Volume Ii Part 135
After these statements we shall be prepared to find that indoor trades and occupations swell the bills of mortality from phthisis much more than those carried on in the open air. That this is the case is shown by the following table:--
_Deaths from Phthisis at Victoria Park Hospital, showing the influence of Occupation._
+------------------------+-----------------------------------------------+-------+
AGES UNDER
Cause of Death. +---+---+---+---+---+---+---+---+---+---+-------+Totals.
Not
20.
25.
30.
35.
40.
45.
50.
55.
60.
65.
stated.
+------------------------+---+---+---+---+---+---+---+---+---+---+-------+-------+
Female lives
45
41
25
15
12
3
1
1
...
...
...
143
Indoor occupation
32
31
30
24
15
9
5
...
...
...
4
150
{ Mixed occupation
10
7
7
5
4
3
4
...
...
...
1
41
Males { Outdoor occup.
9
21
21
13
12
11
8
2
1
...
2
100
+---+---+---+---+---+---+---+---+---+---+-------+-------+
96
100
83
57
43
26
18
3
1
...
7
434
+---+---+---+---+---+---+---+---+---+---+-------+-------+
_The same reduced to
a per centage._
Female lives
32
28
18
10
8
2
1
1
...
...
...
100
Indoor occupation
21
21
20
16
10
7
3
...
...
...
2
100
{ Mixed occupation
24
17
17
12
10
7
10
...
...
...
3
100
Males { Outdoor occup.
9
21
21
13
12
11
8
2
1
...
2
100
+---+---+---+---+---+---+---+---+---+---+-------+-------+
86
87
76
51
40
27
22
3
1
...
7
400
+------------------------+---+---+---+---+---+---+---+---+---+---+-------+-------+
The influence of occupation in developing phthisis is forcibly ill.u.s.trated in the following table:--
+-----------------+--------------------------+--------------------------+
Death-rate by Phthisis and
other Lung Diseases at
District.
Nature of princ.i.p.al
between 15 and 25 years
Industry in the District.
of age, per 100,000 of
each cla.s.s referred to.
+-----------------+--------------------------+-------------+------------+
Male.
Female.
Berkhampstead
}Extensive female {
219
578
Leighton Buzzard
} employment in {
319
554
} straw-plaiting {
Newport Pagnell
}Extensive female {
301
615
Towcester
} employment in {
239
577
} lace-making {
{Extensive female (with }
Yeovil
{ some males) employment}
280
409
{ in glove-making }
Leek
}Extensive employment {
437
856
Congleton
} (more female than {
566
790
Macclesfield
} male) in silk work {
593
890
Standard Northern
District
Agriculture
531
333
+-----------------+--------------------------+-------------+------------+
The above figures may be supplemented by the others, which show the difference between the deaths from phthisis and other lung diseases occurring amongst the agricultural and the manufacturing populations, and are another ill.u.s.tration of the nature of the toiler's occupation upon his liability to consumption. Thus, for every 100 deaths by phthisis and other lung diseases that take place amongst the men in various agricultural districts of England between the ages of fifteen to fifty-five, there are in Coventry 163 deaths; in Blackburn and Skipton, 167; in Congleton and Bradford, 168; in Leek, 182; in Macclesfield, 184; in Bolton, 190; in Nottingham, 192; in Rochdale, 193; in Derby, 198; in Salford and Ashton-under-Lyne, 203; in Leeds, 218; in Preston, 220; and in Manchester, 263.[101]
[Footnote 101: Quoted by Dr Wynter Blyth.]
As bearing directly upon the above portion of our subject, we may quote the sixth report of the medical officer of the Privy Council, who therein states--"In proportion as the people of a district are attracted to any collective indoor occupation, in such proportion, other things being equal, the district death-rate by lung diseases will be increased."
The much larger number of cases of lung disease amongst those who pursue indoor callings than amongst others whose occupations are carried on out of doors, arises princ.i.p.ally from the defective ventilation of the workshops or rooms in which the labour is carried on.
When indoor occupations are practised in large and efficiently ventilated apartments, or existence is pa.s.sed in healthy houses, as in the dwellings of the rich and upper cla.s.ses, who have also the additional advantages of good food and warm clothing, the liability to phthisis becomes immensely diminished.
The much greater immunity from the disease which the richer enjoy over the poorer cla.s.ses has been carefully pointed out by Dr Guy, who, writing on this subject in the 'Journal of the Statistical Society,' says--"The ratio of deaths from consumption follows the same order as the average age at death, being lowest where the average age is highest, and the reverse.
