The Medical Officer of Health for Fulham described in 1872-3 how in

"Fulham New Town" the basements of the houses had been built below any

available sewerage, with the result of constant floodings of cesspool

matter to the great danger of the public health.

And the materials of which the superstructure was made were as bad as

they well could be. Porous, and half baked, and broken bricks being

used, and mortar mixed with garden mould or road scrapings--"some

without a particle of lime in it."

In Battersea Fields--

"You will find them there putting the houses together in such a way

that you may kick the walls down with your feet."[118]

The Medical Officer of Health for Whitechapel put the subject very

tersely when he wrote in 1880:--

"In the construction of houses the only thing that appears to be

considered is that of cheapness."

Until near the end of this decade of 1871-1881, a building could be

constructed without any supervision of the materials, and any number

of structures which could not be occupied without danger to life or

health might be put up, for no one had power to interfere. The London

Building Act had no adequate clauses to secure the effectual purity of

new dwellings, nor had the Sanitary Authority any power to check the

practice of building houses on rotten filth.

And so all these evil practices were very widely indulged in; for

though there were many respectable men among builders of small houses,

there were many who, regardless of all consequences, covered the

suburbs with "small, rotten houses." And immense numbers of the people

were absolutely unprotected either by the Government or by the local

authority from abuses which entailed upon them ill-health and death,

and from practices which created and spread disease throughout the

community.

The Medical Officer of Health for St. George-the-Martyr, Southwark,

referring to "the dishonest and scandalous way" in which some houses

were built, said (1877-8):--

"From the greed of a few builders this traffic in human life, and in

what makes life valuable, is openly and defiantly carried on. Under

such circumstances full health is impossible. Yet for the success

and permanence of natural existence a high standard is absolutely

necessary."

Of builders such as these it may be truly said that having created a

_damnosa hereditas_ in one place, they moved on to create fresh ones in

others, and no one prevented them.

So glaring were these evils that a Select Committee, which sat in

1874 on the Metropolitan Buildings and Management Bill of that year,

recommended--

"That the District Surveyor or the Metropolitan Board shall have full

power to stop the progress of any building in which the materials or

construction is calculated to be dangerous or injurious to health, and

to summon the builder or owner before the magistrate."

At the rate houses were being built, the defective Building Laws were a

grave disaster.

In the two parishes of Bow and Bromley in Poplar, in the five years

ending March, 1878, notices were approved for 1,981 new buildings.

In Hackney, in the year 1876-7, notices were given of intention to

erect 800 new houses, and the extension of streets and houses into the

fields had gone on so rapidly that by that time there were but few

fields left in the district, or even large grounds belonging to any of

the houses.

In Kensington it was reported in 1875 that the increase in the number

of new houses brought into occupation had for a considerable period

averaged 700 annually.

In Wandsworth, in 1874-5, notices were received for 887 new houses.

In 1877-8 for 1,432 new houses.

" 1878-9 " 1,845 "

" 1880-1 " 3,073 "

And in every place land was being grabbed for building purposes.

The Medical Officer of Health for Whitechapel wrote in 1879:--

"We are now paying very dearly both in health and money for the errors

of preceding generations in their having allowed houses to be packed

closely together.... Several cases have recently occurred in this

district of landlords erecting dwelling-houses in the back-yards of

those houses which were formerly occupied by a single family. This is

a serious evil and ought to be prevented. We have power to prevent the

overcrowding of rooms, and we certainly ought to have power to prevent

the cramming together of houses on sites of insufficient size for the

healthy existence of the tenants."

Even burial-grounds were not sacred, nor were public authorities even

immaculate in this respect. Thus in St. Luke:--

"The Quakers' burial-ground by the side of Coleman Street is now

(1876) in progress towards being covered with buildings, and a portion

was taken by the London School Board for the erection of a school.

In the process of excavation for the foundation, human remains were

discovered."

And the areas at the backs of houses were also being rapidly covered

over. The Act of 1855 had provided that 100 superficial feet should be

left open--

"But the exigencies of trade have led the Metropolitan Board of Works

and the District Surveyors to permit the area on the ground storey to

be covered over."[119]

In fact, the insufficiency of the laws as regarded buildings intended

for human habitation, and the mal-administration or non-administration

of those laws which existed, resulted in the creation of evils which

inevitably and most injuriously affected the health of the public, not

merely at the time, but for many years to come.

The Medical Officer of Health for St. Giles', in 1871, pointed out the

necessity of a change of the law.

"It is very much to be desired that the law gave more stringent powers

to local authorities to prevent the re-erection of buildings upon the

old sites, so that the new buildings might not become as unfavourable

to health as the old ones.... Such a perpetuation of mischief ought not

to be permitted, and the rights of landlords should be subordinated to

the public good."

The condition of existing, as apart from new, houses also stood in need

of many changes of the law to effect their redemption. The necessity

was forcibly portrayed by the Medical Officer of Health for St.

Marylebone in 1870. He wrote:--

"Of all the obstacles that stand in the way of anything like effective

sanitary operations, not only in St. Marylebone, but in nearly every

other district of the metropolis, there are none so formidable, so

apparently irremediable as the miserable house accommodation provided

for the labouring classes. Year after year I am called upon to tell

the same unvarying story of rotten floors, broken walls and ceilings,

windows and roofs that let in the wind and the rain, chimneys that will

not let out the smoke, and of these wretched tenements being crowded

with honest, hard-working people, from the cellars to the attics."

Parliament continued in this decade the greater solicitude about

and interest in matters connected with the public health, which it

had recently been showing; and the first year of the decade, 1871,

is noteworthy for the adoption by Parliament of a measure which had

far-reaching effects upon the sanitary evolution of the metropolis.

This was the creation (by "The Local Government Board Act, 1871") of a

Central Government Authority for the supervision by Government of the

sanitary authorities in England and Wales, and also of those in London.

Matters relating to the health of the people had become so large a

portion of the work of government, that the necessity had forced itself

upon Parliament of concentrating in one department of the Government

the supervision of the laws relating to the public health, the relief

of the poor, and local government.

The new authority, which was entitled the Local Government Board, was

not a representative body, but was a Government Department. It was to

consist of a President, appointed by the Queen, and of the following

"ex-officio" members--the Lord President of the Privy Council, all the

Secretaries of State for the time being, the Lord Privy Seal, and the

Chancellor of the Exchequer.

All the powers of the Poor Law Board were transferred to it, also

certain powers and duties vested in Her Majesty's Privy Council.

Several of the powers vested in or imposed on a Secretary of State,

relative to health matters, were also transferred to it. Henceforth

no bye-laws made by the sanitary authorities in connection with their

duties were to be of any force until approved by the new Board.

Also the Board was to possess, in reserve for great epidemic

emergencies, a power to issue directions under the Diseases Prevention

Act, 1855.

But with the exception of such special cases, the function of the new

Central Authority in regard of local sanitary action was primarily one

of observation and inquiry.

The various Vestries and District Boards of the Metropolis being

sanitary authorities thus came under the supervision, and in some

respects under the control, of the new Central Government Board,

instead of, as previously, under a branch of the office of the

Secretary of State for the Home Department; but to all intents and

purposes they retained their liberty of administration, or, to state it

more accurately, their liberty of non-administration. Their relations

to the elected central body, the Metropolitan Board of Works, remained

unchanged.

In 1871, also, Parliament dealt with the water supply of London. The

essential importance to the health of the population, especially in

large towns, of an adequate supply of wholesome water was becoming more

generally recognised.

"Without water life cannot be sustained, cleanliness cannot be

maintained, sanitary measures are at a standstill, drains become

blocked, offensive and deleterious gases are retained or driven back

into the dwellings, disease is caused and fostered, and public as well

as private injury caused in all directions."

The Act of 1852 had failed to secure for the inhabitants the advantage

which they ought to have long since enjoyed, of a well-regulated supply

of water in their houses for domestic purposes.

A Select Committee of the House of Commons recommended that every

company should afford a constant supply of water to each house,[120] so

that the water might be drawn direct and fresh from the company's pipes

at all times during the twenty-four hours, and free from the pollution

so often acquired in dirty receptacles. And a Royal Commission,

appointed in 1867, after an elaborate inquiry,[121] declared that

earnest and prompt efforts ought to be made to introduce the constant

service system to the furthest extent possible in the metropolis.

The Report of the Royal Commission is memorable for the very strong

expression of opinion that the water supply of the metropolis should be

consolidated under public control.

The duty of supplying the inhabitants of a city with water had from a

very early period been regarded as a peculiarly municipal function, and

the supersession of the municipalities by joint stock companies was a

comparatively modern innovation.

Thus far, however, Parliament was not disposed to go. But (by the

Metropolis Water Act, 1871) Parliament--contenting itself mostly with

"mights"--directed that any company might propose to give a constant

supply of water, or the Metropolitan Board of Works might apply to a

company for it; failing both of which, and under certain conditions,

the Board of Trade might require a constant supply to be provided. Also

every company should--

"On Sundays, as on other days, supply sufficient pure and wholesome

water for the domestic use of the inhabitants within their limits."

But the Act did not curtail the power of the companies to cut off the

supply to a house if the water-rate was not paid by the landlord or

owner. An opinion was expressed on this point by the Medical Officer of

Health for St. Mary, Newington, in 1872:--

"I maintain that water is absolutely necessary for the health,

cleanliness, and sanitary condition of every one, and that if a

monopoly of its supply is granted to any company, no power of

withholding it should be allowed.

"In the present and increasing crowded condition of our poorer houses

the act of one person may enable a water company to refuse it to a

household of ten or twelve people.... I do most strongly protest

against a continuation of a power which in its exercise undermines the

very foundation of sanitary improvement."

Little, however, was done either by the Metropolitan Board of Works,

the Board of Trade, or the companies to avail themselves of the

optional provisions of the Act.

"Perhaps," wrote the Medical Officer of Health for Wandsworth, "there

never was an Act of Parliament so completely ignored in many districts

as the one in question."

"The companies," wrote another Medical Officer of Health, "are too busy

in looking after their trade interests to concern themselves much about

the health of the people."

And the constant supply to the people of London was postponed to the

distant future.

In 1871 another subject also claimed the attention of Parliament.

An epidemic of smallpox of unexampled severity began at the end of

the year 1870, "the like of which had not been known in England since

vaccination was first practised." It increased in London at an alarming

rate until it reached its height in May, 1871, when 288 people died of

it in one week, and it killed in London alone, in that one year, 7,876

persons. And as it was reasonable to assume that one death represented

at the very least eight or ten times the number of cases of that most

loathsome disease, the results were frightful, and the injury inflicted

upon the community, present and future, disastrous.

At one time more than 2,000 smallpox patients were under the care of

the Metropolitan Asylums Board, and the admissions into the Board's

hospitals about the same time averaged 500 a week.

