LONDON FROM THE SANITARY POINT OF VIEW.
In considering the sanitary conditions of a great city like London, it
behoves us to remember that it has been a place of importance since the
days of the Roman occupation of this country--that is, for some 1,500
years.
A place that has been peopled for centuries is very apt, in the absence
of special precautions, to become unwholesome by reason of the vast
accumulation of refuse. Roman London is many yards beneath the surface
of the present City. It has been deeply buried, and by what? By refuse
and debris from every source; and this in itself is necessarily a
danger to health, and doubtless has in times past greatly tended to
produce many of those diseases for which mediæval (and even modern)
London was noted.
SITUATION.
The situation of ancient London was most convenient for commerce,
and fairly good from a sanitary point of view. The advantages of its
situation have been dwelt upon by many writers, and were well summed up
by Edward Chamberlayne, who thus speaks of it in his “Present State
of England” (1682), a work which was analogous in many respects to the
“Whitaker’s Almanack” of the present day.
Chamberlayne says:--“In the most excellent situation of London the
profound wisdom of our ancestors is very conspicuous and admirable. It
is seated in a pleasant evergreen valley, upon a gentle rising bank in
an excellent air, in a wholesome soil mixed with gravel and sand upon
the famous navigable river Thames, at a place where it is cast into
a crescent, that so each part of the City might enjoy the benefit of
the river, and yet not be far distant one from the other; about sixty
miles from the sea; not so near, that it might be in danger of surprise
by the fleets of foreign enemies, or be annoyed by the boisterous
wind and unwholesome vapours of the sea; yet not so far but that by
the help of the tide every twelve hours, ships of great burden may be
brought into her heaving bosom; nor yet so far but that it may enjoy
the milder, warmer vapours of the eastern, southern, and western seas;
yet so far up in the country as it might also easily partake even of
all the country commodities; in an excellent air upon the north side
of the river (for the villages seated on the south side are noted to
be unhealthy in regard of the vapours drawn upon them by the sun), but
roughed by gentle hills from the north and south winds.
“The highways leading from all parts to this noble city are large,
smooth, straight and fair; no mountains nor rocks, no marshes nor lakes
to hinder carriages and passengers.” * * *
Chamberlayne, in speaking of the Thames, is, as well he may be, loud in
its praise:
“The river whereon is seated this great city, for its breadth, depth,
gentle, straight, even course, extraordinary wholesome water, and
tides, is more commodious for navigation than any other river in
the world. * * * This river opening _eastward_ towards Germany and
France, is much more advantageous for traffic than any other river of
England. To say nothing of the variety of excellent fish within this
river--above all of the incomparable salmon--the fruitful, fat soil,
the pleasant rich meadows and innumerable stately palaces on both sides
thereof; in a word, the Thames seems to be the very radical moisture
of this city, and in some sense, the natural heat too; for almost all
the fuel for firing is brought up this river from Newcastle, Scotland,
Kent, Essex, etc., or else down the river from Surrey, Middlesex, etc.”
After dwelling on the shipping and commerce of the Thames, he concludes
his article on London by stating “that London is a huge magazine of
men, money, ships, horses and ammunition, of all sorts of commodities
necessary or expedient for the use or pleasure of mankind. That London
is the mighty rendezvous of nobility, gentry, courtiers, divines,
lawyers, physicians, merchants, seamen, and all kinds of excellent
artificers, of the most refined wits, and most excellent beauties; for
it is observed that in most families of England, if there be any son or
daughter that excels the rest in beauty or wit, or perhaps courage or
industry, or any other rare quality, London is their _north star_, and
they are never at rest till they point directly thither.”
A writer of a much earlier date, William Fitz-Stephen, who in 1180
prefixed an account of London to his biography of Thomas-à-Becket, has
also some remarks about the situation of London, from which I will make
a quotation.
“On the north are cornfields, pastures, and delightful meadows,
intermixed with pleasant streams, on which stands many a mill, whose
clack is so grateful to the ear. Beyond them an immense forest extends
itself, beautified with woods and groves, and full of the lairs and
coverts of beasts and game, stags, bucks, boars, and wild bulls.”
“The fields above-mentioned are by no means hungry gravel or barren
sands, but may vie with the fertile plains of Asia, as capable of
producing the most luxuriant crops and filling the barns of the hinds
and farmers.
“Round the city and towards the north arise certain excellent springs
at a small distance, whose waters are sweet, salubrious, clear,” and
“Whose runnels murmur o’er the shining stones.”
WATER SUPPLY.
This final remark of Fitz-Stephen’s leads me to make a few observations
about the water supply of ancient London, which originally was abundant
and excellent.
It is probable that in pre-historic times the rising ground upon which
the “City” is built was an island, the Thames in those days being
much wider and shallower than at present. Even a writer so late as
Fitz-Stephen mentions the fact that Moorfields was used for skating,
and the derivation of the name “London” which finds most favour with
philologists is from the Celtic _Llyn-din_, which means the Lake
fortress.
Many watercourses ran from the north into the Thames, the names of
which are still attached to districts or streets in the Metropolitan
area. Thus, beginning at the East, one has to mention _Langbourn_, a
watercourse flowing through what is now Langbourne Ward in the City,
taking its course from Aldgate along Fenchurch Street, and probably
flowing into the _Wall Brook_, a stream which divided the city into
nearly equal halves, and flowed from Moorgate to Dowgate, through the
Bank of England and the Poultry, and the name of which still remains
in a ward and a street. The river _Fleet_ rose by Highgate Ponds,
and meandered through St. Pancras to King’s Cross, where is “Battle
Bridge;” thence its course skirted the western side of Clerkenwell,
and, flowing at the foot of Saffron Hill, Snow Hill, Holborn Hill, and
Ludgate Hill, reached the Thames at Blackfriars.
Farther west was _Tybourne_, which rose at Hampstead and flowed through
what is now the ornamental water in the Regent’s Park. Then becoming
locally known as the Marybourne, its name was associated with the
village of Marylebone; it then took the circuitous course of what is
now Marylebone Lane, crossed Oxford Street opposite the end of Davies
Street, crossed Brook Street, which was named from this fact, then
flowed at the back of Bond Street to Bruton Street. In Bruton Street
is a curious circuitous mews, which marks its course, running to the
south-east corner of Berkeley Square, whence the Tybourne struck west,
dividing Devonshire House from Lansdowne House, where now there is a
sunken passage between the garden walls. Thence it reached Piccadilly
at its lowest point, and flowed through the Green Park to Buckingham
Palace. Here it divided, and reached the Thames near Vauxhall Bridge
to the west, and near Westminster Bridge to the east, a smaller delta
formed by the eastward branch forming Thorney Island, associated with
the palace of Edward the Confessor and the monks of St. Peter’s Abbey.
The _Westbourne_ also rose at the foot of the Northern Hills, flowed
through Kilburn and Bayswater, both suggestive names, through the
Serpentine to Knightsbridge, another suggestive name, and so to the
Thames at Chelsea Bridge, apparently forming by its course the western
boundary of the Grosvenor Estate.
