; the unhappy man experienced an unusual shock at this opinion,
and in a few hours became violently salivated (that is, became affected
with the peculiar action of mercury on the mouth).”


                                CLIMATE.

Besides the various causes of pestilence to which reference has been
made, there are many others connected with peculiarities of climate,
irrigation, soil, and habitudes of nations, of which the limits of this
work will not permit an extended account. Of the peculiarities of
climate, the most important are the greater or less intensity of the
sun’s rays. It is found that much solar heat disposes to excessive
action of the liver, and hence it is that fever in tropical regions is
biliary; characterized by derangement of the biliary organs, of which
the liver is the principal; that fever in the West Indies is yellow, a
colour which proceeds from the dissemination of the bile throughout the
body. Few persons who have remained long within the tropics are free of
disease of the liver, and this is well known to be a common, nay, almost
a universal complaint among soldiers who have returned to this country
after many years’ service in those regions.

Another active agent in the production of disease in these climates is
the great fall of dew which takes place between the setting and rising
of the sun, and the extreme degree of cold which attends it. The dew
begins to fall as soon as the sun gets below the horizon, and increases
till about an hour or two before dawn; the cold at that time is extreme,
more particularly felt on account of the great heat which is experienced
during the day. The cold is the immediate cause of the falling of the
dew, which is only the water that was dissipated in vapour by the action
of the sun’s rays. The dew favours the action of the cold; and persons
who are exposed to it, are in consequence frequently attacked with
disease.

Persons unaccustomed to the heat, and ignorant or regardless of the
consequences of exposure to the night air, often suffer much, and become
affected with the peculiar distempers of the climate, in this manner:
they lie down on the ground scantily covered, while the sun is still
above the horizon, and make no provision for the cold and damp of night
which is sure to overtake them.

Persons go to bed also with too few clothes, being then warm and
oppressed with heat; in the night the dew falls, the cold arrives, and
they are often awakened with severe rigors or shiverings; and thus
fever, dysentery, and the like disorders are induced.

The winds in all latitudes are often instrumental in the production of
disease. Some have been already referred to in connexion with the
conveyance of vitiated air. Some are hurtful from their excessive heat,
as, for instance, those blowing directly off the burning deserts of
Arabia and of Africa. The Sirocco is not only extremely hot, but is
copiously loaded with aqueous vapour. It visits Italy, blowing there
several days at a time, and acts almost as a vapour bath upon the
inhabitants. The Sirocco blows off the deserts of Africa, passing over
the Mediterranean sea, there imbibing a large quantity of water,
converted into vapour, and rushes upon the fair shores and degenerate
population of Italy. Its immediate effect is to relax the system, and to
open up all the pores on the surface of the body. These effects are very
hurtful to health, and become particularly so, when they are long
continued, as sometimes happens. But more dreadful are the results of
exposure of persons so situated, to the sudden action of an intensely
cold blast, such as the Tramontane, which, driving from the northern
side of the Alps and Pyrenees, passing over their snow-capt summits, and
sharing their bitterness and frost, rushes, without warning, upon the
inhabitants.

The tramontane is very cold, and acting upon persons in a manner
“forcing” in a hot house, soon produces pleurisies, colds, consumptions,
&c. &c.

These vicissitudes in Italy, and those which are wont to occur in
regions within the tropics, are much greater than the variations of
weather which are experienced in the British Isles, and which are
comparatively harmless; or are hurtful, at least, in a much less degree.

In many countries the rivers periodically overflow their banks and cover
the surrounding territory. The Nile overflows annually, and when the
water has almost disappeared by infiltration into the soil, and by
evaporation, and when that which is left is muddy, slimy, and mixed with
organized remains, exhalations arise, and a vitiated atmosphere is
produced, which is said by medical men, who have lived upon the banks of
that river, to be productive of plague.

The territory again on the banks of the Canton river in China, is almost
constantly under water, and its fertility is thereby much increased. The
ground there is used for the growth of rice which delights in a soil
covered with water. When the heat is intense, when the water contains
organized putrefying materials, and when the weather is close, and the
atmosphere is a little agitated, then vapours ascend which, mixing with
the air, cause it to be vitiated, and to be productive of malignant
remittent fever.

The habits of nations are also influential in the production of disease.
The privations and penances which devotees endure are followed by a very
hurtful influence on the health, whether they be what are enjoined, or
whether they be voluntarily suffered, as they suppose, to conciliate the
favour of the Deity.

The diet, clothing, occupations, pleasures, government, laws, social
usages, genius, and ambition of nations, materially influence their
health, and give tendencies to particular maladies; but interesting as
the subject is, the investigation cannot be pursued here.




                              CHAPTER XI.
 THE AVOIDANCE OF DISEASES MARKED WITH PALPABLE CONTAGIOUS POISONS—THE
                 LIMITED RANGE OF ACTION OF CONTAGION.


It was shewn in the first part of this work, that the contagious poisons
of disease, such as the matter of small-pox, are known to act in two
modes only, _first_, by application of the palpable matter itself to a
person, or by contactual contagion; _secondly_, by application of
clothes or other such substances, impregnated with that matter, forming
what has been styled fomitic or mediate contagion. It was also shewn,
that their action through the medium of the atmosphere, has never been
ascertained. Experiments were detailed, which were performed on those
poisons, to ascertain their capability to become dissolved in the air,
and their evidence was as strong as it possibly could be, against their
possessing that attribute.

It was, in short, fully ascertained, that contagious diseases do not
propagate by atmospheric contagion.

Contagious diseases propagate among those who expose their persons to
contact with the matters or clothes impregnated with them. There are
many facts of an incontrovertible character, which prove the occasional
operation of the former mode at least, and to render probable, that of
the latter; and hence, whatever attention is paid to cleanliness of the
sick person, his apartment, and to the prevention and removal of
vitiated air, persons touching a body, when there is present on its
surface specific contagious poison, such as the matter of small-pox, or
even handling clothes, which have become impregnated with it, incur a
risk of being affected with the same disease, by means of that matter or
fomitic contagion.

In all the contagious diseases (those in which there is eliminated a
palpable poison, or matter capable of causing the same disease in
others), their respective matters are invariably formed, and are apt to
propagate in the modes specified, so that visitors and other attendants
should ever be upon their guard, the first not to touch the sick person
at all, and the latter not to touch more than is necessary, and to take
precaution to render the risk as slight as possible.

Subjoined is a list of diseases which are known to be contagious, or to
be possessed of a matter of the nature referred to, and that are
therefore wont to be propagated by contact with the sick, or with his
clothes.

                             Small-Pox.
                             Scarlet Fever.
                             Measles.
                             Chicken-Pox.
                             Cow-Pox.
                             Itch.
                             Plague.
                             Porrigo.
                             &c.

These are almost the only diseases known in this country, which are
positively ascertained to be characterized by the elimination of
contagious matter, and which, therefore, there is any risk of getting by
contagion. The continued fever of this country has been supposed, by
some physicians, to be a contagious disease, from there being sometimes
observed pimples on persons affected with it; but that is by no means an
ascertained point.

Those above enumerated seem to include all the most important diseases
in this country, which are capable of being propagated by contagion,
acting in either of the two ways already described. Some of them are
capable of affecting the same individual only once, and some affect
persons as often as they are exposed to their specific contagious
matters.

How comparatively small, then, is the range of contagion,—an agent which
has been thought to accomplish worlds of mischief, and to destroy almost
whole communities.

Visitors may approach within a very short distance of persons afflicted
with these distempers, without danger of suffering, provided they do not
touch the bodies or the clothes.

They have nothing to apprehend from the atmosphere, if attention is paid
to the maintenance of its purity,—such as is necessary in other
situations, as well as in the sick-room.

Never brought into that immediate contact with the poisons which is
necessary for their propagation, they stand in need of no directions for
their removal or counteraction.

Those persons, on the other hand, who are called upon to touch the
patient and his clothes, are exposed to danger; and they should lessen
its amount, by instantly putting their hands into warm water, and by
freely washing them, with the assistance of soap,—and that ablution
should be performed after each instance of contact.

I have often had occasion to feel the pulse of persons ill of the worst
forms of confluent and black small-pox, and any risk that has thereby
been incurred, has been removed or remedied by immediately washing the
hand as directed.

In addition to washing, after that process is done, a small quantity of
a strong smelling liquid, such as Lavender water or Eau de Cologne,
should be poured into the hands. Their grateful odour may hide or cover
that of the apartment, which the attendant may mistake for contagious
air, as is often done, and thereby remove groundless apprehension. These
seem to be the chief precautions that are necessary for meeting the
dangers of contagion, if there is included what is sometimes used, viz.
a covering for the hand,—a glove and the like,—which, as being harmless,
and such as may possibly be useful, should be employed; and likewise the
avoiding of eating and drinking with the same instruments and vessels
used by the sick persons.

The propagation of disease by contagion, in the modes already stated,
though it can take place, and though it sometimes does take place, still
there are the strongest grounds for supposing it a comparatively rare
occurrence.

I have already shewn, at the beginning of this work, that in one form,
the atmospheric, contagion never operates, and I am now prepared to
assert, that in the two forms in which alone it can act, that the
instances of its undoubted agency are by no means nearly so common as
they are commonly believed to be, especially in connexion with those
acute diseases, accompanied with fever.

It is my belief, founded on much observation, study, and reflection,
that almost all cases of those contagious diseases, arise from causes or
circumstances connected with those great agencies already detailed at
full length, as inductive of pestilence in general, and of a nature
epidemic, endemial, meteorological, and the like.

I am led to the opinion, that this course of origin, even in contagious
diseases, is the rule, and that the origin of disease, by contagion,
whether contactual or mediate, is the exception. The grounds of this
opinion are,—

_1st_, A fact well ascertained, and of which I had lately two instances,
in houses contiguous. Infants neither inoculated, nor vaccinated, lie
with their mothers and others ill of small-pox, and do not take that
distemper.

_2d_, Women, while labouring under small-pox, occasionally bear children
in perfect health.

The above are common occurrences, and I am in possession of the
particulars of several which came under my own observation in the
beginning of 1838.

These cases prove the occasional, nay, the frequent inactivity of
contagious poison, even when applied in a palpable form, and in a recent
condition, to the bodies even of those who are not protected against its
operation by inoculation for cow or small-pox, or by a previous attack
of disease; and this inactivity is observed too, when the most ample
opportunity is afforded for the action of the poison, viz. while
children are asleep together in the same bed, and when infants are upon
the breast of mothers affected with small-pox.

