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- Herausgeber: Science & Technology Publishing
- Kategorie: Fachliteratur
- Sprache: Englisch
The Common Nature of Epidemics and Their Relation to Climate and Civilization by Southwood Smith is a seminal work first published in the 19th century, exploring the underlying principles and causes of epidemic diseases. Drawing from his extensive experience as a physician and public health reformer, Smith delves into the patterns and behaviors of epidemics, arguing that these outbreaks are not random or mysterious, but rather follow certain laws and are influenced by environmental and societal factors. The book meticulously examines the relationship between epidemics and climate, highlighting how variations in temperature, humidity, and other meteorological conditions can affect the spread and severity of diseases. Smith also investigates the impact of civilization, urbanization, and living conditions, emphasizing the role of sanitation, overcrowding, and poverty in fostering environments where epidemics thrive. Throughout the text, Smith advocates for a scientific and rational approach to understanding and combating epidemics, challenging prevailing superstitions and misconceptions of his time. He presents detailed case studies and historical examples, illustrating how improvements in public health infrastructure, hygiene, and social reforms can significantly reduce the incidence and impact of epidemic diseases. The book is both a call to action for policymakers and a foundational text for students of epidemiology, public health, and social medicine. Smith’s insights laid the groundwork for modern approaches to disease prevention and control, making The Common Nature of Epidemics and Their Relation to Climate and Civilization a crucial contribution to the history of medicine and public health.
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The cover image was created by the transcriber and is placed in the public domain.
THE COMMON NATURE OF EPIDEMICS AND THEIR RELATION TOCLIMATE AND CIVILIZATION.
INTRODUCTION.
The recent very serious outbreak of Epidemic disease among the cattle in England may not unreasonably induce the fear that a human Epidemic is approaching. Cholera has prevailed in Paris and several other places on the Continent during the late autumn, and it is well known that the former visitations of that terrible disease in this country have appeared the year following similar attacks abroad. Moreover, human epidemics in numerous instances have been preceded or accompanied by extensive murrain among cattle.[1]
1. See pp. 7, 65, 110.
Never was a country guided through the perils of an Epidemic with greater wisdom and energy than Great Britain during the Cholera of 1848–9. The master spirit on that occasion was Dr Southwood Smith. Long previous to that time this great man had had a more extended experience of the nature, causes, and treatment of Zymotic diseases than perhaps any physician before or since. He had made them his special study, and applied the great powers of his clear, reasoning, and philosophic mind, to the discovery of their causes, and the best means of arresting their progress.
Whilst occupying the post of responsibility as the chief medical adviser of the nation in his capacity of Medical Member of the General Board of Health, Dr Southwood Smith left behind him a set of official reports on the subjects of Epidemics, Contagion, and Quarantine, which will never die.
“The reports drawn up by Dr Southwood Smith,” writes Dean Peacock, “on the proper precautions to be taken to meet the recent outbreaks of cholera, have been of the most essential service wherever their recommendations have been followed. If Dr S. Smith, however, had no other claims on the lasting gratitude of the nation, I would refer to his reports on quarantine, as quite sufficient to establish them. They have contributed, more than any other publications on this subject, to dissipate the gross and mischievous delusions upon which these regulations are founded, and which are known to be so injurious to the free commercial intercourse and prosperity of nations.”
After Dr Southwood Smith left office he gave us a concise summary of his experience in two masterly lectures, now published, together with extracts from his official Reports.
In times of distress it is only natural to look for the most efficient help. Our herds only have extensively suffered of late, but we ourselves may follow, and it is well to be prepared. Even with reference to the causes and treatment of the Epizootic, the reasonings, facts, and conclusions again brought forward in the following pages will apply. But should the worst fears become realized, and an extensive human epidemic follow, these writings will tell with greater force, and the nation will be better prepared to meet the danger, for having calmly considered beforehand the probability of its approach.
One ground of hope that we may escape a visitation of Cholera during the coming summer, may be afforded by the remarkably tempestuous weather which prevailed in December and January last.[2] The loss of the steam-ship “London,” which foundered in the Bay of Biscay, with 226 souls, on the 11th January, and the still more remarkable fact, that during the night of the 10th, out of 62 vessels riding at anchor in Torbay, 41 either foundered or were dashed to pieces on the rocks;—these were terrible calamities, and they were only the most striking examples of the numerous wrecks and disasters which occurred in the course of the late most tempestuous season;—but they afford a hope of escape from a worse peril, viz. nations prostrated by disease and premature death.