These watercourses have all disappeared, because in this Christian
country there is no respect for the purity of pure water. They became
so swinishly filthy, that for very shame we have covered them up,
and when the time arrives for covering up the Thames, which we are
so systematically fouling in the same way, I have no doubt that our
engineers will be equal to the task.
It is very interesting to follow the course of these old streams, and
it will be found that the explanation of the circuitous course of some
streets (such, for example, as Marylebone Lane), is explained by their
following the line of a forgotten rivulet. Nothing can give us a better
idea of the change which has come over London than to go into the City
and search for Walbrook or Langbourne, or to come west and look for
the Tybourne at the end of Conduit Street and follow its course thence
to Piccadilly. I hope that those who amuse themselves by taking such
a walk as I have advised, will ponder well upon how much we have lost
by being obliged to cover them, and why we were obliged to cover them,
and will take a lesson from these reflections. If he does that his time
will not be wasted.
In a district so intersected by pure streams, it was an easy matter
to have a well of good water, and throughout London there were many
such wells. Good water, in fact, abounded on every side, and it
is noteworthy that the Romans have left us no remains of gigantic
aqueducts, such as they knew well how to construct; for the very good
reason that they were not necessary.
The first public waterworks were the Conduits in Cheapside and
Cornhill. Those in Cheapside were supplied by the Tybourne, the water
of which was captured near what is now Stratford Place, and conducted
to the City in leaden pipes. Lamb’s Conduit was another, the name of
which remains. This was at Holborn Bridge (a bridge over the Fleet),
and its water came from fields near the Foundling Hospital. There were
many other Conduits, and it must be borne in mind that local names
ending in _well_ generally indicate the position of a neighbouring
water source.
When these watercourses were open London was a very different place.
The Lord Mayor kept his pack of hounds in those days, and in Aggas’s
map, made in the reign of Elizabeth, one may see the “dogge house” in
Finsbury Fields, for the Lord Mayor was Lord of the Manor of Finsbury,
and here he had his kennels, and frequently he would go a hunting, and
when he made his tour of inspection of the Conduit heads at Tybourne,
he took his pack with him and combined business with pleasure. Strype
records that in 1562 they hunted a hare here, and having dined at the
Suburban Banqueting House in Stratford Place, they started out again
after dinner and killed a fox. How much inspection the watercourses
received on these occasions is not certain.
The first waterworks in London were those constructed by Master Peter
Morrys, a Dutch engineer, in 1582. His plan was to utilise the enormous
force with which the Thames rushed through the nineteen narrow arches
of old London Bridge, and for this purpose the Corporation granted
him a lease of the first arch on the City side for 500 years, at a
rental of 10s. a year, and two years later the second arch was given on
similar terms. In 1701 a third arch was leased to a grandson of Morrys,
and at this time the proprietary rights were sold to Richard Soams, a
goldsmith, for £36,000, who converted it into a Company of 300 shares
of £500 each. In 1761 a fourth arch of the bridge was given to the
Company, and two other arches were closed to give additional force to
the water-wheels. The passage of the narrow arches of the bridge was at
all times difficult, and the process of shooting London Bridge, with a
fall of some five feet through the arch, was not without danger. This
blocking of the bridge caused great complaints, but, nevertheless, the
Company continued to ask for more, and with success, so that in 1767
the first five arches were occupied with immense water wheels, and two
arches on the Surrey side were similarly occupied. We gather that the
Company at this time also possessed a “fire-engine.” The last wheels
were put up under the advice of Brindley and Smeaton. The wheels were
of the undershot variety, and by their power 2,000 gallons of water per
minute were raised to a height of 120 feet, through a pipe which passed
over the tower of St. Magnus’ Church. These wheels continued in use
for 240 years, until 1822, when the Act for rebuilding London Bridge
caused their removal. The pumping machinery was of its kind excellent,
but the mains were very defective, and there was much loss by leakage,
and leakage also caused great damage to the bridge. The chief mains ran
in Bishopsgate Street, Cheapside, Aldgate, Fleet Street, and Newgate
Street. The fact that the London Bridge Waterworks were in use until
1822 is important, as showing that the Thames water up to that time was
not so grossly impure as to preclude the possibility of distributing
it for household purposes without filtration. It is not conceivable
that such a course could be adopted at the present day. The impurities
of Fleet Ditch were due to slop water, and to material negligently
thrown into it, and it was probable that only during a sharp shower,
when the filth of the streets was washed into it, it reached that
state of impurity which Swift has described. Water-carried sewage,
as we understand it, was not then in common use, and cesspools were
not allowed to empty into the sewers; and Public Authorities were not
expected to relieve individuals of responsibility and to undertake
duties, the satisfactory accomplishment of which is impossible.
The first of the great water companies was the “New River,” constructed
by Sir Hugh Myddleton and opened in 1613. This was a conduit on
the old pattern, but on a larger scale, and did not involve the use
of pumping machinery. It brought the water of Chadwell spring in
Hertfordshire, which is 110 feet above ordinance datum, to the New
River head at Clerkenwell, whence it was distributed through the City.
Many additional sources of water have been added to the original
Chadwell spring, and many powerful pumping engines are now in use
by the New River Water Company, which is still the biggest of eight
metropolitan companies. The areas supplied by the different water
companies may be briefly indicated. The “New River” supplies the
northern part of the metropolitan area; the “East London,” which dates
from 1669, supplies the north-east; the “Kent,” which dates its early
beginnings from 1701, supplies the south-east. The “Southwark and
Vauxhall” in its present form dates from 1845, the “Lambeth” from 1785,
the “Chelsea” from 1723, the “Grand Junction” from 1811, and the “West
Middlesex” from 1806.
These eight companies supply about 140,000,000 gallons of water daily
(about one half being from the Thames) to 668,525 houses, by means of
145 engines of 17,145 horse-power, through 4,068 miles of mains, and by
the aid of a capital of £13,150,318.
It is difficult for us to appreciate such a quantity as 140,000,000
gallons, but we may grasp it better if we imagine this water put into
1,400,000 water-butts, of 100 gallons each, and each 4 feet high. These
butts placed end to end would reach considerably more than 1,000 miles,
and that, be it remembered, is a statement of the daily water supply of
this city, which is certainly well within the mark.
The great fault in the situation of London was the proximity to it on
every side of marshy land. The Thames, as I have stated, was formerly
much wider than at present. Certain it is that Moorfields to the north
was often flooded; to the immediate east and north-east was marshy
ground, stretching into Essex; to the west was the low district of
Thorney Island, Chelsea, and Fulham, while on the opposite bank of the
Thames was the ground around Southwark and Lambeth, which was little
better than a swamp, and remained unbuilt upon, except to a very slight
extent, until the end of the last century.
Ague is at present a rare disease in London, although one still
occasionally meets with cases which are apparently due to local causes.
