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If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: Reports Relating to the Sanitary Condition of the City of London - -Author: John Simon - -Release Date: April 28, 2017 [EBook #54622] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK REPORTS--SANITARY CONDITION--LONDON *** - - - - -Produced by Chris Curnow, Harry Lamé and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive) - - - - - - - - Transcriber’s Notes - - Text between _underscores_ and =equal signs= represents text printed - in italics and bold face, respectively. Small capitals have been - changed to ALL CAPITALS. - - More transcriber’s notes may be found at the end of this text. - - - - - REPORTS - RELATING TO - THE SANITARY CONDITION - OF THE - CITY OF LONDON. - - BY - JOHN SIMON, F.R.S. - SURGEON TO ST. THOMAS’S HOSPITAL, AND - OFFICER OF HEALTH TO THE CITY. - - LONDON: - JOHN W. PARKER AND SON, WEST STRAND. - MDCCCLIV. - - - LONDON: - SAVILL AND EDWARDS, PRINTERS, CHANDOS STREET, - COVENT GARDEN. - - - TO - LOUIS MICHAEL SIMON, - OF THE STOCK EXCHANGE, LONDON, AND OF - THE PARAGON, BLACKHEATH, - I DEDICATE THIS REPRINT OF MY REPORTS: - LOOKING - LESS TO WHAT LITTLE INTRINSIC MERIT THEY MAY HAVE, - THAN TO THE YEARS OF ANXIOUS LABOUR THEY REPRESENT: - DEEMING IT FIT TO ASSOCIATE - MY FATHER’S NAME - WITH A RECORD OF ENDEAVOURS TO DO MY DUTY: - BECAUSE IN THIS HE HAS BEEN MY BEST EXAMPLE; - AND - BECAUSE I COUNT IT THE HAPPIEST INFLUENCE IN MY LOT, - THAT, BOUND TO HIM BY EVERY TIE OF GRATEFUL AFFECTION, - I HAVE LIKEWISE BEEN ABLE, FROM MY EARLIEST CHILDHOOD - TILL NOW--THE EVENING OF HIS LIFE, - TO REGARD HIM WITH UNQUALIFIED AND INCREASING RESPECT. - - - - -CONTENTS. - - - Page - DEDICATION iii - - PREFACE vii - - FIRST ANNUAL REPORT 1 - - FURTHER REMARKS ON WATER-SUPPLY 72 - - SECOND ANNUAL REPORT 77 - - THIRD ANNUAL REPORT 177 - - FOURTH ANNUAL REPORT 211 - - FIFTH ANNUAL REPORT 213 - - APPENDIX OF TABLES ILLUSTRATING THE SANITARY CONDITION OF - THE CITY OF LONDON. 264 - - REPORT ON CITY BURIAL-GROUNDS 280 - - REPORT ON EXTRAMURAL INTERMENTS 285 - - - - -PREFACE. - - -The following Reports, officially addressed to the Commissioners of -Sewers of the City of London, were originally printed only for the use -of the Corporation; and although, to my very great pleasure, they have -been extensively circulated through the medium of the daily press, there -has continued so frequent an application for separate copies that the -surplus-stock at Guildhall has long been exhausted. Under these -circumstances--believing the Reports may have some future interest, as -belonging to an important educational period in the matters to which -they refer, I have requested the Commission to allow their collective -reprint and publication; and this indulgence having been kindly accorded -me, I have gathered into the present volume all my Annual Reports, -together with a special Report suggesting arrangements for extramural -burial. - -From the nature of the work, I have not considered myself at liberty to -make those extensive alterations of text which usually belong to a -second edition. I have restricted myself to a few verbal corrections, -and to rectifying or omitting some unimportant paragraph, here or there, -in case its matter has been more fully or more correctly stated in parts -of a subsequent Report. Frequently, where I have wished to explain or -qualify passages in the text, I have added foot-notes; but these are -distinguished as interpolations by the mark--J. S., 1854. - -My Reports lay no claim to the merit of scientific discovery. Rather, -they deal with things already notorious to Science; and, in writing -them, my hopes have tended chiefly towards winning for such doctrines -more general and more practical reception. It has seemed to me no -unworthy object, that, confining myself often to almost indisputable -topics--to truths bordering on truism, I should labour to make trite -knowledge bear fruit in common application. - -Nor in any degree do they profess to be cyclopædic in the subject of -Preventive Medicine; for it is but a small part of this science that -hitherto is recognised by the law; and that--so far as the metropolis is -concerned, scarcely beyond the confines of the City. It would have been -an idle sort of industry, to say much of places or of matters foreign to -the jurisdiction of those whom I officially addressed. - -In re-publishing documents which proclaim extreme sanitary evils, as -affecting the City, I think it right to draw attention to the dates of -the several Reports, and to state that for the last five years many of -these evils have been undergoing progressive diminution, of late at a -rapid and increasing rate; while, at their worst, they represented only -what I fear must be considered the present average condition of our -urban population. - -This national prevalence of sanitary neglect is a very grievous fact; -and though I pretend to no official concern in anything beyond the City -boundaries, I cannot forego the present opportunity of saying a few -words to bespeak for it the reader’s attention. I would beg any educated -person to consider what are the conditions in which alone animal life -can thrive; to learn, by personal inspection, how far these conditions -are realised for the masses of our population; and to form for himself a -conscientious judgment as to the need for great, if even almost -revolutionary, reforms. Let any such person devote an hour to visiting -some very poor neighbourhood in the metropolis, or in almost any of our -large towns. Let him breathe its air, taste its water, eat its bread. -Let him think of human life struggling there for years. Let him fancy -what it would be to himself to live there, in that beastly degradation -of stink, fed with such bread, drinking such water. Let him enter some -house there at hazard, and--heeding where he treads, follow the guidance -of his outraged nose, to the yard (if there be one) or the cellar. Let -him talk to the inmates: let him hear what is thought of the bone-boiler -next door, or the slaughter-house behind; what of the sewer-grating -before the door; what of the Irish basket-makers upstairs--twelve in a -room, who came in after the hopping, and got fever; what of the -artisan’s dead body, stretched on his widow’s one bed, beside her living -children. - -Let him, if he have a heart for the duties of manhood and patriotism, -gravely reflect whether such sickening evils, as an hour’s inquiry will -have shown him, ought to be the habit of our labouring population: -whether the Legislature, which his voice helps to constitute, is doing -all that might be done to palliate these wrongs; whether it be not a -jarring discord in the civilisation we boast--a worse than pagan -savageness in the Christianity we profess, that such things continue, in -the midst of us, scandalously neglected; and that the interests of human -life, except against wilful violence, are almost uncared for by the law. - -And let not the inquirer too easily admit what will be urged by less -earnest persons as their pretext for inaction--that such evils are -inalienable from poverty. Let him, in visiting those homes of our -labouring population, inquire into the actual rent paid for -them--dog-holes as they are; and studying the financial experience of -Model Dormitories and Model Lodgings, let him reckon what that rent can -purchase. He will soon have misgivings as to dirt being cheap in the -market, and cleanliness unattainably expensive. - -Yet what if it be so? Shift the title of the grievance--is the fact less -insufferable? If there be citizens so destitute, that they can afford to -live only where they must straightway die--renting the twentieth -straw-heap in some lightless fever-bin, or squatting amid rotten -soakage, or breathing from the cesspool and the sewer; so destitute that -they can buy no water--that milk and bread must be impoverished to meet -their means of purchase--that the drugs sold them for sickness must be -rubbish or poison; surely no civilised community dare avert itself from -the care of this abject orphanage. And--_ruat cœlum_, let the principle -be followed whithersoever it may lead, that Christian society leaves -none of its children helpless. If such and such conditions of food or -dwelling are absolutely inconsistent with healthy life, what more final -test of pauperism can there be, or what clearer right to public succour, -than that the subject’s pecuniary means fall short of providing him -other conditions than those? It may be that competition has screwed -down the rate of wages below what will purchase indispensable food and -wholesome lodgment. Of this, as fact, I am no judge; but to its meaning, -if fact, I can speak. All labour below that mark is masked pauperism. -Whatever the employer saves is gained at the public expense. When, under -such circumstances, the labourer or his wife or child spends an -occasional month or two in the hospital, that some fever-infection may -work itself out, or that the impending loss of an eye or a limb may be -averted by animal[1] food; or when he gets various aid from his Board of -Guardians, in all sorts of preventable illness, and eventually for the -expenses of interment, it is the public that, too late for the man’s -health or independence, pays the arrears of wage which should have -hindered this suffering and sorrow. - - [1] Twenty years’ daily experience of hospital surgery enables me to - say, from personal knowledge, that our wards and out-patient rooms are - never free from painful illustrations of the effects of insufficient - nutrition--cases, in fact, of chronic starvation-disease among the - poor; such disease as Magendie imitated, in his celebrated - experiments, by feeding animals on an exclusively non-azotised diet. - -Probably on no point of political economy is there more general -concurrence of opinion, than against any legislative interference with -the price of labour. But I would venture to submit, for the -consideration of abler judges than myself, that before wages can safely -be left to find their own level in the struggles of an unrestricted -competition, the law should be rendered absolute and available in -safeguards for the ignorant poor--first, against those deteriorations of -staple food which enable the retailer to disguise starvation to his -customers by apparent cheapenings of bulk; secondly, against those -conditions of lodgment which are inconsistent with decency and health. - -But if I have addressed myself to this objection, partly because--to the -very limited extent in which it starts from a true premiss, it deserves -reply; and partly because I wish emphatically to declare my conviction, -that such evils as I denounce are not the more to be tolerated for their -rising in unwilling Pauperism, rather than in willing Filth; yet I doubt -whether poverty be so important an element in the case as some people -imagine. And although I have referred especially to a poor -neighbourhood--because here it is that knowledge and personal refinement -will have least power to compensate for the insufficiencies of public -law; yet I have no hesitation in saying that sanitary mismanagement -spreads very appreciable evils high in the middle ranks of society; and -from some of the consequences, so far as I am aware, no station can call -itself exempt. - -The fact is, as I have said, that, except against wilful violence, life -is practically very little cared for by the law. Fragments of -legislation there are, indeed, in all directions: enough to establish -precedents--enough to testify some half-conscious possession of a -principle; but, for usefulness, little beyond this. The statutes tell -that now and then, there has reached to high places the wail of physical -suffering. They tell that our law-makers, to the tether of a very scanty -knowledge, have, not unwillingly, moved to the redress of some clamorous -wrong. But--tested by any scientific standard of what should be the -completeness of sanitary legislation; or tested by any personal -endeavour to procure the legal correction of gross and glaring evils; -their insufficiencies, I do not hesitate to say, constitute a national -scandal, and, perhaps in respect of their consequences, something not -far removed from a national sin. - -In respect of _houses_--here and there, under local Acts of Parliament, -exist sanitary powers, generally of a most defective kind; pretending -often to enforce amendments of drainage and water-supply; sometimes to -provide for the cleansing of filthy and unwholesome tenements; in a few -cases to prevent over-crowding; very rarely to ensure stringent measures -against houses certified to be unfit for human habitation. -Occasionally--but a few lines would exhaust the list, an application of -the Public Health Act, or some really efficient local Act, has put it -within reach of the authorities to do all that is needful under certain -of these heads. But I know of no such town that would bear strict -examination as to its possession of legal powers to fulfil, what I -presume must be the principle contemplated by the law--that no house -should be let for hire unless presenting the conditions indispensable -for health, or be hired for more occupants than it can decently and -wholesomely accommodate.[2] However this may be expressed, and in -whatever laws embodied, local or general, I will venture to say that no -Government should suffer a town, either to be without the means of -enforcing this principle, or, having such means, to shirk their -exercise. Our Constitution may properly concede that local -representative authorities shall have their option whether, for sanitary -purposes, to fall under a general law, or to have Local Improvement Acts -of their own; but, in the present state of knowledge, it certainly seems -incontestable that one or other of these alternatives should be -compulsory, and that all Local Improvement Acts should be required, in -their sanitary clauses, to come up to the standard of the Public Health -Act of the time, whatever it may be. - - [2] In addition to the ordinary powers--given, for instance, in the - Public Health or City Sewers Act, for abating accumulated nuisances - and for enforcing wholesome constructional arrangements; a principal - requirement of all bodies having jurisdiction for the public health - is, that there should be vested in them some authority, _enabling them - to regulate_, in the spirit of the Common Lodging House Act, _all - houses which are liable to be thronged by a dangerous excess of low - population_. Almost invariably such houses are of the class - technically known as ‘tenement-houses,’ i. e., houses divided into - several tenements or holdings; whereof each--though very often - consisting but of a single small room, receives its inmates without - any available restriction as to their sex or number, and without - regard to the accommodation requisite for cleanliness, decency, and - health. The inhabitants of such houses, especially where of the lower - order of Irish, constantly lapse into the most brutal filthiness of - habits, and live in almost incredible conditions of dirt, - over-crowding, and disease. See sections of the following Reports, - beginning severally at pages 44, 146, and 195. Powers for dealing with - these evils might be given to Local Boards of Health, most usefully, I - think, in some such form as the following: 1) that--in respect of any - house occupied by more than one family, if it be situate in any court, - alley, or other place having no carriage-way, and be not assessed to - the poor-rate at a higher rental than £...... _per annum_; or if in it - any occupied holding consist of only one room, provided the rent of - such room do not exceed the sum of ......shillings per week, or if in - it there reside, or within three months previous have resided, any - person receiving parochial relief, medically or otherwise; on the - certificate of a duly authorized medical officer, that any such house, - or part thereof, is habitually in a filthy condition, or that from - over-crowding or defective ventilation the health of its inmates is - endangered, or that there has prevailed in it undue sickness or - mortality of an epidemic or infectious kind; the Local Board may call - upon its owner to register it in a book kept for this purpose; and in - respect of all houses thus registered, the Local Board may make rules - for periodical washing, cleansing, and limewhiting, and for the - regular removal of all dust or refuse-matter, may fix the number of - tenements into which it shall be lawful to divide any such house, or - the total number of inmates who may at one time be received therein, - may require its better ventilation by the construction of additional - windows or louvres, and may from time to time make such other - regulations and orders as they shall judge necessary for the - maintenance of health and decency; and may recover from the owner or - lessee of any such house penalties for neglect of any legal - requisitions, rules, and orders, as aforesaid: 2) that--on the - certificate of a duly authorised medical officer, that the condition - of any house or room is such as to render probable the rise or the - spread of infectious and dangerous disease among its inmates, the - Local Board may cause the owner or lessee of such house to be summoned - before a magistrate; who, after due hearing, or in default of the - owner’s or lessee’s appearance, may order the house, or any part of - it, to be evacuated of all tenants within such time as he shall judge - fit, and not again to be tenanted till after licence from the Local - Board given on the certificate of their medical officer that its - causes of unhealthiness are abated; and the magistrate may enforce - penalties for non-compliance with his order, as aforesaid: 3) - that--after an Order in Council bringing into action the extraordinary - clauses of the Nuisances Removal Act, the Local Board, on receiving - the certificate of their medical officer that any house, or part of - house, is in such condition as to be imminently dangerous to the lives - of its inmates in respect of the prevailing epidemic, or any similar - disease, may issue a peremptory order for its evacuation, and may - recover, from the owner or lessee to whom such order is addressed, - penalties for every day during which, or part of which, after such - order, the house, or any part thereof, continues to be tenanted; nor, - under like penalties, shall it be lawful, except after written licence - from the Local Board, given as aforesaid, to allow such house to be - re-occupied. - -Under circumstances like those just adverted to, may be found traces of -enactment against _offensive and injurious trades_. Unregulated -slaughtering throughout all London, except the City, tallow-melting in -St. Paul’s church-yard, bone-boiling beside Lambeth Palace, may serve to -illustrate the completeness and efficiency of these laws--even in our -metropolitan area. Here we greatly lack some competent authority, on the -part of the Government, to investigate all circumstances connected with -such establishments, generally; to suggest laws for their prospective -restriction, as to places wherein they may lawfully settle; and to frame -regulations--enforceable by any Local Board of Health, for ensuring that -all available measures be employed to mitigate their nuisance. -Considering the circumstances under which many of these establishments -have existed, no one can entertain a thought, that--even for the public -health, they should be liable to the tyranny of an unconditional -displacement. But if there existed--as undoubtedly there should exist, -some skilled tribunal, competent to speak on the subject; then, I will -venture to say, it might be quite in accordance with our English sense -of liberty, that--after a certain condemnatory verdict by this tribunal, -it should be open to the Local Board of Health to procure their -expulsion, on payment of whatever compensation an ordinary jury might -award. - -Again, with _factories_; thanks to Lord Shaftesbury’s indefatigable -benevolence, the law has appointed an inspection of certain -establishments, a restriction of their hours of labour, and some care -against the dangers of unboxed machinery. And with mining also the law -has interfered, chiefly as to the ventilation of mines; but hitherto so -ineffectively that, while I write, the coal-miners are remonstrating -with the Legislature on the thousand lives _per annum_ still sacrificed -through the insufficient protection accorded them. If there be meaning -in this legislation--if it imply any principle, the meaning and the -principle require to be developed into a general law, that every -establishment employing labour be liable to inspection and regulation in -regard of whatever acts and conditions are detrimental or hazardous to -life. If factory-children are cared for, lest they be over-worked; and -miners, lest they be stifled; so, for those who labour with copper, -mercury, arsenic, and lead, let us care, lest they be poisoned! for -grinders, lest their lungs be fretted into consumption! for -match-makers, lest their jaws be rotted from them by phosphorus! And -here let it again be noticed, as in the class of cases last spoken of, -how greatly wanted is some skilled tribunal, to form part of any lawful -machinery which might ensure that, in these and similar instances, no -precautions necessary to life are withheld through ignorance or -parsimony. - -Against _adulterations of food_, here and there, obsolete powers exist, -for our ancestors had an eye to these things; but, practically, they are -of no avail. If we, who are educated, habitually submit to have copper -in our preserves, red-lead in our cayenne, alum in our bread, pigments -in our tea, and ineffable nastinesses in our fish-sauce, what can we -expect of the poor? Can they use[3] galactometers? Can they test their -pickles with ammonia? Can they discover the tricks by which bread is -made dropsical[4], or otherwise deteriorated in value, even faster than -they can cheapen it in price? Without entering on details of what might -be the best organisation against such things, I may certainly assume it -as greatly a _desideratum_, that local authorities should uniformly have -power to deal with these frauds (as, of course, with every sale of -decayed and corrupted food) and that they should be enabled to employ -skilled officers, for detecting at least every adulteration of bread and -every poisonous admixture in condiments and the like. - - [3] The proverbial dilutions of milk are not its only deteriorations. - Cows are so ill kept in London, and in consequence so often sickly, - that milk suffers--sometimes by mere impoverishment, sometimes by much - graver derangements. If there were instituted a proper Inspection of - Provisions, one function of its officers should be to visit - cow-houses, and to prevent the distribution of milk thus damaged or - infected. I suspect that a sanitary reform of these establishments - would make a sensible difference to the nursery-population of the - metropolis. - - [4] A chief artifice in the cheapening of bread is to increase its - weight by various means which render it retentive of water. The other - usual frauds consist in the employment of inferior flours--either not - cereal, or damaged and partially deglutinised. - -In some respects this sort of protection is even more necessary, as well -as more deficient, in regard to _the falsification of drugs_. The -College of Physicians and the Apothecaries’ Company are supposed to -exercise supervision in the matter; so that at least its necessity is -recognised by the law. The security thus afforded is, in practice, null. -It is notorious in my profession that there are not many simple drugs, -and still fewer compound preparations, on the standard strength of which -we can reckon. It is notorious that some important medicines are so -often falsified in the market, and others so often mis-made in the -laboratory, that we are robbed of all certainty in their employment. -Iodide of potassium--an invaluable specific, may be shammed to half its -weight with the carbonate of potash. Scammony, one of our best -purgatives, is rare without chalk or starch, weakening it, perhaps, to -half the intention of the giver. Cod-liver oil may have come from seals -or from olives. The two or three drops of prussic acid that we would -give for a dose may be nearly twice as strong at one chemist’s as at -another’s. The quantity of laudanum equivalent to a grain of opium -being, theoretically, 19 minims; we may practically find this grain, it -is said, in 4.5 minims, or in 34.5. And my colleague, Dr. R. D. Thomson, -who has much experience in these matters, tells me that of -calamine--not indeed an important agent, but still an article of our -pharmacopœia--purporting daily to be sold at every druggist’s shop, -there has not for years, he believes, existed a specimen in the -market.[5] - - [5] Dr. Thomson tells me that he has known white precipitate of - mercury sold in hundred-weights as calomel, and in one case (he - believes by accident or ignorance) as trisnitrate of bismuth. In my - text I have endeavoured to adduce such illustrations as I suppose to - be most notorious; but I may refer the reader to various interesting - papers published, through the last two or three years, in the LANCET - (_Analytical Sanitary Commission_) from one of which I quote the - astounding instance, given above, of variations in the strength of - laudanum. Mr. Thomas Taylor, of Vere Street, informs me that, whereas - an ounce of laudanum should contain about four grains of morphia, he - finds the actual quantity varying in different specimens from two - grains to six; and that in two specimens of solid opium, outwardly - alike and supposed to be of equal quality, he has found the per - centage of morphia to vary from 3½ to 10. It requires little - instruction in medicine to appreciate these facts. - -Again, with the _promiscuous sale of poisons_, what incredible laxity of -government! One poison, indeed, has its one law. Arsenic may not be sold -otherwise than coloured, nor except with full registration of the sale, -and in the presence of a witness known to both buyer and vender. -Admirable, so far as it goes! but why should arsenic alone receive this -dab of legislation? Is the principle right, that means of murder and -suicide should be rendered difficult of access for criminal purposes? -Does any one question it? Then, why not legislate equally against all -poisons?--against oxalic acid and opium, ergot and savin, prussic acid, -corrosive sublimate, strychnine? - -Nor can our past legislators be more boastful of their labours for the -_medical profession_--either for its scientific interests, or for the -public protection against ignorance and quackery.[6] Nearly two dozen -corporate bodies within the United Kingdom are said to grant licences -for medical practice; and I hardly know whether it lessens or aggravates -this confusion, that such licences are in many cases partial; that one -licentiate may practise north of the Tweed, but nowise to the south; -that one may practise in London, another only seven miles beyond it. Not -that the licence seems much to matter! for innumerable poachers in all -directions trespass on what the law purports to sell as a secured -preserve for qualified practitioners: their encroachments are made with -almost certain impunity; and--as for the titles of the Profession, any -impostor may style himself _doctor_ or _surgeon_ at his will. Even where -licences are held, conveying identical titles, they imply neither equal -privileges (as I have said) nor even uniform education. The law has -troubled itself little as to the terms on which they shall be granted; -and the qualifications exacted from candidates--the conditions -preliminary to their becoming eligible for licence, vary in so -remarkable a degree among the many corporate bodies which are fountains -of this honour, that the credentials conferred have really little -meaning, apart from a context which the public is unable to supply. It -is charged against particular institutions, that their degrees and -licences are attained with a very inglorious facility; and when it is -recollected that the issuing of such testimonials is a source--sometimes -a chief source--of income to the corporations which grant them, it will -be felt that at least there must exist great danger of this reproach -being sometimes deserved. If a national title to practise medicine is to -be granted by several Boards, and if yet the tenure of that title is to -determine public confidence in favour of its holder, it would seem -indispensable that some guarantee should be given for these several -licences representing equal qualifications--some guarantee that the -holder in each case possesses professional knowledge, and has enjoyed -professional opportunities, at least above some uniform standard -recognised as a _minimum_ qualification by all the diplomatising bodies. -Indispensable, however, as this may seem, years of endeavour have failed -to attain it. What is called _medical reform_ has been agitated longer -than I can remember; and more than one minister has been willing to -legislate for its promotion. Unfortunately the very magnitude of the -evils has delayed their cure. With the constitution I have described--a -system of conflicting jurisdictions, of licences without titles, and -titles without licences, how could we escape internal dissension? how -escape the antagonism, perhaps the jealousies, of rival corporations and -of different professional classes? Home-Secretaries have had little -leisure to fathom these things to the bottom. Unexamined and -unadjudicated by any competent authority, such influences have -bewildered public judgment, made statesmen regard us with despair, -postponed legislative correction, and maintained us in a state of -anarchy and confusion, best to be appreciated when we compare with our -own the organisation and government of the legal profession. - - [6] Legislative passiveness towards scientific medicine is not the - only evil we have to complain of. Surely, in selling Letters Patent - for the protection of quack-medicines--in seeming to sanction and - authenticate whatever lies their proprietor may post upon the wall, - the State demeans itself into complicity with fraud, and soils its - fingers with something fouler than the Vespasian tax. It illustrates - the curious _forgetfulness_ shewn towards medicine by the Legislature, - that this immoral practice of giving patents for pretended cures of - disease should have been allowed to continue--as of course it must - have continued, solely by oversight, till past the middle of the - nineteenth century. - -And be it noted, how this reacts upon the State. So completely is our -government dissevered from Science in general, and, most of all, from -the sciences relating to Life, that, on such subjects, there exists not -for state-purposes anything like a tribunal of appeal. The Legislature -recognises no _Medical Authority_. Occasionally this fact stands out in -painful conspicuousness, and brings most injurious results. In contested -cases requiring scientific testimony--before Parliamentary Committees, -for instance, and in a variety of legal proceedings,--instead of the -Court having satisfactory power of referring particular questions to -skilled impartial adjudicators, the uniform practice is, that scientific -men are retained on opposite sides, to support partisan interests. The -advantages, such as they are, which belong to this system, might, I -believe, easily be obtained under altered arrangements: the -disadvantages are glaring. It might be invidious to refer to -illustrations of their reality: but it is of course impossible to doubt -of the working of this system, that, in so far as it makes each witness -feel himself engaged to maintain the views of his employer, it tends -towards a moral prostitution and subornation of science. In the -interests of truth, it would surely seem desirable that scientific -evidence should be tendered, so far as may be, in a judicial spirit -towards the suit; either that the technical point should be referred to -a technical jury, or that the technical witness should be summoned at -the Court’s discretion, should be examined in-chief by the Court, and -should be subject only to such cross-examination as may procure the most -complete statement of his knowledge on the matter in hand. - -Having said so much on the defects and the wrongs of our existing -sanitary condition, perhaps I may venture to speak of the almost obvious -remedy. ‘Almost obvious’ I say; for surely no one will doubt that this -great subject should be dealt with by comprehensive and scientific -legislation; and I hardly see how otherwise, than that it should be -submitted in its entirety to some single department of the executive, as -a sole charge; that there should be some tangible head, responsible--not -only for the _enforcement_ of existing laws, such as they are or may -become, but likewise for their _progress_ from time to time to the level -of contemporary science, for their _completion_ where fragmentary, for -their _harmonisation_ where discordant. - -If--as is rumoured, the approaching re-constitution of the General Board -of Health is (after the pattern of the Poor-law Board) to give it a -Parliamentary President, that member of the Government ought to be open -to challenge in respect of every matter relating to health. What, for -this purpose, might be the best subordinate arrangements of such a -Board, it would take a volume to discuss. But at least as regards its -constituted head, sitting in Parliament, his department should be, in -the widest sense, to _care for the physical necessities of human -life_. Whether skilled coadjutors be appointed for him or not; -engineers--lawyers--chemists--pathologists; whether he be, as it were, -the foreman of this special jury, or, according to the more usual -precedent of our public affairs, collect advice on his own -responsibility, and speak without quotation of other authority than -himself, his voice, unless the thing is to be a sham, must represent all -these knowledges. - -The people, through its representatives, must be able to arraign him -wherever human life is insufficiently cared for. - -He must be able to justify or to exterminate adulterations of food; to -shew that alum ought to be in our loaves, or to banish it for ever; to -shew that copper is wholesome for dessert, or to give us our olives and -greengages without it; to shew that red-lead is an estimable condiment, -or to divert it from our pepper-pots and curries. - -Similarly with drugs and poisons--the alternatives of life and death--a -minister of Public Health would, I presume, be responsible for whatever -evils arise in their unlicensed and unregulated sale. He would hardly -dare to acquiesce in our present defencelessness against fraud and -ignorance; in doses being sold--critical doses, for the strength of -which we, who prescribe them, cannot answer within a margin of _cent. -per cent._; or in pennyworths of poison being handed across the counter -as nonchalantly as cakes of soap.[7] Surely, before he had been six -months in office, he would have procured some enactment to remedy this -long neglect of the legislature, by providing that the druggist’s trade -be exercised only after some test of fitness, and in subjection to -certain regulations. - - [7] Without referring to what may be considered rare--the sale of - poison for the purposes of intended homicide, I may remind the reader - of the very dreadful facts collected by the Commissioners on Trades - and Manufactures, as to the immense sales of opium in our principal - manufacturing towns, for the purpose of quieting--and with the effect - of killing, children, while their poor mothers are absent from home in - their several occupations. - -Within his province, likewise, it would fall to be cognisant of all that -relates to the constitution of the Medical Profession. The difficulties -which have baffled successive Home-Secretaries might soon find their -solution in the less divided attention which he could bring to their -study. Amid conflicting opinions and an apparent scramble for power, he -would soon distinguish where might be the strife of jealousy and -covetousness, where a truthful zeal for the honour and efficiency of -medicine. I think he could not be long in curing our more scandalous -anomalies. Probably--unless human bowels require other doctoring in -London than in Manchester, he would manage that a doctor there should -be a doctor also here; that no licence for the partial practice of -medicine should be recognised--no licence admitting a man to do in -Edinburgh what it would be a misdemeanour for him to do in Greenwich. -And obviously, in order to this--since a professional diploma is the -only criterion by which the public can measure the competence of those -who seek their patronage, he would see that, as far as may be, the -various licensing bodies exact from their candidates equal and -sufficient qualifications; that the diploma entitling a man to call -himself Surgeon or Physician, Accoucheur or Apothecary, mean the same -thing--imply the same education, whether it be got in Scotland, Ireland, -or England; and that any falsification of such diploma, or any -unauthorised assumption of the title which implies its possession, be -promptly punishable at law.[8] - - [8] This check at least seems indispensable, for the reason above - given, that a professional diploma is the only criterion by which the - public can measure professional competence; and for the validity of - such a criterion, it therefore, I think, becomes the duty of a - government, on behalf of the public, to provide. For anything beyond - this (except in one particular case) the matter might take its natural - course. No law can supersede a necessity for common sense in the - subject; and medicine, I think, requires no _protection_. Let my - neighbour, by all means, if he desire it, send for a green-grocer to - reduce his dislocation or assuage his gout! and let him take the - consequences of his folly, in a spoilt limb or in a hair’s breadth - escape with his life. Only--let the green-grocer be punishable, if he - seek this office under false pretences, calling himself by any title - which implies a professional qualification. And, for what harm he may - do--let him of course (as would, if necessary, the presidents of our - colleges) be prepared to abide before judge and jury his trial for - malpractice. But, in strict adhesion to the principle I have - professed, that protection is wanted, not for the profession, but for - the public, I would suggest one exception to what otherwise might be - universal free-trade in medicine. I refer to the case of druggists; - who, whenever the Legislature may awake to the necessity of regulating - their trade, ought, I think, to be expressly prohibited from the - treatment of disease. To an immense majority of our population--to all - the under-educated classes, the druggist’s shop appears an emporium - for medical skill, as well as for medical appliances. They probably - have some vague overestimate of our art of healing, and think perhaps - that the several bottles on the shelf correspond to the several - ailments they can specifically cure. They ask for something “good for - a dropsy,” or “good for a wasting,” or “good for a palpitation;” not - knowing how much skill may be requisite to interpret the symptom; not - knowing that, to our highest skill, there is no medicine thus - indiscriminately, or even generally, “good.” At present almost - universally, druggists, with no medical qualification, are tampering - more or less with serious medical responsibilities; and the mischief - thus occasioned--especially among the poorer classes, is a matter of - notoriety, on which persons engaged in hospital practice would be - competent and tolerably impartial witnesses. It is because this evil - arises in the _almost inevitable ignorance_ of those who chiefly - suffer from it, that, in accordance with the principle above - suggested, I think it deserves consideration from the Legislature. - -Into the hands of this new minister--advised, perhaps, for such purposes -by some permanent commission[9] of skilled person, would devolve the -guardianship of public health against combined commercial interests, or -incompetent administration. He would provide securities for excluding -sulphur from our gas, and animalcules from our water. He would come into -relation with all Local Improvement Boards, in respect of the sanitary -purposes of their existence. To him we should look, to settle at least -for all practical purposes the polemics of drainage and water-supply; to -form opinions which might guide Parliament, whether street sewers really -require to be avenues for men, whether hard water really be good enough -for all ordinary purposes, whether cisternage really be indispensable to -an urban water-supply. - - [9] There are many instances in my mind, some already adverted to, - where the existence of a standing jury for scientific--especially for - sanitary, purposes might be of great utility. It is an organisation - which prevails extensively in France, under the name of _Conseils de - Salubrité_; forming, in most of the large towns there, a constant - board of reference for the municipality, in respect of sanitary - regulations. _Mutatis mutandis_, it might become invaluable as an - English institution, in respect of many matters touched upon in this - sketch; and perhaps with some division of duties, into such as would - best belong to a General Board of the kind, and such as might properly - be vested in Local Boards. To determine the indispensable conditions - of healthy lodgment; to examine the influence of trades and - occupations, and to devise the regulations they may require, for the - neighbourhood’s sake, or for their operatives’; to supervise the sale - of food and drugs; to be cognisant of medical matters; would seem, - either locally or generally, to require the co-operations of several - skilled persons. But, though I have spoken of such, as indispensable - jurors for these subjects, I do not forget that other interests than - those of life may need to be consulted. For the fair representation of - these, the lay faculty of _educated common-sense_ will fulfil an - inestimable usefulness, if it may be there to mediate between science, - which is sometimes crotchety, and trade, which is sometimes selfish. - -Organisations against epidemic diseases--questions of quarantine--laws -for vaccination, and the like, would obviously lie within his province; -and thither, perhaps, also his colleagues might be glad to transfer many -of those medical questions which now belong to other departments of the -executive--the sanitary regulation of emigrant ships, the ventilation of -mines, the medical inspection of factories and prisons, the insecurities -of railway traffic, _et hoc genus omne_. - -There is another subject respecting which I should reluctantly forego -the present opportunity of saying something. To the philosopher, -perhaps, any partial sanitary legislation--even for a metropolis, may -seem of low importance, as compared with our commanding need that the -general legislation of the country be imbued with deeper sympathies for -life. Yet London is almost a nation in itself; and the good which might -be effected by its sanitary regeneration would, even as example, be of -universal influence. Now, at this moment, there seems a chance--such a -chance as may not soon recur--for gaining a first step towards this -consummation. The re-construction of the Metropolitan Commission of -Sewers, on the principle of local representation, affords extraordinary -facilities for providing London, at length, with an efficient sanitary -government. For, while any administration for this purpose would -require to be entrusted with very extensive and very stringent powers, -it seems probable that such authority might by the public be willingly -conceded to a body constituted, in great part, of persons representing -local interests. The jurisdiction required would be substantially such -as is already vested in the City Commissioners of Sewers, for the -sanitary control of the city; the concession of which--because to a -representative body--was never any matter of municipal dispute. In so -vast a government as that of the metropolis, Local Boards of Health for -its various sections would seem indispensable; it is presumed that these -boards[10] would be represented in the general Commission; which, in -conjunction with them, and including certain skilled assessors, might -constitute a complete sanitary organisation, consultative and executive. - - [10] It would seem premature to discuss what might be the best - constitution of such Local Boards for the metropolis; but it will - appear to the reader, on a moment’s reflection, that there would be no - difficulty in finding materials for their organisation. If, according - to suggestions lately ventilated, municipal institutions should be - given to the parts of London hitherto without them; these new - corporations would probably have sanitary functions allotted them, and - might readily become Local Boards of Health under such a constitution - as I have sketched. If, on the other hand, our present non-municipal - system were to be continued, probably our several Boards of Guardians - might seem specially proper to act as Local Boards of Health; first, - as being elected representative bodies, already invested with certain - authority of the kind--as, for instance, under the Nuisances Removal - Act; secondly, because various of their officers would be almost - indispensable parts of any sanitary machinery. Indeed, my experience - of such matters suggests it to me as not unimportant, that, under any - arrangement which may be made, the jurisdiction of Local Boards of - Health should, at least in area, be conterminous with Poor Law Unions; - so that those who administer sanitary affairs--affairs which are - always chiefly relative to the poor--may, as far as possible, in their - several districts, come into relation with single sets of Poor Law - officers. - -I have one word more to say about the Reports. They have been received -by the public with such remarkable indulgence and favour, that I feel -some anxiety lest I may seem to have plumed myself with other feathers -than my own. Let me, therefore, at least in part, confess my debts. - -Before my first enlistment in the service of public health, others had -fought this great cause with rare courage and devotion; establishing its -main principles in a manner to require no corroboration, and to admit -little immediate increase. The true patriarchs of the cause in this -country are the present working members of the General Board of Health. -The constitution of my city appointment is quite independent of this -Board; but I should be acting an unworthy part if I refrained from -acknowledging, that, in innumerable instances, I have gathered most -valuable knowledge from the Board’s official publications, and that, in -personal intercourse with its members and officers, I have had abundant -reason to be grateful for information invariably given with that frank -kindness which belongs to brotherhood in science, and to sympathy for -common objects. - -I must likewise acknowledge constant obligations to the courtesy of the -Registrar-General, and express with how much pleasure and instruction I -have studied the works of his inestimable office. Especially I would -offer my tribute of respect to Dr. Farr’s learning and industry, as well -as to that capacity for generalisation which the world has long -recognised in his eloquent and thoughtful writings. - -And, though this be not the place to boast of private friendships, I may -venture to say that there are few topics relating to sanitary medicine -that I have not enjoyed the advantage of discussing with men who have -given genius, inquiry, and reflection to their development. - -Thank God! the number of persons capable of apprehending the cause, and -ready to take interest in its promotion, is now daily on the increase. -If some minister of Public Health could take his seat in the House of -Commons--some minister knowing his subject and feeling it, I believe he -would find no lack of sympathy and co-operation. The world abounds with -admirable wishes and intentions, that vaguely miscarry for want of -guidance. How many men can get no farther in their psalm of life than -the question, _in quo corriget_. To such--not masters of the subject, -but willing and eager to be its servants, an official leader might be -everything: for in great causes like this, where the scandal of -continued wrong burns in each man’s conscience, the instincts of justice -thirst for satisfaction. What can we do or give--how shall we speak or -vote, to lessen these dreadful miseries of sanitary neglect--is, at this -moment, I believe, the fervent inquiry of innumerable minds, waiting, as -it were for the word of command, to act. - -How much of this generous earnestness towards the cause exists in -society--how much desire to grasp any reasonable opportunity of good has -lately happened to fall under my notice. Last winter, when the signs of -the times were making us fear that Cholera would presently again be -epidemic in London, it was remembered that, in the greater part of the -metropolis, nothing whatever had been done since the last invasion to -give immunity against the returning disease. It was remembered--too -late, how indescribably dreadful a thing is the epidemic prevalence of -sudden death. And the poor were thought of--in their unprotectedness, -their filth, their ignorance. Among the persons thus aroused, was a -gentleman whom I reluctantly leave unnamed; saying of him only, that, -from a distinguished position in official life, he had retired to -literary enjoyments, amid which he bears the imputation of many -unacknowledged writings which charm and instruct the public. When the -rumours of the pestilence began, he too heard and read and became -aghast. The notion that ‘in a skilful, helpful, Christian country -nothing should be done’ against these impending dangers--that the poor -should be left ‘defenceless, huddled together in some dismal district, -not more helpful than women’--was felt by him, he wrote, ‘deeply as a -disgrace;’ and he pleaded that, ‘on a great and pressing occasion, it -remains for the thoughtful, the rich, and the benevolent, to try and do -these needful things for the people.’[11] Let us, he urged, endeavour to -meet this shameful reproach; let us combine voluntary charitable -assistance for extemporaneous sanitary measures, rapid, though partial; -let us get a hundred thousand pounds and do what we can in aid of local -authorities in the poorest districts--in Bethnal Green, in Shoreditch. -Eventually this plan was abandoned, at least for the time. There was -argued against it, that prompt legislation might do more good, with less -exoneration of local responsibility. Whether rightly or wrongly, the -latter view was acted on; and in accordance with it, the gentleman first -adverted to (waving his own hopes and wishes in the matter) took active -part in framing suggestions,[12] which Lord Palmerston had expressed -himself willing to accept, for modifying the laws of Nuisance and -Disease-Prevention to a form more suitable for the apprehended -emergency. But, in the meantime, what had happened? The author of the -plan, as it were at a moment’s notice, had seemed to draw round himself -half the intellectual and moral strength of the metropolis. Himself -setting aside the literary ambition of his life, he found others ready -to meet him with their several self-sacrifices. Over-worked men of -science and of business, who afford no time to relaxation; favourites of -society, who might have been suspected of mere shuddering at distasteful -subjects; men of high laborious rank in Church and State; poets; heads -of professions; minds that guide the tastes and morals of the country, -or feed its imagination; not least, the invalid from his distant -wintering-place; men, in short, immersed in all kinds and grades of -occupation, were either bodily present at the deliberations referred to, -or were writing about the plan in terms of warm interest, anxious to -promote whatever usefulness could be shown them. About the means there -was discussion--about the object, none; nor lukewarmness. All were -competing, by gifts of time and labour, to snatch some opportunity of -serving this neglected cause. - - [11] I quote from a pamphlet printed by him for private circulation. - It was entitled ‘_Health-Fund for London; some Thoughts for next - Summer: by Friends in Council_.’ - - [12] These have since been laid before the House of Lords, on the - motion, I think, of Lord Harrowby, who took much interest in the - subject. - -Such--to return to my text--such, I am deeply assured, would be the -spirit which a minister of Public Health would find abundantly on his -side in Parliamentary discussion, and in the Press. There is no -attachment to the incongruities I have sketched as belonging to our -abortion of a sanitary system. Still less is there any want of feeling -for the poor--any reluctance to raise their state and better their -circumstances--any unconsciousness that these things are great solemn -duties. On the contrary, everywhere there is the conviction that -_something_ must be done; everywhere a waiting for authority to say -_what_. But, the trumpet giving an uncertain sound, who can prepare -himself to battle? Knowledge, and method, and comprehensiveness, are -wanted--the precise, definite, categorical impulses of a Parliamentary -leader, who can recognise principles and stick to them. - -And for such a minister, what a career! It would be idleness to speak of -the blessings he could diffuse, the anguish he could relieve, the -gratitude and glory he could earn. A heathen can tell him this. _Homines -enim ad Deos nullâ re propius accedunt quam salutem hominibus dando. -Nihil habet nec fortuna tua majus quam ut possis, nec natura tua melius -quam ut velis, conservare quam plurimos._ - - Upper Grosvenor Street, - May 15th, 1854. - - - - - REPORTS - RELATING TO - THE SANITARY CONDITION - OF THE - CITY OF LONDON. - - - - -FIRST ANNUAL REPORT. - - -TO THE HON. THE COMMISSIONERS OF SEWERS OF THE CITY OF LONDON. - - _November 6th, 1849._ - - GENTLEMEN, - -During the 52 weeks dating from October 1st, 1848, to September 29th, -1849, there died of the population of the City of London 3763 persons. - -The rate of mortality, estimated from these _data_ for a population of -125,500, would be about the proportion of 30 deaths to every thousand -living persons.[13] - - [13] The Census of 1851, compared with that of 1841, would lead me to - believe that in 1848-9 the population of the City must have been about - 129,000. With this correction, the death-rate would have been about - 29·16 _per_ thousand.--J. S., 1854. - -The lowest suburban mortality recorded in the fifth volume of the -Registrar-General’s Reports, for the year then under estimation, gave a -rate of 11 in the thousand; and we might perhaps be justified in -adopting that rate as a _minimum_ for the purpose of sanitary -comparison. - -According to this standard (undoubtedly a very superior one) it would -appear that, during the last year, death has prevailed in the City of -London with nearly three times its recognised _minimum_ of severity. - -But, to avoid all sources of fallacy, I will allow a very ample margin -to this estimate; I will take 15 per thousand as a fair standard of -mortality, and will assume that last year’s deaths in the City have -amounted to only double their normal proportion. - -Probably no one contends that the lower rate of mortality, as -illustrated at Dulwich or Sydenham, indicates an over-healthy condition -of the locality to which it refers. Probably no one argues that human -life, in those healthier districts, is prolonged beyond enviable limits. -Surely, on the contrary, every one who can measure the large amount of -misery and destitution which results from a high rate of mortality, will -think it most desirable that, by every means within the scope of -sanitary science, exertion should be made to reduce the higher rate to -the level of the lower. - -Therefore, Gentlemen, I venture to assure myself, that I shall but have -anticipated the wishes of this Hon. Court, in preparing for your -consideration a statement of those circumstances, which apparently -conspire to determine the larger mortality of the City of London. - - * * * * * - -In order to prevent any misapprehension of my remarks, I think it well -to observe that, in commenting on this mortality, I purposely avoid -instituting any comparison between it and the mortality of those urban -districts which immediately adjoin us: for the object of my comparison -is not to illustrate how, by similar or worse circumstances, an equally -great mortality may have been procured elsewhere; but rather to suggest -how, by other and better sanitary arrangements here, our present high -mortality may be diminished. - -Indeed, while I speak of the causes of that high mortality which -distinguishes the City of London from the healthier sub-districts I have -cited, it will be obvious that many of my observations do not apply to -the City of London exclusively, but admit of equal application to -various other central districts of the metropolis;--relating, in fact, -generally to the characteristic evils of all urban residences. - -With those other districts I have nothing to do; but I wish it to be -understood, that in describing the City as healthy or unhealthy, I am -not comparing it with Holborn, or Whitechapel, or Bermondsey, or other -urban localities, where--whatever the relative badness of the places, -the scale of comparison would be essentially vicious, and the results of -comparison worthless. It is my object to test the salubrity of the City -by comparison with a superior standard, in order that some definite aim -may appear, towards which to direct the endeavours of sanitary -improvement. - - * * * * * - -Starting, then, from our Registrars’ Returns, I invite you to inquire -with me, how it has come to pass that within the City of London there -have died in the last year twice as many persons as it seems necessary -that there should die; and whence has arisen the apparent anomaly, that -here--in the very focus of civilization, where the resources of curative -medicine are greatest, and all the appliances of charitable relief most -effectual, still, notwithstanding these advantages, there has passed -away irrevocably during the year so undue a proportion of human life. - -Let it not be imagined that the word _cholera_ is a sufficient answer to -these questions, or that its mention can supersede the necessity for -sanitary investigation. Let it, on the contrary, be observed that the -epidemic which has visited us, extends its ravages only to localities -previously and otherwise hostile to life; so that, while all regions of -the globe in succession are shadowed by its dark transit, the healthiest -districts of each region remain utterly unharmed in presence of the -pestilence. Compare, for instance, the cholera mortality in a healthy -suburban sub-district with that of an unhealthy urban one. Dulwich and -the parish of St. Ann’s, Blackfriars, in the City of London, are -probably nearly equal in population: in the former, there was not a -single death from cholera; in the latter, the deaths from this cause -alone were at the rate of twenty-five to every thousand of the -population. Dulwich is one of the healthiest sub-districts within the -bills of mortality; St. Ann’s belongs to one of the unhealthiest -sub-districts of the City of London; and the cholera visited each in -proportion to its ordinary healthiness. - -Such is the general rule; and accordingly I would suggest to you that -the presence of epidemic cholera, instead of serving to explain away the -local inequalities of mortality, does, in fact, only constitute a most -important additional testimony to the salubrity or insalubrity of a -district, and renders more evident any disparity of condition which may -previously have been overlooked. The frightful phenomenon of a periodic -pestilence belongs only to defective sanitary arrangements; and, in -comparing one local death-rate with another, it is requisite to remember -that, in addition to the ordinary redundance of deaths which marks an -unhealthy district, there is a tendency from time to time to the -recurrence of epidemic pestilence, which visits all unhealthy districts -disproportionately, and renders their annual excess of mortality still -more egregious and glaring. - - * * * * * - -As materials which may aid you to estimate the sanitary defects of the -City, I subjoin two tables[14] illustrating the relative mortality of -the several sub-districts. The first of these tables indicates -numerically the local distribution of the year’s deaths, and gives their -proportion to the population of each district and sub-district. The -second relates particularly to the last quarter, and illustrates the -pressure of the epidemic. The two together furnish a synoptical view of -the several rates of mortality, as calculated for the entire City, for -the Unions separately, for the sub-districts separately; and for the -last quarter of the year separately. In the tedious process of -constructing these tables, I have been careful to avoid every source of -inaccuracy, and believe that they present you with a true measure of the -health of the City during the past year. - - [14] I have not reprinted these tables quite as here described. The - local distribution of the 3763 deaths of the year is given in the - Appendix, No. III.; and the sub-district death-rates of the year, as - nearly as I can get them, in a note overleaf, page 6. The high - mortality of this summer quarter (in which 1395 persons died) will be - best appreciated by the reader in referring to Appendix, No. XIV.; - where it can be compared with the mortality of similar periods of time - in the four other years there accounted for.--J. S., 1854. - -From these comparative tables it will be observed, that the high -mortality of the population does not affect the entire City equally; -that, in some of its portions, the rate of death approaches the -_minimum_ standard much more nearly than in others; that in those -districts where the general rate is best, the temporary aggravation -from epidemic causes has likewise been least; and that our aggregate -City rate, either for ordinary times or for a period of epidemic -disease, is compounded from the joint result of several very different -proportions. Reference to the Registrar-General’s tables will enable any -one to see that the ordinary rate of mortality for the West London Union -is a fourth higher than the rate for the City of London Union, while the -rate for the East London Union bears a still higher proportion; and -these very different rates are, as it were, merged in the one aggregate -rate, struck for the whole City, as comprising the three unions referred -to. It will be obvious, therefore, that many parts of the City are much -healthier than this aggregate rate would signify, while others are much -unhealthier. In regard of last year, for instance, the aggregate rate of -mortality was (as I have stated) 30 per thousand of the general -population of the City: but if this rate be analysed by examination of -the sub-district mortality, it will be seen that in one sub-district the -rate of death stood nearly as low as 20; that in another sub-district of -the same union it rose to 36, and in a third sub-district (of another -union) to within a small fraction of 40.[15] - - [15] On account of changes of population shown by the subsequent - Census, these figures would require correction. The death-rates _per_ - thousand in the several sub-districts were probably about as follows, - viz.:-- - - ------------------+-------------+------------------------------ - EAST LONDON UNION.|W. L. UNION. | CITY OF LONDON UNION. - ---------+--------+------+------+-----+-----+------+-----+----- - St. |Cripple-|North.|South.|S. W.|N. W.|South.|S. E.|N. E. - Botolph. | gate. | | | | | | | - ---------+--------+------+------+-----+-----+------+-----+----- - 26½ | 32 | 34 | 41 | 38 | 22 | 24 | 21⅔ | 22 - ---------+--------+------+------+-----+-----+------+-----+----- - - J. S., 1854. - -If it were possible to furnish you with statistics derived from a still -smaller sub-division of each district, these points would be infinitely -more manifest. In some limited localities of the City you would probably -find an approximation to the average mortality of suburban districts; -while in other spots, if they were isolated for your contemplation, you -would see houses, courts, and streets where the habitual proportion of -deaths is far beyond the heaviest pestilence-rate known for any -metropolitan district aggregately--localities, indeed, where the -habitual rate of death is more appalling than any which such averages -can enable you to conceive. - -These facts are quite unquestionable, and I have felt it my duty to -bring them under your notice as pointedly and impressively as I can; -feeling assured, as I do, that so soon as you are cognisant of them, -every motive of humanity, no less than of economical prudence, must -engage you to investigate with me, whether or not there may lie within -your reach any adoptable measures for lessening this large expenditure -of human life, and for relieving its attendant misery. It is, therefore, -with the deepest feeling of responsibility that I proceed to fulfil the -main object of my First Annual Report, by tracing these effects to their -causes, and by explaining to you, from a year’s observation and -experience, what seem to me the chief influences prevailing against life -within the City of London. - - * * * * * - -My remarks for this purpose will fall under the following heads, viz.:-- - - I. Defective house-drainage; - - II. Incomplete and insufficient water-supply; - - III. Offensive or injurious trades and occupations; - - IV. Intramural burials; - - V. Houses insusceptible of ventilation, and absolutely unfit for - habitation; - - VI. The personal habits of the lowest classes, and the influence of - destitution in increasing their mortality. - -In treating of these topics, I shall not pretend to bring before you all -the details on which my opinions are founded, or to enumerate under each -head those infinite individual instances which require sanitary -correction. It is my wish at this time to submit to you only such -general considerations as may show you the largeness of the subject, its -various ramifications, and its pressing importance; and it is my hope -that these considerations may suffice to convince you of the necessity -which exists in the City of London for some effective and permanent -sanitary organisation. - - -HOUSE-DRAINAGE. - -I. It is not in my power to lay before you any numerical statement of -the proportion of drained to undrained houses. From such information as -I possess, I may venture to speak of imperfect house-drainage as having -been a general evil in all the poorer districts of the City; and the -latest intelligence on the subject leads me to consider this great evil -as but very partially removed. So far as I can calculate from very -imperfect materials, I should conjecture that some thousands of houses -within the City still have cesspools connected with them. It requires -little medical knowledge to understand that animals will scarcely thrive -in an atmosphere of their own decomposing excrements; yet such, strictly -and literally speaking, is the air which a very large proportion of the -inhabitants of the City are condemned to breathe. Sometimes, happily for -the inmates, the cesspool in which their ordure accumulates, lies at -some small distance from the basement-area of the house, occupying the -subsoil of an adjoining yard, or if the privy be a public one, of some -open space exterior to the private premises. But in a very large number -of cases, it lies actually within the four walls of the inhabited house; -the latter reared over it, as a bell-glass over the beak of a retort, -receiving and sucking up incessantly the unspeakable abomination of its -volatile contents. In some such instances, where the basement story of -the house is tenanted, the cesspool lies--perhaps merely boarded -over--close beneath the feet of a family of human beings, whom it -surrounds uninterruptedly, whether they wake or sleep, with its fetid -pollution and poison. - -Now, here is a removable cause of death. These gases, which so many -thousands of persons are daily inhaling, do not, it is true, in their -diluted condition, suddenly extinguish life; but, though different in -concentration, they are identically the same in nature with that -confined sewer-gas which, on a recent occasion, at Pimlico, killed those -who were exposed to it with the rapidity of a lightning stroke. In their -diluted state, as they rise from so many cesspools, and taint the -atmosphere of so many houses, they form a climate the most congenial for -the multiplication of epidemic disorders, and operate beyond all known -influences of their class in impairing the chances of life. - -It may be taken as an axiom for the purposes of sanitary improvement, -that every individual cesspool is hurtful to its vicinage; and it may -hence be inferred how great an injury is done to the public health by -their existence in such numbers, that parts of the City might be -described as having a cesspool-city excavated beneath it. - -I beg most earnestly to press on the consideration of your Hon. Court, -the extreme importance of proceeding with all convenient speed to alter -this very faulty construction, and to substitute for it an arrangement -compatible with the health of the population. - -While addressing you on this subject, and while congratulating your Hon. -Court on the fact, that public attention is so much directed to a matter -in which your exertions are certain to effect large and salutary reform, -I cannot refrain from expressing a wish, that more accurate knowledge -prevailed among the public as to the history and jurisdiction of the -nuisance in question. It seems constantly to be forgotten, that your -responsibility in the matter dates but from last January. The -cesspool-nuisance has been the slow growth of other less enlightened -ages, not in the City merely, but in the whole metropolis, and in all -other towns in England. The extreme injury which it inflicts on the -health of the population, and the vital necessity of abating that -injury, are points which only began to claim attention in this country -about ten years ago; and which have since but very slowly been forcing -their way (chiefly through the indomitable zeal and perseverance of Mr. -Chadwick) into that share of notice which they deserve. House-drainage -with effective water-supply, are the remedies which can alone avail; and -it is only during the present year that authority to enforce these -measures has been vested by the Legislature in any public bodies -whatsoever. - -Before the month of January last, when your increased jurisdiction was -established, it appears to me that, for the existence of cesspools in -the City, you had no more responsibility than for the original site of -the metropolis, or for the architecture of Westminster Abbey. - -During the last ten months, however, the care of effective -house-drainage has rested solely and entirely with your Hon. Court; for -two of those ten months, I thought it desirable, on account of the -epidemic, that no considerable disturbance of the soil should take place -in the construction of new works; in the remaining eight months, two -miles of new sewer were formed, and 900 houses were drained for the -first time. - -If the house-drainage of the City had depended for its completion, even -since that time, solely on the labours of this Commission, no doubt it -would have proceeded at a far quicker pace. How effectively your Hon. -Court had prepared for the best application of your increased powers, is -sufficiently evinced in the 45 miles of sewerage, ramifying through all -the districts of your jurisdiction, ready at every point to receive the -streams of private drainage, and leaving to the owners of house-property -(with few exceptions) no excuse for their non-performance of these -necessary works. I believe the extent of public sewerage within the City -to be quite unparalleled, and to furnish facilities of the rarest kind -for the abolition of cesspools, and for the establishment of an improved -system of house drainage. But, Gentlemen, while you have exerted -yourselves to the utmost in the application of your increased authority, -and have directed your staff of officers, from first to last, to proceed -with all possible despatch in enforcing sanitary improvement in the -matter now under consideration, the intentions of your Court and the -industry of its officers have been in a great measure frustrated by the -passive resistance of landlords. Delays and subterfuges have been had -recourse to by the owners of house-property, in order to avoid -compliance with the injunctions of the Commission; and the temporary -interruption of works, which occurred in August and September, -prevented these evasions from being dealt with as otherwise they would -have been. - -Now, however, the course is again open. For some weeks your Hon. Court -has directed that all works of drainage and sewerage shall proceed; many -are already in progress; and I can see no reason why, within a year from -the present time, the number of cesspools and of undrained houses within -the City of London should not be reduced to a very small proportion. - -Everything, however, in this respect will depend on the spirit of -_thoroughness_ with which the Act of Parliament is enforced; and I would -strongly recommend, in all cases of non-drainage or other non-compliance -with the terms of notice, that no indulgence whatever should be conceded -to landlords beyond the time specified in the notification of the Court; -that no difference should be recognised between a ‘notice’ and ‘a -peremptory notice;’ that all notices should be ‘peremptory;’ and that, a -certain period for performance having been allowed to the landlord, on -the very day of that period’s expiration, the work, if undone, should be -given over for completion by the workmen of the Commissioners of Sewers, -in accordance with the 61st clause of the Act of Parliament. In favour -of the adoption of this principle, I can adduce no stronger argument -than my conviction, that its non-adoption would insure a sacrifice of -human life, in exact proportion to the procrastination allowed; and -that, too, in a matter where henceforth your responsibility is undivided -and your power absolute. - - * * * * * - -In order to give efficiency to whatever improvements of house-drainage -may be instituted, the present system of water-supply will require to -undergo very extensive modifications; for at present in the poorer -tenements, even where some show of house-drainage is made, the -arrangements are constantly rendered inoperative from insufficiency or -absence of water. To this matter, however, I shall presently revert. - -Another most important _desideratum_ in connexion with the sewerage of -the City is that, if possible, some more perfect system of trapping -should be devised, or that, in some way or other, the sewers should be -ventilated effectively and inoffensively.