Chapter IV (3)

"The opinion of the House appeared to prevail that 'a man has a right to do what he likes with his own, as regards the building of as many houses as can possibly be packed together on his own land, without taking into consideration the health of the people who are to inhabit them, or the health of those in the immediate neighbourhood.' So long as the Building Act as regards open spaces at the rear of houses remains unaltered, so long will unhealthy houses continue to be built."

Some of the more capable of the Medical Officers of Health in their reports did not content themselves with mere tables of the births and diseases and deaths in their parishes, and a narrative of the principal incidents in their work during the year, but pointed out the defects in the laws, and made suggestions as to the best ways of coping with some of the great sanitary evils daily confronting them.

Based upon actual experience, their views and suggestions were entitled to great weight, and were often of very great value.

One point, and that the most important of all, finds expression in the reports of more than one of them, namely, that the administration of many of the health laws should be compulsory instead of permissive, and that merely declaring a law compulsory without providing the means for making it compulsory was of little use.

What was wanted in London was a real central authority which should have power to make the local authorities carry out the orders of Parliament. This did not exist, for the Metropolitan Board of Works had no such powers, and the Vestries and Districts Boards were independent local governing authorities acknowledging no master and free to obey or disobey Acts of Parliament just as they pleased.

"It has been one of the great faults of our sanitary arrangements and legislation for London," wrote the Medical Officer of Health for St. James' in 1872, "that the metropolis has not been regarded as a whole, and that through the ignorance, or carelessness, of one District or Local Board the whole of the others may be put in peril."

* * * * *

"It is impossible, with our present municipal machinery, in London, at any rate, to exercise all that power which is necessary for the prevention of the spread of infectious diseases."

And the Medical Officer of Health for Whitechapel in 1873 wrote:--

"If any alteration is made in the constitution of the Metropolitan Board of Works it would be desirable to add to its functions that of a sanitary supervision over the whole metropolis."

And in 1881 the Medical Officer of Health for Kensington wrote:--

"London is grievously in need of a Central Sanitary Department to establish something like unity in the sanitary arrangements of its 39 divisions.... Every other large centre of population has but one sanitary authority."

Though much more time, thought, and labour, were being devoted than ever before to matters relating to the public health, and with very beneficial results, one matter appeared to be quite unaffected thereby, for none of the great measures of sanitary improvement which had been carried out since the central and local authorities had come into being seem to have had any effect during the 1871-80 decade upon infantile mortality.

If anything the figures appear higher. In St. George-in-the-East in 1871-2 the deaths of children under five years were 51 per cent. of all the deaths.

In Mile-End-Old-Town in 1872-3, out of a total of 2,200 deaths, 1,087, or practically 50 per cent., were deaths of children under five, a mortality which evoked the comment from the Medical Officer of Health:--

"Apart from congenital causes, a large majority of these young lives would, under conditions more favourable to existence, be preserved.... It is certain that the present generation of London children is physically degenerate."

And a year later he wrote:--

"I consider about two-thirds of the infantile mortality attributable to neglect, improper feeding, impure air from overcrowding, and general bad management through ignorance and carelessness of parents and nurses."

In Kensington, away in the west, the average annual infantile mortality over a period of ten years--1863-73--was 42 per cent. of the total deaths.

The Medical Officer of Health for Whitechapel wrote (1873):--

"There must be something very wrong in the condition of the people when we find that out of all children born about one-fifth die before they are one year old, and one-third before they are five."

In the north part of his district in the quarter ended December 28, 1872, the rate of mortality of children under five was 61·1 per cent., whilst in the quarter ended September, 1873, in Goodman's Fields the rate was 72·4 per cent.

In St. George-the-Martyr, Southwark, in 1873-4, of 1,256 deaths 694 (= 55·3 per cent.) were under five.

In the same year the Medical Officer of Health for Paddington wrote:--

"In taking fifteen streets typical of the ordinary condition of the dwellings in which the working-class reside, I find the annual proportion of deaths under five ranges from 41 to 75 per cent. of the total deaths....

"The deaths from all causes in eighteen such streets varies from 21·7 to 50 per 1,000."

The Medical Officer of Health for Limehouse wrote in 1874:--

"As usual we find that of 1,000 deaths more than 500 are those of children under five."

Two years later it was 53 per cent.

Nor was it only in the central parts of London that the infantile mortality was so frightful. In Wandsworth, the mean annual rate during the years 1865-74 was 49·6 per cent.

The infantile death-rate did not diminish as the decade proceeded. In Islington in 1875-6 the infant mortality was "much about the same" as it had been twelve years previously.

