Chapter II (2)

"Hence, when a death occurs, the living and the dead must be together in the same room; the living must eat, drink, and sleep beside a decomposing corpse, and this in usually a small, ill-ventilated room, overheated by a fire required for cooking, and already filled with the foul emanations from the bodies of the living and their impure clothes.

"This is an everyday occurrence in Clerkenwell, and constitutes a formidable evil."

So great was the pressure for accommodation of some sort or kind, that even the cellars and kitchens in the basements of the houses were occupied as dwelling-places and overcrowded.

In St. James', "the worst feature of the overcrowding was the very common practice of residence in cellars or kitchens. In the majority of cases the places are quite unfit for human residence.

"... A cellar in St. Giles'," wrote the Medical Officer of Health for that district in 1858, "has been the by-word for centuries to express a wretched habitation unworthy of humanity.

"Dating from the time of Charles I., the underground dwellings of our district attained the acme of their miserable notoriety from the pen and pencil of Fielding and Hogarth.

"... The Building Act of 1844 contained stringent clauses against the use of such rooms unless they possessed requisites of area and ventilation, such as were out of the question in the cellars of St. Giles'.

"The Metropolis Management Act (1855) repeated the prohibition of 1844, and in defence of the public health the Board have lately put this statute in force. This has been done without compromise. As separate habitations for occupation by human beings at night 'a cellar in St. Giles'' is no longer to exist."

This was written in 1858, but in the following year he wrote:--

"The profit derived from letting the basement of these houses as dwelling-rooms was too strong a temptation for their owners, and many of the kitchens were let again as soon as the Inspector had reported them emptied."

In the Strand (1856) underground rooms and kitchens were inhabited "notwithstanding that District Surveyors are numerous, and that the Metropolitan Building Act is in operation."

In Westminster, "an examination of various portions of the parishes shows that large numbers of the poor occupy premises whereby they are not only deprived of the required quantity of air, but being situated below the level of the street, the ventilation is insufficient, the rooms generally damp, and when closed for the night the atmosphere is perfectly insufferable--mostly kitchens and cellars, evidently never intended to be used as sleeping rooms" (1858-9).

The causes of the dreadful overcrowding which existed so extensively were many and deep-seated--springing from the very roots of the social and economic system. And they were of great force and widespread in effect.

The cause to which the various authorities and Medical Officers of Health directly attributed it was the one immediately before their eyes--namely, the pulling down of houses which hitherto had afforded shelter, of a sort, to the people.

As the Medical Officer of Health for St. Olave, Southwark, said (1860-1):--

"To effect street improvements--to build warehouses, or for some other purpose--the habitations of the working classes are broken up without any provision being made for them elsewhere. They are therefore driven by necessity to crowd into other houses in the same neighbourhood perhaps already overcrowded."

An actual illustration was the case reported by the Medical Officer of Health for Limehouse:--

"The London Dock Company have, for the purpose of enlarging and improving their docks, pulled down not less than 400 houses in the parish of Shadwell, the homes of not fewer than 3,000 persons of the poorer classes.

"... The neighbouring parishes are now suffering from an augmentation of their already overcrowded population."

The District Board of St. Saviour, Southwark, stated that the evil of overcrowding "can scarcely be exaggerated, whether it be regarded in a physical, mental, or moral aspect."

The principal of the causes are:--

"(1) The arbitrary power exercised by railway companies in ejecting the labouring classes from their homes without any obligation to provide for their domestic convenience.

"(2) The existing law of (poor law) removal, any break in the three years' residence in the parish rendering them liable to removal to other distant parishes."

The latter had, however, most probably, but very small effect.

A great cause was that described by the Medical Officer of Health for Shoreditch:--

"There is a constant and rapid flow of population into Shoreditch. It is in this circumstance that I see one of the most alarming dangers to the health of the district.

"The area does not enlarge, and yet year after year dense crowds of human beings are packed and squeezed into that limited area. The growth of the population has far outstripped the growth of the house accommodation.

"The immense majority of the immigrants are precisely of that class which most largely increases the dangers of disease by thickening the population. You are largely burdened with the pauperism of other and wealthier districts. The burden is doubly grievous; for it taxes your property, your labour, and gives strength to the elements of disease amongst you.

"It is probable that there is no spot in London more crowded with life than many places in Holywell or St. Leonard's.

"Typhus--a disease more terrible than cholera--has made itself at home in the parish."

And the Medical Officer of Health for Fulham wrote (1857):--

"... The daily necessities of the labourer's family draw so heavily on his earnings as to leave only a very small sum for the payment of rent, and hence the most limited house accommodation is sought for and endured...."

The most powerful cause of all, however, was, undoubtedly, the overpowering instinct of self-preservation, or, in other words, the need of working, no matter under what conditions, for the only means of obtaining food for themselves and their families. That, as a rule, necessitated their being near the work to be done--and rather than lose that work any conceivable hardship or abomination would be put up with.

Another of the great causes of overcrowding was high rent.

"It must not be imagined," wrote the Medical Officer of Health for the Strand (1858), "that this system of overcrowding is altogether a direct consequence of a state of poverty. It certainly does not appear to be so, for among the Metropolitan Districts the Strand ranks seventh in order of wealth.

"The overcrowding seems to be partly a result of the high rental which the houses and rooms of many parts of the district--so peculiarly well situate for business purposes--command, and partly of the 'middleman' system, in which so many of the houses in the occupation of the poorer residents are let.