Those very children who thus escape taking disease by contagion, are
frequently known to be seized with that identical disease, at some
future time, varying from months to years, when no other case is known
to exist in the neighbourhood, and where there is no room to suspect the
operation of contagion.

It is, I believe, as common as the contrary course, for small-pox, and
other reputed contagious diseases, after appearing in one house in a
town or hamlet, to break out in others at a distance and in different
directions, and not to progress from that which was first attacked to
those lying adjacent, or to spread around as from a centre.

For example, the first case of Typhus Fever which occurred in my
practice, in January 1839, was at Meadow Mill, a village half a mile
north of Tranent; the second case was at a hamlet called Redcoll, about
four miles east; the fourth and fifth cases occurred in Tranent; while
the sixth and last for that month appeared at Elphinstone, a village
situated about two miles to the south-west of Tranent.

I am led also to the opinion, that the ordinary cases, even of those
diseases which are known to be occasionally propagated by contagious
poison, do not arise from contagion, but from other circumstances and
agencies; by the history of the plague, for while that scourge is
ravaging in the East, and destroying hundreds daily, it frequently
ceases, immediately upon the overflowing of the Nile, which buries and
covers the pestiferous soil, and the putrefying materials which had been
exhaling noxious emanations.

This sudden departure or cessation of plague, upon the overflowing of
the Nile, proves that contagion, though it may be the cause of some
cases of that disease, is not the occasion of the vast majority,—the
great mass of cases, in short, which constitute the Epidemic; and goes
far to prove that distemper to be dependent upon an unwholesome
condition of the soil, or vitiated atmosphere, and other widely extended
and unwholesome agencies, of a nature totally different from specific
contagious poison.

That fact goes to prove, in reference to one disease, viz. Plague, what
I believe holds with all other contagious distempers, that contagion, at
most, is only an occasional, while such influences as those to which
reference has been made, are the constant and general causes of
sickness.




                              CHAPTER XII.
             THE PREVENTION AND CORRECTION OF VITIATED AIR.


The important part which vitiated air enacts in the production of many
forms of disease, has been already fully shewn; and it must be admitted,
that whatever has for its objects the prevention and correction of that
principle, is deserving of attention.

By preventing the production, and by removing vitiated air when already
formed, a vast amount of disease may be arrested, and much of that
benefit will actually be accomplished, which it was boldly but
fallaciously pronounced would revert from many absurd measures which
were adopted, and which are still recommended for the avoidance of
contagion, and would realize almost all the advantages which Quarantine
Regulations, and the most efficient systems of Contagion Police can or
propose to afford; and that, too, at no inconvenience to individuals, no
restraint upon communication, after certain processes of purification
have been undergone, and no ruinous hindrance of commercial
transactions.

The various sources of vitiated air have been already noted. Some of
them are beyond any present remedy, as the unwholesome condition of the
surface of the earth in many regions, within the tropics, for whose
correction or improvement, time, capital, enterprise, labour, and
perhaps new climates, are essential. To that source of vitiated air,
draining, cutting down superabundant wood, embanking rivers, reclaiming
partially inundated land, and cultivation, must be applied before the
emanations which infest these situations can be prevented from arising.

Another source of vitiated air is, men being crowded together in close
and confined apartments, where no attention is paid to the preservation
of cleanliness and the removal of impurities, as in some jails and other
places for the confinement of criminals.

That source of vitiated air is particularly worthy of notice here,
because a very common form of disease which it induces is what is well
known as Jail or Contagious Fever.

The means for the prevention of this form of vitiated air are obvious.
Large, airy, well ventilated and lofty apartments are essential, if many
persons must be put together; and, where that is not necessary, it is
advisable to have them separated in several different chambers, where
due ventilation is strictly maintained, by retaining the windows more or
less open through the day, or by other equally effective means.

By the sleeping of many persons in one apartment, the atmosphere is
deprived to a great extent of its more vital fluid, and becomes unfit to
support respiration in its integrity; and the health of the inmates is
not unfrequently injured in consequence. The sleeping of many persons in
one bed-room, therefore, should be avoided, where it is possible; but,
where that is not practicable, it becomes necessary to lessen the evil
consequences, and this may be done by keeping a door or window partially
open during the night, when the weather is not too inclement to forbid
that procedure.

At all times, exhalations to a great extent are proceeding from the
bodies of men; and, where individuals are much confined to one
apartment, and where that is small, close, and ill ventilated, they
fasten or adhere to the furniture, curtains, carpets, and the very
walls. During sleep, the amount of these exhalations, it would appear,
is increased. It is then that the pores of the entire system, as well
upon the internal as the external surfaces, are most freely laid open,
and that they pour forth their respective fluids most abundantly. The
quantity of watery vapour which issues during sleep from the lungs is
prodigious; and the large quantity of water which is sometimes seen
collected on the panes of windows in the morning, and which is condensed
vapour, affords some idea of the vast quantity of fluid which is exhaled
during sleep. With this watery vapour, other ingredients of a hurtful
nature are conjoined, and, like it, adhere to the furniture and clothes.
When these exhalations are permitted to remain, they impart to the room
a disagreeable odour, cause the bed-clothes to be damp and unwholesome,
which, with the progress of fermentation, at length emit offensive
effluvia. In order to avoid these hurtful consequences, the following
measures should be adopted. When the bed-room is left in the morning,
the window or windows should be opened, and the bed-clothes freely
exposed to the air for some time: the constant passing of fresh air over
the clothes and through the apartment, will shortly carry off the
greater part of the exhalations which may have adhered.

The window should be left open during a part of the day, if the
atmosphere without is not particularly damp, as the removal of
impurities, when they have adhered to solid bodies, is not effected at
once, or so immediately as is generally believed.

Exhalations of a very hurtful nature proceed also from excretions, which
should be removed immediately, certainly before fermentation can have
proceeded to any considerable length.

The furniture of bed-rooms requires special care. The various processes
of rubbing, washing, and scouring, should be frequently repeated; and
articles, such as bed and window curtains, should be oftener in the
washing-tub than is dreamt of by many very careful housekeepers, and
when they are composed of fabrics of a nature to forbid contact with
soap and water, the necessary purification may be effected, at least in
a partial manner, by occasional exposure to the wind in the open air.

In those apartments in which the sick are contained, the atmosphere is
particularly liable to become vitiated from the exhalations of the body,
and from the excretions being in general more disposed to be virulent
than those of persons in health.

The necessity for a constant supply of pure air is, if possible,
increased, and the utmost care and attention is demanded, in order that
this may be duly provided. In large hospitals for the reception of sick,
ventilation becomes a point of the most important nature; and, when
efficiently established, is entitled to be considered one of the most
powerful remedies which can be obtained to check the progress of
disease, and to promote recovery, when that is once established.

Various methods have been devised to promote ventilation in hospitals,
which it is unnecessary to describe here; for this reason, as well as
others, that the importance of ventilation is too well understood by
medical men, for them not to enforce it in establishments of which they
have the management.

During sickness in private houses, ventilation cannot be too much
enforced. When the weather will permit, one window at least should be
partially opened, pulled down, if possible, during the summer. In
winter, the door of the apartment should be left open for a short time
occasionally; and, if the chamber is not very small, a fire may be used,
which will not only remove the cutting dullness of the air, but will
also ensure a constant change of the atmosphere, from the ventilation
which it causes.

In some forms of disease, as in the “Sweating Sickness of England,”—the
typhus fever, the skin is wont to become covered with perspiration,
which is particularly prone to undergo putrefaction. To obviate that
putrefaction, and to prevent the formation of effluvia, it is proper to
wash the skin of the patient, in almost every form of disease, with soap
and warm water, which will purify that important organ, and assist in
rectifying its functions. Where the character of the disease is putrid,
sponging the skin with vinegar and water, either warm or cold, should be
adopted, and is often of the greatest use.

All impurities should be removed from the sick-room, as they are liable
to vitiate the atmosphere; and all clothes and utensils which have been
used by the patient should be immediately put among warm water, and left
there till a convenient season occur for their being thoroughly
cleansed.

When the patient is in a state to bear the fatigue of being removed for
part of the day to another chamber, advantage should be taken of his
absence from his bed-room, to ventilate the apartment, by throwing open
the doors and windows, to expose his bed and body clothes to the free
action of the air, and to cover the sickly smell frequently present in
sick chambers, by the burning or dissemination of some fragrant
substance in the atmosphere.


                      CORRECTION OF VITIATED AIR.

The effluvia which are wont to arise in sick-rooms, are sometimes so
very strong, especially where little attention is paid to cleanliness
and ventilation, as to fasten most tenaciously to the contents of the
apartments, and to impart to them a most disagreeable and sickly odour,
not immediately removeable upon the establishment of currents of air
obtained by opening the doors and windows.

These effluvia, for the most part, are cognizable to the organ of smell,
and they have long been, and are still, vaguely designated “Contagion,”
“Infection,” and the like.

Where effluvia are not recognised by the organ of smell, there are many
good reasons for believing, notwithstanding that circumstance, that they
may be present in rooms which contain, and which have lately contained,
sick persons.

Well authenticated cases are on record, where persons in health have
inhabited apartments which, at a former period, contained sick persons,
and have been attacked with disease in such a manner as to leave little
doubt of the presence of unwholesome effluvia, and of their having been
the efficient agency in the production of the evil. These instances have
occurred, where it is impossible to suppose that the effluvia could have
been commingled with the atmosphere during the whole interval, often
amounting to years, from the period of the removal of the sick, to that
of the taking up of their abode there by those who have suffered.

The period during which the apartment has been uninhabited has, on many
occasions, been too long to admit of the opinion that the atmosphere has
not been again and again changed. It would therefore appear, that not
only the atmosphere becomes infested, on those occasions, with effluvia,
but that the walls, the furniture, and the floors may likewise become
impregnated with them.

It is consonant with experience to admit, that solid bodies occasionally
combine with, or imbibe, or attract gasiform products, or that aeriform
or vaporic agents adhere to solid substances.

The opinion may be entertained, that the effluvia of sick rooms may
fasten to the furniture, &c., and in that situation, even where
ventilation is maintained, form centres from whence they may be
disengaged, either constantly, for a long period, or only on occasions
which are particularly favourable for their redissemination in the
atmosphere.

It is common to designate these effluvia primarily disseminated in the
atmosphere, and the vitiated air which is formed in old fever and plague
wards, and to which reference has just been made, Contagion, without any
other term to mark the distinction between these principles and those
which are legitimately so called. In a previous part of this work, the
distinction has been carefully made, and it was shewn that the effluvia
under discussion do not form, strictly speaking, a contagious, but only
a vitiated atmosphere.

