Chapter II (3)

The novelty of enforcing upon the owners the improvements deemed necessary naturally raised in the minds of some of the Medical Officers of Health the question as to the justice of such a proceeding. Those who discussed it were clear upon the point.

Thus the Medical Officer of Health for Shoreditch (1856-7) wrote:--

"The question of putting houses into a condition fit for habitation has two bearings. It is, _first_, a question between the landlords and the tenants, whose health is sacrificed by neglect. It is, in the next place, a question between the landlords and the ratepayers.

"If the landlords neglect to make the necessary outlay in improving their property, the expense of maintaining that property in its unhealthy condition is thrown upon the ratepayers, for these have to bear the burden of supporting the sick and the destitute."

And the Medical Officer of Health for Clerkenwell:--

"At present the poor rates are raised by the parish having to pay the expenses of afflicted poor persons, whose misery has in most instances arisen from defective sanitary arrangements, the remedying of which ought to have been effected at the expense of the landlords, who derive their substance from the miseries of the poor."

And the Medical Officer of Health for St. George's, Hanover Square:--

"I am compelled to say that the number of dingy and dilapidated houses is a proof either that the owners of house property do not exercise sufficient control over their tenants, or that they themselves are grievously neglectful of their duties to their tenants and to society at large. The health of the Parish should not be allowed to suffer through the default of either landlord or tenant.... Here there need be no scruple about interference with private property.

"No man is allowed to sell poisonous food, and none should be allowed to sell poisonous lodgings, more especially as the effects of poisonous food are confined to the persons who eat it--the effects of unwholesome apartments may be diseases that may be spread."

On the equity of compelling the owners to put their houses in order, there are many insisters.

"It is but right," wrote the Medical Officer of Health for Fulham (1857), "that those who have hitherto fed their own resources by impoverishing others, should now in their turn make good the damage."

The Medical Officer of Health for Poplar (1856), wrote:--

"While on the one hand we must not proceed in a reckless manner so to burden property as to render it entirely unproductive, yet on the other we cannot allow the labouring man, whose health is the only property he can call his own, to live in unwholesome places to the destruction of that capital, by which alone he is enabled to support himself and family."

And the Medical Officer of Health for Mile-End-Old-Town (1856):--

"... To charge such property (viz., in bad condition and heavily encumbered) with the costs of thorough repair, would leave the owners in some instances, I am fully aware, destitute, but life is more sacred, and possesses higher rights than property, and it cannot be just to inflict or continue a public injury while endeavouring to spare and sympathise with the inconvenience of an individual."

That the evil state of the dwellings of the poorer classes entailed a charge upon the public was also pointed out by the Medical Officer of Health for Bethnal Green, who, referring to the miserable homes in the parish, wrote:--

"From the cradle to the grave their inmates are a direct charge upon our funds."

Happily the law was beginning to be enforced, and beginning to create a little alarm among some house-owners.

"As landlords are now aware that their property will be visited in rotation by the Inspector, the necessary alterations and improvements are frequently effected by them in anticipation."[77]

Others did the necessary work when ordered to do it by the sanitary authority.

Others, however, not until legal proceedings were taken, and they were ordered by the magistrate to do it--and even then some would not obey the magistrate's order, and the work had to be done by the sanitary authority, and the cost thereof levied from the owner.

One case was recorded by the Medical Officer of Health for St. Giles', in 1858-9, in which the authority of the law was more strongly asserted.

"While speaking of the resistance met with in enforcing sanitary requirements, it may be here mentioned that the extreme step of imprisoning the owner of a certain house has been had recourse to for his obstinate refusal to comply with a magistrate's order."

That disease and sickness among the people entailed a great loss and heavy burden upon the community appears scarcely to have received any recognition up to this, and yet it was a truth of far-reaching importance. That individuals suffered was of course clear, but that the community did was by no means realised.

Several of the Medical Officers of Health promptly discerned how true it was, and in their earlier reports dwelt upon it, pointing out the effects, and emphasising their great importance.

"It cannot be too often impressed upon our minds," wrote one, "that sickness among the poor is the great cause of pressure upon the rates; and everything that will tend to diminish the number of sick will be so much saved to the ratepayers."[78]

"The greater the amount of disease," wrote another, "the larger the proportion of pauperism."