In a report on the subject the Committee of the House of Commons

wrote:--

"It is impossible to say what ravages might not have been the result

of the smallpox epidemic of 1870-1 had it not been for the efficiency

and energy of the Asylums Board. Although the prophylactic virtues of

vaccination have been recognised on all sides, it must be remembered

that as yet but a small part of the growing population has been

subjected to the operations of the Compulsory Vaccination Act."

And they expressed "their strong sense of the great services rendered

to the metropolis by the managers."

The prevention of smallpox by vaccination was not yet a very potent

factor in the diminution of that disease. Only slowly could the

Compulsory Vaccination Act of 1867 produce effect, and as the

appointment of public vaccinators and the establishment of vaccination

stations had been made only optional, the mortality of the outbreak in

1870-1 had been but little, if at all, modified by it. The epidemic,

however, was used by some to enforce a lesson.

Thus the Medical Officer of Health for St. James' wrote:--

"The lesson of the great epidemic of smallpox is the necessity for

vaccination.

"The history of no other disease supplies so assuredly and necessarily

the means of its entire destruction."

And the managers of the Metropolitan Asylums Board, in a report issued

in 1871, wrote:--

"The necessity for re-vaccination when the protective power of primary

vaccination has to a great extent passed away, cannot be too strongly

urged. No greater argument to prove the efficacy of this precaution

can be adduced than that out of upwards of 14,800 cases received into

the hospitals, only four well-authenticated cases were treated in

which re-vaccination had been properly performed, and these were light

attacks."

Parliament passed an Act in 1871, making the appointment of paid

Vaccination Officers compulsory on all Guardians, and the law generally

more effective.

Likewise in 1871 Parliament dealt with another matter affecting the

public health, and placed on record its opinion of the Vestries and

District Boards by relieving them of the duty of enforcing the sanitary

provisions of the Workshops Act, which they had failed to carry out,

and transferring it to Government Inspectors appointed by the Home

Secretary.

This was quite an unprecedented amount of sanitary legislation by

Parliament in one year, and is very notable as showing the greater

position health matters were assuming in the opinion of the nation, and

the greater necessity Parliament felt itself under for dealing with

them.

An improvement as regarded the food of the people of the metropolis was

also commenced about this time.

The Corporation of the City of London had undertaken to carry out

the provisions of Part III. of the Contagious Diseases Animals Act,

1869,[122] and had purchased the site of Deptford Dockyard for the

purpose of a cattle market, and for the reception and slaughter of

foreign cattle. The market was opened in 1871, and the system of

inspection there inaugurated secured the good quality of a great

portion of the meat consumed in London.

In the following year (1872) the purity of certain articles of the food

and drink of the people engaged the attention of Parliament.

Under the Act of 1860 the Vestries and District Boards might each

appoint an analyst, but the great majority of them availed themselves

of the permissive character of the Act, and did not appoint one.

A sidelight is thrown upon the effect of this inaction of the local

authorities by evidence given in 1862 by a master baker named W.

Purvis. He said:--

"When the Act passed for preventing the adulteration of articles of

food and drink there was an immediate apprehension among those bakers

in the trade who adulterate their bread that they would be liable to

have their bread frequently analysed, &c. But when it was found that

no sufficient means were provided by the Act to meet the expenses of

this kind of active and constant supervision (the purchaser having to

pay the analyst), they became confident again, and have resumed their

practice of adulteration without any fear of detection."[123]

It was felt now that some further move should be made, and Parliament

added another Act for preventing the adulteration of food, drink, and

drugs to the long list of those which had gone before.

"Whereas the practice of adulterating articles of food and drink

and drugs for sale in fraud of Her Majesty's subjects, and to the

great hurt of their health and danger to their lives, requires to be

repressed by more effectual laws than those which are now in force for

that purpose--

"Be it enacted----"[124]

This Act made it incumbent upon all Vestries and District Boards to

appoint public analysts to analyse all articles of food, drink, and

drugs, on the request of any parishioners, on payment of a fee; and

imposed the duty upon them of procuring and submitting for analysis

articles suspected to be adulterated, and on their being certified to

be so, of taking proceedings before a magistrate, who was given power

to impose severe penalties. The offences were more clearly defined, and

the expense of executing the Act was to be paid out of the rates.

The Act did much good, but the amount of good was not to be judged by

the number of prosecutions and convictions. "Its deterrent effects were

undoubtedly great."[125]

A Select Committee of the House of Commons, which had been appointed in

1872 to inquire into the subject, recommended the repeal of previous

Acts dealing with the subject, and the enactment of a new and more

compulsory measure, and in concluding their report they said: "Your

Committee believe it will afford some consolation to the public to

know that in the matter of adulteration they are cheated rather than

poisoned. Witnesses of the highest standing concur in stating that in

the numerous articles of food and drink which they have analysed, they

have found scarcely anything injurious to health."

In 1875 a further Act dealing with this matter was passed amending and

strengthening the existing law.

In September, 1872, another notable step in the sanitary evolution of

London was taken in the creation of an authority for the protection of

the metropolis against the importation of disease by sea from foreign

countries or from home ports.

"It is now acknowledged," wrote the Port Medical Officer of Health in

his first report, "that, as a natural result of the insular position

of the kingdom, and the vast extent of our commerce, the sanitary

condition of shipping and of the floating population must exercise a

considerable influence on the health of the country as regards the

importation and transmission of epidemic diseases ... the urgent

advisability of using all means to prevent the introduction of disease

into this the largest port in the world is sufficiently apparent."

Hitherto the prevention of the importation of the various sorts of

disease into London by vessels trading to the Port of London from

all quarters of the world had been confided to the officers of Her

Majesty's Customs, and was of the most superficial and inadequate

character.

The district assigned to the Port of London Sanitary Authority extended

from Teddington Lock to the North Foreland, and was 88 miles in length.

It included 8 sets of docks and 13 "creeks."

In the section of river lying between London Bridge and Woolwich

Arsenal Pier, about 10 miles in length, there was a constant average of

no less than 400 vessels of all descriptions moored on both sides of

the river, more than 90 per cent. of which had crews on board.

The creeks were more or less occupied by barges containing manure,

street-sweepings, gas-liquor, bones and other varieties of foul

cargoes, inasmuch as depôts for the storage of these materials existed

on the banks.

And lying in the docks there was an average of between six to seven

hundred vessels, over none of which had the sanitary authorities on the

sides of the river any control whatever.

This was a most unsatisfactory condition of things, and left London

open to the practically unchecked importation of infectious and

contagious disease of every kind.

By "Provisional Order" of the Local Government Board, the Corporation

of London was constituted the Sanitary Authority of the Port of

London,[126] and was made responsible not only for taking proper steps,

under Orders in Council, to prevent the introduction of cholera,

but was required also to carry out, within its allotted area, the

provisions of the various Nuisances Removal Acts and Prevention of

Diseases Acts for England, and the Sanitary Act of 1866.

Its authority extended only to things afloat. Whatever was landed came

within the province of the local Sanitary Authority, except things

landed in the docks, and things "in bond," which were under the control

of Her Majesty's Customs.

The work was undertaken at considerable expense by the Corporation out

of the City's cash, and at no charge to the ratepayer.

And a Medical Officer of Health for the Port and some Inspectors were

appointed.

It was the duty of the Port Medical Officer--

"To inspect, before landing, all emigrants that arrived in the Port

from the Continent for purposes of transhipment, and to isolate all

suspected cases, and to carry out all Special Orders in Council

relating to the prevention of cholera, or other epidemic diseases."

He was also charged with the duty of inspecting, at Gravesend, any

cases of sickness on inward-bound vessels reported to the authorities

by the officers of Her Majesty's Customs.

As to the prevention of the importation of epidemic diseases other

than cholera, reliance was placed upon a speedy and proper examination

of vessels as soon as possible after they had come to moorings. A large

proportion of these vessels required constant general inspection.

Among the various other duties, fumigation and disinfection of vessels,

also of clothing, were not the least important.

For isolation of the sick a hospital ship was maintained at Gravesend.

The work done by the Port Authority was, in spite of many limitations

and difficulties, considerable; and the inspection of thousands of

ships, the cleansing and fumigation of foul or infected vessels, the

removal to hospital of seamen suffering from infectious or contagious

disease, and the disinfection of clothing were, sanitarily, of the

greatest advantage to the inhabitants of the metropolis.

In another matter Parliament, in 1872, made a completely new departure.

It declared that "it was expedient to make better provision for the

protection of infants entrusted to persons to be nursed or maintained

for hire or reward in that behalf." And it inaugurated a plan for

the protection of the health of the most helpless of its numerous

charges--a plan embodied in the Infant Life Protection Act.

"Houses of persons retaining or receiving for hire two or more infants

for the purpose of nursing must be registered."

The Local Authority (the Metropolitan Board of Works) was to cause a

register to be kept and make bye-laws, and might refuse to register an

unsuitable house.

And the registered owner must keep a register of the children, &c., &c.

If proved to the satisfaction of the local authority that such person

has been guilty of serious neglect, or is incapable of providing the

infants with proper food and attention, the house might be struck off

the Register, and penalties be imposed--six months with hard labour,

and up to £5 fine.

The start made was slow, only six houses having been registered in

1876; but the Act laid the foundations of a scheme which has had

considerable developments.

Specially valuable is it to have the views of one of the foremost men

of his time upon the phase of opinion existing at this period upon the

general question of the public health. They help to mark progress along

the road. The late Mr. W. E. Forster, speaking at the meeting of the

British Association at Bradford in 1873, said:--

"I think our aims in this direction are higher than they used to be.

We are aiming not only at preventing death, but at making life better

worth living by making it healthy. And we no longer forget that in

fighting our battle against disease it is not only those who are killed

that are merely to be considered, but also the wounded. In those

terrible inflictions of preventable disease throughout the country

the loss of life is very sad; but even more sorrowful to my mind are

the numbers of our fellow-creatures--fellow-countrymen and women--who

are doomed to struggle and fight the battle of life under the most

severe conditions because of wounds they have received from preventable

diseases."

While Parliament was thus legislating on several matters considerably

influencing the sanitary well-being of the people of the metropolis,

the powerful economic and social forces also affecting it were silently

and uninterruptedly continuing their work with never-ceasing energy.

With the marvellous industrial developments of the time, trade, and

commerce, and businesses of various kinds and sorts were spreading over

a wider area, and constantly claiming accommodation to carry them on;

and the process continued of the conversion of residential houses into

offices and shops and warehouses and workplaces.

The increase of houses in other parts of London, rapid as it was,

barely kept pace with the increase of population, whilst it had

practically done nothing as yet to relieve overcrowding in the central

parts of London.

The excessive density of the population was a great sanitary evil.

"It is a well established law," wrote the Registrar General in 1872,

"that, other things being equal, the insalubrity of a place increases

with the density of the population, and that the fevers generated in

crowded dwellings have a tendency to spread among the whole of the

population."

And it was already pretty generally recognised by Medical Officers of

Health that the chief condition affecting the mortality of a locality

was the density of population.

The Medical Officers of Health never ceased pointing out the evils of

overcrowding.

