![Brave and strong as these Dale men were, their muscles were too
weak for the work demanded. As Vulcan found he needed stronger
journeymen than those of flesh and blood to forge the thunderbolts
of Jove, so an imperative necessity, a growing demand, led men
here to seek a more compelling force to blow their leathern bellows,
to lift their huge forge hammers, than animal force could supply.
Woods were no longer estimated by pannage yielded for swine, but
by the fuel supplied for reducing the stubborn ore to pigs of another
kind. Brooks were pounded up, streams were turned back upon
themselves, and their treasured waters husbanded as a capital of
force to be disposed of as occasion required. Dryads now fled the
woods and Naiads the streams,—as beams and shafts and cranks
were reared or creaked beneath the labours they performed.
The presence of coal and iron ore could not have been inducements
for the first ironworkers to settle here; neither tradition nor facts
warrant the supposition that either were ever found in the valley.
The first syllable of the name is deceptive, and the probability is that
it was neither Coal nor Cole-brook originally, although coal appears
to have been brought here for use more than five centuries ago from
places just outside. Wood fuel seems to have been growing scarce
as far back as the first quarter of the fourteenth century, judging
from an application on the part of a Walter de Caldbrook to the Prior
of Wenlock, to whom the manor belonged, for a license to have a
man to dig coals in “Le Brockholes” for one year. It is not unlikely
that this Walter de Caldbrook had a forge or smithy in the Dale; a
situation chosen on account of the stream, which served to furnish
him with motive power for his machinery. This seems all the more
probable from the fact that distinct mention of such smithy is made
in Henry the Eighth’s time, and that it is called “Smithy Place,” and
“Caldbrooke Smithy,” [277]
in the deed or grant by which the manor
was conveyed by the King to Robert Brook, signed at Westminster
and dated July 23, 1544. (See page 59). The fact too that this
smithy was still called Caldbrook Smithy strengthens the
suppositious, both as to the name and as to the fact that the
Caldbrookes used the Brockholes coal for their smithy in the Dale.](https://image.slidesharecdn.com/6182-250418081524-43e8c1eb/85/Introduction-to-Epidemiology-Understanding-Public-Health-1st-Edition-Lucianne-Bailey-39-320.jpg)
![plain oblong pieces of wood, six feet in length, eight inches in width,
and four inches in depth, and down these, by means of ropes,
waggons by their superior gravity brought up the empty ones to be
refilled with minerals which were conveyed for the use of the works.
The speed was regulated by a brake made to press, not as now
upon the barrel at the top, but upon the wheels of the descending
waggons. The man thus regulating their speed, was the jigger, and
the hill leading from Coalbrookdale to Wellington, where one of
these inclines was situate, became “The Jigger’s Bank.” (Sometimes
called the Jig-house Bank, because, of a house there.) In addition
to this railway for the purpose of supplying the furnaces, there was
another, by which the furnaces at the top were connected with the
foundry at the centre; and rails, first of wood, and then of iron,
continued for many years to be used, facilitating the transport of
heavy materials from place to place.
On the last occasion on which we saw him we were sent by a good
old aunt, a Quaker lady who loaded us with presents for the old
man, when he had gone to live in “Charity Row,” as it was called.
Speaking upon matters connected with the history of the Dale—
more particularly in reference to the Darbys and Reynoldses—the old
man would grow eloquent; and the effect of a little present—a
basket of strawberries or a packet of tobacco—had a wonderful
effect in stimulating memory. Nothing was “open sesame,” however,
like a drop of “Barnaby Spruce’s old Beer.” [292]
Say you had sent for
half-a-gallon of Spruce’s best October brewing, and he grew
loquacious at once.
“Remember him,” speaking of Richard Reynolds, he would say,
arching his eye-brows, and growing animated, as recollections
of the past came tripping upon the heels of each other. “I knew
him well; all the poor knew him; the robins and the sparrows
knew him, for he would carry crumbs a hundred miles in his
pockets ‘for his robins.’ He made a vast fortune, and then
everybody knew him; books, and tracts, and newspapers all
talked about him. He was a Quaker—not a thin, withered,](https://image.slidesharecdn.com/6182-250418081524-43e8c1eb/85/Introduction-to-Epidemiology-Understanding-Public-Health-1st-Edition-Lucianne-Bailey-52-320.jpg)
Introduction to Epidemiology Understanding Public Health 1st Edition Lucianne Bailey
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- 5. Introduction to Epidemiology Understanding Public Health 1st Edition Lucianne Bailey Digital Instant Download Author(s): Lucianne Bailey, Katerina Vardulaki, Julia Langham, Daniel Chandramohan ISBN(s): 9780335218332, 0335218334 Edition: 1 File Details: PDF, 1.03 MB Year: 2005 Language: english
- 6. Lucianne Bailey, Katerina Vardulaki, Julia Langham & Daniel Chandramohan UNDERSTANDING PUBLIC HEALTH UNDERSTANDING PUBLIC HEALTH Introduction to Epidemiology www.openup.co.uk Cover design Hybert Design • www.hybertdesign.com Introduction to Epidemiology Epidemiology, one of the key disciplines in public health, is concerned with describing the patterns of diseases, identifying their causes and evaluating the effectiveness of health care and public health interventions. Such information helps to promote health and treat disease. This book introduces the key elements of epidemiological methods. The book examines: ◗ Concepts and applications of epidemiology ◗ Population measures of health and disease ◗ Descriptive and analytical study designs ◗ Intervention studies ◗ Risk assessment and preventive strategies ◗ Surveillance and screening Lucianne Bailey was a distance learning tutor, Julia Langham is Research Fellow in Epidemiology, and Daniel Chandramohan is Senior Lecturer in Epidemiology at the London School of Hygiene & Tropical Medicine. Katerina Vardulaki is a development manager at the Healthcare Commission. Lucianne Bailey, Katerina Vardulaki, Julia Langham & Daniel Chandramohan Introduction to Epidemiology There is an increasing global awareness of the inevitable limits of individual health care and of the need to complement such services with effective public health strategies. Understanding Public Health is an innovative series of twenty books, published by Open University Press in collaboration with the London School of Hygiene & Tropical Medicine. It provides self-directed learning covering the major issues in public health affecting low, middle and high income countries. The series is aimed at those studying public health, either by distance learning or more traditional methods, as well as public health practitioners and policy makers. UNDERSTANDING PUBLIC HEALTH SERIES EDITORS: NICK BLACK & ROSALIND RAINE
- 8. Understanding Public Health Series editors: Nick Black and Rosalind Raine, London School of Hygiene & Tropical Medicine Throughout the world, recognition of the importance of public health to sustainable, safe and healthy societies is growing. The achievements of public health in nineteenth-century Europe were for much of the twentieth century overshadowed by advances in personal care, in particular in hospital care. Now, with the dawning of a new century, there is increasing understanding of the inevitable limits of individual health care and of the need to complement such services with effective public health strategies. Major improvements in people’s health will come from controlling com- municable diseases, eradicating environmental hazards, improving people’s diets and enhancing the availability and quality of effective health care. To achieve this, every country needs a cadre of know- ledgeable public health practitioners with social, political and organizational skills to lead and bring about changes at international, national and local levels. This is one of a series of 20 books that provides a foundation for those wishing to join in and contribute to the twenty-first-century regeneration of public health, helping to put the concerns and perspectives of public health at the heart of policy-making and service provision. While each book stands alone, together they provide a comprehensive account of the three main aims of public health: protecting the public from environmental hazards, improving the health of the public and ensuring high quality health services are available to all. Some of the books focus on methods, others on key topics. They have been written by staff at the London School of Hygiene & Tropical Medicine with considerable experience of teaching public health to students from low, middle and high income countries. Much of the material has been developed and tested with postgraduate students both in face-to-face teaching and through distance learning. The books are designed for self-directed learning. Each chapter has explicit learning objectives, key terms are highlighted and the text contains many activities to enable the reader to test their own understanding of the ideas and material covered. Written in a clear and accessible style, the series will be essential reading for students taking postgraduate courses in public health and will also be of interest to public health practitioners and policy-makers. Titles in the series Analytical models for decision making: Colin Sanderson and Reinhold Gruen Controlling communicable disease: Norman Noah Economic analysis for management and policy: Stephen Jan, Lilani Kumaranayake, Jenny Roberts, Kara Hanson and Kate Archibald Economic evaluation: Julia Fox-Rushby and John Cairns (eds) Environmental epidemiology: Paul Wilkinson (ed) Environment, health and sustainable development: Megan Landon Environmental health policy: Megan Landon and Tony Fletcher Financial management in health services: Reinhold Gruen and Anne Howarth Global change and health: Kelley Lee and Jeff Collin (eds) Health care evaluation: Sarah Smith, Don Sinclair, Rosalind Raine and Barnaby Reeves Health promotion practice: Maggie Davies, Wendy Macdowall and Chris Bonell (eds) Health promotion theory: Maggie Davies and Wendy Macdowall (eds) Introduction to epidemiology: Lucianne Bailey, Katerina Vardulaki, Julia Langham and Daniel Chandramohan Introduction to health economics: David Wonderling, Reinhold Gruen and Nick Black Issues in public health: Joceline Pomerleau and Martin McKee (eds) Making health policy: Kent Buse, Nicholas Mays and Gill Walt Managing health services: Nick Goodwin, Reinhold Gruen and Valerie Iles Medical anthropology: Robert Pool and Wenzel Geissler Principles of social research: Judith Green and John Browne (eds) Understanding health services: Nick Black and Reinhold Gruen
- 9. Introduction to Epidemiology Lucianne Bailey,Katerina Vardulaki, Julia Langham and Daniel Chandramohan Open University Press