"Of the causes of pauperism, none are so common as disease and death," wrote another.

Indeed, a little consideration must have demonstrated its truth. Difficult as it was for the individual in health to earn a livelihood--when sickness fell upon him there was the instant and complete cessation of his wages, and there were expenses incurred by his sickness. If he recovered, there had been a long disablement from work, and a heavy loss. If, however, he died, the community suffered by the loss of his productive labour, and, where the victim was the breadwinner of a family, his widow and children but too commonly became a charge upon the rates.

"High mortality in a district," wrote the Medical Officer of Health for Clerkenwell (1858), "especially among the poor who are the principal sufferers, does not relate simply to the dead; the living are also deeply concerned. Every death in a poor family causes an interruption to the ordinary remunerative labour, and produces expenses which have to be paid out of scanty wages. Hence the living suffer from want; the parish funds must be appealed to; families become parentless, and next comes crime."

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

"In the course of time the public will learn that sickness, with its concomitant evils, viz., the loss of wages, the calls upon clubs and friendly societies, the increased amount of charitable contributions, a heavier poor rate, &c., entails more expense upon the community than would be required to carry out sanitary improvements in widening streets, converting the culs-de-sac into thoroughfares, and in erecting more commodious houses for the poor."

And the Medical Officer of Health for the Strand wrote:--

"Of every death which occurs in this district over and above the ordinary rate of mortality, the number of _cases of illness in excess_ must be a high multiple. And during every attack of severe illness the patient, whatever his position in life may be, must be maintained--if wealthy, at his own expense, if poor, at that of the community at large. And in the latter case, the community at large must thus suffer a direct loss. _Health is money_, as much as time is money, and sooner or later sickness must be paid for out of the common fund...."

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

"To communities as well as to individuals there is nothing so expensive, so fatal to prosperity, as sickness. To a productive and labouring community, health is the chief estate.... A community is but a system of individuals--if one portion of that system be disabled by sickness, every other portion will feel the blow; the whole community will be taxed to support that part which is rendered incapable of supporting itself. It is then a plain matter of self-interest, as well as of solemn obligation, to exercise the most vigilant care in preserving to the poor their only worldly possession, their health and capacity for self-support."

Nor did the danger to the great community of London, from the prevalence of sickness in any particular district, appear to have received the faintest recognition.

And yet, in the matter of health, and protection from infection, all classes from the highest to the lowest had equal interest; for disease commencing or raging in one district is not long in spreading to other districts.

The Medical Officer of Health for Chelsea (1857-8) wrote:--

"It cannot need any argument to prove that diseases of an epidemic or infectious nature cannot be arrested in their progress by the imaginary line drawn around the boundaries of the parish--that the smoke from the furnaces in Lambeth and Vauxhall must be wafted across the Thames and influence the health of the inhabitants of Chelsea, if not kept in check, and that evils of minor importance in Pimlico, on one side, and Kensington on the other, may be quite as prejudicial to the health of the neighbours residing on this side of the boundary as to those among whom they are generated."

That any one locality had a duty to its neighbours, still less to London as a whole, as well as to the people of its own area, was beyond the range of the ideas of the vestries and district boards. Indeed, if their sense of duty did not induce them to look after and safeguard the people for whose sanitary condition they were immediately responsible, how could it be expected of them to be influenced by considerations as to those residing outside their area, and residing many miles away.

And yet, by the very condition of things, this greater responsibility did exist.

But the great fact that in the vital matter of the public health London was one great community, the various parts thereof being indissolubly welded together into one great whole, had not as yet apparently dawned upon the minds of the newly-created local authorities; nor, indeed, had Parliament even realised it, for it had left the forty and more of those authorities full freedom to scatter disease of the deadliest type from one end of London to the other, and to imperil the lives of London's inhabitants.

The reports of one of the Medical Officers of Health give such an exceptionally complete and vivid description of the condition of the parish to which he had been appointed, and in which he worked, that a series of extracts from them are given.

