[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.
[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 highlevel, 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 tothe 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, tolive 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 41⁄2times 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 improvementsto 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.
[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 theyare 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-mortalityper10,000 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, streetswere 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 otherdiseases, 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 itsspecific causationshould 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 inspecific 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 ofthese 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 characteristicchemical 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 theLancet, and subsequently reprinted.—J. S., 1854.
[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 theLancet, 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 continuouscarrying 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 matterof 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 importantissues 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 oforganic 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 itselfan 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 matterpergallon, and totally unfit for consumption.
[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 matterpergallon, 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—occupiedby 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 atime, 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 constructedtabular formsfor 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.
[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 toclaim 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 housesper 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 ofseeing 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: thelocal 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.
[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.
[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 movemore 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: butthus the fact stands—that there are few persons who do not at intervals require the re-establishing effects of what is calledtonictreatment. 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]