Chapter XI: Appendix (1)

1. Evidence of Mr. John Roe, civil engineer, on the practical
improvement in sewerage and drainage tried in the Holborn
and Finsbury divisions of the metropolis 373

2. Evidence of Mr. John Darke, contractor for cleansing, as to
the obstacles to cleansing, and the conversion of the
refuse of the metropolis to productive uses 379

3. Evidence of Mr. John Treble, contractor for cleansing, as to
the obstacles to cleansing, and the conversion of the
refuse of the metropolis to productive uses 380

4. Extract from the report of Fourcroy and others, showing the
calculation of the extent of pollution of the Seine from
the discharge of the refuse of the streets of Paris 381

5. Communication from Captain Vetch, of the Royal Engineers, on
the structural arrangements of new buildings, and
protection of the public health 382

6. Evidence of Mr. George Gutch, district surveyor, on shifting
and building inferior tenements in the suburbs, to avoid
the provisions of the Metropolis building Act 394

7. Estimate by Mr. Howell, of the cost of structural
arrangements of sewerage, drainage, water-tank, and means
of house cleansing for labourers’ tenements in the
metropolis 394

8. Description of specification of Mr. Loudon’s agriculturists’
model cottage 395

9. Statement of the requisites of cottage architecture, by Mr.
Loudon 396

10. Specification of the cost of erection, weekly rents,
interest on the capital invested, and the numbers of the
tenements and cottages occupied by the poor and labourers;
taken from returns made by the relieving officers of their
respective districts in 24 unions in the counties of
Chester, Stafford, Derby, and Lancaster 400

11. Tables of the expense of building cottages and repairs, in
England and Scotland 401

12. Examination of the Rev. Thomas Whateley, Cookham, Berks, on
cottage allotments and the keeping of pigs by cottagers 403

13. Arrangement of public walks in towns: plan of the arboretum
at Derby, laid out by Mr. Loudon 405

14. Boards of Health: report on the labours of the “Conseil de
Salubrité,” of Paris, from 1829 to 1839, by M. Trebuchet 409

16. Qualifications of officers of public health: statement by M.
Duchâtelet 423

17. Instance by MM. Duchâtelet and D’Arcet, of the erroneous
medical inferences as to the insalubrity of particular
trades 424

18. On the habitations of the lower orders of Paris 426

19. On the habitations and lodgings of the lower orders in Paris 428

20. Extract from the report of the commission appointed by the
Central Board of Public Health, to ascertain the condition
of the dwellings of the working classes in Brussels, and
to suggest means for their improvement 429

21. Principles of sanitary police in Germany: extracts from
Professor Mohl 431

22. A report on the statements of Dr. Mauthner, regarding the
sanitary condition of the operatives in the new cotton
manufactures, Vienna, given at the monthly meeting on the
2nd of November, 1841. By Herr L. M. Von Pacher 432

23. Typhus fever, the vast amount of, produced amongst the poor
of Liverpool, from want of ventilation and cleanliness:
extract from Dr. Currie’s medical reports 441

24. Extract from Dr. Ferriar’s “Advice to the Labouring Classes
in Manchester,” given in 1800 441

25. Principles of jurisprudence and responsibility for
accidents: extract from the First Report of the
Commissioners of Inquiry into the Labour of Children in
Factories 442

26. Extract from the report of Mr. John L. Kennedy,
barrister-at-law, to the Commissioners for inquiring into
the Labour of Young Persons in Mines and Manufactories 445

27. Tables of Sickness in prisons 449

28. Tables of Sickness in the wynds of Edinburgh 452

29. Suggested form of notification to owners or occupiers, for
the distribution of the expense of permanent alterations
and the avoidance of overcharges on persons enjoying only
portions of the benefit 453

30. Extracts from evidence as to the moral and physical evils
that may be created by defective arrangements for hiring
and paying workpeople 454

LIST OF PLATES.

Map, exhibiting the track of fever and cholera, and the
badly-cleansed portions of the town of Leeds 160

Map, exhibiting the numbers and places of death from epidemic and
other diseases affected by locality, in the parish of Bethnal
Green, during one year 160

Linear representation of the comparative numbers and progress of
deaths from consumption, from epidemics, and other classes of
disease, in the metropolis, during the two years ended the 1st of
January, 1842 167

Plans and views of habitations for the labouring classes 266

Group of Northumberland cottages, copied from a view given by Dr.
Gilly, canon of Durham;—Group of cottages at Harlaxton, erected
by Gregory Gregory, Esq.;—Plans and elevations of cottages,
erected by the Rev. Benyon de Beauvoir, at Culford,
Suffolk;—Plans of labourers’ cottages, erected by the Earl of
Leicester, at Holkham; by the Earl of Roseberry in Scotland;—Plan
of a new form of labourers’ cottages, erected by Sir Stewart
Monteath, at Closeburn;—Plan of labourers’ cottages, erected by
Messrs. H. and E. Ashworth, at Turton; by S. Greg, Esq., at
Bollington.

Plan, by Mr. Sydney Smirke, of lodging-houses for workmen in towns 274

Section of the chief forms of sewers used in the metropolis 378

Plan of the arrangement of the future increment of towns for the
protection of the sanitary condition and convenience of the
population, by Captain Vetch, of the Royal Engineers 384

General plan of house and street sewerage, and of the construction
of streets favourable to cleansing and dryness, by Captain Vetch 389

Isometrical view of a model agricultural labourer’s cottage, by Mr.
Loudon 396

Isometrical view of a mechanic’s model double cottage, by Mr.
Loudon 398

Furniture of cottages: plans of construction of beds and windows 399

Plans and elevations of labourers’ cottages erected by the Messrs.
H. and E. Ashworth;—Plans and elevations of houses in Birmingham 402

Plan for the arrangement of public walks in restricted space in
towns, as shown in the arrangement of the Arboretum, in Derby, by
Mr. Loudon 406

REPORT
ON THE
SANITARY CONDITION OF THE LABOURING POPULATION,
AND ON
THE MEANS OF ITS IMPROVEMENT.

