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Provincial Medical JournalSource: Provincial Medical Journal and Retrospect of the Medical Sciences, Vol. 5, No. 114(Dec. 3, 1842), pp. 191-194Published by: BMJStable URL: http://www.jstor.org/stable/25491660 .

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SANITARY CONDITION OF THE LABORING CLASSES. 191

to, he died on the following day, November 19th, at

half-past four in the morning. The body was examined on the 20th. The cranial

bones were remarkably thin, and the right side of the

skull somewhat prominent. Thc whole of the supe rior surface of the cerebral hemispheres was covered

with a layer of yellow fluid pus, and appeared some

what flattened; no trace of the arachnoid could be found at this part. The pia mater was highly con

gested, and infiltrated with pus in its prolongations between the convolutions; the substance of the hemispheres was very much softened, and contained numerous points of blood when cut through; the lateral ventricles empty, and their walls softened in the highest degree; the pineal gland was very much enlarged, and did not contain any calcareous matter. The inferior surface of the cerebrum, and the whole of the cerebellum, were covered with pus, and ex tremely soft; the arachnoid here also appeared to

have been destroyed; the base of the cranium was

bathed in pus; no fluid in the third or fourth ven

tricles; the pineal gland much injected. The inner surface of the trachea was of a light red color, but the bronchi were healthy. There were some adhesions between the pleurae, and the substance of the lungs was much congested; a few tubercles in the upper part of the left lung. The heart was very large, soft,

and loaded with fat, but not diseased. In the abdo minal cavity nothing worthy of notice was found. The bladder contained about half a pint of turbid urine. The fibrous membrane of the spinal marrow

was much injected, and the cellular membrane parti. cularly so; its whole surface, and especially opposite the cauda equina, was bathed in the same kind of

purulent matter as the brain; there was no trace of

the serous membrane, and the substance of the spinal marrow itself was converted into a thin, pultaceous matter.

REMARKS.

This remarkable case is almost unique in the annals

of medical science. Pathologists must decide whether the inflammation commenced in the arachnoid mem brane, or extended to it from the softened nervous

tissue, or whether both states were simultaneously produced by one and the same cause. But, however

this may be, we cannot but be struck with surprise

that such extensive softening of the cerebro-spinal nervous mass, and universal suppuration of its serous

membrane, should have existed without the produca tion of any symptoms to indicate such extensive dis

ease. Particular inquiries were made in the regiment in which the man had served, and it was ascertained

that during the seven previous years he had enjoyed excellent health, having continued to do his duty as a

soldier without interruption. It was only two days

before his decease that gastric and convulsive symp

toms made their appearance, and quickly terminated

in coma and death.-Ostr. Med. Woch., Nov. 4, 1842.

PROVINCIAL' NMEDICAL JOURNAL

SATURDAY, DECEMBER 3, 1842.

The condition of the dwelling-houses of the poorer

classes, whether as regards their internal economy or external situation, forms a most important object of inquiry to the philanthropist and the physician. When

we reflect upon the influence which the varying cir cumstances of site and elevation, and exposure to air and moisture, must exercise upon the health and comfort of the artisan and the cottager-when it is

considered that the free circulation of air, the access of light, and protection from cold and damp, and

from noxious exhalations and impurities, whether of the air respired or the water employed in the various branches of domestic economy, are important to all, but doubly so to those who are from poverty deprived of the means of guarding against many of the inlets

to disease-there is little need of labored argument to

show the importance of such inquiries. No reflecting person, who is conversant with the habits, and, from

personal inspection, familiar with the dwellings of the working population of this country, will hesitate to admit that there is great room for improvement in both. The site of the houses of the manufacturing portion of our population, in particular, has been too generally chosen with reference to the one only view of proximity to the factory, regardless alike of the

comfort and the health of the inmates. These houses are for the most part situated in the midst of the

noxious effluvia generated by the various processes carried on at the manufactory, because it is consi dered advantageous that the workmen should be near at hand; they are crowded into a small space, the

