THE EPIDEMIC OF 1853, IN LONDON.
It will be observed that Lambeth, which is supplied with water in a great measure by the Lambeth Company, occupies a lower position in the above table than it did in the previous table showing the mortality in 1849. Rotherhithe also has been removed from the first to the fifth place; owing, no doubt, to the portion of the district supplied with water from the Kent Water Works, instead of the ditches, being altogether free from the disease, as was noticed above.
As the Registrar-General published a list of all the deaths from cholera which occurred in London in 1853, from the commencement of the epidemic in August to its conclusion in January 1854, I have been able to add up the number which occurred in the various sub-districts on the south side of the Thames, to which the water supply of the Southwark and Vauxhall, and the Lambeth Companies, extends. I have presented them in the table opposite, arranged in three groups.
TABLE VI.
TABLE VI.
TABLE VI.
Besides the general result shown in the table, there are some particular facts well worthy of consideration. In 1849, when the water of the Lambeth Company was quite as impure as that of the Southwark and Vauxhall Company, the parish of Christchurch suffered a rather higher rate of mortality from cholera than the adjoining parish of St. Saviour; but in 1853, whilst the mortality in St. Saviour’s was at the rate of two hundred and twenty-seven to one hundred thousand living, that of Christchurch was only at the rate of forty-three. Now St. Saviour’s is supplied with water entirely by the Southwark and Vauxhall Company, and Christchurch is chiefly supplied by the Lambeth Company. The pipes and other property of the Lambeth Company, in the parish of Christchurch, are rated at about £316, whilst the property of the Southwark and Vauxhall Company in this parish is only rated at about £108. Waterloo Road, 1st part, suffered almost as much as St. Saviour’s in 1849, and had but a single death in 1853; it is supplied almost exclusively by the Lambeth Company. The sub-districts of Kent Road and Borough Road, which suffered severely from cholera, are supplied, through a great part of their extent, exclusively by the Southwark and Vauxhall Company; the supply of the Lambeth Company being intermingled with that of the other only in a part of these districts, as may be seen by consulting the accompanying map (No. 2). The rural districts of Wandsworth and Peckham contain a number of pump-wells, and are only partially supplied by the Water Company; on this account they suffered a lower mortality than the other sub-districts supplied with the water from Battersea Fields. In the three sub-districts to which this water does not extend, there was no death from cholera in 1853.
MAP 2.
MAP 2.
MAP 2.
THE NEW WATER SUPPLY OF THE LAMBETH COMPANY.
Although the facts shown in the above table afford very strong evidence of the powerful influence which the drinking of water containing the sewage of a town exerts over the spread of cholera, when that disease is present, yet the question does not end here; for the intermixing of the water supply of the Southwark and Vauxhall Company with that of the Lambeth Company, over an extensive part of London, admitted of the subject being sifted in such a way as to yield the most incontrovertible proof on one side or the other. In the sub-districts enumerated in the above table as being supplied by both Companies, the mixing of the supply is of the most intimate kind. The pipes of each Company go down all the streets, and into nearly all the courts and alleys. A few houses are supplied by one Company and a few by the other, according to the decision of the owner or occupier at that time when the Water Companies were in active competition. In many cases a single house has a supply different from that on either side. Each Company supplies both rich and poor, both large houses and small; there is no difference either in the condition or occupation of the persons receiving the water of the different Companies. Now it must be evident that, if the diminution of cholera, in the districts partly supplied with the improved water, depended on this supply, the houses receiving it would be the houses enjoying the whole benefit of the diminution of the malady, whilst the houses supplied with the water from Battersea Fields would suffer the same mortality as they would if the improved supply did not exist at all. As there is no difference whatever, either in the houses or the people receiving the supply of the two Water Companies, or in any of the physical conditions with which they are surrounded, it is obvious that no experiment could have been devised which would more thoroughly test the effect of water supply on the progress of cholera than this, which circumstances placed ready made before the observer.