London, May, 1842.

GENTLEMEN,—Since my special attention was directed to the inquiry as
to the chief removable circumstances affecting the health of the
poorer classes of the population, I have availed myself of every
opportunity to collect information respecting them. In company with
Dr. Arnott I visited Edinburgh and Glasgow, and inspected those
residences that were pointed out by the local authorities as the chief
seats of disease. I also visited Dumfries. An inspection of similar
districts in Spitalfields, Manchester, Leeds, and Macclesfield, and
inquiries formerly made under the Commission of Poor Law Inquiry, and
inspections of the condition of the residences of the poorer classes
in parts of Berkshire, Sussex, and Hertfordshire, had supplied me with
means of comparison. Abandoning any inquiries as to remedies, strictly
so called, or the treatment of diseases after their appearance, I have
directed the examinations of witnesses and the reports of medical
officers chiefly to collect information of the best means available as
preventives of the evils in question. On the documentary evidence of
the medical officers, and on the examinations of witnesses, aided by
personal inspections, I have the honour to report as follows:—

Partial descriptions of the condition of the labouring classes, in
respect to their residences and the habits which influence their
health, afford but a faint conception of the evils which are the
subject of inquiry. If only particular instances, or some groups of
individual cases be adduced, the erroneous impression might be created
that they were cases of comparatively infrequent occurrence. But the
following tabular return made up from the registration of the causes
of death in England and Wales, which is the most complete yet
attained, will give a sufficiently correct conception of the extent of
the evils in question, when illustrated by the evidence of
eye-witnesses, the medical officers whose duty it has been to attend
on the spot and alleviate them. The table comprehends the abstract of
the returns of the deaths from the chief diseases, which the medical
officers consider to be the most powerfully influenced by the physical
circumstances under which the population is placed—as the external and
internal condition of their dwellings, drainage, and ventilation.

_To the Poor Law Commissioners._

_Deaths in Counties from Diseases governed by Locality._

┌───────────┬───────────────────────────────────────┐ │ │ │ │ │ │ │ │ │ │ │ │ │ COUNTIES. │Number of Deaths during the Year ended │ │ │ 31st December, 1838 from │ │ │ │ │ │ │ │ │ │ │ ├───────────────────────────────────────┤ │ │ │ │ │ │ │ │ 1 │ │ │ Epidemic, Endemic, and Contagious │ │ │ Diseases. │ │ │ │ │ │ │ │ ├───────────┬──────────┬────────┬───────┤ │ │ Fever: │ │ │Hooping│ │ │ Typhus, │Small-pox.│Measles.│Cough. │ │ │Scarlatina.│ │ │ │ ├───────────┼───────────┼──────────┼────────┼───────┤ │ ENGLAND. │ │ │ │ │ │Bedford │ 155│ 75│ 40│ 66│ │Berks │ 204│ 288│ 21│ 86│ │Bucks │ 256│ 85│ 61│ 27│ │Cambridge │ 231│ 136│ 57│ 90│ │Chester │ 592│ 279│ 178│ 87│ │Cornwall │ 443│ 135│ 168│ 491│ │Cumberland │ 165│ 188│ 11│ 83│ │Derby │ 394│ 77│ 79│ 71│ │Devon │ 615│ 460│ 287│ 312│ │Dorset │ 137│ 255│ 80│ 58│ │Durham │ 347│ 316│ 139│ 304│ │Essex │ 417│ 460│ 83│ 163│ │Gloucester │ 352│ 457│ 440│ 244│ │Hereford │ 84│ 83│ 17│ 36│ │Hertford │ 160│ 116│ 45│ 48│ │Huntingdon │ 61│ 18│ 1│ 17│ │Kent │ 955│ 510│ 169│ 214│ │Lancaster │ 2866│ 1628│ 898│ 910│ │Leicester │ 273│ 98│ 17│ 70│ │Lincoln │ 370│ 138│ 29│ 88│ │Middlesex │ 4422│ 3359│ 487│ 1749│ │Monmouth │ 328│ 321│ 49│ 91│ │Norfolk │ 515│ 126│ 63│ 109│ │Northampt^n│ 348│ 148│ 36│ 36│ │Northumb^d │ 366│ 149│ 46│ 113│ │Nottingham │ 222│ 73│ 18│ 80│ │Oxford │ 222│ 81│ 51│ 59│ │Rutland │ 11│ 2│ │ 13│ │Salop │ 213│ 154│ 112│ 138│ │Somerset │ 560│ 710│ 401│ 46│ │Southampt^n│ 454│ 164│ 78│ 148│ │Stafford │ 610│ 249│ 182│ 268│ │Suffolk │ 480│ 325│ 53│ 158│ │Surrey │ 1348│ 814│ 177│ 565│ │Sussex │ 391│ 80│ 159│ 88│ │Warwick │ 454│ 415│ 153│ 164│ │Westmorel^d│ 41│ 40│ 6│ 41│ │Wilts │ 246│ 259│ 263│ 140│ │Worcester │ 381│ 305│ 122│ 258│ │York, E. R.│ 194│ 92│ 167│ 149│ │York, N. R.│ 123│ 28│ 69│ 114│ │York, W. R.│ 1298│ 993│ 799│ 507│ │ │ │ │ │ │ │ WALES. │ │ │ │ │ │North. │ 660│ 575│ 4│ 210│ │South. │ 1613│ 1004│ 199│ 398│ ├───────────┼───────────┼──────────┼────────┼───────┤ │Total, 1838│ 24,577│ 16,268│ 6514│ 9107│ ╞═══════════╪═══════════╪══════════╪════════╪═══════╡ │Total, 1839│ 25,991│ 9131│ 10,937│ 8165│ └───────────┴───────────┴──────────┴────────┴───────┘

