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  REPORTS
  RELATING TO
  THE SANITARY CONDITION
  OF THE
  CITY OF LONDON.

  BY
  JOHN SIMON, F.R.S.
  SURGEON TO ST. THOMAS’S HOSPITAL, AND
  OFFICER OF HEALTH TO THE CITY.

  LONDON:
  JOHN W. PARKER AND SON, WEST STRAND.
  MDCCCLIV.


  LONDON:
  SAVILL AND EDWARDS, PRINTERS, CHANDOS STREET,
  COVENT GARDEN.


  TO
  LOUIS MICHAEL SIMON,
  OF THE STOCK EXCHANGE, LONDON, AND OF
  THE PARAGON, BLACKHEATH,
  I DEDICATE THIS REPRINT OF MY REPORTS:
  LOOKING
  LESS TO WHAT LITTLE INTRINSIC MERIT THEY MAY HAVE,
  THAN TO THE YEARS OF ANXIOUS LABOUR THEY REPRESENT:
  DEEMING IT FIT TO ASSOCIATE
  MY FATHER’S NAME
  WITH A RECORD OF ENDEAVOURS TO DO MY DUTY:
  BECAUSE IN THIS HE HAS BEEN MY BEST EXAMPLE;
  AND
  BECAUSE I COUNT IT THE HAPPIEST INFLUENCE IN MY LOT,
  THAT, BOUND TO HIM BY EVERY TIE OF GRATEFUL AFFECTION,
  I HAVE LIKEWISE BEEN ABLE, FROM MY EARLIEST CHILDHOOD
  TILL NOW--THE EVENING OF HIS LIFE,
  TO REGARD HIM WITH UNQUALIFIED AND INCREASING RESPECT.




CONTENTS.


                                                            Page
  DEDICATION                                                 iii

  PREFACE                                                    vii

  FIRST ANNUAL REPORT                                          1

  FURTHER REMARKS ON WATER-SUPPLY                             72

  SECOND ANNUAL REPORT                                        77

  THIRD ANNUAL REPORT                                        177

  FOURTH ANNUAL REPORT                                       211

  FIFTH ANNUAL REPORT                                        213

  APPENDIX OF TABLES ILLUSTRATING THE SANITARY CONDITION OF
  THE CITY OF LONDON.                                        264

  REPORT ON CITY BURIAL-GROUNDS                              280

  REPORT ON EXTRAMURAL INTERMENTS                            285




PREFACE.


The following Reports, officially addressed to the Commissioners of
Sewers of the City of London, were originally printed only for the use
of the Corporation; and although, to my very great pleasure, they have
been extensively circulated through the medium of the daily press, there
has continued so frequent an application for separate copies that the
surplus-stock at Guildhall has long been exhausted. Under these
circumstances--believing the Reports may have some future interest, as
belonging to an important educational period in the matters to which
they refer, I have requested the Commission to allow their collective
reprint and publication; and this indulgence having been kindly accorded
me, I have gathered into the present volume all my Annual Reports,
together with a special Report suggesting arrangements for extramural
burial.

From the nature of the work, I have not considered myself at liberty to
make those extensive alterations of text which usually belong to a
second edition. I have restricted myself to a few verbal corrections,
and to rectifying or omitting some unimportant paragraph, here or there,
in case its matter has been more fully or more correctly stated in parts
of a subsequent Report. Frequently, where I have wished to explain or
qualify passages in the text, I have added foot-notes; but these are
distinguished as interpolations by the mark--J. S., 1854.

My Reports lay no claim to the merit of scientific discovery. Rather,
they deal with things already notorious to Science; and, in writing
them, my hopes have tended chiefly towards winning for such doctrines
more general and more practical reception. It has seemed to me no
unworthy object, that, confining myself often to almost indisputable
topics--to truths bordering on truism, I should labour to make trite
knowledge bear fruit in common application.

Nor in any degree do they profess to be cyclopædic in the subject of
Preventive Medicine; for it is but a small part of this science that
hitherto is recognised by the law; and that--so far as the metropolis is
concerned, scarcely beyond the confines of the City. It would have been
an idle sort of industry, to say much of places or of matters foreign to
the jurisdiction of those whom I officially addressed.

In re-publishing documents which proclaim extreme sanitary evils, as
affecting the City, I think it right to draw attention to the dates of
the several Reports, and to state that for the last five years many of
these evils have been undergoing progressive diminution, of late at a
rapid and increasing rate; while, at their worst, they represented only
what I fear must be considered the present average condition of our
urban population.

This national prevalence of sanitary neglect is a very grievous fact;
and though I pretend to no official concern in anything beyond the City
boundaries, I cannot forego the present opportunity of saying a few
words to bespeak for it the reader’s attention. I would beg any educated
person to consider what are the conditions in which alone animal life
can thrive; to learn, by personal inspection, how far these conditions
are realised for the masses of our population; and to form for himself a
conscientious judgment as to the need for great, if even almost
revolutionary, reforms. Let any such person devote an hour to visiting
some very poor neighbourhood in the metropolis, or in almost any of our
large towns. Let him breathe its air, taste its water, eat its bread.
Let him think of human life struggling there for years. Let him fancy
what it would be to himself to live there, in that beastly degradation
of stink, fed with such bread, drinking such water. Let him enter some
house there at hazard, and--heeding where he treads, follow the guidance
of his outraged nose, to the yard (if there be one) or the cellar. Let
him talk to the inmates: let him hear what is thought of the bone-boiler
next door, or the slaughter-house behind; what of the sewer-grating
before the door; what of the Irish basket-makers upstairs--twelve in a
room, who came in after the hopping, and got fever; what of the
artisan’s dead body, stretched on his widow’s one bed, beside her living
children.

Let him, if he have a heart for the duties of manhood and patriotism,
gravely reflect whether such sickening evils, as an hour’s inquiry will
have shown him, ought to be the habit of our labouring population:
whether the Legislature, which his voice helps to constitute, is doing
all that might be done to palliate these wrongs; whether it be not a
jarring discord in the civilisation we boast--a worse than pagan
savageness in the Christianity we profess, that such things continue, in
the midst of us, scandalously neglected; and that the interests of human
life, except against wilful violence, are almost uncared for by the law.

And let not the inquirer too easily admit what will be urged by less
earnest persons as their pretext for inaction--that such evils are
inalienable from poverty. Let him, in visiting those homes of our
labouring population, inquire into the actual rent paid for
them--dog-holes as they are; and studying the financial experience of
Model Dormitories and Model Lodgings, let him reckon what that rent can
purchase. He will soon have misgivings as to dirt being cheap in the
market, and cleanliness unattainably expensive.

Yet what if it be so? Shift the title of the grievance--is the fact less
insufferable? If there be citizens so destitute, that they can afford to
live only where they must straightway die--renting the twentieth
straw-heap in some lightless fever-bin, or squatting amid rotten
soakage, or breathing from the cesspool and the sewer; so destitute that
they can buy no water--that milk and bread must be impoverished to meet
their means of purchase--that the drugs sold them for sickness must be
rubbish or poison; surely no civilised community dare avert itself from
the care of this abject orphanage. And--_ruat cœlum_, let the principle
be followed whithersoever it may lead, that Christian society leaves
none of its children helpless. If such and such conditions of food or
dwelling are absolutely inconsistent with healthy life, what more final
test of pauperism can there be, or what clearer right to public succour,
than that the subject’s pecuniary means fall short of providing him
other conditions than those? It may be that competition has screwed
down the rate of wages below what will purchase indispensable food and
wholesome lodgment. Of this, as fact, I am no judge; but to its meaning,
if fact, I can speak. All labour below that mark is masked pauperism.
Whatever the employer saves is gained at the public expense. When, under
such circumstances, the labourer or his wife or child spends an
occasional month or two in the hospital, that some fever-infection may
work itself out, or that the impending loss of an eye or a limb may be
averted by animal[1] food; or when he gets various aid from his Board of
Guardians, in all sorts of preventable illness, and eventually for the
expenses of interment, it is the public that, too late for the man’s
health or independence, pays the arrears of wage which should have
hindered this suffering and sorrow.

  [1] Twenty years’ daily experience of hospital surgery enables me to
  say, from personal knowledge, that our wards and out-patient rooms are
  never free from painful illustrations of the effects of insufficient
  nutrition--cases, in fact, of chronic starvation-disease among the
  poor; such disease as Magendie imitated, in his celebrated
  experiments, by feeding animals on an exclusively non-azotised diet.

Probably on no point of political economy is there more general
concurrence of opinion, than against any legislative interference with
the price of labour. But I would venture to submit, for the
consideration of abler judges than myself, that before wages can safely
be left to find their own level in the struggles of an unrestricted
competition, the law should be rendered absolute and available in
safeguards for the ignorant poor--first, against those deteriorations of
staple food which enable the retailer to disguise starvation to his
customers by apparent cheapenings of bulk; secondly, against those
conditions of lodgment which are inconsistent with decency and health.

But if I have addressed myself to this objection, partly because--to the
very limited extent in which it starts from a true premiss, it deserves
reply; and partly because I wish emphatically to declare my conviction,
that such evils as I denounce are not the more to be tolerated for their
rising in unwilling Pauperism, rather than in willing Filth; yet I doubt
whether poverty be so important an element in the case as some people
imagine. And although I have referred especially to a poor
neighbourhood--because here it is that knowledge and personal refinement
will have least power to compensate for the insufficiencies of public
law; yet I have no hesitation in saying that sanitary mismanagement
spreads very appreciable evils high in the middle ranks of society; and
from some of the consequences, so far as I am aware, no station can call
itself exempt.

The fact is, as I have said, that, except against wilful violence, life
is practically very little cared for by the law. Fragments of
legislation there are, indeed, in all directions: enough to establish
precedents--enough to testify some half-conscious possession of a
principle; but, for usefulness, little beyond this. The statutes tell
that now and then, there has reached to high places the wail of physical
suffering. They tell that our law-makers, to the tether of a very scanty
knowledge, have, not unwillingly, moved to the redress of some clamorous
wrong. But--tested by any scientific standard of what should be the
completeness of sanitary legislation; or tested by any personal
endeavour to procure the legal correction of gross and glaring evils;
their insufficiencies, I do not hesitate to say, constitute a national
scandal, and, perhaps in respect of their consequences, something not
far removed from a national sin.

In respect of _houses_--here and there, under local Acts of Parliament,
exist sanitary powers, generally of a most defective kind; pretending
often to enforce amendments of drainage and water-supply; sometimes to
provide for the cleansing of filthy and unwholesome tenements; in a few
cases to prevent over-crowding; very rarely to ensure stringent measures
against houses certified to be unfit for human habitation.
Occasionally--but a few lines would exhaust the list, an application of
the Public Health Act, or some really efficient local Act, has put it
within reach of the authorities to do all that is needful under certain
of these heads. But I know of no such town that would bear strict
examination as to its possession of legal powers to fulfil, what I
presume must be the principle contemplated by the law--that no house
should be let for hire unless presenting the conditions indispensable
for health, or be hired for more occupants than it can decently and
wholesomely accommodate.[2] However this may be expressed, and in
whatever laws embodied, local or general, I will venture to say that no
Government should suffer a town, either to be without the means of
enforcing this principle, or, having such means, to shirk their
exercise. Our Constitution may properly concede that local
representative authorities shall have their option whether, for sanitary
purposes, to fall under a general law, or to have Local Improvement Acts
of their own; but, in the present state of knowledge, it certainly seems
incontestable that one or other of these alternatives should be
compulsory, and that all Local Improvement Acts should be required, in
their sanitary clauses, to come up to the standard of the Public Health
Act of the time, whatever it may be.

  [2] In addition to the ordinary powers--given, for instance, in the
  Public Health or City Sewers Act, for abating accumulated nuisances
  and for enforcing wholesome constructional arrangements; a principal
  requirement of all bodies having jurisdiction for the public health
  is, that there should be vested in them some authority, _enabling them
  to regulate_, in the spirit of the Common Lodging House Act, _all
  houses which are liable to be thronged by a dangerous excess of low
  population_. Almost invariably such houses are of the class
  technically known as ‘tenement-houses,’ i. e., houses divided into
  several tenements or holdings; whereof each--though very often
  consisting but of a single small room, receives its inmates without
  any available restriction as to their sex or number, and without
  regard to the accommodation requisite for cleanliness, decency, and
  health. The inhabitants of such houses, especially where of the lower
  order of Irish, constantly lapse into the most brutal filthiness of
  habits, and live in almost incredible conditions of dirt,
  over-crowding, and disease. See sections of the following Reports,
  beginning severally at pages 44, 146, and 195. Powers for dealing with
  these evils might be given to Local Boards of Health, most usefully, I
  think, in some such form as the following: 1) that--in respect of any
  house occupied by more than one family, if it be situate in any court,
  alley, or other place having no carriage-way, and be not assessed to
  the poor-rate at a higher rental than £...... _per annum_; or if in it
  any occupied holding consist of only one room, provided the rent of
  such room do not exceed the sum of ......shillings per week, or if in
  it there reside, or within three months previous have resided, any
  person receiving parochial relief, medically or otherwise; on the
  certificate of a duly authorized medical officer, that any such house,
  or part thereof, is habitually in a filthy condition, or that from
  over-crowding or defective ventilation the health of its inmates is
  endangered, or that there has prevailed in it undue sickness or
  mortality of an epidemic or infectious kind; the Local Board may call
  upon its owner to register it in a book kept for this purpose; and in
  respect of all houses thus registered, the Local Board may make rules
  for periodical washing, cleansing, and limewhiting, and for the
  regular removal of all dust or refuse-matter, may fix the number of
  tenements into which it shall be lawful to divide any such house, or
  the total number of inmates who may at one time be received therein,
  may require its better ventilation by the construction of additional
  windows or louvres, and may from time to time make such other
  regulations and orders as they shall judge necessary for the
  maintenance of health and decency; and may recover from the owner or
  lessee of any such house penalties for neglect of any legal
  requisitions, rules, and orders, as aforesaid: 2) that--on the
  certificate of a duly authorised medical officer, that the condition
  of any house or room is such as to render probable the rise or the
  spread of infectious and dangerous disease among its inmates, the
  Local Board may cause the owner or lessee of such house to be summoned
  before a magistrate; who, after due hearing, or in default of the
  owner’s or lessee’s appearance, may order the house, or any part of
  it, to be evacuated of all tenants within such time as he shall judge
  fit, and not again to be tenanted till after licence from the Local
  Board given on the certificate of their medical officer that its
  causes of unhealthiness are abated; and the magistrate may enforce
  penalties for non-compliance with his order, as aforesaid: 3)
  that--after an Order in Council bringing into action the extraordinary
  clauses of the Nuisances Removal Act, the Local Board, on receiving
  the certificate of their medical officer that any house, or part of
  house, is in such condition as to be imminently dangerous to the lives
  of its inmates in respect of the prevailing epidemic, or any similar
  disease, may issue a peremptory order for its evacuation, and may
  recover, from the owner or lessee to whom such order is addressed,
  penalties for every day during which, or part of which, after such
  order, the house, or any part thereof, continues to be tenanted; nor,
  under like penalties, shall it be lawful, except after written licence
  from the Local Board, given as aforesaid, to allow such house to be
  re-occupied.

Under circumstances like those just adverted to, may be found traces of
enactment against _offensive and injurious trades_. Unregulated
slaughtering throughout all London, except the City, tallow-melting in
St. Paul’s church-yard, bone-boiling beside Lambeth Palace, may serve to
illustrate the completeness and efficiency of these laws--even in our
metropolitan area. Here we greatly lack some competent authority, on the
part of the Government, to investigate all circumstances connected with
such establishments, generally; to suggest laws for their prospective
restriction, as to places wherein they may lawfully settle; and to frame
regulations--enforceable by any Local Board of Health, for ensuring that
all available measures be employed to mitigate their nuisance.
Considering the circumstances under which many of these establishments
have existed, no one can entertain a thought, that--even for the public
health, they should be liable to the tyranny of an unconditional
displacement. But if there existed--as undoubtedly there should exist,
some skilled tribunal, competent to speak on the subject; then, I will
venture to say, it might be quite in accordance with our English sense
of liberty, that--after a certain condemnatory verdict by this tribunal,
it should be open to the Local Board of Health to procure their
expulsion, on payment of whatever compensation an ordinary jury might
award.

Again, with _factories_; thanks to Lord Shaftesbury’s indefatigable
benevolence, the law has appointed an inspection of certain
establishments, a restriction of their hours of labour, and some care
against the dangers of unboxed machinery. And with mining also the law
has interfered, chiefly as to the ventilation of mines; but hitherto so
ineffectively that, while I write, the coal-miners are remonstrating
with the Legislature on the thousand lives _per annum_ still sacrificed
through the insufficient protection accorded them. If there be meaning
in this legislation--if it imply any principle, the meaning and the
principle require to be developed into a general law, that every
establishment employing labour be liable to inspection and regulation in
regard of whatever acts and conditions are detrimental or hazardous to
life. If factory-children are cared for, lest they be over-worked; and
miners, lest they be stifled; so, for those who labour with copper,
mercury, arsenic, and lead, let us care, lest they be poisoned! for
grinders, lest their lungs be fretted into consumption! for
match-makers, lest their jaws be rotted from them by phosphorus! And
here let it again be noticed, as in the class of cases last spoken of,
how greatly wanted is some skilled tribunal, to form part of any lawful
machinery which might ensure that, in these and similar instances, no
precautions necessary to life are withheld through ignorance or
parsimony.

Against _adulterations of food_, here and there, obsolete powers exist,
for our ancestors had an eye to these things; but, practically, they are
of no avail. If we, who are educated, habitually submit to have copper
in our preserves, red-lead in our cayenne, alum in our bread, pigments
in our tea, and ineffable nastinesses in our fish-sauce, what can we
expect of the poor? Can they use[3] galactometers? Can they test their
pickles with ammonia? Can they discover the tricks by which bread is
made dropsical[4], or otherwise deteriorated in value, even faster than
they can cheapen it in price? Without entering on details of what might
be the best organisation against such things, I may certainly assume it
as greatly a _desideratum_, that local authorities should uniformly have
power to deal with these frauds (as, of course, with every sale of
decayed and corrupted food) and that they should be enabled to employ
skilled officers, for detecting at least every adulteration of bread and
every poisonous admixture in condiments and the like.

  [3] The proverbial dilutions of milk are not its only deteriorations.
  Cows are so ill kept in London, and in consequence so often sickly,
  that milk suffers--sometimes by mere impoverishment, sometimes by much
  graver derangements. If there were instituted a proper Inspection of
  Provisions, one function of its officers should be to visit
  cow-houses, and to prevent the distribution of milk thus damaged or
  infected. I suspect that a sanitary reform of these establishments
  would make a sensible difference to the nursery-population of the
  metropolis.

  [4] A chief artifice in the cheapening of bread is to increase its
  weight by various means which render it retentive of water. The other
  usual frauds consist in the employment of inferior flours--either not
  cereal, or damaged and partially deglutinised.

In some respects this sort of protection is even more necessary, as well
as more deficient, in regard to _the falsification of drugs_. The
College of Physicians and the Apothecaries’ Company are supposed to
exercise supervision in the matter; so that at least its necessity is
recognised by the law. The security thus afforded is, in practice, null.
It is notorious in my profession that there are not many simple drugs,
and still fewer compound preparations, on the standard strength of which
we can reckon. It is notorious that some important medicines are so
often falsified in the market, and others so often mis-made in the
laboratory, that we are robbed of all certainty in their employment.
Iodide of potassium--an invaluable specific, may be shammed to half its
weight with the carbonate of potash. Scammony, one of our best
purgatives, is rare without chalk or starch, weakening it, perhaps, to
half the intention of the giver. Cod-liver oil may have come from seals
or from olives. The two or three drops of prussic acid that we would
give for a dose may be nearly twice as strong at one chemist’s as at
another’s. The quantity of laudanum equivalent to a grain of opium
being, theoretically, 19 minims; we may practically find this grain, it
is said, in 4.5 minims, or in 34.5. And my colleague, Dr. R. D. Thomson,
who has much experience in these matters, tells me that of
calamine--not indeed an important agent, but still an article of our
pharmacopœia--purporting daily to be sold at every druggist’s shop,
there has not for years, he believes, existed a specimen in the
market.[5]

  [5] Dr. Thomson tells me that he has known white precipitate of
  mercury sold in hundred-weights as calomel, and in one case (he
  believes by accident or ignorance) as trisnitrate of bismuth. In my
  text I have endeavoured to adduce such illustrations as I suppose to
  be most notorious; but I may refer the reader to various interesting
  papers published, through the last two or three years, in the LANCET
  (_Analytical Sanitary Commission_) from one of which I quote the
  astounding instance, given above, of variations in the strength of
  laudanum. Mr. Thomas Taylor, of Vere Street, informs me that, whereas
  an ounce of laudanum should contain about four grains of morphia, he
  finds the actual quantity varying in different specimens from two
  grains to six; and that in two specimens of solid opium, outwardly
  alike and supposed to be of equal quality, he has found the per
  centage of morphia to vary from 3½ to 10. It requires little
  instruction in medicine to appreciate these facts.

Again, with the _promiscuous sale of poisons_, what incredible laxity of
government! One poison, indeed, has its one law. Arsenic may not be sold
otherwise than coloured, nor except with full registration of the sale,
and in the presence of a witness known to both buyer and vender.
Admirable, so far as it goes! but why should arsenic alone receive this
dab of legislation? Is the principle right, that means of murder and
suicide should be rendered difficult of access for criminal purposes?
Does any one question it? Then, why not legislate equally against all
poisons?--against oxalic acid and opium, ergot and savin, prussic acid,
corrosive sublimate, strychnine?

Nor can our past legislators be more boastful of their labours for the
_medical profession_--either for its scientific interests, or for the
public protection against ignorance and quackery.[6] Nearly two dozen
corporate bodies within the United Kingdom are said to grant licences
for medical practice; and I hardly know whether it lessens or aggravates
this confusion, that such licences are in many cases partial; that one
licentiate may practise north of the Tweed, but nowise to the south;
that one may practise in London, another only seven miles beyond it. Not
that the licence seems much to matter! for innumerable poachers in all
directions trespass on what the law purports to sell as a secured
preserve for qualified practitioners: their encroachments are made with
almost certain impunity; and--as for the titles of the Profession, any
impostor may style himself _doctor_ or _surgeon_ at his will. Even where
licences are held, conveying identical titles, they imply neither equal
privileges (as I have said) nor even uniform education. The law has
troubled itself little as to the terms on which they shall be granted;
and the qualifications exacted from candidates--the conditions
preliminary to their becoming eligible for licence, vary in so
remarkable a degree among the many corporate bodies which are fountains
of this honour, that the credentials conferred have really little
meaning, apart from a context which the public is unable to supply. It
is charged against particular institutions, that their degrees and
licences are attained with a very inglorious facility; and when it is
recollected that the issuing of such testimonials is a source--sometimes
a chief source--of income to the corporations which grant them, it will
be felt that at least there must exist great danger of this reproach
being sometimes deserved. If a national title to practise medicine is to
be granted by several Boards, and if yet the tenure of that title is to
determine public confidence in favour of its holder, it would seem
indispensable that some guarantee should be given for these several
licences representing equal qualifications--some guarantee that the
holder in each case possesses professional knowledge, and has enjoyed
professional opportunities, at least above some uniform standard
recognised as a _minimum_ qualification by all the diplomatising bodies.
Indispensable, however, as this may seem, years of endeavour have failed
to attain it. What is called _medical reform_ has been agitated longer
than I can remember; and more than one minister has been willing to
legislate for its promotion. Unfortunately the very magnitude of the
evils has delayed their cure. With the constitution I have described--a
system of conflicting jurisdictions, of licences without titles, and
titles without licences, how could we escape internal dissension? how
escape the antagonism, perhaps the jealousies, of rival corporations and
of different professional classes? Home-Secretaries have had little
leisure to fathom these things to the bottom. Unexamined and
unadjudicated by any competent authority, such influences have
bewildered public judgment, made statesmen regard us with despair,
postponed legislative correction, and maintained us in a state of
anarchy and confusion, best to be appreciated when we compare with our
own the organisation and government of the legal profession.

  [6] Legislative passiveness towards scientific medicine is not the
  only evil we have to complain of. Surely, in selling Letters Patent
  for the protection of quack-medicines--in seeming to sanction and
  authenticate whatever lies their proprietor may post upon the wall,
  the State demeans itself into complicity with fraud, and soils its
  fingers with something fouler than the Vespasian tax. It illustrates
  the curious _forgetfulness_ shewn towards medicine by the Legislature,
  that this immoral practice of giving patents for pretended cures of
  disease should have been allowed to continue--as of course it must
  have continued, solely by oversight, till past the middle of the
  nineteenth century.

And be it noted, how this reacts upon the State. So completely is our
government dissevered from Science in general, and, most of all, from
the sciences relating to Life, that, on such subjects, there exists not
for state-purposes anything like a tribunal of appeal. The Legislature
recognises no _Medical Authority_. Occasionally this fact stands out in
painful conspicuousness, and brings most injurious results. In contested
cases requiring scientific testimony--before Parliamentary Committees,
for instance, and in a variety of legal proceedings,--instead of the
Court having satisfactory power of referring particular questions to
skilled impartial adjudicators, the uniform practice is, that scientific
men are retained on opposite sides, to support partisan interests. The
advantages, such as they are, which belong to this system, might, I
believe, easily be obtained under altered arrangements: the
disadvantages are glaring. It might be invidious to refer to
illustrations of their reality: but it is of course impossible to doubt
of the working of this system, that, in so far as it makes each witness
feel himself engaged to maintain the views of his employer, it tends
towards a moral prostitution and subornation of science. In the
interests of truth, it would surely seem desirable that scientific
evidence should be tendered, so far as may be, in a judicial spirit
towards the suit; either that the technical point should be referred to
a technical jury, or that the technical witness should be summoned at
the Court’s discretion, should be examined in-chief by the Court, and
should be subject only to such cross-examination as may procure the most
complete statement of his knowledge on the matter in hand.

Having said so much on the defects and the wrongs of our existing
sanitary condition, perhaps I may venture to speak of the almost obvious
remedy. ‘Almost obvious’ I say; for surely no one will doubt that this
great subject should be dealt with by comprehensive and scientific
legislation; and I hardly see how otherwise, than that it should be
submitted in its entirety to some single department of the executive, as
a sole charge; that there should be some tangible head, responsible--not
only for the _enforcement_ of existing laws, such as they are or may
become, but likewise for their _progress_ from time to time to the level
of contemporary science, for their _completion_ where fragmentary, for
their _harmonisation_ where discordant.

If--as is rumoured, the approaching re-constitution of the General Board
of Health is (after the pattern of the Poor-law Board) to give it a
Parliamentary President, that member of the Government ought to be open
to challenge in respect of every matter relating to health. What, for
this purpose, might be the best subordinate arrangements of such a
Board, it would take a volume to discuss. But at least as regards its
constituted head, sitting in Parliament, his department should be, in
the widest sense, to _care for the physical necessities of human
life_. Whether skilled coadjutors be appointed for him or not;
engineers--lawyers--chemists--pathologists; whether he be, as it were,
the foreman of this special jury, or, according to the more usual
precedent of our public affairs, collect advice on his own
responsibility, and speak without quotation of other authority than
himself, his voice, unless the thing is to be a sham, must represent all
these knowledges.

The people, through its representatives, must be able to arraign him
wherever human life is insufficiently cared for.

He must be able to justify or to exterminate adulterations of food; to
shew that alum ought to be in our loaves, or to banish it for ever; to
shew that copper is wholesome for dessert, or to give us our olives and
greengages without it; to shew that red-lead is an estimable condiment,
or to divert it from our pepper-pots and curries.

Similarly with drugs and poisons--the alternatives of life and death--a
minister of Public Health would, I presume, be responsible for whatever
evils arise in their unlicensed and unregulated sale. He would hardly
dare to acquiesce in our present defencelessness against fraud and
ignorance; in doses being sold--critical doses, for the strength of
which we, who prescribe them, cannot answer within a margin of _cent.
per cent._; or in pennyworths of poison being handed across the counter
as nonchalantly as cakes of soap.[7] Surely, before he had been six
months in office, he would have procured some enactment to remedy this
long neglect of the legislature, by providing that the druggist’s trade
be exercised only after some test of fitness, and in subjection to
certain regulations.

  [7] Without referring to what may be considered rare--the sale of
  poison for the purposes of intended homicide, I may remind the reader
  of the very dreadful facts collected by the Commissioners on Trades
  and Manufactures, as to the immense sales of opium in our principal
  manufacturing towns, for the purpose of quieting--and with the effect
  of killing, children, while their poor mothers are absent from home in
  their several occupations.

Within his province, likewise, it would fall to be cognisant of all that
relates to the constitution of the Medical Profession. The difficulties
which have baffled successive Home-Secretaries might soon find their
solution in the less divided attention which he could bring to their
study. Amid conflicting opinions and an apparent scramble for power, he
would soon distinguish where might be the strife of jealousy and
covetousness, where a truthful zeal for the honour and efficiency of
medicine. I think he could not be long in curing our more scandalous
anomalies. Probably--unless human bowels require other doctoring in
London than in Manchester, he would manage that a doctor there should
be a doctor also here; that no licence for the partial practice of
medicine should be recognised--no licence admitting a man to do in
Edinburgh what it would be a misdemeanour for him to do in Greenwich.
And obviously, in order to this--since a professional diploma is the
only criterion by which the public can measure the competence of those
who seek their patronage, he would see that, as far as may be, the
various licensing bodies exact from their candidates equal and
sufficient qualifications; that the diploma entitling a man to call
himself Surgeon or Physician, Accoucheur or Apothecary, mean the same
thing--imply the same education, whether it be got in Scotland, Ireland,
or England; and that any falsification of such diploma, or any
unauthorised assumption of the title which implies its possession, be
promptly punishable at law.[8]

  [8] This check at least seems indispensable, for the reason above
  given, that a professional diploma is the only criterion by which the
  public can measure professional competence; and for the validity of
  such a criterion, it therefore, I think, becomes the duty of a
  government, on behalf of the public, to provide. For anything beyond
  this (except in one particular case) the matter might take its natural
  course. No law can supersede a necessity for common sense in the
  subject; and medicine, I think, requires no _protection_. Let my
  neighbour, by all means, if he desire it, send for a green-grocer to
  reduce his dislocation or assuage his gout! and let him take the
  consequences of his folly, in a spoilt limb or in a hair’s breadth
  escape with his life. Only--let the green-grocer be punishable, if he
  seek this office under false pretences, calling himself by any title
  which implies a professional qualification. And, for what harm he may
  do--let him of course (as would, if necessary, the presidents of our
  colleges) be prepared to abide before judge and jury his trial for
  malpractice. But, in strict adhesion to the principle I have
  professed, that protection is wanted, not for the profession, but for
  the public, I would suggest one exception to what otherwise might be
  universal free-trade in medicine. I refer to the case of druggists;
  who, whenever the Legislature may awake to the necessity of regulating
  their trade, ought, I think, to be expressly prohibited from the
  treatment of disease. To an immense majority of our population--to all
  the under-educated classes, the druggist’s shop appears an emporium
  for medical skill, as well as for medical appliances. They probably
  have some vague overestimate of our art of healing, and think perhaps
  that the several bottles on the shelf correspond to the several
  ailments they can specifically cure. They ask for something “good for
  a dropsy,” or “good for a wasting,” or “good for a palpitation;” not
  knowing how much skill may be requisite to interpret the symptom; not
  knowing that, to our highest skill, there is no medicine thus
  indiscriminately, or even generally, “good.” At present almost
  universally, druggists, with no medical qualification, are tampering
  more or less with serious medical responsibilities; and the mischief
  thus occasioned--especially among the poorer classes, is a matter of
  notoriety, on which persons engaged in hospital practice would be
  competent and tolerably impartial witnesses. It is because this evil
  arises in the _almost inevitable ignorance_ of those who chiefly
  suffer from it, that, in accordance with the principle above
  suggested, I think it deserves consideration from the Legislature.

Into the hands of this new minister--advised, perhaps, for such purposes
by some permanent commission[9] of skilled person, would devolve the
guardianship of public health against combined commercial interests, or
incompetent administration. He would provide securities for excluding
sulphur from our gas, and animalcules from our water. He would come into
relation with all Local Improvement Boards, in respect of the sanitary
purposes of their existence. To him we should look, to settle at least
for all practical purposes the polemics of drainage and water-supply; to
form opinions which might guide Parliament, whether street sewers really
require to be avenues for men, whether hard water really be good enough
for all ordinary purposes, whether cisternage really be indispensable to
an urban water-supply.

  [9] There are many instances in my mind, some already adverted to,
  where the existence of a standing jury for scientific--especially for
  sanitary, purposes might be of great utility. It is an organisation
  which prevails extensively in France, under the name of _Conseils de
  Salubrité_; forming, in most of the large towns there, a constant
  board of reference for the municipality, in respect of sanitary
  regulations. _Mutatis mutandis_, it might become invaluable as an
  English institution, in respect of many matters touched upon in this
  sketch; and perhaps with some division of duties, into such as would
  best belong to a General Board of the kind, and such as might properly
  be vested in Local Boards. To determine the indispensable conditions
  of healthy lodgment; to examine the influence of trades and
  occupations, and to devise the regulations they may require, for the
  neighbourhood’s sake, or for their operatives’; to supervise the sale
  of food and drugs; to be cognisant of medical matters; would seem,
  either locally or generally, to require the co-operations of several
  skilled persons. But, though I have spoken of such, as indispensable
  jurors for these subjects, I do not forget that other interests than
  those of life may need to be consulted. For the fair representation of
  these, the lay faculty of _educated common-sense_ will fulfil an
  inestimable usefulness, if it may be there to mediate between science,
  which is sometimes crotchety, and trade, which is sometimes selfish.

Organisations against epidemic diseases--questions of quarantine--laws
for vaccination, and the like, would obviously lie within his province;
and thither, perhaps, also his colleagues might be glad to transfer many
of those medical questions which now belong to other departments of the
executive--the sanitary regulation of emigrant ships, the ventilation of
mines, the medical inspection of factories and prisons, the insecurities
of railway traffic, _et hoc genus omne_.

There is another subject respecting which I should reluctantly forego
the present opportunity of saying something. To the philosopher,
perhaps, any partial sanitary legislation--even for a metropolis, may
seem of low importance, as compared with our commanding need that the
general legislation of the country be imbued with deeper sympathies for
life. Yet London is almost a nation in itself; and the good which might
be effected by its sanitary regeneration would, even as example, be of
universal influence. Now, at this moment, there seems a chance--such a
chance as may not soon recur--for gaining a first step towards this
consummation. The re-construction of the Metropolitan Commission of
Sewers, on the principle of local representation, affords extraordinary
facilities for providing London, at length, with an efficient sanitary
government. For, while any administration for this purpose would
require to be entrusted with very extensive and very stringent powers,
it seems probable that such authority might by the public be willingly
conceded to a body constituted, in great part, of persons representing
local interests. The jurisdiction required would be substantially such
as is already vested in the City Commissioners of Sewers, for the
sanitary control of the city; the concession of which--because to a
representative body--was never any matter of municipal dispute. In so
vast a government as that of the metropolis, Local Boards of Health for
its various sections would seem indispensable; it is presumed that these
boards[10] would be represented in the general Commission; which, in
conjunction with them, and including certain skilled assessors, might
constitute a complete sanitary organisation, consultative and executive.

  [10] It would seem premature to discuss what might be the best
  constitution of such Local Boards for the metropolis; but it will
  appear to the reader, on a moment’s reflection, that there would be no
  difficulty in finding materials for their organisation. If, according
  to suggestions lately ventilated, municipal institutions should be
  given to the parts of London hitherto without them; these new
  corporations would probably have sanitary functions allotted them, and
  might readily become Local Boards of Health under such a constitution
  as I have sketched. If, on the other hand, our present non-municipal
  system were to be continued, probably our several Boards of Guardians
  might seem specially proper to act as Local Boards of Health; first,
  as being elected representative bodies, already invested with certain
  authority of the kind--as, for instance, under the Nuisances Removal
  Act; secondly, because various of their officers would be almost
  indispensable parts of any sanitary machinery. Indeed, my experience
  of such matters suggests it to me as not unimportant, that, under any
  arrangement which may be made, the jurisdiction of Local Boards of
  Health should, at least in area, be conterminous with Poor Law Unions;
  so that those who administer sanitary affairs--affairs which are
  always chiefly relative to the poor--may, as far as possible, in their
  several districts, come into relation with single sets of Poor Law
  officers.

I have one word more to say about the Reports. They have been received
by the public with such remarkable indulgence and favour, that I feel
some anxiety lest I may seem to have plumed myself with other feathers
than my own. Let me, therefore, at least in part, confess my debts.

Before my first enlistment in the service of public health, others had
fought this great cause with rare courage and devotion; establishing its
main principles in a manner to require no corroboration, and to admit
little immediate increase. The true patriarchs of the cause in this
country are the present working members of the General Board of Health.
The constitution of my city appointment is quite independent of this
Board; but I should be acting an unworthy part if I refrained from
acknowledging, that, in innumerable instances, I have gathered most
valuable knowledge from the Board’s official publications, and that, in
personal intercourse with its members and officers, I have had abundant
reason to be grateful for information invariably given with that frank
kindness which belongs to brotherhood in science, and to sympathy for
common objects.

I must likewise acknowledge constant obligations to the courtesy of the
Registrar-General, and express with how much pleasure and instruction I
have studied the works of his inestimable office. Especially I would
offer my tribute of respect to Dr. Farr’s learning and industry, as well
as to that capacity for generalisation which the world has long
recognised in his eloquent and thoughtful writings.

And, though this be not the place to boast of private friendships, I may
venture to say that there are few topics relating to sanitary medicine
that I have not enjoyed the advantage of discussing with men who have
given genius, inquiry, and reflection to their development.

Thank God! the number of persons capable of apprehending the cause, and
ready to take interest in its promotion, is now daily on the increase.
If some minister of Public Health could take his seat in the House of
Commons--some minister knowing his subject and feeling it, I believe he
would find no lack of sympathy and co-operation. The world abounds with
admirable wishes and intentions, that vaguely miscarry for want of
guidance. How many men can get no farther in their psalm of life than
the question, _in quo corriget_. To such--not masters of the subject,
but willing and eager to be its servants, an official leader might be
everything: for in great causes like this, where the scandal of
continued wrong burns in each man’s conscience, the instincts of justice
thirst for satisfaction. What can we do or give--how shall we speak or
vote, to lessen these dreadful miseries of sanitary neglect--is, at this
moment, I believe, the fervent inquiry of innumerable minds, waiting, as
it were for the word of command, to act.

How much of this generous earnestness towards the cause exists in
society--how much desire to grasp any reasonable opportunity of good has
lately happened to fall under my notice. Last winter, when the signs of
the times were making us fear that Cholera would presently again be
epidemic in London, it was remembered that, in the greater part of the
metropolis, nothing whatever had been done since the last invasion to
give immunity against the returning disease. It was remembered--too
late, how indescribably dreadful a thing is the epidemic prevalence of
sudden death. And the poor were thought of--in their unprotectedness,
their filth, their ignorance. Among the persons thus aroused, was a
gentleman whom I reluctantly leave unnamed; saying of him only, that,
from a distinguished position in official life, he had retired to
literary enjoyments, amid which he bears the imputation of many
unacknowledged writings which charm and instruct the public. When the
rumours of the pestilence began, he too heard and read and became
aghast. The notion that ‘in a skilful, helpful, Christian country
nothing should be done’ against these impending dangers--that the poor
should be left ‘defenceless, huddled together in some dismal district,
not more helpful than women’--was felt by him, he wrote, ‘deeply as a
disgrace;’ and he pleaded that, ‘on a great and pressing occasion, it
remains for the thoughtful, the rich, and the benevolent, to try and do
these needful things for the people.’[11] Let us, he urged, endeavour to
meet this shameful reproach; let us combine voluntary charitable
assistance for extemporaneous sanitary measures, rapid, though partial;
let us get a hundred thousand pounds and do what we can in aid of local
authorities in the poorest districts--in Bethnal Green, in Shoreditch.
Eventually this plan was abandoned, at least for the time. There was
argued against it, that prompt legislation might do more good, with less
exoneration of local responsibility. Whether rightly or wrongly, the
latter view was acted on; and in accordance with it, the gentleman first
adverted to (waving his own hopes and wishes in the matter) took active
part in framing suggestions,[12] which Lord Palmerston had expressed
himself willing to accept, for modifying the laws of Nuisance and
Disease-Prevention to a form more suitable for the apprehended
emergency. But, in the meantime, what had happened? The author of the
plan, as it were at a moment’s notice, had seemed to draw round himself
half the intellectual and moral strength of the metropolis. Himself
setting aside the literary ambition of his life, he found others ready
to meet him with their several self-sacrifices. Over-worked men of
science and of business, who afford no time to relaxation; favourites of
society, who might have been suspected of mere shuddering at distasteful
subjects; men of high laborious rank in Church and State; poets; heads
of professions; minds that guide the tastes and morals of the country,
or feed its imagination; not least, the invalid from his distant
wintering-place; men, in short, immersed in all kinds and grades of
occupation, were either bodily present at the deliberations referred to,
or were writing about the plan in terms of warm interest, anxious to
promote whatever usefulness could be shown them. About the means there
was discussion--about the object, none; nor lukewarmness. All were
competing, by gifts of time and labour, to snatch some opportunity of
serving this neglected cause.

  [11] I quote from a pamphlet printed by him for private circulation.
  It was entitled ‘_Health-Fund for London; some Thoughts for next
  Summer: by Friends in Council_.’

  [12] These have since been laid before the House of Lords, on the
  motion, I think, of Lord Harrowby, who took much interest in the
  subject.

Such--to return to my text--such, I am deeply assured, would be the
spirit which a minister of Public Health would find abundantly on his
side in Parliamentary discussion, and in the Press. There is no
attachment to the incongruities I have sketched as belonging to our
abortion of a sanitary system. Still less is there any want of feeling
for the poor--any reluctance to raise their state and better their
circumstances--any unconsciousness that these things are great solemn
duties. On the contrary, everywhere there is the conviction that
_something_ must be done; everywhere a waiting for authority to say
_what_. But, the trumpet giving an uncertain sound, who can prepare
himself to battle? Knowledge, and method, and comprehensiveness, are
wanted--the precise, definite, categorical impulses of a Parliamentary
leader, who can recognise principles and stick to them.

And for such a minister, what a career! It would be idleness to speak of
the blessings he could diffuse, the anguish he could relieve, the
gratitude and glory he could earn. A heathen can tell him this. _Homines
enim ad Deos nullâ re propius accedunt quam salutem hominibus dando.
Nihil habet nec fortuna tua majus quam ut possis, nec natura tua melius
quam ut velis, conservare quam plurimos._

  Upper Grosvenor Street,
  May 15th, 1854.




  REPORTS
  RELATING TO
  THE SANITARY CONDITION
  OF THE
  CITY OF LONDON.




FIRST ANNUAL REPORT.


TO THE HON. THE COMMISSIONERS OF SEWERS OF THE CITY OF LONDON.

  _November 6th, 1849._

  GENTLEMEN,

During the 52 weeks dating from October 1st, 1848, to September 29th,
1849, there died of the population of the City of London 3763 persons.

The rate of mortality, estimated from these _data_ for a population of
125,500, would be about the proportion of 30 deaths to every thousand
living persons.[13]

  [13] The Census of 1851, compared with that of 1841, would lead me to
  believe that in 1848-9 the population of the City must have been about
  129,000. With this correction, the death-rate would have been about
  29·16 _per_ thousand.--J. S., 1854.

The lowest suburban mortality recorded in the fifth volume of the
Registrar-General’s Reports, for the year then under estimation, gave a
rate of 11 in the thousand; and we might perhaps be justified in
adopting that rate as a _minimum_ for the purpose of sanitary
comparison.

According to this standard (undoubtedly a very superior one) it would
appear that, during the last year, death has prevailed in the City of
London with nearly three times its recognised _minimum_ of severity.

But, to avoid all sources of fallacy, I will allow a very ample margin
to this estimate; I will take 15 per thousand as a fair standard of
mortality, and will assume that last year’s deaths in the City have
amounted to only double their normal proportion.

Probably no one contends that the lower rate of mortality, as
illustrated at Dulwich or Sydenham, indicates an over-healthy condition
of the locality to which it refers. Probably no one argues that human
life, in those healthier districts, is prolonged beyond enviable limits.
Surely, on the contrary, every one who can measure the large amount of
misery and destitution which results from a high rate of mortality, will
think it most desirable that, by every means within the scope of
sanitary science, exertion should be made to reduce the higher rate to
the level of the lower.

Therefore, Gentlemen, I venture to assure myself, that I shall but have
anticipated the wishes of this Hon. Court, in preparing for your
consideration a statement of those circumstances, which apparently
conspire to determine the larger mortality of the City of London.

       *       *       *       *       *

In order to prevent any misapprehension of my remarks, I think it well
to observe that, in commenting on this mortality, I purposely avoid
instituting any comparison between it and the mortality of those urban
districts which immediately adjoin us: for the object of my comparison
is not to illustrate how, by similar or worse circumstances, an equally
great mortality may have been procured elsewhere; but rather to suggest
how, by other and better sanitary arrangements here, our present high
mortality may be diminished.

Indeed, while I speak of the causes of that high mortality which
distinguishes the City of London from the healthier sub-districts I have
cited, it will be obvious that many of my observations do not apply to
the City of London exclusively, but admit of equal application to
various other central districts of the metropolis;--relating, in fact,
generally to the characteristic evils of all urban residences.

With those other districts I have nothing to do; but I wish it to be
understood, that in describing the City as healthy or unhealthy, I am
not comparing it with Holborn, or Whitechapel, or Bermondsey, or other
urban localities, where--whatever the relative badness of the places,
the scale of comparison would be essentially vicious, and the results of
comparison worthless. It is my object to test the salubrity of the City
by comparison with a superior standard, in order that some definite aim
may appear, towards which to direct the endeavours of sanitary
improvement.

       *       *       *       *       *

Starting, then, from our Registrars’ Returns, I invite you to inquire
with me, how it has come to pass that within the City of London there
have died in the last year twice as many persons as it seems necessary
that there should die; and whence has arisen the apparent anomaly, that
here--in the very focus of civilization, where the resources of curative
medicine are greatest, and all the appliances of charitable relief most
effectual, still, notwithstanding these advantages, there has passed
away irrevocably during the year so undue a proportion of human life.

Let it not be imagined that the word _cholera_ is a sufficient answer to
these questions, or that its mention can supersede the necessity for
sanitary investigation. Let it, on the contrary, be observed that the
epidemic which has visited us, extends its ravages only to localities
previously and otherwise hostile to life; so that, while all regions of
the globe in succession are shadowed by its dark transit, the healthiest
districts of each region remain utterly unharmed in presence of the
pestilence. Compare, for instance, the cholera mortality in a healthy
suburban sub-district with that of an unhealthy urban one. Dulwich and
the parish of St. Ann’s, Blackfriars, in the City of London, are
probably nearly equal in population: in the former, there was not a
single death from cholera; in the latter, the deaths from this cause
alone were at the rate of twenty-five to every thousand of the
population. Dulwich is one of the healthiest sub-districts within the
bills of mortality; St. Ann’s belongs to one of the unhealthiest
sub-districts of the City of London; and the cholera visited each in
proportion to its ordinary healthiness.

Such is the general rule; and accordingly I would suggest to you that
the presence of epidemic cholera, instead of serving to explain away the
local inequalities of mortality, does, in fact, only constitute a most
important additional testimony to the salubrity or insalubrity of a
district, and renders more evident any disparity of condition which may
previously have been overlooked. The frightful phenomenon of a periodic
pestilence belongs only to defective sanitary arrangements; and, in
comparing one local death-rate with another, it is requisite to remember
that, in addition to the ordinary redundance of deaths which marks an
unhealthy district, there is a tendency from time to time to the
recurrence of epidemic pestilence, which visits all unhealthy districts
disproportionately, and renders their annual excess of mortality still
more egregious and glaring.

       *       *       *       *       *

As materials which may aid you to estimate the sanitary defects of the
City, I subjoin two tables[14] illustrating the relative mortality of
the several sub-districts. The first of these tables indicates
numerically the local distribution of the year’s deaths, and gives their
proportion to the population of each district and sub-district. The
second relates particularly to the last quarter, and illustrates the
pressure of the epidemic. The two together furnish a synoptical view of
the several rates of mortality, as calculated for the entire City, for
the Unions separately, for the sub-districts separately; and for the
last quarter of the year separately. In the tedious process of
constructing these tables, I have been careful to avoid every source of
inaccuracy, and believe that they present you with a true measure of the
health of the City during the past year.

  [14] I have not reprinted these tables quite as here described. The
  local distribution of the 3763 deaths of the year is given in the
  Appendix, No. III.; and the sub-district death-rates of the year, as
  nearly as I can get them, in a note overleaf, page 6. The high
  mortality of this summer quarter (in which 1395 persons died) will be
  best appreciated by the reader in referring to Appendix, No. XIV.;
  where it can be compared with the mortality of similar periods of time
  in the four other years there accounted for.--J. S., 1854.

From these comparative tables it will be observed, that the high
mortality of the population does not affect the entire City equally;
that, in some of its portions, the rate of death approaches the
_minimum_ standard much more nearly than in others; that in those
districts where the general rate is best, the temporary aggravation
from epidemic causes has likewise been least; and that our aggregate
City rate, either for ordinary times or for a period of epidemic
disease, is compounded from the joint result of several very different
proportions. Reference to the Registrar-General’s tables will enable any
one to see that the ordinary rate of mortality for the West London Union
is a fourth higher than the rate for the City of London Union, while the
rate for the East London Union bears a still higher proportion; and
these very different rates are, as it were, merged in the one aggregate
rate, struck for the whole City, as comprising the three unions referred
to. It will be obvious, therefore, that many parts of the City are much
healthier than this aggregate rate would signify, while others are much
unhealthier. In regard of last year, for instance, the aggregate rate of
mortality was (as I have stated) 30 per thousand of the general
population of the City: but if this rate be analysed by examination of
the sub-district mortality, it will be seen that in one sub-district the
rate of death stood nearly as low as 20; that in another sub-district of
the same union it rose to 36, and in a third sub-district (of another
union) to within a small fraction of 40.[15]

  [15] On account of changes of population shown by the subsequent
  Census, these figures would require correction. The death-rates _per_
  thousand in the several sub-districts were probably about as follows,
  viz.:--

  ------------------+-------------+------------------------------
  EAST LONDON UNION.|W. L. UNION. |   CITY OF LONDON UNION.
  ---------+--------+------+------+-----+-----+------+-----+-----
    St.    |Cripple-|North.|South.|S. W.|N. W.|South.|S. E.|N. E.
  Botolph. |  gate. |      |      |     |     |      |     |
  ---------+--------+------+------+-----+-----+------+-----+-----
     26½   |   32   |  34  |  41  |  38 |  22 |  24  | 21⅔ | 22
  ---------+--------+------+------+-----+-----+------+-----+-----

  J. S., 1854.

If it were possible to furnish you with statistics derived from a still
smaller sub-division of each district, these points would be infinitely
more manifest. In some limited localities of the City you would probably
find an approximation to the average mortality of suburban districts;
while in other spots, if they were isolated for your contemplation, you
would see houses, courts, and streets where the habitual proportion of
deaths is far beyond the heaviest pestilence-rate known for any
metropolitan district aggregately--localities, indeed, where the
habitual rate of death is more appalling than any which such averages
can enable you to conceive.

These facts are quite unquestionable, and I have felt it my duty to
bring them under your notice as pointedly and impressively as I can;
feeling assured, as I do, that so soon as you are cognisant of them,
every motive of humanity, no less than of economical prudence, must
engage you to investigate with me, whether or not there may lie within
your reach any adoptable measures for lessening this large expenditure
of human life, and for relieving its attendant misery. It is, therefore,
with the deepest feeling of responsibility that I proceed to fulfil the
main object of my First Annual Report, by tracing these effects to their
causes, and by explaining to you, from a year’s observation and
experience, what seem to me the chief influences prevailing against life
within the City of London.

       *       *       *       *       *

My remarks for this purpose will fall under the following heads, viz.:--

  I. Defective house-drainage;

  II. Incomplete and insufficient water-supply;

  III. Offensive or injurious trades and occupations;

  IV. Intramural burials;

  V. Houses insusceptible of ventilation, and absolutely unfit for
  habitation;

  VI. The personal habits of the lowest classes, and the influence of
  destitution in increasing their mortality.

In treating of these topics, I shall not pretend to bring before you all
the details on which my opinions are founded, or to enumerate under each
head those infinite individual instances which require sanitary
correction. It is my wish at this time to submit to you only such
general considerations as may show you the largeness of the subject, its
various ramifications, and its pressing importance; and it is my hope
that these considerations may suffice to convince you of the necessity
which exists in the City of London for some effective and permanent
sanitary organisation.


HOUSE-DRAINAGE.

I. It is not in my power to lay before you any numerical statement of
the proportion of drained to undrained houses. From such information as
I possess, I may venture to speak of imperfect house-drainage as having
been a general evil in all the poorer districts of the City; and the
latest intelligence on the subject leads me to consider this great evil
as but very partially removed. So far as I can calculate from very
imperfect materials, I should conjecture that some thousands of houses
within the City still have cesspools connected with them. It requires
little medical knowledge to understand that animals will scarcely thrive
in an atmosphere of their own decomposing excrements; yet such, strictly
and literally speaking, is the air which a very large proportion of the
inhabitants of the City are condemned to breathe. Sometimes, happily for
the inmates, the cesspool in which their ordure accumulates, lies at
some small distance from the basement-area of the house, occupying the
subsoil of an adjoining yard, or if the privy be a public one, of some
open space exterior to the private premises. But in a very large number
of cases, it lies actually within the four walls of the inhabited house;
the latter reared over it, as a bell-glass over the beak of a retort,
receiving and sucking up incessantly the unspeakable abomination of its
volatile contents. In some such instances, where the basement story of
the house is tenanted, the cesspool lies--perhaps merely boarded
over--close beneath the feet of a family of human beings, whom it
surrounds uninterruptedly, whether they wake or sleep, with its fetid
pollution and poison.

Now, here is a removable cause of death. These gases, which so many
thousands of persons are daily inhaling, do not, it is true, in their
diluted condition, suddenly extinguish life; but, though different in
concentration, they are identically the same in nature with that
confined sewer-gas which, on a recent occasion, at Pimlico, killed those
who were exposed to it with the rapidity of a lightning stroke. In their
diluted state, as they rise from so many cesspools, and taint the
atmosphere of so many houses, they form a climate the most congenial for
the multiplication of epidemic disorders, and operate beyond all known
influences of their class in impairing the chances of life.

It may be taken as an axiom for the purposes of sanitary improvement,
that every individual cesspool is hurtful to its vicinage; and it may
hence be inferred how great an injury is done to the public health by
their existence in such numbers, that parts of the City might be
described as having a cesspool-city excavated beneath it.

I beg most earnestly to press on the consideration of your Hon. Court,
the extreme importance of proceeding with all convenient speed to alter
this very faulty construction, and to substitute for it an arrangement
compatible with the health of the population.

While addressing you on this subject, and while congratulating your Hon.
Court on the fact, that public attention is so much directed to a matter
in which your exertions are certain to effect large and salutary reform,
I cannot refrain from expressing a wish, that more accurate knowledge
prevailed among the public as to the history and jurisdiction of the
nuisance in question. It seems constantly to be forgotten, that your
responsibility in the matter dates but from last January. The
cesspool-nuisance has been the slow growth of other less enlightened
ages, not in the City merely, but in the whole metropolis, and in all
other towns in England. The extreme injury which it inflicts on the
health of the population, and the vital necessity of abating that
injury, are points which only began to claim attention in this country
about ten years ago; and which have since but very slowly been forcing
their way (chiefly through the indomitable zeal and perseverance of Mr.
Chadwick) into that share of notice which they deserve. House-drainage
with effective water-supply, are the remedies which can alone avail; and
it is only during the present year that authority to enforce these
measures has been vested by the Legislature in any public bodies
whatsoever.

Before the month of January last, when your increased jurisdiction was
established, it appears to me that, for the existence of cesspools in
the City, you had no more responsibility than for the original site of
the metropolis, or for the architecture of Westminster Abbey.

During the last ten months, however, the care of effective
house-drainage has rested solely and entirely with your Hon. Court; for
two of those ten months, I thought it desirable, on account of the
epidemic, that no considerable disturbance of the soil should take place
in the construction of new works; in the remaining eight months, two
miles of new sewer were formed, and 900 houses were drained for the
first time.

If the house-drainage of the City had depended for its completion, even
since that time, solely on the labours of this Commission, no doubt it
would have proceeded at a far quicker pace. How effectively your Hon.
Court had prepared for the best application of your increased powers, is
sufficiently evinced in the 45 miles of sewerage, ramifying through all
the districts of your jurisdiction, ready at every point to receive the
streams of private drainage, and leaving to the owners of house-property
(with few exceptions) no excuse for their non-performance of these
necessary works. I believe the extent of public sewerage within the City
to be quite unparalleled, and to furnish facilities of the rarest kind
for the abolition of cesspools, and for the establishment of an improved
system of house drainage. But, Gentlemen, while you have exerted
yourselves to the utmost in the application of your increased authority,
and have directed your staff of officers, from first to last, to proceed
with all possible despatch in enforcing sanitary improvement in the
matter now under consideration, the intentions of your Court and the
industry of its officers have been in a great measure frustrated by the
passive resistance of landlords. Delays and subterfuges have been had
recourse to by the owners of house-property, in order to avoid
compliance with the injunctions of the Commission; and the temporary
interruption of works, which occurred in August and September,
prevented these evasions from being dealt with as otherwise they would
have been.

Now, however, the course is again open. For some weeks your Hon. Court
has directed that all works of drainage and sewerage shall proceed; many
are already in progress; and I can see no reason why, within a year from
the present time, the number of cesspools and of undrained houses within
the City of London should not be reduced to a very small proportion.

Everything, however, in this respect will depend on the spirit of
_thoroughness_ with which the Act of Parliament is enforced; and I would
strongly recommend, in all cases of non-drainage or other non-compliance
with the terms of notice, that no indulgence whatever should be conceded
to landlords beyond the time specified in the notification of the Court;
that no difference should be recognised between a ‘notice’ and ‘a
peremptory notice;’ that all notices should be ‘peremptory;’ and that, a
certain period for performance having been allowed to the landlord, on
the very day of that period’s expiration, the work, if undone, should be
given over for completion by the workmen of the Commissioners of Sewers,
in accordance with the 61st clause of the Act of Parliament. In favour
of the adoption of this principle, I can adduce no stronger argument
than my conviction, that its non-adoption would insure a sacrifice of
human life, in exact proportion to the procrastination allowed; and
that, too, in a matter where henceforth your responsibility is undivided
and your power absolute.

       *       *       *       *       *

In order to give efficiency to whatever improvements of house-drainage
may be instituted, the present system of water-supply will require to
undergo very extensive modifications; for at present in the poorer
tenements, even where some show of house-drainage is made, the
arrangements are constantly rendered inoperative from insufficiency or
absence of water. To this matter, however, I shall presently revert.

Another most important _desideratum_ in connexion with the sewerage of
the City is that, if possible, some more perfect system of trapping
should be devised, or that, in some way or other, the sewers should be
ventilated effectively and inoffensively.[16] At present there are
frequent complaints of offensive exhalation from gratings in the open
ways of the City; and it will be obvious to your Hon. Court, that all
which I have urged on the subject of cesspool-exhalations must apply
equally to those which are emitted from sewers. The impediments to
effective trapping are almost insuperable; but I believe that when the
water-supply of the City is very largely increased, washing the drains
amply and incessantly, the evil complained of will undergo a sensible
diminution.

  [16] This subject is adverted to, with more detail, in the next year’s
  Report.--See page 104.

       *       *       *       *       *

In further connexion with my present subject, I would also solicit
attention to the fact that the sanitary purposes of drainage are but
imperfectly achieved, where the outfall of sewerage is into a tidal
river passing through the heart of a densely peopled metropolis. I
should be stepping beyond my province, if I were to say much respecting
the schemes now before the public for dealing with the difficulty to
which I here refer, inasmuch as those schemes involve questions of
engineering and machinery, on which I am incompetent to form an opinion.
But I can have no hesitation in stating it as a matter greatly to be
desired in the City of London, that the noble river which ebbs and flows
beneath its dwellings should cease to be the drainpool of our vast
metropolis; and that the immeasurable filth which now pollutes the
stream should be intercepted in its course, and be conveyed to some
distant destination, where instead of breeding sickness and mortality,
it might become a source of agricultural increase and national
wealth.[17]

  [17] This subject is more particularly dwelt upon in the last Report;
  page 261.

I would venture, likewise, to express an opinion that the City of London
is peculiarly interested in the accomplishment of this great public
work, not only on general grounds relating to the conservancy of the
river, but likewise and especially on sanitary grounds, by reason of the
large bank-side population, subjects of the City, who now, instead of
deriving advantage from their nearness to the stream, are constantly
disgusted and injured by its misuse.

While the consideration of this most important measure is pending, I
would invite attention to some circumstances, by which even the present
evil is needlessly aggravated.

In the first place the sewers are of defective length, so that during
the ebb of the tide their contents, as they escape, are suffered to flow
in a stream of some length across the mud of the retreating river. The
stream, together with the mud which it saturates, and the open mouth of
the sewer, evolve copious and offensive exhalations, and I would
recommend that measures be taken for abatement of the nuisance. This
purpose, as concerns the sewer, would be fulfilled by the addition, in
each instance, of a sufficient length of brick or cast-iron work, to
prolong the canal beyond low water mark; but the great extent of mud
which is left uncovered at each tide, and which during the present
pollution of the river is a source of extreme nuisance and of disease,
constitutes an evil for which no remedy can be found till the stream
shall be narrowed and embanked.