"The 'middleman' system, which obtains so largely in this metropolis, in the letting of houses of the kind referred to, is ruinous in its action upon the working classes. The rent paid for a single room often exceeds a sixth or fifth of the total income of the family...."

In a case in Bow Street Police Court it was given in evidence that 21, Church Lane, St. Giles', was rented of the owner for £25 a year--that the rents recovered from the sub-tenants were £58 10s.--and the rents received by these sub-tenants from lodgers £120 per annum.[65]

Overcrowding was not confined to the sleeping places of the people, for the same causes which cramped the available space for people at night, cramped also the space for very many of them during the day when they were away from their so-called homes.

Of the overcrowding in factories and workshops, where so many of the working classes spent their days, and of the insanitary conditions in which they there worked, no mention is made in these earlier reports of the Medical Officers of Health, not because there were not any, but because the inspection or regulation of factories and workshops did not come within the sphere of their duties. Evidence in plenty there is on this branch of the subject in later years from those who could speak with authority in the matter, and it will be referred to hereafter, and that the state of things then described is equally applicable to this period is an inference so legitimate as to be tantamount to a certainty. That the bad conditions under which the workers worked were a great contributing factor in the insanitary condition of the people is a fact as to which there can be no question.

Mention is made, however, of the overcrowding which existed in another large section of the community--namely, the overcrowding of children in some of the schools. The Medical Officer of Health for Whitechapel reported that there was much overcrowding, and in his report for 1857 gave some instances of it in his district:--

18, _Charlotte Street_.--In a room 8 feet high, 7 wide, 10 long: 14 children and 1 mistress = 37 cubic feet each.

17, _Charlotte Street_.--Matters still worse; the room was underground; 10 feet wide, 10 long; about 7 feet high; 35 children and 1 mistress = 20 cubic feet each.

2, _Gorelston Street_.--672 cubic feet; 31 children and 1 mistress = 20 cubic feet each.

In such cases the atmosphere must have been a rapid poison to those breathing it.

There was another powerful contributory cause to the general insanitation of London, namely, the defilement of the atmosphere which people had to breathe. As one of the Medical Officers of Health said some years later:--

"We should remember that the air we breathe is as much our food as the solids we eat and the liquids we drink, and as much care should be taken that it is free from adulteration."

London was already the greatest manufacturing city in the world, and the great volumes of smoke proceeding from the numerous factories undoubtedly deteriorated the quality of the air. But it was the noxious vapours proceeding from the various processes of manufacture classified as "noxious trades" which rendered the atmosphere in many parts of London dangerous to health.

Many were the descriptions given of the almost intolerable evils. Thus the Medical Officer of Health for Rotherhithe reported in 1857:--

"In the mile length of Rotherhithe Street there are no less than nine factories for the fabrication of patent manure, that is to say, nine sources of foetid gases. The process gives out a stench which has occasioned headache, nausea, vomiting, cough, &c. Many complaints have been made by the inhabitants."

From St. Mary, Newington, "the terrible effluvium of bone-boiling is freely transmitted over the district."

Some manufacture in a yard in Clerkenwell (1856-7), which had existed until lately, was "one of the most abominable, exceeding anything that the imagination could picture."

And in every parish or district of London there were slaughter-houses.

"There are too many slaughter-houses in crowded districts," wrote the Medical Officer of Health for St. Pancras (1856-7). "It is impossible that slaughtering of animals can be carried on amongst a dense population without proving more or less injurious to the public health.

"This it does in several ways--by occasioning the escape of effluvia from decomposing animal refuse into the air and along the drains, and by the numerous trades to which it gives rise in the neighbourhood which are offensive and noxious, such as gut-spinning, tallow-melting, bladder-blowing, and paunch-cleansing."

Even in the Strand District there were (1856)--

"Nuisances arising from various branches of industry, the slaughtering of sheep and calves in the back-yards, and even in the cellars and kitchens, and the keeping of cows in the basements under private dwelling-houses, conditions which continue to exist in the most crowded parts of this district, and should on no account be permitted in such a district:" whilst in Westminster "pig-keeping existed to a very considerable extent."

In some of the outer parishes the "foetid emanations" caused in the process of brickmaking added to the general impurity of the air.

There were many other local causes of impurity of the atmosphere, some even caused by the Sanitary Authorities themselves. Thus the more thorough scavenging and removal of the filth of streets and houses, vitally necessary as that was, resulted in the accumulation of great heaps of filth in crowded centres.

Thus the Medical Officer of Health for Fulham reported that:--

"The collection of dust heaps, and dust contractors' depôts, constitute a most injurious and offensive nuisance--enormous quantities of animal and vegetable matter are heaped together, from which the most noxious effluvia constantly arise."

And the Medical Officer of Health for Rotherhithe pointed out (1858) that:--

"It is little use causing our own dust to be carted away if Rotherhithe is to become the receptacle of all the ashes and offal of a large neighbouring parish (Bermondsey). On a piece of land near the Viaduct there stands an immense heap of house refuse, covering an acre of ground at least, and forming quite an artificial hillock, the level of the surface having been raised 12-14 feet. The bulk of the heap is composed of ashes with a due admixture of putrefying vegetable matter and fish."

A little later he reports it as 1-1/2 acres in extent, averaging 15 feet high, in one place as high as 20 feet.

