Chapter II: Appendix: Page (1)

1. Regulations for the establishment of officers for the care
of the dead and for conducting funerals at Franckfort,
with plans of the houses of reception 205

2. Regulations for the examination and care of the dead at
Munich 218

3. Examination of Mr. Abrahams, surgeon, registrar of deaths,
on the defective arrangements for the verification, and
on the effects produced on the physical and moral
condition of children by the undue pressure of the
causes of disease and death 223

4. Examination of Mr. Blencarne, medical officer of the City
of London Union, on the extent to which the proportions
of deaths are preventive by sanitary measures 226

5, 6, Extracts from the testimony of Dr. Wray, Mr. Porter, and
& 7. Mr. Paul, medical officers of the city of London, on the
same subjects 229–32

8. Extract from Dr. La Chaise’s account of population in the
badly lighted and ventilated and badly cleansed
districts of Paris 233

9. Note on the probable effects producible on the
proportionate mortality and numbers of burials, of
structural arrangements, such as those designed for the
City of London by Sir Christopher Wren 234

10. Letter from the superintendent registrar of Stockport on
cases of infanticides committed partly for the sake of
burial money 235

11. Returns of the proportion of deaths to the population in
each registrar’s district in the metropolis in the year
1839, the excess in number of deaths and funerals beyond
a healthy standard, the average age of death of gentry,
tradesmen, and artisans, and average years of life lost
by premature deaths in each district, according to the
Carlisle table of life insurance, and the proportion of
deaths from epidemics, and the registrars’ returns of
the chief causes of death in the lower districts 239

12. Examples of ordinary undertakers’ bills in the metropolis 267

Lord Stowell’s exposition of the law of England in respect
to perpetuities in burial-grounds 269

13. View of the extent of intra-mural burial-ground provided
as compared with the extent of extra-mural burial-ground
required for the metropolis; and the comparative
proportions of space occupied for the burial of persons
of different religious denominations, and as trading
burial-grounds 272

Return of the amount of burial fees received in some of
the larger parishes in the metropolis 273

Returns of the number of burials in each of the
burial-grounds in the metropolis 274

SANITARY REPORT.—SUPPLEMENT.

INTERMENTS IN TOWNS.

_To the Right Honourable Sir James Graham, Bart.,
&c., &c., &c._

SIR,

In compliance with the request which I have had the honour to receive from you, that I would examine the evidence on the practice of interment, and the means of its improvement, and prepare for consideration a Report thereon, I now submit the facts and conclusions following:—

It has been remarked, as a defect in the General Report on the evidence as to the sanitary condition of the labouring population, that it did not comprise any examination of the evidence as to the effects produced on the public health, by the practice of interring the dead amidst the habitations of the town population. I wish here to explain that the omission arose from the subject being too great in its extent, and too special in its nature, to allow of the completion at that time, of any satisfactory investigation in relation to it even if it had not then been under examination by a Committee of the House of Commons, whose Report is now before the public.

* * * * *

To obtain the information on which the following report is founded, I have consulted, as extensively as the time allowed and my opportunities would permit, ministers of religion who are called upon to perform funereal rites in the poorer districts: I have made inquiries of persons of the labouring classes, and of secretaries and officers of benefit societies and burial clubs, in the metropolis and in several provincial towns in the United Kingdom, on the practice of interments in relation to those classes, and on the alterations and improvements that would be most in accordance with their feelings: I have questioned persons following the occupation of undertaker, and more especially those who are chiefly engaged in the interment of the dead of the labouring classes, on the improvements which they deem practicable in the modes of performing that service: I have consulted foreigners resident in the metropolis, on the various modes of interment in their own countries: I have examined the chief administrative regulations thereon in Germany, France, and the United States: and I have consulted several eminent physiologists as to the effects produced on the health of the living, by emanations from human remains in a state of decomposition. I need scarcely premise that the moral as well as the physical facts developed in the course of this inquiry are often exceedingly loathsome; but general conclusions can only be distinctly made out from the various classes of particular facts, and the object being the suggestion of remedies and preventives, it were obviously as unbecoming to yield to disgusts or to evade the examination and calm consideration of those facts, as it would be in the physician or the surgeon, in the performance of his duty with the like object, to shrink from the investigation of the most offensive manifestations of disease.

§ 1. It appears that the necessity of removing interments from the midst of towns is very generally admitted on various considerations, independently of those founded on the presumed injurious effects arising from the practice to the public health. I believe an alteration of the practice is strongly desired by many clergymen of the established church, whose incomes, even with the probable compensation for the loss of burial dues, might be expected to be diminished by the discontinuance of _intra-mural_ interments. Exemptions from a general prohibition of such interments are, however, claimed in favour of particular burial-grounds, situate within populous districts, of which grounds it is stated that they are not over-crowded with bodies, and of which it is further alleged that they have not been known, and cannot be proved, to be injurious to the public health.

The statements as to the innocuousness of particular graveyards are supported by reference to the general testimony of a number of medical witnesses of high professional position, by whom it is alleged that the emanations from decomposing human remains do not produce specific disease, and, further, that they are not generally injurious. The practical consequences of these doctrines extend beyond the present question, and are so important in their effects on the sanitary economy of all towns, as apparently to require that no opportunity should be lost of examining the statements of facts on which they are founded.