┌───────────┬────────────────────────────────┐ │ │ │ │ │ │ │ │ │ │ │ │ │ COUNTIES. │Number of Deaths during the Year│ │ │ ended 31st December, 1838 from │ │ │ │ │ │ │ │ │ │ │ ├────────────────────────────────┤ │ │ │ │ │ │ │ │ 2 │ │ │ Diseases of Respiratory Organs │ │ │ │ │ │ │ │ │ │ │ ├────────────┬──────────┬────────┤ │ │ │ │ All │ │ │Consumption.│Pneumonia.│ other │ │ │ │ │Classes.│ ├───────────┼────────────┼──────────┼────────┤ │ ENGLAND. │ │ │ │ │Bedford │ 457│ 97│ 57│ │Berks │ 739│ 231│ 162│ │Bucks │ 575│ 131│ 61│ │Cambridge │ 686│ 156│ 70│ │Chester │ 1742│ 366│ 345│ │Cornwall │ 1270│ 342│ 124│ │Cumberland │ 562│ 75│ 142│ │Derby │ 905│ 200│ 205│ │Devon │ 1649│ 564│ 298│ │Dorset │ 571│ 146│ 106│ │Durham │ 1007│ 362│ 207│ │Essex │ 1250│ 276│ 234│ │Gloucester │ 1395│ 578│ 476│ │Hereford │ 333│ 56│ 57│ │Hertford │ 620│ 107│ 90│ │Huntingdon │ 216│ 45│ 42│ │Kent │ 1701│ 564│ 526│ │Lancaster │ 8124│ 2660│ 1916│ │Leicester │ 941│ 243│ 154│ │Lincoln │ 874│ 248│ 242│ │Middlesex │ 6220│ 3097│ 2334│ │Monmouth │ 481│ 183│ 78│ │Norfolk │ 1388│ 325│ 281│ │Northampt^n│ 762│ 192│ 124│ │Northumb^d │ 715│ 287│ 240│ │Nottingham │ 911│ 225│ 201│ │Oxford │ 655│ 108│ 152│ │Rutland │ 64│ 14│ 8│ │Salop │ 995│ 242│ 168│ │Somerset │ 1446│ 426│ 373│ │Southampt^n│ 1222│ 338│ 331│ │Stafford │ 1809│ 539│ 419│ │Suffolk │ 1306│ 315│ 184│ │Surrey │ 2196│ 978│ 700│ │Sussex │ 1047│ 222│ 181│ │Warwick │ 1495│ 678│ 361│ │Westmorel^d│ 248│ 33│ 44│ │Wilts │ 869│ 268│ 212│ │Worcester │ 990│ 353│ 235│ │York, E. R.│ 725│ 194│ 176│ │York, N. R.│ 550│ 102│ 135│ │York, W. R.│ 4253│ 1202│ 848│ │ │ │ │ │ │ WALES. │ │ │ │ │North. │ 1227│ 102│ 223│ │South. │ 1834│ 129│ 277│ ├───────────┼────────────┼──────────┼────────┤ │Total, 1838│ 59,025│ 17,999│ 13,799│ ╞═══════════╪════════════╪══════════╪════════╡ │Total, 1839│ 59,559│ 18,151│ 12,855│ └───────────┴────────────┴──────────┴────────┘

┌───────────┬───────────────────────────────┬───────────┬───────────┐ │ │ │Proportion │Proportion │ │ │ │ of Deaths │ of Deaths │ │ │ │ from the │ from all │ │ │ │ preceding │ Causes of │ │ COUNTIES. │ Number of Deaths during the │ Causes in │ Mortality │ │ │Year ended 31st December, 1838 │every 1000 │ in every │ │ │ from │ of the │1000 of the│ │ │ │Population,│Population,│ │ │ │ 1841. │ 1841. │ │ ├─────────┬─────────┬───────────┤ │ │ │ │ 3 │ │ │ │ │ │ │Diseases │ 4 │ Total │ │ │ │ │of Brain │Diseases │Deaths from│ │ │ │ │ Nerves │ of │ the four │ │ │ │ │ and │Digestive│ preceding │ │ │ │ │ Senses. │ Organs │Classes of │ │ │ │ │ │ │ Diseases. │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ ├───────────┼─────────┼─────────┼───────────┼───────────┼───────────┤ │ ENGLAND. │ │ │ │ │ │ │Bedford │ 304│ 131│ 1382│ 13│ 22│ │Berks │ 467│ 201│ 2399│ 15│ 25│ │Bucks │ 348│ 152│ 1696│ 11│ 19│ │Cambridge │ 318│ 189│ 1933│ 12│ 21│ │Chester │ 1442│ 421│ 5452│ 14│ 21│ │Cornwall │ 631│ 228│ 3832│ 11│ 18│ │Cumberland │ 278│ 169│ 1673│ 9│ 21│ │Derby │ 777│ 268│ 2976│ 11│ 18│ │Devon │ 1237│ 471│ 5893│ 11│ 18│ │Dorset │ 380│ 159│ 1892│ 11│ 19│ │Durham │ 1138│ 274│ 4094│ 13│ 21│ │Essex │ 782│ 268│ 3933│ 11│ 19│ │Gloucester │ 1142│ 510│ 5594│ 13│ 20│ │Hereford │ 238│ 62│ 966│ 8│ 18│ │Hertford │ 453│ 155│ 1794│ 11│ 20│ │Huntingdon │ 140│ 72│ 612│ 10│ 18│ │Kent │ 1650│ 651│ 6940│ 13│ 21│ │Lancaster │ 7457│ 3231│ 29690│ 18│ 25│ │Leicester │ 668│ 314│ 2778│ 13│ 21│ │Lincoln │ 1090│ 358│ 3437│ 9│ 17│ │Middlesex │ 6643│ 2492│ 30803│ 20│ 27│ │Monmouth │ 550│ 100│ 2181│ 16│ 24│ │Norfolk │ 793│ 395│ 3995│ 10│ 19│ │Northampt^n│ 503│ 212│ 2361│ 12│ 21│ │Northumb^d │ 709│ 388│ 3013│ 12│ 21│ │Nottingham │ 901│ 287│ 2918│ 12│ 20│ │Oxford │ 389│ 180│ 1897│ 12│ 21│ │Rutland │ 56│ 28│ 196│ 9│ 17│ │Salop │ 550│ 284│ 2856│ 12│ 21│ │Somerset │ 982│ 473│ 5417│ 12│ 21│ │Southampt^n│ 881│ 372│ 3988│ 17│ 19│ │Stafford │ 1251│ 597│ 5924│ 12│ 18│ │Suffolk │ 538│ 275│ 3634│ 12│ 20│ │Surrey │ 2325│ 763│ 9866│ 11│ 25│ │Sussex │ 863│ 295│ 3326│ 11│ 18│ │Warwick │ 978│ 638│ 5336│ 13│ 20│ │Westmorel^d│ 154│ 46│ 653│ 12│ 21│ │Wilts │ 606│ 241│ 3104│ 12│ 20│ │Worcester │ 645│ 446│ 3735│ 16│ 29│ │York, E. R.│ 1009│ 251│ 2957│ 13│ 21│ │York, N. R.│ 553│ 1861│ │ 9│ 17│ │York, W. R.│ 4374│ 1494│ 15768│ 14│ 21│ │ │ │ │ │ │ │ │ WALES. │ │ │ │ │ │ │North. │ 1311│ 198│ 4510│ 13│ 18│ │South. │ 1200│ 380│ 7034│ 14│ 21│ ├───────────┼─────────┼─────────┼───────────┼───────────┼───────────┤ │Total, 1838│ 49,704│ 19,306│ 216,299│ 14│ 22│ ╞═══════════╪═════════╪═════════╪═══════════╪═══════════╪═══════════╡ │Total, 1839│ 49,215│ 20,767│ 214,771│ 14│ 21│ └───────────┴─────────┴─────────┴───────────┴───────────┴───────────┘

