1847]

Proceedings of Liverpool Association,

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your Committee, form one of the most comprehensive, efficient, and beneficent statutes ever enacted by any legislature in any age or country. Its direct effect will be the renovation of the physical strength and vigour of the people, and an augmentation of their means of subsistence, first, by increasing and sustaining their working power, and secondly by diminishing the sum at present expended on sickness, orphanage, and premature decrepitude; and ultimately, a large addition to their longevity: while indirectly, but not less certainly, it will promote their intellectual, moral, and social improvement. Your Committee, therefore, earnestly request the attention of the members of the Association and of the public generally to the facts and conclusions now stated, and they respectfully submit them to the consideration of the Government and of the Legislature."-L. c., pp. 118-122.

The Liverpool Health of Towns' Association, duly impressed with the painful revelations as respects that great centre of commerce, made in the report of the Commissioners of Inquiry, have zealously and successfully entered upon the good work of improvement; and have set an example which might with great advantage be imitated elsewhere. They have instituted lectures in various parts of the town of Liverpool; they have held public meetings; they have called the attention of the municipal authorities to nuisances and other evils endangering the public health; and, by the publication of a cheap monthly paper, they have laboured to remove error, and to diffuse information, and have thus kept the whole subject alive in the public mind. Efforts such as these are of the first consequenee, inasmuch as they not only enlighten the community upon matters in which all have so deep a concern; but likewise, because, by carrying conviction to the minds of the educated classes, they tend to strengthen the hands of the Government; which even when, as at present, favourably inclined, will generally in affairs of this kind, involving such varied and powerful interests, but presenting no political rallying-point, regulate its action to a much greater extent than is ordinarily conceived, by the amount of support it receives from without.

The "Health of Towns' Advocate" contains much valuable matter; and the principles therein expounded have, as the Committee state in their Preface, more than a merely local interest. In Liverpool the causes of insalubrity-over-crowding, filth, bad drainage, damp dwellings, and defective ventilation-act with dire intensity; and the result is, that the three classes of disease, which are the more peculiar index of the amount of preventive sickness-fever, consumption, and convulsions in infants, prevail to a frightful extent. The following table is a melancholy but instructive evidence of this assertion :

PROPORTION OF DEATHS, FROM THREE DISEASES, TO THE WHOLE 'POPULATION ANNUALLY.

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"We thus find that, in proportion to the population, the deaths from fever are more than double in Liverpool what they are in Birmingham; that above half as many more die from consumption in Liverpool as in London; and that more than three times as many children perish annually from convulsions in Liverpool as in Birmingham."-Health of Towns' Advocate, p. 14.

After adducing other proofs of the vast amount of sickness prevalent in this afflicted town, the conductors of the " Advocate " conclude their second number with these most justremarks:

"It is easy to read of these things; but it is not so easy, without personal experience, to realise their full meaning. We are too apt to consider such statements as mere barren statistical results. They have in them, nevertheless, an awful depth of significancy. They are the indexes of a degree of human woe, compared with which many things that move our deepest sympathies are hardly worthy of mention; and of a needless waste of human life, which whether we consider its continual existence, its extent, or its accompanying sufferings, throws into the shade the slaughter of battle fields. When we think of the dreadful localities in which sickness has to be endured; the absence of even the most needful comforts in illness; the loss of time and wages, which are their only property, on the part of heads of families, and the consequent privation to the families themselves;-the awful mortality, especially amongst the young, from whence it arises that in some instances 64 per cent. of all who die are children under five years of age, while the average age of death of the whole class is reduced to 13 years;-the heart-breaking sorrow that is itself so powerful an agent in the production of disease; when these things are considered, and when we remember that the causes of all are to a great extent under our control, it will surely require no argument on our part to form the determination, in every well-constituted mind, never to rest till such evils have come to an end."-L. c., p. 15.

It is consistent with our personal knowledge to state that the authorities of Manchester have for some time been zealously endeavouring to ameliorate the condition of that populous town; and in the Report before us, there is afforded further proof that the Town Council is anxious to adopt the best means of removing the existing evils. After having devoted so much space to this subject, we can only remark that, according to a most competent judge, Dr. Lyon Playfair, "the improvements suggested are happily conceived, and calculated to prove of immense benefit to the town; the spirit of the recommendations of the Commissioners of Inquiry being completely carried through the whole Report." Although the proposed plan may be unexceptionable, yet all these partial efforts are, in principle, most objectionable; nothing but a general measure, applicable to the whole kingdom, and superintended by responsible public officers, can reach the root of the mischief.

