"It has been a source of pain and sorrow to the Board that, at the

close of thirty-three years' administration of the local affairs

of London, which has been attended with at least some measure of

success, and in the course of which the Board has carried out some

of the greatest works of public utility of which any city can boast,

its good name has during the last year of its existence been sullied

by iniquitous proceedings of which, though carried on in its midst,

its members as a body were entirely without knowledge. It is some

satisfaction to remember, however, that a body of Commissioners, who

in a judicial spirit made the most searching inquiry into the Board's

proceedings, were able, while exposing the wrong-doings which were

revealed to them, and justly distributing the blame, to speak of the

Board, as they do in their report, in the following terms:--

"'It has had a multitude of duties to perform, and very great works

have been constructed by it, which have transformed the face of

some of the most important thoroughfares of the metropolis. And

there has hitherto been no evidence that corruption or malpractice

has affected or marred the greater part of the work which it has

accomplished. The same may be said, too, in relation to the conduct of

the vast majority of the members of the Board. We have received very

numerous communications, some anonymous, some bearing the signature

of the writers, impugning the action of the Board and certain of its

members, but against the vast majority of them not even a suspicion

of corruption or misconduct has been breathed. We believe that many

members of the Board have cheerfully given for the public good much

valuable time, and have rendered most important public services.'"

The change in the constitution, nature, and character of the central

authority of London effected by the Act was momentous and far-reaching.

Instead of an indirectly elected body such as the Metropolitan Board of

Works, over which the inhabitants of London had practically no control,

there was brought into being a body directly chosen by an electorate of

nearly half a million of the ratepayers of the metropolis, responsive

to the views and desires of the electorate, endowed with the great

authority derived from its representative character, and entrusted with

the carrying out of the views and policy of London as one great city.

London had been unified and welded together into one whole by the

constitution of its new central authority; for the first time in his

history it had been given a voice--the voice of one great city--and

though much remained to be done before its entrance into its full

rights as one city--and that the greatest which has ever existed in the

world--the idea had been born, and had been embodied in the statutes of

the realm that London was one great city, and not a mere conglomeration

of petty jarring authorities.

The first election of councillors took place on January 17, 1889.

The first meeting of the Council took place on the 21st of March, when

the Earl of Rosebery was elected Chairman, and the Council entered

energetically on the work lying before it.

The sanitary evolution of London was vitally involved in the change,

but it was at once discovered that the powers of the Council

relating to the public health of London were of a very limited and

unsatisfactory nature.

Matters concerning it were regulated by the Metropolis London

Management Act and a large number of other Acts, the execution of which

was in the hands of the Vestries and District Boards.

These bodies were practically uncontrolled, and no machinery existed

for securing any uniformity of administration in the different parts of

the county.

And even the Metropolitan Board had not used certain powers it

possessed of making bye-laws for certain sanitary purposes.

"We cannot," reported the Sanitary Committee of the Council, "too

strongly emphasise our opinion that the London County Council should

be empowered to frame bye-laws for the proper sanitary government of

London, that the new or existing local bodies should put them in force,

and that the County Council should be the supervising body to see that

they are properly carried out."

A somewhat similar report was made by the Housing of the Working

Classes Committee.

"The Committee," they said, "feels that until the law is strengthened,

and fuller powers to enforce the law are placed in the hands of the

Council, its action in dealing with insanitary areas will be of an

imperfect character."

The question of the housing of the poor in London was at once

energetically taken up by the new body.

Representations were made to the Government as to the necessity of the

Acts relating to the housing of the working classes being consolidated

and amended.

Consequent upon this, the Government introduced a Bill which was

passed--"The Housing of the Working Classes Act, 1890,"[170] which

repealed and codified fourteen enactments, all having for their object

the improvement of the dwellings of the artizan and labouring classes,

and the clearing away of unhealthy areas. Very large powers were placed

in the hands of the Council and of the district authorities to secure

the better housing of the working classes. And the Act may be said to

mark a new era in the history of reform in the matter of insanitary

areas, giving full power to the Council as a central authority to

enforce its provisions.

Before the end of this decade Parliament passed two other Acts of great

advantage to the health of London. One was, "The Infectious Diseases

Notification Act, 1889," making the notification of certain specified

diseases compulsory in London--smallpox, cholera, diphtheria,

membraneous croup, erysipelas, scarlet fever, typhus, and other fevers.

In accordance with well-worn usage London had been left behind in

this matter. Other cities and even towns had, by means of local Acts,

secured the advantages of such legislation long before. So far back

as 1874, indeed, machinery had been in existence in London for the

notification of infectious disease in houses let in lodgings. But owing

to the neglect of the majority of the Vestries and District Boards

to make or enforce regulations under the Sanitary Act of 1866, that

machinery was left unused to the great detriment of the people of

London. Thousands of lives must have been sacrificed by this neglect,

and innumerable cases of preventable disease not prevented. It was not

until a general Act was passed that London became possessed of the

advantages resulting from such notification.

In London, indeed, the health of cattle was better looked after in this

respect than that of the people, for cases of infectious disease in

cattle had to be notified to the Sanitary Authorities.

By this Act it was made compulsory on medical attendants to certify,

and on householders to notify, the existence of any of these diseases.

Hitherto information as to infectious illness only reached the Medical

Officer of Health after a sufficient time had elapsed to allow of the

spread of the infection.

The results of the Act of 1889 were soon found to be very beneficial in

checking the spread of disease.

The receipt of the notices of infectious diseases led to the more

prompt and general disinfection of premises where infectious diseases

prevailed, and led also to the discovery of sanitary defects which

might not otherwise have been discovered.

The information, moreover, kept the Medical Officers of Health informed

of the progress of disease not only in their own districts, but also in

contiguous ones, and so assisted them to take prompt measures for the

eradication of disease in their respective districts.

The other measure which passed the legislature in this same year

contained provisions of the highest importance as affecting the

metropolis. This was "the Poor Law Act, 1889."

Until 1889 patients could be admitted only to the infectious hospitals

of the Metropolitan Asylums Board on the order of the Relieving

Officer and District Medical Officer, so, except in certain cases, the

hospitals were only open to Poor Law cases.

This measure made practical concession of two principles. Free

admission to the hospitals of the Metropolitan Asylums Board of sick

persons in need of isolation, and devolution upon the Metropolitan Poor

Fund of all charges incurred in the maintenance of the sick in those

hospitals.

The Managers were, therefore, enabled to admit other than pauper

patients reasonably believed to be suffering from fever, smallpox, or

diphtheria.

The system was attended with the happiest results in reducing the

amount of infectious disease in the metropolis, and proved a great boon

to all classes of the community.

The Board in its annual report wrote:--

"The Managers are now, for the first time since the establishment of

the Board in 1867, virtually recognised as the Metropolitan Authority

for the provision of accommodation for the isolation and treatment of

infectious disease--both pauper and non-pauper--and are now empowered

to legally perform duties which the Legislature had imposed on the

District Sanitary Authorities, but which the Managers had hitherto been

called upon to perform in consequence of the failure of most of such

Authorities to provide accommodation for non-pauper patients."

The Managers by this date had increased the accommodation for patients

afflicted with any of these infectious diseases. There were six fever

hospitals, 2,463 beds; 350 beds in smallpox hospital ships; and 800

beds in the hospital for convalescing smallpox patients.

One other Act[171] deserves mention before the close of this decade

as it contained an unique section which required the Medical Officer

of Health, on notice from the owner of property in which there are

separate dwellings let for 7s. 6d. or less a week, to visit them and

examine all their sanitary arrangements, &c., so as to be able to

certify or not--

"That the house is so constructed as to afford suitable accommodation

for each of the families or persons inhabiting it, and that due

provision is made for their sanitary requirements."

The certificate, if granted, was to be handed to the owner, who was

then able to obtain the remission of the inhabited house duty.

The owner, therefore, obtained a remission of taxes to which he was

justly liable, because the dwelling which he lets was in a sanitary

condition!

In many ways, then, the sanitary evolution of the great city was

developing satisfactorily, though by no means so rapidly as was to be

desired, or as it might have developed if local governing authorities

had done their duty.

"The war of the community against individuals for the public good,"

which had now lasted for over thirty years, and the war against

disease in its most dangerous forms, was being waged with good effect;

and though an immensity remained to be done, a great deal had been

accomplished. Larger numbers of all classes were beginning to grasp the

idea and to realise that the necessity of securing and guarding the

public health was not a craze or form of mental aberration, but was of

absolutely vital consequence, not merely to certain classes but to the

great community of the metropolis and to the nation itself, and that

the future welfare and power, even the very existence, of the nation

are dependent upon it.

Larger numbers, too, were beginning to see who really were responsible

for the widely prevalent evils, and who really were obstructing

progress towards a higher standard of public health, and how little

claim they had to consideration, either from the hands of the

Legislature or of local administrators.

The reports of the Medical Officers of Health of the latter part of

this decade were distinctly more hopeful in tone, and recorded more

progress than ever before.

The catalogue of things in which improvement had taken place had

lengthened--sewerage, water supply, the removal of refuse, paving,

the regulation of offensive businesses, of cowhouses, dairies, and

bakehouses, the provision of open spaces, the better disinfection of

houses and of infected articles, the erection of hospitals for the

isolation of cases of infectious diseases--all of which things were

elemental necessaries if the public health was to be assured.

In some parishes, in place of the smaller class of houses, great blocks

of artizans' dwellings had been erected. In others great blocks of

flats.

With the increased wealth of the population finer buildings had been

erected in many districts. London had grown enormously in wealth, and

the wealth showed itself in finer public buildings and private houses.

The District Board of Westminster, for instance, said in their report

for 1885-6:--

"Whether viewed as to its character, its statistics, its topography, or

its sanitary condition, the change which Westminster has undergone in

thirty years can only be described as a complete transformation."

"In the St. Margaret's portion, whole streets of fine houses which

were occupied by the nobility and the wealthy for residential purposes

are now let out in offices for the transaction of legal, scientific,

or mechanical business, while narrow streets, wretched courts, and

melancholy homes of squalid poverty and misery have been replaced by

'mansions,' 'flats,' &c.; and on the other hand by huge blocks of

artizans' dwellings, comprising upwards of 1,200 homes."

The Education Act was indirectly producing some good results as

regarded the health of the rising generation.

A most marked improvement had come over the mortality of children at

school ages. Mortality has lessened--

5-10 years 30 per cent.

10-15 " 32 "

15-20 " 30 "[172]

due to the fact that children had been gathered into the schools from

their crowded and insanitary homes, and had thus escaped some of the

perils of disease.

And the Medical Officer of Health for Lambeth referred to this same

subject in his report for 1886:--

"The children of the pauper and mendicant are withdrawn from the

atmosphere of vice and intemperance to which their fathers had become

acclimatised, and are placed under supervision in the schoolroom...."

Some slight improvement there was also as regarded the mortality

of children under five years, though in many parishes it was still

fearfully high.

In Mile-End-Old-Town, for instance, in 1890 the deaths under five years

amounted to 51 per cent. of all deaths. In Deptford district in 1890-1

they amounted to 50 per cent. In Bermondsey in 1889 they amounted to 52

per cent. In St. Olave, Southwark, in 1888-9 to 49-1/2 per cent. In St.

Mary, Newington, in 1890, very slightly under 50 per cent.