In Kensington it had increased to 46·3 in 1878; in St. George-the-Martyr to 57·7 per cent.; in St. Pancras in 1877-8, of 5,068 deaths, 2,212 (or 45·6 per cent.) were of children under five.

The Medical Officer of Health for Poplar wrote (1877-8):--

"The deaths of children under five years have been more than half the total of deaths--truly a 'massacre of the Innocents.'"

The Medical Officer of Health for Islington wrote (1880):--

"The number of deaths of children under one year is still painfully large.... Children seem to be born for little else than to be buried."

Passing from record to comment, there are some striking passages in the reports of the Medical Officers of Health.

Thus the Medical Officer of Health for Paddington wrote:--

"... Of infantile mortality one is tempted to ask whether the provision of so much life, such a prodigality of being, to be followed so soon by an almost Pharaoh sacrifice of it, is necessary to the multiplication of the race."

And the Medical Officer of Health for St. Marylebone (1877):--

"It is sad, and in a sanitary point of view, humiliating to contemplate, that for every three children born in Marylebone, one dies before reaching the age of five years; 'tis true that in this respect Marylebone stands in no worse position than other large parishes in the metropolis, nor so bad as in the majority of them, but the knowledge of this fact will, I apprehend, afford but slender consolation to those who know from experience and daily observation that hereditary diseases, habitual neglect, unwholesome dwellings, together with other preventable causes, are largely concerned in the sacrifice of infant life."

And the Medical Officer of Health for Rotherhithe (1881):--

"Whilst the houses' drain-pipes, from defective construction and workmanship, and want of being cut off from the main sewer, act as much as sewer ventilators as channels for removing filth ... whilst overcrowded houses and foul smells in living and sleeping rooms are taken as a matter of course; whilst infectious disease is sedulously propagated first by concealment, and then by criminal exposure and neglect, ... so long the yearly recurring Herodean massacre of helpless children, whose almost sole use in life appears to be the providing of fees for doctors and undertakers, will continue, in spite of all efforts of sanitary authorities and sanitarians."

The evil done, however, by bad sanitary conditions was not limited to the children who died. Probably ten or twenty times the number of those who died went through the illness and survived--but of those many were injured in constitution for life.

In other respects, however, sanitary progress was being made, and slowly but steadily the conditions of the health of the public were improving. Undoubtedly the main causes of that progress were the great system of main drainage and sewerage which had relieved London of the incubus of enormous accumulations of the deadliest filth in its houses, and of an open main sewer through its midst; and the greater quantity, and improved quality, of the water supplied for household consumption which relieved her inhabitants from the necessity of drinking liquid sewage.

And the construction of sewers in nearly all the streets, and the substitution of an effective system of house drainage instead of the abomination of cesspools, was also a great stride to improvement.

Since 1856 plans for the construction of a total length of nearly 1,000 miles of local sewers had been submitted to the Metropolitan Board for their approval, many of them being in substitution of old and shallow ones for which the Board's new main and intercepting lines afforded the means of improving the gradient and outlet.

In their report for 1881 the Metropolitan Board of Works gave "a brief summary" of what it, as the Central Authority, had accomplished since 1856.

"There was the great main drainage work which had cost about five and three-quarter millions, an undertaking which 'although fruitful of good results, and of greater magnitude than anything of a similar kind that had previously been accomplished, has left, as might be expected, few visible marks of its existence.'"

It is rather the Thames embankments and broad new streets which remind the inhabitants of London of the great changes and improvements that the Board's operations effected.

"On the north side of the Thames, from Blackfriars to Westminster, and from Grosvenor Road to Battersea Bridge, and on the south side, from Westminster to Vauxhall, embankments have been made which, whilst reclaiming from the river a considerable extent of ground, have substituted for the unsightly and offensive mud banks that formerly prevailed, handsome river walls, with broad and commodious thoroughfares, relieved and ornamented by public gardens. New streets have been made, some of the principal of which are Queen Victoria Street, Southwark Street, Northumberland Avenue, Commercial Road, and the new thoroughfare from Oxford Street to Bethnal Green; many other leading thoroughfares, which had become inadequate for the increased traffic of the present day, have been widened and improved, greatly to the convenience and comfort of the public; and liberal grants of money have been made by the Board to the authorities in aid of the cost of smaller street improvements which have not been of sufficient extent or importance to be carried out by the Board.

"Two new parks have been provided, in districts previously unsupplied with such places of needed recreation. Public gardens have been laid out and are maintained in the neighbourhood of dense populations; and suburban commons, to the extent of about 1,500 acres, have by the action of the Board been secured in perpetuity for the undisturbed enjoyment of the public.