The experiment, too, was on the grandest scale. No fewer than three hundred thousand people of both sexes, of every age and occupation, and of every rank and station, from gentlefolks down to the very poor, were divided into two groups without their choice, and, in most cases, without their knowledge; one group being supplied with water containing the sewage of London, and, amongst it, whatever might have come from the cholera patients, the other group having water quite free from such impurity.
EPIDEMIC OF 1854, IN THE SOUTH DISTRICTS OF LONDON.
To turn this grand experiment to account, all that was required was to learn the supply of water to each individual house where a fatal attack of cholera might occur. I regret that, in the short days at the latter part of lastyear, I could not spare the time to make the inquiry; and, indeed, I was not fully aware, at that time, of the very intimate mixture of the supply of the two Water Companies, and the consequently important nature of the desired inquiry.
When the cholera returned to London in July of the present year, however, I resolved to spare no exertion which might be necessary to ascertain the exact effect of the water supply on the progress of the epidemic, in the places where all the circumstances were so happily adapted for the inquiry. I was desirous of making the investigation myself, in order that I might have the most satisfactory proof of the truth or fallacy of the doctrine which I had been advocating for five years. I had no reason to doubt the correctness of the conclusions I had drawn from the great number of facts already in my possession, but I felt that the circumstance of the cholera poison passing down the sewers into a great river, and being distributed through miles of pipes, and yet producing its specific effects, was a fact of so startling a nature, and of so vast importance to the community, that it could not be too rigidly examined, or established on too firm a basis.
I accordingly asked permission at the General Register Office to be supplied with the addresses of persons dying of cholera, in those districts where the supply of the two Companies is intermingled in the manner I have stated above. Some of these addresses were published in the “Weekly Returns,” and I was kindly permitted to take a copy of others. I commenced my inquiry about the middle of August with two sub-districts of Lambeth, called Kennington, first part, and Kennington, second part. There were forty-four deaths in these sub-districts down to 12th August, and I found that thirty-eight of the houses in which these deaths occurred were supplied withwater by the Southwark and Vauxhall Company, four houses were supplied by the Lambeth Company, and two had pump-wells on the premises and no supply from either of the Companies.
As soon as I had ascertained these particulars I communicated them to Dr. Farr, who was much struck with the result, and at his suggestion the Registrars of all the south districts of London were requested to make a return of the water supply of the house in which the attack took place, in all cases of death from cholera. This order was to take place after the 26th August, and I resolved to carry my inquiry down to that date, so that the facts might be ascertained for the whole course of the epidemic. I pursued my inquiry over the various other sub-districts of Lambeth, Southwark, and Newington, where the supply of the two Water Companies is intermixed, with a result very similar to that already given, as will be seen further on. In cases where persons had been removed to a workhouse or any other place, after the attack of cholera had commenced, I inquired the water supply of the house where the individuals were living when the attack took place.
The inquiry was necessarily attended with a good deal of trouble. There were very few instances in which I could at once get the information I required. Even when the water-rates are paid by the residents, they can seldom remember the name of the Water Company till they have looked for the receipt. In the case of working people who pay weekly rents, the rates are invariably paid by the landlord or his agent, who often lives at a distance, and the residents know nothing about the matter. It would, indeed, have been almost impossible for me to complete the inquiry, if I had not found that I could distinguish the water of the two companies with perfectcertainty by a chemical test. The test I employed was founded on the great difference in the quantity of chloride of sodium contained in the two kinds of water, at the time I made the inquiry. On adding solution of nitrate of silver to a gallon of the water of the Lambeth Company, obtained at Thames Ditton, beyond the reach of the sewage of London, only 2·28 grains of chloride of silver were obtained, indicating the presence of ·95 grains of chloride of sodium in the water. On treating the water of the Southwark and Vauxhall Company in the same manner, 91 grains of chloride of silver were obtained, showing the presence of 37·9 grains of common salt per gallon. Indeed, the difference in appearance on adding nitrate of silver to the two kinds of water was so great, that they could be at once distinguished without any further trouble. Therefore when the resident could not give clear and conclusive evidence about the Water Company, I obtained some of the water in a small phial, and wrote the address on the cover, when I could examine it after coming home. The mere appearance of the water generally afforded a very good indication of its source, especially if it was observed as it came in, before it had entered the water-butt or cistern; and the time of its coming in also afforded some evidence of the kind of water, after I had ascertained the hours when the turncocks of both Companies visited any street. These points were, however, not relied on, except as corroborating more decisive proof, such as the chemical test, or the Company’s receipt for the rates.