[16] At present there are -frequent complaints of offensive exhalation from gratings in the open -ways of the City; and it will be obvious to your Hon. Court, that all -which I have urged on the subject of cesspool-exhalations must apply -equally to those which are emitted from sewers. The impediments to -effective trapping are almost insuperable; but I believe that when the -water-supply of the City is very largely increased, washing the drains -amply and incessantly, the evil complained of will undergo a sensible -diminution. - - [16] This subject is adverted to, with more detail, in the next year’s - Report.--See page 104. - - * * * * * - -In further connexion with my present subject, I would also solicit -attention to the fact that the sanitary purposes of drainage are but -imperfectly achieved, where the outfall of sewerage is into a tidal -river passing through the heart of a densely peopled metropolis. I -should be stepping beyond my province, if I were to say much respecting -the schemes now before the public for dealing with the difficulty to -which I here refer, inasmuch as those schemes involve questions of -engineering and machinery, on which I am incompetent to form an opinion. -But I can have no hesitation in stating it as a matter greatly to be -desired in the City of London, that the noble river which ebbs and flows -beneath its dwellings should cease to be the drainpool of our vast -metropolis; and that the immeasurable filth which now pollutes the -stream should be intercepted in its course, and be conveyed to some -distant destination, where instead of breeding sickness and mortality, -it might become a source of agricultural increase and national -wealth.[17] - - [17] This subject is more particularly dwelt upon in the last Report; - page 261. - -I would venture, likewise, to express an opinion that the City of London -is peculiarly interested in the accomplishment of this great public -work, not only on general grounds relating to the conservancy of the -river, but likewise and especially on sanitary grounds, by reason of the -large bank-side population, subjects of the City, who now, instead of -deriving advantage from their nearness to the stream, are constantly -disgusted and injured by its misuse. - -While the consideration of this most important measure is pending, I -would invite attention to some circumstances, by which even the present -evil is needlessly aggravated. - -In the first place the sewers are of defective length, so that during -the ebb of the tide their contents, as they escape, are suffered to flow -in a stream of some length across the mud of the retreating river. The -stream, together with the mud which it saturates, and the open mouth of -the sewer, evolve copious and offensive exhalations, and I would -recommend that measures be taken for abatement of the nuisance. This -purpose, as concerns the sewer, would be fulfilled by the addition, in -each instance, of a sufficient length of brick or cast-iron work, to -prolong the canal beyond low water mark; but the great extent of mud -which is left uncovered at each tide, and which during the present -pollution of the river is a source of extreme nuisance and of disease, -constitutes an evil for which no remedy can be found till the stream -shall be narrowed and embanked. - -Meanwhile, the complaints which reached the Committee of Health during -the summer, together with the results of my own inspection, lead me to -believe that the several small docks which lie along the City bank of -the river from the Tower to the Temple, fulfil little really useful -purpose; that they are to a great extent used as laystalls for their -vicinage; that copious deposits and accumulations of filth take place in -them; that they are a nuisance and injury, except to the very few who -are interested in their maintenance; and that it would be of public -advantage that they should be filled up. - - -WATER-SUPPLY. - -II. I am sure that I do not exaggerate the sanitary importance of water, -when I affirm that its unrestricted supply is the first essential of -decency, of comfort, and of health; that no civilization of the poorer -classes can exist without it; and that any limitation to its use in the -metropolis is a barrier, which must maintain thousands in a state of the -most unwholesome filth and degradation. - -In the City of London the supply of water is but a fraction of what it -should be. Thousands of the population have no supply of it to the -houses where they dwell. For their possession of this first necessary of -social life, such persons wholly depend on their power of attending at -some fixed hour of the day, pail in hand, beside the nearest stand-cock; -where, with their neighbours, they wait their turn--sometimes not -without a struggle, during the tedious dribbling of a single small pipe. -Sometimes there is a partial improvement on this plan; a group of houses -will have a butt or cistern for the common use of some scores of -inmates, who thus are saved the necessity of waiting at a standcock, but -who still remain most insufficiently supplied with water. Next in the -scale of improvement we find water-pipes laid on to the houses; but the -water is turned on only for a few hours in the week, so that all who -care to be adequately supplied with it must be provided with very -spacious receptacles. Receptacles are sometimes provided: and in these, -which are often of the most objectionable description, water is retained -for the purposes of diet and washing, during a period which varies from -twenty-four to seventy-two hours. One of the most important purposes of -a water-supply seems almost wholly abandoned--that, namely, of having a -large quantity daily devoted to cleanse and clear the house-drains and -sewers; and in many cases where a waste-pipe has been conducted from the -water-butt to the privy, the arrangement is one which gives to the -drainage little advantage of water, while it communicates to the water a -well-marked flavour of drainage. - -I consider the system of intermittent water-supply to be radically bad; -not only because it is a system of stint in what ought to be lavishly -bestowed, but also because of the necessity which it creates that large -and extensive receptacles should be provided, and because of the -liability to contamination incurred by water which has to be retained -often during a considerable period. In inspecting the courts and alleys -of the City, one constantly sees butts, for the reception of water, -either public, or in the open yards of the houses, or sometimes in their -cellars; and these butts, dirty, mouldering, and coverless; receiving -soot and all other impurities from the air; absorbing stench from the -adjacent cesspool; inviting filth from insects, vermin, sparrows, cats, -and children; their contents often augmented through a rain water-pipe -by the washings of the roof, and every hour becoming fustier and more -offensive. Nothing can be less like what water should be than the fluid -obtained under such circumstances; and one hardly knows whether this -arrangement can be considered preferable to the precarious chance of -scuffling or dawdling at a standcock. It may be doubted, too, whether, -even in a far better class of houses, the tenants’ water-supply can be -pronounced good. The cisternage is better, and all arrangements -connected with it are generally such as to protect it from the grosser -impurities which defile the water-butts of the poor; but the long -retention of water in leaden cisterns impairs its fitness for drinking; -and the quantity which any moderate cistern will contain is very -generally insufficient for the legitimate requirements of the house -during the intervals of supply. Every one who is personally familiar -with the working of this system of intermittent supply, can testify to -its inconvenience; and though its evils press with immeasurably greater -severity on the poor than on the rich, yet the latter are by no means -without experience on the subject. - - * * * * * - -The following are the chief conditions in respect of water supply, which -peremptorily require to be fulfilled:-- - -1. That every house should be separately supplied with water, and that -where the house is a lodging-house, or where the several floors are let -as separate tenements, the supply of water should extend to each -inhabited floor. - -2. That every privy should have a supply of water, applicable as often -as it may be required, and sufficient in volume to effect, at each -application, a thorough flushing and purification of the discharge-pipe -of the privy. - -3. That in every court, at the point remotest from the sewer-grating, -there should be a standcock for the cleansing of the court; and - -4. That at all these points there should always and uninterruptedly be a -sufficiency of water to fulfil all reasonable requirements of the -population. - - * * * * * - -Now, if my statements are accurate with regard to the imperfect manner -in which thousands participate in the distribution of water, even for -their personal necessities; if my statements are again accurate with -respect to house-drainage, and to the immense increase of water -distribution which must accompany any improvement in this respect--and I -am quite prepared, if necessary, to adduce ample evidence on these -subjects; if, again, it be considered that the appreciation of water by -the multitude, who have so long suffered from lack of it, will lead to a -vast augmentation of its domestic use; then, I apprehend, it cannot be -doubted that the subject of water-supply to the City is one that -requires now to be looked at almost as though it were to-day broached -for the first time. - -Those important conditions, which I just enumerated as urgently -requiring fulfilment, may certainly be accomplished, so far as -mechanical construction is concerned, in more than one way. It may be -possible, no doubt, in further compliance with the principle of -intermittent supply, to furnish every tenement in the City with a -cistern of proper dimensions, and with its usual appurtenances of -ballcock, waste-pipe, &c.; but this, I need hardly say, would be a -process involving a vast expenditure of money, and hardly to be -recommended on the mere ground of conformity with what has hitherto been -done in the matter. It may be possible, on the other hand, to convert -the whole water-supply of the City into a system of uninterrupted -supply, and to construct all new works in conformity with this system. - -I beg to suggest that the choice between these alternatives is one of -immense and very urgent importance to the sanitary welfare of the City; -and I would earnestly commend it to the best consideration of your Hon. -Court. - -The system of a constant supply is now no longer a novelty. In -Philadelphia, in New York, in Nottingham, in Preston, in Glasgow, in -Newcastle, in Bristol, and in various other places, this system has been -adopted; its practicability and its advantages have been amply -demonstrated.[18] Five years ago, when evidence on the subject was given -before the House of Commons, it appeared that in the city and suburbs of -Philadelphia 25,816 houses were supplied at an average rate of five -dollars per house; that in Preston more than 5,000 houses were supplied -continually at high-pressure, and that the company was increasing its -tenants at the rate of 400 annually; that in Nottingham about 8,000 -houses, containing a population of 35,000 persons, were supplied in the -same manner; and in respect of many other towns, public experience has -been equally extensive and satisfactory. About a month ago, the Sanitary -Committee of the last-mentioned town published what I may call a report -of congratulation on their freedom from cholera, which had visited the -town with great severity in 1832. They detail the measures by which -Nottingham has been rendered a healthy town, and the first item in that -enumeration stands thus:--‘An unlimited supply of wholesome filtered -water, forced, by day and night, at high pressure, through all the -streets to the tops of almost all the houses, at a cost, for the -dwellings of the poor, of about five shillings per week.’ - - [18] It seems almost unnecessary to remind the reader that five more - years have added infinite additional testimony to that mentioned in - the text as existing in 1849; and that, two years ago, in a special - Act of Parliament, it was enjoined on the Water Companies of the - Metropolis that, within seven years, they should follow the precedent - so extensively established. In the face of such evidence--with the - knowledge that Manchester has a constant supply and that Glasgow is - arranging one, it certainly tests one’s credulity to hear it rumoured - that our Metropolitan Water-Merchants are hoping to resist that - requirement, on the ground that such a supply in London would be - _impossible_.--J. S., 1854. - -On the relative merits or demerits of the two competing systems of -supply, I have only to speak so far as their adaptation to sanitary -purposes is concerned. In this respect, I have no hesitation in saying -that the system of constant supply is immeasurably superior to its -rival; so superior, that unless competent engineering authorities should -decide on its practical inapplicability to the City of London, I would -strongly recommend its adoption as the only one, in my judgment, by -which the growing necessities of the population can be fully and -effectively satisfied. - - -OFFENSIVE AND INJURIOUS TRADES. - -III. With respect to offensive trades and occupations pursued within the -city of London, my task of recommendation is an easy one. To any person -conversant with the simplest physiological relations of cause and -effect, it is quite notorious that the decomposition of organic matter -within a certain distance of human habitations unfailingly tends to -produce disease; and every one who is competent by knowledge and -impartiality to pronounce an opinion on the subject, must feel that no -occupation which ordinarily leaves a putrid refuse, nor any which -consists in the conversion or manufacture of putrescent material, ought, -under any circumstances, to be tolerated within a town. - - * * * * * - -1. First, in regard to slaughter-houses, I may remind you that, on the -23rd of January last, when your Hon. Commission first met under the new -Act of Parliament, I recommended to you on sanitary grounds, that in -such rules as you might make for the regulation of slaughter houses, all -underground slaughtering should be absolutely prohibited. It was laid -down, however, that your Act of Parliament would not enable you to -establish this restriction, which (it was argued) would be equivalent to -a direct suppression of many existing slaughter-houses.[19] - - [19] Slaughtering in cellars was rendered illegal by the amended City - Sewers Act, 1851, and since that year has been entirely discontinued - in the City. See page 192.--J. S., 1854. - -Considering that, in my first recommendations to the Commission I ought -to confine myself to objects attainable by means of the Act of -Parliament then just coming into operation, I felt myself precluded for -the time from entering on the subject (however important in itself) of -the total abolition of urban slaughtering. Now, however, while treating -generally of sanitary improvement for the City, I can have no hesitation -in repeating an opinion which I have already submitted to the -Health-Committee of the Common Council; and I beg accordingly to state, -that I consider slaughtering within the City as both directly and -indirectly prejudicial to the health of the population;--_directly_, -because it loads the air with effluvia of decomposing animal matter, not -only in the immediate vicinity of each slaughter-house, but likewise -along the line of drainage which conveys away its washings and fluid -filth; _indirectly_, because many very offensive and noxious trades are -in close dependence on the slaughtering of cattle, and round about the -original nuisance of the slaughter-house, within as narrow limits of -distance as circumstances allow, you invariably find established the -concomitant and still more grievous nuisances of gut-spinning, -tripe-dressing, bone-boiling, tallow-melting, paunch-cooking, &c. Ready -illustrations of this fact may be found in the gut-scraping sheds of -Harrow-alley, adjoining Butchers’-row, Aldgate; or in the Leadenhall -skin-market, contiguous to the slaughtering places, where the stinking -hides of cattle lie for many hours together, spread out over a large -area of ground, waiting for sale, to the great offence of the -neighbourhood. - -Such evils as those to which I have adverted are inseparable from the -process of slaughtering, however carefully and cleanlily conducted; and -they may easily be aggravated to an unlimited extent by defects in -drainage, in water supply, or in ventilation, or by the slovenly habits -and impunctuality of those to whom the removal of filth and offal is -intrusted. - -In short, I believe it to be quite impossible, so to conduct the process -of slaughtering within the City of London as to remove it from the -category of nuisances, or to render it harmless to the health of the -population; and I believe it to be equally impossible so to superintend -the details of its performance as to prevent them, where -ill-administered, from rising into considerable and fatal importance -among the promoting causes of epidemic and infectious disease. - - * * * * * - -It is scarcely necessary, after this expression of my opinion, that I -should say how strongly I would recommend that measures should be taken -for the discontinuance of all slaughtering within the City; and that, -with the abolition of slaughtering, all establishments which deal with -animal matter approaching putrefaction, and all sheds and stalls for the -continued keeping of cattle, should likewise be prohibited and -suppressed. - -The number of slaughter-houses at present registered and tolerated -within the City amounts to 138, and in 58 of these the slaughtering -occurs in vaults and cellars. How overwhelming an amount of organic -decomposition must be furnished by these establishments, can neither be -estimated nor conceived; but the influence of that decomposition admits -of being measured in its effects on the population, and in the high -zymotic mortality which denotes an atmosphere over-laden with organic -poison. - -Before leaving this subject, I think it right very briefly to allude to -an argument which is often objected to the view here stated. The -objector looks to a particular district, or to a particular -slaughter-house, and says that the mortality of the district is an -average one; or he points to Mr. A. or Mr. B.--the butcher or the -butcher’s man, saying, ‘Who can be healthier than A. or B.? Surely, if -the pursuit be injurious, these men ought to have been poisoned long -ago.’ Now, to this I reply;--first, as regards the men employed in these -crafts, we have no statistics of any value to decide on their mortality, -and judgment on the matter cannot be deduced from some half-dozen cases, -known to any of us individually; but, further, if we admit (which I by -no means know to be the case) that they are persons of average longevity -and healthiness, then it must be remembered that their activity, their -out-door exercise, and, above all, their unlimited supply of animal -food, are circumstances conducing to give them health beyond the average -of their station; and it must be remembered that these palliating -circumstances, though they may counteract the evil for those persons -most nearly concerned in it, contribute nothing towards deodorising the -neighbourhood, or towards preserving its poorer inhabitants from the -depressive influence of putrid emanations. - -And, as regards the district--although we have certain evidence that -organic decomposition is a chief cause of disease, yet we do not -invariably find disease generated in immediate proximity to the source -of nuisance. Drainage beneath the soil, and currents of air above it, -convey the materials of decomposition to a distance; and if the -particular slaughter-houses be placed on a high level amidst the -surrounding City, so that their drainage be effectual and their -ventilation complete, then obviously their influence must be sought for, -not so much in any special aggravation of the local mortality, as in -certain remoter effects of their diffused emanation; in effects, namely, -which are discoverable along their lines of drainage and ventilation, -and in the various consequences of a highly zymotic atmosphere generally -through the entire town. - - * * * * * - -2. With regard to such trades as are considered to be simply offensive, -and where the evidence of injury to health is indirect and uncertain, I -can hardly doubt that a wise legislation would exclude them also from -the circle of the metropolis. Tallow-melting, whalebone-boiling, -gas-making, and various other chemical proceedings, if not absolutely -injurious to life, are nuisances, at least in the ordinary language of -the law, or are apt to become such. It is the common right of the -neighbourhood to breathe an uncontaminated atmosphere; and, with this -common right, such nuisances must, in their several degrees, be -considered to clash. It might be an infraction of personal liberty to -interfere with a proprietor’s right to make offensive smells within the -limits of his own tenement, and for his own separate inhalation; but -surely it is a still greater infraction of personal liberty when the -proprietor, entitled as he is to but the joint use of an atmosphere -which is the common property of his neighbourhood, assumes what is -equivalent to a sole possession of it, and claims the right of diffusing -through it some nauseous effluvium which others, equally with himself, -are thus obliged to inhale. Such, as it appears to me, is the rational -view of this matter; and although I am not prepared to speak of these -trades in the same terms as I applied to slaughtering and its kindred -occupations,--although, that is to say, I cannot speak of them as -injurious to health on any large scale, yet I would respectfully submit -to your Hon. Court that your Act of Parliament empowers you to deal with -such nuisances in respect of their being simply offensive.[20] - - [20] City Sewers Act, 1848, § 113. - - * * * * * - -3. Under the same head, I would likewise beg leave to suggest whether it -might not be practicable for your Hon. Court to regulate the operation -of establishments which evolve large volumes of smoke. The exterior -dirtiness and dinginess of London depend mainly on this cause; and the -same influence, by rendering domestic cleanliness difficult and -expensive, creates an additional impediment to its cultivation. People -naturally despair of cleansing that which a day’s exposure to the -atmosphere blackens again with soot; or they keep their windows shut, -breathing a fusty and unwholesome air, in the hope of excluding the -inconvenience. Now, when it is remembered that all the smoke of London -is but so much wasted fuel, it must surely be felt that the enforcement -of measures for its consumption would be to the interest of all parties; -amply economizing to the manufacturer whatever might be the trifling -expense of appropriate arrangements, while it would relieve the public -of that which, called by the mildest name, is a nuisance and a source of -heavy expense. - - -INTRAMURAL BURIAL. - -IV. The subject of intramural burial is the next on which I have to -report, as affecting the health of the City. - -In compliance with an order of the Health Committee, I have examined as -fully as circumstances would allow into the requirements of the City of -London in respect of burial accommodation, and the result of my inquiry -obliges me to express my conviction, that the City can no longer with -safety or propriety be allowed to furnish intramural interment to its -dead. - -In all those larger parochial burying-grounds where the maintenance of a -right to bury can be considered important,--in all such, and in most -others, too, the soil is saturated and super-saturated with animal -matter undergoing slow decomposition. There are, indeed, few of the -older burial-grounds of the City where the soil does not rise many feet -above its original level, testifying to the large amount of animal -matter which rots beneath the surface. The vaults beneath churches are, -in many instances, similarly overloaded with materials of putrefaction, -and the atmosphere, which should be kept pure, and without admixture for -the living, is hourly tainted with the fœtid emanations of the dead. For -the most part, houses are seen to rise on all sides in immediate -contiguity to the burial-ground, forbidding the possibility of even such -ventilation as might diminish the evil; and the inhabitants of such -houses complain bitterly, as they well may, of the inconvenience which -they suffer from this confined and noxious atmosphere. - - * * * * * - -With respect to burial in vaults, which prevails to a very great and -dangerous extent in this City, I may observe that, among persons who are -ill-informed on the subject, there exist erroneous notions as to the -preservation of bodies under these circumstances. They are supposed, -from the complete closure of their coffins, to remain unchanged for -ages, like the embalmed bodies of Egypt and Peru; or at least--if -perhaps they undergo some interior and invisible change (as the -chrysalis within its sheath) that there is no interference with the -general arrangement, no breach in the compactness of the envelope. -Nothing can be less correct than this supposition. - -It is unnecessary that I should detail to you the process of decay, as -it occurs within the charnel-house; nor need I inquire for your -information whether indeed it be true, as alleged, that part of the duty -of a sexton consists in tapping the recent coffins, so as to facilitate -the escape of gases which otherwise would detonate from their -confinement. It is sufficient to state, that--whether such be or be not -the duty of the functionary in question, the time certainly comes, -sooner or later, when every corpse buried in the vault of a church -spreads the products of its decomposition through the air as freely as -though no shell had enclosed it. It is matter of the utmost notoriety -that, under all ordinary conditions of vault-sepulture, the wooden case -of the coffin speedily decays and crumbles, while the interior leaden -one, bending with the pressure of whatever mass may be above it (or -often with its own weight) yields, bulges, and bursts, as surely as -would a paper hat-box under the weight of a laden portmanteau. - -If the accuracy of this description be doubted, let inquiry be made on a -large scale after the coffins of 40 years back[21]--let it be seen how -many will appear! If, on the contrary, its accuracy be granted, then I -apprehend nothing further need be urged, to establish the importance of -abolishing a system which maintains on so large a scale the open -putrefaction of human remains within places of frequent resort, and in -the midst of populous habitations. - - [21] Perhaps the expressions in my text are somewhat too general; not - indeed as to the fact of the coffins _ultimately_ giving vent to their - fœtid contents (which is the real point at issue) but as to the time - within which this occurs. In the dryer and better kept vaults, a - longer period certainly elapses than that suggested; in the worse, - probably a shorter one. The sooner or later is of little practical - importance: but, on re-perusing my Report, I think it right to add - this qualification.--J. S., 1854. - -It is a very serious matter for consideration, that close beneath the -feet of those who attend the services of their church, there often lies -an almost solid pile of decomposing human remains, co-extensive with the -area of the building, heaped as high as the vaulting will permit, and -generally (as I have shown) but very partially confined. And if it be -the case, as perhaps it may be, that the frequenters of the place of -worship do not complain of any vitiation of their atmosphere, or perhaps -do not experience it, not the less is it true that such a vitiation -occurs, and--whether to the special detriment of the congregation or -not, contributes to the overladen putrefactiveness of our London -atmosphere. - -In respect of such vaults, I do not consider that the mere cessation of -burial in them will be sufficient; seeing that at the present moment -they contain amongst them many thousand coffins, as yet tenanted by the -materials of decomposition; and year after year, if left in their -present state, these will be poisoning the air with successive -instalments of their progressive decay. It seems to me quite -indispensable that some comprehensive measure should be undertaken, for -abolishing at once and for ever all burial within the City of London. -Conjointly with the general application to Parliament, for prohibition -of further intramural sepulture, I would recommend that authority be -obtained by the City for its several parishes to procure the decent -removal to extramural cemeteries of such coffins as already occupy their -vaults; or, failing this measure, I would recommend that all coffins now -lying within vaults, be walled up in their present resting-places with -uniform impermeable masonry. For very obvious reasons, I should prefer -the former plan to the latter.[22] - - [22] Probably the most successful attempt at hermetical enclosure of - organic matters would not reach beyond effecting a postponement of - their diffusion through the atmosphere. The true principles for burial - of the dead lie rather in recognising their decomposition as - inevitable, and in providing only lest it be offensive or injurious to - the living. This is best attained by interment in a well-chosen soil, - at a depth proportioned to the qualities of the ground; with no - pretence of everlasting coffins and impenetrable cerements; but with - ample vegetation above, to relieve the upper earth from whatever - products of decay may mount and mingle there; and especially with - thorough drainage below, so that down-currents of air and rainfall may - freely traverse the putrefactive strata, ventilating and washing the - soil, and diffusing its organic contents through deeper levels, till - their oxidation is complete and their new inodorous combinations are - discharged in watery solution.--J. S., 1854. - -Intramural burial is an evil, no doubt, that varies in its intensity -according to the numbers interred; becoming appreciable in its effects -on health, so far as the rough measure of statistics can inform us, only -when many interments occur annually, or when ground is disturbed wherein -much animal matter had previously been left to decay. But, be the evil -large or little in any particular case, evil undoubtedly it is in all, -and an unmitigated evil. - -The atmosphere in which epidemic and infectious diseases most readily -diffuse their poison and multiply their victims is one, as I have -already often stated, in which organic matters are undergoing -decomposition. Whence these may be derived signifies little. Whether the -matter passing into decay be an accumulation of soaking straw and -cabbage leaves in some miserable cellar, or the garbage of a -slaughter-house, or an overflowing cesspool, or dead dogs floated at -high water into the mouth of a sewer, or stinking fish thrown overboard -in Billingsgate-dock, or the remains of human corpses undergoing their -last chemical changes in consecrated earth, the previous history of the -decomposed material is of no moment whatever. The pathologist knows no -difference of operation between one decaying substance and another; so -soon as he recognises organic matter undergoing decomposition, so soon -he recognises the most fertile soil for the increase of epidemic -diseases; and I may state with certainty, that there are many -churchyards in the City of London where every spadeful of soil turned up -in burial sensibly adds to the amount of animal decomposition which -advances too often inevitably around us. - -Nor can I refrain from adding, as a matter claiming attention, that, in -the performance of intramural interment, there constantly occur -disgusting incidents dependent on overcrowdedness of the burial-ground; -incidents which convert the extremest solemnity of religion into an -occasion for sickness or horror; perhaps mingling with the ritual of the -Church some clamour of gravediggers who have mis-calculated their space; -perhaps diffusing amidst the mourners some nauseous evidence and -conviction, that a prior tenant of the tomb has been prematurely -displaced, or that the spade has impatiently anticipated the slower -dismembering of decay. Cases of this nature are fresh in the memory of -the public; cases of extreme nuisance and brutal desecration in place of -decent and solemn interment; and it is unnecessary that I should revive -the record of transactions inconsistent with even the dawn of -civilisation.[23] - - [23] It happened that during the few months preceding the presentation - of this Report, there had occurred some of the most flagrant and - disgusting illustrations of the evils adverted to.--J. S., 1854. - - * * * * * - -From the circumstances which I have mentioned, it can hardly fail to -appear most desirable to you, that the use of some spacious and open -cemetery at a distance from the City should be substituted for the -present system of intramural interment, and the urgency of this -requirement will be demonstrated all the more cogently, when it is -remembered that the annual amount of mortality in the City averages -above 3000, and that under the present arrangements every dead body -buried within our walls receives its accommodation at the expense of -the living, and to their great detriment. - -In recommending that consideration be given, at as early a period as -possible, to the means for establishing some sufficient municipal -cemetery (a consideration which, for obvious reasons, must be prior to -any Parliamentary proceedings for the prohibition of intramural -interments) there are three points to which, even now, I think it -advisable to advert, as essential to the admissibility of such a plan. I -would submit, first, that the site of any such cemetery must be -sufficiently remote from the metropolis to obviate any repetition of the -present injury to a resident population; and I hardly know how this -purpose can be attained, without going some distance beyond the -immediate suburbs of London as indicated by the Bills of -Mortality:--secondly, that the space required for the proper inhumation -of the dead of the City of London[24] would be not less than 54 acres; -and, thirdly, I would suggest that the charter of such an establishment -ought to contain provisions against the erection of houses within a -certain distance of the burial-ground, so that this may at all times and -under all circumstances be surrounded, exterior to its wall, by a -considerable belt of land totally devoid of resident population. The -absence of such a provision as the last would very soon lead to the -extramural cemetery becoming _intramuralised_ by the growth of a new -suburb around it, and would again evince, by new and unnecessary -illustrations, how incompatible with each other are the Dead and the -Living as tenants of one locality. - - [24] See Special Report on Extramural Interment, page 285. - - -HOUSES PERMANENTLY UNFIT FOR HABITATION. - -V. Under the last heads of my Report I have touched on matters, which -(in so far as they cannot be adjusted without Parliamentary -interference) may be considered to lie beyond the present jurisdiction -of the Commissioners of Sewers; and the topic which I now approach may, -perhaps, be considered equally foreign to the scope of your ordinary -functions. - - * * * * * - -I have to report that there are houses and localities within the City -which are irremediably bad;--places, which the uninterrupted presence of -epidemic disease has stamped as absolutely unfit for human habitation; -places, where drainage and water-supply, indeed, are defective, but -where the perfection of these necessaries might exist, in all -probability, without giving healthiness to the inhabitants. The -predominant evil in the localities referred to is their thorough -impossibility of ventilation. - -While treating of the manner in which noxious emanations are conveyed to -a distance, and are enabled to diffuse their influence over a whole -town, instead of concentrating it in some single slaughter-house or -burial-ground, I indirectly suggested what I have now to illustrate; -that all the evils of all the nuisances in existence acquire their -utmost local intensity of action when the diffusion of their gaseous -products is interfered with, and when, from absence of ventilation, -these are retained in the immediate vicinity of their source. - -The inhabitants of open streets can hardly conceive the complicated -turnings, the narrow inlets, the close parallels of houses, and the high -barriers of light and air, which are the common characteristics of our -courts and alleys, and which give an additional noxiousness even to -their cesspools and their filth. There are very few who, without -personal verification, would credit an account that might be given of -the worst of such dwelling-places. Let any one, however, who would do -full justice to this frightful subject, visit the courts about -Bishopsgate, Aldgate, and the upper portion of Cripplegate, which -present some of the worst, though by no means the only instances of -pestilential residence. A man of ordinary dimensions almost hesitates, -lest he should immovably wedge himself, with whomsoever he may meet, in -the low and narrow crevice which is called the entrance to some such -court or alley; and, having passed that ordeal, he finds himself as in a -well, with little light, with less ventilation, amid a dense population -of human beings, with an atmosphere hardly respirable from its closeness -and pollution. The stranger, during his visit, feels his breathing -constrained, as though he were in a diving-bell; and experiences -afterwards a sensible and immediate relief as he emerges again into the -comparatively open street. - -Now, I am prepared to show that there are many, very many, courts within -the City, to which the above description accurately applies; courts and -alleys hemmed in on all sides by higher houses; having no possibility of -any current of air; and (worst of all) sometimes so constructed back to -back, as to forbid the advantage of double windows or back doors, and -thus to render the house as perfectly a _cul-de-sac_ out of the court, -as the court is a _cul-de-sac_ out of the next thoroughfare. - - * * * * * - -It is surely superfluous to observe, that these local conditions are -utterly incompatible with health. Among their dense population, it is -rare to see any other appearance than that of squalid sickness and -misery; and the children, who are reproduced with the fertility of a -rabbit-warren, perish in early infancy. In the worst localities probably -not more than half the children born survive their fifth year, and of -the 3763 deaths registered last year in the City of London generally, -1410 were at or under seven years of age. - -The diseases of these localities are well marked. Scrofula more or less -completely blights all that are born: often extinguishing life -prematurely; in childhood, by hydrocephalus; in youth, by pulmonary and -renal affections, which you read of as consumption and dropsy; often -scarring and maiming where it does not kill, and rendering life -miserable by blindness, decrepitude, or deformity; often prolonging -itself as a hereditary curse in the misbegotten offspring of those who, -under such unnatural conditions, attain to maturity and procreation. - -Typhus prevails there too, not as an occasional visitor, but as an -habitual pestilence. - -It is impossible for me, by numbers, to give you an exact knowledge of -the fatality of such spots; because, in the greater part of the City, -hospitals, dispensaries, and private practice, divide with the -parochial officers the treatment of the sick, and diminish the returns -of sickness which those officers would otherwise have to show. But this -I may tell you, as an illustration of what I mean;--that in the few -houses of Seven-Step-alley and its two offsets, (Amelia-place and -Turner-square,) there occurred last year 163 parochial cases of fever; -in Prince’s-place and Prince’s-square, 176 cases--think, Gentlemen, if -this had occurred in Southampton-place and Russell-square! that behind -the east side of Bishopsgate, in the very small distance from -Widegate-street to New-street, there were 126 cases; that behind the -west side, from Primrose-street to Half-moon-street, there were 245 -cases; that the parish of Cripplegate had 354 cases over and above the -number (probably a very large one) treated by private practitioners, by -hospitals, and especially by dispensaries. Similarly, though with less -perfect information, I am enabled to trace fever to a terrible extent in -very many other localities of the City, even on the verge of its better -residences, and close behind its wealthiest thoroughfares; in -Plumtree-court, in Plough-court and place, in Poppin’s-court, -Neville’s-court, Blackhorse-alley, Union-court, Plough-court in Holborn, -Field-lane; in the courts right and left of King-street, Smithfield, in -Hanging-sword-alley and its vicinity, in Peahen-court, in Bell-alley and -its neighbourhood, in Priest’s-alley, in Beer-lane, in Friar’s-alley, in -Bromley’s-buildings, and in the whole large space which stretches from -Ludgate-hill to beside the river. - -And in most of these localities, in addition to other sanitary errors, -there predominates that particular one to which I am now inviting your -attention--the absence, namely, of sufficient ventilation. - -It was in districts such as these, that in the year 1665, the Great -Plague of London found the readiest facilities for its reception; and it -was by the destruction of such districts that the Great Fire of the -following year rendered the utmost conceivable service to the sanitary -progress of the people, and completed their emancipation from the -horrors of an unparalleled pestilence. Long intervening years have -sufficed to reconstruct these miserable habitations almost after their -first type, and to re-exemplify all the evils which belong to them; so -completely indeed, that if the infection of that same plague should -light again amongst us, I scarcely know why it might not traverse the -City and decimate its population as quickly and as virulently as before. -Meanwhile, however, typhus with its kindred disorders, and the -occasional epidemics of influenza and cholera, maintain their attachment -to the soil, and require no further re-inforcement from the pestilence -of other climates. From these fatal diseases we no longer hope to be -rescued by the recurrence of the former casualty. The almost two -centuries which have elapsed since the period referred to, have taught -men better methods than a general conflagration for remedying such -evils; and it is a satisfaction to believe that the wisdom and humanity -of the Corporation of the City of London will apply those methods with -effect. - -As a palliative measure, applicable in many of the least aggravated -instances, I may suggest the removal of unnecessary walls which -intercept the current of air from place to place; the formation of -counter-openings in various blind courts; and, not least, in regard of -many houses thus situated, the admission of light and air by additional -windows. I cannot pass this portion of the subject without recording my -opinion that the operation of the window-tax is in direct opposition to -the sanitary interests of the people; and I must venture to express my -hope that some different method of assessment may presently be adopted, -in place of one which presses on the occupier in proportion to the -healthiness of his tenement.[25] I think it very desirable, indeed -almost indispensable, that your Hon. Court should have the power, under -certain circumstances, to order and enforce the opening of additional -windows in houses occupied by large numbers of persons, when your -Officer of Health may report their ventilation defective; and if it -should seem expedient to you to seek this authority from the -Legislature, it might with the greatest advantage be accompanied by some -concession from her Majesty’s Government, to the effect that the -formation of additional windows, occurring thus under your orders for -the immediate necessities of health and life, should not occasion any -further assessment on the occupiers of the house. - - [25] I ought not to pass this page without a grateful mention of Lord - Duncan’s name in connexion with the removal of the Window Tax, at - length happily effected. It remains, however, greatly to be desired, - in respect of certain specifiable houses inhabited by the poorer - classes, that Local Boards of Health should have power to enforce - improvements of ventilation.--J. S., 1854. - - * * * * * - -But, Gentlemen, within the City of London there exist, to a very large -extent, architectural evils for which no such palliative treatment is -possible; evils against which I would venture to say (borrowing a -metaphor from my profession) that no safety can be found except in -amputation. - -To dwell in hovels like pits, low-sunken between high houses, hemmed in -by barriers which exclude every breath of direct ventilation--this can -never be otherwise than a cause of sickness and mortality to those whose -necessities allot them such residence; and, if it be an incontrovertible -fact that subsistence in closed courts is an unhealthy and short-lived -subsistence in comparison with that of the dwellers in open streets, -then, I apprehend, it cannot be doubted that such a manner of life ought -to be dealt with as a great evil, and ought as much as possible to be -interrupted. - -A surveyor’s inspection of the City would reveal to you many places -answering to the description I have given; places to which no -ventilation could arrive except by removal of whole streets of houses -which wall them in. - -To remove the well-constructed houses of the City, in order that its -wretched courts and alleys should participate in the blessings of light -and air, might seem one method of conquering the difficulty which is -before you; but I apprehend the opposite alternative, of proceeding to a -gradual suppression of all residence in the former class of dwellings, -may more naturally have your approbation. - -To the latter aim, sooner or later, the sanitary efforts of the -Corporation must be directed. - -There are many parts of the City where great and immediate advantage -would arise from an expenditure of money applied solely to the purpose -of destruction; parts, where the purchase of an entire court, or series -of courts, for the sole object of pulling down houses, and leaving open -spaces in their stead, would be the cheapest as well as the most -effective manner of dealing with their sanitary difficulties. And I have -earnestly to suggest for your consideration, that proceedings of this -nature will require to be pursued to a very great extent, and at a large -annual expense, within the City, before the cleanliness and habitability -of its poorer localities will stand in their legitimate proportion to -the modern stateliness of thoroughfare and grandeur of public buildings -which attest the magnificence of the Corporation. - -I would, therefore, beg to recommend that a survey be made of the worst -districts which I have specified, with a view to the immediate purchase -and destruction of some considerable portion of the court-property lying -in them; and, still more, I would urge that this is an exertion, which -for some years must proceed systematically, in order to thin the density -of a population which now breeds pestilence and augments mortality by -its overcrowding and excess. - -I am aware that considerable difficulties lie in the way of -accomplishing an object of this sort with immediate rapidity. It is my -great hope, however, that the principle may be distinctly recognised; -and that the City will not tolerate within its municipal jurisdiction -the continuance of houses absolutely incompatible with healthy -habitation. This principle being once established, and a certain annual -expenditure devoted to enforce it, I feel assured that within a few -years opportunities will have arisen for that outlay to have been made -in the most judicious manner, and for its results amply to have -demonstrated the advantages of the system which I recommend. - - -SOCIAL CONDITION OF THE POOR. - -VI. Last, and not least, among the influences prejudicial to health in -the City of London, as elsewhere, must be reckoned the social condition -of the lower classes; and I refer to this the more especially, because -often, in discussion of sanitary subjects before your Hon. Court, the -filthy, or slovenly, or improvident, or destructive, or intemperate, or -dishonest habits of these classes, are cited as an explanation of the -inefficiency of measures designed for their advantage. It is constantly -urged, that to bring improved domestic arrangements within the reach of -such persons is a waste and a folly; that if you give them a -coal-scuttle, a washing-basin, and a watercloset, these several utensils -will be applied indifferently to the purposes of each other, or one to -the purposes of all; and that meanwhile the objects of your charitable -solicitude will remain in the same unredeemed lowness and misery as -before. Now it is unquestionable, and I admit it,--that in houses -containing all the sanitary evils which I have enumerated--undrained, -and waterless, and unventilated--there do dwell whole hordes of persons, -who struggle so little in self-defence against that which surrounds -them, that they may be considered almost indifferent to its existence, -or almost acclimated to endure its continuance. It is too true that, -among these classes, there are swarms of men and women, who have yet to -learn that human beings should dwell differently from cattle; swarms, to -whom personal cleanliness is utterly unknown; swarms, by whom delicacy -and decency in their social relations are quite unconceived. Men and -women, boys and girls, in scores of each, using jointly one single -common privy; grown persons of both sexes sleeping in common with their -married parents; a woman suffering travail in the midst of the males and -females of three several families of fellow-lodgers in a single room; an -adult son sharing his mother’s bed during her confinement;--such are -instances recently within my knowledge (and I might easily adduce -others) of the degree and of the manner in which a people may relapse -into the habits of savage life, when their domestic condition is -neglected, and when they are suffered to habituate themselves to the -uttermost depths of physical obscenity and degradation. - -Here again, as in an earlier part of my Report, I think it requisite to -remark, that I do not mean in any degree to suggest that the evils -adverted to present themselves within the City to a greater extent than -in sundry other parts of the metropolis. My sphere of duty lies within -the City boundary, and it would be an impertinence in me to comment, -either favourably or unfavourably, on districts which lie within another -jurisdiction than that of the Commission which I have the honour to -address. Simply to guard myself against the possibility of being -misunderstood, I again draw attention to the fact that I studiously -refrain from instituting comparisons with other metropolitan localities. -Let me likewise observe that I am far from insinuating, or suspecting, -that the majority of the poorer population of the city has fallen to -that extreme debasement which I have just illustrated as affecting some -portion (perhaps not an inconsiderable portion) of the poorest; but I -dare not suppress my knowledge that such instances exist, nor can I -refrain from stating my belief, that ignorance and poverty will soon -contribute to increase them, if sanitary and social improvement do not -co-operate against their continuance. - -Contemplating such cases, I feel the deepest conviction that no sanitary -system can be adequate to the requirements of the time, or can cure -those radical evils which infest the under-framework of society, unless -the importance be distinctly recognised, and the duty manfully -undertaken, of improving the social condition of the poor. - -Those who suffer under the calamitous sanitary conditions which I have -disclosed, have been led, perhaps, to consider them as inseparable from -poverty; and after their long habituation to such influences, who can -wonder if personal and moral degradation conform them more and more to -the physical debasement of their abode? In the midst of inevitable -domestic filth, who can wonder that personal cleanliness should be -neglected? In an atmosphere which forbids the breath to be drawn freely, -which maintains habitual ill health, which depresses all the natural -spring and buoyancy of life, who can wonder that frequent recourse -should be had to stimulants, which, however pernicious in themselves, -still for a moment dispel the malarious languor of the place, give -temporary vigour to the brain, and cheer the flagging pulses of a -poisoned circulation? Who can wonder that habits of improvidence and -recklessness should arise in a population, which not only has much -ignorance and prejudice amongst it, but is likewise often unaccustomed -to consideration and kindness? Who can wonder that the laws of society -should at times be forgotten by those whom the eye of society habitually -overlooks, and whom the heart of society often appears to discard? - -I believe that now there is a very growing feeling abroad, that the poor -of a Christian country can no longer, in their own ignorance and -helplessness, be suffered to encounter all the chances which accompany -destitution, and which link it often indissolubly to recklessness, -profligacy, and perdition. The task of interfering in behalf of these -classes, however insensible they may be of their own danger and frequent -degradation, begins at length to be recognised as an obligation of -society; and as such an interference may be fraught with the utmost -advantage to sanitary progress, I shall now proceed to point out the -manner in which, with this view only, it may most usefully and most -humanely be made. - -First of all I would point out to you, that within your Act of -Parliament there are contained some enactments on this subject which -might be of great value, were it not for their very limited -application:--‘Whereas the owners and keepers of lodging-houses of an -inferior description, for the accommodation of mendicants, strangers, -and other persons for the night, or other short periods, allow the same -to be crowded, by receiving more lodgers than such lodging-houses are -adapted to contain with a due regard to health,’ therefore, and for some -other reasons enumerated in the 91st clause, it is enacted that you may -require the registration, and may order the periodical inspection of -such houses; that you may from time to time fix and determine the number -of lodgers who may be accommodated in each lodging-house; that you may -issue ‘rules or instructions regarding health, cleanliness, and -ventilation;’ that you may ‘order that a ticket, containing the number -of lodgers for which the house is registered,’ together with your rules -and regulations, ‘shall be hung up, or placed in a conspicuous part of -each room into which lodgers are received;’ and finally, ‘that if any -keeper of such lodging-house shall offend against any of these -provisions, he shall be liable for each such offence to a penalty not -exceeding 5_l._, and the like penalty for every day after the first upon -which any such offence shall be continued.’ The spirit of these -enactments is excellent; but unhappily the definition given at the end -of the clause excludes from the operation of the law those very cases -which most need to fall within it. ‘Common lodging-house’ (it runs) -‘shall, for the purposes of this act, mean any public lodging-house, not -being a licensed victualling-house, in which persons are harboured or -lodged for hire, for a single night, or for less than a week at one -time, or in which any room is let for hire to be occupied by more than -one family at one time.’ Lodging-houses, according to this definition, -are (I am informed) hardly to be found within the City of London; and -the clause has remained, and seems in its present form likely to remain, -quite inoperative. If, in any future renewal or amendment of your Act, -the definition could be modified in such a manner, that the powers given -in respect of lodging-houses should be extended to all the poorer -tenements of the City, where the several floors are let separately at a -weekly rent, the clause in question would be rendered one of the most -serviceable in the Act, and one of the most general application. In its -present form, the clause barely enables you to deal with the temporary -bed-accommodation of trampers and vagrants,--a class happily not very -numerous in the City; while, modified in the manner I suggest, it would -put under your sanitary regulation the whole household economy of the -permanent industrial population of the City; and, if effectively worked, -would conduce beyond all estimation to the physical, social, and moral -improvement of that class. - - * * * * * - -Secondly, and as a matter of even higher importance, I would beg you to -consider the incalculable good which may be conferred on the poorer -classes of society, by the direct educational influence of those in -better and more enlightened circumstances than their own. When I say -that all the social errors to which I now more particularly refer, would -gradually but swiftly vanish under the influence of education, I do not -mean that the cure would lie in learning to read and to write and to -sum:--though these attainments, of course, would largely increase the -power, usefulness, and market value of their possessor. The education to -which I refer, as an all-important influence for sanitary progress, is -that which would consist in exhibiting to the lowest classes of society -frequent practical evidences of the attainability and the advantages of -higher civilization; an education which, by model and examples, would -lead them to know cleanliness from dirt, decency from grossness, human -propriety from brutish self-abandonment; an education which, by sensible -experience, would teach them to feel the comfort and the profit of -sanitary observances, and would apply their instinct of -self-preservation to the deliberate avoidance of disease. - -It is in this point of view, gentlemen, that I would solicit your -attention to the useful and philanthropic exertions of three societies -which have been established during the last few years, with the object -of improving the condition of the labouring classes; and I would venture -to suggest that the course which those societies have adopted in various -parts of the metropolis, is one that might with the utmost advantage be -pursued within the City of London. - -The establishment of _Model Dwelling_ and _Lodging-houses_, and of -_Public Baths_ and _Laundries_, for the use of the labouring population, -is now no longer a matter of recent speculation. Under the beneficent -auspices of the Societies to which I have referred, the following -experiments have been tried:-- - -The Committee for promoting the establishment of Baths and Wash-houses, -having at first Mr. W. Cotton, and then Sir H. Dukinfield, for its -Chairman, and including in its number, with other influential persons, -several members of this Corporation, founded, at great pains and -expense, a model institution at Goulston-square, Whitechapel. In spite -of many circumstances conspiring to render this first and experimental -establishment particularly expensive, it has more than supported itself -by the small payments of the poor; and its arrangements are sufficiently -extensive for it to have given in one day as many as 932 baths. This -fact, having occurred in the first year of its establishment, shows how -much the poor must have appreciated the additional comfort placed within -their reach; and I may add that, from the first opening of the building, -the annual receipts have been progressively on the increase. Somewhat -earlier, and under the influence of the same parent-committee, though -specially directed by a branch-committee, a similar establishment was -founded in George-street, Euston-square. During the year 1848 the number -of payments made here for bathing was 111,788; the number of payments -for washing in the laundries, 246,760. This establishment has not only -proved self-supporting, but has been enabled to accumulate a large -surplus, which is now being applied to enlarge and improve the building. -At Glasshouse-yard, near the entrance to the London Docks, there has -been founded, on the same model, a small establishment of free baths and -washhouses for the destitute poor. It was opened in May, 1845. In the -first year the baths given amounted to 27,662; the usings of the laundry -to 35,840; and its total working expenses were covered by £378. - -No language, however eloquent--no comment, however instructive, could -equal the significance of the figures which I have cited as illustrating -the great utility of these institutions; and, as regards their pecuniary -success, it is impossible to furnish you with better testimony than is -comprised in the fact, that the Guardians of the Poor in a great -metropolitan parish[26] have recently, out of the poor-rates, founded an -institution of this nature. They have become witnesses to the financial -economy of that sanitary and social boon. In their establishment, which -is not only self-supporting, but amply remunerative, the poor are -enabled to have baths at an expense of a penny for a cold bath, and -twopence for a warm bath; and the women are enabled to do their washing, -ironing, and drying, with an unlimited water-supply, and with other -arrangements of most admirable completeness, at an expense of only -twopence for the first two hours, during which they occupy the separate -chambers allotted to them. A very considerable proportion of the expense -is covered by the receipts for baths given at the higher price of -sixpence, and with some additional luxuries, to persons of a higher -grade in society than those who use the ordinary baths; the former, -though used by a different class of persons, being sought with almost as -much avidity as the latter. - - [26] St. Martin’s in the Fields. - -In the sanitary point of view, I probably need not insist much on the -advantages which these establishments have conferred. You will hardly -doubt how good and wholesome a thing it has been for so many thousands -to have had the means of cleanliness; who, in the absence of such -facilities, must often have carried about their persons accumulations -that one sickens to think of; and whose narrow, crowded chambers must -constantly have steamed with wash-tubs, and been hung round with reeking -clothes. - - * * * * * - -Next, very briefly, let me allude to what has been done in respect of -the habitations of the poor; first, by the Society for the Improvement -of the Condition of the Labouring Classes, under the patronage of their -Majesties the Queen and the Queen Dowager, with the Prince Albert for -its President, and Lord Ashley for its Chairman; secondly, by the -Metropolitan Association for Improving the Dwellings of the Industrious -Classes, under the Chairmanship of Sir Ralph Howard, and with a -committee which, like that of the former society, includes many of the -best and wisest, as well as the highest persons of the country. Under -the influence of these societies the following experiments have been -made:-- - -In the Old Pancras-road a very large building has been erected, to -accommodate 110 families separately and distinctly, in sets of two and -three rooms each. Each set of rooms has its own boiler, range, oven, and -coalbox; its separate scullery, in which are sink, cistern, and -dust-shaft; its own watercloset, its own ample supply of water, and many -other conveniences. The rents vary from 3_s._ 6_d._ to 5_s._ per week -for a set of two rooms; and from 4_s._ 9_d._ to 6_s._ 3_d._ for a set of -three rooms. The founders of this establishment have recently purchased -land at the end of Spicer-street, Spitalfields, on which to erect a -lodging-house for 300 single men, and also houses for families. - -In the Lower-road, Pentonville, houses of three different classes have -been built, on the same general principle of furnishing every -convenience and sanitary requisite. They accommodate, on the whole, 23 -families and 30 single women--widows, or of advanced age. The entire -houses for families, with all the above-mentioned conveniences, are at a -rent of 6_s._, having a good-sized living room, two bedrooms, with -additional enclosed recesses for children’s beds, a yard at the back of -the house, and the joint use of a wash-house and drying yard. A floor of -two rooms is rented at 3_s._ 6_d._, and a single room by a single person -at 1_s._ 6_d._ - -In George-street, St. Giles’s, a model lodging-house has been -established, affording accommodation to 104 single men, and combining -everything essential to such an establishment. The ventilation and -drainage have been carefully attended to; an ample supply of water is -provided, gas extends through the house, the dormitories are arranged so -as to keep their inmates private from each other; there are -washing-closets fitted up with every requisite for cleanliness; there is -a bath-room supplied with hot and cold water; there are a kitchen and -wash-house furnished with all appropriate utensils, a pantry-hatch, with -separate, ventilated, and secure compartments for the food of each -inmate; in the pay-office is a small well-selected library, for the -service of the lodgers, and the use of a spacious coffee-room is -likewise for their common convenience. Their pay is 4_d._ per night, or -2_s._ a week--an amount little above the ordinary rent paid for the most -miserable accommodation in a trampers’ lodging-house. - -At 76, Hatton-garden, a lodging-house for 57 single women has recently -been opened, consisting of three floors of dormitories, divided into -separate compartments, and a basement fitted up with kitchen, washhouse, -bath, pantry, safes, &c. - -In Charles-street, Drury-lane, three tenements, originally separate, -have been converted into a single lodging-house for 82 single men, on -the same general plan and at the same rent as that in George-street, St. -Giles’s. - -All the lodging-houses are furnished; and the inmates are supplied with -utensils for their food and other purposes, which must be returned, or -made good, at their leaving. - -In all these lodging-houses rules exist for the purpose of insuring -cleanliness, sobriety, carefulness, and general propriety of conduct; -any infraction of which subjects the offender to immediate expulsion. -For the sake of those who choose to avail themselves of the opportunity, -Scripture readings are appointed to take place in the common room every -evening at 9 o’clock; and copies of the Scriptures, with other -well-chosen books, are left in charge of the superintendent for -distribution among the lodgers, in the hope that they may thus be -induced to occupy their leisure to advantage. - -In the construction of all these establishments, equally, the greatest -pains have been taken to bring sanitary science to bear on the comfort, -and convenience, and health of the inmates. Ventilation, drainage, -facilities for decency and for cleanliness, have in every instance been -made the leading considerations of the architect.[27] - - [27] The advantages of these admirable institutions may now be spoken - of from longer experience. In a very remarkable pamphlet just - published by Dr. Southwood Smith, _On the Results of Sanitary - Improvement_, it is recorded that there has been no case of typhus - fever in any one of the model-dwellings since they were first opened, - and that their exemption from cholera has been as complete as from - typhus. In the Metropolitan Buildings, during three years, the average - annual mortality has been only 1·36 per cent. For a lower class of - population, very similar advantages have been procured by the - regulations of the Common Lodging-House Act. Dr. Smith mentions that - in 1308 regulated metropolitan lodging-houses (numbering at least - 25,000 lodgers) there had not occurred a single case of fever during - the quarter ending the 23rd of October; yet, before they were under - regulation, twenty cases of fever have been received into the London - Fever Hospital from some one single house in the course of a few - weeks.