Meanwhile, the complaints which reached the Committee of Health during
the summer, together with the results of my own inspection, lead me to
believe that the several small docks which lie along the City bank of
the river from the Tower to the Temple, fulfil little really useful
purpose; that they are to a great extent used as laystalls for their
vicinage; that copious deposits and accumulations of filth take place in
them; that they are a nuisance and injury, except to the very few who
are interested in their maintenance; and that it would be of public
advantage that they should be filled up.


WATER-SUPPLY.

II. I am sure that I do not exaggerate the sanitary importance of water,
when I affirm that its unrestricted supply is the first essential of
decency, of comfort, and of health; that no civilization of the poorer
classes can exist without it; and that any limitation to its use in the
metropolis is a barrier, which must maintain thousands in a state of the
most unwholesome filth and degradation.

In the City of London the supply of water is but a fraction of what it
should be. Thousands of the population have no supply of it to the
houses where they dwell. For their possession of this first necessary of
social life, such persons wholly depend on their power of attending at
some fixed hour of the day, pail in hand, beside the nearest stand-cock;
where, with their neighbours, they wait their turn--sometimes not
without a struggle, during the tedious dribbling of a single small pipe.
Sometimes there is a partial improvement on this plan; a group of houses
will have a butt or cistern for the common use of some scores of
inmates, who thus are saved the necessity of waiting at a standcock, but
who still remain most insufficiently supplied with water. Next in the
scale of improvement we find water-pipes laid on to the houses; but the
water is turned on only for a few hours in the week, so that all who
care to be adequately supplied with it must be provided with very
spacious receptacles. Receptacles are sometimes provided: and in these,
which are often of the most objectionable description, water is retained
for the purposes of diet and washing, during a period which varies from
twenty-four to seventy-two hours. One of the most important purposes of
a water-supply seems almost wholly abandoned--that, namely, of having a
large quantity daily devoted to cleanse and clear the house-drains and
sewers; and in many cases where a waste-pipe has been conducted from the
water-butt to the privy, the arrangement is one which gives to the
drainage little advantage of water, while it communicates to the water a
well-marked flavour of drainage.

I consider the system of intermittent water-supply to be radically bad;
not only because it is a system of stint in what ought to be lavishly
bestowed, but also because of the necessity which it creates that large
and extensive receptacles should be provided, and because of the
liability to contamination incurred by water which has to be retained
often during a considerable period. In inspecting the courts and alleys
of the City, one constantly sees butts, for the reception of water,
either public, or in the open yards of the houses, or sometimes in their
cellars; and these butts, dirty, mouldering, and coverless; receiving
soot and all other impurities from the air; absorbing stench from the
adjacent cesspool; inviting filth from insects, vermin, sparrows, cats,
and children; their contents often augmented through a rain water-pipe
by the washings of the roof, and every hour becoming fustier and more
offensive. Nothing can be less like what water should be than the fluid
obtained under such circumstances; and one hardly knows whether this
arrangement can be considered preferable to the precarious chance of
scuffling or dawdling at a standcock. It may be doubted, too, whether,
even in a far better class of houses, the tenants’ water-supply can be
pronounced good. The cisternage is better, and all arrangements
connected with it are generally such as to protect it from the grosser
impurities which defile the water-butts of the poor; but the long
retention of water in leaden cisterns impairs its fitness for drinking;
and the quantity which any moderate cistern will contain is very
generally insufficient for the legitimate requirements of the house
during the intervals of supply. Every one who is personally familiar
with the working of this system of intermittent supply, can testify to
its inconvenience; and though its evils press with immeasurably greater
severity on the poor than on the rich, yet the latter are by no means
without experience on the subject.

       *       *       *       *       *

The following are the chief conditions in respect of water supply, which
peremptorily require to be fulfilled:--

1. That every house should be separately supplied with water, and that
where the house is a lodging-house, or where the several floors are let
as separate tenements, the supply of water should extend to each
inhabited floor.

2. That every privy should have a supply of water, applicable as often
as it may be required, and sufficient in volume to effect, at each
application, a thorough flushing and purification of the discharge-pipe
of the privy.

3. That in every court, at the point remotest from the sewer-grating,
there should be a standcock for the cleansing of the court; and

4. That at all these points there should always and uninterruptedly be a
sufficiency of water to fulfil all reasonable requirements of the
population.

       *       *       *       *       *

Now, if my statements are accurate with regard to the imperfect manner
in which thousands participate in the distribution of water, even for
their personal necessities; if my statements are again accurate with
respect to house-drainage, and to the immense increase of water
distribution which must accompany any improvement in this respect--and I
am quite prepared, if necessary, to adduce ample evidence on these
subjects; if, again, it be considered that the appreciation of water by
the multitude, who have so long suffered from lack of it, will lead to a
vast augmentation of its domestic use; then, I apprehend, it cannot be
doubted that the subject of water-supply to the City is one that
requires now to be looked at almost as though it were to-day broached
for the first time.

Those important conditions, which I just enumerated as urgently
requiring fulfilment, may certainly be accomplished, so far as
mechanical construction is concerned, in more than one way. It may be
possible, no doubt, in further compliance with the principle of
intermittent supply, to furnish every tenement in the City with a
cistern of proper dimensions, and with its usual appurtenances of
ballcock, waste-pipe, &c.; but this, I need hardly say, would be a
process involving a vast expenditure of money, and hardly to be
recommended on the mere ground of conformity with what has hitherto been
done in the matter. It may be possible, on the other hand, to convert
the whole water-supply of the City into a system of uninterrupted
supply, and to construct all new works in conformity with this system.

I beg to suggest that the choice between these alternatives is one of
immense and very urgent importance to the sanitary welfare of the City;
and I would earnestly commend it to the best consideration of your Hon.
Court.

The system of a constant supply is now no longer a novelty. In
Philadelphia, in New York, in Nottingham, in Preston, in Glasgow, in
Newcastle, in Bristol, and in various other places, this system has been
adopted; its practicability and its advantages have been amply
demonstrated.[18] Five years ago, when evidence on the subject was given
before the House of Commons, it appeared that in the city and suburbs of
Philadelphia 25,816 houses were supplied at an average rate of five
dollars per house; that in Preston more than 5,000 houses were supplied
continually at high-pressure, and that the company was increasing its
tenants at the rate of 400 annually; that in Nottingham about 8,000
houses, containing a population of 35,000 persons, were supplied in the
same manner; and in respect of many other towns, public experience has
been equally extensive and satisfactory. About a month ago, the Sanitary
Committee of the last-mentioned town published what I may call a report
of congratulation on their freedom from cholera, which had visited the
town with great severity in 1832. They detail the measures by which
Nottingham has been rendered a healthy town, and the first item in that
enumeration stands thus:--‘An unlimited supply of wholesome filtered
water, forced, by day and night, at high pressure, through all the
streets to the tops of almost all the houses, at a cost, for the
dwellings of the poor, of about five shillings per week.’

  [18] It seems almost unnecessary to remind the reader that five more
  years have added infinite additional testimony to that mentioned in
  the text as existing in 1849; and that, two years ago, in a special
  Act of Parliament, it was enjoined on the Water Companies of the
  Metropolis that, within seven years, they should follow the precedent
  so extensively established. In the face of such evidence--with the
  knowledge that Manchester has a constant supply and that Glasgow is
  arranging one, it certainly tests one’s credulity to hear it rumoured
  that our Metropolitan Water-Merchants are hoping to resist that
  requirement, on the ground that such a supply in London would be
  _impossible_.--J. S., 1854.

On the relative merits or demerits of the two competing systems of
supply, I have only to speak so far as their adaptation to sanitary
purposes is concerned. In this respect, I have no hesitation in saying
that the system of constant supply is immeasurably superior to its
rival; so superior, that unless competent engineering authorities should
decide on its practical inapplicability to the City of London, I would
strongly recommend its adoption as the only one, in my judgment, by
which the growing necessities of the population can be fully and
effectively satisfied.


OFFENSIVE AND INJURIOUS TRADES.

III. With respect to offensive trades and occupations pursued within the
city of London, my task of recommendation is an easy one. To any person
conversant with the simplest physiological relations of cause and
effect, it is quite notorious that the decomposition of organic matter
within a certain distance of human habitations unfailingly tends to
produce disease; and every one who is competent by knowledge and
impartiality to pronounce an opinion on the subject, must feel that no
occupation which ordinarily leaves a putrid refuse, nor any which
consists in the conversion or manufacture of putrescent material, ought,
under any circumstances, to be tolerated within a town.

       *       *       *       *       *

1. First, in regard to slaughter-houses, I may remind you that, on the
23rd of January last, when your Hon. Commission first met under the new
Act of Parliament, I recommended to you on sanitary grounds, that in
such rules as you might make for the regulation of slaughter houses, all
underground slaughtering should be absolutely prohibited. It was laid
down, however, that your Act of Parliament would not enable you to
establish this restriction, which (it was argued) would be equivalent to
a direct suppression of many existing slaughter-houses.[19]

  [19] Slaughtering in cellars was rendered illegal by the amended City
  Sewers Act, 1851, and since that year has been entirely discontinued
  in the City. See page 192.--J. S., 1854.

Considering that, in my first recommendations to the Commission I ought
to confine myself to objects attainable by means of the Act of
Parliament then just coming into operation, I felt myself precluded for
the time from entering on the subject (however important in itself) of
the total abolition of urban slaughtering. Now, however, while treating
generally of sanitary improvement for the City, I can have no hesitation
in repeating an opinion which I have already submitted to the
Health-Committee of the Common Council; and I beg accordingly to state,
that I consider slaughtering within the City as both directly and
indirectly prejudicial to the health of the population;--_directly_,
because it loads the air with effluvia of decomposing animal matter, not
only in the immediate vicinity of each slaughter-house, but likewise
along the line of drainage which conveys away its washings and fluid
filth; _indirectly_, because many very offensive and noxious trades are
in close dependence on the slaughtering of cattle, and round about the
original nuisance of the slaughter-house, within as narrow limits of
distance as circumstances allow, you invariably find established the
concomitant and still more grievous nuisances of gut-spinning,
tripe-dressing, bone-boiling, tallow-melting, paunch-cooking, &c. Ready
illustrations of this fact may be found in the gut-scraping sheds of
Harrow-alley, adjoining Butchers’-row, Aldgate; or in the Leadenhall
skin-market, contiguous to the slaughtering places, where the stinking
hides of cattle lie for many hours together, spread out over a large
area of ground, waiting for sale, to the great offence of the
neighbourhood.

Such evils as those to which I have adverted are inseparable from the
process of slaughtering, however carefully and cleanlily conducted; and
they may easily be aggravated to an unlimited extent by defects in
drainage, in water supply, or in ventilation, or by the slovenly habits
and impunctuality of those to whom the removal of filth and offal is
intrusted.

In short, I believe it to be quite impossible, so to conduct the process
of slaughtering within the City of London as to remove it from the
category of nuisances, or to render it harmless to the health of the
population; and I believe it to be equally impossible so to superintend
the details of its performance as to prevent them, where
ill-administered, from rising into considerable and fatal importance
among the promoting causes of epidemic and infectious disease.

       *       *       *       *       *

It is scarcely necessary, after this expression of my opinion, that I
should say how strongly I would recommend that measures should be taken
for the discontinuance of all slaughtering within the City; and that,
with the abolition of slaughtering, all establishments which deal with
animal matter approaching putrefaction, and all sheds and stalls for the
continued keeping of cattle, should likewise be prohibited and
suppressed.

The number of slaughter-houses at present registered and tolerated
within the City amounts to 138, and in 58 of these the slaughtering
occurs in vaults and cellars. How overwhelming an amount of organic
decomposition must be furnished by these establishments, can neither be
estimated nor conceived; but the influence of that decomposition admits
of being measured in its effects on the population, and in the high
zymotic mortality which denotes an atmosphere over-laden with organic
poison.

Before leaving this subject, I think it right very briefly to allude to
an argument which is often objected to the view here stated. The
objector looks to a particular district, or to a particular
slaughter-house, and says that the mortality of the district is an
average one; or he points to Mr. A. or Mr. B.--the butcher or the
butcher’s man, saying, ‘Who can be healthier than A. or B.? Surely, if
the pursuit be injurious, these men ought to have been poisoned long
ago.’ Now, to this I reply;--first, as regards the men employed in these
crafts, we have no statistics of any value to decide on their mortality,
and judgment on the matter cannot be deduced from some half-dozen cases,
known to any of us individually; but, further, if we admit (which I by
no means know to be the case) that they are persons of average longevity
and healthiness, then it must be remembered that their activity, their
out-door exercise, and, above all, their unlimited supply of animal
food, are circumstances conducing to give them health beyond the average
of their station; and it must be remembered that these palliating
circumstances, though they may counteract the evil for those persons
most nearly concerned in it, contribute nothing towards deodorising the
neighbourhood, or towards preserving its poorer inhabitants from the
depressive influence of putrid emanations.

And, as regards the district--although we have certain evidence that
organic decomposition is a chief cause of disease, yet we do not
invariably find disease generated in immediate proximity to the source
of nuisance. Drainage beneath the soil, and currents of air above it,
convey the materials of decomposition to a distance; and if the
particular slaughter-houses be placed on a high level amidst the
surrounding City, so that their drainage be effectual and their
ventilation complete, then obviously their influence must be sought for,
not so much in any special aggravation of the local mortality, as in
certain remoter effects of their diffused emanation; in effects, namely,
which are discoverable along their lines of drainage and ventilation,
and in the various consequences of a highly zymotic atmosphere generally
through the entire town.

       *       *       *       *       *

2. With regard to such trades as are considered to be simply offensive,
and where the evidence of injury to health is indirect and uncertain, I
can hardly doubt that a wise legislation would exclude them also from
the circle of the metropolis. Tallow-melting, whalebone-boiling,
gas-making, and various other chemical proceedings, if not absolutely
injurious to life, are nuisances, at least in the ordinary language of
the law, or are apt to become such. It is the common right of the
neighbourhood to breathe an uncontaminated atmosphere; and, with this
common right, such nuisances must, in their several degrees, be
considered to clash. It might be an infraction of personal liberty to
interfere with a proprietor’s right to make offensive smells within the
limits of his own tenement, and for his own separate inhalation; but
surely it is a still greater infraction of personal liberty when the
proprietor, entitled as he is to but the joint use of an atmosphere
which is the common property of his neighbourhood, assumes what is
equivalent to a sole possession of it, and claims the right of diffusing
through it some nauseous effluvium which others, equally with himself,
are thus obliged to inhale. Such, as it appears to me, is the rational
view of this matter; and although I am not prepared to speak of these
trades in the same terms as I applied to slaughtering and its kindred
occupations,--although, that is to say, I cannot speak of them as
injurious to health on any large scale, yet I would respectfully submit
to your Hon. Court that your Act of Parliament empowers you to deal with
such nuisances in respect of their being simply offensive.[20]

  [20] City Sewers Act, 1848, § 113.

       *       *       *       *       *

3. Under the same head, I would likewise beg leave to suggest whether it
might not be practicable for your Hon. Court to regulate the operation
of establishments which evolve large volumes of smoke. The exterior
dirtiness and dinginess of London depend mainly on this cause; and the
same influence, by rendering domestic cleanliness difficult and
expensive, creates an additional impediment to its cultivation. People
naturally despair of cleansing that which a day’s exposure to the
atmosphere blackens again with soot; or they keep their windows shut,
breathing a fusty and unwholesome air, in the hope of excluding the
inconvenience. Now, when it is remembered that all the smoke of London
is but so much wasted fuel, it must surely be felt that the enforcement
of measures for its consumption would be to the interest of all parties;
amply economizing to the manufacturer whatever might be the trifling
expense of appropriate arrangements, while it would relieve the public
of that which, called by the mildest name, is a nuisance and a source of
heavy expense.


INTRAMURAL BURIAL.

IV. The subject of intramural burial is the next on which I have to
report, as affecting the health of the City.

In compliance with an order of the Health Committee, I have examined as
fully as circumstances would allow into the requirements of the City of
London in respect of burial accommodation, and the result of my inquiry
obliges me to express my conviction, that the City can no longer with
safety or propriety be allowed to furnish intramural interment to its
dead.

In all those larger parochial burying-grounds where the maintenance of a
right to bury can be considered important,--in all such, and in most
others, too, the soil is saturated and super-saturated with animal
matter undergoing slow decomposition. There are, indeed, few of the
older burial-grounds of the City where the soil does not rise many feet
above its original level, testifying to the large amount of animal
matter which rots beneath the surface. The vaults beneath churches are,
in many instances, similarly overloaded with materials of putrefaction,
and the atmosphere, which should be kept pure, and without admixture for
the living, is hourly tainted with the fœtid emanations of the dead. For
the most part, houses are seen to rise on all sides in immediate
contiguity to the burial-ground, forbidding the possibility of even such
ventilation as might diminish the evil; and the inhabitants of such
houses complain bitterly, as they well may, of the inconvenience which
they suffer from this confined and noxious atmosphere.

       *       *       *       *       *

With respect to burial in vaults, which prevails to a very great and
dangerous extent in this City, I may observe that, among persons who are
ill-informed on the subject, there exist erroneous notions as to the
preservation of bodies under these circumstances. They are supposed,
from the complete closure of their coffins, to remain unchanged for
ages, like the embalmed bodies of Egypt and Peru; or at least--if
perhaps they undergo some interior and invisible change (as the
chrysalis within its sheath) that there is no interference with the
general arrangement, no breach in the compactness of the envelope.
Nothing can be less correct than this supposition.

It is unnecessary that I should detail to you the process of decay, as
it occurs within the charnel-house; nor need I inquire for your
information whether indeed it be true, as alleged, that part of the duty
of a sexton consists in tapping the recent coffins, so as to facilitate
the escape of gases which otherwise would detonate from their
confinement. It is sufficient to state, that--whether such be or be not
the duty of the functionary in question, the time certainly comes,
sooner or later, when every corpse buried in the vault of a church
spreads the products of its decomposition through the air as freely as
though no shell had enclosed it. It is matter of the utmost notoriety
that, under all ordinary conditions of vault-sepulture, the wooden case
of the coffin speedily decays and crumbles, while the interior leaden
one, bending with the pressure of whatever mass may be above it (or
often with its own weight) yields, bulges, and bursts, as surely as
would a paper hat-box under the weight of a laden portmanteau.

If the accuracy of this description be doubted, let inquiry be made on a
large scale after the coffins of 40 years back[21]--let it be seen how
many will appear! If, on the contrary, its accuracy be granted, then I
apprehend nothing further need be urged, to establish the importance of
abolishing a system which maintains on so large a scale the open
putrefaction of human remains within places of frequent resort, and in
the midst of populous habitations.

  [21] Perhaps the expressions in my text are somewhat too general; not
  indeed as to the fact of the coffins _ultimately_ giving vent to their
  fœtid contents (which is the real point at issue) but as to the time
  within which this occurs. In the dryer and better kept vaults, a
  longer period certainly elapses than that suggested; in the worse,
  probably a shorter one. The sooner or later is of little practical
  importance: but, on re-perusing my Report, I think it right to add
  this qualification.--J. S., 1854.

It is a very serious matter for consideration, that close beneath the
feet of those who attend the services of their church, there often lies
an almost solid pile of decomposing human remains, co-extensive with the
area of the building, heaped as high as the vaulting will permit, and
generally (as I have shown) but very partially confined. And if it be
the case, as perhaps it may be, that the frequenters of the place of
worship do not complain of any vitiation of their atmosphere, or perhaps
do not experience it, not the less is it true that such a vitiation
occurs, and--whether to the special detriment of the congregation or
not, contributes to the overladen putrefactiveness of our London
atmosphere.

In respect of such vaults, I do not consider that the mere cessation of
burial in them will be sufficient; seeing that at the present moment
they contain amongst them many thousand coffins, as yet tenanted by the
materials of decomposition; and year after year, if left in their
present state, these will be poisoning the air with successive
instalments of their progressive decay. It seems to me quite
indispensable that some comprehensive measure should be undertaken, for
abolishing at once and for ever all burial within the City of London.
Conjointly with the general application to Parliament, for prohibition
of further intramural sepulture, I would recommend that authority be
obtained by the City for its several parishes to procure the decent
removal to extramural cemeteries of such coffins as already occupy their
vaults; or, failing this measure, I would recommend that all coffins now
lying within vaults, be walled up in their present resting-places with
uniform impermeable masonry. For very obvious reasons, I should prefer
the former plan to the latter.[22]

  [22] Probably the most successful attempt at hermetical enclosure of
  organic matters would not reach beyond effecting a postponement of
  their diffusion through the atmosphere. The true principles for burial
  of the dead lie rather in recognising their decomposition as
  inevitable, and in providing only lest it be offensive or injurious to
  the living. This is best attained by interment in a well-chosen soil,
  at a depth proportioned to the qualities of the ground; with no
  pretence of everlasting coffins and impenetrable cerements; but with
  ample vegetation above, to relieve the upper earth from whatever
  products of decay may mount and mingle there; and especially with
  thorough drainage below, so that down-currents of air and rainfall may
  freely traverse the putrefactive strata, ventilating and washing the
  soil, and diffusing its organic contents through deeper levels, till
  their oxidation is complete and their new inodorous combinations are
  discharged in watery solution.--J. S., 1854.

Intramural burial is an evil, no doubt, that varies in its intensity
according to the numbers interred; becoming appreciable in its effects
on health, so far as the rough measure of statistics can inform us, only
when many interments occur annually, or when ground is disturbed wherein
much animal matter had previously been left to decay. But, be the evil
large or little in any particular case, evil undoubtedly it is in all,
and an unmitigated evil.

The atmosphere in which epidemic and infectious diseases most readily
diffuse their poison and multiply their victims is one, as I have
already often stated, in which organic matters are undergoing
decomposition. Whence these may be derived signifies little. Whether the
matter passing into decay be an accumulation of soaking straw and
cabbage leaves in some miserable cellar, or the garbage of a
slaughter-house, or an overflowing cesspool, or dead dogs floated at
high water into the mouth of a sewer, or stinking fish thrown overboard
in Billingsgate-dock, or the remains of human corpses undergoing their
last chemical changes in consecrated earth, the previous history of the
decomposed material is of no moment whatever. The pathologist knows no
difference of operation between one decaying substance and another; so
soon as he recognises organic matter undergoing decomposition, so soon
he recognises the most fertile soil for the increase of epidemic
diseases; and I may state with certainty, that there are many
churchyards in the City of London where every spadeful of soil turned up
in burial sensibly adds to the amount of animal decomposition which
advances too often inevitably around us.

Nor can I refrain from adding, as a matter claiming attention, that, in
the performance of intramural interment, there constantly occur
disgusting incidents dependent on overcrowdedness of the burial-ground;
incidents which convert the extremest solemnity of religion into an
occasion for sickness or horror; perhaps mingling with the ritual of the
Church some clamour of gravediggers who have mis-calculated their space;
perhaps diffusing amidst the mourners some nauseous evidence and
conviction, that a prior tenant of the tomb has been prematurely
displaced, or that the spade has impatiently anticipated the slower
dismembering of decay. Cases of this nature are fresh in the memory of
the public; cases of extreme nuisance and brutal desecration in place of
decent and solemn interment; and it is unnecessary that I should revive
the record of transactions inconsistent with even the dawn of
civilisation.[23]

  [23] It happened that during the few months preceding the presentation
  of this Report, there had occurred some of the most flagrant and
  disgusting illustrations of the evils adverted to.--J. S., 1854.

       *       *       *       *       *

From the circumstances which I have mentioned, it can hardly fail to
appear most desirable to you, that the use of some spacious and open
cemetery at a distance from the City should be substituted for the
present system of intramural interment, and the urgency of this
requirement will be demonstrated all the more cogently, when it is
remembered that the annual amount of mortality in the City averages
above 3000, and that under the present arrangements every dead body
buried within our walls receives its accommodation at the expense of
the living, and to their great detriment.

In recommending that consideration be given, at as early a period as
possible, to the means for establishing some sufficient municipal
cemetery (a consideration which, for obvious reasons, must be prior to
any Parliamentary proceedings for the prohibition of intramural
interments) there are three points to which, even now, I think it
advisable to advert, as essential to the admissibility of such a plan. I
would submit, first, that the site of any such cemetery must be
sufficiently remote from the metropolis to obviate any repetition of the
present injury to a resident population; and I hardly know how this
purpose can be attained, without going some distance beyond the
immediate suburbs of London as indicated by the Bills of
Mortality:--secondly, that the space required for the proper inhumation
of the dead of the City of London[24] would be not less than 54 acres;
and, thirdly, I would suggest that the charter of such an establishment
ought to contain provisions against the erection of houses within a
certain distance of the burial-ground, so that this may at all times and
under all circumstances be surrounded, exterior to its wall, by a
considerable belt of land totally devoid of resident population. The
absence of such a provision as the last would very soon lead to the
extramural cemetery becoming _intramuralised_ by the growth of a new
suburb around it, and would again evince, by new and unnecessary
illustrations, how incompatible with each other are the Dead and the
Living as tenants of one locality.

  [24] See Special Report on Extramural Interment, page 285.


HOUSES PERMANENTLY UNFIT FOR HABITATION.

V. Under the last heads of my Report I have touched on matters, which
(in so far as they cannot be adjusted without Parliamentary
interference) may be considered to lie beyond the present jurisdiction
of the Commissioners of Sewers; and the topic which I now approach may,
perhaps, be considered equally foreign to the scope of your ordinary
functions.

       *       *       *       *       *

I have to report that there are houses and localities within the City
which are irremediably bad;--places, which the uninterrupted presence of
epidemic disease has stamped as absolutely unfit for human habitation;
places, where drainage and water-supply, indeed, are defective, but
where the perfection of these necessaries might exist, in all
probability, without giving healthiness to the inhabitants. The
predominant evil in the localities referred to is their thorough
impossibility of ventilation.

While treating of the manner in which noxious emanations are conveyed to
a distance, and are enabled to diffuse their influence over a whole
town, instead of concentrating it in some single slaughter-house or
burial-ground, I indirectly suggested what I have now to illustrate;
that all the evils of all the nuisances in existence acquire their
utmost local intensity of action when the diffusion of their gaseous
products is interfered with, and when, from absence of ventilation,
these are retained in the immediate vicinity of their source.

The inhabitants of open streets can hardly conceive the complicated
turnings, the narrow inlets, the close parallels of houses, and the high
barriers of light and air, which are the common characteristics of our
courts and alleys, and which give an additional noxiousness even to
their cesspools and their filth. There are very few who, without
personal verification, would credit an account that might be given of
the worst of such dwelling-places. Let any one, however, who would do
full justice to this frightful subject, visit the courts about
Bishopsgate, Aldgate, and the upper portion of Cripplegate, which
present some of the worst, though by no means the only instances of
pestilential residence. A man of ordinary dimensions almost hesitates,
lest he should immovably wedge himself, with whomsoever he may meet, in
the low and narrow crevice which is called the entrance to some such
court or alley; and, having passed that ordeal, he finds himself as in a
well, with little light, with less ventilation, amid a dense population
of human beings, with an atmosphere hardly respirable from its closeness
and pollution. The stranger, during his visit, feels his breathing
constrained, as though he were in a diving-bell; and experiences
afterwards a sensible and immediate relief as he emerges again into the
comparatively open street.

Now, I am prepared to show that there are many, very many, courts within
the City, to which the above description accurately applies; courts and
alleys hemmed in on all sides by higher houses; having no possibility of
any current of air; and (worst of all) sometimes so constructed back to
back, as to forbid the advantage of double windows or back doors, and
thus to render the house as perfectly a _cul-de-sac_ out of the court,
as the court is a _cul-de-sac_ out of the next thoroughfare.

       *       *       *       *       *

It is surely superfluous to observe, that these local conditions are
utterly incompatible with health. Among their dense population, it is
rare to see any other appearance than that of squalid sickness and
misery; and the children, who are reproduced with the fertility of a
rabbit-warren, perish in early infancy. In the worst localities probably
not more than half the children born survive their fifth year, and of
the 3763 deaths registered last year in the City of London generally,
1410 were at or under seven years of age.

The diseases of these localities are well marked. Scrofula more or less
completely blights all that are born: often extinguishing life
prematurely; in childhood, by hydrocephalus; in youth, by pulmonary and
renal affections, which you read of as consumption and dropsy; often
scarring and maiming where it does not kill, and rendering life
miserable by blindness, decrepitude, or deformity; often prolonging
itself as a hereditary curse in the misbegotten offspring of those who,
under such unnatural conditions, attain to maturity and procreation.

Typhus prevails there too, not as an occasional visitor, but as an
habitual pestilence.

It is impossible for me, by numbers, to give you an exact knowledge of
the fatality of such spots; because, in the greater part of the City,
hospitals, dispensaries, and private practice, divide with the
parochial officers the treatment of the sick, and diminish the returns
of sickness which those officers would otherwise have to show. But this
I may tell you, as an illustration of what I mean;--that in the few
houses of Seven-Step-alley and its two offsets, (Amelia-place and
Turner-square,) there occurred last year 163 parochial cases of fever;
in Prince’s-place and Prince’s-square, 176 cases--think, Gentlemen, if
this had occurred in Southampton-place and Russell-square! that behind
the east side of Bishopsgate, in the very small distance from
Widegate-street to New-street, there were 126 cases; that behind the
west side, from Primrose-street to Half-moon-street, there were 245
cases; that the parish of Cripplegate had 354 cases over and above the
number (probably a very large one) treated by private practitioners, by
hospitals, and especially by dispensaries. Similarly, though with less
perfect information, I am enabled to trace fever to a terrible extent in
very many other localities of the City, even on the verge of its better
residences, and close behind its wealthiest thoroughfares; in
Plumtree-court, in Plough-court and place, in Poppin’s-court,
Neville’s-court, Blackhorse-alley, Union-court, Plough-court in Holborn,
Field-lane; in the courts right and left of King-street, Smithfield, in
Hanging-sword-alley and its vicinity, in Peahen-court, in Bell-alley and
its neighbourhood, in Priest’s-alley, in Beer-lane, in Friar’s-alley, in
Bromley’s-buildings, and in the whole large space which stretches from
Ludgate-hill to beside the river.

And in most of these localities, in addition to other sanitary errors,
there predominates that particular one to which I am now inviting your
attention--the absence, namely, of sufficient ventilation.

It was in districts such as these, that in the year 1665, the Great
Plague of London found the readiest facilities for its reception; and it
was by the destruction of such districts that the Great Fire of the
following year rendered the utmost conceivable service to the sanitary
progress of the people, and completed their emancipation from the
horrors of an unparalleled pestilence. Long intervening years have
sufficed to reconstruct these miserable habitations almost after their
first type, and to re-exemplify all the evils which belong to them; so
completely indeed, that if the infection of that same plague should
light again amongst us, I scarcely know why it might not traverse the
City and decimate its population as quickly and as virulently as before.
Meanwhile, however, typhus with its kindred disorders, and the
occasional epidemics of influenza and cholera, maintain their attachment
to the soil, and require no further re-inforcement from the pestilence
of other climates. From these fatal diseases we no longer hope to be
rescued by the recurrence of the former casualty. The almost two
centuries which have elapsed since the period referred to, have taught
men better methods than a general conflagration for remedying such
evils; and it is a satisfaction to believe that the wisdom and humanity
of the Corporation of the City of London will apply those methods with
effect.

As a palliative measure, applicable in many of the least aggravated
instances, I may suggest the removal of unnecessary walls which
intercept the current of air from place to place; the formation of
counter-openings in various blind courts; and, not least, in regard of
many houses thus situated, the admission of light and air by additional
windows. I cannot pass this portion of the subject without recording my
opinion that the operation of the window-tax is in direct opposition to
the sanitary interests of the people; and I must venture to express my
hope that some different method of assessment may presently be adopted,
in place of one which presses on the occupier in proportion to the
healthiness of his tenement.[25] I think it very desirable, indeed
almost indispensable, that your Hon. Court should have the power, under
certain circumstances, to order and enforce the opening of additional
windows in houses occupied by large numbers of persons, when your
Officer of Health may report their ventilation defective; and if it
should seem expedient to you to seek this authority from the
Legislature, it might with the greatest advantage be accompanied by some
concession from her Majesty’s Government, to the effect that the
formation of additional windows, occurring thus under your orders for
the immediate necessities of health and life, should not occasion any
further assessment on the occupiers of the house.

  [25] I ought not to pass this page without a grateful mention of Lord
  Duncan’s name in connexion with the removal of the Window Tax, at
  length happily effected. It remains, however, greatly to be desired,
  in respect of certain specifiable houses inhabited by the poorer
  classes, that Local Boards of Health should have power to enforce
  improvements of ventilation.--J. S., 1854.

       *       *       *       *       *

But, Gentlemen, within the City of London there exist, to a very large
extent, architectural evils for which no such palliative treatment is
possible; evils against which I would venture to say (borrowing a
metaphor from my profession) that no safety can be found except in
amputation.

To dwell in hovels like pits, low-sunken between high houses, hemmed in
by barriers which exclude every breath of direct ventilation--this can
never be otherwise than a cause of sickness and mortality to those whose
necessities allot them such residence; and, if it be an incontrovertible
fact that subsistence in closed courts is an unhealthy and short-lived
subsistence in comparison with that of the dwellers in open streets,
then, I apprehend, it cannot be doubted that such a manner of life ought
to be dealt with as a great evil, and ought as much as possible to be
interrupted.

A surveyor’s inspection of the City would reveal to you many places
answering to the description I have given; places to which no
ventilation could arrive except by removal of whole streets of houses
which wall them in.

To remove the well-constructed houses of the City, in order that its
wretched courts and alleys should participate in the blessings of light
and air, might seem one method of conquering the difficulty which is
before you; but I apprehend the opposite alternative, of proceeding to a
gradual suppression of all residence in the former class of dwellings,
may more naturally have your approbation.

To the latter aim, sooner or later, the sanitary efforts of the
Corporation must be directed.

There are many parts of the City where great and immediate advantage
would arise from an expenditure of money applied solely to the purpose
of destruction; parts, where the purchase of an entire court, or series
of courts, for the sole object of pulling down houses, and leaving open
spaces in their stead, would be the cheapest as well as the most
effective manner of dealing with their sanitary difficulties. And I have
earnestly to suggest for your consideration, that proceedings of this
nature will require to be pursued to a very great extent, and at a large
annual expense, within the City, before the cleanliness and habitability
of its poorer localities will stand in their legitimate proportion to
the modern stateliness of thoroughfare and grandeur of public buildings
which attest the magnificence of the Corporation.

I would, therefore, beg to recommend that a survey be made of the worst
districts which I have specified, with a view to the immediate purchase
and destruction of some considerable portion of the court-property lying
in them; and, still more, I would urge that this is an exertion, which
for some years must proceed systematically, in order to thin the density
of a population which now breeds pestilence and augments mortality by
its overcrowding and excess.

I am aware that considerable difficulties lie in the way of
accomplishing an object of this sort with immediate rapidity. It is my
great hope, however, that the principle may be distinctly recognised;
and that the City will not tolerate within its municipal jurisdiction
the continuance of houses absolutely incompatible with healthy
habitation. This principle being once established, and a certain annual
expenditure devoted to enforce it, I feel assured that within a few
years opportunities will have arisen for that outlay to have been made
in the most judicious manner, and for its results amply to have
demonstrated the advantages of the system which I recommend.


SOCIAL CONDITION OF THE POOR.

VI. Last, and not least, among the influences prejudicial to health in
the City of London, as elsewhere, must be reckoned the social condition
of the lower classes; and I refer to this the more especially, because
often, in discussion of sanitary subjects before your Hon. Court, the
filthy, or slovenly, or improvident, or destructive, or intemperate, or
dishonest habits of these classes, are cited as an explanation of the
inefficiency of measures designed for their advantage. It is constantly
urged, that to bring improved domestic arrangements within the reach of
such persons is a waste and a folly; that if you give them a
coal-scuttle, a washing-basin, and a watercloset, these several utensils
will be applied indifferently to the purposes of each other, or one to
the purposes of all; and that meanwhile the objects of your charitable
solicitude will remain in the same unredeemed lowness and misery as
before. Now it is unquestionable, and I admit it,--that in houses
containing all the sanitary evils which I have enumerated--undrained,
and waterless, and unventilated--there do dwell whole hordes of persons,
who struggle so little in self-defence against that which surrounds
them, that they may be considered almost indifferent to its existence,
or almost acclimated to endure its continuance. It is too true that,
among these classes, there are swarms of men and women, who have yet to
learn that human beings should dwell differently from cattle; swarms, to
whom personal cleanliness is utterly unknown; swarms, by whom delicacy
and decency in their social relations are quite unconceived. Men and
women, boys and girls, in scores of each, using jointly one single
common privy; grown persons of both sexes sleeping in common with their
married parents; a woman suffering travail in the midst of the males and
females of three several families of fellow-lodgers in a single room; an
adult son sharing his mother’s bed during her confinement;--such are
instances recently within my knowledge (and I might easily adduce
others) of the degree and of the manner in which a people may relapse
into the habits of savage life, when their domestic condition is
neglected, and when they are suffered to habituate themselves to the
uttermost depths of physical obscenity and degradation.

Here again, as in an earlier part of my Report, I think it requisite to
remark, that I do not mean in any degree to suggest that the evils
adverted to present themselves within the City to a greater extent than
in sundry other parts of the metropolis. My sphere of duty lies within
the City boundary, and it would be an impertinence in me to comment,
either favourably or unfavourably, on districts which lie within another
jurisdiction than that of the Commission which I have the honour to
address. Simply to guard myself against the possibility of being
misunderstood, I again draw attention to the fact that I studiously
refrain from instituting comparisons with other metropolitan localities.
Let me likewise observe that I am far from insinuating, or suspecting,
that the majority of the poorer population of the city has fallen to
that extreme debasement which I have just illustrated as affecting some
portion (perhaps not an inconsiderable portion) of the poorest; but I
dare not suppress my knowledge that such instances exist, nor can I
refrain from stating my belief, that ignorance and poverty will soon
contribute to increase them, if sanitary and social improvement do not
co-operate against their continuance.

Contemplating such cases, I feel the deepest conviction that no sanitary
system can be adequate to the requirements of the time, or can cure
those radical evils which infest the under-framework of society, unless
the importance be distinctly recognised, and the duty manfully
undertaken, of improving the social condition of the poor.

Those who suffer under the calamitous sanitary conditions which I have
disclosed, have been led, perhaps, to consider them as inseparable from
poverty; and after their long habituation to such influences, who can
wonder if personal and moral degradation conform them more and more to
the physical debasement of their abode? In the midst of inevitable
domestic filth, who can wonder that personal cleanliness should be
neglected? In an atmosphere which forbids the breath to be drawn freely,
which maintains habitual ill health, which depresses all the natural
spring and buoyancy of life, who can wonder that frequent recourse
should be had to stimulants, which, however pernicious in themselves,
still for a moment dispel the malarious languor of the place, give
temporary vigour to the brain, and cheer the flagging pulses of a
poisoned circulation? Who can wonder that habits of improvidence and
recklessness should arise in a population, which not only has much
ignorance and prejudice amongst it, but is likewise often unaccustomed
to consideration and kindness? Who can wonder that the laws of society
should at times be forgotten by those whom the eye of society habitually
overlooks, and whom the heart of society often appears to discard?

I believe that now there is a very growing feeling abroad, that the poor
of a Christian country can no longer, in their own ignorance and
helplessness, be suffered to encounter all the chances which accompany
destitution, and which link it often indissolubly to recklessness,
profligacy, and perdition. The task of interfering in behalf of these
classes, however insensible they may be of their own danger and frequent
degradation, begins at length to be recognised as an obligation of
society; and as such an interference may be fraught with the utmost
advantage to sanitary progress, I shall now proceed to point out the
manner in which, with this view only, it may most usefully and most
humanely be made.

First of all I would point out to you, that within your Act of
Parliament there are contained some enactments on this subject which
might be of great value, were it not for their very limited
application:--‘Whereas the owners and keepers of lodging-houses of an
inferior description, for the accommodation of mendicants, strangers,
and other persons for the night, or other short periods, allow the same
to be crowded, by receiving more lodgers than such lodging-houses are
adapted to contain with a due regard to health,’ therefore, and for some
other reasons enumerated in the 91st clause, it is enacted that you may
require the registration, and may order the periodical inspection of
such houses; that you may from time to time fix and determine the number
of lodgers who may be accommodated in each lodging-house; that you may
issue ‘rules or instructions regarding health, cleanliness, and
ventilation;’ that you may ‘order that a ticket, containing the number
of lodgers for which the house is registered,’ together with your rules
and regulations, ‘shall be hung up, or placed in a conspicuous part of
each room into which lodgers are received;’ and finally, ‘that if any
keeper of such lodging-house shall offend against any of these
provisions, he shall be liable for each such offence to a penalty not
exceeding 5_l._, and the like penalty for every day after the first upon
which any such offence shall be continued.’ The spirit of these
enactments is excellent; but unhappily the definition given at the end
of the clause excludes from the operation of the law those very cases
which most need to fall within it. ‘Common lodging-house’ (it runs)
‘shall, for the purposes of this act, mean any public lodging-house, not
being a licensed victualling-house, in which persons are harboured or
lodged for hire, for a single night, or for less than a week at one
time, or in which any room is let for hire to be occupied by more than
one family at one time.’ Lodging-houses, according to this definition,
are (I am informed) hardly to be found within the City of London; and
the clause has remained, and seems in its present form likely to remain,
quite inoperative. If, in any future renewal or amendment of your Act,
the definition could be modified in such a manner, that the powers given
in respect of lodging-houses should be extended to all the poorer
tenements of the City, where the several floors are let separately at a
weekly rent, the clause in question would be rendered one of the most
serviceable in the Act, and one of the most general application. In its
present form, the clause barely enables you to deal with the temporary
bed-accommodation of trampers and vagrants,--a class happily not very
numerous in the City; while, modified in the manner I suggest, it would
put under your sanitary regulation the whole household economy of the
permanent industrial population of the City; and, if effectively worked,
would conduce beyond all estimation to the physical, social, and moral
improvement of that class.

       *       *       *       *       *

Secondly, and as a matter of even higher importance, I would beg you to
consider the incalculable good which may be conferred on the poorer
classes of society, by the direct educational influence of those in
better and more enlightened circumstances than their own. When I say
that all the social errors to which I now more particularly refer, would
gradually but swiftly vanish under the influence of education, I do not
mean that the cure would lie in learning to read and to write and to
sum:--though these attainments, of course, would largely increase the
power, usefulness, and market value of their possessor. The education to
which I refer, as an all-important influence for sanitary progress, is
that which would consist in exhibiting to the lowest classes of society
frequent practical evidences of the attainability and the advantages of
higher civilization; an education which, by model and examples, would
lead them to know cleanliness from dirt, decency from grossness, human
propriety from brutish self-abandonment; an education which, by sensible
experience, would teach them to feel the comfort and the profit of
sanitary observances, and would apply their instinct of
self-preservation to the deliberate avoidance of disease.

It is in this point of view, gentlemen, that I would solicit your
attention to the useful and philanthropic exertions of three societies
which have been established during the last few years, with the object
of improving the condition of the labouring classes; and I would venture
to suggest that the course which those societies have adopted in various
parts of the metropolis, is one that might with the utmost advantage be
pursued within the City of London.

The establishment of _Model Dwelling_ and _Lodging-houses_, and of
_Public Baths_ and _Laundries_, for the use of the labouring population,
is now no longer a matter of recent speculation. Under the beneficent
auspices of the Societies to which I have referred, the following
experiments have been tried:--

The Committee for promoting the establishment of Baths and Wash-houses,
having at first Mr. W. Cotton, and then Sir H. Dukinfield, for its
Chairman, and including in its number, with other influential persons,
several members of this Corporation, founded, at great pains and
expense, a model institution at Goulston-square, Whitechapel. In spite
of many circumstances conspiring to render this first and experimental
establishment particularly expensive, it has more than supported itself
by the small payments of the poor; and its arrangements are sufficiently
extensive for it to have given in one day as many as 932 baths. This
fact, having occurred in the first year of its establishment, shows how
much the poor must have appreciated the additional comfort placed within
their reach; and I may add that, from the first opening of the building,
the annual receipts have been progressively on the increase. Somewhat
earlier, and under the influence of the same parent-committee, though
specially directed by a branch-committee, a similar establishment was
founded in George-street, Euston-square. During the year 1848 the number
of payments made here for bathing was 111,788; the number of payments
for washing in the laundries, 246,760. This establishment has not only
proved self-supporting, but has been enabled to accumulate a large
surplus, which is now being applied to enlarge and improve the building.
At Glasshouse-yard, near the entrance to the London Docks, there has
been founded, on the same model, a small establishment of free baths and
washhouses for the destitute poor. It was opened in May, 1845. In the
first year the baths given amounted to 27,662; the usings of the laundry
to 35,840; and its total working expenses were covered by £378.

No language, however eloquent--no comment, however instructive, could
equal the significance of the figures which I have cited as illustrating
the great utility of these institutions; and, as regards their pecuniary
success, it is impossible to furnish you with better testimony than is
comprised in the fact, that the Guardians of the Poor in a great
metropolitan parish[26] have recently, out of the poor-rates, founded an
institution of this nature. They have become witnesses to the financial
economy of that sanitary and social boon. In their establishment, which
is not only self-supporting, but amply remunerative, the poor are
enabled to have baths at an expense of a penny for a cold bath, and
twopence for a warm bath; and the women are enabled to do their washing,
ironing, and drying, with an unlimited water-supply, and with other
arrangements of most admirable completeness, at an expense of only
twopence for the first two hours, during which they occupy the separate
chambers allotted to them. A very considerable proportion of the expense
is covered by the receipts for baths given at the higher price of
sixpence, and with some additional luxuries, to persons of a higher
grade in society than those who use the ordinary baths; the former,
though used by a different class of persons, being sought with almost as
much avidity as the latter.

  [26] St. Martin’s in the Fields.

In the sanitary point of view, I probably need not insist much on the
advantages which these establishments have conferred. You will hardly
doubt how good and wholesome a thing it has been for so many thousands
to have had the means of cleanliness; who, in the absence of such
facilities, must often have carried about their persons accumulations
that one sickens to think of; and whose narrow, crowded chambers must
constantly have steamed with wash-tubs, and been hung round with reeking
clothes.

       *       *       *       *       *

Next, very briefly, let me allude to what has been done in respect of
the habitations of the poor; first, by the Society for the Improvement
of the Condition of the Labouring Classes, under the patronage of their
Majesties the Queen and the Queen Dowager, with the Prince Albert for
its President, and Lord Ashley for its Chairman; secondly, by the
Metropolitan Association for Improving the Dwellings of the Industrious
Classes, under the Chairmanship of Sir Ralph Howard, and with a
committee which, like that of the former society, includes many of the
best and wisest, as well as the highest persons of the country. Under
the influence of these societies the following experiments have been
made:--

In the Old Pancras-road a very large building has been erected, to
accommodate 110 families separately and distinctly, in sets of two and
three rooms each. Each set of rooms has its own boiler, range, oven, and
coalbox; its separate scullery, in which are sink, cistern, and
dust-shaft; its own watercloset, its own ample supply of water, and many
other conveniences. The rents vary from 3_s._ 6_d._ to 5_s._ per week
for a set of two rooms; and from 4_s._ 9_d._ to 6_s._ 3_d._ for a set of
three rooms. The founders of this establishment have recently purchased
land at the end of Spicer-street, Spitalfields, on which to erect a
lodging-house for 300 single men, and also houses for families.

In the Lower-road, Pentonville, houses of three different classes have
been built, on the same general principle of furnishing every
convenience and sanitary requisite. They accommodate, on the whole, 23
families and 30 single women--widows, or of advanced age. The entire
houses for families, with all the above-mentioned conveniences, are at a
rent of 6_s._, having a good-sized living room, two bedrooms, with
additional enclosed recesses for children’s beds, a yard at the back of
the house, and the joint use of a wash-house and drying yard. A floor of
two rooms is rented at 3_s._ 6_d._, and a single room by a single person
at 1_s._ 6_d._

In George-street, St. Giles’s, a model lodging-house has been
established, affording accommodation to 104 single men, and combining
everything essential to such an establishment. The ventilation and
drainage have been carefully attended to; an ample supply of water is
provided, gas extends through the house, the dormitories are arranged so
as to keep their inmates private from each other; there are
washing-closets fitted up with every requisite for cleanliness; there is
a bath-room supplied with hot and cold water; there are a kitchen and
wash-house furnished with all appropriate utensils, a pantry-hatch, with
separate, ventilated, and secure compartments for the food of each
inmate; in the pay-office is a small well-selected library, for the
service of the lodgers, and the use of a spacious coffee-room is
likewise for their common convenience. Their pay is 4_d._ per night, or
2_s._ a week--an amount little above the ordinary rent paid for the most
miserable accommodation in a trampers’ lodging-house.

At 76, Hatton-garden, a lodging-house for 57 single women has recently
been opened, consisting of three floors of dormitories, divided into
separate compartments, and a basement fitted up with kitchen, washhouse,
bath, pantry, safes, &c.

In Charles-street, Drury-lane, three tenements, originally separate,
have been converted into a single lodging-house for 82 single men, on
the same general plan and at the same rent as that in George-street, St.
Giles’s.

All the lodging-houses are furnished; and the inmates are supplied with
utensils for their food and other purposes, which must be returned, or
made good, at their leaving.

In all these lodging-houses rules exist for the purpose of insuring
cleanliness, sobriety, carefulness, and general propriety of conduct;
any infraction of which subjects the offender to immediate expulsion.
For the sake of those who choose to avail themselves of the opportunity,
Scripture readings are appointed to take place in the common room every
evening at 9 o’clock; and copies of the Scriptures, with other
well-chosen books, are left in charge of the superintendent for
distribution among the lodgers, in the hope that they may thus be
induced to occupy their leisure to advantage.

In the construction of all these establishments, equally, the greatest
pains have been taken to bring sanitary science to bear on the comfort,
and convenience, and health of the inmates. Ventilation, drainage,
facilities for decency and for cleanliness, have in every instance been
made the leading considerations of the architect.[27]

  [27] The advantages of these admirable institutions may now be spoken
  of from longer experience. In a very remarkable pamphlet just
  published by Dr. Southwood Smith, _On the Results of Sanitary
  Improvement_, it is recorded that there has been no case of typhus
  fever in any one of the model-dwellings since they were first opened,
  and that their exemption from cholera has been as complete as from
  typhus. In the Metropolitan Buildings, during three years, the average
  annual mortality has been only 1·36 per cent. For a lower class of
  population, very similar advantages have been procured by the
  regulations of the Common Lodging-House Act. Dr. Smith mentions that
  in 1308 regulated metropolitan lodging-houses (numbering at least
  25,000 lodgers) there had not occurred a single case of fever during
  the quarter ending the 23rd of October; yet, before they were under
  regulation, twenty cases of fever have been received into the London
  Fever Hospital from some one single house in the course of a few
  weeks.--J. S., 1854.

       *       *       *       *       *

In regard of these model houses and model lodgings, it would, I think,
be a great error to estimate their benefit as merely relative to the
number of persons at any one time inmates of them. No doubt it is a
great advantage that they furnish, at the ordinary prices of the day, or
at a still lower price, so excellent accommodation to several hundreds
of persons; and it is a still greater good (particularly in regard of
those established for single men and single women) that they drill their
inmates into decent and orderly habits, and accustom them to a high
standard of household-accommodation, which will probably influence their
subsequent married lives in the same desirable direction. But,
indirectly, their utility has a far wider scope. They stand in bright
contrast to the dark features of filth and unwholesomeness which environ
them; they familiarise the poorest classes generally with all the
practical advantages of cleanliness; they show that dirt is not
inevitable; they therefore create and foster among the humblest members
of society, a laudable discontent with defective sanitary arrangements;
and they establish a strong public opinion, grounded on experience, in
favour of those conditions of cleanliness and comfort, which determine
the maintenance of health.

       *       *       *       *       *

That all the great results of sanitary science can be applied in their
utmost perfectness to the dwellings of the poor, for the payment of a
rent often below, and never above, the average given for some miserable
doghole, that poisons its inhabitants, is a truth of immense importance,
deserving the widest dissemination, and pregnant with the most hopeful
promise. Such advantages spring from and illustrate the economical
application of the associative principle; they cannot be obtained
otherwise than by the application of capital, in such an amount as lies
only within the compass of wealthy corporations, or is reached by the
voluntary combination of several private purses. While the labouring
classes are abundantly able to maintain these institutions when
established, and to render them amply remunerative to those whose
capital has first founded them, it is obvious that no power of
association lying within their means can suffice to originate such work.

The task of initiation rests with others. And therefore it is,
gentlemen, that on this occasion I have been induced to bring under your
notice, as a most important part of my subject, the outline of what has
been done in the matter of Model Dwellings and Public Baths and
Washhouses. Feeling assured that establishments of this nature are of
infinite utility in the several respects I have enumerated; feeling
assured that, beyond their immediate operation on the health of inmates
and users, they also tend, by their indirect educational influence, to
improve the social habits, to promote the civilization, to elevate the
general tone and character of the labouring classes, I earnestly
recommend them to your attention; hoping that you may either yourselves
confer on the poor population of the City the advantage of your
patronage and succour in this respect, or else may transfer the matter
to the jurisdiction of the Common Council, with all the influence and
authority in its favour which your recommendation would insure.


SUGGESTIONS FOR SANITARY ORGANISATION IN THE CITY.

Having now enumerated the sanitary evils of the City, and the remedies
which appear to my mind most appropriate for their removal, it becomes
desirable that, in concluding, I should point out to you the
organisation which seems necessary to be adopted during the gradual
transition of the City from its present to a healthier state;--an
organisation which may render this transitional period as short as
possible, and may most effectually contribute to mitigate, for the time,
the pressure of such evils as cannot immediately be removed.

       *       *       *       *       *

The object of this organisation lies in a word; Inspection--gentlemen,
inspection of the most constant, most searching, most intelligent, and
most trustworthy kind, is that in which the provisional management of
our sanitary affairs must essentially consist.

I presume I may take for granted that, in some form or other, a
_Committee of Health_ will exist, either as a Committee of the Court of
Common Council, or as one of this Hon. Court. I may, perhaps, further
assume that such a Committee will have authority to entertain all
subjects relative to the sanitary improvement of the City, and to make
thereon such recommendations as shall seem fit to them; and, further,
that they will make it their business to receive periodical
intelligence, as complete as possible, on all variations in the public
health, and on all circumstances likely to affect it.

       *       *       *       *       *

In order that any Committee, acting for sanitary purposes within the
City, shall have a reasonable chance of success in its endeavours for
the public good, the following means of information will be necessary
for its use:--

       *       *       *       *       *

1. That an account should be kept, corrected year by year, of every
house within the City; as to the area of building, the number of floors,
rooms, and windows; as to its ventilation; as to its drainage,
water-supply, and other facilities for cleanliness; as to its method of
occupation, and number of inhabitants:

       *       *       *       *       *

2. That from this account there should be made out, at least twice
yearly, a list of houses and streets remaining in an objectionable
sanitary state; and a list, also, of such as may have been remedied to
the satisfaction of the Committee since the formation of their last
preceding list:

       *       *       *       *       *

3. That, while trades injurious to health or offensive to their
neighbourhood are suffered to continue within the City, there should be
given periodical reports on the condition of such establishments, to the
end that they may be so maintained as to be least detrimental to the
public health:

       *       *       *       *       *

4. That a record of every death registered as occurring in the
population of the City should lie before the Committee; and

       *       *       *       *       *

5. I consider it quite indispensable, that they should likewise receive
the largest and most accurate returns which can be procured of all
sickness occurring among the poorer classes; and (particularly in
respect of all epidemic, endemic, and infectious disorders) that the
medical practitioner who communicates the fact of illness, should
likewise report the existence of any local causes, or other influences
of general operation, which have tended to produce, or are tending to
continue, such illness.

       *       *       *       *       *

On the subject of returns of the nature last referred to, I have
already, on various occasions, submitted my opinion to the judgment of
your Hon. Court. A year ago, in the first Report which I had the honour
to make here, and in various discussions which during some months
followed the reception of that Report, I stated how necessary I deemed
such returns, for the purpose of guiding and justifying the various
recommendations which it would become my duty to lay before you. The
period which has since elapsed, including its three months of
pestilence, has furnished me with the strongest confirmation of those
views. As I formerly stated by anticipation, so now I repeat from
experience, that nothing deserving the name of sanitary administration
can exist in the City, without accurate periodical intelligence of all
such sickness (at least) as comes under parochial treatment; or without
such reports on the local sanitary conditions, and on other causes of
disease, as were desired to accompany that intelligence.

When the matter was previously under your consideration, it was argued
that the reception of such intelligence formed no part of your functions
as a Commission for draining, lighting, paving, and cleansing the City
of London; that all sanitary matters, beyond these and the like, were
foreign to your proper sphere of operation; and that your funds, raised
by rates from the citizens of London, could not with propriety be
applied to meet the expenses of such an arrangement. On this question of
jurisdiction and finance I shall, of course, hazard no opinion. I would
simply beg to repeat, with regard to so much of the matter as lies
within my own professional province, that the intelligence in question
is absolutely necessary for the present progress of sanitary measures
within the City; that no Health-Committee can exist for a month without
it; nor can any officer, having proper respect for his character,
consent to be considered responsible for the health of a population,
whose illnesses he learns only from their posthumous record in the
death-register.

During the recent prevalence of cholera, the Health-Committee of the
Common Council complied for the time with my recommendation, and
established a system of daily reports, rendered still more serviceable
by free personal intercourse between myself and the several gentlemen
having medical charge of the three City unions. What needed to be daily
during a period of pestilence, might fitly become a weekly communication
at all other times. I have already reported to the Health-Committee, and
I beg to reiterate here, that the advantages derived from that system of
communication were such as could have been attained in no other way.

I may remind you that each of the gentlemen referred to, serving under
the Poor Law, works within a certain small and definite district; that
he is therefore peculiarly competent to speak on the state of the
population in that district, on their habits and necessities, on their
customary condition of health, and on their liability to epidemic
disease; and that the total staff of these officers, taken collectively,
representing the medical practice of the whole city, can supply exactly
that kind of detailed and precise information which is most serviceable
to your Officer of Health, in guiding him to those more general and
comprehensive conclusions which it is his business to lay before you.
These gentlemen are the habitual medical attendants of the poorer
classes; day by day, in the unobtrusive beneficence of their calling,
they pass from house to house, and from court to court--the constant
recipients of complaint, or the constant observers of ground of
complaint--amid all that destitute population on whose condition you
require to be informed. They are in the constant presence of the
pestilences which reign in our worst localities; they are the chief
treaters of endemic disease within the City--of that disease which, by
its proportion, measures the success of sanitary changes, or indicates
their failure; and it has been the professional education of these
gentlemen, as it is their business, to trace such effects to their
causes. Their reports would be the authenticated statements of
experienced medical practitioners, familiarly conversant with their
several respective localities.

If it were your wish and object, with utter indifference to expense, to
organise the best scheme for procuring to yourselves from time to time a
succession of accurate and trustworthy reports on the state of health,
and condition of dwellings, in the several districts of the City;--if
you were willing to engage a large number of non-medical persons who
should give their whole time to the duty of exploring and reporting on
that state, I am persuaded that this expensive and cumbrous proceeding
would have a smaller measure of success than that which I submit to you,
and which consists essentially in availing yourselves of the local
knowledge and daily observations of a staff of officers, already
organised and in active occupation for the very purposes in question.

That such intelligence, embracing weekly returns from the eleven
parochial surgeons of the City of London, and including their comments
on the local causes of prevailing disease, would involve an annual
expenditure of money,[28]--and that this expenditure, sooner or later,
and in some form or other, would be derived from the rate-paying portion
of the community, are facts which cannot be doubted. But that the
expenditure would be a judicious one; that it is indispensable to the
effective working of any Health-Committee, or any Health-Officer within
the City; that it would be the first step to the mitigation of the
disorders reported on; that it would disclose evils which else must
escape recognition and remedy; that in a few years it would render our
general mortality of 3 per cent. on the entire population of the City a
matter of history and a warning, instead of its being, as now, a present
and awful reality; that in lessening sickness and death, it would stay
a large source of pauperism, would diminish the number of occasional and
habitual claimants of Union relief, and would become a measure of real
and considerable economy;--these are points on which, with the utmost
sense of official responsibility, I beg to record my deliberate
conviction.

  [28] When the matter was last under consideration of the
  Commissioners, it appeared that the expense of such an arrangement
  would be about £250 annually.--J. S., 1854.

Accordingly, I have to recommend that any Committee, which may undertake
the administration of sanitary affairs for the City, shall be furnished
as completely as possible with information of the nature I have
specified.

       *       *       *       *       *

Another element to which I think it necessary to advert, in connexion
with a future sanitary organisation for the City, is this,--that some
permanent arrangement should be made, by which the maintenance of
exterior and interior cleanliness, the enforcement of scavengers’
duties, the suppression of nuisances, and the like, should be brought
under habitual and systematic surveillance; one, by which all breaches
of your present or future sanitary regulations may be quickly detected,
and may be visited with their appropriate penalties as speedily and as
certainly as possible. I am induced the rather to bring this subject
before you, as complaints of scavengers’ duties being neglected have
reached me at every turn. I am informed that it is usual for them to
refuse to remove dirt and rubbish from houses, according to the terms of
their contract, except on the tenants’ payment of an additional
gratuity; and it must be obvious to your Hon. Court that the
arrangements which you have made by contract for this purpose are
virtually defeated, as regards the poorer population, when the removal
of refuse-matter is made contingent on the gift of beer-money by those
whose means are so restricted.