- 10. Open University Press McGraw-Hill Education McGraw-Hill House Shoppenhangers Road Maidenhead Berkshire England SL6 2QL email: [email protected] world wide web: www.openup.co.uk and Two Penn Plaza, New York, NY 10121-2289, USA First published 2005 Copyright © London School of Hygiene & Tropical Medicine All rights reserved. Except for the quotation of short passages for the purpose of criticism and review, no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher or a licence from the Copyright Licensing Agency Limited. Details of such licences (for reprographic reproduction) may be obtained from the Copyright Licensing Agency Ltd of 90 Tottenham Court Road, London W1T 4LP. A catalogue record of this book is available from the British Library ISBN 0 335 21833 4 Library of Congress Cataloging-in-Publication Data CIP data applied for Typeset by RefineCatch Limited, Bungay, Suffolk Printed in the UK by Bell & Bain Ltd, Glasgow
- 11. Contents Overview of the book 1 1 Basic concepts and applications of epidemiology 3 2 Epidemiological measures of health and disease: frequency 19 3 Epidemiological measures of health and disease: association and impact 34 4 Cross-sectional studies 50 5 Ecological studies 58 6 Cohort studies 64 7 Case–control studies 74 8 Intervention studies 86 9 Interpretation of the results of epidemiological studies 97 10 Risk assessment and prevention strategies 113 11 Epidemiological surveillance and routine data 123 12 Screening and diagnostic tests 138 Glossary 152 Index 159
- 13. Acknowledgements Open University Press and the London School of Hygiene and Tropical Medicine have made every effort to obtain permission from copyright holders to reproduce material in this book and to acknowledge these sources correctly. Any omissions brought to our attention will be remedied in future editions. We would like to express our grateful thanks to the following copyright holders for granting permission to reproduce material in this book. p. 55–56 S Abdulla, J Armstrong Schellenberg, R Nathan, O Mukasa, T Marchant, T Smith, M Tanner and C Lengeler, British Medical Journal, 2001, 322:269–273, amended with permission from the BMJ Publishing Group. p. 21 © Lucianne Bailey 2004. Reproduced with permission from Lucianne Bailey. p. 9 Reproduced by permission of the Centers for Disease Control and Prevention. p. 116–7, 120–1 G Rose, The Strategy of Preventive Medicine, 1992, Oxford University Press. p. 8 Based on KJ Rothman, ‘Causes’, American Journal of Epidemiology, 1976, 104(6):587–592 by permission of Oxford University Press. p. 62 A Schatzkin, S Piantadosi, M Miccozzi and D Bartee, ‘Alcohol consumption and breast cancer: a cross-national correlation study,’ International Journal of Epidemiology, 1989, 18(1): 28–31, by permission of Oxford University Press. p. 11–17 Snow on Cholera: being a reprint of two papers by John Snow, M.D., together with a Biographical Memoir by B.W. Richardson, M.D. and an Introduction by Wade Hampton Frost, M.D., London, Oxford University Press, 1936. p. 59 SV Subramanian, S Nandy, M Kelly, D Gordon and G Davey Smith, ‘Patterns and distribution of tobacco consumption in India: cross sectional multilevel evi- dence from the 1998–9 national family health survey,’ British Medical Journal, 2004, 328:801–506, with permission from the BMJ Publishing Group. p. 6 A Taranta and M Markowitz, Rheumatic fever: a guide to its recognition, prevention and cure, 2nd ed., 1989, Kluwer Academic Publishers, by permission of Springer. p. 27–8 Data from WHO IARC Cancer Mortality Statistics 2004 and CancerMondial http://www-dep.iarc.fr/
- 15. Overview of the book Introduction This book provides a summary of the main methods and concepts of epidemiology to enable you to understand, interpret and apply these basic methods. It also aims to introduce more advanced epidemiological and statistical concepts. It is not the intention that epidemiology should be viewed as a solitary field, as it is integral to much of public health. Why study epidemiology? Epidemiology provides the tools (scientific methods) to study the causes of disease and the knowledge base for health care. Thus it provides public health profes- sionals the means to study disease and look at the effectiveness of health care services and, more specifically, the impact of health care interventions. It provides one key approach to understanding health and disease in individuals and populations, and the forces and factors which influence them. This is important both for health care professionals and for patients. The purpose of epidemiology is to use this information to promote health and reduce disease. Clinical practice and health policy cannot be based on clinical experience alone. They need to be based on scientific evidence. Understanding epidemiology and the methods used to study health and disease is a prerequisite for the ability to appraise critically the evidence in scientific literature. The ability to distinguish good from poor science (and good and poor evidence) is an essential skill in promoting evidence-based health care. Epidemiology is one of the key scientific disciplines underlying some of the most important and rapidly developing areas of inquiry into health and health care. Epidemiological methods are central to clinical research, disease prevention, health promotion, health protection and health services research. The results of epidemi- ological studies are also used by other scientists, including health economists, health policy analysts, and health services managers. Structure of the book This book follows the conceptual framework of the basic epidemiology unit at the London School of Hygiene & Tropical Medicine. It is based on materials presented in the lectures and seminars of the taught course, which have been adapted for distance learning.
- 16. 2 Introduction to epidemiology The book is structured around the basic concepts and applications of epidemi- ology. It starts by looking at definitions of epidemiology, introduces the funda- mental strategies for measuring disease frequency and patterns of disease, and associations with exposures or risk factors (Chapters 1–3). Chapters 4–8 discuss different study designs and their strengths and weaknesses. Analysis and interpretation of epidemiological studies are addressed in Chapter 9. The final three chapters (10–12) outline the application of epidemiology for prevention, monitoring and screening. The 12 chapters are shown on the contents page. Each chapter includes: • an overview • a list of learning objectives • a list of key terms • a range of activities • feedback on the activities • a summary. Acknowledgements The authors thank colleagues who developed the original lectures and teaching materials at the London School of Hygiene & Tropical Medicine on which the contents are based, Professor Ross Anderson, St George’s Hospital Medical School, for reviewing the entire book, and Deirdre Byrne (series manager) for help and support.
- 17. 1 Basic concepts and applications of epidemiology Overview Epidemiology is a basic science of public health. Its principles and methods are used to: describe the health of populations; detect causes of health problems; quantify the association between ill health and determinants; test treatments and public health interventions; and monitor changes in states of health over time. The key feature of epidemiology is that it is a study of populations, not individuals. In this chapter you will learn the basic concepts and applications of this discipline. Learning objectives After working through this chapter,you will be better able to: • describe the key aspects of the epidemiological approach • discuss the models of causation of disease • describe the natural history of disease • discuss the applications of epidemiology in public health practice. Studying epidemiology Epidemiology is the study of the distribution and determinants of health states or events in specified populations, and the application of this study to control health problems. It is concerned with the collective health of people in a community or an area and it provides data for directing public health action. Given the definition above, it follows that knowledge of the distribution and determinants of health states and events informs appropriate public health action. What is the distribution of health states or events? The distribution of health states or events is a description of the frequency and pattern of health events in a population. The frequency (e.g. the number of occurrences of a health event in a population within a given time period) is meas- ured by rates and risks of health events in a population, and the pattern refers to the occurrence of health-related events by time, place and personal characteristics. (Rates and risks will be discussed more in Chapters 2 and 3).
- 18. 4 Introduction to epidemiology What are determinants of health states or events? Epidemiology seeks to identify the determinants of health and determinants of disease. The determinants of health states or events are definable factors that influence the occurrence of health-related events. Determinants are also known as risk factors or protective factors, depending on which health-related events they are associated with. Health-related events refer to health outcomes (e.g. death, illness and disability) as well as positive health states (e.g. survival and reduced risk of stroke), and the means to improve health. The epidemiological approach Like detectives, epidemiologists investigate health-related events in a rigorous way. An epidemiologist’s approach to studying these events involves answering the questions: • what? • who? • where? • when? • why? These questions can be referred to as: • case definition • person • place • time • causes What? A case definition is a set of standard criteria for deciding whether or not a person has a particular disease or health-related event. A case definition consists of clinical criteria, sometimes with limitations on time, place and person. The clinical criteria usually include confirmatory laboratory tests, if available, or a combination of symptoms (complaints) and signs (physical findings), and other supportive evi- dence. For example, in the USA, the case definition for paralytic poliomyelitis used by the Centers for Disease Control and Prevention (CDC 1992: 461) is: ‘Acute onset of a flaccid paralysis of one or more limbs with decreased or absent tendon reflexes in the affected limbs, without other apparent cause, and without sensory or cogni- tive loss’. Application of standard criteria ensures that every case is diagnosed in the same way regardless of when and where it occurred. This allows comparison of rates of occurrence of the disease between populations and over time. A case definition may have several sets of criteria, depending on how certain the diagnosis is. For example, during an outbreak of measles, you may classify a person with fever and rash as a suspected case of measles; one with fever, rash and a history of contact with a confirmed case of measles as a probable case of measles; and one with fever, rash and a positive serologic test for measles IgM antibody as a confirmed case of measles.
