Chapter III: Suggested Alterations in the Act of Parliament (2)

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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

* * * * *