How to deal with these noxious or offensive trades was felt by some of the Medical Officers of Health to be a great difficulty.

"We have the health of the community on the one hand," wrote the Medical Officer of Health for Lambeth; "the great manufacturing interests on the other.... We have all a common right to an unpolluted atmosphere, and it is our bounden duty to withstand any encroachments on that right. The personal aggrandisement of the manufacturer must not be achieved by the spoliation of the property, the comforts, and the lives of his poorer neighbours....

"But the manufacturing interest is not a thing to be trifled with. Destroy the manufactures of Lambeth, and you starve its population. There are nuisances of more benefit than of injury to the community," and he rather deprecated "a crusade against those interests, the untrammelled prosecution of which has raised this country to its present proud pre-eminence."

Some of the Medical Officers of Health expressed decided views on the subject (1857):--

"Those who follow unwholesome trades led on by the thirst of gain," reported one Medical Officer of Health, "have no right to poison a neighbourhood and swell its mortality."

The Medical Officer of Health for the Strand wrote (1856):--

"... The protection of the public health which has been committed to your charge is, beyond doubt, of infinitely more importance than, and should far outweigh the interests of, private individuals how numerous soever they should be."

The Nuisances Removal Act, 1855, had given the local authority power on the certificate of the Medical Officer of Health to take proceedings against an offender, and had provided the means for inflicting a penalty. And in some instances it was used, for the Medical Officer of Health for Hackney reported:--

"Several proprietors of noxious trades having omitted to adopt the best practicable means for preventing injury to health, in some cases legal proceedings were taken against them."

The Medical Officer of Health for Whitechapel declared there was no desire on his part to use the powers of the Act to the oppression of any individual or to insist upon the adoption of such arbitrary and stringent measures as shall drive wealthy manufacturers from the district. "All that is necessary to be insisted upon is that the business be so conducted that the health and comfort of the inhabitants shall not be injured."

But whether it was from the unwillingness of the local authorities to prosecute, or the difficulties of enforcing the law, the nuisances continued to the great detriment of the health of the people.

And over and above this combination of nuisances, there was the abominable smell from the river. That still was an evil.

"Rotherhithe," wrote the Medical Officer of Health, in July, 1858, "in common with all other metropolitan riverside parishes, has suffered considerable inconvenience during the last month from the stenches arising from the filthy state of the Thames water. Perhaps in the annals of mankind such a thing was never before known, as that the whole stream of a large river for a distance of seven or eight miles should be in a state of putrid fermentation. The cause is the hot weather acting upon the ninety millions of gallons of sewage which discharge themselves daily into the Thames. And by sewage must be understood not merely house and land drainage, but also drainage from bone-boilers, soap-boilers, chemical works, breweries, and gas factories--the last the most filthy of all.... It is quite impossible to calculate the consequences of such a moving mass of decomposition as the river at present offers to our senses."

As one sums up all these disastrous influences, or rather, these evil powers, unceasing in their work, by night and by day--in the overcrowded dwelling and the street--with their victims unable to escape, one realises somewhat the conditions under which great masses of the people of London were living.

The result was a fearful mortality--an awful waste of human life.

"Death," wrote one of the Medical Officers of Health, "finds easy victims in filthy habits, overcrowded rooms, impure air, and insufficient and ineffective water supply."

The consequences were inevitable.

"Wherever there are crowded apartments, imperfect or no drainage, offensive cesspools, dung-heaps resting against houses or close to inhabited rooms--wherever ventilation is impeded by the narrowness of courts and alleys, and wherever the inhabitants living under these unfavourable circumstances lose their self-respect, pay no regard to personal cleanliness, and consider a state of filth and offensiveness as their natural lot--there we find zymotic diseases in full force and frequency. Those attacked do not simply recover or die. I shall not be exaggerating when I say that all recovering from these complaints are permanently injured."[66]

It is impossible to apportion the respective shares which these various causes of insanitation had in bringing about these dire results, but overcrowding was undoubtedly one of the principal. As to its disastrous effects the Medical Officers of Health were of one opinion. There was no single exception to the strong-voiced insistence upon this fact.

"The main cause," wrote the Medical Officer of Health for the Strand (1856), "to which we must attribute the high mortality is the close packing and overcrowding which exists throughout the district.... Overcrowding and disease mutually act and react upon each other.

"There is one circumstance of general prevalence throughout the district which, so to speak, almost paralyses these efforts of sanitary improvement--overcrowding--the overcrowding of parts of it with courts and alleys, the overcrowding of these courts and alleys with houses, the overcrowding of these houses with human beings" (1859).

"The overcrowding of dwellings," wrote another,[67] "is one of the most frequent sources of sickness and decay at all ages."

"Perhaps," wrote a third,[68] "there is no single influence to which a human being is exposed more prejudicial to his health than overcrowding in rooms the air of which cannot be perpetually and rapidly changed."

"No axiom," wrote another,[69] "can be more positive than the connection of epidemic diseases with defects of drainage and ventilation ... the overcrowded localities being especially scourged by disease."

The consequences were not confined to epidemic disease; other fatal diseases were begotten by it.

"All medical writers," wrote the Medical Officer of Health for St. James' (1858), "are agreed that impure air from want of ventilation is the most potent of all causes of consumption."

