Transactions of the Provincial Medical and Surgical Association/Volume 2/3
BY ANDREW CARRICK M. D.
Senior Physician to the Bristol Infirmary;
JOHN ADDINGTON SYMONDS, M. D.
Physician to the Bristol Hospital, and the Bistrol Dispensary.
THE term Medical Topography has been prefixed to the following paper, in conformity with general custom; but had its strict meaning been adhered to, the subjects of discussion would have become more limited than we have thought right to make them. Something more than an account of those local peculiarities or other external agents, which affect the health of the inhabitants, or, than a description of certain conditions of the latter, as illustrative of the effects of the former, might reasonably be expected in a medical report of a populous city. To us the mere medical topography appears but a part, though an important one, of such an enquiry; the primary object being to ascertain the facts relative to the health or disease of the inhabitants; which may then be traced to their relations with various circumstances, some of which belong to topography, while others consist of the habits, customs, and occupations, which prevail in the locality. Were it desirable to invent a new name, perhaps Medical Demography would be more appropriate, at least, when applied to a thickly-peopled district. If the subject of the treatise be a locality with a small population, and which might require to be considered with reference to a future population or colony, Medical Topography would be the most apposite title, since it comprehends the principal objects of investigation; for soil, climate, geographical peculiarities, natural produce, &c. are almost the only hygienic or morbific agents which exist in such a situation; while, in the other instance, there are the more numerous and no less influential agents comprised in the various artificial circumstances of a fixed and crowded population.
According to this view. it would be more strictly in order, to speak, first, of the conditions of health and disease among the inhabitants of Bristol, and then to investigate their connections with external circumstances; but, for various reasons, it will be more convenient to take the latter first into consideration, just as in monographs upon special maladies, the causes are often enumerated and described before the detail of the symptoms. The first division, then, of our subject, will include those agencies which belong─1st, to the natural history of the locality; 2ndly, to the construction of the dwellings with reference to shelter, ventilation, drainage, &c.; and 3rdly, to the occupations, the physical and moral habits, the kinds of subsistence, clothing, &c. of the inhabitants. In the second part, we propose to make some remarks upon disease as it occurs in Bristol, and upon the average ratio of mortality.
Bristol is situated in 51° 30′ N. L., and 2° 40′ W, L. from Greenwich. It lies on both sides of the River Avon, and, although a county in itself; it occupies what would otherwise form a portion of both Gloucestershire and Somersetshire, which are here conterminous, and separated by the Avon; about four-fifths of the city being on the Gloucestershire, and one-fifth on the Somersetshire, side of the river; yet such is the ignorance of people living at a distance on this subject, that Bristol is vulgarly supposed to lie in Somersetshire.
The River Avon falls into the Bristol Channel or Severn Sea, about seven miles below Bristol; and, although scarcely more than sixty feet wide at low water, is navigable for ships of great burthen, the tide rising, at the Hotwells and the entrance of the floating harbour, to the height, at times, of thirty-six feet perpendicular.
In its course to the sea it passes, for some miles, in a narrow winding channel, through the picturesque and stupendous precipices of Clifton, commonly called St. Vincent's Rocks, which rise from the water's edge almost perpendicularly, to the height of nearly 300 feet. The channel through which the water here escapes, is formed by a fissure in the flat limestone ridge called Durdham-down, Leigh-down, Cleve-down, &c. which skirts the Bristol Channel for almost twenty miles below the embouchure of the Avon, serving as a wall to defend the vale or basin in which Bristol is situated, from the chilly breezes and stormy winds blowing in from the Atlantic, and essentially contributing to the well known comparative mildness of the climate of Bristol and its vicinity.
It is a certain fact that the bare verge of the ocean, where the coast is unbroken by projecting headlands, and destitute of retiring bays or inlets, is considerably colder, on the average, than places a few miles inland, provided the latter are not materially elevated, and are, at the same time, sheltered from the sea breezes by intervening but moderate heights, such as the ridge of low hills just described, which here ultimately connect themselves (excepting some intervening fissures,) with the Cleeve-hills, Brockly-down, Black-down, and the Dundry-ridge; in closing, in their circuit, the vale of Bristol, including the Hotwells, Bedminster, Long Ashton, Bourton, Backwell, Nailsea, Kem, Brockley, &c. which compose, together, an irregular oblong plain, nearly twenty miles in length, at the north-east end of which Bristol is situated, and where it is again covered in to the north and east, by the rising grounds of Kings-down, Stapleton, Kingswood, &c.
It is difficult to conceive a locality more advantageously circumstanced as to shelter, the boundary being, on all sides, sufficiently high to arrest or moderate the winds from whatever quarter, and not high enough to cool, sensibly, the atmosphere by its elevation. Were those eminences considerably higher; were they, for instance, one thousand feet or more high, instead of two or three hundred, as they actually are, the chilly atmosphere embracing their summits, and descending by its gravity to the places at their base, would more than counterbalance the protection they might afford from the maritime blasts; but being, as nearly as possible, of the requisite elevation for the purposes alluded to, we can easily account for the fact of a less intensity of frost occurring in severe winters, in the localities above mentioned, than in the kindred vales of Cross, Mark, Bridgewater, &c. although lower down the Channel, and nearer the Ocean, but destitute of such a barrier against the winter sea-breezes as that above described.