Extent of evils which are the subject of inquiry

The registration of the causes of death for the year 1838 is selected, as that was the year when the report was made on the sanitary condition of the labouring population in the metropolis, which has served as the foundation of the extended inquiry.

There are no returns, and no adequate data for returns, to show the proportion in which deaths from the several causes above specified occur amongst the population of Scotland, but there is evidence to which reference will subsequently be made tending to prove that the mortality from fever is greater in Glasgow, Edinburgh, and Dundee than in the most crowded towns in England.

The registered mortality from all specified diseases in England and Wales was, during the year 1838, 282,940, or 18 per thousand of the population. These deaths are exclusive of the deaths from old age, which amounted to 35,564, and the deaths from violence, which amounted to 12,055. The deaths from causes not specified were 11,970. The total amount of deaths was 342,529 for that year. In the year following the total deaths were 338,979, of which the registered deaths from old age were 35,063, and the deaths from violence 11,980. The proportion of deaths for the whole population was 21 per thousand.

It appears that fever, after its ravages amongst the infant population, falls with the greatest intensity on the adult population in the vigour of life. The periods at which the ravages of the other diseases, consumption, small-pox, and measles take place, are sufficiently well known. The proportions in which the diseases have prevailed in the several counties will be found deserving of peculiar attention.

A conception may be formed of the aggregate effects of the several causes of mortality from the fact, that of the deaths caused during one year in England and Wales by epidemic, endemic, and contagious diseases, including fever, typhus, and scarlatina, amounting to 56,461, the great proportion of which are proved to be preventible, it may be said that the effect is as if the whole county of Westmoreland, now containing 56,469 souls, or the whole county of Huntingdonshire, or any other equivalent district, were entirely depopulated annually, and were only occupied again by the growth of a new and feeble population living under the fears of a similar visitation. The annual slaughter in England and Wales from preventible causes of typhus which attacks persons in the vigour of life, appears to be double the amount of what was suffered by the Allied Armies in the battle of Waterloo. It will be shown that diseases such as those which now prevail on land, did within the experience of persons still living, formerly prevail to a greater extent at sea, and have since been prevented by sanitary regulations; and that when they did so prevail in ships of war, the deaths from them were more than double in amount of the deaths in battle. But the number of persons who die is to be taken also as the indication of the much greater number of persons who fall sick, and who, although they escape, are subjected to the suffering and loss occasioned by attacks of disease. Thus it was found on the original inquiry in the metropolis, that the deaths from fever amounted to 1 in 10 of the number attacked. If this proportion held equally throughout the country, then a quarter of a million of persons will have been subjected to loss and suffering from an attack of fever during the year; and in so far as the proportions of attacks to deaths is diminished, so it appears from the reports is the intensity and suffering from the disease generally increased. It appears that the extremes of mortality at the Small-pox Hospital, in London, amongst those attacked, have been 15 per cent. and 42 per cent. But if, according to other statements, the average mortality be taken at 1 in 5, or 20 per cent., the number of persons attacked in England and Wales during the year of the return, must amount to upwards of 16,000 persons killed, and more than 80,000 persons subjected to the sufferings of disease, including, in the case of the labouring classes, the loss of labour and long-continued debility; and in respect to all classes, often permanent disfigurement, and occasionally the loss of sight.

In a subsequent part of this report, evidence will be adduced to show in what proportion these causes of death fall upon the poorer classes as compared with the other classes of society inhabiting the same towns or districts, and in what proportions the deaths fall amongst persons of the same class inhabiting districts differently situated.

The first extracts present the subjects of the inquiry in their general condition under the operation of several causes, yet almost all will be found to point to one particular, namely, atmospheric impurity, occasioned by means within the control of legislation, as the main cause of the ravages of epidemic, endemic, and contagious diseases among the community, and as aggravating most other diseases. The subsequent extracts from the sanitary reports from different places will show that the impurity and its evil consequences are greater or less in different places, according as there is more or less sufficient drainage of houses, streets, roads, and land, combined with more or less sufficient means of cleansing and removing solid refuse and impurities, by available supplies of water for the purpose. Then will follow the description of the effects of overcrowding the places of work and dwellings, including the effects of the defective ventilation of dwelling-houses, and of places of work where there are fumes or dust produced. To these will be added the information collected as to the good or evil moral habits promoted by the nature of the residence. These will form so many successive sections of the report, and will be followed by information in respect to the means available for the prevention of the evils described, and an exposition of the present state of the law for the protection of the public health, and of modifications apparently requisite to secure the desired results.