- 19. Basic concepts and applications 5 A case definition may also include exclusion criteria to exclude people even if they meet the criteria for a case. For example, cases may be excluded on the basis of their age. Who? Counting the number of persons involved in a health event is one of the basic first steps in an epidemiological investigation. However, a simple count of cases is inadequate for comparing the occurrence of disease in different populations or during different times, so case counts are converted into risks or rates, which relate the number of cases to the size of the population (you will learn more about risks and rates in Chapter 2). People differ in certain inherent characteristics (e.g. age, ethnic group, sex), acquired characteristics (e.g. immunity, nutrition), socioeconomic conditions (e.g. education, occupation, housing), or health-related beliefs and behaviours (e.g. tobacco or alcohol consumption, health care seeking). Since personal attributes are often associated with health events, differences in the distribution of these factors should also be considered while comparing occurrence of health events between populations. Where? Health events are described by place to gain insight into the geographical difference or extent of the event. The place can be, for example, place of residence, birth or employment, a district, a state, or a country, depending on what is appropriate to the occurrence of the health event. Analysis of data by place can also give clues as to the source of agents that cause disease and their mode of transmission. A spot map is a map on which each case is related to a specific type of place, such as a place of work; such maps can be useful in identifying the source of the causal agent while investigating an outbreak. When? Rates of occurrence of disease often change over time. Plotting the annual rate of a disease over a period of years can show the long term or secular trends in the occurrence of the disease. These trends can be used to help predict the future incidence of a disease and also to evaluate programmes or policy decisions, or to suggest what caused an increase or decrease in the occurrence of a disease. Figure 1.1 is an example of such a graph. Activity 1.1 Figure 1.1 shows a declining trend in the incidence of rheumatic fever in Denmark since 1900. The incidence drops particularly sharply after 1900, having been quite steady for the previous 40 years.What might this suggest?
- 20. 6 Introduction to epidemiology Feedback The nature of the curve suggests that some event or action might well have triggered the decline in the incidence of rheumatic fever around 1900. Rheumatic fever is caused by haemolytic streptococcal infection, which is associated with poverty and overcrowding. It is, therefore, plausible to attribute the decline in rheumatic fever to the improvement in socioeconomic conditions in Denmark that occurred at the beginning of the twentieth century. Graphs of the occurrence of a disease by week or month, over the course of a year or more, show its seasonal pattern. Some diseases are known to have typical seasonal patterns; for example, the incidence of influenza increases in winter. Why? In addition to describing the levels and patterns in the occurrence of health events by person, place and time, epidemiology is concerned with the search for causes and effects. Epidemiologists quantify the association between potential determin- ants of health states and health events, and test hypotheses about causality and associations between the determinants and health events. There are several epi- demiological study designs, but their shared basic principle is to make an unbiased comparison between a group with and a group without the determinant or health event under investigation (study designs are dealt with in detail in Chapters 4–8). Figure 1.1 Incidence of rheumatic fever in Denmark,1862–1962 Source:from Beaglehole et al. (1993)
- 21. Basic concepts and applications 7 Models of causation of disease In order to understand the principles and applications of epidemiology, you need to know the potential processes and pathways by which various factors can lead to ill health. There are several models of causation that have been proposed to help the understanding of disease processes. In epidemiology, the models widely applied are: • the epidemiological triad • the sufficient cause and component causes model The epidemiological triad The epidemiological triad or triangle is the traditional model of causation of infectious diseases (Figure 1.2). It is based on three components: an external agent, a susceptible host, and an environment that facilitates interaction between the host and the agent. The agent might be a microorganism such as a virus, bacterium or parasite; or a chemical substance. Host factors are the intrinsic factors that influence an individual’s exposure, susceptibility, or response to a causative agent: for example, age, sex, ethnic group, and behaviour are some of the factors that determine an individual’s risk of exposure to an agent; age, genetic composition, nutritional and immunological status are some of the factors that influence individual susceptibility and response to an agent. The environmental factors are extrinsic factors that affect the agent and the opportunity for exposure. They include physical factors (e.g. climate, geological characteristics), biological factors (e.g. vectors – insects that transmit an agent) and structural factors (e.g. crowding, and availability of health and sanitation services). Agent, host and environmental factors are interrelated in many ways. The balance and interactions between them that lead to the occurrence of disease in humans vary for different diseases. This model can work for some non-infectious diseases, but there can be difficulties because certain factors are not easily classified as agents or environmental factors. Sufficient cause and component causes model A sufficient cause is a set of factors or conditions that inevitably produces disease. The factors or conditions that form a sufficient cause are called component causes. Component causes include host factors, agents and environmental factors. If a Figure 1.2 The epidemiological triad
- 22. 8 Introduction to epidemiology disease does not develop without the presence of a particular component cause, then that component cause is classified as a necessary cause. However, a single component cause, even if it is a necessary cause, is rarely a sufficient cause by itself. For example, exposure to the infectious agent Mycobacterium tuberculosis is a necessary cause for tuberculosis, but it is not sufficient as it does not always result in disease (some people may not develop the disease or may become carriers). Whether a person develops a disease or not depends on other component factors which determine their susceptibility, such as their immune status, concurrent conditions (e.g. HIV infection, diabetes, silicosis), genetic factors, age and socio- economic status. Similarly, smoking is a component cause for lung cancer (smoking increases the risk of lung cancer). However, smoking is not a sufficient cause because not all people who smoke develop lung cancer; nor is it a necessary cause because lung cancer can develop in non-smokers. Activity 1.2 Three sufficient causes (1,2 and 3) and their component causes (denoted by letters) of a hypothetical disease are shown in Figure 1.3. If there are no other sufficient causes of this disease,which component cause is a necessary cause? Feedback Component cause A is the necessary cause since this factor is part of all three sufficient causes;it must be present in combination with other factors for this disease to occur. If Figure 1.3 were a representation of the only sufficient causes of tuberculosis, then Mycobacterium tuberculosis would be represented by component cause A, the necessary cause. Other factors such as immunity, concurrent illness, genetic and socioeconomic factors would be represented by components B, C, D, E, F, G, H, I and J. On the other hand, if Figure 1.3 were a representation of some of the sufficient causes of lung cancer, then smoking could be represented by B which is present in sufficient causes 1 and 2, but not in 3. Sufficient cause 3 may be the cause of lung cancer in individuals who do not smoke. Figure 1.3 Conceptual scheme of three sufficient causes of a hypothetical disease Source:based on Rothman (2002)
- 23. Basic concepts and applications 9 This conceptual scheme is able to show that a disease can occur from different sufficient causes, and that component causes may be unknown (as is often the case in non-communicable diseases). The scheme also demonstrates that it is not necessary to identify every component of a sufficient cause in order to prevent a disease; a disease can be prevented by eliminating any single component cause since this prevents completion of a sufficient cause. For example, eliminating smoking (component B) would prevent lung cancer from sufficient causes 1 and 2, although some lung cancer would still occur from sufficient cause 3. Natural history of disease The natural history of disease refers to the progress of the disease process in an individual over time and in the absence of intervention (Figure 1.4). Knowledge of the natural history of a disease helps us to understand the effects and mechanism of actions, potential interventions, and the different levels of the prevention of disease. The disease process begins with exposure to, or completion of, a sufficient cause of the disease. Without an appropriate intervention, the process ends with recovery, disability or death. For example, exposure to the measles virus in a susceptible individual initiates the stage of subclinical disease. The onset of fever on about the 10th day (range 7–18 days) after exposure marks the beginning of clinical disease. The disease, however, is usually diagnosed around the 14th day when the typical rashes appear and then the disease proceeds to recovery, to complications such as pneumonia, or to death, depending on host and other factors. Many diseases have a typical natural history, but the time frame and manifest- ations of disease may vary between individuals due to the presence of host factors (e.g. immunity and age) and other determinants of the disease. Many factors may affect the progress of a disease in an individual and the likely outcome. The estimation of an individual’s outcome, taking into account the natural history of disease and other risk factors, is known as their prognosis. Figure 1.4 Natural history of disease Source:based on CDC (1992)
- 24. 10 Introduction to epidemiology The course of a disease may also be modified at any point in the progression by preventive and therapeutic measures. The subclinical stage following exposure is usually called the incubation period (for infectious diseases) or the latency period (for chronic diseases). Applications of epidemiology in public health Epidemiological principles, methods, tools and information are applied in every aspect of public health from policy setting at a macro level to decision making at individual level. The brief discussions that follow, although not exhaustive, will give you an idea of the spectrum of application of epidemiology in public health. Community health assessment and priority setting In order to set priorities and appropriate policies, and be able to plan programmes, public heath professionals need answers to questions like the following: • What are the actual and potential health problems in the community? • Where and among whom are they occurring or would they occur? • Which problems are increasing or decreasing, or have the potential to increase or decrease over time? • How do the levels and patterns of health problems relate to the existing health services? Epidemiological methods and tools provide answers to these and other related questions and help decision making for health policies and programmes. Evaluating health interventions and programmes Epidemiological studies of the efficacy (how well a health intervention works under ideal conditions) and effectiveness (how well a health intervention works under usual conditions) of health interventions provide important information for identifying appropriate interventions. Ongoing surveillance of diseases is essential to ensure the continued safety and effectiveness of health interventions. Epidemi- ological principles and methods are also used in evaluating health policies and programmes. Preventing disease and promoting health Epidemiological studies contribute to the understanding of the causes, modes of transmission, natural histories and control measures of diseases. This understand- ing is essential for developing appropriate health promotion strategies to prevent disease perhaps in those most at risk, or as a population-wide effort by tackling known causes. Studies can provide information on the effectiveness of health promotion interventions and identify for whom they are most effective to help direct resources.