Formerly it was a very potent cause of death, but the discovery of
the use of “Jesuits’ Bark,” as Cinchona was at first called, and the
gradual and continuous filling up of the soil, combined with drainage,
led to its extinction. Possibly the impregnation of the soil with
coal-gas may have helped to this end.
MEDIÆVAL LONDON.
Mediæval London was a town in which the clerical element predominated.
I have upon the screen a very beautiful drawing which appeared in the
_Builder_ newspaper, and which is an imaginative and authoritative
reconstruction of the London of Henry VIII., by Mr. W. H. Brewer, whose
great talents will be obvious to all who look at his picture. London
at that time must have been exceedingly beautiful, filled as it was by
grand ecclesiastical and monastic institutions.
The artist’s point of view is from some coign of vantage east of the
Tower. In front of him, in the middle distance, forming at once the
centre and apex of the picture, is old St. Paul’s, with its lofty
steeple towering to a height of 500 feet, and placed on an eminence
which enhances its commanding importance.
To the left is the noble river, its broad expanse dotted with many a
craft, and forming a superb sweep to the south-west, where it is lost
beyond the Abbey of Westminster, which forms the most distant object
to the left of the spectator. The chief feature in the foreground is
“The Tower,” a noble mixture of military, palatial, ecclesiastical,
and domestic architecture. Beyond it, and to the south, is old London
Bridge, probably the most picturesque structure of the kind that the
world has ever seen, with its quaint houses and graceful chapel, and
with the clear water of the Thames roaring through its nineteen narrow
arches. On the south side of the bridge is the church of the Priory of
St. Mary Overy (St. Saviour’s, Southwark), as it may still be seen, and
near it the great palace of the Bishops of Winchester, with the marshy
ground of Southwark and Lambeth, and Lambeth Palace in the distance.
Running northward from the Tower is the castellated city wall, with
its brimming ditch filled with water flowing from the shallow lake of
Moorfields. Between the wall and the spectator is a series of grand
ecclesiastical buildings, with St. Katherine’s Hospital to the south,
and St. Mary Spital to the north, and between them Eastminster or the
Abbey of Grace, the Abbey of St. Clare in the Minories, and the church
of St. Botolph. Behind the city wall is seen a bewildering wealth of
tower and spire and gabled roof.
By the river bank among wharves and quaint mediæval warehouses,
St. Magnus’ steeple, the stern towers of Baynard’s Castle, and the
buildings of the Blackfriars are conspicuous; while in the same
direction, and beyond the Fleet river, is Bridewell Palace, the huge
tower of the Whitefriars, the Temple, St. Dunstan’s Church, Exeter
House, Arundel House, the Savoy, and York Place. Along the eastern
limits of the City are St. Dunstan’s, St. Margaret Pattens, All Hallows
Barking, the great Minster of the Friars of the Holy Cross, and the
still larger Priory of the Holy Trinity in Aldgate. Near Bishopsgate
is the large establishment of the Augustinians, and beyond this again
the Grey Friars, the Priory of St. Bartholomew, the Charter House,
and the Priory of St. John, Clerkenwell. In the centre of the City is
an almost endless array of parish churches, with here and there the
high-pitched roof of some guild house, or the residence of a nobleman
or wealthy merchant.
GARDENS AND PLEASURE GROUNDS.
These ecclesiastical foundations generally had gardens attached to
them, and in the time of Henry VIII. and the subsequent Tudor monarchs,
who discouraged building in London, the houses were by no means so
closely packed as at present. It is usual to find in walled cities that
the houses are packed as closely as possible within the walls; but
this most certainly was not the case in London. A glance at Aggas’s
or Ryther’s map (a copy of which is given in Mr. Loftie’s admirable
“History of London”) will convince one of this. The houses enclose
a great deal of garden ground in every direction, especially in the
northern and north-eastern portions of the city. It was along the river
bank that the crowding of houses was greatest, but even here there were
open spaces; and I must remind you that Pepys, who lived in Seething
Lane in the time of Charles II., when the crowding in the City had very
much increased, makes frequent mention of his garden.
Mr. Loftie tells us that in 1276 an inquiry was held as to the cause
of death of one Adam Shott, who had fallen from a pear tree in the
garden of one Laurence, in the parish of St. Michael Paternoster, which
was close to Thames Street. St. Martin Pomeroy, a church formerly in
Ironmonger Lane, is supposed to have derived its name from an adjoining
orchard. We know that Sir John Crosbie built Crosbie Place, now a
restaurant, in Bishopsgate Street, on part of the land forming the
gardens of the adjoining Convent of St. Helen’s. Sir Thomas Gresham’s
house in Bishopsgate Street also had its garden, and we know that the
College of Physicians had a physic garden, first at Amen Corner, and
subsequently in Warwick Lane.
The Priory of the Augustinians, or Austin Friars, included a large
tract of land. A part of it was given to the Marquis of Winchester, who
built Winchester House, which occupied the site of Winchester Street
and Buildings in Old Broad Street; and Drapers’ Hall was originally the
house of Thomas Cromwell, who made what till a very few years since was
known as Drapers’ Gardens by the simple process of stealing portions
from the gardens of his neighbours, they not daring to quarrel with
so great and so arbitrary a person. Immediately outside the walls was
any amount of open space. The houses of the nobles along the Strand
had each of them its ornamental garden. The Templars had their garden,
which still remains. The Priory of St. Bartholomew had its garden;
the Carthusians at the Charterhouse had their garden. Hotspur lived
in Aldersgate Street, Prince Rupert lived in Barbican, and the dismal
spot now known as Bridgewater Square was once occupied by the Earl of
Bridgewater’s house and garden. Old Gerard, the herbalist, had his
garden in Holborn, where he raised the potato, and he superintended
Burleigh’s garden in the Strand. Hatton Gardens were famous when Sir
Christopher Hatton lived there in state. Gray’s Inn Garden was planted
by Francis Bacon. Grocers’ Hall had its garden, with hedge-rows and a
bowling alley. The Merchant Taylors, the Ironmongers, the Salters, and
the Barber-Surgeons had each of them gardens attached to their halls.
The chief garden, or pleasure ground, for the citizens was Moorfields.
This was originally a wild, undrained place, which extended from the
City wall right away to the villages of Islington and Hoxton. According
to Loftie, it appears that in 1274 the citizens called in question
certain Acts of the previous Mayor, one Walter Hervey. They accused him
of certain “presumptuous acts and injuries,” and the first of these
appears to have been that “He had not attended at the Exchequer to
show the citizens’ title to the Moor.” From this it would appear that
over 600 years ago Moorfields was regarded as a common for the use and
enjoyment of all, and it appears to have been used more or less for
these purposes down to the close of the last century, and it is to be
found in all maps. Moorfields was used for archery and for exercising
the train-bands, that is, it was so used after it was drained, which
was first attempted in the fifteenth century. At one time, the people
living near Moorfields put up fences and showed a disposition to
encroach on the moor, but the citizens, taking the law into their own
hands, levelled the obstructions. When Moorfields had been drained, a
part of it was planted, and it became a fashionable promenade, and in
some maps it is shown as planted with intersecting avenues. According
to Mr. Denton, the historian of Cripplegate, the northern part of
Moorfields was the property of the Dean and Chapter of St. Paul’s being
leased merely to the Corporation, together with the Manor of Finsbury.