value of the ground not allowing of sufficient room for

much attention to ventilation, or to the admission of

light. The banks of rivers and canals being desirable

situations for factories, as well on account of the

supply of water for working the machinery, as for the

convenience of transporting the products of labor, the

ground is very frequently swampy, and drainage, or

'thelr means of providing against accumulation of dirt

and filth, rarely enters into the contemplation either

of owner or occupier of the miserable tenements with

which such places abound. Can it then be a matter

of surprise that the population reared under such cir

cumstances should be squalid, stinted in growth, scro fulous in constitution, and careless of those devencies of every-day life in the absence of which there is no

check to the development of vicious tastes, no impedi

ment to the indulgence of vicious appetites? Can it

be a matter of surprise that in such places scrofula,

pulmonic affections, and rheumatism are endemic, and

that fever aud scarlatina, cholera, diarrhnea, aud

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192 SANITARY CONDITION OF THE POOR.

dysentery, are frequent in their visitations and assume

their most fearful and fatal characters ?

In turning over the pages of Mr. Chadwick's report,

numerous examples both of the wretched condition of the laboring poor as to external circumstances, and

of the necessary consequences of this condition, force themselves on our notice. These are, however, only selections from the mass of evidence afforded by the

medical correspondents of the poor-law commission, to whose able communications the report owes so

much of its value. We have before had occasion to

refer to the condition of the lowest class of the inha

bitants in Liverpool, Manchester, and other large towns. In one of the earlier numbers of this Journal

our readers will find accounts of the destitution and

misery of large numbers of our fellow-creatures, which

it is in the highest degree painful to contemplate.

The parliamentary report on the health of towns con

tains authentic statements, delivered before a com.

mittee of the House of Commons by competent and

intelligent witnesses, of such a character as to compel

public attention to the details there brought forward; and it is not too much to say, that it is to the valuable

evidence given by Dr. Arnott, Dr. Duncan, Dr. Lynch,

anld the other medical witnesses examined by this

committee, that we shall owe whatever of benefit may

be worked out by the present inquiry onl the part of

the poor-law commission. The evidence of Dr. Dun can, as to the condition of the poorer classes of inha

bitants in Liverpool, is well borne out by the reports

furnished to the poor-law authorities by their owvn

medical officers of the condition of the laboring popu

lation of the suburbs and surrounding country. " The

cottages," says one of these gentlemen attached to the

West Derby union, whose name, however, has for

some reason been withheld, "are in general built

more with a view to the per centage of the landlord

than to the accommodation of the poor. The joiner's

work is ill performed; admitting by the doors, win

dows, and even floors, air in abundance, which, how

ever, in many cases, is not disadvantageous to the

inmates. The houses generally consist of three apart

ments-viz, the day-room, into which the street-door

opens, and two bed-rooms, one above the other.

There is likewise beneath the day-room a cellar,

let off either by the landlord or tenant of the house to

a more improvident class of laborers; which cellar,

in almost all cases, is small and damp, and often

crowded with inhabitants to excess. These cellars

are, in my opinion, the source of many diseases, par

ticularly catarrh, rheumatic affections, and tedious cases of typhus mitior, which, owing to the over

crowded state of the apartment, occasionally pass

into typhus gravior. I need scarcely add that the

furniture and bedding are in keeping with the misera

ble inmates. The rooms above the day-room are often

let separately by the tenant to lodgers, varying in

number from one or two, to six or eight individuals

in each, their slovenly habits, indolence, and conse

quent accumulation of filth, go far to promote the

prevalence of contagious and infectious diseases. The houses already alluded to front the street, but there

are houses in back courts still more unfavorably

placed, which have also their cellars, and their tenants,

of a description worse, if possible. There is com

monly only one receptacle for refuse in a court of eight,

or ten, or twelve, densely-crowded houses. In the year 1836-7, I attended a family of thirteenl, twelve of

whom had typhus fever, without a bed in the cellar,

without straw or timber shavings-frequent substi tutes. They lay on the floor, and so crowded, that