As it appears that effluvia which arise from the bodies, and the
excretions of the sick, do not only mingle with the atmosphere, but also
adhere to furniture, walls, &c., when concentrated and long exhaled, it
becomes necessary not only to remove that atmosphere in which they are
disseminated, but also to adopt means for the purification of all those
bodies to which they may adhere, in order that the atmosphere may not
become again and again loaded with them, arising, as they may, from the
places to which they are adhering.

The means best calculated to obtain that end, are those processes to
which reference was made above, viz. rubbing, scouring, washing, and
exposing to the free action of the air.

But besides these means of purification, there are others, as
fumigations, which are calculated to be highly useful, and which should
be used on all occasions of severe general disease.

Fumigations are vapours of an elastic nature, permanent and
non-permanent. They are diffused through the atmosphere, and impart to
it their peculiar odours.

They are highly useful. In the _first_ place, there is reason to believe
that they, especially the more active, may decompose the effluvia which
are mingled with the atmosphere, and which are adhering to solid bodies,
all of which they can be made to reach and act upon, and even to
penetrate where the scrubbing-brush and hot water cannot be applied; in
the _second_ place, they insure a change of atmosphere; and, in the
_third_ place, they effectually cover or hide the smell of the
sick-room, which is at all times highly disagreeable, and which is often
regarded with great terror and apprehension, being ever associated with
ideas of contagion and disease;—and in this way, fumigations are found
of very great value, giving, at the same time confidence to the timid,
and affording something different from what contagion is commonly
thought to be, on which the organ of smell may be safely exercised.

Some fumigations are produced by the volatilization of solid bodies, as
camphor and carbonate of ammonia, or sal volatile;—some by the
volatilization of liquids, such as vinegar, pyroligneous acid, and the
various essential oils, as cinnamon, rose, thyme, mint, pennyroyal,
carraway, and turpentine, while others are permanently elastic fluids or
gases, as muriatic acid gas, chlorine, and ammonia.

The first-mentioned substances, viz. camphor and ammonia, are not very
strong, and may be disseminated through the apartment of the patient,
even when he is present, without giving him any uneasiness. Carried
about with those who visit the sick, and who are apprehensive of
contagion, they are useful by affording a grateful odour, which hides
disagreeable taints, and perhaps it is in that way chiefly that they are
useful.

The liquids which have been named above, have been long used for the
purposes of fumigation, and in general, they may be employed even in the
presence of the patient. A few of them may possibly decompose effluvia,
but there is much reason to think that they are useful, for the most
part, by hiding ungrateful odours, and imparting to the atmosphere,
which is liable to be suspected as unwholesome, a delightful fragrance.

Vinegar is much used for the purpose, and with very considerable
benefit, and is therefore to be employed.

The essential oils are capable of being diffused throughout the air, and
with the assistance of heat, are often made available for the purpose of
covering odours. When they are to be used, the oils should be poured
upon a piece of live coal, held in the middle of the apartment; they are
then immediately converted into vapour. In like manner, vinegar and the
other volatile liquids may be disseminated through the atmosphere.

The oils, the vegetable substances in which they are contained, tar and
the like, are occasionally burnt with the same intention, and sometimes
with advantage.

The incense so much used by the ancients, was procured for the most part
by the burning of the vegetable substances in which these essential and
fragrant oils resided, by which part of them is diffused in vapour.

The ostensible and pretended object of the priests, in offering up
incense, while that and other religious rites were performing over the
bodies of deceased persons, was the conciliation and propitiation of the
Deity. But while this was the sole ostensible object of the priests, and
that which was held by the people, as the only and exclusive purpose
proposed, there is good reason to believe that the offering up of
incense, like many other observances of religion, had its temporal, and
worldly, as well as spiritual ends; and that the sweet smelling odours,
which were thought would be so grateful to Heaven, were, on those
occasions, used in no small degree, as so many fumigations, to defend
the pious and resigned priests from the effluvia of the dead body, and
the consequent corruption of the atmosphere.

The use of fumigations, in a disguised form, was perhaps rendered
necessary, as the purpose of purifying the atmosphere, might have seemed
to cast reflections or imputations on the dead, which the vile,
barbarous, and superstitious people, especially relatives, might have
resented with acts of violence, or which might have thrown priest-craft
into contempt and abhorrence.

Perhaps it was in reference to this matter, as it was in many others of
graver import, that the ignorant and superstitious condition of the
people on the one hand, and the cunning, subtlety, despotism, and
superior knowledge of the ministers of religion on the other, in early
times, made it convenient that certain ends, thought to be desirable,
should be accomplished without reasons, explanations, or intentions
being given.

There is, then, reason to believe, that the burning of oils and other
fragrant substances, was used in very early times to purify the
atmosphere from the effluvia of dead bodies.

The products of the combustion of essential oils, tar, pitch, and the
like, are carbonic acid gas and watery vapour, which, there is reason to
think, cannot be useful in purifying the air, or in neutralizing hurtful
effluvia.

The permanently elastic gases which are used as fumigations, are the
most potent agents of the kind, and they are generally used, and with
much propriety and advantage, in all cases where disease is of a putrid
character, and where, in short, the atmosphere is likely to be vitiated
to a great extent. They form also the most useful fumigations for the
purpose of purifying the atmosphere, and the walls and furniture of
apartments lately inhabited by the sick, and their employment, in such
cases, should never be neglected, even when there is no great reason to
apprehend vitiation of the atmosphere, for when advantage is doubtful,
there can exist no possibility of detriment. The agent now most commonly
employed, is chlorine gas, and it is perhaps the most efficient in the
list of fumigations.

Chlorine gas has a greenish colour, and a most disagreeable and
suffocating odour. Water impregnated with it, has the property of
destroying colours, and chlorine is, on that account, much employed in
bleaching, in the forms of “Bleaching Powder” and “Tennant’s Powder.”

When chlorine gas is disseminated through an apartment, any stench,
however strong and intolerable, which may have been present there, is no
longer perceptible, the odour of the chlorine taking its place, or so
completely covering it, as to render it no longer cognisable to the
senses.

Chlorine gas is employed both alone, and in combination with other
bodies, as lime and soda.

In combination with these alkalis, chlorine forms the chlorides of lime
and soda. The former is well known in this country, and the latter, when
dissolved in water, forms the “Liqueur disinfectante” of Monsieur
Labarraque, which is much celebrated on the Continent.

The solutions of these salts in water, are sprinkled occasionally
through the apartments which are to be purified.

When these solutions are sprinkled about, and exposed to the action of
the air, the chlorine escapes in its gaseous form and mingles with the
atmosphere, while the lime and soda, which are now uncombined, attract
and unite with any carbonic acid which may have arisen from the patient,
his clothes, or excretions.

The solution of chloride or chloruret of lime, answers sufficiently
well, but as it is to be obtained in all drug shops, it is unnecessary
to add here a formula for its preparation.


              FORMULA FOR THE PREPARATION OF CHLORINE GAS.

Take three parts of common salt, one of black oxide of manganese, and
three of strong oil of vitriol. Mix the salt and the oxide together in a
stoppered retort, pour in the oil of vitriol and apply a gentle heat.
The gas is immediately evolved, and rapidly diffuses itself throughout
the atmosphere. Muriatic acid gas, a combination of chlorine and
hydrogen gases, though considered as inferior to chlorine as a
fumigation, is frequently employed for the purpose of decomposing
effluvia, as the materials for its preparation are almost ever at hand.


                FORMULA FOR OBTAINING MURIATIC ACID GAS.

Put a handful of common salt previously made very hot into a saucer, and
pour over it an ounce of strong oil of vitriol. The gas is immediately
extricated.

It has been already said that the fumigations just noticed are on many
occasions highly useful, and their employment is much recommended in all
situations where the atmosphere is liable to be contaminated by effluvia
from sick persons or from dead bodies; but it is not therefore to be
understood that, because the use of these agents has been advocated, it
is for the purpose of destroying atmospheric contagion, of decomposing
the specific animal poisons which have been supposed to be present, and
dissolved in the atmosphere, which is the object, or one of the objects,
held in view by the generality of those who advise the use of
fumigations. These fumigations have been recommended with the view of
correcting what has been treated of as vitiated air, which is distinct
from, but which has long been erroneously regarded as, Atmospheric
Contagion. On some occasions, great fires of wood, coal, pitch,
gunpowder, and the like, have been recommended for the purpose of
destroying contagion and purifying the atmosphere. During the prevalence
of the plague in London, great fires were kindled in the streets, and,
according to some historians, with considerable benefit.

Such great fires produce great agitation of the atmosphere, and it is
possible that in this way they may prove useful in improving the
condition of that fluid, particularly when, as happened occasionally
during the visitations of plague in London, the weather is sultry and
close, and when the atmosphere is confined and little agitated, and
allowed almost to stagnate.

There is much reason to think that the agitation of the ocean, by its
waves and tides, is not more favourable to the preservation of the
purity of its waters, than the movement of the atmosphere, by winds and
currents, is to the maintenance of its wholesome condition, and when
this is lost, to restore it; and in the absence of winds, and when
pestilence is raging, the use of combustion on a large scale may with
advantage be adopted; but in this climate, where the weather is seldom
long calm, the occasions for the employment of that agency can be very
rare indeed.

Heat is much used for the purpose of dissipating effluvia, and purifying
goods, clothes, letters, &c., which are supposed to be impregnated with
contagious matter, or other unwholesome impurities; and there is good
evidence to shew that this agent is perhaps the most powerful instrument
which is ever employed for the purpose in question.

Heat when applied to an atmosphere containing effluvia will rarefy it,
cause it to become lighter, and dissipate it, amid the atmosphere above,
where any opportunity is afforded for its egress; and when the heat is
employed in the sick chamber, much good is effected by the dissipation
of the damp and condensed vapour which cannot fail to be frequently
present in that situation.

In the sick chamber, the presence of a fire for even an hour daily is
highly useful where there is little opportunity for ventilation, and
when the external atmosphere is damp and motionless, for the heat
issuing from it, will dislodge and dissipate any effluvia which may have
become condensed, and have fastened on the furniture of the apartment.

The condensation of effluvia, &c., is thus depicted in the “Mussulman.”
The apartment is that of a prison. —— The pestiferous breath of the
surviving was mingled with the effluvia from the dead, and the
empoisoned exhalation was condensed on the damp walls, and was seen
trickling down in drops of poison to the ground.[10]

Footnote 10:

  The Mussulman by Madden.