The medical evidence of this class has generally been given in answer to complaints made by the public, of the offensiveness, and the danger to health which arises from the practice of dissection in schools of anatomy amidst crowded populations. The chief fact alleged to prove the innocuousness of emanations from the dead is that professors of anatomy experience no injury from them. Thus, Dr. Warren, of Boston, in a paper cited by M. Parent Duchâtelet, states, that he has been accustomed all his life to dissecting-rooms, in which he has been engaged night and day. “It has sometimes happened to me,” he observes, “after having dissected bodies in a state of putrefaction, to have experienced a sort of weakness and the loss of appetite; but the phenomena were never otherwise than transient. During the year 1829, the weather being excessively hot, decomposition advanced with a degree of rapidity such as I have rarely witnessed: at that season the emanations became so irritating, that they paralyzed the hands, producing small pustules and an excessive itching, and yet my general health was in nowise affected.”

Again, whilst it is stated by M. Duchâtelet that students who attend the dissecting-rooms are sometimes seriously injured, and even killed by pricks and cuts with the instruments of dissection, yet it is denied that they are subject to any illness from the emanations from the remains “other than a nausea and a dysentery for two or three days at the commencement of their studies.” Fevers the students of medicine are confessedly liable to, but he says it is only when they are in attendance on the living patients in the fever wards.

Sir Benjamin Brodie pointed out to me, that from the precautions taken, by the removal of such portions of the viscera as might be in an advanced state of decomposition, and from the ventilation of dissecting-rooms being much improved, the emanations from the bodies dissected are not so great as might be supposed; nevertheless, he observes:—

There is no doubt that there are few persons who during the
anatomical season are engaged for many hours daily in a
dissecting-room for a considerable time, whose health is not
affected in a greater or less degree; and there are some whose
health suffers considerably. I have known several young men who have
not been able to prosecute their studies in the dissecting-room for
more than three or four weeks at a time, without being compelled to
leave them and go into the country. The great majority, however, do
not suffer to that extent, nor in such a way as to cause
interruption to their studies; and, altogether, the evil is not on a
sufficiently large scale to attract much notice, even among the
students themselves.

A writer on public health, Dr. Dunglison, maintains that “we have no satisfactory proof that malaria ever arises from animal putrefaction singly;” and as evidence of this position he adduces the alleged fact of the numbers of students who pass through their education without injury; yet he admits—

In stating the opinion that putrefaction singly does not occasion
malarious disease, we do not mean to affirm that air highly charged
with putrid miasmata may not, in some cases, powerfully impress the
nervous system so as to induce syncope and high nervous disorder; or
that, when such miasmata are absorbed by the lungs in a concentrated
state, they may not excite putrid disorders, or dispose the frame to
unhealthy erysipelatous affections. On the contrary, experiment
seems to have shown that they are deleterious when injected; and
cases are detailed in which, when exhaled from the dead body, they
have excited serious mischief in those exposed to their action.
According to Percy, a Dr. Chambon was required by the Dean of the
Faculté de Médecine of Paris to demonstrate the liver and its
appendages before the faculty on applying for his licence. The
decomposition of the subject given him for the demonstration was so
far advanced, that Chambon drew the attention of the Dean to it, but
he was required to go on. One of the four candidates, Corion, struck
by the putrid emanations which escaped from the body as soon as it
was opened, fainted, was carried home, and died in seventy hours;
another, the celebrated Fourcroy, was attacked with a burning
exanthematous eruption; and two others, Laguerenne and Dufresnoy,
remained a long time feeble, and the latter never completely
recovered. “As for Chambon,” says M. Londe, “indignant at the
obstinacy of the Dean, he remained firm in his place, finished his
lecture in the midst of the Commissioners, who inundated their
handkerchiefs with essences, and, doubtless, owed his safety to his
cerebral excitement, which during the night, after a slight febrile
attack, gave occasion to a profuse cutaneous exhalation.”

An eminent surgeon, who expressed to me his belief that no injury resulted from emanations from decomposing remains, for he had suffered none, mentioned an instance where he had conducted the post mortem examination of the corpse of a person of celebrity which was in a dreadful state of decomposition, without sustaining any injury; yet he admitted, as a casual incident which did not strike him as militating against the conclusion, that his assistant was immediately after taken ill, and had an exanthematous eruption, and had been compelled to go to the sea side, but had not yet recovered. Another surgeon who had lived for many years near a churchyard in the metropolis, and had never observed any effluvia from it, neither did _he_ perceive any effects of such emanations at church or anywhere else; yet he admitted that his wife perceived the openings of vaults when she went to the church to which the graveyard belonged, and after respiring the air there, would say, “they have opened a vault,” and on inquiry, the fact proved to be so. He admitted also, that formerly in the school of anatomy which he attended, pupils were sometimes attacked with fever, which was called “the dissecting-room fever,” which, since better regulations were adopted, was now unknown.

§ 2. In proof of the position that the emanations from decomposing remains are not injurious to health at any time, reference is commonly made to the statements in the papers of Parent Duchâtelet, wherein he cites instances of the exhumation of bodies in an advanced stage of decomposition without any injurious consequences being experienced by the persons engaged in conducting them.