"Many areas formerly covered with dwellings unfit for human habitation have been cleared, under the operation of the Artizans' and Labourers' Dwellings Improvement Act, and the ground let to societies which have undertaken to build, and in some cases have built, improved dwellings, in which the humblest class of the working population can live with health, decency, and comfort."

These and many consequential improvements, and the better paving of the streets, and the better cleansing of streets, places, and yards, the more rapid removal of filth from London, had made the general conditions of life much less unwholesome.

The work, too, being done by the Metropolitan Asylums Board was greatly diminishing the dangers of infection in the metropolis, as well as restoring to life and health thousands who would otherwise have fallen victims to disease.

And by "The Poor Law Act, 1879," the Vestries and District Boards were authorised to enter into contracts with the Board, for the reception and treatment of infectious sick who were not paupers, thus in a measure depauperising the Metropolitan Asylums Hospitals.

And a very large amount of most valuable work was done by the Port Sanitary Authority; in the year 1879-80 over 15,000 vessels of all classes having been visited and inspected, the infectious sick removed, and disinfection carried out.

Writing of the year 1877 the Registrar General said:--

"London maintains its position as the healthiest city in the world. During the past year its prosperity was indicated by a birth-rate above the average of the preceding 10 years, while a remarkably low death-rate bears testimony to the success which has attended the efforts that have been made during the last half of a century to promote the public health and safety."

Among the public authorities from which much might have been hoped in the way of improving the public health of the inhabitants of London was the School Board. The Board stood in an exceptionally favourable position for moulding the physical constitution of hundreds of thousands of children and of successive generations, but education appeared to have almost excluded the consideration of health.

In 1871 the Board resolved "that it is highly desirable that means shall be provided for physical training, exercise and drill in public elementary schools established under the Board." But beyond this, little if anything was done, and even it was not made applicable to the girls. And no Medical Officer was appointed, and no systematic means organised for the prevention of the diffusion of diseases by the schools. Indirectly, however, good results were flowing from the schools. The attendance of the children at the schools took them out of their overcrowded tenement-homes for several hours in the day; their playgrounds afforded better means of exercise; the cleanliness expected of them raised their ideas as to cleanliness; the supervision over them was of great use in improving their conduct and character, all helped to improve their physical condition. But how infinitely greater the improvement might have been, not merely at the time but to the rising generation, if the School Board had given greater attention to this branch of the children's welfare. About 230,000 children were in attendance in the Board's Schools in 1880.

The really encouraging feature of the general position was that a larger section of the public was taking an interest in matters relating to the public health.

In Battersea, wrote the Medical Officer of Health (1881):--

"Much assistance is now derived from the general public, who are more alive to the necessity of sanitary measures than at any previous period."

The Medical Officer of Health for St. George-the-Martyr, Southwark, reported:--

"The health of the people occupies the thought and consideration of an ever-increasing number," and he quoted the declaration of the head of the Government that "the sanitary question lies at the bottom of all national well-being."

The Medical Officer of Health for North Poplar stated that--

"Gradually the labouring portion of the population, which so largely outnumbers the remainder with us, is becoming educated to the fact that they must neither breathe air, drink water, nor take food, polluted by filth."

But, as a whole, public opinion was more or less inert.

"The apathy of the public in matters of health is truly lamentable."

Nor was all the apparent progress as genuine as appeared on the surface. The Medical Officer of Health for St. Mary, Newington, in his report of 1874 disclosed this material fact.

Writing of some Returns which he had prepared of sickness in seventeen years, he said:--

"In the period we have seen the end of many fever haunts. We have seen hundreds and hundreds of the old tenements removed and new abodes raised in their stead; but with it, alas! we have seen all the defects of new buildings, all the defects of badly laid drains, all the evils of work ill done, its dangers too often not capable of recognition until sickness and death forced the discovery. We have seen too often in the new houses defects of ventilation, of construction, of drainage, and of overcrowding: we have seen many an evil allowed by law, and over which we cannot extend our sanitary rules. We have also to contend with the indifference, the carelessness, the blindness of the people themselves--intemperance and crime stand in our way...."

But in 1881 he wrote: "Sanitary work has borne fruit."

The progress of sanitation is almost necessarily slow.

"There is not," wrote one of the Medical Officers of Health, "a more difficult task than that of carrying out sanitary reform, for although every one agrees that sanitary laws should be put in force, they are greatly objected to when they interfere with one's self."

And another wrote:--

"Nuisances crop up, are removed, and re-appear. _It is a continuous warfare due to many causes_, such as carelessness and wilfulness on the one hand, and accidental circumstances on the other."

And another:--

"The sanitary labours of your officers increase year by year as the population becomes denser, and the need for sanitary precautions grows more urgent."