Heat, when applied to clothes which are impregnated with specific
contagious matter, or merely impurities or condensed effluvia, is
calculated to be highly useful, and where washing cannot be adopted,
should never be neglected. Clothes which are thus tainted will be
deprived in a great measure of their power of doing mischief, by placing
them before a fire for a considerable time, for there is good reason to
think that specific contagious poisons will be decomposed, and it is
ascertained that condensed effluvia may be dissipated by the application
of a smart heat.

The following experiment will at once illustrate the property which some
bodies possess of absorbing effluvia from the atmosphere, and prove the
influence of heat in again expelling and dissipating them. Pure sand,
exposed to a red heat to drive off impurities, was put amidst tainted
air. Put into a glass tube and exposed to a spirit lamp, it yielded
ammonia or hartshorn,—a product of putrefaction which the sand had
undoubtedly absorbed from the tainted atmosphere. Ammonia is a compound
of nitrogen and hydrogen, gases which are evolved during the
putrefaction of animal materials.

The investigation of the means by which persons, merchandize, clothes,
letters, &c., may be most speedily and most effectually freed from
effluvia, contagion, and other unwholesome impurities, is a most
important point, for it relates to the most vital interests of society,
commerce, freedom of intercourse, personal liberty, and the safety and
health of the community. But from the very important considerations with
which the investigation is connected, the merits of the respective means
employed for the purpose will not be treated of here, as they deserve a
more extended consideration than can be given. In the mean time it would
be highly dangerous and impolitic, to adopt any great and rash change in
a system so important as quarantine, until the most full and sound
inquiry has been made upon the subject. Public safety demands the utmost
caution.

There may exist great diversity of opinion respecting the nature of the
impurities with which merchandize and clothes are sometimes impregnated,
on the period during which they retain their activity, and on the means
of purification; but it has been often clearly demonstrated, that
specific contagious matter, or virus, and effluvia, may be conveyed by
these bodies, may be retained for a considerable time, and, on a
favourable opportunity, produce very hurtful effects.

The impurities may be variously designated, yet their unwholesome
tendency is much the same, and it is necessary to adopt provisions to
counteract it.




                             CHAPTER XIII.
 THE PREVENTION OF VITIATED AIR IN CONNECTION WITH THE DISPOSAL OF THE
         DEAD—OFFALS—CONSTRUCTION OF TOWNS, HOUSES, SEWERS, &C.


In the Chapters which have been dedicated to the subject of Vitiated
Air, its sources were pointed out in a general manner, and it is
intended to consider those usages in society, certain conditions of
towns and houses, and some other circumstances, which favour the
production of an impure and unwholesome atmosphere, and this will be
done with the hope that a knowledge of their hurtful tendency may lead
to their correction.

The disposal of the dead will be first considered.

As soon as the life of man is extinct, his body becomes the seat of
chemical decomposition or putrefaction, and effluvia are exhaled from
the putrid corpse, varying in some degree, in amount, rapidity, and
activity, according as the circumstances in which it is placed are more
or less favourable to putrefaction.

The effluvia which are exhaled are deleterious, and an atmosphere in
which they are evolved, if close, small, and confined, often becomes so
contaminated and vitiated as to be calculated to produce death by
suffocation and disease.

The body of man after death is thus a centre of putrefaction, and the
source of agencies prejudicial to the living, and on that account alone,
it is wise so to dispose of the dead that they may not prove hurtful to
the surviving, which has been done with more or less efficiency from the
very earliest epochs of time, by various forms of burial.

But solicitude for the safety of the living has not been the only motive
for the burial of the dead, for the destiny of man after death is
clearly pointed out, and his doom to the earth is amply shewn by various
expressions contained in the Holy Writings, and his burial or interment
has been performed in obedience to the original or divine plan.

The interment or burial of the dead has likewise been considered as a
rite due to the memory of the deceased, and a mark of respect which the
friends and relatives were bound by every sacred obligation, to perform
with all becoming solemnity.

To neglect the sacred office of interment, or any of the solemnities
usually in practice, was, even among the earliest Greeks and Romans, to
treat the memory of the departed with the grossest disrespect and
indignity.

The denial of burial, with all its formalities, was esteemed by the
Greeks as a mark of infamy due only to villains, traitors to their
country, and those who died in debt, and the bodies of such characters
were accordingly decreed unfit for ordinary interment.

The Jews interred the bodies of the dead for the most part contiguous to
the high ways, in gardens, and on hills.

The Greeks and Romans interred their dead in the ground which surrounded
their sacred buildings, and at the gates and porticoes of their temples.

The Saxons, Danes, and other Scandinavian nations, enclosed the bodies
of the deceased in stone coffins, which were placed or built at the
distance of two or three feet from the surface of the earth.

At this day, these stone coffins are occasionally discovered at a little
depth from the surface. Some such coffins were lately discovered in the
parish of Gladsmuir, in East Lothian, by the coulter of the plough
coming in contact with them. On examination, the coffins were found to
be only a foot and a half below the earth’s surface:—they were about
five feet long, and were composed of several stones fitted together, or
built up. Within were found human bones of the adult size, quite entire
in figure, but so friable, as to fall to powder along with the clay in
which they were imbedded, on being handled. The vertebræ or bones of the
spine, which are at present in my possession, present the same accuracy
of outline to be found in the recent skeleton.

The situation at which these coffins were found, is the very summit of
Seton Hill, a point which commands a view of the surrounding country to
a very great extent, and of the Forth, from its mouth to its meanderings
in Stirlingshire, and which there is much reason to think, may have been
at a very early time, a Danish or Saxon encampment.

The Hindoos dispose of their dead or dying by throwing them into the
Ganges, where they rot and decompose.

In this country the dead are interred at a much greater distance from
the surface than was practised by the Scandinavian nations, generally at
the depth of five, six, or eight feet, and sometimes even more.

After death, corpses are usually kept several days before interment, and
as the temperature of this climate is seldom very great, bad effects are
very seldom experienced, and in that respect, Britain is very unlike
some tropical regions, where, almost as soon as death has taken place,
it becomes necessary to bury the bodies of the deceased in order to
avoid the noxious vapours, which are immediately emitted.

During the time the corpse is kept before interment, attention should be
paid to secure a full and frequent change of air, which is best obtained
by keeping the windows partly open, by volatilizing vinegar, or by
sprinkling the apartment occasionally with the solution of chloride of
lime.

The mode of burial of the present time, which is practised in this
country, is, partly from accidental circumstances, a great improvement
upon that which was in use by our ancestors; for there is much reason to
think that effluvia, proceeding from dead bodies, may percolate or be
strained through a covering of soil of only two or three feet, which may
be completely confined by one of earth and stones of five or six feet in
depth. The great depth to which graves are now dug, originated not so
much with the view of preventing the percolation of effluvia, as with
the intention of embarrassing the operations of the bodysnatcher, whose
violation of tombs is now happily at an end. But though there now
remains no occasion for adopting measures for that purpose, the good
practice of deep burial to which that evil gave rise should not be
allowed to go into desuetude from the absence of those circumstances
which called it into existence.

It is agreeable to information which has been gathered from various
sources, to state, that effluvia may and do penetrate through the loose
soil and other materials of churchyards, when the body is placed within
three feet of the surface of the earth.

With that covering, effluvia do not escape in large quantities at a
time, so as to produce very serious and instantaneous effects; yet a
small amount may percolate from time to time, which, by acting
constantly, without intermission, may be the mean of deteriorating or
undermining the health of those persons who live in their immediate
neighbourhood, and more especially if the situation be one which is not
readily accessible to winds and currents.

It is stated by grave-diggers, that when a body is interred in a grave
five or six feet deep, the effluvia do not reach the surface; so that it
is evident that deep graves are much less dangerous to the living, and
should be adopted in preference to those which are shallow. It is much
to be desired, that no more burying-grounds should be opened or formed
in the heart of towns, and that those which are at present in use, in
such situations, be entirely closed against the admission of more
bodies, and that cemeteries be opened at some distance from the
habitations of men.

Every good purpose which is at present obtained from the burial-grounds
situated in towns, might be also procured from cemeteries placed at a
little distance in the country; and many disadvantages might be avoided
in the latter situation, which attend burial-grounds in densely
populated situations.

One great advantage to be obtained from exurban cemeteries, is the
freedom which the population would enjoy from those exhalations which
must ever arise, in a greater or less degree, from overcrowded
burial-grounds which have, for any considerable time, received the
remains of the dead, and a consequent improved state of health.

Deep graves may for a time prove a security against effluvia, but a day
must come when these graves will be opened, and when their contents,
perhaps not yet totally assimilated with the surrounding clay,—not yet
completely deanimalized,—will be thrown to the surface, and mingled with
the soil, there to finish the process of decomposition, and there to
vitiate the atmosphere.

The burial-grounds of our densely populated towns are actually
supersaturated, if such an expression can be used, with the partially
decomposed remains of mortality, which have not yet had time to be
assimilated with the earth, or to be “ripe,” as the grave-digger would
say.

In general, also, those burial-grounds are so small and ill-proportioned
to the wants of the population, that it is necessary to open graves, and
heap body upon body, until they reach to within a very short distance of
the surface, or to clear the ground of its contents while they are yet
green, in order to procure a place of rest for other bodies.

Such is occasionally the scarcity of ground, small though that space be
which will suffice for any one individual, that ere a few short years
have rolled away, the intrusive spade of the indifferent sexton disturbs
the grave, perhaps of a friend,—that place where peace was promised and
through life expected;—his ashes are rudely handled, and his bones, not
yet denuded of their flesh, are cast without remorse amidst the
rubbish;—and thus the best feelings of humanity are outraged, and the
human heart, already wrung with anguish, is crushed or cruelly
lacerated.

It will perhaps be urged in reply, that the vicinity of burial-grounds
in the large towns of Great Britain are not more unhealthy than other
quarters.

But the answer to this is, that no extended and minute inquiry has been
instituted on the subject; that though the absolute amount of disease
may not be increased (which, however, has not been shewn), still, a part
of the disease which does occur, may arise from the operation of the
emanation from the burial-grounds; and, lastly, it must be obvious to
all who are sensible of the advantage of a pure atmosphere, that the
effluvia which necessarily prevail in those situations, must be
prejudicial to health, whether it be in an amount, or intensity, or
mode, to admit of the detection of the relation between them, as cause
and effect.

