Und weiter reitet der Reitersmann, So zieh' ich denn hin in's Grab so früh,- Die Stimme sprach dazu: Im Grab ist Ruh! Dem Reitersmann eine Thräne rollt Von der Wange kummervoll: Und ist nur im Grabe die Ruhe für mich, So ist mir im Grabe wohl. Die Stimm' erwiedert hohl: Diseases: their Causes and Prevention. BY WILLIAM HENRY HARTILL, M.R.C.S., L.S.A. 5.-Perhaps there are few causes, if taken individually, more fertile in the production of disease than the inhalation of the effluvia, emanations, or vapours which are given off from our bodies or those of animals, by their emunctories, or which arise from the decomposition or fermentation of animal or vegetable refuse; this is most clearly proven by the great frequency and severity of diseases amongst the inmates of over-crowded dwellings, workhouses, &c., and amongst persons who live in mire or filth, or whose houses are situated opposite to the gully-holes of sewers. The breathing of foul-air is a common cause of depression of spirits, nervousness, headache, want of appetite, general weakness, sickness, diarrhoea, especially in young children, dysentery, and gastric fever. No part of the British Empire records so many deaths by fever as does Ireland, and that is not surprising when we consider the habits of the poor Irish, how that they live in thatched clod huts, whose interior exposes the superlative degree of nastiness, and oftentimes forms a place of shelter for a filthy pig, which is usually permitted to occupy the warmest place, because he pays the rent; in front of these said cottages there is generally a vile puddle for the convenience of the family, including their domestic companions. Now although the lower classes of this parish do not often make pigs their constant associates, yet very many of them harbour rabbits, pigeons, broods of ducks, sitting hens, white rats and mice, guineapigs or ferrets, within their houses, always to the detriment of their own health, and not seldom to the causation of serious, if not mortal fevers. Wherever animal or vegetable matter is decaying, and thereby returning to its mineral or inorganic state, there the surrounding air is defiled by the gaseous products of decomposition, and it is mainly through this pollution of the atmosphere that imperfect drainage operates in the production of disease. Underground drainage has some disadvantages, to wit, the production of fevers in dwellings situate opposite to the openings into the main sewers, nevertheless, it has been, and is being verified, that efficient sewerage, by which refuse of every kind may be carried off, diminishes the rate of mortality, especially lessening the number of deaths from fevers and contagious maladies; in fact, it appears that if the emanations from decaying organic matter are not the immediate cause of gastric fever, they are certainly the most powerful predisposing influences, so much so that the source of the fever poison or the conditions which develop it, can in almost every case be conjectured, if not possibly proved; moreover, the presence or absence of the formerly called bilious, low, or typhoid, but now designated gastric fever, is a good criterion of the sanitary state of a neighbourhood. It must be evident, then, that it is desirable for Willenhall to be drained by sewers if it can be done, but, as it seems to me that this cannot at present be accomplished in consequence of the heavy taxation which it would impose upon the present and succeeding generations of inhabitants, and many other objections, I will content myself with offering a few suggestions relating to the surface drainage. Now it is quite certain that during the past year contagious complaints have shown themselves principally in localities where the refuse waters are allowed to accumulate in putrescent plashes or muddy ditches near to houses, for the want of properly paved channels to carry them off; such conditions are to be found chiefly in new streets, where the cost of channelling would devolve on the owners of the property alongside them, over whom the Local Board of Health either has not authority, or else it fails to exercise it; when a house is built in these streets, a gutter may possibly be made in front of it, but the remainder of the street is left gutterless, the dirty water from the newly built houses is allowed to hollow out a course for itself, and in places mixing with the soil it forms sloughs of putridity, which soon become covered with green aquatic vegetation. In London all new streets are properly laid out with paved channels, and underground sewers before any building is permitted to be erected in them; how is it that the Board of Health cannot or do not enforce the necessary forming and guttering of our new streets before building operations are allowed to be commenced in them? The reports of the Registrar-General show that the towns in South Staffordshire are more healthy during wet than dry seasons-the rain no doubt performing the duty of general parish scavenger; believing this, I venture to say, that if two or more men were constantly employed in removing rubbish, and cleansing the gutters, by flushing them with water, it would be found to contribute much to our health and comfort. 