The southern part, however, was, according to the same authority, the
gift of Catherine and Mary Fynes to the City Corporation in trust
for the citizens. Finsbury Square was built on the northern part in
1768, and finally, in 1812, the Corporation obtained an enabling Act
from Parliament and put Finsbury Circus on the lower half, and thus
perished the People’s Park after existing 800 years. The building
upon this open space was a very short-sighted policy, and it says
very little for the spirit of Londoners that such a policy was able
to be carried out. The first encroachments on Moorfields took place,
probably, after the fire, when thousands of citizens were homeless,
and the Moor was used as a temporary place of encampment. Many of the
houses then erected appear to have been fairly substantial, and it is
probable that encroachments having been made in consequence of a sudden
and dire necessity, and possession being nine points of the law, the
City of London lost its park. Part of Moorfields had been used during
the plague as a plague pit, and towards the end of the 17th century
the great burial ground for dissenters, Bunhill Fields, was here
established. The Artillery ground, once the exercising ground of the
train-bands, still remains, and it is fortunate that the extinction of
the Honourable Artillery Company has been averted and has not resulted
in this “eligible building plot” being leased at so much a square foot.
Moorfields is gone, the Drapers’ Garden is gone, and the wealthy City
of London has now the proud distinction of being without any public
recreation ground within its limits.
It is true that the Corporation has bought Epping Forest, in the county
of Essex, and Burnham Beeches, in the county of Buckinghamshire, and
all honour to them for so doing; but it must be remembered that a
third-class return ticket to Loughton, the centre of Epping Forest,
costs 1s. 7d., and that to go from and return to Fenchurch Street takes
one and a half hours, while a return third-class ticket from Mansion
House to Slough, which is, I think, the station for Burnham Beeches,
costs 3s. 6d., and the journey to and fro takes four hours at least, so
that if each of the 51,000 people who reside in the City pay one visit
to each of their parks, they would do so at a minimum cost of nearly
£13,000, and at a necessary loss (collectively) of 281,000 hours, which
at 3d. an hour means an additional £3,500.
It is at least doubtful whether, if Moorfields could be restored as a
playground for the City, it would not be of more use to the City, from
the point of view of the health of those who dwell in it, than are
the Essex and Buckinghamshire estates. Almost every inch of available
ground in the City has been built upon. Goodman’s Fields, once a farm
where Stowe used to buy three pints of milk for a halfpenny, is now
covered with houses. Spitalfields was once an open space, but it is
an open space no longer. Paternoster Square has its centre packed
with buildings, and for aught I know there is nothing to prevent the
occupation in a similar way of the centres of Finsbury Square and
Circus, Lincoln’s Inn Fields, the Gardens of the Temple and Gray’s Inn,
of Russell and Bloomsbury Square, and, in short, of every inch of green
that can be turned into money.
The gradual obliteration of open spaces in London is seen not only in
public and semi-public spaces, but also in the curtilage of private
houses. Before the introduction of our modern system of sewerage and
water supply, it was not possible to build houses without adequate
curtilage for a well and the bestowal of refuse, and this obvious
fact is borne out by a reference to the maps of 1558, 1658, and 1720,
which are hung upon the screen. It is noteworthy that Newcourt’s map
of the time of Charles II. shows that the houses in the City were much
more closely packed than in the time of Elizabeth, and it is probable
that just before the Plague and the Fire the crowding of houses was
excessive.
[Illustration: DIAGRAM SHOWING THE SIZE OF LONDON AT DIFFERENT PERIODS
BETWEEN 1560 AND 1889.]
The diagram (p. 23) shows the growth of London between 1560 and 1889.
The notable features being (_a_) the very rapid extension of the
London area since 1815, and (_b_) the fact that the marshy land south
of the Thames has only been covered with buildings within comparatively
recent times. The frontispiece is a reproduction of part of Newcourt’s
map (1658) showing that the houses in the centre of London were very
densely packed. It also shows the position of Moorfields, and the
Drapers’ Garden, which are alluded to in the text.
HEALTH OF OLD LONDON.
That mediæval London was very unhealthy there is no question, but
whether it was more or less unhealthy than other cities of the time is
doubtful. It would be difficult, however, to conceive a worse state of
public health than that prevalent in old London.
Exact information on the subject is not to be had. It was not till 1593
that deaths were registered and published by the parish clerks, but the
record of deaths without a knowledge of population does not make it
possible to hazard even a guess at the death-rate.
The Parish Clerks’ Bills of Mortality show clearly that from 1593 to
the year 1800, _i.e._, for 207 years, the deaths invariably exceeded
the births, and often to an enormous extent, the maximum being reached
in the memorable year 1665, when the deaths were 87,339, as against
9,967 births. Taking the whole of the 18th century, it would appear
from a table given by Henderson, in the “Encyclopædia Britannica,”
that of the births and deaths registered, the excess of the latter
averaged about 6,000 a year, or 600,000 for the century. At one time
leprosy was common in London, and we know that in the reign of Edward
III. the “black death,” which was probably plague, committed frightful
ravages, and is said to have killed 100,000 in London; and this scourge
reappeared at intervals up to the year 1665, the mortality then being
enormously in excess of the very high mortality which was habitual.
Between 1485 and 1551 there were epidemics of the sweating sickness, a
disease different from plague but scarcely less deadly.
We all know what epidemics of plague and sweating sickness did
for London, but it may be thought that epidemics are accidental
visitations, and are no criterion of the general health of the city.
The numbers I have quoted from Henderson will make it impossible for us
to believe that old London was at any time healthy, not even after the
fire and the rebuilding.
What were the chief ordinary diseases of London? This question may be
answered by reference to the bills of mortality. I will take the year
1661, when 19,771 deaths were registered by the parish clerks, and
will note those diseases which are credited with more than 100 deaths.
These were: Abortive and still-born, 511; chrisomes and infants, 1,400;
ague, 3,490; dysentery (bloody flux, scouring and flux), 314; childbed,
224; aged, 1,302; apoplexy and suddenly, 108; colic, 186; consumption,
3,788; convulsions, 1,198; dropsy and tympany, 967; flox and small-pox,
1,246; griping in the guts, 1,061; jaundice, 141; imposthume, 160;
measles, 188; rickets, 413; rising of the lights, 227; spotted fever
and purples, 335; stopping of the stomach, 170; surfeit, 212; teeth and
worms, 1,195. Looking at the table, and using the best of my judgment
in interpreting it, I should say that about one-fourth of the deaths
were due to the accidents of parturition and the diseases of infants,
and another fourth due to fevers. It is to be noted also that plague is
answerable for 20 deaths, although this was not a plague year.
What were the causes of the high mortality in Old London?