If, perchance, in some instances, no prejudicial influence is exerted
upon the health of persons inhabiting the neighbourhood of
burial-grounds, that fortunate immunity from the ordinary effects of
effluvia arising from decomposing animal remains, accumulated in large
quantities, is to be attributed, not to the innocence or innocuous
nature of the emanations, but to the wholesome influence of winds and
currents, in securing a constant supply of pure air, and which prevent
the accumulation of these gaseous poisons in quantities sufficient to
produce the bad effects which are commonly experienced in situations
where they are much concentrated. It is almost impossible to adopt
measures which will completely prevent the admission of effluvia from
burial-grounds into the atmosphere, and it were therefore wise that the
evil, a necessary one as it would appear to be, should be made to exist
where it is least likely to do harm,—and that situation is certainly in
the country, in the open fields, where there are few or no houses.

It is to be hoped that the subject of exurban cemeteries will shortly
obtain the consideration of the government of this country, and of the
magistrates of the various towns,—as it involves interests of the most
important nature.

Several large towns have already cemeteries at a little distance in the
fields; and among others, Glasgow has its City of the Dead, or
Necropolis, as it is styled, which is situated on a height adjoining the
town.

Paris, the capital of that country which has produced many of the most
eminent chemists, has not been tardy to avail itself of the light which
their philosophers have thrown upon the composition of animal bodies,
and the chemical constitution of the atmosphere. That capital boasts a
magnificent cemetery, called Pere la Chaise, which is situated at a
little distance in the open country.

Pere la Chaise is becoming, as the Place of Rest of the dead, worthy to
hold the ashes of departed mortality. There the bodies of men can in no
way be hurtful to the health of those who survive; there, now incapable
of being useful, they are at least harmless to that community of which
they lately formed a part. There the silence—the proper silence—of the
tomb is maintained; there a serenity of aspect exists, which comports
well with the solemn, the quiescent state of its inhabitants; and there
is a cheerfulness, and a beauty, aye a brightness, of a softened, and a
mellowed kind, which seem to refer to the pure enjoyments of the
promised land. There, as in the burial-grounds situated in our thickly
populated towns, there is no obvious and striking unwholesomeness, no
offensive and humiliating appearance of mortal remains, to deter from a
casual glance, or from entrance on the part of the friends and relatives
of the departed. On the contrary, in Pere la Chaise, they are invited
and allured by the softened and chastened beauty of the place, and
there, without endangering their health from close and vitiated air,
they linger by the ashes of the dead, and revolve those solemn thoughts,
so wholesome and so heavenward bending to the soul;—there the bereft
parent is seen giving the reins to his feelings, fondly recalling
cherished associations, and there he is learning to hear unappalled that
he must share a like fate with that of the object whose grave he now
regards;—there may be seen the orphan, come to shed the tear of filial
love over the manes of his departed parents, reviving ties and
affections which are too liable to be entirely worn away by youthful
enjoyment, and the various unsubstantial fascinations of the world;—and
there he learns that most useful and wholesome lesson, to look with
complacence, if not with prospective joy, on death and its silent
abode,—to divest himself of that dread and horror often excited by these
ideas, and which, alas, too frequently drive the young from such
considerations altogether.

In Pere la Chaise, a murmur is heard proceeding from the town, and the
impression made upon the mind is, that the world is receding, that the
noise, mirth, and tumult of man is vanishing away, and that, in short,
the reign of death has commenced,—the reign of death, solemn but not
terrific.

How different is the abode of the dead in the bustling commercial towns
of Britain. Here, solemnity is incongruously enough and offensively
mixed up with the noise and bustle of every-day concerns of men bent on
business or pleasure. Reflections on eternity are here interrupted,
perhaps by the music, or rather the ungrateful noise, of a musical
instrument being played in an adjoining street, the rolling of
carriages, the trampling of horses, the smacking of whips, and the
indecent oaths of waggoners;—while in another street, or fashionable
promenade, which the eyes of the mournful visitor of the abode of death
cannot possibly avoid, the ill comporting sight is seen, fine ladies and
still finer gentlemen laughing and tittering, busied with fantastic
displays. ’Tis an ill-assorted scene, ’tis Nature burlesqued beside
humanity defunct.

But the improvement in burial-grounds is urged, not on the plea of
feelings and sentiments, but on that of public utility and general
health.


                        THE CLEANSING OF TOWNS.

Until within a comparatively short period, the large towns of this
country were kept in a very unclean condition, from the accumulation of
impurities; and the consequence was, that there prevailed a vitiated and
most offensive atmosphere, which often proved hurtful to the health of
the inhabitants.

Habits of cleanliness, and proper notions of domestic comfort have made
rapid progress of late years, and fortunately all classes of the
community enjoy clean and wholesome apartments and streets, compared
with those occupied by their ancestors of a century back; and families
at the present day, who belong to the middle class of society, have the
advantage of greater cleanliness, both of house and locality, than was
then enjoyed by persons of the higher classes.

In many large towns an admirable system of cleansing is maintained, by
which the removal of impurities is insured, which might taint the
atmosphere. The laudable endeavours of the magistrates for this purpose,
have uniformly met that ready cooperation from the more respectable
portion of the inhabitants which they so well merit; but with the lowest
classes, whose ideas are too coarse to permit their recognising danger
in such things as uncleanliness and impure air, the suggestions of
philanthropic individuals, and the exertions of authority, have failed,
in a great degree, to produce that wholesome condition of houses and
localities which is so desirable.

Much uncleanliness still prevails in some streets in those quarters of
towns occupied by the labouring population, which proves the source of
many effluvia, which again, it is probable, assist much in the
production of the great amount of disease which is wont to prevail in
those parts.

There is reason to fear that a considerable proportion of the lowest
classes in all large towns is too much degraded to give themselves any
concern about lessening the tendencies to disease, or to put themselves
to any trouble to remove impurities, further than is absolutely
necessary for their own convenience; but, in such instances, the
authority of the law should interfere, and compel compliance with
regulations for that purpose, the infringement of which is calculated to
produce consequences prejudicial to the public health.

Many, nay most, of the villages of Scotland are kept in a most offensive
and unwholesome state of filthiness; large heaps of corrupting animal
and vegetable materials being allowed to accumulate, in many instances,
in the public thoroughfares, and before the very doors and windows of
the houses, proving the source of the most abominable effluvia,
offensive to the senses of those who are accustomed to a pure
atmosphere, and injurious to the health of all who inhale them. Trenches
or hollows are, in many instances, to be found before the doors, where
water is collected, and forms a nidus for the putrefaction of the
materials above mentioned, and whence issue effluvia which are often to
be recognised in the houses.

In these hollows or cavities are thrown all sorts of impurities, and
they are allowed to remain till a cart-load or two have accumulated,
when, if sufficiently decomposed, they are sold as manure to farmers and
others, at the rate of about a shilling the cart-load.

The collection of impurities is in this case not the result of apathy
and laziness, as in the purlieus in large towns, but of the desire of
gain, or of a trifling advantage, such, for instance, as getting a small
piece of ground, rent free, for the growth of potatoes, which is a
common practice.

Very bad consequences attend the unwholesome condition of the atmosphere
always found in these situations, and more especially in warm and close
weather.

The quarter of Tranent in which typhus fever prevails most is that
called Dow’s Bounds, and a more filthy part is not to be met with in
Scotland; a large area in front of the houses being completely occupied
with the cavities afore-mentioned, with their putrefying contents, and
the place being ill adapted for ventilation, forming three sides of a
square, and the ground having no declivity, nor efficient sewers to
carry off the rain, the most favourable circumstances exist for
putrefaction, and for the contamination of the atmosphere.

In the construction of future towns, and in additions to the old, the
utmost attention should be given to promote the free agitation of the
atmosphere, if it is proposed that they should be salubrious. Where
health is to be protected, the streets should be made wide, open, and
occasionally terminating in squares or other open places.

Where circumstances will permit a choice, towns should be built in
wholesome situations and dry soils; and the same holds with additions
making to old towns.

The health of a community is much influenced by the situation in which
they live, and by the nature of the ground on which their houses are
built.

In many towns there are some particular districts in which disease is
more particularly prevalent, and the result of careful inquiry is, that
the excessive disease is owing to unwholesomeness of situation. Persons
in all other respects similarly situated, enjoy a better state of
health, or suffer less disease, who inhabit a more wholesome or less
prejudicial situation or locality.


                                SEWERS.

A point next in importance to a proper construction of streets, and the
selection of good situations, is an efficient system of drains or sewers
for the removal of impurities, and the formation of water-courses.

Of the importance of sewers it is unnecessary to enlarge, that being
sufficiently understood.

By water-courses is meant channels for the immediate passage of
rainwater from off the streets. They are easily formed, and where the
ground is level, the advantage is very great. In streets having a slope
or declivity, the water is soon dispersed; but where they are level, it
is apt to collect, and there create dampness, which is communicated to
the houses, and a favourable nidus for putrefaction, where impurities
are permitted to accumulate.

In some parts, principally the suburbs of large towns, and in many of
the villages of Scotland, perhaps more especially those along the
coasts, inhabited by fishermen, no means being adopted to expedite the
removal of rainwater, and there being no natural water-run or course,
the rain collects, and animal and vegetable materials mixing therewith,
green putrefying ditches are formed, plentifully evolving gaseous
products, and supporting a luxuriant vegetation on their surface.


                        CONSTRUCTION OF HOUSES.

So much attention is now paid to health and comfort in the construction
of the houses of the wealthy, that it is unnecessary to say a word
respecting these points, in connection with the higher classes.

But the circumstances being so very different in relation to the houses
of the poor or the labouring class, some notice is required here.

It too often happens that the house of the labouring man in the country
is, in almost every respect, little better than a shed, and calculated
to produce disease. The walls are frequently the only substantial part
of the tenement, the roof of tiles being often pervious to the rain and
wind, and there being no other covering either of lath or lime; the door
opens directly into the body of the house, and the floor is generally
either below or on a level with the ground outside.

When floors of houses are below the level of the ground outside, they
must necessarily be damp, and cause the house to be unwholesome.

The floors even of cottages should be situated about a foot or more
above the level of the adjacent ground, and the interval between them
and the soil should be filled up with small stones, or such materials,
and then the houses might possibly be free of damp, and the rain would
not run in off the streets, and form ditches before the very fire-place,
as it does in many houses in this village.

The necessity of the floors of their houses being at a little distance
above the ground is well known to the natives of Manilla. To avoid the
dampness and the unwholesome emanations of the soil, the poor natives
build their bamboo houses upon a foundation of wooden piles, by which
contrivance a considerable space is left to permit the winds to enter,
and to dissipate the damp and exhalations. In like manner, the rich
inhabitants of Manilla build on piles of brick. Could our working
population, or rather their landlords, not take a hint from these less
refined people, and form some security against that unwholesomeness
inseparable from damp houses?