I could scarcely pass between them. In another house

I attended fourteen patients; there were only two beds in the house. All the patients, as lodgers, lay

on the boards, and during their illness, never had

their clothes off. I met with many cases in similar

conditions, yet, amidst the greatest destituition and want of domestic comfort, I have never heard during

the course of twelve years' practice, a complaint of

inconvenient accommodation." Similar evidence is given as to the state of the

working population in districts situated in the vicinity of Stockport, Wigan, and other towns in the North.

" It is impossible," states Mr. Atkinson, of Gateshead,

"to give a proper representation of the wretched

state of many of the inhabitants of the indigent class,

situated in the confined streets called Pipewellgate

and Killgate, which are kept in a most filthy state,

and to a stranger would appear inimical to the exist

ence of human beings; where each small, ill-ventilated

apartment of the house contained a family with

lodgers in number from seven to nine, and seldom

more than two beds for the whole." " The writer

had occasion a short time ago to visit a person ill of

the cholera; his lodgings were in a room of a miser

able house situated in the very filthiest part of Pipe

wellgate, divided into six apartments, and occupied

by different families to the number of twenty-six

persons in all. The room contained three wretched

beds, with two persons sleeping in each; it measured

about twelve feet in length and seven in breadth, and

its greatest height would not admit of a person's stand

ing erect; it received light from a small window, the

sash of which was fixed. Two of the number lay ill

of the cholera, and the rest appeared afraid of the

admission of pure air, having carefully closed up the

broken panes with plugs of old linen."

Still more wretched, if possible, is the state of the

poor of the manufacturing towvns in Scotland. Mr. Chadwick, it appears, personally visited Glasgow, and, together with Drs. Arnott and Alison and the late Dr.

Cowan, inspected the wynds, narrow streets, and courts of that city. The details of what they wit.

nessed are almost too disgusting to be cited; but after

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SANITARY CONDITION OF THE POOR. 193

wading through filth of every description on the ex

terior of these crowded dwellings, we find Dr. Arnott saying, " The interior of these houses and their in

mates corresponded with the exteriors. We saw half-dressed wretches crowding together to be warm; and in one bed, although in the middle of the day,

several women were imprisoned under a blanket,

because, as many others who had on their backs all the

articles of dress that belonged to the party were then

out of doors in the streets." We find another authority, Mr. J. C. Symonds, who

was appointed by the Government to examine into

the condition of the hand-loom weavers, making the following statement:-" The wynds in Glasgow com prise a fluctuating population of 15,000 to 30,000 per

sons. This quarterconsists of alabyrinth of lanes, out of which numberless entrances lead into small courts, each with a dung-hill reeking in the centre. Revolt ing as was the outward appearance of these places, I was little prepared for the filth and destitution within. In some of these lodging rooms (visited at night), we found a whole lair of human beings littered on the floor, sometimes fifteen and twenty, some clothed, and some naked; men, women, and children, huddled promiscuously together. Their bed consisted of

musty straw intermixed with rags. There was gene.

rally little or no furniture in these places; the sole article of comfort was a fire. Thieving and prostitu tion constitute the main sources of the revenue of this

population. No pains seem to be taken to purge this Augean pandemonium-this nucleus of crime, filth, and pestilence, in the centre of the second city of the empire."

From one such locality as this here described, 754, of about 5,000 cases of fever which occurred in the

year 1839, were carried to the hospitals. " Of the

dreadful danger of such a state of things," says Mr.