"Overcrowding," wrote the Medical Officer of Health for Whitechapel

in 1877, "concerns the whole community, as is strikingly shown

by the spread of many diseases which are, perhaps, in the first

instance endemic, and confined to these overcrowded places, but

which soon become epidemic and extend over large areas, attacking,

indiscriminately, all classes."

And their reports are full of instances which had come under their

observation.

Thus, in 1871, the Medical Officer of Health for Whitechapel wrote:--

"At No. 13, Goulston Street, I found in the back room of the ground

floor, closely contiguous to three closets and a dust hole, one man,

six women, and three children sleeping there. The room measured

12 × 9 × 7 feet, giving only a cubic space of 756 feet for ten persons."

He mentioned also "a room in Cooper's Court, occupied by man, wife, and

seven children, which contained about 630 cubic feet of space, which

allows only 70 feet for each."

And numerous other cases of overcrowding and indecent occupation, and a

case in which the dead body of a child had been retained in a room for

fifteen days.

Passing on to the larger aspects of this dreadful overcrowding, he

wrote:--

"It is manifest that persons living in such circumstances must become

so enfeebled in health as to be unfit for any employment which requires

much physical strength. The mental capacity of such persons is also

so low as to prevent them earning a livelihood in any occupation

requiring much thought, and the consequence is an increase of paupers

or of criminals, or perhaps of both."

"Consumption and the whole tubercular class of disease are chiefly

caused by the defective ventilation of dwelling-houses, and

particularly of sleeping rooms, in which at least one-third of one's

existence is passed."

And the Medical Officer of Health for Paddington, in his report for

1871, wrote:--

"Serious evils of physical and moral character are found to afflict the

population of these overcrowded houses. The want of fresh air, habitual

uncleanliness, bad washing accommodation, with other unsanitary

conditions, favour the spread of contagion. There is a notable increase

of tubercular and consumptive maladies in our large cities, and the low

form of vitality engendered in people who do not enjoy fresh air, leads

to the abuse of stimulants and tobacco."

In 1874 he wrote:--

"... Eighteen per cent. of the whole deaths--a formidable

proportion--are from the tubercular class of diseases: a greater

proportion than zymotic. The 206 deaths from consumption at ages

between 20 and 60 show that there exists some general cause silently

working great mischief and undermining the constitution of parents at

a period of life in health and strength when they can least be spared

from their families."

And he added:--

"Large numbers of sickly and weakly children abound in the

tenement-houses of our thickly populated streets."

Nor were the homes of the people the only place where overcrowding

worked its evil will. Many children--how many there is no means of

knowing--suffered from it in the schools which they attended.

The following extracts from reports of an Inspector of the School

Board[127] present a vivid picture of the condition of many schools in

existence so late as the year 1874.

1. ---- _School_.

"This is a wretched place, a disgrace to the metropolis. The 'school'

is held in an old dwelling-house in Clerkenwell. The house was at one

time used as a stable. The approach is most unwelcome, and on entering

the schoolroom (upstairs) a most deplorable picture presented itself to

the eye. Fifty children crowded together in a small, dingy, shapeless

room with space for sixteen, and the window and door carefully

closed--in fact, the latter and the doors downstairs carefully bolted.

The sooner this place is closed the better."

2. ---- _School_.

"As regards the accommodation provided, thirty-six young children were

sitting in an upper room into which the rays of the sun on a bright day

in June could not enter--twilight in mid-day."

3. ---- _School_.

"It would be impossible for words to describe the inefficient state of

this so-called school. Eighty-two children of different ages--boys and

girls--huddled together in a miserable, badly lighted, badly ventilated

room, affording accommodation for twenty-three at the utmost.

"No books, no apparatus, no seats; floor and bare walls: the 'teacher'

an aged man, standing in the midst of a crowd of children and wielding

a cane to keep the 'scholars' quiet, and thus the time goes on."

4. ---- _School_.

"This is not a school--it seems a baby-farm. Seventeen children in a

small, filthy hovel. There were four infants a few months old; one lay

on a small bed, another in a small cot, and the two others in positions

which I cannot here describe. The little ones were quite naked. The

woman who pretends to look after this 'school' was engaged in a back

yard washing. From the woman down to the infant, all here seemed

steeped in ignorance and wretchedness."

Here is a case reported by the Medical Officer of Health for

Whitechapel, so late as 1880:--

"A schoolroom at 11, Pelham Street, Spitalfields; 9 feet long × 8 × 8.

There were twenty-five children aged 4-7, and the master and his wife,

in all twenty-seven persons, giving 21·3 cubic feet for each."

And here is a report of an early crêche, or baby farm, also in

Whitechapel, in 1879:--

"The Sanitary Inspector found on the ground floor of 24, Freeman

Street, Spitalfields, a woman and twenty-five children all under three.

They were left in charge of the occupier of the room from nine until

5.30 p.m., who was paid 3d. per week per child. The room was 15 feet ×

7 × 7, thus affording 28 cubic feet of space per child!! The room was

badly ventilated, there were neither chairs nor seats, the children

were on the floor, which was in a wet and dirty condition."

The other causes of insanitation were also flourishing. "Noxious

businesses" of various kinds continued to pollute the atmosphere,

despite legislation against them, and the existence of local

authorities charged with the administration of that legislation--a

permanent pollution all the year round, and from which there was no

getting away.

Very commonly the arches under the railways were used for making and

storing artificial manures, the smell from which was intolerable.

The Medical Officer of Health for St. Mary, Newington, 1871:--

"The private manure-mixing yards have ever been the cause of much

annoyance and illness to those living in the neighbourhood. One of

these," he added, "had for years been complained of."

And yet the Vestry had not shut it up. And the air was tainted and

vitiated by the emanations from them, the owners having no vestige of

regard for other people's health.

Another cause of insanitation was the existence of slaughter-houses

throughout London, in the most crowded parts, and in close propinquity

to dwelling-houses; indeed, in the yards of some of them were

slaughter-houses, with all their unpleasant concomitants. Cow-houses,

too, also close to houses, were numerous, and, in the outer parts of

London, even piggeries.

A great opportunity was lost in 1874 for greatly diminishing, if not

actually terminating, the great "nuisance" of slaughter-houses.

By an Act passed in 1844, it was declared absolutely illegal, on the

expiration of thirty years after the passing of the Act, to carry on

certain noxious businesses in any premises nearer a dwelling-house

than 50 feet, or nearer a public way than 40 feet--the business of

slaughtering being among the number. Until 1851 there was no control

over slaughter-houses; any one could conduct a slaughter-house who

pleased, subject only to the common law as to doing anything which

might be considered a nuisance.[128]

The Metropolitan Market Act, passed in that year, required that all

slaughter-houses should be licensed by the justices, thus establishing

some form of control over them.

When, in 1874, the expiration of the thirty years drew nigh, doubts

were raised by those interested in their continuance as to the

interpretation of the Act of 1844. The Select Committee, which was

investigating the subject of "Noxious Businesses," stated that no

evidence had been given before it to show that any of these trades

when properly conducted affect the health of the persons living near

the premises, and Parliament, accepting this view, passed an Act

which undid the enactment of 1844, and allowed slaughter-houses to be

continued indefinitely under license. At the same time it conferred on

the central authority, the Metropolitan Board of Works, power to make

bye-laws with respect to certain noxious trades.

And so this fertile cause of insanitation--slaughter-houses--was

perpetuated to the present time.

There was, however, a far more general and potent cause of disease and

death, and general detriment to the public health, than the pollution

of the atmosphere by noxious trades, and that was the reckless

scattering abroad of infectious or contagious diseases by persons

afflicted with or in contact with such diseases.

The Metropolitan Asylums Board had already erected hospitals, and were

doing a vast amount of good and preventing the spread of disease.

But by the people themselves the seeds of infection were scattered

broadcast.

Dr. Simon, the Medical Officer to the Privy Council, in his Report of

1865, wrote:--

"As to contagions already current in the country, practically any

diseased person scatters his infection broadcast, almost where he

will--typhus or scarlatina, typhoid or smallpox, or diphtheria, ... the

present unlimited license seems urgently to demand restriction."

But the license to kill remained without restriction, except that of

entering a public conveyance.[129]

As the Medical Officer of Health for St. Mary, Newington, wrote in

1871:--

"How many are the ways in which the spread of contagious disease is, as

it were, invited, no one knows better than a sanitary officer. Washing,

mangling, needlework, go on in many an infected house; children, aye

adults also, the sick and the sound, mix indiscriminately. I have

even known the exhibition, as a sight, of the corpse of a smallpox

patient...."

And the Medical Officer of Health for Paddington called attention

(1873-4) to--

"The extreme indifference displayed with regard to these diseases

(measles, &c.), by many of the lower and middle class is an

unmistakable sign of an ignorant belief that they are natural events;

and such a belief leads to a carelessness of management much to be

condemned.

"... The working classes generally visit freely during sickness,

allowing their clothes to become saturated with contagious poison."

The Vestries and District Boards did do a certain amount of

disinfection; but more than three years after the Sanitary Act of 1866

was passed, in twenty-nine districts (out of thirty-eight) no proper

disinfecting establishment in accordance with the requirements of the

law had been provided (Strand, 1869-70).

The Medical Officer of Health for St. James', Westminster, pointed out

(1870-1) that in London there was--

"No legal obligation on the part of the head of a family or landlord,

or a medical man, to declare the presence of scarlet fever to the

sanitary authority. The consequence is, that long before any knowledge

of the existence of the disease has been obtained by the Medical

Officer of Health the disease has spread far and wide. If it were not

so melancholy, one feels inclined to deride the folly and ignorance of

a so-called civilised and enlightened nation allowing such a cruel and

terrible scourge as this to pass over the country without any attempt

to control it."

"In sixteen years we have lost 479 persons by scarlet fever in St.

James'. Where one person dies, 10-20 get it and get well. It is vain

to calculate the pecuniary expense of such a curse, but every one can

make something like an approximation to the cost of such a waste of

human life, and form an opinion of the vast benefit of legislation that

should put a stop to this disease."

The Medical Officer of Health for Paddington referred (1876) to the

disastrous results of cases of infectious illness not being notified

to the sanitary authority, and so enabling precautions being taken to

stamp out the infection.

"Such a state of matters, with the annual huge mortality consequent

thereon, will continue until an educated people, conscious of its

duties and jealous of its rights, demands from a tardy executive the

intervention of the legislature to prevent it."

The Vestries and District Boards were gradually doing a good deal

of useful work of the sort which did not much conflict with private

interests. The great main drainage works of the Central Authority

had enabled them to improve and extend their sewerage and drainage

works, and from 1856 up to March, 1872, they had borrowed from the

Metropolitan Board of Works £757,000 for this purpose;[130] and the

total length of brick and pipe sewer which they constructed in that

period was very close upon 700 miles.

"The large amount which has been expended on works of sewerage and

paving, shows that the local authorities in the metropolis have not

been unmindful of the requirements of their several districts."

St. Giles' reported in 1872 that its sewerage was very complete, "not a

single street or court being without a sewer."