- 25. Basic concepts and applications 11 Improving diagnosis,treatment and prognosis of clinical disease Epidemiological research contributes to identification of appropriate tests and criteria for diagnosis and screening. It is important to know the diagnostic accuracy of tests, that is, how well a test can discriminate between those with and without the disease (you will learn more about diagnostic accuracy and screening in Chapter 11). Epidemiological research can help determine the most effective treatment in a given situation and the likely outcome of patients, which is essential for planning care. Activity 1.3 You have been given a lot of material to take in; some of it is intuitive, some less so. In order to help you put these ideas in context, you will now look at a famous example from the nineteenth century. John Snow (1813–58) was a distinguished physician. As an epidemiologist, he is best known for his studies of cholera, in particular of two outbreaks that occurred in London in 1848–9 and 1854. This exercise is based on his work and illustrates the epidemiological approach from descriptive epidemiology to hypothesis generation and testing,and the application of epidemiological data. Activities 1.3–1.7 are interrelated and use John Snow’s cholera studies as an example. Feedback follows each activity so that you are prepared for the next one,but don’t read the feedback until you have tried to answer the question for yourself. The answers given in the feedback are not the only ‘correct’ answers. There are many ways to approach these questions, and your answers can be different from those given in the feedback. Cholera periodically swept across Europe during the nineteenth century.After a severe epidemic in 1832, the disease next appeared in London in 1848. The first definite case of the outbreak occurred in September 1848 and was that of John Harnold,a seaman of the ship Elbe, newly arrived from Hamburg where cholera was prevalent. Mr Harnold died a few hours after the onset of symptoms on 22 September in a lodge near the River Thames. The next case occurred in the same room; Mr Blenkinsopp, who lodged in the room, had cholera on 30 September. During the epidemic approximately 15,000 deaths were recorded. The mortality from cholera in this epidemic was particularly high in residential areas downstream, but decreased progressively upstream. Since water must flow downhill, upstream areas are, of course, at lower risk than those further downstream. Snow had previously documented several circumstances in which people who had come into contact with cases of cholera developed the disease within a few days.While investigating several case series of cholera,he had made the following observations: • Cholera was more readily transmitted in poor households and to those who had handled a case of cholera. • The mining population had suffered more than people in any other occupation. • Almost no physician who attended to cholera cases or did post-mortems had developed cholera.
- 26. Discovering Diverse Content Through Random Scribd Documents
- 27. THE SEVERN AS A SOURCE OF FOOD. So much importance has been attached to the Severn as the means both of supplying food and innocent recreation, that many Acts of parliament have at various times been passed for its protection. One sets forth that: “The King our Sovereign lord James, c., c. Having certain knowledge that in his stream and river of Severn and in other rivers, streams, creeks, brooks, waters and ditches thereinto running or descending, the spawn and brood of trout, salmon and salmon-effs and other fish is yearly greatly destroyed by the inordinate and unlawful taking of the same by the common fishers useing and occupying unsized and unlawful nets and other engines,” c., c. We have already said in our “History of Broseley” that— The earlier acts of parliament were designed with a view to discourage rod-and-line fishing, anglers, who, according to Holinshead ranked third among the rogues and vagabonds, being subject to a fine of £5; and although recent legislation has been intended to encourage this harmless amusement, and to increase the growth of fish, the best efforts of both legislators and conservators have been frustrated hitherto by the Navigation Company, whose locks and weirs turn back the most prolific breeding fish seeking their spawning grounds. The first of these were erected in 1842; and four more have since been added. By the 158th and 159th sections of the Severn Navigation Act the Company were to construct fish passes; and although attempts have been made at various times to do this, no efficient means have been adopted. Not only salmon decreased since their erection but shad, flounders, and lampreys, never now visit this portion of the river. Formerly Owners of barges and their men, when they were unemployed,
- 28. could spend their time profitably in fishing, and could half keep their families with what they caught. Of the one hundred and fifteen tons of salmon taken in the Severn in 1877, 16,000 fish were supposed to have been taken in the lower or tidal portion of the river, and 1.800 in the upper or non tidal portions; but the latter proportion was larger that year than usual. Salmon in the Severn have been still further reduced by the too common practice of taking samlets, on their downward course to the sea, and we are glad to find that more stringent measures are being taken by the conservators and the water-bailiffs to prevent this. Amateur fishermen, gentlemen of intelligence, have not only contributed to this by their own acts but by encouraging others to do likewise under the pretence or excuse that they were not the young of salmon. It is a well ascertained fact, however, not only that they are young salmon, but that when grown to a proper size they come up the river they go down. We heard the Duke of Sutherland say, in his grounds at Dunrobin, where he rears hundreds of thousands of young salmon to turn into the Brora and other rivers, that he had marked their fins and found that they invariably came up the same river they go down, and the author of “Book of the Salmon,” says:— “Take a salmon bred in the Shin, (one of the duke’s salmon rivers) in Sutherland, and set it at liberty in the Tweed, at Berwick, and it will not ascend the Tweed, but will if not slain in transitu, return to its native river, the Shin, traversing hundreds of miles of ocean to do so. Is this wonderful! No more wonderful than,— “The swallow twittering from its straw-built shed,” migrating, on the first appearance of winter from these shores, to the warm atmosphere, yielding insect food, of Africa, and returning to its natal locality in the spring, to live and give life in the temperate summer of a temperate zone.”
- 29. It is owing to this unconquerable instinct we are indebted for the few salmon we get in the upper Severn. At the spawning season they make their appearance in the estuary, and, so long as they meet with no insurmountable obstruction to their progress, will traverse miles for the deposition of their ova. Slight obstacles in the way will not deter them, and it is only after repeated failures they give up; they swim through rapids, leap from seven to ten feet high, and push on to their destination through powerful floods of descending water; and it is only at insurmountable barriers to their progress that they fall a prey to the rapacity of poachers, who have been known at one time to have taken cart loads with spears. Since the above was in type Mr. Frank Buckland and Mr. S. Walpole, as Inspectors of Salmon fisheries, have issued their report, wherein we learn that the Severn is much polluted in its upper waters by refuse from mines, and in the middle and lower waters by the refuse from manufactories and town sewage; and that out of the 290 miles of spawning ground which the Severn possesses, only 75 are accessible to the fish. Mr. Willis Bund, the chairman of the Severn Board, supplied Mr. Buckland with the following figures as to the value of the Severn salmon fisheries. The figures show the value of the fish caught: 1869£8,006 187013,000 187111,200 1872 8,000 187310,000 187410,500 187510,590 1876 14,560 187712,880
- 30. 1878 8,978 As regards the future prospects of the Severn, Mr. Buckland confesses he does not feel quite happy, but adds that the exact cause of the non-increase of the produce of the river during recent years may possibly depend upon the peculiar conditions of the river between the first navigation weir and the sea. The fish having such a long estuary to traverse before they can get beyond the tidal nets are often unable to pass the lower weirs, and being obliged to fall back with the tide, run a second chance of being caught by the nets. The fish taken in the Severn are usually very large. For the last five years the average has been over 14 lbs. each; last year a great many varying between 30 and 40 lbs. were captured, and some even exceeding the latter weight. The largest recorded, weighing 50 lb., was taken in a draft net on the 18th March, 1878, by Mr. Browning, of Longney, Gloucestershire. The fish spawn in the Severn as early as, if not earlier than, in any other river. During the past year, 1878, Mr. Buckland says fishing was not prosperous, and he gives the number of salmon taken as 12,450, and the weight as 86 tons, against the 16,000 fish, weighing 115 tons, given on a former page, as being the take in 1877. Mr. Buckland adds that the Severn is the largest salmon river in England, and he enumerates the weirs which greatly obstruct the lower part of the river. Shad were formerly taken in considerable numbers at the fords, by bargemen chiefly, who caught more than they could consume, and sold them to others; and in a commercial point of view, in this portion of the river, they were even more important than salmon. They were caught at night, generally by moonlight, by men who stood at the fords, watching for them as they ascended the river. Their approach was marked by a phosphorescent light, or “loom” in the water. They were difficult to catch in the daytime, as they would either go over or under the net, and fix themselves with their heads in the bed of the river, tail upwards. When in proper condition they were well flavoured fish, and attained a large size, sometimes two and three feet in length.
- 31. The flounder was another fine fish, and was as abundant as any in the Severn, affording good sport to “bottom fishers,” with rod and line. Since the locks and weirs were made they have, like the shad, ceased altogether. Lampreys too, which formerly were considered even of more importance than salmon, and which also were caught in this part of the Severn, are fish which have altogether ceased to visit us since the erection of the first weir in 1842. Again, the rich and oily flesh of the eel formed the staple diet of dwellers along the river banks; and even the well-to-do, whose roomy chimney corners were hung with salted swine flesh, and on whose tables fresh meat appeared only at intervals, esteemed eels a luxury. Eels, like shad, were migratory, and before locks and weirs were placed upon the river myriads of minute eels in spring made their way from the brackish waters of the estuary of the Severn, keeping close to the shore. They formed a dark dense mass, like a sunken rope, and were called Elvers, a word said to be of Saxon origin, and a corruption, it is supposed, of Eelfare, meaning to travel, as in wayfare, thoroughfare, and seafaring. In this state they were caught, bushels of them, and sold at a small sum, whilst the remainder were used for manure or pig-wash. Vast numbers of these eels, when left to their instinct, found their way into the upper Severn and its tributaries. An Act of the 30th of Charles II. for the preservation of fishing in the river Severn, imposed a penalty on all persons taking elvers; an Act of George III., but repealed so much of the former, as related to the penalty on persons taking elvers for their own use only, and not for sale; whilst the Salmon Act of 1861, repealed the 30th of Charles II. altogether; and left no law to prevent the destruction of young eels, which was carried on in Gloucestershire in what was called the elver season on a large scale. The Severn Board of conservators, under the powers granted by Mr. Mundella’s Fresh Water Fishing Act, (41 and 42 Vic. Cap. 39) passed a resolution in March, 1879, making it the duty of eel fishermen to pay a sum of ten shillings for an annual license to use their lines.