The situation was not healthy because of the marshy surroundings of
the city. Ague and dysentery were always present, and were terribly
fatal. Not only was the ground around the city marshy, but it was
probably filthy as well. The old town ditch was used as a receptacle
for all kinds of filth, and the cleansing of it was a great work,
which was only occasionally undertaken. When Moorfields was drained,
and the other marshy districts improved, one great cause of sickness
disappeared.
The city itself was certainly as foul as could be. The streets were
unpaved, or paved only with rough cobble stones. There were no side
walks. The houses projected over the roadway, and were unprovided with
rain-water gutters, and during a shower the rain fell from the roofs
into the middle of the street. These streets were filthy from constant
contributions of slops and ordure from animals and human beings. There
were no underground drains, and the soil of the town was soaked with
the filth of centuries. This sodden condition of the soil must have
affected the wells to a greater or less extent.
The streets were filthy without, the houses were filthy within. The
rooms of the poor were more like pig-styes than human habitations,
unventilated, and strewn with rushes, which were seldom changed; and
the wretched inhabitants closely packed in these miserable hovels must
have become very prone to suffer from infection of all kinds. Another
great cause of unhealthiness was the diet, which amongst the poor was
composed largely of salt meat and fish, and with an absence of fresh
vegetables, so that many of the inhabitants must have been on the verge
of scurvy. The potato was not imported till the end of the sixteenth
century, and the eighteenth was well advanced before it became a
common article of diet. Much of the improvement in public health of
late years is due to this wholesome and easily stored vegetable. In the
days of Elizabeth the children of Christ’s Hospital were often ill from
scurvy, and it was not till 1767 that the potato was introduced into
the dietary of St. Bartholomew’s Hospital.
A most important factor in the causation of disease was the moral
condition of the population, which was very low, and marked by
superstition, ignorance, and brutality. An age when even the better
classes crowded into Smithfield to see some poor wretch burnt; when
the most brutal punishments were inflicted for comparatively slight
offences; when kings beheaded their subjects and even their wives,
almost as a matter of course; when the ghastly heads of executed
persons stared from the city gates; when religious-minded Puritans
could do nothing with a misguided king but behead him; and when
restored “monarchy” exhumed the dead bodies of political offenders
in order that it might wreak an unmeaning vengeance on a corpse; and
when even ladies in good positions in society flocked to see these
sickening exhibitions,[A] was not an age in which the nobler feelings
of Christianity were easily evoked; and without these feelings,
measures for securing public health, which cannot be fostered except
in connection with public decency, found no place among the ideas of
governors or governed.
[A] “To my Lady Batten’s; where my wife and she are lately
come back again from being abroad, and seeing of
Cromwell, Ireton, and Bradshaw hanged and buried at
Tyburne.”--“Pepys’s Diary,” Jan. 31, 1660-61.
The public amusements were many of them brutal and cruel. Tournaments
were less brutal than bear-baiting, bull-baiting, and cock-fighting,
because they fostered animal courage; but animal courage it most
distinctly was.
Fitz-Stephen mentions the drunkenness of the population in the
12th century, and there can be little doubt that when beer was the
only drink--the drink which Queen Elizabeth took for breakfast--a
state of fuddle from drink must have been exceedingly common. From
Chamberlayne’s “Present State of England,” I gather that in the year
after the Fire, 452,563 barrels of strong beer, at 12s. 6d. the barrel;
580,420 barrels of ale, at 16s. the barrel; and 489,797 barrels of
small beer, at 6s. 6d. the barrel, were consumed in London, which (if
we take the population at that time at 500,000) allows about three
barrels, or 108 gallons, or some 1,440 pints per head per annum.
Again, Chamberlayne, speaking of the causes of the Great Fire,
mentions: 1. “The drunkenness and supine negligence of the baker and
his servants in whose house it began. 2. The dead time of night wherein
it began, when some were wearied with working, others filled with
drink, and all in a dead sleep.”
The brutality of the people’s amusements continued down to the end of
the last century, and later. Thus in Pink’s “History of Clerkenwell,” I
find the following advertisement culled from a journal of 1716:--
“At the Bear-garden at Hockley-in-the-Hole, at the request of several
persons of quality, on Monday the 4th of this instant of June, is
one of the largest and most mischievous bears that ever was seen in
England to be baited to death, with other variety of bull-baiting, and
bear-baiting; as also a wild bull to be turned loose in the Game Place,
with fireworks all over him. To begin exactly at 3 o’clock in the
afternoon, because the sport continues long.”
Close by, in Spa Fields, female prize fights were held, and there is
a lively account of one of these encounters in which “Bruising Peg”
terribly damaged her antagonist. In such a time, of course, foot-pads
abounded, and it was not without danger that persons crossed Spa Fields
after dark; and those who were invited to Sadler’s Wells, to see a man
eat a live cock, feathers and all, for a wager of £5, were informed
that the New Road and City Road would be patrolled, and that the return
home would be without danger.
Such facts as these, which I could multiply to any extent, show the
rough moral condition of the populace, and I believe that, with such
a state of moral feeling, any real improvement in public health was
impossible.
Another cause of the high death-rate was superstition, which regarded
disease as a “visitation” which had to be borne without question or
inquiry.
With such an attitude towards epidemics, which by some were regarded
as due to an unfortunate conjunction of certain planets, it is not to
be wondered at that the epidemics were mismanaged; and it is certainly
difficult to imagine any measure better calculated to cause the spread
of the plague than that of forbidding those affected to leave their
houses, and compelling them to stay indoors and infect the rest of the
household. The most efficient of all measures which we nowadays adopt
for preserving the public health is that of the instant separation of
the sick from among the healthy, a plan which had been adopted in old
time in the case of “leprosy,” and which we re-introduced in the last
century, when the first small-pox hospital was built.
Another great cause of the high mortality was the ignorance of the
physicians, who were almost as superstitious as the populace, and who
were entirely without any exact or correct knowledge of their art,
which they practised almost entirely by the light of the old Greek,
Roman, and Arabian writers.
To recapitulate, the causes of the high death-rate were probably the
following:--
1. The prevalence of ague from the abundant marshes.
2. The dirt of the city and the houses, and the probable
infection of wells from a soil sodden with putrefactive matter.
3. The ill-nourished, drunken, and scorbutic condition of the
people, and
4. Their condition of superstition and brutality, which made any
rules for public health impossible.
5. The neglect to separate the infected from the healthy.
6. The ignorance of the doctors.
We may get some idea of the state of public health during the sixteenth
and seventeenth centuries by a reference to the families of monarchs.
The difficulty of rearing children was very largely experienced in
royal families. I have, by the help of Burke’s “Peerage,” made a list
of all the children of monarchs (other than those who ascended the
throne) whose ages at death are given by that genealogist.
This difficulty of rearing children, which began in the reign of Edward
III., becomes very marked with the reign of Henry VIII., who, as we are
told by Froude, was disappointed by a succession of still-born children
borne to him by his first wife.