A. Alison, in his able work on the Principles of Popu

lation, and their Connection with Human Happiness, " and the manner in which it speedily comes to affect

the higher orders in their lives and property, if they

cannot be reached through any other and more honor

able channel, decisive proof is afforded by the facts

that no less than twenty thousand persons were seized with typhus fever, the well-known attendant on want

and misery in Glasgow, in the single year of 1839, of

whom 2,180 died; that 40,000 persons have had fever

in that city within the last three years; that 10,000

persons have had fever in Dundee in the last four

years; that, in 1838, one in thirty in Edinburgh was a

fever patient." Now to turn to the effects of such a

state upon the duration of life, it is sufficient to say

that the average annual mortality in Glasgow, in 1822,

was 1 in 41; in 1835, 1 in 29.53; in 1836, 1 in 26.68;

in 1837, 1 in 24.20. (See Br. and For. Med. Rev. for

Oct., p. 456.)

These statements, however, are not coufined to the

reports from the northern districts. The western, eastern, and midland portions of the kingdom furnish instances of the wretched condition of the habitations of the poorer classes, equally instructive and equally calling for attention and amelioration. Even the im

mediate vicinity of royalty itself is not exempt from this calamitous state of the laboring population. Let us hear the report of Mr. Assistant-commimioner Parker:

" Extensive as the improvements in the state of

the drainage of almost every town in these counties (Buc}kingham, Oxford, and Berks) might be, there is no town amongst them in which there is so wide a

field for improvement as Windsor, which, from the contiguity of the palace, the wealth of the inhabitants, and the situation, might have been expected to be superior in this respect to any other provincial town. Such, however, is not the case; for of all the towns

visited by me, Windsor is the worst beyond all com parison. From the gas works at the end of George

street a double line of open, deep, black, and stagnant

ditches extends to Clewer-lane. From these ditches an intolerable stench is perpetually arising, and pro duces fever of a severe character. I visited a cot

tage in Clewer-lane in which typhus fever had ex

isted for some time, and learnt from a woman who

had recently lost a child, the complaint was attri

butable to the state of these ditches. Mr. Bailey, the

relieving officer, informs me that cases of typhus fever are frequent in the neighbourhood; and observes that

there are now seven or eight persons attacked by

typhus in Charles-street, and South-place. He con

siders the neighbourhood of Garden-court in almost the same condition. 'There is a drain,' he says, ' running from the barracks into the Thames across

the Long-walk. That drain is almost as offensive as

the black ditches extending to Clewer-lane. The openings to the sewers in Windsor are exceedingly

offensive in hot weather. The town is not well sup plied with water, and the drainage is very defective.' The ditches of which I have spoken are sometimes emptied by carts; and on the last occasion their con

tents were purchased for the sum of fifteen pounds, by the occupier of land in the parish of Clewer, whose

meadow suffered from the extraordinary strength of the manure,whichwas usedwithoutprevious preparation."

Now we cannot but think that the removal of such

nuisances, generative as it would seem of severe and

dangerous fever, existing in the immediate neighbour hood of the court, is to the full as important in a poli

tical point of view as the support of that court in the

splendour and magnificence which is fitting, and we should prefer seeing a portion of the public funds, so largely drawn upon for this latter purpose, appro priated rather to the rendering the royal residences abodes from which every source of contagious or en.

demic diease was as far removed as posible.

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194 REVIEW OF CAZENAVE ON

Doubtless, too, the honor of the nation is materially concerned in providing for the health and comfort of all classes of its population, and it will scarcely admit of question that the large sums raised and expended to support the honor and dignity of the British name in Syria, Canada, China, Affghanistan, and every other quarter of the habitable globe, might be at least equally well bestowed in improving the condition and adding to the comforts of the artisan and laborer among our home population.

Not long ago a piece of domestic oppression came to our notice which, had the poor-law commission been what it ought to be, would have called for a little interference on their part, possibly also the expenditure of a few shillings weekly by the pa rochial authorities, quite .as much as the undertaking of a distant war on the part of the nation, and a consi

derable expenditure of life and treasure to compel the subjects of a foreign country to receive opium at our hands to the manifest injury of their health and morals. In the case we allude to, a delicate female, threatened

with consumption, was compelled to change her ha bitation in an open and well ventilated part of a ma

nufacturing town for one confined, dark, damp, and chill, one small upstairs room alone being in any way habitable, because the master manufacturer who em ployed her husband had this tenement unoccupied.