- 32. Considerable opposition was offered to this on the part of the Ironbridge and other fishermen; a memorial was drawn up and signed at a meeting of these and others from Bridgnorth and Shrewsbury, and a deputation appointed to present it to the Severn Board of Conservators at their meeting at Shrewsbury. Mr. Yale who presented the memorial said: One complaint was in regard to the license put upon the rod-and-line. It was only 1s., it was true, and that was not much, but it involved a principle which they thought might be carried further at some future day, and to a very oppressive extent. The greatest grievance, however, was the imposition of licenses upon the use of night lines. He did not believe that the scarcity of fish was owing to the anglers or to the netters, for it was a matter of experience that when men were allowed to go and catch as many as they thought proper there were plenty of fish, but it was not so now. He used to think it a very bad day if he could not catch 20 lbs. of fish, and now, perhaps he would not take 10 ozs. That was not caused by the rod-and-line, or by the use of nets, upon which it is now sought to place these restrictions. He believed, as Mr. George had told him the other day, that the scarcity of fish was owing to the pollutions, and not to the taking of fish. Samuel Sandals, made a statement to the effect that he worked all the hours he could at his usual work and spent the rest in fishing, and he thought it very hard to put a license upon the night lines. As to the trout taken with night lines, it was very rare indeed that they could take a trout in that way, except in the spring when the water was muddy: he believed the ducks destroyed “a sight” of the spawn on the fords. Mr. Watton said he did not for a moment dispute what the last speaker had said with respect to his not catching trout on night lines. There might possibly be some very good local reasons for his non-success, but, speaking from his own observation, he
- 33. knew well enough that the night lines were the destruction of the trout. They were laid zig-zag fashion for a great distance down the river, and swept every trout off the fords at night, and they were most destructive engines. Mr. H. Shaw said he quite agreed with what Mr. Watton had said, and he could bring evidence to prove that an immense quantity of trout was taken upon night lines, and a very large number of small fish were destroyed in baiting the lines. To take these baits stones were rooted up and the young salmon were frequently disturbed and got devoured by large fish. No less than 3,000 or 4,000 bait were caught each day in and around Shrewsbury to supply the night lines, and that must be a very serious drawback to the stock of fish in the river. The Chairman said it seemed to him that the gentlemen who had attended the meeting of the Board objected to the principle of issuing licenses, and if it was so, so far as he understood the matter, that Board could do nothing. Petitions were also presented to the Home Secretary; one from the fishermen themselves and another from the inhabitants. Of course these were from fishermen’s point of view. Those who are anxious that fish in the river should be increased, who think the protective provisions of the Act favour such increase, and who follow fishing more by way of sport and pastime, take very different views; they naturally look upon professional fishermen, men who lay night lines, and fish as a means of obtaining a livelihood, as enemies of legitimate sport. The object of protection is a laudable one, namely, that the means of innocent recreation, and the food of the people, may be increased; and eels are, there is no question, a more important article of food, so far as the people on the banks of the Severn are concerned, than Salmon, and that ten times over. Salmon can never be multiplied so as to come within the reach of the people generally. Eels, on the contrary, are an article of food with the poor, the middle classes, and the rich themselves.
- 34. Moreover, they will bear comparison with any well-flavoured fish the Severn produces. It is chiefly for eel fishing, by means of night lines, but sometimes also for fly-fishing for trout and other fish, that the coracle, that ancient British vessel, is still retained on the Severn. The men go down with the stream to lay their lines, and then carry their coracles over their heads and shoulders; so that looking at them from behind they look like huge beetles walking along the road. Of fish unaffected by the obstructions enumerated may be mentioned the river’s pride— “The crimson spotted trout And beauty of the stream.” But it must be sought for higher up or lower down the river, generally at the fords, and the embouchers of streams which come down to join the Severn, as Cound and Linley brooks. In deeper parts of the river too, near these places, good sized chub are found. But the chub is not much esteemed, although a fine fish, and, according to Izaak Walton, “proves excellent meat.” It grows to a large size, and may be caught in holes near Sweyney, where the bushes overhang such holes. Pike too are found here, but are more common about Buildwas and Cressage. That handsome fish the roach, known by the dusky bluish green on head and back, with lighter shades on sides, its silvery white belly, and dorsal and caudal fins tinged with red, is also to be caught. Dace, grayling, and perch, are met with, the latter congregating in holes of the river, or seen herding together hunting its prey. As Drayton says of— “The dainty gudgeon, loche, the minnow, and the bleak, Since they are little, I little need but speak.”
- 35. The former makes up for its small size by the daintiness of “meat.” Its favourite haunts are the swift flowing portions of the river, with pebbly and sandy bottoms. It is a ground feeder, greedy, and rushes at once to seek its prey, if you stir up the bed of the river. The bleak is about the size of the gudgeon, and is a quick biter. From the peculiarities of its watershed the Severn is subject to sudden and unlooked for FLOODS. To quote from our “History of Broseley”:— In modern times these can to some extent be guarded against, as the news of any sudden extraordinary rise in the upper basin may be communicated to those living lower down. Formerly this could not be done; a flood would then travel faster than a letter, and coming down upon the villagers suddenly, perhaps in the night time, people would find the enemy had entered their households unawares. It was no unusual thing to see haystacks, cattle, timber, furniture, and, in one instance, we have heard old people tell of a child in a cradle, floating down the stream. Many of these floods are matters of tradition; others being associated with special events have been recorded. Shakespeare has commemorated one called “Buckingham’s Flood,” in his Richard III., thus:— “The news I have to tell your majesty Is,—that, by sudden floods and fall of waters Buckingham’s army is dispersed and scatter’d And he himself wandered away alone, No man knows whither.” Proclaimed a traitor, and forsaken by his army, he concealed himself in the woods on the banks of the Severn and was betrayed and taken in Banister’s Coppice, near Belswardine.
- 36. The newspapers of 1785 record a sudden rise in the Severn and its disastrous results. It appears that on the 17th of December, 1794, the season was so mild that fruit-trees were in blossom, whilst early in January, 1795, so much ice filled the Severn after a rapid thaw as to do great damage. The river rose at Coalbrookdale 25¼ inches higher than it did in November, 1770. The rise in the night was so rapid that a number of the inhabitants were obliged to fly from their tenements, leaving their goods at the mercy of the floods. The publicans were great sufferers, the barrels being floated and the bungs giving way. In the Swan and White Hart, Ironbridge, the water was several feet deep. Two houses were washed away below the bridge, but the bridge itself stood the pressure, although Buildwas bridge blew up, the river having risen above the keystone in the centre of the main arch. Crowds visited the locality to see the flood and the ruins it had made. On the Coalbrookdale Warehouse, and on a house by the side of the brook, the height of these floods are to be seen recorded. At Worcester, a little above the bridge, a brass plate has the following inscription:—“On the 12th February, 1795, the Flood rose to the lower edge of this plate.” The lower edge measures just three feet from the pavement level. Another plate at the archway opposite the Cathedral bears the following:—“On the 18th November, 1770, the Flood rose to the lower edge of this Brass Plate, being ten inches higher than the Flood which happened on December 23rd, 1672.” This measures seven feet from the ground immediately underneath. There are three other marks which have been cut out the stonework on the wall adjacent to the archway referred to, which are as follows:— “Feb. 8th, 1852. Nov. 15th, 1852. Aug. 5th, 1839.”