Of the children of James I., three out of five died under 3; of the
children of Charles I., the ages at death were 29, 26, 20, 15, 4, 1;
of eleven children of James II., by two wives, one (the old Pretender)
attained the age of 78, and of another the age is doubtful, but eight
died under 4, and two others died at 11 and 15; of the six children
of Anne, one reached the age of 11, and the remaining six died under 1
year.
With the accession of George I. this difficulty of rearing royal
families appears to have ceased, having been more or less marked during
the reigns of 21 monarchs, intervening between Edward III. and George
I. What the cause may have been I will not discuss, but I mention the
fact because it is probable that causes which affected kings affected
subjects also.
There can be no doubt that down to the commencement of the present
century London was a veritable fever-bed, the causes of death being
largely malarial fever, spotted or typhus fever, plague, small-pox,
measles, scarlet fever, and whooping-cough, the two latter being
comparatively recent introductions.
THE LONDON “DEATH RATE.”
The present writers on London, like their predecessors, are loud in its
praises and blind to its defects, and they point to a figure which is
called “the death-rate,” and ask us to accept it as evidence that the
state of public health in London is as good as can be.
It is quite true that the death-rate of London is low, and that it is
not much in excess of the country at large, and is very much below that
of some of the big towns scattered through the kingdom. Nevertheless,
before we accept this figure and rest contented with it, we must take
several facts into consideration.
1. The London of the Registrar-General is very extensive, and no small
part of it is rural or semi-rural in character. Many of the dwellers
in Lewisham, Wandsworth, Fulham, Hampstead, Hackney, Greenwich,
Camberwell, and Woolwich, can hardly be looked upon as dwellers in
a city, and it must be remembered that the death-rates in these
districts, which contain only from 40 to 8 persons to an acre, tend
very materially to reduce the death-rate of the whole town.
2. London is very largely a city of wealthy and well-to-do people, most
of whom must be looked upon as sojourners rather than dwellers in the
city. Among such as these, who can command every luxury and necessary
of life, including change of air, death-rates ought to be low. It is
manifestly unfair to contrast the death-rate of St. George’s, Hanover
Square, or Kensington, with the death-rate of a town packed with the
wage-earning class.
3. The mobility of the London population is so great that it must
vitiate any statistics bearing on the health of the inhabitants.
“Londoners” are a mixture of races, recruited from every clime from
China to Peru. They are, as the phrase goes, “Here to-day and gone
to-morrow,” and probably no one fact quickens their departure more
than ill-health. I am told by the proprietor of Kelly’s Post Office
Directory that the annual correction of addresses amounts to about ten
per cent. of the whole, so that the London population shifts on an
average completely every ten years, even among classes who have far
more stability than the labouring classes. It is also well to point out
that these changes in the Directory do not represent all the changes,
because in trade it is common for new individuals to trade under an old
and established name. I find, on comparing the Directories of 1880 and
1889, that in my own street of 96 houses there have been 87 changes of
names, and that 96 houses are now credited with the addresses of 140
individuals, whereas in 1880 the individuals numbered 120.
4. Still more important, as vitiating the value of the “death-rate,”
is the abnormal age distribution in London. In London (and especially
in the central portions of it) there is a great deficiency of young
children and old people, among whom the death-rate is always highest;
the population of London is largely composed of selected adults
imported from the country, among whom the death-rate ought to be low.
5. The continued low death-rate of London is very largely accounted for
by the diminishing birth-rate. Thus the birth-rate for the ten years
1877-86 averaged 34·4 and the death-rate 21·2, while for the year 1887
the birth-rate was 31·6 and the death-rate 19·5. This is a diminution
of 2·8 per 1,000 of population in the birth-rate. This, in a population
of 4,250,000, means a deficit of 11,900 children; and as out of every
1,000 children born in London in 1887, 158 died before they were one
year old (_i.e._, 13 per 1,000 more than in England as a whole, and 66
per 1,000 more than in the county of Dorsetshire), it is evident that
this diminution of the birth-rate entails a deficit of 1,940 in the
total deaths occurring in London in the year. It is clear from this
that in taking account of a diminishing death-rate we have to take into
consideration the diminishing birth-rate also.
These considerations make it very doubtful whether the death-rate of
London is of much value, as indicating the amount of disease in the
City. Even if we accept it we must not draw any hasty conclusions that
the disease-rate bears any definite proportion to the death-rate. There
may be much disease with comparatively few deaths, as was the case with
the scarlet fever epidemic of last year, and there can be no doubt that
the improvement and extension of medical knowledge has very largely
diminished the death-rate of those who are sick. Further, an enormous
proportion of those who fall ill in London return to the country to die.
A fact which must throw considerable doubt on the healthiness (_i.e._,
a real vigorous and robust condition, which is the true meaning of
health) of the population is the amount of sickness, as evidenced by
the ever-increasing work which is thrown upon the hospitals.
According to a table which was published last June in _The Hospital_,
it appears that in 1887 there were treated in the London hospitals
79,261 in-patients, and 1,180,251 out-patients, or a total of 1,259,512
persons, excluding those who received relief in the hospitals belonging
to the Asylums Board (and these were very numerous, owing to the
epidemic of scarlet fever), the workhouse infirmaries, the lunatic
asylums, and idiot asylums. Thus it appears that in a city whose
death-rate was very low more than 25 per cent. of the population had
recourse to the hospitals for relief. We must therefore conclude that
the death-rate and the disease-rate bear no fixed ratio to each other,
especially when we consider that between 2,000 and 3,000 medical men
found sufficient work among the population to furnish them with an
income. If deaths be few in London, it is clear that second-rate health
is by no means exceptional.
IMPROVED CONDITION OF MODERN LONDON.
Although we have to make many allowances, and take many things into
consideration before we can estimate the true value of the London
death-rate, it is, of course, undeniable that an enormous improvement
in the health of the City has taken place since the beginning of the
present century. To what is this due?
The chief cause is the increase of knowledge as to the modes in which
diseases are spread. Our knowledge of the mode in which small-pox,
scarlet fever, cholera, and typhoid are disseminated has led to the
establishment of fever hospitals, and to the improvement of the
water-supply, and the inspection of dairies. It is not only that the
knowledge of doctors has increased, but what is more important, this
knowledge has spread to the public, and as “self-preservation is the
first law of nature,” the public has assisted in protecting itself.
The practice of vaccination, and the dealing with epidemics by the
method of isolation, have also materially assisted in diminishing the
death-rate.
Another very important point is the disappearance of malaria. Drainage,
the filling up of low-lying places, and extensive building operations,
have banished malaria from our midst, and this, be it remembered, was
not only a cause of death in itself, but probably tended to make other
diseases more deadly. It is conceivable that the impregnation of the
soil by coal-gas may have helped to stop the growth of noxious microbes
which make the soil their habitat.