Kingscote, Wokingham,
May, 1866.
2. See p. 18.
CONTENTS.
EPIDEMICS—
PAGE
Their Common Nature
1
Are all Fevers:—
e.g.
Plague, Sweating Sickness, Cholera, &c.,
2
Rapidity of their Course
4
Warnings of their Approach
5
Periodicity of their Return
8
Are produced by the same Causes
10
Foul Air—Overcrowding
12
Attack Animals
7
,
13
,
16
,
65
,
110
Their Attendant Signs—Meteorology
17
Action of Air on the Blood
19
Theories of Epidemic Causes
23
Influence of Climate
25
Mortality within the Tropics
29
Their Relation to Civilization
33
State of England in the 14th Century
35
Improvements in the 15th Century
41
Prolongation of Life in the 17th and 18th Centuries
45
Disappearance of the Earlier Epidemics,
e.g.
Jail Fever, Sweating Sickness, Plague, Typhus-Gravior, &c.
51
Experience of the Model Dwellings
54
Sanitary Legislation and Works
57
,
129
Epidemics are within Human Control
58
QUARANTINE—
Originated in the Belief that Epidemics spread exclusively by Contagion
61
Sanitary Measures the only Safeguards
63
Effects Attributed to Contagion
67
Inutility of Quarantine
71
Plague, Yellow Fever, Cholera, &c.
73
Mitigation of Disease by Migration,
e.g.
Tramps
75
Sanitary Regulation of Ships
77
CONTAGION—
Cholera averted at Baltimore
79
Cholera averted at Newcastle Barracks
82
Yellow Fever in the
Eclair
84
Alleged Communication of Disease to Boa Vista, and Examination of Evidence
96
Alleged Importation of Disease by the
Dygden
into Gibraltar, and Examination of Evidence
117
APPENDIX.
Sanitary Works accomplished under the Public Health Act
129
Some account of the structure and functions of the human frame, of the action of physical agents on this wonderful machinery, and of the principles which relate to Individual, as well as to Public Health, ought to form a part of elemental education. There is a growing conviction that the necessity for such knowledge is not restricted to the physician; that it is essential also to the educator, the mother, the nurse, and indeed to every one who would enjoy, together with the due development of his physical, intellectual, and moral nature, the full term of the boon of life.
The main causes which shorten and embitter human life, as far as that unhappy result depends on the disturbance of health, are within our own control. There is the closest connection between the knowledge we have acquired of the physical conditions on which the life and health of individuals and communities depend, and on our command over those conditions. Every fact we have learnt respecting the great laws of nature, on our conformity to which our very existence depends, has taught us that the circumstances which produce excessive sickness and early death are preventible.
The character of Pestilence which gave it its great power and terror—that it walketh in darkness,—is its character no longer. Its veil has fallen, and with it its strength. A clear and steady light now marks its course from its commencement to its end; and that light places in equally broad and strong relief its antagonist and conqueror—Cleanliness.
The term Epidemic has become a popular one. It is derived from two Greek words, which signify “upon the people—prevalent among the people”—diseases which, at one and the same time, prevail extensively among large masses of the people.
Recently these diseases have received another name, which is also becoming familiar—“Zymotic,” from a Greek word, which signifies to “ferment,” as if the efficient cause of these diseases, whatever it may be, acts in the manner of a ferment.
Epidemic diseases, though called by a common name, present great differences in their external characters. Plague, Yellow Fever, Cholera, Small-Pox, Typhus, Scarlet Fever, Influenza, present characters so definite and special, that they have been naturally regarded as distinct diseases, and they really are so different as to render it desirable, for many reasons, that each should be discriminated and denoted by its proper name. Amidst this great diversity in form, however, they present very striking resemblances, of which the following are generally recognized:—
1. Epidemics resemble each other in being all fevers. They all exhibit that particular assemblage of symptoms which from time immemorial it has been agreed to denote by the term Fever.
This is as true of the great Epidemics of former times as of those which prevail in our own.
The so-called Black Death of the 14th century was a fever—an aggravated form of the Oriental or Bubo-Plague; in which there occurred, in addition to the ordinary symptoms of that dreadful disease, effusions of black blood, forming black spots on the arms, face, and chest. From this circumstance it derived its name. These effusions on the external surface of the body were accompanied by profuse and mortal discharges from the internal organs.