Thus the average age at death of the cla.s.s of gentlemen is 5861, and the ratio of deaths from consumption 1 to 260; while in the cla.s.s of artisans the average age is 4806, and the proportion from consumption is 1 to 229.
+----------+-----+-----+-----+-----+-----+----+----+-----+-----+------+---------+---------+
Number of
Deaths
+----+----+
O
t
h
C
e
A
o
r
v
n
e a
s
D
r t
u
i
a
m
s
g D
p
e
15
20
30
40
50
60
70
e e
t
a
Under
Under
a
Ratio.
i
s
Condition.
to
to
to
to
to
to
to
30.
40.
a t
o
e
g h
n
s
20.
30.
40.
50.
60.
70.
80.
e .
.
.
+----------+-----+-----+-----+-----+-----+----+----+-----+-----+------+---------+----+----+
Gentlemen,
&c.
1084
1867
2711
1927
1506
603
301
2951
5662
39
1 to 500
166
835
Tradesmen
846
2434
2698
2011
1270
635
106
3280
5978
38
1 to 260
189
491
Artisans
725
2369
2624
2279
1334
626
043
3094
5718
38-1/2
1 to 229
2318
5308
+----------+-----+-----+-----+-----+-----+----+----+-----+-----+------+---------+----+----+
"Again, the cla.s.s of gentry presents a smaller proportional number of deaths under thirty and forty than either of the other cla.s.ses. It is also worthy of observation that the per-centage proportion of deaths from consumption under thirty and forty is higher in the cla.s.s of tradesmen than in that of the artisan and labourer, although the ratio of cases of consumption is greater in the latter cla.s.s. This is doubtless accounted for by the fact already established, that the strong exertion which a considerable portion of the labouring cla.s.s employed within doors use in their occupations, and the large number employed out of doors, has the effect of r.e.t.a.r.ding the effect of pulmonary consumption. The tradesman, it will be seen, occupies the intermediate place between the indoor and outdoor labourer--between the artisan using little exertion and the artisan using much exertion.
... Another point attracts attention, viz. the great proportion of deaths from consumption occurring in the cla.s.s of gentry from fifteen to twenty years of age. Does not this show that the liability to the disease is greater in this cla.s.s than in the two others, and does it not tend to strengthen the position that the excess of the deaths from consumption in the other cla.s.ses is due to the unfavorable circ.u.mstances in which they are placed?
"The ratio of deaths from consumption in the cla.s.s of gentry, low as it is, would have been still lower if the medical men, who are included in it, were omitted. The number of cases of pulmonary consumption occurring in members of that profession is very remarkable, and it is a subject of regret with the author that they were not made a separate cla.s.s."
Much less clearly and satisfactorily established is the question as to whether consumption is or is not contagious. The instances which have occurred of its extensive and rapid spread in overcrowded barracks, prisons, men-of-war, merchant vessels, large workshops, &c., not unreasonably seem to lend weight to the opinion that the germs of the disease might have been conveyed by the atmosphere charged with them from an unhealthy to a healthy subject, on whom they might develop the malady.
"But," as Dr Blyth writes, "it must be remembered that, in all crowded localities, there is direct vitiation of air, and it is difficult to say whether the foul air or actual contagion have most to do with the propagation of the malady." He adds "that consumption, under ordinary conditions, is certainly not contagious; but, under special insanitary influences, certain forms of consumption may be contagious, although it is still a matter not proven." Dr Guy bases his objection to the doctrine of the generally contagious nature of consumption upon the fact of the small fluctuations in the annual number of deaths caused by it.
The lowest rate of mortality for phthisis for a million of inhabitants in London was, he states, for any one of the fifteen years from 1840 to 1854 inclusive, 2645, and the fluctuation was very slight. The figures in three consecutive years were--1849, 2777; 1850, 2645; 1851, 2970. "If, then," Dr Guy says, "any one were to a.s.sert that this disease is contagious, which is tantamount to saying that it may be epidemic, the figures I have quoted would in themselves furnish an answer in the negative. They are suggestive of a domestic disease, influenced, as is bronchitis, by the seasons and the weather."
The statistics before quoted as to the correlation between the prevalence of consumption and unhealthy surroundings, lead to the belief, that before this connection between the two was so well defined, cases of phthisis were often erroneously referred to hereditary taint, when they may simply have arisen from the patient having been environed with the same unfavorable hygienic conditions as his parents; these unfavorable conditions, including not only polluted air, but bad food, deficient apparel, and want of exercise. Hence it is that most of the later pathologists, without denying the existence of the transmitted form of the disease, believe the hereditary influence has been greatly over estimated.