Again, our system of sewers, which has carried filth away from the
dwellings, has probably assisted in improving the public health. That
sewers have done and are doing much harm as well as good is undoubted,
but it is probable that the balance is so far in their favour. For
the present typhus fever has disappeared, and this is probably due
to two causes--first, the prompt separation of the sick from the
healthy, and secondly, to the fact that we have had no scarcity for
some years. Typhus is due to overcrowding and want. I have drawn up a
scheme which shows by a curve the average price of wheat from the year
1800 to 1886. From this it appears that the staple article of food
has, broadly speaking, and with some considerable fluctuation, fallen
steadily in price from 1812 to the present time, when it is at its
minimum. Not only wheat, but all articles of food and clothing, and
also fuel, have of late years been getting steadily cheaper; potatoes
and other vegetables are in common use among the masses, and thus we
have kept away famine diseases, and also that taint of scurvy, which
was undoubtedly a great cause of ill-health in the middle ages. A
most important fact has been the removal of the in-take of the water
companies to a part of the river containing less sewage than that
between the bridges. It is not enough to be able to rejoice in a small
death-rate. We ought to be able to look ahead and feel that to the
best of our knowledge there is no probability of the return of a high
one, and that our sanitary arrangements having been set a-going, will
continue _propriâ motu_. We have to remember that diseases disappear or
become unimportant, and that others become prominent. In our own day
we have seen the rise in importance of diphtheria and enteric fever,
and just at present we seem to have lost sight of typhus, for a long
time the most important of the febrile diseases. “Leprosy,” which was
at one time common in London, has practically disappeared. Plague,
sweating sickness, and malarial fever have also gone. Whooping-cough
was not recognised till the end of the sixteenth century, and could
not, therefore, have been as common as it is now. In like manner,
scarlet fever was not distinguished from measles until the seventeenth
century, and from that fact we may infer that there could have been no
epidemics of it, although we must remember that in the great crowd of
fevers it must have been hard to distinguish individuals. The fact that
diseases wax and wane must be borne in mind, and should prevent us from
indulging in a feeling of false security.
WHAT IS THE OUTLOOK?
Judged by our present standard of knowledge, have we a right to hope
that London is likely to remain free from epidemics?
There are certain facts which make me seriously doubt the permanence of
the present state of health in London.
The first of these is the fact that some of our hygienic measures have
tended to produce overcrowding of houses, which is infinitely the
greatest of all sanitary evils. Formerly the sanitary arrangements
of houses were such that without some garden or back premises they
would have been uninhabitable, and a reference to Aggas’s map, or
Norden’s map, or Newcourt’s map, will show that in Old London a large
proportion of the houses had gardens or back premises large enough to
be shown on a map. These maps also show that in Charles II.’s time,
just before the plague, the overcrowding of houses in London was much
more marked than in the days of Elizabeth. When every drop of water
and all the fuel used had to be carried to the upper storeys by hand,
there were practical inconveniences attending upon very high houses
which prevented them from being built to any great extent. Now all is
changed. Our system of sewerage has made it possible to build houses
with no curtilage whatever, and with no outlet but a hole, and the
possession of a high pressure of water (the result of steam power) and
the modern system of gas has made it possible to have houses of any
height, without any great inconvenience to the occupants. “Five hundred
rooms, passenger and luggage lifts to every floor, 1,000 electric
lights, hot and cold water laid on to every room, bath-rooms on every
floor,” is the kind of advertisement put forward by an eight-storeyed
hotel without an inch of curtilage. Without steam power, without
water under pressure, and without water-carried sewage, such Yankee
monstrosities were not possible, whereas nowadays the loftier the
hotel so much the greater is the profit, because extra storeys do not
increase the ground-rent.
On the other hand, the fact that houses can be and are allowed to
be built without curtilage has given an altogether fictitious value
to land, the price of which varies in this country (according to
situation) from about £200,000 to £10 per acre. It is not surprising
that the bias of landlords and builders is very much in favour of
our present system of Sanitation. Sanitary authorities are also in
favour of it because, having borrowed enormous sums of money, which
have to be paid out of the rates, they are naturally quite regardless
of hygiene if they can increase the rateable value of the district,
and so make the burden of rate-collection lighter. “Black care (in
the form of rates) sits behind the councillor.” Everywhere throughout
the metropolitan area houses are being pulled down and replaced by
others twice as high; extra storeys are being added to old houses,
and back-yards and gardens are fetching enormous prices for building
purposes, so that the buildings in the centre of London have doubled
their height and have lost all their curtilage.
Huge thoroughfares have been driven through London in all directions,
but as the ultimate increase in the height of the buildings has been
proportionately greater than the increase in the width of the street,
locomotion has become more difficult, our traffic has become more in
need of police regulations, and it has become an acknowledged rule in
the City that if you want to keep an appointment it is dangerous to
take a cab, because one can thread one’s way with more certainty on
foot.
And yet the overcrowding in London does not appear in official
documents. Thus the City of London, on an area of 668 acres, in 1871
had 9,415 inhabited houses, and 3,222 uninhabited, and a population
just short of 76,000; whereas in 1881 the inhabited houses had fallen
to 6,562, the uninhabited had risen to 4,770, and the population had
fallen to 51,439. Some historian of the future may draw the conclusion
that the decay of London set in acutely about the year 1871, unless
he should perchance discover that within the same period the rateable
value had risen from £2,500,000 to £3,500,000; that the day population
had risen from 170,000 to 260,000, and that the number of persons
entering the City daily for business had risen from 657,000 to 739,000.
This population is one mainly of adult males, and since, if they get
ill in the City they don’t die in it, the death-rate keeps down, and
we like to think it is a wholesome place for a young man to work in.
The 50,000 people who have to live night and day on this square mile
of ground have not a very cheerful time in this wealthy city, where
nature has been most effectually obliterated by the brute force of the
almighty dollar. What chance have they of any fresh air with a radius
of houses extending to five miles all round them? At one time the
Thames served as a recreation ground, but that was in the days before
the tide rolled in charged with the excrements of 4,000,000 people,
and when it was possible to fish and boat, and perhaps catch a salmon,
without the danger of being sunk by some headlong steam-tug. Until a
few years ago there was a little green spot called Drapers’ Gardens,
but now Drapers’ Gardens is occupied by Throgmorton Avenue, where
dwell 322 different firms of stockbrokers and others, and the nearest
recreation ground is St. James’s Park, three miles off.
I have lately seen a young man, aged 21, with signs of incipient
consumption. He is a fine young fellow, and three years ago entered one
of the large City warehouses connected with the drapery trade, in the
centre of the City. At first he was employed mainly in the basement,
where gas was burning all day. During times of extra pressure he
often worked from eight in the morning to past midnight, and when he
retired to rest he had to share a bedroom with other men, the windows
being shut. I believe this is no uncommon case, and I commend it most
heartily to the attention of the “Sweating Committee.” Occasionally
on a Saturday afternoon he got a game of football, his very slender
resources being severely taxed to pay the railway fare to the spot
where the games are contested.
What has occurred in the City has occurred elsewhere in London.