Infantile mortality was becoming of greater concern than ever as the

birth-rate was showing a decided diminution--that for 1889 being the

lowest on record since 1849.

Though the tables as to death-rate in many of the parishes were still

more or less vitiated by various local circumstances, there was

considerable unanimity that the death-rate was falling and the public

health better. Some diseases which had previously claimed their victims

by thousands, now only claimed them by hundreds. Death from tubercular

disease had steadily fallen, and the mean death-rate from phthisis

in London showed a very satisfactory decrease between 1861-70 and

1881-90.[173]

The _Lancet_ of January, 1887, stated that, measured by its recorded

death-rate, London was healthier in 1887 than in any year on record.

In the Strand in 1886:--

"The efforts that have been made by the Board and its officers have

resulted in a marked and continuous improvement in the sanitary state

of the district."

In St. Pancras in 1888 the death-rate was "by far the lowest yet

recorded."

In Bermondsey, in the same year, "so few deaths have not occurred since

1865."

These and similar reports from other districts showed that sanitary

progress was being made. But, unfortunately, in the autumn of 1888

there was an epidemic of measles of exceptional severity, which raised

the death-rate. And in 1890 there was a sudden increase from 18·4 per

1,000 to 21·4, a mortality which was higher than any since 1882.

The increase served to show the great necessity there was for unceasing

watchfulness and for steady perseverance in sanitary work. The forces

of disease are ever on the watch for the opportunity to work their evil

will, and there were still many weak places in the defences against

them. The central government of London had been improved enormously,

but the corrective was not extended to where it was most wanted,

namely, the local Sanitary Authorities, the Vestries and District

Boards.

FOOTNOTES:

[149] To the then existing population of London.

The South Eastern Counties contributed close on 290,000

" South Midland " " " " 249,000

" Eastern " " " " 196,000

" South Western " " " " 168,000

" West Midland " " " " 95,000

[150] The report was made in 1887, but was as true in 1881 as it was

in 1887.

[151] See Report of Select Committee, 1882, p. v.

[152] _Times_, 20th November, 1883.

[153] See his speech in Parliament, Hansard, 1884, vol. ccxc., p. 529.

[154] Robert Reid (a Surveyor), p. 805.

[155] The regulations suggested by the Local Government Board laid down

that the landlord or owner should not allow a greater number of persons

to occupy a room than would admit of free air space for each of 300

cubic feet--if used exclusively as a sleeping room--or 400 feet if used

day and night.

He was to--

(1) Keep the drainage in good working order, to properly pave the

yard, and provide sufficient sanitary accommodation.

(2) Keep the cisterns clean and in proper order, and keep the

structure of ashpit in proper order.

(3) Cause the ceilings and walls of every room to be whitewashed

and papered every April.

(4) Provide all requisite means for the ventilation of every room,

and of the common passages and staircases thereof.

(5) To notify cases of infectious disease.

[156] Royal Commission, 1884.

[157] Hansard, 1884.

[158] 1884 Royal Commission, vol. ii. p. 2938.

[159] Ibid. p. 724.

[160] Hansard, 1884, vol. cclxxxix. p. 41.

[161] Hansard, 1884, vol. ccxc. p. 541.

[162] See Report of Royal Commission on the Amalgamation of the City

and County of London, 1894.

[163] Hansard, 1884, vol. cclxxxiv.

[164] By the Diseases Prevention (Metropolis) Act, 1883, 46 and 47 Vic.

cap. 35.

[165] The total net expenditure was £401,000 in 1885.

[166] Hansard, vol. ccxxix. p. 889.

[167] Lords' Committee on Sweating, P.P. 1890, vol. 17.

[168] Hansard, p. 1663, March 19, 1888.

[169] See the last Report of the Board.

[170] 53 & 54 Vic., cap. 70.

[171] The Customs and Inland Revenue Act, 1890, 53 & 54 Vic. cap. 8.

[172] See speech by Sir L. Playfair in House of Commons, March 4,

1884.--Hansard, p. 529.

[173] See Report from Royal Commission on Tuberculosis, 1898.

CHAPTER VI

1891-1901

IN 1891 the census once more gave authoritative figures as to the

population of the metropolis of London. The population had increased

from 3,830,297 to 4,228,317.

The increase had been in a somewhat lower ratio than the population of

England and Wales as a whole, and the fact was notable inasmuch as it

was the first time that such a phenomenon had presented itself, London

having been found in every preceding intercensal period to have gained

more or less in its proportions as compared with the country at large.

The movements of population had followed very much the same lines as in

the previous decade. In the central parts--under the pressure of the

great economic forces--the population had increased. In the outer parts

it had increased, but "the wide belt of suburbs was beginning to show

some signs of repletion."

Immigration into London had greatly diminished in the decade. Fewer

immigrants had come from the various counties of England and Wales, and

the proportion of the inhabitants of London who had been born elsewhere

had fallen from 308 persons per 1,000 in 1881 to 283 in 1891.

Thus the influx of country people, mostly in the prime of life, and the

admixture of fresh country blood into the urban population of London

was undergoing diminution--a circumstance which, in the long run, would

materially influence the physique of the people.

Three important facts came into view with the figures set out in the

census, giving food for thoughtful minds as regarded the future of

London.

The first was that the rate of increase of the population had again

slackened off. The flood tide of population was not now flowing so fast.

The second was that the population was being affected by migration.

The natural increase of the population had been 510,384, the actual

increase 396,199--so that London had lost by the excess of emigration

over immigration more than 114,000 persons. This was the first time

such an event had happened.

London's boundaries, however, were very arbitrary and haphazard, and

this emigration was probably only to places immediately outside London

for residence at night, whilst work was performed in London during

the day--as illustrated by the "City" and the Strand, where huge

differences existed between the day and night populations. The figures

showed, however, a movement of population which was bound to have an

effect upon the sanitary condition of the people.

A third and portentous fact, ascertained correctly by aid of the census

figures, was the decline of the birth-rate in London. This had fallen

remarkably since 1881. It was then 34·7 per 1,000 living. It was now

31·9.

Deducible from the census figures, reliable calculations could also be

made as to the death-rate in the metropolis.

In 1891 it was practically the same as in 1881, being 21·4 per 1,000.

It might be inferred that these latter figures did not afford much

testimony to the effects of sanitary administration and labours, but

the pause in the steady decline was only a temporary one.

The authoritative and accurate records thus afforded decennially

by the census are invaluable in tracing some of the most important

developments in the sanitary evolution of London.

Another very noteworthy change was also brought into prominence by

the census. This was the continued rapid growth of the population

immediately outside the boundaries of the County of London.

Between 1871 and 1881 it had increased 312,000. Between 1881 and 1891

it had increased by 469,000, and now in 1891 it stood at 1,405,000,

having more than doubled since 1871.

A passage in the report of the Medical Officer of Health for Islington

in 1895 illustrates this so far as his own district was concerned:--

"The fact cannot be burked that many of the better classes have gone

further into the country to live, induced to do so by the increased

facilities for travelling that railways have provided.... The same

facilities have also checked the influx of people to the same extent as

formerly, so that now in northern London people are flocking to Hornsea

and Hampstead and thereaway."

The fact was that the metropolis had burst its boundaries, and just as

it had grown up around the "City" so now the "outer ring," as it was

called, was growing up around it.

How little reliance could be placed on the intercensal estimates of

Medical Officers of Health as to the number of inhabitants and the

death-rate, is illustrated by the following passage from the report of

the Medical Officer of Health for Islington in 1891:--

"There was an error amounting to nearly 50,000 in the estimated

population of the parish in 1891; consequently all statistics based

on the estimated figures during the decade 1881-91 are more or less

erroneous."

Also "the mortality returns were not kept in such a manner as to lead

to accuracy, for while all deaths of non-residents were excluded, the

deaths of residents dying outside the district in similar institutions

were not included.

"It is impossible to make an accurate statement as to the correct

meaning of the mortality returns--the returns are erroneous."

A similar miscalculation was made by the Vestry of St. George, Hanover

Square. In their report for 1890-1 they stated that they had no reason

to believe that the population was much different from what it was in

1871 and 1881. The census, however, showed that it had fallen over

11,000.

In each successive census the number of inhabited houses in London was

enumerated. In this one the number was 547,120--being an increase of

nearly 60,000; but not much instruction was to be obtained from such

general figures beyond the fact that houses were becoming more and more

densely packed.

The substitution of blocks of dwellings for small houses had also made

considerable progress during the intercensal period.[174]

The same reasons as to the diminution of the number of houses in the

central parts of London continued to be given by Medical Officers of

Health.

In St. George-in-the-East it had been brought about "by the extension

of warehouses and the demolition of insanitary property." In St.

Martin-in-the-Fields it was "due to many former residents having

removed to the country, and to the demolition of so many houses for

improvements." In the Strand to the fact that the district was becoming

like all the central parts of London, "a business, as distinguished

from a residential district." The Vestry of St. James' reported that

"buildings formerly occupied as dwellings were being replaced by

warehouses and business premises commanding a higher rent. As the

centre of trade extends, this condition of things must be expected to

continue, just as the increasing volume of trade has converted the City

of London at night from a populous place to little more than a city of

caretakers," and they drew attention to the "enormous number of people

engaged in business in the parish during the day time who resided

elsewhere."

On the south side of the river the same story was told. The Medical

Officer of Health for Lambeth remarking in his report that--

"The displacement of population from the central districts of Lambeth,

and the settlement of population in those districts which are situated

in the outer ring, or on the circumference of the inner, is a part of a

greater movement which affects the whole metropolitan area."

The census of 1891 is specially memorable by the fact that for the

first time a mass of most valuable information was obtained which was

wholly new, and which threw a blaze of light upon the condition of the

housing of the population of London.

For the first time full details were obtained and published as to the

numbers of the people living in tenements of less than five rooms and

the numbers and character of the tenements they lived in.

A tenement was defined as "any house or part of a house separately

occupied either by the owner or by a tenant."

These tenements were classified into those of one room, two rooms,

three rooms, and four rooms; and the number of persons inhabiting

each of these classes of tenements was given.

The nearest approach to information of this sort had been given by Mr.

Marchant Williams in 1884, but it was only for a particular area in

London. The information now given related to the whole of London.

The total number of tenements in London in 1891 was stated to be

937,606.

Of these, 630,569 were tenements of less than five rooms. And of these--

172,502 were tenements of one room.

189,707 " " two rooms.

153,189 " " three "

115,171 " " four "

An examination of the detailed figures revealed some astounding facts.

In the central group of parishes and districts, in the parish of St.

Luke 21,937 persons, or over one-half of the population, lived in

tenements of one or two rooms; in Clerkenwell, over 33,000 persons; and

in Holborn, over 16,000--practically one-half.

In the eastern group, in Whitechapel, close on 33,000 people, or over

44 per cent., lived in tenements of one or two rooms. In Shoreditch,

over 50,000, or 40 per cent.; in Bethnal Green, 45,000 persons, or 38·4

per cent.; in St. George-in-the-East, 43 per cent. of the population.

In the northern group, in St. Pancras 95,000, or over 40 per cent.,

lived in tenements of one or two rooms; and in one district of

the Parish, namely Somerstown, 57 per cent. of the population were

living in such tenements. In St. Marylebone over 58,000 lived in such

tenements.

In the western group over 173,000 persons lived in tenements of one or

two rooms.