A return had been made to Parliament of the entire number of houses supplied with water by each of the Water Companies, but as the number of houses which they supplied in particular districts was not stated, I found that it would be necessary to carry my inquiry intoall the districts to which the supply of either Company extends, in order to show the full bearing of the facts brought out in those districts where the supply is intermingled. I inquired myself respecting every death from cholera in the districts to which the supply of the Lambeth Company extends, and I was fortunate enough to obtain the assistance of a medical man, Mr. John Joseph Whiting, L.A.C., to make inquiry in Bermondsey, Rotherhithe, Wandsworth, and certain other districts, which are supplied only by the Southwark and Vauxhall Company. Mr. Whiting took great pains with his part of the inquiry, which was to ascertain whether the houses in which the fatal attacks took place were supplied with the Company’s water, or from a pump-well, or some other source.
Mr. Whiting’s part of the investigation extended over the first four weeks of the epidemic, from 8th July to 5th August; and as inquiry was made respecting every death from cholera during this part of the epidemic, in all the districts to which the supply of either of the Water Companies extends, it may be well to consider this period first. There were three hundred and thirty-four deaths from cholera in these four weeks, in the districts to which the water supply of the Southwark and Vauxhall and the Lambeth Company extends. Of these it was ascertained, that in two hundred and eighty-six cases the house where the fatal attack of cholera took place was supplied with water by the Southwark and Vauxhall Company, and in only fourteen cases was the house supplied with the Lambeth Company’s water; in twenty-two cases the water was obtained by dipping a pail directly into the Thames, in four instances it was obtained from pump-wells, in four instances from ditches, and in four cases the source of supply was not ascertained, owing to the person beingtaken ill whilst travelling, or from some similar cause. The particulars of all the deaths which were caused by cholera in the first four weeks of the late epidemic, were published by the Registrar-General in the “Weekly Returns of Births and Deaths in London,” and I have had the three hundred and thirty-four above enumerated reprinted in an appendix to this edition, as a guarantee that the water supply was inquired into, and to afford any person who wishes it an opportunity of verifying the result. Any one who should make the inquiry must be careful to find the house where the attack took place, for in many streets there are several houses having the same number.
According to a return which was made to Parliament, the Southwark and Vauxhall Company supplied 40,046 houses from January 1st to December 31st, 1853, and the Lambeth Company supplied 26,107 houses during the same period; consequently, as 286 fatal attacks of cholera took place, in the first four weeks of the epidemic, in houses supplied by the former Company, and only 14 in houses supplied by the latter, the proportion of fatal attacks to each 10,000 houses was as follows. Southwark and Vauxhall 71. Lambeth 5. The cholera was therefore fourteen times as fatal at this period, amongst persons having the impure water of the Southwark and Vauxhall Company, as amongst those having the purer water from Thames Ditton.
It is extremely worthy of remark, that whilst only five hundred and sixty-three deaths from cholera occurred in the whole of the metropolis, in the four weeks ending 5th August, more than one half of them took place amongst the customers of the Southwark and Vauxhall Company, and a great portion of the remaining deaths were those of mariners and persons employed amongst the shipping inthe Thames, who almost invariably draw their drinking water direct from the river.
It may, indeed, be confidently asserted, that if the Southwark and Vauxhall Water Company had been able to use the same expedition as the Lambeth Company in completing their new works, and obtaining water free from the contents of sewers, the late epidemic of cholera would have been confined in a great measure to persons employed among the shipping, and to poor people who get water by pailsful direct from the Thames or tidal ditches.