The same observations, as to temperature, will hold good with regard to the Welch or northern side of the Bristol Channel, where the advantage of a southern exposure is more than counterbalanced by the want, generally, of the protective barrier of low hills along the water's edge, and still more by the vicinity of high mountains, often covered with snow in winter, and at all times environed with an atmosphere of reduced temperature, the influence of which must be sensibly felt in the vales and low grounds adjoining.
The geographical position of Bristol is not less favourable than its locality, to the mildness of its climate. At the extremity of a narrow bay or inlet of a hundred miles in length, it participates of the equalizing influence of the ocean on its superincumbent atmosphere, and is comparatively exempt from the storms and tempests to which the more projecting coast of the English Channel is obnoxious, as well as from the humidity which characterises the south coasts of Devonshire and Cornwall; the latter being more advanced into the ocean, and surmounted every where by lofty mountainous ridges, attract and condense the clouds, surcharged with moisture, as they roll in from the Atlantic; and thus a smaller portion of rain, and fog and damp, is left for the more inland situations. In this way we can easily account for the quantity of rain which falls in Bristol and its vicinity, being considerably less than in any of the more westerly districts, not averaging more than twenty-four inches; and for the smaller depth of snow at Bristol than in most other parts of the Kingdom. There have, in fact, been winters in which none whatever has been observed to fall; many, in which that which did fall, dissolved the instant it touched the ground; and four or five winters have passed in succession, in which it would have been impossible to make a snow-ball; and this, too, while in almost every other part of the Kingdom, the snow lay to a considerable depth. The deepest snow at Bristol, within our remembrance, was in 1795 and 1813. In both these winters. the snow, on the average, where it was not drifted nor partially blown off, was from ten to twelve inches deep, which, although incommodious on the roads the first morning, was not sufficient to interrupt, nor materially to retard travelling; while in all other directions, east, west, north and south, the depth of the snow and blocking up of the roads, were the theme of every letter and every newspaper. In the last of these years, the roads in Devonshire were for days impassable, and the snow in the streets of Exeter was reported to reach to the second story.
The difference between the temperature of Bristol and most other places in the Kingdom, is not less remarkable, particularly in very cold winters. In 1795, for example, the thermometer was observed in the various towns from Margate to Brighton and Lewes, at or below zero. At Bristol and the Hotwells, the lowest observed was 12°. In other winters since that period, a nearly similar difference has been noticed; and even on a more elevated and exposed situation on Clifton Hill, from 180 to 200 feet above the level of the sea, the lowest temperature we ever remarked was 10½, by Six's thermometer.
To any one in the habit of considering such matters, a single glance at the map will suffice to account for these phenomena; and whoever is acquainted with the superficial structure of the southern counties, would be led to expect that the country about Bristol must be comparatively exempt from the severity of the north-east winds which so remarkably pervade the east and south coast in winter, and particularly in spring. The reason is clearly this: the English Appennines which run through the middle of the Kingdom, from Cumberland to the Landsend, in a somewhat curved direction westward, turn aside the bleak north-east winds which sweep along the frozen continent of Russia, Poland and Germany, from the further Tartary and the sea of Otchakof, giving them a south-westerly direction down the coast of the Channel all the way to Cornwall; while the vale of the Severn, the low lands of Somerset and Gloucestershire, are protected by the intervening high lands of Wiltshire, Hampshire, and Dorset, and thus escape, in part, their frigorific influence. So striking has the effect of this geographical barrier been sometimes observed to be, that invalids and valetudinarians who resorted to Devonshire for mild winter quarters, and who felt well and comfortable during the proper winter months, have been compelled to run for their lives, when the chilly and parching March winds began to blow, and have sought shelter at Bristol or the Hotwells, where they have described the difference in the temperature and constitution of the atmosphere, according to their sensations, to be very decided.
It has already been mentioned that Bristol stands upon both sides of the Avon. This river enters the city from the south-east, and pursues a very tortuous direction till met by the Froom, opposite to Cannon's Marsh, a little to the south-west of the Cathedral; the latter river has an equally winding course through the city from the north-east, tending southward, to the confluence just indicated. This description, however, is more applicable to the former course of these rivers than to the present, because a considerable part of the channels just traced has, of late years, been converted into a floating harbour, to avoid the inconvenience of the tides; the whole, indeed, of the course of the Avon, and a small extent of the Froom have been so converted. This work was effected by damming up the entrance of the former river, and cutting a new channel for it to the south of the city. The gates of the harbour are not far from the Hotwells. The distribution of the stream of the Froom will be spoken of by and bye.