And on the south side of the Thames, in Bermondsey close upon 24,000

lived in tenements of one or two rooms; in Camberwell, 30,000; in

Lambeth, 61,000; in Newington, 31,000; in St. Saviour over 41 per

cent., and in St. George-the-Martyr 26,000, or over 43 per cent.

And examining the numbers of persons living in one-room tenements, it

appeared that in Chelsea one-tenth of the population lived in such

tenements; in St. Marylebone somewhat less than a sixth; in Holborn

a fifth; and in St. George-in-the-East between a fourth and a fifth.

These figures show how large a proportion of the population began,

spent, and ended their existence within the four walls of a single-room

tenement.

The total result shown was that in the metropolis 1,063,000 persons,

or one quarter of the population, lived in one- or two-room tenements,

and 1,250,000 in three- or four-room tenements; making a total of over

2,310,000, or well over half of the population living in tenements of

less than five rooms.

Of still deeper interest and import was the information obtained as to

that dreadful factor in London life--"overcrowding." An effort was now

for the first time made to get reliable information upon this matter.

Hitherto it was only by piecing together the statements made by some of

the Medical Officers of Health as to overcrowding in their respective

parishes that one could form even the crudest idea of what the sum

total in London actually amounted to.

Here, at last, was material enabling accurate calculations to be made,

not only of overcrowding in each separate parish or district, but in

London as a whole.

The Census Commissioners laid down the principle--

"That ordinary tenements which have more than two occupants per room,

bedrooms and sitting-rooms included, may be considered as unduly

overcrowded.

"We may," they wrote, "be tolerably certain that the rooms in tenements

with less than five rooms will not in any but exceptional cases be

of large size, and that ordinary tenements which have more than two

occupants per room, bedrooms and sitting-rooms included, may safely be

considered as unduly overcrowded."

By using the information given in the tables, and excluding all

one-roomed tenements with not more than two occupants, all two-roomed

tenements with not more than four occupants, all three-roomed tenements

with not more than six, and all four-roomed tenements with not more

than eight occupants, the desired information would be obtained. And

they added:--

"Each Sanitary Authority is now provided with the means of examining

with much precision into the house accommodation of its district."

Provided with the tables as to the occupants of tenements, the Medical

Officer of Health for the London County Council, in his report for

1891, worked out the figures for the metropolis. The result showed that

there were in London 145,513 tenements of less than five rooms apiece,

in each of which there were more than two inhabitants per room, and

each of which consequently was "overcrowded."

But it is when one ascertains the number of persons living in these

overcrowded tenements that one realises what the extent of overcrowding

was. In round numbers, one-fifth of the entire population of London

lived in these tenements. The total population was 4,200,000; the

number of "overcrowded" persons was 830,000.

A few illustrations of the overcrowding in certain parishes brings the

meaning of these figures home still more.

In Clerkenwell, 25,600 persons lived in overcrowded tenements; in St.

Luke, 18,700 persons; in Shoreditch, 41,700; in Islington, 64,600; in

Kensington, 28,700; in Lambeth, 43,600. The larger proportion of these

lived in one- or two-room tenements.

Figures are dry things to read and difficult to understand. To

appreciate the true meaning and import of these, and to enable one

who reads them to at all realise the conditions of existence of

these hundreds of thousands of people, one must recall to mind the

descriptions given by many of the Medical Officers of Health of

tenement-houses; of all the misery, the filth, the sickness, the

physical and moral degradation of life in tenement-rooms.

These facts now for the first time revealed the full magnitude and

momentous nature of the problem of the sanitary housing of the people.

The year 1891 is memorable in the history of the sanitary evolution

of London for "the Public Health (London) Act, 1891,"[175] which

consolidated and amended the laws then existing in connection with the

public health of the metropolis.

The state of the law was recognised as very unsatisfactory, being

scattered over some thirty statutes or more--a condition of things

which was greatly to the disadvantage of the public health of London.

Moreover, in accordance with the extraordinary custom, London, which on

account of its huge population needed sanitary legislation almost more

than any other place, had been excepted from much sanitary legislation

which had been in operation for many years, with the most beneficial

results, in the remainder of the country. Part of this legislation

was at long last extended to London. Many amendments were made,

recommendations of the Royal Commission of 1884 were given effect to,

new provisions introduced, and the general result was a Sanitary Code

for London--imperfect still in some important respects, but a great

advance on anything which London had previously possessed.

The Act came into operation on the 1st of January, 1892, and it applied

to the Administrative County of London only; some few of the provisions

extending to the "City."

And for the first time the new Central Authority--the County

Council--with extended powers, occupied a prominent place in this

legislation.

Once more did Parliament enact the oft-ignored direction that "it

shall be the duty of every sanitary authority to cause to be made

from time to time inspection of their district" for detection of

nuisances--a duty so shamelessly neglected--and "to put in force the

powers vested in them relating to public health and local government

so as to secure the proper sanitary condition of all premises in their

district."

With a view to secure fit and proper persons as Medical Officers of

Health and Sanitary Inspectors, their appointment was made subject to

the regulations of the Local Government Board.

The Act greatly strengthened the law both as to the prevention and

definition of nuisances. It provided for the immediate abatement of a

nuisance, not only where actually proved to be injurious or prejudicial

to health, but also where it was dangerous to health. It gave to any

person the right to give information of nuisances to the sanitary

authority instead of that right being limited to the person affected

by the nuisance; and it extended to a Sanitary Authority the power

to take proceedings for the abatement of nuisances arising in the

district of another authority should the nuisance injuriously affect

the inhabitants of their own district. It transferred from the police

to the local authority the enforcement of the provisions of the law

against smoke nuisances. It dealt with the removal of refuse. It

extended the previous laws as to the adulteration of food and drugs,

and the inspection of articles intended for the food of man. It enacted

that a newly-erected dwelling-house must not be occupied until a

certificate had been obtained of the Sanitary Authority to the effect

that a proper and sufficient supply of water exists; and made the

provisions as to the occupation of underground rooms as dwellings more

stringent and effective.

The notification and prevention of the infectious and epidemic

diseases, the provision of hospitals, ambulances, and many other

branches of the great subject--the health of the public--were

legislated upon. Additional duties were imposed on the Sanitary

Authority in the matter of disinfection; the practical result of

which was that the whole cost of disinfecting houses, and cleansing

and disinfecting bedding, clothing, &c., was thrown upon the rates.

In several matters the option given in previous legislation to local

authorities to administer the law was taken away, and the duty made

imperative. Parliament evidently had realised the hostility of many

of the Vestries to administering some of the principal provisions of

sanitary law, and the word "shall" figured much more frequently than

ever before.

The hitherto optional provision of mortuaries by the sanitary

authorities was made compulsory, the need for suitable and convenient

places for the reception of the dead during the time that bodies are

awaiting burial having long been felt, particularly in the poorer

districts, where bodies awaiting burial were of necessity frequently

kept in living rooms under conditions dangerous to health, especially

where the case was an infectious one.

Among these "shalls" was that most important of all health

subjects--overcrowding--and the condition of the tenement-houses of

London. In this matter the local authorities had through a quarter of a

century been tried in the balance and found wanting, and it was enacted

(Sec. 94):--

"Every Sanitary Authority _shall_ make and enforce such bye-laws as are

requisite for the following matters (that is to say): (_a_) for fixing

the number of persons who may inhabit a house, or part of a house,

which is let in lodgings; (_b_) for the registration of houses so let

or occupied; (_c_) for the inspection of such houses; ... (_d_) for

enforcing drainage for such houses, and for promoting cleanliness and

ventilation in such houses; (_e_) for the cleansing and lime-washing at

stated times of the premises; (_f_) for the taking of precautions in

case of any infectious disease."

In another matter, which the Vestries had long opposed, their hostility

was overborne. They were now required to appoint "an adequate number

of fit and proper persons as sanitary inspectors," and, in case of

their failure to do so, the Local Government Board was enabled, on the

complaint of the Council, to order the appointment of a proper number.

The new Central Authority, directly representative of the whole of

London, was not constituted the chief sanitary authority for London,

nor even a sanitary authority. It was given power to make bye-laws

for the prevention of nuisances of various sorts in London, except as

regarded the "City," to license cow-houses, and slaughter-houses, to

appoint Inspectors to inspect them, and also dairies and milkshops, and

it could extend the number of infectious diseases to be notified.

But most important of all was the power given to the County Council (by

Section 100), which enacted, on it being proved to the satisfaction of

the Council, that any Sanitary Authority (except the Commissioners of

Sewers of the City) had made default in doing their duty under this

Act with respect to the removal of any nuisance, the institution of

any proceedings, or the enforcement of any bye-laws, the Council might

institute any proceedings and do any act which the Authority might

have instituted and done, such Authority being made liable to pay the

Council's expenses in so doing.

And, furthermore, Section 101 provided that "when complaint is made by

the Council to the Local Government Board that a Sanitary Authority

have made default in executing and enforcing any provision which it

is their duty to execute or enforce under the Act, or of any bye-law

made in pursuance thereof, the Local Government Board, if satisfied

after due inquiry that the Sanitary Authority have been guilty of the

alleged default, and that the complaint cannot be remedied under the

other provisions of this Act, shall make an order limiting the time

for the performance of the duty of such authority in the matter of

such complaint. If such duty is not performed by the time limited in

the order, the order may be enforced by writ of mandamus, or the Local

Government Board may appoint the Council to perform such duty," and the

expenses were to be paid by the Sanitary Authority in default.

"It seems to me right and proper," said Mr. Ritchie in introducing the

Bill, "that in regard to the great question of public health in London

the County Council ought to be charged with the performance of duty,

which in the opinion of the Local Government Board after inquiry, has

not been adequately and properly performed by the local authority."

These sections were strongly opposed by some of the prominent Vestries,

being held to be "degrading and destructive of local self-government by

completely subordinating the local to the central authority."

The self-government which many people like is the being able to do

exactly as they themselves like, regardless of everybody else's likes

and rights. And it is the same with many local government authorities.

Their idea of self-government too often is to govern for their own

objects, and their own interests, regardless of the infinitely greater

interests and rights of the great community around them; and when it

is brought home to them that they are only a small integral part of a

great community, that their sphere of self-government can only be a

very limited one, and that they cannot be allowed either by action or

neglect to injure the community, they resent it with no little outcry.

The principle of self-government, however, was not one to which appeal

could be made, for it had been dragged through the mire by too many

of the local authorities. Once the unity of London assumed definite

shapes, as it did in the new Central Authority representing the whole

of London, Vestry self-government, except upon certain lines and within

certain limitations, was doomed; for it would have to make way for a

far larger system of self-government--the self-government of London by

Londoners.

Moreover, prolonged experience had proved that the Vestries could

not be relied on to enforce the laws, and it was manifest that some

effective provision must be devised for preventing them perpetually

thwarting the intentions and defeating the imperative enactments of

Parliament designed for the welfare of the community at large.

It was unfortunate, however, for the sanitary welfare of great masses

of the people of London that the principle thus recognised and adopted

by Parliament was not given fuller effect to than it was, for it is the

only principle upon which any really sound system of public health

administration for London can be based.

A few years later the principle was reaffirmed by Parliament.

During the summer of 1892 the appearance of cholera on the west coast

of Europe--particularly Hamburg--exposed London to the importation of

cases of this disease. The unsatisfactory position of the Council with

regard to London administration for the prevention of epidemic disease

was at once made evident.