I.—GENERAL CONDITION OF THE RESIDENCES OF THE LABOURING CLASSES WHERE
DISEASE IS FOUND TO BE THE MOST PREVALENT.

The following extracts will serve to show, in the language chiefly of eye-witnesses, the varied forms in which disease attendant on removable circumstances appears from one end of the island to the other amidst the population of rural villages, and of the smaller towns, as well as amidst the population of the commercial cities and the most thronged of the manufacturing districts—in which last pestilence is frequently supposed to have its chief and almost exclusive residence.

Commencing with the reports on the sanitary condition of the population in Cornwall and Devon, _Mr. Gilbert_, when acting as Assistant Commissioner for those counties, reports, that he found the open drains and sewers the most prominent cause of malaria. He gives the following as an instance of the common condition of the dwellings of the labouring classes in Devon, where it will be observed that the registered deaths from the four classes of disease amounted in one year to 5893 cases.

“In Tiverton there is a large district, from which I find numerous
applications were made for relief to the Board of Guardians, in
consequence of illness from fever. The expense in procuring the
necessary attention and care, and the diet and comforts recommended by
the medical officer, were in each case very high, and particularly
attracted my attention.

“I requested the medical officer to accompany me through the district,
and with him, and afterwards by myself, I visited the district, and
examined the cottages and families living there. The land is nearly on
a level with the water, the ground is marshy, and the sewers all open.
Before reaching the district, I was assailed by a most disagreeable
smell; and it was clear to the sense that the air was full of most
injurious malaria. The inhabitants, easily distinguishable from the
inhabitants of the other parts of the town, had all a sickly,
miserable appearance. The open drains in some cases ran immediately
before the doors of the houses, and some of the houses were surrounded
by wide open drains, full of all the animal and vegetable refuse not
only of the houses in that part, but of those in other parts of
Tiverton. In many of the houses, persons were confined with fever and
different diseases, and all I talked to either were ill or had been
so: and the whole community presented a melancholy spectacle of
disease and misery.

“Attempts have been made on various occasions by the local authorities
to correct this state of things by compelling the occupants of the
houses to remove nuisances, and to have the drains covered; but they
find that in the present state of the law their powers are not
sufficient, and the evil continues and is likely so to do, unless the
legislature affords some redress in the nature of sanitary powers.
Independently of this nuisance, Tiverton would be considered a fine
healthy town, situate as it is on the slope of a hill, with a swift
river running at its foot.

“It is not these unfortunate creatures only who choose this centre of
disease for their living-place who are affected; but the whole town is
more or less deteriorated by its vicinity to this pestilential mass,
where the generation of those elements of disease and death is
constantly going on.

“Another cause of disease is to be found in the state of the cottages.
Many are built on the ground without flooring, or against a damp hill.
Some have neither windows nor doors sufficient to keep out the
weather, or to let in the rays of the sun, or supply the means of
ventilation; and in others the roof is so constructed or so worn as
not to be weather tight. The thatch roof frequently is saturated with
wet, rotten, and in a state of decay, giving out malaria, as other
decaying vegetable matter.”

The report of _Dr. Barham_, on the sanitary condition of the town of Truro, gives instances of the condition of the town population in that part of the country. He states—

“The perfect immunity from deaths by _febrile_ and _acute_ diseases,
enjoyed by Lemon-street during the long period of three years and a
half, is a strong testimony to the value of the breadth of its
roadway, the openness of its site, and the judicious construction of
the houses; for it has to contend with a great deficiency of sewerage.
Fairmantle and Daniell-streets are modern, and are occupied by small
traders, and by decent artisans and labourers; the _former_ lies
rather low, the _latter_ is on a considerable elevation; both are
fairly drained, and are healthy. Charles, Calenick, and Kenwyn-streets
present some of the worst specimens of defective arrangement, rendered
worse still by the recklessness of the very poor, which can be met
with in Truro. The amount of _pauper sickness_ is considerable, the
deaths not few. The two latter streets are, in the greater part of
their length, but little raised above high-water mark. Passing into
_St. Mary’s_ parish, the proportion of sickness and even of deaths in
Castle-street and Castle-hill is, to their extent and population, as
great, perhaps, as that of any part of Truro; yet their situation is
elevated and favourable. There is, however, no mystery in the
causation. Ill-constructed houses, many of them old, with decomposing
refuse close upon their doors and windows, open drains bringing the
oozings of pigsties and other filth to stagnate at the foot of a wall,
between which and the entrances to a row of small dwellings there is
only a very narrow passage; such are a few of the sources of disease
which the breeze of the hill cannot always dissipate. Similar causes
have produced like effects in the courts adjacent to Pyder-street, to
the High Cross, and to St. Clement’s-streets, and in Bodmin-street and
Good-wives’-lane, the situations being all more or less confined. The
benefits, on the other hand, derived from open rows, and cottages of a
better construction are evidenced in Boscawen and Paul’s-row, and St.
Clements’-terrace, which are well ventilated, and consequently suffer
less from the scanty provision of drains and other conveniences.

