FOURTH ANNUAL REPORT.

[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 itindispensable 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 withrespect 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 theamendment 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 indeedrequired, 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 appointedInspectors 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. Seelast 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, yourHon. 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 entireparish, 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 districtwhich 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 thatproperty, no less thanlife, 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 innumerableshafts 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 themoment 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 suchfetters 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„„____________________Ac-countofRoomssepa-rate-ly.No.ondoor.Situation.Height.Length.Breadth.Windows.Flooring.Fire-place.Ventilators.Rent.Number ofInmates.Floor, Aspect.ft.in.ft.in.ft.in.Weekly, ornightly, orper person.Under9 yearsof age.Over9 yearsof age.123456, &c.Staircase, if with windows or skylight _________________________Sinks _________________________________________________________Privies-Number _________________________________________Dustbin _______________________________________________________Situation ________________________________________Water-supply-Receptacles-Material _____________________Yard—size of uncovered area _____________________________________Capacity _____________________Pavement _____________________________________________________Situation _____________________Taps, where situated _________________________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.

House situate at No. _____________________________________Name and Address of Owner ______________________________

Number of Floors (including Cellars and Lofts) ____________________„Rooms„„____________________

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.

Form

September 28th, 1852.

Gentlemen,

Ibegleave 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 isNo. VI.in theAppendix. The others are embodied in the different quinquennial tables of the Appendix.

In thefirst tableI 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 isarranged 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 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 isarranged 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.

November 29th, 1853.

Gentlemen,

Accordingto the practice of previous years, I lay before you, in the annexedtables, 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 beforeme, 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—hasbeen dying during these five years at the rate of about 24perthousandper 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 60per 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 14perthousandper 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 17perthousandper 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.:—

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 andexplained. 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 ofthis 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 fourper 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 beaccomplished, 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 preventabledeaths; 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 explosiveactivity, 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 canspeak 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 myReport 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 41⁄2times 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 fœtorand 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.

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