In order to remove doubts as to the Council's responsibilities as

to the administration of the law relating to epidemic diseases, a

provision defining the Council's position was included in the Council's

General Powers Bill, which was passed by Parliament in 1893. This

provision was to the following effect:--

"The Local Government Board may assign to the Council any powers and

duties under the epidemic regulations made in pursuance of Section 134

of the Public Health Act, 1875, which they may deem it desirable should

be exercised and performed by the Council.

"If the Local Government Board are of opinion that any sanitary

authority in whose default the Council has power to proceed and act

under the Public Health (London) Act, 1891, is making or is likely

to make default in the execution of the said regulations, they may

by order assign to the Council, for such time as may be specified in

the order, such powers and duties of the sanitary authority under the

regulations as they may think fit."

Parliament thus once more emphasised the policy of the local sanitary

authorities being subordinated to the Central Authority.

The new Central Authority--representative of the people of London--gave

early evidence of vitality and energy. The heir had come into his

property, with high ideals as to its government, and as to the

welfare of the people. A new power had suddenly been brought into

London life--an unknown but vigorous force. A capable staff was at

once organised, and a Medical Officer and Assistant Medical Officer

of Health appointed. Inquiries and investigations into the various

matters most concerning the welfare of the citizens of London were at

once undertaken, and conclusions arrived at, and action taken, with a

thoroughness and a rapidity hitherto unknown in the administration of

London affairs.

Bye-laws were made to regulate and unify the administration of sanitary

laws by local authorities.

Several of the water companies were induced to give a constant supply

of water to an increased extent.

And great efforts were made to utilise the powers conferred upon the

Council by the recently passed Acts--the Housing of the Working Classes

Act of 1890, and the Public Health (London) Act of 1891.

It was at once felt that the problem which first faced the Council was

the housing of the people, and the Council determined to attack it on

every side.

In the belief that facilities of communication between the working

centres of London and residences in healthier localities would help

considerably to alleviate some of the worst effects of overcrowding,

and towards the successful treatment of the great housing problem,

action was taken to turn the Cheap Trains Act of 1883 to greater

account, and to secure greater numbers of workmen's trains and more

moderate fares; so as to enable workmen to travel cheaply between more

distant homes and their places of employment.

That Act, which gave a large remission in the amount of passenger duty

paid by railway companies, if the companies would provide a service

of workmen's trains, and would convey workmen at less than the usual

fares, had so far not been made much use of.

On investigation it was found that the facilities afforded to workmen,

particularly on certain railways, were very inadequate. There were no

workmen's trains at all on one important line--on another only one such

train was run, whilst on several others the number of trains run was

very small.

Representations were made to the Board of Trade and negotiations

carried on with the Railway Companies, and by degrees a considerable

extension of the facilities for the conveyance of workmen was secured.

The Council gave its immediate and more anxious attention to those

breeding-places and forcing-pits of disease and misery, the insanitary

areas in London.

The Housing Act of 1890 (by Part I.) constituted the Council the

authority for preparing and carrying into effect schemes for the

clearance and improvement of insanitary areas which were of such

size, and situation, and character, as to render their clearance and

reconstruction of general importance to the County.

The tremendous task of dealing with them was rendered more difficult

and costly by the obligation imposed by Parliament of providing housing

accommodation for the persons displaced; for in the lack of easy means

of communication with the outer parts of London it was held to be

necessary to re-house the greater number of them in the same locality.

The Metropolitan Board of Works had simply acquired and cleared the

properties, and disposed of the sites to companies or individuals,

placing on them the obligation to erect houses for the working classes.

Now, however, the Council determined itself to erect, let, and

maintain, the necessary dwellings. The chief reason for the change was

the difficulty experienced in finding companies or persons who were

willing to undertake the erection of dwellings on some of the sites.

The Council had to complete several schemes which it inherited in an

unfinished condition from the Metropolitan Board of Works, but it at

once initiated many itself, and carried them through to a successful

conclusion.

And as one after another of the insanitary areas was investigated, so

again and again was revealed to public view the appalling condition

in which thousands of people--in the very heart of London--dragged

out an existence more bestial than human; horrors piled on horrors--a

state of things all the more awful because it had been existing for an

indefinite number of years--levying annually the heaviest of tolls

on those who came within its deadly sphere, and scattering its poison

abroad among the community at large.

There was the Clare Market (Strand) Scheme, some 3-1/2 acres--3-1/2

acres of human wretchedness and disease and misery and filth. In

one sub-area there were upwards of 800 persons to the acre. Here

the death-rate was 41·32 per 1,000 in 1894; in another sub-area,

the death-rate had been 50·52 per 1,000 in 1893; the death-rate for

the whole area having been 39·03 in 1894. And in addition to this

was the unknown sick-rate. There was the Webber Row Scheme in St.

George-the-Martyr, Southwark--close upon 5 acres in extent, with a

death-rate of 30·5 per 1,000. There were the Roby Street and Baltic

Street areas in St. Luke, areas which "have about the worst reputation

of any in London."

The largest scheme which the Council undertook was that known as "the

Boundary Street Area" in Bethnal Green. Here some fifteen acres of

old, dilapidated, crowded dwellings--dwellings so insanitary that the

death-rate in them was over 40 per 1,000--were swept away, entailing

the displacement of 5,719 persons; and the ground so cleared was laid

out with wider streets, and a large open space and excellent buildings

were erected thereon to contain 5,524 persons without crowding. The

Prince of Wales once more testified his deep interest in the welfare

of the poorer classes of London by opening the new buildings--a

ceremony which took place on the 3rd of March, 1900--and delivering an

impressive speech.

A summary of the work accomplished by the Council up to this time

showed that the Council had provided, or was engaged in providing,

accommodation for 35,950 persons at a total outlay of close upon

£2,000,000, an amount of building operations which, if conducted at one

spot, would have resulted in the formation of a town of nearly 36,000

inhabitants.[176]

The cost of this work was enormously heavy, owing to the fact that the

arbitrator could and did award commercial value for the land; but, as

was pointed out by the Medical Officer of Health for the London County

Council[177]:--

"The primary object of Part I. of the Act is not to provide artizans'

dwellings, but to secure the removal from the midst of the community

of houses which are unfit for habitation, and the faults of which

are in large degree due to bad arrangement. Where houses are thus

situated, and are in a number of ownerships, rearrangement can only be

carried out by vesting the property in one ownership, that of a public

authority, who can then, by the making of new streets and by complete

rearrangement of the area, ensure that the conditions which in future

will exist are such as are needed for the health of the inhabitants.

The chief value of the Act is, therefore, not so much the provision of

house accommodation which is fit for habitation, as the abolition of

houses which are dangerous to health. Part I. is not, therefore, in

itself so much a Housing Act as an Act for the removal of nuisances on

a large scale."

But another reflection also suggests itself, namely, why should the

ratepayers of London have been obliged to pay these high sums for

property which, by the culpable neglect of the owners and their

predecessors, had been allowed to sink into a condition not alone

exceptionally dangerous to the lives of its inhabitants, but a constant

danger to neighbouring districts--even to London itself. Surely in

common fairness, those who had let it fall into such a state should

have paid the penalty therefor, and not the public of London, who had

had no part in bringing the property into such an evil condition.

Part II. of the Act was mostly a consolidation of Torrens' Acts, 1868

and 1882, with amendments. It enabled the Vestries or District Boards

to take proceedings before a magistrate for the clearing and demolition

of single houses unfit for human habitation, and obstructive buildings,

and empowered them and the County Council to undertake schemes for the

improvement of areas too small to be dealt with by the Council.

The owner might elect to retain the site after the demolition of the

building, and in that case received compensation for the building only.

If the Vestry or District Board acquired the site the same procedure as

to compensation had to be followed as under Part I.

A few schemes were undertaken by Vestries under this Part of the

Act, the Council making a contribution to the cost, and a few by

the Council. Thus in St. George-in-the-East, from November, 1890,

to the end of 1894, 224 houses were "represented" as unfit for

habitation--gruesome pictures of dirt, dilapidation, and insanitation

of every form and variety, and this, too, after nearly forty years

of sanitary work by the Vestry. Many were closed by order of the

magistrate, some by the owner, some pulled down, some repaired and

re-let.

Part III. of the Act embodied the idea, originally started by Lord

Shaftesbury in 1851, as to the erection of labouring classes'

lodging-houses by the local authorities, and grafted several amendments

thereon.

Power was given for the acquisition by the Council of land for the

purpose of erecting lodging-houses thereon. Such land, however, was

to be within the Council's jurisdiction. Under this part of the Act

the Council erected a common lodging-house in Parker Street for the

accommodation of over 300 persons. It also acquired several sites,

including the Millbank estate, upon which it proceeded to build houses;

and one of 38 acres at Lower Tooting for the erection of cottages

thereon.

Altogether the work performed under the Act was considerable, and the

housing for the accommodation of the working classes made sensible

progress, the sites sold by the Metropolitan Board of Works to trusts,

and public companies, and private persons, having been built upon and

covered with artizans' dwellings.

Private building was proceeding at considerable pace, and in many parts

of London the ground was becoming more overcrowded than ever with

houses.

The older parts of London were being rapidly re-built, and open spaces

at the rear of buildings were being gradually covered by buildings.

Of St. Pancras the Medical Officer of Health wrote (1896):--

"... There is a prospect that in course of time the whole of the open

space about buildings may disappear.... Old houses possessing yards,

areas, open spaces, in some form at the front or back or both, are

being re-built in such a manner as to entirely cover the whole ground

area two or three storeys up--leaving not a particle of open space."

The restrictions imposed by the Building Acts were of the most illusory

character, and as the Acts were mostly future in their operation,

and not retrospective, their effect was also limited. Any "owner"

was entitled to re-build on "old foundations," no matter how crowded

the houses were on the spot, so new buildings were usually only a

resurrection in huger and more perpetual and objectionable form of the

evils which ought, as far as possible, to have been eradicated.

During the year 1894 the London Building Law was consolidated and

amended. The Act recognised, for the first time in London, the

principle that, in addition to the height of the building being

proportionate to the width of the street on which it abuts, the amount

of open space about the rear of a building should also be proportionate

to its height, and hence the future crowding of buildings on area was

put under limitation.

But how small was the limitation, how small the concessions exacted

from "owners" in this matter, and how miserably late they came in the

history of London building operations.

The tendency of house construction in London was to ever larger size,

to greater height. To how great an extent this had been carried on in

the "City" was described by the Medical Officer of Health in 1894:--

"It would be a fair and moderate estimate to put the superficial area

(of the City) at _four square miles_ instead of one. We have only to

point to the construction of business premises--the piling of one

floor over another for many storeys high, each floor being occupied

by separate occupiers, forming in itself a distinct tenancy, having

all the rights and privileges of an independent building, and claiming

as much attention from every branch of our municipal system as if it

stood alone.... We have, in fact, to deal with about 28,000 separate

tenancies, with a day population of 301,384."

In some of the more well-to-do parts of the metropolis great blocks

of buildings were built and let out in flats, most of them with the

minimum of light and air prescribed by narrow laws.

In other districts of London considerable numbers of small houses were

removed, and large blocks of artizans' dwellings erected in their

stead. Thus, in the parish of St. Luke, nearly one-fifth of the entire

population resided in the ten blocks of artizans' dwellings which

existed there.