- 37. The one in February measures from the ground six feet two inches; November, 1852, eight feet two inches; and the one August 5th, 1839, six feet two inches. COALBROOKDALE. As an important part of the parish of Madeley, still more as a locality famous on account of its fine castings and other productions, Coalbrookdale is deserving of a much further notice than has incidentally been given on previous pages in speaking of the Darbys and Reynoldses. There are few people perhaps in the kingdom who have not heard or who do not know something of Coalbrookdale; and there are none, probably, who pass through it by rail who do not peer through the windows of the carriage to catch a passing glimpse of its more prominent features. These may be readily grouped, for the benefit of those who have not seen them, but who may read this book, as follows. In the trough of the valley lie the works, stretching along in the direction of the stream, formerly of more importance to the operations carried on in the various workshops than it is at present. Upon the slope of the hill on the south-eastern side the Church, the palatial looking Literary and Scientific Institute, built for the benefit of the workmen, meet the eye, and the more humble looking Methodist chapel. On both sides are goodly looking houses and villa-like residences, where dwell the men of directing minds; whilst here and there are thin sprinklings of workmen’s cottages— few in number compared with the hands employed. A few strips of grass land intervene, whilst above are wooded ridges with pleasant walks, and to the west some curiously rounded knolls, between which the Wellington and Craven Arms branch railway runs, sending down a siding for the accommodation of the works. These are the chief features which strike the eye, and which would come out into prominence in photographic views taken to shew what Coalbrookdale now is. The buildings are comparatively of modern construction, but quaint half-timbered houses, rejoicing in the
- 38. whitewash livery of former times, suggest a phase of Coalbrookdale history much anterior to that other buildings indicate. It is not difficult indeed to depict the earlier stages of the progress the little valley has passed through from its first primitive aspect to the present; there are, for instance, in some of its many windings green nooks and pleasant corners where nature yet reigns, and where lovers of a quiet ramble may feast their eyes and indulge their imaginations, undisturbed by the hammering, and whirl of wheels, lower down. Such a spot is that to which the visitor is led by following the stream above the pool, crossed by a footbridge. To the left of the path is Dale House, Sunnyside, the Friends Meeting House, and the road to Little Wenlock. Little is seen of the brook on the right of the path, but its presence on the margin of the slope is made known beneath over-hanging bushes by prattlings over stones, and a waterfall from some ledges of rock. Following it higher up it is found to be partially fed by droppings from rocks dyed by mineral colours of varying hue, and to present curious petrifactions, rarely permitted however to attain any great proportions. The place is variously called La Mole and Lum Hole, and speculations have been indulged in as to each derivation. The former would, of course, suggest a French origin. Lum is Welsh, and signifies a point, as in Pumlummon, now ordinarily called Plinlimmon, or the hill with five points. It is quite certain that the valley here terminates in a point, but whether this has anything to do with it or not we cannot say. All we say of it is that it is a quiet little sylvan retreat, with wooded heights, green slopes, and precipitous yellow rocks, at the foot of which the stream is treasured up and forms a glassy lakelet. But this stream, in which six centuries since “Lovekin” the fisherman set his baited lines, long ago was made to do other service than that of soothing the listening ear, or paying tribute of its trout to the abbot of Wenlock. The choice of the situation for manufacturing operations was no doubt due to woods like these, which supplied the needed fuel; but much more to the motive power furnished by the stream, for turning the great wheels required to produce the blast, and work the ponderous hammers which shaped the metal.
- 39. Brave and strong as these Dale men were, their muscles were too weak for the work demanded. As Vulcan found he needed stronger journeymen than those of flesh and blood to forge the thunderbolts of Jove, so an imperative necessity, a growing demand, led men here to seek a more compelling force to blow their leathern bellows, to lift their huge forge hammers, than animal force could supply. Woods were no longer estimated by pannage yielded for swine, but by the fuel supplied for reducing the stubborn ore to pigs of another kind. Brooks were pounded up, streams were turned back upon themselves, and their treasured waters husbanded as a capital of force to be disposed of as occasion required. Dryads now fled the woods and Naiads the streams,—as beams and shafts and cranks were reared or creaked beneath the labours they performed. The presence of coal and iron ore could not have been inducements for the first ironworkers to settle here; neither tradition nor facts warrant the supposition that either were ever found in the valley. The first syllable of the name is deceptive, and the probability is that it was neither Coal nor Cole-brook originally, although coal appears to have been brought here for use more than five centuries ago from places just outside. Wood fuel seems to have been growing scarce as far back as the first quarter of the fourteenth century, judging from an application on the part of a Walter de Caldbrook to the Prior of Wenlock, to whom the manor belonged, for a license to have a man to dig coals in “Le Brockholes” for one year. It is not unlikely that this Walter de Caldbrook had a forge or smithy in the Dale; a situation chosen on account of the stream, which served to furnish him with motive power for his machinery. This seems all the more probable from the fact that distinct mention of such smithy is made in Henry the Eighth’s time, and that it is called “Smithy Place,” and “Caldbrooke Smithy,” [277] in the deed or grant by which the manor was conveyed by the King to Robert Brook, signed at Westminster and dated July 23, 1544. (See page 59). The fact too that this smithy was still called Caldbrook Smithy strengthens the suppositious, both as to the name and as to the fact that the Caldbrookes used the Brockholes coal for their smithy in the Dale.
- 40. For smith’s work coal has always been preferred to wood; but the word smithy did not then strictly mean what it now does; that is a smith’s shop; but a place where iron was made in blooms. Thus the “Smithies,” near Willey, at present so called, was a place where there were small iron-making forges, as heaps of slag there now testify; which forges were blown with leathern bellows, by means of water power, a man having to tread them to increase the pressure. Again, the word “Place,” which is a Saxon term for locality, situation, or a particular portion of space, itself indicates an establishment on a scale greater than a modern smithy. The words in the deed are “Smithy Place and New House.” And again, “the rights and privileges attached to the whole of the place and buildings that go under the name of The Smithy Place, and Newhouse, called Caldbrooke Smithy, with its privileges” c. This Newhouse long ago, no doubt, had become an old house. At any rate we know of no house answering to this description at present, unless it is the half- timbered house near the Lower Forge; and if so this house must be about 100 years older than the one which has the date upon it at the forge higher up, shewing it to have been built a century later, or in 1642: and both forges no doubt were then in existence. The latter would be about the period when the flame of Civil War was bursting forth in various parts of the kingdom, and when Richard Baxter, whose old house still stands at Eaton Constantine, was witnessing the battle of Edgehill and others. This old house is such a fair specimen of the half-timbered structures of two centuries and a half or three centuries ago that we add a representation. There are a number of square iron plates at the Lower Forge supposed to have been hearth-plates, with the following dates and initials:— I. H. 1602. T. K. W. 1609. I. E. R. 1627. T. A. 1653. I. A. 1654. B. S. 1693.
- 41. T. E. 1706. The one with the date 1609 has a head cast upon it, and the ‘W’ was for the surname of one of the early proprietors or partners named Wolfe, a member of the same family that gave shelter to King Charles at Madeley: and ‘B’ may have signified Brooke, the family who resided at the Court House, Madeley, and to whom the manor belonged at that time. There is too a beam with the date 1658, being a bearer in an old blast furnace, which is known to have been renewed by Abraham Darby in 1777. This is supposed to have been brought from Leighton, where there was a furnace in blast in 1707. Thus for long periods, during deadly feuds and troubled times, absorbed in the simple arts of industry, these men appear to have toiled on. During the Civil Wars, when Cromwell and his Ironsides were preparing for the pages of history one of its most striking passages, they worked their bloomeries, taking no part, save that a clerk in the Shropshire Ironworks was found to bear to the Protector news of the successes of his troops.
- 42. It may therefore be supposed that when the first Abraham Darby came to the Dale he found works already in existence. Mr. Smiles says “he took the lease of a little furnace which had existed at the place for over a century”; and, fortunately, since his time, the commencement of the 18th century, (1709), records of the proceedings have been carefully kept, so that there is little difficulty in tracing the progress of the art, or in giving prominence to important points which may serve to mark such progress. On page 60 are enumerated some of these discoveries, one being the successful use of coal in iron-making, another the adaptability of iron in bridge making, and a third to railroads. To these three starting points in the history of the iron trade was added that of the discovery of puddling by means of pit coal, by the Craneges; a discovery which preceded that of Henry Cort by seventeen years. It will be seen also from what has been already stated, that whilst Richard Reynolds laid down the first iron rails his son William and the
- 43. Coalbrookdale Co. as early as 1800 were engaged upon locomotives to run on railways. These stages in the history of the works down to the commencement of the present century have been enumerated thus: — “Abraham Darby. 1707. Letters patent for a new way of casting iron pots, and other iron ware, in sand only, without loam or clay.” “Ditto. 1712. First successfully superseded the use of charcoal by that of coke in the blast furnace.” “Abraham Darby (son of above). 1737. First used coal instead of charcoal for converting pig iron into bar iron at the forge.” “Ditto. 1760–63. First laid down rails of cast iron, with carriages having axles with fixed wheels.” “Abraham Darby (the third). The first iron bridge erected over the Severn in 1777.” “Richard Reynolds. Letters patent to Thomas and George Cranage, for a method of puddling, 1766.” William, son of Richard Reynolds, invented a locomotive, upon the plans for which the Coalbrookdale Company were engaged in 1800. This was a locomotive for railroads, as we have shewn on page 179. We have also on a previous page spoken of Mr. W. Reynolds as a chemist, a fact which is borne out by an original letter of James Watt to his friend William Reynolds, a copy of which, being too long to insert here, will be given on a subsequent page. Facts like these, recorded in various publications, added to the intrinsic merits of the high class productions of the works, naturally served to give to the establishment in the Dale a very high position in the trade. To these too were to be added the high integrity of the proprietors and managers of the works, a guarantee of which was to be found in the fact that they were Quakers. In our “History of Broseley” page 219,
- 44. we have shewn that the Friends had established themselves there as early as 1673; that a Meeting house was erected there in 1692; and that the Darbys, the Roses, the Reynoldses, the Fords, the Hortons and others were buried there, prior to the Meeting house at Sunnyside being built. The fact of a man being a Quaker was a tolerable guarantee of his being a fair dealer; and the utterance of the name of Darby or Reynolds was sufficient to command respect. Speaking of these works at an early stage, Mr. Smiles in his “Industrial Biography” says:— “By the exertions and enterprise of the Darbys, the Coalbrookdale Works had become greatly enlarged, giving remunerative employment to a large and increasing population. The firm had extended their operations far beyond the boundaries of the Dale: they had established foundries at London, Bristol, and Liverpool, and agencies at Newcastle and Truro for the disposal of steam-engines and other iron machinery used in the deep mines of those districts. Watt had not yet perfected his steam-engine; but there was considerable demand for pumping-engines of Newcomen’s construction, many of which were made at the Coalbrookdale Works.” One of these engines having the date 1747 was seen at Bilston in 1812. Castings for Watt’s engines also were made here; but the first use to which the steam-engine itself was put was the undignified one of pumping the water which had once gone over the water- wheel back, that it may go over it a second time. It is not our intention to give a detailed description of the present productions of the Coalbrookdale Works; modern castings like those of the Albert Edward bridge, and those high art ornamental ones of a lighter kind with which the public are familiar by means of various international exhibitions, afford sufficient evidence that the firm occupy a position not unworthy of their ancient renown.