The geological situation of Bristol is upon the western frontier of the coal basin which bears its name. This basin forms an irregular triangle, the apex of which is near Tortworth, in Gloucestershire, the base extending from the vicinity of Frome along the chain of the Mendip Hills to the Bristol Channel, a short distance below Weston-Super-mare. The rock of which it is composed, may be seen, also, in the Holm Islands, which lie in the channel nearly opposite to Weston. Those who have the slightest knowledge of geology, will not need to be reminded that while the mountain or carboniferous limestone forms the outer shell, as it were, of a coal basin, it is lined within by the rock called millstone grit, immediately upon which the other coal measures are arranged, consisting, in this district, of lower coal shale, pennant, and upper coal shale. Over these inclined strata lie the horizontal beds of dolomitic conglomerate, new red sand-stone, and lias; and, according as the latter have been removed by various denuding agents or convulsions, the former are exposed. On taking a survey of the tract of country immediately surrounding Bristol, we observe an irregular plain, bounded to the west by the mountain limestone and millstone grit, to the north by the lias, to the north-east and east by pennant, and to the south by lias again. The basis of this plain is composed of red marl and new red sandstone. We shall speak more particularly of the soil which covers it, after describing the city and suburbs in relation to this and the other rocks.
The highest and most picturesque parts of Clifton are on the mountain limestone. This rock extends along the defile of the Avon on both sides, constituting, on the northern bank, St. Vincent's Rock, and after an interruption of dolomitic conglomerate, of small extent, stretching over Durdham-down, and on to Cook's Folly, below which it is seen to rest on the old red sandstone. On the cliffs formed by this rock, along the southern bank of the river, hang the beautiful Leigh Woods. Below Prince's Buildings and the York Crescent, which stand upon the mountain limestone or superjacent limestone shale, we find the millstone grit, which may also be seen on the other side of the river, reposing upon the limestone. All the lower part of Clifton, including the Hotwell Road, and some very high ground, for instance, that of the Paragon and Windsor Terrace, are built upon this rock. Proceeding in a north-easterly direction, we find it over Brandon Hill, Tyndal Park, the upper part of Park-street, and at the foot of St. Michael's Hill, where it disappears under the superincumbent red sandstone and lias. It is not easy to determine, precisely, the boundaries of the millstone grit, as the ground below the parts just enumerated is thickly covered with buildings, and no other outcroppings are visible than at the places just mentioned. As the distance between the known course of these strata and those of the red sandstone is by no means great, the determination of the boundaries is not of much importance. The remainder of Bristol, that is, about three-fourths, is situated on the red ground; from this, however, we must except a small portion north of St. Michael's Hill, which belongs to the lias.
The general character of mountain limestone is too well known to require description here. Elevated to a considerable height, inclined in its stratification, and covered with a shallow soil, it presents obvious advantages with respect to perflation of buildings, and non-detention of moisture on the surface; but, on the other hand, the hardness of its texture is a serious inconvenience in the formation of sewers. The water which it yields is good, but, on boiling, becomes milky in appearance, from the carbonate of lime held in solution. From this rock issues the spring at the Hotwells, so much resorted to by invalids in former times. Its temperature is 74° Fahrenheit, and its specific gravity 1.00077. Each pint contains
|Carbonic Acid,||3.5||cub. in.|
|Carbonate of Lime,||1.5||grs.|
|Sulphate of Soda,||1.5|
|Muriate of Soda,||0.5|
The water obtained from the millstone grit is, for the most part, extremely pure. It occasionally, however, puts on a different appearance, from being tinged with iron, which abounds in this rock. The grit is a compact siliceous stone, and contains large quantities of quartz crystals called Bristol Diamonds, which are six-sided pyramids, frequently deposited on needles of iron, or manganese, or sulphate of strontia.
We shall not attempt any account of the other coal measures, as no part of the city is built upon them. They do not occur within a shorter distance than a mile and a half or two miles. For the same reason we shall pass over the next in order to these, or the dolomitic conglomerate, the first of the unconformable strata.
A section of the new red sandstone is seen just below St. Augustine's Church, on the northern side of the floating basin, or old bed of the river Froom. Another, admitting still better of observation, is in the new cut of the Avon. This stone has been much used in building, but is too deficient in durability for the purpose, a fault which may be seen in the walls of the cathedral. Of the medicinal character of new red sandstone, a very good account has been given by Dr. Henry, when speaking of this formation as it occurs around Manchester, and we shall therefore quote his words.
“ The only principles on which the strata of any district lying beneath the soil and superficial beds of clay and gravel, appear capable of exerting an influence over the health of its inhabitants, are─as those strata absorb water more or less readily and completely, thereby affecting the hygrometrical state of the atmosphere; and as they furnish, by springs and rivers, water more or less impregnated with foreign ingredients, and therefore less or more fit for the use of man. Under the first view, the red sandstone is well adapted, by the avidity with which it imbibes water, to moderate the evils of a rainy climate like that of Lancashire. Under the second aspect, this rock furnishes an abundant supply of beautifully clear water, agreeable to the palate, but holding, in solution, much carbonate of lime, and a little sulphate of that earth, both of which are deposited on boiling. There is no reason to suppose that these impregnations have any effect unfavourable to health. They can have no tendency to produce calculus diseases, which were once imputed to them, but which have been shewn to be produced by causes quite independent of the qualities of water, and to depend on morbid operations of the animal economy. The almost universal freedom of the red sandstone from noxious metals (lead and copper being rarely found in it,) adapts it for the purpose of an excellent natural filter. By its spontaneous decomposition, also, this sandstone is known to furnish an excellent sandy loam, one of the most desirable that can be found for the production of every vegetable; and in this manner it cannot but materially contribute to the salubrity of any country, of which it is the prevailing rock.” 