It is in respect of matters of this sort, and of such only, that I think
the services of the Police-Force might usefully be employed. Their want
of special education, and their employment in other duties, are
circumstances which appear to me quite conclusive for objecting to their
utilisation as sanitary reporters. But while I entertain the opinion
that their employment in the latter direction would be both fruitless
and inconvenient, I would submit that their numbers and their diffusion
through the City qualify them well to act against all causers of
nuisance, as they act against other offenders, both detectively and
preventively; and I would venture to repeat a suggestion, which I made
in January last, ‘that the police should consider it part of their duty,
to report on every nuisance within their knowledge, and on every
infraction of such sanitary rules as this Court may establish.’

       *       *       *       *       *

Here, Gentlemen, terminates the list of subjects which, on this
occasion, I have thought it my duty to bring before you. Long as the
enumeration may have appeared, I can assure you that my present Report
bears a small proportion, in point of dimensions, to the very large and
very various mass of materials on which it is founded. In compressing it
within the narrowest limits consistent with intelligibility, and in
excluding from it nearly all details on the matters treated of, I have
consulted the convenience of your Hon. Court, notwithstanding the
greater labour and difficulty of execution which belong to the plan I
have adopted. At any time, in Court or in Committee, when you may wish
to pursue the subject, I shall be ready to enter at far greater length,
and with more elaborate minuteness, on any of those subjects which, at
the present opportunity, I have only sketched for your general
information.

       *       *       *       *       *

In the matters which I have enumerated, some lie distinctly within your
province, as assigned by the Act of Parliament; while others may be
thought to lie, just as distinctly, without that province. In affairs
strictly under your jurisdiction, and within the present scope of the
law, there remains very much to achieve. The complete enforcement of
house-drainage, till every house washes itself into the sewer; the more
general distribution of water, till every individual within the City has
an abundant supply within his immediate reach; the effective
preservation of public cleanliness; the construction and maintenance of
sewerage, paving, lighting, for all the streets, courts and passages of
this great City;--these constitute an immense amount of responsibility
and labour. Those other objects to which I have referred, are partly
such as cannot be accomplished without the further interference of the
Legislature. It is a point solely for the discretion of your Hon. Court
to determine, how far you may be willing to enlarge the sphere of your
sanitary operations, and to undertake the difficulties of a new
campaign.

       *       *       *       *       *

To your Officer of Health the Act of Parliament allows no such option.
‘Whereas the health of the population, especially of the poorer
classes, is frequently injured by the prevalence of epidemical and other
disorders,’ therefore it is appointed for his duty that he shall report
on whatsoever ‘injuriously affects the health of the inhabitants of the
City,’ and that he shall ‘point out the most efficacious mode of
checking or preventing the spread of contagious or other epidemic
disease.’ Actuated by obligation of the duty thus expressed in your Act
of Parliament, after full reflection on all that those expressions
imply, and with the deepest sense of the responsibility belonging to one
who is honoured with the task of advising the first Corporation of the
country in respect of its sanitary proceedings, I have been compelled,
in the course of my present Report, to trench upon many subjects which
do not customarily fall under your consideration, and which (as I have
stated) may by some be considered as utterly foreign to your
jurisdiction and province.

It rests with your Hon. Court to determine what course you will adopt in
respect of such departments of the great sanitary scheme;--whether you
will retain them under your consideration, and will assume the
responsibility of dealing with them in proportion to their magnitude and
importance, or will transfer them to the Court of Common Council for the
less restricted deliberation of that body.

Let me once more declare my profound conviction of their importance to
the health and welfare of the City.

To provide an inoffensive outfall for the sewerage of our vast
population; to render the river a source of unqualified advantage; to
give wide extension and sounder principles to the system of
water-supply; to suppress all trades and occupations which taint the
atmosphere with materials of organic decomposition; to abate the
nuisance of smoke; to provide the facilities for extramural interment,
and to procure the prohibition of all further burial amidst our living;
to improve the domestic arrangements of the poor, and to insure for them
an adequate supervision; to establish public baths and laundries, which
may offer the utmost facilities and inducement for the maintenance of
personal cleanliness; to hinder the occupation of houses which breed
pestilence; to destroy such as are irremediably hostile to health, and
to disperse the stifled population of courts and alleys; to substitute
for such slums as we hope to depopulate and destroy, but in open streets
and with perfect ventilation, houses and lodgings, which not only shall
offer to the labouring classes every convenience essential to health and
decency and comfort, but shall likewise serve as models of household
economy for the whole district in which they stand;--these, Gentlemen,
are the aims, briefly recapitulated, for the sake of which I have been
obliged, as it were casually in my Report, to touch on many subjects
perhaps foreign to your jurisdiction, but lying at least on the confines
of your province, and remaining with you now either to retain or to
transfer.[29]

  [29] Perhaps, to make these passages intelligible, the reader should
  be apprised that the business of the Corporation is considered in a
  great variety of Committees, which thus have their several and
  particular provinces. Of the many matters adverted to, as foreign to
  the ordinary functions of the Commission of Sewers, some might belong
  to the _City-Lands_ Committee, some to the _Improvement_, some to the
  _Finance_, some to the _Navigation_, some to the _Markets_ Committee,
  and so on. Obviously it would have been out of my place to touch on
  these details of jurisdiction; and I therefore urged only the
  essentially _municipal_ character of the several improvements I
  advocated.--J. S., 1854.

       *       *       *       *       *

That the subject of sanitary improvement in its widest scope, and with
all that even incidentally relates to it, is one which, according to the
ancient constitution of the City, rightfully belongs to the authorities
of the Corporation, in some one or other of their municipal
relations--that it belongs to them equally as their privilege and their
duty, cannot for a moment be questioned. And if your Hon. Court should
determine on a negative opinion as regards yourselves, and should decide
on transferring these matters to the Common Council, I venture to hope
that your influence may accompany them in their course, and may procure
for them the consideration they deserve.

       *       *       *       *       *

Gentlemen, the history of the City of London is full of great examples
of public service. It records many a generous struggle for the Country
and for the Constitution; it records a noble patronage of arts and
letters; it records imperial magnificence and Christian liberality; but
never, within the scope of its annals, has the Corporation had so grand
an opportunity as now for the achievement of an unlimited good. Because
of the City’s illustrious history, and because of the vast wealth and
power which have enabled it so often to undertake the largest measures
of public utility and patriotism,--therefore it is, that the
expectations of the country may well be fixed on the City of London in
regard of this, the distinguishing movement of modern times--the
movement to improve the social condition, and to prolong the lives of
the poor.

Those who are familiar with the many abiding monuments of your civic
munificence and splendor, may well expect that, in approaching this
all-important question, the counsels of the City will be swayed by high
and generous considerations.

In the great objects which sanitary science proposes to itself,--in the
immense amelioration which it proffers to the physical, to the social,
and indirectly to the moral condition of an immense majority of our
fellow-creatures, it transcends the importance of all other sciences,
and in its beneficent operation seems most nearly to embody the spirit
and to fulfil the intentions of practical Christianity.

Ignorant men may sneer at its pretensions; weak and timorous men may
hesitate to commit themselves to its principles, so large in their
application; selfish men may shrink from the labour of change, which its
recognition must entail; wicked men may turn indifferently from
considering that which concerns the health and happiness of millions of
their fellow-creatures. To such men an appeal would indeed be useless.
But, to the Corporation of the City of London--whether as assembled in
its entire Parliament, or as represented within the confines of this
Court--to the Corporation which, on so many occasions, has attained
patriotic ends by great expenditure and sacrifice; to men earnest,
strong-minded, and practical, having much consideration for their
fellow-creatures, and having little consideration for personal toil or
municipal expense, so only that they may fulfil a great Christian duty,
and may confirm the gratitude with which history records their frequent
services to our kind;--to such a Corporation, and to such men, the
Country looks for the perfection of a sanitary scheme which shall serve
as model and example to other municipal bodies undertaking the same
responsibility; and to such a Corporation and to such men do I,
likewise, your Officer of Health, respectfully and confidently address a
well-founded appeal.

  I have the honour,

  &c., &c.




FURTHER REMARKS ON WATER-SUPPLY.


  ADDRESSED TO THE HEALTH-COMMITTEE OF THE HON. THE COMMISSIONERS OF
  SEWERS OF THE CITY OF LONDON, PURSUANT TO A REFERENCE--

  “_What would be a sufficient supply of water to the houses and
  premises within the City, and the best principle upon which to effect
  such supply?_”

  _February 21, 1850._

  GENTLEMEN,

  Such further observations on the subject of ‘Water-Supply to the City’
  as you have desired me to lay before you, I have now the honor to
  submit, in as condensed a form as possible.

       *       *       *       *       *

First, I may remind you, that in my report of last November, which still
remains under your consideration, I stated the following ‘as the chief
conditions in respect of Water-Supply, which peremptorily require to be
fulfilled.

‘1. That every house should be separately supplied with water; and that,
where the house is a lodging-house, or where the several floors are let
as separate tenements, the supply of water should extend to each
inhabited floor.

‘2. That every privy should have a supply of water, applicable as often
as it may be required, and sufficient in volume to effect at each
application a thorough flushing and purification of the discharge-pipe
of the privy.

‘3. That in every court, at the point remotest from the sewer-grating,
there should be a stand-cock for the cleansing of the court; and

‘4. That at all these points there should always and uninterruptedly be
a sufficiency of water to fulfil all reasonable requirements of the
population.’

In re-organising the system of water-supply there are some other
purposes, of a more public nature than these, which would likewise claim
your attention: such as (1) an improved arrangement for meeting all
accidents and emergencies of fire; (2) an efficient distribution of
water to all common urinals and privies; (3) a sufficiency of supply for
any public baths and wash-houses, which may be hereafter erected; and
(4) an ample surplus to be at the disposal of the Commission for the
cleansing of streets and sewers.

       *       *       *       *       *

In order that those domestic purposes, which I first enumerated, should
be adequately fulfilled, the supply of water ought, practically
speaking, to be without limit to any individual consumer. It is the
tendency of the system of constant supply, and constitutes a
distinguishing advantage of that system, that it fulfils this important
condition without any increase, or perhaps rather with a diminution, of
the total draught of water for a large population.

The average of requirement (estimated from the consumption of large
communities) would probably be about 12 gallons per person per diem;
making an amount, for the total population of the City, of about 1½
million gallons per diem. Assuming this estimate to be correct, a point
which I would beg you to observe is the following: that, although there
might be very little fluctuation in the _total quantity consumed_, and
although it might remain constant at the figure I have given, yet in the
items of individual consumption, making up this gross amount, there
would be almost infinite varieties. One family would habitually consume
twice as much water as another family of the same size: one family would
consume six gallons per person on five days of the week, and would
require all its remaining quota on the other two days; and so forth.
These differences and caprices of individual requirement do not sensibly
affect the total quantity consumed in a given week by a population of
130,000 persons; one consuming more, another less, the first
counterbalances the last in forming the materials for a fair personal
average; and a source of supply calculated from such an average for a
large population would, practically speaking, be unlimited to each
individual consumer, provided only that it were so distributed, that
each consumer could draw from the common stock at his own time and
according to his own necessity. This advantage is obviously lost under
the present system of intermittent supply, which compels a larger total
distribution than would else be requisite, entails the expensive and
unwholesome necessity for storage, and yet is notoriously fraught with
the inconveniences of a restricted source, or a defective supply.

I have no sufficient data for judging with precision what quantity of
water might be required to fulfil all those public purposes of
cleanliness and of protection from fire, to which I have adverted. The
supply would require to be _practically_ inexhaustible; but the
consumption, on an average of the four seasons, would probably lie
considerably within half a million of gallons per diem.

When the distribution of water is brought into its proper relations with
the drainage of the City--that is, when the arrangements of domestic
drainage are completed, in conformity with the intentions of the Act of
Parliament, and when all the water, distributed for private consumption,
is made to traverse and to cleanse all the channels of house-drainage,
it is probable that a smaller quantity of water than is now consumed
will suffice for the flushing of sewers, and for other so-called
sanitary purposes.

The quantity at present supplied to the City by its two Water-Companies
is perhaps much in excess of the two millions of gallons per diem, which
I have estimated as a sufficiency for our population; but the
distribution is so unequal, and the waste of the intermittent system so
incalculably great, that the effect produced on the population is, to a
very great extent, that of scarcity.

       *       *       *       *       *

With regard to the _principle of supply_ on which I have been desired to
report, it seems certain to my mind, from such evidence as I can collect
on the subject, that the system of continuous supply at high-pressure
promises advantages which can never be realized under the present system
of intermittent supply. There are many matters connected with the
comparison of these two systems, which lie beyond my sphere of
professional observation, and on which I would not be bold enough to
offer any opinion to your Committee. The sanitary points, on which alone
I would venture to insist, as benefits in the system of continuous
supply, are--first, the practical inexhaustibility of the source, and
secondly, the absence of necessity for storage. If these benefits are
attainable, and especially if (as alleged) they can be obtained at a
material economy of expenditure, as compared with the present system,
there can be little doubt as to which should obtain the preference.

If your Committee should wish, it would be easy to prepare for your
examination a digested summary of such scientific evidence as has been
given on these points: or it might be expedient, if such a course would
be more satisfactory to you, that some person in your confidence should
undertake to visit and inspect one or more of the towns where the
system of continuous supply is in operation, and where direct
information can be gathered on the very important particulars of its
practical efficiency and success. But, at all events, whether your
Committee should wish or should not wish this personal investigation to
be undertaken, I would suggest, that it might be satisfactory to you and
serviceable to the inquiry in which you are engaged, if you would
procure a report from some eminent hydraulic engineer, practically
conversant with the system of continuous supply, who might furnish you
with conclusive testimony as to the admissibility of this system within
the City, and as to the advantages and disadvantages, sanitary and
economical, which might attend its adoption here, as compared with that
which has hitherto prevailed.

It appears to me that at the present time the system of continuous
supply might, provisionally, receive a fair trial in the City, in
respect of some of those poorer habitations, which are now for the first
time about to be supplied with water and drainage. The Water-Companies
would probably not object, if desired by the Commission, to supply a
hundred houses, experimentally, with constant pressure from their mains.
The Commission might select for its experiment some of those courts
about Cripplegate or Bishopsgate, where the drainage, as well as the
water-supply, requires to be constructed anew: some, where there have
hitherto been undrained cesspools, and where the water-supply has been
from a stand-cock. Should this suggestion be found feasible, I would
recommend that the details of its execution should be carried out under
the joint superintendence of your Surveyor and myself, and that we
should afterwards report to you its results, as material for guiding
your decision with regard to the general supply of the City.

Mr. Quick, Engineer to the Southwark Water-Works, in a letter which is
appended to Sir William Clay’s pamphlet, has recently suggested various
arrangements for an uninterrupted supply, and these have no doubt been
under your Surveyor’s consideration. I may add, too, that there are at
present upwards of 40 houses within the City constantly supplied from
the mains of the East London Water-Works; but as these are not houses of
the poorest description, it is possible that they may not constitute so
satisfactory a proof of the feasibility of the constant supply, or so
complete an illustration of the detailed arrangements for its
employment, as could be given by the experimental construction I have
suggested.

While the supply remains, as at present, an interrupted one for the City
generally, I would recommend that the Commission should procure from the
Water-Companies an arrangement for the delivery to occur, under no
circumstances, less than daily; and that Sunday should form no exception
to this arrangement. Many tenants of the Water Companies at present
receive their supply only on alternate days, Sunday counting as a _dies
non_, so that a necessity is entailed in such cases for a three days’
storage of water.

       *       *       *       *       *

Whether the _quality_ of water supplied to the City by the existing
Companies is such as it ought to be, or whether some purer source of
supply may be found; whether their neglect of filtration,
notwithstanding the important weight of testimony given in its favor, be
not a serious dereliction of their duty to the public; whether the
sanitary interests of the consumers of this first necessary of life can
be properly protected, while at variance with those of the great trading
companies which hold a virtual monopoly of the supply; whether it would
not be an immense boon to the Citizens of London, that the control of
the water-supply should be vested in the same jurisdiction as the
drainage, paving, and sanitary cleansing of the district; are questions
which have forced themselves closely on my attention while considering
the sanitary affairs of the City, and on which I hope shortly to lay
some special observations before this Committee or before the Court.

I defer dwelling on these subjects at present, partly because they were
not mentioned in your Committee’s specific reference; partly because I
think it desirable to wait for the issue of the experiment which I have
suggested with regard to the competing system of supply; and partly
because I have reason to know that at the present moment a very
extensive series of chemical investigations is proceeding under orders
of the Government, with a view to ascertain the purest possible sources
for the water-supply of the metropolis. The results of this inquiry, so
far as they have transpired, appear to me so infinitely important in
their relation to some of the questions just alluded to, that I think it
expedient under the circumstances to wait for such new light as may
accrue to our knowledge from the completion of these researches, before
I touch the chemical division of the subject.

  I have, &c. &c.




SECOND ANNUAL REPORT.


  TO THE HON. THE COMMISSIONERS OF SEWERS OF THE CITY OF LONDON.

  _November 26th, 1850._

  GENTLEMEN,

In obedience to that clause in your Act of Parliament under which my
office is constituted, and which enjoins on your Officer of Health that
he shall ‘report periodically upon the Sanitary condition of the City,’
I now submit to your Hon. Court my annual statement on this subject.


I. MORTALITY OF THE CITY OF LONDON.

During the fifty-two weeks, dated from September 30th, 1849, to
September 28th, 1850, there died of the population under your charge
2752 persons. The rate of mortality, estimated from these _data_, for a
population[30] of 125,500, would indicate somewhat less than twenty-two
deaths (21·92) out of every thousand living persons.

  [30] With the required correction for increase of population, the
  death-rate was probably about 21·25 _per_ 1000.

Last year it was my painful duty to record the ravages of pestilence,
then indeed hardly terminated, under the pressure of which our general
death-rate had arisen to the alarming height of thirty in the thousand.
On this present occasion, I have the happier task of laying before you
the evidences of a mortality lessened considerably below its habitual
average; and I rejoice in congratulating your Hon. Court on the
testimony thus borne to the success of your sanitary exertions. For
although, without question, some large share of this striking
improvement may have depended on circumstances beyond our cognizance or
control; although it may in part be but an instance of that tendency to
periodical alternations of activity and repose which we recognise in
disease, as in other operations of nature; although I should be
over-sanguine if I believed, and premature if I stated, that your
sanitary measures during the past twelve months had wrought such a
change in the City as to ensure a continuance of this year’s comparative
healthfulness; yet I may venture without hesitation to assure you, that
the labours of the Commission have been fruitful of real and
demonstrable advantage to the health of the people; that a sensible
diminution has occurred in the physical causes of disease; and that,
from various and disinterested sources, I hear grateful mention of
improvements which you have effected.

In confirmation of this assurance, I may inform your Hon. Court that, in
collecting my materials for the present statement, I solicited from the
Union-Surgeons of the whole City of London certain particulars of
information which they were peculiarly able to furnish; I inquired of
them, namely, whether, during the past year, there had prevailed among
the poorer classes in their several districts more or less than the
ordinary pressure of epidemic, endemic, and infectious disease; and
whether, in case of such difference having been observed, they could
refer it, either for better or worse, to any changes recently wrought
in the physical conditions of their respective neighbourhoods. They have
had the kindness to furnish me with the information requested of them;
and their replies testify with remarkable uniformity, both to the
abatement of disease within their several provinces of practice, and to
the considerable dependence of that improved condition of health on
sanitary works effected under your auspices.

       *       *       *       *       *

In order to form a correct estimate of the average mortality in any
district, it is indispensable that one’s records should extend over many
years. Thus only is it that fallacies can be avoided which arise from
the alternate pressure and remittance of epidemic disease. The havoc
effected by a periodical visitation of influenza, cholera, or plague,
varies, in like manner as the ordinary death-rate varies, in different
localities; and its variation contributes importantly to fix the
healthiness or unhealthiness of such localities. But obviously, if we
wish for practical purposes to calculate an annual rate of mortality,
and to decide, in respect of any district, what are the chances of life
for its population, we must distribute the peculiar mortality of the
pestilence-period over those years which intervene between visitations
of the pestilence.

Hitherto, in respect of the City of London, I have the record of only
two years; two years differing from one another in the proportion of 30
to 22, and the mean mortality deduced from that biennial period would be
26 per thousand per annum.[31] I am, of course, unable to tell you with
certainty whether that ratio be the true average death-rate of the City;
but I incline to believe that an average calculated from a longer
period, with less abrupt fluctuations, would give a lower figure as the
accurate one.

  [31] On account of corrections already adverted to, this mean
  death-rate should be reduced, probably to 25.2.

In future years, so long as I may have the honour of reporting to the
Commission, I purpose proceeding, step by step, to the construction of a
cyclical average from the materials which will constantly be increasing;
and I trust that many years may elapse before any approach shall again
be made to the high death-rate with which the cycle commenced.

It may be useful, for the sake of comparison, that I should remind your
Hon. Court of some of the more important differences which prevail
throughout the country, in regard to the local rates of mortality. The
extreme rates recorded in the Registrar-General’s last publication,
relating to the septennial period 1838-44, give 14 per thousand per
annum as the lowest average, and 33½ as the highest average, for a
population male and female in equal proportion. The low average belongs
to a district in Northumberland, numbering 27-28,000 inhabitants; the
high average is assigned to Liverpool. For the whole south-east division
of England (comprising more than a million and a half of inhabitants)
the death-rate is but 19; while in parts of the division it falls very
considerably below this average. I have thrown these and some similar
comparisons into a tabular form, which may perhaps be interesting to
you.[32]

  [32] Vide page 84.

Possibly it may occur to you that these comparisons are devoid of
practical application--that it is unreasonable to suppose we can
mitigate our London death-rate to the likeness of a selected country
mortality--that the circumstances of the two populations are essentially
and unalterably dissimilar--that the advantages of the one cannot be
given to the other--that the traditional ‘threescore years and ten’ of
human life are allotted only to rustic existence--that the right of
participating in the higher civilisation of the metropolis, or of
trading in its larger market, is not too dearly purchased by the tax of
half or a third of one’s fair expectation of life.

On general grounds I should not hesitate to combat this objection, and
should feel sure of convincing you of its invalidity. I should argue (as
indeed I have already argued here) that the main conditions which
constitute the unhealthiness of towns are definite, palpable, removable
evils; that dense over-crowding of a population--that intricate
ramification of courts and alleys, excluding light and air--that
defective drainage--that the products of organic decomposition--that
contaminated water and a stinking atmosphere, are distinct causes of
disease and death; that each admits of being definitely estimated in its
numerical proportion to the total mortality which it contributes to
cause; that each is susceptible of abatement or removal, which will at
once be followed by diminution of its alleged effects on the health of
the population. Likewise, I should argue, that if there indeed exist,
attached to a metropolitan residence, some really unavoidable and
necessary disadvantages to life (a point which however I am not prepared
to concede) there are likewise, as respects the poor, some peculiar
advantages to counterbalance those evils; that in urban communities the
operations of charitable relief are largest and least remitting; that
the resources of medicine for curing what cannot be prevented are
likewise readiest and most effective.

On all these general grounds I should be prepared to maintain that a
lowness of mortality which has been attained in any considerable rustic
population, may be attained by an urban population, if only the
removable evils be removed, if only the practicable good be made
practical.

Surely too, above all, I would maintain this possibility in respect of
our capital--the treasury as she is of all means for progress in
civilisation, the stronghold of all applicable knowledge. Let but the
wealth, the science, the energy, and the benevolence of the metropolis
deal with removable causes of death as they have dealt with subjects
infinitely more difficult, infinitely less promising, and certainly of
not greater importance; and few competent persons will doubt that the
mortality of London might speedily be reduced to the level of any
district-mortality yet recorded by the Registrar-General.

There may be those in your Hon. Court who will hesitate to accept for
themselves the firm conviction which I entertain on this subject; or
who, at least, will withhold their assent from the line of argument
which I have advanced. To them, what I have now to state may be more
conclusive than any other consideration: viz., during the year on which
I am reporting, there was one sub-district of the City of London
Union--one comprising from twelve to thirteen thousand inhabitants, in
which (after including a due proportion of deaths which had occurred in
the union-workhouse at Mile-end) the mortality stood only at 15 in the
thousand; one in which, if those extramural deaths had been excluded,
the local death-rate for the year would have been only 13·32.[33]

  [33] These figures require some correction for decrease of population
  in the sub-district referred to: the death-rate, inclusive of
  workhouse mortality, was nearly 16, and exclusive of that mortality,
  nearly 14 _per_ thousand.--J. S., 1854.

For an illustration of low and enviable death-rates, I need then no
longer appeal to Northumberland, or to our south-eastern
counties--though, no doubt, their septennial periods of low mortality
are valuable corroborations of any inference which could be drawn from
our more restricted experience;--but I may point to the last year’s
death-rate in the north-west sub-district of the City of London Union as
one of rare excellence, and may content myself with wishing that that
partial rate might become universal for the City, and might be the
permanent expression of its average mortality.

A detailed consideration of our sickness and mortality during the last
year suggests to me a few other remarks, which may, I think, be of
practical utility to your Hon. Court.

First, as regards the ages at which death occurs; the respective
proportions of _timely_ and _untimely_ deaths may, generally speaking,
be inferred from the local death-rates. In general terms, we know a high
death-rate indicates that many die before their time--indicates that a
proportion of the population, more or less considerable, instead of
reaching old age, becomes prematurely blighted and extinguished. In
order to illustrate this subject to you more exactly, I append a table
in which the deaths of the last two years are classified according to
the ages at which they occurred. Of 3763 persons whose deaths are
recorded in my last Report, 1243 died under the age of five years: of
2752 deaths registered in the present year, 1032 belong to the same
early period of life.

The City of London appears peculiarly fatal to infant life. Reference to
the Registrar-General’s last septennial record shows that of every 1000
male children under five years of age within the City of London
(aggregately) nearly 113 die in each year; and the portion of this rate
which is deduced from the East and West London Unions is as high as 119
in the thousand. In the subjoined table,[34] which illustrates some
points of comparative mortality, I have endeavoured to show the extreme
and disproportionate amount of this pressure on infant life. In
referring (for instance, in regard of the City of London Union) to the
last three columns of that table, you will observe that the mortality of
children at the age stated, during the septennial period, was 1/2·66 of
the entire mortality, although their class numerically constituted only
1/11·09 of the entire population; so that they died at more than four
times (4·17) the rate which would have fallen to them as simple
participators in the average mortality of their district. The actual
infant mortality of the past year holds the same proportion to the
general mortality as in the Registrar-General’s septennial period, being
1/2·66 of the whole.

  [34]

  +--------------+---------+--------+----------+----------+-----------+
  |   Places.    | General | Death- | Out of   |  Out of  |  By what  |
  |              |  death- |  rate  |  entire  |  entire  |  multiple |
  |              |   rate  |  _per_ | living   | mortality|   is the  |
  |              |   _per_ |thousand|population|   what   | mortality |
  |              | thousand|  _per  |   what   |proportion|of children|
  |              |   _per  | annum_ |proportion|  occurs  | under five|
  |              | annum_. |of male | is under |   under  | years in  |
  |              |         |children|five years|five years| excess of |
  |              |         |  under |  of age? |  of age? |the average|
  |              |         |  five  |          |          | mortality |
  |              |         |  years |          |          |   of all  |
  |              |         | of age.|          |          |    ages?  |
  +--------------+---------+--------+----------+----------+-----------+
  |City of London|         |        |          |          |           |
  |Union         |    21   |   101  |  1/11·09 |  1/2·66  |    4·17   |
  |E. and W. Lon-|         |        |          |          |           |
  |don Union     |    26¾  |   101  |   1/9·02 |  1/2·24  |    4·02   |
  |Metropolis    |    25   |    93  |   1/8·45 |  1/2·45  |    3·45   |
  |Holborn       |    26   |   115  |   1/8·98 |  1/2·20  |    4·08   |
  |St. Giles     |    27   |   122  |   1/9·85 |  1/2·24  |    4·39   |
  |St. Martin    |    24   |   120  |  1/10·64 |  1/2·42  |    4·39   |
  |Bristol       |    29   |   107  |   1/8·73 |  1/2·53  |    3·45   |
  |Liverpool     |    33   |   143  |   1/7·35 |  1/1·91  |    3·85   |
  |Lancashire    |    26¾  |   102  |   1/7·19 |  1/2·02  |    3·56   |
  |Surrey        |    18   |    48  |   1/7·98 |  1/3·22  |    2·48   |
  |South-east    |         |        |          |          |           |
  |divn. of      |         |        |          |          |           |
  |England       |    19   |    52  |   1/7·76 |  1/3·03  |    2·56   |
  |Glendale    } |         |        |          |          |           |
  |Bellingham  } |    14   |    28  |  1/10·32 |  1/3·99  |    2·58   |
  |Haltwhistle } |         |        |          |          |           |
  +--------------+---------+--------+----------+----------+-----------+

Lest any undue importance should be ascribed to the influence of bad or
inappropriate articles of diet in producing this large infant mortality,
I may inform you that the rate of death is highest during that very
early period of life when the child depends for nourishment on its
mother; so that, of a thousand male children in the first year of life
there die within the district of the City of London Union 242; within
that of the East and West London Unions, 276.

The causes which thus decimate the young population of London are the
common conditions of district unhealthiness--the conditions which it
lies within the scope of sanitary legislation to amend. But, inasmuch as
the few days of these wretched children are passed mainly within doors,
so their high mortality constitutes the readiest and least fallacious
evidence of the unwholesomeness of the dwellings in which they die: and
hence I am acquainted with no correcter material for estimating the
sanitary condition of a district than is afforded by the death-rate of
its infant population.

Secondly, with regard to the alleged _particular causes of death_; I
have extracted from our general registry, and have grouped in a separate
table, those cases of death from acute disease which seem peculiarly due
to physical causes affecting large numbers of persons.

There are deaths by cholera, epidemic diarrhœa, and dysentery, of which
during the biennial period we have had nearly 900; by fever, of which we
have had 284; by erysipelas and puerperal fever, of which we have had
84; by small-pox, of which we have had 50; and cases of this sort
partake of the nature of deaths by violence, not only because they are
abrupt and untimely, but because they are _avoidable_. If in the
instances which I have specified it were possible to make inquiry into
the antecedent circumstances of the dead, you would find irrefragable
evidence that life was lost in each individual instance by the operation
of removable causes--by the foolhardy neglect of some familiar
precaution, or by the obstinate retention of some notorious ill. The
death of a child by small-pox would in most instances call for a verdict
of ‘homicide by omission’ against the parent who had neglected daily
opportunities of giving it immunity from that disease by the simple
process of vaccination; the death of an adult by typhus would commonly
justify still stronger condemnation (though with more difficulty of
fixing and proportioning the particular responsibility) against those
who ignore the duties of property, and who knowingly let, for the
occupation of the poor, dwellings unfit even for brute tenants,
dwellings absolutely incompatible with health. In addition to the
diseases which I have named, there are others which owe their chief
malignity and numerical largeness of fatality, though not their
existence, to local and removable causes. The proportionate mortality
from scarlatina, measles, and hooping-cough, is greatest when the
general death-rate is greatest. Under similar circumstances, too, we
find among the infant population a frequency and fatality of other
diseases, not commonly accounted specific, which warrant us in
considering them to be mainly of endemic and avoidable origin. Such are
the hydrocephalus and convulsions, the diarrhœa, bronchitis, and
pneumonia of infants; often indeed referred to the irritation of
teething, but prevailing in different localities with so marked a
proportion to the causes of other endemic disease that we may be sure of
their partial and considerable dependence on those local and obviable
causes. I dwell on this aspect of the subject, and particularly invite
the attention of your Hon. Court to the table[35] which illustrates it,
because it is in respect of these diseases that your exertions have
already effected valuable improvements for the health of the City, and
because the future registry of such cases will attest year by year the
further progress of your sanitary reforms. In examining this index of
preventable deaths you will notice that those from fever are fewer by 29
_per cent._ in the year just terminated than in the previous twelve
months; that those from scarlatina are 75 _per cent._ fewer; those from
infantile zymotic disorders nearly 40 _per cent._ fewer; those from
erysipelas and puerperal fever 9 _per cent._ fewer. Small-pox, it is
true, is doubled; but the prevention of this disease rests, out of your
jurisdiction, in the exercise of individual discretion. Under the item
of infantile diarrhœa (included in the tenth column) there is likewise
an increase of nearly a third;[36] an exception probably dependent on
the fact that, during last year, many deaths which might have swelled
this column were (on account of the then prevalent influence) catalogued
under the head of epidemic diarrhœa or cholera.

  [35] _Appendix_, No. IX.

  [36] In the column referred to, this is concealed by the marked
  diminution, during the present year, of other disorders classed with
  infantile diarrhœa. Their reduction maintains the total of that column
  (notwithstanding the difference of diarrhœa) considerably less for
  this year than for last.

I should be misleading your Hon. Court, and practising a deception which
next year’s registry would expose, if I pretended that the striking
difference between the two years’ several totals of preventable deaths
(a difference which, leaving cholera out of the question, probably
amounts to a diminution of 30 _per cent._ on the sum of last year) had
resulted wholly, or even chiefly, from sanitary improvement, and could
be interpreted as the evidence of permanent physical changes around the
dwellings of our poorer population. I guard you against this impression
now, because, however satisfactory it might be as a momentary belief, it
would lead to subsequent disappointment; and any future rise in the
proportion of these deaths would induce the erroneous, but
disheartening, supposition that your later sanitary steps had been less
successful than the first. In all these matters, and especially in
analysing the details of a death-registry, it is requisite (as I have
already stated) to deal with cycles of many years. Periods of
pestilence are habitually followed by periods of diminished mortality:
partly because population is diminished, and especially that share of
the population which suffers most from obviable causes of disease;
partly because the great alarm of death has induced vigilance and
precaution, public and private, against the occasions and beginnings of
illness. And, beyond both these circumstances, there are others which we
cannot analyse or explain, though we have scientific certainty of their
operation; circumstances which seem to ensure a comparative quiescence
of the ordinary causes of zymotic disease during those periods which
next succeed the prevalence of certain fatal epidemics.[37]

  [37] For the professional reader I may here throw out a
  hint--referring to the doctrine of epidemic disease stated in the
  Fifth Annual Report, that this apparent healthiness of districts after
  certain epidemic invasions probably bears relation to a temporary
  exhaustion of their zymotic atmosphere under the action of a specific
  ferment, and is in some respects analogous to that immunity from an
  infected fever which belongs to an individual who has recently
  suffered its attack. See also page 235.--J. S., 1854.

Nevertheless, that the sanitary condition of the City has undergone
considerable improvement within the last two years is a fact which no
one can gainsay; and that a considerable share of the mitigation in
mortality arises from this improvement cannot reasonably be questioned.
If even a third of the mitigation in question, if a reduction of ten
_per cent._ on the preventable mortality of the City, may be inferred
from the materials which I lay before you, it is indeed matter for the
utmost congratulation; and a continuance of the same reduction year by
year, perpetuated (as doubtlessly it may be) by a continuance of the
same exertions, would soon raise the City of London above all fear of
comparison, on the ground of healthiness, with urban or suburban
populations.

Thirdly, I would beg the attention of your Hon. Court to those very
important _local differences_ of death-rate which may be deduced from a
study of our death-register. I have already had the pleasure of citing
to you the low rate of mortality which has prevailed during the last
year in the north-west sub-district of the City of London Union. The
rate of death in the north division of the West London Union was nearly
double that proportion; and between these extreme terms of disparity
there were many intermediate degrees.

Similar inequalities of mortality were observable in last year’s record.
In the healthiest sub-district of the City the year’s death-rate was
about 22 in the thousand; while in the worst it stood above 41; and for
the whole West London Union exceeded 38.[38]

  [38] I have here availed myself of the corrections given in the note
  of page 6.

Mainly and essentially these local differences of mortality depend on
the proportion in which _preventable deaths_ enter into the total; the
differences, however partial, depending on the operation within certain
districts, of removable deleterious influences which do not exist in
certain other districts.

In classifying for your consideration the deaths which, during the last
two years, have depended on epidemic, endemic, and infectious diseases,
I have thought it desirable to distribute them according to the
municipal divisions of the City. Strongly believing, as I have
endeavoured to express, that this class of deaths is for the main part
preventable, I have thought it would interest the representatives of the
several Wards, and would more directly enlist their sympathies for
sanitary progress, if I could enable them at a glance to recognise the
ratio in which their respective constituencies contribute to this annual
death-roll. I have included in the table, under eight different heads,
all those acute diseases which depend in an important degree on local
causation, either for their existence or for their fatality. It will be
obvious, even to the unprofessional reader, that local causes are not of
equal prevalence in respect of all the diseases there tabulated. Some
(as fever and cholera) would not be known at all under perfect sanitary
arrangements; others (as scarlatina, measles, and hooping-cough) would
be far less malignant in their attacks; others (as those classified in
the tenth and twelfth columns) would no doubt exist under the most
perfect physical circumstances, but would probably prevail in numbers
quite inconsiderable as compared with those actually observed.

On consulting this table[39], it will be observed that in _Cordwainers_’
Ward, during the last year, not a single death occurred from the causes
referred to, and in the preceding year of epidemic visitation, only
five; that in _Cornhill_ Ward there have been only two such deaths in
each of these years; that in _Coleman-street_ they have been 66; in
_Queenhithe_, 59; in _Portsoken_, 143; in _Aldersgate Within_, 30; in
_Aldersgate Without_, 179; in _Cripplegate Within_, 80; in _Cripplegate
Without_, 299; in _Bishopsgate Within_, 60; in _Bishopsgate Without_,
329; in _Farringdon Within_, 153; in _Farringdon Without_, 845.

  [39] Page 167.

I am unable to state with accuracy, in these several instances, what
proportion subsists between the preventable mortality and the number of
living persons, for I have no means of ascertaining precisely the
population of the separate Wards; and without this knowledge it is
impossible to arrange them in a scale of comparative healthiness. I need
hardly remind your Hon. Court that the Wards differ very considerably in
their magnitude; so that the largest majority of cases occurring in one
Ward (as in Farringdon Without) must not unconditionally be taken to
imply that the Ward, _in proportion to its population_, suffers more
deaths than one in which the apparent number is less considerable. In
the table to which these remarks refer, I have endeavoured to give you
the means of comparing (at least approximatively) the healthiness of
your several departments, by entering against the name of each Ward the
number of holdings for which it stands assessed to your rate. This
entry, with some trifling modifications specified in the table, may be
taken to express the number of houses contained in each Ward of the
City: thus it furnishes indirectly the means for estimating the local
population.

It will be noticed, that the more glaring inequalities which I have
adduced are in some degree due to the epidemic of last year, which did
not press uniformly on all parts of the City. It may, however, likewise
be observed, that the chief operation of that epidemic was to
exaggerate, but not importantly to misrepresent, the features of each
locality; that the habitual sanitary proportions of districts to each
other were for the most part preserved; that (with a qualification to
which I shall presently revert) the Wards numbering fewest deaths last
year numbered also fewest this year.

In my last Report, when the cholera had scarcely subsided, when men’s
minds were full of apprehension on the subject, and when it seemed only
too possible that, with the recurrence of autumn, we might again suffer
from its invasion, I was unwilling to dwell too pointedly on the
wonderful pertinacity with which that disease fixes itself on particular
localities, and tends to re-appear in them on each new occasion of its
rise. Believing that no extemporaneous measures could counteract these
local preferences of the epidemic, I refrained from a course which would
have produced no good result (unless indeed it had depopulated certain
spots of the City), and which might have caused unavailing and hurtful
alarm. Now, however, I think it right to tell you that the local
predilections of this dreadful disease are so marked and so obstinate,
that we may almost certainly predict in what parts of the metropolis it
would tend to arise on any renewed visitation. We may anticipate that at
any such time its latent power of destruction will kindle again in the
districts, the streets, the houses, perhaps even in the very rooms,
where it recently prevailed, _unless the determining local conditions
shall previously have been annulled_.

It would be ridiculous if I should pretend to carry you into any medical
consideration of this subject, or should make my present Report the
vehicle of a professional argument; but I may very briefly acquaint you
with such generalisations as will justify you in pursuing a particular
course with respect to the haunts of cholera. While doing so, I hope
your Hon. Court will believe that I have devoted to this very serious
subject the best consideration of which I am capable, and have done my
utmost to arrive at conclusions which may be fruitful of practical good.

Cholera visited no localities of which it could be said, that they were
generally healthy; but still there seemed to be something peculiar and
specific in the kind of local unhealthiness which determined its
invasion. On the one hand, it is unquestionably true that many habitual
seats of fever were visited by cholera; on the other hand, many of the
worst fever-nests in the whole metropolis were unaffected by it; and it
struck with extreme severity in a class of houses habitually exempt from
fever. See, for instance, how malignantly it prevailed along the line of
Farringdon and New Bridge streets, and in Fleet-street and Ludgate hill,
where their line intersects that just mentioned; and here, you will
observe, not only in those obscure and ill-ventilated courts and
by-ways, where fever is the familiar visitant of a hungry and crowded
population; but also, and very strikingly, in spacious and airy houses,
situate along the main thoroughfare of the City, and inhabited by
opulent tradesmen, by members of the various professions, or by officers
of assurance-companies. Other infective diseases which habitually
desolate the former class of dwellings are almost unknown in the latter.
Cholera came as a startling exception. _Within the infected district_
(fulfilling the classical description of pale death) it trod with equal
foot the gates of rich and poor.[40]

  [40]

    ---- Æquo pulsat pede pauperum tabernas Regumque turres.

  I think it very important that this fact should be fully recognised.
  In London it has often been overlooked, from the accident that our
  most infectable districts happen to contain an excess of poor
  population. But even here it is quite easy to note that the disease
  spreads irrespectively of pauperism or privation; and in other cities,
  (Paris and Copenhagen, for instance) where the quarters of rich and
  poor are less apart than in London, cholera has killed its full share
  of dignitaries and capitalists.--J. S., 1854.

Personal peculiarities, or vicious habits, or temporary indiscretion,
may often have determined its choice of a victim; low nourishment--even
temporary emptiness and exhaustion, very manifestly invited its attack;
but, speaking generally, I may say that it was a disease prevailing over
a certain patch of ground, and (within this limit) tending to strike
equally, or nearly equally, in all classes of habitations. Crowdedness
of dwellings, defective ventilation, squalor of inhabitants, and many
forms of local nuisance, which are omnipotent in giving occasion to
fever, and in adding malignity to many disorders of its class, did not
by themselves exert so marked and specific a power in determining the
onset of cholera.

What then were the conditions determining its local preference?
Consideration of its statistics, or inspection of a cholera-map, enables
one, with some confidence, to answer--a peculiar condition of soil, of
which dampness is one sure and invariable character, and organic
decomposition (promoted by dampness) probably another.[41] Its local
affinities have much analogy to those of ague, and often appear
identical in their range with the sphere of malarious infection. Our
entire metropolis, built down to the very margins of a large river--of a
river, too, which, at each retreating tide, exposes acres of mud
saturated with the reeking sewage of an immense population, is placed
generally in circumstances not unfavourable to the development of the
disease; and its several parts will be liable to suffer especially, in
proportion as they are exposed to these general circumstances, or to
special circumstances of their own of a like nature. The lower level of
districts on the south side of the river, their attendant failure of
natural land-drainage, the consequent soddenness of a soil from which
likewise the materials of house refuse were never efficiently removed,
accounted sufficiently for the frightful epidemic mortality which
prevailed in those quarters of the metropolis.

  [41] After three years’ further inquiry I find no reason to modify
  this general description: but, as regards the local circumstances
  which determine the specified condition of soil and atmosphere, I have
  been able to extend my information; and the subject is therefore
  better treated in my Fifth Annual Report than in the paragraphs here
  following above.--J. S., 1854.

If you now look to the disease as it raged within your own jurisdiction,
you will observe its fatality in two especial directions. First, in the
line I have indicated to you, northward from Blackfriars Bridge, in a
band of two or three hundred yards width; _there_, in the parallelogram
which lies along the main road, from Stonecutter-street to Bridewell
Hospital, were 76 deaths; _there_, in the little clump of houses forming
the angle of Farringdon-street and Holborn-hill, were 17 deaths;
_there_, in a square space behind twenty-seven shop fronts in
Fleet-street, were 57 deaths; _there_, in the small parish of St. Ann’s,
Blackfriars, were deaths at the rate of 25 to every thousand of its
population. This was incomparably the most afflicted portion of your
territory. Those who are acquainted with the ancient geography of the
City will readily conjecture a reason; they will remember when ‘the
course of water running at London under Old-bourne bridge and Fleet
bridge, into the Thames, was of such bredth and depth that ten or twelve
ships, navies at once with merchandises, were wont to come to the
foresaid bridge of Fleet, and some of them unto Old-bourne bridge;’ they
will remember how this broad river (like the Thames of our day) was
thronged on both sides with population; how (again like the Thames) it
was a draining river, probably with wide banks of putrefying mud; how
many fruitless attempts were made to cleanse and preserve its channel;
but how (in Stow’s day) ‘the brooke, by meanes of continuall
incrochments upon the banks, and casting of soylage into the stream, was
become worse cloyed than ever it was before.’ Where that _soylage_ was
cast, and where, since the days referred to, so many habitations have
arisen that no sign of stream remains visible to the wayfarer above
ground, its traces still remain below. Throughout at least a large
portion of this district, the sub-soil (your Surveyor informs me)
consists of black mud, the bed of the ancient river, in which are set
the foundations of the modern houses. The river, which centuries ago
fulfilled for a large population those vile uses which now pollute the
Thames, has gradually yielded its foul banks to the residence of a
growing population; and the sanitary relations of that population are
exactly such as might be imitated, if the volume of the Thames were
henceforth slowly reduced, and if those banks of mud which are now
exposed only at low water, were simultaneously converted into the site
of permanent habitations.

The history of the stream at Walbrook is, I believe, not dissimilar; but
there is this marked difference between the two cases, that the
comparative declivity of the latter district has allowed its soil to
acquire a dryness and healthiness which have never been reached on the
banks of the Fleet. For, owing to the extreme lowness of level in this
district, the tidal influence of the Thames is very inconveniently felt;
the cellars of houses are habitually exposed to dampness, even to
flooding; and probably the whole porous sub-soil, at least as far north
as your jurisdiction extends, is maintained in a sodden and malarious
state.

With respect to the second part of the City in which considerable groups
of cholera cases were observed, it has a not dissimilar peculiarity. I
refer to that northern part of the City which extends (on the other side
of London Wall) from Bishopsgate to Aldersgate. The epidemic prevailed
there with far less severity than in the Fleet district, but still with
a preference which easily shows itself in a cholera-map. At the
intersection of Whitecross-street by Beech-lane, in a space that the
point of one’s finger would hide in Wyld’s large map, there were 12
deaths: in that small portion of the City which lies north of Barbican
and Beech-street there were 40 deaths: in the immediate vicinity of
Half-moon-street, Bishopsgate, 60 deaths, of which more than half were
in the workhouse. Now, certainly, in all this space (and probably still
further in both directions, east and west) without the former gates of
the City, there is a marked local character. It is a reclaimed
marsh.[42] Throughout this district, in the olden times of the City,
there lay (says Stow) ‘a moorish rotten ground, unpassable but for
cawswaies purposely made to that intent;’ and one reads how ‘divers
dikes were cast, and made to drein the waters of the said Moorefields,
with bridges arched over them, whereby the said field was made somewhat
more commodious, but yet it stood full of noisome waters;’ till
gradually ‘by divers sluces was this fenne or moore made maine and hard
ground, which before, being overgrowne with flagges, sedges, and rushes,
served to no use;’ while ‘the farther grounds beyond Finsbury Court were
so over-heightened with laystalls of dung, that divers windmills were
thereon set, the ditches were filled up, and the bridges overwhelmed.’

  [42] I have reason to believe that this statement, though founded on
  the authority of Stow, is erroneous, for so much of the district as
  lies west of Moorgate-street; and that the main cause of this locality
  suffering so severely from cholera must have lain in those very
  extensive defects of house-drainage, which more recently I have become
  better able to appreciate. With the kind assistance of Mr. Haywood, I
  have been enabled to look over the memoranda which are kept in his
  office, of deep cuttings of soil made in the construction of sewers by
  himself and his predecessor, Mr. Kelsey. These sections do not by any
  means tally with Stow’s description of the Moor, as extending in part
  ‘from without the postern called Cripplegate, even to the river of
  Wels;’ for here at least there is no trace of any such condition of
  soil.--J. S., 1854.

It is not as matter of literary curiosity that I quote these passages of
your old historian, but simply that I may avail myself of his accurate
local knowledge for the explanation and the cure of a serious existing
evil. For if, as I believe, the unfortunate preference for certain
localities evinced by the recent epidemic be, _primâ facie_, a reason
for doubting the effectiveness of their sub-soil drainage, and if the
ancient records of the City assure one that these very localities are
such as, from conditions then in active operation, would be liable to
retain, perhaps for an indefinite period, the materials of malarious
poison, useful and practical deductions may be drawn. And as the
liability to this severe recurrent epidemic is an extreme detriment to
the population of such localities--one too, which, if unremoved, must
inevitably lead to the deterioration of property, as well as to the
sacrifice of life, I know that your Hon. Court will be solicitous to
adopt whatever remedial measures are possible.

To those measures I shall presently return, having here dealt with the
question only as it relates to the distribution of our mortality, and
explains the preponderance of a large class of deaths in some special
districts of the City.

       *       *       *       *       *

In the Tables which accompany this portion of my Report, I have arranged
in a synoptical form, convenient for reference, the chief facts of our
sanitary statistics to which I have invited your attention.

In the first[43] you will read a summary of the deaths as they have
occurred, male and female, in the several districts and sub-districts of
the City, during each quarter of the past year.

  [43] _Appendix_, No. IV.

In the second[44] table the deaths of the year are classified according
to the ages at which they befell.

  [44] Now incorporated in the general table, _Appendix_, No. VIII.

In the third table,[45] for the sake of comparison in respect both of
general and of infant mortality, I have arranged the statistics of
certain other localities side by side with our own.

  [45] Now inserted at page 84.

In the fourth[46] (to which I have already especially referred) is
contained an enumeration, according to the several Wards of the City, of
those deaths, during the last two years, which have arisen in
consequence of acute disease partially or entirely preventable.

  [46] Page 167.

In tables of this nature perfection is at present impossible; partly
because of trifling changes in the population which often occur, but
rarely can be estimated; partly because of the slovenly manner in which
deaths are occasionally recorded. While, therefore, I would not consider
myself responsible for their absolute and infinitesimal accuracy
(consisting as they do of so many and so various details) I may assure
your Hon. Court that all proper pains have been taken to render them for
every useful purpose correct and trustworthy: and that I believe them,
in all essential particulars, truthfully to represent whatsoever I have
sought to embody in them.

The annual ratio of deaths within your district; the local differences
of that ratio; the proportion of infantile mortality; the amount of
preventable disease; and, in all these respects, a comparison of parts
of the City with each other, and of the whole City with other inhabited
districts,--these are the materials on which your judgment must be
formed as to the necessity of sanitary measures, whether for the entire
City, or for its component parts: and as a main object of the
appointment which I have the honour to hold is that I should furnish you
with materials for forming that judgment, so I may probably stand
excused for troubling you with these considerations at such great
length.


II. THE CAUSES AND THE PREVENTION OF ENDEMIC DISEASE.

According to the method adopted in my last Annual Report, I now proceed
to offer you such observations as another year’s experience may justify,
on those physical influences which prevail against life within the City
of London, and on such remedial measures as seem aptest to remove them.


_Sub-soil Drainage, House-Drainage, and Sewerage._

1. In respect of drainage, I have already adverted to those unwholesome
conditions which prevail along the low-lying valley of the ancient
Fleet, and have mentioned to you that frequent incursions of the river
aggravate whatever mischief is inherent in the soil, by maintaining it
as a perpetual swamp, and by favoring in it a constant succession of
putrefactive changes. I have likewise illustrated to you the probability
that, in some of the higher portions of the City, chiefly in the
Out-Wards of Cripplegate and Bishopsgate, there still survive some
properties of that old malarious fen, from which these districts were
originally reclaimed. Stow seems in his day to have had misgivings on
this subject; for after describing the improvements that had been
effected there, and the gradual levelling and heightening of the ground,
he adds, ‘it seemeth to me that if it be made level with the battlements
of the city wall, yet will it be little the dryer, such was then the
moorish nature of that ground.’

From a consideration of this former geography of the place, and from
observation of the diseases which prevail there, I am led to think it
highly probable, that some of its sanitary defects depend less on
defective house-drainage than on a still marshy undrained condition of
the ground itself, and that these defects would be removed by an
efficient application of sub-soil drainage.

I would therefore respectfully recommend to you, under this head, that
the state of soil in the specified districts be referred to competent
authorities, and that such measures be adopted as inquiry may prove
requisite, for relieving those parts where the sub-soil drainage is
imperfect, and for protecting the house-foundations, and sewers, and
sub-soil adjacent to the river, from being soaked or flooded by the
tide.

       *       *       *       *       *

2. With respect to house-drainage, I have no addition to offer to those
remarks which I submitted to you in my last Report. Your Hon. Court has
fully recognised that immense peril to life which is connected with the
presence of cesspools beneath houses, and which depends on their
poisonous emanations. At the commencement of the present year, your
Surveyor stated that he might take ‘5414, as a fair approximation of the
number of cesspools’ then in existence within the square mile of the
City of London. This proportion, dangerously large as without doubt it
is, presented an important diminution from the number which existed a
year previously, when your Commission first obtained from the
Legislature authority to enforce their closure; and it may reasonably be
anticipated that at the termination of this present year, a still
further abatement will be recorded in the magnitude of that destructive
nuisance.

       *       *       *       *       *

3. Notwithstanding the variety of stink-traps to which you have given
trial, and notwithstanding the fact (recorded by your Committee of
Health on the Surveyor’s authority) that ‘there does not exist within
your jurisdiction a single gully which is untrapped,’ there continue to
be frequent complaints of offensive exhalations from the sewers.

The mechanical difficulties in this matter of trapping have appeared to
be, from the nature of the case, almost insuperable. It may, indeed,
easily be conceived, how incompatible are the common uses of a
gully-hole with such fineness of adjustment and delicacy of balance as
would render the apparatus air-tight from within, and effectually
preclude an escape of the gaseous contents of a sewer. Under such
circumstances, your Hon. Court has desired that I should express my
opinion, how far a different course might be adopted in respect of these
exhalations; how far, namely, they might be neutralised within the
sewers; how far it might be chemically feasible, and in a sanitary point
of view expedient, that a systematic use should be made of deodorising
agents; so that any gas escaping from the sewers should at least be
divested of its original smell.

On this subject, I would submit to you the following considerations. As
respects its feasibility (putting aside as foreign to my province all
questions of the expense, and all details of the daily arrangement) a
first and obvious objection is this: Granted in the abstract, that
sewer-gases can be converted by appropriate agents into inodorous
compounds; in the practical application of these agents, you would find
impediments with which you are already familiar. Theoretically, there
may be no difficulty in providing air-tight traps; practically there is
said to be every difficulty. Just as that mechanical problem has
defeated you in practice, so would the chemical one; and for the same
reason. The fulfilment of either problem is a matter of nice adjustment.
In proportion as your gully-hole is exquisitely trapped, it becomes
liable to obstruction; it loses its use as an inlet to the sewer, nearly
in the same measure as it becomes an effective obstacle to regurgitant
gases. Similarly, in proportion as these alleged deodorisers might
succeed in completely stifling the characteristic odour of sewage, they
would be liable to diffuse perfumes peculiarly their own, and to
establish, in the vicinity of gully-holes, the alternation of a new
nuisance with the old. To proportion with accuracy the introduction of
these chlorinous preparations to the amount of refuse traversing the
sewers--an amount varying most considerably at different hours of the
day, seems to me quite a visionary hope. Failing such accurate
proportions, I am not prepared to say that the result would be useful;
and I accordingly consider the scheme as not chemically feasible.

Further--as involving an important sanitary principle, I would say, that
the great object which must be aimed at is not the mere chemical
neutralisation of certain stinks which arise within your jurisdiction,
but the closest possible limitation, and the promptest possible removal
of all those materials which are decomposed into fœtid products.
Admirable, no doubt, is that arrangement by which Nature, stationing a
sense of smell at the inlet of our breath, cautions us by this vigilant
sentinel against the inhalation of many poisonous airs; but, in respect
of organic decomposition, I am in no degree satisfied that its odorous
products are its only, if even its principal, agents of injury; nor have
I any reason to suppose that the real detriment to health which arises
from breathing the miasms of sewers or marshes, of cesspools,
burial-grounds, or slaughter-houses, would in any important degree be
lessened by the mere mitigation of fœtor in their effluvia. Offensive as
these are, they at least answer the useful purpose of warning us against
the other poisons with which they are associated.

Let me likewise take the opportunity of correcting a misapprehension,
which, by the use of an inappropriate word, is sometimes shown to exist
on this subject. The agents in question are spoken of as
_dis-infectant_. As there is no scientific reason whatever for believing
that they in any degree interfere with the spread of epidemic or
infectious disease, and as an erroneous opinion on this point may lead
to the neglect of measures which are truly precautionary and useful, I
think it well to state explicitly, for your information, that I have no
evidence of their possessing any other utility, in the respects under
consideration, than simply and singly that of removing stink from the
atmosphere around them.

For reducing to a _minimum_ the exhalations which arise from sewers and
house-drains, it appears to me that the following are the essential
principles: First, to render the current through them as rapid as
possible; and, above all, by every care for their form, their junctions,
their slope, and their material, to provide against the occurrence of
obstructions and deposit: Secondly, to employ in their construction, so
far as may be possible, such substances as are porous in the least
procurable degree; such as consequently will be least apt to imbibe and
retain in their interstices any considerable impregnation from the fœtid
fluids running over them at intervals; such, too, as will be least
likely to permit soakage into the surrounding soil: Thirdly, by reducing
the size of drains and sewers to the lowest dimensions compatible with a
full performance of their uses, to diminish to the utmost the extent of
their interior evaporating surface, and of those large chambers which
they now offer for the evolution, retention, and diffusion of gases.

To the application of these principles (together with a sufficient and
appropriate distribution of water) far more than to chemical agents, or
to the invention of mechanical traps, I believe that you must look for
rendering inodorous the vicinity of your numerous gully-holes. I content
myself with stating them to you, as a practical deduction from physical
laws, without venturing to offer any opinion on the degree in which they
are applicable within your jurisdiction, or on the manner in which they
should be applied. For although, as principles, they have their
foundation in physics, and although their importance to sanitary
improvement is beyond measure great, all details relating to their
application lie out of my province, and belong to a class of subjects in
which your Surveyor’s opinion will, of course, be infinitely more useful
to you than mine.


_Water-Supply._

During the past year, as in the preceding one, I have given frequent
consideration to the subject of water-supply within the City.

I have already endeavoured to convey to you the deep sense which I
entertain of its importance, and I have every reason to believe that
your Hon. Court recognises, at its full weight, the necessity of
providing for the City of London a supply of water which in quantity
shall be ample, in quality pure, in distribution constant and
accessible.

In my former Annual Report, and in some remarks subsequently addressed
to your Committee of Health, I dwelt especially on such defects of our
present system as relate to the quantity and distribution of water;
endeavouring to illustrate the insufficiency of its supply to the poorer
tenements of the City, and the extreme inconvenience which is entailed
on their inmates, sometimes by dependence on a common tap, sometimes by
the troublesome, expensive, and unwholesome necessity of storing water.

In reverting to this subject, I may correct a fallacy which is apt to
prevail with respect to the abundance of supply. I have no reason
whatever to doubt that a very liberal allowance of water is daily pumped
into the City--enough, or more than enough, so far as I know, to fulfil
all necessary purposes.

But those purposes are not fulfilled by it. A certain large figure is
stated as representing the average quantity daily driven through the
mains of the City; this quantity is divided by the number of residents
within your area, and the inference is drawn that each individual inmate
of the City has at his disposal 25 gallons a day; or (after deduction
for public purposes and the like) 21¼ for his domestic supply. As an
arithmetical conclusion from the premises this may be true: nothing can
be less accurate as a practical representation of the facts. An average
amount of three million gallons _per diem_ may, or may not, be pumped
through the mains of the City: but to calculate the _available
water-supply_ from this dividend, without previous deduction for the
immense escape of _un-available water_ by waste-pipes or otherwise,
gives a most fictitious result. The large waste which naturally arises
in the system of intermittent supply has been well illustrated by some
evidence given by Mr. Lovick before the late Metropolitan Commission of
Sewers, in respect of a particular block of nearly 1200 houses.[47] Some
of the houses were of the higher, and many of the poorer class, but the
average might be stated to be of the middle class, and to present a fair
example of an urban population. The drainage of all these houses was
discharged through one main sewer. The run of water through this sewer
was carefully watched and gauged every hour, during the night as well as
the day, on days when the water was on, that is to say, when the
intermittent supplies were delivered, and also on the ordinary days,
when the consumption of the houses was from butts and cisterns, into
which the intermittent supplies were delivered. The gaugings of the
discharge of waste water into the sewer were checked by gaugings of the
consumption of water from the butts and cisterns, during the interval of
the delivery of the supply by the company. It was ascertained that the
average quantity discharged _per diem_ through the sewers was 44½
gallons per house; but it appeared that, on the days when the
intermittent supplies of water were on, the quantity discharged _per
diem_ was 209 gallons _per_ house. The waste in this district from
defects in house apparatus of distribution, incident to an intermittent
supply of water, was, on the water days, three and three quarter times
greater than the consumption on those days.