In the earlier stages of the reform of the housing of London such

buildings had been acclaimed as great improvements, as indeed they

were. The later opinions of Medical Officers of Health were not

so laudatory. Thus, in 1891, the Medical Officer of Health for

Whitechapel, after stating that there were in his district 27 buildings

having 3,127 apartments containing 12,279 persons, added that he was

"not enlisted amongst the enthusiasts of this method of providing for

the housing of the working classes." In 1896 he wrote: "All model

dwellings are not equally models of good sanitary houses." And in

1897:--

"The increased population are housed in huge barrack buildings which

sometimes are constructed so as to allow light and air to permeate the

rooms and sometimes not. The effect of this modern invention is to

increase the density of population to a damaging degree....

"That the direct influence of these barrack buildings upon the health

of their occupants--more especially the children--is adverse, I have

not the slightest doubt."

The Vestry of Shoreditch reported in 1892-3:--

"'Model Artizans' Dwellings' do not appear to have been quite what

their title implied. At Norfolk Buildings, Shoreditch, on the Medical

Officer of Health causing them to be examined for a certificate for

exemption from the inhabited house duty, the whole system of drainage

was found to be in a most defective and dangerous state. A number of

cases of typhoid, diphtheria, and other infectious illness had occurred

on the premises."

And a couple of years later the Chief Sanitary Inspector submitted to

his Vestry a report on some so-called "model dwellings": "These blocks

of buildings, 50 feet high, are packed together so as to exclude light

and air, and four rooms occupy the site of two: evil conditions which

the architect and owner were not only privileged to create, but also,

and very practically, in so doing were they privileged to condemn

unborn generations of people, whose necessities condemn them to live in

these tenements, to endure the evils of their creation."

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

"Block dwellings in such an area as St. James' do not provide the

conditions in which healthy children can be reared, nor in which there

can be a family life comparable with that possible in the open suburbs

of London."

The Medical Officer of Health for St. Olave gave a description of

Barnham Buildings:--

"Many of the rooms, &c., on the ground and first floor are generally

very dark, and the buildings have not been maintained in a sanitary

condition, notwithstanding the hundreds of notices that have been

served the past five years. The average death-rate of the past five

years of the unhealthy tenements was at least 49·6 per 1,000 and of the

remainder at least 29·1."

The Medical Officer of Health for St. Marylebone gave an interesting

explanation of the condition of this class of houses:--

"The following is a list of applications, under the Customs and

Inland Revenue Act, 1891, from which it will be gathered that it is

quite exceptional for a block of artizans' dwellings of even recent

construction to be in a tolerable sanitary condition. The reason for

this anomalous state of things is, that in the building of these

dwellings the Sanitary Authority seems to have no power; a dwelling

must be occupied before it comes under supervision."

In spite of these and many other drawbacks, however, many of these

buildings afforded accommodation far superior to that which had

previously existed on the spots where they were erected, and provided

residence for large numbers of people who otherwise might have been

doomed to living in the worst class of tenement-house.

Closely connected with the Public Health Act of 1891 was another Act

passed in the same year--"The Factory and Workshop Act."

The Select Committee of the House of Lords on the Sweating System had

finished their inquiry and reported in 1890. The evidence given before

it was, as regarded factories, workshops, and workplaces, very much a

repetition of that which for thirty-five years had been detailed by

Medical Officers of Health as regarded the dwellings of the people, but

now obtaining greater publicity attracted more attention.

Overcrowding and insanitation of almost every conceivable kind pursued

large numbers of the unfortunate workers from their overcrowded and

insanitary tenements to their overcrowded and insanitary workplaces,

and with the same disastrous results. And as regarded domestic

workshops the conditions were even worse, workers spending their days

and nights often in the one room--sometimes with extra workers brought

in.

Want of light and air and overcrowding in workshops and factories are

quite as serious matters as they are in inhabited houses.

The Select Committee, in their conclusions and recommendations, said:--

"The sanitary conditions under which the work is conducted are not only

injurious to the health of the persons employed, but are dangerous to

the public, especially in the case of the trades concerned in making

clothes, as infectious diseases are spread by the sale of garments

made in rooms inhabited by persons suffering from smallpox and other

diseases. Three or four gas jets may be flaring in the room, a coke

fire burning in the wretched fireplace, sinks untrapped, closets

without water, and altogether the sanitary condition abominable."

"A witness told us that in a double room, perhaps nine by fifteen feet,

a man, his wife, and six children slept, and in the same room ten men

were usually employed, so that at night eighteen persons would be in

that one room."

"In nine cases out of ten the windows are broken and filled up with

canvas; ventilation is impossible and light insufficient--the workshops

are miserable dens. We are of opinion that all workplaces included in

the above description should be required to be kept in a cleanly state,

to be lime-washed or washed throughout at stated intervals, to be kept

free from noxious effluvia, and not to be overcrowded--in other words,

to be treated for sanitary purposes as factories are treated under the

factory law."

Lord Kenry, Chairman of the Committee, in his draft report, said:--

"It has been shown that the dwellings or shops in which the sweated

class live and work are too often places in which all the conditions

of health, comfort, and decency are violated or ignored.... Sanitary

inspection is totally inadequate, and the local bodies have seldom

done their duty effectually. At the East End of London generally the

sanitary state of homes and shops could not possibly be much worse than

it is."

And Mr. Lakeman (Government Inspector under the Factories and Workshops

Act) said, in reference to workshops: "I think that the evidence given

your Lordships upon the insanitary state of those places is not at all

too black."

Once more the necessity of inspection was insisted upon. "On no point,"

wrote the Chairman, "was the unanimity of witnesses more emphatic than

with reference to the necessity of more efficient sanitary inspection,

not only of workshops, but of the dwellings of the poor."

And just as it was as regarded tenement-houses, inspection here was

lamentably deficient, if not absolutely non-existent.

"The inspection at present carried on is totally inadequate,

and nothing was more clearly proved before us than the fact that

satisfactory results cannot be looked for from the system as it now

stands."[178]

"Even when an unmistakable cause of unhealthiness is discovered, and

steps are taken to remove it, the process of applying the remedy is

slow and uncertain. The Local Board meets once a week or fortnight ...

the landlord is allowed a fortnight to carry out the work; three weeks

may elapse before the inspector can go and see it, then perhaps nothing

has been done; the summons, &c., takes time. In any case much valuable

time is lost, and smallpox or fever is allowed to pursue its ravages

with the source of the disease daily aggravated in intensity.

"At present the inspectors under the Factory and Workshop Act of 1878

have no power to deal with any nuisance which lies within the district

over which the local authorities preside. On the other hand, the local

inspector cannot interfere should he discover any breach of the Factory

Act."

The Home Secretary, in moving the second reading of the Bill, explained

its scope. He said:--

"The design and object of this Bill is to bring all workshops and

all factories up to the same sanitary level, and to require the

same conditions as to ventilation, overcrowding, lime-washing, and

cleanliness to be applied to all kinds of workshops in which men alone,

or women, children, and young persons are employed. The Bill does not

deal with 'domestic workshops.' The President of the Local Government

Board will introduce a Bill dealing with the public health, and the

House may rest content with leaving what is called 'the domestic

workshop'--that is to say, the working-man's home in which he works

with the members of his family--subject to the provisions of the law of

public health alone. It is obvious that in the domestic workshop you

have not got the presence of the employer and the employé. You have

the members of the same family ... and it seems to me that we may

allow him and his family to work in a place which is sufficiently good

so far as sanitary conditions are concerned for him and his family

to live in. Now that we are extending the sanitary provisions of the

Factory Act to all workshops throughout the country, of whatever kind

they may be except the domestic workshop, so that every cobbler's

shop, every blacksmith's shop, every tailor's shop, will come under

the provisions of the sanitary law, it seems to me foolish not to take

advantage of the existing machinery provided by the local authorities,

and the enforcement of the sanitary provisions, so far as workshops are

concerned, is by this Bill given to the local authorities."

The passing of the Factory and Workshops Act (1891) and of the Public

Health (London) Act of 1891 made the sanitary authorities primarily

responsible for enforcing many new provisions. Those authorities were

charged with the duty of securing the maintenance of the "workshops"

in a sanitary condition, of preventing overcrowding in them, and

of enforcing cleanliness, ventilation, lime-washing, and freedom

from effluvia, and securing the provision of sufficient sanitary

accommodation.

Added to this was the sanitary supervision of the places of

"outworkers."[179]

It would appear, however, that only in exceptional instances was any

systematic attempt made in 1892 to carry out the new duties imposed by

the Legislature upon the Vestries and District Boards.

In several instances the Medical Officers of Health drew attention

to the impossibility of undertaking workshop inspection with their

existing staff. Thus the Medical Officer of Health of Hackney:--

"Inquiry has revealed the presence of something like 2,000 workshops

and dwellings of outworkers which, under this Act and Order, should

be inspected to ascertain the presence or otherwise of any insanitary

condition. With the present staff it is impossible that this can be

attempted."

In St. Marylebone the Medical Officer of Health stated, in 1894, that

the number of workshops and workplaces in his parish amounted to 3,550.

And in 1895 he wrote: "The workplaces are so numerous in the parish

that it is not practicable for them all to be inspected regularly with

the present staff."

"Increased duties," wrote the Medical Officer of Health for Fulham in

1893, "having been placed on the sanitary staff by the 'Factory and

Workshop Act' of 1891, relating to outworkers; but with the existing

number of inspectors it is not possible to attend to them thoroughly,

so that the Act in Fulham is almost 'a dead letter.'"

"In Islington," reported the Medical Officer of Health in 1895,

"neither the factories nor workshops in the district, nor the smoke

nuisances receive any attention worth mentioning, and so far as this

district is concerned they may be said to have been entirely neglected.

"I look upon the inspection of factories and workshops as one of the

greatest necessities of the present day, not only from a health point

of view, but also from the social aspect."

The manifest solution of this difficulty was the appointment of

additional inspectors, but the local authorities had a sort of horror

of such appointments, though by this time they must have known that the

benefit to workers and to the community generally would have been very

great.

A report in 1892 of the Medical Officer of Health of St.

George-the-Martyr shows the grievous need there was for inspection of

one very important class of workshop:--

"I have inspected sixty-three retail bakehouses within the parish, and

found them (with few exceptions) to be in a filthy and unwholesome

state, dangerous alike to the health of the journeyman baker, who makes

the bread, and to the public who eat it. Twenty-one were completely

underground.... In times of heavy rainfall sewage forces itself through

the draintraps of these cellars, soiling the sacks containing flour,

and fouling the atmosphere."

Parliament again legislated about factories and workshops in 1895.

Under the Act a minimum space was required in each room of a factory

or workshop of 250 cubic feet for each person employed. For the

prevention of the infection of clothing, the occupier of a factory,

&c., was prohibited from causing wearing apparel to be made or cleaned

in a dwelling-house having an inmate suffering from scarlet fever or

smallpox. An important step was also taken in extending the provisions

of the Factory Acts to laundries, of which there were a great number

in London, and where the workers stood in great need of improved

conditions of work, and of public supervision.

Lamentable as were the results of the non-protection of the workers in

workshops, still more lamentable and disastrous were they as regarded

the 2,310,000 dwellers in the 630,569 tenements of less than five

rooms. Up to 1889 regulations under the Sanitary Acts of 1866 and

1874 had been adopted in 31 of the 40 London sanitary districts. In

only nine of these was any considerable use made of them. Had these

regulations been put into force a great amount of overcrowding would

have been prevented and the houses kept in a fairly clean and sanitary

condition.