St. Marylebone reported in 1877:--

"£33,500 has been spent in new sewers in the parish in the last three

years, and £7,000 is to be spent. Over three miles of new sewers were

constructed. These are large items in our parochial expenditure, but

the fact cannot be ignored that the sewerage of the parish had got into

a disgraceful and indeed dangerous condition.

"In some of the finest streets and squares of the parish the sewers

were but little better than elongated cesspools."

Bermondsey reported, in 1872, that the entire district was drained

into low level sewers, all open sewers, tidal and other ditches, and

cesspools having been abolished; £5,200 expended in widening and

improving certain streets, £92,000 spent in sewerage, paving, and other

improvements.

St. Mary, Newington, reported in 1871 that the whole of the open sewers

and tidal ditches had been covered over; that the drainage was in a

satisfactory condition, and that within a few pounds of £400,000 had

been spent since 1856 in various parish works and maintenance.

In the Wandsworth district (1873-4):--

"The enormous sanitary works carried on by the Metropolitan Board

of Works and the Board of the District have, by drying the soil and

altering the waterlogged condition which formerly prevailed, completely

changed the sanitary aspect of the locality."

Not all the work reported as done, however, was done as satisfactorily

as was to be desired.

Thus the Medical Officer of Health for St. James', Westminster, wrote

(1871-2):--

"Sewers and drains being out of sight admit of a great amount of

'scamping' work.

"Speaking from experience, some of the local sewers in St. James' are

specimens, I hope unique, of the extent to which 'scamping' can be

carried."

And the Medical Officer of Health for Shoreditch wrote (1878) that:--

"Some of the new drains (being so badly laid) are more dangerous than

the old."

The arrangements for water supply were also in some few parishes, in

process of years, being slowly improved.

In Lambeth, in 1872, 646 houses without proper water supply were

provided with it; and in 1873, 804 houses.

Read one way, this was satisfactory. Read the other, it was a

revelation of the number of houses in Lambeth which had been left until

1873 without that great essential of health--a "proper water supply."

A large amount of street paving had been done, and a few small street

improvements had been carried out.

Considering the very limited staff of Inspectors which it suited the

policy and purposes of the Vestries to appoint, a fair amount of

sanitary inspection was done in some parishes and districts.

The striking fact about the inspections made is the very high

proportion of houses in which the sanitation was defective.

In Bermondsey, in 1879, where 1,577 houses and premises were inspected,

1,495 notices were served.

In Limehouse, in 1879, 1,411 houses were inspected; and 1,070 orders

for sanitary amendments issued.

In Shoreditch, where there were 15,500 houses, the two Sanitary

Inspectors appear to have done a lot of useful sanitary work. In

1877-8, 5,465 separate nuisances dangerous to health were abated.

If anything like a similar proportion prevailed generally throughout

London, the housing of its huge population was indeed in a dreadful

state.

In some ways the local authorities were awakening to their

responsibilities, and beginning to avail themselves of some of the

provisions placed by Parliament at their disposal.

In Paddington, St. Giles', and Rotherhithe, the Vestries had adopted

the Baths and Washhouses Act of 1846, and thus helped to promote habits

of cleanliness, and to diminish some of the insanitary evils consequent

on the tenements being turned into temporary wash-rooms.

And in St. James' (Westminster) and Lambeth, mortuaries had been

provided, which, in some cases, at any rate, obviated some of the

insanitary evils consequent on the retention of dead bodies for long

periods in single-roomed tenements where death had been caused by

contagious or infectious diseases.

More action was being taken, too, as regards the disinfection of rooms

where there had been cases of infectious disease. Thus in Lambeth in

1877-8, 824 houses were disinfected.

Here and there, too, the owners of noxious trades were being compelled

to adopt methods rendering their businesses less insanitary and

objectionable to their neighbourhoods.

The Local Government Board had caused an elaborate inquiry to be made

by Dr. Ballard as to--

"'In what measure and by what means nuisances and injury to health from

offensive businesses might be avoided,' and the report led to quite a

satisfactory result.

"It showed that by the application of such knowledge as was at

command, all or nearly all businesses that are in a serious degree

offensive might be carried on either without offence, or with such

important reduction of offence, as should make it tolerable, or even

trivial."[131]

In Fulham several piggeries were closed by law; not without regret,

apparently, for the Medical Officer of Health stated in his report:--

"It certainly is very hard on the pig keepers individually, but it

is in accordance with the recognised law of civilisation, that the

interests of the few must be sacrificed to the welfare of the many."

Upon one course of action all the Medical Officers of Health were in

agreement--the absolute necessity of inspection and supervision of the

houses of the people. In season and out of season they advised it, and

urged it as the most essential and the most useful of all duties.

In support of these views they could point to the results of inspection

and supervision in the registered Common Lodging Houses.

In the parish of Spitalfields (in Whitechapel, 1880) there were 109

of these houses containing 454 rooms registered to accommodate 3,992

lodgers. The class of persons occupying them were, notoriously, the

very lowest.

"We failed to learn that any respectable mechanic with his wife and

family ever applied at these houses for lodging accommodation. Yet,"

reported the Sanitary Inspector (1880), "we discovered no case of

overcrowding. The bedding was clean; the yards and closets were in a

good sanitary condition; there was a good water supply, and the walls

and ceilings of the houses were clean."

If these results were obtainable in dealing with the worst classes,

in the overcrowded parts of Whitechapel, _a fortiori_, inspection and

supervision would have been productive of similar benefits among the

general tenement population.

The Medical Officer of Health for St. George-in-the-East referred

to the low mortality in model lodging-houses, where also there was

supervision.

"There we find good sound dwellings, &c., &c. No overcrowding is

permitted, only a certain number in family being accepted as tenants.

Cleanliness on their part is expected--enforced if necessary--or a

notice to quit is speedily given."

While thus recommending inspection, supervision, and compulsory rules,

another view was also expressed.[132]

"As laws have been enacted for the abatement of overcrowding, it is

easy to say: 'let those in authority put them in force'; but I much

fear unless the question is taken up with a spirit of love towards the

poorer and more ignorant classes by the upper and middle classes, and

measures adopted to give instruction to the poor in matters concerning

their physical well-being, the existing state of things will long

continue."

"No class will become civilised by being left to themselves, as

unfortunately is the case in the numerous back slums of London, but

improvement, physically and socially, can only be effected by a

superior class mixing and associating with a class below them."

The Medical Officer of Health for Poplar wrote:--

"The poor want more than model dwellings, more than warmth, food and

clothing; they want humanity, and the knowledge of the laws governing

health."

Unfortunately those remedies were, at best, a matter of considerable

time, and improvement could be but of slow growth. Immediate

measures were required to cope with the appalling evils, and for

the house-owners, even more than for the unfortunate tenants, were

supervision and compulsory rules requisite.

But not one tithe of the Vestries and District Boards would enforce

against owners the regulations under the 35th Section of the Sanitary

Act of 1866.

Though something was being done as regarded the inspection of houses

and the repair of sanitary defects, hardly any progress could be said

to have been made for the improvement of the dwellings of the poor.

The Artizans' and Labourers' Dwellings Act (Torrens) of 1868 was to a

small extent being made use of.

In some parishes houses considered by the Vestry or District Board

as unfit for human habitation had been closed, and were only allowed

to be reopened upon proper repairs having been carried out. In other

cases where no amount of repairs could put the house into habitable

condition, the landlord was directed to pull down the buildings

(without his receiving any compensation), and, in default, the Vestry

could pull it down at his expense. The site remained unoccupied, until

the owner or landlord used it again for building purposes, or sold it

to some one else.

In St. Giles' (1873-4) the District Board has been enabled under the

Act to enforce "considerable improvements in and immediately adjoining

the worst parts of St. Giles'." (Houses in yards and courts were

demolished.)

In St. Luke the total number of houses "pulled down or closed" amounted

by the year 1875 to 104.[133]

In Holborn the Board had been--

"Applying or threatening to apply the Act to houses that could be

fairly subjected to it. Besides having 150 houses, chiefly belonging to

one owner, put into a complete sanitary repair, it has been actually

applied to 136 houses; 70 thoroughly repaired, 40 demolished, 26 to be

rebuilt, and 10 to be closed."

There were many difficulties in using the Act. Notice of houses being

unfit had to be given to "owners." A certain case in Chelsea was

mentioned where--

"There were freeholders, lessees, under-lessees, and sub-lessees, and

their trustees and mortgagees, and besides there were the occupiers."

But in the great majority of parishes or districts no steps were taken

under the Act. The Act did not give any compensation to the owners of

condemned property, as Parliament had declared by it that compensation

should not be given to those who permitted their property to fall into

such a state, whilst at the same time extracting the fullest benefit

from it.

To such a doctrine there was, of course, the strongest hostility by

all those who held the opinion that a man might do as he liked with

his own, and extract from it the uttermost farthing regardless of the

infliction of disease and suffering and death upon those who were so

unfortunate as to become his tenants, and reckless as to the injury his

action was inflicting upon the community at large. And so:--

"The reluctance of the local authorities to take away a man's property

was insuperable, and consequently no very great demolition took place."

The Medical Officer of Health for St. Pancras wrote (1876):--

"The Act is almost inoperative. The highly penal nature of this

statute, which in the event of demolition gives no compensation to

the owner whose property is destroyed, makes Courts of Justice extend

every possible leniency to the owner. Moreover it does not contemplate

any scheme for the reconstruction of the houses demolished, or other

provision for population displaced...."

And the Medical Officer of Health for St. James', Westminster, where no

action was taken under it, wrote (1872-3):--

"It is scarcely necessary to say that such an Act could not be acted

upon without the grossest injustice to the owners of property, and the

infliction of the greatest hardship on the poor."

But there was another view, much nearer justice, which was given

expression to before the Select Committee in 1881.

"An owner of property who allowed his property to fall into such a

miserable state as to be unfit for human habitation is not a man that

deserves the slightest consideration of any kind from Parliament--he

ought to be treated rather as a criminal than an owner of property. To

compensate him is a mistake entirely."

And the Medical Officer of Health for Whitechapel said it was his

opinion that--

"If the landlord leaves his house in a very bad state, and will not

listen to any representations, he ought not to be paid by the public

when he is creating a nuisance."

The Act of 1868 having helped so little to a solution of the housing

problem, and the matter being one of ever-increasing urgency, an effort

was made to deal with it in 1875, when a Bill for facilitating the

improvement of the working classes in large towns was introduced into

Parliament by Sir R. A. Cross, and was carried.

It often happened that in some of the worst slums, the houses were the

property of several owners, and it was not therefore in the power of

any one owner to make such alterations as were necessary for the public

health.

The Act[134] of 1875 contemplated--

"Dealing with whole areas, where the houses are so structurally

defective as to be incapable of repair, and so ill-placed with

reference to each other as to require, to bring them up to a proper

sanitary standard, nothing short of demolition and reconstruction.