The parish was the parish of St. George-the-Martyr in Southwark, on the south side of the river, just opposite the City; "low-lying and flat, and about half a foot below Trinity high-water mark," with an area of 282 acres, and a population of about 52,000 persons, and the Medical Officer of Health was Dr. William Rendle, who speaks of himself as "an old parish surgeon."

"If a loose drain conducts stenches into a man's house instead of out of it, if the concentrated filthiness of a gully is blown into a front door or window, if a house often visited with fever has not been cleansed or whitewashed for many years, if there is no water but putrid water filled with disgusting living creatures, and no butt except a rotten one, not even the most enthusiastic lover of things as they are can find fault with us if we try to alter these things for the better....

"Let us picture to ourselves the man of the alley come home from work.

"The house is filthy, the look of it is dingy and repulsive, the air is close and depressing; he is thirsty: the water-butt, decayed and lined with disgusting green vegetation, stands open nigh a drain, and foul liquids which cannot run off are about it, tainting it with an unwholesome and unpleasant taste; the refuse heap with decaying vegetable matter is near, and the dilapidated privy and cesspool send up heavy, poisonous, and depressing gases. Such are the homes, may I say, of thousands in this parish?"

He contrasts the public-house with that, and says: "The surprise is not so much that one man here and there reels home drunk and a savage, as that for every such a one there are not twenty. Gentlemen of the Vestry who have seen these things can bear me witness that I do not exaggerate. This is no fancied statement....

"This parish has always been remarkable for its deathly pre-eminence. Hitherto there has been no sufficient law. After this we shall stand without excuse....

"... Who is to say, when the question is improvement, as to where we shall stop? No doubt there is a question of more or less rapid progress, so as to hurt existing interests as little as may be....

"Our intrusive visits, as some would call them, into filthy and diseased houses, benevolent as they are, on behalf of those who cannot always help themselves, have example even in the most remote times and from the highest authority. The ancient authority was more imperative, and made it more a matter of conscience. In the ancient Jewish law it was ordained 'that he that owneth the house shall himself come and tell the Priest, saying: "It seemeth to me there is, as it were, a plague in the house."' The Priest was then to command the emptying it, so that "all in the house be not made unclean." He was then to cause it to be scraped within and about, and finally he was to pronounce when the house was clean, and might be again inhabited.

"The Priest was, you perceive, the Medical Officer of Health under the Jewish law, and this text of Leviticus is the 13th section of the Diseases Prevention Act....

"From what I see of the parish we cannot without inconveniently close packing hold many more.[79]

"The growth of our parish is not from births alone; some persons of course immigrate from other parts of England, but the greater part come from Ireland, bringing with them disease and poverty....

"I am afraid that the poor of other parishes are forced upon us. We increase in poverty, and, paradoxical as it looks, the poorer we get the more we shall have to pay.

"There are now from 6-7,000 cases of illness per year attended by the poor-law surgeons.

"Our poor work at the waterside, in the city, and at the docks; their productive labour helps to pay the rates of other parishes, but in difficulty and sickness they live and lean upon us.

"Now as to _overcrowding:--_

In Lewisham there are 2 persons to an acre.
" Camberwell " 13 " " "
" Rotherhithe " 21 " " "
" All London " 30 " " "
" Newington " 104 " " "
While we have 184 " " "
And in one of the
parts of the parish 244 " " "

"Our parish is now almost completely built over.

"In 1850, out of 1,169 deaths 565 (or one half) were under 5 years.

"In Bermondsey, 506 out of 983.

"Our parish and Bermondsey are quite ahead (of others) in this unenviable race towards death."

"The contents of our sewers can only be discharged 4 hours each tide--8 hours each day--the remaining 16 hours daily they are reservoirs of stagnant sewage."

"We are sadly deficient in sewers. At least 100 courts, alleys, and back streets are entirely without drainage.... Some of our sewers have remarkably little incline. That in Friar Street, a most important one, is so level from Bean Street to Suffolk Street that it has a most curious quality for a sewer, that of flowing either way equally well.

"One very prevalent evil is loose brick drains which let the deadly gases into houses."

"... We are a most melancholy parish, low in level and low in circumstances. The lowest and poorest of the human race drop from higher and richer parishes into our courts and alleys, and the liquid filth of higher places finds its way down to us. We receive the refuse as well as the outcomings of more happily situated places."