In the whole of London, with its 547,000 houses, only 7,713

tenement-houses were on the register in 1897, of which more than a

half were in four parishes, namely: 1,500 in Kensington, 1,190 in

Westminster, 840 in Hampstead, and 610 in St. Giles'; leaving 3,573 in

the whole of the rest of London--a mere fraction of the tenement-houses

of London.

In Bethnal Green (1894), "76·1 per cent. of the population lived in

tenements of less than five rooms. No houses had been registered."

In Lambeth over one-half of the population lived in tenements of less

than five rooms, and of these nearly one-third lived under conditions

of overcrowding. There was one Sanitary Inspector to about 60,000

people. The inadequacy of the staff had been pressed upon the Vestry by

the Medical Officer of Health from time to time for a number of years.

Considerable ingenuity was in many cases exercised by the opponents

of the regulation of tenements in the working of the bye-laws which

resulted practically in rendering them inoperative. In some cases all

houses were to be exempted where the rent was higher than certain

specified weekly sums. The result was that the "owners" promptly

raised the rent above these sums, and so secured their exemption, at

the same time getting an increased rent. In others, the bye-laws gave

the Vestry power to decide what houses should be registered, and thus

enabled the Vestry to evade the necessity of registering any at all.

In others, notices were to be given to the "owner" before a house was

registered--the notice was not sent. And so, in one way or another, the

imperative "shall" of Parliament was evaded by the largest proportion

of the Vestries and District Boards.

As regarded the Vestries and District Boards who made a show of putting

the regulations in force, the Medical Officers explained that, owing to

the inadequacy of the staff of Sanitary Inspectors, it was "impossible"

to inspect the houses regularly.

In other parishes and districts the number registered and inspected

was but a fraction of the houses which ought to have been registered.

In Bow (in Poplar) where none were registered, the Medical Officer of

Health wrote in 1891: "I should say 4,000 houses require registration."

In St. Mary, Newington: "At least 80 per cent. of the houses are

occupied by members of more than one family." But as yet none were

registered. And this same Medical Officer of Health pointed out how in

his parish--"The indisposition that has hitherto been shown on the part

of the Vestry to put into force the bye-laws for houses let in lodgings

has led to great license in house-farming and house-crowding."

Where really put into operation the regulations had an excellent

effect. Thus the District Board of St. Giles' said: "The advantage of

these regulations has been very great."

And in Paddington the Medical Officer of Health stated: "The work done

... has had an excellent effect."

Of some streets where houses were registered (1897-8)--"The

whitewashing and cleansing has without doubt had a good effect. The

streets have been freer from infectious diseases than they have been

for several years past."

The advantages of the regulations in the administration of the health

laws were time after time pointed out and insisted upon by many Medical

Officers of Health.

The Medical Officer of Health for Westminster, where nearly 1,000

houses were registered, wrote (1899):--

"The great advantage in legal procedure lies in the fact that a breach

of them is a finable offence with a further daily penalty after written

notice, and is not a nuisance subject to abatement within a certain

time.

"If the conditions imposed by the bye-laws are carried out, no doubt

one of the best methods for preventing overcrowding is thus achieved."

The advantage of this quicker procedure was manifest, for, under the

other Public Health or Sanitary Acts, the whole process of dealing

with, or getting a nuisance abated, took "a long time--a very long

time," but the advantages did not appeal to people who did not want to

use them.

Thus there was a most grievous neglect of duty on the part of the great

majority of the Vestries and District Boards, with the inevitable

result of the most disastrous consequences to the working and poorer

classes all over London.

It must have appeared strange, in view of this glaring and scandalous

neglect of duty by the Vestries in enforcing the regulations, that the

London County Council as the Central Authority did not use the powers

which they were supposed to possess of acting in the default of the

local authorities, or of making representation to the Local Government

Board of the neglect of those authorities.

The explanation was, that in the administration of this, absolutely

the most important of all branches of the housing problem of London,

the London County Council, had been left entirely out--had not even

been given a voice in the framing of the bye-laws or regulations,

and therefore had no legal power to act. Regulations or bye-laws,

drafted by the Local Government Board as "models" for adoption by

the local authorities, suggested "exemptions" to what Parliament had

directed--though there was not a single word in the 94th Section or in

any part of the Act to justify such a suggestion--or suggested phrases

in them which actually placed the enforcement or non-enforcement of

the Act in the discretion of those authorities, this, too, though

Parliament had made the explicit imperative enactment that these local

authorities should make and enforce regulations.

Most of the Vestries made bye-laws under Section 94 of the Act, nearly

all containing exemption or elusive clauses as suggested; some even

avowedly reserving to themselves the option of registering or not

registering houses, as they thought fit.

The London County Council was not in a position to act in their

default, as these authorities could shelter themselves under the option

contained in the terms of the regulations, and a representation to the

Local Government Board would have been useless, as the same defence

would be effectively made by the local authorities if called to account.

Thus, the deliberate enactment of Parliament was frustrated; the Act

was prevented being a remedy for overcrowding, or even a protection

against it, and except in a few parishes or districts where the great

advantages of the Act were appreciated, all the dreadful evils of

overcrowding were given free play, and allowed to flourish on as

gigantic a scale as ever.

The effects of the inaction of the Vestries and District Boards were

unfortunately not confined to the moment. A legacy of suffering, of

misery, and physical deterioration was left to subsequent generations.

Once more might hundreds of thousands of voices of the victims and

sufferers have cried out: "While you remain inactive, death and disease

do not."[180]

A special census of the population of London was taken on March 29,

1896, which showed that the population had increased to 4,443,018

persons, being an increase of 200,900; and the number of inhabited

houses from 547,120 to 553,119.

As years had gone by, and the necessity and importance of sanitation

had become more widely recognised, and as London had grown in size and

increased in population, the duties of the Vestries had grown heavier,

and the tendency of legislation was to broaden the basis of their

action.

The mileage of public streets to be paved, lighted, cleansed, and

watered, had multiplied two, three, and four times since 1855; the

number of houses in many districts had more than doubled; the drainage

work had increased proportionally; the scavenging and removing of

refuse also. Nominal duties had become real ones, and new duties had

been added--the disinfection of infected houses and infected clothes,

the inspection of food, the working of the Food and Drugs Act--these,

with numerous smaller matters, meant a very considerable amount of

work, expense, and responsibility.

But all these were what one of the Vestries in their Report described

as "well-worn grooves of familiar routine." In addition thereto,

and now more than ever of primary importance, was the great duty of

inspection--inspection of houses, and of rooms in houses, and of

workshops, and often the consequent proceedings for the abatement of

nuisances, or the punishment of offenders.

"House-to-house inspection," wrote the Medical Officer of Health for

Islington in 1893, "is the only efficient remedy for extensive sanitary

evils. It is the life and soul of sanitary work."

House-to-house inspection of their districts was the most necessary of

all sanitary work--as it was the means by which most sanitary defects

and malpractices were detected--but it was the first to be sacrificed

under the increased pressure of work, and the last for which adequate

provision was made.

"A house-to-house inspection has been attempted more than once," wrote

the Medical Officer of Health for Islington in 1893, "but it has never

yet been brought to a complete and satisfactory finish."

In fact the main breakdown of the Vestry administration in London

was their antipathy to inspection, and their refusal to appoint a

sufficient number of inspectors.

"The subject of overcrowding alone," wrote one Medical Officer of

Health, "if properly attended to, would pretty well occupy the whole of

the time of the present staff."

The complaints of the Medical Officers of Health were frequent and

insistent on the inadequacy of the inspectorate. Thus the Medical

Officer of Health for Fulham wrote:--

"The Vestry must clearly understand that the present staff of Sanitary

Inspectors is quite inadequate to properly perform the duties devolving

upon the Sanitary Authority. There is only one Sanitary Inspector to

every 35,000 inhabitants. Should the Vestry persist in their refusal to

employ an adequate staff, the inference will be unavoidable that they

are unwilling that the Acts--for the faithful administration of which,

in the interests of the public health, they as Sanitary Authority are

responsible--should be properly carried out."

Interesting light is often to be found in the reports sometimes of the

Vestries, and oftener of the Medical Officers of Health, upon various

aspects of the great housing problem.

Sometimes a sentence enables so much else to be understood. Thus, in

1892, a Medical Officer of Health wrote:--

"Many persons think the Public Health Act an innovation on their

privileges."

Describing the insanitary condition of 230 houses in Provost Street,

Shoreditch, the Sanitary Inspector wrote in 1892:--

"The difficulty of dealing with these houses has been greatly increased

by the circumstance that the leases will expire in a very few years.

There was, therefore, a very natural objection on the part of many of

the leaseholders to execute substantial works, of which the freeholder

would in a few years reap the benefit, and without contributing

anything to the expense of the improvements."

This "very natural objection" entailed, of necessity, sickness and

death upon a considerable number of persons.

The Vestry of St. Pancras wrote in 1893:--

"The primary cause of houses and buildings becoming insanitary is the

neglect of freeholders to compel lessees to comply with the terms

and conditions of their leases. If the Vestry were empowered (where

freeholders are negligent) to compel freeholders to cause lessees to

carry into effect the covenants of the leases, the houses inhabited by

the poorer classes would not become so wretchedly dilapidated and a

scandal, but might be maintained in a fairly habitable condition."

The Medical Officer of Health for Bethnal Green exonerated some

property owners, whilst fixing the blame on others.

"... As a rule it is the professional insanitary property owner who has

to be summoned time after time, and who exhausts every technicality and

raises every possible objection, well knowing that in the usual way

only an order costing some few shillings will be made against him."

Others, however, went further. The Medical Officer of Health for

Islington wrote in 1893:--

"Since 1891 there has been a steady forward movement, and ... one now

constantly hears of the persecution of the 'poor property owner.'

"That owner who for long years had everything his own way, and who did

as little as he could to make things healthy for his tenants, knowing

well that there were plenty of persons ready to occupy any or every

house. Property has rights, but so has flesh and blood; and if it be

right that property should be protected from unnecessary exactions, it

is surely righteous that the health and lives of human beings should be

safeguarded in every way."

And in the following year, writing about some insanitary bakehouses, he

said: "It has always seemed to me a very absurd argument that because a

place has been allowed to be occupied for a long series of years to the

detriment of the health of the people working therein that therefore it

must not be now abolished.

"If those insanitary places have been occupied for such a long time,

surely they have more than recouped their owners for the money that has

been originally spent on their erection?"

The Medical Officer of Health for St. James', after twenty-five years'

work as Medical Officer of Health, declared in 1898:--

"The only practical course is to saddle the landlord with full

responsibility for the neglect or misconduct of the tenants whom he

harbours, at large rents, for his own profit."

In 1894 Parliament passed "The Local Government (England and Wales)

Act," which included London in its scope, and which introduced

great changes as to the electorate, the mode of election, and the

qualification of vestrymen.

A new electorate on almost the widest basis was created, all persons,

male or female, on the Parliamentary or County Council Register,

including lodgers and service voters, and married women, who were

themselves tenants of property, being made parochial electors; and the

Vestry was to be elected under the provisions of the Ballot Act of 1872.