Accordingly, in this case, the local authority, armed with compulsory

powers, at once enters as a purchaser, and on completion of the

purchase proceeds forthwith to a scheme of reconstruction."[135]

An official representation, that the houses within a particular

area were unfit for human habitation, was to be made to the Central

Authority, the Metropolitan Board of Works, by the Medical Officer of

Health of a Vestry or District Board, and the Metropolitan Board was

empowered to declare the same to be an unhealthy area, and to make an

improvement scheme in respect of it. If it decided that an improvement

scheme ought to be made, it should forthwith make such a scheme, which,

after sundry formalities, was embodied in a Provisional Order which had

to be confirmed by Parliament.

The compensation to be paid for the property so taken might be settled

by agreement between the Metropolitan Board of Works and the owner, but

where no agreement was arrived at, an arbitrator was to be appointed by

the Secretary of State. The arbitrator was to assess the compensation

at the fair market value of the lands concerned, due regard being had

to the nature and then condition of the property, but no additional

allowance was to be made in respect of the compulsory purchase of the

area.

The value settled, and the land having passed into the hands of the

Metropolitan Board of Works, the obligation was imposed on that body

of pulling down the buildings, and selling, or letting, the cleared

ground for the erection of improved dwellings for the same number of

people.

The hardship of working class and poorer persons being turned out of

houses and no other accommodation being provided for them was formally

recognised in this matter, and the scheme had to provide for the--

"Accommodation of at the least as many persons of the working class as

may be displaced in the area ... in suitable dwellings which, unless

there are any reasons to the contrary, shall be situate within the

limits of the same area, or in the vicinity thereof. It shall also

provide for proper sanitary arrangements."

The Act was intended to relieve owners of such property without loss or

benefit, and several representations as to unhealthy areas were made

to the Metropolitan Board. The facts stated in these representations

and subsequently brought out in evidence in the public inquiries held,

were illuminating as to the terrible depths which the conditions of

life of numbers of the people had been allowed to reach, without

the intervention of the law, or the staying hand of the freeholder,

lessees, or sub-lessees, who derived financial profit from the property.

The Medical Officer of Health for Limehouse described one of them:--

"The area, though not large, contained abominations sufficient for

an area three times its size. Here were crowded houses, built no

one knows when; how they stood was a marvel, their walls bulged,

their floors sunk, an indescribable musty odour pervaded them; water

supply, drainage, closets, all were bad, and in my opinion, nothing

could remedy such a state of things short of pulling down the rickety

buildings."

"The area is inhabited by about 800 people, and the death-rate is about

36 per 1,000."

In another of these schemes, in one Court (Sugar Loaf Court) the

death-rate was 105·2 per 1,000.

The Medical Officer of Health for the Strand gave a report on the

sanitary state of Bedfordbury:--

"Bedfordbury is the black spot of this parish. It and the contiguous

courts are a little over three acres. Population census of 1871 =

2,163. It is a long narrow street of 47 houses with courts leading out

of it on either side. Some of the courts are blind and very narrow,

thus rendering light and air difficult of access.

"These 47 houses are so old and dilapidated that it is quite impossible

to make them fit and proper habitation for the poor to live in.

* * * * *

"Even this bright and sunny morning the staircases were so dark that

you could not see a single stair--there was not a scrap of ventilation,

and no means of getting light or air to them.

"No. 37 is occupied by 33 people living in six rooms; on the second

floor the two rooms are tenanted by two families, respectively five and

seven, and the third floor by two families of six each."

No. 41 was very similar. "These two houses may be taken as a type of

the condition of the houses in Bedfordbury."

"Off this street were various Courts, one of them of six three-roomed

houses; its width three feet five. Another Court--seven houses, 20

rooms in all--population 71. All of them apparently as bad, or worse,

than those in the street--miserable hovels, the birthplace of disease

and vice, and centres for infectious diseases, which are likely to

spread through the whole community."

The births and deaths were almost equivalent. In 1872, there were 92

births and 95 deaths. In 1873, there were 108 births and 108 deaths.

"In 1874, there were 95 deaths and only 82 births. The deaths are

exclusive of those people who have been removed from the neighbourhood

and gone elsewhere to die, either in the hospital or the workhouse,

where a great many people at the present time do go to die."

Of the overcrowded rooms he says:--

"Here legions of crimes and legions of vices unite, fostering diseases

of body, weakened intellect, and utter destruction of the soul; leading

inevitably to a career of wickedness and sin."

Confirmatory of the Medical Officer of Health's description, was that

given in a memorial to the Metropolitan Board by 118 persons: "The

Clergy, Medical Men, Bankers, Residents, Professional men, and Traders

of the parish of St. Martin-in-the-Fields, in support of a scheme of

improvement."

"Bedfordbury, with its swarming, ill-built, badly ventilated, rotten,

inappropriate, unsavoury tenements, has seemed to us a very forcing pit

of immorality."

"In it there are 797 people living on one acre of land."

"There is a very large number of interests to be paid for. There is

first the freeholder; then there is the first lessee; then there are

numbers of under-lessees, and all the trades of those little shops, and

they ought all to get something."

And another area was the "Great Wild Street Scheme," in the parish of

St. Giles'-in-the-Fields.[136]

"This area has long been a hot-bed of disease. It contains about 5-1/2

acres, and 227 houses stand upon it inhabited by 3,897 persons.

Great Wild Street 58 houses containing 926 persons.

Drury Lane 31 " " 425 "

Princes' Street 14 " " 315 "

Wild Court 14 " " 346 "

"Many of the courts and passages are approached by a narrow passage

under a house at either end which renders ventilation very defective.

Some of the houses are built close together and have dark passages and

staircases, others have no back yards, and their sanitary arrangements

are placed in the basement. Health under such circumstances is

impossible. This part of St. Giles' has long been noted for its heavy

sick and death rates, especially from diseases of the respiratory and

pulmonary organs, and from typhus fever and other zymotic disorders in

their most contagious forms."[137]

Dr. Lovett, the Medical Officer of Health, stated that diseases were

very rife in it, and a very high rate of mortality as compared with the

number of cases.

And he added, "The district is a nest of zymotic diseases of the most

contagious kind. In 1874, 27 cases of typhus were sent to Stockwell

Hospital. This state of things cannot be dealt with under Torrens'

Act. The houses are built so close together, the people are so huddled

together ... you must make a clean sweep of the buildings."

Another of these insanitary areas was Pear Tree Court, in Clerkenwell,

"consisting of small tenements of an exceedingly inferior description.

All are more or less calculated to engender disease and filth. The

condition of the property has been such as to be a reproach to the

neighbourhood.

"Occupied by the very poorest of the community. When disease made

its appearance it has been fostered and engendered and continued by

the state in which the property and its surroundings have been--the

death-rate is nearly double of that which prevails over the whole

parish.

"Some of the tenements are of the most wretched description--some

constructed of lath and plaster--some wooden houses--the floors rotted

partly by the cisterns, partly by rain coming in.

"In some cases the sanitary convenience is in the very rooms

themselves--also the water-butt--thereby engendering and perpetuating

the worst kind of zymotic disease: the chosen home of fever and also of

smallpox.

"An entire absence of ventilation.

"... When we come to those occupying only one room each, and

remembering that in many of these rooms the closet, the water-butt, the

water supply, and everything else was contained in the room itself, and

that there was no provision for manure, ashes, or refuse of any kind,

you can easily conceive what a wretched state of things that presents.

On the average there were 2·80 persons per room permanently occupying

them. So it cannot be wondered at an outbreak of the zymotic disease

finding a resting-place there, and that such a locality becomes a

plague spot in the neighbourhood, and extends its ravages thence into

healthier neighbourhoods."

Some of the houses the Medical Officer of Health had known to be in the

same state for the last 36 years.

"... An ill-constructed, unhealthy warren;" some were "regular old

shanties--you could hardly find anything like those in the metropolis,

they are worth looking at as a curiosity."

"Some in Clerkenwell Close are large and very old wooden houses, all

tumbledown. There is no straight line in roof or windows--the windows

are like cabin windows."

One more case is worth giving details about, as it is one of those rare

cases in which one gets a more continuous account of the effects of

slum ownership than is usually accessible.[138]

This was the Little Coram Street scheme, in St. George, Bloomsbury, in

St. Giles' District, comprising 119 houses--1,027 inhabitants.

The Medical Officer of Health, in his representation to the

Metropolitan Board, gave a minute description of the place.

"The houses are principally let to cab owners, who stable their horses

in the lower floor, and reside with their families in the rooms

over; they are without back yards, and the rooms mainly derive their

ventilation from the staircase leading out of the stable, so that the

air is contaminated by the noxious gases which issue from it. All

the closets are inside the houses; there are no dustbins, and the

drinking-water is often obtained from underground tanks, which serve

both for stable, cleaning, and culinary purposes.

"These houses are unfit for human habitation."

"The district now represented as unfit, &c., constitutes the worst

part of the parish of St. George, Bloomsbury, and has been notorious

for years as largely contributing to the sick and death rates of the

sub-district."

In 1862 it was reported that it had "habitually a much higher mortality

than the rest of the parish."

In the following years "the mortality was seriously increasing there."

In 1870 smallpox broke out first in it, and 25 cases occurred in a

short time. During the same year the deaths in Chapel Place from three

classes of disease--the zymotic, pulmonary, and tubercular--having been

17, the death-rate to population was 70 per 1,000 without reckoning

those from other causes.

In 1871 the general mortality was 50 per cent. greater in it than that

in the parish, whilst that of cholera was four times greater.

In 1874, nine cases of typhoid and typhus fevers occurred in it, "and

the locality was conspicuous for diseases and premature deaths."

In 1876 scarlet fever was prevalent.

Asked what class of disease the people chiefly suffer from, the Medical

Officer of Health replied:--

"Mostly from debility--zymotic diseases, and infectious diseases--such

as whooping cough, typhus, typhoid fever, cholera, diarrhoea, measles,

scarlet-fever, &c., &c., smallpox, and gin liver disease.... They

are obliged to resort to gin on account of the close and depressing

condition in which the people live in these Courts free from the public

eye.

"The women have to stop at home; they do not get out, and therefore do

not get any excitement. Then they take their drops. You can often see

women at twelve o'clock in the day drinking in public-houses."

The Parochial District Medical Officer said:--

"The houses are so old that the air is really poisonous; it is full of

miasma and dirt ... all the whitewashing and ventilation in the world

would do no good. The condition of the property has got worse year by

year."

These are but some of the cases about which "representations" were

made to the Metropolitan Board of Works--sufficient, however, as

illustration of others. And what an awful and appalling picture they

present. Had the condition described been only temporary, a mere

passing phase, it would have been dreadful enough; but it had been

going on for years--it was permanently so--producing year after

year its fearful crop of misery and crime, of disease and death, and

scattering broadcast the seeds of disease and death, the "owners" all

the while exacting the uttermost farthing they could in rents from the

miserable inhabitants, and placidly and remorselessly giving disease

and death in return: going on, too, during twenty years of government

by "local authority"--Vestry and District Board--and nearly ten years

after the passing of the Sanitary Act of 1866, with its provisions for

the abatement of overcrowding and the maintenance of a certain standard

of cleanliness.