His report for 1857 continued his description:--

"We lose annually 30 per 1,000--there are only two parishes worse than we are. Some at least of this mortality is preventable. If we could keep to the average of all London we should lose 300 less a year; or even to that of Bethnal Green we should lose 200 less.

"Few people believe we are so bad as we really are, and if we do not believe we shall not of course try to mend it, but it cannot be denied.

"The rich Londoners pay a low poor-rate. The poor Londoners pay a high poor-rate. This bears hardly upon us; it stifles us: more and more packed, more and more impoverished; with very little space between the poor ratepayer and the pauper, there is more sickness and death.

"Density of population brings you more deaths, more sickness, more expense.

"The dreadfully vitiated air of our courts and close rooms produces and fosters consumption."

Commenting on the common lodging-houses, he wrote:--

"The police regulations for order, cleanliness, and prevention of disease are in the highest degree satisfactory.... The benefits are so great that the employment of the same regulations in the more crowded and filthier houses of the poor can only be a question of time. It is the highest humanity to quicken the progress.

"Vestries have power sufficient for the purpose. The need is so great, so undoubted by those who have seen the evils with their own eyes, and the benefit to be obtained so certain, that if the local authorities do not enforce the improvements, the police will have to do it.

"As to the overcrowding, I have brought many cases before you, each from illness resulting in difficulty of cure, constantly recurring. 'I can never get out of that house,' said the district surgeon of one of them. The eight rooms in this house were always full, the receipts £2 2s. a week, yet it was dirty, neglected, and overcrowded. So the poor live, and I may say, so they die."

"As to some manufactories, some of them are very bad, and their pernicious influence spreads widely. I do not think any manufacturer should be obliged to leave; trades must, of course, be protected; but one man must not, to save a little expense in his building and machinery, be allowed to poison a neighbourhood, containing as this does some 30,000 people.

"There are various ways of making almost all of them bearable."

"In this parish are at least 4,000 houses rated under £10 a year, and containing 30,000 persons."

1858. _1st Quarter:_--

"Of smallpox and vaccination there are some who neglect this great precaution, and so not only imperil themselves but others. Here is the evil, and indeed, I believe, the reason why the disease is not altogether banished."

"... A case registered as diphtheria occurred and died; it began in one of the very worst localities and then extended to opener and better places. Thus it is that modern society neglects the social condition of its poor, and the poor with a well-ordered revenge bring disease and death as a consequence."

Referring to some tables he compiled, he said:--

"In this table appear 42 deaths from consumption; it has but recently become prominent how very preventable a disease this is ... the principal causes have here been made obvious enough: sleeping closely in ill-ventilated rooms, overcrowding, and bad ventilation."

"It is now quite established that, with close overcrowded rooms--that is, by assiduously causing the continued breathing a tainted atmosphere--you may insure consumption in the most healthy.

"3,500 years ago the Jewish legislator promulgated laws and duties almost identical with those we are now engaged in carrying out as new in the nineteenth century--but so it is."

"... There is a great deal of carelessness touching human life, and a great want of common sense or serious thought in the preserving it. Much is left to chance. There is either fatalism or stolid indifference upon the matter pervading highest society, and the poor, driven as they are from richer districts into poorer neighbourhoods, can scarcely help themselves; they lose at last all healthy communication with richer or better neighbours, and all taste for pure air and healthy pursuits; they pack close, they descend a little, often a great deal, toward the lower animals, and so live neither for this world nor the next."

"There are 7,000 houses in this parish. 890 of these have been visited this year, and in 756 the work ordered has been carried out--sometimes in a most slovenly manner--an apparent compliance with your orders. In the poorer districts the most incompetent men are employed to plaster over, patch over, whitewash, or cover over the evils ordered to be _not covered but amended_. Still a great amount of good work has been done.

"... Overcrowding is the normal state in our poorer districts. Small houses of four rooms are usually inhabited by 3 or 4 families, and by 8, 16, or 24 persons, _e.g._, 133 inhabitants in 8 houses ... a filthy yard generally implies a filthy house and unclean habits" ... "this parish with its thousands of refuse heaps."