Not merely directly did overcrowding bring about fatal results. Indirectly it also led thither. It was recognised as a cause of intemperance and of the evils, moral as well as physical, which ensued from intemperance.

"Men whose nervous systems became depressed, and the tone of their system generally lowered, became the subjects of a continued craving for stimulants."[70]

Dr. Simon, Medical Officer of the General Board of Health, wrote:--

"In an atmosphere which forbids the breath to be drawn freely, which maintains habitual ill-health and depresses all the natural spring and buoyancy of life, who can wonder that frequent recourse is had to stimulants?"

The evils were disastrous enough for the adult population, but they fell with more dire effect upon infants and young children.

"Conditions more or less injurious to health gradually impair the matured energies and slowly undermine the fully developed constitution of the adult; but the self-same conditions, exerting their baneful influence on the infant or young child, nip the tender plant in the bud and speedily destroy its young life."[71]

Throughout the whole of the metropolis the infantile mortality--that is, of children under five years of age--was very great: Almost without exception it was close upon, or over, 50 per cent. of all the deaths in the various parishes or districts.

In Clerkenwell the infantile mortality, which was "nearly one-half of all the deaths," was characterised as "enormous"; but in Shoreditch it was actually one-half, being 50 per cent. (1858); in Bethnal Green it was over one-half, being 52 per cent. (1858); in St. George-in-the-East it was 53-1/2 per cent.--or, to put it otherwise, of 1,351 deaths in the year, 720 were of children under five. In Poplar it was more than half. In Islington, in 1857, nearly half. In St. Saviour, Southwark, 50 per cent. in 1860-1, "a waste of life which appears almost incredible."

In Limehouse (in 1857) of 1,403 deaths 690 were under five.

The Medical Officer of Health wrote:--

"It is when such wretched offspring, ill-nourished, ill-clothed, and in every way neglected, become exposed to the depressing influences of an impure atmosphere that they sicken, and such children when they sicken they die.... When the habitation of such children is an overcrowded, dilapidated tenement in some close, ill-ventilated court or alley, furnished with an undrained closet, surrounded by untrapped drains, and festering heaps of filth, we find ourselves astonished, not that so many die, but that so many survive."

In some special places the mortality was still higher. Thus the Medical Officer of Health for Kensington reports in 1856:--

"In some places the mortality among infants under five years of age was at the enormous rate of 61·3 per cent. of the total deaths.

"One of the most deplorable spots, not only in Kensington, but in the whole metropolis, is the Potteries at Nottingdale. It occupies about 8 or 9 acres, and contains about 1,000 inhabitants ... the general death-rate varies from 40-60 per 1,000 per annum. Of these deaths, the very large proportion of 87·5 per cent. are under five years of age."

The Medical Officer of Health for Whitechapel (in 1858), after reporting that the total mortality under five years in the Whitechapel district is about 56 per cent., wrote:--

"How to overcome this frightful and apparently increasing amount of mortality of the young is a problem well worthy the attentive consideration of every citizen. The time may be far distant before this problem is solved; nevertheless it is my duty to chronicle facts, and although I may not be able to suggest a remedy to meet this evil, still the knowledge that so large an amount of infant mortality does exist in our district--I may say, at our very doors--will perhaps rouse the attention of the philanthropist, the man of science, and the man of leisure, to investigate its cause, and endeavour to mitigate it."

Once more it must be called to mind that this mortality was not the whole of the evil, for it was indicative of widespread infantile sickness and disease among those who escaped the death penalty--sickness and disease impairing the health and strength of thousands upon thousands of the juvenile population.

The facts set forth by many of the Medical Officers of Health must have enlightened many of the new local authorities as to the nature and extent of the work which it had now become their duty to perform, and the grave problems for which they were expected to find the best solution.

The earlier annual reports of many of the Vestries and District Boards were poverty-stricken in the extreme, and were mostly confined to bald and uninforming tables of receipts and expenditure, which practically threw but little light upon the condition of their parishes.

The Vestry of St. Mary, Newington, evidently anxious to prevent disappointment as to immediate results from its action, stated that:--

"In consequence of the previous want of adequate sanitary powers in the local authorities of this and other suburban parishes, so great an extent of sanitary improvement was required when the Vestry came into operation, that it was impossible the whole could be dealt with at once, at the same time acting with consideration for those who have to bear the effects of many years' neglect of those sanitary duties which are now found to be so essential."

Lambeth Vestry expressed its desire to discover--

"In what manner a prompt and beneficial execution of the provisions of the Act can be secured without creating any serious increase in local taxation."

One of the Vestries, indeed, gave the quaint explanation that one of the things which somewhat retarded sanitary improvement was "the novelty of applying compulsory powers to landlords."

The desirability of securing parks and places of recreation for the people was one of the matters which first appealed to some of the Vestries and District Boards, and memorials were addressed to the Metropolitan Board urging the importance of their putting in force the powers conferred on them for the purchase of land for such purposes.

Others directed their attention to the promotion in a small way of improvements in their parishes by widening streets and roads, and preserving open spaces--towards which, in some cases, they received a contribution from the central authority.

A good deal of paving was done, and better measures taken for scavenging the streets and courts, and for the removal of refuse and dirt of all sorts.

To local sewerage, as distinct from main sewerage, they also gave attention, and in 1856 designs for 45 miles of new sewers were sent in to the Metropolitan Board for approval, and £34,700 borrowed for the purpose; and in the following year for 46 miles of new sewers, and loans for £109,000.