A few years' experience of the working of the Housing Act of 1875

proved that it was dilatory, cumbrous, and costly to the ratepayers of

London.

The arbitrator frequently awarded to owners of places unfit for

habitation compensation equal or almost equal in amount to what would

have been given if the houses had been good and sound. This the

Metropolitan Board felt to be an injustice to the ratepayers upon whom

the charge fell, and an encouragement to owners of houses occupied

by poor people to allow them to fall into or remain in a dilapidated

condition.

In the year 1879 the Board accordingly made representations to the

Government, and suggested that the owners of unhealthy houses should

not be compensated in proportion to the profit they derived from such

houses, but according to their value as places pronounced unfit for

habitation. The Board also pointed out--"the great loss entailed upon

the ratepayers by the obligation which the Board was under to provide

for the accommodation in suitable dwellings in the same area of at

least as many persons as were displaced. This obligation rendered it

necessary for the Board to sell, at a very low price, ground, which,

with the dilapidated buildings upon it, had cost the Board seven or

eight times as much, and which, if the Board had been free to dispose

of it for commercial purposes, and to provide for the dispossessed

people elsewhere, would have realised a much higher price."[139]

On the six areas which had been sold to the Peabody Trustees it

was estimated that the Board--or in other words, the ratepayers of

London--would lose the large sum of £562,000.

The Board suggested that it should have power to dispose of the cleared

ground for commercial purposes, and to provide for the re-housing of

the displaced families in other parts of London.

This latter suggestion was not adopted, but Parliament passed an Act

in 1879 which to some extent lessened, though it by no means removed

the defects of which the Board complained, for the Board declared that

"after careful consideration, it thought it well not to prepare any

more improvement schemes until some further experience has been gained

of the working of the Amendment Act of 1879."

And in 1879, also, an Act[140] was passed which nominally "amended,"

but in reality destroyed the real good of Torrens' Act of 1868, and

gave the owner power to require the local authority to purchase the

premises which had been condemned as unfit for human habitation, and

which the local authorities were to rebuild and hold--thus practically

relieving the worst class of slum house "owners" of any consequences

for their malpractices, relieving them, too, in the most open way at

the expense of the ratepaying public, as it empowered the Vestry "to

levy a rate of twopence in the pound to bear this expense as well as

that of building sanitary dwellings on the site."

By one means or another it invariably worked out that the slum owner

obtained large sums for his vile property, and that the public had to

pay heavily for his iniquities.

The work which was within the power of the Vestries and District Boards

to do, in connection with the sanitary condition of houses, was far

more wide-reaching in extent, and more immediately effective than

any the Central Authority could do under its powers. Practically the

Vestries had under their supervision the sanitary condition of all the

houses of London. Moreover they could act upon their own initiative,

whereas the Central Authority could only act when representations were

made to it.

But with few exceptions, they resolutely fought shy of dealing with the

crucial evil--the condition of the tenement-house population of the

metropolis.

"There is no doubt," wrote the Medical Officer of Health for

Paddington, in 1871, "from the abundant experience and records of the

Sanitary Department of this and other Vestries, that houses let out

in single rooms, and to several families, have endangered the life of

people, have favoured the spread of contagion, and are a source of

pauperism and degradation."

The various Health Acts gave them power to deal with most of the

prevalent nuisances.

But no Act gave them such rapid and effective means of action, or so

fixed upon the owner the responsibility and cost of keeping his houses

which he let as tenement-houses in proper sanitary order, as did the

Act of 1866 by its 35th Section.

This Act had conferred power upon them to make effective bye-laws or

regulations as regarded such houses; and in 1874 the Sanitary Law

Amendment Act conferred further powers upon them. Regulations could now

be made as to the paving and drainage of premises, the ventilation of

rooms, the separation of the sexes, and to securing notices being given

to the Medical Officer of Health, and precautions being taken in case

of any dangerously infectious disease occurring in a registered house.

By such regulations the notification of infectious disease occurring in

tenement-houses could have been made compulsory, and such notification

would have been of the very utmost value in enabling sanitary

authorities to combat the ravages of infectious disease.

The regulations struck at the root of the very worst and most prevalent

evils in the homes of the people, and had they been enforced, would

have been a charter of health to millions of the people.

The Medical Officer of Health for Chelsea, in one of his reports, well

enforced their importance.

"When it is remembered that the whole of the labouring population

occupies but part of the house in which their families live; that in

many houses three or four families live together; and not infrequently

each family occupies only a single room; and when it is considered that

whenever necessary all such houses may be registered, it will at once

be seen how important is this regulation."[141]

These sections nevertheless remained absolutely a dead letter in nearly

every one of the metropolitan districts, and even the newly constituted

Local Government Board did not exercise its power of declaring them to

be in force in any district.

From a return compiled in 1874 it appears that:--

(_a_) In only seven parishes or districts[142] were regulations made

and enforced; how imperfectly even in these is illustrated by Lambeth

where, in 1873, 47 houses only had been registered--there being 29,000

in the parish, one half of which were probably let in lodgings.

(_b_) In six districts regulations were made but no attempt made to

enforce them.

(_c_) And in twenty-five parishes or districts no regulations whatever

had been made.

In Hackney and Chelsea alone was any widespread use made of the

regulation.

The explanation usually put forward of the determination on the part of

the Vestries not to enforce the sanitary laws as regarded houses was

their regard for the financial interests of the ratepayers. But the

real ground of their aversion was that action would put house-owners to

expense. "Vested rights in filth and dirt" were strongly represented on

the Vestries and District Boards.

As a witness said before a Select Committee in 1882:--

"So long as vestrymen own little properties, and so long as their

relations and friends do the same thing, and they are all mixed up

in a friendly association, you can never get the prevention of the

continuance of unhealthy tenements carried through."[143]

And not only was there a passive but often an active opposition to work

being performed which it was their duty to do.

A general inspection would have shown what houses ought to have been

made subject to such regulations, but it would also have exposed too

publicly the iniquities of house-owners, and would have entailed a

heavy expense on those who left the houses in a perpetual state of

dilapidation, insanitation, and filth; and so the staff of inspectors

was kept as low as possible.

A thorough enforcement of the regulations would have necessitated a

supervision of their houses by the owners in addition to expense.

Many straws showed which way the wind blew. Thus the Medical Officer of

Health for Bethnal Green wrote:--

"It is by the constant inspection and reinspection of property

inhabited by careless and destructive tenants that most good can

be done. I recently felt it my duty to recommend a house-to-house

inspection of the whole parish--a procedure urgently required to

ascertain the condition of the drainage and water supply arrangements.

I regret to say this recommendation was not acted upon."

And the Medical Officer of Health for St. Pancras, in referring to

house-to-house inspection, wrote:--

"This most important branch of all sanitary work has received as much

attention as the number of the sanitary staff will admit."

And so the regulations were not made, or if made were not enforced.

And, as the result, the great masses of the working classes, and the

poorer classes in the metropolis, were by the deliberate decision of

the great majority of Vestries and District Boards deprived of the

protection which Parliament had devised and provided for their sanitary

and physical well-being; and all the well-known evils of overcrowding

were indefinitely perpetuated.

Apart from the sense of duty or responsibility to the people which

ought to have appealed to them, there were other motives which might

have done so.

The Medical Officer of Health for Paddington called attention to one of

them in 1872. He wrote:--

"The costliness of preventable disease is enormous.

"(_a_) Sanitary supervision. (_b_) Removal to hospitals. (_c_)

Disinfection. (_d_) Expenses in hospital. (_e_) Cost of burial. (_f_)

Loss of work in wages. (_g_) Loss of life to the community. (_h_) Cost

of widows and children."

And the Medical Officer of Health for Whitechapel wrote in 1871:--

"... As the local rates are continually increasing for the relief of

sickness and the support of widows and orphans, the building of asylums

for the insane, and the providing of workhouse infirmaries for the

debilitated and prematurely old, it is probable that local boards will

direct more attention to the condition of the houses of the poor than

they have hitherto done."

The cost was brought home to them in 1871--"an exceptional year of

mortality caused by the continued spread of smallpox."

"It has been," wrote the Medical Officer of Health for Lambeth, "one of

the most alarming and expensive epidemics that have visited the country

for a century. The cost in a pecuniary sense has been great, but it is

nothing as compared to the cost of human life.

"... I know of no disease that can be made so preventable as this."

The Medical Officer of Health for St. George-the-Martyr wrote:--

"No extravagance can be compared with that of sanitary neglect. Pounds

are willingly paid for cure, where ha'pence would be grudged to

prevent. Some diseases we can create, most we can propagate, and send

on their errand of misery and destruction."

In 1878 the Medical Officer of Health for Whitechapel again referred to

the subject:--

"It may be asserted without fear of contradiction, that all money

laid out for the improvement of the public health will secure an ample

dividend....

"The alleviation of suffering and the prolongation of human life is the

duty of every noble-minded man to endeavour to promote.

"It cannot be too frequently reiterated, too extensively known, that

the rich not only pay a heavy pecuniary penalty, but often suffer a

heavy affliction in themselves and families by neglecting to improve

the sanitary condition of the houses and localities occupied by the

poor. It is well known that defective sanitary arrangements in the

poorer localities are the chief causes of disease among the poor, and

when a contagious disease is once located it soon assumes an epidemic

form and attacks, indiscriminately, all classes of the people."

These views were sound and true, but the contingencies described always

appeared remote, and arguments of more immediate and remunerative

results were constantly present.

If the conduct of the Vestries and District Boards was reprehensible

for not administering the existing laws for the improvement of the

sanitary condition of the poorer classes, and if the consequences of

their deliberate inaction were so fatal to the lives of countless

thousands of the people and so disastrous to the well-being of the

community, the conduct of the "owners" of the houses, for the manner in

which they allowed their tenants to live, was still more so.

"I often wonder," wrote the Medical Officer of Health for St.

George-the-Martyr (1874-5), "what many of the owners of property think

man was created for except indeed that he should be housed in foul,

wretched dwellings in order that money may be put in their purses,

and so they may reap where they have not sown. A grim kind of harvest

that will prove. Surely the owners have neither humanity nor justice

on their side when they allow their houses to become hotbeds for the

fostering and spreading of disease, moral and physical, and in which

it is impossible either to maintain cleanliness, or support health, or

practice morality. There are thousands of such houses....

"The only true and lasting foundation upon which the glory and safety

of a nation can be built, must be upon the cultivation of the moral and

physical powers belonging to man."

The "owners" were of all classes.

An experienced witness[144] before the Committee of 1881, who had acted

as arbitrator in some of these cases, referring to some of the worst

slum areas in London, said:--

"It came before me that a great many people in life better than that

supposed, do draw considerable incomes from insanitary house property."

"Some of these worst places are held by rich gentlemen and ladies."

"The class of landlords we have here are very shrewd money-making men,

and they would not show much consideration to their tenants."