In a medical point of view, the soil and subsoil are, perhaps, of more importance than the subjacent rock. In some parts of the low ground on which Bristol stands, the sandstone is merely covered with red loam or earth; in others, there are large deposits of alluvial clay, and peat, filling up the hollows in the sandstone. The clay is of a blue colour, and from 10 to 20 feet thick. Dr. Bright says that, on digging the channel of the New River, a bed of peat, 2 feet thick, was found, 12 or 14 feet below the surface. From the geographical account which has been given of the distribution of the rivers which intersect the city in so many directions, it might reasonably be inferred that there must be a considerable extent of alluvial matter corresponding with their course, and this is found to be the case. Thus the principal part of Temple Parish, St. Philip's, St. Paul's, the southern part of St. James', including Broadmead and Lewin's Mead; that division of St. Augustine's which is situated between College Green and the southern base of Brandon Hill, on ground redeemed from Cannon's Marsh; Queen's Square, and its vicinity, which lie between the two rivers; are all built upon soil more or less argillaceous.
The buildings in Bristol, as it respects both their mode of construction and their relative situation, present no very marked difference from those of other large cities of a date equally antique. In consequence of the abundance of stone-quarries in the vicinity, even the poorest tenements, as far as the walls are concerned, afford good shelter from inclement seasons and atmospheric vicissitudes in general. Ventilation, however, is by no means so well provided for. The streets are, for the most part, narrow, and the houses of considerable height, and in those parts of the city inhabited more especially by the lower orders, we find courts and close alleys very frequent. As if the original object had been to make every inch of ground available, houses may be observed in some of these courts, with their faces opposed to each other, at the distance of five or six feet only, the entrance to the area being under an archway from some street, only a little less confined than the court itself. On looking at them, and considering the filthy, careless habits of the occupants, the medical observer is puzzled to imagine how any degree of health can be preserved, in places where exhalations from the soil, and every description of human miasmata must be almost constantly detained and concentrated. Narrow passages are sufficiently unhealthy, but they have greatly the advantage of the courts to which we refer, since, in the former, there are, for the most part, two open extremities which allow a pretty free current of air, while in the latter, all perflation is obstructed by the quadrangular arrangement of the buildings. When it is borne in mind that the areas are often half-filled with deposits of the refuse of animal and vegetable matters, as well as with other impurities, it must be evident that few circumstances are wanting for the production of all the morbific agency of which buildings are capable. But even those parts of the city formerly tenanted by the wealthy citizens, seem to have been as little exempt from the character of closeness as those which gave shelter to the more needy. The truth of this statement is strikingly confirmed by the name of Broad-street. What must have been the width of the other streets when this received its distinctive appellation!
In the important particulars of drainage and sewerage, some districts of the city suffer great disadvantages. Before the floating harbour was constructed, every facility was afforded for the removal of filth, by the unobstructed course of the rivers; but after the accomplishment of that work, the accumulation of the matters discharged by the drains in a stagnant body of water, occasioned no slight inconvenience to the citizens for many years. It is proper, however, to mention that, previously to the formation of the floating harbour, those parts of the city which stand upon the banks of the Froom were liable to serious inundations, the effects of which were highly prejudicial to the inhabitants. These floods took place whenever there was a concurrence of the three following events:─a sudden dissolution of snow, a spring tide, and a south-west wind blowing up the Bristol Channel. Within the last few years it has been customary to empty the float twice annually, and a large sewer has been formed, which runs from the embouchure of the Froom in a direction parallel with the Float, and after receiving the drains from the central parts of the city, discharges itself into the new channel of the Avon. Into this sewer the Froom sends a division of its stream, loaded with the contributions which it has received at every step of its progress through some of the most closely built and densely crowded districts. Unhappily, the current of this river is narrow, torpid, and scanty, in consequence of which it often struggles ineffectually with the burthens accumulated upon it, and deposits them upon its bed, the sides of which become elevated into pillows for the exhausted and almost stagnant waters, and exhale miasms sufficient. it might be imagined, to infect the whole neighbourhood. In the summer time we have seen the stream shrunk to a width, scarcely exceeding that of a large gutter, and trickling between two mounds of mud. At all times it is almost impossible to cross the bridges by which it is concealed from sight in the midst of streets and lanes, without being reminded by particular odours, of its propinquity. Great and highly commendable pains have been taken by the proper authorities for the mitigation of this evil, and certainly the annoyances, although still considerable, are much less so than in former times.