- 45. It will be seen from what has been said that the religious no less than the inventive element seems to have distinguished these men, who, so far as we have gone were Quakers; but the brothers Cranege, who anticipated Cort in the discovery of puddling were Wesleyans. Little seems to be known of these men or of their families; but Dr. Edward Cranage, of the Old Hall, Wellington is, we believe, of the same family. Another descendant of the family writes us to say that— “George Cranage, one of the patentees, and Thomas his brother, the other, both married daughters of John Ward, of Eye Manor Farm, near Leighton; the writer’s grandfather on his mother’s side. Thomas and his wife died without issue, but George Cranage who married Ann Ward, left two sons and five daughters; William, the elder of the sons, was manager or in some such position at Coalbrookdale, and was concerned in the construction of the Iron Bridge. From a small manuscript volume of religious verses and paraphrases into verse of the Psalms composed by him, and now in my possession, he appears to have had some taste for literature. I have his copy of Coke and Moore’s life of Wesley, and Paradise Lost, the latter containing his autograph. He was, I have heard, a Wesleyan of the true type; worshipping at his chapel regularly, but always communicating at Madeley Parish Church on Sacrament Sundays. He lived in the house where Mr. Moses now lives, opposite the church, which house, we believe was built for him. He died in 1823, one son having died previously. The following notice appeared in a Shrewsbury paper of his death: “Suddenly, at Coalbrookdale, aged 63, Mr. Wm. Cranage, a man whose truly benevolent nature and friendly disposition secured him the respect and esteem of all who knew him, and whose loss as a member of society will be much felt by his neighbours. In him the poor man recognised a friend, the world an honest man, and the church a steady and useful member.”
- 46. John the younger, and only other son of George, died in infancy, while the five daughters all married in Bridgnorth or the neighbourhood. Whilst upon the subject of old workmen at the Dale it may be well here to introduce a notice of the Luccucks, some of whom were Quakers, but two of whom, Benjamin and Thomas, became clergymen of the church of England. Benjamin was apprenticed at Coalport, where he painted a set of china, which whilst breakfasting with an English prelate he was surprised to see produced at table. When a lad he was of a daring disposition. He would lie down, for instance, between the rails of the Incline Plane and allow the carriage and a boat with five tons of iron in it to pass over him, notwithstanding the risk run of being caught and drawn over the rollers by the hook dangling at the end of the carriage. The mother of Mr. W. G. Norris, the present manager, and one of the proprietors, was a Luccock; and other members of the same family are still employed in the works. The grandfather of the former was apprenticed to the first Abraham Darby soon after he came to the Dale. A copy of the indenture or agreement between the parties may not be without interest at the present day. It commences thus: “Abraham Darby and Thomas Luccuck, concluded and made this 13 day of June, 1714, between Abraham Darby, of the city of Bristol, Smith, in behalf of himself and rest of his co-partners in the ironworks of Coalbrookdale, in the County of Salop, on the one part; and Thomas Luccuck, of the parish of Norfield, in the County of Worcester, who agrees to serve in the art and mystery of making or casting of iron pots and kettles, c.” It then proceeds to state that “Abraham Darby promises to pay the said Thomas Luccuck the sum of 6s. per week during the said term of the year. Thomas Luccuck also covenants not to divulge or make known the mystery of the art of moulding in sand, tools, or utensils,
- 47. belonging to the said works; and that if he divulges he will agree to pay the sum of £5 for every pot or kettle made by another, c., through him.” The mystery alluded to, and which it was deemed then so important not to divulge, was an improvement introduced by one of the Thomases, an ancestor of the Bristol merchants of that name, which consisted in the substitution of green sand for the more expensive and laborious method of using clay and loam in the manufacture of cast pots. By this means, not only was the article cheapened, and the number multiplied, but a more suitable and economical form was obtained; the old one being now rarely seen, except in museums, or as an antiquated heir-loom in some remote cottage. One of the old pots with a neat border has the date 1717. These domestic utensils appear to have formed the staple manufacture at the time that the first Abraham Darby removed here from Bristol, in the year 1709. One member of this old family of Dale workmen lived to the extraordinary age of 103; and an allusion to the venerable patriarch may serve to introduce at this stage of our history a notice of two local circumstances: the extreme age of an old Coalbrookdale workman of the above name, and the “Great Land Flood” of the Dale. An account of the latter appeared in the Philosophical Transactions of the time; but we prefer following the example of Southey who on an occasion we remember makes use of an old man’s memory to set forth his views of certain changes which had taken place; but at the same time with such toning down as becometh the thoughts of more sober age. Every village has incidents and events associated with it, which some old inhabitant is usually privileged to expound. Beyond the venerable grey-beards and wrinkled grand-dames there is the village sage—vested with the dignity of a last appeal, and whose version of matters local is deemed truthful as the current coin. Age as a rule commands respect; and the wider the span that measures intervening space between the present and the past the
- 48. greater the esteem. Coalbrookdale within our recollection boasted, not an octogenarian merely, or one whose claim to the honour was weakened by that of half-a-dozen others—but one, the “oldest inhabitant,” by being a quarter of a century in advance of the whole of the Coalbrookdale elders. He not only lived to celebrate the centenary of his natal day but—like a tree blanched by the storms of ages yet putting forth its leaves afresh—as showing the stamina that still remained—cut, at a still riper age his second set of wisdom teeth. Envy never sought to dim the lustre of his fame. At local festivals, when, unfettered for the day, the members of a club with flags and band met in gay summer time, he was brought to crown the presidential chair. Old Adam—such was his name—a name truly suggestive of the past and well fitted for a village sage—old Adam Luccock was widely known. He was a specimen of archæology in himself—the solitary link of a patriarchal chain that had fallen one by one—he the only one remaining. And old Adam’s cottage—perched upon a rock beneath the Rotunda, quaint, ancient, and impressed by the storms of passing time,—odorous from a narrow strip of garden sheltered by a grey limestone pile, catching the last lingering rays of the setting sun as it mantled with deep shadow the Dale below, and flooded with mellow light the uplands of the river’s western bank— was a counterpart of himself. Like the little vine that girdled its frail and wattled walls—tapping with wiry fingers at the diamond leaded window-panes—old Adam clung to the place long after his friends began to fear the two would disappear together. White as were these white-washed walls, Adam’s locks were whiter, and the accessories of dress and minor details of person and of place were in perfect keeping. A curious net-work of wrinkled smiles accompanied the delivery of one of the old man’s homilies; and amusing enough were the landmarks which memory set up for giving to each event its place in point of time. Of red-lettered ever-to-be-remembered occurrences in the village the more prominent were the phenomena of the land-slip at the Birches, and the land-flood at the Dale. We still see the old man drawing slowly from his mouth a long pipe, still more slowly letting out a wreath of fragrant smoke, as speaking of the latter he would say:—
- 49. “I remember well; it was autumn, the berries were ripe on the hedge, and fruits were mellow in the field; we had a funeral that day at Madeley, it was on the 6th of September, 1801. The air was close. A thin steamy vapour swam along the valley, and a dense, fog-looking cloud hung in the sky. The mist spread, and drops like ripe fruit when you shake a tree came down suddenly. The leaves on every tree trembled, we could hear them quake; and the cattle hung down their heads to their fetlocks. The wind blew by fits and starts in different directions, and waves of cold air succeeded warm. Dull rushing sounds, sharp crackling thunderclaps were heard, and streams of fire could be seen—like molten iron at casting time—running in and out among the clouds. Up the valley, driving dust and sticks and stones, came on a roaring wind with pelting rain. Another current moved in a different direction; they met where the black cloud stood, and striking it both sides at once, it dropped like a sponge filled with water, but large as the Wrekin. In a moment houses and fields and woods were flooded by a deluge, and a rushing torrent from the hills came driving everything before it with a roar louder than the great blast or the splash of the great wheel. Lightnings flashed, thunders roared, and before the echo of one peal died you heard another—as if it were the crack of doom. Down came the brooks, the louder where they met, snapping trees, carrying bridges, stones, and stacks of wood. Houses were inundated in an instant, gardens were swept away, and women and children were carried from windows through the boiling flood. Fiercer came the rush and higher swelled the stream, forcing the dam of the great pool; timber snapped like glass, stones were tossed like corks, and driven against buildings that in turn gave way. Steam then came hissing up from the furnace as the water neared and sought entrance to the works. The elements met; it was a battle for a time; the water driven with great force from behind was soon brought into contact with the liquid iron, and then came the climax! Thunders from below answered to those above; water converted into gas caused one loud terrific explosion that burst