“A detailed account of the public sewers is given in the Appendix, and
is believed to be nearly, if not quite, complete. Many of these are of
recent date, and owe their existence to the alarm excited when the
cholera was near at hand. Some of them are made to discharge
themselves into the rivers; and such of these as are swept by a stream
of water are unobjectionable in themselves. Several others stop short
of this desirable termination, and, after collecting filth from
various localities, deposit a portion in catch-pits here and there,
and finally open on the surface, frequently in some street or lane,
where a neglected deposit of a mixed animal and vegetable nature is
allowed to become a probable source of annoyance or mischief. Much of
this incompleteness may be removed (as regards the main lines of
sewerage) at no great expense; and it is said to be the intention of
the commissioners of improvement to remedy the deficiency, when they
are free from the debt with which they are now encumbered. Many of the
smaller sewers are, however, much too narrow to be effective, and some
of them are no better than covered drains. But the greatest evils in
this department are unquestionably those which spring from the
ignorance, cupidity, or negligence of landlords. It is useless to have
a good sewer carried through the centre of a street, if the houses at
the sides, and still more those situated in courts and lanes
adjoining, have no communicating drains; and it is worse than useless
to furnish these backlets with the mere semblance of drains—gutters
forming pits here and there—then as they approach the street, perhaps
slightly covered so as to produce obstruction more frequently than
protection, a concentrated solution of all sorts of decomposing refuse
being allowed to soak through and thoroughly impregnate the walls and
ground adjoining. One or more of these mischievous conditions is to be
found in connexion with a large proportion of the older houses in
Truro, excepting the better class; and in many of the courts and
backlets all these evils are in full operation. I have repeatedly
noticed in the country that the occurrence of fever has been connected
with _near proximity to even a small amount of decomposing organic
matter_; and it is certain that all measures for effecting improvement
in the sewerage of streets, the supply of water, and ventilation, may
be rendered nearly inoperative for the obviating of the causes of
disease, if a little nidus of morbific effluvia be permitted to remain
in almost every corner of the confined court; where the poor man opens
his narrow habitation in the hope of refreshing it with the breeze of
summer, but gets instead a mixture of gases from reeking dunghills,
or, what is worse, because more insidious, from a soil which has
become impregnated with organic matters imbibed long before; and now,
though, perhaps, to all appearance dry and clean, emitting the
poisonous vapour in its most pernicious state. Nothing short of the
placing in proper hands a peremptory authority for the removal of what
is hurtful, and the supply of what is defective, making the exercise
of that authority a duty, can remedy the existing evils.

“The houses occupied by the lower orders do not often exceed two
stories in height, and it is rare to find families occupying less than
two rooms. The more recent additions to the town—I speak of residences
of the humbler class—have mainly consisted of rows of moderate
cottages, having, the majority of them, gardens in front, and usually
containing four rooms, commonly occupied by a single family. Some
instances have, however, occurred of the building of a very inferior
class of dwellings, which will be hereafter pointed out.

“No interments now take place in the town, the present burying-ground
being at the distance of a third of a mile to the north of the church.
The slaughter-houses are all, or nearly all, situated in populous
parts, and occasionally constitute a decided nuisance. No
manufactories exist which can be looked upon as prejudicial from any
effluvia to which they give rise. The gas-works and smelting-houses
are so placed that no mischievous effects can fairly be attributed to
them.”

The state of the dwellings of many of the agricultural labourers in Dorset, where the deaths from the four classes of disease bear a similar proportion to those in Devon, is described in the return of _Mr. John Fox_, the medical officer of the Cerne union, who, remarking upon some cases of disease among the poor whom he had attended, says,—

“These cases (of diarrhœa and common fever) occurred in a house
(formerly a poor house) occupied by nearly 50 persons on the
ground-floor; the rooms are neither boarded nor paved, and generally
damp; some of them are occupied by two families. The up-stairs rooms
are small and low, and separated from each other by boards only.
Eleven persons slept in one room. The house stands in a valley between
two hills, very little above the level of the river, which
occasionally overflows its banks, and within a few yards of it. There
is generally an accumulation of filth of every description in a gutter
running about two feet from its front, and a large cesspool within a
few feet behind. The winter stock of potatoes was kept in some of the
day-rooms, and generally put away in a wet state. The premises had not
been white-limed during three years; in addition to this state of
things, the poor were badly fed, badly clothed, and many of them
habitually dirty, and consequently typhus, synochus, or diarrhœa,
constantly prevailed. No house-rent was paid by the occupants. Many,
under more favourable circumstances were clean and tidy, and if their
wages were sufficient to enable them to rent a decent cottage, I have
no doubt they would soon regain their lost spirit of cleanliness. In
this same parish I have often seen the springs bursting through the
_mud_ floor of some of the cottages, and little channels cut from the
centre under the doorways to carry off the water, whilst the door has
been removed from its hinges for the children to put their feet on
whilst employed in making buttons. Is it surprising that fever and
scrofula in all its forms prevail under such circumstances?

“It is somewhat singular that seven cases of typhus occurred in one
village heretofore famed for the health and general cleanliness of its
inhabitants and cottages. The first five cases occurred in one family,
in a detached house on high and dry ground, and free from
accumulations of vegetable or animal matter. The cottage was
originally built for a school-room, and consists of one room only,
about 18 feet by 10, and 9 high. About one-third part was partitioned
off by boards reaching to within three feet of the roof, and in this
small space were three beds, in which six persons slept; had there
been two bed-rooms attached to this one day-room, these cases of
typhus would not have occurred. The fatal case of typhus occurred in a
very small village, containing about sixty inhabitants, and from its
locality it appears favourable to the production of typhus, synochus,
and acute rheumatism. It stands between two hills, with a river
running through it, and is occasionally flooded. It has extensive
water meadows both above and below, and a farm-yard in the centre,
where there is always a large quantity of vegetable matter undergoing
decomposition. Most of the cases of synochus occurred under
circumstances favourable to its production. Most of the cottages being
of the worst description, some mere mud hovels, and situated in low
and damp places with cesspools or accumulations of filth close to the
doors. The _mud floors_ of many are much below the level of the road,
and in wet seasons are little better than so much clay. The following
shocking case occurred in my practice. In a family consisting of six
persons, two had fever; the mud floor of their cottage was at least
one foot below the lane; it consisted of _one_ small room only, in the
centre of which stood a foot-ladder reaching to the edge of a platform
which extended over nearly one-half of the room, and upon which were
placed two beds, with space between them for one person only to stand,
whilst the outside of each touched the thatch. The head of one of
these beds stood within six inches of the edge of the platform, and in
this bed one of my unfortunate patients, a boy about 11 years old, was
sleeping with his mother, and in a fit of delirium jumped over the
head of his bed and fell to the ground below, a height of about seven
feet. The injury to the head and spine was so serious that he lived a
few hours only after the accident. In a cottage fit for the residence
of a human being this could not have occurred. In many of the
cottages, also, where synochus prevailed, the beds stood on the
ground-floor, which was damp three parts of the year; scarcely one had
a fire-place in the bed-room, and one had a single small pane of glass
stuck in the mud wall as its only window, with a large heap of wet and
dirty potatoes in one corner. Persons living in such cottages are
generally very poor, very dirty, and usually in rags, living almost
wholly on bread and potatoes, scarcely ever tasting animal food, and
consequently highly susceptible of disease and very unable to contend
with it. I am quite sure if such persons were placed in good,
comfortable, clean cottages, the improvement in themselves and
children would soon be visible, and the exceptions would only be found
in a few of the poorest and most wretched, who perhaps had been born
in a mud hovel, and had lived in one the first 30 years of their
lives.