A fair amount of drainage work was also carried out--thousands of cesspools were filled in and drains made. Also a certain amount of inspection, with the disclosure of an enormous amount of insanitation.

Thus, in the Strand District in 1856--where 813 houses were inspected--in 774, or 91 per cent. of these, works had to be done to remedy sanitary defects. In the following year 1,760 houses were inspected, and in 1,102 sanitary defects were found. In Poplar, of 1,299 houses which were visited, 795 required sanitary improvement. In Paddington 2,201 houses were inspected; in over 1,600 works had to be executed to put them in sanitary order; figures which showed that, roughly speaking, two out of every three houses were sanitarily defective.

"The last year," wrote the Medical Officer of Health for Hackney (1857)--where 1,518 houses had been connected with the sewers--"has been a year of drainage."

Parliament having enacted that the "owner" was responsible for the state of his property, this work had to be done at the expense of the owners; but how many decades had passed in which "owners" had spent nothing on the property, and had been receiving large rents; and how many cases of sickness and death had occurred in their houses, the result of the insanitary condition in which they had been allowed to fall, and in which they were allowed to continue.

In Holborn such works cost the owners about £3,400 in 1857, and in Lambeth about £10,700.

But the work thus chronicled touched little more than the fringe of the matter. Most of the local authorities had, out of a spirit of economy, or for some other reason, appointed only one Inspector of Nuisances; yet in nearly every one of their parishes there were thousands of houses--in Greenwich 11,000, in St. Marylebone 16,000, in Lambeth 22,000--and years would have had to elapse before the solitary inspector could have completed even one round of inspection and got the houses he inspected put in order; whilst the others would inevitably have been existing in, or falling into, a state of insanitation. For years, therefore, the most vile disease-begetting nuisances might not merely exist throughout the parish, but work endless evil without any interference, as indeed they did.

Some of the Vestries put forward their economy as a claim for praise. Thus, the Wandsworth Board said that "a due and careful regard to economy had characterised all their proceedings," and the Vestry of St. Mary Newington said, in 1860, that it had carried out its operations out of current income and had incurred no debt.

The Medical Officers of Health held their offices at the pleasure of the Vestries, and, therefore, if they valued their position, had to be cautious in their criticisms of the management of the affairs of the parishes.

But their reports convey that the work which ought to have been done was not being done as rapidly as they wished.

"I wish I could induce the Vestry to insist more upon having the poorer dwellings cleansed and lime-whited." And again, "The Vestry has the power to restrict the operation of underground rooms, yet it has not moved in this important matter."[72]

The Medical Officer of Health for St. Giles' (1857) referred to the--

"Indisposition of the Board to do works and charge the owners"; and, referring to a special case, he wrote, "It becomes your duty to do something to prevent the production of disease among the neighbours."

The Medical Officer of Health for St. Pancras wrote in 1856-7:--

"In many houses the overcrowding is very great. There is a clause under the Nuisances Removal Act by which the Vestry is called on to take proceedings before a magistrate to abate overcrowding, if it is certified to be such as to endanger health. No prosecutions have been taken under this clause."

And again in 1859:--

"Very little has been done in this parish to abate over-crowding--extreme cases have been proceeded against. No systematic efforts have been made in this direction."

And the Medical Officer of Health for Hampstead wrote (1856):--

"Nothing short of constant vigilance and inspection can keep the dwellings and premises of the people in a tolerably healthy state. I am not sure that your Board is blameless in some of these respects--an amiable, though weak, reluctance to act severely to any."

And in 1857 he pleaded for the appointment of an Inspector of Nuisances, which, however, he did not get.

The local authorities had their difficulties in dealing with many of these matters, even when they were disposed or anxious to do so, owing to--

"The imperfection of the powers conferred on them by the legislature, and to the great and stubborn apathy of a poor population."

And the Medical Officer of Health for St. James' (1858) attributed blame to the public generally:--

"One of the greatest barriers to the practical efficiency of sanitary arrangements is the ignorance and carelessness of the public. It is frequently seen that where infectious illness occurs, little or no attention is paid to its infective character, and an unscrupulous intercourse is carried on between the members of infected families, not only amongst themselves, but amongst their neighbours, and thus these diseases are propagated in spite of every warning and precaution."

"I regret," wrote the Medical Officer of Health for Whitechapel, "that the powers of your Board are not at present sufficient to compel the owners of small house property to provide an adequate supply of water for their tenants."

The Medical Officer of Health for Westminster wrote:--

"Few of the objects of sanitary improvement can be fairly attained without intrenching upon private interests to an extent which would appear harsh and oppressive. One great obstacle consists in the habits of a great portion of the poor--generally deficient in cleanliness or order; they consider any endeavour to improve their dwelling as an interference, and throw every obstacle in the way. On the other hand, a large number are most grateful for what has been effected."

But in many matters the local authorities would not take action. In only four parishes or districts in London had public baths and wash-houses been established under the Act of 1846, though where they were in existence "the benefits were immense by promoting habits of cleanliness."

In Poplar in 1858-9 nearly 40,000 men, and 3,000 women, and 400 children availed themselves of the baths.

In St. Pancras (1856-7) the laundry department, erected by the "Society for Establishing Public Baths and Wash-houses," was of great value in affording the poor housewife an opportunity of washing and drying her linen away from her one room, in which the family had to live night and day.