At the conclusion of this inquiry, and whilst engaged in the preparation of the report, I was favoured by Dr. Forbes with the copy of a report by Dr. V. A. Riecke, of Stuttgart. “On the Influence of Putrefactive Emanations on the Health of Man,” &c., in which the medical evidence of this class is closely investigated. In reference to the statements of Parent Duchâtelet on this question, Dr. Riecke observes—

When Parent Duchâtelet appeals to and gives such prominence to the
instance of the disinterments from the churchyard of St. Innocens,
and states that they took place without any injurious consequences,
although at last all precautions in the mode of disinterring were
thrown aside, and that it occurred during the hottest season of the
year, and therefore that the putrid emanations might be believed to
be in their most powerful and injurious state, I would reply to this
by asking the simple question, what occasion was there for the
disinterment? Parent Duchâtelet maintains complete silence on this
point; but to me the following notices appear worthy of attention.
In the year 1554, Houlier and Fernel, and in the year 1738, Lemery,
Geoffroy, and Hunaud, raised many complaints of this churchyard; and
the two first had asserted that, during the plague, the disease had
lingered longest in the neighbourhood of the Cimetière de la
Trinité, and that there the greatest number had fallen a sacrifice.
In the years 1737 and 1746 the inhabitants of the houses round the
churchyard of St. Innocens complained loudly of the revolting stench
to which they were exposed. In the year 1755 the matter again came
into notice: the inspector who was intrusted with the inquiry,
himself saw the vapour rising from a large common grave, and
convinced himself of the injurious effects of this vapour on the
inhabitants of the neighbouring house.[1] “Often,” says the author
of a paper which we have before often alluded to, “the complexions
of the young people who remain in this neighbourhood grow pale. Meat
sooner becomes putrid there than elsewhere, and many persons cannot
get accustomed to these houses.” In the year 1779, in a cemetery
which yearly received from 2000 to 3000 corpses, they dug an immense
common grave near to that part of the cemetery which touches upon
the Rue de la Lingerie. The grave was 50 feet deep, and made to
receive from 1500 to 1600 bodies. But in February, 1780, the whole
of the cellars in the street were no longer fit to use. Candles were
extinguished by the air in these cellars; and those who only
approached the apertures were immediately seized with the most
alarming attacks. The evil was only diminished on the bodies being
covered with half a foot of lime, and all further interments
forbidden. But even that must have been found insufficient, as,
after some years, the great work of disinterring the bodies from
this churchyard was determined upon. This undertaking, according to
Thouret’s report, was carried on from December, 1785, to May, 1786;
from December, 1786, to February, 1787; and in August and October of
the same year: and it is not unimportant to quote this passage, as
it clearly shows how little correct Parent Duchâtelet was in his
general statement, that those disinterments took place in the
hottest seasons of the year. It is very clear that it was exactly
the coldest seasons of the year which were chosen for the work; and
though in the year 1787 there occurs the exception of the work
having been again begun in August, I think it may be assumed that
the weather of this month was unusually cold, and it was therefore
thought the work might be carried on without injurious effects. It
does not, however, appear to have been considered safe to continue
the work at that season, since the report goes on to state that the
operations were again discontinued in September.

Against those statements of Parent Duchâtelet, as to the
innocuousness of the frequent disinterments in Père La Chaise,
statements which are supported by the testimony of Orfila and
Ollivier, in regard to their experience of disinterments, I would
here place positive facts, which are not to be rejected. “I,” also
remarks Duvergie, “have undertaken judicial disinterments, and must
declare that, during one of these disinterments at which M.
Piedagnel was present with me, we were attacked with an illness,
although it was conducted under the shade of a tent, through which
there was passing a strong current of wind, and although we used
chloride of lime in abundance, M. Piedagnel was confined to his room
for six weeks.” Apparently, Duvergie is not far wrong when he states
his opinion that Orfila had allowed himself to be misled by his
praiseworthy zeal for the more general recognition of the use of
disinterments for judicial purposes, to understate the dangers
attending them, as doubtless he had used all the precautions during
the disinterments which such researches demand: and to these
precautions (which Orfila himself recommended) may be attributed the
few injurious effects of these disinterments. It, however, deserves
mentioning, that, if Orfila did undertake disinterments during the
heat of summer, it must have been only very rarely; at least,
amongst the numerous special cases which he gives, we find only two
which took place in July or August, most of the cases occurred in
the coldest season of the year. I cannot refrain from giving, also,
the information which Fourcroy gained from the grave-diggers of the
churchyard of St. Innocens. Generally they did not seem to rate the
danger of displacing the corpses very high: they remarked, however,
that some days after the disinterment of the corpses the abdomen
would swell, owing to the great development of gas; and that if an
opening forced itself at the navel, or anywhere in the region of the
belly, there issued forth the most horribly smelling liquid and a
mephitic gas; and of the latter they had the greatest fear, as it
produced sudden insensibility and faintings. Fourcroy wished much to
make further researches into the nature of this gas, but he could
not find any grave-digger who could be induced by an offered reward
to assist him by finding a body which was in a fit state to produce
the gas. They stated, that, at a certain distance, this gas only
produced a slight giddiness, a feeling of nausea, languor, and
debility. These attacks lasted several hours, and were followed by
loss of appetite, weakness, and trembling. “Is it not very
probable,” says Fourcroy, “that a poison so terrible that when in a
concentrated state, it produced sudden death, should, even when
diluted and diffused through the atmosphere, still possess a power
sufficient to produce depression of the nervous energy and an entire
disorder of their functions? Let any one witness the terror of these
grave-diggers, and also see the cadaverous appearance of the
greatest number, and all the other signs of the influence of a slow
poison, and they will no longer doubt of the dangerous effects of
the air from churchyards on the inmates of neighbouring houses.”