“In my district I do not think there is _one_ cottage to be found
consisting of a day-room, three bed-rooms, scullery, pantry, and
convenient receptacles for refuse and for fuel in the occupation of a
labourer, but there are many consisting of a day-room and two
bed-rooms, constructed with a due regard to ventilation and warmth,
pantry, and fuel house, with a small garden and pigsty adjoining, and
the labourers occupying such cottages, generally speaking, are far
superior to others less advantageously situated. Their persons and
cottages are always neater and cleaner, they are less disposed to
frequent the beer-houses or to engage in poaching, whilst their
children are generally sent daily to some school, in many instances
chiefly supported by the clergyman of the parish. As a corroboration
of my opinion, I need only state that I am frequently employed by the
labourers in the good cottages to attend their wives during their
confinement, and generally receive my guinea before I leave the house,
whilst the labourer less favourably situated invariably applies to his
parish for medical relief under such circumstances. I think there
cannot be a doubt if the whole of the wretched hovels were converted
into good cottages, with a strict attention to warmth, ventilation,
and drainage, and a receptacle for filth of every kind placed at a
proper distance, it would not only improve the health of the poor by
removing a most prolific source of disease, and thereby most sensibly
diminish the rates, but I am convinced it would also tend most
materially to raise the moral character of the poor man, and render
him less susceptible to the allurements of the idle and wicked.”

The tenor of much information respecting the condition of many of the labouring classes in Somerset, where the deaths from the four classes of disease were still higher than in the two other counties, and amounted during the one year to 5417, is exhibited in the sanitary report of _Mr. James Gane_, the medical officer of the Axbridge union, who states that,—

“The situation of this district where the diseases herein mentioned
prevail, is a perfect flat called the South Marsh, in the main road
between Bristol and Bridgewater. There are numerous dykes or ditches
for the purpose of drainage. The cottages of the poor are mostly of a
bad description, frequently mud wall, and often situated close to the
dykes, where the water for the most part is in a state of stagnation.
Oftentimes not more than one room for the whole family; sometimes two;
one above the other; with the really poor, the latter is seldom to be
met with, (unless it should happen now and then in a parish where a
poor-house was built a short time before the formation of the Union).
A pigsty where the inmates are capable of keeping a pig is frequently
attached to the dwelling, and in the heat of summer produces a stench
quite intolerable; the want of space however prevents it being
otherwise. The regular poor-house (those mentioned above being
detached cottages) in most of the parishes in this district are of a
much worse description, several large families existing under the same
roof, occupying only one room each family, and having but one entrance
door to the dwelling; here filth and poverty go hand-in-hand without
any restriction and under no control. The accumulation of filth being
attributable to the want of proper receptacles for refuse, and the
indolent and filthy disposition of the inhabitants, in no instance
_have_ such places been provided. The floors are seldom or never
scrubbed; and the parish authorities pay so little attention to these
houses, that the walls never get white-limed from one end of the year
to the other. The windows are kept air-tight by the stuffing of some
old garments, and every article for use is kept in the same room. The
necessary is close to the building, where all have access, and
producing a most intolerable nuisance. In a locality naturally
engendering malaria, the diseases with which the poor are for the most
part afflicted are, fevers such as are stated in this report and which
sometimes run into a low typhoid state. The neighbourhood in general
is considered in as good a state of drainage as it will admit of. The
occurrence of disease among the poor population is for the most part
at spring and autumn, at those times agues and fevers prevail.
Small-pox and scarlet fever are met with at all seasons of the year,
but prevail as epidemics, the former in spring and summer, and the
latter about autumn or the beginning of winter. I attribute the
prevalence of diseases of an epidemic character, which exists so much
more among the poor than among the rich, to be, from the want of
better accommodation as residence, (their dwelling instead of being
built of solid materials are complete shells of mud on a spot of waste
land the most swampy in the parish, this is to be met with almost
everywhere in rural districts,) to the want of better clothing, being
better fed, more attention paid to the cleanliness of their dwellings,
and less congregated together. The health of persons even where a
large family is, and where superior cottage accommodation is afforded
to them, is much better generally than others less advantageously
situated. The influence over their habits will also be very
beneficial, they will be less likely to run to a beer-house with their
last penny, the comforts of a home after the toils of the day keeps
them by their own fireside; they become better contented, less liable
to disease, make better husbands, better fathers, better neighbours,
and with each other better friends. There is a subject which I wish
particularly to press on the attention of the Commissioners; the
presence throughout the country, and to be found in every parish, of
low lodging-houses, where persons of the lowest grade of society,
beggars, thieves, and such like, take up a temporary abode in passing
from one part of the kingdom to another, bringing with them the seeds
of infectious diseases and oftentimes the actual disease itself into a
neighbourhood previously in a comparative state of health. I have
observed, where persons are living in a locality habitually affected
with malaria, that when becoming convalescent from any other disease,
are often attacked with ague, more particularly among the poorer
classes.