We have said that there is a willing Government; and among its members, happily, is that estimable nobleman, Lord Ebrington, whose zealous and personal labours in the advancement of this question are deserving of the highest praise. The whole of his lecture, in addition to a clear exposition of the causes of unhealthiness and on the means of removing it, abounds in the most elevated and benevolent sentiments. How would the whole constitution of society be renovated and ennobled if those who influence its progress, regulated their actions by the divine precepts of Christian charity, thus set forth :

"The golden rule of doing to others as we would be done by would never have led us into such wastefulness and extravagance as what you have seen. If we, in the town and country, landlords and tenants, employers and employed, had endeavoured to make the material, moral, and spiritual condition of our neighbours as healthy as we would wish our own to be, we should have found our reward literally here upon earth. I have shown you the costliness of neglect; but in this as in all other cases, we shall be deceived and led astray if we

1847]

Lord Ebrington's Lecture.

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begin in a wrong spirit. If we seek merely that which is expedient, no foresight and calculation will be sufficient to guard us against error. Shrewd calculators enough there have been at Liverpool; but all their shrewdness and calculation has not prevented the waste of hundreds of thousands on ill health. Had one half of that energy and thought been devoted to their duty to their neighbour by that wealthy community, how much richer would they have been! Seek ye first the kingdom of God and his righteousness, and all these things shall be added unto you.""-Lord Ebrington's Lecture, p. 37.

In alluding to that important point, the duty of the Government in this matter, it is encouraging to find Lord Ebrington thus expressing himself:

"It only remains that I should say a few words of the power which Government has in this matter. Legislation can do much-very much-so much that no efforts of individuals or associations can avail without its help. We are dependent upon legislation for our supplies of water, and the construction of sewers. Unsound legislation may place a thousand obstacles in the way of both, but a good and comprehensive measure may carry these cheap blessings into every court and alley in the kingdom. To legislation, again, we must look for a good system of supervision and inspection, the abatement of nuisances, the closing up of crowded churchyards, the removal of cattle-markets and slaughterhouses from the centre of our large towns, the consumption of smoke, the purification of our rivers, and the application of the valuable refuse of towns to its proper use, and what is doubtless more difficult, the regulation of the hours of work, and the enforcement of ventilation in public buildings, churches, schools, barracks, factories, shops, and workshops.-L. c., p. 46."

It is still more fortunate that these sentiments are shared by other and influential members of the Administration, several of whom have evinced the warmest interest in the sanitary question.

The lecture of Dr. Guy has reference to a very important subject-the feasibility of reducing the expense of improvement by the scientific application of the refuse of great towns to agricultural purposes; its great object being "to prove that the waste of life and health at present taking place is closely connected with a waste of the raw material of food." It is a truth important to be generally known, "that unnecessary sickness and premature death impeach the prudence, no less than the humanity of the nation which suffers them, and that sanitary measures are, in every sense, and in every way, a gain."-Lecture, p. 8.

This proposition is established by various interesting details, but of which our space will only allow us to extract the following:

"Wherever a proper system of house-drainage prevails, the valuable excreta of the human frame containing the ashes of all the food that has been consumed, by the inhabitants, find their way into the sewers. Experience has proved that these excreta, but especially the urine, are among the most effective of our manures; and that they far exceed in value the products of the farm-yard and all solid manures, not even excepting guano. It is well known too, that in China, and in those parts of the Continent of Europe where agriculture is most skilfully practised, great store is set by this fertilizing liquid.

"To this, the most important constituent of sewer water, we must add, as also derived from house-drainage, the alkalies, potash and soda, which are so largely used for household purposes, in the form of pearl-ash, soap, and coommon salt. These alkalies form, as is well known, very important elements of the food and structure of plants.

"Such, then, are the valuable matters poured into our sewers, wherever a proper system of house-drainage is in force.

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Large contributions are also made to the same fertilizing liquid by the refuse of slaughter-houses, markets, and manufactories. The animals fed and worked in our large towns also enrich the sewer-water, by that portion of their excreta which finds its way, in a more or less circuitous manner, into the sewers. Then we must not forget that our granite roads, rubbed down by constant traffic, furnish a large and valuable supply of silica, alumina, and iron, in a state of minute division, and therefore ready to become the food of plants.

"I have yet to mention the large quantities of soot rich in ammonia and sulphurous acid, which, issuing from our chimneys, is brought down by every shower, and conveyed direct into the sewers, forming a not unimportant addition to their

contents.