It is unnecessary to detail at length instances of the greater
prevalence of disease among the inhabitants of low-lying, confined,
damp, ill ventilated, and filthy towns, over the populace of cities more
favourably situated in these respects.

It will suffice to say, that typhus fever prevails more in the Old Town,
where there are many local causes of disease, than in the New Town of
Edinburgh, where the streets are clean, wide, and well drained;—and that
the plague prevails more in the Jews’ quarter, remarkable for the filth
and closeness of the streets, than in any other part of Constantinople.




                              CHAPTER XIV.
     PREVENTION OF DISEASE BY AN ACTIVE AND CHEERFUL STATE OF MIND,
                SUFFICIENT CLOTHING, AND WHOLESOME DIET.


The bad effects of despondency and apprehension have been already
stated, and they were found to be very important and highly favourable
to the invasion of disease. Instances have already been given of disease
and general decline of health following depression of mind and long
continued apprehension, and it now remains to point out the salutary
action of an active and cheerful state of mind.

An active and cheerful state of mind imparts an activity to the various
organs of the body, whereby their functions are more perfectly
performed; it spreads a kindly glow over the entire system, and tends to
dispel any sluggishness of action present in any part which perhaps
would, under other circumstances, increase, and lead to the development
of disease.

On some occasions a cheerful state of mind, induced by sudden
improvement of prospects, or by the unexpected receipt of good
intelligence, has been the efficient instrument in dispelling the first
symptoms of disease which had been induced by depressing causes.

It has been often observed among soldiers and sailors, who, losing their
health and beginning to suffer from disease, under no other apparent
unwholesome cause than the distrust with which they regarded an
insufficient and unskilful commander, that their health has suddenly
improved, and disease has rapidly diminished when they have been put
under an able chief in whom they reposed confidence, and with whom they
were willing and ready to place the safety of their lives.

Soldiers and sailors suffering many privations, mortified with defeat,
failing in their energies, and beginning to drop under the influence of
disease, have, on the sudden and unexpected brightening of their
prospects, regained their lost strength, cast out the seeds of disease,
thrown off their despondency, and have achieved worlds of enterprise.
The following interesting case, which illustrates well the powerful
influence of hope, and a cheerful state of mind, is taken from Paris’s
Pharmacologia.

“In the celebrated siege of Breda in 1625 by Spinola, the garrison
suffered extreme distress from the ravages of scurvy, and the Prince of
Orange being unable to relieve the place, sent in, by a confidential
messenger, a preparation which was directed to be added to a very large
quantity of water, and to be given as a specific for the epidemic; the
remedy was administered, and the garrison recovered its health; when it
was afterwards acknowledged that the substance in question was no other
than a little colouring matter.”

That impaired state of health, and much of the disease, especially of
the digestive organs, which is so much experienced by persons who are
suddenly deprived of much occupation of the mind in business, and find
themselves totally unemployed, and who, from their previous habits, are
unable to derive enjoyment from literary and scientific pursuits, as
some retired tradesmen, have been suddenly removed, and health has been
fully re-established on the individuals being again immersed in
business, either from choice or by a happy reverse in their
circumstances rendering that step unavoidable.

During epidemics, that confident assurance which some persons are known
to entertain, that they will escape the prevalent distempers, there is
much reason to think, has on many occasions been a complete prophylactic
or preventive.

Instances are not uncommon where an assurance or settled conviction on
the part of the patient has gone far to promote, if not to produce,
recovery from very dangerous disease, when physicians have despaired of
life, and even when that opinion has been communicated to the unmoved
and still confident sufferer.

The history of amulets or charms and of the cures performed by the royal
touch, affords much amusing and interesting detail illustrative of
confidence and hope, in the prevention and cure of disease. Instances
are also familiar of naval and military officers who have lost their
health from the long continued suffering of “hope deferred” in respect
to promotion, and of neglect of meritorious services, where advancement
and the grant of their longing and earnest wishes has at length acted as
a charm upon every bodily ailment, and where a rapid succession of
cheerfulness and health has been the immediate consequence, to the joy
of anxious and apprehensive friends.

The beneficial effects of activity and cheerfulness of mind in warding
off the attack of disease, and in promoting recovery therefrom, having
been so strikingly illustrated in the above examples, there remains no
occasion to say more than to recommend them strongly for adoption, both
among those in health and in sickness.


                               CLOTHING.

The want of sufficient clothing as productive of disease has been
already noticed.

Clothing in this climate is used for the purpose of retaining the body
warm. Now this is an important purpose, and the means by which it is
attained are highly deserving of notice, and they exert a very powerful
influence upon health.

The temperature of the human body is generally about 98° Fahrenheit, and
that of the surrounding atmosphere being in this climate always below,
sometimes in severe winters, as for instance the last, being near zero.

Now, all bodies possess a property by which they are disposed to
maintain an equilibrium of temperature, that is, to be of the same
amount of heat, and the temperature of the human body being above that
of the surrounding atmosphere, in an amount varying at different times,
it parts with a portion of its heat, or caloric, as it is called by
chemists, which is communicated to the atmosphere and surrounding
bodies.

A portion of the heat of the body is constantly, and under all
circumstances, being abstracted by the atmosphere and other surrounding
bodies which are at a lower temperature, and were it not that the loss
of heat, which the body is thus constantly sustaining, is supplied by
the formation of heat in the system, which is ever going on, the body
would soon become so very cold as to be incapable of performing its
functions, and death would consequently ensue.

The amount of heat which the body loses, and the rapidity with which it
is abstracted, is proportionate to the coldness of the atmosphere and
surrounding bodies.

But the rapid and great abstraction of heat from the human body, which
is apt to take place when it is immersed in a very cold atmosphere, is
very hurtful, and often induces disease, especially fevers, colds,
coughs, and inflammations.

It is for the purpose of checking the rapid abstraction of heat from the
body, that the warm clothing used in these latitudes is adopted. It is a
bad conductor of heat, and the consequence is, that the temperature of
the body is not reduced so rapidly as it would be were it exposed
without any covering to the atmosphere, which, more especially when
damp, is a superior conductor of heat.

Clothing of a sufficient nature is useful in the preservation of health,
by preserving in its integrity the circulation of the blood on the
surface of the body, by maintaining the constant flow of the secretion
from the skin, or perspiration as it is commonly called, which is so
useful to the system in many different ways, and by preventing any
deviation from that balance in the distribution of the fluids of the
body which that process goes so far to maintain, much to the comfort and
freedom from disease of the individual.

Many instances of a very striking nature are known, where such
inveterate and mortal disease has supervened in consequence of the
privation, total and partial, of clothing, and from that being of a
texture and nature inadequate to meet the exigencies of the case. Some
have been referred to in this work where the want of sufficient clothing
has been one of many concurrent potent circumstances, the attendants and
consequences of poverty and destitution which have given rise to
epidemics. On occasions of great distress and destitution, the disease
which is then so very prevalent is not the product of one circumstance
merely, such as want of food, but is induced by the many concurrent
powerful and unwholesome influences to which poverty is ever sure to
give rise. One of the chief circumstances on which the wide prevalence
of disease depends on those occasions, there can be little doubt, is
insufficiency of clothing among the poorer classes. But it is the
advantages which are to be derived from sufficient clothing which should
here occupy attention. Of late years, it has been the practice in some
towns in this country, on occasions of fever and other diseases
prevailing during the cold and inclemency of winter, for funds to be
collected for the purchase and distribution of clothes among the poor
and ill-clad portion of the population.

The motives and feelings with which this form of charity has been
adopted, must of themselves be a sufficient and highly delightful return
for the liberality and exertions of its benevolent projectors and
supporters, but it must afford them much gratification and much
encouragement in their laudable and christian endeavours, to know that
the clothing which they have dispensed has had a powerful influence in
preserving many from becoming the victims of the prevalent distempers,
and of preventing the relapse of the convalescent.

The late Sir John Pringle, a distinguished army surgeon, states that
“the best clothed were generally among the most healthy regiments.”

The quantity of clothing should of course vary with the season, more
being used in winter than in summer. A minute account of the outer
clothing is unnecessary here, but a word may not be thrown away; the
body should at all times have that quantity of clothing which will
secure it from unpleasant feelings of cold and chilliness, and it would
be wise to be influenced more by comfort and a regard to health, and
less by fashion and caprice in the choice of clothing, which is so
intimately connected with the preservation of health and its unspeakable
comforts and enjoyments.

The clothing which is next the skin is more important, and will here
obtain some consideration. It may be laid down as a general rule that
flannel or some such woollen cloth should be used next the skin
throughout the entire year. It will be well to vary the cloth or flannel
in different seasons, perhaps using a thick flannel during winter, and a
material of lighter and less close texture during summer and autumn. A
fabric of fine flannel, or what is called “stocking,” answers very well
for the summer, when the flannel which is commonly used is felt to be
too warm and irritating to the skin. In the summer it is common for many
persons who use flannel during winter to discontinue its use, but it is
safer, merely to exchange the thick flannel which has been used during
winter for one of a finer fabric or some such equally fine material.

During winter when the weather is always cold, and in spring when it is
generally chilly, flannel or some such material should form an essential
portion of the clothing of every inhabitant of these islands.

It is safe to say that hundreds in this country are at present alive and
enjoy excellent health who, but for the use of flannel and such like
fabrics next the skin, would have been, ere this, numbered with the
dead; and it is not too much to say that thousands are at this moment in
perfect health through the kindly action of the same clothing, whose
lives were threatened with constant coughs, periodical colds, quinseys,
rheumatisms, and incipient disease of lungs, and other organs of the
chest, before this efficient guardian of health was adopted.

Flannel and fabrics of the same or like nature go far to preserve an
equable temperature at the surface of the body, promote the perspiration
of the skin, which they readily absorb when copiously secreted, and are
specially useful in preserving the balance of the secretions on the
surface and in the interior of the body. Now all these most important
conditions, which the use of flannel goes so far to maintain, are ever
liable to be subverted and disturbed, whenever the body is thinly or
inadequately covered, by changes in the ever varying temperature of the
atmosphere, and by the prevalence of winds and currents.

Most of the important constitutional diseases which occur in this
country, begin with a sensation of coldness with shivering and
trembling; now it is the usual property of flannel, and such fabrics,
when worn next the skin, and indeed of warm and general good clothing,
to obviate and prevent these conditions of the body, and thus disease
may be met at its very onset, and perhaps baffled ere it has time to
establish its dominion.

