Chapter IV: Overcrowding, Its Causes and Effects

I have been at some pains to demonstrate the dangers and inconveniences which are inseparable from houses built, as are the majority of town houses, upon an area which is wholly insufficient when considered in relation to their cubic contents.

Feeling, as I do, that the question of space round the dwelling is of the greatest importance—so important that every other sanitary regulation sinks into insignificance when compared with it—I have endeavoured to show how detached houses may, to their great advantage, be independent of the public sewers, and equally independent, if their owner choose, of public water supplies; and this I have done in the hope that in country places, and places which are developing, the precious boon of living in a detached house may be recognised.

While I am not slow to admit that water under pressure is a great advantage if it be wisely used, I have pointed out persistently for some years that our present system of water-carried sewage gives a 'fatal facility' to the overcrowding of houses, and has made life, of a sort, physically possible under conditions of overcrowding which have never been equalled in the history of the world.

In China and the East generally, be it remembered, the large population lives upon one plane. It has been left to Europe and America to try the experiment of piling the city populations in heaps, of housing them in many-storeyed buildings, some of which (in America) are fifty times the height of a man.

The facilities for overcrowding which are afforded by big schemes of water-supply and sewerage are now well understood, and have caused the formation of 'Building Societies' throughout the country. A large number of these societies during the past few years have been proved to have been dishonestly managed, and have involved widespread financial disaster amongst the poor and thrifty.

The mode of proceeding of these societies is to buy up, on the outskirts of towns having a system of sewers and a common water-supply, plots of land abutting on roads which have been sewered at the expense of the ratepayers.

These plots are then sold to purchasers who pay 10 per cent. deposit for possession, and pay the rest of the purchase money in monthly or quarterly instalments for a term of years, 10 or 15, as the case may be, with 5 per cent. interest. Thus the artisan, having paid a most exorbitant price for a plot of ground, starts in life with a mortgage round his neck, and probably finds, should anything interfere with the regular payment of instalments, that he has a hard-faced usurer to deal with, who merely concealed his identity behind the title of 'Company, Limited.'

The accompanying diagram (fig. 31) gives a good idea of the development of a district subsequent to sewering. It has been copied from the prospectus of a Building Society. A A A is an old road having houses on the north side only; B B B is an old road with houses on the south side only, _i.e._, seven dwelling houses in a course of more than half a mile.

The space between A A A and B B B was, until a few months ago, a market garden full of fruit trees, and about nine acres in extent.

A few years ago A A A and B B B were sewered at the expense of the ratepayers, and very soon afterwards this market garden was bought by a 'Building Society' and converted into a 'building estate.'

It is obviously a very 'eligible' estate, for there is a Railway (R.), with a Station (S.), a Post and Telegraph Office (P.O.), a Church (Ch.), and two Public Houses (P.H.). None of the elements of modern civilisation are wanting. After the sewering of roads A A A and B B B, the District Council, in a fit of zealous extravagance, destroyed the gravel paths at the side of B, and put a 12 by 6 inch kerb, and laid half a mile of granolithic pavement for the benefit of the aforesaid seven houses.

When the Building Society issued its prospectus the plots abutting on the old roads A A A and B B B were sold at once, and the reason is obvious, viz., that the roads are ready made and sewered; and a note with regard to road B B B says, 'This road is a highway maintainable by the local authorities, who will provide a proper footway in front of the plots in due course.' The ratepayers as a whole are to provide pavements for the speculative builder in this particular instance, and it is evident that the owners of the plot and the Local Council had come to an agreement in the matter. The houses abutting on the new roads, Z Z Z, will, in addition to the purchase money for the land, be charged 3_s._ per foot frontage for sewers, and 'also such a proportion as their surveyor shall assess of the expense of repairing and maintaining the road or roads, until the same shall be handed over to the local authorities.' On an adjoining property the cost of 'making up' a private road was estimated at 12_s._ per foot run, so that the cost would amount to between 10_l._ and 11_l._ for a plot having a frontage of 18 feet, and might form a ruinous charge on some of the corner plots.

The ground will accommodate 177 plots, and the plots facing the old roads fetched 3_l._ a foot. Of these there is room for fifty-nine, having a frontage of 20 feet each, so that the price paid for these at 60_l._ per plot would be over 3,500_l._; and if the remaining 118 plots fetched 40_l._ each (4,720_l._), the total price realised for this 9 acres would be over 8,000_l._, in addition to the charge for sewerage and road-making.