Work was short, and if the poor man refused to im mure himself, his wife, and child therein, he was threatened with the loss of the scanty measure of employment, which was all he had to depend upon. The consequence is confirmed consumption in the case of the poor woman, and certain loss of life at no

distant period, with all the acompanying domestic afflictions, to the husband, and the worst of all be reavements to the infant. Is this a solitary instance?

We know that very many such might be adduced, and the providing of some remedy for such a state, the enactment of some general provision by which the

habitations of the poor may be rendered as far as prac

ticable free from all extraneous sources of disease, and the rendering the poor-law protective of theirinterests rather than oppressive to them in their' 'aamities,

would be a wreath of honor to the statesman who

should effect such a genuine reform, which would cast into shade all the laurels which the most sptendidauc ceses of whatever kind could bestow.

WESTMINSTER HOSPITAL.

A vacancy will, we understand, soon occur in the office of physician to this hospital, by the retirement of Dr. Burne. We should not have alluded to Dr. Burne's retirement, which has not been officially an nounced, had we not seen an unusual sort 'o "feeler" put forth by the friends of Dr. Basham on the ex. pected vacancy.

RE VIEWS.

A Manual of Diseases of the Skin, from the French of MM. Cazenave and Schedel, with Notes and Additions. By THOM&S R. BURGESS, M.D, Surgeon to the Blenheim-street Dispensary for Diseases of the Skin. 8Svo, pp. 320. London: Henry Ren shaw.

All of our readers who cultivate acquaintance with

French medical literature must be familiar with the origiual of the volume now before us. It has for several

years past been considered a standard work on dis

eases of the skin; indeed, up to the present date it is

unrivalled in point of accuracy of description and

clearness and conciseness of style-qualities of no mean importance in a treatise on cutaneous pathology.

The " Abreg6 Pratique" of MM. Cazenave and

Schedel was written under the most favorable cir cumstances. The authors were for a long period

internes at the Hospital of St. Louis, under M. Biett, where they had opportunities which fall to the lot of

few, of seeing, and comparing with the descriptions

set down in books, the different diseases of the skin in every variety and in every form. They had, more

over, the admirable oral discourses of M. Biett to

guide them in their studies from nature, and thus,

with so many elements of success ready placed before

them, it is not surprising that their descriptions of

cutaneous disease should bear the impress of truth

and accuracy. The Hospital of St. Louis affords

facilities for studying diseases of the skin which are

unequalled by any other medical institution in Europe,

Indeed, it is unique of its kind. We know of no other

establishment of a similar nature in which several

hundred beds are devoted exclusively to skin affec

tions, to say nothing of the crowds of out-patients by

whom the doors of the hospital are beset every week.

If we have cause to regret that the eminent derma

tologist who had the care of that excellent institution for a long series of years has not himself written on a

subject which he understood so well, we have the

satisfaction to know that the work of his pupil and

successor, M. Cazenave, contains a faithful exposition of his views and extensive experience in dermoid pathology.

After exposing the fallacy of various classifications which have been advanced from time to time by dif

ferent writers on cutaneous affections, the authors proceed to show that the arrangement of Willan is by

far the most correct of all that have been published,

and adopt it accordingly for the groundwork of their

manual, with some alterations made at the suggestion

of M. Biett. They very justly reprehend the system of

multiplying classifications, the invariable result of which is confusion and mystification; hence they chose rather to adopt that which they found to be the

most accurate, the most simple, and the best known,

with the modifications above-mentioned, than to add to the confusion already existing by writing a new

one. The differential diagnosis of diseases of the skin is,

as every one who has studied that branch of pathology

must be aware, one of the most important points con

nected with their history. It is also the greatest

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