“In some situations my personal experience enables me to vouch for the
utility of flannel. Of this we had a very striking proof in the second
battalion of the Royals, while suffering from a most aggravated form of
dysentery in India. General Conran, the late Lieutenant-Governor of
Jamaica, who at that time commanded the Royals, was so fully persuaded
of the benefits likely to accrue from the general use of flannel, that
he went down from Wallajahabbad, where the regiment was then stationed,
to Madras, on purpose to represent to the government the distress of his
men, and to suggest the expediency of a supply of flannel shirts. This
he did with so much effect, backed by the late Dr Anderson, the
Physician-General, that the flannels were immediately ordered, and, in
my opinion, contributed much to check the alarming progress of the
disease.”[11]

Footnote 11:

  Ballingall’s Military Surgery.

It is usual with many individuals to wear flannel only over the chest,
but it is wise to envelope the whole body in that most useful article of
clothing.

The poor or labouring man should endeavour to procure thick soled shoes,
in good repair, and substantial worsted stockings.

The latter are generally esteemed stronger and more durable when made at
home, and will form excellent work for his wife or daughter in the
winter nights.

The working man will find, that though clothing substantially, as has
been above recommended, takes a considerable proportion of his money
immediately out of his pocket, he will be a certain gainer in the end,
aye, probably in the course of a few years or months, by consequent
immunity from disease, and from continued capacity for labour.


                                 FOOD.

It has been already shewn in this work, that the want of sufficient and
wholesome food is frequently attended and followed by disease. It is now
proposed to shew how important food and drink, of good quality, are to
the preservation of health; but the fact is so well known, and so
undoubted, that it is almost unnecessary to say that they are essential
to the preservation of the body in its strength and dimensions.

That sense of sinking and languor, which is so commonly experienced upon
long fasting, would soon be exchanged for the actual pains of disease,
were it not to be removed shortly by the taking of food.

When the body is exhausted from the want of food for some hours, a good
and ample repast imparts strength to the body, and cheerfulness to the
mind, and goes far to prevent the evasion of some forms of disease.

An individual who is well fed, is generally more secure against the
invasion of disease of a low character, than another who is only
scantily and occasionally supplied with food.

It is generally believed that individuals who have lately partaken of
food, are less subject to the operation of vitiated air, or as it is
commonly termed, “contagious air;” and it was commonly reported during
the late prevalence of cholera, that persons who took breakfast before
going out, suffered less from that disease than those who followed a
contrary course.

Many well authenticated instances are recorded of the health of armies
undergoing very great improvement, and of disease in these bodies being
greatly checked by the distribution of ample wholesome food, and by the
privation which they had suffered for some time previous, being ended,
by some accidental circumstances, as the gaining the enemy’s magazines,
or the reduction of a siege. Sir George Ballingall relates in his work
on Military Surgery, that “during the prevalence of a malignant fever in
this regiment (33d), then stationed in the garrison of Hull, in the
autumn of 1817, amongst other measures calculated to check the rapid
extension of the disease, I recommended the regular supply of breakfast
to the men. This was immediately ordered by the commanding officer, and
nothing appeared either to the officers, to the soldiers, or to myself,
to have so much effect in obviating attacks of the fever.”

The institution of soup kitchens in this country, for the distribution
of wholesome and nourishing food to the perishing poor, there is no
doubt, has a most salutary influence in the prevention of disease, by,
in short, so fortifying individuals, otherwise incapable of resistance,
as to render them proof against the influence of many causes of
pestilence.

There can be little doubt that the liberal distribution of nutritious
food, which of late years has happily taken place from these charitable
institutions, has gone far to check the ravages of fever, which is so
prevalent in this climate, during winter, when the labouring classes are
subject in so great a degree to cold, and the privation of food and
other necessaries of life.

It is stated on good medical authority, that no measure which was
instituted for the purpose of stopping the progress of typhus fever in
Glasgow, in the winter of 1837–8, then very prevalent and mortal, was so
useful, and so immediately and obviously efficient, as the establishment
of soup kitchens in that city.

Among the arrangements in Edinburgh in 1832, which tended apparently to
render cholera less extensive than in other large towns, a soup kitchen
formed one.

Fever has been much less prevalent in Tranent during the present, than
for many winters past, and this is to be attributed partly to a soup
kitchen which has been instituted in that village, and which has been in
operation for about two months (16th March 1839).

The excellent tendency of such establishments must be obvious to all who
are at all conversant with the nature of disease, and the animal
economy, and it can form no valid objection to that proposition, that
fever is still known to have raged where soup kitchens have been
established; for, though the pestilence may not have been extinguished,
still it may have been abated, and though the malignant character and
mortality may not have been reduced, still these excellent institutions
may have been the means of preventing their being increased.

Let not, therefore, those who are willing and able to support whatever
is calculated to reduce the sufferings and privations of the poor, be
driven from extending their support to soup kitchens, because they have
only diminished the number of the victims of disease, and made the stage
of convalescence more sure and less liable to relapse.

It would indeed be vain to expect, that the distribution of food would
act as an entire preventive of fever and disease, which is the result
not of scanty food only, but of that and many other circumstances of a
very different nature, whose operation, the supply of soup, in any
quantity, can go a very short way only, to remedy.

Some of the circumstances which exert the most important influence in
the production of pestilential disease, and the measures which are best
calculated to counteract their pestiferous tendencies, have now been
detailed.

It is hoped the enforcement of the hurtful operation of many
circumstances, erroneously thought to be innocent, may lead to their
being remedied in future, and it is expected, that if the suggestions
which have been thrown out in the latter part of this work, are duly
acted upon, or if others of a like nature, which may, at a future
period, emanate from another better qualified for the task, should meet
with the attention, which this object so well demands, the amount of
disease will be diminished, human suffering will be abated, and human
life extended nearer to that point of maturity which the Divinity has
decreed, and which the organization of the human body proclaims was
meant to be attained by one and all of the members of the human family.

By avoiding the causes of disease which have been detailed in this work,
and by attending to the rules which have been laid down here and
elsewhere for the preservation of health, disease will be greatly
abated, but a mighty revolution must be accomplished in the habits, the
dispositions, and minds of men, ere mankind will enjoy that course of
health, and all that greater freedom from pain and disease, of which
their lot is capable:—but far from the consideration of the manifold
changes and long course of time which will be required to make a very
great improvement in the health of the human race, leading to apathy and
inaction, it should serve to stimulate to powerful attempts, and
persevering and reiterated efforts for amelioration.


                                  END.


          PRINTED BY NEILL AND CO. OLD FISHMARKET, EDINBURGH.

------------------------------------------------------------------------




                          TRANSCRIBER’S NOTES


 ● Typos fixed; non-standard spelling and dialect retained.
 ● Enclosed italics font in _underscores_.





*** END OF THE PROJECT GUTENBERG EBOOK AN INQUIRY INTO THE PROPAGATION OF CONTAGIOUS POISONS, BY THE ATMOSPHERE ***


    

Updated editions will replace the previous one—the old editions will
be renamed.

Creating the works from print editions not protected by U.S. copyright
law means that no one owns a United States copyright in these works,
so the Foundation (and you!) can copy and distribute it in the United
States without permission and without paying copyright
royalties. Special rules, set forth in the General Terms of Use part
of this license, apply to copying and distributing Project
Gutenberg™ electronic works to protect the PROJECT GUTENBERG™
concept and trademark. Project Gutenberg is a registered trademark,
and may not be used if you charge for an eBook, except by following
the terms of the trademark license, including paying royalties for use
of the Project Gutenberg trademark. If you do not charge anything for
copies of this eBook, complying with the trademark license is very
easy. You may use this eBook for nearly any purpose such as creation
of derivative works, reports, performances and research. Project
Gutenberg eBooks may be modified and printed and given away—you may
do practically ANYTHING in the United States with eBooks not protected
by U.S. copyright law. Redistribution is subject to the trademark
license, especially commercial redistribution.


START: FULL LICENSE

THE FULL PROJECT GUTENBERG LICENSE

PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK

To protect the Project Gutenberg™ mission of promoting the free
distribution of electronic works, by using or distributing this work
(or any other work associated in any way with the phrase “Project
Gutenberg”), you agree to comply with all the terms of the Full
Project Gutenberg™ License available with this file or online at
www.gutenberg.org/license.

Section 1. General Terms of Use and Redistributing Project Gutenberg™
electronic works

1.A. By reading or using any part of this Project Gutenberg™
electronic work, you indicate that you have read, understand, agree to
and accept all the terms of this license and intellectual property
(trademark/copyright) agreement. If you do not agree to abide by all
the terms of this agreement, you must cease using and return or
destroy all copies of Project Gutenberg™ electronic works in your
possession. If you paid a fee for obtaining a copy of or access to a
Project Gutenberg™ electronic work and you do not agree to be bound
by the terms of this agreement, you may obtain a refund from the person
or entity to whom you paid the fee as set forth in paragraph 1.E.8.

1.B. “Project Gutenberg” is a registered trademark. It may only be
used on or associated in any way with an electronic work by people who
agree to be bound by the terms of this agreement. There are a few
things that you can do with most Project Gutenberg™ electronic works
even without complying with the full terms of this agreement. See
paragraph 1.C below. There are a lot of things you can do with Project
Gutenberg™ electronic works if you follow the terms of this
agreement and help preserve free future access to Project Gutenberg™
electronic works. See paragraph 1.E below.

1.C. The Project Gutenberg Literary Archive Foundation (“the
Foundation” or PGLAF), owns a compilation copyright in the collection
of Project Gutenberg™ electronic works. Nearly all the individual
works in the collection are in the public domain in the United
States. If an individual work is unprotected by copyright law in the
United States and you are located in the United States, we do not
claim a right to prevent you from copying, distributing, performing,
displaying or creating derivative works based on the work as long as
all references to Project Gutenberg are removed. Of course, we hope
that you will support the Project Gutenberg™ mission of promoting
free access to electronic works by freely sharing Project Gutenberg™
works in compliance with the terms of this agreement for keeping the
Project Gutenberg™ name associated with the work. You can easily
comply with the terms of this agreement by keeping this work in the
same format with its attached full Project Gutenberg™ License when
you share it without charge with others.

1.D. The copyright laws of the place where you are located also govern
what you can do with this work. Copyright laws in most countries are
in a constant state of change. If you are outside the United States,
check the laws of your country in addition to the terms of this
agreement before downloading, copying, displaying, performing,
distributing or creating derivative works based on this work or any
other Project Gutenberg™ work. The Foundation makes no
representations concerning the copyright status of any work in any
country other than the United States.