When, moreover, it is remembered that the society may possibly hold a mortgage on every plot and every house, for which they get 5 per cent. and excellent security, it will be admitted that running a 'Building Society' is a tolerably profitable business.

If all these plots are sold there will be a population of over 1,200 persons on 9 acres of ground, and the ratepayers will be at the charge not only of educating the children, but of providing hospitals for the segregation of infectious diseases, allotments, free libraries, open spaces, and additions to the sewerage works for dealing with the sewage of 1,200 persons.

When a 'progressive' municipality sets to work to 'develop' its district (a speculative and hazardous process, which it should leave to private enterprise), the ratepayer soon begins to see that a great diversity of interests has to be served.

The little shopkeeper (and it is of this class that Boards and Councils are largely composed) wants the greatest number of people on the smallest space; and he sees that in proportion as the dwelling has an insufficient curtilage, so are its inhabitants wholly and entirely dependent on the shop.

The person with a fixed income who settles in a district wishes the district to remain picturesque, rural, and quiet, and, above all, he desires that the 'rates' may be kept down. He naturally objects to be taxed for the sewering of country roads in order that the fields may be covered with courts and alleys of jerry-built houses, and equally he objects to be taxed in order that every railway station in the country may display a large invitation to trippers to invade his solitude and make his life a burden.

All sanitarians are agreed that mortality and density of populations are directly proportional. The following figures, taken from Table R (p. xlvii.) of the decennial supplement of the Registrar-General (1895), show this very clearly, as does also the diagram of the mortality figures for London (p. 144).

Persons to a square mile Death-rate (corrected)
138 12·70
187 14·48
307 16·47
662 18·55
1,803 20·43
3,299 22·30
4,295 24·51
19,584 33·00

The corrected death-rate for 'Urban England,' as given by the same authority, is 22·32, as against 16·95 for 'Rural England.'

To form a just estimate of the comparative healthiness or unhealthiness of a great city like London is no easy matter. The composition of the population is, especially in the central parts, so abnormal in regard to age and sex that unless corrections be made for this abnormality any comparison of London with other places is futile. Such corrections are now made by the Registrar-General.

It is probable that in no city are the annual variations of population greater than in London. The population of June (the height of the season) and the population of September (when 'everybody is out of town') must be very different. In September the rich go to the country, the shopkeepers go to the seaside, and the poorest of the poor go hop-picking. The School Board attendances for the first week of September show a deficit of 80,700 children, or 11·1 per cent., figures which clearly demonstrate that the autumn exodus is not limited to the wealthy classes.

It is at this season that we see paragraphs in the paper to the effect that the death-rate of some London parish for the Michaelmas quarter reached an incredibly low figure, and we are asked to infer that the population, thanks to the wise policy pursued by the vestry, is fast making for immortality. Of course such statements are not worth the paper they are written on, because there are no data as to population, and the period chosen is so short as to be valueless.

In estimating the death-rates of different sanitary areas of London it has been customary for the last six years to distribute the deaths occurring in institutions to the districts to which the deceased 'belonged,' and to exclude entirely the deaths of persons belonging to districts outside registration London; in this way about 1·5 per cent. of the deaths occurring in registration London may be excluded. This manœuvre helps to diminish the London death-rate, but, as no account is taken of sick people who leave London to die elsewhere, it is manifestly an unjustifiable thing to do.

If the strangers who die in London institutions are to be excluded, it is a question whether all strangers merely sojourning in London ought not to be excluded from the estimate of population. Again, a man comes from the country and is knocked down by a vehicle in the street and dies in a London hospital; or during a sojourn in London he gets caught in a London fog and dies of bronchitis; or he 'catches' influenza, or pneumonia, or diphtheria in London and dies. Surely the deaths of these three ought to be credited to London in all fairness. It is a very dangerous thing to 'cook' statistics, and we do not get much nearer the truth by doing so.

The best indication, probably, as to whether the conditions of life in any locality are healthy or the reverse is the infant mortality; in this way we exclude the fallacies due to abnormal age distribution, because we compare identical age periods; and the proportion of the sexes among children is practically the same everywhere. We exclude also the influences of occupation. By studying the mortality of children under five we are studying the influence of the home and home surroundings on the incidence of disease, which is particularly what we wish to do.