"I know that we are on the right track. May Pole Alley, a cul-de-sac with its 23 houses and 180 people, was once a nest of infectious diseases. I attended some 10 cases of typhus there, some of them malignant enough to destroy life in 48 hours. With great trouble this court has been cleansed and amended. It is very much more healthy."

1858. _2nd Quarter:_--

"June--an exceedingly hot and dry month. You may judge of the effect of such temperature upon exposed dung-heaps, wet sloppy yards, and rotten, filthy, uncovered water-butts; three characteristics of this parish....

"The Surgeon of the District writes thus to the Board of Guardians: 'The smell is very bad from a horse-boiling establishment in Green Street, which causes a great increase of sickness near that part.' This of course refers to the bone boiling and other like establishments, of which there are, in this one small street, three cat gut manufacturers, one soap boiler, one horse slaughterer, and four bone boilers--all very offensive trades. I am receiving complaints in all directions as to this matter. I am inclined to think that this is not altogether just to the 20,000 inhabitants who live within the effluvia circle of Green Street."

As to infantile mortality he writes: "I confess I see but little difference between that sanguinary ancient law that directly destroyed weakly and deformed children, and that modern indifference that insures at the very least an equally fatal result" ... "these disturbing truths involving so much trouble and expense, and giving us painful reminders of new duties, as well as of old ones neglected."

He complains of having to neglect a great many cases of insanitation owing to want of staff. "... Of those upon whom orders come to remove nuisances, &c., a large number are objectors, and not a few positive obstructors...."

"The items in this last table merit attention, and throw a sad sort of light upon the condition of the poor of this parish. We have visited 73 unclean and ruinous houses; 118 in which the water was stored in a most unwholesome manner; 163 in which the drains were defective enough to be disease producing; 72 in which the w.c.'s were more or less unfit for use; 110 yards sloppy, not paved, or ill-paved; and 138 in which there was no sufficient provision for house refuse....

"We are packing more and more closely.

"In the great mass of our poorer habitations the allowance of breathing room is not more than 200 cubic feet per head--often as low as 120. In one house reported to me there were 30 in four rooms with only 2,410 cubic feet, or 80 cubic feet per individual. This must, of course, be premature death to many of them....

"We cannot overlook what is going on: improvements are being effected elsewhere, the dwellings of the poor are being destroyed, a few parishes are fast becoming pre-eminently poor, over-crowded, and filthy. I need not tell you that this parish is one that gets in this respect steadily worse from the improvement in others.

"The temptation is very great to overcrowd; the poor family, however large, by crowding into one room, and by even taking a casual lodger in addition, obtains a sort of home at a cheaper rate, and the owner gets a much larger revenue out of what I must, I suppose, call human habitations. The resulting illness and death are considered inevitable, or are viewed with a stolid indifference."

1858. _3rd Quarter:_--

Of the greatness of the mass of prevalent evils he wrote: "I have often reported it here, but the very enormity of the evil blunts our appreciation of it...."

There had been a high mortality in the Quarter. "We are once more, I believe, the worst parish in London...."

"The back districts of this parish require relief, as much as Ireland ever did, from a class of middlemen who, with some few most honourable exceptions, grind out all they can from the most squalid districts, and carry nothing back in the way of cleanliness or improvement."

He gives a long list of streets and courts and places where disease was rampant and deadly owing to the insanitary conditions.

"It may perhaps be said that all this is in the order of nature, and cannot be prevented. My experience of a quarter of a century among these diseases points quite the other way. Providence does not intend that reservoirs of stinking putrid matter shall stand so close to the poor man's door as to infest him at bed and board.... In the Jewish scriptures the places for the purposes here mentioned are ordered to be without the camp, as far from the breathing and eating places as possible; and among us, as you see, when we tolerate such abominations, He visits us with death. It is the result of the irrevocable laws of nature often averted by what appear as happy accidents, but at last, when disregarded, deadly. Gentlemen, you are the trustees for life and death to a population of well-nigh 30,000 people, who from the force of circumstances are more or less unable to help themselves...."