  [47] General Board of Health Report on Supply of Water to the
  Metropolis, page 120.

No similar gaugings have, I believe, been made within the City; so I am
unable to tell you with accuracy what are the proportions of waste and
consumption. In an interview with your Committee on Health, when they
were collecting information on the subject, Mr. Mylne, the engineer of
the New River Company, stated (as a reason against fulfilling some
object desired by the Committee) that within the City of London, in
connexion with its distributing apparatus, there existed for the escape
and waste of water, during the period of supply, ‘at least 10,000 open
cocks.’

Assuming the accuracy of this statement, I doubt whether the average
available supply of water for domestic purposes within the City can
possibly exceed a quarter of its alleged quantity; and I am persuaded
that there must be large numbers of persons to whom the enjoyment even
of that reduced average is utterly unknown. Your Hon. Court, observing
the incalculable waste, and knowing that the cost of water-supply (as of
all other commodities) must of necessity vary according to the quantity
supplied, can appreciate the consequences of so much fruitless
expenditure.

I would beg likewise to observe to you that this unapplied flood of
water is in itself not unobjectionable. It would be of questionable
advantage if the drainage of the City were so perfect as to carry all
away without inundation of the soil; while under opposite circumstances,
in every quarter where drainage is absent or faulty, evil must arise
from the extensive and habitual infiltration of moisture.

On the extreme inconvenience which attends the storage of water in the
poorer habitations of the City, I have already reported to you, and will
now only add that increased experience has given much confirmation to my
view. Their receptacles are generally such as contribute to the
contamination of water, and are constantly so arranged as to invite an
admixture of the most varied impurities.

In the large proportion of them, which are open casks, one sees
habitually a film of soot floating on the surface; one sees (if indeed
one can see so deeply into water which is often turbid and opaque) that
filth and rubbish lie at the bottom; one sees the interior of the cask
itself dirty and mouldering.

I now merely glance at this part of the subject, because you have
already on other occasions allowed me to state my knowledge at greater
length. But there is one evil in particular to which I would beg leave
to advert. Those works of drainage which are established under your
orders depend for their efficiency on a proper supply of water; and in
every case where you enforce the construction of house-drains, you order
that those drains shall be served efficiently with water. Your wishes on
this subject are nominally complied with by those on whom your orders
are served, but are often virtually evaded by a filthy and ineffectual
contrivance. The butt or cistern of the house--that on which the inmates
depend for their supply of fresh and pure drinking-water, is placed in
immediate contiguity to the privy, so as to reduce the requisite length
of connecting pipe to the fewest possible number of inches; the
application of water is not made discretionary on the users of the
privy, nor are any of the cheap and common self-acting contrivances
introduced; but the waste-pipe of the butt or cistern is conducted into
the discharge-pipe of the privy, so that, _periodically_, with a
frequency varying according to the arrangements of the water-company,
the arrears of excrement are removed, so far as the overflow of the
water-receptacle may have power to dislodge and propel them. Frequent
evidence has been before me of the insufficiency of this arrangement:
and, in addition to its actual failure (on the reasons of which your
Surveyor can speak more competently than I) there is strong reason to
object to its prevalence on other grounds. Water, as you probably know,
is a very active absorbent of many gaseous materials; and the open
butts, which are thus placed in immediate contact and communication with
privies, must rapidly become infected by their foulness. I need not
explain to you how injurious an addition this is to the other
objectionable incidents of water-storage, or how unattractive as a
beverage to the poor inhabitants of the City must be this vapid,
privy-flavoured stuff.

For this arrangement I can suggest to your Hon. Court no easy
alternative or remedy, so long as the distribution of water continues to
be on its present intermittent plan: but it is matter for extreme regret
that, by circumstances over which you have no control, the success of
your sanitary measures should be seriously diminished. By the
enforcement or execution of house-drainage, your Hon. Court has
conferred great advantages on many districts of the City; but it is my
duty to tell you that, in my judgment, the present condition of the
water-trade contributes to neutralise those advantages, and constitutes
a restriction on your power of doing good.

As respects the evils to which I have just adverted, unquestionably they
admit of abatement by devoting separate water-receptacles to the very
different uses of diet and drainage. But the expense of additional
cisterns in tenements so poor cannot be considered trifling; and I
believe that your Hon. Court would hesitate, even if you have the power,
to enforce this double burthen on the owners of house-property, at a
time when one may reasonably hope that the necessity for cisterns will
be superseded.

There can be no doubt on the extreme degree in which it is desirable for
the poor of the City of London, that water should be delivered to their
houses on the principle of constant supply, and that they should thus be
relieved from the expensive and unwholesome necessity of storing it in
small quantities and in improper receptacles. That it is _desirable_ is
a certainty within my official knowledge and on which therefore I can
give an opinion of my own. That it is _practicable_ is not within my
official knowledge; for in this part of the question are involved
various considerations of hydraulic engineering, on which I am
incompetent to offer an opinion. But I cannot ignore the fact, that in
many parts of England and Scotland the practicability of a constant
supply has been evinced by the very conclusive evidence of its success.
To some such instances I alluded in my last Report, and from the present
year I can quote you a striking additional one. At Wolverhampton, in
1849, the system of supply, which had previously been intermittent, was
made continuous. Instead of waste ensuing on the change, its immediate
effect was a reduction of 22 _per cent._ on the quantity consumed. So
great had been the unpopularity of the intermittent system of supply,
that at the time of the change the company had not more than 600
customers. Immediately on the adoption of the new system, their
customers increased, and within ten months had risen to 1400. This
increase was continuing up to the date of the Report (May 4th, 1850), at
which time they were adding to the number of their customers at the rate
of 50 each week. The above facts (as is well observed by the resident
engineer, Mr. Marten) may be taken as a fair test that the system of
continuous supply is one of superior adaptation to the domestic wants of
the public.

This case is but an inconsiderable fraction of the evidence which lies
before the public on the subject of continuous supply. With such
evidence before me, in contrast to what I observe of the distribution of
water within the City of London, I cannot refrain from repeating to your
Hon. Court my confirmed and deliberate opinion that our method of supply
is essentially bad, and that it withholds from the poorer population of
the City a large proportion of those sanitary advantages which it is the
object of water to confer. No doubt it will occur to you that against
evils of this nature--evils arising in the conflictive interests of
water-buyer and water-seller, the first principles of commerce imply a
resource; and that in this matter, as in others of the sort, a customer
holds in his own hands the remedy for his dissatisfaction. But although
the supply of water, in the hands of the powerful companies who vend it,
is in many respects a common transaction of trade, and as such is in
theory open to competition, yet I would beg to point out to your Hon.
Court that, in regard of the City under your jurisdiction, no such check
and no such stimulus as competition can virtually be said to exist. In
every practical sense the sale of water is a monopoly. The individual
customer, dwelling in Cripplegate or in Farringdon, who is dissatisfied
with his bargain in water, can go to no other market; and however
legitimate may be his claim to be supplied with this prime necessary of
life at its cheapest rate, in the most efficient manner, and of the best
possible quality, your Hon. Court, hitherto, possesses no power to
enforce it.

All who have given impartial consideration to the subject seem to concur
as to the advantages which result from a control over the supply and
distribution of water being possessed by those who are responsible for
the drainage and cleanliness of a district. These different duties are
in such essential relation to each other that they would seem almost of
necessity to require a single direction and control. House-drainage
pre-supposes water-supply; water-supply pre-supposes house-drainage; the
efficiency of either implies their mutual adaptation; just as the
circulation of blood within an animal body implies uninterrupted
continuity of arteries and veins, each harmonising with the uses of the
other, to ensure the efficiency of the whole. But while the works of
drainage executed under your orders lose much of their sanitary
usefulness for want of an effectual water-supply, your Hon. Court has no
power of interference in the matter, closely associated as it is with
the performance of your other functions. These anomalies would be
removed, and a most beneficial power over the distribution of water
would be vested in the hands of your Commission, if in the renewal of
your Act of Parliament you procured authority to represent the citizens
in this matter. All the advantages which could possibly be gained by
competition, together with many benefits which no competition could
ensure, would thus be realised to the population under your charge; if,
namely, a clause were inserted in your Bill, empowering you, at your
discretion, to contract corporately with any person or any company for
the supply of water to the City of London.

In the Public Health Act (passed simultaneously with yours) an enactment
of this nature exists, authorising local boards of health to ‘provide
their district with such a supply of water as may be proper and
sufficient,’ and for this purpose ‘to contract with any person
whomsoever to do and execute all such works, matters, and things as
shall be necessary and proper, and to require that houses shall be
supplied with water,’ and to ‘make and levy water rates upon the
premises, at a rate not exceeding twopence per week.’ With a power like
this in your hands, you would easily enforce for the City of London
whatever method of supply you might deliberately believe to be best; and
you would then be enabled and entitled, in the application of other
clauses in your Act, to require of landlords acting under your orders,
a far completer, though less expensive, improvement of their property
than you are yet in a position to obtain.

In submitting to your Hon. Court my views as to the expediency of your
having a controlling power over the supply of water, I am glad to find
myself supported by the recorded opinion of the present Lord Mayor,
himself formerly the Chairman of a Commission of Sewers; and I am
induced to believe that such an addition to your functions might not be
objectionable to the water companies, as I observe that Sir William
Clay, the chairman of two metropolitan companies, has expressed himself
strongly on its ‘great and obvious convenience.’

       *       *       *       *       *

2. Of equal importance with anything which relates to the distribution
of water are those momentous questions which relate to its _quality_,
and which tend to determine its fitness for human consumption.

Considering the great share of public attention which these questions at
present very properly obtain, the many projects which are broached for
improving the quality of our metropolitan supply, and the importance of
your being in a position to decide as to the merits of any plan which
may affect the City of London, I have thought it desirable in this
Report to submit to you some general observations on the subject. During
the last few months, I have accordingly been collecting such information
as might, in my judgment, be useful for this purpose. In pursuing one
portion of my inquiry--that which relates to the chemical constitution
of certain waters, I have availed myself of the permission of your Hon.
Court to procure a limited amount of assistance from some one more
conversant than myself with the practice of analysis. For this purpose I
have addressed myself to Mr. Thomas Taylor, lately Lecturer on Chemistry
at St. Thomas’s Hospital, a gentleman on whose skill and impartiality I
can implicitly trust. His account of the very careful analyses which he
has made is subjoined to my Report.[48] Concurrently with the experience
of other chemists, it has furnished me with material for many of the
conclusions which I am about to lay before you.

  [48] See page 168.

The water which is supplied by the New River and East London companies
for the consumption of the City of London is substantially of one kind.
The River Lea, on which the East London Company entirely depends,
furnishes likewise much of the supply conveyed by the New River.[49] The
springs in which the latter originate are of the same chemical kind as
those which contribute to the Lea; and the artificial aqueduct runs its
forty miles of course through much the same country as the natural
river. Chemically, therefore, one description may apply to both; and I
the rather speak of them conjointly, as any extension of its resources
for our supply which the New River might obtain, would apparently be
provided by increasing considerably its present draught from the Lea.

  [49] It appears that the New River Company at present derives about
  two-thirds of its supply from the River Lea, and proposes to draw from
  this source a still larger proportion. Any chemical difference of
  quality in the City pipe-water (as between that supplied by the New
  River and that by the East London Company) would probably not exceed
  those limits of difference which prevail in respect of waters gathered
  _under varying circumstances_ from one and the same source.

The pipe-water consumed in the City has for its general chemical
character, that it contains a considerable quantity of carbonate of
lime, held in solution by an excess of carbonic acid. To this and
another salt of lime (the sulphate) the water chiefly owes the property
which is complained of under the name of _hardness_: it is by reason of
these salts, namely, that it decomposes a certain large proportion of
whatever soap is used with it; preventing the formation of a lather,
till those salts are exhausted by a wasted proportion of soap, by
boiling or otherwise, and hindering to that extent the several purposes
for which soap is employed. You are probably aware that soda is
extensively used in the laundry, as an antidote to this objectionable
quality of hard waters; and the excess of its employment tends, by
corrosion, very observably to hasten the destruction of washed articles
of dress. In the same measure as water possesses the property of
decomposing soap, its utility as an universal solvent is impaired; it
extends to various other substances which one seeks to dissolve in it
(especially to many vegetable matters) that same disposition to waste
them in the form of insoluble precipitates. Its conveniences for the
purposes of cooking and manufacture are _pari passu_ diminished.

Of the actual extent of which these disadvantages are sustained within
the City of London, I have no means of forming an exact opinion; but
statements are before the public (from the general correctness of which
I have no reason to withhold reliance and belief) rating the pecuniary
loss to the metropolis, in the two articles of soap and tea, at a very
high figure. You will see from Mr. Taylor’s observations the proportion
in which waste occurs, as regards one of these articles; namely that,
for the production of a lather in washing, the pipe-water of the City of
London, used without boiling, consumes from 13 to 19 times as much soap
as distilled water would consume.[50]

  [50] It has been alleged that, by the use of soft water, the saving in
  soap would probably be equivalent to the whole of the money at present
  expended on water-supply; and that in the article of tea, the economy
  would amount to about one-third of the tea now consumed in the
  metropolis. It strikes me as possible that, in forming these
  estimates, the argument may have proceeded too much from a
  consideration of the hardness of London waters in their unboiled
  state; and that sufficient allowance may not have been made for the
  change which boiling produces. If boiling were prolonged for some
  hours before culinary or detergent use of the water, the results (for
  tea or soap) would be identical with those produced under the
  employment of soft water. Notoriously this precaution is not taken:
  but to avoid disputable ground, I confine myself to _the fact of
  considerable pecuniary loss_, arising from the cause in question, and
  I avoid any attempt to determine its exact amount.

The chemical constitution of these waters occasions another
inconvenience. Their carbonate of lime is held in solution (in the
chemical form of bicarbonate) by an excess of carbonic acid: under the
influence of heat this excess is gradually disengaged and driven off;
consequently, as they approach the boiling point, they begin to
precipitate the earthy salt which that gas was instrumental in
dissolving. Each gallon of water under these circumstances would deposit
from ten to fifteen grains of earthy matter on the interior of whatever
vessel might contain it, or on the surface of whatever solid--linen or
mutton, might be contained in the boiler. Hence arises the well-known
_furring_ of vessels in which such waters have habitually been boiled.

I refrain from dwelling on the economical considerations which arise in
these points of the subject, as very obvious inferences from the result
of chemical analysis; and I pass to other matters more strictly within
my own province of observation.

Is water thus constituted in any degree detrimental to the health of
those who drink it? It is not in a single word that this question can be
fairly answered. Almost insuperable difficulty belongs to it, from the
absence of any statistical method by which we might isolate the
water-drinking portion of our population, and might compare them, in
regard of the diseases to which they are liable, with similar sections
of population in soft-water districts and in harder-water districts.
Obviously, no other method of comparison can be unobjectionable; and, in
arguing the subject from such materials as I have, I can pretend to
nothing more than a rational approximation to truth.

Except in the comparatively few instances where active medicinal agents
are naturally dissolved in a water, its effects, if injurious, would be
so slow as to elude ordinary observation. If, as is exceedingly
probable, the same constitution of water as impairs its solvency out of
the body, do likewise operate against its being the most eligible
menstruum or dissolvent for processes occurring within the body--such
processes I mean as attend the act of digestion; if the lime and other
hardening ingredients which waste soap in our laundries, and tea in our
parlours, do similarly waste within us those organic agencies by which
our food is dissolved and converted; any result arising from this source
would be of gradual operation, would not easily admit of being traced to
its source, and (except in susceptible persons) would rarely produce
such symptoms as might immediately draw attention to their cause. The
ill effects (whatever they may be) arising from the use of hard waters
must be looked for in chronic impairment of digestion, and in those
various derangements of nutrition in distant parts (the skin and teeth
particularly) which follow as secondary results on such chronic
disorder. It would be ridiculous to look for the operation of an
ill-chosen water, after its habitual use during two centuries, as though
one were inquiring for the symptoms of an acute poison. The signs that
are to be ascertained among a population, if such signs exist, are those
which would evidence a premature exhaustion of the power of digestion,
and would testify that the machine on which we depend for that power had
been exposed to unnecessary and avoidable fatigue. This, I believe, is
the utmost which Medicine, proceeding from theoretical grounds, would
venture to say on the subject.

Perhaps I need not inform you that indigestion, with all that follows
from it, is so frequent in the metropolis, in persons after the first
strength of youth, that, for large classes of society, a perfect
discharge of the natural process of digestion (such a discharge of it as
a lecturer would describe to be the exact type and intention of Nature),
is exceptional and rare. Unquestionably, in large numbers of cases, wine
and beer and spirits, rather than water, have to do with this effect.
Unquestionably, other influences of metropolitan life--and, not least,
the mental wear and tear which belong to its large excitement,
contribute immensely to this chronic derangement of health; but there
are reasons likewise for believing, that the quality of water consumed
is not a matter of indifference to the result. We cannot but give it an
important place among those influences of health or unhealth which we
consider _local_; and we cannot refuse to recognise the fact, that in
recommending our patients (as we do often recommend them) to try ‘change
of air’ for complaints which baffle us by their obstinacy, so long as
the subject of them remains in London, the course on which we rely for
success implies ‘change of water,’ equally with that other change to
which more popular importance is attached.

In illustration of this view, I may quote to you the experience of two
other towns. Dr. Sutherland stated, in evidence before the General Board
of Health, that having lived for a number of years at Liverpool (where
the water is said to be of about the same degree of hardness as ours),
he had long entertained a conviction that ‘the hard water, in a certain
class of constitutions, tends to produce visceral obstructions; that it
diminishes the natural secretions, produces a constipated or irregular
state of the bowels, and consequently deranges the health. He had
repeatedly known these complaints to vanish on leaving the town, and to
re-appear immediately on returning to it, and it was such repeated
occurrences which fixed his attention on the hard selenitic water of the
new red sandstone as the probable cause, as he believed it to be, of
these affections.’ (Rep. p. 51). And Dr. Leach, of Glasgow, stated
before the same Board, as the result in that town of two years’
experience of a substitution of soft for hard drinking-water, that in
his opinion, ‘dyspeptic complaints had become diminished in number;’
and that it had ‘been observed, since this change, urinary diseases have
become less frequent, especially those attended by the deposition of
gravel.’

Inferences useful for ourselves cannot be drawn from statements like the
above, on the fullest assumption of their accuracy, without comparing
the waters referred to with our own, more completely than is done by the
one characteristic of ‘hardness;’ and there may likewise be other
qualifications requisite for an application of the analogy. But those
disorders of health which are specified by the gentlemen quoted, as
produced by the use and diminished by the disuse of hard waters, are
such as might very probably stand in the relation of effect to their
alleged cause; results, namely, primary and secondary, of disordered
digestion.

Practically, I may tell you, that there are many individuals whose
stomachs are extremely sensitive to the impression of hard water, who
derive immediate inconvenience from its use, and who refuse to drink it
without artificial reduction of its objectionable quality. I may
likewise inform you that a physician, recently deceased, whose knowledge
of indigestion and its chronic effects (especially in relation to the
skin and urinary organs) was most profound and accurate, and whose
consulting practice in such disorders was for many years almost a
monopoly (I mean Dr. Prout) was in the habit of enjoining on his
patients the use of distilled water. He evidently considered that the
consumption of such waters as are habitually drunk in the metropolis was
detrimental, at least to an enfeebled digestion. This is an opinion
which, I have reason to believe, is generally entertained by medical
practitioners in London.

It may not be irrelevant to mention to you (since the influence of
imagination or of artificial habits can have little to do with this
result) that horses are liable to be much inconvenienced by hard water,
if unaccustomed to its use; and it is, I believe, notorious that grooms
in charge of racers habitually take the trouble of conveying with them,
to their temporary racing stables, a supply of the accustomed water.
Veterinary surgeons say that under the continued use of hard water,
which horses will avoid if possible, their coats become rough and
staring;--an effect, I may observe, analogous to those skin-disorders of
the human subject which are apt to occur from impairment of the
digestive functions.

Taking into account all these considerations, together with others of a
more technical description; and believing that water is eligible for
human consumption in proportion as it is free from the admixture of any
material foreign to its simple elementary constitution--exception being
made only of so much dissolved air as will render it sparkling and
palatable; I entertain no doubt that a water, devoid of considerable
hardness, would (_cæteris paribus_) for the purposes of cooking and
drinking, be far preferable to that which the companies now distribute
through the City of London.

Hitherto, however, I have spoken of the waters supplied to the City,
merely as regards that large impregnation of earthy material which they
gather from their source; and I have criticised them only in respect of
that admixture. Their essential chemical quality is one native to the
soil from which they are derived; and whatever censure thus far belongs
to them could only have been avoided by the selection of a different
source. Chemistry, in the days of Morrys and Myddleton, was not
sufficiently advanced to inform the water-merchants of a city on those
different conditions which determine the fitness of a soil to serve as
the natural or artificial _gathering-ground_ of a supply; and by which
(as they vary in different localities) hardness is imparted to the
rain-fall of one district, while softness is preserved for that of
another.

But there are other evils belonging to these waters, less appreciable
indeed by chemistry, but open to universal observation, and meriting
unqualified blame. They are conducted to the metropolis in open
channels; they receive in large measure the surface-washing, the
drainage, and even the sewage of the country through which they pass;
they derive casual impurities from bathers and barges; they are liable
to whatever pollutions mischievous or filthy persons may choose to
inflict on them; and then on their arrival in the metropolis (after a
short subsidence in reservoirs, which themselves are not
unobjectionable) are distributed, without filtration, to the public.
Whatever chemistry may say on this subject (and I need not remind you of
very powerful causes of disease which lie beyond its cognisance), I
cannot consider it matter of indifference, that we drink--with whatever
dilution, or with whatever imperfect oxidation, the excremental and
other impurities which mingle in these sources of our supply. Such
admixtures, though in their _quantity_ less, are in their _quality_
identical with those which render Thames-water, as taken at London
Bridge, inadmissible for domestic consumption, and which occasion it,
when stored for sea-use, to undergo, before it becomes fit to drink, a
succession of offensive changes strictly comparable to putrefaction.

In this slovenly method of conveyance and distribution there is a
neglect of common precaution for the purity and healthfulness of the
supply, which I must report to you as highly objectionable: and
this--the method of supply to our great metropolis, strikes one the more
with astonishment and disgust, as one reflects on the long experience
and admirable models which past centuries in foreign countries have
supplied; and especially, as one remembers those colossal works which,
more than two thousand years ago, were constructed under the Roman
government, for the cool and cleanly conduction of water.

The present imperfections of knowledge forbid me to cite, as definite
causes of disease, the contaminations to which I have adverted: I cannot
say to you--pointing to our classified list of sickness and mortality,
_this_ depends on drinking the diluted drainage of Hertford, _that_ on
the contributions of Ware. Indeed I know that, under the influence of
the river and the atmosphere, very considerable changes occur in the
materials thus furnished, tending eventually to render them inert; and
if injury to life occur from their ingestion, it is probably only under
peculiar and exceptional conditions, increasing their quantity, or
delaying their oxidation. In protesting against their continued
distribution as articles of diet, I therefore insist less on inferences
deducible from medicine, and shall probably have the concurrence of your
Hon. Court in grounding my appeal on the common principles of taste.

On the incidental contaminations to which the pipe-water consumed within
the City becomes liable, by reason of its storage in receptacles both
foul in themselves and surrounded by causes of foulness, I have already
addressed you; and I have shown to you the dependence of this evil on
the system of intermittent supply as adapted to the houses of the poor.

Of other sources of water-supply existing within the City of London,
there are many of small extent in the form of superficial springs. These
are eagerly sought after, sometimes from a distance, on account of their
coolness and sparkling condition. In the Appendix[51] you will find an
account of one of these waters--that in the vicinity of Bishopsgate
church, which is very much drunk in that quarter of the City. Any praise
given to it illustrates exceedingly the fallacy of popular judgment on
such subjects, and shows how easily those qualities of coolness and
freshness, which are absent from stored waters, impose on the palate,
and induce a preference to be given to waters which are relatively most
objectionable.

  [51] See page 170.

The chemical faults which belong to our London pipe-water are possessed
in a far greater degree by this water of Bishopsgate pump, and the
latter has moreover some vices which are absent from the former; but the
vapidity and fustiness of water which has been stored in cisterns are so
repugnant to the taste, that the water chemically preferable is not in
practice preferred.

To the use of waters of this description, within a large city, there is
always much objection. In addition to extreme hardness, which in London
they universally possess, they are liable, in a dangerous degree, to
become contaminated by the leakage of drains, and by other sources of
impurity; as, for instance, where situated within the immediate vicinity
of grave-yards they derive products of animal decomposition from the
soil.[52] Very recently, a celebrated pump within the City of London,
that adjoining St. Bride’s church-yard, has been abandoned on account of
such impregnations. Or perhaps I should rather say (for the difference
again illustrates the readiness with which the palate is deceived or
corrupted) that it was not _abandoned_--for till almost the last moment
the neighbours adhered to it with fondness; but the parochial
authorities--alarmed by the proximity of cholera--caused its handle to
be locked.

  [52] This is illustrated in the analysis of Bishopsgate pump-water,
  just alluded to. The very large quantity of _nitrates_, there referred
  to that water, must be due to the oxidation of human bodies in the
  adjoining soil, which serves in part as gathering-ground to the
  spring. I should fear that, during rain-fall, this oxidation of
  organic compounds may not always have completed itself, and that
  materials of decomposition _still in progress of decay_ may thus often
  be mingled in the water. [I have lately had occasion to recommend that
  the use of Aldgate pump should be discontinued on account of its water
  containing, in addition to a large quantity of alkaline nitrate, so
  much unoxidised organic matters, as were sufficient to give it a foul
  taste.--J. S., 1854.]

As an available source of supply to the City of London, the use of deep
(Artesian) wells has been recommended: the clearness and softness of
these waters, together with their freedom from organic matters, having
concurred to suggest their employment. I feel bound to express the
strongest opinion against the fitness of these waters for the purpose of
beverage. They uniformly contain a considerable proportion of medicinal
ingredients; they are capable of exerting definite and demonstrable
influence over the natural actions of the body; and information is
before me of various injury to health, affecting large numbers of
persons, arising from the continued dietetic use of such waters.

In addressing your Hon. Court on the subject of water-supply for the
City, it is impossible that I should do otherwise than advert to the
fact, that, during the last few months, under the auspices of Her
Majesty’s government, as represented for sanitary purposes by the
General Board of Health, a plan has been gradually maturing itself, for
the supply of the entire metropolis with pure soft water. Founding
itself on very extensive investigations as to the qualities of water, as
to the influence of soils on its chemical composition, as to the
relation between streams and rain-fall, as to the hydraulic principles
of distribution, and the like, this plan proposes to gather water in
certain silicious soils, which can impart to it the least possible
admixture of foreign ingredients; to conduct it in closed channels, with
every precaution for its perfect purity; and to distribute it throughout
the metropolis, at a rate which shall be from 30 to 50 _per cent._ less
than our present water-charges. The proposed area for the collection of
this supply is in the extensive range of sandy soil in the south of
Surrey, extending around Farnham, about ten miles in each direction.
Since the publication of the first Report made on this subject by the
General Board of Health, unremitting inquiry has been advancing, under
their direction, into all details of the plan; and the Hon. William
Napier, who, with others, has been engaged in the investigation of the
proposed sources, has advocated an important modification, which
promises to reduce very considerably the anticipated expense of the
undertaking. The essential and most important principles which governed
the Board, in arranging their plan, were, first, to seek their supply
in a silicious soil, where little soluble material could exist for its
contamination; secondly, to take possession of the water so near to its
source that all its original purity might be preserved; and, during
conduction, to isolate it from those contaminations which are incidental
to the onward passage of a stream through miles of promiscuous country.
To fulfil these indications, there were two conceivable courses; and
studious local inquiries could alone determine which of them was
preferable: on the one hand, if the streams which represent the natural
drainage of the country should be found uniformly pure and copious, they
might admit of being conducted bodily into the artificial river of
supply: on the other hand, it might be requisite to carry the
interference of art still further, to absorb the filtering moisture of
this large sand-district before it had become confluent into streams,
and thus from day to day, by extensively ramified works of artificial
sub-drainage, to derive immediately from the soil, the varying
contributions of rain-fall and dew. The Board, apparently solicitous for
the completer security of their plan, preferred to estimate its cost on
the latter very expensive supposition; they allowed apparently for the
diffusion of drain-pipes over 150 square miles of country, and for a
reservoir which should contain storage of water equivalent to a very
long metropolitan consumption. The later examination, made by Mr. Napier
and confirmed by others, tends and appears to show, that these large
sources of expense may be avoided; that the waters may be collected of
unusual purity and softness, where they have united themselves into
rivulets of considerable volume; that the gauged and estimated discharge
of these rivulets is sufficient day by day for the needs of the
metropolis, according to the largest construction of those needs; that
capillary drain-pipes and very extensive storage-room may thus be
dispensed with; and that under the modification of arrangement suggested
by these facts, some very large reduction might be inferred for the
total estimate of this comprehensive plan.

Many of these particulars are already before the public; but in a matter
of so much importance to the health of the City, as that of
participating in a supply of pure water, collected and distributed on
the soundest principles, and sold at the cheapest rate, I did not think
it would become me, as your Officer of Health, to remain an indolent
auditor. I have felt it my duty to inform myself, so far as I could, on
the real merits of this scheme, and on its probable relation hereafter
to the sanitary condition of the metropolis. I have spent three days on
the site of the proposed sources, and many other days in informing
myself on all the bearings of the subject. I have likewise collected
water from a proposed tributary of the future supply, which has been
analysed, and which shows (as my Appendix will illustrate to you) a
remarkable and rare excellence. On one occasion of visiting the country,
I was accompanied by Mr. T. Taylor, and we made on the spot a sufficient
number of extemporaneous examinations, to assure us that the essential
features, shown in the more elaborate analysis, are (as geological
considerations would lead us to believe) the general characters of water
throughout the district.

On any other than the sanitary relations of this subject I can have
nothing officially to say; but, confining myself to these relations, I
may certify to your Hon. Court that the water in question is, in my
judgment, of a quality admirably suited for domestic purposes; that its
distribution through the City of London would conduce to the health and
comfort of the population; and that the principles, proposed by the
Board for its collection and conveyance, appear to me such as sanitary
science, in its present condition, should counsel for the water-service
of the metropolis.

There is, however, one aspect of the subject which must not pass
unconsidered. Water that is free from earthy ingredients requires a
peculiar distributory apparatus. If conveyed in leaden pipes with access
of air, or if stored in leaden cisterns, it corrodes the metal of which
they are composed, and is liable to derive from this source an
impregnation very hazardous to life. Under certain circumstances,
especially under alternations of air and water (such as occur in the
intermittent supply), or where organic impurities are held in solution
or suspension, or probably where from any cause uncombined carbonic acid
is present, even the hardest waters are not free from this risk.
Speaking generally, however, it affects soft water chiefly; distilled
water most of all: and the Farnham water (in common with all pure water)
is decidedly liable to this empoisonment, if used with leaden apparatus
of conduction and storage. In my Appendix you will find some interesting
particulars on this head; and you will observe that with experiments
conducted by Mr. Taylor in imitation of the constant supply (i. e. with
total submersion of the metal) the formation of carbonate of lead in the
Farnham water was exceedingly gradual. This concurs with the alleged
experience of Aberdeen, where it is said by Professor Clark to have been
found (to my mind, by a somewhat dangerous trial) that pure and soft
water, _distributed on the principle of constant supply_, does not
exert on the leaden pipes any action injurious to the health of the
population. You will likewise observe, that when hard water, as at
present employed in the City, is softened by boiling, it acquires this
property of pure water, and becomes capable of acting on lead; and here
is an important observation, as it has been proposed by similar
artificial means, employed on a very large scale, to soften all the
water now distributed in the metropolis.

Obviously, as regards one and all of the many proposals for supplying
water destitute of hardening ingredients, any chemical process, or any
change of source, which might lead to the distribution of such pure
water through the metropolis, could not be considered as a single and
separate reform, but must be undertaken conjointly with such alterations
in the distributive arrangements as might be requisite for removing from
the new plan _any chance, however slight or remote, of injuring the
population by metallic poison_.

What those alterations must be, it would now be premature to decide. The
experience of Aberdeen might seem to suggest, that the system of
constant supply (on all other accounts so eminently desirable for the
metropolis) would in itself, if accompanied by the total disuse and
prohibition of leaden cisternage, give sufficient security against the
danger in question; or, on the other hand, further inquiry may show it
to be quite indispensable for a safe distribution of the new supply,
that leaden pipage should be entirely superseded by the use of some
non-metallic material, as earthenware or glass. Should this change
become necessary, its adoption would no doubt be facilitated by the
comparative cheapness of these preferable materials.


_Offensive or injurious Trades._

With respect to offensive or injurious trades and occupations pursued
within the City of London, you were reminded by your Committee of
Health, in their Report of March 26th, ‘that upon your attempting to put
in force the powers of your Act of Parliament in reference thereto, it
was found that considerable difficulties were opposed to your efforts.
Sufficient powers (the Report proceeds to say) are not given by the City
of London Sewers Act to meet some of the cases alluded to, while other
legal and technical objections presented themselves to the enforcement
of the powers in question.’ The Committee concluded their Report by
‘pointing out to you the necessity, when the question of renewing your
Act should come into consideration, of procuring additional powers which
may enable you effectually to remedy those evils.’

On the grounds thus expressed by your Committee, I avail myself of the
present opportunity for bringing the subject again under your notice.

In my former Report I spoke particularly of those trades and occupations
which deal with animal substances liable to decomposition; and in
expressing my knowledge of their danger to the health of an urban
population, I argued that no occupation which ordinarily leaves a putrid
refuse, nor any which consists in the conversion or manufacture of
putrescent material, ought, under any circumstances, to be tolerated
within a town. To that subject I now revert, only to assure your Hon.
Court that the past year has given me no reason to alter my opinion. But
the trades to which I wish, on this occasion, more especially to request
your attention, are those which are complained of on the ground of
their offensiveness, rather than of their injury to health--as nuisances
rather than as poisons. During the year, I have received a very
considerable number of complaints of this nature; some of them perhaps
frivolous, but many well-founded and reasonable.

At the head of this class of evils stands the flagrant nuisance of
smoke. Those members of the Court who have visited foreign capitals
where other fuel than coal is employed, will remember the contrast
between their climate and ours--will remember (for instance even in
Paris) the transparence of air, the comparative brightness of all
colour, the visibility of distant objects, the cleanliness of faces and
buildings, instead of our opaque atmosphere, deadened colours, obscured
distance, smutted faces, and black architecture. Those, even, who have
never left our metropolis, but who, by early rising or late going to
rest, have had opportunities of seeing a London sunrise, can judge, as
well as by any foreign comparison, the difference between London as it
might be, and London as it is. Viewed at dawn and at noon-day, the
appearances contrast as though they were of different cities and in
different latitudes. Soon after daybreak, the great factory shafts
beside the river begin to discharge immense volumes of smoke; their
clouds soon become confluent; the sky is overcast with a dingy veil; the
house-chimneys presently add their contributions; and by ten o’clock, as
one approaches London from any hill in the suburbs, one may observe the
total result of this gigantic nuisance hanging over the City like a
pall.

If its consequences were confined to rendering London (in spite of its
advantages) the unsightliest metropolis in Europe, to defacing all works
of art, and rendering domestic cleanliness expensive, I should have
nothing officially to say on the subject; but inasmuch as it renders
cleanliness more difficult, and creates a despair of cultivating it with
success, people resign themselves to dirt, domestic and personal, which
they could remove but so temporarily: or windows are kept shut, in spite
of immeasurable fustiness, because the ventilation requisite to health
would bring with it showers of soot, occasioning inconvenience and
expense. Such is the tendency of many complaints which have reached me,
and of their foundation in truth and reason I have thorough conviction
and knowledge.

I would submit to your Hon. Court that these evils are not
inconsiderable; and that beside the injury to property (with which I
have nothing to do) the detriment to health, if only indirect, claims to
be removed. Yet, while I am cautious to speak of this latter injury, as
though it were only indirect--only by its obstruction of healthy habits,
I ought likewise to tell you, that there are valid reasons for supposing
that we do not with impunity inhale day by day so much air which leaves
a palpable sediment; that many persons of irritable lungs find
unquestionable inconvenience from these mechanical impurities of the
atmosphere; and (gathering a hint from the pathology of vegetation) that
few plants will flourish in the denser districts of London, unless the
air which conduces to their nourishment be previously filtered from its
dirt.

If the smoke of London were inseparably identified with its commercial
greatness, one might willingly resign oneself to the inconvenience. But
to every other reason against its continuance must be added as a last
one, on the evidence of innumerable competent and disinterested
witnesses, that the nuisance, where habitual, is, for the greater part
or entirely, voluntary and preventable; that it indicates mismanagement
and waste; that the adoption of measures for the universal consumption
of smoke, while relieving the metropolis and its population from injury,
would conduce to the immediate interest of the individual consumer, as
well as to indirect and general economy. For all the smoke that hangs
over us is wasted fuel.

The consumption of smoke in private houses is unfortunately a matter to
which hitherto little attention has been given; and it would be vain to
hope that the reform should begin with those, whose individual
contributions to the public stock of nuisance are comparatively
trifling. With the progress of knowledge on these subjects, a time will
undoubtedly arrive, and at no distant period, when chimneys will cease
to convey to the atmosphere their present immense freight of fuel that
has not been burnt, and of heat that has not been utilised; when each
entire house will be uniformly warmed with less expenditure of material
than now suffices to its one kitchen fire; and our successors[53] will
wonder at the ludicrous ingenuity with which we have so long managed to
diffuse our caloric and waste our coal in the directions where they
least conduce to the purposes of comfort and utility.

  [53] To the philosophical thinker there would seem to exist no
  important difficulty which should prevent the collective warming of
  many houses in a district by the distribution of heat from a central
  furnace--perhaps even so, that each house might receive its _ad
  libitum_ share of ventilation with warmed air. Ingenuity and
  enterprise, in this country, have accomplished far more arduous tasks;
  and I little doubt that our next successors will have heat-pipes laid
  on to their houses, with absence of smoke and immense economy of fuel,
  on some such general organisation as we now enjoy for gas-lighting and
  water-supply.--J. S., 1854.

But, while the arrangements of private establishments may, perhaps
wisely, be left to the operation of this spontaneous reform, I would
venture to recommend in regard to furnaces, employed for steam-engines
and otherwise for manufactures within the City, that you should
endeavour to control the nuisance of smoke.

The members of your Hon. Court are probably cognisant of the great mass
of evidence on this subject, collected by two separate committees of the
House of Commons, and of the almost unanimous conclusions to which that
evidence led; ‘that opaque smoke issuing from steam-engine chimneys may
be so abated as no longer to be a public nuisance; that a variety of
means are found to exist for the accomplishment of this object, simple
in construction, moderate in expense, and applicable to existing
furnaces and flues of stationary steam-engines; that a sufficient body
of evidence has been adduced, founded upon the experience of practical
men, to induce the opinion that a law, making it imperative upon the
owners of stationary steam-engines, to abate the issue of opaque smoke
is desirable for the benefit of the community;’[54] ‘that the expense
attendant on putting up whatever apparatus may be required to prevent
smoke arising from furnaces is very trifling, and (as some of the
witnesses observed) the outlay may be repaid within the year, by the
diminished consumption of fuel; that the means of preventing smoke might
also be applied to the furnaces of steam-boats, but such application
would be attended with rather more expense than on land, from the
occasional want of space, and the setting of boilers in a steam-vessel.
No doubt, however, existed, in the opinions of those examined, that the
prevention of smoke could be accomplished in steam-vessels.’[55]

  [54] Report of Committee, 1845.

  [55] Report of Committee, 1849.

In two local improvement Acts (those of Leeds and Manchester) clauses
have been introduced in accordance with the sense of these conclusions;
and in order to render them as little oppressive as possible to those
whose interests might be affected by their operation, the enactments
(which apply to every variety of furnace) have been so framed as to
enforce penalties for the issuing of smoke only when it should appear
(as no doubt it commonly would appear) that the proprietor had refrained
from “using the best practicable means for preventing or counteracting
such annoyance.”

Surely if such applicable means exist, it is a just and reasonable thing
that the public should be defended against offence and injury, arising
in the mere indifference or obstinacy of those who inflict them; and I
venture to hope that your Hon. Court, in renewing your application to
Parliament, may procure the enactment of a clause, giving you control
over so much of the nuisance as is wanton and avoidable.

       *       *       *       *       *

There are still under the present head, some points to which I am
anxious to advert. During the two years that your Act has been in
operation, various complaints have been made with respect to nuisances
arising in particular trades; and with many of the causes of complaint
you have been unable effectually to contend. Soap-makers,
tallow-melters, gut-spinners, naphtha-distillers, preparers of patent
manure, dealers in soot, exposers of stinking hides, wire-makers,
dealers in kitchen-stuff, fish-curers, tripe-boilers, type-founders,
gold-refiners, slaughterers, varnish-makers, roasters of coffee and
chicory, whalebone-boilers, iron and brass-founders, keepers of
cattle-sheds, makers of printing-ink, dealers in camphine, cookers of
cats’-meat, and manufacturing chemists, have all, at different times and
in various degrees, been complained of.

In respect of those of the enumerated trades which deal in the
manufacture or sale of organic materials in a putrid or putrescent
state, I have already submitted to you my opinion that the City of
London, the home of a large and crowded population, is no place for
them. With regard to the many other occupations, it would obviously be
absurd, in the present state of society, to think of banishing them from
the City which their industry has contributed to enrich, and where
immemorial custom has given sanction to their continuance, unless you
could with certainty affirm of them, that they cause direct and
inevitable detriment to their neighbourhood. Every useful purpose, as
regards the health of the City, might be fulfilled by the enactment of
some moderate restriction.

Manifestly, it is opposed to the spirit of your Act of Parliament, that
any trader or manufacturer should possess the right of diffusing in the
vicinity of his house, to the detriment and disgust of his neighbours,
any product (whether in the form of running fluid, or volatile dust, or
vapour, or smoke, or odour) which is either disagreeable to the senses
or may be hurtful to the health. Many of the instances which I have
enumerated fall within this description, and yet remain unaffected by
the restrictive sections of your Act.

I would submit to the consideration of your Hon. Court, whether, in the
renewal of your Act, some comprehensive clause might not be introduced,
which should deal with these difficulties, as well as with the nuisance
of smoke--and deal with them, too, on the same principle: a clause,
which (without enumerating all trades which have been, or possibly may
become, sources of nuisance in the City, and without specifying too
narrowly the nature of the nuisances to be guarded against) should
empower your Commission generally, in respect of every trade practised
within the City, to require that its operations shall be conducted with
the least possible amount of inconvenience to the neighbourhood; and
which should enable you to enforce penalties in case of every nuisance
arising in such operations, unless it should be distinctly shown on the
part of the proprietor, that every practicable measure for abatement of
the inconvenience had been constantly and thoroughly employed.[56]

  [56] Such a clause was introduced in the Act of 1851 (see page 193)
  and has been worked with considerable advantage.--J. S., 1854.

I would beg to express my conviction that your possession of the
authority with which such a clause would invest you, would very largely
increase your powers of utility, in respect of many acknowledged
grievances hitherto beyond your control; and the influence of your
example, in the achievement of this great municipal purpose, would, I
doubt not, speedily lead to the adoption of general measures throughout
the metropolis, for the total suppression of smoke, and for the
mitigation of other nuisances which now exist around your territory no
less than within it.[57]

  [57] This expectation has recently been fulfilled in the Smoke
  Prevention Act, for which the metropolis has to thank Lord
  Palmerston.--J. S., 1854.


_Burial-Grounds._

In my last year’s Report I had occasion to represent to your Hon. Court
the evils of intramural sepulture. I testified to that large
accumulation of human remains, by which, in numerous parts of the City,
the soil of burial-grounds has been raised many feet above its original
level; and I advised you of the injury which must accrue to health from
the constant organic decomposition thus suffered to proceed in the midst
of our crowded population. I likewise invited your attention to the
still greater evil of burial in vaults; I explained and endeavoured to
remove the misconception which commonly prevails, as to the preservation
of bodies under those circumstances; and I showed you how unfailingly,
sooner or later after such burial, the products of putrefaction make
their way from within the coffin (whatever may have been its
construction) and diffuse themselves offensively and injuriously through
the air. I concluded by expressing to you my strong conviction of the
necessity that some comprehensive measure should be undertaken, for
abolishing, at once and for ever, all burial within the City of London.

During the session of Parliament that has intervened between that Report
and my present one, an event has occurred, which promises to remove
effectually the evils on which I then addressed you. Her Majesty’s
government, acting at the instigation of the General Board of Health,
carried through Parliament a Bill, enacting that the Queen, by Order in
Council, may prohibit further burials within any district of the
metropolis, so soon (after the close of this year) as the General Board
of Health should have provided the means of extramural interment. The
operation of this Act of Parliament is such as, I have every reason to
believe, you will welcome within the City of London: and I look forward
to the complete cessation of burial within your territory, as a matter
for warm congratulation among all who are interested in the cause of
sanitary improvement.[58]

  [58] The Act of Parliament here referred to never passed into
  operation, and was repealed in 1852 by a second Metropolitan Burials
  Act, under which the City Commissioners of Sewers are at present
  acting as a Burial Board for the City of London. See the last Reports
  of this Volume, from page 280 to the end.--J. S., 1854.

From the terms of the Act in question I find that Her Majesty’s Order in
Council is to be preceded by a Report from the General Board of Health,
stating their opinion of the expediency, that (in any particular case
reported on) burial should forthwith be discontinued. Accordingly, in
the present state of the law, it will devolve on that Board to initiate
whatever measures may be necessary for the prohibition of further
interment in the City.

Two clauses of your Act of Parliament, which have hitherto been
inoperative, may perhaps come into requisition whenever Her Majesty’s
Order in Council closes the burial-grounds of the City; viz., clause 89,
which empowers your Commission, if you shall “think fit, to provide fit
and proper places, in which the poor, under proper rules and
regulations, may be permitted to deposit the bodies of their dead
previous to interment;” and the following clause, which authorises your
Officer of Health, in case of necessity, and for protection of the
living, to cause any dead body to be removed at your expense, to
whatever building may have been provided for the reception of the dead,
previous to interment. It may hardly be necessary that I should trouble
you with any remarks on the subject of these clauses, till such time as
they are likely to come into operation.

With respect to the burial-grounds within the City, which will fall into
disuse so soon as the new Interment Act becomes operative, I trust that
your Hon. Commission will procure the power of regulating and
supervising their maintenance, so that they may no longer be hurtful to
the health of their vicinity. The arrangement of them, which would be
most advantageous to their locality, would be that of planting them with
whatever trees or shrubs may be made to flourish in a London atmosphere.
The putrefactive changes, which for some years longer must proceed in
these saturated soils, will be rendered comparatively harmless and
imperceptible, if at the same time there advance in the ground a
sufficiency of vegetation, which for its growth would gradually
appropriate, as fast as they are evolved, the products of animal decay.

It seems almost superfluous for me to observe, that, from the time when
burials are discontinued, no unnecessary disturbance of the soil should
be allowed; nor any attempts at levelling or the like, except under the
direct sanction of your Hon. Court.

Another point in connexion with these burial-grounds, to which I may
here advert (though I must recur to it hereafter) is, that while great
advantage may be expected from the discontinuance of their former uses,
if their several areas be left open and without building, so as to
subserve the ventilation of their neighbourhood, all that advantage
would be lost, and a heavier evil inflicted on the neighbourhood than
that of which it purports to be relieved, if these spaces were at any
time to be covered with houses; and I trust it may be found within the
province of your Hon. Court to obtain authority for preventing any
encroachment of this nature on the limited breathing-spaces of the City.


_Habitations and Social Condition of the Poor._

In my last Report (under its fifth and sixth heads) I particularly
solicited the attention of your Hon. Court to certain circumstances
connected with the dwellings and habits of the poor, which, though they
then lay apparently out of your jurisdiction, as defined by the Act of
Parliament, yet appeared to me of immeasurable weight in the sanitary
fluctuations of the City, as tending in their operation constantly to
thwart your endeavours for improvement, and to neutralise day by day
whatever good you could achieve.

I reported to you that there were sanitary defects, inherent in certain
large proportions of your municipal cure, which the most absolute
control of drainage and water-supply would do nothing to
amend,--constructional defects of houses and of courts, whereby their
crowded inhabitants were excluded from a sufficiency of light and air,
and were constrained, without remission or change, to breathe an
atmosphere fetid with their own stagnant exhalations. I reported to you
that, however unexceptionable might be the arrangement of such
localities in matters already within your control--however clean their
pavements, however pure their water, however effective their drainage,
yet fever and the allied disorders could never be absent from their
population; while under opposite arrangements, with nuisances around
them, with organic poisons rising from the soil or mingling in the
water, their mortality would rise to the horrors of pestilence, and
might easily renew the most awful precedents in history. I described to
you the class of miserable dwellings alluded to--‘Courts and alleys with
low, dark, filthy, tenements, hemmed in on all sides by higher
buildings, having no possibility of any current of air, and (worst of
all) sometimes so constructed, back to back, as to forbid the advantage
of double windows or back doors, and thus to render the house as perfect
a _cul-de-sac_ out of the court, as the court is a _cul-de-sac_ out of
the next thoroughfare:’ I affirmed that ‘this could never be otherwise
than a cause of sickness and mortality to those whose necessities allot
them such residence;’ and assured you of the ‘incontrovertible fact,
that subsistence in closed courts is an unhealthy and short-lived
subsistence, in comparison with that of the dwellers in open streets.’

In habitations of this kind the death-rate would of necessity be high,
even if the population were distributed thinly in the district. A single
pair of persons, with their children, having such a court for their sole
occupancy, would hardly be otherwise than unhealthy; the infants would
die teething, or would live pallid and scrofulous; or a parent would
perish prematurely--the father, perhaps, with typhus, the mother with
puerperal fever. Judge then, gentlemen, how the mortality of such courts
must swell your aggregate death-rate for the City, when I tell you that
their population is in many instances so excessive, as, in itself, and
by its mere density, to breed disease.

Statistics can give you no conception of this crowding. If you refer to
the results of the last census, you find the average population _per_
house, in the City of London Union to be 7·1; in the East and West
London Unions, 8·8; for the construction of these averages, the most
dissimilar materials are blended together; and the density of population
is apparently reduced by the very large number of business-houses which
have no resident inmates, beyond the porter or the housekeeper who has
charge of them. If you turn from the deceptions of an average to the
exact analysis of detail, you will find many single rooms in the City
with a larger number of inmates than you might otherwise ascribe to
entire houses. Instances are innumerable, in which a single room is
occupied by a whole family--whatever may be its number, and whatever the
ages and sexes of the children; where birth and death go on side by
side; where the mother in travail, or the child with small-pox, or the
corpse waiting interment, has no separation from the rest.

This is evil enough; but worse remains behind. It is no uncommon thing,
in a room of twelve feet square or less, to find three or four families
_styed_ together (perhaps with infectious disease among them) filling
the same space night and day--men, women, and children, in the
promiscuous intimacy of cattle.[59] Of these inmates it is nearly
superfluous to observe, that in all offices of nature they are
gregarious and public; that every instinct of personal or sexual decency
is stifled; that every nakedness of life is uncovered there. Such an
apartment is commonly hired in the first instance by a single pair, who
sub-let a participation in the shelter, probably to as many others as
apply. Sometimes a noxious occupation is carried on within the space:
thus, I have seen mud-larks (_chiffonniers_) sitting on the floor with
baskets of filth before them, sorting out the occasional bit of coal or
bone, from a heterogeneous collection made along the bed of the river,
or in the mouths of the sewers; and this in a small room, inhabited
night and day by such a population as I have described.

  [59] I purposely refrain from any attempt to illustrate all the
  horrors which are incidental to this method of life; but, as a single
  exemplification of the text (chosen, not because of its rarity, but
  because it happens to occur at the moment) I insert an extract from a
  note, with which I was favoured a fortnight ago, by Mr. Hutchinson,
  Surgeon to the North District of the West London Union: ‘I was sent
  for to attend a poor Irish woman in labour, at half-past six o’clock
  yesterday morning, at 17, Fox and Knot court. There were three
  families, each consisting of a man and wife and two or more children,
  in a small room, 15 feet by 8, all lying upon dirty rags on the floor.
  I found one of the children suffering under small-pox. The adjoining
  room was occupied by six grown-up persons and two children.’ In the
  circumstances to which my Report refers, scenes of this description
  must of necessity be _habitual_: and it is to their habit, not to
  their exceptional occurrence, that my remarks apply.

Who can wonder at what becomes, physically or morally, of infants
begotten and born in these bestial crowds?

In my former Report, I drew your attention to this pestilential heaping
of human beings, and suggested to you its results; and on many
occasions, during the past year, complaints have been before your Hon.
Court which have had their real origin in this uncontrolled evil. I
revert to it because of its infinite importance. While it maintains
physical filth that is indescribable, while it perpetuates fever and the
allied disorders, while it creates mortality enough to mask the results
of all your sanitary progress, its moral consequences are too dreadful
to be detailed. I have to deal with the matter only as it relates to
bodily health. Whatever is morally hideous and savage in the
scene--whatever contrast it offers to the superficial magnificence of
the metropolis--whatever profligacy it implies and continues--whatever
recklessness and obscene brutality arise from it--whatever deep injury
it inflicts on the community--whatever debasement or abolition of God’s
image in men’s hearts is tokened by it--these matters belong not to my
office, nor would it become me to dwell on them. Only because of the
physical sufferings am I entitled to speak; only because pestilence is
for ever within the circle; only because Death so largely comforts these
poor orphans of civilisation. To my duty it alone belongs, in such
respects, to tell you where disease ravages the people under your
charge, and wherefore; but while I lift the curtain to show you this--a
curtain which propriety might gladly leave unraised, you cannot but see
that side by side with pestilence there stalks a deadlier presence;
blighting the moral existence of a rising population; rendering their
hearts hopeless, their acts ruffianly and incestuous; and scattering,
while society averts her eyes, the retributive seeds of increase for
crime, turbulence, and pauperism.

While I refer to these painful topics, I may remind your Hon. Court of
the Report of your Committee on Health, in respect of the same heads in
my previous communication, and may strengthen myself with their
testimony: ‘We feel it due to Mr. Simon to add, from the result of
personal investigation, that the statements contained in his Report
under this subject, distressing as they are, are not exaggerated:’ and,
as regards whatever I may have recapitulated from that Report, I would
beg leave to add, that my experience during the past year has confirmed
the opinions which I then expressed; assuring me more and more, that the
correction of these crying evils must advance simultaneously with the
other labours of sanitary reform.

Recently, while having the honour to attend your Committee of Health in
their deliberations on your Act of Parliament, I have submitted to them,
as my view of what is desirable for legislation on the subject of my
present section, substantially the same suggestions as I formerly laid
before your Hon. Court. As their recommendations must shortly come
before you for consideration, and as I entertain the deepest conviction
that the subject is of paramount importance to the cause in which you
are interested, I have hoped you would excuse my recurrence to it, and
my brief repetition of those suggestions which the incompleteness of
your Act of Parliament has hitherto prevented your adopting.

1. There are within the City some blocks of houses which are, I fear,
irremediably bad and pestilential from such errors of construction as I
have already described; and which, further, are so dilapidated, as to
show at a glance their little pecuniary value. In many instances the
destruction of such a block of houses would confer a sensible advantage
on the population of a considerable district. Of this class I could
hardly give you a better illustration than would be seen in the
ground-plan of Seven-step alley. There are other instances (frequent in
Cripplegate) where the removal of a single house at the extremity of a
court or passage would make a material difference to the ventilation of
several houses, and to the health of a numerous population.

2. Again, in very many parts of the City, you find illustrations of a
constructional error to which I have adverted as in the highest degree
pernicious to health. You find a number of courts, probably with very
narrow inlets, diverging from the open street in such close succession,
that their backs adjoin with no intermediate space whatsoever.
Consequently, each row of houses has but a single row of windows, facing
into the confined court; and thus there is no possibility of
ventilation, either through the court generally, or through the houses
which compose it. In the Out-Wards of Cripplegate, Farringdon, and
Bishopsgate, examples of this arrangement are both most numerous, and I
believe, most removable: but they may likewise be found in considerable
numbers in the In-Wards of the City; _e.g._, in the neighbourhood of
Printing-house-square, of Great Bell-alley, of Leadenhall-street, of
Aldgate, of Skinner-street, and of St. Martin’s-le-Grand.

In many of these cases, if the management of the property were under a
single control, it is possible that effectual relief might be given, by
converting any two rows of houses which are back to back, each having
windows only on one side, into a single row of houses, with doors and
windows both before and behind: and if changes of this nature were
accompanied by the removal of an occasional house, or other impediment
to the circulation of air, I would guarantee to your Hon. Court that the
next year’s register would show a very large diminution in the local
amount of preventable sickness and mortality.

3. In other cases, the immediate impediment to ventilation apparently
consists in the operation of the window-tax. Your Hon. Court, at various
times, has heard how unfortunate for the health of cities is this
ill-chosen method of taxation, assessing the amount of rate for houses
in proportion to their means of ventilation. You can easily conceive how
much it would impede your endeavours to promote health and cleanliness
within the City, if an additional direct tax were levied on houses by
reason of their _drainage_; or if the assessor regulated his rate
according to the _consumption of water_ for household purposes. The
working of the window-tax is on this principle; and although it may be
very true that health is the greatest of treasures, and that, on this
ground, its means and appliances are eligible for taxation, I cannot but
regret that a struggling population should be tempted by the hope of
some small saving, to make a sensible diminution in their chances of
life, by retrenching within the narrowest measures their inlets of
ventilation and light.

       *       *       *       *       *

In reference to the more important constructional errors which I have
described to you, as affecting the courts and alleys of the City, it
will be obvious, from the remedies which I have suggested, that no hope
of alteration can be expected from landlords. To throw together the
adjoining houses of two different courts, or to remove one house for the
advantage of certain others, or to destroy a whole block of houses for
the sake of its neighbourhood, could evidently be undertaken, as a
matter of private enterprise, only where property of very considerable
extent, and close juxtaposition, happened to be in the hands of a single
individual; and, as regards the City of London, this is rarely or never
the case. The only manner, then, it occurs to me, in which the requisite
remedies could be applied, would be through the wealth and benevolence
of the Corporation. If there were vested in your Hon. Court (or in any
other authority of the Corporation) the power to make compulsory
purchases of house-property, on the ground of its unfitness for human
habitation, it would be easy to correct the extreme errors which exist;
and, under a single large landlordship of this nature, it might not
improbably be found that measures such as I have described would give to
the localities in which they might be effected as much improvement in
value as in health. After the necessary alterations, such houses would
no longer need to continue under tenure of the Corporation, and the
proceeds of their sale might again be applied to the reclamation of
similar property in other parts of the City.

In throwing out this suggestion to your Hon. Court, I, of course, do not
pretend to offer you any details for its realisation. These can more
fitly be supplied by others; nor should I have introduced even this
general mention of a plan, but for the vividness with which its
practicability and usefulness have struck me. During my period of
office, I have seen distinctly that what seems incurable in the dark
intricacies of our worst courts and alleys often depends for its
difficulty on the _number_ of landlords, and on their mutual
independence. The conviction had thus been forced on me, which I have
endeavoured briefly to express to you; that the only available cure for
such evils would consist in the Corporation assuming to itself (if only
for a time, and in gradual succession) the proprietage of such wretched
tenements, and fulfilling towards them those large and liberal duties
of landlordship, which now remain unperformed through the multiplicity
and neediness of petty owners. And, as a precedent for one species of
such improvement, I may mention to your Hon. Court, that in such
property as I have described to you, situated in other parts of the
metropolis, private societies have already effected purchases which have
enabled them to convert bad and unwholesome residences into the form of
model lodgings for the working classes.

Before leaving the consideration of evils, in which over-density of
building and defective ventilation form such important parts, I would
avail myself of the opportunity to observe, that it is of incalculable
importance to preserve, for the health of the City, every open space
which at present exists. The density of buildings within the City of
London Union is very great, and in the East and West London Unions, is
very considerably greater than in any other part of the metropolis; and
not merely are the houses closely packed together, but (as I have
already described them) very thickly inhabited. Within the City of
London Union, each human being, on an average, has less than an eighth
part of the space he would have if residing in the district of
Islington; and, small as is this pittance, it is more than double what
he would enjoy if he were living in the district of the East and West
London Unions. With such density of population, it would, of course, be
advantageous if any space now occupied by buildings should hereafter
become vacant, so as to increase the breathing-room of the
neighbourhood; and your Hon. Court will see the imperative necessity of
discountenancing, so far as may be, the erection of additional houses on
the few unoccupied spaces which remain. In order to do this effectually,
it would be desirable to procure the enactment of a clause, giving you
absolute prohibiting power in this respect, whenever, for sanitary
reasons, you might think it right to interfere.

With respect to those evils which I have set before you, as arising from
the unrestricted accumulation of persons of both sexes, and of all ages,
within a single sleeping-room--dreadful as they are, I do not consider
them irremediable. In the first place, I would beg you to observe, that
the very restricted definition of a ‘lodging-house’ given in your Act of
Parliament, has hitherto rendered it impossible, in any degree, to
regulate dwellings of the description referred to. An amendment of that
definition might bring them within your control, and might enable you,
not only in these instances, but in many others, to restrict the numbers
of inmates, to compel the removal of persons with infectious disease,
and to enforce provisions of decency, cleanliness, and ventilation.