The number of houses in London at the time of the last census was 327,391. If the houses supplied with water by the Southwark and Vauxhall Company, and the deaths from cholera occurring in these houses, be deducted, we shall have in the remainder of London 287,345 houses, in which 277 deaths from cholera took place in the first four weeks of the epidemic. This is at the rate of nine deaths to each 10,000. But the houses supplied with water by the Lambeth Company only suffered a mortality of five in each 10,000 at this period; it follows, therefore, that these houses, although intimately mixed with those of the Southwark and Vauxhall Company, in which so great a proportional mortality occurred, did not suffer even so much as the rest of London which was not so situated.
In the beginning of the late epidemic of cholera in London, the Thames water seems to have been the great means of its diffusion, either through the pipes of the Southwark and Vauxhall Company, or more directly by dipping a pail in the river. Cholera was prevailing in the Baltic Fleet in the early part of summer, and the following passage from the “Weekly Returns” of the Registrar-General shows that the disease was probably imported thence to the Thames.
“Bermondsey, St. James. At 10, Marine Street, on 25th July, a mate mariner, aged 34 years, Asiatic cholera 101 hours, after premonitory diarrhœa 16¹⁄₂ hours. The medical attendant states: ‘This patient was the chief mate to a steam-vessel taking stores to and bringing home invalids from the Baltic Fleet. Three weeks ago he brought home in his cabin the soiled linen of an officer who had been ill. The linen was washed and returned.’”
The time when this steam-vessel arrived in the Thames with the soiled linen on board, was a few days before the first cases of cholera appeared in London, and these first cases were chiefly amongst persons connected with the shipping in the river. It is not improbable therefore that a few simple precautions, with respect to the communications with the Baltic Fleet, might have saved London from the cholera this year, or at all events greatly retarded its appearance.
As the epidemic advanced, the disproportion between the number of cases in houses supplied by the Southwark and Vauxhall Company and those supplied by the Lambeth Company, became not quite so great, although it continued very striking. In the beginning of the epidemic the cases appear to have been almost altogether produced through the agency of the Thames water obtained amongst the sewers; and the small number of cases occurring in houses not so supplied, might be accounted for by the fact of persons not keeping always at home and taking all their meals in the houses in which they live; but as the epidemic advanced it would necessarily spread amongst the customers of the Lambeth Company, as in parts of London where the water was not in fault, by all the usual means of its communication. The two subjoined tables,VIIandVIII, show the number of fatal attacks in houses supplied respectively by the two Companies, in allthe sub-districts to which their water extends. The cases in tableVII, are again included in the larger number which appear in the next table. The sub-districts are arranged in three groups, as they were in tableVI, illustrating the epidemic of 1853.
In tableVIII, showing the mortality in the first seven weeks of the epidemic, the water supply is the result of my own personal inquiry, in every case, in all the sub-districts to which the supply of the Lambeth Company extends; but in some of the sub-districts supplied only by the Southwark and Vauxhall Company, the inquiry of Mr. Whiting having extended only to 5th August, the water supply of the last three weeks is calculated to have been in the same proportion by the Company, or by pump wells, etc., as in the first four weeks,—a calculation which is perfectly fair, and must be very near the truth. The sub-districts in which the supply is partly founded on computation, are marked with an asterisk.
The numbers in tableVIIIdiffer a very little from those of the table I communicated to theMedical Times and Gazetteof 7th October, on account of the water supply having since been ascertained in some cases in which I did not then know it. The small number of instances in which the water supply remains unascertained are chiefly those of persons taken into a workhouse without their address being known.
TABLE VII.The mortality from Cholera in the four weeks ending 5th August.
TABLE VII.The mortality from Cholera in the four weeks ending 5th August.
TABLE VII.
The mortality from Cholera in the four weeks ending 5th August.
TABLE VIII.Mortality from Cholera in the seven weeks ending 26th August.
TABLE VIII.Mortality from Cholera in the seven weeks ending 26th August.
TABLE VIII.
Mortality from Cholera in the seven weeks ending 26th August.
The following is the proportion of deaths to 10,000 houses, during the first seven weeks of the epidemic, in the population supplied by the Southwark and Vauxhall Company, in that supplied by the Lambeth Company, and in the rest of London.