And underneath all was the view expressed by the Medical Officer of Health for Islington (1881):--

"I fear the public have not even yet learned to regard health as a matter of infinitely greater moment than rates and taxes."

How far-reaching were the effects of disease was admirably set forth by Dr. Simon:--

"I do not pretend to give any exact statement of the total influence which preventable diseases exert against the efficiency and happiness of our population, for it is only so far as such diseases kill, and even thus far but very imperfectly, that the effect can be reported in numbers. Of the incalculable amount of physical suffering and disablement which they occasion, and of the sorrows, and anxieties, the permanent darkening of life, the straitened means of such subsistence, the very frequent destitution and pauperism which attend or follow such suffering, death statistics testify only in sample or by suggestion."[148]

Few people realise the infinite importance of health to a great community.

As one of the Medical Officers of Health truly wrote:--

"It is a question whether the greatness of countries will not in future to a very large extent depend upon the standard of public health."

One of the very best and most experienced of the men who held the responsible office of Medical Officer of Health during the last half century--Dr. Bateson, the Medical Officer of Health for St. George in Southwark--in his reports often dwelt upon this aspect of the subject:--

"The only true and lasting foundation upon which the glory and safety of a nation can be built must be upon the cultivation of the moral and physical powers belonging to man."

"... The quality of a race is of far more importance than the quantity."

"Health to the majority of the population is their only wealth; without it they become pauperised."

"The welfare and safety of this country need a healthy, stalwart race of men--men who can labour and endure."

And in his last report (1878), after twenty years' service as Medical Officer of Health, he quoted the Prime Minister (Lord Beaconsfield) as saying:--

"The health of a people was really the foundation upon which all their happiness and all their powers as a state depended. If the population of a country was stationary, or that it yearly diminished, or that whilst it diminished it diminished also in stature and strength, then that country was ultimately doomed."

"Nothing," said Dr. Bateson, "could be more solemn and emphatic."

"For the success and permanence of national existence a high standard of health is absolutely necessary. To maintain in its integrity the vast power which England now wields, and to retain the high position which she now holds will depend upon the nation's health."

Before considerations such as these, how lamentable the blindness of those who could not see that even a measurable expenditure in health matters would have been productive of immeasurable benefits; how reprehensible the conduct of those who refused to administer laws which it was their duty to administer, and the administration of which would have been of inestimable value to their fellow citizens; and how disastrous their studied inaction to the great metropolis, and through it, to the nation itself.

FOOTNOTES:

[117] Select Committee on Metropolitan Buildings and Management Bill, 1874. P.P., vol. x.

[118] Evidence of G. Vulliamy, Select Committee, 1874. Superintending-Architect to that Board.

[119] See Report of Select Committee, &c., 1874, Q. 23,445.

[120] Select Committee of 1867.

[121] P.P., 1868-9, vol. xxxiii.

[122] 32 and 33 Vic. cap. 70.

[123] See P.P. 1863, vol. xxv. Report by Tremenheere on Bakehouses, p. 113.

[124] Adulteration of Food and Drink and Drugs Act, 1872, 35 and 36 Vic. cap. 74.

[125] P.P. 1874, vol. vi.

[126] Issued on the 17th of September, 1872, and renewed the 25th of March, 1873.

[127] Final Report of the School Board for London, 1870-1904.

[128] See Select Committee on Noxious Businesses, 1873. P.P., vol. x.

[129] See Sections 25 and 26 of the Sanitary Act, 1866.

[130] See Report of Metropolitan Board, 1871-2.

[131] P.P. 1878-9. Report of Local Government Board, vol. xxix., p. xiii.

[132] By the Medical Officer of Health for Whitechapel, 1878.

[133] P.P. 1875, vol. lxiv.

[134] "The Artizans' and Labourers' Dwellings Improvement Act," 38 and 39 Vic. cap. 36.

[135] See Royal Commission Report, 1884.

[136] 1877, 24th March.

[137] Inquiry by Cubitt Nicholls, March 24, 1877.

[138] Appendix. Select Committee Housing, 1881, p. 354.

[139] See Report of Metropolitan Board, 1888.

[140] 42 and 43 Vic. cap. 64.

[141] The Medical Officer of Health for Chelsea (writing of his own parish).

[142] Chelsea, Hackney, Shoreditch, Lambeth, St. George (Southwark), Camberwell, Plumstead.

[143] Goddard, 1882, Select Committee, p. 576.

[144] Mr. Hunter Rodwell, Q.C., M.P.

[145] 41 and 42 Vic. cap. 32.

[146] 41 Vic. cap. 16.

[147] P.P., vol. xxix.

[148] J. Simon, vol. ii., 1874.