Not, however, alone to restrictive and compulsory measures do I look for
the social improvement of numbers, now so destitute and miserable. That
our entire industrial population within the City might, in such
respects, gain great advantage from an enlightened supervision and
guidance, I formerly endeavoured to show. I sought (from other
experience) to illustrate the benefits they would derive, not only from
your exercising habitual inspection, and possessing a more extensive
control, in many matters relative to their dwellings and mode of life;
but likewise, from the establishment, under the auspices of the
Corporation, of institutions which, raising before them a higher
standard of civilisation, would improve their social habits by an
indirect educational influence, and would elevate the general tone and
character of their class.

On the subject of Model Dwellings for the labouring classes, and of
Public Baths and Wash-houses, as illustrating this view, I dwelt at some
length in my former Report; and, deeply convinced of the boon which
their establishment would confer on the poor, I explained, to the best
of my ability, the nature and the extent of their usefulness.

I now recur to the subject, only that I may repeat my profound
conviction of its importance; and that in doing so, I may congratulate
your Hon. Court, and may utter my deep thankfulness for the labouring
and suffering poor of this great community, that, in compliance with the
Standing Orders of Parliament, formal notice has been given on the part
of the Corporation of the City of London, of their intention, in the
approaching session of the Legislature, to apply for authority which may
enable them to achieve, for their dependent fellow-citizens, this almost
incalculable good.[60]

  [60] The intention of the Corporation, here spoken of, has not
  hitherto been carried into effect.--J. S., 1854.

I cannot too strongly express the importance I attach to this implied
intention of the Corporation, to establish model dwellings for the
industrial population of the City. But the first and immediate operation
of such an Act will, from the nature of things, hardly reach to those
very destitute and degraded classes of which I have spoken. Model
lodgings of the ordinary character will become the residence of men, who
now pay from two to five shillings a week for such space as they occupy,
and who have the habit of sleeping in beds. To them the gain will be
very great; and the example of improved domestic habits will be
beneficial to their entire class. But among the lowest order which I
have described to you, as it subsists in thronged and pestilent heaps
within your worst quarters, there is little knowledge of beds. The first
hirer of the room may possibly have a pile of rags on which he lies,
with his wife and children, in one corner of the tenement; but the
majority of his sub-tenants (paying for their family-lodging from
sixpence to ten-pence a week) lie on straw, or on the bare boards. It
will be obvious to you, that no _Model_ Lodging-house could be reduced
to the level of their means. By those restrictions to which I have
adverted, something may be done, no doubt, for improving the arrangement
of houses so tenanted--something to prevent the more glaring outrages of
decency which at present prevail--something to maintain comparative
cleanliness, and to check the spread of disease. I fear that no further
remedy than this would prove effectual, unless it were universal for the
metropolis. Unquestionably, it would be possible, with persons even of
the lowest sort above pauperism, to proceed on the same principle as in
the establishment of model-lodgings for the working orders; to provide
for them, namely, under respectable control and supervision, the best
accommodation which their price could purchase, of the kind to which
they have been habituated; to give them the means of lying down, free
from damp or cold, partitioned from one another, and with isolation of
sexes, in a building constructed or arranged for the purpose, where the
ventilation and the facilities for cleanliness might be complete. There
seems little room to doubt that this might be done, on a very large
scale, at a rate considerably less than the poorest now pay for the
right of lairage amid vermin, filth, obscenity, and fever; and with such
dormitories, obviously, there might be connected other arrangements for
giving comfort and cleanliness to the very poor and destitute, at the
lowest possible price. Of gratuitous reception I do not speak, because
that is already provided, under certain regulations, in all the
work-houses of the metropolis. But while I conceive that such a measure,
if generally adopted throughout London, would defray its own cost, and
would remove evils and miseries horrid to contemplate, I cannot but feel
that it would be inadmissible (in its cheapest form) as a local measure.
For if the price of reception--for instance, here, were so low as to
allure the wretched population in question from their places of present
resort within the City, it cannot be doubted that its influence would
extend beyond your jurisdiction, and would throng your dormitories with
the destitute of other districts. As the evil is metropolitan, so ought
the remedy to be; and if there were thus instituted within each Union of
the metropolis, a _Ragged Dormitory_ of the nature described, I am
persuaded, from my knowledge of the poorest classes, that its
establishment would be of infinite advantage in improving the habits,
and diminishing the mortality of those who would become its inmates.


III. SUGGESTED ALTERATIONS IN THE ACT OF PARLIAMENT.

Finally, gentlemen, considering that you are about to procure a renewal
of your Act of Parliament, and that you contemplate strengthening it
with such additional clauses as may render it effective for the
eradication of all preventable disease within the City of London, I
would ask permission, in this point of view, to submit to you in a
connected series, such modifications as in my judgment would contribute
to that purpose. Most of these I have already had the advantage of
suggesting to your Committee on Health; and to many of them I have
adverted by anticipation, in previous passages of my Report. I would beg
to enumerate the _desiderata_ under the following heads, _viz._

1. A clause, which would give you control over the supply and
distribution of water, would enable you in your corporate capacity to
contract with any person or any company for the total service of the
City; and would authorise you to defray the expenses of such contract by
certain specified rates.

2. A clause empowering you to require, that every trade or manufacture
practised within the City shall be carried on with such precautions, and
with such available improvements, from time to time, as shall reduce to
the lowest practicable amount whatever nuisance or inconvenience to the
neighbourhood is apt to arise therefrom.

3. Such change in the definition affixed to your 91st clause as would
render this operative for the regulation and improvement of a larger
number of houses; and such addition to the clause as would enable you,
on the joint certificate of your Officer of Health and Surveyor, to
enforce the making of additional windows, where requisite for the proper
ventilation of houses.

4. A clause permitting and empowering you, on sufficient medical
testimony, to remove, or to call upon the Board of Guardians to remove,
from any lodging-house, within the new definition of your Act, any
person diseased with fever or other infectious malady, whose continuance
there would endanger the lives of other inmates.

5. A clause prohibiting the occupation of under-ground cellars for the
purposes of dwelling.

6. A clause prohibiting the keeping of cattle in or under
dwelling-houses.

7. A clause vesting in the Commission a right to purchase houses by jury
valuation, in any case where they shall determine that such houses are
permanently unwholesome and unfit for human habitation, or that their
alteration or removal is necessary for the public health.

8. A clause enabling the Commission to control all further encroachments
on spaces which are now open within the City; so that on ground now
unoccupied by buildings, no future erection shall be made, except with
the sanction of the Commission.

9. A clause to protect the purity and wholesomeness of human food, as
sold within the City, by affixing penalties to its exposure for sale in
any adulterated, decayed, or corrupted condition, which may impair its
fitness for consumption.

These are the heads under which it has appeared to me that the most
useful additions might be made to your Act of Parliament, in matters
within the scope of my official observation. There are some other minor
modifications, which I have submitted to your Committee of Health, and
which, as they relate merely to detail, it is unnecessary for me to
bring before you. All the recommendations which I have made on this
subject result from a careful scrutiny of the operation of your present
Act, during the two years that I have had the honour of serving you.
Each separate paragraph of my enumeration founds itself upon a distinct
recollection of occasions, sometimes numerous, wherein, for want of such
enactments, nuisances which you were anxious to suppress have eluded
your authority, or advantages which you were desirous to realise have
stood beyond your attainment.

It was in the nature of things that this should be so; for the period
has been one of experiment. When the City Sewers Act became law for a
period of two years, every one interested in its success must have felt
the advantage of that limited duration, and have rejoiced in the
opportunity, thus afforded, of rendering it eventually the most perfect
embodiment of sanitary law.

Parts of the Act have abundantly fulfilled your intention. In the
all-important particular of house-drainage--in the enforcement of
water-supply, so far as circumstances rendered possible--in the
effective preservation of exterior cleanliness--in the abatement of
innumerable nuisances--in the provision and maintenance of sewerage and
paving and lighting throughout the City--the public has seen your Hon.
Court exercising very large powers with very unusual success. And this,
let me add, during a time of no ordinary difficulty: a time when, day by
day, the vast importance of sanitary improvement has been gaining ground
among the educated classes of the country, as a deep and settled
conviction; a time when the feelings of all classes have been powerfully
excited, and when the metropolis especially has been convulsed with
alarm, in the anticipation and in the aspect of a pestilence.

In some other respects the Act has been less operative, and for an
obvious reason. To legislate for health was new to you. It was only
through the gradual investigation of officers, appointed under the Act,
that you could become adequately informed of those sanitary requirements
on which your ultimate legislation for the City must found itself. Only
by their slow experience, only by failure as well as by success, was it
possible that correct knowledge could be obtained of the powers really
needful for fulfilling your sanitary intentions.

In carefully watching the fluctuations of health amid your population;
in investigating the causes which determine them; and in testing, on
every occasion, how far these causes are amenable to the control of your
Act of Parliament, I have arrived at the conclusions submitted to you in
the present and in my previous Report.

       *       *       *       *       *

To excuse the length at which I have addressed you, I have but another
word to say. My apology consists in the assurance, which again I lay
before you, that in spite of all your exertions, untimely and
preventable death still prevails most largely in the population under
your charge. If the deliberate promises of Science be not an empty
delusion, it is practicable to reduce human mortality within your
jurisdiction to nearly the half of its present prevalence.

It is the sad prerogative of my Profession to have such knowledge of
death as cannot lie within your experience. Knowing all that is implied
in each one separate instance of its visitation--how much pain and
sorrow, often how much bereavement and destitution, we, perhaps better
than others, learn to appreciate that vast amount of social misery which
has its symbol in the high death-rate of a population. It is from this
practical point of view that I have ever estimated the importance of
your functions, and have fixed the obligations of my own humbler office.
Notwithstanding all that Medicine can achieve, to succour the body as it
struggles against actual disease--notwithstanding those resources of
drugs and handicraft, by which the physician or surgeon opposes death or
mitigates pain in the detailed exercise of his art, all past experience,
and every transaction of our daily practice, confirm the popular adage
that _prevention is better than cure_. If this be true in any particular
case, much more is it true in the largest application. While _Curative
Medicine_--ministering step by step to the individual units of a
population, can produce only minute and molecular changes in the health
of society; Sanitary Law, embodying the principles of _Preventive
Medicine_, may ensure to the aggregate masses of the community
prolongation of life and diminution of suffering: in the working of some
single enactment, it may affect the lives of generations of men, and may
moderate in respect of millions the sources of orphanage and poverty.

Surely, it is no common epoch in the history of the metropolis when you
are appealing to the Legislature, on behalf of the Corporation, for the
grant of additional powers towards the accomplishment of so great a
beneficence. To me it has always been an act of the deepest and most
anxious responsibility to address you; and it would ill have become me
now, in the attempt to discharge so grave a duty, if I had spared any
pains or withholden any conviction.

While endeavouring in this, and in my previous Report, faithfully and in
detail to depict for you the actual condition of human life within the
City, and while seeking to deduce for you, from reason and experience,
those sanitary principles which are applicable for its improvement, I
have had no trivial or easy task; and you will pardon me, I hope, both
if I have incompletely surmounted the difficulties of so large a
subject, and if, by the length of my Report, I have made too great
claims on your indulgence.

  I have the honour to remain,

  &c., &c.

Note to Column I.

  Speaking generally, this column may be taken to express the number of
  houses in each Ward. Exception must be made, however, in respect of
  the four wards marked with asterisks; for in them the real number of
  houses somewhat exceeds the number of assessments. This discrepancy
  depends on the fact that, in the specified wards, a court containing
  several houses is often assessed by composition as a single property.
  Mr. Daw informs me that in order to correct on this score the numbers
  which stand opposite the Wards in question, addition should be made as
  follows:--to Bishopsgate Without, 80--raising its number to 1100; to
  Cripplegate Without, 150--raising its number to 1112; to Farringdon
  Without, 100--raising its number to 3633; to Portsoken, 150--raising
  its number to 1408. This would raise the total number to 16,384, which
  is about the estimated number of houses in the City. From the results
  of the last census it appeared that the population of the City was
  distributed as follows:--within the district of the City of London
  Union on an average of 7·1 persons to each house; within the district
  of the East and West London Unions on an average of 8·8 persons to
  each house.

_Comparative prevalence, in the several Wards of the City, of such
Deaths as particularly depend on local circumstances._

  +-------+--------------------+--------+---------+---------+---------+
  |   I.  |        II.         |  III.  |   IV.   |    V.   |   VI.   |
  |       |                    |        |         |         |         |
  |Number |      WARDS         |Total   |Separate |Cholera, |Fever,   |
  |of     |                    |for the |Totals of|Dysen-   |_&c._    |
  |Assess-|                    |biennial|the two  |tery,    |Year     |
  |ments. |                    |period, |years    |Epidemic |ending   |
  |       |                    |from    |ending   |Diarrhœa.|Sept.    |
  |_vide_ |                    |Oct. 1, |respec-  |Year     |         |
  |Note.  |                    |1848, to|tively   |ending   |         |
  |       |                    |Sept.   |Sept. 29.|Sept.    |         |
  |       |                    |28,     |         |         |         |
  |       |                    |1850.   |         |         |         |
  |       |                    |        |         |         |         |
  |       |                    |        |         |         |         |
  |       |                    |        |1849|1850|1849|1850|1849|1850|
  +-------+--------------------+--------+----+----+----+----+----+----+
  |    184|Aldersgate Within   |     30 |  15|  15|   1| ...|   1|   1|
  |    572|Aldersgate Without  |    179 | 122|  57|  32|   4|  15|   5|
  |    809|Aldgate             |    102 |  66|  36|   3|   1|   7|   7|
  |    133|Bassishaw           |      7 |   5|   2|   3| ...| ...|   1|
  |    314|Billingsgate        |     33 |  28|   5|  15| ...|   2| ...|
  |    334|Bishopsgate Within  |     60 |  43|  17|  20| ...|   1|   3|
  |  *1020|Bishopsgate Without |    329 | 231|  98|  88|   7|  18|  13|
  |    251|Bread Street        |     22 |  16|   6|   2| ...|   3| ...|
  |    205|Bridge              |     18 |  12|   6|   4| ...| ...| ...|
  |    536|Broad Street        |     42 |  29|  13|   7| ...|   4|   1|
  |    194|Candlewick          |     13 |  12|   1|   7| ...| ...| ...|
  |    499|Castlebaynard       |    103 |  75|  28|  28| ...|   5|   5|
  |    341|Cheap               |     32 |  22|  10|   4|   1|   3| ...|
  |    626|Coleman Street      |     66 |  42|  24|   1|   3|   8|   3|
  |    294|Cordwainer          |      5 |   5| ...|   2| ...| ...| ...|
  |    158|Cornhill            |      4 |   2|   2| ...| ...| ...| ...|
  |    471|Cripplegate Within  |     80 |  50|  30|   8| ...|   4|   1|
  |   *962|Cripplegate Without |    299 | 207|  92|  86|  11|  15|   6|
  |    232|Dowgate             |     25 |  20|   5|  12| ...| ...| ...|
  |    961|Farringdon Within   |    153 | 117|  36|  67| ...|   9|   4|
  |  *3533|Farringdon Without  |    845 | 613| 232| 370|  19|  48|  40|
  |    409|Langbourn           |     29 |  12|  17|   3|   1|   1|   2|
  |    166|Lime Street         |      8 |   4|   4|   1| ...| ...| ...|
  |  *1258|Portsoken           |    143 |  82|  61|  29|   5|   7|  14|
  |    343|Queenhithe          |     59 |  36|  23|  14|   1|   2|   4|
  |    611|Tower               |     46 |  22|  24|   9| ...|   4|   3|
  |    253|Vintry              |     14 |  11|   3|   5| ...|   2|   1|
  |    235|Walbrook            |     24 |  15|   9|   3|   1| ...|   2|
  |       |City of London Union|     25 |  18|   7|   1| ...|   7|   2|
  +-------+--------------------+--------+----+----+----+----+----+----+
  |  15904|The Deaths from all}|        |    |    |    |    |    |    |
  |    480|causes within same }|   2795 |1932| 863| 825|  54| 166| 118|
  |-------|period were 6551   }|        |    |    |    |    |    |    |
  |  16384|                    |        |  2795   |   879   |   284   |
  +-------+--------------------+--------+---------+---------+---------+

  +-------+--------------------+---------+---------+---------+---------+
  |   I.  |        II.         |   VII.  |  VIII.  |   IX.   |    X.   |
  |       |                    |         |         |         |         |
  |Number |      WARDS         |Small    |Erysipe- |Scarlet  |Diarrhœa,|
  |of     |                    |Pox,     |las,     |Fever,   |Pneumo-  |
  |Assess-|                    |_&c._    |Puerp.   |Cynanche |nia, &   |
  |ments. |                    |Year     |Fever,   |Maligna, |Bronchi- |
  |       |                    |ending   |Pyæmia,  |_&c._    |tis of   |
  |_vide_ |                    |Sept.    |_&c._    |Year     |Infants. |
  |Note.  |                    |         |Year     |ending   |Year     |
  |       |                    |         |ending   |Sept.    |ending   |
  |       |                    |         |Sept.    |         |Sept.    |
  |       |                    |         |         |         |         |
  |       |                    |         |         |         |         |
  |       |                    |         |         |         |         |
  |       |                    |1849|1850|1849|1850|1849|1850|1849|1850|
  +-------+--------------------+----+----+----+----+----+----+----+----+
  |    184|Aldersgate Within   | ...| ...| ...|   1|   4|   2|   3|   7|
  |    572|Aldersgate Without  |   1|   5|   4|   3|  14| ...|  27|  12|
  |    809|Aldgate             |   2| ...|   2|   2|   5|   2|  18|   9|
  |    133|Bassishaw           | ...| ...|   1| ...| ...| ...| ...| ...|
  |    314|Billingsgate        | ...| ...|   2| ...|   3| ...|   2|   1|
  |    334|Bishopsgate Within  | ...| ...|   1|   1|   2| ...|   3|   5|
  |  *1020|Bishopsgate Without |   4|   5|   3|   5|  10|   3|  41|  19|
  |    251|Bread Street        | ...| ...|   1|   1| ...| ...|   6|   3|
  |    205|Bridge              | ...| ...| ...|   1|   2|   1|   3|   1|
  |    536|Broad Street        | ...| ...|   1| ...|   3|   3|   4|   6|
  |    194|Candlewick          | ...| ...| ...| ...| ...| ...| ...| ...|
  |    499|Castlebaynard       |   1| ...|   1| ...|   4| ...|   6|  11|
  |    341|Cheap               | ...| ...|   2|   1|   2| ...|   5|   3|
  |    626|Coleman Street      | ...| ...|   2| ...|   3| ...|  10|   9|
  |    294|Cordwainer          | ...| ...| ...| ...| ...| ...| ...| ...|
  |    158|Cornhill            | ...| ...| ...| ...| ...| ...|   2| ...|
  |    471|Cripplegate Within  | ...| ...|   2|   2|   3| ...|  12|   8|
  |   *962|Cripplegate Without |   3|   7|   3|   3|  17| ...|  33|  29|
  |    232|Dowgate             | ...|   2| ...| ...|   1|   1|   2| ...|
  |    961|Farringdon Within   |   1|   1|   1|   1|   4|   1|  15|  17|
  |  *3533|Farringdon Without  |   2|  10|  13|  12|  34|  10|  56|  72|
  |    409|Langbourn           |   1| ...| ...|   2|   1|   1|   1|   2|
  |    166|Lime Street         | ...| ...| ...| ...| ...| ...|   1|   1|
  |  *1258|Portsoken           | ...|   2|   2|   1|   9|   1|  14|  10|
  |    343|Queenhithe          |   2|   1|   1|   1|   7|   2|   5|   4|
  |    611|Tower               | ...| ...|   1|   3|   1|   2|   3|   8|
  |    253|Vintry              | ...| ...| ...| ...|   1| ...|   1| ...|
  |    235|Walbrook            | ...| ...| ...| ...|   2|   2|   4|   3|
  |       |City of London Union| ...| ...|   1| ...|   2|   1|   3|   3|
  +-------+--------------------+----+----+----+----+----+----+----+----+
  |  15904|The Deaths from all}|    |    |    |    |    |    |    |    |
  |    480|causes within same }|  17|  33|  44|  40| 135|  32| 285| 243|
  |-------|period were 6551   }|    |    |    |    |    |    |    |    |
  |  16384|                    |    50   |    84   |   167   |   528   |
  +-------+--------------------+---------+---------+---------+---------+

  +-------+--------------------+---------+---------+
  |   I.  |        II.         |   XI.   |   XII.  |
  |       |                    |         |         |
  |Number |      WARDS         |Infantile|Hydro-   |
  |of     |                    |Zymotic  |cephalus,|
  |Assess-|                    |Dis.     |Convul-  |
  |ments. |                    |Hooping- |sions,   |
  |       |                    |cough,   |_&c._    |
  |_vide_ |                    |Croup,   |Year     |
  |Note.  |                    |Measles, |ending   |
  |       |                    |_&c._    |Sept.    |
  |       |                    |Year     |         |
  |       |                    |ending   |         |
  |       |                    |Sept.    |         |
  |       |                    |         |         |
  |       |                    |1849|1850|1849|1850|
  +-------+--------------------+----+----+----+----+
  |    184|Aldersgate Within   |   2|   2|   4|   2|
  |    572|Aldersgate Without  |  13|   9|  16|  19|
  |    809|Aldgate             |   9|   5|  20|  10|
  |    133|Bassishaw           | ...| ...|   1|   1|
  |    314|Billingsgate        |   4| ...| ...|   4|
  |    334|Bishopsgate Within  |   6|   5|   5|   3|
  |  *1020|Bishopsgate Without |  32|  15|  35|  31|
  |    251|Bread Street        | ...| ...|   4|   2|
  |    205|Bridge              |   2|   1|   1|   2|
  |    536|Broad Street        |   7|   1|   3|   2|
  |    194|Candlewick          |   2| ...|   3|   1|
  |    499|Castlebaynard       |  10|   5|  20|   7|
  |    341|Cheap               | ...|   2|   5|   3|
  |    626|Coleman Street      |   6|   2|  12|   7|
  |    294|Cordwainer          | ...| ...|   3| ...|
  |    158|Cornhill            | ...|   1| ...|   1|
  |    471|Cripplegate Within  |   7|   7|  14|  12|
  |   *962|Cripplegate Without |  31|  15|  19|  21|
  |    232|Dowgate             |   1|   1|   4|   1|
  |    961|Farringdon Within   |   9|   2|  11|  10|
  |  *3533|Farringdon Without  |  33|  31|  57|  38|
  |    409|Langbourn           |   3|   2|   2|   7|
  |    166|Lime Street         | ...|   2|   2|   1|
  |  *1258|Portsoken           |  12|  10|   9|  18|
  |    343|Queenhithe          |   4|   4|   1|   6|
  |    611|Tower               | ...|   1|   4|   7|
  |    253|Vintry              |   1| ...|   5|   2|
  |    235|Walbrook            |   1|   1|   5| ...|
  |       |City of London Union|   1| ...|   3|   1|
  +-------+--------------------+----+----+----+----+
  |  15904|The Deaths from all}|    |    |    |    |
  |    480|causes within same }| 196| 124| 264| 219|
  |-------|period were 6551   }|    |    |    |    |
  |  16384|                    |   320   |   483   |
  +-------+--------------------+---------+---------+

  Letter by Mr. THOMAS TAYLOR, Lecturer on Chemistry at the Medical
  School of the Middlesex Hospital, on the Chemical Qualities of certain
  Waters.

  4, Vere-street, Oxford-street,
  November, 1850.

  DEAR SIR,

  Having, by your desire, submitted the following samples of water to
  chemical analysis, I now beg leave to lay before you the result; and
  also, at the same time, to reply to certain questions which you
  likewise proposed.

  The samples of water taken for examination were derived from the
  following sources:--

  A. Water supplied by the New River Company.

  B. Water supplied by the East London Company.

  C. Water from a spring in the neighbourhood of Haslemere, Surrey.

  D. Water from a well in Bishopsgate-street.

  A. This water was taken from an upright pipe in a court-yard of the
  Guildhall. It was slightly opalescent, inodorous, and tasteless;
  numerous small particles floated in it, which took a considerable time
  to subside. The matter deposited was of a rust colour, and consisted
  of peroxide of iron, with a little sulphate and carbonate of lime, and
  organic matter. It is to be observed that, as the water from this pipe
  is seldom used, these impurities collect in the pipe, and are
  therefore in some measure accidental, although, prior to collecting
  the water, a considerable quantity had been allowed to run away. The
  water was allowed to free itself from these impurities by subsidence,
  before being submitted to analysis.

  By evaporation to dryness, an imperial gallon left a solid residue,
  weighing 17·33 grs., which consisted of--

  Carbonate of lime, with a little oxide of iron      11·12
  Carbonate of magnesia                                0·60
  Sulphate of lime                                     1·56
  Chloride of sodium                                   2·40
  Silicic acid                                         0·37
  Organic matter                                       1·19
                                                      -----
                                                      17·24

  When heated, this water became turbid; and, by continued boiling for
  two hours in an apparatus so arranged that the whole of the steam was
  condensed and returned to the water, 10·95 grs. of the earthy
  carbonates, coloured by oxide of iron, were deposited.

  The relative hardness of this water, as determined by the soap test,
  distilled water being taken as unity, was 13·3.

       *       *       *       *       *

  B. The second sample of water was taken from a small tap in the house
  of Mr. Hall, Bishopsgate-street. The tap was attached to the main.

  This water was without smell or taste, and free from floating matter.
  After standing some time, it deposited a very small quantity of oxide
  of iron. Although clear and transparent, it was not bright.

  It contained 19·10 grs. of solid matter in the imperial gallon. The
  solid matter consisted of--

  Carbonate of lime, with a little oxide of iron      14·58
  Carbonate of magnesia                                0·44
  Sulphate of lime                                     1·54
  Chloride of sodium                                   1·71
  Silicic acid                                         0·32
  Organic matter                                       0·72
                                                      -----
                                                      19·31

  Like the preceding water it became turbid when heated to the boiling
  point, and by continued ebullition for two hours, 12·90 grs. of
  carbonate of lime, coloured by oxide of iron, were precipitated.

  Hardness in reference to distilled water as unity = 19.

       *       *       *       *       *

  C. This water was taken by ourselves from a spring-head near
  Haslemere, Surrey. The spring issued from the foot of a low sand-hill
  covered with bushes, and was received into a natural basin about four
  or five feet in diameter, the bottom of which was lined with pebbles
  and small gravel. From this basin the water flowed into a large
  shallow pond.

  The temperature of the spring at its source was 49° Fahr., that of the
  air being 56° Fahr.

  This water was perfectly clear and brilliant, but not sparkling. It
  had no appreciable taste, but was peculiarly soft and agreeable. It
  did not contain carbonic acid in a free state, for when mixed with a
  solution of chloride of calcium and of ammonia not the slightest
  turbidity was produced. When boiled it did not lose its transparency,
  nor produce any deposit, until concentrated to about one-sixth of its
  volume, when glittering scales of hydrated silicic acid separated.

  An imperial gallon, when evaporated to dryness, left a solid residue,
  which weighed 5·24 grs.

  This residue was perfectly white when dried at 300° Fahr.; when heated
  to low redness, it charred slightly at the edges. The quantity of
  organic matter was therefore exceedingly small.

  Hardness in reference to distilled water as unity = 2·4.

  On analysis, an imperial gallon was found to contain--

  Carbonate of lime      2·00
  Chloride of sodium     1·46
  Sulphate of soda       0·407
  Silicic acid           1·143
  Organic matter         0·23
                         -----
                         5·24

  Traces of an alkaline nitrate were also detected.

  During the short visit I made with you to Farnham, we examined several
  other springs near to their sources. In their general characters these
  waters closely resembled the preceding sample, all of them being
  remarkably soft, clear, transparent, inodorous, and free from any
  excess of organic matter, or of oxide of iron.

  By your desire two samples were subsequently sent to me; one marked
  ‘Barford,’ the other ‘Boorley.’

  The water marked Barford contained 6·30 grs. of solid matter in the
  imperial gallon; when evaporated, scales of silicic acid separated
  from it in the same manner as from the water taken at Haslemere.
  Neither of these waters contained any trace of carbonic acid. Their
  relative hardness (distilled being unity) was--Barford 2·4, Boorley
  1·5.

       *       *       *       *       *

  D. The fourth sample of water was drawn from the pump near the church
  in Bishopsgate-street.

  This water was selected as exemplifying the general composition of the
  shallow well-water of the City of London, when the well is situated
  near to a burial-ground, as is frequently the case with the parochial
  wells.

  The water from this well is perfectly bright, clear, and even
  brilliant; it has an agreeable soft taste, and is much esteemed by
  the inhabitants of the parish, although, as will be seen by the
  subjoined analysis, it is an exceedingly hard water, and the large
  quantity of earthy salts it contains renders it unfit for all culinary
  and for most domestic purposes.

  When heated to the boiling point, this water becomes turbid, and by
  continued boiling of an imperial gallon of the water for two hours,
  23·03 grs. of solid matter were deposited, consisting of 22·15 grs.
  carbonate of lime, and 0·88 carbonate of magnesia, with a trace of
  phosphate of lime.

  An imperial gallon of this water, when evaporated to dryness and the
  residue dried at a temperature of about 300° Fahr., left a residue
  which amounted to 88·07 grs. From another sample of the same water
  taken a month afterwards, 84·53 grs. of solid residue were obtained.

  By an analysis, an imperial gallon of the water gave--

  Carbonate of lime          28·97
  Carbonate of magnesia       2·61
  Sulphate of lime           17·85
  Chloride of sodium         16·95
  Nitrate of potass          12·40
  Nitrate of soda             1·50
  Nitrate of magnesia         4·92
  Nitrate of ammonia          4·01
  Silica                      0·80
  Phosphate of lime         traces
  Organic matter
                            ------
                             90·01

  The residue left by evaporation was of a light brown colour; when
  calcined at a low red heat it became slightly charred; but I could
  not, with any degree of certainty, determine the precise quantity of
  organic matter it contained: it was certainly very small.

  The excess of solid matter, as shown by the analysis, over the
  quantity obtained by evaporating the water to dryness, is owing to the
  decomposition of the nitrate of ammonia.

  The quantity of alkaline and earthy nitrates in this water is very
  remarkable. These salts are doubtless derived from the decomposition
  of animal matter in the adjacent churchyard. Their presence, conjoined
  with the inconsiderable quantity of organic matter which the water
  contains, illustrates in a very forcible manner the power the earth
  possesses of depriving the water that percolates it of any animal
  matter it may hold in solution; and moreover shows in how complete and
  rapid a manner this process is effected.

  In this case the distance of the well from the churchyard is little
  more than the breadth of the footpath, and yet this short extent of
  intervening ground has, by virtue of the oxidizing power of the earth,
  been sufficient wholly to decompose and render inoffensive the liquid
  animal matter that has oozed from the putrefying corpses in the
  churchyard.

       *       *       *       *       *

  The result of these analyses confirms the general statement that the
  water derived from the sandy districts of Farnham and Bagshot is of
  eminent purity, and therefore peculiarly fitted for all those purposes
  of domestic and manufacturing economy which require the use of a very
  soft water.

  When regarded in conjunction with the analyses made by other chemists,
  of the water taken from the streams, pools, and other collections of
  water in the same locality, it also points out that, if it be
  desirable to secure the water in its utmost state of purity, it should
  be collected at its very source, before it has had time to become
  impregnated with the various mineral and saline ingredients of the
  different soils through which it would have to pass. The total absence
  of free carbonic acid in these waters is a very remarkable fact, and
  one which I believe has not been hitherto noticed.

  It will also be perceived that the principal solid constituent of the
  water supplied by the New River and the East London companies is
  carbonate of lime, held in solution by an excess of carbonic acid, an
  opinion already expressed by several chemists. These waters also
  contain an appreciable quantity of oxide of iron.

  When the water from these sources is boiled, or simply brought to the
  boiling temperature, the excess of carbonic acid is driven off, and
  the carbonate of lime being thus deprived of its solvent, the greater
  portion of it, together with the oxide of iron, is thrown down in the
  form of an insoluble crystalline powder, while the water is rendered
  comparatively soft and pure.

  Were it therefore possible that means could be devised by which the
  quantity of water necessary for the daily supply of London could be
  deprived of its excess of earthy carbonates in a manner sufficiently
  economic, comprehensive, and effectual, the citizens of the metropolis
  would enjoy the advantage of a tolerably pure soft water, free from
  those inconveniences which attend the use of the present hard-water
  supply.

  Confining myself wholly to a chemical view of the subject, the
  principal disadvantages attending the use of hard river waters are--

  First, The precipitation of earthy matter on the inside of vessels in
  which the water is heated. This furring of the vessel, as it is
  called, leads to its more rapid destruction, and has also the
  inconvenience of rendering it more difficult to cleanse, so that the
  flavour and odour of the various substances cooked in it are not
  readily removed. From the non-conducting power of the earthy crust, an
  increased consumption of fuel is also required for the due heating of
  the vessel.

  Secondly, The admixture of the earthy salts with the various articles
  of food submitted to the action of hot water.

  Thirdly, Diminished solvent power, as required for the purposes of the
  chemist, the brewer, and for many domestic purposes, as in the making
  of tea, soups, &c.

  Fourthly, Diminished cleansing power, both as regards the direct
  solvent action of the water, and also as causing the decomposition of
  soap, and consequent increased consumption of that article. I must,
  however, remark that the annual loss reported to arise from this cause
  appears to me considerably overrated, since water is rarely used for
  the washing of linen until previously boiled, and the common practice
  of adding carbonate of soda to the water completely destroys the ill
  effects resulting from the hardness of the water. The additional
  expense of the carbonate of soda, thus added, is too trifling to merit
  notice; but when this salt is used in excess, as is generally the
  case, it produces the more serious evil of materially impairing the
  strength of the fabric submitted to its action.

  The only real advantage which hard water possesses over soft (and in
  the present state of things one of considerable importance), is, that
  it does not act upon or erode the lead of the pipes and cisterns in
  which it is contained.

  There are also some particular cases of minor importance in which hard
  water is preferred; thus dyers prefer hard water for rinsing of their
  goods, soft water extracting too much of the colour; but these cases
  are comparatively rare, and might be easily accomplished by an
  artificial hardening of the water.

  The following Table indicates the relative hardness of the different
  waters as determined by the Soap test; distilled water being taken as
  unity, as proposed by Professor Brande. It also shows the effect of
  boiling in reducing the hardness of the water. The numbers express
  the direct quantity of an alcoholic solution of soap, which an equal
  bulk of each water requires in order to form a lather remaining
  permanent for from five to ten minutes.

  Distilled water                                 1·0
  Water from Haslemere                            2·4
             Boorley                              1·5
             Barford                              2·4
  Water of the New River Company                 13·3
    Ditto                 after being boiled      4·7
  Water of the East London Company               19·0
    Ditto                 after being boiled      5·6
  Water from the well in Bishopsgate-street      47·4
    Ditto                 after being boiled     26·0

  The experiments which I have recently made on the action of pure water
  upon lead, clearly point out the necessity of keeping the pipes always
  full, especially in those instances in which the water has a tendency,
  however slight, to erode the lead. As the importance of this part of
  the question does not appear to have been sufficiently appreciated by
  the advocates of a constant instead of an intermittent supply, I will
  briefly recount the facts of the case, although I do not offer them as
  presenting anything particularly novel. If a piece of bright lead be
  placed in a stoppered bottle, completely filled with recently
  distilled water, so that the access of air be wholly excluded, the
  lead is but very slightly acted upon, and it is only after the lapse
  of three or four days that its surface becomes spangled with a few
  minute crystals of carbonate of lead.

  If the stopper of the bottle be now removed, the lead still remaining
  beneath the surface of the water, the erosive action of the water on
  the lead proceeds more rapidly, but still slowly. But if now a portion
  of the water be poured off, so as to leave the lead only partially
  immersed, rapid action on the lead immediately commences. In the
  course of thirty-six or forty-eight hours, its surface becomes coated
  with crystalline scales of carbonate of lead, which, falling off, are
  succeeded by others, so that after the lapse of a few days an abundant
  deposit of carbonate and hydrated oxide of lead is found at the bottom
  of the vessel. If the experiment be made with distilled water that has
  been previously agitated with air, so as to completely aërate it, the
  lead is more rapidly acted upon, even in a closed vessel, thus clearly
  showing how much the action of the water upon the lead depends upon
  the presence or absence of atmospheric air.

  Now, in a minor degree, this is precisely what takes place in a leaden
  pipe conveying water capable of eroding lead. While the pipe is full,
  comparatively but little action occurs; but when the pipe is filled
  alternately with air and with water, it is placed under the most
  favourable circumstances to ensure a rapid erosion of its substance,
  and consequent contamination of the water.

  The rush of water necessarily produced by an intermittent flow must
  also detach portions of carbonate of lead from the sides of the pipe,
  even in those cases where the water has no very decided action on
  lead, and it is therefore far from improbable that in this manner the
  poison of lead is occasionally conveyed into our kitchens, and becomes
  mixed with our food.

  According to your desire, I have examined the action of the waters
  from the above-mentioned sources on clean lead, and have arrived at
  the following conclusions:--the water from Haslemere has a slow though
  decided action upon the metal, no effect taking place until the lead
  had been partially immersed for four or five days. After that time, a
  small deposit of carbonate of lead was perceptible at the bottom of
  the vessel, although none could be detected in solution. The absence
  of carbonic acid in the water from Haslemere, Boorley, and Barford,
  would in all probability prevent their acting upon lead, were
  atmospheric air at the same time excluded. A piece of lead that had
  been kept for a week in a closed bottle filled with water from
  Haslemere did not exhibit the least trace of carbonate of lead, nor
  could the presence of lead be detected in the water.

  It is scarcely necessary to add, that the water as drawn from the
  pipes of the New River and East London Companies does not exhibit the
  least solvent action upon lead; when, however, purified by boiling,
  and placed in contact with lead, crystals of carbonate of lead were
  observable after the lapse of three days in the water of the New River
  Company, while, owing to its greater hardness, the water of the East
  London Company did not exhibit any traces of carbonate of lead until
  the expiration of more than a week, and even then only in a slight
  degree. The same waters purified by the patented process of Clark did
  not exhibit so decided an action upon lead as when purified by
  boiling; but after evaporating to dryness the water in which lead had
  been immersed for three weeks, and dissolving the residue in dilute
  nitric acid, the presence of a minute quantity of lead was rendered
  evident.

  It therefore appears that if leaden pipes, and especially if leaden
  cisterns, are to be employed in the distribution and storage of water,
  on the system of interrupted supply, it will be a necessary safeguard,
  that the water thus conveyed and stored should not be of less hardness
  than from six to seven degrees, compared with distilled water as
  unity; and conversely, it also follows, that if the inhabitants of the
  metropolis are to gain the advantage of using a still purer and softer
  water, it will be requisite to do away with the existing leaden pipes
  and cisterns, and to substitute for them some material which shall not
  communicate any poisonous or noxious ingredient to the water. As
  matters now stand, we escape daily poisoning by the use of water
  loaded with earthy salts, and are thus compelled to drink an impure
  water on account of the impurity of our vessels. Would it not be
  better, and is it impossible, to drink the pure element from a pure
  cup?

  I remain, dear sir, with much respect,
  Yours obediently,

  THOMAS TAYLOR.

  To JOHN SIMON, Esq., F.R.S.,
  Officer of Health to the City of London.




THIRD ANNUAL REPORT.


  _November 25th, 1851._

  GENTLEMEN,

I have the honour of laying before you, in the various subjoined tables,
such information as will enable you to measure the present sanitary
condition of the City of London.

       *       *       *       *       *

1. The first table (Appendix, No. I.) contains a statement of the
present population of the City, as derived from the Registrar-General’s
recent census; and it compares the existing numbers in each division of
the City with those given at the last enumeration in 1841.

In examining this table you will observe that, during these ten years,
the general population of the City has increased about 3⅖ _per cent._;
that this increase has not been uniform through the nine sub-districts
of your jurisdiction; that in some it has been unimportant; that in
others there has been an actual decrease, extending even to 4⅔ _per
cent._ on the previous population; while in the whole East London Union
the numbers have risen considerably above the aggregate rate of
increase, and in the St. Botolph sub-district exceed those of the former
census by more than 16 _per cent._

Passing over the minor differences which have taken place in the
distribution of the population, I cannot regard that larger increase
without apprehension and regret. Probably for the most part it
represents the continued influx of a poor population into localities
undesirable for residence, and implies that habitations--previously
unwholesome by their over-crowdedness--are now still more densely
thronged by a squalid and sickly population.

I congratulate your Hon. Court on the recent acquisition of powers (to
the nature of which I shall presently advert) for the reduction and
prevention of this serious evil.

       *       *       *       *       *

2. The second table[61] presents a summary of the City mortality for the
year which terminated at Michaelmas last; showing the deaths, as they
have occurred, male and female, during each quarter of the year, in the
several districts and sub-districts of the City; and including at the
foot of each column, a statement of the year’s death-rate _per_ thousand
of the living in each such district and sub-district.

  [61] _Appendix_, No. V. The calculated death-rates are omitted from
  this, as from the other annual tables:--the quinquennial rates (App.
  No. II.) giving more useful results.--J. S., 1854.

You will observe that, during the 52 weeks, dated from September 29th,
1850, to September 27th, 1851, there have died of the population under
your charge 2978 persons; giving, for the City aggregately, a rate of
nearly 23 deaths for every thousand living persons.

The rate of last year was little over 21 _per_ thousand.

In my last Annual Report I suggested that the death-rate then prevailing
was probably (from temporary circumstances) more favourable than the
true average of the City; that it corresponded to the period of recovery
from severe epidemic influences; that it seemed exceptional; and that
you might be prepared for this year’s mortality showing again a tendency
to increase.

Such has been the case; and it illustrates the necessity of appealing to
cyclical averages for correct intelligence as to the healthiness of a
population. To my mind the increased mortality of this year does not
indicate any deterioration of the City in respect of sanitary matters
under your control; it shows merely that the death-rate, which must be
considered our present average for the City, is in truth higher than
that which favourable circumstances, foreign to your jurisdiction, last
year permitted us to attain.

Looking to the total mortality of the last three years (the period for
which I have had the honour of serving your Commission), I find that
9493 deaths have taken place; which, the mean population of the time
being 129,922, gives an average rate of 24·35 deaths _per_ thousand _per
annum_. This accords very nearly with a death-rate (24·36) deduced from
the septennial period 1838-44, during which (according to the
Registrar-General) 22,127 deaths occurred in a population estimated at
129,739.[62]

  [62] Since 1841, when the Census gave these figures, the limits of the
  West London Union have been slightly altered. The Inner Temple and
  Barnard’s Inn have been added to it, while part of St. Sepulchre’s
  parish has been taken away.

Assuming our City mortality to be accurately represented by these
averages, I need not inform your Hon. Court that such a death-rate is
unduly high. I have already, in previous Reports, laid before you the
materials for measuring its excess,--materials which seem to show that
our existing death-rate is nearly the double of that which better
circumstances have elsewhere rendered attainable.[63]

  [63] The death-rate to which I particularly refer in the text, and
  which I cited in my last year’s report, is that of a large district in
  Northumberland, numbering 27,628 inhabitants, where, during the seven
  years 1838-44, the mortality was at the rate of only 14 _per_ thousand
  _per annum_; and even in this comparatively low proportion a very
  distinct share might still be called preventable deaths.

It is not to the City alone of metropolitan districts that this high
mortality belongs. Unhappily it affects the entire Metropolis; and we
may find other towns in England, and still more on the Continent, where
the death-rate is higher than under your jurisdiction. Yet your Hon.
Court will not doubt that the standard to be adopted for your estimate
of healthiness ought to be the lowest known death-rate; that every
avoidable death represents an evil to society; and that, if a mortality
of 12, or 13, or 14 _per_ thousand _per annum_ can be reached for one
mixed population, there is ample room for discontent among any other
population, which finds itself doomed to perish at double the rate of
the first.

       *       *       *       *       *

3. In the third table[64] all the deaths of the last three years are
enumerated in a form which may enable you to compare one year with
another, and one sub-district with another, in respect of their several
contributions to the total mortality.

  [64] This information is now included in the Quinquennial Synopsis,
  _Appendix_, No. II.

       *       *       *       *       *

4. In the fourth table[65] are classified, according to the ages at
which they occurred, 9476[66] deaths of the last three years. This table
is arranged in a manner to display its results--(1) for each year
separately, and (2) for each Union separately, in order that you may
observe what local or annual differences have obtained as to the ages of
chief mortality. You will notice that in 3469 instances, nearly
three-eighths of the whole, death has befallen children under five years
old. Children at this age constitute about a tenth part of the
population of the City. They accordingly die at about four times the
rate which would fall to them as equal participators in the average
mortality of the district. The next table will throw some light on this
disproportionate excess of infant deaths.

  [65] Now embodied in Table VIII.

  [66] In the remaining number (17) the particulars of age and residence
  could not be correctly ascertained.

       *       *       *       *       *

5. In it[67] an enumeration is made of such deaths, during the last
three years, as have arisen in consequence of acute disease partially or
entirely preventable. They amount to 3923--more than two-fifths of the
entire mortality of the period.

  [67] _Appendix_, No. IX. includes this Table.

I would especially beg the attention of your Hon. Court to the
particulars set forth in the successive columns of this table.

The first column shows 391 deaths by fever; and of these, without
hesitation, I would speak as entirely preventable. Under favourable
sanitary conditions fever is unknown. The deaths arising from it befall
for the most part persons in the prime of life, whose premature removal,
in the midst of their vigour and usefulness, is not only a direct
weakening of society, but is also, in respect of orphanage and
widowhood, a frequent source to the public of indirect detriment and
expense.

In the second column, swelled by the epidemic visitation of 1849, you
will find 902 deaths referred to Asiatic Cholera, and to other kindred
diseases. Comparatively few cases of the kind have occurred since
Michaelmas, 1849; an overwhelming majority belonged to the summer
quarter then terminating, when the Metropolis generally was suffering
from the presence of Cholera. I have already had occasion to show you
that this frightful pestilence belongs only to localities which, by
their general epidemic mortality, have previously been stigmatised as
unhealthy; that, over districts otherwise healthy, it migrates without
striking a blow; that it may, therefore, with confidence be spoken of as
a disease proportionate to removable causes--in other words, as a
preventable disease.

I cannot pass over these two columns, without begging you to observe
what perhaps may be novel to you. If, instead of reckoning the
cholera-deaths as belonging solely to the one year in which they
happened, you reckon them as belonging to the whole term of years which
elapsed between the two visitations of the epidemic, and distribute them
equally over that period, so as to form an average--say for fifteen
years, you cannot fail to notice how largely, in the long run, the
destruction by fever (which is always here) surpasses the fatality of
that Eastern disease; so much so, that the average annual mortality by
the latter probably does not amount to half the fatality of the former.

Nor must it be lost sight of, that if the _deaths_ by typhus double in
number those produced by cholera, the list of _persons attacked_ by the
former disease, and thereby for a long while incapacitated and
suffering, is immeasurably beyond this proportion. Two or three times
the number of deaths by cholera would give you the number of seizures,
and enable you to estimate all the direct mischief caused by it; while,
in regard of typhus, probably for one death there are twenty cases of
protracted illness, tardy convalescence, and injured constitution. Not
only are the deaths double in number, but each of them indicates an
infinitely larger amount of sickness and suffering not immediately
productive of death.

The frightful suddenness of the rarer disease, and the condensation of
its epidemic fatality into some single year, give it more apparent
importance than belongs to the familiar name of typhus; but I can assure
your Hon. Court, that if a large amount of preventable death, and a
still larger amount of preventable misery, be strong arguments for
sanitary improvement and activity, those arguments are more abundantly
derivable from the constant pressure of fever and its kindred maladies,
than from the sharper but infrequent visitations of the foreign
pestilence.

In the third column of this table come deaths by scarlatina. Of these,
perhaps a certain proportion would occur even under favourable
circumstances; for, whatever may have been the original derivation of
the disease, it is impossible to doubt that the severity of its attack
mainly depends on conditions peculiar to the person of the patient, and
that no perfection of external circumstances will ensure mildness of
infection. But on the other hand it is certain, that, under attacks of
the disease at first equally malignant, adequate ventilation with pure
air will enable one patient to wrestle successfully against the poison,
while another, less favourably circumstanced, will rapidly sink beneath
its influence; and hence I have no hesitation in assuring you, in
respect of the 213 deaths registered under this head, that a majority
would have been avoided under improved domestic arrangements.

In the fourth column, you will read of 91 deaths by small pox. Your
judgment will not be a harsh one, if you assume that 90 of these were
the result of criminal negligence. Under the present administration of
the Poor Laws, vaccination is not only accessible to all members of the
community, but is literally pressed on the acceptance of the poor. Those
stupid prejudices, which for some years retarded the universal adoption
of Jenner’s great discovery, have now died away; the neglect of
vaccination must be regarded as the omission of a recognised and
imperative duty. Deaths of children, arising in this parental neglect,
ought to be considered in the same light as if they arose in the neglect
to feed or to clothe; and I am disposed to believe, that the readiest
way of bringing this view of the case before those uneducated classes,
where the omission usually arises, would be to procure Coroner’s
inquests every year in respect of some half dozen or more instances
where the evidence of neglect might happen to be glaring.

In the fifth column of the table stand recorded a hundred deaths by the
poison of erysipelas, in one form or another; arising sometimes
spontaneously, sometimes in connection with the child-bearing state,
sometimes in sequel of accidental lesions and surgical operations.

My daily experience as a Surgeon--especially as a Hospital-Surgeon,
enables me confidently to speak of these diseases as an artificial
product of unhealthy exterior conditions. The contrasting results of
surgical operations in town and in country--of operations undertaken
amid pur-ventilation, in spacious cleanly rooms and dry localities,
with those undertaken under opposite circumstances (in the dwellings of
the poor for instance, or wherever else amid damp, dirt, and
over-crowding), and the similar experience which exists as to the
origination of puerperal fever, would be quite conclusive as to the
fact, that of the 101 deaths under this head, a large majority might
have been prevented.

Next, in the sixth, seventh and eighth columns, stand deaths arising in
the chief acute diseases of infancy, those to which the disproportionate
mortality of infants is mainly due. Many careful statistical
observations, as well as personal experience, convince me that the
immense fatality recorded under this head, is, to a very great extent,
due to obviable causes.

To bring this matter distinctly before you, I must take, as a standard
of comparison, some district where the general death-rate is
sufficiently low to distinguish it as eminently healthy; and in such an
one you will notice a marked diminution, not only (of course) in the
_number_ of infant deaths, but likewise in their _proportion_ to the
total mortality.

Such a district is that of the combined parishes of Glendale, Bellingham
and Haltwhistle, in the county of Northumberland. In it the general
death-rate is 14; in the East and West London Unions of the City of
London, the general death-rate is 26·73. In the former district,
children under five constituting more than an eighth of the population
(1/7·6), their deaths form about a quarter of the whole mortality; while
in the latter district, where the children are in smaller
proportion--namely about 1/9 of the population, their deaths are not
much less than half (1/2·21) of the whole mortality. Thus, in the
healthier district they die at less than double the average rate for all
ages; in the unhealthier, at more than four times that average.

A still better method of district-comparison, is to arrange in a series
the death-rates prevailing in several localities for persons _over five
years of age_, and side by side with this column, another for the
death-rates of children _under five years of age_. The first column will
of course indicate very well the relative sanitary conditions of the
districts; but the differences between them will be expressed far more
clearly, and, as it were, in a magnified form, in the column of
infantine death-rates. Thus, for instance--to repeat the comparison just
instituted between the Northumberland and the London district; the
death-rate for all ages over five is about 12 in the former district,
and nearly 15 in the latter; a difference quite sufficient to establish
the inequality of their sanitary conditions. But, how much more strongly
is this disparity expressed in the comparison of the infantine
death-rates--26·5 for the healthier district, 107·57 for the unhealthier
one!

Nothing can be more conclusive than the evidence afforded by statistics,
as to the dependence of high infantine mortality on the general causes
of endemic unhealthiness. My own observation within the City gives
complete confirmation to this view, showing me that the diseases
specified in my table (diarrhœa, bronchitis and pneumonia,
hooping-cough, croup and measles, hydrocephalus and convulsions) however
various in nature they may seem, and however apt you may be to
dissociate their occurrence from the thought of local causation, yet
unquestionably multiply their victims, in proportion to the otherwise
demonstrable unhealthiness of a place, owe most of their fatality to
local causes, and may, therefore, to a great extent he disarmed of their
malignity.

The last column gives the total of those which have preceded it, and
shows, out of 9493 deaths, 3923, all from acute disease, in intimate
dependence on local and obviable causes. It will be a moderate
computation with respect to these deaths, if we estimate that two-thirds
of them might have been hindered.

And yet it is not only by _acute_ disorders, that preventable death
succeeds in ravaging the population. If we turn to the examination of
_chronic_ ailments producing death, we may quickly recognise many
indications of their preventability, and may satisfy ourselves that here
also the general mortality might be very largely reduced.

Look, for instance, at the whole immense class of scrofulous diseases,
including pulmonary consumption, a class probably causing, directly or
indirectly, at least a quarter of our entire mortality; and consider the
vast influence which circumstances exert over its development.

Of such circumstances some lie within your control, and affect masses of
the people; but the more special causes of chronic disease lie rather
out of your jurisdiction, and the option of avoiding them is a matter of
individual will. Vicious habits and indiscretion; a life too indolent,
or too laborious; poverty and privation; vicissitudes of weather and
temperature; intemperance in diet; unwholesome and adulterated food;
and, not least, inappropriate marriages tending to perpetuate particular
kinds of disease; these words may suggest to you, briefly, that there
are many influences, within the sphere of private life, by which the
aggregate death-rate of a population is largely enhanced, but the
control of which, if attainable, lies almost entirely at the discretion
of the classes subject to their operation.

Considering all these causes, and the needless waste of life occasioned
by them, I can have little doubt that as much might be done by
individuals, under the influence of improved education, to lessen the
mortality from chronic disease, as by sanitary legislation to stay the
sources of epidemic death. And regarding both classes of disease
together--those, on the one hand, which are of endemic origin (arising
in imperfect drainage, in defective water-supply, in ill-devised
arrangement of buildings, in offensive and injurious trades, in the
putrefaction of burial-grounds, and the like) and those classes, on the
other, which arise in the circumstances of individual life, I can have
no hesitation in estimating their joint operation at a moiety of our
total death-rate, or in renewing an assertion of my last years’ Report,
‘if the deliberate promises of Science be not an empty delusion, it is
practicable to reduce human mortality within your jurisdiction to the
half of its present average prevalence.’

To revert, however, to your more special branch of the subject,--I have
thought the present a convenient time for indicating to you the pressure
of preventable death, arising in acute disease, because of the great
addition which you have recently gained to your powers for enforcing
prevention.

That an average death-rate of nearly 25 _per_ thousand _per annum_
prevails in the City; that three-eighths of your mortality consists in a
premature extinction of infant life; that fatal disease, in more than
two-fifths of its visitations, is of a kind which operates endemically
and preventably;--these are the facts to which I have appealed, as my
evidence of the need for sanitary activity and perseverance.

On other occasions I have endeavoured to set before you what are those
agencies hostile to life, which affect the masses of an urban
population; and during the last three years your Hon. Court has shown
its recognition of these causes, and has devoted attention to the means
of counteracting them by appropriate sanitary measures.

In too many instances, the powers first given you by the Legislature
were inadequate to this great purpose. But now, armed with the further
authority of your new Act of Parliament, you enjoy such means for
sanitary improvement as have never yet been possessed by any Corporation
in the country; such means as, judiciously wielded, cannot but produce
the greatest advantage to persons living under your jurisdiction.

As you are only now entering on the exercise of these powers, it may be
convenient that I should submit to you a brief account of them, and I
gladly turn from contemplating the spectacle of preventable death, to
analyse the means of prevention now vested in you by the Legislature.

       *       *       *       *       *

1. In regard of _public drainage or sewerage_, the first and most
elementary condition of endemic health, I need hardly tell you that
within the City, your powers are absolute. You have entire and sole
responsibility for the construction and maintenance of sewers, for their
cleaning or flushing, and for the prevention of noxious effluvia from
their innumerable gully-holes.

       *       *       *       *       *

2. In the all-important particular of _house-drainage_, your authority
is sufficient for every purpose. You can order the complete abolition of
cesspools; the construction of drainage in any premises within fifty
feet of a sewer; its repair, cleansing, or renewal, whenever it may be
disordered: and not only can you order these works to be done,
but--failing the owner’s compliance with your notice, you can devolve
the performance of his duty on your own workmen, and can recover your
expenses from the recusant.

       *       *       *       *       *

3. In regard of _water-supply to houses_ your powers are equally cogent,
though the unsatisfactory condition of the water-trade continues a
serious obstacle to their effective employment. You have authority here,
as with house-drainage, to order the construction of all necessary
apparatus, and to enforce the fulfilment of your order.

Under both these heads, you possess a power hitherto but imperfectly
used, the complete and constant exercise of which I would strongly
recommend to your Hon. Court. In all those clauses of your Acts of
Parliament, which relate to private works of house-drainage and
water-supply, there occurs a very important phrase:--such works shall be
constructed ‘to the satisfaction of the Commissioners.’ Now, of private
works effected under the authority of your Act, during the last three
years, a certain, not inconsiderable, share proves inoperative and bad.
The mere overflowing of a water-butt (and in numberless instances this
is the arrangement evasively adopted under your orders) can never
suffice for the effectual cleansing of house-drains. I need scarcely
inform you that an obstructed drain and choked privy, wherever they
occur, are equivalent to a cesspool; shedding abroad the same effluvia,
and producing the same deadly results. No gain is gotten to the
wholesomeness of a house, by substituting for its former cesspool an
equally offensive and inoperative drain. To my knowledge, much of the
drainage done during the last three years is liable to this risk; and it
appears to me indispensable that you should exert direct supervision
against so serious an evil.

I would recommend to your Hon. Court that, in issuing orders for the
construction of drainage and water-supply, you should require a full
specification to be delivered you of the works about to be undertaken,
and should distinctly decide as to their sufficiency; or by a still
simpler process, that you should fix and determine a certain standard of
combined works; a model plan, in short, for house-drainage, privies, and
water-supply, and should direct your Inspectors to certify to you the
sufficiency of only such works as may accurately correspond to this
design.

I cannot but regard it as a grave calamity, that the general supply of
water to the City remains beyond your control, in the hands of
irresponsible traders; for its imperfect adaptation to the requirements
of the public constitutes the largest sanitary evil of the day.

       *       *       *       *       *

4. You have entire control over the _pavement of every public way_
within the City, for its construction, maintenance, and cleansing; and
in this respect you exercise a power of great sanitary value. The
preservation of cleanliness along the whole extended surface of the
City, including its many hundred courts and alleys, is indeed a branch
of your functions which can hardly be over-estimated for its importance;
and the fines which you have the power of levying from your
contractors, whenever the scavenging is neglected, are useful securities
for the general performance of their duties.

It lies within your power to order, wherever you may think fit, the
employment of the hose and jet for the purpose of surface-cleansing in
courts and alleys: and, I may add, that the advantages of this most
effective sanitary process have been highly appreciated where you have
directed its application.

In some of the poorer localities, complaints have arisen in a matter
relating to the pavements, where you are not able to afford the
complainants effectual relief: viz., with respect to certain inhabitants
throwing refuse and offensive matters from the houses into the public
way, so that nuisance is created. I have already suggested to your Hon.
Court, and I beg leave here to repeat, that in the 41st clause of the
City Police Act, provision is made for the prevention of this particular
offence, and that your four Inspectors are manifestly unable to relieve
the Police Force of their legal responsibility in the matter.

       *       *       *       *       *

5. Your powers for enforcing the wholesome _cleanliness of private
premises_ are equally considerable. You can order the removal of
offensive matter, the purification and whitewashing of premises, and the
abatement of any nuisance arising in conditions of filth. In case of
need, as shown by a medical certificate, you can summon the offender
before your Court; and (under your new Act) you can punish with a heavy
fine any repetition of the nuisance against which your order has once
been issued.

       *       *       *       *       *

6. So long as _slaughter-houses_ are tolerated within the City (and it
is to be hoped this may not be long) you have power to regulate their
use, according to your discretion, with a view to their cleanliness and
better management; and in case of disobedience to your orders, you have
power to enforce the temporary suspension of slaughtering. Your new Act
renders illegal any slaughtering in cellars, or any keeping of cattle
there: and it prohibits that offensive exposure of putrescent hides,
which has so often been complained of in the vicinity of Leadenhall
Market.

       *       *       *       *       *

7. In close connection with the regulation of slaughter-houses, your new
Act gives you authority in a matter hitherto quite foreign to your
jurisdiction, but where your vigilance may no doubt be exercised with
great advantage to the public health. You are authorised to _appoint
Inspectors of slaughter-houses and of meat_; and these officers are
required to inspect shops, markets, and slaughter-houses, and to seize
and destroy any meat which may appear to them unsound or unwholesome. A
further clause of very extensive application enables you to deal
generally with all cases, where _unwholesome provisions_ are exposed for
sale; and this clause is so constructed as to include and render penal
all those _fraudulent adulterations of food_ which render it detrimental
to health.

       *       *       *       *       *

8. You are invested with important authority against _such trades and
occupations as are offensive or injurious_ to their neighbourhood. Under
your former Act, you can subject to penalties any person who shall
‘roast or burn, boil, distil, or otherwise decompose any root, drug, or
other article or thing, in any house or building, and thereby cause
offensive or injurious smells or vapours to be emitted therefrom, so as
to become a common nuisance;’ and the same Act also gave you a very
inoperative clause against such nuisance-causing manufactories as might
begin to work in the City after the commencement of that Act.