6. In the next place we have to notice briefly the infectious and contagious diseases; the two words infection and contagion are generally used as though they were synonymous, but scientific persons mean by infection, the production of disorders by the operation of malaria, miasmta or bad air, which usually result from the action of the sun's rays upon marshy lands, swamps, fens, the banks of tidal rivers, or upon decaying organic matter; whilst they reserve the term contagion to express the transmission of a malady from sick to healthy persons, whether this happen by direct contact or through the medium of the atmosphere, or articles of dress, &c. Ague, remittent fever, and yellow fever are the most striking examples of infectious complaints; the first and second of these formerly abounded in this neighbourhood, but fortunately for us, since the wet lands have been drained, and the generation of the poisons thereby prevented, and since fires and smoke have become abundantly prevalent, which would neutralize or destroy them if produced in a limited quantity only, these disagreeable visitors have disappeared from among us; therefore, I need say no more about them. Unhappily, however, the same cannot be said of the contagious variety, for although the foothold of one of the greatest scourges of our race-smallpox-has of late (thanks to Dr. Jenner) been almost destroyed by vaccination, (for the performance of which the medical profession is but barely requited, and often when innocent, shamefully maligned by the public) we are still very subject to many diseases of this class. Almost all these complaints are produced by specific poisons, which have the power of reproducing and multiplying themselves within the bodies of persons attacked, and whatever may have been the original source of these poisons, there is no evidence to prove that most of them are now ever generated in any other way, and much to sanction the belief that they are not. Singularly enough one attack of very many of these disorders generally renders the body proof against a second invasion of the same complaint. The poison which causes smallpox is so virulent, that no unprotected person can enter the chamber of any one suffering from it at the seventh or eighth day of the eruption without being seized with it, and of the persons taken ill with this frightful distemper, who have not either been vaccinated or previously had smallpox, one third die by it. The risk of taking smallpox is very small to those who have had the cowpock efficiently, and if by chance they should contract it, not one case in a hundred proves fatal; but be it known that the degree of security depends upon the number and size of the vaccine pocks, for it was found out at the London smallpox Hospital that of persons who were brought thither suffering from smallpox, and who possessed the scar of Four of moderate size or a less number of larger pocks will bestow as much protection as the vaccine disease can give. I mention these facts because there are many mothers who object to a number of pustules being put upon their children's arms. Vaccination was made compulsory in Denmark in 1810, from which time, for fifteen consecutive years, smallpox was not seen there, although during the twelve years preceding upwards of 3000 persons died of it in Copenhagen alone. From these statements, to which an almost endless catalogue might be added, it must occur to most of us that the institution of vaccination was one of the greatest blessings which the beneficent Divine Providence has ever permitted one man to confer upon his fellows; and yet how much it is neglected by parents in this country, and how often it is blamed for that of which it is not guilty! It is popularly believed that other diseases besides the cowpox are not unfrequently transmitted from one child to another by vaccination, and the parents of children who happen to be afflicted with any kind of skin disease at any time subsequent to vaccination, often unjustly censure and upbraid the vaccinator, alleging that he used "bad matter" which has caused their child's complaint, and this conclusion of theirs is not seldom ignorantly strengthened by druggists to whom such children are taken for advice, and who, knowing nothing of the true causes, take upon themselves to assert that they have arisen from vaccination, when in reality they are either inherited diseases now brought into operation by exposure to cold, errors in diet, or some other exciting agent; or they are directly caused by exposure to cold or contagion, or by the mother's indiscretion in allowing her child a provocative variety of unsuitable viands, including perhaps sweetmeats, sugar, cakes, gingerbread, pickles, cabbage, bacon, cheese, pastry or anything else which happens to come to table. Need I say that it is a very difficult task for a medical man to overcome the prejudices of such people, since this very vaccination forms so neat an excuse to hide their own constitutional defects or wilful faults, for there are but few, who being of unsound constitution are willing that