"Of course it cannot be expected that we can provide the homes of the poor with the orderly arrangements and benefits of these Institutions (Dispensaries, &c.)--that, however, will form no excuse here or hereafter for not carrying out the improvements we can easily achieve, and which a wise legislature has given us full authority to do."

"Total deaths in Quarter ended October 2nd, 1858--369, of which 225 were of children under 5 years = 61 per cent!!"

The whole tone of this report was such that he could not possibly continue as Medical Officer of Health to a then existing Vestry, and he resigned.

He was succeeded by another very able man, Dr. Henry Bateson, from whose reports may be continued the description of this parish up to the census of 1861.

"The onward moral and intellectual progress of the human race depends far more upon the sanitary state which surrounds it than has ever yet entered into our imaginations to conceive....

"We have suffered severely from the ravages of smallpox. Smallpox is a disease over which we have perfect control, and which, were vaccination thoroughly carried out, might be banished from these dominions."

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

"... Our wells are but the receptacles of the washings from our streets, the off-scourings from our manufactories, the permeations from our cesspools, and the filterings from our graveyards."

1860-1861. After five years' local government:--

"The circumstances are various and complicated, which contribute to prevent the improvement of the district, and even make the endeavour seem at times hopeless. No one can know the fertile sources that exist for producing in the mind this feeling of despair save those engaged in sanitary labours; or those perchance whose duty it may be to visit our poorest and lowest localities." ... "It is no light and easy work to remove the aggregate evils of centuries which, like the coral reefs of the ocean, have grown up silently and continuously to their present magnitude.... There are hindrances all around, some of which are unsurmountable, such as those arising from the imperfections of the law itself ... there are also vested rights, customs, ignorance, stupidity, and avarice, all of which have to be dealt with and overcome if possible."

"Nature never pardons. Obey and it is well; disobey and reap the bitter consequences."

Referring to some houses "of the worst description, having no yards, nor even windows behind, so that ventilation was impossible," he says: "I am sorry to say that there are numbers of similar houses still standing, and occupied by the most ignorant and degraded of our population--a class living almost in the neglect of laws human and divine; and as heedless about the present and the future as the very heathen themselves...."

"The state and condition of the dwellings of the poorer classes are a stain upon our civilisation."

"... No one can conceive, nor would they believe, unless eye-witnesses, the wretched circumstances in which vast numbers of families have to spend their lives. It is indescribable."

"The daily task of keeping clean their houses and families, once a pleasure to them as well as a duty, having to be performed amid overwhelming obstacles on every side, from which no hope of escape remains to cheer them on, is gradually neglected and ultimately abandoned, their spirits become torpid and depressed, and this is necessarily followed by the derangement of the functions of the body. Finally they become reckless, and this recklessness increases the evil which gave it birth. There is action and reaction. What marvel then that, like unto those about them, they float down the ebb tide towards the dead sea of physical dirt and moral degradation. It has been truly said by Dr. Southwood Smith, 'The wretchedness being greater than humanity can bear, annihilates the mental feelings, the faculty distinctive of the human being.'"

"The heedlessness shown in the building of houses is astonishing. No care is taken about the nature of the subsoil, the position, the ventilation, and means of cleanliness. They are run up anywhere and almost anyhow, and too often become the prolific source of disease." And he quotes: "No man has a right to erect a nuisance, and the public has clearly as good a right, as great an interest in enforcing cleanliness to prevent the outbreak of an epidemic as in requiring walls to prevent the spread of fire. Yet, where one is destroyed by fire, how many thousands are there destroyed by disease, the indirect result of such erections?"

"We are desperately careless about our health, and apparently esteem it of small value. A great modern writer has truly said: 'The first wealth is health. No labour, pains, temperance, poverty, nor exercise that can gain it must be grudged. For sickness is a cannibal which eats up all the life and youth it can lay hold of, and absorbs its own sons and daughters.'"

The descriptions here given enable us to realise how terrible and pitiable a state of things had been reached, and the depths of filth, and misery, and abomination into which the people had been allowed to sink through the indifference of Parliament, the absence of any local government, and the neglect or avarice of the "owners."

One hope there now was. Parliament had at last made laws to remedy these evils, and local governing authorities had been created to administer and enforce the laws.

