Chapter V (3)

By this Act it was made compulsory on medical attendants to certify, and on householders to notify, the existence of any of these diseases.

Hitherto information as to infectious illness only reached the Medical Officer of Health after a sufficient time had elapsed to allow of the spread of the infection.

The results of the Act of 1889 were soon found to be very beneficial in checking the spread of disease.

The receipt of the notices of infectious diseases led to the more prompt and general disinfection of premises where infectious diseases prevailed, and led also to the discovery of sanitary defects which might not otherwise have been discovered.

The information, moreover, kept the Medical Officers of Health informed of the progress of disease not only in their own districts, but also in contiguous ones, and so assisted them to take prompt measures for the eradication of disease in their respective districts.

The other measure which passed the legislature in this same year contained provisions of the highest importance as affecting the metropolis. This was "the Poor Law Act, 1889."

Until 1889 patients could be admitted only to the infectious hospitals of the Metropolitan Asylums Board on the order of the Relieving Officer and District Medical Officer, so, except in certain cases, the hospitals were only open to Poor Law cases.

This measure made practical concession of two principles. Free admission to the hospitals of the Metropolitan Asylums Board of sick persons in need of isolation, and devolution upon the Metropolitan Poor Fund of all charges incurred in the maintenance of the sick in those hospitals.

The Managers were, therefore, enabled to admit other than pauper patients reasonably believed to be suffering from fever, smallpox, or diphtheria.

The system was attended with the happiest results in reducing the amount of infectious disease in the metropolis, and proved a great boon to all classes of the community.

The Board in its annual report wrote:--

"The Managers are now, for the first time since the establishment of the Board in 1867, virtually recognised as the Metropolitan Authority for the provision of accommodation for the isolation and treatment of infectious disease--both pauper and non-pauper--and are now empowered to legally perform duties which the Legislature had imposed on the District Sanitary Authorities, but which the Managers had hitherto been called upon to perform in consequence of the failure of most of such Authorities to provide accommodation for non-pauper patients."

The Managers by this date had increased the accommodation for patients afflicted with any of these infectious diseases. There were six fever hospitals, 2,463 beds; 350 beds in smallpox hospital ships; and 800 beds in the hospital for convalescing smallpox patients.

One other Act[171] deserves mention before the close of this decade as it contained an unique section which required the Medical Officer of Health, on notice from the owner of property in which there are separate dwellings let for 7s. 6d. or less a week, to visit them and examine all their sanitary arrangements, &c., so as to be able to certify or not--

"That the house is so constructed as to afford suitable accommodation for each of the families or persons inhabiting it, and that due provision is made for their sanitary requirements."

The certificate, if granted, was to be handed to the owner, who was then able to obtain the remission of the inhabited house duty.

The owner, therefore, obtained a remission of taxes to which he was justly liable, because the dwelling which he lets was in a sanitary condition!

In many ways, then, the sanitary evolution of the great city was developing satisfactorily, though by no means so rapidly as was to be desired, or as it might have developed if local governing authorities had done their duty.

"The war of the community against individuals for the public good," which had now lasted for over thirty years, and the war against disease in its most dangerous forms, was being waged with good effect; and though an immensity remained to be done, a great deal had been accomplished. Larger numbers of all classes were beginning to grasp the idea and to realise that the necessity of securing and guarding the public health was not a craze or form of mental aberration, but was of absolutely vital consequence, not merely to certain classes but to the great community of the metropolis and to the nation itself, and that the future welfare and power, even the very existence, of the nation are dependent upon it.

Larger numbers, too, were beginning to see who really were responsible for the widely prevalent evils, and who really were obstructing progress towards a higher standard of public health, and how little claim they had to consideration, either from the hands of the Legislature or of local administrators.

The reports of the Medical Officers of Health of the latter part of this decade were distinctly more hopeful in tone, and recorded more progress than ever before.

The catalogue of things in which improvement had taken place had lengthened--sewerage, water supply, the removal of refuse, paving, the regulation of offensive businesses, of cowhouses, dairies, and bakehouses, the provision of open spaces, the better disinfection of houses and of infected articles, the erection of hospitals for the isolation of cases of infectious diseases--all of which things were elemental necessaries if the public health was to be assured.

In some parishes, in place of the smaller class of houses, great blocks of artizans' dwellings had been erected. In others great blocks of flats.

With the increased wealth of the population finer buildings had been erected in many districts. London had grown enormously in wealth, and the wealth showed itself in finer public buildings and private houses. The District Board of Westminster, for instance, said in their report for 1885-6:--

"Whether viewed as to its character, its statistics, its topography, or its sanitary condition, the change which Westminster has undergone in thirty years can only be described as a complete transformation."

"In the St. Margaret's portion, whole streets of fine houses which were occupied by the nobility and the wealthy for residential purposes are now let out in offices for the transaction of legal, scientific, or mechanical business, while narrow streets, wretched courts, and melancholy homes of squalid poverty and misery have been replaced by 'mansions,' 'flats,' &c.; and on the other hand by huge blocks of artizans' dwellings, comprising upwards of 1,200 homes."