The Medical Officer of Health for St. George-the-Martyr, Southwark,

reported (1876-7):--

"We have heard denounced, times out of number, and in the strongest

terms, the conduct of the holders of small property as being most

selfish, and they themselves the most persistent and obstinate

opponents of sanitary measures and improvements; and moreover that this

class formed a considerable portion of our Vestries. However this may

be, they cannot claim a monopoly to this unenviable distinction....

"Much of the small class property is placed in the hands of agents who

neither hold nor cultivate any interest in the welfare and comfort of

the tenants.

"To get the most rent with the least possible trouble and outlay seems

to comprise their whole duty (of course there are exceptions).

"How much better in all respects would it be that the owner himself

should give some personal supervision to his property and to the state

of those who dwell in it."

And there was another class of "owners"--the middlemen--"the very curse

that is incident in all society."

"There are a great many middlemen dealing with these properties. A

great deal of it is to let out in lodgings. A man goes and buys this

wretched property at public auction in different parts of London to

pay him 10 or 12 per cent., and he underlets it at so much a room to

weekly tenants."

"It is these small men who go into it to make a profit, and screw the

poor, wretched holders down to the last farthing--in fact they get as

much as they can out of the property, and do as little as they can."

Some of the Medical Officers of Health referred to the difficulties of

getting the "owners" to do anything to keep their property in order.

Thus the Medical Officer of Health for St. James' wrote (1877-8):--

"On eastern border of parish a large number of houses are

now increasingly being underleased in order to be let out as

tenement-houses.... Dealers in these houses make enormous aggregate

rentals out of the improvident working people whom they thus herd

together; and persistent efforts on the part of the sanitary officers

are needed to goad some of these 'landlords' into keeping their

'property' in a decent condition."

With a very large number of house-owners and other sanitary misdoers,

nothing but the vigorous administration of the law would induce them to

abate nuisances or do anything for their tenants.

"I am quite sure," wrote the Medical Officer of Health for Hackney in

1880, "that a prompt and strict enforcement of the various sanitary

Acts is beneficial not only to tenants, but landlords, because the

latter will not allow tenants to occupy their houses who frequently

bring them under the notice of the sanitary officers."

With many, however, the fact that the law had been put in force against

them, and would, if necessary, again be put in force was sufficient.

"The number of statutory notices this year was not much more than half.

Owners have carried out the necessary works for fear of being summoned."

And numerous other reports were to the same effect. But a vigorous

administration of the sanitary laws against owners was the very last

thing which it was of use looking to the Vestries or District Boards

for.

Some of the Vestries and District Boards put pressure upon their

Medical Officers of Health to prevent energy upon their part.

Thus the Medical Officer of Health for St. Pancras in 1875 tendered his

resignation, giving the following reasons:--

"That while I am held responsible for the sanitary condition of

the parish, I am denied that assistance in outdoor inspection of

houses either visited with contagious diseases or habitually in an

unsatisfactory condition, which I believe to be necessary. I feel

that the severe condemnation which a house-to-house visitation of the

poorer parts of the parish has received from a majority of the sanitary

committee must of necessity hopelessly weaken my authority with the

sanitary inspectors, and render nugatory my efforts to carry out the

Sanitary Acts...."

Parliament was passing some useful legislation for the improvement of

the public health, and taking some action against some of the more

heinous existing abuses.

Several of the evils already described connected with the building

of houses were dealt with in an Act[145] passed in 1878. It was at

last declared to be--"expedient to make provisions with respect to

the making, filling up, and preparation of the foundation of sites of

houses and buildings to be erected within the metropolis, and with

respect to the quality of the substances to be used in the formation or

construction of the sites, foundations and walls of such houses with

a view to the stability of the same, the prevention of fires, and for

purposes of health."

The Metropolitan Board of Works was empowered to make bye-laws

respecting the foundations and sites of houses to be constructed,

and with respect to the material used in the construction of such

houses and of the walls and buildings; and the Board issued a set of

comprehensive regulations upon the subject.

"Considerable opposition was manifested by builders before the

Secretary of State."

But, nevertheless, the regulations were sanctioned and approved.

And in the same year (1878) Parliament had passed an Act which

materially improved the sanitary conditions under which men, women, and

children worked in factories and workshops.[146]

Guided by experience, Parliament had gradually been extending the

operation of the previous Acts from one trade to another, and as Lord

Shaftesbury said:--

"The general result had been to introduce and establish a system

of order, content, and satisfaction. The children in the factories

presented quite a different appearance from that which was their

characteristic in former times; they were now hale and stout."

And the Factory and Workshops Royal Commission[147] in 1876 wrote:--

"The improvement in the sanitary arrangements and ventilation of

factories had been most marked in recent years; and the cases in which

young persons and women suffer in labour unfitted for their years, or

in which young persons and women suffer physically from overwork, are

now, we believe, as uncommon as formerly they were common.

"Much of this great improvement is undoubtedly due to factory

legislation."

The Act directed that:--

"A factory or workshop should be kept in a cleanly state and free from

effluvia arising from any drain, or other nuisance."

And that they should "not be so overcrowded while work is carried

on therein as to be injurious to the health of the persons employed

therein, and should be ventilated in such a manner as to render

harmless, as far as practicable, all the gases, dust, &c., generated in

the course of the manufacturing process and that may be injurious to

health."

By subsequent order of the Secretary of State, 250 cubic feet air space

were to be given to each adult during the day, 400 cubic feet after

eight o'clock at night.

It was to be "the duty of the sanitary authority to make such inquiry

and to take such action thereon as to that authority may seem proper

for the purpose of enforcing the law."

A very material factor in the health of the people was dealt with in

this Act--namely, the condition of the bakehouses where the daily bread

of the community was prepared.

Legislation as to bakehouses had been left unchanged since the Act of

1863, and in harmony with the usual disregard of their duties by the

local sanitary authorities, little use was made of that Act.

The Royal Commission of 1875 reported that it was "only here and there

that any active steps had been taken by the local authorities to carry

out the provisions of the Bakehouse Act."

By the Act passed in 1878 the Bakehouse Regulation Act of 1863 was

repealed, and the duty of regulating the sanitary condition of

bakehouses was transferred from the local authority to the Inspectors

of Factories.

In 1878, also, the Contagious Diseases Animals Act was passed.

Primarily it was directed to the protection from cattle plague of the

cattle of the country, and the prevention of the spread of disease,

which had been entailing heavy losses upon their owners, and very

stringent precautions were imposed.

But it contained also some very valuable provisions as to the condition

of cowhouses and dairies, and early in 1879 the Privy Council issued

an Order providing for the registration of all persons carrying on the

trade of cowkeepers and purveyors of milk, for regulating the lighting,

ventilation, cleansing, drainage, and water supply of dairies and

cowsheds, for securing the cleanliness of milk stores, milk shops,

and milk vessels, and for protecting milk against infection and

contamination.

Inspectors were appointed by the Board.

"At the time of the passing of the Order the London cowsheds were,

with few exceptions, unsuitable in construction and in sanitary

arrangements. By opposing the renewal of licenses the Metropolitan

Board succeeded in abolishing from two to three hundred of the worst of

them, and obtained improvements, amounting to entire reconstruction,

in the remainder. In the larger dairies and milk stores much

improvement was also effected."

It was this Act of 1878 which drew from the Medical Officer of Health

for Whitechapel the following remarkable passages in his report;

passages which are enlightening as to the prevalent views of the time.

"We have a striking instance of the great interest that is shown in

the protection of property and the comparatively little value that is

attached to the health of the people in the recent Act--'The Contagious

Diseases Animals Act 1878.'

"As regards the laws which are in force for the protection of the

health of cattle, which may be looked upon as property, I have nothing

to complain; but as a health officer I may express my surprise that

similar laws to those which are now in force respecting disease in

cattle are not enacted to prevent the spreading of infectious and

contagious diseases among the people. At present there is no general

law in force to compel persons, who may become acquainted with the

existence of an infectious disease in a dwelling-house, to give notice

of the same to the Sanitary Officer....

"Surely it is more important to protect the lives of the people than

to protect from loss the dealers in cattle; but until the care of

public health is considered to be of more importance than the care of

property, little improvement in the laws relating to health can be

expected."

"The preference which is given by our law makers to the protection of

the supposed vested rights of property above that of public health is

likewise shown by the rejection of the several Building Bills for the

amendment of the Building Act.

"The opinion of the House appeared to prevail that 'a man has a right

to do what he likes with his own, as regards the building of as many

houses as can possibly be packed together on his own land, without

taking into consideration the health of the people who are to inhabit

them, or the health of those in the immediate neighbourhood.' So long

as the Building Act as regards open spaces at the rear of houses

remains unaltered, so long will unhealthy houses continue to be built."

Some of the more capable of the Medical Officers of Health in their

reports did not content themselves with mere tables of the births and

diseases and deaths in their parishes, and a narrative of the principal

incidents in their work during the year, but pointed out the defects in

the laws, and made suggestions as to the best ways of coping with some

of the great sanitary evils daily confronting them.

Based upon actual experience, their views and suggestions were entitled

to great weight, and were often of very great value.

One point, and that the most important of all, finds expression in the

reports of more than one of them, namely, that the administration of

many of the health laws should be compulsory instead of permissive, and

that merely declaring a law compulsory without providing the means for

making it compulsory was of little use.

What was wanted in London was a real central authority which should

have power to make the local authorities carry out the orders of

Parliament. This did not exist, for the Metropolitan Board of Works had

no such powers, and the Vestries and Districts Boards were independent

local governing authorities acknowledging no master and free to obey or

disobey Acts of Parliament just as they pleased.

"It has been one of the great faults of our sanitary arrangements and

legislation for London," wrote the Medical Officer of Health for St.

James' in 1872, "that the metropolis has not been regarded as a whole,

and that through the ignorance, or carelessness, of one District or

Local Board the whole of the others may be put in peril."

* * * * *

"It is impossible, with our present municipal machinery, in London,

at any rate, to exercise all that power which is necessary for the

prevention of the spread of infectious diseases."

And the Medical Officer of Health for Whitechapel in 1873 wrote:--

"If any alteration is made in the constitution of the Metropolitan

Board of Works it would be desirable to add to its functions that of a

sanitary supervision over the whole metropolis."

And in 1881 the Medical Officer of Health for Kensington wrote:--

"London is grievously in need of a Central Sanitary Department to

establish something like unity in the sanitary arrangements of its

39 divisions.... Every other large centre of population has but one

sanitary authority."

Though much more time, thought, and labour, were being devoted than

ever before to matters relating to the public health, and with very

beneficial results, one matter appeared to be quite unaffected thereby,

for none of the great measures of sanitary improvement which had been

carried out since the central and local authorities had come into being

seem to have had any effect during the 1871-80 decade upon infantile

mortality.

If anything the figures appear higher. In St. George-in-the-East in

1871-2 the deaths of children under five years were 51 per cent. of all

the deaths.