The Oriental Plague, the great devastator of Europe in former times, and still the scourge of some portions of it, is a fever characterized by specific glandular inflammation.
The Sweating Sickness of the 15th and 16th centuries was a fever, with symptoms of acute rheumatism, attended with a fœtid perspiration which poured from the body in streams. “Suddenly,” says Hollingshed, “a deadly burning sweat assailed their bodies and distempered their blood, and all, as soon as the sweat took them, yielded the ghost.”
The Cholera of modern times is a fever, which appears in its true character when the first stroke of the disease does not prove fatal, and time is allowed for the full development of its successive stages.
The common Epidemics of the day—Ordinary as distinguished from Extraordinary Epidemics—typhus, scarlet fever, small-pox, measles,—are so universally recognized as fevers that the popular notion of fever is derived from the external characters which these maladies present.
2. Epidemics resemble each other in the extent of their range. Ordinary diseases attack single individuals, and if, from season or other causes, several cases occur simultaneously, they are still isolated and scattered. They never prevail at the same time among several members of a family, or among the inhabitants generally of a court, street, or town. Epidemics, on the contrary, derive their name from their attacking large numbers at once.
The great Epidemics of all ages have been strikingly characterized by their wide-spread course. The Black Death extended from China to Greenland, and desolated in its course Asia, Europe, and Africa.
The Bubo-Plague of the middle ages often extended beyond its proper seat. In the 15th century it spread seventeen times over different European countries, and extended to the most distant northern nations.
The Sweating Sickness prevailed simultaneously or in rapid succession over England, France, Germany, Prussia, Poland, Russia, Norway, and Sweden. “It extended,” say the chronicles of the day, “like a violent conflagration which spread in all directions; yet the flames did not issue from one focus, but rose up everywhere as if self-ignited.”
The Influenza of the middle ages took a range which may be said to have been universal. In our own day we have seen the same disease attack almost every family, in nearly every city, town, and village; spread within a short period over the whole of Europe, and then extend through the vast continent of the New World.
Cholera traverses the earth in zones, spreads with equal facility through tropical and polar regions, and attacks alike the seats of civilization and the huts of the slave and the savage.
3. Epidemics resemble each other in the rapidity of their course. Sometimes, indeed, they begin slowly, advance haltingly, and gather strength in silence. For some time they give so little indication of their power that the apprehension of their presence is very constantly regarded as a “false alarm.” Now and then, here and there, they strike a sudden and mortal blow; but it is only an individual that falls. After a considerable interval, perhaps at a great distance, another blow is struck; and then one by one, another and another, until at last the fact becomes too manifest to be doubted or denied, that two victims have been seized in one family—several in the same street—three or four on the same day, in distant parts of the town, or in the adjoining town, or it may be in towns separated from each other by the distance of hundreds of miles. At length the terror-stricken nation, startled from its fondly cherished security, sees no place safe from the Plague. When, however, the causes are intense, it may break forth quite suddenly, and spread with astonishing rapidity.
In 1831, when Cholera first appeared in Cairo, it extended within the space of five days over the whole of Lower Egypt, desolating simultaneously all the towns and villages of the Delta.
In 1832 it leaped at one bound from London to Paris, and when once there, spread in five days over thirty-five out of forty-eight quarters of the city.
When Influenza broke out in London in 1847, it spread in one day over every part of the metropolis, and upwards of 500,000 persons suffered from the malady.
4. Epidemics resemble each other in giving distinct and unmistakeable warnings of their approach. These warnings consist of two events: first, the sudden outbreak and general spread of some milder epidemic; and, secondly, the transformation of ordinary diseases into diseases of a new type, more or less resembling the character of the extraordinary disease at hand.
It is a very singular fact that both in the middle ages, and in modern times, the lesser Epidemic which has generally preceded and pre-announced the coming of the greater, is Influenza.
The history of European Epidemics from the 14th century downwards, shows that whenever a new Plague was at hand, destined to become truly European, it was preceded by a sudden outbreak of Influenza, as general as it was violent. This is exemplified with singular uniformity in the Epidemics of the 16th century—the severest epidemic period on record. It is most remarkable that in our own day the first visitation of Epidemic Cholera was preceded by an outbreak of Influenza which resembled, in the most minute particulars, the violent and universal Influenza that ushered in the mortal Sweating Sickness Epidemic of 1517.