--J. S., 1854. - - * * * * * - -In regard of these model houses and model lodgings, it would, I think, -be a great error to estimate their benefit as merely relative to the -number of persons at any one time inmates of them. No doubt it is a -great advantage that they furnish, at the ordinary prices of the day, or -at a still lower price, so excellent accommodation to several hundreds -of persons; and it is a still greater good (particularly in regard of -those established for single men and single women) that they drill their -inmates into decent and orderly habits, and accustom them to a high -standard of household-accommodation, which will probably influence their -subsequent married lives in the same desirable direction. But, -indirectly, their utility has a far wider scope. They stand in bright -contrast to the dark features of filth and unwholesomeness which environ -them; they familiarise the poorest classes generally with all the -practical advantages of cleanliness; they show that dirt is not -inevitable; they therefore create and foster among the humblest members -of society, a laudable discontent with defective sanitary arrangements; -and they establish a strong public opinion, grounded on experience, in -favour of those conditions of cleanliness and comfort, which determine -the maintenance of health. - - * * * * * - -That all the great results of sanitary science can be applied in their -utmost perfectness to the dwellings of the poor, for the payment of a -rent often below, and never above, the average given for some miserable -doghole, that poisons its inhabitants, is a truth of immense importance, -deserving the widest dissemination, and pregnant with the most hopeful -promise. Such advantages spring from and illustrate the economical -application of the associative principle; they cannot be obtained -otherwise than by the application of capital, in such an amount as lies -only within the compass of wealthy corporations, or is reached by the -voluntary combination of several private purses. While the labouring -classes are abundantly able to maintain these institutions when -established, and to render them amply remunerative to those whose -capital has first founded them, it is obvious that no power of -association lying within their means can suffice to originate such work. - -The task of initiation rests with others. And therefore it is, -gentlemen, that on this occasion I have been induced to bring under your -notice, as a most important part of my subject, the outline of what has -been done in the matter of Model Dwellings and Public Baths and -Washhouses. Feeling assured that establishments of this nature are of -infinite utility in the several respects I have enumerated; feeling -assured that, beyond their immediate operation on the health of inmates -and users, they also tend, by their indirect educational influence, to -improve the social habits, to promote the civilization, to elevate the -general tone and character of the labouring classes, I earnestly -recommend them to your attention; hoping that you may either yourselves -confer on the poor population of the City the advantage of your -patronage and succour in this respect, or else may transfer the matter -to the jurisdiction of the Common Council, with all the influence and -authority in its favour which your recommendation would insure. - - -SUGGESTIONS FOR SANITARY ORGANISATION IN THE CITY. - -Having now enumerated the sanitary evils of the City, and the remedies -which appear to my mind most appropriate for their removal, it becomes -desirable that, in concluding, I should point out to you the -organisation which seems necessary to be adopted during the gradual -transition of the City from its present to a healthier state;--an -organisation which may render this transitional period as short as -possible, and may most effectually contribute to mitigate, for the time, -the pressure of such evils as cannot immediately be removed. - - * * * * * - -The object of this organisation lies in a word; Inspection--gentlemen, -inspection of the most constant, most searching, most intelligent, and -most trustworthy kind, is that in which the provisional management of -our sanitary affairs must essentially consist. - -I presume I may take for granted that, in some form or other, a -_Committee of Health_ will exist, either as a Committee of the Court of -Common Council, or as one of this Hon. Court. I may, perhaps, further -assume that such a Committee will have authority to entertain all -subjects relative to the sanitary improvement of the City, and to make -thereon such recommendations as shall seem fit to them; and, further, -that they will make it their business to receive periodical -intelligence, as complete as possible, on all variations in the public -health, and on all circumstances likely to affect it. - - * * * * * - -In order that any Committee, acting for sanitary purposes within the -City, shall have a reasonable chance of success in its endeavours for -the public good, the following means of information will be necessary -for its use:-- - - * * * * * - -1. That an account should be kept, corrected year by year, of every -house within the City; as to the area of building, the number of floors, -rooms, and windows; as to its ventilation; as to its drainage, -water-supply, and other facilities for cleanliness; as to its method of -occupation, and number of inhabitants: - - * * * * * - -2. That from this account there should be made out, at least twice -yearly, a list of houses and streets remaining in an objectionable -sanitary state; and a list, also, of such as may have been remedied to -the satisfaction of the Committee since the formation of their last -preceding list: - - * * * * * - -3. That, while trades injurious to health or offensive to their -neighbourhood are suffered to continue within the City, there should be -given periodical reports on the condition of such establishments, to the -end that they may be so maintained as to be least detrimental to the -public health: - - * * * * * - -4. That a record of every death registered as occurring in the -population of the City should lie before the Committee; and - - * * * * * - -5. I consider it quite indispensable, that they should likewise receive -the largest and most accurate returns which can be procured of all -sickness occurring among the poorer classes; and (particularly in -respect of all epidemic, endemic, and infectious disorders) that the -medical practitioner who communicates the fact of illness, should -likewise report the existence of any local causes, or other influences -of general operation, which have tended to produce, or are tending to -continue, such illness. - - * * * * * - -On the subject of returns of the nature last referred to, I have -already, on various occasions, submitted my opinion to the judgment of -your Hon. Court. A year ago, in the first Report which I had the honour -to make here, and in various discussions which during some months -followed the reception of that Report, I stated how necessary I deemed -such returns, for the purpose of guiding and justifying the various -recommendations which it would become my duty to lay before you. The -period which has since elapsed, including its three months of -pestilence, has furnished me with the strongest confirmation of those -views. As I formerly stated by anticipation, so now I repeat from -experience, that nothing deserving the name of sanitary administration -can exist in the City, without accurate periodical intelligence of all -such sickness (at least) as comes under parochial treatment; or without -such reports on the local sanitary conditions, and on other causes of -disease, as were desired to accompany that intelligence. - -When the matter was previously under your consideration, it was argued -that the reception of such intelligence formed no part of your functions -as a Commission for draining, lighting, paving, and cleansing the City -of London; that all sanitary matters, beyond these and the like, were -foreign to your proper sphere of operation; and that your funds, raised -by rates from the citizens of London, could not with propriety be -applied to meet the expenses of such an arrangement. On this question of -jurisdiction and finance I shall, of course, hazard no opinion. I would -simply beg to repeat, with regard to so much of the matter as lies -within my own professional province, that the intelligence in question -is absolutely necessary for the present progress of sanitary measures -within the City; that no Health-Committee can exist for a month without -it; nor can any officer, having proper respect for his character, -consent to be considered responsible for the health of a population, -whose illnesses he learns only from their posthumous record in the -death-register. - -During the recent prevalence of cholera, the Health-Committee of the -Common Council complied for the time with my recommendation, and -established a system of daily reports, rendered still more serviceable -by free personal intercourse between myself and the several gentlemen -having medical charge of the three City unions. What needed to be daily -during a period of pestilence, might fitly become a weekly communication -at all other times. I have already reported to the Health-Committee, and -I beg to reiterate here, that the advantages derived from that system of -communication were such as could have been attained in no other way. - -I may remind you that each of the gentlemen referred to, serving under -the Poor Law, works within a certain small and definite district; that -he is therefore peculiarly competent to speak on the state of the -population in that district, on their habits and necessities, on their -customary condition of health, and on their liability to epidemic -disease; and that the total staff of these officers, taken collectively, -representing the medical practice of the whole city, can supply exactly -that kind of detailed and precise information which is most serviceable -to your Officer of Health, in guiding him to those more general and -comprehensive conclusions which it is his business to lay before you. -These gentlemen are the habitual medical attendants of the poorer -classes; day by day, in the unobtrusive beneficence of their calling, -they pass from house to house, and from court to court--the constant -recipients of complaint, or the constant observers of ground of -complaint--amid all that destitute population on whose condition you -require to be informed. They are in the constant presence of the -pestilences which reign in our worst localities; they are the chief -treaters of endemic disease within the City--of that disease which, by -its proportion, measures the success of sanitary changes, or indicates -their failure; and it has been the professional education of these -gentlemen, as it is their business, to trace such effects to their -causes. Their reports would be the authenticated statements of -experienced medical practitioners, familiarly conversant with their -several respective localities. - -If it were your wish and object, with utter indifference to expense, to -organise the best scheme for procuring to yourselves from time to time a -succession of accurate and trustworthy reports on the state of health, -and condition of dwellings, in the several districts of the City;--if -you were willing to engage a large number of non-medical persons who -should give their whole time to the duty of exploring and reporting on -that state, I am persuaded that this expensive and cumbrous proceeding -would have a smaller measure of success than that which I submit to you, -and which consists essentially in availing yourselves of the local -knowledge and daily observations of a staff of officers, already -organised and in active occupation for the very purposes in question. - -That such intelligence, embracing weekly returns from the eleven -parochial surgeons of the City of London, and including their comments -on the local causes of prevailing disease, would involve an annual -expenditure of money,[28]--and that this expenditure, sooner or later, -and in some form or other, would be derived from the rate-paying portion -of the community, are facts which cannot be doubted. But that the -expenditure would be a judicious one; that it is indispensable to the -effective working of any Health-Committee, or any Health-Officer within -the City; that it would be the first step to the mitigation of the -disorders reported on; that it would disclose evils which else must -escape recognition and remedy; that in a few years it would render our -general mortality of 3 per cent. on the entire population of the City a -matter of history and a warning, instead of its being, as now, a present -and awful reality; that in lessening sickness and death, it would stay -a large source of pauperism, would diminish the number of occasional and -habitual claimants of Union relief, and would become a measure of real -and considerable economy;--these are points on which, with the utmost -sense of official responsibility, I beg to record my deliberate -conviction. - - [28] When the matter was last under consideration of the - Commissioners, it appeared that the expense of such an arrangement - would be about £250 annually.--J. S., 1854. - -Accordingly, I have to recommend that any Committee, which may undertake -the administration of sanitary affairs for the City, shall be furnished -as completely as possible with information of the nature I have -specified. - - * * * * * - -Another element to which I think it necessary to advert, in connexion -with a future sanitary organisation for the City, is this,--that some -permanent arrangement should be made, by which the maintenance of -exterior and interior cleanliness, the enforcement of scavengers’ -duties, the suppression of nuisances, and the like, should be brought -under habitual and systematic surveillance; one, by which all breaches -of your present or future sanitary regulations may be quickly detected, -and may be visited with their appropriate penalties as speedily and as -certainly as possible. I am induced the rather to bring this subject -before you, as complaints of scavengers’ duties being neglected have -reached me at every turn. I am informed that it is usual for them to -refuse to remove dirt and rubbish from houses, according to the terms of -their contract, except on the tenants’ payment of an additional -gratuity; and it must be obvious to your Hon. Court that the -arrangements which you have made by contract for this purpose are -virtually defeated, as regards the poorer population, when the removal -of refuse-matter is made contingent on the gift of beer-money by those -whose means are so restricted. - -It is in respect of matters of this sort, and of such only, that I think -the services of the Police-Force might usefully be employed. Their want -of special education, and their employment in other duties, are -circumstances which appear to me quite conclusive for objecting to their -utilisation as sanitary reporters. But while I entertain the opinion -that their employment in the latter direction would be both fruitless -and inconvenient, I would submit that their numbers and their diffusion -through the City qualify them well to act against all causers of -nuisance, as they act against other offenders, both detectively and -preventively; and I would venture to repeat a suggestion, which I made -in January last, ‘that the police should consider it part of their duty, -to report on every nuisance within their knowledge, and on every -infraction of such sanitary rules as this Court may establish.’ - - * * * * * - -Here, Gentlemen, terminates the list of subjects which, on this -occasion, I have thought it my duty to bring before you. Long as the -enumeration may have appeared, I can assure you that my present Report -bears a small proportion, in point of dimensions, to the very large and -very various mass of materials on which it is founded. In compressing it -within the narrowest limits consistent with intelligibility, and in -excluding from it nearly all details on the matters treated of, I have -consulted the convenience of your Hon. Court, notwithstanding the -greater labour and difficulty of execution which belong to the plan I -have adopted. At any time, in Court or in Committee, when you may wish -to pursue the subject, I shall be ready to enter at far greater length, -and with more elaborate minuteness, on any of those subjects which, at -the present opportunity, I have only sketched for your general -information. - - * * * * * - -In the matters which I have enumerated, some lie distinctly within your -province, as assigned by the Act of Parliament; while others may be -thought to lie, just as distinctly, without that province. In affairs -strictly under your jurisdiction, and within the present scope of the -law, there remains very much to achieve. The complete enforcement of -house-drainage, till every house washes itself into the sewer; the more -general distribution of water, till every individual within the City has -an abundant supply within his immediate reach; the effective -preservation of public cleanliness; the construction and maintenance of -sewerage, paving, lighting, for all the streets, courts and passages of -this great City;--these constitute an immense amount of responsibility -and labour. Those other objects to which I have referred, are partly -such as cannot be accomplished without the further interference of the -Legislature. It is a point solely for the discretion of your Hon. Court -to determine, how far you may be willing to enlarge the sphere of your -sanitary operations, and to undertake the difficulties of a new -campaign. - - * * * * * - -To your Officer of Health the Act of Parliament allows no such option. -‘Whereas the health of the population, especially of the poorer -classes, is frequently injured by the prevalence of epidemical and other -disorders,’ therefore it is appointed for his duty that he shall report -on whatsoever ‘injuriously affects the health of the inhabitants of the -City,’ and that he shall ‘point out the most efficacious mode of -checking or preventing the spread of contagious or other epidemic -disease.’ Actuated by obligation of the duty thus expressed in your Act -of Parliament, after full reflection on all that those expressions -imply, and with the deepest sense of the responsibility belonging to one -who is honoured with the task of advising the first Corporation of the -country in respect of its sanitary proceedings, I have been compelled, -in the course of my present Report, to trench upon many subjects which -do not customarily fall under your consideration, and which (as I have -stated) may by some be considered as utterly foreign to your -jurisdiction and province. - -It rests with your Hon. Court to determine what course you will adopt in -respect of such departments of the great sanitary scheme;--whether you -will retain them under your consideration, and will assume the -responsibility of dealing with them in proportion to their magnitude and -importance, or will transfer them to the Court of Common Council for the -less restricted deliberation of that body. - -Let me once more declare my profound conviction of their importance to -the health and welfare of the City. - -To provide an inoffensive outfall for the sewerage of our vast -population; to render the river a source of unqualified advantage; to -give wide extension and sounder principles to the system of -water-supply; to suppress all trades and occupations which taint the -atmosphere with materials of organic decomposition; to abate the -nuisance of smoke; to provide the facilities for extramural interment, -and to procure the prohibition of all further burial amidst our living; -to improve the domestic arrangements of the poor, and to insure for them -an adequate supervision; to establish public baths and laundries, which -may offer the utmost facilities and inducement for the maintenance of -personal cleanliness; to hinder the occupation of houses which breed -pestilence; to destroy such as are irremediably hostile to health, and -to disperse the stifled population of courts and alleys; to substitute -for such slums as we hope to depopulate and destroy, but in open streets -and with perfect ventilation, houses and lodgings, which not only shall -offer to the labouring classes every convenience essential to health and -decency and comfort, but shall likewise serve as models of household -economy for the whole district in which they stand;--these, Gentlemen, -are the aims, briefly recapitulated, for the sake of which I have been -obliged, as it were casually in my Report, to touch on many subjects -perhaps foreign to your jurisdiction, but lying at least on the confines -of your province, and remaining with you now either to retain or to -transfer.[29] - - [29] Perhaps, to make these passages intelligible, the reader should - be apprised that the business of the Corporation is considered in a - great variety of Committees, which thus have their several and - particular provinces. Of the many matters adverted to, as foreign to - the ordinary functions of the Commission of Sewers, some might belong - to the _City-Lands_ Committee, some to the _Improvement_, some to the - _Finance_, some to the _Navigation_, some to the _Markets_ Committee, - and so on. Obviously it would have been out of my place to touch on - these details of jurisdiction; and I therefore urged only the - essentially _municipal_ character of the several improvements I - advocated.--J. S., 1854. - - * * * * * - -That the subject of sanitary improvement in its widest scope, and with -all that even incidentally relates to it, is one which, according to the -ancient constitution of the City, rightfully belongs to the authorities -of the Corporation, in some one or other of their municipal -relations--that it belongs to them equally as their privilege and their -duty, cannot for a moment be questioned. And if your Hon. Court should -determine on a negative opinion as regards yourselves, and should decide -on transferring these matters to the Common Council, I venture to hope -that your influence may accompany them in their course, and may procure -for them the consideration they deserve. - - * * * * * - -Gentlemen, the history of the City of London is full of great examples -of public service. It records many a generous struggle for the Country -and for the Constitution; it records a noble patronage of arts and -letters; it records imperial magnificence and Christian liberality; but -never, within the scope of its annals, has the Corporation had so grand -an opportunity as now for the achievement of an unlimited good. Because -of the City’s illustrious history, and because of the vast wealth and -power which have enabled it so often to undertake the largest measures -of public utility and patriotism,--therefore it is, that the -expectations of the country may well be fixed on the City of London in -regard of this, the distinguishing movement of modern times--the -movement to improve the social condition, and to prolong the lives of -the poor. - -Those who are familiar with the many abiding monuments of your civic -munificence and splendor, may well expect that, in approaching this -all-important question, the counsels of the City will be swayed by high -and generous considerations. - -In the great objects which sanitary science proposes to itself,--in the -immense amelioration which it proffers to the physical, to the social, -and indirectly to the moral condition of an immense majority of our -fellow-creatures, it transcends the importance of all other sciences, -and in its beneficent operation seems most nearly to embody the spirit -and to fulfil the intentions of practical Christianity. - -Ignorant men may sneer at its pretensions; weak and timorous men may -hesitate to commit themselves to its principles, so large in their -application; selfish men may shrink from the labour of change, which its -recognition must entail; wicked men may turn indifferently from -considering that which concerns the health and happiness of millions of -their fellow-creatures. To such men an appeal would indeed be useless. -But, to the Corporation of the City of London--whether as assembled in -its entire Parliament, or as represented within the confines of this -Court--to the Corporation which, on so many occasions, has attained -patriotic ends by great expenditure and sacrifice; to men earnest, -strong-minded, and practical, having much consideration for their -fellow-creatures, and having little consideration for personal toil or -municipal expense, so only that they may fulfil a great Christian duty, -and may confirm the gratitude with which history records their frequent -services to our kind;--to such a Corporation, and to such men, the -Country looks for the perfection of a sanitary scheme which shall serve -as model and example to other municipal bodies undertaking the same -responsibility; and to such a Corporation and to such men do I, -likewise, your Officer of Health, respectfully and confidently address a -well-founded appeal. - - I have the honour, - - &c., &c. - - - - -FURTHER REMARKS ON WATER-SUPPLY. - - - ADDRESSED TO THE HEALTH-COMMITTEE OF THE HON. THE COMMISSIONERS OF - SEWERS OF THE CITY OF LONDON, PURSUANT TO A REFERENCE-- - - “_What would be a sufficient supply of water to the houses and - premises within the City, and the best principle upon which to effect - such supply?_” - - _February 21, 1850._ - - GENTLEMEN, - - Such further observations on the subject of ‘Water-Supply to the City’ - as you have desired me to lay before you, I have now the honor to - submit, in as condensed a form as possible. - - * * * * * - -First, I may remind you, that in my report of last November, which still -remains under your consideration, I stated the following ‘as the chief -conditions in respect of Water-Supply, which peremptorily require to be -fulfilled. - -‘1. That every house should be separately supplied with water; and that, -where the house is a lodging-house, or where the several floors are let -as separate tenements, the supply of water should extend to each -inhabited floor. - -‘2. That every privy should have a supply of water, applicable as often -as it may be required, and sufficient in volume to effect at each -application a thorough flushing and purification of the discharge-pipe -of the privy. - -‘3. That in every court, at the point remotest from the sewer-grating, -there should be a stand-cock for the cleansing of the court; and - -‘4. That at all these points there should always and uninterruptedly be -a sufficiency of water to fulfil all reasonable requirements of the -population.’ - -In re-organising the system of water-supply there are some other -purposes, of a more public nature than these, which would likewise claim -your attention: such as (1) an improved arrangement for meeting all -accidents and emergencies of fire; (2) an efficient distribution of -water to all common urinals and privies; (3) a sufficiency of supply for -any public baths and wash-houses, which may be hereafter erected; and -(4) an ample surplus to be at the disposal of the Commission for the -cleansing of streets and sewers. - - * * * * * - -In order that those domestic purposes, which I first enumerated, should -be adequately fulfilled, the supply of water ought, practically -speaking, to be without limit to any individual consumer. It is the -tendency of the system of constant supply, and constitutes a -distinguishing advantage of that system, that it fulfils this important -condition without any increase, or perhaps rather with a diminution, of -the total draught of water for a large population. - -The average of requirement (estimated from the consumption of large -communities) would probably be about 12 gallons per person per diem; -making an amount, for the total population of the City, of about 1½ -million gallons per diem. Assuming this estimate to be correct, a point -which I would beg you to observe is the following: that, although there -might be very little fluctuation in the _total quantity consumed_, and -although it might remain constant at the figure I have given, yet in the -items of individual consumption, making up this gross amount, there -would be almost infinite varieties. One family would habitually consume -twice as much water as another family of the same size: one family would -consume six gallons per person on five days of the week, and would -require all its remaining quota on the other two days; and so forth. -These differences and caprices of individual requirement do not sensibly -affect the total quantity consumed in a given week by a population of -130,000 persons; one consuming more, another less, the first -counterbalances the last in forming the materials for a fair personal -average; and a source of supply calculated from such an average for a -large population would, practically speaking, be unlimited to each -individual consumer, provided only that it were so distributed, that -each consumer could draw from the common stock at his own time and -according to his own necessity. This advantage is obviously lost under -the present system of intermittent supply, which compels a larger total -distribution than would else be requisite, entails the expensive and -unwholesome necessity for storage, and yet is notoriously fraught with -the inconveniences of a restricted source, or a defective supply. - -I have no sufficient data for judging with precision what quantity of -water might be required to fulfil all those public purposes of -cleanliness and of protection from fire, to which I have adverted. The -supply would require to be _practically_ inexhaustible; but the -consumption, on an average of the four seasons, would probably lie -considerably within half a million of gallons per diem. - -When the distribution of water is brought into its proper relations with -the drainage of the City--that is, when the arrangements of domestic -drainage are completed, in conformity with the intentions of the Act of -Parliament, and when all the water, distributed for private consumption, -is made to traverse and to cleanse all the channels of house-drainage, -it is probable that a smaller quantity of water than is now consumed -will suffice for the flushing of sewers, and for other so-called -sanitary purposes. - -The quantity at present supplied to the City by its two Water-Companies -is perhaps much in excess of the two millions of gallons per diem, which -I have estimated as a sufficiency for our population; but the -distribution is so unequal, and the waste of the intermittent system so -incalculably great, that the effect produced on the population is, to a -very great extent, that of scarcity. - - * * * * * - -With regard to the _principle of supply_ on which I have been desired to -report, it seems certain to my mind, from such evidence as I can collect -on the subject, that the system of continuous supply at high-pressure -promises advantages which can never be realized under the present system -of intermittent supply. There are many matters connected with the -comparison of these two systems, which lie beyond my sphere of -professional observation, and on which I would not be bold enough to -offer any opinion to your Committee. The sanitary points, on which alone -I would venture to insist, as benefits in the system of continuous -supply, are--first, the practical inexhaustibility of the source, and -secondly, the absence of necessity for storage. If these benefits are -attainable, and especially if (as alleged) they can be obtained at a -material economy of expenditure, as compared with the present system, -there can be little doubt as to which should obtain the preference. - -If your Committee should wish, it would be easy to prepare for your -examination a digested summary of such scientific evidence as has been -given on these points: or it might be expedient, if such a course would -be more satisfactory to you, that some person in your confidence should -undertake to visit and inspect one or more of the towns where the -system of continuous supply is in operation, and where direct -information can be gathered on the very important particulars of its -practical efficiency and success. But, at all events, whether your -Committee should wish or should not wish this personal investigation to -be undertaken, I would suggest, that it might be satisfactory to you and -serviceable to the inquiry in which you are engaged, if you would -procure a report from some eminent hydraulic engineer, practically -conversant with the system of continuous supply, who might furnish you -with conclusive testimony as to the admissibility of this system within -the City, and as to the advantages and disadvantages, sanitary and -economical, which might attend its adoption here, as compared with that -which has hitherto prevailed. - -It appears to me that at the present time the system of continuous -supply might, provisionally, receive a fair trial in the City, in -respect of some of those poorer habitations, which are now for the first -time about to be supplied with water and drainage. The Water-Companies -would probably not object, if desired by the Commission, to supply a -hundred houses, experimentally, with constant pressure from their mains. -The Commission might select for its experiment some of those courts -about Cripplegate or Bishopsgate, where the drainage, as well as the -water-supply, requires to be constructed anew: some, where there have -hitherto been undrained cesspools, and where the water-supply has been -from a stand-cock. Should this suggestion be found feasible, I would -recommend that the details of its execution should be carried out under -the joint superintendence of your Surveyor and myself, and that we -should afterwards report to you its results, as material for guiding -your decision with regard to the general supply of the City. - -Mr. Quick, Engineer to the Southwark Water-Works, in a letter which is -appended to Sir William Clay’s pamphlet, has recently suggested various -arrangements for an uninterrupted supply, and these have no doubt been -under your Surveyor’s consideration. I may add, too, that there are at -present upwards of 40 houses within the City constantly supplied from -the mains of the East London Water-Works; but as these are not houses of -the poorest description, it is possible that they may not constitute so -satisfactory a proof of the feasibility of the constant supply, or so -complete an illustration of the detailed arrangements for its -employment, as could be given by the experimental construction I have -suggested. - -While the supply remains, as at present, an interrupted one for the City -generally, I would recommend that the Commission should procure from the -Water-Companies an arrangement for the delivery to occur, under no -circumstances, less than daily; and that Sunday should form no exception -to this arrangement. Many tenants of the Water Companies at present -receive their supply only on alternate days, Sunday counting as a _dies -non_, so that a necessity is entailed in such cases for a three days’ -storage of water. - - * * * * * - -Whether the _quality_ of water supplied to the City by the existing -Companies is such as it ought to be, or whether some purer source of -supply may be found; whether their neglect of filtration, -notwithstanding the important weight of testimony given in its favor, be -not a serious dereliction of their duty to the public; whether the -sanitary interests of the consumers of this first necessary of life can -be properly protected, while at variance with those of the great trading -companies which hold a virtual monopoly of the supply; whether it would -not be an immense boon to the Citizens of London, that the control of -the water-supply should be vested in the same jurisdiction as the -drainage, paving, and sanitary cleansing of the district; are questions -which have forced themselves closely on my attention while considering -the sanitary affairs of the City, and on which I hope shortly to lay -some special observations before this Committee or before the Court. - -I defer dwelling on these subjects at present, partly because they were -not mentioned in your Committee’s specific reference; partly because I -think it desirable to wait for the issue of the experiment which I have -suggested with regard to the competing system of supply; and partly -because I have reason to know that at the present moment a very -extensive series of chemical investigations is proceeding under orders -of the Government, with a view to ascertain the purest possible sources -for the water-supply of the metropolis. The results of this inquiry, so -far as they have transpired, appear to me so infinitely important in -their relation to some of the questions just alluded to, that I think it -expedient under the circumstances to wait for such new light as may -accrue to our knowledge from the completion of these researches, before -I touch the chemical division of the subject. - - I have, &c. &c. - - - - -SECOND ANNUAL REPORT. - - - TO THE HON. THE COMMISSIONERS OF SEWERS OF THE CITY OF LONDON. - - _November 26th, 1850._ - - GENTLEMEN, - -In obedience to that clause in your Act of Parliament under which my -office is constituted, and which enjoins on your Officer of Health that -he shall ‘report periodically upon the Sanitary condition of the City,’ -I now submit to your Hon. Court my annual statement on this subject. - - -I. MORTALITY OF THE CITY OF LONDON. - -During the fifty-two weeks, dated from September 30th, 1849, to -September 28th, 1850, there died of the population under your charge -2752 persons. The rate of mortality, estimated from these _data_, for a -population[30] of 125,500, would indicate somewhat less than twenty-two -deaths (21·92) out of every thousand living persons. - - [30] With the required correction for increase of population, the - death-rate was probably about 21·25 _per_ 1000. - -Last year it was my painful duty to record the ravages of pestilence, -then indeed hardly terminated, under the pressure of which our general -death-rate had arisen to the alarming height of thirty in the thousand. -On this present occasion, I have the happier task of laying before you -the evidences of a mortality lessened considerably below its habitual -average; and I rejoice in congratulating your Hon. Court on the -testimony thus borne to the success of your sanitary exertions. For -although, without question, some large share of this striking -improvement may have depended on circumstances beyond our cognizance or -control; although it may in part be but an instance of that tendency to -periodical alternations of activity and repose which we recognise in -disease, as in other operations of nature; although I should be -over-sanguine if I believed, and premature if I stated, that your -sanitary measures during the past twelve months had wrought such a -change in the City as to ensure a continuance of this year’s comparative -healthfulness; yet I may venture without hesitation to assure you, that -the labours of the Commission have been fruitful of real and -demonstrable advantage to the health of the people; that a sensible -diminution has occurred in the physical causes of disease; and that, -from various and disinterested sources, I hear grateful mention of -improvements which you have effected. - -In confirmation of this assurance, I may inform your Hon. Court that, in -collecting my materials for the present statement, I solicited from the -Union-Surgeons of the whole City of London certain particulars of -information which they were peculiarly able to furnish; I inquired of -them, namely, whether, during the past year, there had prevailed among -the poorer classes in their several districts more or less than the -ordinary pressure of epidemic, endemic, and infectious disease; and -whether, in case of such difference having been observed, they could -refer it, either for better or worse, to any changes recently wrought -in the physical conditions of their respective neighbourhoods. They have -had the kindness to furnish me with the information requested of them; -and their replies testify with remarkable uniformity, both to the -abatement of disease within their several provinces of practice, and to -the considerable dependence of that improved condition of health on -sanitary works effected under your auspices. - - * * * * * - -In order to form a correct estimate of the average mortality in any -district, it is indispensable that one’s records should extend over many -years. Thus only is it that fallacies can be avoided which arise from -the alternate pressure and remittance of epidemic disease. The havoc -effected by a periodical visitation of influenza, cholera, or plague, -varies, in like manner as the ordinary death-rate varies, in different -localities; and its variation contributes importantly to fix the -healthiness or unhealthiness of such localities. But obviously, if we -wish for practical purposes to calculate an annual rate of mortality, -and to decide, in respect of any district, what are the chances of life -for its population, we must distribute the peculiar mortality of the -pestilence-period over those years which intervene between visitations -of the pestilence. - -Hitherto, in respect of the City of London, I have the record of only -two years; two years differing from one another in the proportion of 30 -to 22, and the mean mortality deduced from that biennial period would be -26 per thousand per annum.[31] I am, of course, unable to tell you with -certainty whether that ratio be the true average death-rate of the City; -but I incline to believe that an average calculated from a longer -period, with less abrupt fluctuations, would give a lower figure as the -accurate one. - - [31] On account of corrections already adverted to, this mean - death-rate should be reduced, probably to 25.2. - -In future years, so long as I may have the honour of reporting to the -Commission, I purpose proceeding, step by step, to the construction of a -cyclical average from the materials which will constantly be increasing; -and I trust that many years may elapse before any approach shall again -be made to the high death-rate with which the cycle commenced. - -It may be useful, for the sake of comparison, that I should remind your -Hon. Court of some of the more important differences which prevail -throughout the country, in regard to the local rates of mortality. The -extreme rates recorded in the Registrar-General’s last publication, -relating to the septennial period 1838-44, give 14 per thousand per -annum as the lowest average, and 33½ as the highest average, for a -population male and female in equal proportion. The low average belongs -to a district in Northumberland, numbering 27-28,000 inhabitants; the -high average is assigned to Liverpool. For the whole south-east division -of England (comprising more than a million and a half of inhabitants) -the death-rate is but 19; while in parts of the division it falls very -considerably below this average. I have thrown these and some similar -comparisons into a tabular form, which may perhaps be interesting to -you.[32] - - [32] Vide page 84. - -Possibly it may occur to you that these comparisons are devoid of -practical application--that it is unreasonable to suppose we can -mitigate our London death-rate to the likeness of a selected country -mortality--that the circumstances of the two populations are essentially -and unalterably dissimilar--that the advantages of the one cannot be -given to the other--that the traditional ‘threescore years and ten’ of -human life are allotted only to rustic existence--that the right of -participating in the higher civilisation of the metropolis, or of -trading in its larger market, is not too dearly purchased by the tax of -half or a third of one’s fair expectation of life. - -On general grounds I should not hesitate to combat this objection, and -should feel sure of convincing you of its invalidity. I should argue (as -indeed I have already argued here) that the main conditions which -constitute the unhealthiness of towns are definite, palpable, removable -evils; that dense over-crowding of a population--that intricate -ramification of courts and alleys, excluding light and air--that -defective drainage--that the products of organic decomposition--that -contaminated water and a stinking atmosphere, are distinct causes of -disease and death; that each admits of being definitely estimated in its -numerical proportion to the total mortality which it contributes to -cause; that each is susceptible of abatement or removal, which will at -once be followed by diminution of its alleged effects on the health of -the population. Likewise, I should argue, that if there indeed exist, -attached to a metropolitan residence, some really unavoidable and -necessary disadvantages to life (a point which however I am not prepared -to concede) there are likewise, as respects the poor, some peculiar -advantages to counterbalance those evils; that in urban communities the -operations of charitable relief are largest and least remitting; that -the resources of medicine for curing what cannot be prevented are -likewise readiest and most effective. - -On all these general grounds I should be prepared to maintain that a -lowness of mortality which has been attained in any considerable rustic -population, may be attained by an urban population, if only the -removable evils be removed, if only the practicable good be made -practical. - -Surely too, above all, I would maintain this possibility in respect of -our capital--the treasury as she is of all means for progress in -civilisation, the stronghold of all applicable knowledge. Let but the -wealth, the science, the energy, and the benevolence of the metropolis -deal with removable causes of death as they have dealt with subjects -infinitely more difficult, infinitely less promising, and certainly of -not greater importance; and few competent persons will doubt that the -mortality of London might speedily be reduced to the level of any -district-mortality yet recorded by the Registrar-General. - -There may be those in your Hon. Court who will hesitate to accept for -themselves the firm conviction which I entertain on this subject; or -who, at least, will withhold their assent from the line of argument -which I have advanced. To them, what I have now to state may be more -conclusive than any other consideration: viz., during the year on which -I am reporting, there was one sub-district of the City of London -Union--one comprising from twelve to thirteen thousand inhabitants, in -which (after including a due proportion of deaths which had occurred in -the union-workhouse at Mile-end) the mortality stood only at 15 in the -thousand; one in which, if those extramural deaths had been excluded, -the local death-rate for the year would have been only 13·32.[33] - - [33] These figures require some correction for decrease of population - in the sub-district referred to: the death-rate, inclusive of - workhouse mortality, was nearly 16, and exclusive of that mortality, - nearly 14 _per_ thousand.--J. S., 1854. - -For an illustration of low and enviable death-rates, I need then no -longer appeal to Northumberland, or to our south-eastern -counties--though, no doubt, their septennial periods of low mortality -are valuable corroborations of any inference which could be drawn from -our more restricted experience;--but I may point to the last year’s -death-rate in the north-west sub-district of the City of London Union as -one of rare excellence, and may content myself with wishing that that -partial rate might become universal for the City, and might be the -permanent expression of its average mortality. - -A detailed consideration of our sickness and mortality during the last -year suggests to me a few other remarks, which may, I think, be of -practical utility to your Hon. Court. - -First, as regards the ages at which death occurs; the respective -proportions of _timely_ and _untimely_ deaths may, generally speaking, -be inferred from the local death-rates. In general terms, we know a high -death-rate indicates that many die before their time--indicates that a -proportion of the population, more or less considerable, instead of -reaching old age, becomes prematurely blighted and extinguished. In -order to illustrate this subject to you more exactly, I append a table -in which the deaths of the last two years are classified according to -the ages at which they occurred. Of 3763 persons whose deaths are -recorded in my last Report, 1243 died under the age of five years: of -2752 deaths registered in the present year, 1032 belong to the same -early period of life. - -The City of London appears peculiarly fatal to infant life. Reference to -the Registrar-General’s last septennial record shows that of every 1000 -male children under five years of age within the City of London -(aggregately) nearly 113 die in each year; and the portion of this rate -which is deduced from the East and West London Unions is as high as 119 -in the thousand. In the subjoined table,[34] which illustrates some -points of comparative mortality, I have endeavoured to show the extreme -and disproportionate amount of this pressure on infant life. In -referring (for instance, in regard of the City of London Union) to the -last three columns of that table, you will observe that the mortality of -children at the age stated, during the septennial period, was 1/2·66 of -the entire mortality, although their class numerically constituted only -1/11·09 of the entire population; so that they died at more than four -times (4·17) the rate which would have fallen to them as simple -participators in the average mortality of their district. The actual -infant mortality of the past year holds the same proportion to the -general mortality as in the Registrar-General’s septennial period, being -1/2·66 of the whole. - - [34] - - +--------------+---------+--------+----------+----------+-----------+ - | Places. | General | Death- | Out of | Out of | By what | - | | death- | rate | entire | entire | multiple | - | | rate | _per_ | living | mortality| is the | - | | _per_ |thousand|population| what | mortality | - | | thousand| _per | what |proportion|of children| - | | _per | annum_ |proportion| occurs | under five| - | | annum_. |of male | is under | under | years in | - | | |children|five years|five years| excess of | - | | | under | of age? | of age? |the average| - | | | five | | | mortality | - | | | years | | | of all | - | | | of age.| | | ages? | - +--------------+---------+--------+----------+----------+-----------+ - |City of London| | | | | | - |Union | 21 | 101 | 1/11·09 | 1/2·66 | 4·17 | - |E. and W. Lon-| | | | | | - |don Union | 26¾ | 101 | 1/9·02 | 1/2·24 | 4·02 | - |Metropolis | 25 | 93 | 1/8·45 | 1/2·45 | 3·45 | - |Holborn | 26 | 115 | 1/8·98 | 1/2·20 | 4·08 | - |St. Giles | 27 | 122 | 1/9·85 | 1/2·24 | 4·39 | - |St. Martin | 24 | 120 | 1/10·64 | 1/2·42 | 4·39 | - |Bristol | 29 | 107 | 1/8·73 | 1/2·53 | 3·45 | - |Liverpool | 33 | 143 | 1/7·35 | 1/1·91 | 3·85 | - |Lancashire | 26¾ | 102 | 1/7·19 | 1/2·02 | 3·56 | - |Surrey | 18 | 48 | 1/7·98 | 1/3·22 | 2·48 | - |South-east | | | | | | - |divn. of | | | | | | - |England | 19 | 52 | 1/7·76 | 1/3·03 | 2·56 | - |Glendale } | | | | | | - |Bellingham } | 14 | 28 | 1/10·32 | 1/3·99 | 2·58 | - |Haltwhistle } | | | | | | - +--------------+---------+--------+----------+----------+-----------+ - -Lest any undue importance should be ascribed to the influence of bad or -inappropriate articles of diet in producing this large infant mortality, -I may inform you that the rate of death is highest during that very -early period of life when the child depends for nourishment on its -mother; so that, of a thousand male children in the first year of life -there die within the district of the City of London Union 242; within -that of the East and West London Unions, 276. - -The causes which thus decimate the young population of London are the -common conditions of district unhealthiness--the conditions which it -lies within the scope of sanitary legislation to amend. But, inasmuch as -the few days of these wretched children are passed mainly within doors, -so their high mortality constitutes the readiest and least fallacious -evidence of the unwholesomeness of the dwellings in which they die: and -hence I am acquainted with no correcter material for estimating the -sanitary condition of a district than is afforded by the death-rate of -its infant population. - -Secondly, with regard to the alleged _particular causes of death_; I -have extracted from our general registry, and have grouped in a separate -table, those cases of death from acute disease which seem peculiarly due -to physical causes affecting large numbers of persons. - -There are deaths by cholera, epidemic diarrhœa, and dysentery, of which -during the biennial period we have had nearly 900; by fever, of which we -have had 284; by erysipelas and puerperal fever, of which we have had -84; by small-pox, of which we have had 50; and cases of this sort -partake of the nature of deaths by violence, not only because they are -abrupt and untimely, but because they are _avoidable_. If in the -instances which I have specified it were possible to make inquiry into -the antecedent circumstances of the dead, you would find irrefragable -evidence that life was lost in each individual instance by the operation -of removable causes--by the foolhardy neglect of some familiar -precaution, or by the obstinate retention of some notorious ill. The -death of a child by small-pox would in most instances call for a verdict -of ‘homicide by omission’ against the parent who had neglected daily -opportunities of giving it immunity from that disease by the simple -process of vaccination; the death of an adult by typhus would commonly -justify still stronger condemnation (though with more difficulty of -fixing and proportioning the particular responsibility) against those -who ignore the duties of property, and who knowingly let, for the -occupation of the poor, dwellings unfit even for brute tenants, -dwellings absolutely incompatible with health. In addition to the -diseases which I have named, there are others which owe their chief -malignity and numerical largeness of fatality, though not their -existence, to local and removable causes. The proportionate mortality -from scarlatina, measles, and hooping-cough, is greatest when the -general death-rate is greatest. Under similar circumstances, too, we -find among the infant population a frequency and fatality of other -diseases, not commonly accounted specific, which warrant us in -considering them to be mainly of endemic and avoidable origin. Such are -the hydrocephalus and convulsions, the diarrhœa, bronchitis, and -pneumonia of infants; often indeed referred to the irritation of -teething, but prevailing in different localities with so marked a -proportion to the causes of other endemic disease that we may be sure of -their partial and considerable dependence on those local and obviable -causes. I dwell on this aspect of the subject, and particularly invite -the attention of your Hon. Court to the table[35] which illustrates it, -because it is in respect of these diseases that your exertions have -already effected valuable improvements for the health of the City, and -because the future registry of such cases will attest year by year the -further progress of your sanitary reforms. In examining this index of -preventable deaths you will notice that those from fever are fewer by 29 -_per cent._ in the year just terminated than in the previous twelve -months; that those from scarlatina are 75 _per cent._ fewer; those from -infantile zymotic disorders nearly 40 _per cent._ fewer; those from -erysipelas and puerperal fever 9 _per cent._ fewer. Small-pox, it is -true, is doubled; but the prevention of this disease rests, out of your -jurisdiction, in the exercise of individual discretion. Under the item -of infantile diarrhœa (included in the tenth column) there is likewise -an increase of nearly a third;[36] an exception probably dependent on -the fact that, during last year, many deaths which might have swelled -this column were (on account of the then prevalent influence) catalogued -under the head of epidemic diarrhœa or cholera. - - [35] _Appendix_, No. IX. - - [36] In the column referred to, this is concealed by the marked - diminution, during the present year, of other disorders classed with - infantile diarrhœa. Their reduction maintains the total of that column - (notwithstanding the difference of diarrhœa) considerably less for - this year than for last. - -I should be misleading your Hon. Court, and practising a deception which -next year’s registry would expose, if I pretended that the striking -difference between the two years’ several totals of preventable deaths -(a difference which, leaving cholera out of the question, probably -amounts to a diminution of 30 _per cent._ on the sum of last year) had -resulted wholly, or even chiefly, from sanitary improvement, and could -be interpreted as the evidence of permanent physical changes around the -dwellings of our poorer population. I guard you against this impression -now, because, however satisfactory it might be as a momentary belief, it -would lead to subsequent disappointment; and any future rise in the -proportion of these deaths would induce the erroneous, but -disheartening, supposition that your later sanitary steps had been less -successful than the first. In all these matters, and especially in -analysing the details of a death-registry, it is requisite (as I have -already stated) to deal with cycles of many years. Periods of -pestilence are habitually followed by periods of diminished mortality: -partly because population is diminished, and especially that share of -the population which suffers most from obviable causes of disease; -partly because the great alarm of death has induced vigilance and -precaution, public and private, against the occasions and beginnings of -illness. And, beyond both these circumstances, there are others which we -cannot analyse or explain, though we have scientific certainty of their -operation; circumstances which seem to ensure a comparative quiescence -of the ordinary causes of zymotic disease during those periods which -next succeed the prevalence of certain fatal epidemics.[37] - - [37] For the professional reader I may here throw out a - hint--referring to the doctrine of epidemic disease stated in the - Fifth Annual Report, that this apparent healthiness of districts after - certain epidemic invasions probably bears relation to a temporary - exhaustion of their zymotic atmosphere under the action of a specific - ferment, and is in some respects analogous to that immunity from an - infected fever which belongs to an individual who has recently - suffered its attack. See also page 235.--J. S., 1854. - -Nevertheless, that the sanitary condition of the City has undergone -considerable improvement within the last two years is a fact which no -one can gainsay; and that a considerable share of the mitigation in -mortality arises from this improvement cannot reasonably be questioned. -If even a third of the mitigation in question, if a reduction of ten -_per cent._ on the preventable mortality of the City, may be inferred -from the materials which I lay before you, it is indeed matter for the -utmost congratulation; and a continuance of the same reduction year by -year, perpetuated (as doubtlessly it may be) by a continuance of the -same exertions, would soon raise the City of London above all fear of -comparison, on the ground of healthiness, with urban or suburban -populations. - -Thirdly, I would beg the attention of your Hon. Court to those very -important _local differences_ of death-rate which may be deduced from a -study of our death-register. I have already had the pleasure of citing -to you the low rate of mortality which has prevailed during the last -year in the north-west sub-district of the City of London Union. The -rate of death in the north division of the West London Union was nearly -double that proportion; and between these extreme terms of disparity -there were many intermediate degrees. - -Similar inequalities of mortality were observable in last year’s record. -In the healthiest sub-district of the City the year’s death-rate was -about 22 in the thousand; while in the worst it stood above 41; and for -the whole West London Union exceeded 38.[38] - - [38] I have here availed myself of the corrections given in the note - of page 6. - -Mainly and essentially these local differences of mortality depend on -the proportion in which _preventable deaths_ enter into the total; the -differences, however partial, depending on the operation within certain -districts, of removable deleterious influences which do not exist in -certain other districts. - -In classifying for your consideration the deaths which, during the last -two years, have depended on epidemic, endemic, and infectious diseases, -I have thought it desirable to distribute them according to the -municipal divisions of the City. Strongly believing, as I have -endeavoured to express, that this class of deaths is for the main part -preventable, I have thought it would interest the representatives of the -several Wards, and would more directly enlist their sympathies for -sanitary progress, if I could enable them at a glance to recognise the -ratio in which their respective constituencies contribute to this annual -death-roll. I have included in the table, under eight different heads, -all those acute diseases which depend in an important degree on local -causation, either for their existence or for their fatality. It will be -obvious, even to the unprofessional reader, that local causes are not of -equal prevalence in respect of all the diseases there tabulated. Some -(as fever and cholera) would not be known at all under perfect sanitary -arrangements; others (as scarlatina, measles, and hooping-cough) would -be far less malignant in their attacks; others (as those classified in -the tenth and twelfth columns) would no doubt exist under the most -perfect physical circumstances, but would probably prevail in numbers -quite inconsiderable as compared with those actually observed. - -On consulting this table[39], it will be observed that in _Cordwainers_’ -Ward, during the last year, not a single death occurred from the causes -referred to, and in the preceding year of epidemic visitation, only -five; that in _Cornhill_ Ward there have been only two such deaths in -each of these years; that in _Coleman-street_ they have been 66; in -_Queenhithe_, 59; in _Portsoken_, 143; in _Aldersgate Within_, 30; in -_Aldersgate Without_, 179; in _Cripplegate Within_, 80; in _Cripplegate -Without_, 299; in _Bishopsgate Within_, 60; in _Bishopsgate Without_, -329; in _Farringdon Within_, 153; in _Farringdon Without_, 845. - - [39] Page 167. - -I am unable to state with accuracy, in these several instances, what -proportion subsists between the preventable mortality and the number of -living persons, for I have no means of ascertaining precisely the -population of the separate Wards; and without this knowledge it is -impossible to arrange them in a scale of comparative healthiness. I need -hardly remind your Hon. Court that the Wards differ very considerably in -their magnitude; so that the largest majority of cases occurring in one -Ward (as in Farringdon Without) must not unconditionally be taken to -imply that the Ward, _in proportion to its population_, suffers more -deaths than one in which the apparent number is less considerable. In -the table to which these remarks refer, I have endeavoured to give you -the means of comparing (at least approximatively) the healthiness of -your several departments, by entering against the name of each Ward the -number of holdings for which it stands assessed to your rate. This -entry, with some trifling modifications specified in the table, may be -taken to express the number of houses contained in each Ward of the -City: thus it furnishes indirectly the means for estimating the local -population. - -It will be noticed, that the more glaring inequalities which I have -adduced are in some degree due to the epidemic of last year, which did -not press uniformly on all parts of the City. It may, however, likewise -be observed, that the chief operation of that epidemic was to -exaggerate, but not importantly to misrepresent, the features of each -locality; that the habitual sanitary proportions of districts to each -other were for the most part preserved; that (with a qualification to -which I shall presently revert) the Wards numbering fewest deaths last -year numbered also fewest this year. - -In my last Report, when the cholera had scarcely subsided, when men’s -minds were full of apprehension on the subject, and when it seemed only -too possible that, with the recurrence of autumn, we might again suffer -from its invasion, I was unwilling to dwell too pointedly on the -wonderful pertinacity with which that disease fixes itself on particular -localities, and tends to re-appear in them on each new occasion of its -rise. Believing that no extemporaneous measures could counteract these -local preferences of the epidemic, I refrained from a course which would -have produced no good result (unless indeed it had depopulated certain -spots of the City), and which might have caused unavailing and hurtful -alarm. Now, however, I think it right to tell you that the local -predilections of this dreadful disease are so marked and so obstinate, -that we may almost certainly predict in what parts of the metropolis it -would tend to arise on any renewed visitation. We may anticipate that at -any such time its latent power of destruction will kindle again in the -districts, the streets, the houses, perhaps even in the very rooms, -where it recently prevailed, _unless the determining local conditions -shall previously have been annulled_. - -It would be ridiculous if I should pretend to carry you into any medical -consideration of this subject, or should make my present Report the -vehicle of a professional argument; but I may very briefly acquaint you -with such generalisations as will justify you in pursuing a particular -course with respect to the haunts of cholera. While doing so, I hope -your Hon. Court will believe that I have devoted to this very serious -subject the best consideration of which I am capable, and have done my -utmost to arrive at conclusions which may be fruitful of practical good. - -Cholera visited no localities of which it could be said, that they were -generally healthy; but still there seemed to be something peculiar and -specific in the kind of local unhealthiness which determined its -invasion. On the one hand, it is unquestionably true that many habitual -seats of fever were visited by cholera; on the other hand, many of the -worst fever-nests in the whole metropolis were unaffected by it; and it -struck with extreme severity in a class of houses habitually exempt from -fever. See, for instance, how malignantly it prevailed along the line of -Farringdon and New Bridge streets, and in Fleet-street and Ludgate hill, -where their line intersects that just mentioned; and here, you will -observe, not only in those obscure and ill-ventilated courts and -by-ways, where fever is the familiar visitant of a hungry and crowded -population; but also, and very strikingly, in spacious and airy houses, -situate along the main thoroughfare of the City, and inhabited by -opulent tradesmen, by members of the various professions, or by officers -of assurance-companies. Other infective diseases which habitually -desolate the former class of dwellings are almost unknown in the latter. -Cholera came as a startling exception. _Within the infected district_ -(fulfilling the classical description of pale death) it trod with equal -foot the gates of rich and poor.[40] - - [40] - - ---- Æquo pulsat pede pauperum tabernas Regumque turres. - - I think it very important that this fact should be fully recognised. - In London it has often been overlooked, from the accident that our - most infectable districts happen to contain an excess of poor - population. But even here it is quite easy to note that the disease - spreads irrespectively of pauperism or privation; and in other cities, - (Paris and Copenhagen, for instance) where the quarters of rich and - poor are less apart than in London, cholera has killed its full share - of dignitaries and capitalists.--J. S., 1854. - -Personal peculiarities, or vicious habits, or temporary indiscretion, -may often have determined its choice of a victim; low nourishment--even -temporary emptiness and exhaustion, very manifestly invited its attack; -but, speaking generally, I may say that it was a disease prevailing over -a certain patch of ground, and (within this limit) tending to strike -equally, or nearly equally, in all classes of habitations. Crowdedness -of dwellings, defective ventilation, squalor of inhabitants, and many -forms of local nuisance, which are omnipotent in giving occasion to -fever, and in adding malignity to many disorders of its class, did not -by themselves exert so marked and specific a power in determining the -onset of cholera. - -What then were the conditions determining its local preference? -Consideration of its statistics, or inspection of a cholera-map, enables -one, with some confidence, to answer--a peculiar condition of soil, of -which dampness is one sure and invariable character, and organic -decomposition (promoted by dampness) probably another.[41] Its local -affinities have much analogy to those of ague, and often appear -identical in their range with the sphere of malarious infection. Our -entire metropolis, built down to the very margins of a large river--of a -river, too, which, at each retreating tide, exposes acres of mud -saturated with the reeking sewage of an immense population, is placed -generally in circumstances not unfavourable to the development of the -disease; and its several parts will be liable to suffer especially, in -proportion as they are exposed to these general circumstances, or to -special circumstances of their own of a like nature. The lower level of -districts on the south side of the river, their attendant failure of -natural land-drainage, the consequent soddenness of a soil from which -likewise the materials of house refuse were never efficiently removed, -accounted sufficiently for the frightful epidemic mortality which -prevailed in those quarters of the metropolis. - - [41] After three years’ further inquiry I find no reason to modify - this general description: but, as regards the local circumstances - which determine the specified condition of soil and atmosphere, I have - been able to extend my information; and the subject is therefore - better treated in my Fifth Annual Report than in the paragraphs here - following above.--J. S., 1854. - -If you now look to the disease as it raged within your own jurisdiction, -you will observe its fatality in two especial directions. First, in the -line I have indicated to you, northward from Blackfriars Bridge, in a -band of two or three hundred yards width; _there_, in the parallelogram -which lies along the main road, from Stonecutter-street to Bridewell -Hospital, were 76 deaths; _there_, in the little clump of houses forming -the angle of Farringdon-street and Holborn-hill, were 17 deaths; -_there_, in a square space behind twenty-seven shop fronts in -Fleet-street, were 57 deaths; _there_, in the small parish of St. Ann’s, -Blackfriars, were deaths at the rate of 25 to every thousand of its -population. This was incomparably the most afflicted portion of your -territory. Those who are acquainted with the ancient geography of the -City will readily conjecture a reason; they will remember when ‘the -course of water running at London under Old-bourne bridge and Fleet -bridge, into the Thames, was of such bredth and depth that ten or twelve -ships, navies at once with merchandises, were wont to come to the -foresaid bridge of Fleet, and some of them unto Old-bourne bridge;’ they -will remember how this broad river (like the Thames of our day) was -thronged on both sides with population; how (again like the Thames) it -was a draining river, probably with wide banks of putrefying mud; how -many fruitless attempts were made to cleanse and preserve its channel; -but how (in Stow’s day) ‘the brooke, by meanes of continuall -incrochments upon the banks, and casting of soylage into the stream, was -become worse cloyed than ever it was before.’ Where that _soylage_ was -cast, and where, since the days referred to, so many habitations have -arisen that no sign of stream remains visible to the wayfarer above -ground, its traces still remain below. Throughout at least a large -portion of this district, the sub-soil (your Surveyor informs me) -consists of black mud, the bed of the ancient river, in which are set -the foundations of the modern houses. The river, which centuries ago -fulfilled for a large population those vile uses which now pollute the -Thames, has gradually yielded its foul banks to the residence of a -growing population; and the sanitary relations of that population are -exactly such as might be imitated, if the volume of the Thames were -henceforth slowly reduced, and if those banks of mud which are now -exposed only at low water, were simultaneously converted into the site -of permanent habitations. - -The history of the stream at Walbrook is, I believe, not dissimilar; but -there is this marked difference between the two cases, that the -comparative declivity of the latter district has allowed its soil to -acquire a dryness and healthiness which have never been reached on the -banks of the Fleet. For, owing to the extreme lowness of level in this -district, the tidal influence of the Thames is very inconveniently felt; -the cellars of houses are habitually exposed to dampness, even to -flooding; and probably the whole porous sub-soil, at least as far north -as your jurisdiction extends, is maintained in a sodden and malarious -state. - -With respect to the second part of the City in which considerable groups -of cholera cases were observed, it has a not dissimilar peculiarity. I -refer to that northern part of the City which extends (on the other side -of London Wall) from Bishopsgate to Aldersgate. The epidemic prevailed -there with far less severity than in the Fleet district, but still with -a preference which easily shows itself in a cholera-map. At the -intersection of Whitecross-street by Beech-lane, in a space that the -point of one’s finger would hide in Wyld’s large map, there were 12 -deaths: in that small portion of the City which lies north of Barbican -and Beech-street there were 40 deaths: in the immediate vicinity of -Half-moon-street, Bishopsgate, 60 deaths, of which more than half were -in the workhouse. Now, certainly, in all this space (and probably still -further in both directions, east and west) without the former gates of -the City, there is a marked local character. It is a reclaimed -marsh.[42] Throughout this district, in the olden times of the City, -there lay (says Stow) ‘a moorish rotten ground, unpassable but for -cawswaies purposely made to that intent;’ and one reads how ‘divers -dikes were cast, and made to drein the waters of the said Moorefields, -with bridges arched over them, whereby the said field was made somewhat -more commodious, but yet it stood full of noisome waters;’ till -gradually ‘by divers sluces was this fenne or moore made maine and hard -ground, which before, being overgrowne with flagges, sedges, and rushes, -served to no use;’ while ‘the farther grounds beyond Finsbury Court were -so over-heightened with laystalls of dung, that divers windmills were -thereon set, the ditches were filled up, and the bridges overwhelmed.’ - - [42] I have reason to believe that this statement, though founded on - the authority of Stow, is erroneous, for so much of the district as - lies west of Moorgate-street; and that the main cause of this locality - suffering so severely from cholera must have lain in those very - extensive defects of house-drainage, which more recently I have become - better able to appreciate. With the kind assistance of Mr. Haywood, I - have been enabled to look over the memoranda which are kept in his - office, of deep cuttings of soil made in the construction of sewers by - himself and his predecessor, Mr. Kelsey. These sections do not by any - means tally with Stow’s description of the Moor, as extending in part - ‘from without the postern called Cripplegate, even to the river of - Wels;’ for here at least there is no trace of any such condition of - soil.--J. S., 1854. - -It is not as matter of literary curiosity that I quote these passages of -your old historian, but simply that I may avail myself of his accurate -local knowledge for the explanation and the cure of a serious existing -evil. For if, as I believe, the unfortunate preference for certain -localities evinced by the recent epidemic be, _primâ facie_, a reason -for doubting the effectiveness of their sub-soil drainage, and if the -ancient records of the City assure one that these very localities are -such as, from conditions then in active operation, would be liable to -retain, perhaps for an indefinite period, the materials of malarious -poison, useful and practical deductions may be drawn. And as the -liability to this severe recurrent epidemic is an extreme detriment to -the population of such localities--one too, which, if unremoved, must -inevitably lead to the deterioration of property, as well as to the -sacrifice of life, I know that your Hon. Court will be solicitous to -adopt whatever remedial measures are possible. - -To those measures I shall presently return, having here dealt with the -question only as it relates to the distribution of our mortality, and -explains the preponderance of a large class of deaths in some special -districts of the City. - - * * * * * - -In the Tables which accompany this portion of my Report, I have arranged -in a synoptical form, convenient for reference, the chief facts of our -sanitary statistics to which I have invited your attention. - -In the first[43] you will read a summary of the deaths as they have -occurred, male and female, in the several districts and sub-districts of -the City, during each quarter of the past year. - - [43] _Appendix_, No. IV. - -In the second[44] table the deaths of the year are classified according -to the ages at which they befell. - - [44] Now incorporated in the general table, _Appendix_, No. VIII. - -In the third table,[45] for the sake of comparison in respect both of -general and of infant mortality, I have arranged the statistics of -certain other localities side by side with our own. - - [45] Now inserted at page 84. - -In the fourth[46] (to which I have already especially referred) is -contained an enumeration, according to the several Wards of the City, of -those deaths, during the last two years, which have arisen in -consequence of acute disease partially or entirely preventable. - - [46] Page 167. - -In tables of this nature perfection is at present impossible; partly -because of trifling changes in the population which often occur, but -rarely can be estimated; partly because of the slovenly manner in which -deaths are occasionally recorded. While, therefore, I would not consider -myself responsible for their absolute and infinitesimal accuracy -(consisting as they do of so many and so various details) I may assure -your Hon. Court that all proper pains have been taken to render them for -every useful purpose correct and trustworthy: and that I believe them, -in all essential particulars, truthfully to represent whatsoever I have -sought to embody in them. - -The annual ratio of deaths within your district; the local differences -of that ratio; the proportion of infantile mortality; the amount of -preventable disease; and, in all these respects, a comparison of parts -of the City with each other, and of the whole City with other inhabited -districts,--these are the materials on which your judgment must be -formed as to the necessity of sanitary measures, whether for the entire -City, or for its component parts: and as a main object of the -appointment which I have the honour to hold is that I should furnish you -with materials for forming that judgment, so I may probably stand -excused for troubling you with these considerations at such great -length. - - -II. THE CAUSES AND THE PREVENTION OF ENDEMIC DISEASE. - -According to the method adopted in my last Annual Report, I now proceed -to offer you such observations as another year’s experience may justify, -on those physical influences which prevail against life within the City -of London, and on such remedial measures as seem aptest to remove them. - - -_Sub-soil Drainage, House-Drainage, and Sewerage._ - -1. In respect of drainage, I have already adverted to those unwholesome -conditions which prevail along the low-lying valley of the ancient -Fleet, and have mentioned to you that frequent incursions of the river -aggravate whatever mischief is inherent in the soil, by maintaining it -as a perpetual swamp, and by favoring in it a constant succession of -putrefactive changes. I have likewise illustrated to you the probability -that, in some of the higher portions of the City, chiefly in the -Out-Wards of Cripplegate and Bishopsgate, there still survive some -properties of that old malarious fen, from which these districts were -originally reclaimed. Stow seems in his day to have had misgivings on -this subject; for after describing the improvements that had been -effected there, and the gradual levelling and heightening of the ground, -he adds, ‘it seemeth to me that if it be made level with the battlements -of the city wall, yet will it be little the dryer, such was then the -moorish nature of that ground.’ - -From a consideration of this former geography of the place, and from -observation of the diseases which prevail there, I am led to think it -highly probable, that some of its sanitary defects depend less on -defective house-drainage than on a still marshy undrained condition of -the ground itself, and that these defects would be removed by an -efficient application of sub-soil drainage. - -I would therefore respectfully recommend to you, under this head, that -the state of soil in the specified districts be referred to competent -authorities, and that such measures be adopted as inquiry may prove -requisite, for relieving those parts where the sub-soil drainage is -imperfect, and for protecting the house-foundations, and sewers, and -sub-soil adjacent to the river, from being soaked or flooded by the -tide. - - * * * * * - -2. With respect to house-drainage, I have no addition to offer to those -remarks which I submitted to you in my last Report. Your Hon. Court has -fully recognised that immense peril to life which is connected with the -presence of cesspools beneath houses, and which depends on their -poisonous emanations. At the commencement of the present year, your -Surveyor stated that he might take ‘5414, as a fair approximation of the -number of cesspools’ then in existence within the square mile of the -City of London. This proportion, dangerously large as without doubt it -is, presented an important diminution from the number which existed a -year previously, when your Commission first obtained from the -Legislature authority to enforce their closure; and it may reasonably be -anticipated that at the termination of this present year, a still -further abatement will be recorded in the magnitude of that destructive -nuisance. - - * * * * * - -3. Notwithstanding the variety of stink-traps to which you have given -trial, and notwithstanding the fact (recorded by your Committee of -Health on the Surveyor’s authority) that ‘there does not exist within -your jurisdiction a single gully which is untrapped,’ there continue to -be frequent complaints of offensive exhalations from the sewers. - -The mechanical difficulties in this matter of trapping have appeared to -be, from the nature of the case, almost insuperable. It may, indeed, -easily be conceived, how incompatible are the common uses of a -gully-hole with such fineness of adjustment and delicacy of balance as -would render the apparatus air-tight from within, and effectually -preclude an escape of the gaseous contents of a sewer. Under such -circumstances, your Hon. Court has desired that I should express my -opinion, how far a different course might be adopted in respect of these -exhalations; how far, namely, they might be neutralised within the -sewers; how far it might be chemically feasible, and in a sanitary point -of view expedient, that a systematic use should be made of deodorising -agents; so that any gas escaping from the sewers should at least be -divested of its original smell. - -On this subject, I would submit to you the following considerations. As -respects its feasibility (putting aside as foreign to my province all -questions of the expense, and all details of the daily arrangement) a -first and obvious objection is this: Granted in the abstract, that -sewer-gases can be converted by appropriate agents into inodorous -compounds; in the practical application of these agents, you would find -impediments with which you are already familiar. Theoretically, there -may be no difficulty in providing air-tight traps; practically there is -said to be every difficulty. Just as that mechanical problem has -defeated you in practice, so would the chemical one; and for the same -reason. The fulfilment of either problem is a matter of nice adjustment. -In proportion as your gully-hole is exquisitely trapped, it becomes -liable to obstruction; it loses its use as an inlet to the sewer, nearly -in the same measure as it becomes an effective obstacle to regurgitant -gases. Similarly, in proportion as these alleged deodorisers might -succeed in completely stifling the characteristic odour of sewage, they -would be liable to diffuse perfumes peculiarly their own, and to -establish, in the vicinity of gully-holes, the alternation of a new -nuisance with the old. To proportion with accuracy the introduction of -these chlorinous preparations to the amount of refuse traversing the -sewers--an amount varying most considerably at different hours of the -day, seems to me quite a visionary hope. Failing such accurate -proportions, I am not prepared to say that the result would be useful; -and I accordingly consider the scheme as not chemically feasible. - -Further--as involving an important sanitary principle, I would say, that -the great object which must be aimed at is not the mere chemical -neutralisation of certain stinks which arise within your jurisdiction, -but the closest possible limitation, and the promptest possible removal -of all those materials which are decomposed into fœtid products. -Admirable, no doubt, is that arrangement by which Nature, stationing a -sense of smell at the inlet of our breath, cautions us by this vigilant -sentinel against the inhalation of many poisonous airs; but, in respect -of organic decomposition, I am in no degree satisfied that its odorous -products are its only, if even its principal, agents of injury; nor have -I any reason to suppose that the real detriment to health which arises -from breathing the miasms of sewers or marshes, of cesspools, -burial-grounds, or slaughter-houses, would in any important degree be -lessened by the mere mitigation of fœtor in their effluvia. Offensive as -these are, they at least answer the useful purpose of warning us against -the other poisons with which they are associated. - -Let me likewise take the opportunity of correcting a misapprehension, -which, by the use of an inappropriate word, is sometimes shown to exist -on this subject. The agents in question are spoken of as -_dis-infectant_. As there is no scientific reason whatever for believing -that they in any degree interfere with the spread of epidemic or -infectious disease, and as an erroneous opinion on this point may lead -to the neglect of measures which are truly precautionary and useful, I -think it well to state explicitly, for your information, that I have no -evidence of their possessing any other utility, in the respects under -consideration, than simply and singly that of removing stink from the -atmosphere around them. - -For reducing to a _minimum_ the exhalations which arise from sewers and -house-drains, it appears to me that the following are the essential -principles: First, to render the current through them as rapid as -possible; and, above all, by every care for their form, their junctions, -their slope, and their material, to provide against the occurrence of -obstructions and deposit: Secondly, to employ in their construction, so -far as may be possible, such substances as are porous in the least -procurable degree; such as consequently will be least apt to imbibe and -retain in their interstices any considerable impregnation from the fœtid -fluids running over them at intervals; such, too, as will be least -likely to permit soakage into the surrounding soil: Thirdly, by reducing -the size of drains and sewers to the lowest dimensions compatible with a -full performance of their uses, to diminish to the utmost the extent of -their interior evaporating surface, and of those large chambers which -they now offer for the evolution, retention, and diffusion of gases. - -To the application of these principles (together with a sufficient and -appropriate distribution of water) far more than to chemical agents, or -to the invention of mechanical traps, I believe that you must look for -rendering inodorous the vicinity of your numerous gully-holes. I content -myself with stating them to you, as a practical deduction from physical -laws, without venturing to offer any opinion on the degree in which they -are applicable within your jurisdiction, or on the manner in which they -should be applied. For although, as principles, they have their -foundation in physics, and although their importance to sanitary -improvement is beyond measure great, all details relating to their -application lie out of my province, and belong to a class of subjects in -which your Surveyor’s opinion will, of course, be infinitely more useful -to you than mine. - - -_Water-Supply._ - -During the past year, as in the preceding one, I have given frequent -consideration to the subject of water-supply within the City. - -I have already endeavoured to convey to you the deep sense which I -entertain of its importance, and I have every reason to believe that -your Hon. Court recognises, at its full weight, the necessity of -providing for the City of London a supply of water which in quantity -shall be ample, in quality pure, in distribution constant and -accessible. - -In my former Annual Report, and in some remarks subsequently addressed -to your Committee of Health, I dwelt especially on such defects of our -present system as relate to the quantity and distribution of water; -endeavouring to illustrate the insufficiency of its supply to the poorer -tenements of the City, and the extreme inconvenience which is entailed -on their inmates, sometimes by dependence on a common tap, sometimes by -the troublesome, expensive, and unwholesome necessity of storing water. - -In reverting to this subject, I may correct a fallacy which is apt to -prevail with respect to the abundance of supply. I have no reason -whatever to doubt that a very liberal allowance of water is daily pumped -into the City--enough, or more than enough, so far as I know, to fulfil -all necessary purposes. - -But those purposes are not fulfilled by it. A certain large figure is -stated as representing the average quantity daily driven through the -mains of the City; this quantity is divided by the number of residents -within your area, and the inference is drawn that each individual inmate -of the City has at his disposal 25 gallons a day; or (after deduction -for public purposes and the like) 21¼ for his domestic supply. As an -arithmetical conclusion from the premises this may be true: nothing can -be less accurate as a practical representation of the facts. An average -amount of three million gallons _per diem_ may, or may not, be pumped -through the mains of the City: but to calculate the _available -water-supply_ from this dividend, without previous deduction for the -immense escape of _un-available water_ by waste-pipes or otherwise, -gives a most fictitious result. The large waste which naturally arises -in the system of intermittent supply has been well illustrated by some -evidence given by Mr. Lovick before the late Metropolitan Commission of -Sewers, in respect of a particular block of nearly 1200 houses.[47] Some -of the houses were of the higher, and many of the poorer class, but the -average might be stated to be of the middle class, and to present a fair -example of an urban population. The drainage of all these houses was -discharged through one main sewer. The run of water through this sewer -was carefully watched and gauged every hour, during the night as well as -the day, on days when the water was on, that is to say, when the -intermittent supplies were delivered, and also on the ordinary days, -when the consumption of the houses was from butts and cisterns, into -which the intermittent supplies were delivered. The gaugings of the -discharge of waste water into the sewer were checked by gaugings of the -consumption of water from the butts and cisterns, during the interval of -the delivery of the supply by the company. It was ascertained that the -average quantity discharged _per diem_ through the sewers was 44½ -gallons per house; but it appeared that, on the days when the -intermittent supplies of water were on, the quantity discharged _per -diem_ was 209 gallons _per_ house. The waste in this district from -defects in house apparatus of distribution, incident to an intermittent -supply of water, was, on the water days, three and three quarter times -greater than the consumption on those days. - - [47] General Board of Health Report on Supply of Water to the - Metropolis, page 120. - -No similar gaugings have, I believe, been made within the City; so I am -unable to tell you with accuracy what are the proportions of waste and -consumption. In an interview with your Committee on Health, when they -were collecting information on the subject, Mr. Mylne, the engineer of -the New River Company, stated (as a reason against fulfilling some -object desired by the Committee) that within the City of London, in -connexion with its distributing apparatus, there existed for the escape -and waste of water, during the period of supply, ‘at least 10,000 open -cocks.’ - -Assuming the accuracy of this statement, I doubt whether the average -available supply of water for domestic purposes within the City can -possibly exceed a quarter of its alleged quantity; and I am persuaded -that there must be large numbers of persons to whom the enjoyment even -of that reduced average is utterly unknown. Your Hon. Court, observing -the incalculable waste, and knowing that the cost of water-supply (as of -all other commodities) must of necessity vary according to the quantity -supplied, can appreciate the consequences of so much fruitless -expenditure. - -I would beg likewise to observe to you that this unapplied flood of -water is in itself not unobjectionable. It would be of questionable -advantage if the drainage of the City were so perfect as to carry all -away without inundation of the soil; while under opposite circumstances, -in every quarter where drainage is absent or faulty, evil must arise -from the extensive and habitual infiltration of moisture. - -On the extreme inconvenience which attends the storage of water in the -poorer habitations of the City, I have already reported to you, and will -now only add that increased experience has given much confirmation to my -view. Their receptacles are generally such as contribute to the -contamination of water, and are constantly so arranged as to invite an -admixture of the most varied impurities. - -In the large proportion of them, which are open casks, one sees -habitually a film of soot floating on the surface; one sees (if indeed -one can see so deeply into water which is often turbid and opaque) that -filth and rubbish lie at the bottom; one sees the interior of the cask -itself dirty and mouldering. - -I now merely glance at this part of the subject, because you have -already on other occasions allowed me to state my knowledge at greater -length. But there is one evil in particular to which I would beg leave -to advert. Those works of drainage which are established under your -orders depend for their efficiency on a proper supply of water; and in -every case where you enforce the construction of house-drains, you order -that those drains shall be served efficiently with water. Your wishes on -this subject are nominally complied with by those on whom your orders -are served, but are often virtually evaded by a filthy and ineffectual -contrivance. The butt or cistern of the house--that on which the inmates -depend for their supply of fresh and pure drinking-water, is placed in -immediate contiguity to the privy, so as to reduce the requisite length -of connecting pipe to the fewest possible number of inches; the -application of water is not made discretionary on the users of the -privy, nor are any of the cheap and common self-acting contrivances -introduced; but the waste-pipe of the butt or cistern is conducted into -the discharge-pipe of the privy, so that, _periodically_, with a -frequency varying according to the arrangements of the water-company, -the arrears of excrement are removed, so far as the overflow of the -water-receptacle may have power to dislodge and propel them. Frequent -evidence has been before me of the insufficiency of this arrangement: -and, in addition to its actual failure (on the reasons of which your -Surveyor can speak more competently than I) there is strong reason to -object to its prevalence on other grounds. Water, as you probably know, -is a very active absorbent of many gaseous materials; and the open -butts, which are thus placed in immediate contact and communication with -privies, must rapidly become infected by their foulness. I need not -explain to you how injurious an addition this is to the other -objectionable incidents of water-storage, or how unattractive as a -beverage to the poor inhabitants of the City must be this vapid, -privy-flavoured stuff. - -For this arrangement I can suggest to your Hon. Court no easy -alternative or remedy, so long as the distribution of water continues to -be on its present intermittent plan: but it is matter for extreme regret -that, by circumstances over which you have no control, the success of -your sanitary measures should be seriously diminished. By the -enforcement or execution of house-drainage, your Hon. Court has -conferred great advantages on many districts of the City; but it is my -duty to tell you that, in my judgment, the present condition of the -water-trade contributes to neutralise those advantages, and constitutes -a restriction on your power of doing good. - -As respects the evils to which I have just adverted, unquestionably they -admit of abatement by devoting separate water-receptacles to the very -different uses of diet and drainage. But the expense of additional -cisterns in tenements so poor cannot be considered trifling; and I -believe that your Hon. Court would hesitate, even if you have the power, -to enforce this double burthen on the owners of house-property, at a -time when one may reasonably hope that the necessity for cisterns will -be superseded. - -There can be no doubt on the extreme degree in which it is desirable for -the poor of the City of London, that water should be delivered to their -houses on the principle of constant supply, and that they should thus be -relieved from the expensive and unwholesome necessity of storing it in -small quantities and in improper receptacles. That it is _desirable_ is -a certainty within my official knowledge and on which therefore I can -give an opinion of my own. That it is _practicable_ is not within my -official knowledge; for in this part of the question are involved -various considerations of hydraulic engineering, on which I am -incompetent to offer an opinion. But I cannot ignore the fact, that in -many parts of England and Scotland the practicability of a constant -supply has been evinced by the very conclusive evidence of its success. -To some such instances I alluded in my last Report, and from the present -year I can quote you a striking additional one. At Wolverhampton, in -1849, the system of supply, which had previously been intermittent, was -made continuous. Instead of waste ensuing on the change, its immediate -effect was a reduction of 22 _per cent._ on the quantity consumed. So -great had been the unpopularity of the intermittent system of supply, -that at the time of the change the company had not more than 600 -customers. Immediately on the adoption of the new system, their -customers increased, and within ten months had risen to 1400. This -increase was continuing up to the date of the Report (May 4th, 1850), at -which time they were adding to the number of their customers at the rate -of 50 each week. The above facts (as is well observed by the resident -engineer, Mr. Marten) may be taken as a fair test that the system of -continuous supply is one of superior adaptation to the domestic wants of -the public. - -This case is but an inconsiderable fraction of the evidence which lies -before the public on the subject of continuous supply. With such -evidence before me, in contrast to what I observe of the distribution of -water within the City of London, I cannot refrain from repeating to your -Hon. Court my confirmed and deliberate opinion that our method of supply -is essentially bad, and that it withholds from the poorer population of -the City a large proportion of those sanitary advantages which it is the -object of water to confer. No doubt it will occur to you that against -evils of this nature--evils arising in the conflictive interests of -water-buyer and water-seller, the first principles of commerce imply a -resource; and that in this matter, as in others of the sort, a customer -holds in his own hands the remedy for his dissatisfaction. But although -the supply of water, in the hands of the powerful companies who vend it, -is in many respects a common transaction of trade, and as such is in -theory open to competition, yet I would beg to point out to your Hon. -Court that, in regard of the City under your jurisdiction, no such check -and no such stimulus as competition can virtually be said to exist. In -every practical sense the sale of water is a monopoly. The individual -customer, dwelling in Cripplegate or in Farringdon, who is dissatisfied -with his bargain in water, can go to no other market; and however -legitimate may be his claim to be supplied with this prime necessary of -life at its cheapest rate, in the most efficient manner, and of the best -possible quality, your Hon. Court, hitherto, possesses no power to -enforce it. - -All who have given impartial consideration to the subject seem to concur -as to the advantages which result from a control over the supply and -distribution of water being possessed by those who are responsible for -the drainage and cleanliness of a district. These different duties are -in such essential relation to each other that they would seem almost of -necessity to require a single direction and control. House-drainage -pre-supposes water-supply; water-supply pre-supposes house-drainage; the -efficiency of either implies their mutual adaptation; just as the -circulation of blood within an animal body implies uninterrupted -continuity of arteries and veins, each harmonising with the uses of the -other, to ensure the efficiency of the whole. But while the works of -drainage executed under your orders lose much of their sanitary -usefulness for want of an effectual water-supply, your Hon. Court has no -power of interference in the matter, closely associated as it is with -the performance of your other functions. These anomalies would be -removed, and a most beneficial power over the distribution of water -would be vested in the hands of your Commission, if in the renewal of -your Act of Parliament you procured authority to represent the citizens -in this matter. All the advantages which could possibly be gained by -competition, together with many benefits which no competition could -ensure, would thus be realised to the population under your charge; if, -namely, a clause were inserted in your Bill, empowering you, at your -discretion, to contract corporately with any person or any company for -the supply of water to the City of London. - -In the Public Health Act (passed simultaneously with yours) an enactment -of this nature exists, authorising local boards of health to ‘provide -their district with such a supply of water as may be proper and -sufficient,’ and for this purpose ‘to contract with any person -whomsoever to do and execute all such works, matters, and things as -shall be necessary and proper, and to require that houses shall be -supplied with water,’ and to ‘make and levy water rates upon the -premises, at a rate not exceeding twopence per week.’ With a power like -this in your hands, you would easily enforce for the City of London -whatever method of supply you might deliberately believe to be best; and -you would then be enabled and entitled, in the application of other -clauses in your Act, to require of landlords acting under your orders, -a far completer, though less expensive, improvement of their property -than you are yet in a position to obtain. - -In submitting to your Hon. Court my views as to the expediency of your -having a controlling power over the supply of water, I am glad to find -myself supported by the recorded opinion of the present Lord Mayor, -himself formerly the Chairman of a Commission of Sewers; and I am -induced to believe that such an addition to your functions might not be -objectionable to the water companies, as I observe that Sir William -Clay, the chairman of two metropolitan companies, has expressed himself -strongly on its ‘great and obvious convenience.’ - - * * * * * - -2. Of equal importance with anything which relates to the distribution -of water are those momentous questions which relate to its _quality_, -and which tend to determine its fitness for human consumption. - -Considering the great share of public attention which these questions at -present very properly obtain, the many projects which are broached for -improving the quality of our metropolitan supply, and the importance of -your being in a position to decide as to the merits of any plan which -may affect the City of London, I have thought it desirable in this -Report to submit to you some general observations on the subject. During -the last few months, I have accordingly been collecting such information -as might, in my judgment, be useful for this purpose. In pursuing one -portion of my inquiry--that which relates to the chemical constitution -of certain waters, I have availed myself of the permission of your Hon. -Court to procure a limited amount of assistance from some one more -conversant than myself with the practice of analysis. For this purpose I -have addressed myself to Mr. Thomas Taylor, lately Lecturer on Chemistry -at St. Thomas’s Hospital, a gentleman on whose skill and impartiality I -can implicitly trust. His account of the very careful analyses which he -has made is subjoined to my Report.[48] Concurrently with the experience -of other chemists, it has furnished me with material for many of the -conclusions which I am about to lay before you. - - [48] See page 168. - -The water which is supplied by the New River and East London companies -for the consumption of the City of London is substantially of one kind. -The River Lea, on which the East London Company entirely depends, -furnishes likewise much of the supply conveyed by the New River.[49] The -springs in which the latter originate are of the same chemical kind as -those which contribute to the Lea; and the artificial aqueduct runs its -forty miles of course through much the same country as the natural -river. Chemically, therefore, one description may apply to both; and I -the rather speak of them conjointly, as any extension of its resources -for our supply which the New River might obtain, would apparently be -provided by increasing considerably its present draught from the Lea. - - [49] It appears that the New River Company at present derives about - two-thirds of its supply from the River Lea, and proposes to draw from - this source a still larger proportion. Any chemical difference of - quality in the City pipe-water (as between that supplied by the New - River and that by the East London Company) would probably not exceed - those limits of difference which prevail in respect of waters gathered - _under varying circumstances_ from one and the same source. - -The pipe-water consumed in the City has for its general chemical -character, that it contains a considerable quantity of carbonate of -lime, held in solution by an excess of carbonic acid. To this and -another salt of lime (the sulphate) the water chiefly owes the property -which is complained of under the name of _hardness_: it is by reason of -these salts, namely, that it decomposes a certain large proportion of -whatever soap is used with it; preventing the formation of a lather, -till those salts are exhausted by a wasted proportion of soap, by -boiling or otherwise, and hindering to that extent the several purposes -for which soap is employed. You are probably aware that soda is -extensively used in the laundry, as an antidote to this objectionable -quality of hard waters; and the excess of its employment tends, by -corrosion, very observably to hasten the destruction of washed articles -of dress. In the same measure as water possesses the property of -decomposing soap, its utility as an universal solvent is impaired; it -extends to various other substances which one seeks to dissolve in it -(especially to many vegetable matters) that same disposition to waste -them in the form of insoluble precipitates. Its conveniences for the -purposes of cooking and manufacture are _pari passu_ diminished. - -Of the actual extent of which these disadvantages are sustained within -the City of London, I have no means of forming an exact opinion; but -statements are before the public (from the general correctness of which -I have no reason to withhold reliance and belief) rating the pecuniary -loss to the metropolis, in the two articles of soap and tea, at a very -high figure. You will see from Mr. Taylor’s observations the proportion -in which waste occurs, as regards one of these articles; namely that, -for the production of a lather in washing, the pipe-water of the City of -London, used without boiling, consumes from 13 to 19 times as much soap -as distilled water would consume.[50] - - [50] It has been alleged that, by the use of soft water, the saving in - soap would probably be equivalent to the whole of the money at present - expended on water-supply; and that in the article of tea, the economy - would amount to about one-third of the tea now consumed in the - metropolis. It strikes me as possible that, in forming these - estimates, the argument may have proceeded too much from a - consideration of the hardness of London waters in their unboiled - state; and that sufficient allowance may not have been made for the - change which boiling produces. If boiling were prolonged for some - hours before culinary or detergent use of the water, the results (for - tea or soap) would be identical with those produced under the - employment of soft water. Notoriously this precaution is not taken: - but to avoid disputable ground, I confine myself to _the fact of - considerable pecuniary loss_, arising from the cause in question, and - I avoid any attempt to determine its exact amount. - -The chemical constitution of these waters occasions another -inconvenience. Their carbonate of lime is held in solution (in the -chemical form of bicarbonate) by an excess of carbonic acid: under the -influence of heat this excess is gradually disengaged and driven off; -consequently, as they approach the boiling point, they begin to -precipitate the earthy salt which that gas was instrumental in -dissolving. Each gallon of water under these circumstances would deposit -from ten to fifteen grains of earthy matter on the interior of whatever -vessel might contain it, or on the surface of whatever solid--linen or -mutton, might be contained in the boiler. Hence arises the well-known -_furring_ of vessels in which such waters have habitually been boiled. - -I refrain from dwelling on the economical considerations which arise in -these points of the subject, as very obvious inferences from the result -of chemical analysis; and I pass to other matters more strictly within -my own province of observation. - -Is water thus constituted in any degree detrimental to the health of -those who drink it? It is not in a single word that this question can be -fairly answered. Almost insuperable difficulty belongs to it, from the -absence of any statistical method by which we might isolate the -water-drinking portion of our population, and might compare them, in -regard of the diseases to which they are liable, with similar sections -of population in soft-water districts and in harder-water districts. -Obviously, no other method of comparison can be unobjectionable; and, in -arguing the subject from such materials as I have, I can pretend to -nothing more than a rational approximation to truth. - -Except in the comparatively few instances where active medicinal agents -are naturally dissolved in a water, its effects, if injurious, would be -so slow as to elude ordinary observation. If, as is exceedingly -probable, the same constitution of water as impairs its solvency out of -the body, do likewise operate against its being the most eligible -menstruum or dissolvent for processes occurring within the body--such -processes I mean as attend the act of digestion; if the lime and other -hardening ingredients which waste soap in our laundries, and tea in our -parlours, do similarly waste within us those organic agencies by which -our food is dissolved and converted; any result arising from this source -would be of gradual operation, would not easily admit of being traced to -its source, and (except in susceptible persons) would rarely produce -such symptoms as might immediately draw attention to their cause. The -ill effects (whatever they may be) arising from the use of hard waters -must be looked for in chronic impairment of digestion, and in those -various derangements of nutrition in distant parts (the skin and teeth -particularly) which follow as secondary results on such chronic -disorder. It would be ridiculous to look for the operation of an -ill-chosen water, after its habitual use during two centuries, as though -one were inquiring for the symptoms of an acute poison. The signs that -are to be ascertained among a population, if such signs exist, are those -which would evidence a premature exhaustion of the power of digestion, -and would testify that the machine on which we depend for that power had -been exposed to unnecessary and avoidable fatigue. This, I believe, is -the utmost which Medicine, proceeding from theoretical grounds, would -venture to say on the subject. - -Perhaps I need not inform you that indigestion, with all that follows -from it, is so frequent in the metropolis, in persons after the first -strength of youth, that, for large classes of society, a perfect -discharge of the natural process of digestion (such a discharge of it as -a lecturer would describe to be the exact type and intention of Nature), -is exceptional and rare. Unquestionably, in large numbers of cases, wine -and beer and spirits, rather than water, have to do with this effect. -Unquestionably, other influences of metropolitan life--and, not least, -the mental wear and tear which belong to its large excitement, -contribute immensely to this chronic derangement of health; but there -are reasons likewise for believing, that the quality of water consumed -is not a matter of indifference to the result. We cannot but give it an -important place among those influences of health or unhealth which we -consider _local_; and we cannot refuse to recognise the fact, that in -recommending our patients (as we do often recommend them) to try ‘change -of air’ for complaints which baffle us by their obstinacy, so long as -the subject of them remains in London, the course on which we rely for -success implies ‘change of water,’ equally with that other change to -which more popular importance is attached. - -In illustration of this view, I may quote to you the experience of two -other towns. Dr. Sutherland stated, in evidence before the General Board -of Health, that having lived for a number of years at Liverpool (where -the water is said to be of about the same degree of hardness as ours), -he had long entertained a conviction that ‘the hard water, in a certain -class of constitutions, tends to produce visceral obstructions; that it -diminishes the natural secretions, produces a constipated or irregular -state of the bowels, and consequently deranges the health. He had -repeatedly known these complaints to vanish on leaving the town, and to -re-appear immediately on returning to it, and it was such repeated -occurrences which fixed his attention on the hard selenitic water of the -new red sandstone as the probable cause, as he believed it to be, of -these affections.’ (Rep. p. 51). And Dr. Leach, of Glasgow, stated -before the same Board, as the result in that town of two years’ -experience of a substitution of soft for hard drinking-water, that in -his opinion, ‘dyspeptic complaints had become diminished in number;’ -and that it had ‘been observed, since this change, urinary diseases have -become less frequent, especially those attended by the deposition of -gravel.’ - -Inferences useful for ourselves cannot be drawn from statements like the -above, on the fullest assumption of their accuracy, without comparing -the waters referred to with our own, more completely than is done by the -one characteristic of ‘hardness;’ and there may likewise be other -qualifications requisite for an application of the analogy. But those -disorders of health which are specified by the gentlemen quoted, as -produced by the use and diminished by the disuse of hard waters, are -such as might very probably stand in the relation of effect to their -alleged cause; results, namely, primary and secondary, of disordered -digestion. - -Practically, I may tell you, that there are many individuals whose -stomachs are extremely sensitive to the impression of hard water, who -derive immediate inconvenience from its use, and who refuse to drink it -without artificial reduction of its objectionable quality. I may -likewise inform you that a physician, recently deceased, whose knowledge -of indigestion and its chronic effects (especially in relation to the -skin and urinary organs) was most profound and accurate, and whose -consulting practice in such disorders was for many years almost a -monopoly (I mean Dr. Prout) was in the habit of enjoining on his -patients the use of distilled water. He evidently considered that the -consumption of such waters as are habitually drunk in the metropolis was -detrimental, at least to an enfeebled digestion. This is an opinion -which, I have reason to believe, is generally entertained by medical -practitioners in London. - -It may not be irrelevant to mention to you (since the influence of -imagination or of artificial habits can have little to do with this -result) that horses are liable to be much inconvenienced by hard water, -if unaccustomed to its use; and it is, I believe, notorious that grooms -in charge of racers habitually take the trouble of conveying with them, -to their temporary racing stables, a supply of the accustomed water. -Veterinary surgeons say that under the continued use of hard water, -which horses will avoid if possible, their coats become rough and -staring;--an effect, I may observe, analogous to those skin-disorders of -the human subject which are apt to occur from impairment of the -digestive functions. - -Taking into account all these considerations, together with others of a -more technical description; and believing that water is eligible for -human consumption in proportion as it is free from the admixture of any -material foreign to its simple elementary constitution--exception being -made only of so much dissolved air as will render it sparkling and -palatable; I entertain no doubt that a water, devoid of considerable -hardness, would (_cæteris paribus_) for the purposes of cooking and -drinking, be far preferable to that which the companies now distribute -through the City of London. - -Hitherto, however, I have spoken of the waters supplied to the City, -merely as regards that large impregnation of earthy material which they -gather from their source; and I have criticised them only in respect of -that admixture. Their essential chemical quality is one native to the -soil from which they are derived; and whatever censure thus far belongs -to them could only have been avoided by the selection of a different -source. Chemistry, in the days of Morrys and Myddleton, was not -sufficiently advanced to inform the water-merchants of a city on those -different conditions which determine the fitness of a soil to serve as -the natural or artificial _gathering-ground_ of a supply; and by which -(as they vary in different localities) hardness is imparted to the -rain-fall of one district, while softness is preserved for that of -another. - -But there are other evils belonging to these waters, less appreciable -indeed by chemistry, but open to universal observation, and meriting -unqualified blame. They are conducted to the metropolis in open -channels; they receive in large measure the surface-washing, the -drainage, and even the sewage of the country through which they pass; -they derive casual impurities from bathers and barges; they are liable -to whatever pollutions mischievous or filthy persons may choose to -inflict on them; and then on their arrival in the metropolis (after a -short subsidence in reservoirs, which themselves are not -unobjectionable) are distributed, without filtration, to the public. -Whatever chemistry may say on this subject (and I need not remind you of -very powerful causes of disease which lie beyond its cognisance), I -cannot consider it matter of indifference, that we drink--with whatever -dilution, or with whatever imperfect oxidation, the excremental and -other impurities which mingle in these sources of our supply. Such -admixtures, though in their _quantity_ less, are in their _quality_ -identical with those which render Thames-water, as taken at London -Bridge, inadmissible for domestic consumption, and which occasion it, -when stored for sea-use, to undergo, before it becomes fit to drink, a -succession of offensive changes strictly comparable to putrefaction. - -In this slovenly method of conveyance and distribution there is a -neglect of common precaution for the purity and healthfulness of the -supply, which I must report to you as highly objectionable: and -this--the method of supply to our great metropolis, strikes one the more -with astonishment and disgust, as one reflects on the long experience -and admirable models which past centuries in foreign countries have -supplied; and especially, as one remembers those colossal works which, -more than two thousand years ago, were constructed under the Roman -government, for the cool and cleanly conduction of water. - -The present imperfections of knowledge forbid me to cite, as definite -causes of disease, the contaminations to which I have adverted: I cannot -say to you--pointing to our classified list of sickness and mortality, -_this_ depends on drinking the diluted drainage of Hertford, _that_ on -the contributions of Ware. Indeed I know that, under the influence of -the river and the atmosphere, very considerable changes occur in the -materials thus furnished, tending eventually to render them inert; and -if injury to life occur from their ingestion, it is probably only under -peculiar and exceptional conditions, increasing their quantity, or -delaying their oxidation. In protesting against their continued -distribution as articles of diet, I therefore insist less on inferences -deducible from medicine, and shall probably have the concurrence of your -Hon. Court in grounding my appeal on the common principles of taste. - -On the incidental contaminations to which the pipe-water consumed within -the City becomes liable, by reason of its storage in receptacles both -foul in themselves and surrounded by causes of foulness, I have already -addressed you; and I have shown to you the dependence of this evil on -the system of intermittent supply as adapted to the houses of the poor. - -Of other sources of water-supply existing within the City of London, -there are many of small extent in the form of superficial springs. These -are eagerly sought after, sometimes from a distance, on account of their -coolness and sparkling condition. In the Appendix[51] you will find an -account of one of these waters--that in the vicinity of Bishopsgate -church, which is very much drunk in that quarter of the City. Any praise -given to it illustrates exceedingly the fallacy of popular judgment on -such subjects, and shows how easily those qualities of coolness and -freshness, which are absent from stored waters, impose on the palate, -and induce a preference to be given to waters which are relatively most -objectionable. - - [51] See page 170. - -The chemical faults which belong to our London pipe-water are possessed -in a far greater degree by this water of Bishopsgate pump, and the -latter has moreover some vices which are absent from the former; but the -vapidity and fustiness of water which has been stored in cisterns are so -repugnant to the taste, that the water chemically preferable is not in -practice preferred. - -To the use of waters of this description, within a large city, there is -always much objection. In addition to extreme hardness, which in London -they universally possess, they are liable, in a dangerous degree, to -become contaminated by the leakage of drains, and by other sources of -impurity; as, for instance, where situated within the immediate vicinity -of grave-yards they derive products of animal decomposition from the -soil.[52] Very recently, a celebrated pump within the City of London, -that adjoining St. Bride’s church-yard, has been abandoned on account of -such impregnations. Or perhaps I should rather say (for the difference -again illustrates the readiness with which the palate is deceived or -corrupted) that it was not _abandoned_--for till almost the last moment -the neighbours adhered to it with fondness; but the parochial -authorities--alarmed by the proximity of cholera--caused its handle to -be locked. - - [52] This is illustrated in the analysis of Bishopsgate pump-water, - just alluded to. The very large quantity of _nitrates_, there referred - to that water, must be due to the oxidation of human bodies in the - adjoining soil, which serves in part as gathering-ground to the - spring. I should fear that, during rain-fall, this oxidation of - organic compounds may not always have completed itself, and that - materials of decomposition _still in progress of decay_ may thus often - be mingled in the water. [I have lately had occasion to recommend that - the use of Aldgate pump should be discontinued on account of its water - containing, in addition to a large quantity of alkaline nitrate, so - much unoxidised organic matters, as were sufficient to give it a foul - taste.--J. S., 1854.] - -As an available source of supply to the City of London, the use of deep -(Artesian) wells has been recommended: the clearness and softness of -these waters, together with their freedom from organic matters, having -concurred to suggest their employment. I feel bound to express the -strongest opinion against the fitness of these waters for the purpose of -beverage. They uniformly contain a considerable proportion of medicinal -ingredients; they are capable of exerting definite and demonstrable -influence over the natural actions of the body; and information is -before me of various injury to health, affecting large numbers of -persons, arising from the continued dietetic use of such waters. - -In addressing your Hon. Court on the subject of water-supply for the -City, it is impossible that I should do otherwise than advert to the -fact, that, during the last few months, under the auspices of Her -Majesty’s government, as represented for sanitary purposes by the -General Board of Health, a plan has been gradually maturing itself, for -the supply of the entire metropolis with pure soft water. Founding -itself on very extensive investigations as to the qualities of water, as -to the influence of soils on its chemical composition, as to the -relation between streams and rain-fall, as to the hydraulic principles -of distribution, and the like, this plan proposes to gather water in -certain silicious soils, which can impart to it the least possible -admixture of foreign ingredients; to conduct it in closed channels, with -every precaution for its perfect purity; and to distribute it throughout -the metropolis, at a rate which shall be from 30 to 50 _per cent._ less -than our present water-charges. The proposed area for the collection of -this supply is in the extensive range of sandy soil in the south of -Surrey, extending around Farnham, about ten miles in each direction. -Since the publication of the first Report made on this subject by the -General Board of Health, unremitting inquiry has been advancing, under -their direction, into all details of the plan; and the Hon. William -Napier, who, with others, has been engaged in the investigation of the -proposed sources, has advocated an important modification, which -promises to reduce very considerably the anticipated expense of the -undertaking. The essential and most important principles which governed -the Board, in arranging their plan, were, first, to seek their supply -in a silicious soil, where little soluble material could exist for its -contamination; secondly, to take possession of the water so near to its -source that all its original purity might be preserved; and, during -conduction, to isolate it from those contaminations which are incidental -to the onward passage of a stream through miles of promiscuous country. -To fulfil these indications, there were two conceivable courses; and -studious local inquiries could alone determine which of them was -preferable: on the one hand, if the streams which represent the natural -drainage of the country should be found uniformly pure and copious, they -might admit of being conducted bodily into the artificial river of -supply: on the other hand, it might be requisite to carry the -interference of art still further, to absorb the filtering moisture of -this large sand-district before it had become confluent into streams, -and thus from day to day, by extensively ramified works of artificial -sub-drainage, to derive immediately from the soil, the varying -contributions of rain-fall and dew. The Board, apparently solicitous for -the completer security of their plan, preferred to estimate its cost on -the latter very expensive supposition; they allowed apparently for the -diffusion of drain-pipes over 150 square miles of country, and for a -reservoir which should contain storage of water equivalent to a very -long metropolitan consumption. The later examination, made by Mr. Napier -and confirmed by others, tends and appears to show, that these large -sources of expense may be avoided; that the waters may be collected of -unusual purity and softness, where they have united themselves into -rivulets of considerable volume; that the gauged and estimated discharge -of these rivulets is sufficient day by day for the needs of the -metropolis, according to the largest construction of those needs; that -capillary drain-pipes and very extensive storage-room may thus be -dispensed with; and that under the modification of arrangement suggested -by these facts, some very large reduction might be inferred for the -total estimate of this comprehensive plan. - -Many of these particulars are already before the public; but in a matter -of so much importance to the health of the City, as that of -participating in a supply of pure water, collected and distributed on -the soundest principles, and sold at the cheapest rate, I did not think -it would become me, as your Officer of Health, to remain an indolent -auditor. I have felt it my duty to inform myself, so far as I could, on -the real merits of this scheme, and on its probable relation hereafter -to the sanitary condition of the metropolis. I have spent three days on -the site of the proposed sources, and many other days in informing -myself on all the bearings of the subject. I have likewise collected -water from a proposed tributary of the future supply, which has been -analysed, and which shows (as my Appendix will illustrate to you) a -remarkable and rare excellence. On one occasion of visiting the country, -I was accompanied by Mr. T. Taylor, and we made on the spot a sufficient -number of extemporaneous examinations, to assure us that the essential -features, shown in the more elaborate analysis, are (as geological -considerations would lead us to believe) the general characters of water -throughout the district. - -On any other than the sanitary relations of this subject I can have -nothing officially to say; but, confining myself to these relations, I -may certify to your Hon. Court that the water in question is, in my -judgment, of a quality admirably suited for domestic purposes; that its -distribution through the City of London would conduce to the health and -comfort of the population; and that the principles, proposed by the -Board for its collection and conveyance, appear to me such as sanitary -science, in its present condition, should counsel for the water-service -of the metropolis. - -There is, however, one aspect of the subject which must not pass -unconsidered. Water that is free from earthy ingredients requires a -peculiar distributory apparatus. If conveyed in leaden pipes with access -of air, or if stored in leaden cisterns, it corrodes the metal of which -they are composed, and is liable to derive from this source an -impregnation very hazardous to life. Under certain circumstances, -especially under alternations of air and water (such as occur in the -intermittent supply), or where organic impurities are held in solution -or suspension, or probably where from any cause uncombined carbonic acid -is present, even the hardest waters are not free from this risk. -Speaking generally, however, it affects soft water chiefly; distilled -water most of all: and the Farnham water (in common with all pure water) -is decidedly liable to this empoisonment, if used with leaden apparatus -of conduction and storage. In my Appendix you will find some interesting -particulars on this head; and you will observe that with experiments -conducted by Mr. Taylor in imitation of the constant supply (i. e. with -total submersion of the metal) the formation of carbonate of lead in the -Farnham water was exceedingly gradual. This concurs with the alleged -experience of Aberdeen, where it is said by Professor Clark to have been -found (to my mind, by a somewhat dangerous trial) that pure and soft -water, _distributed on the principle of constant supply_, does not -exert on the leaden pipes any action injurious to the health of the -population. You will likewise observe, that when hard water, as at -present employed in the City, is softened by boiling, it acquires this -property of pure water, and becomes capable of acting on lead; and here -is an important observation, as it has been proposed by similar -artificial means, employed on a very large scale, to soften all the -water now distributed in the metropolis. - -Obviously, as regards one and all of the many proposals for supplying -water destitute of hardening ingredients, any chemical process, or any -change of source, which might lead to the distribution of such pure -water through the metropolis, could not be considered as a single and -separate reform, but must be undertaken conjointly with such alterations -in the distributive arrangements as might be requisite for removing from -the new plan _any chance, however slight or remote, of injuring the -population by metallic poison_. - -What those alterations must be, it would now be premature to decide. The -experience of Aberdeen might seem to suggest, that the system of -constant supply (on all other accounts so eminently desirable for the -metropolis) would in itself, if accompanied by the total disuse and -prohibition of leaden cisternage, give sufficient security against the -danger in question; or, on the other hand, further inquiry may show it -to be quite indispensable for a safe distribution of the new supply, -that leaden pipage should be entirely superseded by the use of some -non-metallic material, as earthenware or glass. Should this change -become necessary, its adoption would no doubt be facilitated by the -comparative cheapness of these preferable materials. - - -_Offensive or injurious Trades._ - -With respect to offensive or injurious trades and occupations pursued -within the City of London, you were reminded by your Committee of -Health, in their Report of March 26th, ‘that upon your attempting to put -in force the powers of your Act of Parliament in reference thereto, it -was found that considerable difficulties were opposed to your efforts. -Sufficient powers (the Report proceeds to say) are not given by the City -of London Sewers Act to meet some of the cases alluded to, while other -legal and technical objections presented themselves to the enforcement -of the powers in question.’ The Committee concluded their Report by -‘pointing out to you the necessity, when the question of renewing your -Act should come into consideration, of procuring additional powers which -may enable you effectually to remedy those evils.’ - -On the grounds thus expressed by your Committee, I avail myself of the -present opportunity for bringing the subject again under your notice. - -In my former Report I spoke particularly of those trades and occupations -which deal with animal substances liable to decomposition; and in -expressing my knowledge of their danger to the health of an urban -population, I argued that no occupation which ordinarily leaves a putrid -refuse, nor any which consists in the conversion or manufacture of -putrescent material, ought, under any circumstances, to be tolerated -within a town. To that subject I now revert, only to assure your Hon. -Court that the past year has given me no reason to alter my opinion. But -the trades to which I wish, on this occasion, more especially to request -your attention, are those which are complained of on the ground of -their offensiveness, rather than of their injury to health--as nuisances -rather than as poisons. During the year, I have received a very -considerable number of complaints of this nature; some of them perhaps -frivolous, but many well-founded and reasonable. - -At the head of this class of evils stands the flagrant nuisance of -smoke. Those members of the Court who have visited foreign capitals -where other fuel than coal is employed, will remember the contrast -between their climate and ours--will remember (for instance even in -Paris) the transparence of air, the comparative brightness of all -colour, the visibility of distant objects, the cleanliness of faces and -buildings, instead of our opaque atmosphere, deadened colours, obscured -distance, smutted faces, and black architecture. Those, even, who have -never left our metropolis, but who, by early rising or late going to -rest, have had opportunities of seeing a London sunrise, can judge, as -well as by any foreign comparison, the difference between London as it -might be, and London as it is. Viewed at dawn and at noon-day, the -appearances contrast as though they were of different cities and in -different latitudes. Soon after daybreak, the great factory shafts -beside the river begin to discharge immense volumes of smoke; their -clouds soon become confluent; the sky is overcast with a dingy veil; the -house-chimneys presently add their contributions; and by ten o’clock, as -one approaches London from any hill in the suburbs, one may observe the -total result of this gigantic nuisance hanging over the City like a -pall. - -If its consequences were confined to rendering London (in spite of its -advantages) the unsightliest metropolis in Europe, to defacing all works -of art, and rendering domestic cleanliness expensive, I should have -nothing officially to say on the subject; but inasmuch as it renders -cleanliness more difficult, and creates a despair of cultivating it with -success, people resign themselves to dirt, domestic and personal, which -they could remove but so temporarily: or windows are kept shut, in spite -of immeasurable fustiness, because the ventilation requisite to health -would bring with it showers of soot, occasioning inconvenience and -expense. Such is the tendency of many complaints which have reached me, -and of their foundation in truth and reason I have thorough conviction -and knowledge. - -I would submit to your Hon. Court that these evils are not -inconsiderable; and that beside the injury to property (with which I -have nothing to do) the detriment to health, if only indirect, claims to -be removed. Yet, while I am cautious to speak of this latter injury, as -though it were only indirect--only by its obstruction of healthy habits, -I ought likewise to tell you, that there are valid reasons for supposing -that we do not with impunity inhale day by day so much air which leaves -a palpable sediment; that many persons of irritable lungs find -unquestionable inconvenience from these mechanical impurities of the -atmosphere; and (gathering a hint from the pathology of vegetation) that -few plants will flourish in the denser districts of London, unless the -air which conduces to their nourishment be previously filtered from its -dirt. - -If the smoke of London were inseparably identified with its commercial -greatness, one might willingly resign oneself to the inconvenience. But -to every other reason against its continuance must be added as a last -one, on the evidence of innumerable competent and disinterested -witnesses, that the nuisance, where habitual, is, for the greater part -or entirely, voluntary and preventable; that it indicates mismanagement -and waste; that the adoption of measures for the universal consumption -of smoke, while relieving the metropolis and its population from injury, -would conduce to the immediate interest of the individual consumer, as -well as to indirect and general economy. For all the smoke that hangs -over us is wasted fuel. - -The consumption of smoke in private houses is unfortunately a matter to -which hitherto little attention has been given; and it would be vain to -hope that the reform should begin with those, whose individual -contributions to the public stock of nuisance are comparatively -trifling. With the progress of knowledge on these subjects, a time will -undoubtedly arrive, and at no distant period, when chimneys will cease -to convey to the atmosphere their present immense freight of fuel that -has not been burnt, and of heat that has not been utilised; when each -entire house will be uniformly warmed with less expenditure of material -than now suffices to its one kitchen fire; and our successors[53] will -wonder at the ludicrous ingenuity with which we have so long managed to -diffuse our caloric and waste our coal in the directions where they -least conduce to the purposes of comfort and utility. - - [53] To the philosophical thinker there would seem to exist no - important difficulty which should prevent the collective warming of - many houses in a district by the distribution of heat from a central - furnace--perhaps even so, that each house might receive its _ad - libitum_ share of ventilation with warmed air. Ingenuity and - enterprise, in this country, have accomplished far more arduous tasks; - and I little doubt that our next successors will have heat-pipes laid - on to their houses, with absence of smoke and immense economy of fuel, - on some such general organisation as we now enjoy for gas-lighting and - water-supply.--J. S., 1854. - -But, while the arrangements of private establishments may, perhaps -wisely, be left to the operation of this spontaneous reform, I would -venture to recommend in regard to furnaces, employed for steam-engines -and otherwise for manufactures within the City, that you should -endeavour to control the nuisance of smoke. - -The members of your Hon. Court are probably cognisant of the great mass -of evidence on this subject, collected by two separate committees of the -House of Commons, and of the almost unanimous conclusions to which that -evidence led; ‘that opaque smoke issuing from steam-engine chimneys may -be so abated as no longer to be a public nuisance; that a variety of -means are found to exist for the accomplishment of this object, simple -in construction, moderate in expense, and applicable to existing -furnaces and flues of stationary steam-engines; that a sufficient body -of evidence has been adduced, founded upon the experience of practical -men, to induce the opinion that a law, making it imperative upon the -owners of stationary steam-engines, to abate the issue of opaque smoke -is desirable for the benefit of the community;’[54] ‘that the expense -attendant on putting up whatever apparatus may be required to prevent -smoke arising from furnaces is very trifling, and (as some of the -witnesses observed) the outlay may be repaid within the year, by the -diminished consumption of fuel; that the means of preventing smoke might -also be applied to the furnaces of steam-boats, but such application -would be attended with rather more expense than on land, from the -occasional want of space, and the setting of boilers in a steam-vessel. -No doubt, however, existed, in the opinions of those examined, that the -prevention of smoke could be accomplished in steam-vessels.’[55] - - [54] Report of Committee, 1845. - - [55] Report of Committee, 1849. - -In two local improvement Acts (those of Leeds and Manchester) clauses -have been introduced in accordance with the sense of these conclusions; -and in order to render them as little oppressive as possible to those -whose interests might be affected by their operation, the enactments -(which apply to every variety of furnace) have been so framed as to -enforce penalties for the issuing of smoke only when it should appear -(as no doubt it commonly would appear) that the proprietor had refrained -from “using the best practicable means for preventing or counteracting -such annoyance.” - -Surely if such applicable means exist, it is a just and reasonable thing -that the public should be defended against offence and injury, arising -in the mere indifference or obstinacy of those who inflict them; and I -venture to hope that your Hon. Court, in renewing your application to -Parliament, may procure the enactment of a clause, giving you control -over so much of the nuisance as is wanton and avoidable. - - * * * * * - -There are still under the present head, some points to which I am -anxious to advert. During the two years that your Act has been in -operation, various complaints have been made with respect to nuisances -arising in particular trades; and with many of the causes of complaint -you have been unable effectually to contend. Soap-makers, -tallow-melters, gut-spinners, naphtha-distillers, preparers of patent -manure, dealers in soot, exposers of stinking hides, wire-makers, -dealers in kitchen-stuff, fish-curers, tripe-boilers, type-founders, -gold-refiners, slaughterers, varnish-makers, roasters of coffee and -chicory, whalebone-boilers, iron and brass-founders, keepers of -cattle-sheds, makers of printing-ink, dealers in camphine, cookers of -cats’-meat, and manufacturing chemists, have all, at different times and -in various degrees, been complained of. - -In respect of those of the enumerated trades which deal in the -manufacture or sale of organic materials in a putrid or putrescent -state, I have already submitted to you my opinion that the City of -London, the home of a large and crowded population, is no place for -them. With regard to the many other occupations, it would obviously be -absurd, in the present state of society, to think of banishing them from -the City which their industry has contributed to enrich, and where -immemorial custom has given sanction to their continuance, unless you -could with certainty affirm of them, that they cause direct and -inevitable detriment to their neighbourhood. Every useful purpose, as -regards the health of the City, might be fulfilled by the enactment of -some moderate restriction. - -Manifestly, it is opposed to the spirit of your Act of Parliament, that -any trader or manufacturer should possess the right of diffusing in the -vicinity of his house, to the detriment and disgust of his neighbours, -any product (whether in the form of running fluid, or volatile dust, or -vapour, or smoke, or odour) which is either disagreeable to the senses -or may be hurtful to the health. Many of the instances which I have -enumerated fall within this description, and yet remain unaffected by -the restrictive sections of your Act. - -I would submit to the consideration of your Hon. Court, whether, in the -renewal of your Act, some comprehensive clause might not be introduced, -which should deal with these difficulties, as well as with the nuisance -of smoke--and deal with them, too, on the same principle: a clause, -which (without enumerating all trades which have been, or possibly may -become, sources of nuisance in the City, and without specifying too -narrowly the nature of the nuisances to be guarded against) should -empower your Commission generally, in respect of every trade practised -within the City, to require that its operations shall be conducted with -the least possible amount of inconvenience to the neighbourhood; and -which should enable you to enforce penalties in case of every nuisance -arising in such operations, unless it should be distinctly shown on the -part of the proprietor, that every practicable measure for abatement of -the inconvenience had been constantly and thoroughly employed.[56] - - [56] Such a clause was introduced in the Act of 1851 (see page 193) - and has been worked with considerable advantage.--J. S., 1854. - -I would beg to express my conviction that your possession of the -authority with which such a clause would invest you, would very largely -increase your powers of utility, in respect of many acknowledged -grievances hitherto beyond your control; and the influence of your -example, in the achievement of this great municipal purpose, would, I -doubt not, speedily lead to the adoption of general measures throughout -the metropolis, for the total suppression of smoke, and for the -mitigation of other nuisances which now exist around your territory no -less than within it.[57] - - [57] This expectation has recently been fulfilled in the Smoke - Prevention Act, for which the metropolis has to thank Lord - Palmerston.--J. S., 1854. - - -_Burial-Grounds._ - -In my last year’s Report I had occasion to represent to your Hon. Court -the evils of intramural sepulture. I testified to that large -accumulation of human remains, by which, in numerous parts of the City, -the soil of burial-grounds has been raised many feet above its original -level; and I advised you of the injury which must accrue to health from -the constant organic decomposition thus suffered to proceed in the midst -of our crowded population. I likewise invited your attention to the -still greater evil of burial in vaults; I explained and endeavoured to -remove the misconception which commonly prevails, as to the preservation -of bodies under those circumstances; and I showed you how unfailingly, -sooner or later after such burial, the products of putrefaction make -their way from within the coffin (whatever may have been its -construction) and diffuse themselves offensively and injuriously through -the air. I concluded by expressing to you my strong conviction of the -necessity that some comprehensive measure should be undertaken, for -abolishing, at once and for ever, all burial within the City of London. - -During the session of Parliament that has intervened between that Report -and my present one, an event has occurred, which promises to remove -effectually the evils on which I then addressed you. Her Majesty’s -government, acting at the instigation of the General Board of Health, -carried through Parliament a Bill, enacting that the Queen, by Order in -Council, may prohibit further burials within any district of the -metropolis, so soon (after the close of this year) as the General Board -of Health should have provided the means of extramural interment. The -operation of this Act of Parliament is such as, I have every reason to -believe, you will welcome within the City of London: and I look forward -to the complete cessation of burial within your territory, as a matter -for warm congratulation among all who are interested in the cause of -sanitary improvement.[58] - - [58] The Act of Parliament here referred to never passed into - operation, and was repealed in 1852 by a second Metropolitan Burials - Act, under which the City Commissioners of Sewers are at present - acting as a Burial Board for the City of London. See the last Reports - of this Volume, from page 280 to the end.--J. S., 1854. - -From the terms of the Act in question I find that Her Majesty’s Order in -Council is to be preceded by a Report from the General Board of Health, -stating their opinion of the expediency, that (in any particular case -reported on) burial should forthwith be discontinued. Accordingly, in -the present state of the law, it will devolve on that Board to initiate -whatever measures may be necessary for the prohibition of further -interment in the City. - -Two clauses of your Act of Parliament, which have hitherto been -inoperative, may perhaps come into requisition whenever Her Majesty’s -Order in Council closes the burial-grounds of the City; viz., clause 89, -which empowers your Commission, if you shall “think fit, to provide fit -and proper places, in which the poor, under proper rules and -regulations, may be permitted to deposit the bodies of their dead -previous to interment;” and the following clause, which authorises your -Officer of Health, in case of necessity, and for protection of the -living, to cause any dead body to be removed at your expense, to -whatever building may have been provided for the reception of the dead, -previous to interment. It may hardly be necessary that I should trouble -you with any remarks on the subject of these clauses, till such time as -they are likely to come into operation. - -With respect to the burial-grounds within the City, which will fall into -disuse so soon as the new Interment Act becomes operative, I trust that -your Hon. Commission will procure the power of regulating and -supervising their maintenance, so that they may no longer be hurtful to -the health of their vicinity. The arrangement of them, which would be -most advantageous to their locality, would be that of planting them with -whatever trees or shrubs may be made to flourish in a London atmosphere. -The putrefactive changes, which for some years longer must proceed in -these saturated soils, will be rendered comparatively harmless and -imperceptible, if at the same time there advance in the ground a -sufficiency of vegetation, which for its growth would gradually -appropriate, as fast as they are evolved, the products of animal decay. - -It seems almost superfluous for me to observe, that, from the time when -burials are discontinued, no unnecessary disturbance of the soil should -be allowed; nor any attempts at levelling or the like, except under the -direct sanction of your Hon. Court. - -Another point in connexion with these burial-grounds, to which I may -here advert (though I must recur to it hereafter) is, that while great -advantage may be expected from the discontinuance of their former uses, -if their several areas be left open and without building, so as to -subserve the ventilation of their neighbourhood, all that advantage -would be lost, and a heavier evil inflicted on the neighbourhood than -that of which it purports to be relieved, if these spaces were at any -time to be covered with houses; and I trust it may be found within the -province of your Hon. Court to obtain authority for preventing any -encroachment of this nature on the limited breathing-spaces of the City. - - -_Habitations and Social Condition of the Poor._ - -In my last Report (under its fifth and sixth heads) I particularly -solicited the attention of your Hon. Court to certain circumstances -connected with the dwellings and habits of the poor, which, though they -then lay apparently out of your jurisdiction, as defined by the Act of -Parliament, yet appeared to me of immeasurable weight in the sanitary -fluctuations of the City, as tending in their operation constantly to -thwart your endeavours for improvement, and to neutralise day by day -whatever good you could achieve. - -I reported to you that there were sanitary defects, inherent in certain -large proportions of your municipal cure, which the most absolute -control of drainage and water-supply would do nothing to -amend,--constructional defects of houses and of courts, whereby their -crowded inhabitants were excluded from a sufficiency of light and air, -and were constrained, without remission or change, to breathe an -atmosphere fetid with their own stagnant exhalations. I reported to you -that, however unexceptionable might be the arrangement of such -localities in matters already within your control--however clean their -pavements, however pure their water, however effective their drainage, -yet fever and the allied disorders could never be absent from their -population; while under opposite arrangements, with nuisances around -them, with organic poisons rising from the soil or mingling in the -water, their mortality would rise to the horrors of pestilence, and -might easily renew the most awful precedents in history. I described to -you the class of miserable dwellings alluded to--‘Courts and alleys with -low, dark, filthy, tenements, hemmed in on all sides by higher -buildings, having no possibility of any current of air, and (worst of -all) sometimes so constructed, back to back, as to forbid the advantage -of double windows or back doors, and thus to render the house as perfect -a _cul-de-sac_ out of the court, as the court is a _cul-de-sac_ out of -the next thoroughfare:’ I affirmed that ‘this could never be otherwise -than a cause of sickness and mortality to those whose necessities allot -them such residence;’ and assured you of the ‘incontrovertible fact, -that subsistence in closed courts is an unhealthy and short-lived -subsistence, in comparison with that of the dwellers in open streets.’ - -In habitations of this kind the death-rate would of necessity be high, -even if the population were distributed thinly in the district. A single -pair of persons, with their children, having such a court for their sole -occupancy, would hardly be otherwise than unhealthy; the infants would -die teething, or would live pallid and scrofulous; or a parent would -perish prematurely--the father, perhaps, with typhus, the mother with -puerperal fever. Judge then, gentlemen, how the mortality of such courts -must swell your aggregate death-rate for the City, when I tell you that -their population is in many instances so excessive, as, in itself, and -by its mere density, to breed disease. - -Statistics can give you no conception of this crowding. If you refer to -the results of the last census, you find the average population _per_ -house, in the City of London Union to be 7·1; in the East and West -London Unions, 8·8; for the construction of these averages, the most -dissimilar materials are blended together; and the density of population -is apparently reduced by the very large number of business-houses which -have no resident inmates, beyond the porter or the housekeeper who has -charge of them. If you turn from the deceptions of an average to the -exact analysis of detail, you will find many single rooms in the City -with a larger number of inmates than you might otherwise ascribe to -entire houses. Instances are innumerable, in which a single room is -occupied by a whole family--whatever may be its number, and whatever the -ages and sexes of the children; where birth and death go on side by -side; where the mother in travail, or the child with small-pox, or the -corpse waiting interment, has no separation from the rest. - -This is evil enough; but worse remains behind. It is no uncommon thing, -in a room of twelve feet square or less, to find three or four families -_styed_ together (perhaps with infectious disease among them) filling -the same space night and day--men, women, and children, in the -promiscuous intimacy of cattle.[59] Of these inmates it is nearly -superfluous to observe, that in all offices of nature they are -gregarious and public; that every instinct of personal or sexual decency -is stifled; that every nakedness of life is uncovered there. Such an -apartment is commonly hired in the first instance by a single pair, who -sub-let a participation in the shelter, probably to as many others as -apply. Sometimes a noxious occupation is carried on within the space: -thus, I have seen mud-larks (_chiffonniers_) sitting on the floor with -baskets of filth before them, sorting out the occasional bit of coal or -bone, from a heterogeneous collection made along the bed of the river, -or in the mouths of the sewers; and this in a small room, inhabited -night and day by such a population as I have described. - - [59] I purposely refrain from any attempt to illustrate all the - horrors which are incidental to this method of life; but, as a single - exemplification of the text (chosen, not because of its rarity, but - because it happens to occur at the moment) I insert an extract from a - note, with which I was favoured a fortnight ago, by Mr. Hutchinson, - Surgeon to the North District of the West London Union: ‘I was sent - for to attend a poor Irish woman in labour, at half-past six o’clock - yesterday morning, at 17, Fox and Knot court. There were three - families, each consisting of a man and wife and two or more children, - in a small room, 15 feet by 8, all lying upon dirty rags on the floor. - I found one of the children suffering under small-pox. The adjoining - room was occupied by six grown-up persons and two children.’ In the - circumstances to which my Report refers, scenes of this description - must of necessity be _habitual_: and it is to their habit, not to - their exceptional occurrence, that my remarks apply. - -Who can wonder at what becomes, physically or morally, of infants -begotten and born in these bestial crowds? - -In my former Report, I drew your attention to this pestilential heaping -of human beings, and suggested to you its results; and on many -occasions, during the past year, complaints have been before your Hon. -Court which have had their real origin in this uncontrolled evil. I -revert to it because of its infinite importance. While it maintains -physical filth that is indescribable, while it perpetuates fever and the -allied disorders, while it creates mortality enough to mask the results -of all your sanitary progress, its moral consequences are too dreadful -to be detailed. I have to deal with the matter only as it relates to -bodily health. Whatever is morally hideous and savage in the -scene--whatever contrast it offers to the superficial magnificence of -the metropolis--whatever profligacy it implies and continues--whatever -recklessness and obscene brutality arise from it--whatever deep injury -it inflicts on the community--whatever debasement or abolition of God’s -image in men’s hearts is tokened by it--these matters belong not to my -office, nor would it become me to dwell on them. Only because of the -physical sufferings am I entitled to speak; only because pestilence is -for ever within the circle; only because Death so largely comforts these -poor orphans of civilisation. To my duty it alone belongs, in such -respects, to tell you where disease ravages the people under your -charge, and wherefore; but while I lift the curtain to show you this--a -curtain which propriety might gladly leave unraised, you cannot but see -that side by side with pestilence there stalks a deadlier presence; -blighting the moral existence of a rising population; rendering their -hearts hopeless, their acts ruffianly and incestuous; and scattering, -while society averts her eyes, the retributive seeds of increase for -crime, turbulence, and pauperism. - -While I refer to these painful topics, I may remind your Hon. Court of -the Report of your Committee on Health, in respect of the same heads in -my previous communication, and may strengthen myself with their -testimony: ‘We feel it due to Mr. Simon to add, from the result of -personal investigation, that the statements contained in his Report -under this subject, distressing as they are, are not exaggerated:’ and, -as regards whatever I may have recapitulated from that Report, I would -beg leave to add, that my experience during the past year has confirmed -the opinions which I then expressed; assuring me more and more, that the -correction of these crying evils must advance simultaneously with the -other labours of sanitary reform. - -Recently, while having the honour to attend your Committee of Health in -their deliberations on your Act of Parliament, I have submitted to them, -as my view of what is desirable for legislation on the subject of my -present section, substantially the same suggestions as I formerly laid -before your Hon. Court. As their recommendations must shortly come -before you for consideration, and as I entertain the deepest conviction -that the subject is of paramount importance to the cause in which you -are interested, I have hoped you would excuse my recurrence to it, and -my brief repetition of those suggestions which the incompleteness of -your Act of Parliament has hitherto prevented your adopting. - -1. There are within the City some blocks of houses which are, I fear, -irremediably bad and pestilential from such errors of construction as I -have already described; and which, further, are so dilapidated, as to -show at a glance their little pecuniary value. In many instances the -destruction of such a block of houses would confer a sensible advantage -on the population of a considerable district. Of this class I could -hardly give you a better illustration than would be seen in the -ground-plan of Seven-step alley. There are other instances (frequent in -Cripplegate) where the removal of a single house at the extremity of a -court or passage would make a material difference to the ventilation of -several houses, and to the health of a numerous population. - -2. Again, in very many parts of the City, you find illustrations of a -constructional error to which I have adverted as in the highest degree -pernicious to health. You find a number of courts, probably with very -narrow inlets, diverging from the open street in such close succession, -that their backs adjoin with no intermediate space whatsoever. -Consequently, each row of houses has but a single row of windows, facing -into the confined court; and thus there is no possibility of -ventilation, either through the court generally, or through the houses -which compose it. In the Out-Wards of Cripplegate, Farringdon, and -Bishopsgate, examples of this arrangement are both most numerous, and I -believe, most removable: but they may likewise be found in considerable -numbers in the In-Wards of the City; _e.g._, in the neighbourhood of -Printing-house-square, of Great Bell-alley, of Leadenhall-street, of -Aldgate, of Skinner-street, and of St. Martin’s-le-Grand. - -In many of these cases, if the management of the property were under a -single control, it is possible that effectual relief might be given, by -converting any two rows of houses which are back to back, each having -windows only on one side, into a single row of houses, with doors and -windows both before and behind: and if changes of this nature were -accompanied by the removal of an occasional house, or other impediment -to the circulation of air, I would guarantee to your Hon. Court that the -next year’s register would show a very large diminution in the local -amount of preventable sickness and mortality. - -3. In other cases, the immediate impediment to ventilation apparently -consists in the operation of the window-tax. Your Hon. Court, at various -times, has heard how unfortunate for the health of cities is this -ill-chosen method of taxation, assessing the amount of rate for houses -in proportion to their means of ventilation. You can easily conceive how -much it would impede your endeavours to promote health and cleanliness -within the City, if an additional direct tax were levied on houses by -reason of their _drainage_; or if the assessor regulated his rate -according to the _consumption of water_ for household purposes. The -working of the window-tax is on this principle; and although it may be -very true that health is the greatest of treasures, and that, on this -ground, its means and appliances are eligible for taxation, I cannot but -regret that a struggling population should be tempted by the hope of -some small saving, to make a sensible diminution in their chances of -life, by retrenching within the narrowest measures their inlets of -ventilation and light. - - * * * * * - -In reference to the more important constructional errors which I have -described to you, as affecting the courts and alleys of the City, it -will be obvious, from the remedies which I have suggested, that no hope -of alteration can be expected from landlords. To throw together the -adjoining houses of two different courts, or to remove one house for the -advantage of certain others, or to destroy a whole block of houses for -the sake of its neighbourhood, could evidently be undertaken, as a -matter of private enterprise, only where property of very considerable -extent, and close juxtaposition, happened to be in the hands of a single -individual; and, as regards the City of London, this is rarely or never -the case. The only manner, then, it occurs to me, in which the requisite -remedies could be applied, would be through the wealth and benevolence -of the Corporation. If there were vested in your Hon. Court (or in any -other authority of the Corporation) the power to make compulsory -purchases of house-property, on the ground of its unfitness for human -habitation, it would be easy to correct the extreme errors which exist; -and, under a single large landlordship of this nature, it might not -improbably be found that measures such as I have described would give to -the localities in which they might be effected as much improvement in -value as in health. After the necessary alterations, such houses would -no longer need to continue under tenure of the Corporation, and the -proceeds of their sale might again be applied to the reclamation of -similar property in other parts of the City. - -In throwing out this suggestion to your Hon. Court, I, of course, do not -pretend to offer you any details for its realisation. These can more -fitly be supplied by others; nor should I have introduced even this -general mention of a plan, but for the vividness with which its -practicability and usefulness have struck me. During my period of -office, I have seen distinctly that what seems incurable in the dark -intricacies of our worst courts and alleys often depends for its -difficulty on the _number_ of landlords, and on their mutual -independence. The conviction had thus been forced on me, which I have -endeavoured briefly to express to you; that the only available cure for -such evils would consist in the Corporation assuming to itself (if only -for a time, and in gradual succession) the proprietage of such wretched -tenements, and fulfilling towards them those large and liberal duties -of landlordship, which now remain unperformed through the multiplicity -and neediness of petty owners. And, as a precedent for one species of -such improvement, I may mention to your Hon. Court, that in such -property as I have described to you, situated in other parts of the -metropolis, private societies have already effected purchases which have -enabled them to convert bad and unwholesome residences into the form of -model lodgings for the working classes. - -Before leaving the consideration of evils, in which over-density of -building and defective ventilation form such important parts, I would -avail myself of the opportunity to observe, that it is of incalculable -importance to preserve, for the health of the City, every open space -which at present exists. The density of buildings within the City of -London Union is very great, and in the East and West London Unions, is -very considerably greater than in any other part of the metropolis; and -not merely are the houses closely packed together, but (as I have -already described them) very thickly inhabited. Within the City of -London Union, each human being, on an average, has less than an eighth -part of the space he would have if residing in the district of -Islington; and, small as is this pittance, it is more than double what -he would enjoy if he were living in the district of the East and West -London Unions. With such density of population, it would, of course, be -advantageous if any space now occupied by buildings should hereafter -become vacant, so as to increase the breathing-room of the -neighbourhood; and your Hon. Court will see the imperative necessity of -discountenancing, so far as may be, the erection of additional houses on -the few unoccupied spaces which remain. In order to do this effectually, -it would be desirable to procure the enactment of a clause, giving you -absolute prohibiting power in this respect, whenever, for sanitary -reasons, you might think it right to interfere. - -With respect to those evils which I have set before you, as arising from -the unrestricted accumulation of persons of both sexes, and of all ages, -within a single sleeping-room--dreadful as they are, I do not consider -them irremediable. In the first place, I would beg you to observe, that -the very restricted definition of a ‘lodging-house’ given in your Act of -Parliament, has hitherto rendered it impossible, in any degree, to -regulate dwellings of the description referred to. An amendment of that -definition might bring them within your control, and might enable you, -not only in these instances, but in many others, to restrict the numbers -of inmates, to compel the removal of persons with infectious disease, -and to enforce provisions of decency, cleanliness, and ventilation. - -Not, however, alone to restrictive and compulsory measures do I look for -the social improvement of numbers, now so destitute and miserable. That -our entire industrial population within the City might, in such -respects, gain great advantage from an enlightened supervision and -guidance, I formerly endeavoured to show. I sought (from other -experience) to illustrate the benefits they would derive, not only from -your exercising habitual inspection, and possessing a more extensive -control, in many matters relative to their dwellings and mode of life; -but likewise, from the establishment, under the auspices of the -Corporation, of institutions which, raising before them a higher -standard of civilisation, would improve their social habits by an -indirect educational influence, and would elevate the general tone and -character of their class. - -On the subject of Model Dwellings for the labouring classes, and of -Public Baths and Wash-houses, as illustrating this view, I dwelt at some -length in my former Report; and, deeply convinced of the boon which -their establishment would confer on the poor, I explained, to the best -of my ability, the nature and the extent of their usefulness. - -I now recur to the subject, only that I may repeat my profound -conviction of its importance; and that in doing so, I may congratulate -your Hon. Court, and may utter my deep thankfulness for the labouring -and suffering poor of this great community, that, in compliance with the -Standing Orders of Parliament, formal notice has been given on the part -of the Corporation of the City of London, of their intention, in the -approaching session of the Legislature, to apply for authority which may -enable them to achieve, for their dependent fellow-citizens, this almost -incalculable good.[60] - - [60] The intention of the Corporation, here spoken of, has not - hitherto been carried into effect.--J. S., 1854. - -I cannot too strongly express the importance I attach to this implied -intention of the Corporation, to establish model dwellings for the -industrial population of the City. But the first and immediate operation -of such an Act will, from the nature of things, hardly reach to those -very destitute and degraded classes of which I have spoken. Model -lodgings of the ordinary character will become the residence of men, who -now pay from two to five shillings a week for such space as they occupy, -and who have the habit of sleeping in beds. To them the gain will be -very great; and the example of improved domestic habits will be -beneficial to their entire class. But among the lowest order which I -have described to you, as it subsists in thronged and pestilent heaps -within your worst quarters, there is little knowledge of beds. The first -hirer of the room may possibly have a pile of rags on which he lies, -with his wife and children, in one corner of the tenement; but the -majority of his sub-tenants (paying for their family-lodging from -sixpence to ten-pence a week) lie on straw, or on the bare boards. It -will be obvious to you, that no _Model_ Lodging-house could be reduced -to the level of their means. By those restrictions to which I have -adverted, something may be done, no doubt, for improving the arrangement -of houses so tenanted--something to prevent the more glaring outrages of -decency which at present prevail--something to maintain comparative -cleanliness, and to check the spread of disease. I fear that no further -remedy than this would prove effectual, unless it were universal for the -metropolis. Unquestionably, it would be possible, with persons even of -the lowest sort above pauperism, to proceed on the same principle as in -the establishment of model-lodgings for the working orders; to provide -for them, namely, under respectable control and supervision, the best -accommodation which their price could purchase, of the kind to which -they have been habituated; to give them the means of lying down, free -from damp or cold, partitioned from one another, and with isolation of -sexes, in a building constructed or arranged for the purpose, where the -ventilation and the facilities for cleanliness might be complete. There -seems little room to doubt that this might be done, on a very large -scale, at a rate considerably less than the poorest now pay for the -right of lairage amid vermin, filth, obscenity, and fever; and with such -dormitories, obviously, there might be connected other arrangements for -giving comfort and cleanliness to the very poor and destitute, at the -lowest possible price. Of gratuitous reception I do not speak, because -that is already provided, under certain regulations, in all the -work-houses of the metropolis. But while I conceive that such a measure, -if generally adopted throughout London, would defray its own cost, and -would remove evils and miseries horrid to contemplate, I cannot but feel -that it would be inadmissible (in its cheapest form) as a local measure. -For if the price of reception--for instance, here, were so low as to -allure the wretched population in question from their places of present -resort within the City, it cannot be doubted that its influence would -extend beyond your jurisdiction, and would throng your dormitories with -the destitute of other districts. As the evil is metropolitan, so ought -the remedy to be; and if there were thus instituted within each Union of -the metropolis, a _Ragged Dormitory_ of the nature described, I am -persuaded, from my knowledge of the poorest classes, that its -establishment would be of infinite advantage in improving the habits, -and diminishing the mortality of those who would become its inmates. - - -III. SUGGESTED ALTERATIONS IN THE ACT OF PARLIAMENT. - -Finally, gentlemen, considering that you are about to procure a renewal -of your Act of Parliament, and that you contemplate strengthening it -with such additional clauses as may render it effective for the -eradication of all preventable disease within the City of London, I -would ask permission, in this point of view, to submit to you in a -connected series, such modifications as in my judgment would contribute -to that purpose. Most of these I have already had the advantage of -suggesting to your Committee on Health; and to many of them I have -adverted by anticipation, in previous passages of my Report. I would beg -to enumerate the _desiderata_ under the following heads, _viz._ - -1. A clause, which would give you control over the supply and -distribution of water, would enable you in your corporate capacity to -contract with any person or any company for the total service of the -City; and would authorise you to defray the expenses of such contract by -certain specified rates. - -2. A clause empowering you to require, that every trade or manufacture -practised within the City shall be carried on with such precautions, and -with such available improvements, from time to time, as shall reduce to -the lowest practicable amount whatever nuisance or inconvenience to the -neighbourhood is apt to arise therefrom. - -3. Such change in the definition affixed to your 91st clause as would -render this operative for the regulation and improvement of a larger -number of houses; and such addition to the clause as would enable you, -on the joint certificate of your Officer of Health and Surveyor, to -enforce the making of additional windows, where requisite for the proper -ventilation of houses. - -4. A clause permitting and empowering you, on sufficient medical -testimony, to remove, or to call upon the Board of Guardians to remove, -from any lodging-house, within the new definition of your Act, any -person diseased with fever or other infectious malady, whose continuance -there would endanger the lives of other inmates. - -5. A clause prohibiting the occupation of under-ground cellars for the -purposes of dwelling. - -6. A clause prohibiting the keeping of cattle in or under -dwelling-houses. - -7. A clause vesting in the Commission a right to purchase houses by jury -valuation, in any case where they shall determine that such houses are -permanently unwholesome and unfit for human habitation, or that their -alteration or removal is necessary for the public health. - -8. A clause enabling the Commission to control all further encroachments -on spaces which are now open within the City; so that on ground now -unoccupied by buildings, no future erection shall be made, except with -the sanction of the Commission. - -9. A clause to protect the purity and wholesomeness of human food, as -sold within the City, by affixing penalties to its exposure for sale in -any adulterated, decayed, or corrupted condition, which may impair its -fitness for consumption. - -These are the heads under which it has appeared to me that the most -useful additions might be made to your Act of Parliament, in matters -within the scope of my official observation. There are some other minor -modifications, which I have submitted to your Committee of Health, and -which, as they relate merely to detail, it is unnecessary for me to -bring before you. All the recommendations which I have made on this -subject result from a careful scrutiny of the operation of your present -Act, during the two years that I have had the honour of serving you. -Each separate paragraph of my enumeration founds itself upon a distinct -recollection of occasions, sometimes numerous, wherein, for want of such -enactments, nuisances which you were anxious to suppress have eluded -your authority, or advantages which you were desirous to realise have -stood beyond your attainment. - -It was in the nature of things that this should be so; for the period -has been one of experiment. When the City Sewers Act became law for a -period of two years, every one interested in its success must have felt -the advantage of that limited duration, and have rejoiced in the -opportunity, thus afforded, of rendering it eventually the most perfect -embodiment of sanitary law. - -Parts of the Act have abundantly fulfilled your intention. In the -all-important particular of house-drainage--in the enforcement of -water-supply, so far as circumstances rendered possible--in the -effective preservation of exterior cleanliness--in the abatement of -innumerable nuisances--in the provision and maintenance of sewerage and -paving and lighting throughout the City--the public has seen your Hon. -Court exercising very large powers with very unusual success. And this, -let me add, during a time of no ordinary difficulty: a time when, day by -day, the vast importance of sanitary improvement has been gaining ground -among the educated classes of the country, as a deep and settled -conviction; a time when the feelings of all classes have been powerfully -excited, and when the metropolis especially has been convulsed with -alarm, in the anticipation and in the aspect of a pestilence. - -In some other respects the Act has been less operative, and for an -obvious reason. To legislate for health was new to you. It was only -through the gradual investigation of officers, appointed under the Act, -that you could become adequately informed of those sanitary requirements -on which your ultimate legislation for the City must found itself. Only -by their slow experience, only by failure as well as by success, was it -possible that correct knowledge could be obtained of the powers really -needful for fulfilling your sanitary intentions. - -In carefully watching the fluctuations of health amid your population; -in investigating the causes which determine them; and in testing, on -every occasion, how far these causes are amenable to the control of your -Act of Parliament, I have arrived at the conclusions submitted to you in -the present and in my previous Report. - - * * * * * - -To excuse the length at which I have addressed you, I have but another -word to say. My apology consists in the assurance, which again I lay -before you, that in spite of all your exertions, untimely and -preventable death still prevails most largely in the population under -your charge. If the deliberate promises of Science be not an empty -delusion, it is practicable to reduce human mortality within your -jurisdiction to nearly the half of its present prevalence. - -It is the sad prerogative of my Profession to have such knowledge of -death as cannot lie within your experience. Knowing all that is implied -in each one separate instance of its visitation--how much pain and -sorrow, often how much bereavement and destitution, we, perhaps better -than others, learn to appreciate that vast amount of social misery which -has its symbol in the high death-rate of a population. It is from this -practical point of view that I have ever estimated the importance of -your functions, and have fixed the obligations of my own humbler office. -Notwithstanding all that Medicine can achieve, to succour the body as it -struggles against actual disease--notwithstanding those resources of -drugs and handicraft, by which the physician or surgeon opposes death or -mitigates pain in the detailed exercise of his art, all past experience, -and every transaction of our daily practice, confirm the popular adage -that _prevention is better than cure_. If this be true in any particular -case, much more is it true in the largest application. While _Curative -Medicine_--ministering step by step to the individual units of a -population, can produce only minute and molecular changes in the health -of society; Sanitary Law, embodying the principles of _Preventive -Medicine_, may ensure to the aggregate masses of the community -prolongation of life and diminution of suffering: in the working of some -single enactment, it may affect the lives of generations of men, and may -moderate in respect of millions the sources of orphanage and poverty. - -Surely, it is no common epoch in the history of the metropolis when you -are appealing to the Legislature, on behalf of the Corporation, for the -grant of additional powers towards the accomplishment of so great a -beneficence. To me it has always been an act of the deepest and most -anxious responsibility to address you; and it would ill have become me -now, in the attempt to discharge so grave a duty, if I had spared any -pains or withholden any conviction. - -While endeavouring in this, and in my previous Report, faithfully and in -detail to depict for you the actual condition of human life within the -City, and while seeking to deduce for you, from reason and experience, -those sanitary principles which are applicable for its improvement, I -have had no trivial or easy task; and you will pardon me, I hope, both -if I have incompletely surmounted the difficulties of so large a -subject, and if, by the length of my Report, I have made too great -claims on your indulgence. - - I have the honour to remain, - - &c., &c. - -Note to Column I. - - Speaking generally, this column may be taken to express the number of - houses in each Ward. Exception must be made, however, in respect of - the four wards marked with asterisks; for in them the real number of - houses somewhat exceeds the number of assessments. This discrepancy - depends on the fact that, in the specified wards, a court containing - several houses is often assessed by composition as a single property. - Mr. Daw informs me that in order to correct on this score the numbers - which stand opposite the Wards in question, addition should be made as - follows:--to Bishopsgate Without, 80--raising its number to 1100; to - Cripplegate Without, 150--raising its number to 1112; to Farringdon - Without, 100--raising its number to 3633; to Portsoken, 150--raising - its number to 1408. This would raise the total number to 16,384, which - is about the estimated number of houses in the City. From the results - of the last census it appeared that the population of the City was - distributed as follows:--within the district of the City of London - Union on an average of 7·1 persons to each house; within the district - of the East and West London Unions on an average of 8·8 persons to - each house. - -_Comparative prevalence, in the several Wards of the City, of such -Deaths as particularly depend on local circumstances._ - - +-------+--------------------+--------+---------+---------+---------+ - | I. | II. | III. | IV. | V. | VI. | - | | | | | | | - |Number | WARDS |Total |Separate |Cholera, |Fever, | - |of | |for the |Totals of|Dysen- |_&c._ | - |Assess-| |biennial|the two |tery, |Year | - |ments. | |period, |years |Epidemic |ending | - | | |from |ending |Diarrhœa.|Sept. | - |_vide_ | |Oct. 1, |respec- |Year | | - |Note. | |1848, to|tively |ending | | - | | |Sept. |Sept. 29.|Sept. | | - | | |28, | | | | - | | |1850. | | | | - | | | | | | | - | | | | | | | - | | | |1849|1850|1849|1850|1849|1850| - +-------+--------------------+--------+----+----+----+----+----+----+ - | 184|Aldersgate Within | 30 | 15| 15| 1| ...| 1| 1| - | 572|Aldersgate Without | 179 | 122| 57| 32| 4| 15| 5| - | 809|Aldgate | 102 | 66| 36| 3| 1| 7| 7| - | 133|Bassishaw | 7 | 5| 2| 3| ...| ...| 1| - | 314|Billingsgate | 33 | 28| 5| 15| ...| 2| ...| - | 334|Bishopsgate Within | 60 | 43| 17| 20| ...| 1| 3| - | *1020|Bishopsgate Without | 329 | 231| 98| 88| 7| 18| 13| - | 251|Bread Street | 22 | 16| 6| 2| ...| 3| ...| - | 205|Bridge | 18 | 12| 6| 4| ...| ...| ...| - | 536|Broad Street | 42 | 29| 13| 7| ...| 4| 1| - | 194|Candlewick | 13 | 12| 1| 7| ...| ...| ...| - | 499|Castlebaynard | 103 | 75| 28| 28| ...| 5| 5| - | 341|Cheap | 32 | 22| 10| 4| 1| 3| ...| - | 626|Coleman Street | 66 | 42| 24| 1| 3| 8| 3| - | 294|Cordwainer | 5 | 5| ...| 2| ...| ...| ...| - | 158|Cornhill | 4 | 2| 2| ...| ...| ...| ...| - | 471|Cripplegate Within | 80 | 50| 30| 8| ...| 4| 1| - | *962|Cripplegate Without | 299 | 207| 92| 86| 11| 15| 6| - | 232|Dowgate | 25 | 20| 5| 12| ...| ...| ...| - | 961|Farringdon Within | 153 | 117| 36| 67| ...| 9| 4| - | *3533|Farringdon Without | 845 | 613| 232| 370| 19| 48| 40| - | 409|Langbourn | 29 | 12| 17| 3| 1| 1| 2| - | 166|Lime Street | 8 | 4| 4| 1| ...| ...| ...| - | *1258|Portsoken | 143 | 82| 61| 29| 5| 7| 14| - | 343|Queenhithe | 59 | 36| 23| 14| 1| 2| 4| - | 611|Tower | 46 | 22| 24| 9| ...| 4| 3| - | 253|Vintry | 14 | 11| 3| 5| ...| 2| 1| - | 235|Walbrook | 24 | 15| 9| 3| 1| ...| 2| - | |City of London Union| 25 | 18| 7| 1| ...| 7| 2| - +-------+--------------------+--------+----+----+----+----+----+----+ - | 15904|The Deaths from all}| | | | | | | | - | 480|causes within same }| 2795 |1932| 863| 825| 54| 166| 118| - |-------|period were 6551 }| | | | | | | | - | 16384| | | 2795 | 879 | 284 | - +-------+--------------------+--------+---------+---------+---------+ - - +-------+--------------------+---------+---------+---------+---------+ - | I. | II. | VII. | VIII. | IX. | X. | - | | | | | | | - |Number | WARDS |Small |Erysipe- |Scarlet |Diarrhœa,| - |of | |Pox, |las, |Fever, |Pneumo- | - |Assess-| |_&c._ |Puerp. |Cynanche |nia, & | - |ments. | |Year |Fever, |Maligna, |Bronchi- | - | | |ending |Pyæmia, |_&c._ |tis of | - |_vide_ | |Sept. |_&c._ |Year |Infants. | - |Note. | | |Year |ending |Year | - | | | |ending |Sept. |ending | - | | | |Sept. | |Sept. | - | | | | | | | - | | | | | | | - | | | | | | | - | | |1849|1850|1849|1850|1849|1850|1849|1850| - +-------+--------------------+----+----+----+----+----+----+----+----+ - | 184|Aldersgate Within | ...| ...| ...| 1| 4| 2| 3| 7| - | 572|Aldersgate Without | 1| 5| 4| 3| 14| ...| 27| 12| - | 809|Aldgate | 2| ...| 2| 2| 5| 2| 18| 9| - | 133|Bassishaw | ...| ...| 1| ...| ...| ...| ...| ...| - | 314|Billingsgate | ...| ...| 2| ...| 3| ...| 2| 1| - | 334|Bishopsgate Within | ...| ...| 1| 1| 2| ...| 3| 5| - | *1020|Bishopsgate Without | 4| 5| 3| 5| 10| 3| 41| 19| - | 251|Bread Street | ...| ...| 1| 1| ...| ...| 6| 3| - | 205|Bridge | ...| ...| ...| 1| 2| 1| 3| 1| - | 536|Broad Street | ...| ...| 1| ...| 3| 3| 4| 6| - | 194|Candlewick | ...| ...| ...| ...| ...| ...| ...| ...| - | 499|Castlebaynard | 1| ...| 1| ...| 4| ...| 6| 11| - | 341|Cheap | ...| ...| 2| 1| 2| ...| 5| 3| - | 626|Coleman Street | ...| ...| 2| ...| 3| ...| 10| 9| - | 294|Cordwainer | ...| ...| ...| ...| ...| ...| ...| ...| - | 158|Cornhill | ...| ...| ...| ...| ...| ...| 2| ...| - | 471|Cripplegate Within | ...| ...| 2| 2| 3| ...| 12| 8| - | *962|Cripplegate Without | 3| 7| 3| 3| 17| ...| 33| 29| - | 232|Dowgate | ...| 2| ...| ...| 1| 1| 2| ...| - | 961|Farringdon Within | 1| 1| 1| 1| 4| 1| 15| 17| - | *3533|Farringdon Without | 2| 10| 13| 12| 34| 10| 56| 72| - | 409|Langbourn | 1| ...| ...| 2| 1| 1| 1| 2| - | 166|Lime Street | ...| ...| ...| ...| ...| ...| 1| 1| - | *1258|Portsoken | ...| 2| 2| 1| 9| 1| 14| 10| - | 343|Queenhithe | 2| 1| 1| 1| 7| 2| 5| 4| - | 611|Tower | ...| ...| 1| 3| 1| 2| 3| 8| - | 253|Vintry | ...| ...| ...| ...| 1| ...| 1| ...| - | 235|Walbrook | ...| ...| ...| ...| 2| 2| 4| 3| - | |City of London Union| ...| ...| 1| ...| 2| 1| 3| 3| - +-------+--------------------+----+----+----+----+----+----+----+----+ - | 15904|The Deaths from all}| | | | | | | | | - | 480|causes within same }| 17| 33| 44| 40| 135| 32| 285| 243| - |-------|period were 6551 }| | | | | | | | | - | 16384| | 50 | 84 | 167 | 528 | - +-------+--------------------+---------+---------+---------+---------+ - - +-------+--------------------+---------+---------+ - | I. | II. | XI. | XII. | - | | | | | - |Number | WARDS |Infantile|Hydro- | - |of | |Zymotic |cephalus,| - |Assess-| |Dis. |Convul- | - |ments. | |Hooping- |sions, | - | | |cough, |_&c._ | - |_vide_ | |Croup, |Year | - |Note. | |Measles, |ending | - | | |_&c._ |Sept. | - | | |Year | | - | | |ending | | - | | |Sept. | | - | | | | | - | | |1849|1850|1849|1850| - +-------+--------------------+----+----+----+----+ - | 184|Aldersgate Within | 2| 2| 4| 2| - | 572|Aldersgate Without | 13| 9| 16| 19| - | 809|Aldgate | 9| 5| 20| 10| - | 133|Bassishaw | ...| ...| 1| 1| - | 314|Billingsgate | 4| ...| ...| 4| - | 334|Bishopsgate Within | 6| 5| 5| 3| - | *1020|Bishopsgate Without | 32| 15| 35| 31| - | 251|Bread Street | ...| ...| 4| 2| - | 205|Bridge | 2| 1| 1| 2| - | 536|Broad Street | 7| 1| 3| 2| - | 194|Candlewick | 2| ...| 3| 1| - | 499|Castlebaynard | 10| 5| 20| 7| - | 341|Cheap | ...| 2| 5| 3| - | 626|Coleman Street | 6| 2| 12| 7| - | 294|Cordwainer | ...| ...| 3| ...| - | 158|Cornhill | ...| 1| ...| 1| - | 471|Cripplegate Within | 7| 7| 14| 12| - | *962|Cripplegate Without | 31| 15| 19| 21| - | 232|Dowgate | 1| 1| 4| 1| - | 961|Farringdon Within | 9| 2| 11| 10| - | *3533|Farringdon Without | 33| 31| 57| 38| - | 409|Langbourn | 3| 2| 2| 7| - | 166|Lime Street | ...| 2| 2| 1| - | *1258|Portsoken | 12| 10| 9| 18| - | 343|Queenhithe | 4| 4| 1| 6| - | 611|Tower | ...| 1| 4| 7| - | 253|Vintry | 1| ...| 5| 2| - | 235|Walbrook | 1| 1| 5| ...| - | |City of London Union| 1| ...| 3| 1| - +-------+--------------------+----+----+----+----+ - | 15904|The Deaths from all}| | | | | - | 480|causes within same }| 196| 124| 264| 219| - |-------|period were 6551 }| | | | | - | 16384| | 320 | 483 | - +-------+--------------------+---------+---------+ - - Letter by Mr. THOMAS TAYLOR, Lecturer on Chemistry at the Medical - School of the Middlesex Hospital, on the Chemical Qualities of certain - Waters. - - 4, Vere-street, Oxford-street, - November, 1850. - - DEAR SIR, - - Having, by your desire, submitted the following samples of water to - chemical analysis, I now beg leave to lay before you the result; and - also, at the same time, to reply to certain questions which you - likewise proposed. - - The samples of water taken for examination were derived from the - following sources:-- - - A. Water supplied by the New River Company. - - B. Water supplied by the East London Company. - - C. Water from a spring in the neighbourhood of Haslemere, Surrey. - - D. Water from a well in Bishopsgate-street. - - A. This water was taken from an upright pipe in a court-yard of the - Guildhall. It was slightly opalescent, inodorous, and tasteless; - numerous small particles floated in it, which took a considerable time - to subside. The matter deposited was of a rust colour, and consisted - of peroxide of iron, with a little sulphate and carbonate of lime, and - organic matter. It is to be observed that, as the water from this pipe - is seldom used, these impurities collect in the pipe, and are - therefore in some measure accidental, although, prior to collecting - the water, a considerable quantity had been allowed to run away. The - water was allowed to free itself from these impurities by subsidence, - before being submitted to analysis. - - By evaporation to dryness, an imperial gallon left a solid residue, - weighing 17·33 grs., which consisted of-- - - Carbonate of lime, with a little oxide of iron 11·12 - Carbonate of magnesia 0·60 - Sulphate of lime 1·56 - Chloride of sodium 2·40 - Silicic acid 0·37 - Organic matter 1·19 - ----- - 17·24 - - When heated, this water became turbid; and, by continued boiling for - two hours in an apparatus so arranged that the whole of the steam was - condensed and returned to the water, 10·95 grs. of the earthy - carbonates, coloured by oxide of iron, were deposited. - - The relative hardness of this water, as determined by the soap test, - distilled water being taken as unity, was 13·3. - - * * * * * - - B. The second sample of water was taken from a small tap in the house - of Mr. Hall, Bishopsgate-street. The tap was attached to the main. - - This water was without smell or taste, and free from floating matter. - After standing some time, it deposited a very small quantity of oxide - of iron. Although clear and transparent, it was not bright. - - It contained 19·10 grs. of solid matter in the imperial gallon. The - solid matter consisted of-- - - Carbonate of lime, with a little oxide of iron 14·58 - Carbonate of magnesia 0·44 - Sulphate of lime 1·54 - Chloride of sodium 1·71 - Silicic acid 0·32 - Organic matter 0·72 - ----- - 19·31 - - Like the preceding water it became turbid when heated to the boiling - point, and by continued ebullition for two hours, 12·90 grs. of - carbonate of lime, coloured by oxide of iron, were precipitated. - - Hardness in reference to distilled water as unity = 19. - - * * * * * - - C. This water was taken by ourselves from a spring-head near - Haslemere, Surrey. The spring issued from the foot of a low sand-hill - covered with bushes, and was received into a natural basin about four - or five feet in diameter, the bottom of which was lined with pebbles - and small gravel. From this basin the water flowed into a large - shallow pond. - - The temperature of the spring at its source was 49° Fahr., that of the - air being 56° Fahr. - - This water was perfectly clear and brilliant, but not sparkling. It - had no appreciable taste, but was peculiarly soft and agreeable. It - did not contain carbonic acid in a free state, for when mixed with a - solution of chloride of calcium and of ammonia not the slightest - turbidity was produced. When boiled it did not lose its transparency, - nor produce any deposit, until concentrated to about one-sixth of its - volume, when glittering scales of hydrated silicic acid separated. - - An imperial gallon, when evaporated to dryness, left a solid residue, - which weighed 5·24 grs. - - This residue was perfectly white when dried at 300° Fahr.; when heated - to low redness, it charred slightly at the edges. The quantity of - organic matter was therefore exceedingly small. - - Hardness in reference to distilled water as unity = 2·4. - - On analysis, an imperial gallon was found to contain-- - - Carbonate of lime 2·00 - Chloride of sodium 1·46 - Sulphate of soda 0·407 - Silicic acid 1·143 - Organic matter 0·23 - ----- - 5·24 - - Traces of an alkaline nitrate were also detected. - - During the short visit I made with you to Farnham, we examined several - other springs near to their sources. In their general characters these - waters closely resembled the preceding sample, all of them being - remarkably soft, clear, transparent, inodorous, and free from any - excess of organic matter, or of oxide of iron. - - By your desire two samples were subsequently sent to me; one marked - ‘Barford,’ the other ‘Boorley.’ - - The water marked Barford contained 6·30 grs. of solid matter in the - imperial gallon; when evaporated, scales of silicic acid separated - from it in the same manner as from the water taken at Haslemere. - Neither of these waters contained any trace of carbonic acid. Their - relative hardness (distilled being unity) was--Barford 2·4, Boorley - 1·5. - - * * * * * - - D. The fourth sample of water was drawn from the pump near the church - in Bishopsgate-street. - - This water was selected as exemplifying the general composition of the - shallow well-water of the City of London, when the well is situated - near to a burial-ground, as is frequently the case with the parochial - wells. - - The water from this well is perfectly bright, clear, and even - brilliant; it has an agreeable soft taste, and is much esteemed by - the inhabitants of the parish, although, as will be seen by the - subjoined analysis, it is an exceedingly hard water, and the large - quantity of earthy salts it contains renders it unfit for all culinary - and for most domestic purposes. - - When heated to the boiling point, this water becomes turbid, and by - continued boiling of an imperial gallon of the water for two hours, - 23·03 grs. of solid matter were deposited, consisting of 22·15 grs. - carbonate of lime, and 0·88 carbonate of magnesia, with a trace of - phosphate of lime. - - An imperial gallon of this water, when evaporated to dryness and the - residue dried at a temperature of about 300° Fahr., left a residue - which amounted to 88·07 grs. From another sample of the same water - taken a month afterwards, 84·53 grs. of solid residue were obtained. - - By an analysis, an imperial gallon of the water gave-- - - Carbonate of lime 28·97 - Carbonate of magnesia 2·61 - Sulphate of lime 17·85 - Chloride of sodium 16·95 - Nitrate of potass 12·40 - Nitrate of soda 1·50 - Nitrate of magnesia 4·92 - Nitrate of ammonia 4·01 - Silica 0·80 - Phosphate of lime traces - Organic matter - ------ - 90·01 - - The residue left by evaporation was of a light brown colour; when - calcined at a low red heat it became slightly charred; but I could - not, with any degree of certainty, determine the precise quantity of - organic matter it contained: it was certainly very small. - - The excess of solid matter, as shown by the analysis, over the - quantity obtained by evaporating the water to dryness, is owing to the - decomposition of the nitrate of ammonia. - - The quantity of alkaline and earthy nitrates in this water is very - remarkable. These salts are doubtless derived from the decomposition - of animal matter in the adjacent churchyard. Their presence, conjoined - with the inconsiderable quantity of organic matter which the water - contains, illustrates in a very forcible manner the power the earth - possesses of depriving the water that percolates it of any animal - matter it may hold in solution; and moreover shows in how complete and - rapid a manner this process is effected. - - In this case the distance of the well from the churchyard is little - more than the breadth of the footpath, and yet this short extent of - intervening ground has, by virtue of the oxidizing power of the earth, - been sufficient wholly to decompose and render inoffensive the liquid - animal matter that has oozed from the putrefying corpses in the - churchyard. - - * * * * * - - The result of these analyses confirms the general statement that the - water derived from the sandy districts of Farnham and Bagshot is of - eminent purity, and therefore peculiarly fitted for all those purposes - of domestic and manufacturing economy which require the use of a very - soft water. - - When regarded in conjunction with the analyses made by other chemists, - of the water taken from the streams, pools, and other collections of - water in the same locality, it also points out that, if it be - desirable to secure the water in its utmost state of purity, it should - be collected at its very source, before it has had time to become - impregnated with the various mineral and saline ingredients of the - different soils through which it would have to pass. The total absence - of free carbonic acid in these waters is a very remarkable fact, and - one which I believe has not been hitherto noticed. - - It will also be perceived that the principal solid constituent of the - water supplied by the New River and the East London companies is - carbonate of lime, held in solution by an excess of carbonic acid, an - opinion already expressed by several chemists. These waters also - contain an appreciable quantity of oxide of iron. - - When the water from these sources is boiled, or simply brought to the - boiling temperature, the excess of carbonic acid is driven off, and - the carbonate of lime being thus deprived of its solvent, the greater - portion of it, together with the oxide of iron, is thrown down in the - form of an insoluble crystalline powder, while the water is rendered - comparatively soft and pure. - - Were it therefore possible that means could be devised by which the - quantity of water necessary for the daily supply of London could be - deprived of its excess of earthy carbonates in a manner sufficiently - economic, comprehensive, and effectual, the citizens of the metropolis - would enjoy the advantage of a tolerably pure soft water, free from - those inconveniences which attend the use of the present hard-water - supply. - - Confining myself wholly to a chemical view of the subject, the - principal disadvantages attending the use of hard river waters are-- - - First, The precipitation of earthy matter on the inside of vessels in - which the water is heated. This furring of the vessel, as it is - called, leads to its more rapid destruction, and has also the - inconvenience of rendering it more difficult to cleanse, so that the - flavour and odour of the various substances cooked in it are not - readily removed. From the non-conducting power of the earthy crust, an - increased consumption of fuel is also required for the due heating of - the vessel. - - Secondly, The admixture of the earthy salts with the various articles - of food submitted to the action of hot water. - - Thirdly, Diminished solvent power, as required for the purposes of the - chemist, the brewer, and for many domestic purposes, as in the making - of tea, soups, &c. - - Fourthly, Diminished cleansing power, both as regards the direct - solvent action of the water, and also as causing the decomposition of - soap, and consequent increased consumption of that article. I must, - however, remark that the annual loss reported to arise from this cause - appears to me considerably overrated, since water is rarely used for - the washing of linen until previously boiled, and the common practice - of adding carbonate of soda to the water completely destroys the ill - effects resulting from the hardness of the water. The additional - expense of the carbonate of soda, thus added, is too trifling to merit - notice; but when this salt is used in excess, as is generally the - case, it produces the more serious evil of materially impairing the - strength of the fabric submitted to its action. - - The only real advantage which hard water possesses over soft (and in - the present state of things one of considerable importance), is, that - it does not act upon or erode the lead of the pipes and cisterns in - which it is contained. - - There are also some particular cases of minor importance in which hard - water is preferred; thus dyers prefer hard water for rinsing of their - goods, soft water extracting too much of the colour; but these cases - are comparatively rare, and might be easily accomplished by an - artificial hardening of the water. - - The following Table indicates the relative hardness of the different - waters as determined by the Soap test; distilled water being taken as - unity, as proposed by Professor Brande. It also shows the effect of - boiling in reducing the hardness of the water. The numbers express - the direct quantity of an alcoholic solution of soap, which an equal - bulk of each water requires in order to form a lather remaining - permanent for from five to ten minutes. - - Distilled water 1·0 - Water from Haslemere 2·4 - Boorley 1·5 - Barford 2·4 - Water of the New River Company 13·3 - Ditto after being boiled 4·7 - Water of the East London Company 19·0 - Ditto after being boiled 5·6 - Water from the well in Bishopsgate-street 47·4 - Ditto after being boiled 26·0 - - The experiments which I have recently made on the action of pure water - upon lead, clearly point out the necessity of keeping the pipes always - full, especially in those instances in which the water has a tendency, - however slight, to erode the lead. As the importance of this part of - the question does not appear to have been sufficiently appreciated by - the advocates of a constant instead of an intermittent supply, I will - briefly recount the facts of the case, although I do not offer them as - presenting anything particularly novel. If a piece of bright lead be - placed in a stoppered bottle, completely filled with recently - distilled water, so that the access of air be wholly excluded, the - lead is but very slightly acted upon, and it is only after the lapse - of three or four days that its surface becomes spangled with a few - minute crystals of carbonate of lead. - - If the stopper of the bottle be now removed, the lead still remaining - beneath the surface of the water, the erosive action of the water on - the lead proceeds more rapidly, but still slowly. But if now a portion - of the water be poured off, so as to leave the lead only partially - immersed, rapid action on the lead immediately commences. In the - course of thirty-six or forty-eight hours, its surface becomes coated - with crystalline scales of carbonate of lead, which, falling off, are - succeeded by others, so that after the lapse of a few days an abundant - deposit of carbonate and hydrated oxide of lead is found at the bottom - of the vessel. If the experiment be made with distilled water that has - been previously agitated with air, so as to completely aërate it, the - lead is more rapidly acted upon, even in a closed vessel, thus clearly - showing how much the action of the water upon the lead depends upon - the presence or absence of atmospheric air. - - Now, in a minor degree, this is precisely what takes place in a leaden - pipe conveying water capable of eroding lead. While the pipe is full, - comparatively but little action occurs; but when the pipe is filled - alternately with air and with water, it is placed under the most - favourable circumstances to ensure a rapid erosion of its substance, - and consequent contamination of the water. - - The rush of water necessarily produced by an intermittent flow must - also detach portions of carbonate of lead from the sides of the pipe, - even in those cases where the water has no very decided action on - lead, and it is therefore far from improbable that in this manner the - poison of lead is occasionally conveyed into our kitchens, and becomes - mixed with our food. - - According to your desire, I have examined the action of the waters - from the above-mentioned sources on clean lead, and have arrived at - the following conclusions:--the water from Haslemere has a slow though - decided action upon the metal, no effect taking place until the lead - had been partially immersed for four or five days. After that time, a - small deposit of carbonate of lead was perceptible at the bottom of - the vessel, although none could be detected in solution. The absence - of carbonic acid in the water from Haslemere, Boorley, and Barford, - would in all probability prevent their acting upon lead, were - atmospheric air at the same time excluded. A piece of lead that had - been kept for a week in a closed bottle filled with water from - Haslemere did not exhibit the least trace of carbonate of lead, nor - could the presence of lead be detected in the water. - - It is scarcely necessary to add, that the water as drawn from the - pipes of the New River and East London Companies does not exhibit the - least solvent action upon lead; when, however, purified by boiling, - and placed in contact with lead, crystals of carbonate of lead were - observable after the lapse of three days in the water of the New River - Company, while, owing to its greater hardness, the water of the East - London Company did not exhibit any traces of carbonate of lead until - the expiration of more than a week, and even then only in a slight - degree. The same waters purified by the patented process of Clark did - not exhibit so decided an action upon lead as when purified by - boiling; but after evaporating to dryness the water in which lead had - been immersed for three weeks, and dissolving the residue in dilute - nitric acid, the presence of a minute quantity of lead was rendered - evident. - - It therefore appears that if leaden pipes, and especially if leaden - cisterns, are to be employed in the distribution and storage of water, - on the system of interrupted supply, it will be a necessary safeguard, - that the water thus conveyed and stored should not be of less hardness - than from six to seven degrees, compared with distilled water as - unity; and conversely, it also follows, that if the inhabitants of the - metropolis are to gain the advantage of using a still purer and softer - water, it will be requisite to do away with the existing leaden pipes - and cisterns, and to substitute for them some material which shall not - communicate any poisonous or noxious ingredient to the water. As - matters now stand, we escape daily poisoning by the use of water - loaded with earthy salts, and are thus compelled to drink an impure - water on account of the impurity of our vessels. Would it not be - better, and is it impossible, to drink the pure element from a pure - cup? - - I remain, dear sir, with much respect, - Yours obediently, - - THOMAS TAYLOR. - - To JOHN SIMON, Esq., F.R.S., - Officer of Health to the City of London. - - - - -THIRD ANNUAL REPORT. - - - _November 25th, 1851._ - - GENTLEMEN, - -I have the honour of laying before you, in the various subjoined tables, -such information as will enable you to measure the present sanitary -condition of the City of London. - - * * * * * - -1. The first table (Appendix, No. I.) contains a statement of the -present population of the City, as derived from the Registrar-General’s -recent census; and it compares the existing numbers in each division of -the City with those given at the last enumeration in 1841. - -In examining this table you will observe that, during these ten years, -the general population of the City has increased about 3⅖ _per cent._; -that this increase has not been uniform through the nine sub-districts -of your jurisdiction; that in some it has been unimportant; that in -others there has been an actual decrease, extending even to 4⅔ _per -cent._ on the previous population; while in the whole East London Union -the numbers have risen considerably above the aggregate rate of -increase, and in the St. Botolph sub-district exceed those of the former -census by more than 16 _per cent._ - -Passing over the minor differences which have taken place in the -distribution of the population, I cannot regard that larger increase -without apprehension and regret. Probably for the most part it -represents the continued influx of a poor population into localities -undesirable for residence, and implies that habitations--previously -unwholesome by their over-crowdedness--are now still more densely -thronged by a squalid and sickly population. - -I congratulate your Hon. Court on the recent acquisition of powers (to -the nature of which I shall presently advert) for the reduction and -prevention of this serious evil. - - * * * * * - -2. The second table[61] presents a summary of the City mortality for the -year which terminated at Michaelmas last; showing the deaths, as they -have occurred, male and female, during each quarter of the year, in the -several districts and sub-districts of the City; and including at the -foot of each column, a statement of the year’s death-rate _per_ thousand -of the living in each such district and sub-district. - - [61] _Appendix_, No. V. The calculated death-rates are omitted from - this, as from the other annual tables:--the quinquennial rates (App. - No. II.) giving more useful results.--J. S., 1854. - -You will observe that, during the 52 weeks, dated from September 29th, -1850, to September 27th, 1851, there have died of the population under -your charge 2978 persons; giving, for the City aggregately, a rate of -nearly 23 deaths for every thousand living persons. - -The rate of last year was little over 21 _per_ thousand. - -In my last Annual Report I suggested that the death-rate then prevailing -was probably (from temporary circumstances) more favourable than the -true average of the City; that it corresponded to the period of recovery -from severe epidemic influences; that it seemed exceptional; and that -you might be prepared for this year’s mortality showing again a tendency -to increase. - -Such has been the case; and it illustrates the necessity of appealing to -cyclical averages for correct intelligence as to the healthiness of a -population. To my mind the increased mortality of this year does not -indicate any deterioration of the City in respect of sanitary matters -under your control; it shows merely that the death-rate, which must be -considered our present average for the City, is in truth higher than -that which favourable circumstances, foreign to your jurisdiction, last -year permitted us to attain. - -Looking to the total mortality of the last three years (the period for -which I have had the honour of serving your Commission), I find that -9493 deaths have taken place; which, the mean population of the time -being 129,922, gives an average rate of 24·35 deaths _per_ thousand _per -annum_. This accords very nearly with a death-rate (24·36) deduced from -the septennial period 1838-44, during which (according to the -Registrar-General) 22,127 deaths occurred in a population estimated at -129,739.[62] - - [62] Since 1841, when the Census gave these figures, the limits of the - West London Union have been slightly altered. The Inner Temple and - Barnard’s Inn have been added to it, while part of St. Sepulchre’s - parish has been taken away. - -Assuming our City mortality to be accurately represented by these -averages, I need not inform your Hon. Court that such a death-rate is -unduly high. I have already, in previous Reports, laid before you the -materials for measuring its excess,--materials which seem to show that -our existing death-rate is nearly the double of that which better -circumstances have elsewhere rendered attainable.[63] - - [63] The death-rate to which I particularly refer in the text, and - which I cited in my last year’s report, is that of a large district in - Northumberland, numbering 27,628 inhabitants, where, during the seven - years 1838-44, the mortality was at the rate of only 14 _per_ thousand - _per annum_; and even in this comparatively low proportion a very - distinct share might still be called preventable deaths. - -It is not to the City alone of metropolitan districts that this high -mortality belongs. Unhappily it affects the entire Metropolis; and we -may find other towns in England, and still more on the Continent, where -the death-rate is higher than under your jurisdiction. Yet your Hon. -Court will not doubt that the standard to be adopted for your estimate -of healthiness ought to be the lowest known death-rate; that every -avoidable death represents an evil to society; and that, if a mortality -of 12, or 13, or 14 _per_ thousand _per annum_ can be reached for one -mixed population, there is ample room for discontent among any other -population, which finds itself doomed to perish at double the rate of -the first. - - * * * * * - -3. In the third table[64] all the deaths of the last three years are -enumerated in a form which may enable you to compare one year with -another, and one sub-district with another, in respect of their several -contributions to the total mortality. - - [64] This information is now included in the Quinquennial Synopsis, - _Appendix_, No. II. - - * * * * * - -4. In the fourth table[65] are classified, according to the ages at -which they occurred, 9476[66] deaths of the last three years. This table -is arranged in a manner to display its results--(1) for each year -separately, and (2) for each Union separately, in order that you may -observe what local or annual differences have obtained as to the ages of -chief mortality. You will notice that in 3469 instances, nearly -three-eighths of the whole, death has befallen children under five years -old. Children at this age constitute about a tenth part of the -population of the City. They accordingly die at about four times the -rate which would fall to them as equal participators in the average -mortality of the district. The next table will throw some light on this -disproportionate excess of infant deaths. - - [65] Now embodied in Table VIII. - - [66] In the remaining number (17) the particulars of age and residence - could not be correctly ascertained. - - * * * * * - -5. In it[67] an enumeration is made of such deaths, during the last -three years, as have arisen in consequence of acute disease partially or -entirely preventable. They amount to 3923--more than two-fifths of the -entire mortality of the period. - - [67] _Appendix_, No. IX. includes this Table. - -I would especially beg the attention of your Hon. Court to the -particulars set forth in the successive columns of this table. - -The first column shows 391 deaths by fever; and of these, without -hesitation, I would speak as entirely preventable. Under favourable -sanitary conditions fever is unknown. The deaths arising from it befall -for the most part persons in the prime of life, whose premature removal, -in the midst of their vigour and usefulness, is not only a direct -weakening of society, but is also, in respect of orphanage and -widowhood, a frequent source to the public of indirect detriment and -expense. - -In the second column, swelled by the epidemic visitation of 1849, you -will find 902 deaths referred to Asiatic Cholera, and to other kindred -diseases. Comparatively few cases of the kind have occurred since -Michaelmas, 1849; an overwhelming majority belonged to the summer -quarter then terminating, when the Metropolis generally was suffering -from the presence of Cholera. I have already had occasion to show you -that this frightful pestilence belongs only to localities which, by -their general epidemic mortality, have previously been stigmatised as -unhealthy; that, over districts otherwise healthy, it migrates without -striking a blow; that it may, therefore, with confidence be spoken of as -a disease proportionate to removable causes--in other words, as a -preventable disease. - -I cannot pass over these two columns, without begging you to observe -what perhaps may be novel to you. If, instead of reckoning the -cholera-deaths as belonging solely to the one year in which they -happened, you reckon them as belonging to the whole term of years which -elapsed between the two visitations of the epidemic, and distribute them -equally over that period, so as to form an average--say for fifteen -years, you cannot fail to notice how largely, in the long run, the -destruction by fever (which is always here) surpasses the fatality of -that Eastern disease; so much so, that the average annual mortality by -the latter probably does not amount to half the fatality of the former. - -Nor must it be lost sight of, that if the _deaths_ by typhus double in -number those produced by cholera, the list of _persons attacked_ by the -former disease, and thereby for a long while incapacitated and -suffering, is immeasurably beyond this proportion. Two or three times -the number of deaths by cholera would give you the number of seizures, -and enable you to estimate all the direct mischief caused by it; while, -in regard of typhus, probably for one death there are twenty cases of -protracted illness, tardy convalescence, and injured constitution. Not -only are the deaths double in number, but each of them indicates an -infinitely larger amount of sickness and suffering not immediately -productive of death. - -The frightful suddenness of the rarer disease, and the condensation of -its epidemic fatality into some single year, give it more apparent -importance than belongs to the familiar name of typhus; but I can assure -your Hon. Court, that if a large amount of preventable death, and a -still larger amount of preventable misery, be strong arguments for -sanitary improvement and activity, those arguments are more abundantly -derivable from the constant pressure of fever and its kindred maladies, -than from the sharper but infrequent visitations of the foreign -pestilence. - -In the third column of this table come deaths by scarlatina. Of these, -perhaps a certain proportion would occur even under favourable -circumstances; for, whatever may have been the original derivation of -the disease, it is impossible to doubt that the severity of its attack -mainly depends on conditions peculiar to the person of the patient, and -that no perfection of external circumstances will ensure mildness of -infection. But on the other hand it is certain, that, under attacks of -the disease at first equally malignant, adequate ventilation with pure -air will enable one patient to wrestle successfully against the poison, -while another, less favourably circumstanced, will rapidly sink beneath -its influence; and hence I have no hesitation in assuring you, in -respect of the 213 deaths registered under this head, that a majority -would have been avoided under improved domestic arrangements. - -In the fourth column, you will read of 91 deaths by small pox. Your -judgment will not be a harsh one, if you assume that 90 of these were -the result of criminal negligence. Under the present administration of -the Poor Laws, vaccination is not only accessible to all members of the -community, but is literally pressed on the acceptance of the poor. Those -stupid prejudices, which for some years retarded the universal adoption -of Jenner’s great discovery, have now died away; the neglect of -vaccination must be regarded as the omission of a recognised and -imperative duty. Deaths of children, arising in this parental neglect, -ought to be considered in the same light as if they arose in the neglect -to feed or to clothe; and I am disposed to believe, that the readiest -way of bringing this view of the case before those uneducated classes, -where the omission usually arises, would be to procure Coroner’s -inquests every year in respect of some half dozen or more instances -where the evidence of neglect might happen to be glaring. - -In the fifth column of the table stand recorded a hundred deaths by the -poison of erysipelas, in one form or another; arising sometimes -spontaneously, sometimes in connection with the child-bearing state, -sometimes in sequel of accidental lesions and surgical operations. - -My daily experience as a Surgeon--especially as a Hospital-Surgeon, -enables me confidently to speak of these diseases as an artificial -product of unhealthy exterior conditions. The contrasting results of -surgical operations in town and in country--of operations undertaken -amid pur-ventilation, in spacious cleanly rooms and dry localities, -with those undertaken under opposite circumstances (in the dwellings of -the poor for instance, or wherever else amid damp, dirt, and -over-crowding), and the similar experience which exists as to the -origination of puerperal fever, would be quite conclusive as to the -fact, that of the 101 deaths under this head, a large majority might -have been prevented. - -Next, in the sixth, seventh and eighth columns, stand deaths arising in -the chief acute diseases of infancy, those to which the disproportionate -mortality of infants is mainly due. Many careful statistical -observations, as well as personal experience, convince me that the -immense fatality recorded under this head, is, to a very great extent, -due to obviable causes. - -To bring this matter distinctly before you, I must take, as a standard -of comparison, some district where the general death-rate is -sufficiently low to distinguish it as eminently healthy; and in such an -one you will notice a marked diminution, not only (of course) in the -_number_ of infant deaths, but likewise in their _proportion_ to the -total mortality. - -Such a district is that of the combined parishes of Glendale, Bellingham -and Haltwhistle, in the county of Northumberland. In it the general -death-rate is 14; in the East and West London Unions of the City of -London, the general death-rate is 26·73. In the former district, -children under five constituting more than an eighth of the population -(1/7·6), their deaths form about a quarter of the whole mortality; while -in the latter district, where the children are in smaller -proportion--namely about 1/9 of the population, their deaths are not -much less than half (1/2·21) of the whole mortality. Thus, in the -healthier district they die at less than double the average rate for all -ages; in the unhealthier, at more than four times that average. - -A still better method of district-comparison, is to arrange in a series -the death-rates prevailing in several localities for persons _over five -years of age_, and side by side with this column, another for the -death-rates of children _under five years of age_. The first column will -of course indicate very well the relative sanitary conditions of the -districts; but the differences between them will be expressed far more -clearly, and, as it were, in a magnified form, in the column of -infantine death-rates. Thus, for instance--to repeat the comparison just -instituted between the Northumberland and the London district; the -death-rate for all ages over five is about 12 in the former district, -and nearly 15 in the latter; a difference quite sufficient to establish -the inequality of their sanitary conditions. But, how much more strongly -is this disparity expressed in the comparison of the infantine -death-rates--26·5 for the healthier district, 107·57 for the unhealthier -one! - -Nothing can be more conclusive than the evidence afforded by statistics, -as to the dependence of high infantine mortality on the general causes -of endemic unhealthiness. My own observation within the City gives -complete confirmation to this view, showing me that the diseases -specified in my table (diarrhœa, bronchitis and pneumonia, -hooping-cough, croup and measles, hydrocephalus and convulsions) however -various in nature they may seem, and however apt you may be to -dissociate their occurrence from the thought of local causation, yet -unquestionably multiply their victims, in proportion to the otherwise -demonstrable unhealthiness of a place, owe most of their fatality to -local causes, and may, therefore, to a great extent he disarmed of their -malignity. - -The last column gives the total of those which have preceded it, and -shows, out of 9493 deaths, 3923, all from acute disease, in intimate -dependence on local and obviable causes. It will be a moderate -computation with respect to these deaths, if we estimate that two-thirds -of them might have been hindered. - -And yet it is not only by _acute_ disorders, that preventable death -succeeds in ravaging the population. If we turn to the examination of -_chronic_ ailments producing death, we may quickly recognise many -indications of their preventability, and may satisfy ourselves that here -also the general mortality might be very largely reduced. - -Look, for instance, at the whole immense class of scrofulous diseases, -including pulmonary consumption, a class probably causing, directly or -indirectly, at least a quarter of our entire mortality; and consider the -vast influence which circumstances exert over its development. - -Of such circumstances some lie within your control, and affect masses of -the people; but the more special causes of chronic disease lie rather -out of your jurisdiction, and the option of avoiding them is a matter of -individual will. Vicious habits and indiscretion; a life too indolent, -or too laborious; poverty and privation; vicissitudes of weather and -temperature; intemperance in diet; unwholesome and adulterated food; -and, not least, inappropriate marriages tending to perpetuate particular -kinds of disease; these words may suggest to you, briefly, that there -are many influences, within the sphere of private life, by which the -aggregate death-rate of a population is largely enhanced, but the -control of which, if attainable, lies almost entirely at the discretion -of the classes subject to their operation. - -Considering all these causes, and the needless waste of life occasioned -by them, I can have little doubt that as much might be done by -individuals, under the influence of improved education, to lessen the -mortality from chronic disease, as by sanitary legislation to stay the -sources of epidemic death. And regarding both classes of disease -together--those, on the one hand, which are of endemic origin (arising -in imperfect drainage, in defective water-supply, in ill-devised -arrangement of buildings, in offensive and injurious trades, in the -putrefaction of burial-grounds, and the like) and those classes, on the -other, which arise in the circumstances of individual life, I can have -no hesitation in estimating their joint operation at a moiety of our -total death-rate, or in renewing an assertion of my last years’ Report, -‘if the deliberate promises of Science be not an empty delusion, it is -practicable to reduce human mortality within your jurisdiction to the -half of its present average prevalence.’ - -To revert, however, to your more special branch of the subject,--I have -thought the present a convenient time for indicating to you the pressure -of preventable death, arising in acute disease, because of the great -addition which you have recently gained to your powers for enforcing -prevention. - -That an average death-rate of nearly 25 _per_ thousand _per annum_ -prevails in the City; that three-eighths of your mortality consists in a -premature extinction of infant life; that fatal disease, in more than -two-fifths of its visitations, is of a kind which operates endemically -and preventably;--these are the facts to which I have appealed, as my -evidence of the need for sanitary activity and perseverance. - -On other occasions I have endeavoured to set before you what are those -agencies hostile to life, which affect the masses of an urban -population; and during the last three years your Hon. Court has shown -its recognition of these causes, and has devoted attention to the means -of counteracting them by appropriate sanitary measures. - -In too many instances, the powers first given you by the Legislature -were inadequate to this great purpose. But now, armed with the further -authority of your new Act of Parliament, you enjoy such means for -sanitary improvement as have never yet been possessed by any Corporation -in the country; such means as, judiciously wielded, cannot but produce -the greatest advantage to persons living under your jurisdiction. - -As you are only now entering on the exercise of these powers, it may be -convenient that I should submit to you a brief account of them, and I -gladly turn from contemplating the spectacle of preventable death, to -analyse the means of prevention now vested in you by the Legislature. - - * * * * * - -1. In regard of _public drainage or sewerage_, the first and most -elementary condition of endemic health, I need hardly tell you that -within the City, your powers are absolute. You have entire and sole -responsibility for the construction and maintenance of sewers, for their -cleaning or flushing, and for the prevention of noxious effluvia from -their innumerable gully-holes. - - * * * * * - -2. In the all-important particular of _house-drainage_, your authority -is sufficient for every purpose. You can order the complete abolition of -cesspools; the construction of drainage in any premises within fifty -feet of a sewer; its repair, cleansing, or renewal, whenever it may be -disordered: and not only can you order these works to be done, -but--failing the owner’s compliance with your notice, you can devolve -the performance of his duty on your own workmen, and can recover your -expenses from the recusant. - - * * * * * - -3. In regard of _water-supply to houses_ your powers are equally cogent, -though the unsatisfactory condition of the water-trade continues a -serious obstacle to their effective employment. You have authority here, -as with house-drainage, to order the construction of all necessary -apparatus, and to enforce the fulfilment of your order. - -Under both these heads, you possess a power hitherto but imperfectly -used, the complete and constant exercise of which I would strongly -recommend to your Hon. Court. In all those clauses of your Acts of -Parliament, which relate to private works of house-drainage and -water-supply, there occurs a very important phrase:--such works shall be -constructed ‘to the satisfaction of the Commissioners.’ Now, of private -works effected under the authority of your Act, during the last three -years, a certain, not inconsiderable, share proves inoperative and bad. -The mere overflowing of a water-butt (and in numberless instances this -is the arrangement evasively adopted under your orders) can never -suffice for the effectual cleansing of house-drains. I need scarcely -inform you that an obstructed drain and choked privy, wherever they -occur, are equivalent to a cesspool; shedding abroad the same effluvia, -and producing the same deadly results. No gain is gotten to the -wholesomeness of a house, by substituting for its former cesspool an -equally offensive and inoperative drain. To my knowledge, much of the -drainage done during the last three years is liable to this risk; and it -appears to me indispensable that you should exert direct supervision -against so serious an evil. - -I would recommend to your Hon. Court that, in issuing orders for the -construction of drainage and water-supply, you should require a full -specification to be delivered you of the works about to be undertaken, -and should distinctly decide as to their sufficiency; or by a still -simpler process, that you should fix and determine a certain standard of -combined works; a model plan, in short, for house-drainage, privies, and -water-supply, and should direct your Inspectors to certify to you the -sufficiency of only such works as may accurately correspond to this -design. - -I cannot but regard it as a grave calamity, that the general supply of -water to the City remains beyond your control, in the hands of -irresponsible traders; for its imperfect adaptation to the requirements -of the public constitutes the largest sanitary evil of the day. - - * * * * * - -4. You have entire control over the _pavement of every public way_ -within the City, for its construction, maintenance, and cleansing; and -in this respect you exercise a power of great sanitary value. The -preservation of cleanliness along the whole extended surface of the -City, including its many hundred courts and alleys, is indeed a branch -of your functions which can hardly be over-estimated for its importance; -and the fines which you have the power of levying from your -contractors, whenever the scavenging is neglected, are useful securities -for the general performance of their duties. - -It lies within your power to order, wherever you may think fit, the -employment of the hose and jet for the purpose of surface-cleansing in -courts and alleys: and, I may add, that the advantages of this most -effective sanitary process have been highly appreciated where you have -directed its application. - -In some of the poorer localities, complaints have arisen in a matter -relating to the pavements, where you are not able to afford the -complainants effectual relief: viz., with respect to certain inhabitants -throwing refuse and offensive matters from the houses into the public -way, so that nuisance is created. I have already suggested to your Hon. -Court, and I beg leave here to repeat, that in the 41st clause of the -City Police Act, provision is made for the prevention of this particular -offence, and that your four Inspectors are manifestly unable to relieve -the Police Force of their legal responsibility in the matter. - - * * * * * - -5. Your powers for enforcing the wholesome _cleanliness of private -premises_ are equally considerable. You can order the removal of -offensive matter, the purification and whitewashing of premises, and the -abatement of any nuisance arising in conditions of filth. In case of -need, as shown by a medical certificate, you can summon the offender -before your Court; and (under your new Act) you can punish with a heavy -fine any repetition of the nuisance against which your order has once -been issued. - - * * * * * - -6. So long as _slaughter-houses_ are tolerated within the City (and it -is to be hoped this may not be long) you have power to regulate their -use, according to your discretion, with a view to their cleanliness and -better management; and in case of disobedience to your orders, you have -power to enforce the temporary suspension of slaughtering. Your new Act -renders illegal any slaughtering in cellars, or any keeping of cattle -there: and it prohibits that offensive exposure of putrescent hides, -which has so often been complained of in the vicinity of Leadenhall -Market. - - * * * * * - -7. In close connection with the regulation of slaughter-houses, your new -Act gives you authority in a matter hitherto quite foreign to your -jurisdiction, but where your vigilance may no doubt be exercised with -great advantage to the public health. You are authorised to _appoint -Inspectors of slaughter-houses and of meat_; and these officers are -required to inspect shops, markets, and slaughter-houses, and to seize -and destroy any meat which may appear to them unsound or unwholesome. A -further clause of very extensive application enables you to deal -generally with all cases, where _unwholesome provisions_ are exposed for -sale; and this clause is so constructed as to include and render penal -all those _fraudulent adulterations of food_ which render it detrimental -to health. - - * * * * * - -8. You are invested with important authority against _such trades and -occupations as are offensive or injurious_ to their neighbourhood. Under -your former Act, you can subject to penalties any person who shall -‘roast or burn, boil, distil, or otherwise decompose any root, drug, or -other article or thing, in any house or building, and thereby cause -offensive or injurious smells or vapours to be emitted therefrom, so as -to become a common nuisance;’ and the same Act also gave you a very -inoperative clause against such nuisance-causing manufactories as might -begin to work in the City after the commencement of that Act. - -Your new law enacts that everything practicable shall be done for the -suppression of all nuisances arising in manufactures and the -like:--that, after the first of January next, every furnace used in the -City shall be such as to consume its own smoke; and that whatever trade -or business may occasion noxious or offensive effluvia, or otherwise -annoy the inhabitants of its neighbourhood, shall be required to employ, -to your satisfaction, the best known means for preventing or -counteracting such annoyance. - - * * * * * - -9. You have certain powers, to which I adverted in my former Report, as -likely to come into activity whenever the injurious practice of -intramural burial might cease; powers, namely, relating to the _disposal -of dead bodies_ in certain specified cases: and under your new Act, you -have acquired some further authority (likewise only to be exercised -after that cessation, and with the consent of the Bishop of London) to -_appropriate the disused burial-grounds_ for purposes of improvement. At -the time of my last Report I looked ‘forward to the complete -discontinuance of burial within your territory as a matter for warm -congratulation among all who are interested in the cause of sanitary -improvement;’ and it is with proportionate disappointment and regret, -that I have now to report to you that the Order in Council, which was to -have closed all metropolitan burial grounds, has never yet been issued; -and that negociations, conducted by the General Board of Health for the -purchase of a sufficient extramural cemetery, were suddenly arrested at -the close of the last session of Parliament. Your powers in relation to -these matters remain of course meanwhile inoperative.[68] - - [68] In the Parliamentary Session of 1852, the Interments Act of 1850, - which had remained inoperative, was repealed under a new ‘Act to amend - the Laws concerning the Burial of the Dead in the Metropolis,’ which - became law July 1st, 1852. Under this Act, the powers, alluded to in a - later part of this volume, were given to the Commissioners of Sewers - of the City of London as a Burial Board for the City.--J. S., 1854. - - * * * * * - -10. The most important additions made to your power relate to the -_dwellings of the poor_, and are embodied chiefly in the tenth section -of your new Act. The definition of ‘lodging-house’ given in this clause -is so extensive, and the power of regulation conceded to you is so -unconditional (where once the necessity for your interference is shown) -that your Hon. Court can now exert your authority for every legitimate -object, in respect of all the poorer houses in the City.[69] The -definition is, that ‘the expression _common lodging-house_ shall, for -the purposes of this Act, mean any house, not being a licensed -victualling house, let, or any part of which is let, at a daily or -weekly rent not exceeding the rate of three shillings and sixpence per -week; or in which persons are harboured or lodged for hire for a single -night, or for less than a week at one time; or in which any room let for -hire is occupied by more than one family at one time.’ And your powers -are to the following effect:--Wherever over-crowding has taken place -unwholesomely or indecently--wherever undue illness has -prevailed--wherever from any one of several causes the house is unfit -for occupation, you can require its _immediate registration_; you can -then _make such rules_ as you think fit for the _maintenance of decency -and health_; and you can enforce conformity to those regulations with -appropriate penalties. - - [69] Circumstances, which need not here be detailed, have led to - disappointment in the working of this clause, and have shown, to my - great regret, that I over-estimated the benefits it was capable of - conferring.--J. S., 1854. - -The terms of the clause throw on your Medical Officer the responsibility -of initiating these proceedings; and his task in the matter will be one -of anxiety and arduousness. In most other clauses of your Acts of -Parliament, an alternative is allowed as to your taking the opinion ‘of -the Officer of Health, or of any two duly qualified Medical -Practitioners:’ but in this clause you are expressly restricted to the -certificate of your Officer of Health. - -In my two former Reports, I have addressed you at length on those -conditions relative to the dwellings and social habits of the poor which -made the enactments of this clause indispensable; and I look forward to -its operation with a sanguine belief that it may be rendered one of the -most important boons ever conferred on the labouring classes of the -community. - -I subjoin to my Report the schedule which I would suggest for the -registration of lodging-houses, and which (as you will observe) requires -detailed information as to every sanitary particular of the -dwelling.[70] I would recommend that in every case, where registration -is made, the owner’s specification of these particulars should be -accompanied by a written certificate from your Inspector; testifying -(in some such form as that annexed to the schedule in my Appendix) -first, to the accuracy of the statement, and, secondly, to the general -condition of the house. - - [70] Vide page 210. - -With respect to the rules, which, under authority of this clause, you -may find it requisite to lay down for better regulating the residences -of the poor,--the conditions for which you have to legislate are so -various and complicated, that no formula will apply universally; and you -will often be called on to adapt special rules to particular cases as -they come before you. I can therefore only venture at present to offer -you general suggestions on the subject. - -You will find that the houses in which your interference is required -fall into three cases, characterised as follows:--(1) Where the house is -let in several independent holdings (often as many holdings as rooms) -each occupied by a single family and no more, and paid for at a rent not -exceeding 3s. 6d. _per_ week;--(2) Where the house is thus let in -several independent holdings, and where the renter of each or any -portion, admits other persons to share his holding with him, on their -payment to him of a sub-rent _per_ week or _per_ night, so that a room -comes to be occupied by more than one family at a time;--(3) Where the -entire house, or all such part as is let in lodgings is under the direct -management of a single resident proprietor or keeper, where the lodgings -are let at . . . . _per_ night, and where many persons not belonging to -one single family are lodged together in some single room, or in various -single rooms of the house. - -Of the first arrangement, where a single room is the residence of a -single family, you have innumerable illustrations in the City; as, for -instance in the large houses of Windsor-street (to which I have recently -drawn your attention) where in one house there are sixteen such -holdings:--of the second arrangement--the most abominable and -brutalising which can be conceived, you have sufficient illustrations in -Plumtree-court:--of the third--comparatively little known in the City, -there are instances in Field-lane. - -In respect of the first class of houses, I should be disposed to look -upon each holding as the house of its occupier, and not to interfere -within his threshold, except on the ground of some commanding necessity. -I would require only that the general arrangements of the house should -be adapted to the number of its holdings; that, for instance, numerous -families should not be left competing for the use of a single privy, but -that such accommodation should be provided in strict proportion to the -requirements of the inmates; that every room should be efficiently -ventilated; that water should be supplied to the highest occupied part -of the house, and a water-tap and sink furnished on every floor; that -the dust and refuse of the house should be removed at least once daily. - -In dealing with the worst specimens of this class, it may be requisite -to go further than I have here intimated; and it appears to me that for -this purpose your Hon. Court must address your regulations not to the -tenant, but to the landlord. He, I apprehend, must be held responsible -for the decent and wholesome condition of his property, and for such -conduct of his tenants as will maintain that condition. - -Seeing the punctuality with which weekly visitation is made for the -collection of rents in these wretched dwellings, it would not be -unreasonable, I think, to insist on some such regulation as the -following:--The owner of the house, or his agent, or collector, shall -visit each room on an appointed day, at least once weekly, between the -hours of eleven and three; he shall see that the floor and other -woodwork of the room have been properly washed on that day, that the -room be free from all dirt, rubbish, or offensive smell, that no -objectionable trade be pursued in it, and that it be generally in good -and proper repair; he shall see that the premises generally[71] be in a -clean and wholesome condition, that water be sufficiently supplied, and -that the dustman’s work be regularly performed; and failing either of -the two latter conditions, he shall forthwith lay complaint thereof -before your Commission; in case of any inmate suffering from cholera, -small-pox, erysipelas, or any kind of fever, the owner, or his agent or -collector, shall immediately give notice of such illness to the -Inspector of his district; and at the meeting of the Commission next -after such notice, he shall, if required, attend your Court, to receive -any order which you may issue for reducing the number of his lodgers, or -for improving the condition of his house, or for employing any -disinfectant process; and he shall fulfil any such order within the time -therein specified. - - [71] Namely--passages, staircases, area, cellar, yard, privy, &c., and - if common privies and urinals exist, he shall provide for the - cleansing of these, where requisite, at least once daily. - -In a proceeding so experimental as the present, I cannot assure you of -infallible means for meeting every evil contingency; but it seems to me -that a regulation having the general tendency here indicated, enforced -by moderate penalties, would work an important revolution in the economy -of dwellings affected by its operation, would render it indispensable -to the landlord of such holdings to promote cleanly and decent habits -among his tenants--even to obtain security for their good behaviour, and -it would make it difficult or impossible for persons of opposite habits -to obtain holdings under a landlord who would be virtually punishable -for their misconduct. - -Such a regulation would apply, as I have said, to the lowest and -filthiest specimens of the first class of lodging-houses; for, to the -large majority of that class less stringent rules would suffice; and it -would apply most usefully to the second class of lodging-houses--those -in which the single rooms of a house are severally occupied by more than -one family. So great are the physical and moral evils attending this -indiscriminate admixture of adult persons of both sexes (as I have -submitted to you in my former reports), that I entertain no doubts of -the necessity for prohibiting it in the most absolute manner. A -regulation to the following effect would, probably, fulfil the purpose -contemplated by the law, and would disperse these loathsome heaps of -disease, destitution, and profligacy: viz.--There shall not be lodged in -a sleeping-room, at any one time, more than two persons over fourteen -years of age, if of different sexes; nor more than[72] ---- such -persons, if they be all of one sex. - - [72] This number would be proportioned to the cubical contents of the - room, and its facilities for ventilation, of which mention would be - made in the registration-schedule of the house. - -This order--in addition to its wholesome influence on the second class -of lodging-houses, would apply beneficially to the third class; and, in -further relation to the latter, there would probably be required various -minor regulations with respect to facilities for washing, lighting, -ventilation and the like, which admit of being fixed in detail, only as -each particular case comes under your notice, with its deficiencies -recorded in the schedule of its registration. - - * * * * * - -11. In addition to this power of regulating lodging-houses, a further -authority has been conceded you by the Legislature, for the _amendment -or removal of houses presenting aggravated structural faults_. Wherever -your Officer of Health may certify to you that any house or building is -permanently unwholesome and unfit for human habitation, you are -empowered to require of the owner (or, in his neglect, yourselves to -undertake) the execution of whatever works may be requisite for -rendering the house habitable with security to life. - - * * * * * - -Finally,--under your former Act you were authorised, and indeed -_required, to appoint Inspectors of Nuisances_, whose duties were to -consist in the following particulars:--They were to superintend and -enforce the due execution of all duties to be performed by the -scavengers; to report to your Commission all breaches of your rules and -regulations; to point out the existence of nuisances; to record whatever -complaints might arise in relation to the supply of water, or in -relation to any infraction, either of the Act, or of any of the -regulations made by you under its authority for the preservation of -order and cleanliness and for the suppression of nuisances. - -Hitherto your Hon. Court has deemed it sufficient compliance with the -terms of the Act, to engraft the functions above described on the office -of your previously appointed Inspectors of Pavements; and these -Officers have endeavoured very diligently to fulfil the multifarious -obligations thus imposed on them. During the past year it has become -obvious to me that this arrangement of their duties is inconvenient, and -that the occupation of their time as Inspectors of Pavements prevents -them devoting the requisite number of hours to the other important -duties. - -I need hardly add, for the information of your Hon. Court, that the -immense increase of sanitary business implied in your new Act (an -increase probably equivalent to doubling or trebling the former amount) -renders a continuance of the former arrangement still less possible than -heretofore; the important functions assigned to your Inspectors of -Nuisances will now require to be discharged, under the superintendence -of your Officer of Health, with uninterrupted assiduity and vigilance; -and I would therefore take the liberty of begging your Hon. Court to -refer this subject to the consideration of your Committee, together with -some other points relative to the administration of your new powers.[73] - - [73] Two additional Inspectors came into work, under appointment of - the Commission, at Christmas, 1853. See last Annual Report.--J. S., - 1854. - - * * * * * - -Here, gentlemen, terminates my statement of the powers now vested in you -for the maintenance of the public health. Authority so complete for this -noble purpose has never before been delegated to any municipal body in -the country. In exercising the means of such wide beneficence, your -Hon. Court will be discharging duties of immeasurable importance to the -public welfare; and those who have the honour and responsibility of -giving you professional advice will have a task of more than ordinary -difficulty. - -It is easy to foresee the numerous obstacles which interested persons -will set before you to delay the accomplishment of your great task. -Sometimes technical objections will be raised to your proceedings: -sometimes vexatious delays and evasions will occur in the fulfilment of -your injunctions. - -When your orders are addressed to some owner of objectionable -property--of some property which is a constant source of nuisance, or -disease, or death; when you would force one person to refrain from -tainting the general atmosphere with results of an offensive occupation; -when you would oblige another to see that his tenantry are better housed -than cattle, and that, while he takes rent for lodging, he shall not -give fever as the equivalent;--amid these proceedings, you will be -reminded of the ‘rights of property,’ and of ‘an Englishman’s inviolable -claim to do as he will with his own.’ - -Permit me, gentlemen, to remind you that your law makes full recognition -of these principles, and that the cases in which sophistical appeal will -oftenest be made to them, are exactly those which are most completely -condemned by a full and fair application of the principles adverted to. -With private affairs you interfere, only when they become of public -import; with private liberty, only when it becomes a public -encroachment. The factory chimney that eclipses the light of heaven with -unbroken clouds of smoke, the melting-house that nauseates an entire -parish, the slaughter-house that forms round itself a circle of -dangerous disease--these surely are not private, but public affairs. And -how much more justly may the neighbour appeal to you against each such -nuisance, as an interference with his privacy; against the smoke, the -stink, the fever, that bursts through each inlet of his dwelling, -intrudes on him at every hour, disturbs the enjoyment and shortens the -duration of his life. And for the rights of property--they are not only -pecuniary. Life, too, is a great property; and your Act asserts its -rights. The landlord of some overthronged lodging-house complains, that -to reduce the numbers of his tenantry, to lay on water, to erect -privies, or to execute some other indispensable sanitary work, would -diminish his rental: in the spirit of your Act, it is held a sufficient -reply, that human life is at stake, and that a landlord, in his dealings -with the ignorant and indefensive poor, cannot be suffered to estimate -them at the value of cattle, to associate them in worse than bestial -habits, or let to them for hire, at however moderate a rent, the certain -occasions of suffering and death. - -And indeed, gentlemen, the mere pecuniary import of life thus squandered -is not inconsiderable. The costs of medical attendance on these -superfluities of disease are heavy items of parochial expenditure: and -although much of the undue mortality is of children, and consists in the -premature extinction of life that hitherto has no market value--costing -only the tears that are shed for it; yet there likewise occur among your -preventable deaths, very many cases in which adult life is sacrificed, -with all its strength and utility; and where, besides the wasted capital -which that loss implies, there often remains for the district which has -poisoned the man an entailment of orphanage and widowhood. - -Nor, again, can it be questioned, that year by year, as general -education advances, the sanitary condition of a district will be an -important element in determining the value of its property. In engaging -houses, men will not only look to rent, and to rates on rent; they will -look also to rates on life, and will doubt the cheapness of a town -residence, however small in rental, where their lease of life must be -shortened from its intended duration, and form part of an average -mortality two-thirds higher than in the suburbs. It is an instinct in -this direction, or perhaps the guidance of knowledge, that within late -years has given so much extension to suburban residence, and has carried -numbers of the wealthier inhabitants of the City to dwell so far from -their places of daily business: and the same instinct or knowledge -yearly acts more towards the less affluent classes, urging them to fly -as far as possible beyond the smoke and crowding and unwholesome vapours -of the metropolis. I entertain great hope and little doubt, that, within -a few years, the working classes will have organised for themselves -extensive means of suburban residence; that vast barracks of -model-houses, rising on healthier soil and amid purer atmosphere, will -receive hundreds of thousands of inmates from those classes of society -which now throng the courts and alleys of the metropolis; and that by -this spontaneous emigration, in so far as it may affect the City, great -assistance will be given to those endeavours which will be made, under -authority of your Act, to thin the court population of the City, and to -diminish the too dense array of houses inhabited by the poor. - -As I look to the poor-rates of the City of London, as well as to the -other circumstances just adverted to, I feel the deepest conviction that -_property_, no less than _life_, is interested in the progress of -sanitary reform: and once again, most earnestly, I beg leave to -congratulate your Hon. Court on the acquisition of powers, conferring on -you the inestimable privilege of doing so much good for those whom you -represent, and for the often unrepresented poor; of relieving so much -suffering; of prolonging so much life. - -That much improvement remains to be accomplished within your province, -is a certainty which I have endeavoured here, as on former occasions, -plainly to set before you. - -But I cannot close my Report without adverting to the fact, that both -within and around the City, there are sanitary evils for which you are -not responsible--evils beyond your control--powerful causes of diseases -in hourly operation; and that these are so extensive in their agency, as -to neutralise much of the good which it lies in your competence to -effect. - -The mere fact, that for the metropolis generally there is hitherto no -sanitary law, such as you possess for your territory, is an evil to you. -When, at the commencement of next year, you will be proceeding to -suppress the several nuisances against which you are armed; when the -various trades of the City will have ceased to send forth smoke or -stink, you can raise no barrier against invasions from around; -southward, you cannot exclude the unwholesome airs wafted from the river -and from across it; nor on either side, east or west, the soot that -showers down from innumerable shafts encircling you; nor northward, the -odours that rise from the shambles of Clerkenwell. - -And likewise within the City there will be remaining--out of your -control, unremedied evils, the existence of which has long been -denounced, and the removal long expected. - -In 1849, with the cholera amidst us, great exertions were made, and -greater promises. In that dreadful week, when two thousand victims of -our metropolitan population fell beneath its poison; when every -household, from hour to hour, trembled at the visible nearness of death; -the public were scared out of indifference. If the visitation could have -been bought away, at the expense of doubling all local rates in -perpetuity, no doubt the sacrifice would have been made. Public opinion -was kindled to overwhelm all opposition. - -The metropolis was to be drained afresh; the outfall of sewerage was no -longer to be beneath our windows; the river was to be embanked; its -rising tide was no longer to make our sewers disgorge their poisonous -contents into our streets and houses; dead bodies in their decay, were -no more to desecrate the breathing-space of the living; water was no -longer to be supplied--clumsily, insufficiently, and unwholesomely, at -the discretion of private capitalists: all was to be amended. - -For participation in these advantages, the City had to look beyond its -own representatives, and to await the more comprehensive measures of Her -Majesty’s Government. - -Two years have elapsed, and none of the measures referred to has made -visible progress. The water question remains unsettled; arrangements for -extramural interment of the dead have been disconcerted at what seemed -the moment of their completion; the river still receives the entire -sewage of this immense metropolis, and still at each retreating tide, -spreads amid the town, as heretofore, its many miles of fetid, malarious -mud. - -In justice it should indeed be remembered, that any one of the required -amendments could only be the result of long preparatory labour, and that -its organisation would often of necessity be the travail of some single -mind, not insusceptible of fatigue. Particularly as respects the scheme -(now understood to approach its maturity) for the complete drainage of -the metropolis, it cannot be overlooked that very extensive surveys, -superficial and subterranean, with innumerable drawings and -specifications, were necessary to the construction of so comprehensive a -plan. - -But neither can it be disguised or disregarded, that meanwhile, in the -absence of these sanitary works, there are dying needlessly and -prematurely thousands of the population; that preventable death, -hitherto unprevented, is proceeding at its accustomed pace; that -children continue to perish at three or four times their due rate; that -time, which carries us from one visitation of the great epidemic and -obliterates the remembrance of our alarm, also, too probably, carries us -towards the day of another outbreak: that typhus--our home-bred and -daily visitant, rehearses the same warnings as heretofore, moving -uniformly onward like the shadow on a dial, toward the hour when that -Eastern pestilence may again be here. - -Therefore, gentlemen, I have felt it my duty to represent to you that, -in the promotion of those metropolitan works, the population of the City -of London have an incalculable interest;--that the emancipation of human -life from such fetters of disease as weigh on it, can never even -approximate to completion within your City, while the saturated -burial-grounds still continue to receive their annual multitudes of the -dead, while the administration of the water-supply interposes an -effectual hindrance to your most important functions, and while the -river, contaminated and unembanked, diffuses injurious miasms through -the whole extent of your jurisdiction. And I would further venture to -urge on the consideration of your Hon. Court, that your legitimate -influence with Her Majesty’s Government and with Parliament--your -influence as trustees of the Public Health for so large a constituency, -exerted in furtherance of those metropolitan reforms to which I have -adverted--would be tending, not only to the general good, but directly -and eminently to the sanitary advantage of the City of London. - - I have the honour, - - &c., &c. - -_Proposed Schedule of specification for the Register of Lodging-houses._ - - House situate at No. __________ - - Name and Address of Owner _________ - - Number of Floors (including Cellars and Lofts) ____ - - „ Rooms „ „ ____ - - +-------+------+-------------+--------+--------+--------+--------+ - | | No. | | | | | | - | | on | Situation. |Height. |Length. |Breadth.|Windows.| - | |door. | | | | | | - | | +-------------+--------+--------+--------+ | - |Account| |Floor, Aspect|ft. in.|ft. in.|ft. in.| | - | +------+-------------+--------+--------+--------+--------+ - | of | 1 | | | | | | - | +------+-------------+--------+--------+--------+--------+ - | Rooms | 2 | | | | | | - | +------+-------------+--------+--------+--------+--------+ - |separ- | 3 | | | | | | - | +------+-------------+--------+--------+--------+--------+ - |ately. | 4 | | | | | | - | +------+-------------+--------+--------+--------+--------+ - | | 5 | | | | | | - | +------+-------------+--------+--------+--------+--------+ - | |6, &c.| | | | | | - +-------+------+-------------+--------+--------+--------+--------+ - - +-------+------+---------+-------+-------+--------+-------------+ - | | No. | | | | |Number | - | | on |Flooring.| Fire- |Venti- | Rent. |of | - | |door. | |place. |lators.| |Inmates. | - | | | | | +--------+-------------+ - | | | | | |Weekly, |Under | Over | - | | | | | | or | 9 | 9 | - | | | | | |nightly,|years |years | - | | | | | | or per | of | of | - |Account| | | | |person. | age. | age. | - | +------+---------+-------+-------+--------+------+------+ - | of | 1 | | | | | | | - | +------+---------+-------+-------+--------+------+------+ - | Rooms | 2 | | | | | | | - | +------+---------+-------+-------+--------+------+------+ - |Separ- | 3 | | | | | | | - | +------+---------+-------+-------+--------+------+------+ - |ately. | 4 | | | | | | | - | +------+---------+-------+-------+--------+------+------+ - | | 5 | | | | | | | - | +------+---------+-------+-------+--------+------+------+ - | |6, &c.| | | | | | | - +-------+------+---------+-------+-------+--------+------+------+ - - Staircase, if with windows or skylight __________ - - Privies {Number ____ - {Situation ____ - - { {Material ______ - {Receptacles-{Capacity ______ - Water-supply-{ {Situation ______ - { - {Taps, where situated _____________ - - Sinks ____ - - Dustbin ____ - - Yard--size of uncovered area ____ - - Pavement ____ - - Laundry ____ - - Date ________ Signature of Owner ________________ - - NOTE.--I, ____________________, Inspector for the Commissioners of - Sewers of the City of London, do certify that the above schedule - contains a true account of the matters to which it relates; also that - I have examined the privies, drains, sinks, and water-supply in the - above house, and do find the same to be in an efficient and - satisfactory condition; also that the house generally is in good - repair, perfectly clean, and free from disagreeable smell. - - Date____, signed ________________ Inspector. - - - - -FOURTH ANNUAL REPORT. - - - _September 28th, 1852._ - - GENTLEMEN, - -I beg leave to lay before your Hon. Court the several tables[74] which I -have prepared, to illustrate the mortality of the City of London during -the past year. They refer to fifty-two weeks, dating from September -28th, 1851, to September 25th, 1852. - - [74] These tables are not here reprinted in a separate form, except - the enumeration of deaths for the year, which is No. VI. in the - Appendix. The others are embodied in the different quinquennial - tables of the Appendix. - - In the first table I have distributed the 3064 deaths of the period, - according to their localities and seasons; showing them as they - occurred, male and female, during each quarter of the year, in the - several districts and sub-districts of the City. For the foot of each - column, I have calculated the year’s death’s rate, per thousand of the - living, in the district or sub-district referred to; and at the head - of the columns, for facility of reference, I have introduced an - analysis of the population, founded on the Registrar-General’s recent - census. - - In the second table all the deaths of the last four years are stated, - in a form which will enable you to compare one year with another, and - one sub-district with another, in respect of their several - contributions to the total mortality of the period. - - In the third table 12,540 deaths[75] of the last four years are - classified according to the ages at which they befell. This table is - arranged in a manner to display its results, first for each year - separately, and next for each Union separately; in order that you may - observe what local or annual differences have obtained as to the ages - of chief mortality. - - [75] In the remaining number (17) the particulars of age and - residence could not be correctly ascertained. - - The fourth table also relates to the last four years. It restricts - itself to those various forms of acute disease--epidemic, endemic, and - infectious, which occasion, most of all, the predominant mortality of - particular districts or seasons; and which are susceptible, in the - highest degree, of being mitigated or removed under an efficient - sanitary system. - -In their general import these documents agree very nearly with last -year’s record; though showing unfortunately a somewhat higher death-rate -(23·62) and especially a larger proportion of fever. - -On former occasions I have examined, with great minuteness, all such -facts as these tables set forth, and have offered you the best -suggestions in my power for the mitigation of preventable disease. - -The sanitary condition of the City is now substantially the same as at -the date of my last Report; and any comment which I might make on the -present tables could be little else than a repetition of arguments -already submitted to your notice. - -Therefore, as other topics[76] of importance to the health of the City -press for more immediate consideration, I refrain from occupying your -time by any further remark on the materials which I subjoin. - - [76] We were at this time closely occupied in considering the general - questions of extramural interment for the City.--J. S., 1854. - - I have the honour, - - &c., &c. - - - - -FIFTH ANNUAL REPORT. - - - _November 29th, 1853._ - - GENTLEMEN, - -According to the practice of previous years, I lay before you, in the -annexed tables, a brief digest of your death-register for the fifty-two -weeks which terminated at Michaelmas last. - -The deaths there enumerated amount to 3040--being 24 fewer than in the -last preceding similar period. - -Beyond these statistics of the past year, there are other facts which I -have thought it well to tabulate for your information. They relate to -the entire term of five years, during which I have kept record of your -mortality. Midway in this quinquennial period--namely, in the spring of -1851, the general census happened to occur. The inhabitants of the City, -then enumerated, may fairly be taken to represent the mean of your -somewhat fluctuating population; and the five years’ mortality, compared -with the numbers of this mean population, will express pretty accurately -their habitual death-rate. - -The period mentioned is indeed short for the purpose of establishing an -average; but ten years at least must elapse before even similar -materials can again be given for calculation, and a still longer time -before the statistical basis can be enlarged. I have therefore thought -it desirable to make the best use in my power of such facts as were -before me, for the construction of quinquennial tables; out of which, -with sufficient accuracy for all practical purposes, you may draw your -own inferences as to the health of that large population which is under -your sanitary government. - -The facts are classified, as heretofore, in the manner which will most -easily display their practical meaning. First, namely, the deaths of the -period are recorded in their local distribution, so that you may compare -one part of the City with another in respect of healthiness. Next, they -are so tabulated according to ages, as to indicate the prevailing -proportion of untimely death. Thirdly, those of them are separately -enumerated which, in their several classes, chiefly occur as results of -acute disease in connexion with removable causes. - -In after years, when sanitary improvements, now only in contemplation or -commencement, shall have produced their legitimate results and rewards, -these tables may serve an important use. Indicating the standard of -public health within the City before such works were achieved, and -constituting a permanent record of your starting-point, they will -qualify your successors to estimate the amount of amelioration which -your endeavours shall have produced. - -The details of your present sanitary condition, as varying in different -sub-districts of the City, and as fluctuating in the several years and -seasons of the quinquennial period, are expressed in the figures of -these tables more compendiously and more clearly than I could hope to -convey them in words. Here, therefore I restrict myself to telling you -very briefly their general results. - -The population of the City--about 130,000 persons--has been dying -during these five years at the rate of about 24 _per_ thousand _per -annum_. The sub-district rates which give this aggregate vary from under -18 to above 29; the former death-rate belonging to your healthiest -locality--the north-west sub-district of the City of London Union; while -the latter--more than 60 _per cent._ higher--mortality belongs to the -north sub-district of the West London Union. The lowest death-rate -hitherto attained in this country for a considerable population, during -a term of seven years, has been 14 _per_ thousand _per annum_; which -your worst sub-district mortality more than doubles. - -As different districts contribute unequally to your average death-rate, -so also do different ages. Among all the population exceeding five years -of age, the death-rate is under 17 _per_ thousand _per annum_; while, -for children under five years of age, the rate is nearly 85. And these -rates are unequally constituted by your three chief districts in the -following proportion; viz.:-- - - Annual Rate of Deaths to 1000 Over 5 Years Under 5 Years - living persons. of age. of age. - - East London Union 16·68 91·99 - West London Union 20·58 94·84 - City of London Union 15·06 71·72 - ----- ----- - Average death-rate in the City 16·85 84·72 - -How various are the diseases which have conspired to produce your annual -average of 3120 deaths, it would be tedious to describe; and in the -table which I have devoted to a partial analysis of this subject, I have -restricted myself to a consideration of those ailments which are likely -to become less fatal under a well-developed sanitary system. To the -annual average typhus has contributed 140 deaths; choleraic affections -(including the epidemic of 1849) 196; scarlet fever, 76; small pox, 40; -erysipelas, 30; the acute nervous and mucous diseases of children, 572; -their measles, hooping-cough, and croup, 182;--making, from this class -of disorders, an annual average of about 1250 deaths--nearly two-fifths -of the entire mortality. - -My tables will show you that the different seasons of the year have -pressed somewhat differently on human life; and there is exhibited in -them a point of some interest to which I would beg your attention. In -your healthier sub-districts it is easy to perceive the influence, the -almost inevitable influence, exerted by the inclemency of winter against -the aged and feeble. In your unhealthier sub-districts, this effect is -completely masked, and summer becomes the fatal season; its higher -temperature acting in some sort as a test of defective sanitary -conditions, and giving to the several local causes of endemic disease an -augmentation of activity and virulence. - -On the facts which these tables set forth, I have nothing further to say -than would consist in a repetition of arguments already submitted to -your notice. In my third Annual Report, especially, I endeavoured to lay -before you the conclusions which are fairly deducible from the -proportions of early death, and from the partial allotment of particular -diseases. - -These conditions, indeed, are in obvious mutual relation. To human life -there has been affixed a normal range of duration; and when it -prematurely fails--when children perish in the cradle, or adults amid -the glow of manhood, the exception in every case is a thing to be -investigated and explained. Of the 15,597 persons who have died within -your jurisdiction, not an eighth part had reached the traditional -‘threescore years and ten;’ while nearly three-eighths died in the first -five years of life. In proportion as facts like these appear in the -death-tables of a particular district, in the same proportion we can -trace the local prevalence of particular diseases, to explain the -abridgment of life; and passing from such a locality to other districts, -where the natural term of existence is more nearly attained, invariably -we find that these diseases have fallen into comparative inertness. -Finally, in grouping the fatal results of such diseases in their -proportionate geographical allotment, invariably we find that their -prevalence or non-prevalence, here or there, has been associated with -demonstrable physical differences; that life has not capriciously been -long in one place and short in another, but that, where short, it has -been shortened; that its untimely extinction has depended on the direct -operation of local and preventable causes. - -In this recognition of cause and effect, which the experience of late -years has rendered vivid and precise; and in that higher appreciation of -human life, which belongs to civilized nations in peaceful times; and in -that deeper sympathy for the suffering poor, which should be at the -heart of every Christian government, sanitary legislation had its origin -in this country; and it has been the good fortune of the City of London -(in respect of your two Acts of Parliament) to precede the rest of the -metropolis in acquiring and exercising authority for the mitigation of -preventable disease. - -Nearly five years have now passed over your tenure of this very grave -responsibility; and although in many respects the period must be -regarded as one of apprenticeship to a new and difficult -career--although you have hardly yet arrived at what may permanently -represent your method of action--although important changes which you -have determined to adopt are not yet in actual working--although the far -greatest evils still remain for correction--yet I rejoice to inform you -that sensible improvement has already shown itself in the sanitary state -of your population. My comparison of the past five years with any -considerable previous period cannot be as precise as I would wish, owing -to the absence of circumstantial records for the time anterior to my -appointment; but, judging from such information as I can consult on the -subject, I am induced to believe that the deaths, for equal numbers of -population, are about four _per cent._ fewer than before your Acts of -Parliament came into operation, and that the disproportionate mortality -of children is decidedly lessened. - -On this first improvement--the beginning, I would fain hope, of a long -series of similar steps for regaining the allotted duration of human -life, I beg to offer my respectful congratulations to your Hon. Court, -under whose auspices it has been effected. Further impetus in the same -direction will shortly be given by the removal of sanitary evils, -already in fact or in principle condemned. The approaching institution -of your extramural cemetery, and, I venture to hope, the translation of -all slaughtering establishments to the site of your new Smithfield, will -be important contributions to this effect. I therefore make bold to -speak with some sanguineness of the slight change of death-rate already -noticed; though, while so much remains to be accomplished, I doubt not -you will welcome the amelioration rather as an encouragement to proceed, -than as the final reward of a completed task. - - * * * * * - -Here, Gentlemen, terminates all that I have to submit for your -consideration in respect of your past and present record of deaths. The -greater extension which, during the last two years, I have given to my -habitual Weekly Reports, and to sundry occasional statements which it -has been my duty to lay before you, may seem, at least generally, to -render it superfluous for my Annual Report to contain anything beyond -such statistical particulars as I have now brought under your notice. -But, however this may generally be, there exist exceptional -circumstances at the present time which induce me to trouble you at -somewhat greater length. - - * * * * * - -II. Two years ago--adverting to the non-completion of metropolitan -sanitary works, on which the health of entire London is vitally -dependent, I could not but comment[77] on the utter unpreparedness with -which the metropolis was awaiting any sudden return of Asiatic cholera. -It was indeed impossible to foresee how soon, or how late, that dreadful -visitation might recur to desolate our homes--whether it might return at -once, or never. But typhus--averaging in fifteen years double the -fatality of that rarer epidemic--was adding day by day to its list of -preventable deaths; and other endemic diseases were co-operating with -it, demonstrably, uninterruptedly, to decimate, impoverish, and abase -the people. - - [77] Third Annual Report, p. 206. - -Whatever doubts might have existed as to a return of the foreign -pestilence were soon solved: whatever hasty conclusions had been formed, -as to its again remaining absent during half a generation, were soon -disappointed and reversed. Even while I was addressing you on the -subject, the plague had again kindled its smouldering fire, and was -widening its circle of destruction. Perhaps from the eastern centres of -its habitual dominion--from the alluvial swamps and malarious jungles of -Asia, where it was first engendered amid miles of vaporous poison, and -still broods over wasted nations as the agent of innumerable deaths; or -perhaps from the congenial flats of Eastern Europe, where it may have -lingered latent and acclimatised; the subtle ferment was spreading its -new infection to all kindred soils. Repelled again from the dry and airy -acclivities of the earth, and their hardier population, it filtered -along the blending-line of land and water--the shore, the river-bank, -and the marsh. Conducted by the Oder and Vistula from the swamps of -Poland to the ports of the Baltic, it raged east and west, from St. -Petersburg to Copenhagen, with frightful severity, and, obedient to old -precedents, let us witness its arrival at Hamburg. - -Twice in the European history of cholera, had this town seemed the -immediate channel of epidemic communication to our island; the disease -having on each occasion commenced in our north-eastern sea-ports within -a very short time of its outburst there. A third time, not unexpectedly, -has this dreadful guest, following the line of former visitation, -touched upon the banks of the Tyne; where[78] a worse than beastly -condition of the crowded poor, and sewage-water diluted through the -people’s drink, had prepared it an appropriate welcome. - - [78] Having had recent occasion to examine judicially into the matters - here adverted to, I think it proper to mention that the allusions in - my text were long prior to this examination, and were founded chiefly - on the Registrar-General’s Reports of the time, with other official - statements.--J. S., 1854. - -Next, the disease was rumoured to be in London. Hope and belief are too -near akin for this not to have been doubted and denied; but the last few -weeks have shown, with sad incontrovertible certainty, that after only -four years absence, Cholera has again obtained its footing on our soil. -Six or seven hundred deaths, registered in the metropolis since the -beginning of September, have already attested its presence. - -Anxiously adverting to the future, and asking what may be the onward -progress of the disease, we can appeal only to a narrow experience. -Before us lie the records of but two complete visitations of the -disease, and the commencement of this, the third. It would be a shallow -philosophy that should pretend, from two observations, to predict the -possible orbit of this obscurely wandering plague. - -Yet I dare not disguise from you that such knowledge as we have, to -justify scientific anticipation, is pregnant with threats and gloom. -For--let me remind you of the past. At each former period of attack, the -infection, after a certain course over Continental Europe, struck upon -our eastern coast in the summer of an unforgotten year. In the northern -parts of Great Britain, so soon as it had lit among the population, each -time it burst forth into explosive activity, and worked its full -measure of destruction without delay. More faintly it reached the South. -On each occasion, indeed, at the close of summer, London was sensibly -affected by the disease; but, we hoped, under a milder infliction. Here -and there, within its Bills of Mortality (as at Tooting in 1848) there -was thrown some astounding flash on a particular hot-bed of co-operating -poison; but on the whole it seemed to the sanguine, on each occasion, -that the fury of the epidemic was expending itself in our northern -towns, and that the metropolis was to be comparatively spared. - -Each time, at the commencement of the new year, our London mortality -from Cholera seemed stationary within the limit of a few hundred deaths. -Each time winter and spring allowed a long respite to our invaded City, -and confirmed the omens of the hopeful. - -But each time there was disappointment. Each time, as the warmth of -summer requickened the exterior conditions of chemical activity, the -dormant fire kindled afresh--slowly at first, but with speedy -acceleration of rate. Each time, in the few weeks before -Michaelmas--amid almost universal threatenings of the disease, and amid -such panic of death as the metropolis had not known since the Great -Plague, there suddenly fell many thousands of the population. - -Thus then our position stands. Scientific prediction of phenomena can -arise only in the knowledge of laws. That the phenomena of this disease, -however capricious they may seem, are obedient to some absolute -uniformity as yet beyond our ken--are enchained by that same rigid -sequence of cause and effect which is imposed on all remaining -Nature--it would be impossible to doubt. But these conditions are -hitherto unknown to science. Hitherto we can speak of the facts alone, -with a short empirical knowledge of their succession. Yet in this light, -such as it is, the conclusion is only too obvious. If the disease, -already notorious for a tendency to return on its former vestiges, -repeat on this third occasion the steps of its two previous courses; or, -perhaps I should rather say, if it now proceed consistently to complete -a repetition which it has already half-effected; Asiatic Cholera will be -severely epidemic in London in the third quarter of next year--will -proceed, with a stern unflattering test, to measure the degree in which -those promises of sanitary improvement have been redeemed, which the -terror of its recent visitation extorted even from the supinest and most -ignorant of its witnesses. - -In the face of so great a danger, you will reasonably claim of your -Officer of Health that he shall report to you, how far the City is -already fortified against this dreadful invasion--how far the hygienic -defences of life, if weak, may be strengthened--how far there remain -breaches now insusceptible of repair. - - * * * * * - -1. It forms an all-important part of these considerations for resistance -to the disease, to recognise quite accurately what is its fashion of -attack. Since I last addressed you on the subject, in my Report for -1849-50, the materials for correct generalisation have been very largely -increased by Dr. Farr’s admirable Report to the Registrar-General on the -Cholera in England, and by numerous other important publications. By -collating with these works the more restricted, yet not uninstructive, -experience which arose within your particular jurisdiction, I hope to -have enlarged my knowledge of the subject, and to have become able with -greater confidence to submit my conclusions for your acceptance. - -The first and most obvious characteristic of the disease is its -preference for particular localities. It is eminently a -district-disease. And the conditions which determine its local -settlement are demonstrable physical peculiarities. - -After carefully reviewing the subject, I do not know that I need -qualify, except to express more confidently, the account I formerly gave -you of those peculiarities, as consisting in the conjunction of dampness -with organic decomposition. - -It is in respect of these conditions--especially among dense urban -populations, that the level of occupied ground, relatively to the -nearest water-surface, becomes of primary importance. The low level, in -itself, or rather in respect of the watery dampness which it implies, is -not enough to localise the pestilence. To be afloat at sea might be the -safest lodging. - -The sub-district of St. Peter’s, Hammersmith, averages only four feet -above high-water level; that of St. Olave’s, Southwark, two feet higher; -yet among the former and worse placed of these two populations, the -Cholera-mortality was only 18 per 10,000; while among the latter and -better placed it rose to 196--multiplying nearly eleven times the minor -phenomena of a lower level. So also within your own jurisdiction. Side -by side along the river lie four of your sub-districts; three at the -elevation of twenty-one feet, one at the elevation of twenty-four feet. -The Cholera-mortality, if simply proportioned to level, should have been -nearly the same for these four sub-districts, but somewhat less in the -last one than in the first three. Yet contrary was the fact; for in two -of these sub-districts the Cholera-mortality, for equal numbers of -population, was 4½ times as great as in the other two. - -It would, therefore, appear that in certain low-lying levels--to -constitute them favorable soils for the disease, there must be joined to -their first condition of lowness (with the mere watery dampness which it -implies) some other and second condition; one, which is of extreme -frequency in such districts, though not essentially present there. - -This second condition impends wherever there dwells at such levels a -certain density of population; _it mainly varies with the degree in -which that dense population lives in the atmosphere of its own -excrements and refuse_. In this respect I cannot refrain from saying, -that the giant error of London is its present system of drainage. -Probably in considerable parts of the metropolitan area, house-drainage -is extensively absent: probably in considerable parts, the sewers, from -the nature of their construction, are very doubtful advantages to the -districts they traverse: but the evil, before all others, to which I -attach importance in relation to the present subject, is that habitual -empoisonment of soil and air which is inseparable from our tidal -drainage. From this influence, I doubt not, a large proportion of the -metropolis has derived its liability to Cholera. A moment’s reflection -is sufficient to show the immense distribution of putrefactive dampness -which belongs to this vicious system. There is implied in it that the -entire excrementation of the metropolis (with the exception of such as, -not less poisonously, lies pent beneath houses) shall sooner or later be -mingled in the stream of the river, there to be rolled backward and -forward amid the population; that, at low water, for many hours, this -material shall be trickling over broad belts of spongy bank which then -dry their contaminated mud in the sunshine, exhaling fœtor and poison; -that at high water, for many hours, it shall be retained[79] or driven -back within all low-level sewers and house-drains, soaking far and wide -into the soil, or leaving putrescent deposit along miles of underground -brickwork, as on a deeper pavement. Sewers which, under better -circumstances, should be benefactions and appliances for health in their -several districts, are thus rendered inevitable sources of evil. During -a large proportion of their time they are occupied in retaining or -re-distributing that which it is their office to remove. They furnish -chambers for an immense fæcal evaporation; at every breeze which strikes -against their open mouths, at every tide which encroaches on their -inward space, their gases are breathed into the upper air--wherever -outlet exists, into houses, foot-paths, and carriage-way. - - [79] I am informed that in large districts on the south side of the - river, this retention of sewage is prolonged for two-thirds of every - tide--sixteen hours out of every twenty-four. - -To you, Gentlemen, as Commissioners of Sewers for the City of London, -these remarks may seem superfluous; the rather so, as the worst evils of -tidal drainage are not largely exemplified within your jurisdiction. But -it seems to me of extreme moment at the present time, when very costly -improvements of the metropolitan drainage are about to undergo -parliamentary discussion, that the public should be well aware how -indispensable such improvements are for the general health of London, -and how important, in fact, they are to thousands who at first sight -might think themselves little interested in their completion. - -To some individual householder, dwelling at a high level, all concern -in the subject may seem to terminate with the defluxion of his own -sewage. So that his own pipes remain clear, little cares he for the -ultimate outfall of his nuisance! Perhaps, if he knew better, he would -care more. His gift returns to him with increase. Down in the valley, -whither his refuse runs, converge innumerable kindred contributions. -From city and suburb--from an area of a hundred square miles covered by -a quarter of a million of houses, with their unprecedented throng of -metropolitan life, there pours into that single channel every -conceivable excrement, outscouring, garbage and refuse, from man and -beast, street and slum, shamble and factory, market and hospital. From -the polluted bosom of the river steam up, incessantly though unseen, the -vapours of a retributive poison; densest and most destructive, no doubt, -along the sodden banks and stinking sewers of lowest level; but -spreading over miles of land--sometimes rolled high by wind, sometimes -blended low with mist, and baneful, even to their margin that curls over -distant fields. For, not alone in Rotherhithe and Newington--not alone -along the Effra or the Fleet, are traced the evils of this great miasm. -The deepest shadows of the cloud lie here; but its outskirts darken the -distance, A fever hardly to be accounted for, an infantile sickness of -undue malignity, a doctor’s injunction for change of air, may at times -suggest to the dweller in our healthiest suburbs, that while draining -his refuse to the Thames, he receives for requital some partial workings -of the gigantic poison-bed which he has contributed to maintain. - -The subject of these remoter effects I refrain from pursuing, as foreign -to my present purpose. That on which I wish to insist is the character -of the river, in its relation to the marginal sub-districts which it -habitually dampens and occasionally floods with putrescent soakage, and -in its relation to the sewers of low gradient which it converts (often -with their adjoining soil) into the similitude and hurtfulness of -cesspools. I wish emphatically to point out, that the several parts of -London have suffered, and are likely again to suffer, from Cholera, in -proportion as either this malarious influence is exerted on them, or -other kindred miasms are furnished by their soil. And it is my belief, -from such evidence as is before me, that the general liability of London -to suffer the epidemic visitation will cease, whenever an efficient and -inodorous system of drainage, conveying all refuse of the metropolis -beyond range of its atmosphere, shall be substituted for our present -elaborate disguise of an unremoved nuisance. I deem it right to state -this explicitly: not only because it is my duty to give you, in simple -truth, the conclusions to which I am led by careful reflection on the -facts; but likewise because--for the credit of sanitary medicine and for -your justification in the awful presence of a recurrent pestilence -within your jurisdiction--it ought to be thoroughly known how much of -the cause is common to the entire metropolis, and has not admitted of -removal by measures of partial improvement. And the circumstances will -perhaps excuse me if I repeat to your Hon. Court--represented as you are -both in the Metropolitan Commission of Sewers and in Parliament, where -this question must shortly be discussed--that the universal reform of -our metropolitan drainage, at whatever imaginable pecuniary cost, is an -urgent claim and necessity, unless this great city is again, as two -centuries ago, to live under the constant alarm of increasing epidemic -destruction. - -Reverting, however, to the more especial relations of the disease within -your territory, you will remember that, among your four bank-side -sub-districts, two suffered in marked excess; their Cholera-mortality -having been 4½ times as great as that of the other two. The fact is -instructive; because those two suffering sub-districts (though not of -lower mean level than the others) were marginal to the valley of the -Fleet, and were therefore exposed, more than any other part of your -province, to the class of evils I have described. For a considerable -part of this locality may be regarded as but recently[80] a creek of the -Thames; its shelving banks, singularly foul from ancient misuse, though -now built over and paved, undergo in their lower levels very -considerable soakage; while those vast sewers which lie in the -mid-channel of the former river, are more liable than any within your -jurisdiction, to suffer injurious interference from the action of the -tide. At every such interference, and at every current of air setting up -the sewers, all gases generated in these large chambers would diffuse -themselves, not only in the low level, but likewise widely east and -west, up those important slopes which depend on this valley for their -drainage. I can easily understand that the radical cure of this district -may be possible, only as part of those metropolitan improvements to -which I have adverted; but I do think it of supreme importance, in -reference to any such visitation as we dread, that, during the next -twelve months, there should be taken every precaution which technical -knowledge can suggest, for restricting, even by palliative and temporary -expedients, those mischievous effects which I have endeavoured to -illustrate. - - [80] New Bridge Street was built over the Fleet in 1765. The present - site of Farringdon Street had been arched in thirty years earlier, for - the purposes of the Fleet Market. - -In describing to you the local affinities of cholera, I have intimated -that, in its preference for our low metropolitan levels, it selects -these soils specifically in respect of their being damp with organic -putrefaction. A moment’s consideration will suffice to show that, if -this be true, the higher levels of the metropolis will be exempt from -the disease, only in proportion as they exempt themselves from the local -conditions which invite it--only in proportion as they avail themselves -of those natural advantages which their situation enables them to -command. Let a district be defective in house-drainage, so that its soil -is excavated by cesspools and sodden by their soakage; let its sewers be -ill-constructed and foul, so that offensive gases are ventilated into -the immediate breathing-air of the inhabitants; let its pavement be -absent or imperfect, scattered with refuse and puddled with water;--you -will easily conceive that, under these circumstances, all distinctions -of level are merged in the strong identity of filth, and whatever -diseases belong to putrefactive dampness of soil will strike here as -readily as on the low-lying mud-banks of the river. - -So, likewise, in still narrower limits--the predisposition of a house to -Cholera may be stated in the same terms as define the liability of a -district--viz., that the humid gases of organic decomposition, in -proportion as they are breathed into one house in a district more than -into other houses there, will engender the greater liability of that -house, as compared with its collaterals, to suffer an invasion of -Cholera. And thus it often happens, during epidemic prevalence of the -disease, that sporadic cases are determined in localities which might -generally claim to be free from infection: for, what avails it to be on -the highest ground and the best soil, with every neighbouring facility -of sewers and scavenage, if, owing to individual carelessness and filth, -the conditions of dampness and putridity are by choice retained within a -house, and its basement flooded with rotting liquids, or piled with -accumulated refuse? - -I might give you many instances in illustration of these points--showing -you how, under the operation of specific sanitary faults, the -Cholera-mortality of districts acquires an artificial exaltation; but -few comparisons will suffice. At the period of the epidemic of 1849, -your best conditioned sub-district was the north-west of the City of -London Union; and (among those of the same level) your worst was the -sub-district of Cripplegate, which at that time was in a very -unsatisfactory state, abounding in open cesspools and their -consequences. In the former of these sub-districts the Cholera-mortality -_per_ 10,000 was 19; in the latter 47; and it is easy to show that -additional sanitary errors soon develop a larger fatality. Not far from -your boundary, at the same level with these two sub-districts, in the -Hackney-Road division of Bethnal-Green, it rose to 110; this large -mortality being principally confined to a very small portion of the -district, wherein (the local Registrar reports) sewers were almost -entirely absent, houses were contaminated with the filth of years, -streets were remaining for days uncleansed from accumulating dirt, and -all waste water (including animal secretions) was uniformly thrown into -the public way. - -Such are the conditions under which, at any imaginable height in the -metropolis, Cholera may decimate a population: such, in their worst -form, were the conditions which at Merthyr-Tydvil--several hundred feet -above the water-level, carried the Cholera-mortality to more than double -the high metropolitan rate just mentioned. Taught by this case the power -of human mismanagement to futilise the favours of Nature; taught that -perverse ingenuity can construct poison-beds for the development of -Cholera, high above the usual track of its devastation; one gladly turns -from the horrible instructiveness of such a lesson, to gather the -kindred evidence of contrast: and happily there is abundant evidence to -show how much may be effected, even in the most tainted districts, to -purchase a circumscribed exemption from the disease by the judicious -application of sanitary care. - -In the remarks which I have made on the local distribution of Cholera, -you will have observed that I dwell particularly on one class of -sanitary evils as concerned in its production; on that class, namely, -which consists in the retention and soakage of organic refuse--on that -class, which has its appointed antidote in a system of inodorous -drainage, of uninterrupted pavement, of complete and punctual scavenage. - -On this I particularly insist, because I believe that here is the very -atmosphere without which Cholera would cease. - -Sanitary evils abound; and, if I were speaking of other diseases, I -might have more to say of other causes. I am unwilling, even for a -moment, to seem indifferent to those remaining fertile sources of -suffering that surround the poor of our metropolitan population--to -their over-crowded condition, to their scantiness of ventilation, to -their insufficient or disgusting water-supply, to their frequent -personal dirt, to their habitually defective diet. These several -influences have their own characteristic sequels and retribution, on -which I have often addressed you, and which I am little likely to -underrate; believing, as I do, that, in the lapse of years, the -aggregate of their effects is far more fatal than any periodical -epidemic visitation. Likewise, I cannot doubt that, under certain -circumstances, and in respect of particular cases, they may assist the -operation of the choleraic poison. Nor will I pretend so exactly to -limit the affinities of that which evolves this poison, as to deny that -rooms, fœtid with animal exhalations, may (like cesspool-sodden cellars) -be ready to answer the stimulus of its infection. And at any rate, I -think it highly important to recognise that all sanitary defects which -embarrass the excretive purification of the human body--whether by -breathing or otherwise, do naturally tend in the same direction as the -causes of Cholera, and are liable--if only by indirect means, to become -accessory in its destructive work. - -But, deeply impressed as I am with the importance of these -considerations, I esteem it of still higher consequence, if measures are -ever to be taken for an effective prevention of the disease, that the -principle of its _specific causation_ should be steadfastly kept in -view. What may be the exact chemistry of this process, I do not pretend -to say: urging only, that, in all human probability, the poison arises -in specific changes impressed by some migratory agent upon certain -refuse-elements of life. Perhaps nowhere, and certainly not before your -Hon. Court, can it be desirable, in the present immaturity of -pathological knowledge, to argue as to the first origin or absolute -nature of that wandering influence which determines in particular -localities the generation of epidemic malaria. Simply, since it leads to -all-important practical conclusions, let this distinction be recognised: -that which seems to have come to us from the East is not itself a -poison, so much as it is a test and touchstone of poison. Whatever in -its nature it may be, this at least we know of its operation. Past -millions of scattered population it moves innocuous. Through the -unpolluted atmosphere of cleanly districts, it migrates silently, -without a blow: that which it can kindle into poison, lies not there. To -the foul, damp breath of low-lying cities, it comes like a spark to -powder. Here is contained that which it can swiftly make -destructive,--soaked into soil, stagnant in water, griming the pavement, -tainting the air--the slow rottenness of unremoved excrement, to which -the first contact of this foreign ferment brings the occasion of -changing into new and more deadly combinations. - -These are matters which it is hateful to hear, and, believe me, to speak -about. But the thing is worse than the statement; and I would suggest to -you this easy test of its reality. Take at random any consecutive -hundred entries of Cholera-Deaths in the Registrar-General’s -metropolitan returns, where local conditions are described; and let any -man decide for himself, whether what I have sketched in general terms -convey more than the essential features of these several records. In -1849, such an atmosphere as these influences engender existed -continuously and intensely on the low-lying south side of the river, and -to some distance inland, from Greenwich to Wandsworth; it existed also -continuously, but in far less intensity, and with comparatively little -extension inland, along the northern side of the river from Poplar to -Chelsea, and it existed very intensely in several independent centres, -scattered about those healthier levels of the metropolis, which, by -their better position, ought to have been exempted from such a reproach. -The Cholera struck in the same proportion as this atmosphere prevailed; -and herein, I repeat, lies that definite local condition, except for -which--to the best of my knowledge and belief, the migratory ferment -(whatever it may be) would pass harmlessly through the midst of us. - -For, towards the chemical constitution of local atmospheres, it seems -that the several principles of epidemic diseases stand in the same sort -of fixed respective relations, as do the several principles of infective -fevers towards certain elements in the blood of individual persons. Just -as the infective ferment acts on man, so appears the epidemic ferment to -act on locality. We know that, in a given group of human beings, -small-pox chooses one victim, scarlatina another, measles a third, by -reason of some material quality in each person respectively, which his -blood possesses, and which his neighbour’s blood does not possess. By -virtue of this quality--not the less chemical because chemists have no -name for it, that specific exterior agency, which we call infection, has -the power of affecting each such person--has the power of producing in -him a succession of characteristic chemical changes which tend to an -eventual close by exhausting this material which feeds them.