After having strenuously asserted the general innocuousness of such emanations, and the absence of foundation for the complaints against the anatomical schools, Parent Duchâtelet concludes by an admission of their offensiveness, and a recommendation in the following terms:—

“Instead of retaining the ‘debris’ of dissection near the theatres
of anatomy, it would certainly be better to remove them every day:
but as that is often impracticable, there ought, on a good system of
‘assainissement,’ to be considered the mode of retaining them
without incurring the risk of suffering from their infection.”

After describing the mode of removing the “debris,” he concludes—

“Thus will this part of the work be freed from the inconveniences
which accompanied and formed one of the widest sources of
‘infection,’ and of the disgust which were complained of in the
theatres of anatomy.”

§ 3. The statements of M. Duchâtelet respecting the innocuousness of emanations from decomposing animal and vegetable remains, observed by him at the _chantiers d’équarrissage_, or receptacle for dead horses, and the _dépôts de vidange_, or receptacle of night soil, &c., at Montfaucon, near Paris, are cited in this country, and on the continent, as leading evidence to sustain the general doctrine; but as it is with his statements of the direct effects of the emanations from the grave-yards, so it is with relation to his statements as to the effects of similar emanations on the health of the population; the facts appear to have been imperfectly observed by him even in his own field of observation. In the Medical Review, conducted by Dr. Forbes, reference is made to the accounts given by Caillard of the epidemic which occurred in the vicinity of the Canal de l'Ourcq near Paris in 1810 and subsequent years:—

In the route from Paris to Pantin (says he), exposed on the one side
to the miasmatic emanations of the canal, and on the other, to the
putrid effluvia of the _voiries_, the diseases were numerous, almost
all serious and obstinate. This disastrous effect of the union of
putrid effluvia with marsh miasmata, was especially evident in one
part of this route, termed the Petit Pont hamlet, inhabited by a
currier and a gut-spinner, the putrid waters from whose operations
are prevented from escaping by the banks of the canal, and exposed
before the draining to the emanations of a large marsh. This hamlet
was so unhealthy, that of five-and-twenty or thirty inhabitants I
visited about twenty were seriously affected, of whom five died.

In the carefully prepared report on the progress of cholera at Paris, made by the commission of medical men, of which Parent Duchâtelet was a member, it is mentioned, as a singular incident, that in those places where putrid emanations prevailed, “le cholera ne s'est montré ni plus redoutable ni plus meurtrier que dans autres localities.” Yet the testimony cited as to this point is that of the Maire, “whose zeal equalled his intelligence,” and he alleges the occurrence of the fact of the liability to fevers which M. Duchâtelet elsewhere denies.

“I have also made some observations which seem to destroy the
opinions received at this time, as to the sanitary effect of these
kinds of receptacles; for,

“1st. The inhabitants of the houses situated the nearest to the
depôt, and which are sometimes _tormented_ with fevers, have never
felt any indisposition.”

§ 4. To prove the innocuousness of emanations from human remains on the general health, evidence of another class is adduced, consisting of instances of persons acting as keepers of dissecting rooms, and grave-diggers, and the undertakers’ men, who it is stated have pursued their occupations for long periods, and have nevertheless maintained robust health.

The examination of persons engaged in processes exposed to miasma from decomposing animal remains in general only shows that habit combined with associations of profit often prevents or blunts the perceptions of the most offensive remains. Men with shrunken figures, and the appearance of premature age, and a peculiar cadaverous aspect, have attended as witnesses to attest their own perfectly sound condition, as evidence of the salubrity of their particular occupations. Generally, however, men with robust figures and the hue of health are singled out and presented as examples of the general innocuousness of the offensive miasma generated in the process in which they are engaged. Professor Owen mentions an instance of a witness of this class, a very robust man, the keeper of a dissecting room, who appeared to be in florid health (which however proved not to be so sound as he himself conceived), who professed perfect unconsciousness of having sustained any injury from the occupation, and there was no reason to doubt that he really was unconscious of having sustained or observed any; but it turned out, on inquiry, that he had always had the most offensive and dangerous work done by an inferior assistant; and that within his time he had had no less than eight assistants, and that every one had died, and some of these had been dissected in the theatre where they had served. So, frequently, the sextons of grave-yards, who are robust men, attest the salubrity of the place; but on examining the inferiors, the grave-diggers, it appears, where there is much to do, and even in some of the new cemeteries, that as a class they are unhealthy and cadaverous, and, notwithstanding precautions, often suffer severely on re-opening graves, and that their lives are frequently cut short by the work.[2] There are very florid and robust undertakers; but, as a class, and with all the precautions they use, they are unhealthy; and a master undertaker, of considerable business in the metropolis, states, that “in nine cases out of ten the undertaker who has much to do with the corpse is a person of cadaverous hue, and you may almost always tell him whenever you see him.” Fellmongers, tanners, or the workmen employed in the preparation of hides, have been instanced by several medical writers as a class who, being exposed to emanations from the skins when in a state of putrefaction, enjoy good health; but it appears that all the workmen are not engaged in the process when the skins are in that state, and that those of them who are, as a class, do experience the common consequences. The whole class of butchers, who are much in the open air and have very active exercise, and who are generally robust and have florid health, are commonly mentioned as instances in proof of the innocuousness of the emanations from the remains in slaughter-houses; but master butchers admit that the men exclusively engaged in the slaughter-houses, in which perfect cleanliness and due ventilation are neglected, are of a cadaverous aspect, and suffer proportionately in their health.