"I have frequently seen a small room of this kind with from four to eight or even ten inmates rendered doubly unhealthy by these laundry operations, which produce a damp and almost malarious atmosphere."

The Medical Officer of Health for Lambeth had pleaded for such an establishment in his district, but "the idea of erecting them seems quite abandoned by the Vestry."

"I know nothing more objectionable in a sanitary point of view than the washing of foul clothes in the dwellings of the poor, and still worse the drying of them in courts and rooms already deficient of free circulation of air and light."

Nothing, however, was done. But inaction far greater in gravity and infinitely more reprehensible was that relating to the housing of the people. The Medical Officer of Health for Whitechapel drew attention, in his report of 1857, to their power in this respect:--

"Docks, railways, warehouses, &c., &c., must be constructed for the increase of the trade of this great metropolis, but our construction of them ought not to prevent us from providing better habitations for the working classes whose labours effect these improvements; more especially as it is in the power of parishes by virtue of an Act of Parliament to encourage the establishment of lodging-houses for the labouring classes."[73] Not one single Vestry or District Board ever attempted to deal with the evils of bad housing and overcrowding by putting into operation the provisions of this Act.

The occasional statement in the report of a Medical Officer of Health as to what was actually done in his parish, by showing what might have been done in any other one, brings into strong relief the incapacity or deliberate inaction of the local authorities of other parishes. Thus, in some parishes the Medical Officers of Health endeavoured to effect some diminution of overcrowding--for instance, the Medical Officer of Health for Islington reported that--

"In several instances the owners of dwelling-houses had been summoned for permitting the overcrowding of their houses; and the magistrate had fined the offenders."

And the Medical Officer of Health for Holborn in the same year wrote:--

"Your Board has already done much to ameliorate the condition of this class of society (the poor and overcrowded) by compelling the owners to cleanse, drain, and ventilate their dwellings; to close cellars, to provide proper water supply, sanitary accommodation, and in many cases had abated overcrowding."

But few of the Vestries followed, or attempted to follow, these examples, and in many of the most vital matters a deliberate inactivity was the prevailing characteristic of the Vestries and District Boards.

"In several Vestries resolutions were actually moved with the view of averting the construction of sewers. It was thought by many persons of influence to be better to live in the midst of overflowing cesspools than to add to the defilement of the Thames."[74]

The Medical Officers of Health did not confine themselves to merely reporting what was annually done to ameliorate the existing state of affairs.

As was their duty, they made numerous and frequent suggestions to their authorities as to what it was best to do. And some of them, going further than this, sometimes endeavoured to inspire the members of the Vestries and District Boards with a sense of the gravity of their work, and with lofty views of their duty. Occasionally, even, they did not hesitate to censure their employers for inaction or lethargy.

The Medical Officer of Health for the Strand wrote (1856):--

"To pave streets, and to water roads, to drain houses or even to construct sewers, however necessary these works may be, are among the least important of the duties which devolve upon you. But to improve the social condition of the poorer classes, to check the spread of disease, and to prolong the term of human life, while they are works of a high and ennobling character, are yet duties involving the gravest responsibility. Should less care be bestowed upon our fellow creatures than is daily afforded the lower animals? At the present moment the condition of many of the working classes is degraded in the extreme."

The Medical Officer of Health for St. Saviour, Southwark, wrote (1856):--

"In all our efforts at sanitary improvement we are chiefly dealing with persons who in most instances have not the power of helping themselves, and who until of late have had no source to which they might apply for aid in rendering their dwellings clean and wholesome."

The Medical Officer of Health in St. Pancras wrote:--

"All who have made themselves acquainted with the condition of many of the poor of London will agree with me when I say that before their moral or religious state is likely to be remedied, their physical condition must be improved, and their houses made more comfortable. On you devolves, to a great extent, the solemn responsibility for carrying out the preparatory work."

The Medical Officer of Health for St. Martin-in-the-Fields wrote to his Vestry in 1858: "To permit such grievous evils as are to be seen in the worst localities of this great city is a contradiction to the teaching of Christianity ... such outrages on humanity as many of the abodes of the poor are permitted to remain.

"It is unholy, it is unchristian, that people should herd together in such dens; and so long as such dwellings are allowed to be occupied our assumed religion must be a pretence and a sham...."

And thus, the Medical Officer of Health for Bethnal Green:--

"To open out avenues through our cul-de-sac courts, to promote the sanitary condition of every house, to arrest by thorough drainage and removal of refuse the elimination of aerial poison, are the great duties that we have day by day to do. Though the task before us be great, the objects in view are immeasurably greater--to exalt the standard of life, to economise rates, and above all to decrease the sum of misery, disease, and death.... To supply the arm strong to labour, to substitute productive for unproductive citizens, to decrease the death-roll of the young, and to protract life beyond the present span, these are the tasks that sanitary science imposes on us."

The Medical Officer of Health for Clerkenwell pointed out that--

"The poorer classes have not the means of remedying the defective sanitary conditions under which they are living. But the Vestry has this power."

The Medical Officer of Health for St. Pancras made a calculation that nearly 1,200 deaths in the parish in 1858 were due to causes which might have been prevented by sanitary improvements. "To every death we may safely assume more than thirty cases of illness. This gives us 36,000 cases of preventable disease in the year."

