In Victorian Scotland, epidemic disease, closely linked to bad sanitation and the cramped living conditions of the urban poor, was a terrible threat. Part of the reason we know so much about epidemics in the 19th century is that debate was raging in the medical profession about how to stop them. There were two major theories about cholera: one was that it was contagious, spread by touch from human to human. the other harked back to the old ideas about the spreading of the Black Death, that it was supposedly spread by unhealthy vapours in the air and bad smells, therefore the solution was increased sanitation. The theory behind this latter position was wrong, but the practices which stemmed from it were right - cholera was spread through water supplies contaminated by poor sanitation. The answer was an urban clean-up campaign. James Maxwell Adams was a doctor in one of the poorest parts of Glasgow in 1849 before the vital medical breakthrough into the causes of cholera was made. As can be seen from his careful observations, he was documenting the living conditions which seemed to give rise to epidemics.
During the late epidemic of cholera in the City parish, Glasgow, I had favourable opportunities of observing the disease, having had the charge of one of the seventeen medical districts, into which the parish is divided. The following observations refer chiefly to the disease as it appeared in that district; but include, also, the results of cases treated in private practice, and which occurred in various localities throughout the city.
The thirteenth medical district comprises that central portion of the city which is bounded on the upper or north side by George Street; by the west side of High Street to Stirling Street; by Stirling Street to Candleriggs; thence to Argyle Street; by Argyle Street to Buchanan Street, and thence to George Street. It forms pretty nearly an oblong quadrangle, running from east to west, half a mile in length, by a quarter in breadth. The population of the entire district can scarcely be under 14,000; and of this number I consider that about 5,000 are of that class who avail themselves of the services of the parochial surgeon. By far the greater proportion of this class reside in the north east corner of the district, within a space 280 yards in length, by 120 in breadth, and it was within this limited area that fully nine-tenths of the cases of the late epidemic occurred.
The condition of the great mass of the inhabitants, and the general sanitary state of this portion of the district, are probably as bad as can well be conceived. The locality consists chiefly of five or six narrow streets, and about a dozen of the dirty 'closes' or 'wynds' for which Glasgow has acquired a discreditable notoriety. There are very few sewers, or gratings which conduct to sewers, and the greatest amount of drainage consequently takes place on the surface. The receptacles for filth consist of large open dungsteads placed either in the centre of the closes, or of the lower flats of inhabited tenements, with an open window through which the refuse is cast, and in these places of deposit, the filth accumulates till it is in such quantity as to necessitate the removal of a portion from want of space for further deposit. The cases are exceptional in which regular arrangements are made for this purpose, and in all they are miserably inefficient. Thus, in three of the worst closes of the district, I occasionally observe a frail old pauper paddling about the principal dungstead with a broom or shovel, and the entire sanitary operations of these localities are due to his solitary exertions, - in return for which, he receives the shelter, rent free, of a wretched cellar in the neighbourhood.
The supply of water is very scanty; a single pipe or fountain is made to suffice for one or more of these closes, and the trouble of going such a distance as is required in order to procure a supply, seems to be sufficient excuse for the people to limit the use of this essential element to the narrowest limit compatible with necessity.
The houses are of a wretched character, excessively over-crowded and filthy. They generally consist of one apartment, but occasionally of two, of from eight to twelve feet square, seldom containing less than four, and very commonly as many as twelve, inmates for each apartment. A great proportion of the population is migratory, and only lodge with the party who rents the premises, paying a small pittance nightly or weekly. Beds are rarely seen - the inmates lying on the floor, often without doffing the clothes worn during the day. In numerous instances where the parties work in-door upon soft fabric goods procured from warehouses, the webs of cloth so obtained, serve as coverlets until the period when they are returned to the manufacturer or warehouseman. There are few of these houses in which there is not a pauper receiving out-door relief.
Fever may be considered as endemic in the district, and the expense which the parish incurs in the maintenance and attendance of the victims of epidemic, endemic, and contagious diseases, and in making the various provisions which are, in consequence obligatory on parochial boards, cannot fall far short of the whole rental which the proprietors of these lazarettos draw from their inheritances.
During six months only of 1847, as many as 400 cases of typhus fever occurred within this portion of the district, and were treated at the cost of the parish. The total cases of disease occurring within the district, within the last two years, and treated at the cost of the parish, was 1900, of which number, fully 1,000 were cases of epidemic, endemic and contagious disease.
Cholera first appeared in the district on 9th December 1848, in the ground flat of a building in 22 Shuttle Street. The patient, a female aged fifty-six, was of occasionally intemperate habits, and her previous general health was not good. She had not been in communication with any infected district or locality so far as could be ascertained. She was immediately conveyed to hospital, where she died on the following day. I immediately got the house lime-washed, and the straw-bed on which she had lain destroyed, but the inmates would not consent to removal.
The next case occurred in the same house. A female child, aged two years became affected on 12th December with bilious diarrhoea, which was followed on the 17th by all the symptoms of cholera. She died on the following day.
The third case occurred in 51 Shuttle Street, being on the opposite side of the street, and at a distance of about thirty yards from the last locality. The patient, a female aged twenty-six, was of irregular habits, of infirm intellect, and subject to occasional attacks of dysenteric diarrhoea. She resided in the top story of the tenement: and for a few days prior to December 18th, had been very little out of doors, and had not, so far as I could ascertain, been in communication with the sick. I had her conveyed to hospital, where she died on the following day.
The fourth case occurred in the same house with the preceeding. The patient, a female, aged fifty-three, of irregular habits, and average good health, became affected with bilious diarrhoea on December 23, and, on the following day, with all the best marked symptoms of the malignant disease. She recovered after a somewhat protracted convalescence.
The fifth case occurred in 34 Shuttle Street, in the top flat of a building closely adjoining that in which the first case occurred. There is no direct communication between the buildings. The patient was a healthy temperate female, aged eighteen. She had slight diarrhoea on December 24, and next morning, soon after breakfast, she was seized with vomiting, speedily followed with purging and cramps. I had her immediately sent to hospital, where she died, soon after admission. Up to this date, there had occurred, in all, of cholera and diarrhoea, only seven cases, all within a circle of a few yards, and at the extreme north-east corner of the district; but within the next three days, I was called to twenty cases in various parts of the district, and of this number, eleven were malignant cholera.
James Maxwell Adams, Observations on the Epidemic Cholera of 1848-9, chiefly as it prevailed in the 13th Medical District of City Parish Glasgow, Edinburgh, 1849.