[81] - - [81] For the scientific reader, I may perhaps be permitted to add, - that the very difficult Subject, at which here I can only venture to - glance, is discussed at some length in one of my Pathological - Lectures, delivered at St. Thomas’s Hospital in 1850, published at - that time in the _Lancet_, and subsequently reprinted.--J. S., 1854. - -Strictly analogous to this, in its principle of choice and in its method -of operation, appears the epidemic action--not on persons indeed, but on -places. The specific migrating power--whatever its nature, has the -faculty of infecting districts in a manner detrimental to life, only -when their atmosphere is fraught with certain products susceptible, -under its influence, of undergoing poisonous transformation. - -These products, it is true, are but imperfectly known to us. Under the -vague name of putrefaction we include all those thousand-fold -possibilities of new combination, to which organic matters are exposed -in their gradual declension from life. The birth of one such combination -rather than another is the postulate for an epidemic poison. - -Whether the ferment, which induces this particular change in certain -elements of our atmosphere, may ever be some accident of local origin, -or must always be the creeping infection from similar atmospheres -elsewhere similarly affected; whether the first impulse, here or there, -be given by this agency or by that--by heat, by magnetism, by planets or -meteors--such questions are widely irrelevant to the purpose for which I -have the honour of addressing you. The one great pathological fact, -which I have sought to bring into prominence for your knowledge and -application, is this:--that the epidemic prevalence of Cholera does not -arise in some new cloud of venom, floating above reach and control, high -over successive lands, and raining down upon them without difference its -prepared distillation of death; but that--so far as scientific analysis -can decide, it depends on one occasional phase of an influence which is -always about us--on one change of materials which in their other changes -give rise to other ills; that these materials, so perilously prone to -explode into one or other breath of epidemic pestilence, are the dense -exhalations of animal uncleanness which infect, in varying proportion, -the entire area of our metropolis; and that, from the nature of the -case, it must remain optional with those who witness the dreadful -infliction, whether they will indolently acquiesce in their continued -and increasing liabilities to a degrading calamity, or will employ the -requisite skill, science, and energy, to remove from before their -thresholds these filthy sources of misfortune. - - * * * * * - -2. If, gentlemen, I have detained you long in stating conclusions as to -the habits of the disease, and as to the significance of its local -partialities, it has been in order to render quite obvious to you the -intention of those precautionary measures which it is now my duty to -recommend. - -First, I would allude to influences of an exterior and public kind; and -here, all that I have to advocate might be included in a single -stipulation, that cleanliness--in the widest sense of the word--should -be enforced to the full extent of your authority. - -Over the pollutions of the river, and over the tidal exposure of its -malarious banks, you have no power. - -Whether for the relief of your low-lying districts--subject to imminent -risk from causes I have described--there can be found any temporary -protection to save their atmosphere from contamination, is a question -which you will resolve upon other judgment than mine. - -Along the river-bank there is one especial source of nuisance which has -repeatedly been under your notice, and which is likely to become of -serious local import under the presence of epidemic disease. I refer to -the docks, and chiefly to that of Whitefriars. I mention it -particularly, not only because the accumulations of putrid matter there -have often been alarmingly great, but likewise because, at the head of -this dock, during the former invasion of Cholera, there was remarkable -prevalence of the disease; and I can well remember how often the -offensive condition of the dock was accused, not unjustly, of -contributing to the mortality of the neighbourhood. The fœtid materials, -floated into these several recesses of the river, and left stranded -there by the receding tide, are often so copious as to produce very -objectionable effects on the atmosphere which surrounds them; and I -would beg leave strongly to urge that such sources of nuisance should be -thoroughly and permanently removed. - -Further--from what I have said as to the conditions of our vulnerability -by Cholera, you will be prepared to think it of great importance that, -during the next six months, you should be certified on the state of your -sewers, in every part of the City, as to their greatest possible -cleanliness and least possible offensiveness of ventilation. Fifty miles -of sewer, reticulated through the City, sufficiently attest your active -desire to provide for the complete and continuous carrying away of all -excremental matters: and you will excuse me, I hope, in consideration of -the anxieties of my office, if I seem superfluously cautious in -reminding you that the test of successful sewers lies in an inodorous -fulfilment of their duty, and that every complaint of offensive -emanations indicates, in proportion to its extent, a failure of that -sanitary object for which the construction was designed. - -There is one precaution--always of great value to the health of towns, -and especially useful against any malarious infection, which happily I -find it needless to recommend. The paving of all public ways within the -City--including every court and alley--is already so complete as to -constitute a very favorable point in your sanitary defences. In order -that this excellent arrangement may give its full fruit, it will be -requisite--though this again I need hardly press on your consideration, -that the duties of scavengers and dustmen be thoroughly and punctually -performed. - -Again, I would particularly advise that great vigilance be exercised in -all markets, slaughtering-places, and other establishments under your -jurisdiction, to prevent the retention of refuse-matter, animal or -vegetable. I would urge the strictest enforcement of all regulations -which you have made for the cleanliness of such places, and for the -removal of their putrefiable refuse. - -Likewise, I have to suggest that after the month of May, at latest, no -disturbance of earth to any considerable depth should be allowed to take -place, either in your works or in those of gas and water companies, -except under circumstances of urgent necessity. In the lower levels of -the City, particularly, I conceive this prohibition to be a matter of -paramount importance; because the soil, never of unexceptionable -cleanliness in towns, is here especially apt to be of offensive quality. - -On the subject of water in its general relations to the City, I have -only again to express my deep regret that it lies out of your present -power to compel a continuous supply, and that your means are restricted -to choosing what may best compensate for the absence of this sanitary -boon. It must be your aim to mitigate, so far as may be, the evils that -belong to an ill-regulated intermittent system in its adaptation to the -houses of the poor--evils which imply, as I have often told you, not -only much domestic dirt, but likewise a frequent suspension of all -efficiency in the drainage of innumerable houses. With a view to the -best alternative for a continuous supply, I would recommend that at -least a daily filling of all cisternage take place, and expressly that -Sunday form no exception to the advantages of this rule. If a choice of -evils must be made, I trust it is no heathen’s part to urge that the -Christian Sabbath suffers more desecration in the filth and preventable -unwholesomeness of many thousand households, than in the honest industry -of a dozen turncocks. I likewise submit, that it would be highly -advantageous to the labouring poor, most of whose domestic cleansing is -reserved for the last day of the week, that, on that day, a second -delivery of water should take place at some hour in the afternoon. - -I wish it were in my power to tell your Hon. Court that the supply of -water to the City of London had become, in quality, all that I think it -might be rendered. Such as it is, however, there depend other very -important issues on its being delivered in ample abundance for all the -purposes of cleanliness; and I am glad to have learned from the eminent -engineer of the New River Company, that he has it in expectation very -shortly to be able to furnish to the City a largely increased and -practically inexhaustible supply. - -The subject of water in its district relations ought hardly to be passed -without a word of caution as to the use of pumps within the City. I need -hardly inform you that every spring of water represents the drainage of -a certain surface or thickness of soil, and that--such as are the -qualities of this gathering ground, such must be the qualities of the -water. You will, perhaps, remember that in my account of one celebrated -City pump, which sucks from beneath a churchyard, I showed you ninety -grains of solid matter in every gallon of its water. In virtue of that -wonderful action which earth exerts on organic matter, the former -contents of a coffin, here re-appearing in a spring, had undergone so -complete a change as to be insusceptible of further putrefaction: the -grateful coolness, so much admired in the produce of that popular pump, -chiefly depending on a proportion of nitre, which arises in the chemical -transformation of human remains, and which being dissolved in the water, -gives it, I believe, some refrigerant taste and slight diuretic action. -Undoubtedly this water is an objectionable beverage in respect of its -several saline ingredients; but my present object in adverting to them -is rather to illustrate an anterior danger which they imply. Their -presence indicates a comparative completion of the putrefactive process, -effected by the uniform filtration of organic solutions through a -porous soil.[82] Let that soil have frequent fissures in its substance; -or let its thickness be scanty in proportion to the organic matters to -be acted on: and the water, imperfectly filtered, would run off foul and -putrescent. Now this risk, more or less, belongs to all pumps within the -City of London. They draw from a ground excavated in all directions by -sewers, drains, cesspools, gas-pipes, burial-pits. The immense amount of -organic matter which infiltrates the soil does undoubtedly, for the -greater part, suffer oxidation, and pass into chemical repose: but in -any particular case it is the merest chance, whether the glass of water -raised to the mouth shall be fraught only with saline results of -decomposition--in itself an objectionable issue--or shall contain -organic refuse in the active and infectious stage of its earlier -transformations. Some recent cutting of a trench, or breakage of a drain -in the neighbourhood, may have converted a draught, which before was -chronicly unwholesome, into one immediately perilous to life. Such facts -ought to be known to all persons having custody of pumps within urban -districts; and it ought likewise to be known that this infiltrative -spoiling of springs may occur to the distance of many hundred yards.[83] - - [82] This very important influence, exerted by the earth on various - organic infiltrations, is referred to in the text only under one point - of view; only as it occasions the deterioration of land-springs in - urban districts, and renders their water unfit for consumption. But - the subject has another equally important side. Such springs, having - their waters laden with nitrates, represent the continuous removal of - organic impurities which otherwise would contaminate the air. The evil - of spoiled springs, therefore--while it necessitates for every urban - population that their water-supply shall be artificially furnished - from a distance, has great countervailing advantages. A given organic - soakage will cease to vitiate the atmosphere by evaporation, in - proportion as it gravitates to lower levels, and undergoes those - chemical changes which accompany filtration through the soil. Hence it - is evident that, for the healthiness of inhabited districts (where - extensive soakage of organic matters is almost invariable) it becomes - most important to maintain, or by artificial measures to accelerate, - this down-draught through the soil; and the reader will scarcely need - to be reminded, that, in those improvements of metropolitan sewerage, - which it is a chief object of this Report to advocate, complete - provision for the continuous drainage of soil is implied as an - essential part. - - [83] For a fact strikingly illustrative of this, I am indebted to my - colleague, Dr. R. D. THOMSON, Lecturer on Chemistry at St. Thomas’s - Hospital. At Liverpool--in three wells which he examined, distant - severally 760, 800, and 1050 yards from the Mersey, he found the water - brackish from marine soakage, containing four or five hundred grains - of solid matter _per_ gallon, and totally unfit for consumption. - -In final reference to the quality of water, whether supplied by our -trading companies or derived from springs within the City, I think it -expedient to mention that, against its lesser impurities, great -protection is given by filtration through animal charcoal, as in various -‘filters and purifiers’ which are before the public. These protective -means do not lie within reach of the poorer classes; nor, whatever their -accessibility to individuals, can any such personal arrangements render -it less important to provide that water--the first necessary of life--be -supplied for universal use in its utmost procurable purity. - - * * * * * - -Beyond the above points, which are of general application within the -City, all your remaining precautions will relate to the condition of -private houses: and of these--occupied by the poorer classes, there -exist in the City some thousands over which it will be requisite, by -repeated inspection, to maintain an efficient sanitary watch. From -circumstances to which I have already referred, it appears that your -defences against Cholera will very mainly consist in removing the causes -of disease from within individual houses; and it is only by an organised -system of inspection, for detecting and removing every unclean -condition, that this object can be attained. For your encouragement in -this task, I may venture to express my belief that, throughout a -considerable portion of the City, the local affinities for Cholera are -not too strong to be greatly modified and obviated by such a system. - -With respect to this important work of sanitary inspection, what I now -propose is no new proceeding within the City. More or less since the -date of my appointment, but I hope with gradual increase of completeness -and efficiency, weekly visitations on a considerable scale have been -made, under my direction, by your four Inspectors of Nuisances. Acting -under your authority, and guided by what information I could obtain on -the existence of endemic disease[84] in your several districts, I have -furnished the Inspectors every week with a variable list of houses, -ranging probably from fifty to one hundred and fifty at a time, for -their visitation and inquiry. The information which I have directed them -to seek has referred of course to the various details of sanitary -condition: to questions of lodgment, ventilation, cleanliness, drainage, -water-supply, dust-removal, paving of yards and cellars, existence of -nuisances, and the like: and I have constructed tabular forms for their -use, which admit of this information being recorded and reviewed in the -readiest manner. Week by week, before each meeting of your Court, I have -had the habit of going through every particular of these somewhat -considerable details. I have sorted out of them those very numerous -cases in which your lawful powers could be usefully exerted. When I have -deemed it necessary, I have myself made visits of verification or -inquiry; and have finally laid before you, in the form which is familiar -to your weekly meetings, such recommendations as the week’s survey has -shown necessary, for enforcing works of local improvement under the -powers of your Acts of Parliament. I find that within the last twelve -months there have been made 3147 visitations of this nature, the results -of which are recorded in your office; and, founded on the result of -these inspections, there have been issued 983 orders for abatement of -causes of disease. - - [84] This information has been mainly derived from two - sources:--first, from the weekly Death-Returns of the nine City - Registrars, which the Registrar-General most kindly allows me to have - transcribed so soon as they arrive at his office;--secondly, from - weekly returns which the Medical Officers of the three City Unions - have had the great kindness and liberality to supply for my - assistance, as to the existence of fever and kindred disorders in the - several localities under their charge. - -I am very far from considering that these arrangements have been -perfect. Circumstances beyond my control have prevented me from -constructing as complete an organisation as I could wish; and the fact -that your Inspectors are very largely employed in other duties, has -perhaps occasionally given some hurry and imperfection to their share of -the work. Still, such as it is, this system has been the means of -considerable advantage; and I am glad to be able to claim for your Hon. -Court the distinction of being first in the metropolis to have -established an arrangement for the systematic sanitary visitation of the -dwellings of the poor. In relation to this subject, I beg to inform your -Hon. Court that your Inspectors have discharged, with much zeal, -intelligence, and industry, the duties which you authorised me to impose -on them. - -During the last few weeks it has become obvious to your Hon. Court that -the duties of this department of your service have grown to such -dimensions as to necessitate some increase of your staff; and acting on -this opinion, mainly with a view to render more complete your sanitary -supervision of the City, you have just appointed two additional -Inspectors of Nuisances. In making this appointment, you have determined -not to restrict any two or three Inspectors exclusively to the business -of house-inspection, but to allot the joint duties, sanitary and -surveying, equally among their number: parting the area of the City into -six, instead of four, Inspectors’ districts; so that each Inspector -shall give a certain proportion of time to the duties which he has to -fulfil under your Surveyor’s direction, and another certain proportion -to those in which he will be engaged under the direction of your Officer -of Health. It is only some experience of this arrangement that can -decide whether it will be the most effectual for your purpose; but in -the mean time I have studied so to dispose the industry of your -increased staff, under the arrangement you have ordered, as to obtain -the most systematic and efficient discharge of those duties which you -have desired me to superintend. - -Reckoning that each Inspector, if he fulfilled no other duty, could -report on the condition of about fifty houses _per diem_, I presume -that henceforth, in each of your five more important districts, from one -hundred to one hundred and twenty houses can be visited weekly by the -Inspector, without encroaching on the time required for his other -duties. - -The general plan, on which I would propose that this force should be -disposed, is the following:--first, as heretofore, the weekly list would -contain all places needing investigation on the ground of such deaths -and illness as are usually associated with preventable causes, in order -that any sanitary defects may at once be remedied in them; secondly, in -each week there would fall due a certain number of sanitary works -(relating to house-drainage, water-supply, and the like) for which you -would have previously issued orders requiring them to be completed -within a stated time, and on the satisfactory execution of these it will -be the Inspectors duty to examine and certify; thirdly, in each district -I would have a certain rota of visitation, according to the badness of -the spot and its known liability to fall into filthy and unwholesome -condition, requiring one set of houses to be seen weekly, another set -fortnightly, another monthly, another quarterly, and so on--a rota, -varying from time to time with the changing circumstances of each -locality; and, out of this rota, each week would supply a stated number -of cases for inquiry, to which I should occasionally add certain of -those establishments in which offensive occupations are pursued. Thus, -in the large number of weekly visits which I suppose the Inspector to -make, there would be a certain proportion of that more elaborate kind -which involves an examination of the entire house; another proportion, -made for the sole purpose of seeing that previous orders have been -executed; another proportion, repeated at fixed intervals, simply to -ascertain that houses, once cleansed and repaired, are not relapsing -into filth, nor their works becoming inefficient. - -By utilising, on some such plan as this, the increased staff which you -have appointed for the purpose, and by giving to its execution my -continual superintendence, I trust to be able, from time to time, to -certify you that the City becomes better and better capable of resisting -epidemic invasion.[85] From such statements as I have set before you, on -the local affinities of disease--not of Cholera alone, but of typhus and -its kindred, you will be prepared to expect increased sanitary -advantage, from this more systematic suppression of the causes of death: -and I believe you will not be disappointed. Whether the anticipated -pestilence rage in our metropolis or not, you will be combating, day by -day, the influence of other malignant diseases. Whenever it may be in my -power to tell you generally of the City, that the dwellings of the poor -are no longer crowded and stifling; nor their walls mouldy; nor their -yards and cellars unpaved and sodden; nor their water-supply defective; -nor their drainage stinking; nor their atmosphere hurt by neighbouring -nuisances; then, gentlemen, whether Cholera test your success or not, -surely you will have contributed much to conquer more habitual enemies. -For whatever there may be specific and exceptional in the production of -Cholera, at least it touches no healthy spot: the local conditions -which welcome its occasional presence are, in its absence, hour by hour, -the workers of other death; and in rendering a locality secure against -the one, you will also have made it less vulnerable by the others. - - [85] I may take this opportunity of mentioning that, during the last - few months, the increased sanitary staff has been worked with very - great advantage.--J. S., May, 1854. - -As a last suggestion in this part of my subject, there are two steps -which I would recommend to your Hon. Court, as likely to assist the -labours of your officers, and to bring a large quantity of important -information before you:--first (according to a plan adopted here in the -last epidemic) that printed notices should be posted in every -back-street, court and alley of the City, and should be renewed once a -month, advising the careful maintenance of cleanliness in all houses, -and inviting all persons who are aggrieved by any nuisance, or by any -neglect of scavengers and dustmen, or by any defect of water-supply, -forthwith to make complaint at your Office, or to the Inspector of the -district, whose name and address might be subjoined; secondly, that a -circular letter should be written to all persons in parochial authority, -also to other clergy, to heads of visiting societies and the like, -begging them to communicate with your officers on every occasion when -any local uncleanliness or nuisance may come within their knowledge. - - * * * * * - -3. Finally, gentlemen--in the probable anticipation that next year -Cholera will prevail in London with at least its former severity, it may -be claimed of my office, that I should say something with respect to -personal precautions for avoidance of the disease. While most willing to -place at your disposal any useful results of my practical experience in -the matter, I cannot but feel the great difficulty of making general -suggestions in a form really capable of particular application. - -From the eminently local prevalence of the poison, it may be inferred -that, for all whose circumstances allow an option in the matter, the -first and most important precaution would consist in avoiding those -localities where the epidemic is active. Our knowledge of the subject -enables us confidently to say that, if in one spot the chance of being -attacked by Cholera is as 1 to 100, in another it becomes 1 to 50, in a -third 1 to 5, in a fourth almost an equal chance whether to be attacked -or not. Nothing is gained towards security by the mere act of leaving -our metropolitan area, if one resorts to some other place where the -system of drainage is equally vicious, or where--as at our nearest -bathing-place, the beach is made almost as offensive by sewage as here -the river-banks.[86] From earlier statements in my Report, it will be -obvious to you that the eligible sites of residence are those which -stand high and dry, with clean effectual drainage of their soils and -houses, conveying all organic refuse beyond range of the local -atmosphere. - - [86] Unless the sanitary improvement of Brighton be soon set about in - earnest, the reputation for healthiness, which established its - prosperity, will undergo a very sensible reverse. The natural - advantages of the place are now almost neutralised by the evil - adverted to in the text, and by other filthinesses of the kind.--J. - S., 1854. - -I will not pass this part of the subject without admitting that the -course here suggested might involve a considerable desertion of -particular localities, and a transient injury to their commerce. This -unavoidable result of proclaiming the laws of the disease, I must regret -in regard of its personal bearings. But the facts of the case are -all-important for the public; and sanitary improvement will perhaps -move more quickly in the country, when it is known that the pecuniary -prosperity of places may suffer from their reputation for endemic -disease. - -In case of Cholera prevailing with severity in spots containing a dense -poor population, great assistance would be given to medical and sanitary -measures, if a number of empty unlet houses, healthily situated, were at -the disposal of the authorities; into which, under proper regulations, -they might induce certain of the poorest families to migrate for a time, -as to places of refuge, till the disease should have subsided about -their original dwellings. - -For persons, whose circumstances or duties retain them unavoidably in -the midst of those suffering districts where the poison is most active, -the best counsel I can offer--even if at first hearing it seem -vague--is, that they should be vigilant as to preserving the greatest -possible soundness and vigour of general health; keeping the body, so -far as may be, undisturbed by extremes of heat and cold, undepressed by -long confinement, unfluttered by violent passions, unexhausted by -physical or mental fatigue, untried by any excess or any privation; -taking for diet a sufficiency of fit and nutritive food, rather in -generous measure than otherwise, but far from the confines of -intemperance; and giving meanwhile a prompt attention and cure to -whatever accidental ailments may arise. - -Such, in general language, are our best fortifications against the -poison. It may be well, however, to add that in our metropolitan -climate--perhaps everywhere else--the human frame tends to require some -periodical aid from medicine. It may be the excitement and labour of -London; it may be its atmosphere; it may be native peculiarity: but -thus the fact stands--that there are few persons who do not at intervals -require the re-establishing effects of what is called _tonic_ treatment. -Probably three-fourths of the prescriptions we write are aimed at this -mere tendency to depression in the human body, as manifested in one form -or another. Now, as a man, going on some distant voyage of exploration, -submits his chronometer to a last intelligent scrutiny, before he -exposes it to the ordeal of other climates, so, in this matter of -frequenting infected districts, men will do prudently, before they pass -into perils which may test their powers of resistance, to see that they -carry about with them no enfeeblement or disrepair which a short -submission to medical discipline could effectually remove. For with -epidemic poisons generally, and in a marked degree with Asiatic Cholera, -it seems that all states of languor, depression, and debility enhance -the risk of infection.[87] - - [87] For my medical readers, I may suggest that perhaps the daily use - of _sulphate of quinine_, in small doses, during the height of the - epidemic, would seem to deserve trial as a prophylactic; subject, of - course, to what each practitioner is best able to estimate--of - personal peculiarity in the patient, forbidding the use of this - drug.--J. S., 1854. - -Beyond these general cautions, there is yet one which requires very -particular mention. - -In respect of the commencement and predispositions of the disease, it is -now well known--first, that in this country it habitually begins with -diarrhœa of a painless and apparently trivial character; secondly, that -diarrhœa, however produced, is, of all known personal conditions, the -one most likely to invite an attack of Cholera at times when that -disease is epidemic; thirdly, that during the prevalence of Cholera, -side by side with it in a district, there is always a vast amount of -epidemic diarrhœa, apparently constituting slighter degrees or earlier -stages of the same disease; that this condition is just as amenable to -treatment as the confirmed collapse of Cholera is utterly the opposite; -and--since we can never say how incurable a few hours may render this -insidious symptom, that its immediate arrest is a consideration of vital -importance. - -Precautions against causing diarrhœa to oneself by errors of diet will -vary somewhat with different individuals. Every person of ordinary -discretion knows the habits of his own body, and can be tolerably -confident, within certain limits of food, that he gives himself no -occasion of sickness. He remembers articles of diet, which his neighbour -perhaps may innocently indulge in, but which to himself are the occasion -of inward disorder--of purging or vomiting, ‘bilious attack’ or nettle -rash, headache, nightmare, or some other inconvenience. This knowledge -fixes the limits which it primarily behoves him to regard; taking such -food only into his body as experience has shown best to agree with it; -and adhering to this course, without panic as to particular accustomed -articles, and without abrupt discontinuance of old harmless habits. -Apart from personal peculiarities, the chief dangers of diet appear to -lie as follows: first, in those excesses of meat and drink, which -(especially under circumstances of fatigue) occasion sickness to the -stomach, or an increased labour of digestion; secondly, in taking food, -solid or fluid, which is midway in some process of chemical -transition--half-fermented beer and wine, water containing organic -matters, meat and game and venison no longer fresh and not completely -cooked, fish and shell-fish, in any state but the most perfect -freshness, fruit or vegetables long-gathered or badly kept, and the -like; thirdly, in a profusion of cold sour drink; fourthly, in partaking -largely of those articles of diet which habitually, or by reason of -imperfect cooking, pass unchanged through the intestinal canal; and -fifthly, in the indiscreet use of purgative medicines, or in taking any -article of diet which is likely to produce the same effect. - -In short, if care be taken under all these heads to avoid occasions of -intestinal disturbance; if the diet, while generous, be simple and -strictly temperate; if regular hours be given to sleep, to meals, to -industry, to recreation; if a fair proportion of out-door exercise be -taken; if damp and extremes of temperature be guarded against; and all -practical pains be given to avoid the sources of bodily and mental -depression; the danger will certainly be reduced to its _minimum_; and -whatever effects the epidemic may happen to produce can be readily -recognised and boldly encountered. - -Should these effects arise in their customary form of diarrhœa, it is of -absolute urgent necessity that immediate medical treatment be resorted -to: and so important for the safety of life is the recognition of this -symptom in the earliest stage of its occurrence, that no unwonted action -of the bowels should pass unobserved. - -The public constantly asks to be informed of some drug, or combination -of drugs, to which under these circumstances they may have immediate -recourse. But after very careful consideration of this subject, after -hearing arguments on both sides, and reading those prescriptions which -have been recommended for adoption, I venture to express my opinion -that the safest course for the public, in regard of this threatened -disease, will be to follow the same principle as guides them in their -ordinary seizures of illness, and to obtain as quickly as possible the -aid of their customary medical advisers. There is an invincible aptitude -in the public to misapply all precautionary medicines within their -reach; often superstitiously to treat them as charms, under the -protection of which they may neglect temperance of diet and all other -solicitude for health; often ignorantly to employ them in cases for -which their use is forbidden; often, at the instigation of panic, to -abuse them by preposterous and hurtful excess. Nervous and uneducated -persons, instead of employing their astringent dose simply to stop any -undue action from the bowels, would be apt, as the danger neared them, -to make it an habitual dram in order to anticipate any such action; and -the frequent after-necessity for purgative medicine, thus created, would -constitute the very danger they desire to avoid. Recognising, therefore, -at its full value, the importance of immediately treating, in every -case, the first phenomena of epidemic diarrhœa, I must yet doubt whether -the conditions of medical science and general education are such as to -justify the promulgation of general formulæ so liable to extensive -abuse. - -I speak of course with particular reference to the metropolis. In remote -rural districts it may often be desirable that discreet and intelligent -persons--the Clergy, for instance, should obtain from their medical -neighbours some astringent preparation to which--in the very rare event -of real emergency, temporary recourse might be had: but--for so -hazardous a condition of disease, I must repeat as a general rule, that -no nostrum, even in the best-intentioned hands of ignorance, can supply -the place of medical discrimination. - -During the acute prevalence of the epidemic in any particular locality, -it becomes of great importance to bring the uneducated classes of -society, as far as possible, under systematic medical care; in the -absence of which they are likely to neglect all premonitions of the -disease, and thus to incur much unnecessary danger. To fulfil this -object as regards the poor, express provision has been made by the Law: -and it might be well for other classes, under similar exposure to -attack, to consider how far they could arrange for their households a -similar plan of protection. - -Under any Order in Council which brings into action the extraordinary -powers of the Nuisances Removal Act, the General Board of Health has -authority to enjoin on all Boards of Guardians throughout the country, -that they provide, for ‘persons afflicted by or threatened with’ the -disease, such medical aid as may be required: and the actual working of -this has been that, on all occasions of epidemic Cholera prevailing in -particular localities, the General Board of Health has called on the -local Boards of Guardians to establish systematic house-to-house -visitation, for discovering and treating among the poor all premonitory -symptoms of the disease. - -In the too probable event of its becoming necessary next year to -establish this system of medical organisation in parts of the -metropolis, I have no reason to doubt that a requisition to the above -effect will be addressed to the Guardians of the City poor; and, in this -anticipation, I think it desirable to bring, in conclusion, one more -point under notice of your Hon. Court. During the former invasion, the -Guardians within the City of London resisted the requisitions of the -General Board of Health; and the first fourteen weeks of the epidemic -consequently passed without the establishment of any visitational system -for arresting its progress. In the fifteenth week, however, the -Corporation of the City undertook the unperformed duty, not legally -devolving on them, and requested me to make arrangements for the purpose -of its execution. With the assistance of the several Medical Officers of -the City Unions, I immediately organised the requisite staff, and from -that moment to the close of the epidemic there continued under my -superintendence a systematic visitation of the poor, with beneficial, -though tardy and imperfect, results. - -Recalling these incidents to the recollection of your Hon. Court, I -would beg to observe that no similar endeavour can fully succeed, except -as a system--well considered beforehand, and adjusted to the various -circumstances which may require its application. Uncertainties of -responsibility and conflicts of jurisdiction would inevitably occasion a -sacrifice of life; and therefore, before the time when Cholera is likely -to become epidemic, it should be definitively settled who is to -undertake this organisation. Your Commission can have no jurisdiction in -the matter; and the interference of the Corporation would be only at its -own option. The legal responsibility rests solely with the Boards of -Guardians: and it seems to me indispensable that, before the time for -action arrives, the Corporation should determine its intentions; in -order that the Boards of Guardians, if again called upon to organise -arrangements of the kind in question, may know distinctly--either that -the Corporation has relieved them of their task, or that there rests on -them the undivided obligation of providing for the crisis. - - * * * * * - -III. Gentlemen, in concluding this report, I will not attempt to -disguise from you that it has been written under feelings of -considerable apprehension; and I am fully conscious that, in thus -expressing myself, I am liable to the imputation of raising unnecessary -alarm. - -If the possible mischief to be wrought by epidemic Cholera lay in some -fixed inflexible fate, whatever opinion or knowledge I might hold on the -subject of its return, silence would be better than speech; and I could -gladly refrain from vexing the public ear by gloomy forebodings of an -inevitable future. - -But from this supposition the case differs diametrically: and the people -of England are not like timid cattle, capable, only when blindfold, of -confronting danger. It belongs to their race--it belongs to their -dignity of manhood, to take deliberate cognisance of their foes, and not -lightly to cede the victory. A people that has fought the greatest -battles--not of arms alone, but of genius and skilful toil, is little -likely to be scared at the necessity of meeting large danger by -appropriate devices of science. A people that has inaugurated -railways--that has spanned the Menai Strait and reared the Crystal -Palace, can hardly fear the enterprise of draining poison from its -infected towns. A people that has freed its foreign slaves at twenty -millions’ ransom, will never let its home population perish, for -cheapness sake, in the ignominious ferment of their filth. - -Therefore, gentlemen, advisedly I state the danger as it seems to me. -England has again become subject to a plague, the recurrence of -which--or the duration--or the malignity, no human being can predict. - -But, if I state the danger, so likewise, to the best of my belief, I -state the remedy and defence. Colossal statistics concur with the -results of detailed inspection, to refer this disease, in common with -many others that scourge our population, distinctly and infallibly, to -the working of local causes--of causes susceptible of removal--of causes -which it devolves on our Legislature to remove. - -The exemption we seek is worth a heavy purchase. My thoughts turn -involuntarily to the epidemics of former centuries, to their frequent -returns and immense fatality. I reflect on the Plague, and how it -influenced the average death-rate of London; how in 1593 it doubled it, -in 1603 trebled it, in 1625 quadrupled it: and how (after a less -considerable visitation in 1636) it actually multiplied the mortality -sevenfold in the tremendous epidemic of ‘65. The ravages of that -pestilence are best appreciated in the fact, that we esteem the Great -Fire of London a cheap equivalent for their arrest; looking to that -eventful conflagration of the metropolis with gratitude, rather than -horror, because of the mightier evils that were extinguished with its -flames. - -To so frightful a development as this, Cholera, by many degrees, has not -attained; but, ignorant as we are of its laws and resources, we dare not -surmise, at any renewed invasion, what increment of severity it may have -won. In the simple fact, that our country has again become subject to -pestilential epidemics, there lies an amount of threat only to be -measured by those who are conversant, by history or experience, with -the possible developments of such disease. - -Therefore, gentlemen, having the deepest assurance that these unexplored -possibilities of evil may be foreclosed by appropriate means, I should -ill deserve your confidence if I shrank from setting before you--however -ungracious the task--my deliberate estimate of the peril. - -It pertains to my local office to tell you of local cures; and this I -have sought to do. I have suggested that, by active superintendence of -all houses within your jurisdiction, there may be suppressed in detail -those several causes of the disease which arise in individual neglect; -that, by elaborate care as to the cleanliness of pavements, markets, -docks, and sewers, something may be done towards the mitigation of more -general causes; that, by a well-organised system of medical visitation, -very much may be effected towards encountering attacks of the disease, -while still amenable to treatment:--that these, with similar -precautions, are therefore to be recommended. - -And not for a moment would I seem to depreciate such measures, -palliative only, and partial though they be. By their judicious -application, from Aldgate to the Temple, life may possibly be saved to -some hundreds; to children that are fondly loved, to parents that are -the stay of numbers. - -But against the full significance of any epidemic, I am bound to tell -you that these are but poor substitutes for protection. To render them -effectual, even in their narrow sphere of operation, there must be great -vigilance and great expenditure; a weary vigilance and a -disproportionate expenditure, because chiefly given to defeat in detail -what should have been prevented in principle. And be done what may, in -this palliative spirit, the sources of the disease are substantially -unstayed: for the faults, to which its metropolitan prevalence is due, -consist not simply in a number of individual mismanagements, but include -a common and radical mal-construction as their chief. - -No city, so far as Science may be trusted, can deserve immunity from -epidemic disease, except by making absolute cleanliness the first law of -its existence; such cleanliness, I mean, as consists in the perfect -adaptation of drainage, water-supply, scavenage, and ventilation, to the -purposes they should respectively fulfil; such cleanliness, as consists -in carrying away by these means, inoffensively, all refuse materials of -life--gaseous, solid, or fluid, from the person, the house, the factory, -or the thoroughfare, so soon as possible after their formation, and with -as near an approach, as their several natures allow, to one continuous -current of removal. - -To realise for London this conception of how a city should cleanse -itself may involve, no doubt, the perfection of numberless details. Yet, -most of all, it would pre-suppose a comprehensive organisation of plan -and method: not alone for that intramural unity of system which is -needful for all the works, as most for those of drainage and -water-supply; but, equally, to harmonise these works with other -extramural arrangements for utilising to the country the boundless -wealth of metropolitan refuse--for distributing to the uses of -agriculture what is then rescued from the character of filth--for -requiting to the fields in gifts for vegetation, what they have rendered -to the town in food for man. - -How far the construction of London has proceeded on the recognition of -such objects, or how far the advantages of such a plan have been -realised, it could only be a mockery to ask. Our metropolis, by -successive accretions, has covered mile after mile of land. Each new -addition has been made with scarcely more reference to the legitimate -necessities of life, than if it had clustered there by crystallisation. -With no scientific forecast to plan the whole, with little but chance -and cheapness to shape the parts, our desultory architecture has -eclipsed the conditions of health. Draining up-hill or down-hill, as the -case might be, and running their aqueducts at random from chalk-quarries -or river-mud; or ponding sewage in their cellars, and digging beside it -for water; blocking-up the inlets of freshness and, equally, the outlets -of nuisance; constructing sewers to struggle with the Thames--now to -pollute its ebb, now to be obstructed by its flow; the builders of many -generations have accumulated sanitary errors in so intricate a system, -that their apprehension and their cure seem equally remote. - -Therefore--by reason of causes, ramified through the whole metropolis -and deep-rooted in its soil, which bind all parts together in one common -endurance of their effects--therefore cannot epidemic disease be -conquered by any exertions or by any amelioration, short of the complete -and comprehensive cure. Against the danger we dread, no shelter is to be -found in petty reforms and patchwork legislation. Not to inspectorships -of nuisances, but to the large mind of State-Policy, one must look for a -real emancipation from this threatening plague. - -A child’s intellect can appreciate the wild absurdity of seeking at Peru -what here runs to waste beneath our pavements,--of ripening only -epidemic disease with what might augment the food of the people--of -waiting, like our ancestors, to expiate the neglected divinity of water -in some bitter purgation by fire. - -But it needs the grasp of political mastership, not uninformed by -Science, to convert to practical application these obvious elements of -knowledge; to recognise a national object irrelevant to the interests of -party; to lift an universal requirement from the sphere of professional -jealousies, and to found in immutable principles the sanitary -legislation of a people. - - I have the honour to remain, - - &c. &c. - - - APPENDIX OF TABLES - ILLUSTRATING THE - SANITARY CONDITION OF THE CITY OF LONDON. - - I. Area and Population of the several Districts and Sub-districts of - the City. - - II. Quinquennial Synopsis of City Mortality, from Michaelmas 1848 to - Michaelmas 1853; with Death-Rates calculated for this period, on the - Population enumerated in 1851, for each District and Sub-District of - the City. - - III. First annual enumeration of Deaths, relating to the fifty-two - weeks dating from October 1st, 1848, to September 29th, 1849. - - IV. Second annual enumeration of Deaths, relating to the fifty-two - weeks, dating from September 30th, 1840, to September 28th, 1850. - - V. Third annual enumeration of Deaths, relating to the fifty-two - weeks, dating from September 29th, 1850, to September 27th, 1851. - - VI. Fourth annual enumeration of Deaths, relating to the fifty-two - weeks, dating from September 28th, 1851, to September 25th, 1852. - - VII. Fifth annual enumeration of Deaths, relating to the fifty-two - weeks, dating from September 26th, 1852, to September 24th, 1853. - - VIII. Quinquennial Mortality, classified by Age; first, for the entire - City; next, for the Three Unions severally. - - IX. Number of Deaths occasioned, during the last five years, by - certain Acute Diseases, chiefly epidemic, infectious, and endemic. - - X. Comparative Mortality in different seasons of the year: namely, in - the Autumn-Quarters (October, November, December), in the - Winter-Quarters (January, February, March), in the Spring-Quarters - (April, May, June), and in the Summer-Quarters (July, August, - September), of the five years from Michaelmas 1848 to Michaelmas 1853. - - XI. Autumn Mortality. - - XII. Winter Mortality. - - XIII. Spring Mortality. - - XIV. Summer Mortality. - - -No. I. _Area and Population of the several Districts and Sub-districts -of the City of London._ - - +-----------------------------+-------+-------+-------------+-------+ - | | Census| Census| Decennial |Area of| - | Sub-district. | of | of | increase (+)|Land in| - | | 1841. | 1851. | or |Acres. | - | | | |decrease. (-)| | - +-----------------------------+-------+-------+-------------+-------+ - | {St. Botolph | 20,197| 23,435| + 3238| 85| - |EAST LONDON. {Cripplegate | 19,161| 20,582| + 1421| 68| - | {Workhouses[88]| 454| 576| + 122| | - | { +-------+-------+-------------+-------+ - | {Total | 39,812| 44,593| + 4781| 153| - +-----------------------------+-------+-------+-------------+-------+ - | {North | 12,138| 12,350| + 212| 47| - |WEST LONDON. {South | 16,460| 15,844| - 616| 77| - | {Workhouse[89] | 387| 409| + 22| | - | { +-------+-------+-------------+-------+ - | {Total | 28,985| 28,603| - 382| 124| - +-----------------------------+-------+-------+-------------+-------+ - | {South-West | 8839| 9204| + 365| 49| - | {North-West | 12,427| 11,847| - 580| 72| - |CITY OF {South | 11,954| 11,461| - 493| 82| - |LONDON. {South-East | 10,597| 10,594| - 3| 84| - | {North-East | 12,103| 12,826| + 723| 92| - | {Workhouse[90] | 920| 794| - 126| | - | { +-------+-------+-------------+-------+ - | {Total | 56,840| 56,726| - 114| 379| - +-----------------------------+-------+-------+-------------+-------+ - | Entire Population of} 125,637|129,922| + 4285| 656| - | the City of London} | | | | - +-------------------------------------+-------+-------------+-------+ - - [88] One of these workhouses is situated in the North sub-district of - the West London Union. In 1841 it contained 157 inmates; in 1851, 187 - inmates. The other workhouse is situated in the St. Botolph - sub-district: in 1841 it contained 297, in 1851, 389 persons. - - [89] This workhouse is situated in the North sub-district of the - Union. - - [90] In 1841, the 920 paupers of this Union were received, partly at - Marlborough House, Peckham; partly in Deacon’s Farm-house, Stepney - Green. The present workhouse, erected since 1841, is at Bow. - - -No. II.--_Quinquennial Synopsis of City Mortality, with Death-rates -calculated per Thousand on the Population of 1851._ - - +-----------------------+-------------------------+ - | | EAST | - |Population,} | LONDON | - |according }Entire City| UNION, | - |to the }of London, | 44,593. | - |Census }129,922. +--------+--------+-------+ - |of 1851. } | Saint |Cripple-| Work- | - | |Botolph,| gate, |houses,| - | | 23,435.| 20,582.| 576. | - +-----------------------+--------+--------+-------+ - |Mortality of five years| | | | - |from Michaelmas 1848 to| | | | - |Michaelmas 1853. | | | | - | {1848-9 =3763= | 519| 574| 179| - | {1849-50 =2752= | 296| 444| 125| - | {1850-1 =2978= | 493| 471| 167| - | {1851-2 =3064= | 534| 460| 176| - | {1852-3 =3040= | 516| 534| 155| - | { +--------+--------+-------+ - | { =⁂= | 2458| 2483| 802| - | { | | - | {Total =15,597= | =5743= | - +-----------------------+-------------------------+ - |Yearly Death-rate _per_| =25.75= | - |thousand of the living | | - |Population. | | | | - | =24.00= | =24.30=| =27.41=| =*= | - +-----------------------+--------+--------+-------+ - - +-----------------------+----------------------+ - | | WEST | - |Population,} | LONDON | - |according }Entire City| UNION, | - |to the }of London, | 28,603. | - |Census }129,922. +-------+-------+------+ - |of 1851. } | North,| South,| Work-| - | | | |house,| - | |12,350.|15,844.| 409. | - +-----------------------+-------+-------+------+ - |Mortality of five years| | | | - |from Michaelmas 1848 to| | | | - |Michaelmas 1853. | | | | - | {1848-9 =3763= | 372| 598| 126| - | {1849-50 =2752= | 324| 290| 108| - | {1850-1 =2978= | 317| 313| 68| - | {1851-2 =3064= | 266| 379| 129| - | {1852-3 =3040= | 289| 309| 164| - | { +-------+-------+------+ - | { =⁂= | 1568| 1889| 595| - | { | | - | {Total =15,597= | =4052= | - +-----------------------+----------------------+ - |Yearly Death-rate _per_| =28.33= | - |thousand of the living | | - |Population. | | | | - | =24.00= |=29.19=|=27.66=| =*= | - +-----------------------+-------+-------+------+ - - +---------------------+----------------------------------------------+ - | | CITY OF LONDON UNION, | - |Population,}Entire | | - |according }City of | | - |to the }London, | 56,726. | - |Census }129,922. +-------+-------+-------+-------+-------+------+ - |of 1851. } | S. W. | N. W. | South,| S. E. | N. E. | Work-| - | | | | | | |house,| - | | 9,204.|11,847.|11,461.|10,594.|12,826.| 794. | - +---------------------+-------+-------+-------+-------+-------+------+ - |Mortality of five | | | | | | | - |years from Michaelmas| | | | | | | - |1848 toMichaelmas | | | | | | | - |1853. | | | | | | | - | {1848-9 =3763= | 293| 245| 263| 214| 262| 103| - | {1849-50 =2752= | 176| 168| 218| 183| 219| 101| - | {1850-1 =2978= | 191| 169| 258| 217| 213| 101| - | {1851-2 =3064= | 196| 198| 203| 171| 235| 117| - | {1852-3 =3040= | 170| 188| 223| 164| 224| 104| - | { +-------+-------+-------+-------+-------+------+ - | { =⁂= | 1026| 968| 1165| 949| 1153| 526| - | { | | - | {Total =15,597= | =5787= | - +---------------------+----------------------------------------------+ - |Yearly Death-rate | =20.40= | - |_per_ thousand of the| | - |living Population. | | | | | | | - | =24.00= |=23.83=|=17.96=|=21.90=|=19.52=|=19.58=| =*= | - +-----------------------+-------+-------+-------+-------+-------+----+ - |N.B. The first year’s total (3763) includes 15 deaths, which, by | - |reason of their imperfect registration, it has been impossible | - |to refer correctly to the Unions where they occurred. | - +--------------------------------------------------------------------+ - -NOTE TO TABLE No. II. - -In calculating the Death-Rates given in the last lines of this Table, I -have proceeded as follows:-- - -First, I have counted all _Workhouse-Population_ and _Workhouse-Deaths_ -as forming part of the aggregate population and aggregate mortality of -that Union to which the particular workhouse legally belongs. - -Next, I have distributed among the several sub-districts the population -and the mortality of their Union Workhouses, in the ratio of the general -sub-district population; so as to prevent the high Workhouse-Mortality -from telling unjustly against that sub-district in which the Workhouse -happens to have been erected. - -Thus, for instance, the East London Union has its male Workhouse placed -in the territory of the West London Union; but I have reckoned it as -belonging to the East London Union, in respect both of its population -and its deaths. Similarly, the City of London Union has its Workhouse -situate at Bow; but, not the less, I have considered its 794 inmates and -526 deaths as belonging to the population and the mortality of our -central Union. - -Thus again for the sub-district death-rates--for instance, in -the two sub-districts of the East London Union: reckoning the -Workhouse-Population not as exclusively due either to Cripplegate or to -St. Botolph, but as furnished by these sub-districts jointly, in the -ratio of their populations, I have distributed 576 between them in the -proportion, 23,435 : 20,582. The Workhouse-Deaths of the period (802) -have been similarly distributed; and the rates, given in the last line -of the table, are finally deduced from a comparison of these sums, -viz:-- - -23,435 + 306.66 : 2458 + 426.991 :: 1000 : 121.515, which divided by 5 -(to show an annual, instead of a quinquennial, result) gives 24.30 as -the annual death-rate for St. Botolph; and, in like manner, 20,582 + -269.33 : 2483 + 375.008 gives 137.065 as the quinquennial, and 27.41 as -the annual death-rate _per_ thousand for the sub-district of -Cripplegate. - -_Hospital Deaths_ have been distributed, as far as possible, according -to the previous residence of the patients. Thus the north sub-district -of the West London Union, in which St. Bartholomew’s Hospital is -situated, is made to retain only its just proportion of deaths. On the -same principle I have reckoned to the death-lists of other sub-districts -those cases in which I could ascertain that the residents of such -sub-districts had gone to die either in St. Bartholomew’s, or in other -Metropolitan Hospitals. - - -No. III.--_First Annual Enumeration of Deaths, relating to the Fifty-two -Weeks dating from October 1st, 1848, to September 29th, 1849._ - - +------------------+-------------------------+-----------------------+ - |DEATHS in the four| EAST LONDON UNION. | WEST LONDON UNION. | - |quarterly periods,+--------+--------+-------+-------+-------+-------+ - |terminating as |Saint |Cripple-| Work- |North. |South. |Work- | - |follows:-- |Botolph.|gate. |houses.| | |house. | - | +--------+--------+-------+-------+-------+-------+ - |In the quarter | M. F.| M. F.| M. F.| M. F.| M. F.| M. F.| - |ending: | | | | | | | - | I. Dec. } =766={| 63 64| 69 59| 10 21| 44 30| 55 48| 14 15| - | 30th } {| 127 | 128 | 31 | 74 | 103 | 29 | - | | | | | | | | - | II. March} =822={| 70 66| 60 57| 17 19| 39 34| 50 40| 20 10| - | 31st } {| 136 | 117 | 36 | 73 | 90 | 30 | - | | | | | | | | - |III. June } =765={| 40 45| 62 68| 16 23| 46 31| 61 49| 13 21| - | 30th } {| 85 | 130 | 39 | 77 | 110 | 34 | - | | | | | | | | - | IV. Sept.}=1395={| 88 83|104 95| 17 56| 75 73|116 179| 15 18| - | 29th } {| 171 | 199 | 73 | 148 | 295 | 53 | - +------------------+--------+--------+-------+-------+-------+-------+ - |Sum of the four {|261 258|295 279| 60 119|204 168|282 316| 62 64| - |quarters =3748={| 519 | 574 | 179 | 372 | 598 | 126 | - |Unclassified =15= | =1272= | =1096= | - |TOTAL FOR THE YEAR =3763= - +--------------------------------------------------------------------- - - +------------------+-----------------------------------------------+ - |DEATHS in the four| CITY OF LONDON UNION. | - |quarterly periods,+-------+-------+-------+-------+-------+-------+ - |terminating as | S. W. | N. W. |South. | S. E. | N. E. | Work- | - |follows:-- | | | | | |house. | - | +-------+-------+-------+-------+-------+-------+ - |In the quarter | M. F. | M. F. | M. F. | M. F. | M. F. | M. F.| - |ending: | | | | | | | - | I. Dec. } =766={| 25 15 | 27 23 | 36 23 | 25 15 | 31 31 | 1 22| - | 30th } {| 40 | 50 | 59 | 40 | 62 | 23 | - | | | | | | | | - | II. March} =822={| 20 32 | 32 31 | 28 32 | 29 23 | 40 37 | 14 22| - | 31st } {| 52 | 63 | 60 | 52 | 77 | 36 | - | | | | | | | | - |III. June } =765={| 35 21 | 31 24 | 37 21 | 24 21 | 22 28 | 12 14| - | 30th } {| 56 | 55 | 58 | 45 | 50 | 26 | - | | | | | | | | - | IV. Sept.}=1395={| 62 83 | 37 40 | 48 38 | 45 32 | 40 33 | 5 13| - | 29th } {| 145 | 77 | 86 | 77 | 73 | 18 | - +------------------+-------+-------+-------+-------+-------+-------+ - |Sum of the four {|142 151|127 118|149 114|123 91|133 129| 32 71| - |quarters =3748={| 293 | 245 | 263 | 214 | 262 | 103 | - |Unclassified =15= | =1380= | - |TOTAL FOR THE YEAR | - +------------------------------------------------------------------+ - - -No. IV.--_Second Annual Enumeration of Deaths, relating to the Fifty-two -Weeks dating from September 30th, 1849, to September 28th, 1850._ - - +------------------+-------------------------+-----------------------+ - |DEATHS in the four| EAST LONDON UNION. | WEST LONDON UNION. | - |quarterly periods,+--------+--------+-------+-------+-------+-------+ - |terminating as |Saint |Cripple-| Work- |North. |South. |Work- | - |follows:-- |Botolph.|gate. |houses.| | |house. | - | +--------+--------+-------+-------+-------+-------+ - |In the quarter | M. F.| M. F.| M. F.| M. F.| M. F.| M. F.| - |ending: | | | | | | | - | I. Dec. } =765={| 62 56| 72 65|22 22| 42 43| 30 40| 10 13| - | 29th } {| 118 | 137 | 44 | 85 | 70 | 23 | - | | | | | | | | - | II. March} =803={| 49 47| 68 56| 21 15| 50 41| 42 42| 21 19| - | 30th } {| 96 | 124 | 36 | 91 | 84 | 40 | - | | | | | | | | - |III. June } =589={| 39 41| 42 48| 6 13| 39 35| 45 26| 5 22| - | 29th } {| 80 | 90 | 19 | 74 | 71 | 27 | - | | | | | | | | - | IV. Sept.} =595={| 57 45| 57 36| 12 14| 35 39| 26 39| 5 13| - | 28th } {| 102 | 93 | 26 | 74 | 65 | 18 | - +------------------+--------+--------+-------+-------+-------+-------+ - |Sum of the four {|207 189|239 205| 61 64|166 158|143 147|41 67| - |quarters =2752={| 396 | 444 | 125 | 324 | 290 | 108 | - | | =965= | =722= | - |TOTAL FOR THE YEAR =2752= - +--------------------------------------------------------------------- - - +------------------+-----------------------------------------------+ - |DEATHS in the four| CITY OF LONDON UNION. | - |quarterly periods,+-------+-------+-------+-------+-------+-------+ - |terminating as | S. W. | N. W. |South. | S. E. | N. E. | Work- | - |follows:-- | | | | | |house. | - | +-------+-------+-------+-------+-------+-------+ - |In the quarter | M. F. | M. F. | M. F. | M. F. | M. F. | M. F. | - |ending: | | | | | | | - | I. Dec. } =765={| 35 22| 26 19| 27 28| 30 21| 22 30| 9 19| - | 29th } {| 57 | 45 | 55 | 51 | 52 | 28 | - | | | | | | | | - | II. March} =803={| 23 23| 16 29| 48 32| 22 36| 45 29| 15 14| - | 30th } {| 46 | 45 | 80 | 58 | 74 | 29 | - | | | | | | | | - |III. June } =589={| 13 21| 14 25| 25 15| 23 20| 21 29| 9 13| - | 29th } {| 34 | 39 \ 40 | 43 | 50 | 22 | - | | | | | | | | - | IV. Sept.} =595={| 20 19| 18 21| 22 21| 16 15| 15 28| 12 10| - | 28th } {| 39 | 39 | 43 | 31 | 43 | 22 | - +------------------+-------+-------+-------+-------+-------+-------+ - |Sum of the four {| 91 85| 74 94|122 96| 91 92|103 116| 45 56| - |quarters =2752={| 176 | 168 | 218 | 183 | 219 | 101 | - | | =1065= | - |TOTAL FOR THE YEAR | - +------------------------------------------------------------------+ - - -No. V.--_Third Annual Enumeration of Deaths, relating to the Fifty-two -Weeks dating from September 29th, 1850, to September 27th, 1851._ - - +------------------+-------------------------+-----------------------+ - |DEATHS in the four| EAST LONDON UNION. | WEST LONDON UNION. | - |quarterly periods,+--------+--------+-------+-------+-------+-------+ - |terminating as |Saint |Cripple-| Work- |North. |South. |Work- | - |follows:-- |Botolph.|gate. |houses.| | |house. | - | +--------+--------+-------+-------+-------+-------+ - |In the quarter | M. F.| M. F.| M. F.| M. F.| M. F.| M. F.| - |ending: | | | | | | | - | I. Dec. } =672={| 47 54| 68 57| 7 25| 29 33| 35 37| 8 6| - | 28th } {| 101 | 125 | 32 | 62 | 72 | 14 | - | | | | | | | | - | II. March} =876={| 87 67| 77 63| 19 30| 51 36| 46 43| 11 11| - | 29th } {| 154 | 140 | 49 | 87 | 89 | 22 | - | | | | | | | | - |III. June } =767={| 72 43| 58 43| 26 22| 45 47| 38 41| 11 10| - | 28th } {| 115 | 101 | 48 | 92 | 79 | 21 | - | | | | | | | | - | IV. Sept.