Medical papers have been written in this country and on the continent to show that the exposure of workmen to putrid emanations in the employment of sewer cleansing has no effect on the general health; and when the employers of the labourers engaged in such occupations are questioned on the subject, their general reply is, that their men “have nothing the matter with them:” yet when the _class_ of men who have been engaged in the work during any length of time are assembled; when they are compared with classes of men of the same age and country, and of the like periods of service in other employments free from such emanations, or still more when they are compared with men of the same age coming from the purer atmosphere of a rural district, the fallacy is visible in the class, in their more pallid and shrunken aspect—the evidence of languid circulation and reduced “tone,” and even of vitality—and there is then little doubt of the approximation given me by an engineer who has observed different classes of workmen being correct, that employment under such a mephitic influence as that in question ordinarily entails a loss of at least one-third of the natural duration of life and working ability.

The usual comment of the employers on the admitted facts of the ill-health and general brevity of life of the inferior workmen engaged in such occupations is, “But they drink—they are a drunken set;” and such appears frequently, yet by no means invariably, to be the case. On further examination it appears that the exposure to the emanations is productive of nervous depression, which is constantly urged by the workmen as necessitating the stimulus of spirituous or fermented liquors. The inference that the whole of the effects are ascribable to the habitual indulgence in such stimuli is rebutted by the facts elicited on examination of other classes of workmen who indulge as much or more, but who nevertheless enjoy better health, and a much greater average duration of life. It is apt to be overlooked that the weakly rarely engage in such occupations, or soon quit them; and that, in general, the men are of the most robust classes, and have high wages and rather short hours of work, as well as stimulating food. A French physician, M. Labarraque, states in respect to the tanners, that, notwithstanding the constant exposure to the emanations from putrid fermentations, it has not been “remarked” of the workmen of this class that they are more subject to illness than others. A tanner, in a manual written for the use of the trade, without admitting the correctness of this statement, observes: “Whatever may be the opinion of M. Labarraque on this point, we do not hesitate to declare the fact that this species of labour cannot be borne by weakly, scrofulous, or lymphatic subjects.”[3]

§ 5. So far as observations have been made on the point (and the more those reported upon it are scrutinized, the less trustworthy they appear to be), workmen so exposed do not appear to be peculiarly subject to epidemics; many, indeed, appear to be exempted from them to such an extent as to raise a presumption that such emanations have on those “acclimated” to them an unexplained preservative effect analogous to vaccination. That one miasma may exclude, or neutralize, or modify the influence of another, would appear to be _primâ facie_ probable. But it is now becoming more extensively apparent that the same cause is productive of very different effects on different persons, and on the same persons at different times; as in the case mentioned by Dr. Arnott of the school badly drained at Clarendon Square, Somers’ Town, where every year, while the nuisance was at its height, and until it was removed by drainage, the malaria caused some remarkable form of disease; one year, extraordinary nervous affection, exhibiting rigid spasms, and then convulsions of the limbs, such as occur on taking various poisons into the stomach; another year, typhoid fever; in another, ophthalmia; in another, extraordinary constipation of the bowels, affecting similar numbers of the pupils. Such cases as the one before cited with respect to the depôt for animal matter in Paris, where the workmen suffered very little, whilst the people living near the depôt were “tormented with fevers,” are common. The effects of such miasma are manifested immediately on all surrounding human life (and there is evidence to believe they are manifest in their degree on animal life[4]), in proportion to the relative strength of the destructive agents and the relative strength or weakness of the beings exposed to them; the effects are seen first on infants; then on children in the order of their age and strength; then on females, or on the sickly, the aged, and feeble; last of all, on the robust workmen, and on them it appears on those parts of the body that have been previously weakened by excess or by illness. Whilst M. Parent Duchâtelet was looking for immediate appearances of acute disease on the robust workmen living amidst the decomposing animal effluvium of the Montfaucon, I have the authority of Dr. Henry Bennett for stating that he might have found that the influence of that effluvium was observable on the sick at half a mile distant. “When I was house surgeon at St. Louis,” says Dr. Bennett, “I several times remarked, that whenever the wind was from the direction of the Montfaucon, the wounds and sores under my care assumed a foul aspect. M. Jobert, the surgeon of the hospital, has told me that he has repeatedly seen hospital gangrene manifest itself in the wards apparently under the same influence. It is a fact known to all who are acquainted with St. Louis, that the above malady is more frequent at that hospital than at any other in Paris, although it is the most airy and least crowded of any. This, I think, can only be attributed to the proximity of the Montfaucon. Indeed, when the wind blows from that direction, which it often does for several months in the year, the effluvium is most odious.” As an instance of a similar influence of another species of effluvium, not observed by the healthy inhabitants of a district, it is stated that at a large infirmary in this country, when the piece of ornamental water, which was formerly stagnant in front of the edifice, had a greenish scum upon it, some descriptions of surgical operations were not so successful as at other times, and a flow of fresh water has been introduced into the reservoir to prevent the miasma.