The Education Act was indirectly producing some good results as regarded the health of the rising generation.

A most marked improvement had come over the mortality of children at school ages. Mortality has lessened--

5-10 years 30 per cent.
10-15 " 32 "
15-20 " 30 "[172]

due to the fact that children had been gathered into the schools from their crowded and insanitary homes, and had thus escaped some of the perils of disease.

And the Medical Officer of Health for Lambeth referred to this same subject in his report for 1886:--

"The children of the pauper and mendicant are withdrawn from the atmosphere of vice and intemperance to which their fathers had become acclimatised, and are placed under supervision in the schoolroom...."

Some slight improvement there was also as regarded the mortality of children under five years, though in many parishes it was still fearfully high.

In Mile-End-Old-Town, for instance, in 1890 the deaths under five years amounted to 51 per cent. of all deaths. In Deptford district in 1890-1 they amounted to 50 per cent. In Bermondsey in 1889 they amounted to 52 per cent. In St. Olave, Southwark, in 1888-9 to 49-1/2 per cent. In St. Mary, Newington, in 1890, very slightly under 50 per cent.

Infantile mortality was becoming of greater concern than ever as the birth-rate was showing a decided diminution--that for 1889 being the lowest on record since 1849.

Though the tables as to death-rate in many of the parishes were still more or less vitiated by various local circumstances, there was considerable unanimity that the death-rate was falling and the public health better. Some diseases which had previously claimed their victims by thousands, now only claimed them by hundreds. Death from tubercular disease had steadily fallen, and the mean death-rate from phthisis in London showed a very satisfactory decrease between 1861-70 and 1881-90.[173]

The _Lancet_ of January, 1887, stated that, measured by its recorded death-rate, London was healthier in 1887 than in any year on record.

In the Strand in 1886:--

"The efforts that have been made by the Board and its officers have resulted in a marked and continuous improvement in the sanitary state of the district."

In St. Pancras in 1888 the death-rate was "by far the lowest yet recorded."

In Bermondsey, in the same year, "so few deaths have not occurred since 1865."

These and similar reports from other districts showed that sanitary progress was being made. But, unfortunately, in the autumn of 1888 there was an epidemic of measles of exceptional severity, which raised the death-rate. And in 1890 there was a sudden increase from 18·4 per 1,000 to 21·4, a mortality which was higher than any since 1882.

The increase served to show the great necessity there was for unceasing watchfulness and for steady perseverance in sanitary work. The forces of disease are ever on the watch for the opportunity to work their evil will, and there were still many weak places in the defences against them. The central government of London had been improved enormously, but the corrective was not extended to where it was most wanted, namely, the local Sanitary Authorities, the Vestries and District Boards.

FOOTNOTES:

[149] To the then existing population of London.
The South Eastern Counties contributed close on 290,000
" South Midland " " " " 249,000
" Eastern " " " " 196,000
" South Western " " " " 168,000
" West Midland " " " " 95,000

[150] The report was made in 1887, but was as true in 1881 as it was in 1887.

[151] See Report of Select Committee, 1882, p. v.

[152] _Times_, 20th November, 1883.

[153] See his speech in Parliament, Hansard, 1884, vol. ccxc., p. 529.

[154] Robert Reid (a Surveyor), p. 805.

[155] The regulations suggested by the Local Government Board laid down that the landlord or owner should not allow a greater number of persons to occupy a room than would admit of free air space for each of 300 cubic feet--if used exclusively as a sleeping room--or 400 feet if used day and night.

He was to--
(1) Keep the drainage in good working order, to properly pave the
yard, and provide sufficient sanitary accommodation.
(2) Keep the cisterns clean and in proper order, and keep the
structure of ashpit in proper order.
(3) Cause the ceilings and walls of every room to be whitewashed
and papered every April.
(4) Provide all requisite means for the ventilation of every room,
and of the common passages and staircases thereof.
(5) To notify cases of infectious disease.

[156] Royal Commission, 1884.

[157] Hansard, 1884.

[158] 1884 Royal Commission, vol. ii. p. 2938.

[159] Ibid. p. 724.

[160] Hansard, 1884, vol. cclxxxix. p. 41.

[161] Hansard, 1884, vol. ccxc. p. 541.

[162] See Report of Royal Commission on the Amalgamation of the City and County of London, 1894.

[163] Hansard, 1884, vol. cclxxxiv.

[164] By the Diseases Prevention (Metropolis) Act, 1883, 46 and 47 Vic. cap. 35.

[165] The total net expenditure was £401,000 in 1885.

[166] Hansard, vol. ccxxix. p. 889.

[167] Lords' Committee on Sweating, P.P. 1890, vol. 17.

[168] Hansard, p. 1663, March 19, 1888.

[169] See the last Report of the Board.

[170] 53 & 54 Vic., cap. 70.

[171] The Customs and Inland Revenue Act, 1890, 53 & 54 Vic. cap. 8.

[172] See speech by Sir L. Playfair in House of Commons, March 4, 1884.--Hansard, p. 529.

[173] See Report from Royal Commission on Tuberculosis, 1898.