} =663={| 63 60| 62 43| 13 25| 53 23| 38 35| 9 2| - | 27th } {| 123 | 105 | 38 | 76 | 73 | 11 | - +------------------+--------+--------+-------+-------+-------+-------+ - |Sum of the four {|269 224|265 206| 65 102|178 139|157 156| 39 29| - |quarters =2978={| 493 | 471 | 167 | 317 | 313 | 68 | - | | =1131= | =698= | - |TOTAL FOR THE YEAR =2978= - +--------------------------------------------------------------------- - - +------------------+-----------------------------------------------+ - |DEATHS in the four| CITY OF LONDON UNION. | - |quarterly periods,+-------+-------+-------+-------+-------+-------+ - |terminating as | S. W. | N. W. |South. | S. E. | N. E. | Work- | - |follows:-- | | | | | |house. | - | +-------+-------+-------+-------+-------+-------+ - |In the quarter | M. F. | M. F. | M. F. | M. F. | M. F. | M. F. | - |ending: | | | | | | | - | I. Dec. } =672={| 27 21| 24 20| 25 24| 24 31| 19 29| 16 6| - | 28th } {| 48 | 44 | 49 | 55 | 48 | 22 | - | | | | | | | | - | II. March} =876={| 28 31| 22 26| 39 42| 27 29| 35 32| 12 12| - | 29th } {| 59 | 48 | 81 | 56 | 67 | 24 | - | | | | | | | | - |III. June } =767={| 26 18| 22 16| 40 35| 35 35| 31 25| 15 13| - | 28th } {| 44 | 38 | 75 | 70 | 56 | 28 | - | | | | | | | | - | IV. Sept.} =663={| 24 16| 21 18| 29 24| 23 13| 17 25| 14 13| - | 27th } {| 40 | 39 | 53 | 36 | 42 | 27 | - +------------------+-------+-------+-------+-------+-------+-------+ - |Sum of the four {|105 86| 89 80|133 125|109 108|102 111| 57 44| - |quarters =2978={| 191 | 169 | 258 | 217 | 213 | 101 | - | | =1149= | - |TOTAL FOR THE YEAR | - +------------------------------------------------------------------+ - - -No. VI.--_Fourth Annual Enumeration of Deaths, relating to the Fifty-two -Weeks dating from September 28th, 1851, to September 25th, 1852._ - - +------------------+-------------------------+-----------------------+ - |DEATHS in the four| EAST LONDON UNION. | WEST LONDON UNION. | - |quarterly periods,+--------+--------+-------+-------+-------+-------+ - |terminating as |Saint |Cripple-| Work- |North. |South. |Work- | - |follows:-- |Botolph.|gate. |houses.| | |house. | - | +--------+--------+-------+-------+-------+-------+ - |In the quarter | M. F.| M. F.| M. F.| M. F.| M. F.| M. F.| - |ending: | | | | | | | - | I. Dec. } =800={| 73 67| 59 58| 32 32| 40 28| 37 43| 18 12| - | 27th } {| 140 | 117 | 64 | 68 | 80 | 30 | - | | | | | | | | - | II. March} =773={| 62 62| 50 46| 18 30| 30 24| 58 43| 25 12| - | 27th } {| 124 | 96 | 48 | 54 | 101 | 37 | - | | | | | | | | - |III. June } =774={| 54 56| 78 53| 21 17| 39 31| 65 56| 23 8| - | 26th } {| 110 | 131 | 38 | 70 | 121 | 31 | - | | | | | | | | - | IV. Sept.} =717={| 77 83| 54 62| 6 20| 35 39| 41 36| 17 14| - | 27th } {| 160 | 116 | 26 | 74 | 77 | 31 | - +------------------+--------+--------+-------+-------+-------+-------+ - |Sum of the four {|266 268|241 219| 77 99|144 122|201 178| 83 46| - |quarters =3064={| 534 | 460 | 176 | 266 | 379 | 129 | - | | =1170= | =774= | - |TOTAL FOR THE YEAR =3064= - +--------------------------------------------------------------------- - - +------------------+-----------------------------------------------+ - |DEATHS in the four| CITY OF LONDON UNION. | - |quarterly periods,+-------+-------+-------+-------+-------+-------+ - |terminating as | S. W. | N. W. |South. | S. E. | N. E. | Work- | - |follows:-- | | | | | |house. | - | +-------+-------+-------+-------+-------+-------+ - |In the quarter | M. F. | M. F. | M. F. | M. F. | M. F. | M. F. | - |ending: | | | | | | | - | I. Dec. } =800={| 33 30| 29 25| 26 26| 23 25| 32 23| 9 20| - | 27th } {| 63 | 54 | 52 | 48 | 55 | 29 | - | | | | | | | | - | II. March} =773={| 20 22| 33 28| 33 28| 31 19| 27 40| 17 15| - | 27th } {| 42 | 61 | 61 | 50 | 67 | 32 | - | | | | | | | | - |III. June } =774={| 24 33| 29 22| 22 19| 30 17| 33 26| 17 11| - | 26th } {| 47 | 51 | 41 | 47 | 59 | 28 | - | | | | | | | | - | IV. Sept.} =717={| 26 18| 15 17| 29 20| 15 11| 31 23| 12 16| - | 27th } {| 44 | 32 | 49 | 26 | 54 | 28 | - +------------------+-------+-------+-------+-------+-------+-------+ - |Sum of the four {|103 93|106 92|110 93| 99 72|123 112| 55 62| - |quarters =3064={| 196 | 198 | 203 | 171 | 235 | 117 | - | | =1120= | - |TOTAL FOR THE YEAR | - +------------------------------------------------------------------+ - - -No. VII.--_Fifth Annual Enumeration of Deaths, relating to the Fifty-two -Weeks dating from September 26th, 1852, to September 24th, 1853._ - - +------------------+-------------------------+-----------------------+ - |DEATHS in the four| EAST LONDON UNION. | WEST LONDON UNION. | - |quarterly periods,+--------+--------+-------+-------+-------+-------+ - |terminating as |Saint |Cripple-| Work- |North. |South. |Work- | - |follows:-- |Botolph.|gate. |houses.| | |house. | - | +--------+--------+-------+-------+-------+-------+ - |In the quarter | M. F.| M. F.| M. F.| M. F.| M. F.| M. F.| - |ending: | | | | | | | - | I. Dec. } =675={| 72 58| 46 60| 10 20| 35 33| 35 32| 14 19| - | 25th } {| 130 | 106 | 30 | 68 | 67 | 33 | - | | | | | | | | - | II. March} =878={| 67 64| 80 66| 32 22| 35 31| 45 55| 34 20| - | 26th } {| 131 | 146 | 54 | 66 | 100 | 54 | - | | | | | | | | - |III. June } =817={| 69 60| 69 62| 24 27| 53 36| 46 44| 25 21| - | 25th } {| 129 | 131 | 51 | 89 | 90 | 46 | - | | | | | | | | - | IV. Sept.} =670={| 70 56| 84 67| 8 12| 32 34| 25 27| 18 13| - | 24th } {| 126 | 151 | 20 | 66 | 52 | 31 | - +------------------+--------+--------+-------+-------+-------+-------+ - |Sum of the four {|278 238|279 255| 74 81|155 134|151 158| 91 73| - |quarters =3040={| 516 | 534 | 155 | 289 | 309 | 164 | - | | =1205= | =762= | - |TOTAL FOR THE YEAR =3040= - +--------------------------------------------------------------------- - - +------------------+-----------------------------------------------+ - |DEATHS in the four| CITY OF LONDON UNION. | - |quarterly periods,+-------+-------+-------+-------+-------+-------+ - |terminating as | S. W. | N. W. |South. | S. E. | N. E. | Work- | - |follows:-- | | | | | |house. | - | +-------+-------+-------+-------+-------+-------+ - |In the quarter | M. F. | M. F. | M. F. | M. F. | M. F. | M. F. | - |ending: | | | | | | | - | I. Dec. } =675={| 23 14| 21 22| 31 26| 18 15| 25 29| 10 7| - | 25th } {| 37 | 43 | 57 | 33 | 54 | 17 | - | | | | | | | | - | II. March} =878={| 19 30| 38 19| 32 33| 29 20| 40 35| 15 17| - | 26th } {| 49 | 57 | 65 | 49 | 75 | 32 | - | | | | | | | | - |III. June } =817={| 20 25| 27 20| 30 29| 24 26| 27 20| 19 14| - | 25th } {| 45 | 47 | 59 | 50 | 47 | 33 | - | | | | | | | | - | IV. Sept.} =670={| 16 23| 18 23| 25 17| 18 14| 28 20| 10 12| - | 24th } {| 39 | 41 | 42 | 32 | 48 | 22 | - +------------------+-------+-------+-------+-------+-------+-------+ - |Sum of the four {| 78 92|104 84|118 105| 89 75|120 104| 54 50| - |quarters =3040={| 170 | 188 | 223 | 164 | 224 | 104 | - | | =1073= | - |TOTAL FOR THE YEAR | - +------------------------------------------------------------------+ - - -No. VIII.--_Quinquennial Mortality, classified by Age, first for the -entire City, next for the three Unions severally._ - - +--------------------+------+-----+-----+-----+------+------+------+ - | | Under| From| From| From| From | From | From | - |Deaths in the Popu- | 5 | 5 | 10 | 15 | 20 | 30 | 40 | - |lation of the City | Years| to | to | to | to | to | to | - |of London. | of | 10.| 15.| 20.| 30. | 40. | 50. | - | | Age. | | | | | | | - +--------------------+------+-----+-----+-----+------+------+------+ - |Year by year{1848-49| 1243 | 202 | 92 | 90 | 292 | 345 | 396 | - |dating from {1849-50| 1032 | 83 | 44 | 70 | 166 | 200 | 251 | - |Michaelmas {1850-51| 1194 | 124 | 48 | 60 | 169 | 227 | 248 | - |to {1851-52| 1197 | 113 | 57 | 84 | 196 | 253 | 267 | - |Michaelmas. {1852-53| 1135 | 94 | 37 | 59 | 179 | 258 | 268 | - +--------------------+------+-----+-----+-----+------+------+------+ - |Sum of five year’s |=5801=|=616=|=278=|=363=|=1002=|=1283=|=1430=| - |deaths | | | | | | | | - +--------------------+------+-----+-----+-----+------+------+------+ - |Deaths East London | 2471 | 215 | 80 | 105 | 338 | 432 | 488 | - |of five Union | | | | | | | | - |years West London | 1416 | 141 | 75 | 122 | 305 | 376 | 405 | - |in Union | | | | | | | | - |their City of Lon-| 1914 | 260 | 123 | 136 | 359 | 475 | 537 | - |Local don Union | | | | | | | | - |Distri- Uncertain | * | * | * | * | * | * | * | - |bution. Address | | | | | | | | - +--------------------+------+-----+-----+-----+------+------+------+ - - +--------------------+------+------+------+----+-------+ - | | From | From | From | Age| Total.| - |Deaths in the Popu- | 50 | 60 | 70 | not| | - |lation of the City | to | to | up- | re-| | - |of London. | 60. | 70. |wards.|por-| | - | | | | |ted.| | - +--------------------+------+------+------+----+-------+ - |Year by year{1848-49| 355 | 366 | 367 | 15 | 3763 | - |dating from {1849-50| 254 | 318 | 334 | 0 | 2752 | - |Michaelmas {1850-51| 261 | 303 | 342 | 2 | 2978 | - |to {1851-52| 260 | 287 | 350 | 0 | 3064 | - |Michaelmas. {1852-53| 297 | 320 | 393 | 0 | 3040 | - +--------------------+------+------+------+----+-------+ - |Sum of five year’s |=1427=|=1594=|=1786=|=17=|=15597=| - |deaths | | | | | | - +--------------------+------+------+------+----+-------+ - |Deaths East London | 444 | 551 | 619 | 0 | 5743 | - |of five Union | | | | | | - |years West London | 393 | 420 | 398 | 1 | 4052 | - |in Union | | | | | | - |their City of Lon-| 590 | 623 | 769 | 1 | 5787 | - |Local don Union | | | | | | - |Distri- Uncertain | * | * | * | 15 | 15 | - |bution. Address | | | | | | - +--------------------+------+------+------+----+-------+ - - -No. IX.--_Number of Deaths occasioned, during the last Five Years, by -certain Acute Diseases, chiefly Epidemic, Infectious, and Endemic._ - - +-------------------+------+----------+--------+------+-----------+ - | | | Acute |Scarlet-| | | - | | | Diarrhœa | Fever | |Erysipelas,| - |In the successive | | (not of | and |Small-| Pyæmia, | - |years terminating |Fever.| infants),|Cynanche| Pox. | and | - |severally as | |Dysentery,|maligna.| | Puerperal | - |follows:-- | | and | | | Fever. | - | | | Cholera. | | | | - | | | | | | | - +-------------------+------+----------+--------+------+-----------+ - |At Michaelmas, 1849| 166 | 825 | 135 | 17 | 44 | - |„ „ 1850| 118 | 54 | 32 | 33 | 40 | - |„ „ 1851| 107 | 23 | 46 | 41 | 17 | - |„ „ 1852| 165 | 37 | 86 | 96 | 24 | - |„ „ 1853| 145 | 43 | 85 | 15 | 26 | - +-------------------+------+----------+--------+------+-----------+ - |Total number of | | | | | | - |such Deaths in the | =701=| =982= | =384= | =202=| =151= | - |Five Years 1848-53.| | | | | | - +-------------------+------+----------+--------+------+-----------+ - - +-------------------+----------+--------+--------+---------+ - | |Diarrhœa, | | | | - | |Bronchitis|Measles,| Hydro- | Total | - |In the successive | and |Hooping-|cephalus| of | - |years terminating |Pneumonia | cough | and |preceding| - |severally as |of Infants| and | Convul-| columns.| - |follows:-- | under | Croup. |sions of| | - | | 3 years | |Infancy.| | - | | of age. | | | | - +-------------------+----------+--------+--------+---------+ - |At Michaelmas, 1849| 285 | 196 | 264 | =1932= | - |„ „ 1850| 243 | 124 | 219 | =863= | - |„ „ 1851| 340 | 272 | 282 | =1128= | - |„ „ 1852| 330 | 132 | 308 | =1178= | - |„ „ 1853| 304 | 190 | 289 | =1097= | - +-------------------+----------+--------+--------+---------+ - |Total number of | | | | | - |such Deaths in the | =1502= | =914= | =1362= | =6198= | - |Five Years 1848-53.| | | | | - +-------------------+----------+--------+--------+---------+ - - -No. X.--_Comparative Mortality in different seasons of the Year; namely, -in the Autumn Quarters (Oct., Nov., Dec.) in the Winter Quarters (Jan., -Feb., March,) in the Spring Quarters (April, May, June) and in the -Summer Quarters (July, Aug., Sept.) of the Five Years from Michaelmas, -1848, to Michaelmas, 1853._ - -SYNOPSIS. - - +------------------+-------------------------+--------------------+ - |DEATHS in the dif-| EAST LONDON UNION. | WEST LONDON UNION. | - |ferent seasons of +--------+--------+-------+------+------+------+ - |five years, as | Saint |Cripple-| Work- | | |Work- | - |follows:-- |Botolph.| gate. |houses.|North.|South.|house.| - +------------------+--------+--------+-------+------+------+------+ - |In five Autumn | 616 | 613 | 201 | 357 | 392 | 129 | - |Quarters | =1430= | =878= | - +------------------+--------+--------+-------+------+------+------+ - |In five Winter | 641 | 623 | 223 | 371 | 464 | 183 | - |Quarters | =1487= | =1018= | - +------------------+--------+--------+-------+------+------+------+ - |In five Spring | 519 | 583 | 195 | 402 | 471 | 159 | - |Quarters | =1297= | =1032= | - +------------------+--------+--------+-------+------+------+------+ - |In five Summer | 682 | 664 | 183 | 438 | 562 | 124 | - |Quarters | =1529= | =1124= | - +------------------+--------+--------+-------+------+------+------+ - - +------------------+-------------------------------------+------+ - |DEATHS in the dif-| CITY OF LONDON UNION. | Total| - |ferent seasons of +-----+-----+------+-----+-----+------+ for | - |five years, as |S. W.|N. W.|South.|S. E.|N. E.|Work- |entire| - |follows:-- | | | | | |house.|City. | - +------------------+-----+-----+------+-----+-----+------+------+ - |In five Autumn | 245 | 236 | 272 | 227 | 271 | 119 |=3678=| - |Quarters | =1370= | - +------------------+-----+-----+------+-----+-----+------+------+ - |In five Winter | 248 | 274 | 347 | 265 | 360 | 153 |=4152=| - |Quarters | =1647= | - +------------------+-----+-----+------+-----+-----+------+------+ - |In five Spring | 226 | 230 | 273 | 255 | 262 | 137 |=3712=| - |Quarters | =1383= | - +------------------+-----+-----+------+-----+-----+------+------+ - |In five Summer | 307 | 228 | 273 | 202 | 260 | 117 |=4040=| - |Quarters | =1387= | - +------------------+-----+-----+------+-----+-----+------+------+ - - -No. XI.--_Comparative Mortality in Different Seasons of the Year._ - -AUTUMN QUARTERS. - - +-----------------+--------------------------+--------------------+ - | | EAST LONDON UNION. | WEST LONDON UNION. | - |DEATHS in five +--------+--------+--------+------+------+------+ - |Autumn Quarters | Saint |Cripple-| Work- |North.|South.|Work- | - |as follows:-- |Botolph.| gate. |houses. | | |house.| - | +--------+--------+--------+------+------+------+ - |Oct., Nov., Dec.,| | | | | | | - | 1848| 127 | 128 | 31 | 74 | 103 | 29 | - | „ „ „ | | | | | | | - | 1849| 118 | 137 | 44 | 85 | 70 | 23 | - | „ „ „ | | | | | | | - | 1850| 101 | 125 | 32 | 62 | 72 | 14 | - | „ „ „ | | | | | | | - | 1851| 140 | 117 | 64 | 68 | 80 | 30 | - | „ „ „ | | | | | | | - | 1852| 130 | 106 | 30 | 68 | 67 | 33 | - +-----------------+--------+--------+--------+------+------+------+ - |Total of five | =616= | =613= | =201= | =357=|=392= |=129= | - |Seasons | | | | | | | - +-----------------+--------+--------+--------+------+------+------+ - - +-----------------+-----------------------------------------+------+ - | | CITY OF LONDON UNION. |Totals| - |DEATHS in five +------+------+------+------+------+------+ for | - |Autumn Quarters | S.W. | N.W. |South.| S.E. | N.E. |Work- |entire| - |as follows:-- | | | | | |house.|City. | - | +------+------+------+------+------+------+------+ - |Oct., Nov., Dec.,| | | | | | | | - | 1848| 40 | 50 | 59 | 40 | 62 | 23 | =766=| - | „ „ „ | | | | | | | | - | 1849| 57 | 45 | 55 | 51 | 52 | 28 | =765=| - | „ „ „ | | | | | | | | - | 1850| 48 | 44 | 49 | 55 | 48 | 22 | =672=| - | „ „ „ | | | | | | | | - | 1851| 63 | 54 | 52 | 48 | 55 | 29 | =800=| - | „ „ „ | | | | | | | | - | 1852| 37 | 43 | 57 | 33 | 54 | 17 | =675=| - +-----------------+------+------+------+------+------+------+------+ - |Total of five |=245= |=236= |=272= |=227= |=271= |=119= |=3678=| - |Seasons | | | | | | | | - +-----------------+------+------+------+------+------+------+------+ - - -No. XII.--_Comparative Mortality in Different Seasons of the Year._ - -WINTER QUARTERS. - - +-----------------+--------------------------+--------------------+ - | | EAST LONDON UNION. | WEST LONDON UNION. | - |DEATHS in five +--------+--------+--------+------+------+------+ - |Autumn Quarters | Saint |Cripple-| Work- |North.|South.|Work- | - |as follows:-- |Botolph.| gate. |houses. | | |house.| - | +--------+--------+--------+------+------+------+ - |Jan., Feb., Mar.,| | | | | | | - | 1849| 136 | 117 | 36 | 73 | 90 | 30 | - | „ „ „ | | | | | | | - | 1850| 96 | 124 | 36 | 91 | 84 | 40 | - | „ „ „ | | | | | | | - | 1851| 154 | 140 | 49 | 87 | 89 | 22 | - | „ „ „ | | | | | | | - | 1852| 124 | 96 | 48 | 54 | 101 | 37 | - | „ „ „ | | | | | | | - | 1853| 131 | 146 | 54 | 66 | 100 | 54 | - +-----------------+--------+--------+--------+------+------+------+ - |Total of five | =641= | =623= | =223= | =371=| =464=| =183=| - |Seasons | | | | | | | - +-----------------+--------+--------+--------+------+------+------+ - - +-----------------+-----------------------------------------+------+ - | | CITY OF LONDON UNION. |Totals| - |DEATHS in five +------+------+------+------+------+------+ for | - |Autumn Quarters | S.W. | N.W. |South.| S.E. | N.E. |Work- |entire| - |as follows:-- | | | | | |house.|City. | - | +------+------+------+------+------+------+------+ - |Jan., Feb., Mar.,| | | | | | | | - | 1849| 52 | 63 | 60 | 52 | 77 | 36 | =822=| - | „ „ „ | | | | | | | | - | 1850| 46 | 45 | 80 | 58 | 74 | 29 | =803=| - | „ „ „ | | | | | | | | - | 1851| 59 | 48 | 81 | 56 | 67 | 24 | =876=| - | „ „ „ | | | | | | | | - | 1852| 42 | 61 | 61 | 50 | 67 | 32 | =773=| - | „ „ „ | | | | | | | | - | 1853| 49 | 57 | 65 | 49 | 75 | 32 | =878=| - +-----------------+------+------+------+------+------+------+------+ - |Total of five | =248=| =274=| =347=| =265=| =360=| =153=|=4152=| - |Seasons | | | | | | | | - +-----------------+------+------+------+------+------+------+------+ - - -No. XIII.--_Comparative Mortality in Different Seasons of the Year._ - -SPRING QUARTERS. - - +-----------------+--------------------------+--------------------+ - | | EAST LONDON UNION. | WEST LONDON UNION. | - |DEATHS in five +--------+--------+--------+------+------+------+ - |Autumn Quarters | Saint |Cripple-| Work- |North.|South.|Work- | - |as follows:-- |Botolph.| gate. |houses. | | |house.| - | +--------+--------+--------+------+------+------+ - |April, May, June,| | | | | | | - | 1849| 85 | 130 | 39 | 77 | 110 | 34 | - | „ „ „ | | | | | | | - | 1850| 80 | 90 | 19 | 74 | 71 | 27 | - | „ „ „ | | | | | | | - | 1851| 115 | 101 | 48 | 92 | 79 | 21 | - | „ „ „ | | | | | | | - | 1852| 110 | 131 | 38 | 70 | 121 | 31 | - | „ „ „ | | | | | | | - | 1853| 129 | 131 | 51 | 89 | 90 | 46 | - +-----------------+--------+--------+--------+------+------+------+ - |Total of five | =519= | =583= | =195= | =402=| =471=| =159=| - |Seasons | | | | | | | - +-----------------+--------+--------+--------+------+------+------+ - - +-----------------+-----------------------------------------+------+ - | | CITY OF LONDON UNION. |Totals| - |DEATHS in five +------+------+------+------+------+------+ for | - |Autumn Quarters | S.W. | N.W. |South.| S.E. | N.E. |Work- |entire| - |as follows:-- | | | | | |house.|City. | - | +------+------+------+------+------+------+------+ - |April, May, June,| | | | | | | | - | 1849| 56 | 55 | 58 | 45 | 50 | 26 | =765=| - | „ „ „ | | | | | | | | - | 1850| 34 | 39 | 40 | 43 | 50 | 22 | =589=| - | „ „ „ | | | | | | | | - | 1851| 44 | 38 | 75 | 70 | 56 | 28 | =767=| - | „ „ „ | | | | | | | | - | 1852| 47 | 51 | 41 | 47 | 59 | 28 | =774=| - | „ „ „ | | | | | | | | - | 1853| 45 | 47 | 59 | 50 | 47 | 33 | =817=| - +-----------------+------+------+------+------+------+------+------+ - |Total of five | =226=| =230=| =273=| =255=| =262=| =137=|=3712=| - |Seasons | | | | | | | | - +-----------------+------+------+------+------+------+------+------+ - - -No. XIV.--_Comparative Mortality in Different Seasons of the Year._ - -SUMMER QUARTERS. - - +-----------------+--------------------------+--------------------+ - | | EAST LONDON UNION. | WEST LONDON UNION. | - |DEATHS in five +--------+--------+--------+------+------+------+ - |Autumn Quarters | Saint |Cripple-| Work- |North.|South.|Work- | - |as follows:-- |Botolph.| gate. |houses. | | |house.| - | +--------+--------+--------+------+------+------+ - |July, Aug., Sep.,| | | | | | | - | 1849| 171 | 199 | 73 | 148 | 295 | 33 | - | „ „ „ | | | | | | | - | 1850| 102 | 93 | 26 | 74 | 65 | 18 | - | „ „ „ | | | | | | | - | 1851| 123 | 105 | 38 | 76 | 73 | 11 | - | „ „ „ | | | | | | | - | 1852| 160 | 116 | 26 | 74 | 77 | 31 | - | „ „ „ | | | | | | | - | 1853| 126 | 151 | 20 | 66 | 52 | 31 | - +-----------------+--------+--------+--------+------+------+------+ - |Total of five | =682= | =664= | =183= | =438=| =562=| =124=| - |Seasons | | | | | | | - +-----------------+--------+--------+--------+------+------+------+ - - +-----------------+-----------------------------------------+------+ - | | CITY OF LONDON UNION. |Totals| - |DEATHS in five +------+------+------+------+------+------+ for | - |Autumn Quarters | S.W. | N.W. |South.| S.E. | N.E. |Work- |entire| - |as follows:-- | | | | | |house.|City. | - | +------+------+------+------+------+------+------+ - |July, Aug., Sep.,| | | | | | | | - | 1849| 145 | 77 | 86 | 77 | 73 | 18 |=1395=| - | „ „ „ | | | | | | | | - | 1850| 39 | 39 | 43 | 31 | 43 | 22 | =595=| - | „ „ „ | | | | | | | | - | 1851| 40 | 39 | 53 | 36 | 42 | 27 | =663=| - | „ „ „ | | | | | | | | - | 1852| 44 | 32 | 49 | 26 | 54 | 28 | =717=| - | „ „ „ | | | | | | | | - | 1853| 39 | 41 | 42 | 32 | 48 | 22 | =670=| - +-----------------+------+------+------+------+------+------+------+ - |Total of five | =307=| =228=| =273=| =202=| =260=| =117=|=4040=| - |Seasons | | | | | | | | - +-----------------+------+------+------+------+------+------+------+ - - - - - ON THE PRESENT - BURIAL-PLACES OF THE CITY. - - - TO THE IMPROVEMENT COMMITTEE OF THE HON. THE COMMISSIONERS OF SEWERS - OF THE CITY OF LONDON. - - _December 10th, 1852._ - - GENTLEMEN, - -In order to an application of the Metropolitan Burials Act by the -constituted authorities of the City, you have requested me to report how -far, in my judgment, the existing burial-places within this jurisdiction -are fit for further reception of the dead. - -I have little to add to the information which I have laid before the -Commission in my successive annual reports--especially in that of 1849, -and which long since induced me to express my conviction ‘that the City -of London could no longer with safety or propriety be allowed to furnish -intramural burial to its dead.’ - -It would, indeed, be ridiculous if I should pretend to you that this -part of the subject requires any further inquiry. Putrefactive -decomposition of one kind and another is the principal cause of -town-unhealthiness. Against its occurrence round about our houses all -your legislation is directed. The human body, once destitute of life, -furnishes no exception to the laws of organic decay: under the common -laws of chemical change, it soon dissolves itself into products neither -less offensive, nor less poisonous, than those of any brute’s -decomposition. And you cannot take a juster view of the subject--you -cannot arrive at stronger arguments for the immediate abolition of -intramural interment, than by forcing yourselves to discard for a moment -all memory of the fading human outline which masks this dreadful -nuisance, and to conceive it as _a mere bulk of animal matter_, planted -every year to undergo decomposition within the City, beneath our -Churches, and before our thresholds.[91] - - [91] The right of interment in the City may at present be claimed in - respect probably of more than three thousand corpses _per_ annum. The - number actually interred of late years has, I believe, not exceeded an - average of two thousand _per_ annum. - -Dead bodies thus buried contribute importantly in their neighbourhood to -the vitiation of air and water. Those that lie shelved in vaults, -eventually, if not at first, spread through the atmosphere every product -of their decomposition. Those that are dug into the soil have their -decay modified by its influence, mingle with its drainage the products -of their transformation, and thus (as I have shown in my remarks on the -Bishopsgate pump water) find their issue in the nearest land-spring of -the spot, polluting the drink of the population. Further, in all the -more frequented burial-grounds, the soil seems to be saturated with -animal matters only partially transformed; and at every new disturbance -by the spade, a fresh quantity of this unctuous clay comes upmost, -tainting the air with materials of fœtid decomposition, often to the -great distress of persons who dwell in the vicinity. - -On such grounds as these, I cannot hesitate in renewing my report that -the City of London is absolutely unfit to serve as a further -burial-place for the dead; and this, whether by inhumation or in vaults, -whether in parochial burying-grounds, or in those of other communities. - -Regard being had to the object of your reference, you would probably not -desire me at present to enter on the ulterior questions of extramural -interment. - -On such representations as I have made, the Court of Common Council -(acting under the Metropolitan Act already referred to) has authority to -determine in respect of the City of London, whether the existing places -of burial, either from their insufficiency, or from their dangerousness -to health, are so unfit for their purpose as to render it necessary that -other burial-space be provided. - -Should they affirm this view, they can then ‘authorise and direct the -Commissioners of Sewers of the City of London to exercise for the said -City and Liberties all the powers and authorities vested in -Burial-Boards under the Act.’ - -This course being taken, the Commission (subject to approval from the -Secretary of State) will have authority to make all arrangements -requisite for the final closure of burial-places within the City. - -In approaching the subject of extramural sepulture, with its innumerable -details of inquiry, for site, for conveyance, and for burial--details -which form the knowledge and experience of a special class of persons, -the Commission may perhaps first consider whether works so foreign to -their usual functions shall be undertaken by themselves directly, or -shall be made matter of contract with existing Cemetery Companies, or -other associations or individuals. Till this decision is made, it seems -impossible to conjecture what topics you may wish to entertain, or -within what limits the industry of your officers may most usefully be -exercised. - -There are many very important parts of the subject with which it may -hereafter become my duty to deal; but till the preliminary questions are -settled, it would be idle to detain you with sanitary considerations -belonging to a later stage of your inquiry. - -As my Report for 1849 had long been out of print, I subjoin an extract -from it of so much as relates to the matter in hand.[92] - - [92] The passages here referred to form a separate section of the - First Annual Report; and therefore need not be reprinted in this part - of the present volume.--J. S., 1854. - - -NOTE. - - _On considering the above Report, the Improvement Committee of the - Commissioners (to whom the subject had been specially referred) at - once resolved to report to the General Court that, in their ‘judgment, - steps should be taken for closing the several burial-places within the - City;’ and at the same time they desired that the Officer of Health - would prepare for them his opinion on those ulterior arrangements - which such closure might render necessary._ - - _The following Report was written accordingly._ - - - - - INTRODUCTORY REPORT - SUGGESTING THE - OUTLINE OF A SCHEME - FOR - EXTRAMURAL INTERMENT. - - TO THE IMPROVEMENT COMMITTEE - OF THE - HON. THE COMMISSIONERS OF SEWERS OF THE CITY OF - LONDON. - - - GENTLEMEN, - -Under the several clauses of the Metropolitan Burials Act, and under -certain clauses of the City Sewers Act 1848, the Commissioners of -Sewers, acting as a Burial-Board for the City of London, will be subject -to the following responsibilities--viz.: - - _First_,--That a sufficient extramural burial-place be provided for - those classes of persons who have heretofore had right of interment - within the City; - - _Secondly_,--That the facilities of transit and conveyance to such - burial-place be commensurate with the purposes for which it is - established; - - _Thirdly_,--That evil no longer accrue to the health of the City from - unnecessary delays of interment, or from the keeping of dead bodies in - the dwelling-rooms of the poor. - - * * * * * - -I. To measure the sufficiency of a burial-place, one must know for what -numbers of population it is intended to suffice. - -Burial-Boards under the new Act are obliged to provide accommodation for -all _parishioners_ or _inhabitants_ of the several parishes within their -jurisdiction. - -Under the term ‘parishioners’ as relating to the City, there may be -included, I am told, an indefinite number of non-resident rate-payers: -and although, at first, interment might not be claimed under the latter -head to any considerable extent, yet, with the completion and success of -your Cemetery, the applications might year by year become more numerous. -From the nature of the case, such claimants would in most instances be -of the wealthier classes, and might consequently be expected to apply -for special allotments of ground. It seems therefore desirable that you -should have some knowledge of the number for whom you may thus be -required to provide. - -I would accordingly suggest as expedient, that a legal opinion should be -obtained on your exact liabilities under the law referred to; and -especially as to whether the right of burial possessed by non-resident -rate-payers does likewise extend to the non-resident households of such -rate-payers. - -In the meantime I will leave this set of claimants out of my argument; -assuming that, whenever you have reckoned their number, you will be -able, on their account, to add to your general estimate, according to a -fixed proportion, the assessment of whatever additional accommodation -they may legally require. - -The number of deaths belonging to the ‘inhabitants’ of the City of -London may be more precisely given. It would probably lie, as an -average, within 3200 per annum. - -In attempting to fix the extent of ground required for your purpose in -respect of this mortality, I must bring before you some preliminary -considerations. - -First,--as regards the _minimum accommodation_ to be given in your -Cemetery; I assume that every person buried there, however humble his -previous station in life, may in death claim a grave to himself. It has -been the opprobrium of our previous system that, in the poorer classes -of interments, many bodies have been huddled together into a single pit. -Probably you will think, as regards your future burial-place, that no -consideration of cheapness can justify this indecency: probably you will -be unwilling that, in a presence which confounds all social comparisons, -there should be drawn, with your sanction, between rich and poor any so -disrespectful distinction. But at all events, on sanitary grounds, I -feel bound to assure you that these multiple burials are quite -inadmissible. With such concentration of organic remains in very narrow -compass, the soil grows utterly fœtid; and it becomes impossible to -guard against nuisance arising to the public, or against danger to those -who are occupied in digging and tending the ground. These evils, indeed, -are so glaring, and the indecorum of crowded interment has long been so -notorious, that nothing could have given them continuance except the -necessities of our narrow accommodation under the system of intramural -burial: and it would of course be without excuse to perpetuate them -under the changed circumstances of extramural Cemeteries, where space -can so readily be obtained for all legitimate requirements of the -public. So far as the experience of other countries may help to -determine your judgment in this matter, I may inform you that, in every -foreign interment system which can deserve to be considered an -establishment of public authority, the right of single burial is -universally recognised. - -Next--as regards the _succession of interments_; according to the -burial-usages of modern times, no public Cemetery with fixed limits can -be permanently useful, except on a full recognition of the fact that it -is a decaying place for the dead, not a place for their embalmment or -mummification. For hence it follows, that ground once used for burial -becomes equally fitted for a second use, whenever by gradual -decomposition the bodies first interred there have thoroughly vanished -from the soil. - -This principle has given the common rule of burial; and for obvious -reasons. Under any other plan, the entire area allotted for interment -would presently be in holding. No portion, however remote the date of -its first occupation, could be resumed for a second series of -interments; and the provision of a new Cemetery would be indispensable. -Pushed to its extreme consequences, such a system must eventually -convert the entire country into its burial-ground. - -Under the practice of intramural interments--that practice which the new -law supersedes, the principle of temporary tenure has been made to cover -all manner of brutal abuses. Graves have been disturbed--within -metropolitan churchyards and other burying-grounds, in which the -transformations of decay had not half accomplished themselves; and -public decency has been outraged--here, in the centre of civilisation, -by the spectacle of human remains being tossed about like offal. It is -one chief advantage of extramural sepulture, that, while the inevitable -decay of the dead will be removed from the vicinity of the living, and -the latter will no longer have their atmosphere tainted by this hideous -contamination; so likewise for the dead--however humble, that in this -new resting-place, room will be allotted them with no indecent stint; -that the dwellings and market-places of the living will no longer hem -them in, grudging their narrow requirements; that their return to dust -will be respected, as beseems the last phase of mortal existence; and -that, against any desecration of their repose, there will be given every -security which piety and affection can demand. - -There may be difference of opinion as to the precise time when a grave -can with truth and decency be thought to have become distenanted. The -rapidity of decay varies in so extraordinary a degree according to soil, -that some inhumations are almost equivalent to embalming; while, in -other cases, the process is comparatively rapid. Only experience of a -particular soil will enable you to know with precision, what length of -tenure is needed there for the purposes of interment to accomplish -themselves; but on general principles one can approximate pretty nearly -to the truth. Assuming the site of your Cemetery to have been selected -with due regard to those qualities of soil which determine the -differences adverted to, I think it unlikely that any adult grave can -properly be re-opened within twenty years[93] of the time when interment -shall last have occurred in it. Very long within this time, however, all -soft textures of the body would have completed their decay. Remains of -the coffin and of the skeleton--materials insusceptible of putrefaction, -would alone occupy the grave, and with gradual crumbling blend -themselves in the soil. Not till this final disintegration of the -skeleton is complete--not till the identity of its different elements is -destroyed, can the first occupant of a grave be fairly deemed to have -abdicated his tenure. From this time only, can his interest in it be -held as having reverted to the public, for whoever next may claim a -similar usufruct of the ground. - - [93] Twenty years would probably represent at least four times the - average period during which the bodies of the poor have been left at - rest in many grave-yards of the metropolis. Yet I would willingly - advocate a longer term of years as the personal tenure of a grave, if - public opinion would sanction the heavier expense which must thus be - entailed on the living. - -Taken for granted that, as regards the general public, your Cemetery -will be established on the principle of a temporary tenure of graves, it -remains for you to determine to what extent you will permit wealthier -applicants to purchase exemption from this rule, and obtain a freehold -interest in particular portions of your ground. I have little to say on -this point, because it is of no sanitary importance, provided that -privileges so purchased do not in any degree interfere with the general -economy of your plan. Barring any risk of this kind, it comes before you -simply as a question of finance. - -A precaution, however, which I would suggest, is, that, first of all, -you should provide a cemeterial space sufficient for the interment -purposes of your population, on the principle of temporary tenure; that -no portion of this space should, under any circumstances, be alienated -from its public destination; that the whole of it should remain in -perpetuity the common burying-ground of the City of London. This prime -necessity of your plan being secured, it will be competent for you to -include in your purchase a certain redundant number of acres; and out of -these you can allot, at your discretion, such quantities of ground as -may be desired in freehold, either for the purposes of family interment, -generation after generation, or for the fiction of perpetual tenure by -some single occupant.[94] - - [94] In regard of these exceptional burials, it will be requisite to - fix certain regulations; especially for the construction of family - graves, wherein it will be desired that many who during life have been - united, shall after death have their ashes mingled together in the - soil. A frequent custom in private Cemeteries for fulfilling this - purpose has been, for graves to be dug to a considerable - depth--sometimes such that twelve coffins could be piled there, one on - the other; and these deep pits have commonly been provided with brick - walls. Now, for the same reason as determined my opinion against the - multiple burial of the poor, I would argue against this arrangement, - as one which might occasion excessive accumulation in single spots of - your Cemetery, and as being in principle bad. In preference, I would - venture to recommend the endeavour to introduce an interment-custom, - which is prevalent abroad, of _family plots of ground instead of - family pits_. Under ordinary circumstances, all the accommodation - heretofore sought in the one arrangement would be found superiorly in - the other; and in a well-projected suburban Cemetery the larger - superficial extent could probably be afforded at much less cost than - is usually paid for the pit. Persons familiar with the details of - Cemetery-burial would easily devise an arrangement of such plots, - whereby they should be separate and secluded, admitting of appropriate - decoration, and altogether likely to prove more acceptable to public - opinion than many existing arrangements. In regard of such plots, too, - there might be conceded a privilege which I believe has not been - allowed in private Cemeteries; namely, an hereditary right to refill - the ground for any successive number of times, subject only to such - restrictions as will determine the succession of interments in other - parts of the Cemetery. - -In thus selling portions of your land for private and privileged -employment, you would be satisfying what has become a habit, and may be -considered a legitimate claim of the wealthier classes. Beyond this, it -is also evident, that you would virtually be competing with the ordinary -Cemetery-companies of the metropolis, in the most lucrative department -of their trade. It would probably be easy for you, by varying your fees -according to circumstances, either on the one hand to diminish, and -almost prohibit, the frequency of applications for exceptional -interments; or, on the other hand, to attract such applications. Even, -if you thought it desirable, you might admit purchasers from other -classes than those having right of burial in your municipal -Cemetery;--in short, you might manage it commercially, with a view to -profit, looking to its proceeds for covering many expenses of the -general establishment. - -With respect to the ordinary arrangement of your ground for public -purposes, and the distribution of burials therein, you may estimate -that, taking one grave with another, and allowing for the marginal -spaces of each, the average size of a grave will be twenty-eight square -feet. For illustration’s sake, I will suppose the ground to be laid out -in plots--say the third of an acre in extent. Each such plot would -contain four hundred single graves, mixed adult and young, with what -foot-paths might be requisite for approaching them. The City mortality -of twenty years (assuming this period to be the ordinary leasehold of a -grave) might be reckoned at sixty-four thousand deaths; for the -accommodation of which number there would be wanted one hundred and -sixty plots of the above-mentioned size--say fifty-four acres of ground. -I would propose that throughout each line of every such space, adult and -infant graves should, as far as possible, lie alternately; and that, -instead of filling all the graves together at stated periods (say every -twenty years) half of them, taken alternately, should be filled at each -semi-period--say every ten years. By this arrangement, half the -complement of burials would take place in each plot, at a time when the -decomposition of the preceding half-complement had finished itself, so -far as putrefaction is concerned; and whatever contamination of air -might be liable to occur under the best-considered sanitary arrangement, -would certainly be reduced to the lowest conceivable amount. Or, as an -alternative equal to this arrangement for the purposes of health, you -might adopt the plan of filling in immediate succession all the -burial-spaces of a plot; provided the surface could then at once be -devoted to the growth of appropriate vegetation. - -Fifty-four acres being then the quantity of ground which would suffice, -on sound principles, for the ordinary interment of your entire annual -mortality during a period of twenty years; at the expiration of which -time (assuming your soil to be appropriate) one may reasonably expect -that the ground will admit of a second similar occupation; and so forth -in perpetuity: it will be requisite to add a considerable allowance of -space for other accessory purposes. - -Thus, room would be required for the various buildings that belong to -the institution of a Cemetery: partly for the dwelling of such officers -as you may require to be there resident, partly for the temporary -accommodation of persons resorting thither for the burial of their -friends, partly for the religious services of different -congregations.[95] - - [95] The distinction of the ground into a consecrated and an - unconsecrated portion, as required by the Act of Parliament, will - require no addition to its total area; and therefore the proportion - which these parts should bear to one another need not now be - discussed. - -Something likewise must be added for such mainways as will be wanted -along various lines of the burial-ground, for the carriage traffic which -belongs to funeral ceremonies among the richer classes of society, and -for other like purposes. - -Further, I dare say you would think it inexpedient that your Cemetery -should be entirely without decoration and elegance. Fifty-four acres of -head-and-foot stones, or the same extent of bare mounds, might vulgarise -even the aspect of death. By the judicious introduction of trees and -turf and shrubs, of bends and undulations, you would probably seek to -interrupt the long perspective of so many tombs, and, by these -artificial resources of planning and planting, to enhance the native -solemnity of the spot. Amid such ornamental portions of your ground -might be scattered irregularly the various sites of exceptional -interment,--family graves, personal graves in perpetuity, long leasehold -graves, and the like; and the interposition of these large portions of -comparatively un-occupied soil, with as much appropriate vegetation as -could conveniently be introduced, might not only allow much tasteful -decoration of the ground, but would likewise conduce to the healthful -accomplishment of those purposes for which the Cemetery is established. - -In respect of these and many other details of your plan, you will -doubtless be guided by the direct and responsible advice of men -specially skilled in the subject. I have, therefore, confined myself to -the mention of those points which may determine your judgment merely as -to the quantity of land required for your purpose. - -Without offering any opinion as to the possible claims of non-resident -parishioners, on which liability I would again suggest your obtaining a -legal opinion; and without pretending to advise what allowance should be -made for purely decorative purposes; I may yet conclude from such -information as I have collected, that, with a hundred acres of suitable -soil at your disposal, you would be amply able to meet all legitimate -burial-requirements of your population in perpetuity, and would likewise -(for many years at least) have a considerable excess which might be -applied to the uses of ornamental arrangement. - -From what I have said on the influence of soil, in determining the -period after which burying-grounds may be resumed for a second series of -interments, it will be obvious to you that this condition is an -important element in deciding the sufficiency of any area for given -burial purposes. And the site of your Cemetery might be such as somewhat -to lessen, or greatly to increase, the suggested extent of your -estimate. It would be fruitless, however, now to detain you with any -endeavour to trace the several influences which different soils exert -over animal decay. Such remarks, at the present time, could only be -addressed to hypothetical cases, or stated in the most general form. -Therefore, instead of attempting this anticipative argument on the -subject, I hold myself ready to report to you, specifically, on the -suitableness of whatever soil may be proposed to you for the purposes of -your Cemetery.[96] - - [96] For similar reasons, I defer any discussion of the depth at which - bodies may most properly be deposited in the ground. The thickness of - superjacent soil, which will deodorise, before their escape, the - gaseous products of any given decomposing mass, or which will retain - these gases more or less permanently in combination, varies most - importantly with certain chemical and mechanical qualities of the - soil: and on these it would be useless to dwell by anticipation. For - accurate results, it may be necessary, after the selection of a site - and during its preparation, to institute experiments on the subject. - -There is yet one other consideration which may affect the extent of your -purchase. The law restricts you from approaching within 200 yards of any -dwelling-house, without the previous written consent of its owner, -lessee, and occupier. But there is no law restricting the nearness -within which any builder may approach your wall with his design for new -habitations; and it might easily occur to you, within a short time of -establishing your Cemetery, to find a new town growing in close -proximity around it. If there be any meaning and value in the clause, -which forbids your undue approach to inhabited houses--if it truly -represent that this approach would be a sanitary evil, then obviously -the law is deficient in the respect adverted to. It would be in your -power to guarantee the continuance of a belt of unoccupied ground, as an -immediate circuit to your Cemetery, in either of two ways:--either, -namely, you might purchase a considerable extent of ground beyond the -actual requirements of your Cemetery, might devote its central hundred -acres to interment, and might let its remaining circumference for -agricultural purposes; or, if you were fortunate enough to be treating -for the central portion of some considerable estate, you might -stipulate, as a condition of purchase, that no building should be reared -within such distance of the wall of your Cemetery, as you, on due -consideration, may deem fit. - - * * * * * - -II. In the provision of a Cemetery, it is required by the Act of -Parliament, that ‘the Burial-Board shall have reference to the -convenience of access thereto from the Parish or Parishes for which the -same is provided;’ and it is legalised, that ‘any Burial-Board may make -such arrangements as they may from time to time think fit, for -facilitating the conveyance of the Bodies of the Dead from the Parish, -or the place of Death, to the Burial-ground which shall be provided.’ - -It cannot but be obvious to you, that the choice of a site for your -Cemetery might be such as to interpose very serious obstacles in the way -of interment, even for the richest classes; and under the most favorable -circumstances, the removal of the dead to a distance of some miles from -their previous residence, cannot but threaten serious difficulty to the -poor. Assuming--what various conditions of the Act of Parliament render -almost inevitable, that your Cemetery must be distant at least six miles -from the centre of the City, the present funeral charges can hardly be -maintained without increase, if the traffic is to be conducted on the -same principles as heretofore. The price for which an artisan could -procure a decent funeral for his wife or child, within a stone’s throw -of his door, will unavoidably be augmented by every mile you add to the -distance, if the conveyance is still to depend on the old means and -arrangements. - -When I consider the classes of persons likely, as inhabitants of the -City, to claim interment in your Cemetery--classes, among which the -predominance of narrow, if not necessitous, circumstances will be -frequent; when, for instance, in a year’s official returns, I see that -artisans and paupers make more than two-thirds of your entire classified -mortality; I cannot but think this aspect of the matter a very important -one. From some years’ experience of your death-register, I should say -that, of City funerals, there would not be one in ten where the friends -could afford to disregard an additional expenditure of half a guinea; -and, in the majority of instances, I am persuaded that a smaller -addition would be enough to cause inconvenience and distress. It -therefore seems to me certain, that your plan for extramural sepulture, -however perfect at all other points, might either entirely fail of its -purpose, or become cruelly oppressive to the poor, by the simple -expensiveness of approaching the burial-place. And I suppose it was in -anticipation of the difficulties here adverted to, that the framers of -the Metropolitan Burials Act introduced the permissive clause, which I -just quoted, empowering Burial-Boards ‘to facilitate the conveyance’ of -the dead, and thus virtually rendering them responsible, so far as the -poorer classes are concerned, for the cheapness and efficiency of such -conveyance. - -I would therefore submit, that in your decision as to the site of your -Cemetery, so soon as the indispensable conditions of appropriate soil -are given, the first point to examine is accessibility; that the spot to -be chosen should have, in addition to its carriage roads, the utmost -facility of railway approach; and that, for those with whom small -differences of price are an important consideration, you should be able -to guarantee a rate of transport for coffin and mourners, not in excess -of existing charges. - -From observation of arrangements which have lately been made with -Railway-Companies by the Directors of Cemeteries, and from inquiry of -persons engaged in such undertakings, I entertain little doubt that you -might make a contract to the following effect with the authorities of -any line convenient for your purpose--viz., that every day, at a fixed -hour, there should be a train, or some portion of a train, exclusively -adapted to the funeral purposes of the poorer classes; that for this -train there should be issued funeral tickets, franking the conveyance of -a coffin with some stated number of mourners, who should also be -entitled to return; that the introduction of funeral traffic should be -by a special entrance, and its exit at a special terminus. - -Such contract supposed,--in connexion with this funeral train, you might -further arrange to maintain public hearses; which, at the option of -persons concerned, and on due requisition being made, should convey any -coffin from its former home to the railway terminus; and which again, if -necessary, at the distal station, should complete its conveyance to the -grave. This facility might even be extended, if the distances were -considerable, to the similar conveyance of a certain number of -mourners, with the undertaker in charge of their procession. - -Also, if desirable, it could no doubt be arranged, with a view to -economy, that the undertaker’s responsibility for a funeral should -terminate at the railway terminus, up to which he would have conducted -it; and that its reception at the distal station should be entrusted to -servants of your Cemetery, who would then fulfil all remaining duties in -respect of it. - -Arrangements to the above effect would be much simplified in working, -and their general adoption much promoted, if all disbursements for -funeral tickets, and for such other facilitations of conveyance as I -have adverted to, were made by your Burial-Board,--their cost to be -included in an uniform Cemetery fee; so that the friends of the -deceased, after paying for his grave, should, without further payment, -be entitled, if they desired it, to claim conveyance for his coffin from -home to the Cemetery, and for themselves (in stated number) by a funeral -ticket, at least for the railway portion of their transit. Thus to have -one single and inclusive price for all that belongs to the new -system--for the extramural grave, namely, and for conveyance thereto, -would enable your Burial-Board to maintain its total cost at a level -within reach of the poorer classes, and probably below that of existing -prices. - -In addition to what I have here suggested, there are many other steps -which might be taken, if unforeseen circumstances should render them -necessary, to diminish the pressure of new burial-charges on the poor. -Time will develop, better than one can foretell, the exact operation of -our reformed system; and for such inconveniences as it may bring, you -will have no difficulty, I think, in finding appropriate cures. Nor -could it be otherwise than easy, if you thought it desirable, to extend -to the comparatively few funerals of wealthier classes which occur from -within the City of London, those same arrangements for facilitating -conveyance, which I have here deemed it requisite to consider only in -their relation to the poor. - -For the latter, it has seemed indispensable that your scheme should -provide assistance, equivalent at least to the difficulty which its -adoption must occasion them. Beyond this, I believe you would wish to -disturb as little as possible the ordinary routine of interment; and I -have aimed, therefore, at suggesting assistance only in such kind, and -in such degree, as may least interfere with any interests of trade, -least derange any established habits, least offend any prejudices of the -people. - - * * * * * - -III. There is no part of the subject which I have considered with more -anxiety than that which relates to delays of interment, and to the -prolonged keeping of dead bodies in the rooms of their living kindred. - -Evils arising in this source are unknown to the rich. Soldered in its -leaden coffin, on tressels in some separate and spacious room, a corpse -may await the convenience of survivors with little detriment to their -atmosphere. - -Not so in the poor man’s dwelling. The sides of a wooden coffin, often -imperfectly joined, are at best all that divide the decomposition of the -dead from the respiration of the living. A room, tenanted night and day -by the family of mourners, likewise contains the remains of the dead. -For some days the coffin is unclosed. The bare corpse lies there amid -the living; beside them in their sleep; before them at their meals. - -The death perhaps has occurred on a Wednesday or Thursday; the next -Sunday is thought too early for the funeral; the body remains unburied -till the Sunday week. Summer or winter makes little difference to this -detention: nor is there sufficient knowledge on the subject, among the -poorer population, for alarm to be excited even by the concurrence of -infectious disease in a room so hurtfully occupied. - -I have no means of telling you, with statistical precision, in how many -of your annual deaths the corpse is detained in dangerous proximity to -the living. But I have already quoted an official classification of -deaths, by which it would appear that more than two-thirds of your -deaths are of the artisan class or below it. Among them at least, it -would be exceptional for the corpse to have a room to itself. On an -average, then, there would probably be lying within the City at any -moment, from thirty to forty dead bodies in rooms tenanted by living -persons. - -This very serious evil is well known to all persons who have taken an -interest in the sanitary advancement of the poor; and ineffectual -endeavours have been made for its diminution. The law does indeed -empower your Officer of Health, under certain circumstances, to order -the removal of a corpse from any inhabited room. And, under the -Nuisances Removal Act, the General Board of Health may be authorised, -during times of epidemic disease, to issue directions and regulations -for the speedy interment of the dead. Both laws have remained -inoperative, and are likely to remain so. - -If one were starting anew--legislating for a people with unformed -habits, nothing might be easier than to devise regulations of a perfect -kind with regard to the sanitary management of the dead. But our case is -widely different. The evils against which we have to contend are among -the deepliest-rooted habits of the country. In defence of what exists -there are many stupid and ignorant prejudices: but, interwoven with -these are feelings of tenderness and affection, to which all -consideration and reverence are due;--feelings which would be shocked -and outraged by any abrupt endeavour to reduce the care of the dead to a -system of fixed regulations. - -For myself, having the deepest sense of the evil in question, and having -officially the power to order the removal of the dead, I may repeat that -I have never yet exercised my authority. Practically speaking, I can -hardly conceive an instance in which I should attempt to do so. It would -require the strongest case that could be shown of actual mischief in -progress--of disease and death multiplied day by day through the -presence of some particular dead body, to justify interference even in -that single instance. Nothing like the operation of a general law would -be tolerated;--nothing like including the dead in a compulsory plan of -hygienic police. - -After very careful consideration of the subject, I may confess myself -even more impressed with its difficulties than when I first began to -give it my attention; and in the few suggestions which follow I cannot -pretend to do more than intimate where, in my opinion, a beginning may -usefully be made towards an improvement which it will take many years -to accomplish. - -Legislative remedies, proposed for the evils which I am bringing under -your notice, have been of two kinds--viz., _first_, to restrict the time -during which it should be lawful to keep a body unburied; _secondly_, to -promote the use of reception-houses (as they have been called) whither -bodies might be removed from within all dwelling-places, and be kept -under certain regulations during the days preceding their interment. - -As regards the first point;--there are many foreign countries (and even -some parts of the United Kingdom) where either law or custom has made it -imperative to bury within two, three, or four days of death. Our habit, -unfortunately, is to keep the corpse unburied for twice as long. A week -may probably be considered our medium interval between death and -interment; and with this delay, I need hardly tell you, the body becomes -putrid--sometimes intensely so, before the time for its removal arrives. - -Among the wealthier classes, as I have said, this delay is practically -unimportant; except in so far as every repetition maintains the -pernicious custom. Scarcely on account of any risk arising to themselves -in emanations from the dead, but mainly for the sake of influence and -example, would one wish the educated classes of the community to adopt -the usage of earlier burial. Our present practice is upheld by no law of -necessity; nor for the most part does it represent any extravagance of -grief, or fond reluctance of separation. Chiefly it subsists by our -indolent acquiescence in a habit, which former prejudices and former -exigencies established. Fears of premature interment, which had much to -do with it, are now seldom spoken of but with a smile. The longer -interval, once rightly insisted on as necessary for the gathering of -distant friends, has now, in the progress of events, become absurdly -excessive: in a vast majority of cases, all whose presence is needed, -live within a narrow circle; and the more distant mourner, who, fifty -years ago, would have spent several days in coming from Paris or -Edinburgh, can now finish his journey in twelve hours. It is much to be -wished that, under these changed circumstances, an altered practice -might ensue in the upper classes of society, fixing their time of burial -within three or four days of death. Such example of wealthier -neighbours, aided by greater enlightenment and education among -themselves, would greatly tend to detach the poor from many observances -and delays, in relation to the dead, which, in their narrow dwellings -cannot continue with impunity. - -But, as regards these poorer classes, cannot anything be done in -connexion with your new arrangements, to abridge the period of delay? As -for any positive regulation, limiting the time during which it should be -allowed to retain dead bodies in certain dwelling-houses,--such could -only be enforced by an extensive organisation of sanitary police, which -you would have to call into existence for the purpose, and which, in the -present state of public opinion, would encounter insurmountable -difficulties on every occasion of its authoritative interference. - -It is by indirect means and inducements alone, that I can hope at -present to effect the desired alteration; and by them, I think, -something can be ensured toward shortening the delays of interment. - -First, I believe that everything which cheapens the cost of burial, will -conduce to such a result; for, among the poor, one considerable cause of -procrastination must often be the immediate absence of money. The plan -of conveyance and payment which I have suggested, would at least ensure -you against any increase of this difficulty, and might readily be -applied to diminish it. For, under such a system of single payment for -grave and conveyance, it would be practicable, and, I think, most -advantageous, to fix two prices, with a difference of at least five -shillings between them; to charge the lower fee whenever the funeral -should occur within eighty hours of death, the higher whenever this -period should be exceeded. If, by the general adoption of the former -alternative, the Cemetery receipts should be diminished in respect of -artisan funerals, even to the utmost extent--say five or six hundred -pounds per annum--this money, or much more, would have been -advantageously expended in purchasing so great a reform. If, on the -contrary, the immediate option of the working classes should be in -favour of continuing a system so injurious to themselves and to their -neighbours, there would be no injustice in leaving them the incumbrance -of a cost, from which it would require only their own will to escape. -The difference of price would soon be recognised as a municipal tax on -delays of interment;--a tax, rendered legitimate by the public evil -which it is designed to correct, and guarded against remonstrance, -because any man may avoid it who will. And since the delays in question -often arise in a passive habit of the people, founded on no deliberate -intention or reason, I cannot but believe that a well-marked difference -of fee would, as it were, startle the poor into considering the -question, which would come to be of daily argument in their houses:--‘Is -it worth while that our funeral cost should be increased by the amount -of one or two days wages, in order that we may retain within our -dwelling-rooms four days longer, that which every one tells us is -hurtful to ourselves and to others?’ - -It has been suggested to me, that many delays occur owing to Sunday -being considered specially as a funeral day among the labouring classes; -that an equal distribution of burials over the week would be preferable -to this waiting for a particular day; and that the closure of your -Cemetery on Sundays might accordingly be beneficial for the purposes -under consideration. Many arguments will doubtless occur to you, both -for and against the desirability of Sunday interments; but this probably -may be regarded as a point of detail, more fitly to be considered when -your scheme is complete, or even when it has actually given you some -experience of its operation. - -As regards the second point adverted to--the establishment of special -reception-houses for the dead, I do not hesitate to say that, if they -could be brought into general use, their institution would confer great -advantages on the poor. But against this event, at least as an immediate -one, I grieve to see strong probabilities. - -A first proposal made to some mourning household, that they should trust -to strangers’ hands the custody of their unburied dead, would in most -instances greatly and suddenly clash with their customs, and prejudices, -and affections. Whatever success you might have in conquering this -difficulty would of necessity be slow: and my practical familiarity with -the poorer classes makes me so little hopeful of their immediate -acquiescence in the plan, that I should hardly feel justified in urging -you to incur any very large expense, or to embarrass yourselves at -starting with any elaborate machinery, for the sake of so scanty an -expectation. - -The reception-houses of Germany, as you probably know, are founded with -a double intention; partly for the purpose which I am here chiefly -considering--that the dead may be removed from an injurious contiguity -to the living; partly also, that the bodies may be vigilantly observed, -in case of suspended animation. With the latter view, many of them are -specially furnished and specially officered. In that at Frankfort, for -instance, each body is placed in a separate, warmed and ventilated cell; -cords are attached to the fingers in such manner that the slightest -movement occasions the ringing of an alarum; night and day watch is kept -in a central apartment which looks into each cell, and has the several -alarum-bells hung round it; adjacent is a room designed for acts of -resuscitation, with bath, galvanic apparatus and the like, always in -readiness for instant use; and, so long as any corpse lies within the -reception-house, the medical superintendent of the establishment never -goes beyond its walls. Dr. Sutherland, whose report to the General Board -of Health is full of interesting information on the burial-institutions -of the Continent, praises the completeness and ingenuity of these -contrivances; adding, however, that ‘after careful inquiry at all the -cities where he found them to exist, he could not learn that any case of -resuscitation had as yet occurred.’ I may add, too, as regards my own -personal experience in this country, that, with extensive opportunities, -it has never happened to me, either to see any case of suspended -animation where doubts of death and question of interment could arise, -nor to hear in professional circles of any such occurrence, I therefore -think it quite unnecessary to recommend any arrangement of -reception-houses, with reference to the resuscitation of persons -apparently dead. - -The object for which I would desire their institution, is exclusively -that of receiving dead bodies out of the houses of the poor, in order to -mitigate those evils which arise in prolonged retention of the corpse. -That this object is in itself very desirable, and that under the -prevalence of epidemic disease its accomplishment might be of urgent -necessity, you will not doubt: and the responsibility for fulfilling -it--or at least for giving all facilities to its fulfilment, is so -distinctly imposed on you by the letter and spirit of the law, that you -will probably wish to take measures accordingly. - -The extent, then, to which my information on the subject would lead me -to recommend provision to be made, is this: I would advise that -accommodation of an appropriate character (savouring in style rather of -an ecclesiastical construction, than of the workhouse or -dissecting-room) be arranged for the reception of fifty coffins. Tor -this purpose I would suggest--not the building of several separate -reception-houses within the City of London, in order to their being -respectively adjacent to the portions of population which might use -them,--but rather the establishment of one only, and that on the site of -your Cemetery. Thus the conveyance of bodies which would take place -under your auspices, might be made with greater economy, since it could -work into the plan I have already suggested. The advantage of having -only a single edifice (especially since its use is likely to be limited) -and of including its superintendence in the general organisation of -your Cemetery, cannot be questioned. And it seems to me, likewise, that -a building designed for the reception of many dead bodies, cannot -conveniently be established in the heart of the City. - -I would of course recommend that the use of this building should be -entirely optional with the poor, and that its advantages should be -allowed gratuitously to persons burying in your ground: so that any one -who, in respect of his cemetery-fee, would be entitled to have a corpse -conveyed thither for funeral purposes, might claim this conveyance as -soon as he chose after the occurrence of death, and might have the -coffin kept with all proper formalities in the reception-house, till the -moment fixed for its interment. - -On further particulars connected with this part of your arrangements, I -do not think it requisite at present to dwell; especially because, while -I regard the establishment of a reception-house to be quite -indispensable to the complete fulfilment of your new responsibilities, I -still look upon it as an institution to be gradually developed in the -course of years, and according to circumstances yet undetermined, rather -than as something which ought at once to assume its permanent character -and proportions. - - * * * * * - -Here, too, in concluding this introductory report, I may observe that I -have endeavoured as far as possible to avoid encumbering it with detail. -For myself, in its construction, I have thought it indispensable to -pursue the subject into minuter ramifications, to consider a vast number -of circumstances here scarcely mentioned, to make myself acquainted with -the burial customs of other countries, to review a great variety of -opinions and arguments which have been advanced on the several matters -alluded to, and to consult with persons practically versed in them. But -to have brought all this material before you, would have prolonged my -report to an inconvenient extent with no proportionate utility. - -Further, as regards these details of the subject, there are many parts -on which I cannot address you with the confidence that belongs to -personal knowledge. The general principles which I have set before you, -do indeed lie within range of my official and professional observation. -But the next stage of your inquiry relates to matters of special pursuit -with which I am only indirectly conversant: and whatever information I -may have compiled for myself from other sources, you will probably best -obtain at first hand. Practical experience in the construction and -working of Cemeteries has now for many years been the growing knowledge -of persons connected with their administration by ties of business, or -by official appointment. In many instances it has been dearly purchased, -and notorious failures have arisen from its absence. Regard being had to -the magnitude of your undertaking--hitherto unprecedented in the -country, and to the immense interests involved in your success, I cannot -but earnestly hope that such experience may be made available for your -information. - -At an early period you will have to determine what appointments will be -requisite, with a view to the architectural and other designs of your -cemetery, to its economical planning and decorations, to the -superintendence of its daily working, to its financial management, to -the conveyance of bodies, and to all intramural organisation connected -therewith. Minute details will be best considered when these -appointments are made, and when you will naturally have the benefit of -such practical experience as may best assist your deliberations. - -For the task on which you are engaged extends, I need hardly say, far -beyond the purchase of certain acres for your burial-ground. It implies -for its completion, that you shall possess an adequate plan on which the -interment of your population may be managed during many succeeding -generations; a plan constructed, first of all, with entire regard to the -general good of the public, and next, with as little violence as may be -to those habits, prejudices, and interests, which are involved in the -present system of interment. - -The construction of such a plan constitutes a very large question of -municipal policy;--one which, because of its solemn subject, and because -of the degree in which human feelings and affections are involved in it, -requires to be handled with peculiar discretion and delicacy; but which -not the less requires to be contemplated in a large and comprehensive -manner. - -I have therefore thought I should best fulfil the object of your -reference, by bringing before you those general principles which lie at -the root of all minute considerations: in order that, having first -determined on them, and having taken one collective view of the subject, -you may better know at what time, and in what order, and to what extent, -you would wish the minor details to be developed for your information. - - I have the honour, - - &c. &c. - - -THE END. - - - - - STANDARD BOOKS - PUBLISHED BY - JOHN W. 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