“There is a class of persons called the ‘second poor,’ who for the
most part are constantly employed throughout the year as farmers’
labourers, and who are in much better circumstances than those to whom
I have above alluded; they have much better cottage accommodation,
their houses being provided with one, sometimes two day-rooms, two
bed-rooms, a pantry, and other conveniences for fuel and for refuse,
and whose general health and condition is much better than those less
advantageously situated. Therefore detached cottages for the poor,
with a moderate sized day-room, two or three bed-rooms, a pantry,
receptacles for refuse and for fuel, with casement windows or some
such contrivance for ventilation, will be a blessing to them, and very
available sanitary regulations. I know of no better method than is to
be seen in all cottages for the economical management of fuel, both in
cooking and maintaining a proper temperature of the rooms.”

The following extract from the report of _Mr. Aaron Little_, the medical officer of the Chippenham union, affords a specimen of the frequent condition of rural villages which have apparently the most advantageous sites:—

“The parish of Colerne, which, upon a cursory view, any person
(unacquainted with its peculiarities) would pronounce to be the most
healthy village in England, is in fact the most unhealthy. From its
commanding position (being situated upon a high hill) it has an
appearance of health and cheerfulness which delight the eye of the
traveller, who commands a view of it from the Great Western road, but
this impression is immediately removed on entering at any point of the
town. The filth, the dilapidated buildings, the squalid appearance of
the majority of the lower orders, have a sickening effect upon the
stranger who first visits this place. During three years’ attendance
on the poor of this district, I have never known the small-pox,
scarlatina, or the typhus fever to be absent. The situation is damp,
and the buildings unhealthy, and the inhabitants themselves inclined
to be of dirty habits. There is also a great want of drainage.”

_Mr. William Blower_, the surgeon of the Bedford union, to whose evidence on the influence of moral causes on the health of the population, we shall again have occasion to refer, states:—

“Throughout the whole of this district, there is a great want of
‘superior cottage accommodation.’ Most of the residences of the
labourers are thickly inhabited, and many of them are damp, low, cold,
smoky, and comfortless. These circumstances occasion the inmates to be
sickly in the winter season, but I have not observed them to generate
typhus, the prevailing form of disease being principally catarrhal;
such as colds, coughs, inflammations of the eyes, dysentery,
rheumatism, &c. However, when any contagious or epidemic malaria
occurs, the cases are generally more numerous.”

_Mr. Weale_ reports instances of the condition of large proportions of the agricultural population in the counties of Bedford, Northampton, and Warwick. The medical officer of the Woburn union states, in respect to Toddington, that—

“In this town fever prevailed during the last year, and, from the
state of the dwellings of the persons I called on, this could not be
wondered at. Very few of the cottages were furnished with privies that
could be used, and contiguous to almost every door a dung heap was
raised on which every species of filth was accumulated, either for the
purpose of being used in the garden allotments of the cottagers, or to
be disposed of for manure. Scarcely any cottage was provided with a
pantry, and I found the provisions generally kept in the bed-rooms. In
several instances I found whole families, comprising adult and infant
children with their parents, sleeping in one room.”

The medical officer of the Ampthill union states:—

“Typhus fever has existed for the last three or four months in the
parish of Flitwick, and although the number of deaths has not been
considerable as compared with the progress of the disease, new cases
have occurred as those under treatment became convalescent, and
several are still suffering under this malady. The cottages in which
it first appeared (and to which it has been almost exclusively
confined), are of the most wretched description: a stagnant pond is in
the immediate vicinity, and none of the tenements have drains; rubbish
is thrown within a few yards of the dwellings, and there is no doubt
but in damp foggy weather, and also during the heat of summer, the
exhalations arising from those heaps of filth must generate disease,
and the obnoxious effluvia tends to spread contagion where it already
exists. It appears that most of the cottages alluded to were erected
for election purposes, and have since been allowed to decay; the roofs
are repaired with turf dug in the neighbourhood, and the walls
repaired with prepared clay, without the addition of lime-washing.
Contagious disease has not been remarkable within the Union in any
other spot than the one alluded to.”

_Messrs. Smith_ and _Moore_, the medical officers of the Bishop Stortford union, state,—

“We have always found the smallest and most slightly-built houses the
seats of the lowest forms of disease; and although, during the last
year, no epidemic or infectious disease here prevailed, it is but just
to state that, generally speaking, the cottages of labourers in this
district are small, badly protected from both extremes of weather,
badly drained, and low in the ground.”

_Mr. J. S. Nott_, the medical officer of the Witham union, states,—

“As medical officer of my district, I am glad to have an opportunity
of recording my opinion of many of the causes of fever that uniformly
prevails in the autumn and spring in this neighbourhood. I must first
state that the situation of the town is exceedingly low, with two
small rivers passing through it, and numerous open sewers intersecting
the town and its environs, the effluvia of which is frequently
exceedingly offensive, and at all times prejudicial to the general
health, and calculated to create, by its malaria, the various kinds of
fevers, (typhus and remittent). Part of the town is subject to floods;
added to which, the cottages are small and crowded together. A great
number of the inhabitants accumulate filth and manure for the purpose
of sale. There are also many open slaughter-houses, where the refuse
and filth is allowed to accumulate for weeks together without removal;
and innumerable pigs are kept and fattened on the back of the premises
of a great number of the inhabitants; and altogether it would be
difficult to find any town of its size where so little regard is paid
to cleanliness and ventilation; but where we do find the exception,
roomy and well-ventilated cottages, (and they are but few,) the cases
of fever are more manageable, and recover sooner.”

The state of Windsor affords an example that the highest neighbourhoods in power and wealth do not at present possess securities for the prevention of nuisances dangerous to the public health. _Mr. Parker_, in his report on the condition of his district, states—