Thus the scandals hitherto associated with Vestry elections were for

the future obviated, and greater publicity--that safeguard of all

public bodies--was assured.

Additional powers were also obtainable under the Act by the Vestries

on application to the Local Government Board, who could transfer to

the Vestry the powers and properties of the Library Commissioners, the

Baths Commissioners, and the Burial Board; the power of appointing the

Overseers of the Poor, and some other powers and duties of more or less

importance, possessed or possessable by Parish Councils. The elections

were held on December 15, 1894.

The new Vestries, however, did not mend the ways of their predecessors

as regarded "inspection."

Of Bethnal Green the Chief Sanitary Inspector said (1897): "With the

existing staff (five Inspectors) and having regard to other work, it

would take five years to visit all the houses in the parish--about

17,000."

The Medical Officer of Health for Kensington wrote (1898): "The staff

is quite inadequate for the discharge of the duties devolving upon your

Vestry as Sanitary Authority."

And the Medical Officer of Health for Hammersmith wrote in 1899: "The

house-to-house inspection of the district is now nearly completed, and

has taken six years to accomplish. The result of the inspection is in

the highest degree satisfactory ... nevertheless it cannot be contended

that inspecting the district once in six years is properly carrying out

the 1st Section of the Public Health (London) Act, 1891."

A series of investigations was made by the Medical Officer of Health

of the London County Council, or by his assistant, into the sanitary

condition of various parishes or districts, and an instructive light

thrown upon the administration of their affairs by their respective

local governing authorities.

Almost uniformly, so far as they were concerned, it was found that

bye-laws as to houses let in lodgings were not enforced, and no, or

practically no inspection of workshops, of which there were thousands,

nor of "outworkers" had been carried out, and that the sanitary staff

was quite inadequate for the work.

Though much was thus most unsatisfactory, yet in many other important

matters which vitally affected the public health, considerable progress

was being made.

In the matter of water supply a steady but slow improvement had, under

public pressure, taken place. In 1892 a Royal Commission was appointed

to inquire as to whether the existing sources of supply were adequate,

and it reported in the following year.

"We are strongly of opinion," they said, "that the water as supplied

to the consumer in London is of a very high standard of excellence

and of purity, and that it is suitable in quality for all household

purposes. We are well aware that a certain prejudice exists against

the use of drinking water derived from the Thames and the Lea, because

these rivers are liable to pollution, however perfect the subsequent

purification by natural or artificial means may be; but having regard

to the experience of London during the last thirty years, and to the

evidence given us on the subject, we do not believe that any danger

exists of the spread of disease by the use of this water, provided that

there is adequate storage, and that the water is efficiently filtered

before delivery to the consumers."

This statement was to a certain extent satisfactory, but the fact

remained that both the Thames and Lea still received sewage effluents

above the intakes, and considerable pollution from other causes; and

that diseases might still be water-borne and water-distributed by them.

The thoroughness of the filtration also was often open to doubt.

Improvement was gradually being effected in the system of removal or

disposal of filth and refuse of all sorts and kinds; the sweepings of

the streets, the refuse from houses. According to the general practice

of the local authorities the great bulk of this stuff was first brought

to yards or places, the property of the authorities, and there sorted

or sifted and sent down the river or along the canals in barges, or

sometimes even by rail to the country. But the system was costly and

insanitary and inefficient, and as was pointed out--"it could not be

deemed satisfactory when large metropolitan districts inflict their

filth upon smaller communities in urban districts."

A system of destroying much of this filth by fire had been devised,

and gradually was adopted by the local authorities. It was found that

with a properly constructed and efficient destructor no nuisance need

result, and this method of disposing of house refuse was much more

desirable from a sanitary point of view than that usually adopted by

London Sanitary Authorities.

A certain number of local authorities adopted this method to the great

advantage of the community, and though there is still much to be done

in this direction, the change, so far as it has gone, has undoubtedly

minimised a great evil.

Both numerous and various are the measures which have to be taken for

the protection of the public from disease. One of the most essential

of these was disinfection--the disinfection of rooms where there

had been infectious or contagious disease, and the disinfection or

destruction of clothing or articles used by the person suffering from

the disease. The process of disinfection originally was of the most

primitive character and doubtful efficacy, but the progress of science

had elaborated really effective methods.

In 1866 the local authorities had been given power to provide a proper

place with all necessary apparatus, &c., for the disinfection of

infected clothing, &c., free of charge, and to give compensation for

articles destroyed. Thus every inducement was given to the public to

get infected articles disinfected. But many years were to pass before

provision by the Vestries was extensively made.

By the Public Health London Act, 1891, this provision was made

imperative on the local authorities.

Disinfection by steam was considered practically the only efficient

system. By 1895 twenty-four sanitary authorities had provided

themselves with this apparatus, six with an apparatus whereby

disinfection was effected by dry heat, and eight had arranged with a

contractor.

When it is a fact that a few infected rags could let loose disease of

the worst type upon a community, the advantages to the public of the

general practice of disinfection were incalculable. And in London the

advantages were specially great.

In almost every district hundreds of houses were disinfected every

year, and thousands--even tens of thousands--of articles.

The system of the compulsory notification of infectious diseases

facilitated greatly the work of disinfection, for by informing the

authorities where cases of such disease occurred it enabled them to

scotch disease in its breeding-places, and so it was of the greatest

benefit to the community. How great may be gathered from the following

figures.

The number of cases of Infectious Diseases in London notified under the

Act of 1889 were:--

29,795 in 1890

46,074 " 1892

67,485 " 1893

49,699 " 1896

42,344 " 1899

Of those in 1893:--

36,901 were cases of Scarlet Fever

3,633 " " Enteric "

22 " " Typhus

13,026 " " Diphtheria

2,813 " " Smallpox

Great work was being done in the prevention of the spread of infectious

disease in London by the Metropolitan Asylums Board, in whose hospitals

thousands of persons suffering from such disease were isolated.

Dr. G. Buchanan, Chief Medical Officer to the Local Government Board,

wrote in 1892:--

"In regard to some infectious cases, notably those of scarlet fever and

diphtheria, there are no means at all to be compared to isolation in

hospital for preventing the spread of a limited number of cases into a

formidable epidemic.

"And the wonderful and repeated checks to small outbreaks of smallpox

in the metropolis in the course of the past seven years bears

overwhelming evidence to the truth of this dictum."

As the population of the metropolis increased in density it became more

and more necessary in the interests of the people as a whole to make

proper and sufficient provision for the prompt isolation of those of

its inhabitants who might be smitten with infectious disorders.

Home isolation in London was difficult even under the best

circumstances, but in the smaller tenements it was impossible.

"The removal to hospital of so many of the cases (of scarlet fever) is

a vast blessing to this neighbourhood," wrote the Medical Officer for

St. Mary, Newington, in 1897.

For some time a growing tendency on the part of the public to accept

hospital treatment for infectious cases had been evinced.

"The 'depauperisation' of the Hospitals had led to a great increase in

the admissions, so that the public are on the whole very willing to

take advantage of the facilities offered for having their infectious

sick cared for in hospital, whereby the other members of the patient's

family can follow their avocations without hindrance and without risk

to the public generally."

The Chief Sanitary Inspector for Bethnal Green gives information as to

the numbers who from his parish availed themselves of the hospitals.

"A satisfactory feature, and of the greatest assistance in dealing

with infectious disease, is the large number of patients now sent

to hospital. This year nearly two-thirds of the cases notified were

removed. The importance of this either to the patients themselves or to

the public can hardly be overestimated."

By the Public Health London Act, 1891, every inhabitant of London

suffering from any dangerous infectious disease was entitled to free

treatment at one of these hospitals.[181] On receipt of notice an

ambulance was at once sent for his removal.

Year by year greater use was made of the Board's hospitals, and at

times there was not sufficient room in the Metropolitan Asylums

hospitals to receive all the cases. In 1892 the total number of

patients received amounted to over 13,000, there being at one time

4,389 patients suffering from all classes of fever or diphtheria

receiving treatment in the hospitals, whilst in 1893 the admissions

amounted to 20,316.

By 1895 the Board had eight fever hospitals, including diphtheria, with

3,384 beds; three ships for smallpox cases with 300 beds; and a large

hospital for convalescents with 1,200 beds. By 1898 the accommodation

had reached the large total of about 6,000.

The Chairman of the Metropolitan Asylums Board, reviewing in 1897 the

thirty years' work of the Board, said:--

"Whilst, during the first twenty years of the Board's experience,

London was again and again visited with epidemics of smallpox, during

the past seven years it has, thanks to the action of the managers in

having removed to and isolated at Long Reach all cases of the disease,

been practically non-existent as a health disturbing factor.

"The percentage mortality of smallpox cases treated by the Board

decreased from 20·81 in 1871 to 4·0 in 1896, and the annual mortality

from 2·42 to practically zero."

The rate of death from diphtheria also showed a continuous fall, and

this fall had been coincident with the introduction and increasing use

of the anti-toxic serum treatment of the disease.

A valuable criticism on the existing machinery for the sanitary

government of London was given in a report of the Metropolitan Asylums

Board Statistical Committee in June, 1892:--

"Although London possesses an ambulance service and a system of

hospitals admittedly unrivalled, yet it has no central authority

charged with the duties of tracing out an outbreak of this infectious

disease (smallpox), and of taking concerted action towards stamping it

out by measures of disinfection and vaccination and re-vaccination.

"These matters still remain in the hands partly of the 41 local

sanitary authorities, partly of the Local Government Board, and partly

of the London County Council.

"Clearly the present arrangements are not only cumbrous and incapable

of that rapid action essential to success in dealing with infectious

disease, but they are also excessively expensive."

In connection with hospital accommodation there were two other factors

in the sanitary evolution of London. One of these was the provision

made by the Poor Law for the treatment and care of the sick poor.[182]

Previous to 1867 the accommodation provided by the Poor Law for the

sick was in the sick wards of the workhouses. The Act of that year,

which had established the Metropolitan Asylums Board, laid the basis

for the removal to separate hospitals of paupers suffering from the

worst forms of infectious disease. The same Act authorised the building

and establishment of Poor Law infirmaries, thus removing most of the

sick from the workhouse wards, giving them better treatment and better

prospect of recovery.

In 1892 the number of new infirmaries was 24, containing 12,445 beds;

but a large proportion of the sick were still kept in the workhouses,

the returns for 1890 showing about 4,000 occupied beds in them.

And, in addition to these institutions, there were Poor Law

dispensaries. The establishment of these dated from 1870, and by 1890

there were 44 of them. The immense amount of work they did is shown by

the following figures: "In 1890 nearly 120,000 orders were given to

Medical Officers for attendance on patients, 53,572 being seen at their

own homes, and 59,149 at the dispensaries. It is calculated that there

are about eight attendances on each order. Favourable opinions were

expressed as to the quality of the treatment afforded at them."

There is no means of even forming an estimate of the results of

these great remedial agencies, but that they were an immense advance

on previous arrangements for the treatment of the sick poor is a

well-established fact.

The Lords Select Committee reported that:--

"The evidence on the whole appears to indicate a general recognition

of the high standard of efficiency attained by the best of the new

infirmaries.

"The poor do not generally regard the infirmary as they do the

workhouse; they look upon it rather as a State-supported hospital; they

come to the infirmary, are cared for, cured, and go out again without

feeling that they are tainted with pauperism."