So again, on the second visitation of Cholera, in 1848, it was preceded, as we have just seen, by the universal Influenza of 1847.[3]
3. It may be remarked that for some time prior to the Cattle Plague in the autumn of 1865, the disease called pleuro-pneumonia had extensively prevailed among the herds throughout the country. [Ed.]
The second circumstance, and a most instructive one it is, premonitory of the advent of a great Epidemic, is a general transformation of the type of ordinary diseases into the characteristic type of the approaching pestilence. Sydenham gives a graphic description of such a transformation in the character of the fevers and inflammatory diseases prevailing in London some months before the outbreak of the Great Plague. He states that this change consisted in an approximation, in several striking features, of the general type of disease, to the distinguishing characters of the Pestilence which had not yet appeared, but was close at hand.
In 1831, in the wards of the London Fever Hospital, I observed and recorded a precisely similar change in the general type of the fevers in London, six months before the first visitation of Cholera. Anterior to that period, fever in London, for a long series of years, had been essentially an acute, inflammatory disease, for which bloodletting and other depleting remedies were indispensable. At this period it ceased to be an inflammatory disease; it became a disease of debility, in which no one could think of bleeding; and so closely did the prevailing fever now put on the general character of the approaching plague, which was as yet six months distant, that the fever into which those Cholera patients fell, who were not killed by the first stroke—the consecutive fever, as it was afterwards called—could not be distinguished from the primary fever in the wards of the Hospital when Cholera was at its height, which had appeared there for the first time six months previously, and which has never disappeared since.[4]
4. This was written in November, 1855.
It is further very remarkable that the Professors of Veterinary Medicine and Surgery in London noted at the same time a similar change in the type of the diseases of the lower animals—horses, cows, sheep, and all domestic creatures;—a change requiring a similar modification of the remedies which they had been in the habit of using.
5. A further character of great Epidemics, partly arising from the last, is this:—they are actually present and in operation some time before they assume their distinct and proper form. Sometimes, indeed, the very first cases are most intense and characteristic, but at others they are scarcely to be distinguished from the severer attacks of ordinary disease of a like nature. Hence doubt is sometimes reasonably entertained of their true character. When at length increasing numbers leave no doubt of the actual presence of the dreaded malady, the first announcement of it is always received with incredulity and sometimes with resentment; and so it is that Epidemics always take a country by surprise—burst suddenly on an unprepared people, who wilfully shut their eyes against the plainest evidence, as if they would avert the event by denying its existence.
6. Again, Epidemics resemble each other in the uniformity of their course. They present, with great regularity, periods of comparative quiescence and activity—periods of well-marked increase, culmination, and decrease.
7. They further resemble each other in the manner of their migration. They advance by leaps. On breaking out in a locality they soon come to their height, decline, and disappear. Then they attack another locality; here they pass through precisely the same process as before, and proceed to a third, fourth, or fifth district, and so on. Sometimes indeed they localize themselves on the same spot for a considerable period, and then several places may be simultaneously affected; but for the most part a large city may be regarded as a cluster of towns, through the several districts of which epidemics advance as if they were proceeding from one town or village to another. Hence the duration of an epidemic in a place is generally proportionate to its size. The several localities attacked being visited in succession, a space of time is required to spread through the whole of them proportionate to the magnitude of the town.
8. Epidemics resemble each other in the periodicity of their return.
On its first visitation (1485) the Sweating Sickness spread over the whole of England in the course of one year, when it disappeared.
After an interval of twenty years it broke out a second time quite suddenly (1505); revisited nearly all the seats of its former ravages, and again disappeared at the end of six months.
On its third visitation (1517), after an interval of eleven years, it again finished its course within six months.
Its fourth visitation (1528) was repeated after a further interval of precisely eleven years. Such was its violence on this occasion, that the historians of that day designate this period by the significant name of the “Great Mortality.” It drove Henry VIII. from London, destroyed several of the most distinguished persons of the Court, impressed the nation, from the monarch to the peasant, with an awful feeling of the uncertainty of life, continued its destructive course for its accustomed period of six months, and then again disappeared.
From this to its fifth and last visitation, twenty-three years elapsed (from 1528 to 1551.) It then broke out with unmitigated fury, spread once more over the whole of England, ceased within six months, and from that period has never reappeared in any country.