- 50. the strongest bars, shattered the stoutest walls, drove back the furious flood, and filled the air with heated cinders and red-hot scoria. The horrid lurid light and heat and noise were dreadful. Many said ‘The day of God’s wrath is come;’ ‘Let us fly to the rocks and to the hills.’” After a pause, and re-lighting his pipe, he added: “I think I forgot to say it was Sunday, and that the Darbys were at meeting; the Meeting-house was in Tea-kettle-row, it was before the neat little chapel at Sunnyside was built. It was a silent meeting,—outside among the elements there was noise enough—I mean among the members there had been no speaking, and if there had they may have heard plain enough what was going on outside. Well, when the furnace blew up they broke up and came down to see what was the matter. They never appear in a hurry, Quakers don’t, and did not then, though thousands of pounds of their property were going to rack every minute. ‘Is any one hurt?’ that was the first question by Miss Darby; she is now Mrs Rathbone. She was an angel of a woman; indeed, every one of the Miss Darbys have been. ‘Is there any one hurt, Adam;’ she said. I said ‘no, ma’am, there’s nobody hurt, but the furnace, and blowing mill, the pool dam, and the buildings are all gone.’ ‘Oh, I am so thankful,’ she said; ‘never mind the building, so no one’s hurt’; and they all looked as pleased—if you’ll believe—as if they had found a new vein of coal in the Dawley Field, instead of having lost an estate at Coalbrookdale.” Old age sat as fittingly on Adam as glory upon the sun, or as autumnal bloom upon the mellow fruit ripened by the summer’s heat. Nature, in the old man, had completed her work, religion had not left him without its blessings; and, while lingering or waiting, rather, upon the verge of another world, he liked to live again the active past, and to amuse himself by talking of scenes with which he had been associated. He had none of the garrulous tendencies of
- 51. age; and when once upon his favourite topic, he was all smiles immediately. “We used,” he said, “to bring the mine for the Dale on pack- horses; and Horsehay being one of the halting places, was, as I believe, called Horsehay in consequence. We used, also, to take minerals on horse-back all the way to Leighton, where there was plenty of wood and charcoal, and water to blow the bellows. Strings of horses, the first having a bell to tell of their coming, used to go; they called them ‘Crickers’—and a very pretty sight it was to see them winding through upland, wood, and meadow, the little bells tinkling as they went.” “Aye, aye, sir,” said our ancient friend, “Pedlars and pack-horses were the means of locomotion and the medium of news in my day; and if we travelled, it was in the four-wheeled covered waggon, over roads with three or four feet ruts. Lord, sir, I remember, in good old George the Third’s time, when turnpike gates were first put up, there was a great outcry against them. Before that, roads went just where they liked, and there was a blacksmith’s shop at every corner to repair the damage done in bumping over the large stones. Why, sir, in this ere Dale, I can remember when there was no road through it but the tram- road. The road then was over rocks and along the brow of the hill—a bridle road only. There never was such a thing as a one- horse cart seen in the Dale till just before the road was made to Wellington; and then, as I can remember, the road was so narrow that every carter carried a mattock to stock the road wider, in order to pass, if he met another.” The old man described the construction of those primitive forerunners of that iron network which now spreads its meshes over the entire kingdom, one of which, much worn on the one side by the flange of the wheels is before us. It has a square hole at the end, for the purpose of being pegged to the sleeper. Down the steep banks that enclose the Dale inclined planes were laid with rails of
- 52. plain oblong pieces of wood, six feet in length, eight inches in width, and four inches in depth, and down these, by means of ropes, waggons by their superior gravity brought up the empty ones to be refilled with minerals which were conveyed for the use of the works. The speed was regulated by a brake made to press, not as now upon the barrel at the top, but upon the wheels of the descending waggons. The man thus regulating their speed, was the jigger, and the hill leading from Coalbrookdale to Wellington, where one of these inclines was situate, became “The Jigger’s Bank.” (Sometimes called the Jig-house Bank, because, of a house there.) In addition to this railway for the purpose of supplying the furnaces, there was another, by which the furnaces at the top were connected with the foundry at the centre; and rails, first of wood, and then of iron, continued for many years to be used, facilitating the transport of heavy materials from place to place. On the last occasion on which we saw him we were sent by a good old aunt, a Quaker lady who loaded us with presents for the old man, when he had gone to live in “Charity Row,” as it was called. Speaking upon matters connected with the history of the Dale— more particularly in reference to the Darbys and Reynoldses—the old man would grow eloquent; and the effect of a little present—a basket of strawberries or a packet of tobacco—had a wonderful effect in stimulating memory. Nothing was “open sesame,” however, like a drop of “Barnaby Spruce’s old Beer.” [292] Say you had sent for half-a-gallon of Spruce’s best October brewing, and he grew loquacious at once. “Remember him,” speaking of Richard Reynolds, he would say, arching his eye-brows, and growing animated, as recollections of the past came tripping upon the heels of each other. “I knew him well; all the poor knew him; the robins and the sparrows knew him, for he would carry crumbs a hundred miles in his pockets ‘for his robins.’ He made a vast fortune, and then everybody knew him; books, and tracts, and newspapers all talked about him. He was a Quaker—not a thin, withered,
- 53. crotchety disciple of George Fox, but a full-fed Quaker, fair and ruddy, with eyes of blue that gave back the bright azure of the sky and lighted up a fine and manly face. I see him now—his light hair flowing in curls beneath his broad brimmed hat upon his shoulders. He yielded to every man his own, not only as concerned money, but in demands upon his respect. I have known him when in a fit of temper he thought he had spoken harshly or slightingly to any one, follow him home and apologise for his warmth. He loved everybody and was beloved by everybody in return. There’s my neighbour, she will tell you how when she was a child he would run into their shop in a morning, put half-a-crown into her hand, saying, ‘There, thee be a good child all day.’ He could not do with the colliers, though; he built schools for their children, but the mothers would not let them go unless he would pay them so much a day for allowing them to attend. They were curious schoolmasters in my day. Old John Share made nails and kept a school in the Dale; he was one of the most learned about these parts for a schoolmaster, but he never would believe that the earth turned round, because, as he said, the Wrekin was always in the same place. Then, there was old Carter, the chairmaker, of Madeley Wood; he always spelt bacon with a ‘k,’ and I remember him giving Charles Clayton a souce on the side of the head that sent him reeling, because he insisted upon it that it should be bacon. The Wrekin, sir, was always an object of admiration to Mr. Reynolds. He had an arbour made from which he could see the sun going down behind it (he used to revel in a good sunset), and with no companion but his pipe was often used to watch it. Every year he treated his clerks and most of the members of the Society of Friends to the Wrekin. Benthall Edge was another favourite resort, and he would revel at such times in the scene.” “I could tell you many more anecdotes (the old man continued) of the Quakers; I mean the Darbys. They all liked a joke right well; and as for kindness, it seemed as if they thought it a
- 54. favour to be allowed to assist you. They allow me a weekly pension, have done for years, and pay a woman to wait upon me. They are people that never like to be done, however.” “You knew old Solomon, the Sexton. Well he once went to the haunted house, as they call it, for an Easter offering. The servants were ordered to attend him, and he sat for some time and eat and drank, and smoked his pipe—but not a word was said about Easter dues. He knocked the ashes out of his third pipe, and feeling muddled a bit about the head thought it time to be moving. At last Mr. Darby entered the room, and Solomon made bold to ask for the Easter offering. ‘Friend,’ said Mr. Darby, throwing up the sash, and assuming a determined attitude, ‘thou hast had a meat-offering and a drink-offering; thou hast even had a burnt offering—as I judge from the fumes of this room, and unless thou choosest to go about thy business, thou shalt have an heave-offering.’ As Solomon had no wish to be pitched head-foremost out of the window, you may imagine (said the old man) that he quickly disappeared.” The old village sage, whose venerable form and long white locks rise before us like some vision of the past—is gone; he died, as his friends assert, at the advanced age of 107, or, as his headstone more modestly states (and modesty is not a fault common with posthumous records) at the age of 103. He died January 27, 1831, and his gravestone may be seen near the southwest door of Madeley Church, under the wall; but as the inscription is near to the grave, being below those of the Parkers, and that of Samuel Luckock, it will, we fear, be soon obliterated by the damp acting on the stone. Among other servants of the Darbys who succeeded each other and held important positions in the works were the Fords. Richard married Miss Darby, daughter of Abraham, and was manager of the works in 1747. He also was a Quaker; and to him really is due the credit ascribed to Mr. Darby, of the successful use of coal in iron
- 55. smelting. In the Philosophical Transactions for 1747, for instance, the year Mr. Ford was manager, it is stated that— “Several attempts have been made to run iron-ore with pit-coal: he (the Rev. Mr. Mason, Woodwardian Professor at Cambridge) thinks it has not succeeded anywhere, as we have had no account of its being practised; but Mr. Ford, of Coalbrookdale in Shropshire, from iron-ore and coal, both got in the same dale, makes iron brittle or tough as he pleases, there being cannon thus cast so soft as to bear turning like wrought-iron.” A son or grandson of this Richard Ford was foreman and manager in the engine department of the works, which flourished greatly till he resigned his office, nearly half a century since. The late John Cox Ford was a son, and A. J. Ford, recently of Madeley, a grandson. Of later members of the Darby family we may speak in part from personal knowledge. Like their ancestors, they were members of the Society of Friends, although not by any means the straitest of the sect. Whilst adhering to the grand cardinal doctrine of the Inner Light, they indulged their own ideas of the extent to which the strict discipline of the body should control their tastes. They were birth- members, but lax in their opinions, and did not live by strict Quaker rule. On one occasion, when a disciple of the old school got up as was his wont to deliver himself in meeting, one of the younger and more lax of the members rose and said, “Friend N—y, it would be more agreeable to this meeting if thou wouldst sit down.” Francis Darby, of the White House, had great taste, loved high art, and filled his rooms with costly paintings, which he felt a pride in shewing to his friends. Others indulged a forbidden love of music and luxury, contrary to the faith and discipline of their fathers, without otherwise breaking through bounds or committing faults to justify the advocates of the truest code of Quaker rule to disown them.
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