In the decennial supplement of the Registrar-General published in 1896, Dr. Tatham gives a table (Table II. p. lxxxii. _et seq._) of the 'annual death-rate per million living among children under five years of age, from all causes and from several causes, 1881-90.' This valuable table ought to be most widely studied. Being based upon statistics of ten years intervening between the censuses of 1881 and 1891, the estimates of population have a maximum of reliability, because we are relieved of the errors inseparable from statistics referring only to short periods of time.

It is constantly stated that London is the healthiest city in the world, a statement which, if true, must make us very sorry for the other cities. In Dr. Tatham's table, alluded to above, he first deals with counties.

We find that the death-rate of children under five from all causes in England was 56,825 per million; that the highest death-rate among children was in Lancashire (72,795), and the next highest was in the county of London (68,164). The lowest death-rate was in the county of Dorset (35,651).

Table Legend:

A = Smallpox
B = Measles
C = Scarlet fever
D = Diphtheria
E = Whooping cough
F = Fever
G = Diarrhœa
H = Tuberculosis Disease
I = Respiratory Disease

-----------+------+---+-----+-----+-----+-----+----+-----+-----+------
| All | | | | | | | | |
|Causes| A | B | C | D | E | F | G | H | I
-----------+------+---+-----+-----+-----+-----+----+-----+-----+------
Lancashire |72,795| 37|5,053|2,454| 706|3,805|285 |6,461|5,364|17,037
London |68,164|240|4,743|1,780|1,371|5,342|165 |5,444|6,581|16,021
Hampshire |42,222| 10|2,005| 505| 939|2,508|280 |2,783|3,299| 9,011
Dorsetshire|35,651| 4|1,748| 488| 493|1,815| 62 |1,305|2,401| 9,390
-----------+------+---+-----+-----+-----+-----+----+-----+-----+------

I have also thrown in Hampshire, because not only is it my own county, but it is a mixed county, largely rural, but also containing the big towns of Southampton and Portsmouth.

Looking at these four in tabular form, we see that in Lancashire the mortality from measles, scarlet fever, fever, diarrhœa, and respiratory disease was greater than in London; and in London the mortality from small-pox, diphtheria, whooping cough, and tuberculous disease was greater than in Lancashire.

In Hampshire and Dorsetshire the mortality was very much less from every cause than in either Lancashire or London.

It is important to point out that the deaths of children from tuberculous disease are greater in London than in any other county, and that the deaths from tuberculous and respiratory diseases combined are greater in London than in Lancashire.

We have seen that the mortality of children under five averaged for the whole of London 68,164 in the decennium 1881-90, while that for England and Wales was 56,825, or, omitting the last three figures, let us say they were 68 and 57.

Examining the various registration districts more closely, we find that the child mortality was less than the average for England and Wales in four London districts only, viz., Lewisham (44), Hampstead (48), Woolwich (51), and Wandsworth (56), districts which are all on the outskirts of the place we call London. Certain other districts had a child mortality less than the average of London as a whole, viz., Camberwell (59), Hackney (60), Islington (61), Paddington and Kensington (63), Greenwich (63), St. Pancras (66), Fulham, Poplar, and Lambeth (67).

All the other districts had a child mortality greater than the average of London, viz., Mile End (69), St. George's, Hanover Square (71), Westminster (72), Chelsea and St. Olave's (73), Marylebone (75), Bethnal Green (76), Shoreditch (78), St. Saviour's (79), St. Giles's (80), Holborn (82), Whitechapel (85), St. George's in the East (87), the City (90), Stepney (99) and the Strand (109).

With the exception of the City, Stepney, and the Strand, there are only two registration districts in the whole country which have a child mortality over 90, viz., Manchester (93) and Liverpool (114). To Liverpool therefore belongs the distinction of being the most unwholesome place for little children in the whole country, and the 'Strand,' which constitutes the very centre of London, comes next.

Let us examine these figures more closely, and let us throw the child mortality of Liverpool and the Strand into tabular form, and contrast them with the registration district of Andover, in Hampshire, a district which I select for reasons which will appear later.