The Oriental Plague of the middle ages returned with a like periodicity; and so it does at the present day in the countries in which it maintains its ancient reign. It recurs with much regularity about every ten years.
The Fever Epidemics of the metropolis return pretty constantly about every ten or twelve years.
The Irish Typhus Epidemics have recurred nearly decennially for the last 150 years.
Epidemic Cholera, on its first visitation, ravaged Great Britain for a period of fifteen months. It then wholly ceased; after an interval of sixteen years it again broke out, and pursued its former course for the same exact period of fifteen months, and then ceased.
Within the brief interval of only five years, it last year (1854) accomplished its third visitation. It now protracted its stay for a period of seventeen months; coming sooner and staying longer.
9. Again, Epidemics resemble each other in the brevity of the space that intervenes between the attack and death.
The Black Death was often fatal on the first day of the attack—generally on the third or fourth. In England it was sometimes fatal within twelve hours, and frequently in two days, particularly when spitting of blood or any other form of hœmorrhage was amongst the early symptoms.
The violent inflammatory fever which characterized the Sweating Sickness, generally ran its course in a few hours; in severe cases, indeed, the crisis was always over within a day and night, but it often proved fatal in six hours.
In our own day we have witnessed many instances in which Epidemic Cholera was fatal within twelve hours. I have known several in which the fatal event followed in ten hours, the patient having been within an hour of the dreaded attack in apparent health.
In all great epidemics the protraction of the disease beyond three or four days is a favourable omen. One of the objects in the treatment of the sick is to gain time. If Nature’s first violent effort to expel the enemy that has taken possession of the system, does not destroy life, the vital powers rally, and the frame often survives the storm.
10. Lastly, Epidemics resemble each other in being produced by the same causes. The whole tenor of experience shows that whatever produces an especial liability to one epidemic, produces a similar liability to every other.
The Causes of epidemics, as of all other diseases, are divided into two classes,—the predisposing and the primary. The predisposing causes are those circumstances which bring the body into a fit state for the action of the primary. The primary cause is the agent which directly and immediately excites the disease.
If a number of persons, in an ordinary state of health, say a hundred, are exposed to the primary cause of any epidemic—to the poison of Cholera for example—probably not more than ten would be seized with the disease. Why do the ninety escape? The poison, by the supposition, encompasses and acts upon all alike: why do ten only suffer? Suppose these same hundred persons took a large dose of arsenic, or an over-dose of chloroform, not only would not one in ten escape, but every individual would certainly perish.
It is conceived that the primary cause cannot take effect unless the system be in a state of susceptibility to its action; that there is in the body an innate power of resistance to all noxious agents of this kind, rendering it, when in full vigour, invulnerable to them; that there are certain circumstances which weaken or destroy this resisting power, and which even impart to the body a peculiar susceptibility to the influence of such agents—and these circumstances are called predisposing causes.
The predisposing causes of epidemics may be divided into two classes—External and Internal. The external are those which vitiate the atmosphere; the internal are those which more immediately vitiate the blood.
The vitiators of the atmosphere include overcrowding, filth, putrescent animal and vegetable matters of all kinds, exhalations from foul cesspools, sewers, rivers, canals, ditches, marshes, swamps, &c. Causes of this class are also called localizing, because they favour the generation and spread of epidemics in the localities in which they abound.
The causes which more immediately act from within are those which either directly introduce pernicious matters into the interior of the body, in the shape of foul water or putrescent food; or which indirectly accumulate noxious matters within the system, by impairing the action of the excretory or depurating organs whose office it is to maintain the blood in a state of purity, by removing out of the system substances which having served their purpose have become useless and pernicious.
The earnest attention which has been recently directed to the first class of causes has led to an advancement in the science of prevention, the importance of which it is impossible to over-estimate.
To give only one illustration of the action of a predisposing cause, I select as my example, Overcrowding.
The Statistical Society of London some time ago appointed a Committee of its Council to make a house-to-house examination of the parish of Marylebone, with a view to ascertain how many families in the parish occupied a single room as a living and sleeping room. In the course of this inquiry, one of the examiners came to a house in which there was one remarkable room. It was occupied not by one family only, but by five. A separate family ate, drank, and slept in each of the four corners of this room; a fifth occupied the centre.