As there is no staple manufacture in Bristol, the occupations of the working classes are very various. There are, however, as might naturally be expected in a city of such magnitude, many extensive manufactories, which give employment to a large proportion of the population. The most numerous of the trades prosecuted upon a large scale, are those which depend upon the port; such are the building and fitting-up of vessels, rope-making, chain and anchor works, &c. From the connection of the place with the commerce of the West Indies, sugar-refining occupies a conspicuous place among our local manufactures. Glass-works are carried on to a great extent; so, likewise, are tanning, and the manufacture of soap, glue, parchment and floor-cloth. There are no employments here which exert a specifically injurious influence upon the constitution excepting the preparation of white lead and flax dressing. In some of the occupations which we have mentioned, such as glass blowing, iron-working, sugar-baking, &c. there is, of course, a frequent risk of contracting those disorders which result from exposure to alternations of temperature, but it does not appear that the operatives in these trades are shorter lived than others. It would be out of place to dwell here upon the agency of these employments, in a medical point of view, since they are not so prevalent in, or peculiar to, Bristol, as to hold any prominent place in relation to its healthy or morbid character. Each of them must, of course, contribute to the aggregate of disease, but cannot be considered with reference to the population, in the same important light as the needle-grinding of Sheffield or the cotton-spinning of Manchester. With regard to the workmen engaged in the various preparations of shipping, we are inclined to think that their labours are rather conducive than prejudicial to their health, since, on the one hand, they are not subject to long or close confinement, nor, on the other, are they too much exposed to the atmosphere; in addition to this, their occupations are, for the most part, the reverse of sedentary, and yet are not attended with inordinate or exhausting exertions. On the whole, then, we are decidedly of opinion that the occupations of the population of this locality, bear but a small proportion in the causes of disease, if we compare it with other cities peopled to an equal amount.
The kinds of subsistence used among the lower classes, are constantly varying with the demand for work and the rate of wages. When the latter are not very low, the families of the poor contrive, for the most part, to obtain animal food three or four times a week. but the meat is generally bacon. When they are unable to procure meat, the mid-day meal generally consists of boiled potatoes, or, almost as frequently, of tea with bread and lard. It is to be regretted that the prejudice against oatmeal is almost universally prevalent in this district, and that the deficiency of other articles is not supplied by porridge. Occasionally the fish-market is overstocked, and the poor have then an opportunity of purchasing herrings, mackerel, and such kinds of fish, at a very low rate, but too often not till the delay in the sale has occasioned the commencement of putrefaction. We have been informed that frequently late at night they are tempted to buy tainted meat, which the sellers did not dare to expose in their shambles by day, at two-pence per pound; and that in the like manner the farmers in the neighbourhood occasionally dispose of the carcases of cattle which have died of disease. In certain obscure districts we have had the pain to see meat hanging in the shops, black in colour and almost liquid in consistence. When to such examples of diet we add the sweepings of green-grocers' stalls, which are often insufficiently boiled for want of fuel, some idea may be formed of the innutritious, or even noxious, character of the aliment on which a large portion of the populace subsist. To those who happened to witness the avidity with which the allowances of rice and gruel (neither spiced nor sweetened,) were sought at the time of the prevalence of cholera, when these articles were largely distributed, no further proof was wanting of the scarcity of the necessaries of life. Great as are these evils, the lot of the poor half-fed people would be comparatively happy, if the practice of spirit drinking were not prevalent. No tongue can tell the miseries induced by these poisons among the unthinking wretches, who often resort to them at first for the relief of gnawing hunger, and the fancied obviation of the results of deficient clothing. All their unavoidable ills are increased a hundred-fold. The evils of a spare maintenance might be to a certain degree endurable, with bodies not subjected to worse agencies, with passions under control, and with families peaceable and well-regulated; but such supports or alleviations are unknown among the votaries of ardent spirits.
Wherever food is deficient, it may be safely concluded that there is a still greater scarcity of clothing among the indigent. The physiologist has no need to try experiments upon the capability which the human system possesses of resisting low temperatures, when he can enquire into the circumstances of a poor population during an inclement season. We have often been astonished at the minimum of clothing to which individuals in these ranks reduce themselves, when pressed by the calls of hunger, far more imperious than the urgencies of frost and snow. In the winter of 1831 and 1832, when engaged with others in enquiries into the condition of the poor, with a view to arm them, if possible, against the threatened pestilence, we frequently found a family of five or six persons with one threadbare blanket between them, and the mother with a single flannel petticoat in the same predicament; all other articles of warm covering having been long before bartered for food, or deposited at the pawn-brokers.