Table Legend:

A = Smallpox B = Measles C = Scarlet fever D = Diphtheria E = Whooping cough F = Fever G = Diarrhœa H = Tuberculosis Disease I = Respiratory Disease

----------+-------+----+-----+-----+-----+-----+----+-----+------+------+ | All | | | | | | | | | | |Causes | A | B | C | D | E | F | G | H | I | ----------+-------+----+-----+-----+-----+-----+----+-----+------+------+ Liverpool |114,253| 29|9,492|2,966| 852|5,894| 483|9,818| 7,138|26,080| Strand |109,596| 38|6,626|1,828|4,760|6,359| 76|7,692|11,881|30,122| Andover | 32,260| 0|1,227| 307| 225|2,505| 153|1,074| 2,096| 7,209| ----------+-------+----+-----+-----+-----+-----+----+-----+------+------+

From this table it appears that the mortality from measles, scarlet-fever, and diarrhœa was greater in Liverpool than in the Strand; but that the other diseases scheduled were more fatal in the Strand than in Liverpool.

We have previously pointed out that the deaths of children from tuberculous and respiratory diseases are greater in London than in any other county, and now we find that the death-rate of children from these two classes of diseases amounted in the 'Strand' to 42,003, far and away the highest figure in the country, Liverpool coming second with 33,218. The death-rate of children from the same causes in Andover was only 9,305, considerably less than a quarter of the Strand death-rate.

Thanks to vaccination and the purity of the water-supply the mortality in the Strand from small-pox and fever is very small, but the mortality of children from the acute air-borne contagia (measles, whooping cough, scarlet-fever, and diphtheria), and still more from the chronic air-borne contagia, is fearful to contemplate.

The big mortality from tuberculous disease forces upon us the reflection that a large number of children who become tuberculous in the 'Strand' do not die within the age limits with which we are concerned, but drop off later in life after years of invalidism and suffering. We have seen that children under five are decimated yearly in the Strand. How many more are crippled for life?

The deaths of children under one year of age per 1,000 births is a safe criterion of the health conditions of a locality. This figure for the ten years 1881-90 was, for the whole of England and Wales, 142. In London, we find that in five districts (Hampstead 117, Lewisham 121, Woolwich 124, Hackney 137, and Wandsworth 141) this mortality was below the average of the whole country, while in the remaining twenty-five districts it was above the average.

In Paddington, Islington, Camberwell, Lambeth, Greenwich, Mile End, Poplar, and Marylebone, it was above 142 and under 150. In St. Pancras, Kensington, St. George's (Hanover Square), St. Giles's, Bethnal Green, and St. Olave's, it was above 150 and under 160; in Chelsea, Fulham, Westminster, Holborn, Shoreditch, and St. Saviour's, it was over 160 and under 170. The City was 171, Whitechapel 173, St. George's-in-the-East 182, Stepney 196, the Strand 226.

To show what this figure of 226—the infant mortality of the Strand—means, I will give the infant mortality of some of the worst towns in Lancashire: in Liverpool 219, Wigan 161, Bolton 163, Salford 183, Manchester 193, Ashton-under-Lyne 173, Oldham 169, Rochdale 145, Burnley 184, Blackburn 178, Preston 203. On the other hand, one may say that the infant mortality of Andover, which has just adopted a great part of the London Building Act, with the approval of the Local Government Board, was (for the ten years 1881-90) 91, or 23 per cent. less than the best of the London districts, and nearly 60 per cent. better than the Strand.

Glancing at the other Hampshire districts, one may note that in the New Forest the infant mortality was as low as 80, and that it was only in Portsea Island (139), Alverstoke (123), and Southampton (135) that even the lowest of the metropolitan figures were approached. It is interesting to note that even the worst districts in Hampshire are below the average of the whole kingdom in the matter of infant mortality.

THE STRAND

I have previously alluded to the high mortality of the Strand registration district, and my remarks on one occasion were contemptuously dismissed, with the criticism that it was unfair to judge of the state of London by the health of the slums.

It becomes necessary therefore to say that the Strand registration district includes the Temple, St. Clement Danes, the Precinct of the Savoy, St. Mary-le-Strand, St. Paul, Covent Garden, and St. Martin's in the Fields.