the world should know it, and but fewer still, who are so humble as to own that man their friend, who tells them of their faults. On the other hand, however, there are some mothers, whose children have an eruption previous to vaccination, candid enough to confess that, had the rash not appeared until after vaccination, they should then have blamed the doctor, and obstinately asserted that the skindisease was the result of the operation. One case of disease supposed to be caused by vaccination, often unfavourably influences a whole neighbourhood, especially if that be a poor one, and it is amongst the negligent poor that such instances are chiefly to be met with. I have visited the poor very much, have vaccinated a very large number of children, and have seen numbers that have been vaccinated by other medical men, but have never yet seen to the best of my knowledge a single instance in which vaccination produced any other disease of any moment besides the cowpox. The only diseases which I believe can be transmitted from one to another by vaccation (if properly performed) are the contagious varieties, and as these are so plain to the observation of a careful man, there is little risk of their being ingrafted upon another along with the cowpox matter. Remembering these facts, I would warn parents who are disposed to stigmatise vaccination, and druggists or others who thoughtlessly sanction popular errors, if you detest the disgusting disease smallpox, if you have a Christian-like spirit which teaches you to do unto others as you would that they should do unto you, take heed lest you wrongfully injure the cause of vaccination, or unlawfully damage the good name and character of those neighbours who more than any other, are at your beck and call. The poison which excites scarlet fever, is very certain in its operation, and when once it manifests itself is not easily destroyed or got rid of. When one person is attacked, all residing in the same domicile who have not previously suffered from it are usually assailed by it, and the poison may lurk about the house itself, for a very considerable time after those who have suffered from it have recovered, so as to be a source of contagion to visitors who happen to be susceptible to its action. The word scarlatina, which means in truth the same complaint as scarletfever, has lately been employed to designate the disease when it does not assume its most virulent form, and it is popularly believed that scarlatina differs from, and is less dangerous than scarlet-fever; such an error cannot be too clearly exposed, or strenuously condemned, inasmuch as it lulls into a false security all who have faith in it, and prevents them from adopting measures which they would employ if they were more correctly informed. Measles, though less dangerous, is now-a-days a more general complaint than either small pox or scarlet-fever: it is in this country, especially, a disease of childhood, this, however, is merely because the dispersion of the measles poison is so general that almost all persons are attacked by it whilst they are young, and one seizure usually grants an immunity from a future attack That measles will attack persons of all ages indiscriminately, and | that it probably does not acknowledge any other cause except contagion, was proved by the facts that for the 65 years preceding the year 1846, measles had not been seen at the Faroe Islands, in that year a workman from Copenhagen, upon whom the measles poison had operated previous to his departure from Denmark, landed upon one of the islands, the eruption broke out upon him on the second day after his arrival, and the disease ran quickly through out the islands, until more than of a population of 7,700 were attacked, the few who escaped being chiefly persons who had had it in their childhood. Typhus fever the fever to which the poor are by far more subject than persons in easy circumstances, is engendered by such conditions as are especially to be found in times of scarcity of provisions or depression of trade, by the over-crowding of human beings together (because of their inability to pay separate rents, or purchase fuel or sufficient clothing,) combined with defective ventilation and insufficient nourishment. When once it has originated, it invariably spreads by contagion. It is much to be lamented that typhus has already shown itself in some of the towns in Lancashire, and to be feared that in spite of the enormous sums of money which have been so generously contributed for the relief of the distressed operatives, that this disease will yet prove itself to be one of their most formidable enemies. May God defend them! Hooping-cough, chicken-pox, and a few other complaints are caused by specific poisons which I have not time to particularize. Warmth, closeness, and filth, augment the malignancy of all these poisons, and nothing is more conducive to the propagation of contagious diseases than crowding together many people who are afflicted with them. In the larger number of instances these poisons find access to the blood through the medium of the air respired in the lungs, and moreover, it is well |