"You will see," wrote the Medical Officer of Health for St. James' (1856), "that by diminishing death and disease, you are diminishing poverty and want.... The sanitary question lies at the root of all others. It is a national one and a religious one. It is true that in the exercise of your powers you will often be met by the assertion of the rights of property, but the right of life stands before the right of property, and it is this recognition of the sacredness of human life that lies at the foundation of sanitary legislation."

The Medical Officer of Health for Whitechapel wrote:--

"I have in this report, as in duty bound, spoken plainly; if in the opinion of some members of the Board too plainly, my apology is--the deep sense I entertain of the importance of sanitary progress; for upon the success that shall attend the labours of those engaged in this most sacred cause depends the improvement of the social, moral, and intellectual condition of the people."

And the Medical Officer of Health for St. Giles' made this pathetic appeal for action:--

"While you are listening to the remainder of this report, I trust you will hold in your mind how many lives are being sacrificed every month to deficiencies in sanitary arrangements."

It is only here and there in the earlier reports of the Medical Officers of Health that specific mention is made of intemperance, but every reference to the subject showed how largely "drink" affected the sanitary condition of the people and intensified and complicated the evil conditions in which the people were placed, and rendered any amelioration, physical, moral, or religious, infinitely more difficult.

It was becoming more and more generally recognised that a very large proportion of the deaths and of disease were preventable.

"Any skilled eye glancing over the mortality tables will observe that a considerable number of deaths might have been prevented."

"We are now to a great extent aware," wrote the Medical Officer of Health for St. Saviour's (1856), "of the physical conditions on which the lives of individuals and communities depend."

The Medical Officer of Health for Fulham wrote in 1857:--

"Sanitary science and experience have full clearly proved to us how great an extent the prevention of disease and its extension rests with us."

But against contagion and infection no precautions whatever were taken, and so disease was sown broadcast throughout the community, and death followed.

As to suggested remedies and action there was a chorus of absolute unanimity upon some points:--

"The principal cause of the extent of zymotic disease," wrote the Medical Officer of Health for Mile-End-Old-Town, in 1859, "is the defective state of the habitations of the poorer classes. The remedy for the evil is only to be secured by a systematic house visitation.

"... Without a general house inspection it is impossible to secure the proper entry to and use of the expensive sewers which have been and are being constructed.

"Having done so much for the streets, pavements, and drains, the improvements will lose half their salutary effect if the interior of the dwellings are not placed in a corresponding condition of wholesome cleanliness."

"It is," wrote the Medical Officer of Health for Whitechapel, "to the interior of the houses that our attention must be directed, for it is here that the source of disease is usually found.... An habitual and detailed inspection of the houses occupied by the poorer classes is therefore essential."

A house-to-house visitation was, indeed, the first essential. By no other means could the actual condition of the abodes of the people be ascertained, and the breeding places of disease be discovered, cleared out, and rendered innocuous. And as there was a never ceasing tendency on the part of the poorer classes to sink into a condition of uncleanliness, and on the part of their abodes to fall into dilapidation, or, as it was expressed, "a pertinacity for dirt," so was constant inspection and supervision of vital necessity for the maintenance of any improvements made.

"There are," wrote the Medical Officer of Health for St. Pancras (1858), "many parts of the parish densely crowded. Some of the people have become so used to filth, they appear to prefer it to cleanliness; at any rate, they have not the energy to get rid of it and improve their condition. Such houses--perfect hotbeds of infectious diseases--ought to be visited two or three times a year...."

The Medical Officers of Health had one valuable object lesson before them in the common lodging-houses, which, regulated and inspected by the police under the Acts passed by Parliament, had shown that even the very worst conditions of life could be ameliorated, and that the very lowest and most miserable classes of society were not beyond improvement.

"The chief points which are regulated by the authorities (the Police) are cleanliness, drainage and water supply, the separation of the sexes, and the prevention of overcrowding. The testimony of all who are acquainted with the dwellings of the poor is concurrent as to the immense sanitary advantages gained by the provisions of the Common Lodging Houses Act, and the results had been to improve in a marked degree the health, habits, and morals of the persons using these places."[75]

"The cleanliness, comfort, and ventilation of the licensed rooms in common lodging-houses offer a very marked contrast to those which are unlicensed."[76]

To more than one of these officers the idea occurred that similar benefits would follow if tenement houses were similarly inspected.

"I believe considerable good might be accomplished by a legislative enactment placing every house let out in weekly tenements to more than one family under similar regulations to those affecting common lodging-houses, and rendering landlords liable for permitting overcrowding to exist upon their property."

The success of the common lodging-houses was due to the enforcement upon the owner of the first essentials of sanitation in the house he let to occupants, and to the regular "inspection" of his house to secure that those essentials were maintained in a state of efficiency.

But it was just these two things that were most held in abhorrence by the majority of tenement-house owners in London.

The Medical Officer of Health for the Strand, after describing the overcrowding of tenement-houses, wrote (1858):--

"No remedy it is feared will be found until all houses of the class alluded to, the rooms of which are let out as separate tenancies, shall be compulsorily _registered_ under the supervision of the Local Authority of the District in which they are situate, as fit for the accommodation of a certain number of persons, and no more."