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"I should not have entered so much into detail with regard to the contents of our sewers, but that I thought it of great importance to prove by every possible means the value of the fertilizing liquid which we are now so ignorantly wasting."-Lecture, p. 20.

So valuable are these debris of towns that it has been calculated the inhabitants of Chorlton-on-Medlock, (a township of Manchester,) rather less than 100,000 in number, would furnish sufficient nitrogen, phosphoric acid, and the other substances, to manure no less than 93,440 acres of wheat and in Flanders, where these things are managed better than with us, the excreta of an adult are valued at £1. 17s. per annum. In an instance extracted from the Journal of Royal Agricultural Society, it is stated that some water-meadows at Clipstone Park, the property of the Duke of Portland, and which formerly were nothing but a swampy waste, producing for 300 acres but £80. a year, have yielded, by the application of sewerage manure, as much as £11. 4s. per acre annually.

In conclusion, we would urge upon all whose sympathy has been touched by the unexampled sufferings of our poorer fellow-countrymen, as disclosed in the various reports and other documents which have from time to time appeared, to arouse themselves and give a practical direction to their philanthropy. The time is come for sustained and energetic action; public meetings, petitions to the legislature, appeals to members of parliament, these and similar measures are imperatively demanded of each and all who can exert any, the least, influence upon the march of public events. Whilst it is thus incumbent upon every class to make some effort, there are two professions upon whom, at this critical period, a heavy responsibility rests; we allude to the clergy and to medical practitioners. Daily witnessing, in all their appalling realities, the calamities and miseries inflicted upon the poor in our great towns and populous places; and knowing by personal experience the evils, which owing either to a benighted ignorance or to a cruel selfishness, some individuals are unwilling to admit, the medical practitioner and the minister of religion have no excuse for inaction. That both will cheerfully enter upon their mission, the experience of the past will not permit us to doubt; and we may therefore confidently anticipate that the clamours which a few interested persons have already raised, will be instantly silenced by the united voice of science and religion, seconded by the good sense of the enlightened part of the community.

18471

Latham on the Diseases of the Heart.

LECTURES ON SUBJECTS CONNECTED WITH CLINICAL MEDICINE, COMPRISING DISEASES OF THE HEART. By P. M. Latham, M.D. Physician Extraordinary to the Queen, and late Physician of St. Bartholomew's Hospital. Vol. II. pp. 419. London: Longman and Co., 1846.

In the Number of this Journal for July, 1845, will be found an ample review of the first volume of these Lectures. We have now to continue the analysis of the valuable information which they contain on Diseases of the Heart. Although the important subject of endocardial and pericardial inflammation occupied much of our attention on the former occasion, there still remain a few points in the history of these morbid states, that call for notice.

The prognosis in cases of Endocarditis and Pericarditis is-provided the diseases have been sufficiently early detected, and at the same time judiciously treated-unquestionably favourable, if we have respect only to the present restoration of the patient. But what the proportion of cases is in which—although the patient so recovers his health as to be able to resume, without inconvenience, his wonted occupation—the foundation is laid of future cardiac mischief, it is by no means easy to determine. Dr. Latham tells us that of 90 cases of acute Endocarditis and Pericarditis, the result of Rheumatism, observed by him, death took place in not more than three. But of the remaining 87, it was in 17 only that he could feel anything like an assurance of a perfect recovery having taken place-perfect, as indicated by the cessation of all abnormal sounds or murmurs. With respect to the other 70 cases, although the patients were discharged from the hospital as recovered, in none had the heart entirely lost all the auscultatory signs of having suffered; and we need scarcely say that the circumstance of a persistent cardiac murmur, remaining after an attack of Carditis, indubitably demonstrates that some degree of structural lesion, however slight, has been left behind.

But the danger of cardiac inflammation is not always proportionate to its severity or to the amount of local injury inflicted on the central organ of the circulation. The state of the patient's general constitution, and the condition of other visceral organs, as well as of the fluids of the body, more especially of the blood itself, have much to do with the chances of recovery in each individual case. Let us briefly note a few of the fatal casualties or accidents, which are observed to occur every now and then in the clinical experience of carditic disease.

1. In some patients, at the very time when the symptoms of recovery may be reasonably expected to take place, a sudden prostration of the nervous system occasionally supervenes, and then there may be such alternate rallying and sinking that, for weeks together, a fatal issue is daily looked for. Yet the patient will less frequently die than recover from this alarming state;-not indeed with a perfect recovery, but so far at least as regards his immediate safety: the heart retains more or less of the foot prints of the disease.

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