The immediate contrasts of the apparent immunity of adults to conspicuous attacks of epidemics, may perhaps account for the persuasion which masters and workmen sometimes express, that they owe an immunity from epidemics to their occupation, and that the stenches to which they are exposed actually “purify” the atmosphere. Numbers of such witnesses have heretofore been ready to attest their conviction of the preservative effect, and even the positive advantages to health, of the effluvia generated by the decomposition of animal or of vegetable matter, or of the fumes of minerals, of smoke, soot, and coal gas. But though they do not peculiarly suffer from epidemics, it is usually found that they are not exempted. In a recent return of the state of health of some workmen engaged in cleansing sewers, whilst it appeared that very few had suffered any attack from fever, nearly all suffered bowel attacks and violent intestinal derangement. If the effects of such emanations invariably appeared in the form of acute disease, large masses of the population who have lived under their influence must have been exterminated. In general the poison appears only to be generated in a sufficient degree of intensity to create acute disease under such a conjunction of circumstances, as a degree of moisture sufficient to facilitate decomposition, a hot sun, a stagnant atmosphere, and a languid population. The injurious effects of diluted emanations are constantly traceable, not in constitutional disturbance at any one time; they have their effect even on the strong, perceptible over a space of time in a general depression of health and a shortened period of existence. This or that individual may have the florid hue of health, and may live under constant exposure to noxious influences to his sixtieth or his seventieth year; but had he not been so exposed he might have lived in equal or greater vigour to his eightieth or his ninetieth year. A cause common to a whole class is often, however, not manifest in particular individuals, but is yet visible in the pallor and the reduced sum of vitality of the whole class, or in the average duration of life in that class, as compared with the average duration of life of another class similarly situated, in all respects except in the exposure to that one cause.[5] The effects of a cause of depression on a class are sometimes visible in the greater fatality of common accidents. An excess of mortality to a class is almost always found, on examination, to be traceable to an adequate cause. From the external circumstances of a class of the population, a confident expectation may be formed of the sum of vitality of the class, though nothing could be separately predicated of a single individual of it. If the former vulgar notions were correct as to the salubrity of the stenches which prevail in towns, the separate as well as the combined results of these several supposed causes of salubrity must be to expel fevers and epidemics from the most crowded manufacturing districts, and to advance the general health of the inhabitants above that of the poorer rural population; but all such fallacies are dissipated by the dreadful facts on the face of the mortuary records showing a frequency of deaths, and a reduction of the mean duration of life, in proportion to the constancy and the intensity of the combined operation of these same causes.[6]

§ 6. The observations of the effects of such emanations on the general health of classes of human beings have been corroborated by experiments on animals.

§ 7. Another doctrine more extensively entertained than that above noticed, is, that although putrid emanations are productive of injury, they are not productive of specific disease, such as typhus. The medical witnesses say, that they were exposed to such emanations in dissecting-rooms, where bodies of persons who have died of small-pox, typhus, scarlatina, and every species of disease, are brought; that they pursued their studies in such places, and were unaware of typhus or other disease having been taken by the students in them, though that disease was frequently caught by students whilst attending the living in the fever wards.[7]

The strongest of this class of negative evidence appears to be that of undertakers, all of whom that I have seen state that neither specific disease nor the propagation of any disease was known to occur amongst them, from their employment. Neither the men who handle, or who “coffin,” the remains; nor the barbers who are called in to shave[8] the corpses of the adult males; nor the bearers of the coffins, although, when the remains are in an advanced state of decomposition, the liquid matter from the corpse frequently escapes from the coffin, and runs down over their clothes, are observed to catch any specific disease from it, either in their noviciate, or at any other time. When decomposition is very far advanced, and the smell is very offensive, the men engaged in putting the corpse into the coffin smoke tobacco; and all have recourse to the stimulus of spirituous liquor. But it is not known that, by their infected clothes they ever propagate specific disease in their families, or elsewhere. Neither does this appear to be observed amongst the medical men themselves.[9]

§ 8. On the other hand, the undertakers observe such instances, as will be stated in their own words in a subsequent part of the report, where others have caught fever and small-pox, apparently from the remains of the dead, and they mention instances of persons coming from a distance to attend funerals, who have shortly afterwards become affected with the disease of which the person buried had died. Of the undertakers it is observed, that being adults, they were likely to have had small-pox. Dr. Williams, in a work stated to be of good authority, on the effects of morbid poisons, relates the case of four students infected with small-pox by the dead body of a man who had died of this disease, that was brought into the Windmill-street Theatre, in London, for dissection. One of them saw the body, but did not approach it; another was near it, but did not touch it; a third, accustomed to make sketches from dead bodies, saw this subject, but did not touch it; the fourth alone touched it with both his hands; yet all the four caught the disease. Sir Benjamin Brodie mentions cases which occurred within his own knowledge, of pupils who caught small-pox after exposure to the emanations in the dissecting-room from the bodies of persons who had died of that disease.