"This suggestion will doubtless excite the sneers of the ignorant, the fears of the weak, and the ridicule of the selfish, coupled with the usual expressions about interference with the liberty of the subject; but the upright and unprejudiced will not fail to perceive that it is the liberty and the health of the working classes, forming, as they do, so large a proportion of the mass of the people which it is sought to protect from the tyrannical and grasping covetousness of an avaricious few who care little whether the health of the working man be destroyed, or whether his children be reared up in such a way that disease and vice must almost necessarily result, provided they succeed in obtaining for themselves an additional percentage upon their investment."

And the following year he again forcibly adverted to the subject.

"When it is borne in mind that in some of the small courts in this District there are packed together as many persons as almost equal in number the soldiers congregated in a commodious barracks, is the high death-rate a matter of surprise? But what can be done? The authorities, general or local, cannot surely be expected to provide suitable dwellings for the people! Undoubtedly they cannot; but it is incumbent upon these authorities, in the interest of the well-being of all classes of the community, to place a prohibitive limit in regard of overcrowding upon the class of houses the rooms of which are let out as separate tenements, which would, without hardship upon their occupants, speedily produce the desired effect. Such a condition, practically speaking, already exists in regard of most of the Public Institutions of this country in which large numbers of persons reside; such a condition is enacted by law in regard of our emigrant ships: such a condition is enforced by Act of Parliament in regard of Common Lodging Houses: and in all these instances the principle works well. Is it reasonable, then, that in relation to the influence of over-crowding upon health and life, less care should be taken of the people who occupy the densely populated districts of our great towns and cities than is already provided by law for the inmates of our Common Lodging Houses, or for the paupers admitted into our Workhouses, or for the emigrants who leave our shores? Surely the injustice cannot but be apparent."

Other suggestions were also made.

The Medical Officer of Health for Whitechapel wrote (1859):--

"If the public is to enjoy health, and a freedom from the ravages of epidemic disease, a stop must be put to the present scheme of erecting houses in crowded situations; for although the rights of property are to be respected, yet, in my opinion, such rights are of secondary consideration when compared with the public health and the increased burdens which must be borne by the ratepayers to support those whose sickness is occasioned by the unhealthiness of the localities where they reside."

Several urged the vigorous enforcement of the existing law. To the Vestry of Lambeth the Medical Officer of Health wrote in his report in 1856:--

"You must proceed actively against those who have raised the value of their possessions by ignoring the value of human life, who wilfully multiply disease by neglect of their pestiferous property."

The Medical Officer of Health for Hackney wrote (1858):--

"I feel assured that it cannot be too widely known that individuals will not be allowed to deal with their property in such a manner as to cause injury to the public health. For although individual liberty has long been the boast of England, yet there is a point beyond which it cannot be tolerated with safety; and private good should always be made to give way to the public welfare."

The greater the light thrown upon the sanitary condition of the people of London, the clearer became the fact that the principal blame therefor rested upon the house-owner, lessee, or middleman, or as Parliament defined him, "the owner."

Many of the Medical Officers of Health were outspoken and unhesitating in their opinion as to the responsibility of the house-owner for the existing condition of the dwellings of the people.

"The enemies of the poorer classes," wrote the Medical Officer of Health for Clerkenwell, "are the landlords, who know well that proper lodgings for the really poor do not exist. They know also that if they buy at a cheap rate any old premises not fit for a pig-sty and let them cheaply they will be sure to find tenants."

If it was not the real owner of the house, it was the middleman or person or persons between the owner and the tenant. Rents were high in most parts of London where there was urgent demand for accommodation, and "the yearly rental is unfortunately in many cases still further increased by the 'middleman system'; many of the houses being rented by an individual who sub-lets them in separate rooms as weekly tenancies, and this at an increase of 20 per cent. (Strand 1856):--

"And thus it is that health and life are daily sacrificed at the shrine of gain."

What sort of property some of them held, and the condition in which they allowed it to remain, whilst they drew their "gain" from it, is graphically illustrated by the Medical Officer of Health in St. Olave's, Southwark (1856).

He thus described the houses in three small courts:--

"The whole of these houses are held by one person, and it is impossible to imagine any state much worse than the condition of everything connected with their drainage, &c.

"Here, within a small area, are thirty-nine houses, all having open foul privies, cesspools all filled, and many overflowing. The yards are foul, dirty, damp, and wretchedly paved with small, loose, broken bricks--most of them are daily filled with the overflowing of the drains and cesspools, the drains are all untrapped, and scarcely a house has a proper receptacle for water; they are mostly broken, dilapidated, uncovered tubs, placed close to the cesspools, so as to absorb the foul gases emanating from them. The effluvium on entering any of these places is abominable, and greatly complained of....

"These three courts are thickly inhabited."

In the following month he reported nineteen houses in two streets very much the same as above. In the next month twenty more--in the month after, thirty more. He might almost have had the general description printed, with blanks for filling up the number of such houses and where situated.

If it had not been for the new Acts passed in 1855, this condition of things would doubtless have continued indefinitely. That condition had been reached under absence of inspection, or regulation, and freedom on the part of the owner to do as he liked; and had no laws been enacted to terminate it, no change would ever have been effected.

And when efforts were made by the local authorities to remedy similar places, strong opposition was met with. Thus in Hackney (1856-7):--

"1839 nuisances have been rooted out. In very many cases prosecutions have been ordered by the Board. They were almost invariably opposed by the offenders, generally people of substance, with the advantage of able legal aid, in the most pertinacious and resolute manner...."