Its southern boundary extends from the Temple Stairs to Whitehall Court, along the Thames Embankment. From Whitehall Court, the western boundary runs through the 'Horse Guards' and through the middle of Buckingham Palace to the top of Constitution Hill. It includes the whole of the Green Park, but none of the houses abutting on it, with the exception, I believe, of Stafford House. From Stafford House the northern boundary runs south of Pall Mall, and includes Clarence House, St. James's Palace, the War Office, Marlborough House, and Carlton House Terrace. Thence the boundary runs up the Haymarket, along the north side of Leicester Square and Long Acre to Drury Lane and by Sardinia Street and the south side of Lincoln's Inn Fields to Chancery Lane, the south end of which constitutes its eastern boundary.

This district includes parts of four royal palaces and also Somerset House, Horse Guards, Admiralty, War Office, National Gallery, and National Portrait Gallery. In it are to be found five churches (Temple, St. Clement, St. Mary, St. Martin, St. Paul, Covent Garden), Exeter Hall, and more than twenty of the largest and best known theatres and music-halls. The Constitutional and National Liberal Clubs are within its boundaries, and its numerous huge hotels are famous throughout the world.

The worst parts of the district are in the north-east, but one must mention that it does _not_ include the Seven Dials or the north half of Drury Lane. Clare Market, the south end of Drury Lane, Drury Court and Bedfordbury, are the slums of the Strand registration district. It is not a poor district. The percentage of persons 'in poverty' in London as a whole is given by Mr. Charles Booth as 30·7, while that for the Strand is only 23·9.

Many of the labourers employed in Covent Garden Market and in the theatres earn very good wages, but Mr. Booth specially mentions the fact that in some of the lowest districts house rent is very dear. Wages is a relative term, and the potential prosperity of a person is only to be determined by subtracting from the earnings the cost of the necessaries of life, inclusive of house rent.

It is obvious, however, that the prime necessary of life (fresh air) is not to be had in the Strand at any price.

It may be well to add that the Strand _sanitary area_ is not co-terminous with the Strand _registration district_, which we have been considering. The chief difference is that the former includes St. Anne's, Soho, and excludes St. Martin's in the Fields.

This district of the 'Strand,' which I have chosen because it is the most unhealthy district in London, and in some respects the worst in the whole country, is, so to say, the pulpit from which the British have preached sanitation to the whole world. In it we find the offices of the Registrar-General and the London County Council; the Temple, where Sanitary Bills are drafted, and the Law Courts, where the sanitary law is administered; the Royal College of Physicians; the Examination Hall where candidates for diplomas of Public Health and Medicine are examined, and also the offices of the 'Lancet' and the 'British Medical Journal.' The Royal College of Surgeons, the Local Government Board and Imperial Parliament, if not within, are only just outside its limits.

It is doubtful if any district in London or any other city is better provided with open spaces than the Strand. St. James's Park and the Green Park are both partly within its limits. It has the Embankment and the Thames to the south, the Temple Gardens to the east, Lincoln's Inn Fields to the north-east, and Trafalgar Square in the centre. It is wonderfully provided with what are miscalled 'lungs,' but it is evident that lungs are of little good if the blood only circulates in them occasionally on a Sunday. It is well to bear this fact in mind, because our municipal governors sometimes talk as if the provision of 'open spaces' at exorbitant and extravagant cost could compensate for overcrowding in the dwelling, with a lack of light and air therein.

It is in the Strand, more than in any other district, that houses have been built of great height and enormous cubic capacity without any curtilage whatever. I have attended 'banquets' at more than one hostelry in this district where 150 or 200 persons have been fed in a room having no outside windows of any kind, and where, late in the evening, the guests have been provided with a little fresh (!) air by opening glass partitions communicating with a huge 'coffee-room' or table d'hôte room. These rooms are made by enclosing what ought to be open courts in the centre of these huge hotels, and their utilisation is only possible because of the perfection to which the science of artificial illumination has been brought. There can be no health without daylight, and sunlight, and fresh air, but the electric light is good enough to make money by.

To a greater or less extent, throughout London the height of the houses has been gradually raised, and the available curtilage has been built upon. This is seen in the dwellings of the rich, and there is no doubt that the conditions which lead to overcrowding are all intensified in the poorer quarters.

BUILDING REGULATIONS