Dr. Copeland, in his evidence before the Committee of the House of Commons, adduced the following remarkable case, stated to be of fever communicated after death:—

About two years ago (says he) I was called, in the course of my
profession, to see a gentleman, advanced in life, well known to many
members in this house and intimately known to the Speaker. This
gentleman one Sunday went into a dissenting chapel, where the
principal part of the hearers, as they died, were buried in the
ground or vaults underneath. I was called to him on Tuesday evening,
and I found him labouring under symptoms of malignant fever; either
on that visit or the visit immediately following, on questioning him
on the circumstances which could have given rise to this very
malignant form of fever, for it was then so malignant that its fatal
issue was evident, he said that he had gone on the Sunday before
(this being on the Tuesday afternoon) to this dissenting chapel, and
on going up the steps to the chapel he felt a rush of foul air
issuing from the grated openings existing on each side of the steps;
the effect upon him was instantaneous; it produced a feeling of
sinking, with nausea, and so great debility, that he scarcely could
get into the chapel. He remained a short time, and finding this
feeling increase he went out, went home, was obliged to go to bed,
and there he remained. When I saw him he had, up to the time of my
ascertaining the origin of his complaint, slept with his wife; he
died eight days afterwards; his wife caught the disease and died in
eight days also, having experienced the same symptoms. These two
instances illustrated the form of fever arising from those
particular causes. Means of counteraction were used, and the fever
did not extend to any other members of the family.

Assuming that that individual had gone into a crowded hospital with
that fever, it probably would have become a contagious fever. The
disease would have propagated itself most likely to others, provided
those others exposed to the infection were predisposed to the
infection, or if the apartments where they were confined were not
fully ventilated, but in most cases where the emanations from the
sick are duly diluted by fresh air, they are rendered innocuous. It
is rarely that I have found the effects from dead animal matter so
very decisive as in this case, because in the usual circumstances of
burying in towns the fetid or foul air exhaled from the dead is
generally so diluted and scattered by the wind, as to produce only a
general ill effect upon those predisposed; it affects the health of
the community by lowering the vital powers, weakening the digestive
processes, but without producing any prominent or specific disease.

Mr. Barnett, surgeon, one of the medical officers of the Stepney Union, who has observed the symptoms observable in those persons who are exposed to the emanations from a crowded grave-yard, thus describes them:—

They are characterized by more or less disturbance of the whole
system, with evident depression of the vital force, as evinced
throughout the vascular and nervous systems, by the feeble action of
the heart and arteries, and lowness of the spirits, &c. These
maladies, I doubt not, if surrounded by other causes, would
terminate in fever of the worst description. The cleanliness, &c.,
of the surrounding neighbourhood, perhaps, prevents this actually
taking place.

Some years since a vault was opened in the church-yard (Stepney),
and shortly after one of the coffins contained therein burst with so
loud a report that hundreds flocked to the place to ascertain the
cause. So intense was the poisonous nature of the effluvia arising
therefrom, that a great number were attacked with sudden sickness
and fainting, many of whom were a considerable period before they
recovered their health.

The vaults and burial ground attached to Brunswick chapel,
Limehouse, are much crowded with dead, and from the accounts of
individuals residing in the adjoining houses, it would appear that
the stench arising therefrom, particularly when a grave happens to
be opened during the summer months, is most noxious. In one case it
is described to have produced instant nausea and vomiting, and
attacks of illness are frequently imputed to it. Some say they have
never had a day’s good health since they have resided so near the
chapel-ground, which, I may remark, is about five feet above the
level of the surrounding yards, and very muddy—so much so, that
pumps are frequently used to expel the water from the vaults into
the streets.

The bursting of leaden coffins in the vaults of cemeteries, unless they are watched and “tapped” to allow the mephitic vapour to escape, appears to be not unfrequent. In cases of rapid decomposition, such instances occur in private houses before the entombment. An undertaker of considerable experience states:—

“I have known coffins to explode, like the report of a small gun, in
the house. I was once called up at midnight by the people, who were
in great alarm, and who stated that the coffin had burst in the
night, as they described it, with ‘a report like the report of a
cannon.’ On proceeding to the house I found in that case, which was
one of dropsy, very rapid decomposition had occurred, and the lead
was forced up. Two other cases have occurred within my experience of
coffins bursting in this manner. I have heard of similar cases from
other undertakers. The bursting of lead coffins without noise is
more frequent. Of course it is never told to the family unless they
have heard it, as they would attribute the bursting to some
defective construction of the coffins.”

The occurrence of cases of instant death to grave-diggers, from accidentally inhaling the concentrated miasma which escapes from coffins, is undeniable. Slower deaths from exposure to such miasma are designated as “low fevers,” and whether or not the constitutional disturbances attendant on the exposure to the influence of such miasma be or not the true typhus, it suffices as a case requiring a remedy, that the exposure to that influence is apt to produce grievous and fatal injuries amongst the public.

§ 9. Undertakers state that they sometimes experience, in particularly crowded grave-yards, a sensation of faintness and nausea without perceiving any offensive smell. Dr. Riecke appears to conclude, from various instances which are given, that emanations from putrid remains operate in two ways,—one set of effects being produced through the lungs by impurity of the air from the mixture of irrespirable gases; the other set, through the olfactory nerves by powerful, penetrating, and offensive smells. On the whole, the evidence tends to establish the general conclusion that offensive smells are true warnings of sanitary evils to the population. The fact of the general offensiveness of such emanations is adduced by Dr. Riecke also as evidence of their injurious quality.