1.E. Unless you have removed all references to Project Gutenberg:

1.E.1. The following sentence, with active links to, or other
immediate access to, the full Project Gutenberg™ License must appear
prominently whenever any copy of a Project Gutenberg™ work (any work
on which the phrase “Project Gutenberg” appears, or with which the
phrase “Project Gutenberg” is associated) is accessed, displayed,
performed, viewed, copied or distributed:

    This eBook is for the use of anyone anywhere in the United States and most
    other parts of the world at no cost and with almost no restrictions
    whatsoever. You may copy it, give it away or re-use it under the terms
    of the Project Gutenberg License included with this eBook or online
    at www.gutenberg.org. If you
    are not located in the United States, you will have to check the laws
    of the country where you are located before using this eBook.
  
1.E.2. If an individual Project Gutenberg™ electronic work is
derived from texts not protected by U.S. copyright law (does not
contain a notice indicating that it is posted with permission of the
copyright holder), the work can be copied and distributed to anyone in
the United States without paying any fees or charges. If you are
redistributing or providing access to a work with the phrase “Project
Gutenberg” associated with or appearing on the work, you must comply
either with the requirements of paragraphs 1.E.1 through 1.E.7 or
obtain permission for the use of the work and the Project Gutenberg™
trademark as set forth in paragraphs 1.E.8 or 1.E.9.

1.E.3. If an individual Project Gutenberg™ electronic work is posted
with the permission of the copyright holder, your use and distribution
must comply with both paragraphs 1.E.1 through 1.E.7 and any
additional terms imposed by the copyright holder. Additional terms
will be linked to the Project Gutenberg™ License for all works
posted with the permission of the copyright holder found at the
beginning of this work.

1.E.4. Do not unlink or detach or remove the full Project Gutenberg™
License terms from this work, or any files containing a part of this
work or any other work associated with Project Gutenberg™.

1.E.5. Do not copy, display, perform, distribute or redistribute this
electronic work, or any part of this electronic work, without
prominently displaying the sentence set forth in paragraph 1.E.1 with
active links or immediate access to the full terms of the Project
Gutenberg™ License.

1.E.6. You may convert to and distribute this work in any binary,
compressed, marked up, nonproprietary or proprietary form, including
any word processing or hypertext form. However, if you provide access
to or distribute copies of a Project Gutenberg™ work in a format
other than “Plain Vanilla ASCII” or other format used in the official
version posted on the official Project Gutenberg™ website
(www.gutenberg.org), you must, at no additional cost, fee or expense
to the user, provide a copy, a means of exporting a copy, or a means
of obtaining a copy upon request, of the work in its original “Plain
Vanilla ASCII” or other form. Any alternate format must include the
full Project Gutenberg™ License as specified in paragraph 1.E.1.

1.E.7. Do not charge a fee for access to, viewing, displaying,
performing, copying or distributing any Project Gutenberg™ works
unless you comply with paragraph 1.E.8 or 1.E.9.

1.E.8. You may charge a reasonable fee for copies of or providing
access to or distributing Project Gutenberg™ electronic works
provided that:

    • You pay a royalty fee of 20% of the gross profits you derive from
        the use of Project Gutenberg™ works calculated using the method
        you already use to calculate your applicable taxes. The fee is owed
        to the owner of the Project Gutenberg™ trademark, but he has
        agreed to donate royalties under this paragraph to the Project
        Gutenberg Literary Archive Foundation. Royalty payments must be paid
        within 60 days following each date on which you prepare (or are
        legally required to prepare) your periodic tax returns. Royalty
        payments should be clearly marked as such and sent to the Project
        Gutenberg Literary Archive Foundation at the address specified in
        Section 4, “Information about donations to the Project Gutenberg
        Literary Archive Foundation.”
    
    • You provide a full refund of any money paid by a user who notifies
        you in writing (or by e-mail) within 30 days of receipt that s/he
        does not agree to the terms of the full Project Gutenberg™
        License. You must require such a user to return or destroy all
        copies of the works possessed in a physical medium and discontinue
        all use of and all access to other copies of Project Gutenberg™
        works.
    
    • You provide, in accordance with paragraph 1.F.3, a full refund of
        any money paid for a work or a replacement copy, if a defect in the
        electronic work is discovered and reported to you within 90 days of
        receipt of the work.
    
    • You comply with all other terms of this agreement for free
        distribution of Project Gutenberg™ works.
    

1.E.9. If you wish to charge a fee or distribute a Project
Gutenberg™ electronic work or group of works on different terms than
are set forth in this agreement, you must obtain permission in writing
from the Project Gutenberg Literary Archive Foundation, the manager of
the Project Gutenberg™ trademark. Contact the Foundation as set
forth in Section 3 below.

1.F.

1.F.1. Project Gutenberg volunteers and employees expend considerable
effort to identify, do copyright research on, transcribe and proofread
works not protected by U.S. copyright law in creating the Project
Gutenberg™ collection. Despite these efforts, Project Gutenberg™
electronic works, and the medium on which they may be stored, may
contain “Defects,” such as, but not limited to, incomplete, inaccurate
or corrupt data, transcription errors, a copyright or other
intellectual property infringement, a defective or damaged disk or
other medium, a computer virus, or computer codes that damage or
cannot be read by your equipment.

1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the “Right
of Replacement or Refund” described in paragraph 1.F.3, the Project
Gutenberg Literary Archive Foundation, the owner of the Project
Gutenberg™ trademark, and any other party distributing a Project
Gutenberg™ electronic work under this agreement, disclaim all
liability to you for damages, costs and expenses, including legal
fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT
LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE
PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE FOUNDATION, THE
TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE
LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR
INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH
DAMAGE.

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a
defect in this electronic work within 90 days of receiving it, you can
receive a refund of the money (if any) you paid for it by sending a
written explanation to the person you received the work from. If you
received the work on a physical medium, you must return the medium
with your written explanation. The person or entity that provided you
with the defective work may elect to provide a replacement copy in
lieu of a refund. If you received the work electronically, the person
or entity providing it to you may choose to give you a second
opportunity to receive the work electronically in lieu of a refund. If
the second copy is also defective, you may demand a refund in writing
without further opportunities to fix the problem.

1.F.4. Except for the limited right of replacement or refund set forth
in paragraph 1.F.3, this work is provided to you ‘AS-IS’, WITH NO
OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT
LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PURPOSE.

1.F.5. Some states do not allow disclaimers of certain implied
warranties or the exclusion or limitation of certain types of
damages. If any disclaimer or limitation set forth in this agreement
violates the law of the state applicable to this agreement, the
agreement shall be interpreted to make the maximum disclaimer or
limitation permitted by the applicable state law. The invalidity or
unenforceability of any provision of this agreement shall not void the
remaining provisions.

1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the
trademark owner, any agent or employee of the Foundation, anyone
providing copies of Project Gutenberg™ electronic works in
accordance with this agreement, and any volunteers associated with the
production, promotion and distribution of Project Gutenberg™
electronic works, harmless from all liability, costs and expenses,
including legal fees, that arise directly or indirectly from any of
the following which you do or cause to occur: (a) distribution of this
or any Project Gutenberg™ work, (b) alteration, modification, or
additions or deletions to any Project Gutenberg™ work, and (c) any
Defect you cause.

Section 2. Information about the Mission of Project Gutenberg™

Project Gutenberg™ is synonymous with the free distribution of
electronic works in formats readable by the widest variety of
computers including obsolete, old, middle-aged and new computers. It
exists because of the efforts of hundreds of volunteers and donations
from people in all walks of life.

Volunteers and financial support to provide volunteers with the
assistance they need are critical to reaching Project Gutenberg™’s
goals and ensuring that the Project Gutenberg™ collection will
remain freely available for generations to come. In 2001, the Project
Gutenberg Literary Archive Foundation was created to provide a secure
and permanent future for Project Gutenberg™ and future
generations. To learn more about the Project Gutenberg Literary
Archive Foundation and how your efforts and donations can help, see
Sections 3 and 4 and the Foundation information page at www.gutenberg.org.

Section 3. Information about the Project Gutenberg Literary Archive Foundation

The Project Gutenberg Literary Archive Foundation is a non-profit
501(c)(3) educational corporation organized under the laws of the
state of Mississippi and granted tax exempt status by the Internal
Revenue Service. The Foundation’s EIN or federal tax identification
number is 64-6221541. Contributions to the Project Gutenberg Literary
Archive Foundation are tax deductible to the full extent permitted by
U.S. federal laws and your state’s laws.

The Foundation’s business office is located at 809 North 1500 West,
Salt Lake City, UT 84116, (801) 596-1887. Email contact links and up
to date contact information can be found at the Foundation’s website
and official page at www.gutenberg.org/contact

Section 4. Information about Donations to the Project Gutenberg
Literary Archive Foundation

Project Gutenberg™ depends upon and cannot survive without widespread
public support and donations to carry out its mission of
increasing the number of public domain and licensed works that can be
freely distributed in machine-readable form accessible by the widest
array of equipment including outdated equipment. Many small donations
($1 to $5,000) are particularly important to maintaining tax exempt
status with the IRS.

The Foundation is committed to complying with the laws regulating
charities and charitable donations in all 50 states of the United
States. Compliance requirements are not uniform and it takes a
considerable effort, much paperwork and many fees to meet and keep up
with these requirements. We do not solicit donations in locations
where we have not received written confirmation of compliance. To SEND
DONATIONS or determine the status of compliance for any particular state
visit www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states where we
have not met the solicitation requirements, we know of no prohibition
against accepting unsolicited donations from donors in such states who
approach us with offers to donate.

International donations are gratefully accepted, but we cannot make
any statements concerning tax treatment of donations received from
outside the United States. U.S. laws alone swamp our small staff.

Please check the Project Gutenberg web pages for current donation
methods and addresses. Donations are accepted in a number of other
ways including checks, online payments and credit card donations. To
donate, please visit: www.gutenberg.org/donate.

Section 5. General Information About Project Gutenberg™ electronic works

Professor Michael S. Hart was the originator of the Project
Gutenberg™ concept of a library of electronic works that could be
freely shared with anyone. For forty years, he produced and
distributed Project Gutenberg™ eBooks with only a loose network of
volunteer support.

Project Gutenberg™ eBooks are often created from several printed
editions, all of which are confirmed as not protected by copyright in
the U.S. unless a copyright notice is included. Thus, we do not
necessarily keep eBooks in compliance with any particular paper
edition.

Most people start at our website which has the main PG search
facility: www.gutenberg.org.

This website includes information about Project Gutenberg™,
including how to make donations to the Project Gutenberg Literary
Archive Foundation, how to help produce our new eBooks, and how to
subscribe to our email newsletter to hear about new eBooks.