Your new law enacts that everything practicable shall be done for the
suppression of all nuisances arising in manufactures and the
like:--that, after the first of January next, every furnace used in the
City shall be such as to consume its own smoke; and that whatever trade
or business may occasion noxious or offensive effluvia, or otherwise
annoy the inhabitants of its neighbourhood, shall be required to employ,
to your satisfaction, the best known means for preventing or
counteracting such annoyance.

       *       *       *       *       *

9. You have certain powers, to which I adverted in my former Report, as
likely to come into activity whenever the injurious practice of
intramural burial might cease; powers, namely, relating to the _disposal
of dead bodies_ in certain specified cases: and under your new Act, you
have acquired some further authority (likewise only to be exercised
after that cessation, and with the consent of the Bishop of London) to
_appropriate the disused burial-grounds_ for purposes of improvement. At
the time of my last Report I looked ‘forward to the complete
discontinuance of burial within your territory as a matter for warm
congratulation among all who are interested in the cause of sanitary
improvement;’ and it is with proportionate disappointment and regret,
that I have now to report to you that the Order in Council, which was to
have closed all metropolitan burial grounds, has never yet been issued;
and that negociations, conducted by the General Board of Health for the
purchase of a sufficient extramural cemetery, were suddenly arrested at
the close of the last session of Parliament. Your powers in relation to
these matters remain of course meanwhile inoperative.[68]

  [68] In the Parliamentary Session of 1852, the Interments Act of 1850,
  which had remained inoperative, was repealed under a new ‘Act to amend
  the Laws concerning the Burial of the Dead in the Metropolis,’ which
  became law July 1st, 1852. Under this Act, the powers, alluded to in a
  later part of this volume, were given to the Commissioners of Sewers
  of the City of London as a Burial Board for the City.--J. S., 1854.

       *       *       *       *       *

10. The most important additions made to your power relate to the
_dwellings of the poor_, and are embodied chiefly in the tenth section
of your new Act. The definition of ‘lodging-house’ given in this clause
is so extensive, and the power of regulation conceded to you is so
unconditional (where once the necessity for your interference is shown)
that your Hon. Court can now exert your authority for every legitimate
object, in respect of all the poorer houses in the City.[69] The
definition is, that ‘the expression _common lodging-house_ shall, for
the purposes of this Act, mean any house, not being a licensed
victualling house, let, or any part of which is let, at a daily or
weekly rent not exceeding the rate of three shillings and sixpence per
week; or in which persons are harboured or lodged for hire for a single
night, or for less than a week at one time; or in which any room let for
hire is occupied by more than one family at one time.’ And your powers
are to the following effect:--Wherever over-crowding has taken place
unwholesomely or indecently--wherever undue illness has
prevailed--wherever from any one of several causes the house is unfit
for occupation, you can require its _immediate registration_; you can
then _make such rules_ as you think fit for the _maintenance of decency
and health_; and you can enforce conformity to those regulations with
appropriate penalties.

  [69] Circumstances, which need not here be detailed, have led to
  disappointment in the working of this clause, and have shown, to my
  great regret, that I over-estimated the benefits it was capable of
  conferring.--J. S., 1854.

The terms of the clause throw on your Medical Officer the responsibility
of initiating these proceedings; and his task in the matter will be one
of anxiety and arduousness. In most other clauses of your Acts of
Parliament, an alternative is allowed as to your taking the opinion ‘of
the Officer of Health, or of any two duly qualified Medical
Practitioners:’ but in this clause you are expressly restricted to the
certificate of your Officer of Health.

In my two former Reports, I have addressed you at length on those
conditions relative to the dwellings and social habits of the poor which
made the enactments of this clause indispensable; and I look forward to
its operation with a sanguine belief that it may be rendered one of the
most important boons ever conferred on the labouring classes of the
community.

I subjoin to my Report the schedule which I would suggest for the
registration of lodging-houses, and which (as you will observe) requires
detailed information as to every sanitary particular of the
dwelling.[70] I would recommend that in every case, where registration
is made, the owner’s specification of these particulars should be
accompanied by a written certificate from your Inspector; testifying
(in some such form as that annexed to the schedule in my Appendix)
first, to the accuracy of the statement, and, secondly, to the general
condition of the house.

  [70] Vide page 210.

With respect to the rules, which, under authority of this clause, you
may find it requisite to lay down for better regulating the residences
of the poor,--the conditions for which you have to legislate are so
various and complicated, that no formula will apply universally; and you
will often be called on to adapt special rules to particular cases as
they come before you. I can therefore only venture at present to offer
you general suggestions on the subject.

You will find that the houses in which your interference is required
fall into three cases, characterised as follows:--(1) Where the house is
let in several independent holdings (often as many holdings as rooms)
each occupied by a single family and no more, and paid for at a rent not
exceeding 3s. 6d. _per_ week;--(2) Where the house is thus let in
several independent holdings, and where the renter of each or any
portion, admits other persons to share his holding with him, on their
payment to him of a sub-rent _per_ week or _per_ night, so that a room
comes to be occupied by more than one family at a time;--(3) Where the
entire house, or all such part as is let in lodgings is under the direct
management of a single resident proprietor or keeper, where the lodgings
are let at . . . . _per_ night, and where many persons not belonging to
one single family are lodged together in some single room, or in various
single rooms of the house.

Of the first arrangement, where a single room is the residence of a
single family, you have innumerable illustrations in the City; as, for
instance in the large houses of Windsor-street (to which I have recently
drawn your attention) where in one house there are sixteen such
holdings:--of the second arrangement--the most abominable and
brutalising which can be conceived, you have sufficient illustrations in
Plumtree-court:--of the third--comparatively little known in the City,
there are instances in Field-lane.

In respect of the first class of houses, I should be disposed to look
upon each holding as the house of its occupier, and not to interfere
within his threshold, except on the ground of some commanding necessity.
I would require only that the general arrangements of the house should
be adapted to the number of its holdings; that, for instance, numerous
families should not be left competing for the use of a single privy, but
that such accommodation should be provided in strict proportion to the
requirements of the inmates; that every room should be efficiently
ventilated; that water should be supplied to the highest occupied part
of the house, and a water-tap and sink furnished on every floor; that
the dust and refuse of the house should be removed at least once daily.

In dealing with the worst specimens of this class, it may be requisite
to go further than I have here intimated; and it appears to me that for
this purpose your Hon. Court must address your regulations not to the
tenant, but to the landlord. He, I apprehend, must be held responsible
for the decent and wholesome condition of his property, and for such
conduct of his tenants as will maintain that condition.

Seeing the punctuality with which weekly visitation is made for the
collection of rents in these wretched dwellings, it would not be
unreasonable, I think, to insist on some such regulation as the
following:--The owner of the house, or his agent, or collector, shall
visit each room on an appointed day, at least once weekly, between the
hours of eleven and three; he shall see that the floor and other
woodwork of the room have been properly washed on that day, that the
room be free from all dirt, rubbish, or offensive smell, that no
objectionable trade be pursued in it, and that it be generally in good
and proper repair; he shall see that the premises generally[71] be in a
clean and wholesome condition, that water be sufficiently supplied, and
that the dustman’s work be regularly performed; and failing either of
the two latter conditions, he shall forthwith lay complaint thereof
before your Commission; in case of any inmate suffering from cholera,
small-pox, erysipelas, or any kind of fever, the owner, or his agent or
collector, shall immediately give notice of such illness to the
Inspector of his district; and at the meeting of the Commission next
after such notice, he shall, if required, attend your Court, to receive
any order which you may issue for reducing the number of his lodgers, or
for improving the condition of his house, or for employing any
disinfectant process; and he shall fulfil any such order within the time
therein specified.

  [71] Namely--passages, staircases, area, cellar, yard, privy, &c., and
  if common privies and urinals exist, he shall provide for the
  cleansing of these, where requisite, at least once daily.

In a proceeding so experimental as the present, I cannot assure you of
infallible means for meeting every evil contingency; but it seems to me
that a regulation having the general tendency here indicated, enforced
by moderate penalties, would work an important revolution in the economy
of dwellings affected by its operation, would render it indispensable
to the landlord of such holdings to promote cleanly and decent habits
among his tenants--even to obtain security for their good behaviour, and
it would make it difficult or impossible for persons of opposite habits
to obtain holdings under a landlord who would be virtually punishable
for their misconduct.

Such a regulation would apply, as I have said, to the lowest and
filthiest specimens of the first class of lodging-houses; for, to the
large majority of that class less stringent rules would suffice; and it
would apply most usefully to the second class of lodging-houses--those
in which the single rooms of a house are severally occupied by more than
one family. So great are the physical and moral evils attending this
indiscriminate admixture of adult persons of both sexes (as I have
submitted to you in my former reports), that I entertain no doubts of
the necessity for prohibiting it in the most absolute manner. A
regulation to the following effect would, probably, fulfil the purpose
contemplated by the law, and would disperse these loathsome heaps of
disease, destitution, and profligacy: viz.--There shall not be lodged in
a sleeping-room, at any one time, more than two persons over fourteen
years of age, if of different sexes; nor more than[72] ---- such
persons, if they be all of one sex.

  [72] This number would be proportioned to the cubical contents of the
  room, and its facilities for ventilation, of which mention would be
  made in the registration-schedule of the house.

This order--in addition to its wholesome influence on the second class
of lodging-houses, would apply beneficially to the third class; and, in
further relation to the latter, there would probably be required various
minor regulations with respect to facilities for washing, lighting,
ventilation and the like, which admit of being fixed in detail, only as
each particular case comes under your notice, with its deficiencies
recorded in the schedule of its registration.

       *       *       *       *       *

11. In addition to this power of regulating lodging-houses, a further
authority has been conceded you by the Legislature, for the _amendment
or removal of houses presenting aggravated structural faults_. Wherever
your Officer of Health may certify to you that any house or building is
permanently unwholesome and unfit for human habitation, you are
empowered to require of the owner (or, in his neglect, yourselves to
undertake) the execution of whatever works may be requisite for
rendering the house habitable with security to life.

       *       *       *       *       *

Finally,--under your former Act you were authorised, and indeed
_required, to appoint Inspectors of Nuisances_, whose duties were to
consist in the following particulars:--They were to superintend and
enforce the due execution of all duties to be performed by the
scavengers; to report to your Commission all breaches of your rules and
regulations; to point out the existence of nuisances; to record whatever
complaints might arise in relation to the supply of water, or in
relation to any infraction, either of the Act, or of any of the
regulations made by you under its authority for the preservation of
order and cleanliness and for the suppression of nuisances.

Hitherto your Hon. Court has deemed it sufficient compliance with the
terms of the Act, to engraft the functions above described on the office
of your previously appointed Inspectors of Pavements; and these
Officers have endeavoured very diligently to fulfil the multifarious
obligations thus imposed on them. During the past year it has become
obvious to me that this arrangement of their duties is inconvenient, and
that the occupation of their time as Inspectors of Pavements prevents
them devoting the requisite number of hours to the other important
duties.

I need hardly add, for the information of your Hon. Court, that the
immense increase of sanitary business implied in your new Act (an
increase probably equivalent to doubling or trebling the former amount)
renders a continuance of the former arrangement still less possible than
heretofore; the important functions assigned to your Inspectors of
Nuisances will now require to be discharged, under the superintendence
of your Officer of Health, with uninterrupted assiduity and vigilance;
and I would therefore take the liberty of begging your Hon. Court to
refer this subject to the consideration of your Committee, together with
some other points relative to the administration of your new powers.[73]

  [73] Two additional Inspectors came into work, under appointment of
  the Commission, at Christmas, 1853. See last Annual Report.--J. S.,
  1854.

       *       *       *       *       *

Here, gentlemen, terminates my statement of the powers now vested in you
for the maintenance of the public health. Authority so complete for this
noble purpose has never before been delegated to any municipal body in
the country. In exercising the means of such wide beneficence, your
Hon. Court will be discharging duties of immeasurable importance to the
public welfare; and those who have the honour and responsibility of
giving you professional advice will have a task of more than ordinary
difficulty.

It is easy to foresee the numerous obstacles which interested persons
will set before you to delay the accomplishment of your great task.
Sometimes technical objections will be raised to your proceedings:
sometimes vexatious delays and evasions will occur in the fulfilment of
your injunctions.

When your orders are addressed to some owner of objectionable
property--of some property which is a constant source of nuisance, or
disease, or death; when you would force one person to refrain from
tainting the general atmosphere with results of an offensive occupation;
when you would oblige another to see that his tenantry are better housed
than cattle, and that, while he takes rent for lodging, he shall not
give fever as the equivalent;--amid these proceedings, you will be
reminded of the ‘rights of property,’ and of ‘an Englishman’s inviolable
claim to do as he will with his own.’

Permit me, gentlemen, to remind you that your law makes full recognition
of these principles, and that the cases in which sophistical appeal will
oftenest be made to them, are exactly those which are most completely
condemned by a full and fair application of the principles adverted to.
With private affairs you interfere, only when they become of public
import; with private liberty, only when it becomes a public
encroachment. The factory chimney that eclipses the light of heaven with
unbroken clouds of smoke, the melting-house that nauseates an entire
parish, the slaughter-house that forms round itself a circle of
dangerous disease--these surely are not private, but public affairs. And
how much more justly may the neighbour appeal to you against each such
nuisance, as an interference with his privacy; against the smoke, the
stink, the fever, that bursts through each inlet of his dwelling,
intrudes on him at every hour, disturbs the enjoyment and shortens the
duration of his life. And for the rights of property--they are not only
pecuniary. Life, too, is a great property; and your Act asserts its
rights. The landlord of some overthronged lodging-house complains, that
to reduce the numbers of his tenantry, to lay on water, to erect
privies, or to execute some other indispensable sanitary work, would
diminish his rental: in the spirit of your Act, it is held a sufficient
reply, that human life is at stake, and that a landlord, in his dealings
with the ignorant and indefensive poor, cannot be suffered to estimate
them at the value of cattle, to associate them in worse than bestial
habits, or let to them for hire, at however moderate a rent, the certain
occasions of suffering and death.

And indeed, gentlemen, the mere pecuniary import of life thus squandered
is not inconsiderable. The costs of medical attendance on these
superfluities of disease are heavy items of parochial expenditure: and
although much of the undue mortality is of children, and consists in the
premature extinction of life that hitherto has no market value--costing
only the tears that are shed for it; yet there likewise occur among your
preventable deaths, very many cases in which adult life is sacrificed,
with all its strength and utility; and where, besides the wasted capital
which that loss implies, there often remains for the district which has
poisoned the man an entailment of orphanage and widowhood.

Nor, again, can it be questioned, that year by year, as general
education advances, the sanitary condition of a district will be an
important element in determining the value of its property. In engaging
houses, men will not only look to rent, and to rates on rent; they will
look also to rates on life, and will doubt the cheapness of a town
residence, however small in rental, where their lease of life must be
shortened from its intended duration, and form part of an average
mortality two-thirds higher than in the suburbs. It is an instinct in
this direction, or perhaps the guidance of knowledge, that within late
years has given so much extension to suburban residence, and has carried
numbers of the wealthier inhabitants of the City to dwell so far from
their places of daily business: and the same instinct or knowledge
yearly acts more towards the less affluent classes, urging them to fly
as far as possible beyond the smoke and crowding and unwholesome vapours
of the metropolis. I entertain great hope and little doubt, that, within
a few years, the working classes will have organised for themselves
extensive means of suburban residence; that vast barracks of
model-houses, rising on healthier soil and amid purer atmosphere, will
receive hundreds of thousands of inmates from those classes of society
which now throng the courts and alleys of the metropolis; and that by
this spontaneous emigration, in so far as it may affect the City, great
assistance will be given to those endeavours which will be made, under
authority of your Act, to thin the court population of the City, and to
diminish the too dense array of houses inhabited by the poor.

As I look to the poor-rates of the City of London, as well as to the
other circumstances just adverted to, I feel the deepest conviction that
_property_, no less than _life_, is interested in the progress of
sanitary reform: and once again, most earnestly, I beg leave to
congratulate your Hon. Court on the acquisition of powers, conferring on
you the inestimable privilege of doing so much good for those whom you
represent, and for the often unrepresented poor; of relieving so much
suffering; of prolonging so much life.

That much improvement remains to be accomplished within your province,
is a certainty which I have endeavoured here, as on former occasions,
plainly to set before you.

But I cannot close my Report without adverting to the fact, that both
within and around the City, there are sanitary evils for which you are
not responsible--evils beyond your control--powerful causes of diseases
in hourly operation; and that these are so extensive in their agency, as
to neutralise much of the good which it lies in your competence to
effect.

The mere fact, that for the metropolis generally there is hitherto no
sanitary law, such as you possess for your territory, is an evil to you.
When, at the commencement of next year, you will be proceeding to
suppress the several nuisances against which you are armed; when the
various trades of the City will have ceased to send forth smoke or
stink, you can raise no barrier against invasions from around;
southward, you cannot exclude the unwholesome airs wafted from the river
and from across it; nor on either side, east or west, the soot that
showers down from innumerable shafts encircling you; nor northward, the
odours that rise from the shambles of Clerkenwell.

And likewise within the City there will be remaining--out of your
control, unremedied evils, the existence of which has long been
denounced, and the removal long expected.

In 1849, with the cholera amidst us, great exertions were made, and
greater promises. In that dreadful week, when two thousand victims of
our metropolitan population fell beneath its poison; when every
household, from hour to hour, trembled at the visible nearness of death;
the public were scared out of indifference. If the visitation could have
been bought away, at the expense of doubling all local rates in
perpetuity, no doubt the sacrifice would have been made. Public opinion
was kindled to overwhelm all opposition.

The metropolis was to be drained afresh; the outfall of sewerage was no
longer to be beneath our windows; the river was to be embanked; its
rising tide was no longer to make our sewers disgorge their poisonous
contents into our streets and houses; dead bodies in their decay, were
no more to desecrate the breathing-space of the living; water was no
longer to be supplied--clumsily, insufficiently, and unwholesomely, at
the discretion of private capitalists: all was to be amended.

For participation in these advantages, the City had to look beyond its
own representatives, and to await the more comprehensive measures of Her
Majesty’s Government.

Two years have elapsed, and none of the measures referred to has made
visible progress. The water question remains unsettled; arrangements for
extramural interment of the dead have been disconcerted at what seemed
the moment of their completion; the river still receives the entire
sewage of this immense metropolis, and still at each retreating tide,
spreads amid the town, as heretofore, its many miles of fetid, malarious
mud.

In justice it should indeed be remembered, that any one of the required
amendments could only be the result of long preparatory labour, and that
its organisation would often of necessity be the travail of some single
mind, not insusceptible of fatigue. Particularly as respects the scheme
(now understood to approach its maturity) for the complete drainage of
the metropolis, it cannot be overlooked that very extensive surveys,
superficial and subterranean, with innumerable drawings and
specifications, were necessary to the construction of so comprehensive a
plan.

But neither can it be disguised or disregarded, that meanwhile, in the
absence of these sanitary works, there are dying needlessly and
prematurely thousands of the population; that preventable death,
hitherto unprevented, is proceeding at its accustomed pace; that
children continue to perish at three or four times their due rate; that
time, which carries us from one visitation of the great epidemic and
obliterates the remembrance of our alarm, also, too probably, carries us
towards the day of another outbreak: that typhus--our home-bred and
daily visitant, rehearses the same warnings as heretofore, moving
uniformly onward like the shadow on a dial, toward the hour when that
Eastern pestilence may again be here.

Therefore, gentlemen, I have felt it my duty to represent to you that,
in the promotion of those metropolitan works, the population of the City
of London have an incalculable interest;--that the emancipation of human
life from such fetters of disease as weigh on it, can never even
approximate to completion within your City, while the saturated
burial-grounds still continue to receive their annual multitudes of the
dead, while the administration of the water-supply interposes an
effectual hindrance to your most important functions, and while the
river, contaminated and unembanked, diffuses injurious miasms through
the whole extent of your jurisdiction. And I would further venture to
urge on the consideration of your Hon. Court, that your legitimate
influence with Her Majesty’s Government and with Parliament--your
influence as trustees of the Public Health for so large a constituency,
exerted in furtherance of those metropolitan reforms to which I have
adverted--would be tending, not only to the general good, but directly
and eminently to the sanitary advantage of the City of London.

  I have the honour,

  &c., &c.

_Proposed Schedule of specification for the Register of Lodging-houses._

  House situate at No. __________

  Name and Address of Owner _________

  Number of Floors (including Cellars and Lofts) ____

    „       Rooms        „         „             ____

  +-------+------+-------------+--------+--------+--------+--------+
  |       | No.  |             |        |        |        |        |
  |       |  on  | Situation.  |Height. |Length. |Breadth.|Windows.|
  |       |door. |             |        |        |        |        |
  |       |      +-------------+--------+--------+--------+        |
  |Account|      |Floor, Aspect|ft.  in.|ft.  in.|ft.  in.|        |
  |       +------+-------------+--------+--------+--------+--------+
  |  of   |  1   |             |        |        |        |        |
  |       +------+-------------+--------+--------+--------+--------+
  | Rooms |  2   |             |        |        |        |        |
  |       +------+-------------+--------+--------+--------+--------+
  |separ- |  3   |             |        |        |        |        |
  |       +------+-------------+--------+--------+--------+--------+
  |ately. |  4   |             |        |        |        |        |
  |       +------+-------------+--------+--------+--------+--------+
  |       |  5   |             |        |        |        |        |
  |       +------+-------------+--------+--------+--------+--------+
  |       |6, &c.|             |        |        |        |        |
  +-------+------+-------------+--------+--------+--------+--------+

  +-------+------+---------+-------+-------+--------+-------------+
  |       | No.  |         |       |       |        |Number       |
  |       |  on  |Flooring.| Fire- |Venti- | Rent.  |of           |
  |       |door. |         |place. |lators.|        |Inmates.     |
  |       |      |         |       |       +--------+-------------+
  |       |      |         |       |       |Weekly, |Under | Over |
  |       |      |         |       |       |   or   |  9   |  9   |
  |       |      |         |       |       |nightly,|years |years |
  |       |      |         |       |       | or per | of   | of   |
  |Account|      |         |       |       |person. | age. | age. |
  |       +------+---------+-------+-------+--------+------+------+
  |  of   |  1   |         |       |       |        |      |      |
  |       +------+---------+-------+-------+--------+------+------+
  | Rooms |  2   |         |       |       |        |      |      |
  |       +------+---------+-------+-------+--------+------+------+
  |Separ- |  3   |         |       |       |        |      |      |
  |       +------+---------+-------+-------+--------+------+------+
  |ately. |  4   |         |       |       |        |      |      |
  |       +------+---------+-------+-------+--------+------+------+
  |       |  5   |         |       |       |        |      |      |
  |       +------+---------+-------+-------+--------+------+------+
  |       |6, &c.|         |       |       |        |      |      |
  +-------+------+---------+-------+-------+--------+------+------+

  Staircase, if with windows or skylight __________

  Privies {Number    ____
          {Situation ____

               {            {Material  ______
               {Receptacles-{Capacity  ______
  Water-supply-{            {Situation ______
               {
               {Taps, where situated _____________

  Sinks   ____

  Dustbin ____

  Yard--size of uncovered area ____

  Pavement ____

  Laundry  ____

  Date ________ Signature of Owner ________________

  NOTE.--I, ____________________, Inspector for the Commissioners of
  Sewers of the City of London, do certify that the above schedule
  contains a true account of the matters to which it relates; also that
  I have examined the privies, drains, sinks, and water-supply in the
  above house, and do find the same to be in an efficient and
  satisfactory condition; also that the house generally is in good
  repair, perfectly clean, and free from disagreeable smell.

  Date____, signed ________________ Inspector.




FOURTH ANNUAL REPORT.


  _September 28th, 1852._

  GENTLEMEN,

I beg leave to lay before your Hon. Court the several tables[74] which I
have prepared, to illustrate the mortality of the City of London during
the past year. They refer to fifty-two weeks, dating from September
28th, 1851, to September 25th, 1852.

    [74] These tables are not here reprinted in a separate form, except
    the enumeration of deaths for the year, which is No. VI. in the
    Appendix. The others are embodied in the different quinquennial
    tables of the Appendix.

  In the first table I have distributed the 3064 deaths of the period,
  according to their localities and seasons; showing them as they
  occurred, male and female, during each quarter of the year, in the
  several districts and sub-districts of the City. For the foot of each
  column, I have calculated the year’s death’s rate, per thousand of the
  living, in the district or sub-district referred to; and at the head
  of the columns, for facility of reference, I have introduced an
  analysis of the population, founded on the Registrar-General’s recent
  census.

  In the second table all the deaths of the last four years are stated,
  in a form which will enable you to compare one year with another, and
  one sub-district with another, in respect of their several
  contributions to the total mortality of the period.

  In the third table 12,540 deaths[75] of the last four years are
  classified according to the ages at which they befell. This table is
  arranged in a manner to display its results, first for each year
  separately, and next for each Union separately; in order that you may
  observe what local or annual differences have obtained as to the ages
  of chief mortality.

    [75] In the remaining number (17) the particulars of age and
    residence could not be correctly ascertained.

  The fourth table also relates to the last four years. It restricts
  itself to those various forms of acute disease--epidemic, endemic, and
  infectious, which occasion, most of all, the predominant mortality of
  particular districts or seasons; and which are susceptible, in the
  highest degree, of being mitigated or removed under an efficient
  sanitary system.

In their general import these documents agree very nearly with last
year’s record; though showing unfortunately a somewhat higher death-rate
(23·62) and especially a larger proportion of fever.

On former occasions I have examined, with great minuteness, all such
facts as these tables set forth, and have offered you the best
suggestions in my power for the mitigation of preventable disease.

The sanitary condition of the City is now substantially the same as at
the date of my last Report; and any comment which I might make on the
present tables could be little else than a repetition of arguments
already submitted to your notice.

Therefore, as other topics[76] of importance to the health of the City
press for more immediate consideration, I refrain from occupying your
time by any further remark on the materials which I subjoin.

  [76] We were at this time closely occupied in considering the general
  questions of extramural interment for the City.--J. S., 1854.

  I have the honour,

  &c., &c.




FIFTH ANNUAL REPORT.


  _November 29th, 1853._

  GENTLEMEN,

According to the practice of previous years, I lay before you, in the
annexed tables, a brief digest of your death-register for the fifty-two
weeks which terminated at Michaelmas last.

The deaths there enumerated amount to 3040--being 24 fewer than in the
last preceding similar period.

Beyond these statistics of the past year, there are other facts which I
have thought it well to tabulate for your information. They relate to
the entire term of five years, during which I have kept record of your
mortality. Midway in this quinquennial period--namely, in the spring of
1851, the general census happened to occur. The inhabitants of the City,
then enumerated, may fairly be taken to represent the mean of your
somewhat fluctuating population; and the five years’ mortality, compared
with the numbers of this mean population, will express pretty accurately
their habitual death-rate.

The period mentioned is indeed short for the purpose of establishing an
average; but ten years at least must elapse before even similar
materials can again be given for calculation, and a still longer time
before the statistical basis can be enlarged. I have therefore thought
it desirable to make the best use in my power of such facts as were
before me, for the construction of quinquennial tables; out of which,
with sufficient accuracy for all practical purposes, you may draw your
own inferences as to the health of that large population which is under
your sanitary government.

The facts are classified, as heretofore, in the manner which will most
easily display their practical meaning. First, namely, the deaths of the
period are recorded in their local distribution, so that you may compare
one part of the City with another in respect of healthiness. Next, they
are so tabulated according to ages, as to indicate the prevailing
proportion of untimely death. Thirdly, those of them are separately
enumerated which, in their several classes, chiefly occur as results of
acute disease in connexion with removable causes.

In after years, when sanitary improvements, now only in contemplation or
commencement, shall have produced their legitimate results and rewards,
these tables may serve an important use. Indicating the standard of
public health within the City before such works were achieved, and
constituting a permanent record of your starting-point, they will
qualify your successors to estimate the amount of amelioration which
your endeavours shall have produced.

The details of your present sanitary condition, as varying in different
sub-districts of the City, and as fluctuating in the several years and
seasons of the quinquennial period, are expressed in the figures of
these tables more compendiously and more clearly than I could hope to
convey them in words. Here, therefore I restrict myself to telling you
very briefly their general results.

The population of the City--about 130,000 persons--has been dying
during these five years at the rate of about 24 _per_ thousand _per
annum_. The sub-district rates which give this aggregate vary from under
18 to above 29; the former death-rate belonging to your healthiest
locality--the north-west sub-district of the City of London Union; while
the latter--more than 60 _per cent._ higher--mortality belongs to the
north sub-district of the West London Union. The lowest death-rate
hitherto attained in this country for a considerable population, during
a term of seven years, has been 14 _per_ thousand _per annum_; which
your worst sub-district mortality more than doubles.

As different districts contribute unequally to your average death-rate,
so also do different ages. Among all the population exceeding five years
of age, the death-rate is under 17 _per_ thousand _per annum_; while,
for children under five years of age, the rate is nearly 85. And these
rates are unequally constituted by your three chief districts in the
following proportion; viz.:--

  Annual Rate of Deaths to 1000      Over 5 Years  Under 5 Years
    living persons.                     of age.       of age.

  East London Union                     16·68          91·99
  West London Union                     20·58          94·84
  City of London Union                  15·06          71·72
                                        -----          -----
  Average death-rate in the City        16·85          84·72

How various are the diseases which have conspired to produce your annual
average of 3120 deaths, it would be tedious to describe; and in the
table which I have devoted to a partial analysis of this subject, I have
restricted myself to a consideration of those ailments which are likely
to become less fatal under a well-developed sanitary system. To the
annual average typhus has contributed 140 deaths; choleraic affections
(including the epidemic of 1849) 196; scarlet fever, 76; small pox, 40;
erysipelas, 30; the acute nervous and mucous diseases of children, 572;
their measles, hooping-cough, and croup, 182;--making, from this class
of disorders, an annual average of about 1250 deaths--nearly two-fifths
of the entire mortality.

My tables will show you that the different seasons of the year have
pressed somewhat differently on human life; and there is exhibited in
them a point of some interest to which I would beg your attention. In
your healthier sub-districts it is easy to perceive the influence, the
almost inevitable influence, exerted by the inclemency of winter against
the aged and feeble. In your unhealthier sub-districts, this effect is
completely masked, and summer becomes the fatal season; its higher
temperature acting in some sort as a test of defective sanitary
conditions, and giving to the several local causes of endemic disease an
augmentation of activity and virulence.

On the facts which these tables set forth, I have nothing further to say
than would consist in a repetition of arguments already submitted to
your notice. In my third Annual Report, especially, I endeavoured to lay
before you the conclusions which are fairly deducible from the
proportions of early death, and from the partial allotment of particular
diseases.

These conditions, indeed, are in obvious mutual relation. To human life
there has been affixed a normal range of duration; and when it
prematurely fails--when children perish in the cradle, or adults amid
the glow of manhood, the exception in every case is a thing to be
investigated and explained. Of the 15,597 persons who have died within
your jurisdiction, not an eighth part had reached the traditional
‘threescore years and ten;’ while nearly three-eighths died in the first
five years of life. In proportion as facts like these appear in the
death-tables of a particular district, in the same proportion we can
trace the local prevalence of particular diseases, to explain the
abridgment of life; and passing from such a locality to other districts,
where the natural term of existence is more nearly attained, invariably
we find that these diseases have fallen into comparative inertness.
Finally, in grouping the fatal results of such diseases in their
proportionate geographical allotment, invariably we find that their
prevalence or non-prevalence, here or there, has been associated with
demonstrable physical differences; that life has not capriciously been
long in one place and short in another, but that, where short, it has
been shortened; that its untimely extinction has depended on the direct
operation of local and preventable causes.

In this recognition of cause and effect, which the experience of late
years has rendered vivid and precise; and in that higher appreciation of
human life, which belongs to civilized nations in peaceful times; and in
that deeper sympathy for the suffering poor, which should be at the
heart of every Christian government, sanitary legislation had its origin
in this country; and it has been the good fortune of the City of London
(in respect of your two Acts of Parliament) to precede the rest of the
metropolis in acquiring and exercising authority for the mitigation of
preventable disease.

Nearly five years have now passed over your tenure of this very grave
responsibility; and although in many respects the period must be
regarded as one of apprenticeship to a new and difficult
career--although you have hardly yet arrived at what may permanently
represent your method of action--although important changes which you
have determined to adopt are not yet in actual working--although the far
greatest evils still remain for correction--yet I rejoice to inform you
that sensible improvement has already shown itself in the sanitary state
of your population. My comparison of the past five years with any
considerable previous period cannot be as precise as I would wish, owing
to the absence of circumstantial records for the time anterior to my
appointment; but, judging from such information as I can consult on the
subject, I am induced to believe that the deaths, for equal numbers of
population, are about four _per cent._ fewer than before your Acts of
Parliament came into operation, and that the disproportionate mortality
of children is decidedly lessened.

On this first improvement--the beginning, I would fain hope, of a long
series of similar steps for regaining the allotted duration of human
life, I beg to offer my respectful congratulations to your Hon. Court,
under whose auspices it has been effected. Further impetus in the same
direction will shortly be given by the removal of sanitary evils,
already in fact or in principle condemned. The approaching institution
of your extramural cemetery, and, I venture to hope, the translation of
all slaughtering establishments to the site of your new Smithfield, will
be important contributions to this effect. I therefore make bold to
speak with some sanguineness of the slight change of death-rate already
noticed; though, while so much remains to be accomplished, I doubt not
you will welcome the amelioration rather as an encouragement to proceed,
than as the final reward of a completed task.

       *       *       *       *       *

Here, Gentlemen, terminates all that I have to submit for your
consideration in respect of your past and present record of deaths. The
greater extension which, during the last two years, I have given to my
habitual Weekly Reports, and to sundry occasional statements which it
has been my duty to lay before you, may seem, at least generally, to
render it superfluous for my Annual Report to contain anything beyond
such statistical particulars as I have now brought under your notice.
But, however this may generally be, there exist exceptional
circumstances at the present time which induce me to trouble you at
somewhat greater length.

       *       *       *       *       *

II. Two years ago--adverting to the non-completion of metropolitan
sanitary works, on which the health of entire London is vitally
dependent, I could not but comment[77] on the utter unpreparedness with
which the metropolis was awaiting any sudden return of Asiatic cholera.
It was indeed impossible to foresee how soon, or how late, that dreadful
visitation might recur to desolate our homes--whether it might return at
once, or never. But typhus--averaging in fifteen years double the
fatality of that rarer epidemic--was adding day by day to its list of
preventable deaths; and other endemic diseases were co-operating with
it, demonstrably, uninterruptedly, to decimate, impoverish, and abase
the people.

  [77] Third Annual Report, p. 206.

Whatever doubts might have existed as to a return of the foreign
pestilence were soon solved: whatever hasty conclusions had been formed,
as to its again remaining absent during half a generation, were soon
disappointed and reversed. Even while I was addressing you on the
subject, the plague had again kindled its smouldering fire, and was
widening its circle of destruction. Perhaps from the eastern centres of
its habitual dominion--from the alluvial swamps and malarious jungles of
Asia, where it was first engendered amid miles of vaporous poison, and
still broods over wasted nations as the agent of innumerable deaths; or
perhaps from the congenial flats of Eastern Europe, where it may have
lingered latent and acclimatised; the subtle ferment was spreading its
new infection to all kindred soils. Repelled again from the dry and airy
acclivities of the earth, and their hardier population, it filtered
along the blending-line of land and water--the shore, the river-bank,
and the marsh. Conducted by the Oder and Vistula from the swamps of
Poland to the ports of the Baltic, it raged east and west, from St.
Petersburg to Copenhagen, with frightful severity, and, obedient to old
precedents, let us witness its arrival at Hamburg.

Twice in the European history of cholera, had this town seemed the
immediate channel of epidemic communication to our island; the disease
having on each occasion commenced in our north-eastern sea-ports within
a very short time of its outburst there. A third time, not unexpectedly,
has this dreadful guest, following the line of former visitation,
touched upon the banks of the Tyne; where[78] a worse than beastly
condition of the crowded poor, and sewage-water diluted through the
people’s drink, had prepared it an appropriate welcome.

  [78] Having had recent occasion to examine judicially into the matters
  here adverted to, I think it proper to mention that the allusions in
  my text were long prior to this examination, and were founded chiefly
  on the Registrar-General’s Reports of the time, with other official
  statements.--J. S., 1854.

Next, the disease was rumoured to be in London. Hope and belief are too
near akin for this not to have been doubted and denied; but the last few
weeks have shown, with sad incontrovertible certainty, that after only
four years absence, Cholera has again obtained its footing on our soil.
Six or seven hundred deaths, registered in the metropolis since the
beginning of September, have already attested its presence.

Anxiously adverting to the future, and asking what may be the onward
progress of the disease, we can appeal only to a narrow experience.
Before us lie the records of but two complete visitations of the
disease, and the commencement of this, the third. It would be a shallow
philosophy that should pretend, from two observations, to predict the
possible orbit of this obscurely wandering plague.

Yet I dare not disguise from you that such knowledge as we have, to
justify scientific anticipation, is pregnant with threats and gloom.
For--let me remind you of the past. At each former period of attack, the
infection, after a certain course over Continental Europe, struck upon
our eastern coast in the summer of an unforgotten year. In the northern
parts of Great Britain, so soon as it had lit among the population, each
time it burst forth into explosive activity, and worked its full
measure of destruction without delay. More faintly it reached the South.
On each occasion, indeed, at the close of summer, London was sensibly
affected by the disease; but, we hoped, under a milder infliction. Here
and there, within its Bills of Mortality (as at Tooting in 1848) there
was thrown some astounding flash on a particular hot-bed of co-operating
poison; but on the whole it seemed to the sanguine, on each occasion,
that the fury of the epidemic was expending itself in our northern
towns, and that the metropolis was to be comparatively spared.

Each time, at the commencement of the new year, our London mortality
from Cholera seemed stationary within the limit of a few hundred deaths.
Each time winter and spring allowed a long respite to our invaded City,
and confirmed the omens of the hopeful.

But each time there was disappointment. Each time, as the warmth of
summer requickened the exterior conditions of chemical activity, the
dormant fire kindled afresh--slowly at first, but with speedy
acceleration of rate. Each time, in the few weeks before
Michaelmas--amid almost universal threatenings of the disease, and amid
such panic of death as the metropolis had not known since the Great
Plague, there suddenly fell many thousands of the population.

Thus then our position stands. Scientific prediction of phenomena can
arise only in the knowledge of laws. That the phenomena of this disease,
however capricious they may seem, are obedient to some absolute
uniformity as yet beyond our ken--are enchained by that same rigid
sequence of cause and effect which is imposed on all remaining
Nature--it would be impossible to doubt. But these conditions are
hitherto unknown to science. Hitherto we can speak of the facts alone,
with a short empirical knowledge of their succession. Yet in this light,
such as it is, the conclusion is only too obvious. If the disease,
already notorious for a tendency to return on its former vestiges,
repeat on this third occasion the steps of its two previous courses; or,
perhaps I should rather say, if it now proceed consistently to complete
a repetition which it has already half-effected; Asiatic Cholera will be
severely epidemic in London in the third quarter of next year--will
proceed, with a stern unflattering test, to measure the degree in which
those promises of sanitary improvement have been redeemed, which the
terror of its recent visitation extorted even from the supinest and most
ignorant of its witnesses.

In the face of so great a danger, you will reasonably claim of your
Officer of Health that he shall report to you, how far the City is
already fortified against this dreadful invasion--how far the hygienic
defences of life, if weak, may be strengthened--how far there remain
breaches now insusceptible of repair.

       *       *       *       *       *

1. It forms an all-important part of these considerations for resistance
to the disease, to recognise quite accurately what is its fashion of
attack. Since I last addressed you on the subject, in my Report for
1849-50, the materials for correct generalisation have been very largely
increased by Dr. Farr’s admirable Report to the Registrar-General on the
Cholera in England, and by numerous other important publications. By
collating with these works the more restricted, yet not uninstructive,
experience which arose within your particular jurisdiction, I hope to
have enlarged my knowledge of the subject, and to have become able with
greater confidence to submit my conclusions for your acceptance.

The first and most obvious characteristic of the disease is its
preference for particular localities. It is eminently a
district-disease. And the conditions which determine its local
settlement are demonstrable physical peculiarities.

After carefully reviewing the subject, I do not know that I need
qualify, except to express more confidently, the account I formerly gave
you of those peculiarities, as consisting in the conjunction of dampness
with organic decomposition.

It is in respect of these conditions--especially among dense urban
populations, that the level of occupied ground, relatively to the
nearest water-surface, becomes of primary importance. The low level, in
itself, or rather in respect of the watery dampness which it implies, is
not enough to localise the pestilence. To be afloat at sea might be the
safest lodging.

The sub-district of St. Peter’s, Hammersmith, averages only four feet
above high-water level; that of St. Olave’s, Southwark, two feet higher;
yet among the former and worse placed of these two populations, the
Cholera-mortality was only 18 per 10,000; while among the latter and
better placed it rose to 196--multiplying nearly eleven times the minor
phenomena of a lower level. So also within your own jurisdiction. Side
by side along the river lie four of your sub-districts; three at the
elevation of twenty-one feet, one at the elevation of twenty-four feet.
The Cholera-mortality, if simply proportioned to level, should have been
nearly the same for these four sub-districts, but somewhat less in the
last one than in the first three. Yet contrary was the fact; for in two
of these sub-districts the Cholera-mortality, for equal numbers of
population, was 4½ times as great as in the other two.

It would, therefore, appear that in certain low-lying levels--to
constitute them favorable soils for the disease, there must be joined to
their first condition of lowness (with the mere watery dampness which it
implies) some other and second condition; one, which is of extreme
frequency in such districts, though not essentially present there.

This second condition impends wherever there dwells at such levels a
certain density of population; _it mainly varies with the degree in
which that dense population lives in the atmosphere of its own
excrements and refuse_. In this respect I cannot refrain from saying,
that the giant error of London is its present system of drainage.
Probably in considerable parts of the metropolitan area, house-drainage
is extensively absent: probably in considerable parts, the sewers, from
the nature of their construction, are very doubtful advantages to the
districts they traverse: but the evil, before all others, to which I
attach importance in relation to the present subject, is that habitual
empoisonment of soil and air which is inseparable from our tidal
drainage. From this influence, I doubt not, a large proportion of the
metropolis has derived its liability to Cholera. A moment’s reflection
is sufficient to show the immense distribution of putrefactive dampness
which belongs to this vicious system. There is implied in it that the
entire excrementation of the metropolis (with the exception of such as,
not less poisonously, lies pent beneath houses) shall sooner or later be
mingled in the stream of the river, there to be rolled backward and
forward amid the population; that, at low water, for many hours, this
material shall be trickling over broad belts of spongy bank which then
dry their contaminated mud in the sunshine, exhaling fœtor and poison;
that at high water, for many hours, it shall be retained[79] or driven
back within all low-level sewers and house-drains, soaking far and wide
into the soil, or leaving putrescent deposit along miles of underground
brickwork, as on a deeper pavement. Sewers which, under better
circumstances, should be benefactions and appliances for health in their
several districts, are thus rendered inevitable sources of evil. During
a large proportion of their time they are occupied in retaining or
re-distributing that which it is their office to remove. They furnish
chambers for an immense fæcal evaporation; at every breeze which strikes
against their open mouths, at every tide which encroaches on their
inward space, their gases are breathed into the upper air--wherever
outlet exists, into houses, foot-paths, and carriage-way.

  [79] I am informed that in large districts on the south side of the
  river, this retention of sewage is prolonged for two-thirds of every
  tide--sixteen hours out of every twenty-four.

To you, Gentlemen, as Commissioners of Sewers for the City of London,
these remarks may seem superfluous; the rather so, as the worst evils of
tidal drainage are not largely exemplified within your jurisdiction. But
it seems to me of extreme moment at the present time, when very costly
improvements of the metropolitan drainage are about to undergo
parliamentary discussion, that the public should be well aware how
indispensable such improvements are for the general health of London,
and how important, in fact, they are to thousands who at first sight
might think themselves little interested in their completion.

To some individual householder, dwelling at a high level, all concern
in the subject may seem to terminate with the defluxion of his own
sewage. So that his own pipes remain clear, little cares he for the
ultimate outfall of his nuisance! Perhaps, if he knew better, he would
care more. His gift returns to him with increase. Down in the valley,
whither his refuse runs, converge innumerable kindred contributions.
From city and suburb--from an area of a hundred square miles covered by
a quarter of a million of houses, with their unprecedented throng of
metropolitan life, there pours into that single channel every
conceivable excrement, outscouring, garbage and refuse, from man and
beast, street and slum, shamble and factory, market and hospital. From
the polluted bosom of the river steam up, incessantly though unseen, the
vapours of a retributive poison; densest and most destructive, no doubt,
along the sodden banks and stinking sewers of lowest level; but
spreading over miles of land--sometimes rolled high by wind, sometimes
blended low with mist, and baneful, even to their margin that curls over
distant fields. For, not alone in Rotherhithe and Newington--not alone
along the Effra or the Fleet, are traced the evils of this great miasm.
The deepest shadows of the cloud lie here; but its outskirts darken the
distance, A fever hardly to be accounted for, an infantile sickness of
undue malignity, a doctor’s injunction for change of air, may at times
suggest to the dweller in our healthiest suburbs, that while draining
his refuse to the Thames, he receives for requital some partial workings
of the gigantic poison-bed which he has contributed to maintain.

The subject of these remoter effects I refrain from pursuing, as foreign
to my present purpose. That on which I wish to insist is the character
of the river, in its relation to the marginal sub-districts which it
habitually dampens and occasionally floods with putrescent soakage, and
in its relation to the sewers of low gradient which it converts (often
with their adjoining soil) into the similitude and hurtfulness of
cesspools. I wish emphatically to point out, that the several parts of
London have suffered, and are likely again to suffer, from Cholera, in
proportion as either this malarious influence is exerted on them, or
other kindred miasms are furnished by their soil. And it is my belief,
from such evidence as is before me, that the general liability of London
to suffer the epidemic visitation will cease, whenever an efficient and
inodorous system of drainage, conveying all refuse of the metropolis
beyond range of its atmosphere, shall be substituted for our present
elaborate disguise of an unremoved nuisance. I deem it right to state
this explicitly: not only because it is my duty to give you, in simple
truth, the conclusions to which I am led by careful reflection on the
facts; but likewise because--for the credit of sanitary medicine and for
your justification in the awful presence of a recurrent pestilence
within your jurisdiction--it ought to be thoroughly known how much of
the cause is common to the entire metropolis, and has not admitted of
removal by measures of partial improvement. And the circumstances will
perhaps excuse me if I repeat to your Hon. Court--represented as you are
both in the Metropolitan Commission of Sewers and in Parliament, where
this question must shortly be discussed--that the universal reform of
our metropolitan drainage, at whatever imaginable pecuniary cost, is an
urgent claim and necessity, unless this great city is again, as two
centuries ago, to live under the constant alarm of increasing epidemic
destruction.

Reverting, however, to the more especial relations of the disease within
your territory, you will remember that, among your four bank-side
sub-districts, two suffered in marked excess; their Cholera-mortality
having been 4½ times as great as that of the other two. The fact is
instructive; because those two suffering sub-districts (though not of
lower mean level than the others) were marginal to the valley of the
Fleet, and were therefore exposed, more than any other part of your
province, to the class of evils I have described. For a considerable
part of this locality may be regarded as but recently[80] a creek of the
Thames; its shelving banks, singularly foul from ancient misuse, though
now built over and paved, undergo in their lower levels very
considerable soakage; while those vast sewers which lie in the
mid-channel of the former river, are more liable than any within your
jurisdiction, to suffer injurious interference from the action of the
tide. At every such interference, and at every current of air setting up
the sewers, all gases generated in these large chambers would diffuse
themselves, not only in the low level, but likewise widely east and
west, up those important slopes which depend on this valley for their
drainage. I can easily understand that the radical cure of this district
may be possible, only as part of those metropolitan improvements to
which I have adverted; but I do think it of supreme importance, in
reference to any such visitation as we dread, that, during the next
twelve months, there should be taken every precaution which technical
knowledge can suggest, for restricting, even by palliative and temporary
expedients, those mischievous effects which I have endeavoured to
illustrate.

  [80] New Bridge Street was built over the Fleet in 1765. The present
  site of Farringdon Street had been arched in thirty years earlier, for
  the purposes of the Fleet Market.

In describing to you the local affinities of cholera, I have intimated
that, in its preference for our low metropolitan levels, it selects
these soils specifically in respect of their being damp with organic
putrefaction. A moment’s consideration will suffice to show that, if
this be true, the higher levels of the metropolis will be exempt from
the disease, only in proportion as they exempt themselves from the local
conditions which invite it--only in proportion as they avail themselves
of those natural advantages which their situation enables them to
command. Let a district be defective in house-drainage, so that its soil
is excavated by cesspools and sodden by their soakage; let its sewers be
ill-constructed and foul, so that offensive gases are ventilated into
the immediate breathing-air of the inhabitants; let its pavement be
absent or imperfect, scattered with refuse and puddled with water;--you
will easily conceive that, under these circumstances, all distinctions
of level are merged in the strong identity of filth, and whatever
diseases belong to putrefactive dampness of soil will strike here as
readily as on the low-lying mud-banks of the river.

So, likewise, in still narrower limits--the predisposition of a house to
Cholera may be stated in the same terms as define the liability of a
district--viz., that the humid gases of organic decomposition, in
proportion as they are breathed into one house in a district more than
into other houses there, will engender the greater liability of that
house, as compared with its collaterals, to suffer an invasion of
Cholera. And thus it often happens, during epidemic prevalence of the
disease, that sporadic cases are determined in localities which might
generally claim to be free from infection: for, what avails it to be on
the highest ground and the best soil, with every neighbouring facility
of sewers and scavenage, if, owing to individual carelessness and filth,
the conditions of dampness and putridity are by choice retained within a
house, and its basement flooded with rotting liquids, or piled with
accumulated refuse?

I might give you many instances in illustration of these points--showing
you how, under the operation of specific sanitary faults, the
Cholera-mortality of districts acquires an artificial exaltation; but
few comparisons will suffice. At the period of the epidemic of 1849,
your best conditioned sub-district was the north-west of the City of
London Union; and (among those of the same level) your worst was the
sub-district of Cripplegate, which at that time was in a very
unsatisfactory state, abounding in open cesspools and their
consequences. In the former of these sub-districts the Cholera-mortality
_per_ 10,000 was 19; in the latter 47; and it is easy to show that
additional sanitary errors soon develop a larger fatality. Not far from
your boundary, at the same level with these two sub-districts, in the
Hackney-Road division of Bethnal-Green, it rose to 110; this large
mortality being principally confined to a very small portion of the
district, wherein (the local Registrar reports) sewers were almost
entirely absent, houses were contaminated with the filth of years,
streets were remaining for days uncleansed from accumulating dirt, and
all waste water (including animal secretions) was uniformly thrown into
the public way.

Such are the conditions under which, at any imaginable height in the
metropolis, Cholera may decimate a population: such, in their worst
form, were the conditions which at Merthyr-Tydvil--several hundred feet
above the water-level, carried the Cholera-mortality to more than double
the high metropolitan rate just mentioned. Taught by this case the power
of human mismanagement to futilise the favours of Nature; taught that
perverse ingenuity can construct poison-beds for the development of
Cholera, high above the usual track of its devastation; one gladly turns
from the horrible instructiveness of such a lesson, to gather the
kindred evidence of contrast: and happily there is abundant evidence to
show how much may be effected, even in the most tainted districts, to
purchase a circumscribed exemption from the disease by the judicious
application of sanitary care.

In the remarks which I have made on the local distribution of Cholera,
you will have observed that I dwell particularly on one class of
sanitary evils as concerned in its production; on that class, namely,
which consists in the retention and soakage of organic refuse--on that
class, which has its appointed antidote in a system of inodorous
drainage, of uninterrupted pavement, of complete and punctual scavenage.

On this I particularly insist, because I believe that here is the very
atmosphere without which Cholera would cease.

Sanitary evils abound; and, if I were speaking of other diseases, I
might have more to say of other causes. I am unwilling, even for a
moment, to seem indifferent to those remaining fertile sources of
suffering that surround the poor of our metropolitan population--to
their over-crowded condition, to their scantiness of ventilation, to
their insufficient or disgusting water-supply, to their frequent
personal dirt, to their habitually defective diet. These several
influences have their own characteristic sequels and retribution, on
which I have often addressed you, and which I am little likely to
underrate; believing, as I do, that, in the lapse of years, the
aggregate of their effects is far more fatal than any periodical
epidemic visitation. Likewise, I cannot doubt that, under certain
circumstances, and in respect of particular cases, they may assist the
operation of the choleraic poison. Nor will I pretend so exactly to
limit the affinities of that which evolves this poison, as to deny that
rooms, fœtid with animal exhalations, may (like cesspool-sodden cellars)
be ready to answer the stimulus of its infection. And at any rate, I
think it highly important to recognise that all sanitary defects which
embarrass the excretive purification of the human body--whether by
breathing or otherwise, do naturally tend in the same direction as the
causes of Cholera, and are liable--if only by indirect means, to become
accessory in its destructive work.

But, deeply impressed as I am with the importance of these
considerations, I esteem it of still higher consequence, if measures are
ever to be taken for an effective prevention of the disease, that the
principle of its _specific causation_ should be steadfastly kept in
view. What may be the exact chemistry of this process, I do not pretend
to say: urging only, that, in all human probability, the poison arises
in specific changes impressed by some migratory agent upon certain
refuse-elements of life. Perhaps nowhere, and certainly not before your
Hon. Court, can it be desirable, in the present immaturity of
pathological knowledge, to argue as to the first origin or absolute
nature of that wandering influence which determines in particular
localities the generation of epidemic malaria. Simply, since it leads to
all-important practical conclusions, let this distinction be recognised:
that which seems to have come to us from the East is not itself a
poison, so much as it is a test and touchstone of poison. Whatever in
its nature it may be, this at least we know of its operation. Past
millions of scattered population it moves innocuous. Through the
unpolluted atmosphere of cleanly districts, it migrates silently,
without a blow: that which it can kindle into poison, lies not there. To
the foul, damp breath of low-lying cities, it comes like a spark to
powder. Here is contained that which it can swiftly make
destructive,--soaked into soil, stagnant in water, griming the pavement,
tainting the air--the slow rottenness of unremoved excrement, to which
the first contact of this foreign ferment brings the occasion of
changing into new and more deadly combinations.

These are matters which it is hateful to hear, and, believe me, to speak
about. But the thing is worse than the statement; and I would suggest to
you this easy test of its reality. Take at random any consecutive
hundred entries of Cholera-Deaths in the Registrar-General’s
metropolitan returns, where local conditions are described; and let any
man decide for himself, whether what I have sketched in general terms
convey more than the essential features of these several records. In
1849, such an atmosphere as these influences engender existed
continuously and intensely on the low-lying south side of the river, and
to some distance inland, from Greenwich to Wandsworth; it existed also
continuously, but in far less intensity, and with comparatively little
extension inland, along the northern side of the river from Poplar to
Chelsea, and it existed very intensely in several independent centres,
scattered about those healthier levels of the metropolis, which, by
their better position, ought to have been exempted from such a reproach.
The Cholera struck in the same proportion as this atmosphere prevailed;
and herein, I repeat, lies that definite local condition, except for
which--to the best of my knowledge and belief, the migratory ferment
(whatever it may be) would pass harmlessly through the midst of us.

For, towards the chemical constitution of local atmospheres, it seems
that the several principles of epidemic diseases stand in the same sort
of fixed respective relations, as do the several principles of infective
fevers towards certain elements in the blood of individual persons. Just
as the infective ferment acts on man, so appears the epidemic ferment to
act on locality. We know that, in a given group of human beings,
small-pox chooses one victim, scarlatina another, measles a third, by
reason of some material quality in each person respectively, which his
blood possesses, and which his neighbour’s blood does not possess. By
virtue of this quality--not the less chemical because chemists have no
name for it, that specific exterior agency, which we call infection, has
the power of affecting each such person--has the power of producing in
him a succession of characteristic chemical changes which tend to an
eventual close by exhausting this material which feeds them.[81]

  [81] For the scientific reader, I may perhaps be permitted to add,
  that the very difficult Subject, at which here I can only venture to
  glance, is discussed at some length in one of my Pathological
  Lectures, delivered at St. Thomas’s Hospital in 1850, published at
  that time in the _Lancet_, and subsequently reprinted.--J. S., 1854.

Strictly analogous to this, in its principle of choice and in its method
of operation, appears the epidemic action--not on persons indeed, but on
places. The specific migrating power--whatever its nature, has the
faculty of infecting districts in a manner detrimental to life, only
when their atmosphere is fraught with certain products susceptible,
under its influence, of undergoing poisonous transformation.

These products, it is true, are but imperfectly known to us. Under the
vague name of putrefaction we include all those thousand-fold
possibilities of new combination, to which organic matters are exposed
in their gradual declension from life. The birth of one such combination
rather than another is the postulate for an epidemic poison.

Whether the ferment, which induces this particular change in certain
elements of our atmosphere, may ever be some accident of local origin,
or must always be the creeping infection from similar atmospheres
elsewhere similarly affected; whether the first impulse, here or there,
be given by this agency or by that--by heat, by magnetism, by planets or
meteors--such questions are widely irrelevant to the purpose for which I
have the honour of addressing you. The one great pathological fact,
which I have sought to bring into prominence for your knowledge and
application, is this:--that the epidemic prevalence of Cholera does not
arise in some new cloud of venom, floating above reach and control, high
over successive lands, and raining down upon them without difference its
prepared distillation of death; but that--so far as scientific analysis
can decide, it depends on one occasional phase of an influence which is
always about us--on one change of materials which in their other changes
give rise to other ills; that these materials, so perilously prone to
explode into one or other breath of epidemic pestilence, are the dense
exhalations of animal uncleanness which infect, in varying proportion,
the entire area of our metropolis; and that, from the nature of the
case, it must remain optional with those who witness the dreadful
infliction, whether they will indolently acquiesce in their continued
and increasing liabilities to a degrading calamity, or will employ the
requisite skill, science, and energy, to remove from before their
thresholds these filthy sources of misfortune.

       *       *       *       *       *

2. If, gentlemen, I have detained you long in stating conclusions as to
the habits of the disease, and as to the significance of its local
partialities, it has been in order to render quite obvious to you the
intention of those precautionary measures which it is now my duty to
recommend.

First, I would allude to influences of an exterior and public kind; and
here, all that I have to advocate might be included in a single
stipulation, that cleanliness--in the widest sense of the word--should
be enforced to the full extent of your authority.

Over the pollutions of the river, and over the tidal exposure of its
malarious banks, you have no power.

Whether for the relief of your low-lying districts--subject to imminent
risk from causes I have described--there can be found any temporary
protection to save their atmosphere from contamination, is a question
which you will resolve upon other judgment than mine.

Along the river-bank there is one especial source of nuisance which has
repeatedly been under your notice, and which is likely to become of
serious local import under the presence of epidemic disease. I refer to
the docks, and chiefly to that of Whitefriars. I mention it
particularly, not only because the accumulations of putrid matter there
have often been alarmingly great, but likewise because, at the head of
this dock, during the former invasion of Cholera, there was remarkable
prevalence of the disease; and I can well remember how often the
offensive condition of the dock was accused, not unjustly, of
contributing to the mortality of the neighbourhood. The fœtid materials,
floated into these several recesses of the river, and left stranded
there by the receding tide, are often so copious as to produce very
objectionable effects on the atmosphere which surrounds them; and I
would beg leave strongly to urge that such sources of nuisance should be
thoroughly and permanently removed.

Further--from what I have said as to the conditions of our vulnerability
by Cholera, you will be prepared to think it of great importance that,
during the next six months, you should be certified on the state of your
sewers, in every part of the City, as to their greatest possible
cleanliness and least possible offensiveness of ventilation. Fifty miles
of sewer, reticulated through the City, sufficiently attest your active
desire to provide for the complete and continuous carrying away of all
excremental matters: and you will excuse me, I hope, in consideration of
the anxieties of my office, if I seem superfluously cautious in
reminding you that the test of successful sewers lies in an inodorous
fulfilment of their duty, and that every complaint of offensive
emanations indicates, in proportion to its extent, a failure of that
sanitary object for which the construction was designed.

There is one precaution--always of great value to the health of towns,
and especially useful against any malarious infection, which happily I
find it needless to recommend. The paving of all public ways within the
City--including every court and alley--is already so complete as to
constitute a very favorable point in your sanitary defences. In order
that this excellent arrangement may give its full fruit, it will be
requisite--though this again I need hardly press on your consideration,
that the duties of scavengers and dustmen be thoroughly and punctually
performed.

Again, I would particularly advise that great vigilance be exercised in
all markets, slaughtering-places, and other establishments under your
jurisdiction, to prevent the retention of refuse-matter, animal or
vegetable. I would urge the strictest enforcement of all regulations
which you have made for the cleanliness of such places, and for the
removal of their putrefiable refuse.

Likewise, I have to suggest that after the month of May, at latest, no
disturbance of earth to any considerable depth should be allowed to take
place, either in your works or in those of gas and water companies,
except under circumstances of urgent necessity. In the lower levels of
the City, particularly, I conceive this prohibition to be a matter of
paramount importance; because the soil, never of unexceptionable
cleanliness in towns, is here especially apt to be of offensive quality.