Another circumstance which must awaken in us distrust of putrid
emanations, is the powerful impression they make on the sense of
smell. It certainly cannot be far from the truth to call the organ
of smell the truest sentinel of the human frame. “Many animals,”
observes Rudolphi, “are entirely dependent on their sense of smell
for finding out food that is not injurious; where their smell is
injured they are easily deceived, and have often fallen a sacrifice
to the consequent mistakes.” Amongst all known smells, there is,
perhaps, no one which is so universally, and to such a degree
revolting to man, as the smell of animal decomposition. The roughest
savage, as well as the most civilized European, fly with equal
disgust from a place where the air is infected by it. If an instinct
ever can be traced in man, certainly it is in the present case: and
is instinct a superfluous monitor exactly in this one case? Can
instinct mislead just in this one circumstance? Can it ever be, that
the air which fills us with the greatest disgust, is the finest
elixir of life, as Dumoulins had the boldness to maintain in one of
his official reports. Hippolyte Cloquet, in his Osphrestologie has
attempted to throw some light on the effect of smell on the human
frame, and though we must entirely disregard many of the anecdotes
which he has blended into his inquiry, yet the result remains firmly
proved that odours in general exert a very powerful influence on the
health of men, and that all very acutely impressing smells are
highly to be suspected of possessing injurious properties.

§ 10. I beg leave on this particular topic to submit the facts and opinions contained in communications from two gentlemen who have paid close and comprehensive attention to the subject.

Dr. Southwood Smith, who, as physician to the London Fever Hospital, and from having been engaged in several investigations as to the effects of putrid emanations on the public health, must have had extensive means of observation, states as follows:—

1. That the introduction of dead animal matter under certain
conditions into the living body is capable of producing disease, and
even death, is universally known and admitted. This morbific animal
matter may be the product either of secretion during life or of
decomposition after death. Familiar instances of morbific animal
matter, the result of secretion during life, are the poisons of
small-pox and cow-pox, and the vitiated fluids formed in certain
acute diseases, such as acute inflammations, and particularly of the
membranes that line the chest and abdomen. On the examination of the
body a short time after death from such inflammations, the fluids
are found so extremely acrid, that even when the skin is entirely
sound, they make the hands of the examiner smart; and if there
should happen to be the slightest scratch on the finger, or the
minutest point not covered by cuticle, violent inflammation is often
produced, ending, sometimes within forty-eight hours, in death. It
is remarkable, and it is a proof that in these cases the poison
absorbed is not putrid matter, that the most dangerous period for
the examination of the bodies of persons who die of such diseases is
from four to five hours after the fatal event, and while the body is
yet warm.

That the direct introduction into the system of decomposing and
putrescent animal matter is capable of producing fevers and
inflammations, the intensity and malignity of which may be varied at
will, according to the putrescency of the matter and the quantity of
it that is introduced, is proved by numerous experiments on animals;
while the instances in which human beings are seized with severe and
fatal affections from the application of the fluids of a dead animal
body to a wounded, punctured, or abraded surface, sometimes when the
aperture is so minute as to be invisible without the aid of a lens,
are of daily occurrence. Though this fact is now well known, and is
among the few that are disputed by no one, it may be worth while to
cite a few examples of it, as specimens of the manner in which the
poison of animal matter, when absorbed in this way, acts; a volume
might be filled with similar instances.

The following case is recorded by Sir Astley Cooper:—Mr. Elcock,
student of anatomy, slightly punctured his finger in opening the
body of a hospital patient about twelve o’clock at noon, and in the
evening of the same day, finding the wound painful, showed it to Sir
Astley Cooper after his surgical lecture. During the night the pain
increased to extremity, and symptoms of high constitutional
irritation presented themselves on the ensuing morning. No trace of
inflammation was apparent beyond a slight redness of the spot at
which the wound had been inflicted, which was a mere puncture. In
the evening he was visited by Dr. Babington, in conjunction with Dr.
Haighton and Sir Astley Cooper; still no local change was to be
discovered, but the nervous system was agitated in a most violent
and alarming degree, the symptoms nearly resembling the universal
excitation of hydrophobia, and in this state he expired within the
period of forty-eight hours from the injury.

The late Dr. Pett, of Hackney, being present at the examination of
the body of a lady who had died of peritoneal inflammation after her
confinement, handled the diseased parts. In the evening of the same
day, while at a party, he felt some pain in one of his fingers, on
which there was a slight blush, but no wound was visible at that
time. The pain increasing, the finger was examined in a stronger
light, when, by the aid of a lens, a minute opening in the cuticle
was observed. During the night the pain increased to agony, and in
the morning his appearance was extremely altered; his countenance
was suffused with redness, his eyes were hollow and ferrety; there
was a peculiarity in his breathing, which never left him during his
illness; his manner, usually gay and playful, was now torpid, like
that of a person who had taken an excessive dose of opium, he
described himself as having suffered intensely, and said that he was
completely knocked down and had not the strength of a child, and he
sunk exhausted on the fifth day from the examination of the body.