"As regards the origin of tubercle," writes Dr Douglas Powell, "opinions are extremely various, and indeed irreconcileable; but the tendency of modern research--the experiments of inoculation in animals, and the very powerful advocacy of Prof. Niemeyer, is certainly to show that tubercles is much more commonly a secondary disease than has until lately been suspected--that people are, in fact, only exceptionally, if ever, born to die of tuberculosis.
"A due appreciation of this doctrine, so different from that even now accepted by many, is of almost national importance in giving encouragement to those hygienic and other measures of prevention, the neglect of which has too often been sanctioned by a foregone conclusion.
"It would I think be extremely injudicious to deny hereditary predisposition to tubercles altogether. Moreover, when we come to the question of hereditary predisposition to the forms of consumption which originate in catarrhal pneumonia, it is freely admitted that the offspring of consumptive parents have a tendency to this form of pulmonary phthisis, that the scrofulous have a like tendency (Niemeyer), and that scrofulosis is sometimes hereditary."
As allied to this portion of the question may be mentioned the opinion of some pathologist, that phthisis may be either caused or promoted by habitual drunkenness; and that a drunkard may transmit it to his offspring.
The p.r.o.neness to consumption is greatly modified by s.e.x and age, the influences of which upon the disease are very defined and unmistakable.
Thus, women are more liable to its attacks than men, and young and middle aged persons of both s.e.xes than old ones.
"In Edinburgh the ratio of deaths from phthisis was found to decline from 285 at twenty years to 052 above sixty years; at Nottingham, from 416 to 017 in the same period of time; at Chester, from 245 to 054; at Carlisle, from 290 to 097; and in Paris, according to Louis, from 325 to 042; while the general average decline was from 285, or 285 per cent., at twenty to thirty, to 078, or 780 per cent., above 60."[102]
[Footnote 102: Blyth.]
Amongst other conditions unfavorable to the consumptive patient, in addition to the breathing of a polluted atmosphere, may be named insufficiency of nourishing food and apparel, variable weather, and a damp soil. This latter is particularly inimical to phthisical sufferers. Indeed so closely is dampness of soil a.s.sociated with the spread of phthisis, that the disease has been conclusively shown to have diminished in localities in proportion as these have been properly drained. Dr Andrews, of Chicago, says that consumption is most prevalent near the sea, and that it diminishes in proportion to the distance of the inland locality from the ocean. A damp atmosphere also provokes the disease.
Phthisis seems to be a malady peculiar to temperate climates. As to the influence of the season upon the disease, Dr Haviland says, "In England we learn from the statistical returns that the spring is the most fatal to consumptive patients, whether male or female, but with regard to the other seasons there is considerable variability. For instance, suppose we take the seasons of 1838 in the order of their fatality to males, they would stand thus--spring, 1137; winter, 1048; summer, 968; autumn, 904. To females--spring, 972; summer, 937; winter, 896; autumn, 825. Then again, although the spring invariably takes the lead, the other seasons change places with each other from year to year; and what is remarkable, this inconsistency does not seem to be dependent upon the temperature, as we shall presently see. In the returns for 1853, the following statistics in deaths from consumption appear:--Winter, 1872; spring, 1971; summer, 1745; autumn, 1914. The order of fatality in the years above quoted would therefore be:--
1838.--_Males._ 1. Spring. 2. Winter. 3. Summer. 4. Autumn.
1838.--_Females._ 1. Spring. 2. Summer. 3. Winter. 4. Autumn.
1840.--_Total._ 1. Spring. 2. Winter. 3. Summer. 4. Autumn.
1853.--_Total._ 1. Spring. 2. Autumn. 3. Winter. 4. Summer.
"So far, therefore, as seasons are concerned, the above table proves that spring, _i.e._ April, May, June, is the most inimical quarter to phthisical patients, and probably Autumn--October, November, December, the least so. In London at least, if not throughout England generally, the spring is undoubtedly the most obnoxious to consumptive cases; and this statement is in accordance with the experience of those physicians who have opportunities of seeing the rise, progress, and end of many hundreds of phthisical patients during the year. Dr Richard Quain observes that the cold easterly wind of spring completes the work, which the winter had left undone."[103]
[Footnote 103: 'Climate, Weather, and Disease,' by Dr Haviland.]