On the subject of water in its general relations to the City, I have
only again to express my deep regret that it lies out of your present
power to compel a continuous supply, and that your means are restricted
to choosing what may best compensate for the absence of this sanitary
boon. It must be your aim to mitigate, so far as may be, the evils that
belong to an ill-regulated intermittent system in its adaptation to the
houses of the poor--evils which imply, as I have often told you, not
only much domestic dirt, but likewise a frequent suspension of all
efficiency in the drainage of innumerable houses. With a view to the
best alternative for a continuous supply, I would recommend that at
least a daily filling of all cisternage take place, and expressly that
Sunday form no exception to the advantages of this rule. If a choice of
evils must be made, I trust it is no heathen’s part to urge that the
Christian Sabbath suffers more desecration in the filth and preventable
unwholesomeness of many thousand households, than in the honest industry
of a dozen turncocks. I likewise submit, that it would be highly
advantageous to the labouring poor, most of whose domestic cleansing is
reserved for the last day of the week, that, on that day, a second
delivery of water should take place at some hour in the afternoon.

I wish it were in my power to tell your Hon. Court that the supply of
water to the City of London had become, in quality, all that I think it
might be rendered. Such as it is, however, there depend other very
important issues on its being delivered in ample abundance for all the
purposes of cleanliness; and I am glad to have learned from the eminent
engineer of the New River Company, that he has it in expectation very
shortly to be able to furnish to the City a largely increased and
practically inexhaustible supply.

The subject of water in its district relations ought hardly to be passed
without a word of caution as to the use of pumps within the City. I need
hardly inform you that every spring of water represents the drainage of
a certain surface or thickness of soil, and that--such as are the
qualities of this gathering ground, such must be the qualities of the
water. You will, perhaps, remember that in my account of one celebrated
City pump, which sucks from beneath a churchyard, I showed you ninety
grains of solid matter in every gallon of its water. In virtue of that
wonderful action which earth exerts on organic matter, the former
contents of a coffin, here re-appearing in a spring, had undergone so
complete a change as to be insusceptible of further putrefaction: the
grateful coolness, so much admired in the produce of that popular pump,
chiefly depending on a proportion of nitre, which arises in the chemical
transformation of human remains, and which being dissolved in the water,
gives it, I believe, some refrigerant taste and slight diuretic action.
Undoubtedly this water is an objectionable beverage in respect of its
several saline ingredients; but my present object in adverting to them
is rather to illustrate an anterior danger which they imply. Their
presence indicates a comparative completion of the putrefactive process,
effected by the uniform filtration of organic solutions through a
porous soil.[82] Let that soil have frequent fissures in its substance;
or let its thickness be scanty in proportion to the organic matters to
be acted on: and the water, imperfectly filtered, would run off foul and
putrescent. Now this risk, more or less, belongs to all pumps within the
City of London. They draw from a ground excavated in all directions by
sewers, drains, cesspools, gas-pipes, burial-pits. The immense amount of
organic matter which infiltrates the soil does undoubtedly, for the
greater part, suffer oxidation, and pass into chemical repose: but in
any particular case it is the merest chance, whether the glass of water
raised to the mouth shall be fraught only with saline results of
decomposition--in itself an objectionable issue--or shall contain
organic refuse in the active and infectious stage of its earlier
transformations. Some recent cutting of a trench, or breakage of a drain
in the neighbourhood, may have converted a draught, which before was
chronicly unwholesome, into one immediately perilous to life. Such facts
ought to be known to all persons having custody of pumps within urban
districts; and it ought likewise to be known that this infiltrative
spoiling of springs may occur to the distance of many hundred yards.[83]

  [82] This very important influence, exerted by the earth on various
  organic infiltrations, is referred to in the text only under one point
  of view; only as it occasions the deterioration of land-springs in
  urban districts, and renders their water unfit for consumption. But
  the subject has another equally important side. Such springs, having
  their waters laden with nitrates, represent the continuous removal of
  organic impurities which otherwise would contaminate the air. The evil
  of spoiled springs, therefore--while it necessitates for every urban
  population that their water-supply shall be artificially furnished
  from a distance, has great countervailing advantages. A given organic
  soakage will cease to vitiate the atmosphere by evaporation, in
  proportion as it gravitates to lower levels, and undergoes those
  chemical changes which accompany filtration through the soil. Hence it
  is evident that, for the healthiness of inhabited districts (where
  extensive soakage of organic matters is almost invariable) it becomes
  most important to maintain, or by artificial measures to accelerate,
  this down-draught through the soil; and the reader will scarcely need
  to be reminded, that, in those improvements of metropolitan sewerage,
  which it is a chief object of this Report to advocate, complete
  provision for the continuous drainage of soil is implied as an
  essential part.

  [83] For a fact strikingly illustrative of this, I am indebted to my
  colleague, Dr. R. D. THOMSON, Lecturer on Chemistry at St. Thomas’s
  Hospital. At Liverpool--in three wells which he examined, distant
  severally 760, 800, and 1050 yards from the Mersey, he found the water
  brackish from marine soakage, containing four or five hundred grains
  of solid matter _per_ gallon, and totally unfit for consumption.

In final reference to the quality of water, whether supplied by our
trading companies or derived from springs within the City, I think it
expedient to mention that, against its lesser impurities, great
protection is given by filtration through animal charcoal, as in various
‘filters and purifiers’ which are before the public. These protective
means do not lie within reach of the poorer classes; nor, whatever their
accessibility to individuals, can any such personal arrangements render
it less important to provide that water--the first necessary of life--be
supplied for universal use in its utmost procurable purity.

       *       *       *       *       *

Beyond the above points, which are of general application within the
City, all your remaining precautions will relate to the condition of
private houses: and of these--occupied by the poorer classes, there
exist in the City some thousands over which it will be requisite, by
repeated inspection, to maintain an efficient sanitary watch. From
circumstances to which I have already referred, it appears that your
defences against Cholera will very mainly consist in removing the causes
of disease from within individual houses; and it is only by an organised
system of inspection, for detecting and removing every unclean
condition, that this object can be attained. For your encouragement in
this task, I may venture to express my belief that, throughout a
considerable portion of the City, the local affinities for Cholera are
not too strong to be greatly modified and obviated by such a system.

With respect to this important work of sanitary inspection, what I now
propose is no new proceeding within the City. More or less since the
date of my appointment, but I hope with gradual increase of completeness
and efficiency, weekly visitations on a considerable scale have been
made, under my direction, by your four Inspectors of Nuisances. Acting
under your authority, and guided by what information I could obtain on
the existence of endemic disease[84] in your several districts, I have
furnished the Inspectors every week with a variable list of houses,
ranging probably from fifty to one hundred and fifty at a time, for
their visitation and inquiry. The information which I have directed them
to seek has referred of course to the various details of sanitary
condition: to questions of lodgment, ventilation, cleanliness, drainage,
water-supply, dust-removal, paving of yards and cellars, existence of
nuisances, and the like: and I have constructed tabular forms for their
use, which admit of this information being recorded and reviewed in the
readiest manner. Week by week, before each meeting of your Court, I have
had the habit of going through every particular of these somewhat
considerable details. I have sorted out of them those very numerous
cases in which your lawful powers could be usefully exerted. When I have
deemed it necessary, I have myself made visits of verification or
inquiry; and have finally laid before you, in the form which is familiar
to your weekly meetings, such recommendations as the week’s survey has
shown necessary, for enforcing works of local improvement under the
powers of your Acts of Parliament. I find that within the last twelve
months there have been made 3147 visitations of this nature, the results
of which are recorded in your office; and, founded on the result of
these inspections, there have been issued 983 orders for abatement of
causes of disease.

  [84] This information has been mainly derived from two
  sources:--first, from the weekly Death-Returns of the nine City
  Registrars, which the Registrar-General most kindly allows me to have
  transcribed so soon as they arrive at his office;--secondly, from
  weekly returns which the Medical Officers of the three City Unions
  have had the great kindness and liberality to supply for my
  assistance, as to the existence of fever and kindred disorders in the
  several localities under their charge.

I am very far from considering that these arrangements have been
perfect. Circumstances beyond my control have prevented me from
constructing as complete an organisation as I could wish; and the fact
that your Inspectors are very largely employed in other duties, has
perhaps occasionally given some hurry and imperfection to their share of
the work. Still, such as it is, this system has been the means of
considerable advantage; and I am glad to be able to claim for your Hon.
Court the distinction of being first in the metropolis to have
established an arrangement for the systematic sanitary visitation of the
dwellings of the poor. In relation to this subject, I beg to inform your
Hon. Court that your Inspectors have discharged, with much zeal,
intelligence, and industry, the duties which you authorised me to impose
on them.

During the last few weeks it has become obvious to your Hon. Court that
the duties of this department of your service have grown to such
dimensions as to necessitate some increase of your staff; and acting on
this opinion, mainly with a view to render more complete your sanitary
supervision of the City, you have just appointed two additional
Inspectors of Nuisances. In making this appointment, you have determined
not to restrict any two or three Inspectors exclusively to the business
of house-inspection, but to allot the joint duties, sanitary and
surveying, equally among their number: parting the area of the City into
six, instead of four, Inspectors’ districts; so that each Inspector
shall give a certain proportion of time to the duties which he has to
fulfil under your Surveyor’s direction, and another certain proportion
to those in which he will be engaged under the direction of your Officer
of Health. It is only some experience of this arrangement that can
decide whether it will be the most effectual for your purpose; but in
the mean time I have studied so to dispose the industry of your
increased staff, under the arrangement you have ordered, as to obtain
the most systematic and efficient discharge of those duties which you
have desired me to superintend.

Reckoning that each Inspector, if he fulfilled no other duty, could
report on the condition of about fifty houses _per diem_, I presume
that henceforth, in each of your five more important districts, from one
hundred to one hundred and twenty houses can be visited weekly by the
Inspector, without encroaching on the time required for his other
duties.

The general plan, on which I would propose that this force should be
disposed, is the following:--first, as heretofore, the weekly list would
contain all places needing investigation on the ground of such deaths
and illness as are usually associated with preventable causes, in order
that any sanitary defects may at once be remedied in them; secondly, in
each week there would fall due a certain number of sanitary works
(relating to house-drainage, water-supply, and the like) for which you
would have previously issued orders requiring them to be completed
within a stated time, and on the satisfactory execution of these it will
be the Inspectors duty to examine and certify; thirdly, in each district
I would have a certain rota of visitation, according to the badness of
the spot and its known liability to fall into filthy and unwholesome
condition, requiring one set of houses to be seen weekly, another set
fortnightly, another monthly, another quarterly, and so on--a rota,
varying from time to time with the changing circumstances of each
locality; and, out of this rota, each week would supply a stated number
of cases for inquiry, to which I should occasionally add certain of
those establishments in which offensive occupations are pursued. Thus,
in the large number of weekly visits which I suppose the Inspector to
make, there would be a certain proportion of that more elaborate kind
which involves an examination of the entire house; another proportion,
made for the sole purpose of seeing that previous orders have been
executed; another proportion, repeated at fixed intervals, simply to
ascertain that houses, once cleansed and repaired, are not relapsing
into filth, nor their works becoming inefficient.

By utilising, on some such plan as this, the increased staff which you
have appointed for the purpose, and by giving to its execution my
continual superintendence, I trust to be able, from time to time, to
certify you that the City becomes better and better capable of resisting
epidemic invasion.[85] From such statements as I have set before you, on
the local affinities of disease--not of Cholera alone, but of typhus and
its kindred, you will be prepared to expect increased sanitary
advantage, from this more systematic suppression of the causes of death:
and I believe you will not be disappointed. Whether the anticipated
pestilence rage in our metropolis or not, you will be combating, day by
day, the influence of other malignant diseases. Whenever it may be in my
power to tell you generally of the City, that the dwellings of the poor
are no longer crowded and stifling; nor their walls mouldy; nor their
yards and cellars unpaved and sodden; nor their water-supply defective;
nor their drainage stinking; nor their atmosphere hurt by neighbouring
nuisances; then, gentlemen, whether Cholera test your success or not,
surely you will have contributed much to conquer more habitual enemies.
For whatever there may be specific and exceptional in the production of
Cholera, at least it touches no healthy spot: the local conditions
which welcome its occasional presence are, in its absence, hour by hour,
the workers of other death; and in rendering a locality secure against
the one, you will also have made it less vulnerable by the others.

  [85] I may take this opportunity of mentioning that, during the last
  few months, the increased sanitary staff has been worked with very
  great advantage.--J. S., May, 1854.

As a last suggestion in this part of my subject, there are two steps
which I would recommend to your Hon. Court, as likely to assist the
labours of your officers, and to bring a large quantity of important
information before you:--first (according to a plan adopted here in the
last epidemic) that printed notices should be posted in every
back-street, court and alley of the City, and should be renewed once a
month, advising the careful maintenance of cleanliness in all houses,
and inviting all persons who are aggrieved by any nuisance, or by any
neglect of scavengers and dustmen, or by any defect of water-supply,
forthwith to make complaint at your Office, or to the Inspector of the
district, whose name and address might be subjoined; secondly, that a
circular letter should be written to all persons in parochial authority,
also to other clergy, to heads of visiting societies and the like,
begging them to communicate with your officers on every occasion when
any local uncleanliness or nuisance may come within their knowledge.

       *       *       *       *       *

3. Finally, gentlemen--in the probable anticipation that next year
Cholera will prevail in London with at least its former severity, it may
be claimed of my office, that I should say something with respect to
personal precautions for avoidance of the disease. While most willing to
place at your disposal any useful results of my practical experience in
the matter, I cannot but feel the great difficulty of making general
suggestions in a form really capable of particular application.

From the eminently local prevalence of the poison, it may be inferred
that, for all whose circumstances allow an option in the matter, the
first and most important precaution would consist in avoiding those
localities where the epidemic is active. Our knowledge of the subject
enables us confidently to say that, if in one spot the chance of being
attacked by Cholera is as 1 to 100, in another it becomes 1 to 50, in a
third 1 to 5, in a fourth almost an equal chance whether to be attacked
or not. Nothing is gained towards security by the mere act of leaving
our metropolitan area, if one resorts to some other place where the
system of drainage is equally vicious, or where--as at our nearest
bathing-place, the beach is made almost as offensive by sewage as here
the river-banks.[86] From earlier statements in my Report, it will be
obvious to you that the eligible sites of residence are those which
stand high and dry, with clean effectual drainage of their soils and
houses, conveying all organic refuse beyond range of the local
atmosphere.

  [86] Unless the sanitary improvement of Brighton be soon set about in
  earnest, the reputation for healthiness, which established its
  prosperity, will undergo a very sensible reverse. The natural
  advantages of the place are now almost neutralised by the evil
  adverted to in the text, and by other filthinesses of the kind.--J.
  S., 1854.

I will not pass this part of the subject without admitting that the
course here suggested might involve a considerable desertion of
particular localities, and a transient injury to their commerce. This
unavoidable result of proclaiming the laws of the disease, I must regret
in regard of its personal bearings. But the facts of the case are
all-important for the public; and sanitary improvement will perhaps
move more quickly in the country, when it is known that the pecuniary
prosperity of places may suffer from their reputation for endemic
disease.

In case of Cholera prevailing with severity in spots containing a dense
poor population, great assistance would be given to medical and sanitary
measures, if a number of empty unlet houses, healthily situated, were at
the disposal of the authorities; into which, under proper regulations,
they might induce certain of the poorest families to migrate for a time,
as to places of refuge, till the disease should have subsided about
their original dwellings.

For persons, whose circumstances or duties retain them unavoidably in
the midst of those suffering districts where the poison is most active,
the best counsel I can offer--even if at first hearing it seem
vague--is, that they should be vigilant as to preserving the greatest
possible soundness and vigour of general health; keeping the body, so
far as may be, undisturbed by extremes of heat and cold, undepressed by
long confinement, unfluttered by violent passions, unexhausted by
physical or mental fatigue, untried by any excess or any privation;
taking for diet a sufficiency of fit and nutritive food, rather in
generous measure than otherwise, but far from the confines of
intemperance; and giving meanwhile a prompt attention and cure to
whatever accidental ailments may arise.

Such, in general language, are our best fortifications against the
poison. It may be well, however, to add that in our metropolitan
climate--perhaps everywhere else--the human frame tends to require some
periodical aid from medicine. It may be the excitement and labour of
London; it may be its atmosphere; it may be native peculiarity: but
thus the fact stands--that there are few persons who do not at intervals
require the re-establishing effects of what is called _tonic_ treatment.
Probably three-fourths of the prescriptions we write are aimed at this
mere tendency to depression in the human body, as manifested in one form
or another. Now, as a man, going on some distant voyage of exploration,
submits his chronometer to a last intelligent scrutiny, before he
exposes it to the ordeal of other climates, so, in this matter of
frequenting infected districts, men will do prudently, before they pass
into perils which may test their powers of resistance, to see that they
carry about with them no enfeeblement or disrepair which a short
submission to medical discipline could effectually remove. For with
epidemic poisons generally, and in a marked degree with Asiatic Cholera,
it seems that all states of languor, depression, and debility enhance
the risk of infection.[87]

  [87] For my medical readers, I may suggest that perhaps the daily use
  of _sulphate of quinine_, in small doses, during the height of the
  epidemic, would seem to deserve trial as a prophylactic; subject, of
  course, to what each practitioner is best able to estimate--of
  personal peculiarity in the patient, forbidding the use of this
  drug.--J. S., 1854.

Beyond these general cautions, there is yet one which requires very
particular mention.

In respect of the commencement and predispositions of the disease, it is
now well known--first, that in this country it habitually begins with
diarrhœa of a painless and apparently trivial character; secondly, that
diarrhœa, however produced, is, of all known personal conditions, the
one most likely to invite an attack of Cholera at times when that
disease is epidemic; thirdly, that during the prevalence of Cholera,
side by side with it in a district, there is always a vast amount of
epidemic diarrhœa, apparently constituting slighter degrees or earlier
stages of the same disease; that this condition is just as amenable to
treatment as the confirmed collapse of Cholera is utterly the opposite;
and--since we can never say how incurable a few hours may render this
insidious symptom, that its immediate arrest is a consideration of vital
importance.

Precautions against causing diarrhœa to oneself by errors of diet will
vary somewhat with different individuals. Every person of ordinary
discretion knows the habits of his own body, and can be tolerably
confident, within certain limits of food, that he gives himself no
occasion of sickness. He remembers articles of diet, which his neighbour
perhaps may innocently indulge in, but which to himself are the occasion
of inward disorder--of purging or vomiting, ‘bilious attack’ or nettle
rash, headache, nightmare, or some other inconvenience. This knowledge
fixes the limits which it primarily behoves him to regard; taking such
food only into his body as experience has shown best to agree with it;
and adhering to this course, without panic as to particular accustomed
articles, and without abrupt discontinuance of old harmless habits.
Apart from personal peculiarities, the chief dangers of diet appear to
lie as follows: first, in those excesses of meat and drink, which
(especially under circumstances of fatigue) occasion sickness to the
stomach, or an increased labour of digestion; secondly, in taking food,
solid or fluid, which is midway in some process of chemical
transition--half-fermented beer and wine, water containing organic
matters, meat and game and venison no longer fresh and not completely
cooked, fish and shell-fish, in any state but the most perfect
freshness, fruit or vegetables long-gathered or badly kept, and the
like; thirdly, in a profusion of cold sour drink; fourthly, in partaking
largely of those articles of diet which habitually, or by reason of
imperfect cooking, pass unchanged through the intestinal canal; and
fifthly, in the indiscreet use of purgative medicines, or in taking any
article of diet which is likely to produce the same effect.

In short, if care be taken under all these heads to avoid occasions of
intestinal disturbance; if the diet, while generous, be simple and
strictly temperate; if regular hours be given to sleep, to meals, to
industry, to recreation; if a fair proportion of out-door exercise be
taken; if damp and extremes of temperature be guarded against; and all
practical pains be given to avoid the sources of bodily and mental
depression; the danger will certainly be reduced to its _minimum_; and
whatever effects the epidemic may happen to produce can be readily
recognised and boldly encountered.

Should these effects arise in their customary form of diarrhœa, it is of
absolute urgent necessity that immediate medical treatment be resorted
to: and so important for the safety of life is the recognition of this
symptom in the earliest stage of its occurrence, that no unwonted action
of the bowels should pass unobserved.

The public constantly asks to be informed of some drug, or combination
of drugs, to which under these circumstances they may have immediate
recourse. But after very careful consideration of this subject, after
hearing arguments on both sides, and reading those prescriptions which
have been recommended for adoption, I venture to express my opinion
that the safest course for the public, in regard of this threatened
disease, will be to follow the same principle as guides them in their
ordinary seizures of illness, and to obtain as quickly as possible the
aid of their customary medical advisers. There is an invincible aptitude
in the public to misapply all precautionary medicines within their
reach; often superstitiously to treat them as charms, under the
protection of which they may neglect temperance of diet and all other
solicitude for health; often ignorantly to employ them in cases for
which their use is forbidden; often, at the instigation of panic, to
abuse them by preposterous and hurtful excess. Nervous and uneducated
persons, instead of employing their astringent dose simply to stop any
undue action from the bowels, would be apt, as the danger neared them,
to make it an habitual dram in order to anticipate any such action; and
the frequent after-necessity for purgative medicine, thus created, would
constitute the very danger they desire to avoid. Recognising, therefore,
at its full value, the importance of immediately treating, in every
case, the first phenomena of epidemic diarrhœa, I must yet doubt whether
the conditions of medical science and general education are such as to
justify the promulgation of general formulæ so liable to extensive
abuse.

I speak of course with particular reference to the metropolis. In remote
rural districts it may often be desirable that discreet and intelligent
persons--the Clergy, for instance, should obtain from their medical
neighbours some astringent preparation to which--in the very rare event
of real emergency, temporary recourse might be had: but--for so
hazardous a condition of disease, I must repeat as a general rule, that
no nostrum, even in the best-intentioned hands of ignorance, can supply
the place of medical discrimination.

During the acute prevalence of the epidemic in any particular locality,
it becomes of great importance to bring the uneducated classes of
society, as far as possible, under systematic medical care; in the
absence of which they are likely to neglect all premonitions of the
disease, and thus to incur much unnecessary danger. To fulfil this
object as regards the poor, express provision has been made by the Law:
and it might be well for other classes, under similar exposure to
attack, to consider how far they could arrange for their households a
similar plan of protection.

Under any Order in Council which brings into action the extraordinary
powers of the Nuisances Removal Act, the General Board of Health has
authority to enjoin on all Boards of Guardians throughout the country,
that they provide, for ‘persons afflicted by or threatened with’ the
disease, such medical aid as may be required: and the actual working of
this has been that, on all occasions of epidemic Cholera prevailing in
particular localities, the General Board of Health has called on the
local Boards of Guardians to establish systematic house-to-house
visitation, for discovering and treating among the poor all premonitory
symptoms of the disease.

In the too probable event of its becoming necessary next year to
establish this system of medical organisation in parts of the
metropolis, I have no reason to doubt that a requisition to the above
effect will be addressed to the Guardians of the City poor; and, in this
anticipation, I think it desirable to bring, in conclusion, one more
point under notice of your Hon. Court. During the former invasion, the
Guardians within the City of London resisted the requisitions of the
General Board of Health; and the first fourteen weeks of the epidemic
consequently passed without the establishment of any visitational system
for arresting its progress. In the fifteenth week, however, the
Corporation of the City undertook the unperformed duty, not legally
devolving on them, and requested me to make arrangements for the purpose
of its execution. With the assistance of the several Medical Officers of
the City Unions, I immediately organised the requisite staff, and from
that moment to the close of the epidemic there continued under my
superintendence a systematic visitation of the poor, with beneficial,
though tardy and imperfect, results.

Recalling these incidents to the recollection of your Hon. Court, I
would beg to observe that no similar endeavour can fully succeed, except
as a system--well considered beforehand, and adjusted to the various
circumstances which may require its application. Uncertainties of
responsibility and conflicts of jurisdiction would inevitably occasion a
sacrifice of life; and therefore, before the time when Cholera is likely
to become epidemic, it should be definitively settled who is to
undertake this organisation. Your Commission can have no jurisdiction in
the matter; and the interference of the Corporation would be only at its
own option. The legal responsibility rests solely with the Boards of
Guardians: and it seems to me indispensable that, before the time for
action arrives, the Corporation should determine its intentions; in
order that the Boards of Guardians, if again called upon to organise
arrangements of the kind in question, may know distinctly--either that
the Corporation has relieved them of their task, or that there rests on
them the undivided obligation of providing for the crisis.

       *       *       *       *       *

III. Gentlemen, in concluding this report, I will not attempt to
disguise from you that it has been written under feelings of
considerable apprehension; and I am fully conscious that, in thus
expressing myself, I am liable to the imputation of raising unnecessary
alarm.

If the possible mischief to be wrought by epidemic Cholera lay in some
fixed inflexible fate, whatever opinion or knowledge I might hold on the
subject of its return, silence would be better than speech; and I could
gladly refrain from vexing the public ear by gloomy forebodings of an
inevitable future.

But from this supposition the case differs diametrically: and the people
of England are not like timid cattle, capable, only when blindfold, of
confronting danger. It belongs to their race--it belongs to their
dignity of manhood, to take deliberate cognisance of their foes, and not
lightly to cede the victory. A people that has fought the greatest
battles--not of arms alone, but of genius and skilful toil, is little
likely to be scared at the necessity of meeting large danger by
appropriate devices of science. A people that has inaugurated
railways--that has spanned the Menai Strait and reared the Crystal
Palace, can hardly fear the enterprise of draining poison from its
infected towns. A people that has freed its foreign slaves at twenty
millions’ ransom, will never let its home population perish, for
cheapness sake, in the ignominious ferment of their filth.

Therefore, gentlemen, advisedly I state the danger as it seems to me.
England has again become subject to a plague, the recurrence of
which--or the duration--or the malignity, no human being can predict.

But, if I state the danger, so likewise, to the best of my belief, I
state the remedy and defence. Colossal statistics concur with the
results of detailed inspection, to refer this disease, in common with
many others that scourge our population, distinctly and infallibly, to
the working of local causes--of causes susceptible of removal--of causes
which it devolves on our Legislature to remove.

The exemption we seek is worth a heavy purchase. My thoughts turn
involuntarily to the epidemics of former centuries, to their frequent
returns and immense fatality. I reflect on the Plague, and how it
influenced the average death-rate of London; how in 1593 it doubled it,
in 1603 trebled it, in 1625 quadrupled it: and how (after a less
considerable visitation in 1636) it actually multiplied the mortality
sevenfold in the tremendous epidemic of ‘65. The ravages of that
pestilence are best appreciated in the fact, that we esteem the Great
Fire of London a cheap equivalent for their arrest; looking to that
eventful conflagration of the metropolis with gratitude, rather than
horror, because of the mightier evils that were extinguished with its
flames.

To so frightful a development as this, Cholera, by many degrees, has not
attained; but, ignorant as we are of its laws and resources, we dare not
surmise, at any renewed invasion, what increment of severity it may have
won. In the simple fact, that our country has again become subject to
pestilential epidemics, there lies an amount of threat only to be
measured by those who are conversant, by history or experience, with
the possible developments of such disease.

Therefore, gentlemen, having the deepest assurance that these unexplored
possibilities of evil may be foreclosed by appropriate means, I should
ill deserve your confidence if I shrank from setting before you--however
ungracious the task--my deliberate estimate of the peril.

It pertains to my local office to tell you of local cures; and this I
have sought to do. I have suggested that, by active superintendence of
all houses within your jurisdiction, there may be suppressed in detail
those several causes of the disease which arise in individual neglect;
that, by elaborate care as to the cleanliness of pavements, markets,
docks, and sewers, something may be done towards the mitigation of more
general causes; that, by a well-organised system of medical visitation,
very much may be effected towards encountering attacks of the disease,
while still amenable to treatment:--that these, with similar
precautions, are therefore to be recommended.

And not for a moment would I seem to depreciate such measures,
palliative only, and partial though they be. By their judicious
application, from Aldgate to the Temple, life may possibly be saved to
some hundreds; to children that are fondly loved, to parents that are
the stay of numbers.

But against the full significance of any epidemic, I am bound to tell
you that these are but poor substitutes for protection. To render them
effectual, even in their narrow sphere of operation, there must be great
vigilance and great expenditure; a weary vigilance and a
disproportionate expenditure, because chiefly given to defeat in detail
what should have been prevented in principle. And be done what may, in
this palliative spirit, the sources of the disease are substantially
unstayed: for the faults, to which its metropolitan prevalence is due,
consist not simply in a number of individual mismanagements, but include
a common and radical mal-construction as their chief.

No city, so far as Science may be trusted, can deserve immunity from
epidemic disease, except by making absolute cleanliness the first law of
its existence; such cleanliness, I mean, as consists in the perfect
adaptation of drainage, water-supply, scavenage, and ventilation, to the
purposes they should respectively fulfil; such cleanliness, as consists
in carrying away by these means, inoffensively, all refuse materials of
life--gaseous, solid, or fluid, from the person, the house, the factory,
or the thoroughfare, so soon as possible after their formation, and with
as near an approach, as their several natures allow, to one continuous
current of removal.

To realise for London this conception of how a city should cleanse
itself may involve, no doubt, the perfection of numberless details. Yet,
most of all, it would pre-suppose a comprehensive organisation of plan
and method: not alone for that intramural unity of system which is
needful for all the works, as most for those of drainage and
water-supply; but, equally, to harmonise these works with other
extramural arrangements for utilising to the country the boundless
wealth of metropolitan refuse--for distributing to the uses of
agriculture what is then rescued from the character of filth--for
requiting to the fields in gifts for vegetation, what they have rendered
to the town in food for man.

How far the construction of London has proceeded on the recognition of
such objects, or how far the advantages of such a plan have been
realised, it could only be a mockery to ask. Our metropolis, by
successive accretions, has covered mile after mile of land. Each new
addition has been made with scarcely more reference to the legitimate
necessities of life, than if it had clustered there by crystallisation.
With no scientific forecast to plan the whole, with little but chance
and cheapness to shape the parts, our desultory architecture has
eclipsed the conditions of health. Draining up-hill or down-hill, as the
case might be, and running their aqueducts at random from chalk-quarries
or river-mud; or ponding sewage in their cellars, and digging beside it
for water; blocking-up the inlets of freshness and, equally, the outlets
of nuisance; constructing sewers to struggle with the Thames--now to
pollute its ebb, now to be obstructed by its flow; the builders of many
generations have accumulated sanitary errors in so intricate a system,
that their apprehension and their cure seem equally remote.

Therefore--by reason of causes, ramified through the whole metropolis
and deep-rooted in its soil, which bind all parts together in one common
endurance of their effects--therefore cannot epidemic disease be
conquered by any exertions or by any amelioration, short of the complete
and comprehensive cure. Against the danger we dread, no shelter is to be
found in petty reforms and patchwork legislation. Not to inspectorships
of nuisances, but to the large mind of State-Policy, one must look for a
real emancipation from this threatening plague.

A child’s intellect can appreciate the wild absurdity of seeking at Peru
what here runs to waste beneath our pavements,--of ripening only
epidemic disease with what might augment the food of the people--of
waiting, like our ancestors, to expiate the neglected divinity of water
in some bitter purgation by fire.

But it needs the grasp of political mastership, not uninformed by
Science, to convert to practical application these obvious elements of
knowledge; to recognise a national object irrelevant to the interests of
party; to lift an universal requirement from the sphere of professional
jealousies, and to found in immutable principles the sanitary
legislation of a people.

  I have the honour to remain,

  &c. &c.


  APPENDIX OF TABLES
  ILLUSTRATING THE
  SANITARY CONDITION OF THE CITY OF LONDON.

  I. Area and Population of the several Districts and Sub-districts of
  the City.

  II. Quinquennial Synopsis of City Mortality, from Michaelmas 1848 to
  Michaelmas 1853; with Death-Rates calculated for this period, on the
  Population enumerated in 1851, for each District and Sub-District of
  the City.

  III. First annual enumeration of Deaths, relating to the fifty-two
  weeks dating from October 1st, 1848, to September 29th, 1849.

  IV. Second annual enumeration of Deaths, relating to the fifty-two
  weeks, dating from September 30th, 1840, to September 28th, 1850.

  V. Third annual enumeration of Deaths, relating to the fifty-two
  weeks, dating from September 29th, 1850, to September 27th, 1851.

  VI. Fourth annual enumeration of Deaths, relating to the fifty-two
  weeks, dating from September 28th, 1851, to September 25th, 1852.

  VII. Fifth annual enumeration of Deaths, relating to the fifty-two
  weeks, dating from September 26th, 1852, to September 24th, 1853.

  VIII. Quinquennial Mortality, classified by Age; first, for the entire
  City; next, for the Three Unions severally.

  IX. Number of Deaths occasioned, during the last five years, by
  certain Acute Diseases, chiefly epidemic, infectious, and endemic.

  X. Comparative Mortality in different seasons of the year: namely, in
  the Autumn-Quarters (October, November, December), in the
  Winter-Quarters (January, February, March), in the Spring-Quarters
  (April, May, June), and in the Summer-Quarters (July, August,
  September), of the five years from Michaelmas 1848 to Michaelmas 1853.

  XI. Autumn Mortality.

  XII. Winter Mortality.

  XIII. Spring Mortality.

  XIV. Summer Mortality.


No. I. _Area and Population of the several Districts and Sub-districts
of the City of London._

  +-----------------------------+-------+-------+-------------+-------+
  |                             | Census| Census|  Decennial  |Area of|
  |      Sub-district.          |  of   |  of   | increase (+)|Land in|
  |                             | 1841. | 1851. |    or       |Acres. |
  |                             |       |       |decrease. (-)|       |
  +-----------------------------+-------+-------+-------------+-------+
  |              {St. Botolph   | 20,197| 23,435|       + 3238|     85|
  |EAST LONDON.  {Cripplegate   | 19,161| 20,582|       + 1421|     68|
  |              {Workhouses[88]|    454|    576|       +  122|       |
  |              {              +-------+-------+-------------+-------+
  |              {Total         | 39,812| 44,593|       + 4781|    153|
  +-----------------------------+-------+-------+-------------+-------+
  |              {North         | 12,138| 12,350|       +  212|     47|
  |WEST LONDON.  {South         | 16,460| 15,844|       -  616|     77|
  |              {Workhouse[89] |    387|    409|       +   22|       |
  |              {              +-------+-------+-------------+-------+
  |              {Total         | 28,985| 28,603|       -  382|    124|
  +-----------------------------+-------+-------+-------------+-------+
  |              {South-West    |   8839|   9204|       +  365|     49|
  |              {North-West    | 12,427| 11,847|       -  580|     72|
  |CITY OF       {South         | 11,954| 11,461|       -  493|     82|
  |LONDON.       {South-East    | 10,597| 10,594|       -    3|     84|
  |              {North-East    | 12,103| 12,826|       +  723|     92|
  |              {Workhouse[90] |    920|    794|       -  126|       |
  |              {              +-------+-------+-------------+-------+
  |              {Total         | 56,840| 56,726|       -  114|    379|
  +-----------------------------+-------+-------+-------------+-------+
  |  Entire Population of}       125,637|129,922|       + 4285|    656|
  |    the City of London}              |       |             |       |
  +-------------------------------------+-------+-------------+-------+

  [88] One of these workhouses is situated in the North sub-district of
  the West London Union. In 1841 it contained 157 inmates; in 1851, 187
  inmates. The other workhouse is situated in the St. Botolph
  sub-district: in 1841 it contained 297, in 1851, 389 persons.

  [89] This workhouse is situated in the North sub-district of the
  Union.

  [90] In 1841, the 920 paupers of this Union were received, partly at
  Marlborough House, Peckham; partly in Deacon’s Farm-house, Stepney
  Green. The present workhouse, erected since 1841, is at Bow.


No. II.--_Quinquennial Synopsis of City Mortality, with Death-rates
calculated per Thousand on the Population of 1851._

  +-----------------------+-------------------------+
  |                       |           EAST          |
  |Population,}           |          LONDON         |
  |according  }Entire City|          UNION,         |
  |to the     }of London, |         44,593.         |
  |Census     }129,922.   +--------+--------+-------+
  |of 1851.   }           | Saint  |Cripple-| Work- |
  |                       |Botolph,|  gate, |houses,|
  |                       | 23,435.| 20,582.|  576. |
  +-----------------------+--------+--------+-------+
  |Mortality of five years|        |        |       |
  |from Michaelmas 1848 to|        |        |       |
  |Michaelmas 1853.       |        |        |       |
  |     {1848-9   =3763=  |     519|     574|    179|
  |     {1849-50  =2752=  |     296|     444|    125|
  |     {1850-1   =2978=  |     493|     471|    167|
  |     {1851-2   =3064=  |     534|     460|    176|
  |     {1852-3   =3040=  |     516|     534|    155|
  |     {                 +--------+--------+-------+
  |     {          =⁂=    |    2458|    2483|    802|
  |     {                 |                         |
  |     {Total  =15,597=  |           =5743=        |
  +-----------------------+-------------------------+
  |Yearly Death-rate _per_|          =25.75=        |
  |thousand of the living |                         |
  |Population.            |        |        |       |
  |               =24.00= | =24.30=| =27.41=|  =*=  |
  +-----------------------+--------+--------+-------+

  +-----------------------+----------------------+
  |                       |         WEST         |
  |Population,}           |        LONDON        |
  |according  }Entire City|        UNION,        |
  |to the     }of London, |       28,603.        |
  |Census     }129,922.   +-------+-------+------+
  |of 1851.   }           | North,| South,| Work-|
  |                       |       |       |house,|
  |                       |12,350.|15,844.| 409. |
  +-----------------------+-------+-------+------+
  |Mortality of five years|       |       |      |
  |from Michaelmas 1848 to|       |       |      |
  |Michaelmas 1853.       |       |       |      |
  |     {1848-9   =3763=  |    372|    598|   126|
  |     {1849-50  =2752=  |    324|    290|   108|
  |     {1850-1   =2978=  |    317|    313|    68|
  |     {1851-2   =3064=  |    266|    379|   129|
  |     {1852-3   =3040=  |    289|    309|   164|
  |     {                 +-------+-------+------+
  |     {          =⁂=    |   1568|   1889|   595|
  |     {                 |                      |
  |     {Total  =15,597=  |         =4052=       |
  +-----------------------+----------------------+
  |Yearly Death-rate _per_|        =28.33=       |
  |thousand of the living |                      |
  |Population.            |       |       |      |
  |               =24.00= |=29.19=|=27.66=|  =*= |
  +-----------------------+-------+-------+------+

  +---------------------+----------------------------------------------+
  |                     |           CITY OF LONDON UNION,              |
  |Population,}Entire   |                                              |
  |according  }City of  |                                              |
  |to the     }London,  |                  56,726.                     |
  |Census     }129,922. +-------+-------+-------+-------+-------+------+
  |of 1851.   }         | S. W. | N. W. | South,| S. E. | N. E. | Work-|
  |                     |       |       |       |       |       |house,|
  |                     | 9,204.|11,847.|11,461.|10,594.|12,826.| 794. |
  +---------------------+-------+-------+-------+-------+-------+------+
  |Mortality of five    |       |       |       |       |       |      |
  |years from Michaelmas|       |       |       |       |       |      |
  |1848 toMichaelmas    |       |       |       |       |       |      |
  |1853.                |       |       |       |       |       |      |
  |   {1848-9   =3763=  |    293|    245|    263|    214|    262|   103|
  |   {1849-50  =2752=  |    176|    168|    218|    183|    219|   101|
  |   {1850-1   =2978=  |    191|    169|    258|    217|    213|   101|
  |   {1851-2   =3064=  |    196|    198|    203|    171|    235|   117|
  |   {1852-3   =3040=  |    170|    188|    223|    164|    224|   104|
  |   {                 +-------+-------+-------+-------+-------+------+
  |   {          =⁂=    |   1026|    968|   1165|    949|   1153|   526|
  |   {                 |                                              |
  |   {Total  =15,597=  |                    =5787=                    |
  +---------------------+----------------------------------------------+
  |Yearly Death-rate    |                    =20.40=                   |
  |_per_ thousand of the|                                              |
  |living Population.   |       |       |       |       |       |      |
  |             =24.00= |=23.83=|=17.96=|=21.90=|=19.52=|=19.58=| =*=  |
  +-----------------------+-------+-------+-------+-------+-------+----+
  |N.B. The first year’s total (3763) includes 15 deaths, which, by    |
  |reason of their imperfect registration, it has been impossible      |
  |to refer correctly to the Unions where they occurred.               |
  +--------------------------------------------------------------------+

NOTE TO TABLE No. II.

In calculating the Death-Rates given in the last lines of this Table, I
have proceeded as follows:--

First, I have counted all _Workhouse-Population_ and _Workhouse-Deaths_
as forming part of the aggregate population and aggregate mortality of
that Union to which the particular workhouse legally belongs.

Next, I have distributed among the several sub-districts the population
and the mortality of their Union Workhouses, in the ratio of the general
sub-district population; so as to prevent the high Workhouse-Mortality
from telling unjustly against that sub-district in which the Workhouse
happens to have been erected.

Thus, for instance, the East London Union has its male Workhouse placed
in the territory of the West London Union; but I have reckoned it as
belonging to the East London Union, in respect both of its population
and its deaths. Similarly, the City of London Union has its Workhouse
situate at Bow; but, not the less, I have considered its 794 inmates and
526 deaths as belonging to the population and the mortality of our
central Union.

Thus again for the sub-district death-rates--for instance, in
the two sub-districts of the East London Union: reckoning the
Workhouse-Population not as exclusively due either to Cripplegate or to
St. Botolph, but as furnished by these sub-districts jointly, in the
ratio of their populations, I have distributed 576 between them in the
proportion, 23,435 : 20,582. The Workhouse-Deaths of the period (802)
have been similarly distributed; and the rates, given in the last line
of the table, are finally deduced from a comparison of these sums,
viz:--

23,435 + 306.66 : 2458 + 426.991 :: 1000 : 121.515, which divided by 5
(to show an annual, instead of a quinquennial, result) gives 24.30 as
the annual death-rate for St. Botolph; and, in like manner, 20,582 +
269.33 : 2483 + 375.008 gives 137.065 as the quinquennial, and 27.41 as
the annual death-rate _per_ thousand for the sub-district of
Cripplegate.

_Hospital Deaths_ have been distributed, as far as possible, according
to the previous residence of the patients. Thus the north sub-district
of the West London Union, in which St. Bartholomew’s Hospital is
situated, is made to retain only its just proportion of deaths. On the
same principle I have reckoned to the death-lists of other sub-districts
those cases in which I could ascertain that the residents of such
sub-districts had gone to die either in St. Bartholomew’s, or in other
Metropolitan Hospitals.


No. III.--_First Annual Enumeration of Deaths, relating to the Fifty-two
Weeks dating from October 1st, 1848, to September 29th, 1849._

  +------------------+-------------------------+-----------------------+
  |DEATHS in the four|    EAST LONDON UNION.   |   WEST LONDON UNION.  |
  |quarterly periods,+--------+--------+-------+-------+-------+-------+
  |terminating as    |Saint   |Cripple-| Work- |North. |South. |Work-  |
  |follows:--        |Botolph.|gate.   |houses.|       |       |house. |
  |                  +--------+--------+-------+-------+-------+-------+
  |In the quarter    | M.   F.| M.   F.| M.  F.| M.  F.| M.  F.| M.  F.|
  |ending:           |        |        |       |       |       |       |
  |  I. Dec. } =766={| 63   64| 69   59| 10  21| 44  30| 55  48| 14  15|
  |     30th }      {|   127  |   128  |   31  |   74  |  103  |   29  |
  |                  |        |        |       |       |       |       |
  | II. March} =822={| 70   66| 60   57| 17  19| 39  34| 50  40| 20  10|
  |     31st }      {|   136  |   117  |   36  |   73  |   90  |   30  |
  |                  |        |        |       |       |       |       |
  |III. June } =765={| 40   45| 62   68| 16  23| 46  31| 61  49| 13  21|
  |     30th }      {|    85  |   130  |   39  |   77  |  110  |   34  |
  |                  |        |        |       |       |       |       |
  | IV. Sept.}=1395={| 88   83|104   95| 17  56| 75  73|116 179| 15  18|
  |     29th }      {|   171  |   199  |   73  |  148  |  295  |   53  |
  +------------------+--------+--------+-------+-------+-------+-------+
  |Sum of the four  {|261  258|295  279| 60 119|204 168|282 316| 62  64|
  |quarters   =3748={|   519  |   574  |  179  |  372  |  598  |  126  |
  |Unclassified =15= |         =1272=          |         =1096=        |
  |TOTAL FOR THE YEAR                                             =3763=
  +---------------------------------------------------------------------

  +------------------+-----------------------------------------------+
  |DEATHS in the four|             CITY OF LONDON UNION.             |
  |quarterly periods,+-------+-------+-------+-------+-------+-------+
  |terminating as    | S. W. | N. W. |South. | S. E. | N. E. | Work- |
  |follows:--        |       |       |       |       |       |house. |
  |                  +-------+-------+-------+-------+-------+-------+
  |In the quarter    | M. F. | M. F. | M. F. | M. F. | M. F. | M.  F.|
  |ending:           |       |       |       |       |       |       |
  |  I. Dec. } =766={| 25 15 | 27 23 | 36 23 | 25 15 | 31 31 |  1  22|
  |     30th }      {|   40  |   50  |   59  |   40  |   62  |   23  |
  |                  |       |       |       |       |       |       |
  | II. March} =822={| 20 32 | 32 31 | 28 32 | 29 23 | 40 37 | 14  22|
  |     31st }      {|   52  |   63  |   60  |   52  |   77  |   36  |
  |                  |       |       |       |       |       |       |
  |III. June } =765={| 35 21 | 31 24 | 37 21 | 24 21 | 22 28 | 12  14|
  |     30th }      {|   56  |   55  |   58  |   45  |   50  |   26  |
  |                  |       |       |       |       |       |       |
  | IV. Sept.}=1395={| 62 83 | 37 40 | 48 38 | 45 32 | 40 33 |  5  13|
  |     29th }      {|  145  |   77  |   86  |   77  |   73  |   18  |
  +------------------+-------+-------+-------+-------+-------+-------+
  |Sum of the four  {|142 151|127 118|149 114|123  91|133 129| 32  71|
  |quarters   =3748={|  293  |  245  |  263  |  214  |  262  |  103  |
  |Unclassified =15= |                     =1380=                    |
  |TOTAL FOR THE YEAR                                                |
  +------------------------------------------------------------------+


No. IV.--_Second Annual Enumeration of Deaths, relating to the Fifty-two
Weeks dating from September 30th, 1849, to September 28th, 1850._

  +------------------+-------------------------+-----------------------+
  |DEATHS in the four|    EAST LONDON UNION.   |   WEST LONDON UNION.  |
  |quarterly periods,+--------+--------+-------+-------+-------+-------+
  |terminating as    |Saint   |Cripple-| Work- |North. |South. |Work-  |
  |follows:--        |Botolph.|gate.   |houses.|       |       |house. |
  |                  +--------+--------+-------+-------+-------+-------+
  |In the quarter    | M.   F.| M.   F.| M.  F.| M.  F.| M.  F.| M.  F.|
  |ending:           |        |        |       |       |       |       |
  |  I. Dec. } =765={| 62   56| 72   65|22   22| 42  43| 30  40| 10  13|
  |     29th }      {|   118  |   137  |   44  |   85  |   70  |  23   |
  |                  |        |        |       |       |       |       |
  | II. March} =803={| 49   47| 68   56| 21  15| 50  41| 42  42| 21  19|
  |     30th }      {|    96  |   124  |   36  |   91  |   84  |   40  |
  |                  |        |        |       |       |       |       |
  |III. June } =589={| 39   41| 42   48|  6  13| 39  35| 45  26|  5  22|
  |     29th }      {|    80  |    90  |   19  |   74  |   71  |   27  |
  |                  |        |        |       |       |       |       |
  | IV. Sept.} =595={| 57   45| 57   36| 12  14| 35  39| 26  39|  5  13|
  |     28th }      {|   102  |    93  |   26  |   74  |   65  |   18  |
  +------------------+--------+--------+-------+-------+-------+-------+
  |Sum of the four  {|207  189|239  205| 61  64|166 158|143 147|41   67|
  |quarters   =2752={|   396  |   444  |  125  |  324  |  290  |  108  |
  |                  |           =965=         |         =722=         |
  |TOTAL FOR THE YEAR                                             =2752=
  +---------------------------------------------------------------------

  +------------------+-----------------------------------------------+
  |DEATHS in the four|             CITY OF LONDON UNION.             |
  |quarterly periods,+-------+-------+-------+-------+-------+-------+
  |terminating as    | S. W. | N. W. |South. | S. E. | N. E. | Work- |
  |follows:--        |       |       |       |       |       |house. |
  |                  +-------+-------+-------+-------+-------+-------+
  |In the quarter    | M. F. | M. F. | M. F. | M. F. | M. F. | M. F. |
  |ending:           |       |       |       |       |       |       |
  |  I. Dec. } =765={| 35  22| 26  19| 27  28| 30  21| 22  30|  9  19|
  |     29th }      {|   57  |   45  |   55  |   51  |   52  |   28  |
  |                  |       |       |       |       |       |       |
  | II. March} =803={| 23  23| 16  29| 48  32| 22  36| 45  29| 15  14|
  |     30th }      {|   46  |   45  |   80  |   58  |   74  |   29  |
  |                  |       |       |       |       |       |       |
  |III. June } =589={| 13  21| 14  25| 25  15| 23  20| 21  29|  9  13|
  |     29th }      {|   34  |   39  \   40  |   43  |   50  |   22  |
  |                  |       |       |       |       |       |       |
  | IV. Sept.} =595={| 20  19| 18  21| 22  21| 16  15| 15  28| 12  10|
  |     28th }      {|   39  |   39  |   43  |   31  |   43  |   22  |
  +------------------+-------+-------+-------+-------+-------+-------+
  |Sum of the four  {| 91  85| 74  94|122  96| 91  92|103 116| 45  56|
  |quarters   =2752={|  176  |  168  |  218  |  183  |  219  |  101  |
  |                  |                     =1065=                    |
  |TOTAL FOR THE YEAR                                                |
  +------------------------------------------------------------------+


No. V.--_Third Annual Enumeration of Deaths, relating to the Fifty-two
Weeks dating from September 29th, 1850, to September 27th, 1851._

  +------------------+-------------------------+-----------------------+
  |DEATHS in the four|    EAST LONDON UNION.   |   WEST LONDON UNION.  |
  |quarterly periods,+--------+--------+-------+-------+-------+-------+
  |terminating as    |Saint   |Cripple-| Work- |North. |South. |Work-  |
  |follows:--        |Botolph.|gate.   |houses.|       |       |house. |
  |                  +--------+--------+-------+-------+-------+-------+
  |In the quarter    | M.   F.| M.   F.| M.  F.| M.  F.| M.  F.| M.  F.|
  |ending:           |        |        |       |       |       |       |
  |  I. Dec. } =672={| 47   54| 68   57|  7  25| 29  33| 35  37|  8   6|
  |     28th }      {|   101  |   125  |   32  |   62  |   72  |   14  |
  |                  |        |        |       |       |       |       |
  | II. March} =876={| 87   67| 77   63| 19  30| 51  36| 46  43| 11  11|
  |     29th }      {|   154  |   140  |   49  |   87  |   89  |   22  |
  |                  |        |        |       |       |       |       |
  |III. June } =767={| 72   43| 58   43| 26  22| 45  47| 38  41| 11  10|
  |     28th }      {|   115  |   101  |   48  |   92  |   79  |   21  |
  |                  |        |        |       |       |       |       |
  | IV. Sept.} =663={| 63   60| 62   43| 13  25| 53  23| 38  35|  9   2|
  |     27th }      {|   123  |   105  |   38  |   76  |   73  |   11  |
  +------------------+--------+--------+-------+-------+-------+-------+
  |Sum of the four  {|269  224|265  206| 65 102|178 139|157 156| 39  29|
  |quarters   =2978={|   493  |   471  |  167  |  317  |  313  |   68  |
  |                  |          =1131=         |         =698=         |
  |TOTAL FOR THE YEAR                                             =2978=
  +---------------------------------------------------------------------

  +------------------+-----------------------------------------------+
  |DEATHS in the four|             CITY OF LONDON UNION.             |
  |quarterly periods,+-------+-------+-------+-------+-------+-------+
  |terminating as    | S. W. | N. W. |South. | S. E. | N. E. | Work- |
  |follows:--        |       |       |       |       |       |house. |
  |                  +-------+-------+-------+-------+-------+-------+
  |In the quarter    | M. F. | M. F. | M. F. | M. F. | M. F. | M. F. |
  |ending:           |       |       |       |       |       |       |
  |  I. Dec. } =672={| 27  21| 24  20| 25  24| 24  31| 19  29| 16   6|
  |     28th }      {|   48  |   44  |   49  |   55  |   48  |   22  |
  |                  |       |       |       |       |       |       |
  | II. March} =876={| 28  31| 22  26| 39  42| 27  29| 35  32| 12  12|
  |     29th }      {|   59  |   48  |   81  |   56  |   67  |   24  |
  |                  |       |       |       |       |       |       |
  |III. June } =767={| 26  18| 22  16| 40  35| 35  35| 31  25| 15  13|
  |     28th }      {|   44  |   38  |   75  |   70  |   56  |   28  |
  |                  |       |       |       |       |       |       |
  | IV. Sept.} =663={| 24  16| 21  18| 29  24| 23  13| 17  25| 14  13|
  |     27th }      {|   40  |   39  |   53  |   36  |   42  |   27  |
  +------------------+-------+-------+-------+-------+-------+-------+
  |Sum of the four  {|105  86| 89  80|133 125|109 108|102 111| 57  44|
  |quarters   =2978={|  191  |  169  |  258  |  217  |  213  |  101  |
  |                  |                    =1149=                     |
  |TOTAL FOR THE YEAR                                                |
  +------------------------------------------------------------------+


No. VI.--_Fourth Annual Enumeration of Deaths, relating to the Fifty-two
Weeks dating from September 28th, 1851, to September 25th, 1852._

  +------------------+-------------------------+-----------------------+
  |DEATHS in the four|    EAST LONDON UNION.   |   WEST LONDON UNION.  |
  |quarterly periods,+--------+--------+-------+-------+-------+-------+
  |terminating as    |Saint   |Cripple-| Work- |North. |South. |Work-  |
  |follows:--        |Botolph.|gate.   |houses.|       |       |house. |
  |                  +--------+--------+-------+-------+-------+-------+
  |In the quarter    | M.   F.| M.   F.| M.  F.| M.  F.| M.  F.| M.  F.|
  |ending:           |        |        |       |       |       |       |
  |  I. Dec. } =800={| 73   67| 59   58| 32  32| 40  28| 37  43| 18  12|
  |     27th }      {|   140  |   117  |   64  |   68  |   80  |   30  |
  |                  |        |        |       |       |       |       |
  | II. March} =773={| 62   62| 50   46| 18  30| 30  24| 58  43| 25  12|
  |     27th }      {|   124  |    96  |   48  |   54  |  101  |   37  |
  |                  |        |        |       |       |       |       |
  |III. June } =774={| 54   56| 78   53| 21  17| 39  31| 65  56| 23   8|
  |     26th }      {|   110  |   131  |   38  |   70  |  121  |   31  |
  |                  |        |        |       |       |       |       |
  | IV. Sept.} =717={| 77   83| 54   62|  6  20| 35  39| 41  36| 17  14|
  |     27th }      {|   160  |   116  |   26  |   74  |   77  |   31  |
  +------------------+--------+--------+-------+-------+-------+-------+
  |Sum of the four  {|266  268|241  219| 77  99|144 122|201 178| 83  46|
  |quarters   =3064={|  534   |  460   |  176  |  266  |  379  |  129  |
  |                  |         =1170=          |         =774=         |
  |TOTAL FOR THE YEAR                                             =3064=
  +---------------------------------------------------------------------

  +------------------+-----------------------------------------------+
  |DEATHS in the four|             CITY OF LONDON UNION.             |
  |quarterly periods,+-------+-------+-------+-------+-------+-------+
  |terminating as    | S. W. | N. W. |South. | S. E. | N. E. | Work- |
  |follows:--        |       |       |       |       |       |house. |
  |                  +-------+-------+-------+-------+-------+-------+
  |In the quarter    | M. F. | M. F. | M. F. | M. F. | M. F. | M. F. |
  |ending:           |       |       |       |       |       |       |
  |  I. Dec. } =800={| 33  30| 29  25| 26  26| 23  25| 32  23|  9  20|
  |     27th }      {|   63  |   54  |   52  |   48  |   55  |   29  |
  |                  |       |       |       |       |       |       |
  | II. March} =773={| 20  22| 33  28| 33  28| 31  19| 27  40| 17  15|
  |     27th }      {|   42  |   61  |   61  |   50  |   67  |   32  |
  |                  |       |       |       |       |       |       |
  |III. June } =774={| 24  33| 29  22| 22  19| 30  17| 33  26| 17  11|
  |     26th }      {|   47  |   51  |   41  |   47  |   59  |   28  |
  |                  |       |       |       |       |       |       |
  | IV. Sept.} =717={| 26  18| 15  17| 29  20| 15  11| 31  23| 12  16|
  |     27th }      {|   44  |   32  |   49  |   26  |   54  |   28  |
  +------------------+-------+-------+-------+-------+-------+-------+
  |Sum of the four  {|103  93|106  92|110  93| 99  72|123 112| 55  62|
  |quarters   =3064={|  196  |  198  |  203  |  171  |  235  |  117  |
  |                  |                     =1120=                    |
  |TOTAL FOR THE YEAR                                                |
  +------------------------------------------------------------------+


No. VII.--_Fifth Annual Enumeration of Deaths, relating to the Fifty-two
Weeks dating from September 26th, 1852, to September 24th, 1853._

  +------------------+-------------------------+-----------------------+
  |DEATHS in the four|    EAST LONDON UNION.   |   WEST LONDON UNION.  |
  |quarterly periods,+--------+--------+-------+-------+-------+-------+
  |terminating as    |Saint   |Cripple-| Work- |North. |South. |Work-  |
  |follows:--        |Botolph.|gate.   |houses.|       |       |house. |
  |                  +--------+--------+-------+-------+-------+-------+
  |In the quarter    | M.   F.| M.   F.| M.  F.| M.  F.| M.  F.| M.  F.|
  |ending:           |        |        |       |       |       |       |
  |  I. Dec. } =675={| 72   58| 46   60| 10  20| 35  33| 35  32| 14  19|
  |     25th }      {|   130  |   106  |   30  |   68  |   67  |   33  |
  |                  |        |        |       |       |       |       |
  | II. March} =878={| 67   64| 80   66| 32  22| 35  31| 45  55| 34  20|
  |     26th }      {|   131  |   146  |   54  |   66  |  100  |   54  |
  |                  |        |        |       |       |       |       |
  |III. June } =817={| 69   60| 69   62| 24  27| 53  36| 46  44| 25  21|
  |     25th }      {|   129  |   131  |   51  |   89  |   90  |   46  |
  |                  |        |        |       |       |       |       |
  | IV. Sept.} =670={| 70   56| 84   67|  8  12| 32  34| 25  27| 18  13|
  |     24th }      {|   126  |   151  |   20  |   66  |   52  |   31  |
  +------------------+--------+--------+-------+-------+-------+-------+
  |Sum of the four  {|278  238|279  255| 74  81|155 134|151 158| 91  73|
  |quarters   =3040={|   516  |   534  |  155  |  289  |  309  |  164  |
  |                  |          =1205=         |         =762=         |
  |TOTAL FOR THE YEAR                                             =3040=
  +---------------------------------------------------------------------

  +------------------+-----------------------------------------------+
  |DEATHS in the four|             CITY OF LONDON UNION.             |
  |quarterly periods,+-------+-------+-------+-------+-------+-------+
  |terminating as    | S. W. | N. W. |South. | S. E. | N. E. | Work- |
  |follows:--        |       |       |       |       |       |house. |
  |                  +-------+-------+-------+-------+-------+-------+
  |In the quarter    | M. F. | M. F. | M. F. | M. F. | M. F. | M. F. |
  |ending:           |       |       |       |       |       |       |
  |  I. Dec. } =675={| 23  14| 21  22| 31  26| 18  15| 25  29| 10   7|
  |     25th }      {|   37  |   43  |   57  |   33  |   54  |   17  |
  |                  |       |       |       |       |       |       |
  | II. March} =878={| 19  30| 38  19| 32  33| 29  20| 40  35| 15  17|
  |     26th }      {|   49  |   57  |   65  |   49  |   75  |   32  |
  |                  |       |       |       |       |       |       |
  |III. June } =817={| 20  25| 27  20| 30  29| 24  26| 27  20| 19  14|
  |     25th }      {|   45  |   47  |   59  |   50  |   47  |   33  |
  |                  |       |       |       |       |       |       |
  | IV. Sept.} =670={| 16  23| 18  23| 25  17| 18  14| 28  20| 10  12|
  |     24th }      {|   39  |   41  |   42  |   32  |   48  |   22  |
  +------------------+-------+-------+-------+-------+-------+-------+
  |Sum of the four  {| 78  92|104  84|118 105| 89  75|120 104| 54  50|
  |quarters   =3040={|  170  |  188  |  223  |  164  |  224  |  104  |
  |                  |                     =1073=                    |
  |TOTAL FOR THE YEAR                                                |
  +------------------------------------------------------------------+


No. VIII.--_Quinquennial Mortality, classified by Age, first for the
entire City, next for the three Unions severally._

  +--------------------+------+-----+-----+-----+------+------+------+
  |                    | Under| From| From| From| From | From | From |
  |Deaths in the Popu- |   5  |   5 |  10 |  15 |  20  |  30  |  40  |
  |lation of the City  | Years|  to |  to |  to |  to  |  to  |  to  |
  |of London.          |  of  |  10.|  15.|  20.|  30. |  40. |  50. |
  |                    | Age. |     |     |     |      |      |      |
  +--------------------+------+-----+-----+-----+------+------+------+
  |Year by year{1848-49| 1243 | 202 |  92 |  90 |  292 |  345 |  396 |
  |dating from {1849-50| 1032 |  83 |  44 |  70 |  166 |  200 |  251 |
  |Michaelmas  {1850-51| 1194 | 124 |  48 |  60 |  169 |  227 |  248 |
  |to          {1851-52| 1197 | 113 |  57 |  84 |  196 |  253 |  267 |
  |Michaelmas. {1852-53| 1135 |  94 |  37 |  59 |  179 |  258 |  268 |
  +--------------------+------+-----+-----+-----+------+------+------+
  |Sum of five year’s  |=5801=|=616=|=278=|=363=|=1002=|=1283=|=1430=|
  |deaths              |      |     |     |     |      |      |      |
  +--------------------+------+-----+-----+-----+------+------+------+
  |Deaths  East London | 2471 | 215 |  80 | 105 |  338 |  432 |  488 |
  |of five Union       |      |     |     |     |      |      |      |
  |years   West London | 1416 | 141 |  75 | 122 |  305 |  376 |  405 |
  |in      Union       |      |     |     |     |      |      |      |
  |their   City of Lon-| 1914 | 260 | 123 | 136 |  359 |  475 |  537 |
  |Local   don Union   |      |     |     |     |      |      |      |
  |Distri- Uncertain   |   *  |  *  |  *  |  *  |   *  |   *  |   *  |
  |bution. Address     |      |     |     |     |      |      |      |
  +--------------------+------+-----+-----+-----+------+------+------+

  +--------------------+------+------+------+----+-------+
  |                    | From | From | From | Age| Total.|
  |Deaths in the Popu- |  50  |  60  |  70  | not|       |
  |lation of the City  |  to  |  to  |  up- | re-|       |
  |of London.          |  60. |  70. |wards.|por-|       |
  |                    |      |      |      |ted.|       |
  +--------------------+------+------+------+----+-------+
  |Year by year{1848-49|  355 |  366 |  367 | 15 |  3763 |
  |dating from {1849-50|  254 |  318 |  334 |  0 |  2752 |
  |Michaelmas  {1850-51|  261 |  303 |  342 |  2 |  2978 |
  |to          {1851-52|  260 |  287 |  350 |  0 |  3064 |
  |Michaelmas. {1852-53|  297 |  320 |  393 |  0 |  3040 |
  +--------------------+------+------+------+----+-------+
  |Sum of five year’s  |=1427=|=1594=|=1786=|=17=|=15597=|
  |deaths              |      |      |      |    |       |
  +--------------------+------+------+------+----+-------+
  |Deaths  East London |  444 |  551 |  619 |  0 |  5743 |
  |of five Union       |      |      |      |    |       |
  |years   West London |  393 |  420 |  398 |  1 |  4052 |
  |in      Union       |      |      |      |    |       |
  |their   City of Lon-|  590 |  623 |  769 |  1 |  5787 |
  |Local   don Union   |      |      |      |    |       |
  |Distri- Uncertain   |   *  |   *  |   *  | 15 |    15 |
  |bution. Address     |      |      |      |    |       |
  +--------------------+------+------+------+----+-------+


No. IX.--_Number of Deaths occasioned, during the last Five Years, by
certain Acute Diseases, chiefly Epidemic, Infectious, and Endemic._

  +-------------------+------+----------+--------+------+-----------+
  |                   |      |   Acute  |Scarlet-|      |           |
  |                   |      | Diarrhœa | Fever  |      |Erysipelas,|
  |In the successive  |      | (not of  |  and   |Small-|  Pyæmia,  |
  |years terminating  |Fever.| infants),|Cynanche| Pox. |    and    |
  |severally as       |      |Dysentery,|maligna.|      | Puerperal |
  |follows:--         |      |    and   |        |      |  Fever.   |
  |                   |      | Cholera. |        |      |           |
  |                   |      |          |        |      |           |
  +-------------------+------+----------+--------+------+-----------+
  |At Michaelmas, 1849|  166 |    825   |   135  |   17 |     44    |
  |„       „      1850|  118 |     54   |    32  |   33 |     40    |
  |„       „      1851|  107 |     23   |    46  |   41 |     17    |
  |„       „      1852|  165 |     37   |    86  |   96 |     24    |
  |„       „      1853|  145 |     43   |    85  |   15 |     26    |
  +-------------------+------+----------+--------+------+-----------+
  |Total number of    |      |          |        |      |           |
  |such Deaths in the | =701=|   =982=  |  =384= | =202=|   =151=   |
  |Five Years 1848-53.|      |          |        |      |           |
  +-------------------+------+----------+--------+------+-----------+

  +-------------------+----------+--------+--------+---------+
  |                   |Diarrhœa, |        |        |         |
  |                   |Bronchitis|Measles,| Hydro- |  Total  |
  |In the successive  |   and    |Hooping-|cephalus|   of    |
  |years terminating  |Pneumonia | cough  |  and   |preceding|
  |severally as       |of Infants|  and   | Convul-| columns.|
  |follows:--         |  under   | Croup. |sions of|         |
  |                   | 3 years  |        |Infancy.|         |
  |                   | of age.  |        |        |         |
  +-------------------+----------+--------+--------+---------+
  |At Michaelmas, 1849|    285   |   196  |   264  |  =1932= |
  |„       „      1850|    243   |   124  |   219  |   =863= |
  |„       „      1851|    340   |   272  |   282  |  =1128= |
  |„       „      1852|    330   |   132  |   308  |  =1178= |
  |„       „      1853|    304   |   190  |   289  |  =1097= |
  +-------------------+----------+--------+--------+---------+
  |Total number of    |          |        |        |         |
  |such Deaths in the |  =1502=  |  =914= | =1362= |  =6198= |
  |Five Years 1848-53.|          |        |        |         |
  +-------------------+----------+--------+--------+---------+


No. X.--_Comparative Mortality in different seasons of the Year; namely,
in the Autumn Quarters (Oct., Nov., Dec.) in the Winter Quarters (Jan.,
Feb., March,) in the Spring Quarters (April, May, June) and in the
Summer Quarters (July, Aug., Sept.) of the Five Years from Michaelmas,
1848, to Michaelmas, 1853._

SYNOPSIS.