It would be difficult to designate the miserable creatures reduced to this degree of destitution, as belonging to any particular class. They are such as may be found in almost every populous district; in this place they consist principally of unemployed labourers, artisans, and seamen, among our own people, and of hordes of Irish adventurers, whose existence seems to have no other object than that of showing upon how little extraneous material their athletic frames can be maintained, and how little derived from outward sources of enjoyment is the current of their happy spirits. We must not dismiss this part of our subject, without alluding to the manner in which the dwellings of the working classes are occupied. If the enquirer into the condition of the poor is amazed at their achievements in abridging the necessaries of life, he will experience no less surprise at the ingenuity which they manifest in accommodating crowds of living beings in a small compass. And in this art our Hibernian brethren maintain their supremacy. It is a common circumstance for a house to be tenanted by five or six families. In their arrangements there are many grades of landlords or letters; thus, one individual, not much higher in the world than his tenants, rents the entire house of the landlord, and lets the floors to other individuals, who, in their turn, let single rooms to families or single persons; the latter, also, have their tenants, who hire corners in the room. We have found thirteen individuals, men, women and children, living promiscuously in one garret of no very large dimensions. On one occasion it happened to us to discover that thirty individuals had, on one night, slept in a room, the measurements of which did not exceed 20 ft. by 16. The people thus congregated were Irish; they chanced to be on their way from London to their native country. At that period cholera was hovering over us, and on the night to which we refer, it swooped down on nine out of the thirty, and seven became corpses in the course of a few hours. By mentioning the latter fact in this connection, we do not mean to intimate that the accumulation of so many individuals in a small space, was the only cause of the terrible incursion, for they were under the scarcely less noxious agency of a loathsome diet. Many other instances of crowding fell under our notice at the same time; among others, we had once the pain of seeing, in a confined chamber, three persons labouring under the same malady, who could only find room for the extension of their bodies by lying with their heads in the several corners, while their feet met in the centre of the floor. A great variety of such details might be collected, but they would swell this paper unnecessarily. What has been mentioned will suffice to shew, that although Bristol is exempt from many morbific causes to which other large cities are subject, yet she has her share of those common sources of disease, want and wretchedness.
Of the moral habits of the people, it is difficult to speak with any degree of precision, and I am doubtful whether any thing more specific can be stated, than that where so much indigence exists, its offspring, vice and ignorance, must also abound. Dr. Chisholm remarks, that he had much satisfaction in observing the regularity with which the poor of Clifton and the Hotwell-road, attended to their religious duties on Sundays. We fear that there has been some degeneration, in this particular, since the time of Dr. Chisholm.
In reciting the morbid history of a locality, the first and most prominent topic would naturally be an account of the endemial diseases. But on looking over the catalogue of maladies at our charitable institutions, and taxing our own experience, we cannot fix upon any individual affection, or any classes of affections that can be said to prevail in Bristol more than in other places. This conclusion, indeed, might have been anticipated from the foregoing pages, wherein it appears that our population, though exposed to the morbific agencies common to all populous cities, has no specific causes to contend with. Thus the statements which have been made respecting the geology of the district, will have prepared the reader for the announcement, that the disorders originating in malaria, such as intermittent and remit tent fevers, are known to us only among persons who have immigrated hither from fenny countries. Dysentery, when it occurs, appears either in sporadic cases only, or as the result of an epidemic constitution of the atmosphere. Calculous diseases are not so prevalent as to lead the medical observer to refer them to any local peculiarities of diet. Nor are we aware of any modification of the types of those diseases which are derived from common causes, sufficiently notable to induce us to assign them to the operation of topical circumstances. It has already been observed, that there is no one prevalent trade that exerts any appreciable influence on the health of the community.
Hence it follows that we must content ourselves with making a few remarks upon some of the diseases which owe their origin to causes not peculiar to the place. Of these the most frequent are pectoral, gastric, and rheumatic affections.
Bronchitis has, in our experience, far surpassed in, frequency all other pulmonic maladies of an acute description. We are bound to attribute this fact, in a great measure, to atmospheric influence, though it is not easy to determine what condition of the air has a preference for bronchitis, over pneumonia or pleuritis, unless it be allowable to conclude that, while the former disease is, for the most part, the result of a morbid stimulant, directly applied to the mucous surface, the latter are more generally referrible to a causation, compounded of deranged sanguineous determinations and remote sympathies; not that we imagine bronchial inflammation to be exempt from these influences. If this be granted, it is not difficult to conceive of states of the atmosphere, of a chemical or specific character, which might be quite adequate to the excitement of bronchitic disorder, without those alterations of its temperature, which tend to disturb the equilibrium of the circulation, and to accumulate the blood in the parenchyma of the lungs, or to effect those derangements of the cutaneous function which provoke the irritability of serous membranes. Certainly pleurisy, more commonly than any other active inflammation of the chest, succeeds sudden transitions from heat to cold. In Naples, as we are told by Dr. James Johnson and other writers, this disease is endemic, and is very reasonably attributed by them to the chilling tramontanes, which are constantly surprising the inhabitants enervated by sultry skies and siroccos. It is possible that the foreign particles abounding in the air of Bristol, may have something to do with the frequency of bronchitis. We seldom find this disease fatal in its acute form, when judiciously treated, but it is very prone to pass into the chronic form, and then becomes extremely intractable.