In Mile-End-Old-Town in 1872-3, out of a total of 2,200 deaths, 1,087,

or practically 50 per cent., were deaths of children under five, a

mortality which evoked the comment from the Medical Officer of Health:--

"Apart from congenital causes, a large majority of these young lives

would, under conditions more favourable to existence, be preserved....

It is certain that the present generation of London children is

physically degenerate."

And a year later he wrote:--

"I consider about two-thirds of the infantile mortality attributable to

neglect, improper feeding, impure air from overcrowding, and general

bad management through ignorance and carelessness of parents and

nurses."

In Kensington, away in the west, the average annual infantile mortality

over a period of ten years--1863-73--was 42 per cent. of the total

deaths.

The Medical Officer of Health for Whitechapel wrote (1873):--

"There must be something very wrong in the condition of the people when

we find that out of all children born about one-fifth die before they

are one year old, and one-third before they are five."

In the north part of his district in the quarter ended December 28,

1872, the rate of mortality of children under five was 61·1 per cent.,

whilst in the quarter ended September, 1873, in Goodman's Fields the

rate was 72·4 per cent.

In St. George-the-Martyr, Southwark, in 1873-4, of 1,256 deaths 694 (=

55·3 per cent.) were under five.

In the same year the Medical Officer of Health for Paddington wrote:--

"In taking fifteen streets typical of the ordinary condition of

the dwellings in which the working-class reside, I find the annual

proportion of deaths under five ranges from 41 to 75 per cent. of the

total deaths....

"The deaths from all causes in eighteen such streets varies from 21·7

to 50 per 1,000."

The Medical Officer of Health for Limehouse wrote in 1874:--

"As usual we find that of 1,000 deaths more than 500 are those of

children under five."

Two years later it was 53 per cent.

Nor was it only in the central parts of London that the infantile

mortality was so frightful. In Wandsworth, the mean annual rate during

the years 1865-74 was 49·6 per cent.

The infantile death-rate did not diminish as the decade proceeded. In

Islington in 1875-6 the infant mortality was "much about the same" as

it had been twelve years previously.

In Kensington it had increased to 46·3 in 1878; in St.

George-the-Martyr to 57·7 per cent.; in St. Pancras in 1877-8, of 5,068

deaths, 2,212 (or 45·6 per cent.) were of children under five.

The Medical Officer of Health for Poplar wrote (1877-8):--

"The deaths of children under five years have been more than half the

total of deaths--truly a 'massacre of the Innocents.'"

The Medical Officer of Health for Islington wrote (1880):--

"The number of deaths of children under one year is still painfully

large.... Children seem to be born for little else than to be buried."

Passing from record to comment, there are some striking passages in the

reports of the Medical Officers of Health.

Thus the Medical Officer of Health for Paddington wrote:--

"... Of infantile mortality one is tempted to ask whether the provision

of so much life, such a prodigality of being, to be followed so soon by

an almost Pharaoh sacrifice of it, is necessary to the multiplication

of the race."

And the Medical Officer of Health for St. Marylebone (1877):--

"It is sad, and in a sanitary point of view, humiliating to

contemplate, that for every three children born in Marylebone, one dies

before reaching the age of five years; 'tis true that in this respect

Marylebone stands in no worse position than other large parishes in the

metropolis, nor so bad as in the majority of them, but the knowledge

of this fact will, I apprehend, afford but slender consolation to

those who know from experience and daily observation that hereditary

diseases, habitual neglect, unwholesome dwellings, together with other

preventable causes, are largely concerned in the sacrifice of infant

life."

And the Medical Officer of Health for Rotherhithe (1881):--

"Whilst the houses' drain-pipes, from defective construction and

workmanship, and want of being cut off from the main sewer, act as

much as sewer ventilators as channels for removing filth ... whilst

overcrowded houses and foul smells in living and sleeping rooms are

taken as a matter of course; whilst infectious disease is sedulously

propagated first by concealment, and then by criminal exposure and

neglect, ... so long the yearly recurring Herodean massacre of

helpless children, whose almost sole use in life appears to be the

providing of fees for doctors and undertakers, will continue, in spite

of all efforts of sanitary authorities and sanitarians."

The evil done, however, by bad sanitary conditions was not limited to

the children who died. Probably ten or twenty times the number of those

who died went through the illness and survived--but of those many were

injured in constitution for life.

In other respects, however, sanitary progress was being made, and

slowly but steadily the conditions of the health of the public were

improving. Undoubtedly the main causes of that progress were the great

system of main drainage and sewerage which had relieved London of the

incubus of enormous accumulations of the deadliest filth in its houses,

and of an open main sewer through its midst; and the greater quantity,

and improved quality, of the water supplied for household consumption

which relieved her inhabitants from the necessity of drinking liquid

sewage.

And the construction of sewers in nearly all the streets, and the

substitution of an effective system of house drainage instead of the

abomination of cesspools, was also a great stride to improvement.

Since 1856 plans for the construction of a total length of nearly 1,000

miles of local sewers had been submitted to the Metropolitan Board for

their approval, many of them being in substitution of old and shallow

ones for which the Board's new main and intercepting lines afforded the

means of improving the gradient and outlet.

In their report for 1881 the Metropolitan Board of Works gave "a brief

summary" of what it, as the Central Authority, had accomplished since

1856.

"There was the great main drainage work which had cost about five and

three-quarter millions, an undertaking which 'although fruitful of good

results, and of greater magnitude than anything of a similar kind that

had previously been accomplished, has left, as might be expected, few

visible marks of its existence.'"

It is rather the Thames embankments and broad new streets which remind

the inhabitants of London of the great changes and improvements that

the Board's operations effected.

"On the north side of the Thames, from Blackfriars to Westminster,

and from Grosvenor Road to Battersea Bridge, and on the south side,

from Westminster to Vauxhall, embankments have been made which,

whilst reclaiming from the river a considerable extent of ground,

have substituted for the unsightly and offensive mud banks that

formerly prevailed, handsome river walls, with broad and commodious

thoroughfares, relieved and ornamented by public gardens. New streets

have been made, some of the principal of which are Queen Victoria

Street, Southwark Street, Northumberland Avenue, Commercial Road, and

the new thoroughfare from Oxford Street to Bethnal Green; many other

leading thoroughfares, which had become inadequate for the increased

traffic of the present day, have been widened and improved, greatly to

the convenience and comfort of the public; and liberal grants of money

have been made by the Board to the authorities in aid of the cost of

smaller street improvements which have not been of sufficient extent or

importance to be carried out by the Board.

"Two new parks have been provided, in districts previously unsupplied

with such places of needed recreation. Public gardens have been laid

out and are maintained in the neighbourhood of dense populations; and

suburban commons, to the extent of about 1,500 acres, have by the

action of the Board been secured in perpetuity for the undisturbed

enjoyment of the public.

"Many areas formerly covered with dwellings unfit for human habitation

have been cleared, under the operation of the Artizans' and Labourers'

Dwellings Improvement Act, and the ground let to societies which have

undertaken to build, and in some cases have built, improved dwellings,

in which the humblest class of the working population can live with

health, decency, and comfort."

These and many consequential improvements, and the better paving of

the streets, and the better cleansing of streets, places, and yards,

the more rapid removal of filth from London, had made the general

conditions of life much less unwholesome.

The work, too, being done by the Metropolitan Asylums Board was greatly

diminishing the dangers of infection in the metropolis, as well as

restoring to life and health thousands who would otherwise have fallen

victims to disease.

And by "The Poor Law Act, 1879," the Vestries and District Boards were

authorised to enter into contracts with the Board, for the reception

and treatment of infectious sick who were not paupers, thus in a

measure depauperising the Metropolitan Asylums Hospitals.

And a very large amount of most valuable work was done by the Port

Sanitary Authority; in the year 1879-80 over 15,000 vessels of all

classes having been visited and inspected, the infectious sick removed,

and disinfection carried out.

Writing of the year 1877 the Registrar General said:--

"London maintains its position as the healthiest city in the world.

During the past year its prosperity was indicated by a birth-rate

above the average of the preceding 10 years, while a remarkably low

death-rate bears testimony to the success which has attended the

efforts that have been made during the last half of a century to

promote the public health and safety."

Among the public authorities from which much might have been hoped in

the way of improving the public health of the inhabitants of London

was the School Board. The Board stood in an exceptionally favourable

position for moulding the physical constitution of hundreds of

thousands of children and of successive generations, but education

appeared to have almost excluded the consideration of health.

In 1871 the Board resolved "that it is highly desirable that means

shall be provided for physical training, exercise and drill in public

elementary schools established under the Board." But beyond this,

little if anything was done, and even it was not made applicable to

the girls. And no Medical Officer was appointed, and no systematic

means organised for the prevention of the diffusion of diseases by

the schools. Indirectly, however, good results were flowing from the

schools. The attendance of the children at the schools took them out of

their overcrowded tenement-homes for several hours in the day; their

playgrounds afforded better means of exercise; the cleanliness expected

of them raised their ideas as to cleanliness; the supervision over

them was of great use in improving their conduct and character, all

helped to improve their physical condition. But how infinitely greater

the improvement might have been, not merely at the time but to the

rising generation, if the School Board had given greater attention to

this branch of the children's welfare. About 230,000 children were in

attendance in the Board's Schools in 1880.

The really encouraging feature of the general position was that a

larger section of the public was taking an interest in matters relating

to the public health.

In Battersea, wrote the Medical Officer of Health (1881):--

"Much assistance is now derived from the general public, who are more

alive to the necessity of sanitary measures than at any previous

period."

The Medical Officer of Health for St. George-the-Martyr, Southwark,

reported:--

"The health of the people occupies the thought and consideration of an

ever-increasing number," and he quoted the declaration of the head of

the Government that "the sanitary question lies at the bottom of all

national well-being."

The Medical Officer of Health for North Poplar stated that--

"Gradually the labouring portion of the population, which so largely

outnumbers the remainder with us, is becoming educated to the fact that

they must neither breathe air, drink water, nor take food, polluted by

filth."

But, as a whole, public opinion was more or less inert.

"The apathy of the public in matters of health is truly lamentable."

Nor was all the apparent progress as genuine as appeared on the

surface. The Medical Officer of Health for St. Mary, Newington, in his

report of 1874 disclosed this material fact.

Writing of some Returns which he had prepared of sickness in seventeen

years, he said:--

"In the period we have seen the end of many fever haunts. We have seen

hundreds and hundreds of the old tenements removed and new abodes

raised in their stead; but with it, alas! we have seen all the defects

of new buildings, all the defects of badly laid drains, all the evils

of work ill done, its dangers too often not capable of recognition

until sickness and death forced the discovery. We have seen too often

in the new houses defects of ventilation, of construction, of drainage,

and of overcrowding: we have seen many an evil allowed by law, and over

which we cannot extend our sanitary rules. We have also to contend

with the indifference, the carelessness, the blindness of the people

themselves--intemperance and crime stand in our way...."

But in 1881 he wrote: "Sanitary work has borne fruit."