  +------------------+-------------------------+--------------------+
  |DEATHS in the dif-|    EAST LONDON UNION.   | WEST LONDON UNION. |
  |ferent seasons of +--------+--------+-------+------+------+------+
  |five years, as    | Saint  |Cripple-| Work- |      |      |Work- |
  |follows:--        |Botolph.| gate.  |houses.|North.|South.|house.|
  +------------------+--------+--------+-------+------+------+------+
  |In five Autumn    |   616  |   613  |  201  | 357  |  392 | 129  |
  |Quarters          |          =1430=         |        =878=       |
  +------------------+--------+--------+-------+------+------+------+
  |In five Winter    |   641  |   623  |  223  | 371  |  464 | 183  |
  |Quarters          |          =1487=         |       =1018=       |
  +------------------+--------+--------+-------+------+------+------+
  |In five Spring    |   519  |   583  |  195  | 402  |  471 | 159  |
  |Quarters          |          =1297=         |       =1032=       |
  +------------------+--------+--------+-------+------+------+------+
  |In five Summer    |   682  |   664  |  183  | 438  |  562 | 124  |
  |Quarters          |          =1529=         |       =1124=       |
  +------------------+--------+--------+-------+------+------+------+

  +------------------+-------------------------------------+------+
  |DEATHS in the dif-|        CITY OF LONDON UNION.        | Total|
  |ferent seasons of +-----+-----+------+-----+-----+------+ for  |
  |five years, as    |S. W.|N. W.|South.|S. E.|N. E.|Work- |entire|
  |follows:--        |     |     |      |     |     |house.|City. |
  +------------------+-----+-----+------+-----+-----+------+------+
  |In five Autumn    | 245 | 236 |  272 | 227 | 271 | 119  |=3678=|
  |Quarters          |                 =1370=                     |
  +------------------+-----+-----+------+-----+-----+------+------+
  |In five Winter    | 248 | 274 |  347 | 265 | 360 | 153  |=4152=|
  |Quarters          |                  =1647=                    |
  +------------------+-----+-----+------+-----+-----+------+------+
  |In five Spring    | 226 | 230 |  273 | 255 | 262 | 137  |=3712=|
  |Quarters          |                  =1383=                    |
  +------------------+-----+-----+------+-----+-----+------+------+
  |In five Summer    | 307 | 228 |  273 | 202 | 260 | 117  |=4040=|
  |Quarters          |                  =1387=                    |
  +------------------+-----+-----+------+-----+-----+------+------+


No. XI.--_Comparative Mortality in Different Seasons of the Year._

AUTUMN QUARTERS.

  +-----------------+--------------------------+--------------------+
  |                 |    EAST LONDON UNION.    | WEST LONDON UNION. |
  |DEATHS in five   +--------+--------+--------+------+------+------+
  |Autumn Quarters  | Saint  |Cripple-| Work-  |North.|South.|Work- |
  |as follows:--    |Botolph.| gate.  |houses. |      |      |house.|
  |                 +--------+--------+--------+------+------+------+
  |Oct., Nov., Dec.,|        |        |        |      |      |      |
  |             1848|  127   |  128   |   31   |  74  | 103  |  29  |
  |  „    „    „    |        |        |        |      |      |      |
  |             1849|  118   |  137   |   44   |  85  |  70  |  23  |
  |  „    „    „    |        |        |        |      |      |      |
  |             1850|  101   |  125   |   32   |  62  |  72  |  14  |
  |  „    „    „    |        |        |        |      |      |      |
  |             1851|  140   |  117   |   64   |  68  |  80  |  30  |
  |  „    „    „    |        |        |        |      |      |      |
  |             1852|  130   |  106   |   30   |  68  |  67  |  33  |
  +-----------------+--------+--------+--------+------+------+------+
  |Total of five    | =616=  | =613=  | =201=  | =357=|=392= |=129= |
  |Seasons          |        |        |        |      |      |      |
  +-----------------+--------+--------+--------+------+------+------+

  +-----------------+-----------------------------------------+------+
  |                 |          CITY OF LONDON UNION.          |Totals|
  |DEATHS in five   +------+------+------+------+------+------+ for  |
  |Autumn Quarters  | S.W. | N.W. |South.| S.E. | N.E. |Work- |entire|
  |as follows:--    |      |      |      |      |      |house.|City. |
  |                 +------+------+------+------+------+------+------+
  |Oct., Nov., Dec.,|      |      |      |      |      |      |      |
  |             1848|  40  |  50  |  59  |  40  |  62  |  23  | =766=|
  |  „    „    „    |      |      |      |      |      |      |      |
  |             1849|  57  |  45  |  55  |  51  |  52  |  28  | =765=|
  |  „    „    „    |      |      |      |      |      |      |      |
  |             1850|  48  |  44  |  49  |  55  |  48  |  22  | =672=|
  |  „    „    „    |      |      |      |      |      |      |      |
  |             1851|  63  |  54  |  52  |  48  |  55  |  29  | =800=|
  |  „    „    „    |      |      |      |      |      |      |      |
  |             1852|  37  |  43  |  57  |  33  |  54  |  17  | =675=|
  +-----------------+------+------+------+------+------+------+------+
  |Total of five    |=245= |=236= |=272= |=227= |=271= |=119= |=3678=|
  |Seasons          |      |      |      |      |      |      |      |
  +-----------------+------+------+------+------+------+------+------+


No. XII.--_Comparative Mortality in Different Seasons of the Year._

WINTER QUARTERS.

  +-----------------+--------------------------+--------------------+
  |                 |    EAST LONDON UNION.    | WEST LONDON UNION. |
  |DEATHS in five   +--------+--------+--------+------+------+------+
  |Autumn Quarters  | Saint  |Cripple-| Work-  |North.|South.|Work- |
  |as follows:--    |Botolph.| gate.  |houses. |      |      |house.|
  |                 +--------+--------+--------+------+------+------+
  |Jan., Feb., Mar.,|        |        |        |      |      |      |
  |             1849|   136  |   117  |    36  |   73 |   90 |   30 |
  |  „    „    „    |        |        |        |      |      |      |
  |             1850|    96  |   124  |    36  |   91 |   84 |   40 |
  |  „    „    „    |        |        |        |      |      |      |
  |             1851|   154  |   140  |    49  |   87 |   89 |   22 |
  |  „    „    „    |        |        |        |      |      |      |
  |             1852|   124  |    96  |    48  |   54 |  101 |   37 |
  |  „    „    „    |        |        |        |      |      |      |
  |             1853|   131  |   146  |    54  |   66 |  100 |   54 |
  +-----------------+--------+--------+--------+------+------+------+
  |Total of five    |  =641= |  =623= |  =223= | =371=| =464=| =183=|
  |Seasons          |        |        |        |      |      |      |
  +-----------------+--------+--------+--------+------+------+------+

  +-----------------+-----------------------------------------+------+
  |                 |          CITY OF LONDON UNION.          |Totals|
  |DEATHS in five   +------+------+------+------+------+------+ for  |
  |Autumn Quarters  | S.W. | N.W. |South.| S.E. | N.E. |Work- |entire|
  |as follows:--    |      |      |      |      |      |house.|City. |
  |                 +------+------+------+------+------+------+------+
  |Jan., Feb., Mar.,|      |      |      |      |      |      |      |
  |             1849|   52 |   63 |   60 |   52 |   77 |   36 | =822=|
  |  „    „    „    |      |      |      |      |      |      |      |
  |             1850|   46 |   45 |   80 |   58 |   74 |   29 | =803=|
  |  „    „    „    |      |      |      |      |      |      |      |
  |             1851|   59 |   48 |   81 |   56 |   67 |   24 | =876=|
  |  „    „    „    |      |      |      |      |      |      |      |
  |             1852|   42 |   61 |   61 |   50 |   67 |   32 | =773=|
  |  „    „    „    |      |      |      |      |      |      |      |
  |             1853|   49 |   57 |   65 |   49 |   75 |   32 | =878=|
  +-----------------+------+------+------+------+------+------+------+
  |Total of five    | =248=| =274=| =347=| =265=| =360=| =153=|=4152=|
  |Seasons          |      |      |      |      |      |      |      |
  +-----------------+------+------+------+------+------+------+------+


No. XIII.--_Comparative Mortality in Different Seasons of the Year._

SPRING QUARTERS.

  +-----------------+--------------------------+--------------------+
  |                 |    EAST LONDON UNION.    | WEST LONDON UNION. |
  |DEATHS in five   +--------+--------+--------+------+------+------+
  |Autumn Quarters  | Saint  |Cripple-| Work-  |North.|South.|Work- |
  |as follows:--    |Botolph.| gate.  |houses. |      |      |house.|
  |                 +--------+--------+--------+------+------+------+
  |April, May, June,|        |        |        |      |      |      |
  |             1849|    85  |   130  |    39  |   77 |  110 |   34 |
  |  „     „    „   |        |        |        |      |      |      |
  |             1850|    80  |    90  |    19  |   74 |   71 |   27 |
  |  „     „    „   |        |        |        |      |      |      |
  |             1851|   115  |   101  |    48  |   92 |   79 |   21 |
  |  „     „    „   |        |        |        |      |      |      |
  |             1852|   110  |   131  |    38  |   70 |  121 |   31 |
  |  „     „    „   |        |        |        |      |      |      |
  |             1853|   129  |   131  |    51  |   89 |   90 |   46 |
  +-----------------+--------+--------+--------+------+------+------+
  |Total of five    |  =519= |  =583= |  =195= | =402=| =471=| =159=|
  |Seasons          |        |        |        |      |      |      |
  +-----------------+--------+--------+--------+------+------+------+

  +-----------------+-----------------------------------------+------+
  |                 |          CITY OF LONDON UNION.          |Totals|
  |DEATHS in five   +------+------+------+------+------+------+ for  |
  |Autumn Quarters  | S.W. | N.W. |South.| S.E. | N.E. |Work- |entire|
  |as follows:--    |      |      |      |      |      |house.|City. |
  |                 +------+------+------+------+------+------+------+
  |April, May, June,|      |      |      |      |      |      |      |
  |             1849|   56 |   55 |   58 |   45 |   50 |   26 | =765=|
  |  „     „    „   |      |      |      |      |      |      |      |
  |             1850|   34 |   39 |   40 |   43 |   50 |   22 | =589=|
  |  „     „    „   |      |      |      |      |      |      |      |
  |             1851|   44 |   38 |   75 |   70 |   56 |   28 | =767=|
  |  „     „    „   |      |      |      |      |      |      |      |
  |             1852|   47 |   51 |   41 |   47 |   59 |   28 | =774=|
  |  „     „    „   |      |      |      |      |      |      |      |
  |             1853|   45 |   47 |   59 |   50 |   47 |   33 | =817=|
  +-----------------+------+------+------+------+------+------+------+
  |Total of five    | =226=| =230=| =273=| =255=| =262=| =137=|=3712=|
  |Seasons          |      |      |      |      |      |      |      |
  +-----------------+------+------+------+------+------+------+------+


No. XIV.--_Comparative Mortality in Different Seasons of the Year._

SUMMER QUARTERS.

  +-----------------+--------------------------+--------------------+
  |                 |    EAST LONDON UNION.    | WEST LONDON UNION. |
  |DEATHS in five   +--------+--------+--------+------+------+------+
  |Autumn Quarters  | Saint  |Cripple-| Work-  |North.|South.|Work- |
  |as follows:--    |Botolph.| gate.  |houses. |      |      |house.|
  |                 +--------+--------+--------+------+------+------+
  |July, Aug., Sep.,|        |        |        |      |      |      |
  |             1849|   171  |   199  |    73  |  148 |  295 |   33 |
  |  „     „    „   |        |        |        |      |      |      |
  |             1850|   102  |    93  |    26  |   74 |   65 |   18 |
  |  „     „    „   |        |        |        |      |      |      |
  |             1851|   123  |   105  |    38  |   76 |   73 |   11 |
  |  „     „    „   |        |        |        |      |      |      |
  |             1852|   160  |   116  |    26  |   74 |   77 |   31 |
  |  „     „    „   |        |        |        |      |      |      |
  |             1853|   126  |   151  |    20  |   66 |   52 |   31 |
  +-----------------+--------+--------+--------+------+------+------+
  |Total of five    |  =682= |  =664= |  =183= | =438=| =562=| =124=|
  |Seasons          |        |        |        |      |      |      |
  +-----------------+--------+--------+--------+------+------+------+

  +-----------------+-----------------------------------------+------+
  |                 |          CITY OF LONDON UNION.          |Totals|
  |DEATHS in five   +------+------+------+------+------+------+ for  |
  |Autumn Quarters  | S.W. | N.W. |South.| S.E. | N.E. |Work- |entire|
  |as follows:--    |      |      |      |      |      |house.|City. |
  |                 +------+------+------+------+------+------+------+
  |July, Aug., Sep.,|      |      |      |      |      |      |      |
  |             1849|  145 |   77 |   86 |   77 |   73 |   18 |=1395=|
  |  „     „    „   |      |      |      |      |      |      |      |
  |             1850|   39 |   39 |   43 |   31 |   43 |   22 | =595=|
  |  „     „    „   |      |      |      |      |      |      |      |
  |             1851|   40 |   39 |   53 |   36 |   42 |   27 | =663=|
  |  „     „    „   |      |      |      |      |      |      |      |
  |             1852|   44 |   32 |   49 |   26 |   54 |   28 | =717=|
  |  „     „    „   |      |      |      |      |      |      |      |
  |             1853|   39 |   41 |   42 |   32 |   48 |   22 | =670=|
  +-----------------+------+------+------+------+------+------+------+
  |Total of five    | =307=| =228=| =273=| =202=| =260=| =117=|=4040=|
  |Seasons          |      |      |      |      |      |      |      |
  +-----------------+------+------+------+------+------+------+------+




  ON THE PRESENT
  BURIAL-PLACES OF THE CITY.


  TO THE IMPROVEMENT COMMITTEE OF THE HON. THE COMMISSIONERS OF SEWERS
  OF THE CITY OF LONDON.

  _December 10th, 1852._

  GENTLEMEN,

In order to an application of the Metropolitan Burials Act by the
constituted authorities of the City, you have requested me to report how
far, in my judgment, the existing burial-places within this jurisdiction
are fit for further reception of the dead.

I have little to add to the information which I have laid before the
Commission in my successive annual reports--especially in that of 1849,
and which long since induced me to express my conviction ‘that the City
of London could no longer with safety or propriety be allowed to furnish
intramural burial to its dead.’

It would, indeed, be ridiculous if I should pretend to you that this
part of the subject requires any further inquiry. Putrefactive
decomposition of one kind and another is the principal cause of
town-unhealthiness. Against its occurrence round about our houses all
your legislation is directed. The human body, once destitute of life,
furnishes no exception to the laws of organic decay: under the common
laws of chemical change, it soon dissolves itself into products neither
less offensive, nor less poisonous, than those of any brute’s
decomposition. And you cannot take a juster view of the subject--you
cannot arrive at stronger arguments for the immediate abolition of
intramural interment, than by forcing yourselves to discard for a moment
all memory of the fading human outline which masks this dreadful
nuisance, and to conceive it as _a mere bulk of animal matter_, planted
every year to undergo decomposition within the City, beneath our
Churches, and before our thresholds.[91]

  [91] The right of interment in the City may at present be claimed in
  respect probably of more than three thousand corpses _per_ annum. The
  number actually interred of late years has, I believe, not exceeded an
  average of two thousand _per_ annum.

Dead bodies thus buried contribute importantly in their neighbourhood to
the vitiation of air and water. Those that lie shelved in vaults,
eventually, if not at first, spread through the atmosphere every product
of their decomposition. Those that are dug into the soil have their
decay modified by its influence, mingle with its drainage the products
of their transformation, and thus (as I have shown in my remarks on the
Bishopsgate pump water) find their issue in the nearest land-spring of
the spot, polluting the drink of the population. Further, in all the
more frequented burial-grounds, the soil seems to be saturated with
animal matters only partially transformed; and at every new disturbance
by the spade, a fresh quantity of this unctuous clay comes upmost,
tainting the air with materials of fœtid decomposition, often to the
great distress of persons who dwell in the vicinity.

On such grounds as these, I cannot hesitate in renewing my report that
the City of London is absolutely unfit to serve as a further
burial-place for the dead; and this, whether by inhumation or in vaults,
whether in parochial burying-grounds, or in those of other communities.

Regard being had to the object of your reference, you would probably not
desire me at present to enter on the ulterior questions of extramural
interment.

On such representations as I have made, the Court of Common Council
(acting under the Metropolitan Act already referred to) has authority to
determine in respect of the City of London, whether the existing places
of burial, either from their insufficiency, or from their dangerousness
to health, are so unfit for their purpose as to render it necessary that
other burial-space be provided.

Should they affirm this view, they can then ‘authorise and direct the
Commissioners of Sewers of the City of London to exercise for the said
City and Liberties all the powers and authorities vested in
Burial-Boards under the Act.’

This course being taken, the Commission (subject to approval from the
Secretary of State) will have authority to make all arrangements
requisite for the final closure of burial-places within the City.

In approaching the subject of extramural sepulture, with its innumerable
details of inquiry, for site, for conveyance, and for burial--details
which form the knowledge and experience of a special class of persons,
the Commission may perhaps first consider whether works so foreign to
their usual functions shall be undertaken by themselves directly, or
shall be made matter of contract with existing Cemetery Companies, or
other associations or individuals. Till this decision is made, it seems
impossible to conjecture what topics you may wish to entertain, or
within what limits the industry of your officers may most usefully be
exercised.

There are many very important parts of the subject with which it may
hereafter become my duty to deal; but till the preliminary questions are
settled, it would be idle to detain you with sanitary considerations
belonging to a later stage of your inquiry.

As my Report for 1849 had long been out of print, I subjoin an extract
from it of so much as relates to the matter in hand.[92]

  [92] The passages here referred to form a separate section of the
  First Annual Report; and therefore need not be reprinted in this part
  of the present volume.--J. S., 1854.


NOTE.

  _On considering the above Report, the Improvement Committee of the
  Commissioners (to whom the subject had been specially referred) at
  once resolved to report to the General Court that, in their ‘judgment,
  steps should be taken for closing the several burial-places within the
  City;’ and at the same time they desired that the Officer of Health
  would prepare for them his opinion on those ulterior arrangements
  which such closure might render necessary._

  _The following Report was written accordingly._




  INTRODUCTORY REPORT
  SUGGESTING THE
  OUTLINE OF A SCHEME
  FOR
  EXTRAMURAL INTERMENT.

  TO THE IMPROVEMENT COMMITTEE
  OF THE
  HON. THE COMMISSIONERS OF SEWERS OF THE CITY OF
  LONDON.


  GENTLEMEN,

Under the several clauses of the Metropolitan Burials Act, and under
certain clauses of the City Sewers Act 1848, the Commissioners of
Sewers, acting as a Burial-Board for the City of London, will be subject
to the following responsibilities--viz.:

  _First_,--That a sufficient extramural burial-place be provided for
  those classes of persons who have heretofore had right of interment
  within the City;

  _Secondly_,--That the facilities of transit and conveyance to such
  burial-place be commensurate with the purposes for which it is
  established;

  _Thirdly_,--That evil no longer accrue to the health of the City from
  unnecessary delays of interment, or from the keeping of dead bodies in
  the dwelling-rooms of the poor.

       *       *       *       *       *

I. To measure the sufficiency of a burial-place, one must know for what
numbers of population it is intended to suffice.

Burial-Boards under the new Act are obliged to provide accommodation for
all _parishioners_ or _inhabitants_ of the several parishes within their
jurisdiction.

Under the term ‘parishioners’ as relating to the City, there may be
included, I am told, an indefinite number of non-resident rate-payers:
and although, at first, interment might not be claimed under the latter
head to any considerable extent, yet, with the completion and success of
your Cemetery, the applications might year by year become more numerous.
From the nature of the case, such claimants would in most instances be
of the wealthier classes, and might consequently be expected to apply
for special allotments of ground. It seems therefore desirable that you
should have some knowledge of the number for whom you may thus be
required to provide.

I would accordingly suggest as expedient, that a legal opinion should be
obtained on your exact liabilities under the law referred to; and
especially as to whether the right of burial possessed by non-resident
rate-payers does likewise extend to the non-resident households of such
rate-payers.

In the meantime I will leave this set of claimants out of my argument;
assuming that, whenever you have reckoned their number, you will be
able, on their account, to add to your general estimate, according to a
fixed proportion, the assessment of whatever additional accommodation
they may legally require.

The number of deaths belonging to the ‘inhabitants’ of the City of
London may be more precisely given. It would probably lie, as an
average, within 3200 per annum.

In attempting to fix the extent of ground required for your purpose in
respect of this mortality, I must bring before you some preliminary
considerations.

First,--as regards the _minimum accommodation_ to be given in your
Cemetery; I assume that every person buried there, however humble his
previous station in life, may in death claim a grave to himself. It has
been the opprobrium of our previous system that, in the poorer classes
of interments, many bodies have been huddled together into a single pit.
Probably you will think, as regards your future burial-place, that no
consideration of cheapness can justify this indecency: probably you will
be unwilling that, in a presence which confounds all social comparisons,
there should be drawn, with your sanction, between rich and poor any so
disrespectful distinction. But at all events, on sanitary grounds, I
feel bound to assure you that these multiple burials are quite
inadmissible. With such concentration of organic remains in very narrow
compass, the soil grows utterly fœtid; and it becomes impossible to
guard against nuisance arising to the public, or against danger to those
who are occupied in digging and tending the ground. These evils, indeed,
are so glaring, and the indecorum of crowded interment has long been so
notorious, that nothing could have given them continuance except the
necessities of our narrow accommodation under the system of intramural
burial: and it would of course be without excuse to perpetuate them
under the changed circumstances of extramural Cemeteries, where space
can so readily be obtained for all legitimate requirements of the
public. So far as the experience of other countries may help to
determine your judgment in this matter, I may inform you that, in every
foreign interment system which can deserve to be considered an
establishment of public authority, the right of single burial is
universally recognised.

Next--as regards the _succession of interments_; according to the
burial-usages of modern times, no public Cemetery with fixed limits can
be permanently useful, except on a full recognition of the fact that it
is a decaying place for the dead, not a place for their embalmment or
mummification. For hence it follows, that ground once used for burial
becomes equally fitted for a second use, whenever by gradual
decomposition the bodies first interred there have thoroughly vanished
from the soil.

This principle has given the common rule of burial; and for obvious
reasons. Under any other plan, the entire area allotted for interment
would presently be in holding. No portion, however remote the date of
its first occupation, could be resumed for a second series of
interments; and the provision of a new Cemetery would be indispensable.
Pushed to its extreme consequences, such a system must eventually
convert the entire country into its burial-ground.

Under the practice of intramural interments--that practice which the new
law supersedes, the principle of temporary tenure has been made to cover
all manner of brutal abuses. Graves have been disturbed--within
metropolitan churchyards and other burying-grounds, in which the
transformations of decay had not half accomplished themselves; and
public decency has been outraged--here, in the centre of civilisation,
by the spectacle of human remains being tossed about like offal. It is
one chief advantage of extramural sepulture, that, while the inevitable
decay of the dead will be removed from the vicinity of the living, and
the latter will no longer have their atmosphere tainted by this hideous
contamination; so likewise for the dead--however humble, that in this
new resting-place, room will be allotted them with no indecent stint;
that the dwellings and market-places of the living will no longer hem
them in, grudging their narrow requirements; that their return to dust
will be respected, as beseems the last phase of mortal existence; and
that, against any desecration of their repose, there will be given every
security which piety and affection can demand.

There may be difference of opinion as to the precise time when a grave
can with truth and decency be thought to have become distenanted. The
rapidity of decay varies in so extraordinary a degree according to soil,
that some inhumations are almost equivalent to embalming; while, in
other cases, the process is comparatively rapid. Only experience of a
particular soil will enable you to know with precision, what length of
tenure is needed there for the purposes of interment to accomplish
themselves; but on general principles one can approximate pretty nearly
to the truth. Assuming the site of your Cemetery to have been selected
with due regard to those qualities of soil which determine the
differences adverted to, I think it unlikely that any adult grave can
properly be re-opened within twenty years[93] of the time when interment
shall last have occurred in it. Very long within this time, however, all
soft textures of the body would have completed their decay. Remains of
the coffin and of the skeleton--materials insusceptible of putrefaction,
would alone occupy the grave, and with gradual crumbling blend
themselves in the soil. Not till this final disintegration of the
skeleton is complete--not till the identity of its different elements is
destroyed, can the first occupant of a grave be fairly deemed to have
abdicated his tenure. From this time only, can his interest in it be
held as having reverted to the public, for whoever next may claim a
similar usufruct of the ground.

  [93] Twenty years would probably represent at least four times the
  average period during which the bodies of the poor have been left at
  rest in many grave-yards of the metropolis. Yet I would willingly
  advocate a longer term of years as the personal tenure of a grave, if
  public opinion would sanction the heavier expense which must thus be
  entailed on the living.

Taken for granted that, as regards the general public, your Cemetery
will be established on the principle of a temporary tenure of graves, it
remains for you to determine to what extent you will permit wealthier
applicants to purchase exemption from this rule, and obtain a freehold
interest in particular portions of your ground. I have little to say on
this point, because it is of no sanitary importance, provided that
privileges so purchased do not in any degree interfere with the general
economy of your plan. Barring any risk of this kind, it comes before you
simply as a question of finance.

A precaution, however, which I would suggest, is, that, first of all,
you should provide a cemeterial space sufficient for the interment
purposes of your population, on the principle of temporary tenure; that
no portion of this space should, under any circumstances, be alienated
from its public destination; that the whole of it should remain in
perpetuity the common burying-ground of the City of London. This prime
necessity of your plan being secured, it will be competent for you to
include in your purchase a certain redundant number of acres; and out of
these you can allot, at your discretion, such quantities of ground as
may be desired in freehold, either for the purposes of family interment,
generation after generation, or for the fiction of perpetual tenure by
some single occupant.[94]

  [94] In regard of these exceptional burials, it will be requisite to
  fix certain regulations; especially for the construction of family
  graves, wherein it will be desired that many who during life have been
  united, shall after death have their ashes mingled together in the
  soil. A frequent custom in private Cemeteries for fulfilling this
  purpose has been, for graves to be dug to a considerable
  depth--sometimes such that twelve coffins could be piled there, one on
  the other; and these deep pits have commonly been provided with brick
  walls. Now, for the same reason as determined my opinion against the
  multiple burial of the poor, I would argue against this arrangement,
  as one which might occasion excessive accumulation in single spots of
  your Cemetery, and as being in principle bad. In preference, I would
  venture to recommend the endeavour to introduce an interment-custom,
  which is prevalent abroad, of _family plots of ground instead of
  family pits_. Under ordinary circumstances, all the accommodation
  heretofore sought in the one arrangement would be found superiorly in
  the other; and in a well-projected suburban Cemetery the larger
  superficial extent could probably be afforded at much less cost than
  is usually paid for the pit. Persons familiar with the details of
  Cemetery-burial would easily devise an arrangement of such plots,
  whereby they should be separate and secluded, admitting of appropriate
  decoration, and altogether likely to prove more acceptable to public
  opinion than many existing arrangements. In regard of such plots, too,
  there might be conceded a privilege which I believe has not been
  allowed in private Cemeteries; namely, an hereditary right to refill
  the ground for any successive number of times, subject only to such
  restrictions as will determine the succession of interments in other
  parts of the Cemetery.

In thus selling portions of your land for private and privileged
employment, you would be satisfying what has become a habit, and may be
considered a legitimate claim of the wealthier classes. Beyond this, it
is also evident, that you would virtually be competing with the ordinary
Cemetery-companies of the metropolis, in the most lucrative department
of their trade. It would probably be easy for you, by varying your fees
according to circumstances, either on the one hand to diminish, and
almost prohibit, the frequency of applications for exceptional
interments; or, on the other hand, to attract such applications. Even,
if you thought it desirable, you might admit purchasers from other
classes than those having right of burial in your municipal
Cemetery;--in short, you might manage it commercially, with a view to
profit, looking to its proceeds for covering many expenses of the
general establishment.

With respect to the ordinary arrangement of your ground for public
purposes, and the distribution of burials therein, you may estimate
that, taking one grave with another, and allowing for the marginal
spaces of each, the average size of a grave will be twenty-eight square
feet. For illustration’s sake, I will suppose the ground to be laid out
in plots--say the third of an acre in extent. Each such plot would
contain four hundred single graves, mixed adult and young, with what
foot-paths might be requisite for approaching them. The City mortality
of twenty years (assuming this period to be the ordinary leasehold of a
grave) might be reckoned at sixty-four thousand deaths; for the
accommodation of which number there would be wanted one hundred and
sixty plots of the above-mentioned size--say fifty-four acres of ground.
I would propose that throughout each line of every such space, adult and
infant graves should, as far as possible, lie alternately; and that,
instead of filling all the graves together at stated periods (say every
twenty years) half of them, taken alternately, should be filled at each
semi-period--say every ten years. By this arrangement, half the
complement of burials would take place in each plot, at a time when the
decomposition of the preceding half-complement had finished itself, so
far as putrefaction is concerned; and whatever contamination of air
might be liable to occur under the best-considered sanitary arrangement,
would certainly be reduced to the lowest conceivable amount. Or, as an
alternative equal to this arrangement for the purposes of health, you
might adopt the plan of filling in immediate succession all the
burial-spaces of a plot; provided the surface could then at once be
devoted to the growth of appropriate vegetation.

Fifty-four acres being then the quantity of ground which would suffice,
on sound principles, for the ordinary interment of your entire annual
mortality during a period of twenty years; at the expiration of which
time (assuming your soil to be appropriate) one may reasonably expect
that the ground will admit of a second similar occupation; and so forth
in perpetuity: it will be requisite to add a considerable allowance of
space for other accessory purposes.

Thus, room would be required for the various buildings that belong to
the institution of a Cemetery: partly for the dwelling of such officers
as you may require to be there resident, partly for the temporary
accommodation of persons resorting thither for the burial of their
friends, partly for the religious services of different
congregations.[95]

  [95] The distinction of the ground into a consecrated and an
  unconsecrated portion, as required by the Act of Parliament, will
  require no addition to its total area; and therefore the proportion
  which these parts should bear to one another need not now be
  discussed.

Something likewise must be added for such mainways as will be wanted
along various lines of the burial-ground, for the carriage traffic which
belongs to funeral ceremonies among the richer classes of society, and
for other like purposes.

Further, I dare say you would think it inexpedient that your Cemetery
should be entirely without decoration and elegance. Fifty-four acres of
head-and-foot stones, or the same extent of bare mounds, might vulgarise
even the aspect of death. By the judicious introduction of trees and
turf and shrubs, of bends and undulations, you would probably seek to
interrupt the long perspective of so many tombs, and, by these
artificial resources of planning and planting, to enhance the native
solemnity of the spot. Amid such ornamental portions of your ground
might be scattered irregularly the various sites of exceptional
interment,--family graves, personal graves in perpetuity, long leasehold
graves, and the like; and the interposition of these large portions of
comparatively un-occupied soil, with as much appropriate vegetation as
could conveniently be introduced, might not only allow much tasteful
decoration of the ground, but would likewise conduce to the healthful
accomplishment of those purposes for which the Cemetery is established.

In respect of these and many other details of your plan, you will
doubtless be guided by the direct and responsible advice of men
specially skilled in the subject. I have, therefore, confined myself to
the mention of those points which may determine your judgment merely as
to the quantity of land required for your purpose.

Without offering any opinion as to the possible claims of non-resident
parishioners, on which liability I would again suggest your obtaining a
legal opinion; and without pretending to advise what allowance should be
made for purely decorative purposes; I may yet conclude from such
information as I have collected, that, with a hundred acres of suitable
soil at your disposal, you would be amply able to meet all legitimate
burial-requirements of your population in perpetuity, and would likewise
(for many years at least) have a considerable excess which might be
applied to the uses of ornamental arrangement.

From what I have said on the influence of soil, in determining the
period after which burying-grounds may be resumed for a second series of
interments, it will be obvious to you that this condition is an
important element in deciding the sufficiency of any area for given
burial purposes. And the site of your Cemetery might be such as somewhat
to lessen, or greatly to increase, the suggested extent of your
estimate. It would be fruitless, however, now to detain you with any
endeavour to trace the several influences which different soils exert
over animal decay. Such remarks, at the present time, could only be
addressed to hypothetical cases, or stated in the most general form.
Therefore, instead of attempting this anticipative argument on the
subject, I hold myself ready to report to you, specifically, on the
suitableness of whatever soil may be proposed to you for the purposes of
your Cemetery.[96]

  [96] For similar reasons, I defer any discussion of the depth at which
  bodies may most properly be deposited in the ground. The thickness of
  superjacent soil, which will deodorise, before their escape, the
  gaseous products of any given decomposing mass, or which will retain
  these gases more or less permanently in combination, varies most
  importantly with certain chemical and mechanical qualities of the
  soil: and on these it would be useless to dwell by anticipation. For
  accurate results, it may be necessary, after the selection of a site
  and during its preparation, to institute experiments on the subject.

There is yet one other consideration which may affect the extent of your
purchase. The law restricts you from approaching within 200 yards of any
dwelling-house, without the previous written consent of its owner,
lessee, and occupier. But there is no law restricting the nearness
within which any builder may approach your wall with his design for new
habitations; and it might easily occur to you, within a short time of
establishing your Cemetery, to find a new town growing in close
proximity around it. If there be any meaning and value in the clause,
which forbids your undue approach to inhabited houses--if it truly
represent that this approach would be a sanitary evil, then obviously
the law is deficient in the respect adverted to. It would be in your
power to guarantee the continuance of a belt of unoccupied ground, as an
immediate circuit to your Cemetery, in either of two ways:--either,
namely, you might purchase a considerable extent of ground beyond the
actual requirements of your Cemetery, might devote its central hundred
acres to interment, and might let its remaining circumference for
agricultural purposes; or, if you were fortunate enough to be treating
for the central portion of some considerable estate, you might
stipulate, as a condition of purchase, that no building should be reared
within such distance of the wall of your Cemetery, as you, on due
consideration, may deem fit.

       *       *       *       *       *

II. In the provision of a Cemetery, it is required by the Act of
Parliament, that ‘the Burial-Board shall have reference to the
convenience of access thereto from the Parish or Parishes for which the
same is provided;’ and it is legalised, that ‘any Burial-Board may make
such arrangements as they may from time to time think fit, for
facilitating the conveyance of the Bodies of the Dead from the Parish,
or the place of Death, to the Burial-ground which shall be provided.’

It cannot but be obvious to you, that the choice of a site for your
Cemetery might be such as to interpose very serious obstacles in the way
of interment, even for the richest classes; and under the most favorable
circumstances, the removal of the dead to a distance of some miles from
their previous residence, cannot but threaten serious difficulty to the
poor. Assuming--what various conditions of the Act of Parliament render
almost inevitable, that your Cemetery must be distant at least six miles
from the centre of the City, the present funeral charges can hardly be
maintained without increase, if the traffic is to be conducted on the
same principles as heretofore. The price for which an artisan could
procure a decent funeral for his wife or child, within a stone’s throw
of his door, will unavoidably be augmented by every mile you add to the
distance, if the conveyance is still to depend on the old means and
arrangements.

When I consider the classes of persons likely, as inhabitants of the
City, to claim interment in your Cemetery--classes, among which the
predominance of narrow, if not necessitous, circumstances will be
frequent; when, for instance, in a year’s official returns, I see that
artisans and paupers make more than two-thirds of your entire classified
mortality; I cannot but think this aspect of the matter a very important
one. From some years’ experience of your death-register, I should say
that, of City funerals, there would not be one in ten where the friends
could afford to disregard an additional expenditure of half a guinea;
and, in the majority of instances, I am persuaded that a smaller
addition would be enough to cause inconvenience and distress. It
therefore seems to me certain, that your plan for extramural sepulture,
however perfect at all other points, might either entirely fail of its
purpose, or become cruelly oppressive to the poor, by the simple
expensiveness of approaching the burial-place. And I suppose it was in
anticipation of the difficulties here adverted to, that the framers of
the Metropolitan Burials Act introduced the permissive clause, which I
just quoted, empowering Burial-Boards ‘to facilitate the conveyance’ of
the dead, and thus virtually rendering them responsible, so far as the
poorer classes are concerned, for the cheapness and efficiency of such
conveyance.

I would therefore submit, that in your decision as to the site of your
Cemetery, so soon as the indispensable conditions of appropriate soil
are given, the first point to examine is accessibility; that the spot to
be chosen should have, in addition to its carriage roads, the utmost
facility of railway approach; and that, for those with whom small
differences of price are an important consideration, you should be able
to guarantee a rate of transport for coffin and mourners, not in excess
of existing charges.

From observation of arrangements which have lately been made with
Railway-Companies by the Directors of Cemeteries, and from inquiry of
persons engaged in such undertakings, I entertain little doubt that you
might make a contract to the following effect with the authorities of
any line convenient for your purpose--viz., that every day, at a fixed
hour, there should be a train, or some portion of a train, exclusively
adapted to the funeral purposes of the poorer classes; that for this
train there should be issued funeral tickets, franking the conveyance of
a coffin with some stated number of mourners, who should also be
entitled to return; that the introduction of funeral traffic should be
by a special entrance, and its exit at a special terminus.

Such contract supposed,--in connexion with this funeral train, you might
further arrange to maintain public hearses; which, at the option of
persons concerned, and on due requisition being made, should convey any
coffin from its former home to the railway terminus; and which again, if
necessary, at the distal station, should complete its conveyance to the
grave. This facility might even be extended, if the distances were
considerable, to the similar conveyance of a certain number of
mourners, with the undertaker in charge of their procession.

Also, if desirable, it could no doubt be arranged, with a view to
economy, that the undertaker’s responsibility for a funeral should
terminate at the railway terminus, up to which he would have conducted
it; and that its reception at the distal station should be entrusted to
servants of your Cemetery, who would then fulfil all remaining duties in
respect of it.

Arrangements to the above effect would be much simplified in working,
and their general adoption much promoted, if all disbursements for
funeral tickets, and for such other facilitations of conveyance as I
have adverted to, were made by your Burial-Board,--their cost to be
included in an uniform Cemetery fee; so that the friends of the
deceased, after paying for his grave, should, without further payment,
be entitled, if they desired it, to claim conveyance for his coffin from
home to the Cemetery, and for themselves (in stated number) by a funeral
ticket, at least for the railway portion of their transit. Thus to have
one single and inclusive price for all that belongs to the new
system--for the extramural grave, namely, and for conveyance thereto,
would enable your Burial-Board to maintain its total cost at a level
within reach of the poorer classes, and probably below that of existing
prices.

In addition to what I have here suggested, there are many other steps
which might be taken, if unforeseen circumstances should render them
necessary, to diminish the pressure of new burial-charges on the poor.
Time will develop, better than one can foretell, the exact operation of
our reformed system; and for such inconveniences as it may bring, you
will have no difficulty, I think, in finding appropriate cures. Nor
could it be otherwise than easy, if you thought it desirable, to extend
to the comparatively few funerals of wealthier classes which occur from
within the City of London, those same arrangements for facilitating
conveyance, which I have here deemed it requisite to consider only in
their relation to the poor.

For the latter, it has seemed indispensable that your scheme should
provide assistance, equivalent at least to the difficulty which its
adoption must occasion them. Beyond this, I believe you would wish to
disturb as little as possible the ordinary routine of interment; and I
have aimed, therefore, at suggesting assistance only in such kind, and
in such degree, as may least interfere with any interests of trade,
least derange any established habits, least offend any prejudices of the
people.

       *       *       *       *       *

III. There is no part of the subject which I have considered with more
anxiety than that which relates to delays of interment, and to the
prolonged keeping of dead bodies in the rooms of their living kindred.

Evils arising in this source are unknown to the rich. Soldered in its
leaden coffin, on tressels in some separate and spacious room, a corpse
may await the convenience of survivors with little detriment to their
atmosphere.

Not so in the poor man’s dwelling. The sides of a wooden coffin, often
imperfectly joined, are at best all that divide the decomposition of the
dead from the respiration of the living. A room, tenanted night and day
by the family of mourners, likewise contains the remains of the dead.
For some days the coffin is unclosed. The bare corpse lies there amid
the living; beside them in their sleep; before them at their meals.

The death perhaps has occurred on a Wednesday or Thursday; the next
Sunday is thought too early for the funeral; the body remains unburied
till the Sunday week. Summer or winter makes little difference to this
detention: nor is there sufficient knowledge on the subject, among the
poorer population, for alarm to be excited even by the concurrence of
infectious disease in a room so hurtfully occupied.

I have no means of telling you, with statistical precision, in how many
of your annual deaths the corpse is detained in dangerous proximity to
the living. But I have already quoted an official classification of
deaths, by which it would appear that more than two-thirds of your
deaths are of the artisan class or below it. Among them at least, it
would be exceptional for the corpse to have a room to itself. On an
average, then, there would probably be lying within the City at any
moment, from thirty to forty dead bodies in rooms tenanted by living
persons.

This very serious evil is well known to all persons who have taken an
interest in the sanitary advancement of the poor; and ineffectual
endeavours have been made for its diminution. The law does indeed
empower your Officer of Health, under certain circumstances, to order
the removal of a corpse from any inhabited room. And, under the
Nuisances Removal Act, the General Board of Health may be authorised,
during times of epidemic disease, to issue directions and regulations
for the speedy interment of the dead. Both laws have remained
inoperative, and are likely to remain so.

If one were starting anew--legislating for a people with unformed
habits, nothing might be easier than to devise regulations of a perfect
kind with regard to the sanitary management of the dead. But our case is
widely different. The evils against which we have to contend are among
the deepliest-rooted habits of the country. In defence of what exists
there are many stupid and ignorant prejudices: but, interwoven with
these are feelings of tenderness and affection, to which all
consideration and reverence are due;--feelings which would be shocked
and outraged by any abrupt endeavour to reduce the care of the dead to a
system of fixed regulations.

For myself, having the deepest sense of the evil in question, and having
officially the power to order the removal of the dead, I may repeat that
I have never yet exercised my authority. Practically speaking, I can
hardly conceive an instance in which I should attempt to do so. It would
require the strongest case that could be shown of actual mischief in
progress--of disease and death multiplied day by day through the
presence of some particular dead body, to justify interference even in
that single instance. Nothing like the operation of a general law would
be tolerated;--nothing like including the dead in a compulsory plan of
hygienic police.

After very careful consideration of the subject, I may confess myself
even more impressed with its difficulties than when I first began to
give it my attention; and in the few suggestions which follow I cannot
pretend to do more than intimate where, in my opinion, a beginning may
usefully be made towards an improvement which it will take many years
to accomplish.

Legislative remedies, proposed for the evils which I am bringing under
your notice, have been of two kinds--viz., _first_, to restrict the time
during which it should be lawful to keep a body unburied; _secondly_, to
promote the use of reception-houses (as they have been called) whither
bodies might be removed from within all dwelling-places, and be kept
under certain regulations during the days preceding their interment.

As regards the first point;--there are many foreign countries (and even
some parts of the United Kingdom) where either law or custom has made it
imperative to bury within two, three, or four days of death. Our habit,
unfortunately, is to keep the corpse unburied for twice as long. A week
may probably be considered our medium interval between death and
interment; and with this delay, I need hardly tell you, the body becomes
putrid--sometimes intensely so, before the time for its removal arrives.

Among the wealthier classes, as I have said, this delay is practically
unimportant; except in so far as every repetition maintains the
pernicious custom. Scarcely on account of any risk arising to themselves
in emanations from the dead, but mainly for the sake of influence and
example, would one wish the educated classes of the community to adopt
the usage of earlier burial. Our present practice is upheld by no law of
necessity; nor for the most part does it represent any extravagance of
grief, or fond reluctance of separation. Chiefly it subsists by our
indolent acquiescence in a habit, which former prejudices and former
exigencies established. Fears of premature interment, which had much to
do with it, are now seldom spoken of but with a smile. The longer
interval, once rightly insisted on as necessary for the gathering of
distant friends, has now, in the progress of events, become absurdly
excessive: in a vast majority of cases, all whose presence is needed,
live within a narrow circle; and the more distant mourner, who, fifty
years ago, would have spent several days in coming from Paris or
Edinburgh, can now finish his journey in twelve hours. It is much to be
wished that, under these changed circumstances, an altered practice
might ensue in the upper classes of society, fixing their time of burial
within three or four days of death. Such example of wealthier
neighbours, aided by greater enlightenment and education among
themselves, would greatly tend to detach the poor from many observances
and delays, in relation to the dead, which, in their narrow dwellings
cannot continue with impunity.

But, as regards these poorer classes, cannot anything be done in
connexion with your new arrangements, to abridge the period of delay? As
for any positive regulation, limiting the time during which it should be
allowed to retain dead bodies in certain dwelling-houses,--such could
only be enforced by an extensive organisation of sanitary police, which
you would have to call into existence for the purpose, and which, in the
present state of public opinion, would encounter insurmountable
difficulties on every occasion of its authoritative interference.

It is by indirect means and inducements alone, that I can hope at
present to effect the desired alteration; and by them, I think,
something can be ensured toward shortening the delays of interment.

First, I believe that everything which cheapens the cost of burial, will
conduce to such a result; for, among the poor, one considerable cause of
procrastination must often be the immediate absence of money. The plan
of conveyance and payment which I have suggested, would at least ensure
you against any increase of this difficulty, and might readily be
applied to diminish it. For, under such a system of single payment for
grave and conveyance, it would be practicable, and, I think, most
advantageous, to fix two prices, with a difference of at least five
shillings between them; to charge the lower fee whenever the funeral
should occur within eighty hours of death, the higher whenever this
period should be exceeded. If, by the general adoption of the former
alternative, the Cemetery receipts should be diminished in respect of
artisan funerals, even to the utmost extent--say five or six hundred
pounds per annum--this money, or much more, would have been
advantageously expended in purchasing so great a reform. If, on the
contrary, the immediate option of the working classes should be in
favour of continuing a system so injurious to themselves and to their
neighbours, there would be no injustice in leaving them the incumbrance
of a cost, from which it would require only their own will to escape.
The difference of price would soon be recognised as a municipal tax on
delays of interment;--a tax, rendered legitimate by the public evil
which it is designed to correct, and guarded against remonstrance,
because any man may avoid it who will. And since the delays in question
often arise in a passive habit of the people, founded on no deliberate
intention or reason, I cannot but believe that a well-marked difference
of fee would, as it were, startle the poor into considering the
question, which would come to be of daily argument in their houses:--‘Is
it worth while that our funeral cost should be increased by the amount
of one or two days wages, in order that we may retain within our
dwelling-rooms four days longer, that which every one tells us is
hurtful to ourselves and to others?’

It has been suggested to me, that many delays occur owing to Sunday
being considered specially as a funeral day among the labouring classes;
that an equal distribution of burials over the week would be preferable
to this waiting for a particular day; and that the closure of your
Cemetery on Sundays might accordingly be beneficial for the purposes
under consideration. Many arguments will doubtless occur to you, both
for and against the desirability of Sunday interments; but this probably
may be regarded as a point of detail, more fitly to be considered when
your scheme is complete, or even when it has actually given you some
experience of its operation.

As regards the second point adverted to--the establishment of special
reception-houses for the dead, I do not hesitate to say that, if they
could be brought into general use, their institution would confer great
advantages on the poor. But against this event, at least as an immediate
one, I grieve to see strong probabilities.

A first proposal made to some mourning household, that they should trust
to strangers’ hands the custody of their unburied dead, would in most
instances greatly and suddenly clash with their customs, and prejudices,
and affections. Whatever success you might have in conquering this
difficulty would of necessity be slow: and my practical familiarity with
the poorer classes makes me so little hopeful of their immediate
acquiescence in the plan, that I should hardly feel justified in urging
you to incur any very large expense, or to embarrass yourselves at
starting with any elaborate machinery, for the sake of so scanty an
expectation.

The reception-houses of Germany, as you probably know, are founded with
a double intention; partly for the purpose which I am here chiefly
considering--that the dead may be removed from an injurious contiguity
to the living; partly also, that the bodies may be vigilantly observed,
in case of suspended animation. With the latter view, many of them are
specially furnished and specially officered. In that at Frankfort, for
instance, each body is placed in a separate, warmed and ventilated cell;
cords are attached to the fingers in such manner that the slightest
movement occasions the ringing of an alarum; night and day watch is kept
in a central apartment which looks into each cell, and has the several
alarum-bells hung round it; adjacent is a room designed for acts of
resuscitation, with bath, galvanic apparatus and the like, always in
readiness for instant use; and, so long as any corpse lies within the
reception-house, the medical superintendent of the establishment never
goes beyond its walls. Dr. Sutherland, whose report to the General Board
of Health is full of interesting information on the burial-institutions
of the Continent, praises the completeness and ingenuity of these
contrivances; adding, however, that ‘after careful inquiry at all the
cities where he found them to exist, he could not learn that any case of
resuscitation had as yet occurred.’ I may add, too, as regards my own
personal experience in this country, that, with extensive opportunities,
it has never happened to me, either to see any case of suspended
animation where doubts of death and question of interment could arise,
nor to hear in professional circles of any such occurrence, I therefore
think it quite unnecessary to recommend any arrangement of
reception-houses, with reference to the resuscitation of persons
apparently dead.

The object for which I would desire their institution, is exclusively
that of receiving dead bodies out of the houses of the poor, in order to
mitigate those evils which arise in prolonged retention of the corpse.
That this object is in itself very desirable, and that under the
prevalence of epidemic disease its accomplishment might be of urgent
necessity, you will not doubt: and the responsibility for fulfilling
it--or at least for giving all facilities to its fulfilment, is so
distinctly imposed on you by the letter and spirit of the law, that you
will probably wish to take measures accordingly.

The extent, then, to which my information on the subject would lead me
to recommend provision to be made, is this: I would advise that
accommodation of an appropriate character (savouring in style rather of
an ecclesiastical construction, than of the workhouse or
dissecting-room) be arranged for the reception of fifty coffins. Tor
this purpose I would suggest--not the building of several separate
reception-houses within the City of London, in order to their being
respectively adjacent to the portions of population which might use
them,--but rather the establishment of one only, and that on the site of
your Cemetery. Thus the conveyance of bodies which would take place
under your auspices, might be made with greater economy, since it could
work into the plan I have already suggested. The advantage of having
only a single edifice (especially since its use is likely to be limited)
and of including its superintendence in the general organisation of
your Cemetery, cannot be questioned. And it seems to me, likewise, that
a building designed for the reception of many dead bodies, cannot
conveniently be established in the heart of the City.

I would of course recommend that the use of this building should be
entirely optional with the poor, and that its advantages should be
allowed gratuitously to persons burying in your ground: so that any one
who, in respect of his cemetery-fee, would be entitled to have a corpse
conveyed thither for funeral purposes, might claim this conveyance as
soon as he chose after the occurrence of death, and might have the
coffin kept with all proper formalities in the reception-house, till the
moment fixed for its interment.

On further particulars connected with this part of your arrangements, I
do not think it requisite at present to dwell; especially because, while
I regard the establishment of a reception-house to be quite
indispensable to the complete fulfilment of your new responsibilities, I
still look upon it as an institution to be gradually developed in the
course of years, and according to circumstances yet undetermined, rather
than as something which ought at once to assume its permanent character
and proportions.

       *       *       *       *       *

Here, too, in concluding this introductory report, I may observe that I
have endeavoured as far as possible to avoid encumbering it with detail.
For myself, in its construction, I have thought it indispensable to
pursue the subject into minuter ramifications, to consider a vast number
of circumstances here scarcely mentioned, to make myself acquainted with
the burial customs of other countries, to review a great variety of
opinions and arguments which have been advanced on the several matters
alluded to, and to consult with persons practically versed in them. But
to have brought all this material before you, would have prolonged my
report to an inconvenient extent with no proportionate utility.

Further, as regards these details of the subject, there are many parts
on which I cannot address you with the confidence that belongs to
personal knowledge. The general principles which I have set before you,
do indeed lie within range of my official and professional observation.
But the next stage of your inquiry relates to matters of special pursuit
with which I am only indirectly conversant: and whatever information I
may have compiled for myself from other sources, you will probably best
obtain at first hand. Practical experience in the construction and
working of Cemeteries has now for many years been the growing knowledge
of persons connected with their administration by ties of business, or
by official appointment. In many instances it has been dearly purchased,
and notorious failures have arisen from its absence. Regard being had to
the magnitude of your undertaking--hitherto unprecedented in the
country, and to the immense interests involved in your success, I cannot
but earnestly hope that such experience may be made available for your
information.

At an early period you will have to determine what appointments will be
requisite, with a view to the architectural and other designs of your
cemetery, to its economical planning and decorations, to the
superintendence of its daily working, to its financial management, to
the conveyance of bodies, and to all intramural organisation connected
therewith. Minute details will be best considered when these
appointments are made, and when you will naturally have the benefit of
such practical experience as may best assist your deliberations.

For the task on which you are engaged extends, I need hardly say, far
beyond the purchase of certain acres for your burial-ground. It implies
for its completion, that you shall possess an adequate plan on which the
interment of your population may be managed during many succeeding
generations; a plan constructed, first of all, with entire regard to the
general good of the public, and next, with as little violence as may be
to those habits, prejudices, and interests, which are involved in the
present system of interment.

The construction of such a plan constitutes a very large question of
municipal policy;--one which, because of its solemn subject, and because
of the degree in which human feelings and affections are involved in it,
requires to be handled with peculiar discretion and delicacy; but which
not the less requires to be contemplated in a large and comprehensive
manner.

I have therefore thought I should best fulfil the object of your
reference, by bringing before you those general principles which lie at
the root of all minute considerations: in order that, having first
determined on them, and having taken one collective view of the subject,
you may better know at what time, and in what order, and to what extent,
you would wish the minor details to be developed for your information.

  I have the honour,

  &c. &c.


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  Transcriber’s Notes


  Inconsistencies in spelling, lay-out, hyphenation, etc. (including the
  use of · and . as decimal points), and unusual spelling have been
  retained, except as mentioned below.

  In some places, the numbering of paragraphs (Roman or Arabic numbers)
  is incomplete: some numbers are missing. This has been retained.

  References to the tables are not always correct: for this collection,
  the author has combined some of the tables originally contained in the
  individual reports in the Appendices.

  Depending on the hard- and software used and their settings, not all
  elements may display as intended.

  Page 87/88 ff. and footnote [35]: the author appears to refer
  variously to the summary table in Appendix No. IX. (cf. the years
  covered) and to the detailed table on page 167 (cf. the column
  numbers).

  Page 184, pur-ventilation: as printed in the original work.


  =Changes made:=

  Some missing punctuation has been added silently; some obvious
  typographical errors have been corrected silently.

  Some of the larger tables have been split or otherwise rearranged.

  Footnotes have been moved to under the paragraph or table where they
  are referenced.

  Page 5, Table of Contents: Entry “Appendix of Tables ...” inserted.

  Page 22: of about five tf ings per week changed to of about five
  shillings per week.

  Page 65: ’ added after ... Court may establish.

  Page 140: ... in steam-vessels.” changed to ... in steam-vessels.’

  Page 167: some ellipses added where they were lacking; sub-total 483
  added (last column, bottom row).

  Page 207: pyœmia changed to pyæmia.

  Page 270, second column Saint Botolph, row Sum of the four quarters:
  22 changed to 224; last column, row quarter II, totals: 42 changed to
  24.

  Page 271, last column West London Union Workhouse, row quarter III: 9
  changed to 8.

  Page 277, bottom row, column West London Union Workhouse: 123 changed
  to 183.