Of the chronic diseases of the lungs, phthisis maintains its predominance here as elsewhere. Sometimes it supervenes on acute inflammation of the bronchial membrane, or of the pulmonary tissue, but far more frequently it takes its origin solely from the peculiar structural degeneration in which its essence consists. Our consumptive patients often, indeed, with that confidence and self-delusion which characterise the disease, refer their complaints to some accidental occasion of taking cold, suffering “ a chill,” exposure to rain or fog, and similar causes, fancying that their symptoms are consequently of a less serious description; but on close cross-questioning, it generally appears that, for some time prior to the date, which they would fain assign to their indisposition, they had experienced an acceleration of breathing on any increase of exertion, had been sensible of a slight oppression on the chest in the recumbent posture, had been troubled with a short cough, and had even expectorated small quantities of blood. Their friends, also, when reminded by our enquiries of observations which they had formerly made, though without reflecting upon them, will tell us that they remember having occasionally noticed an alteration of the complexion, a “ faded look,” that a loss of flesh had certainly taken place, and that the intonation of the voice had been, in some measure, changed; all these circumstances not having been striking enough to detain attention at the time, though sufficiently impressive to be remembered afterwards. Now all these symptoms indicate the commencement of a morbid action prior to the bronchitic or pneumonia seizure; but the action is just such an one as readily invites the operation of inflammatory causes, and this is the reason we imagine why persons, both in and out of the profession, are so disposed to look upon tuberculous deposits as uniformly the results rather than the causes of phlogistic action. We are by no means so exclusive as to maintain that tubercles always take their very beginning in a derangement sui generis; on the contrary, we are of opinion that very frequently inflammation is the first of that series of capillary aberrations, which terminate in the substitution of tubercular for the proper interstitial secretion; in other words, that inflammation developes the peculiar diathesis. Perhaps the declaration of this opinion may appear irrelevant here, unless we can offer any grounds for it, derived from circumstances more immediately connected with this locality. We are, however, not aware of the existence of any such circumstances. It might not unnaturally be conjectured that scrofula is so prevalent here, that the frequent occurrence of phthisis, in persons who have this form of cachexy strongly marked, has led us to believe in its non-inflammatory origin. But we are disposed to assert our attachment to this view, the rather because such circumstances as we have hinted at, are by no means more common here than in other large cities, where many of the inhabitants are compelled to struggle with the injurious influence of close air, bad or scanty food, and squalid habits; and, consequently, our opinion is founded on the general history of the disorder in question.
Rheumatism is a most prolific parent of cases in this locality, but does not, as far as we have been able to determine, present any peculiar characters. Both in the acute and chronic form, it appears such as we have observed it elsewhere, whether with reference to the constitutional affection, the parts most frequently attacked, its sequelæ, or its amenability to remedies. Correspondently with its remarkable frequency in this place, we meet with a large number of cardiac cases, particularly pericarditis, hypertrophy, and disease of the valves. Simple dilation, which has no immediate connection with rheumatism, is of more rare occurrence.
Next to rheumatism in the order of frequency, we must place those gastric derangements which pass under the denomination of pyrosis, gastralgia, morbid sensibility of the stomach, &c. It very seldom happens that a patient complains of a gnawing pain in the stomach, without also mentioning that he is subject to the ejection of a clear glairy fluid. There is often tenderness at the epigastrium, but the tongue, which, for the most part, assumes a pale, pasty, sodden look, occasionally, however, presenting nothing uncommon, has very rarely the red tip and margin, indicative of mucous inflammation. It is true that leeches, generally, give temporary relief, but they appear to do so in the same manner in which they alleviate pains of a spasmodic or neuralgic character. Purgatives, followed by subnitrate of bismuth, and, occasionally, by acetate of morphia, seldom fail to cure the disorder for a time; but it returns unless the cause be removed, which is, unquestionably, the use of indigestible irritating articles of food. The triple use of potatoes, tea, and gin, will reduce the hardiest stomach to the painful condition we speak of. The great frequency of the disorder in Bristol, evidently results from the poverty of the people, and its relation with alimentary causes.
Omitting the febrile exanthemata, together with infantile remit tents, and diseases connected with dentition, which constitute so large a proportion of medical cases in all parts of the kingdom, we find, among the most frequent of our patients, females labouring under some form or other of hysteria, considering this term as generic for all those neurotic, atonic, anomalous ailments, to which females are so obnoxious, and which are all less or more related with catamenial deficiencies and disturbances. To attempt to specify them is vain; no cases preserve so much individuality, united with so much family resemblance. Numerous as they seem to us, we by no means imagine that they are eminently so; for their very nature and causation intimate that they must be prevalent wherever a great variety of moral stimulants are in operation, as, for instance, in a crowded population.
Fever has, in all ages and countries, manifested such close relations with local peculiarities of air and soil, that to omit the consideration of it in reference to the subject of our remarks, would be altogether unjustifiable. It is unnecessary to repeat our former statement, that regular periodic fevers are unknown as indigenous productions. Continued fever is common enough, but nine-tenths of the cases are of a simple character, terminating, for the most part, within seven days, and uncomplicated with anything more serious than slight catarrhal or rheumatic disorder. Those cases which are longer in their duration, and assume a more serious aspect, have inflammatory complications, which render the terms cephalic, bronchitic, gastro-enteric, appropriate adjuncts. But typhus gravior is rare, much more so than might be expected by those who consider such circumstances, as accumulation of filth, ill-ventilation, had diet, putrid effluvia, to be capable of generating this form of fever. Even the fever that does occur in this locality, indicates but a very slight relation with such causes as have been just enumerated. It has often been observed to be infrequent, or altogether absent, in the most crowded and dirty parts of the city, at times when it was prevailing considerably in institutions and dwellings where cleanliness and free air are most carefully attended to. Of the various local circumstances with which it has been connected, the most frequent has appeared to be a moist argillaceous soil, such as is found in certain parts of the parishes of St. Paul and St. Augustine. In the post-mortem examinations of febrile cases, ulceration of the mucous membrane of the bowels is the most common morbid appearance.