In 1858 a Public Health Act was passed by Parliament, which put an end to the existence of the Board of Health, and transferred to the Privy Council the administration of the Diseases Prevention Act. And the Privy Council was authorised to cause inquiry to be made in relation to matters concerning the public health. In 1861 a medical department of the Privy Council was formed which has in many ways been of immense service to the cause of public health, and which, as time went on, developed towards a true Ministry of Public Health.

All things considered, by the end of the first five years of the working of the new local constitution conferred upon the metropolis, a real beginning had been made in the sanitary evolution of the great city. Some of the grossest evils had been attacked, and a start made in lifting London out of the depths of the appalling slough of abominable filth in which it had become submerged.

In some of the vitally important matters progress was material. The improvement in the water supply was considerable, the main drainage works had been started; the construction of many new sewers, the abolition of great numbers of cesspools, and the better drainage of houses, were all events of a decidedly satisfactory character.

And the death-rate of London as a whole showed a slight decrease--from 23·38 per 1,000 in 1851 to 23·18 in 1861. In some districts there was an increase--in the majority, however, there was a decrease.

But most encouraging of all was the direct evidence afforded by experience as to the effects of sanitary improvements.

Thus, in Whitechapel, the Medical Officer of Health, in reporting that the cases of fever had diminished from 1,929 in 1856 to 190 in 1860, said:--

"This diminution may be fairly attributed to the additions made to the sewerage of the district, the improvements effected in the drainage of 2,172 houses, the abolition of 3,002 cesspools, the better paving of many of the courts, the systematic inspection, &c., of houses where fever occurred, the removal of 37,607 nuisances, and to the abolition of several offensive trade nuisances."

And the Medical Officer of Health for Shoreditch wrote, in 1861:--

"That the diminished mortality and the lesser frequency of epidemic diseases are really due in great measure to sanitary works and inspection is proved by the diminution and even disappearance of certain forms of sickness from streets, courts, and districts where sewers have been constructed, ventilation provided, and other improvements effected; whilst, on the other hand, the districts still requiring those necessary reforms furnish far more than their proportion of the epidemic sickness and mortality."

Philanthropic individuals were increasing their efforts for the improvement of the people; and societies, working on a self-supporting basis, were taking more active interest in the housing problem, and erecting model lodging-houses and more healthy habitations.[80]

Public opinion was more interested than before in sanitary matters, and it was thought that the working classes had also in some degree awakened to the care of their own health.

"Altogether," wrote the Registrar General, in his report on the health of London after the census figures of 1861 were known, "there is abundant proof of that increased regard for human life that attends civilisation."

FOOTNOTES:

[54] 18 and 19 Vic. cap. 120.

[55] 18 and 19 Vic. cap. 121.

[56] 18 and 19 Vic. cap. 122.

[57] Section 103 of Metropolis Local Management Act.

[58] There is in the library of the London County Council an almost complete set of these annual reports inherited from the Metropolitan Board of Works. Unless those sent to the Secretary of State, as directed by the Act, have been preserved, there is no other collection in existence.

[59] St. Giles'.

[60] Fulham.

[61] Rotherhithe.

[62] Hackney.

[63] Medical Officer of Health, 1856.

[64] "Lungs for London," _Household Words_, vol. i. p. 45, 1850.

[65] P.P. 1852-3, vol. lxxviii. p. 327.

[66] Clerkenwell, 1856.

[67] Fulham, 1857.

[68] Whitechapel, 1857.

[69] St. Giles', 1859.

[70] St. George the Martyr, 1859-60.

[71] Strand, 1859-60.

[72] Clerkenwell, 1860-1.

[73] 14 and 15 Vic. cap. 34.

[74] Shoreditch, 1859-60.

[75] St. Giles', 1857-8.

[76] St. Olave, Southwark, 1856.

[77] Whitechapel, 1857.

[78] Whitechapel.

[79] Population went up from 51,824 in 1851 to 60,278 in 1896.

[80] "The moral and social benefits conferred by these buildings has been immeasurable," wrote one Medical Officer of Health (St. Pancras).

"They are institutions whose larger acceptance would save the lives of hundreds, and reclaim the morals of thousands," wrote another.