That greater or less destruction of the lungs, which is characteristic of pulmonary phthisis, originates in the presence in them of a diseased growth, consisting of very minute ma.s.ses or grains, which are sometimes grey, and at others yellow or cheeselike in appearance.
These little bodies are either diffused uniformly through the substance of the lungs, or are collected together in them in larger or smaller ma.s.ses.
In the latter case, each little ma.s.s generally sets up in the surrounding tissue of the lungs, inflammation and suppuration, which, although only processes by which nature endeavours to expel the alien substance from the lung, may, by constant repet.i.tion, cause the destruction of the greater part of the respiratory organs.
=PHYLLOXERA VASTATRIX.= In 1866 M. Delorme, of Arles, in the South of France, was the first to suggest that a peculiar disease which had manifested itself the previous year amongst the vines growing in the plateau of Pujaut on the west bank of the river Rhone, in the Department of the Gard, was of a new and specific character.
Shortly afterwards a commission appointed by the Herault Agricultural Society visited one of the infested localities, and one of its members, M.
Planchon, confirmed M. Delorme's conjectures, by discovering the cause of the vine malady. This he conclusively showed was due to the presence of a peculiar and hitherto unknown description of _Aphis_, belonging to the genus _Phylloxera_, which, as ill.u.s.trative of its devastating qualities, he named _P. vastatrix_.
A full-grown _Phylloxera vastatrix_ does not exceed more than the 33rd or 40th of an inch in length. Examined under a microscope, in addition to short pointed legs, it is seen to be furnished with a proboscis nearly half as long as its body. Upon examination this proboscis seems to be composed of three tongues, of which the centre one is the longest, and these are united at their base into a kind of flat, sharp-pointed blade, which is the boring or puncturing apparatus, by the aid of which the insect pierces into the roots, from which it sucks the juices that const.i.tutes its food. About half the proboscis or sucker is inserted into the bark of the root, and the creature can not only attach itself to the root by means of it, but can also turn on it, as on a pivot, when engaged in the depredations.
[Ill.u.s.tration: Male Phylloxera; dot in circle showing natural size.]
These are continued from April to October, by which month the insect has lost the yellow colour that distinguishes it in the summer months, and a.s.sumed a copper brown shade.
From October to April the Phylloxera hybernate, or rather, such of them do as have laid no eggs during the period of their active existence, for the egg-laying females die, and young phylloxerae only are preserved during the winter months.
With the return of April they awake from their winter sleep, and recommence their devastating career. They then increase rapidly in size and begin to lay unimpregnated eggs, for there are at that time no males.
"These bring forth females which in their turn develop and lay unimpregnated eggs, and the virginal reproduction continues for five or six generations, the development increasing in rapidity with the heat, but the prolificacy or the number of the eggs decreases.
"In July some of the individuals show little wing-pads at the sides, and begin to issue from the ground and acquire wings. These winged individuals become very numerous in August, and continue to appear in diminishing numbers thereafter till the leaves have all fallen. They are all females and carry in their abdomen from three to eight eggs of two sizes, the larger ones about 2/100ths of an inch long and half as wide; the smaller 3/4th as long. These eggs are also unimpregnated and are laid by preference on the under side of the more tender leaves, attached by one end, amid the natural down. They increase somewhat in size, and give birth in about ten days to the true s.e.xual individuals, the larger producing females, the smaller, males.
"Anomalous as it may seem these creatures are born perfect, though without mouth, and with no other than the reproductive function.
[Ill.u.s.tration: True female Phylloxera; _a_, ventral view, showing obsolete mouth and solitary egg, occupying nearly the entire body; _b_, dorsal view; _c_, tarsus; _d_, contracted a.n.a.l joints after the egg is laid; dot in circle showing natural size.]
"A most remarkable fact, discovered by Babiani, is that some of the females never acquire wings, but always remain on the roots, also produce the few different sized eggs from which these true, mouthless males and females hatch. The s.e.xes pair soon after hatching, and the female is delivered on the 3rd or 4th day of a solitary egg, and then perishes. This egg is never laid on the leaf, but always on the wood, either under the bark, or in sheltered situations above ground, or on the roots underground. The young hatching from it is the normal agamous mother, which, with increased vigour and fertility, lays a large number of eggs, and recommences the virginal reproduction and the cycle of the species'
curious life. The impregnated eggs laid early in the season doubtless hatch the same year, though some of the later deposited ones may pa.s.s the winter before hatching."[104]