Consistently with the infrequency of the low or malignant typhus, we seldom observe that inflammatory affections of the head, the lungs, or the abdominal viscera, have a tendency to assume the type designated after this form of fever. The same may be said of the exanthemata.
The following is a classification of 700 medical cases treated in the Bristol Infirmary, in the year 1832, for which we are indebted to our very intelligent friend Mr. Morgan, late house-surgeon to that institution.
|Diseases of the Organs of Digestion,||73|
|─────── of the Nervous System,||58|
|──────────── Urinary Organs,||6|
We shall now proceed to offer one or two statements relative to the ratio of mortality in this district, which we are the better enabled to do through the assistance of some original tables, kindly furnished us by Mr. Rankin, Actuary to the Bristol Union Fire and Life Insurance Company. This gentleman was at the pains of consulting, a few years ago, the various registers of burials in the city and out-parishes, in order to ascertain the numbers and respective ages of all who had died in a period of ten years; viz. from 1813 to 1822 inclusive. By means of the results thus obtained, Mr. Rankin was enabled to calculate the expectations of life at the several ages in this locality.
|Total of Burials in the City of Bristol and Bedminster, from 1813 to 1822 inclusive.|
|All Saints, Christ Church, and Cathedral,||279|
|St. Mary Radcliff,||1330|
|St. Philip and Jacob,||2437|
|St. Mary (Bedminster,)||1265|
|Temple or Holy Cross,||1903|
|Total from Parish Registers,||13670|
|Total from Dissenters' and Private Burial Grounds||6896|
|Grand Total in 10 years,||20566|
If we divide the whole mortality stated in the above table by 10, in order to obtain the average annual number of deaths, and make the result the divisor of the population the ratio of mortality will be about 1 in 45. In London the ratio is 1 in 40; in Liverpool the same; in Birmingham 1 in 43.
From another table we have selected the following statements of the expectations of life, to a person at the age of 20, in different places; these, it will be seen, are highly favourable to Bristol and Clifton.
A third table acquaints us with the number of persons living at the age of 20, out of |000 born, in the following places:─
From another table which Mr. Rankin was so obliging as to lend us, we have calculated the annual number of deaths at certain periods of life, in this city, which are as follows:─
It is to be lamented that, in consequence of the present mode of keeping public registers, the first table does not afford us such valuable results as might otherwise, have been derived from such a document. The deaths being registered at the places of burial, no estimate can be formed of the proportionate mortality of a parish, from an inspection of the register in that parish, because a large number of the inhabitants may have been interred in other parishes, or in private burial-grounds, or in those attached to dissenting places of worship. As a proof of the great inaccuracy that would accrue from a calculation founded upon parochial registers, the number of interments stated to have taken place in the parish church-yard of St. Philip and Jacob, would give a ratio of mortality amounting to no more than 1 in 82, to the most. ill-fed and ill-clothed portion of the population of Bristol. If deaths, instead of burials, were registered, and in the places where they occur, information of the most important kind might be deduced from them, relative to the comparative salubrity of particular districts. We trust that this change, together with many others greatly needed in the system of registering, will, ere long, be effected by the legislature.
- See Kirwan on Temperature.
- See a paper by Dr. Lyon, on the Medical Topography of Manchester, in the North of England Medical and Surgical Journal, No. I.
- Geological Transactions, vol. iv.
- For a full and luminous view of the geology of the neighbourhood of Bristol, the reader is referred to a paper upon the Bristol Coal Basin, by Professor Buckland and the Rev. Mr. Conybeare, in the Geol. Trans.
- In the out-parish of St. Philip and Jacob, all the evils of squalidity, united with destitution of comforts, seem to have attained their utmost limits; yet, strange to say, the health of the inhabitants would appear to be comparatively little affected by this circumstance. Typhus is but seldom observed in the parish, or any other of the diseases commonly referred to the influence of filth and the congregation of human beings in a narrow space. This fact, however, agrees with what we are told of the general immunity of certain savages, such as the Esquimaux and Kamschatkans, from pestilential diseases; but, although the loathsome habits of these tribes are not capable of generating poisons, yet, when the morbific cause is applied, its effects are much greater than in a population better circumstanced.
- Statistical Pathology of Bristol and Clifton.─Ed. Med. and Surg. Journ. vol xiii.
- The nearest marshes are in the vicinity of Compton, Henbury, Cross, and Bridgewater.
- The population of Bristol and the Out-parishes, is 92434.