The other great factor in the sanitary evolution of London was the

group of great hospitals--general and special--supported, not by the

State nor by aid from the local rates, but by the charitable public,

and governed and managed and worked not by officials, paid either by

the central or local authorities, but by men--lay and medical--who,

from the highest and most public-spirited motives, devoted themselves

to this responsible work.

The general hospitals in 1890 numbered nineteen--some of them great

institutions, such as St. Bartholomew's, St. Thomas's, Guy's, the

London Hospital; and the number of special hospitals--many of them

small--was stated to be 67 in 1890.

"The total number of beds in the general and special hospitals in

London combined was stated by Dr. Steele to be 8,500, of which 6,500

are continually employed. But according to Mr. Burdett--8,094 and

6,143."

"The vast numbers of persons who are treated in out-patients'

departments of hospitals, the number treated at the eleven hospitals

with schools, were estimated by one witness at over half a million."

Here, again, no precise estimate can be formed of the part these great

institutions have taken in the sanitary evolution of London. That their

part has been a really great one is evident without figures--proved

not only by the millions restored to health and capable citizenship,

but even more by their adopting and reducing to practice, and placing

within the reach of the whole community, the vast benefits following

the great scientific discoveries of recent times.

Among the many causes of insanitation, and all its miserable

accompaniments, one of the most hopeless and most difficult to deal

with has always been intemperance or "drink." Statistics give no means

of estimating its disastrous consequences, but these consequences

always have been, and still are, of the most deplorable kind. The

overcrowded dwellings and bad sanitary arrangements constantly tended

to increase the habit of intemperance, and the moral degradation

caused by drink made people indifferent to their housing, and lead to

the poverty which increased overcrowding and insanitation.

In London the facilities for obtaining drink are practically unlimited.

In the evidence given before the Royal Commission on Liquor Licensing

Laws, which was appointed in 1896, it was stated that:--

"In Soho District, in an area of a quarter of a square mile, there were

1950 inhabited houses and 116 public-houses. In another district, a

little over half a square mile in extent, there were 259 public-houses

(excluding restaurants and private hotels)."

Down one mile of Whitechapel Road there were 45 public-houses.

"The streets branching off, the hinterland, are also thickly supplied;

some exactly opposite each other."

"In one street in St. George-in-the-East so crowded are the

public-houses that there are 27 licensed houses out of 215 houses."

And these facilities are intensified by the great number of hours

during the day in which licensed houses keep their doors open to all

comers.

Parliament has done but little to mitigate this terrible evil. Happily,

however, other influences are at work.

The Royal Commissioners in their Report in 1899 said:--

"Most persons who have studied the question are of opinion that actual

drunkenness has materially diminished in all classes of society in the

last twenty-five or thirty years. Many causes have contributed to this.

The zealous labour of countless workers in the temperance cause counts

for much. Education has opened avenues to innumerable studies which

interest the rising generation. The taste for reading has multiplied

manyfold within a comparatively brief period. The passion for games

and athletics, which has been so remarkably stimulated during the past

quarter of a century, has served as a powerful rival to 'boozing,'

which was at one time almost the only excitement open to working men."

And then followed this weighty statement: "Yet it is undeniable that a

gigantic evil remains to be remedied, and hardly any sacrifice would

be too great which would result in a marked diminution of this national

degradation."

And the Chairman of the Commission (Viscount Peel), the Archbishop of

Canterbury, and seven Commissioners in a Minority Report stated that--

"The broad facts remain unchallenged of the prevalence of the evil

arising from drink."

That drink and insanitary housing constitute a vicious circle should by

no means deter the most vigorous efforts being continued to improve the

conditions of housing and to raise the standard of the public health.

There was widespread testimony through the latter half of the decade

that the public health in London was improving. Thus the Medical

Officer of Health for the Bow District in Poplar wrote in 1895: "We

have only to remember what London used to be, and consolation can be

found in the comparison. Epidemics are not so frequent, disease is

not so virulent, and those attacked stand greater chances of recovery

through better and more skilful treatment."

And the Medical Officer of Health for Paddington in 1896: "There

has been a steady diminution in water-borne disease since

efficiently-filtered Thames water has been substituted for the numerous

wells and pumps of former days."

The Medical Officer of Health for the Strand reported in 1897: "The

Strand District (as to health) compares favourably with other years.

The result of your labours is a steady improvement in the health of the

inhabitants."

And the Medical Officer of Health for Islington in 1897 reported the

death-rate as 15·80--the lowest since registration was introduced in

1837.

In Whitechapel "the policy of your Board has resulted in a considerable

saving of human life." The death-rate for the district in 1879 was 26·0

per 1,000, and in 1899 it was 19·3 per 1,000.

In Battersea the death-rate was 26·8 in 1871, and 17·6 in 1901.

But infantile mortality did not show a similar rate of improvement.

In many parishes there was a decided improvement. In many, however,

infantile mortality remained at a very high rate.

In Bethnal Green, in 1893, nearly half the total deaths were of

children under five years of age--a figure which drew from the Medical

Officer of Health the remark: "The ignorance of women of the working

classes on the subject of infant feeding is colossal." In 1896 it was

51·5 per cent., and in 1898 it was 49·7 per cent.

In Poplar the Medical Officer of Health wrote, in 1895: "I think it my

duty to point out the terribly high rate of infant mortality...."

In Of 1,000 Births in 1895 Died under 1 Year.

Bow 179

Shoreditch 199

St. George's-in-the-East 196

Limehouse 202

"It is an awful state of affairs that so many young children die every

year."

In Shoreditch, in 1896, 49·1 per cent. of the total deaths were of

children under five; in Islington, in 1896, 42·4 per cent.; in Hackney,

in 1898, 40·9 per cent.; in Fulham, in 1896, 51 per cent.

On the south side of the river--in St. George-the-Martyr, in 1894, it

was 58 per cent. of the total deaths; in St. Olave, Southwark, 48·6 per

cent. in 1896.

A most hopeful sign was the greater public interest taken in matters

pertaining to the public health.

The Medical Officer of Health for Islington wrote in 1892:--

"With the advance of education the public and Parliament appreciate the

importance of more and more safeguarding the public health."

In 1895:--

"They (middle class) will not tolerate the sanitation of a few years

ago; indeed, they expect that the houses they live in will at least

be rendered safe against the entrance of sewer gas, and themselves

safeguarded against infectious disease."

And the Medical Officer of Health for the "City" in 1894:--

"Attention has been more particularly directed to premises and

dwellings of the better class, the occupants of which are becoming more

and more exacting owing to the increased knowledge acquired by the

public on all sanitary questions. Some of these premises are of great

size and employ many hundreds of persons, and many enormous insurance,

banking, and gigantic commercial establishments."

And that there is a community of interest in a healthy London was

becoming more widely realised. That the fact should have taken so long

to be grasped is extraordinary as it was so manifest a one. Over and

over again it had been proved that disease was not restrained by the

paper boundaries of parishes, and that once set alight anywhere no

limit could be put to its widespread devastations. An unhealthy area in

any part of the metropolis constituted a danger to the whole. Nor was

disease a respecter of classes. All were interested in keeping it away.

And, after many painful lessons, people were realising much more than

formerly that disease was a most costly infliction. The Medical Officer

of Health for St. James', Westminster, in his report for 1893, set out

the business aspect of it:--

"The position of St. James', as the shopping centre for the best

retail trade of the West-end of London, makes the district more and

more a city of luxurious shops, hotels, clubs, and lodging-houses.

Increasing facilities for travel to the suburbs, and the increasing

value of premises, necessitate its utilisation for business purposes

during the day, and its comparative desertion at night.... Its resident

population of 25,000 persons is therefore an inadequate exponent of the

activity of its daily life, of the importance of its retail trade, and

of the necessity for active sanitation. An outbreak of smallpox or of

cholera would at once so damage the trade of the district as to inflict

upon its ratepayers a thousand times the cost which is now incurred

by their preventive sanitary service, and by the prompt removal of

infectious cases to suburban hospitals as is now done."

But that was only a single and a limited case.

The industrial classes realised to a greater extent than ever before

the disastrous results to themselves and their families of sickness and

ill-health; the prolonged suffering, the loss of work and wages, the

ensuing hardships. And it was upon them more than on others that the

effects of disease fell most heavily.

In most matters the interests of the various parts of London, and of

the various classes, are one and the same, but in none to anything like

the same extent as in the vital matter of public health. Here they are

one and indivisible.

But neither Parliament nor the Government had got so far as to

recognise that yet, and London--the great metropolis--with its

four-and-a-half millions of people, was left for its protection against

disease to a number of semi-independent local sanitary authorities who

had no authority beyond their own area, and who could take no action

for the safety of London as a whole.

One thing was absolutely certain--and that was that the civic life

of London had within the decade been lifted to altogether a higher

plane. The publicity of the proceedings of the central representative

authority--whether of its meetings in the Council Chamber, or of

its constant applications to Parliament for legislation embodying

far-reaching civic reforms in London--the triennial elections, when

the area of discussion was shifted from the Council Chamber to the

constituencies, quickened the interest and awoke the dormant masses of

the people to the importance of civic administration and of civic laws.

In this remarkable change the subject of the public health strode to

the front. Men began to realise how it entered into every branch or

part of their own lives and of their families, how its ramifications

invaded every part of their existence, how much their welfare and

comfort and even their existence depended upon it. And the people had

a great load lifted off them--the load of despair begotten by the

hopelessness of any amelioration of the conditions of life which so

long had weighed them down. They felt now that there was some one to

whom they could complain, some public authority who would see that

things would be righted, if they could be righted, and hope was born in

their lives.

In 1899 another change was made in the system of local government in

London.

The Act of 1888, while dealing with the central government of London,

had practically not touched the local areas. The work was felt to be

incomplete, and in 1893 Commissioners were appointed "to consider the

proper conditions under which the amalgamation of the City and the

County of London can be effected, and to make specific and practical

proposals for that purpose."

They reported in August, 1894. Their general conclusion was contained

in the following paragraph.[183]

"A consideration of the evidence we have received confirms the opinion

suggested by the course of previous inquiries and of legislation, or,

in other words, by the historic development of the metropolis, that the

government of London must be entrusted to one body, exercising certain

functions throughout all the areas covered by the name, and to a number

of local bodies exercising certain other functions within the local

areas which collectively make up London, the central body and the local

bodies deriving their authority as representative bodies by direct

election, and the functions assigned to each being determined so as to

secure complete independence and responsibility to every member of the

system."

In February, 1899, Mr. Balfour introduced in the House of Commons a

"London Government Bill."[184] He referred to the Act of 1888 which

created the London County Council as effecting a change "so much in

consonance with the traditions of English municipal government that it

is likely to be permanent," and said:--

"We recognise to the full that there must be a great central authority

in London."

"Broadly speaking," he said, "the administrative Vestry and the

District Board exist now as they were framed in 1855."

"It is with these administrative Vestries and District Boards that the

present Bill proposes to deal. It is with the subordinate area, not

with the central area, that we are now concerned.

"We do not propose to touch the City of London.

"We have determined that, by the appointed day it would be desirable

that all London should be divided into areas for local government,

and that every area should be simultaneously provided with all the

necessary machinery for government of its local affairs."

He mentioned the areas.

"The constitution of the governing bodies in these areas shall be

practically identical with the constitution which our great municipal

boroughs already possess....

"We propose that there should be mayor, councillors, and aldermen.