I need hardly say that the crowding of houses means loss of liberty,
and increases competition--that competition is the cause of “sweating”
and other miseries. Having wilfully produced these evils, I for
one do not believe that they are to be removed even by the best
intentioned efforts of city missionaries, nor by young men’s Christian
associations, nor even by music halls, though tea be the beverage and
hymn tunes the melodies.
We have to bear in mind the fact that all writers on sanitary matters
are agreed that of all dangers to health, overcrowding is the
greatest, and that the death-rate rises in proportion to the density
of population. When, therefore, we allow building to go practically
unchecked, and move the poor out of two-storeyed dwellings into
six-storeyed barracks, we must remember the possible drawbacks of such
a system.
The death-rate of Paris is higher than that of London (it was nearly
26 per 1,000 in 1881), but the density of population in Paris is
twice that of London, being 117 to the acre, as against 50 in London.
Some parts of Paris are very much more crowded than any parts of
London, and no parts of it have a density of population so slight
as Fulham, Hampstead, Wandsworth, Woolwich, or Lewisham. The effect
of overcrowding on death-rate is seen very markedly in the city of
New York, which has a population of 1,337,000, which has an almost
unlimited water-supply, and the sewage of which is discharged direct
into the sea. According to the writer in the “Encyclopædia Britannica,”
there is an excessive crowding of the inhabitants into tenement houses,
and the houses are to a great extent without back entrances. As a
consequence, the death-rate was 26·47 in 1880, 31·08 in 1881, and 29·64
in 1882.
In overcrowded places the danger is great when contagious disease makes
its appearance. The spread of such diseases as typhus, measles, and
whooping-cough is very much favoured by overcrowding.
I have prepared a table, taken from the Registrar-General’s decennial
abstract, which shows this fact very clearly with regard to London. I
have arranged the various registration districts of London according
to the density of population, and in another column I have given the
death-rate per 100,000 from whooping-cough and measles, two diseases
which are rarely treated in hospitals, and which are very prone to
follow each other in epidemics, so that when we have not measles with
us we have whooping-cough, and _vice versâ_.
ANNUAL DEATH-RATE PER 100,000 LIVING OF CHILDREN UNDER 5 YEARS OF
AGE FROM WHOOPING-COUGH AND MEASLES DURING THE 10 YEARS 1871-80.
Death-rate per
District. Persons to 100,000 from
an acre. Measles and
Whooping-cough.
Westminster 250 1089
St. Giles 200 1152
Holborn 200 1229
Shoreditch 200 1099
Whitechapel 200 1020
St. George’s, E. 200 1327
Bethnal Green 166 1113
Mile End 143 982
St. Saviour’s, Southwark 143 1150
Stepney 125 1220
St. Olave, Southwark 111 1091
Marylebone 100 1145
Strand 100 987
City 100 963
Chelsea 91 856
St. George’s, Hanover Square 83 974
Pancras 83 1046
Islington 77 965
Kensington 66 992
Poplar 59 985
Lambeth 59 960
London as a whole 50 967
Hackney 40 698
Camberwell 35 879
Greenwich 35 778
Fulham 23 850
Hampstead 17 701
Wandsworth 15 701
Woolwich 12 794
Lewisham 6 546
County of Dorset 3 352
The above figures show the effects of overcrowding, on the mortality
from two important diseases, very conclusively; and it is interesting
to note how very far the mortality from these two diseases in
Dorsetshire is below that of even the best parts of London.
Among other diseases which are very common in London are the tubercular
and respiratory diseases. Thus the mortality from scrofula, tabes
mesenterica, phthisis, and hydrocephalus in London, during the ten
years 1871-80, was (collectively) 349 per 100,000 (no correction being
made for abnormal age distribution), as against 224 in Dorsetshire,
and the death-rate from respiratory disease was 460, as against 315
in Dorsetshire. During the fifteen years 1872-1886 I find that 34,254
in-patients have been treated in University College Hospital. Of
these, 3,798 were cases of respiratory disease, and 2,453 were cases
of disease of bones and joints, a very large proportion of which,
according to recent investigations, are tubercular. Thus we have 6,251
cases of disease (or more than 18 per cent. of the whole) in which
tubercle plays an important part.
There were also 459 cases of enteric fever, 276 cases of diphtheria,
and 1,020 cases of rheumatic fever. These, taken together, amount to
1,755, or about 5 per cent. of the whole. Rheumatic fever is one of
the common diseases of London, which attacks young adults, and very
often cripples them for life. It is a disease of great importance, and
appears from the last report of the Registrar-General to have been on
the increase since 1858.
Besides the greater liability to premature death which is caused
by overcrowding, there are other drawbacks which are scarcely less
important. One of these, with which we are well acquainted in London,
is an increase in the dirtiness and smokiness of the air, which is
mainly due to private fireplaces. When huge piles of offices are run up
in the City or elsewhere, we like to imagine that, because most of them
are tenantless at night, they cause no inconvenience, forgetting that
each office has its fireplace, which helps to foul the air, and that
each office supplies its quota of sewage to help to foul the river. The
state of the air in London is such that the most beautiful of all arts,
gardening, has become impracticable from the fact that comparatively
few flowers or shrubs will flourish. This absence of green plants
entails a great loss of nascent oxygen or ozone, which gives to air
its peculiar quality of freshness. It is hardly conceivable that a
high level of health can be maintained in a spot where vegetable life
languishes, animal life and vegetable life being complementary to each
other.
The overcrowding in London has, of late years, been mitigated by the
conversion of old grave-yards into gardens, thanks to the society over
which the Earl of Meath so ably presides. If cremation as a means of
disposing of the dead should become general, and spacious cemeteries be
replaced by furnaces, it is clear that these spaces bequeathed us by
the dead will not be available for “lungs” in the London of the future,
and that cremation, unless it be counteracted by suitable legislation,
is certain to intensify our state of overcrowding.
The moral side of overcrowding must not be forgotten, but it is not
necessary to dwell upon it, as the Whitechapel horrors are still fresh
in the memory, and the difficulty of detecting crime in a labyrinth
of hiding-places has been demonstrated. The first aim of a sanitary
authority should be to prevent overcrowding, and its most important
duty is to control building operations, a duty which is never performed
because buildings help to pay the rates.
THE LOOSE END OF OUR SANITATION.
Another reason why it is not possible to regard the present sanitary
condition of London with much complacency arises from the fact that
our sanitarians have failed to “make both ends meet,” but have left a
terrible loose end to their measures, which is a constant menace and an
increasing danger.
This “loose end” consists of a daily allowance of 150,000,000 gallons
of sewage, which our new councillors have inherited from the late
Board, and which is the result of probably the greatest sanitary
blunder ever committed in the history of the world. The proper
destination of organic refuse is the soil. Nobody doubts this. Why,
therefore, in a moment of weakness, did we construct six millions’
worth of machinery to throw it in the water? The great glory of London,
time out of mind, has been the Thames, but now certainly our glory
has departed. Having adopted a method of sanitation which is based
on an utterly wrong principle, the condition of the Thames must get
progressively worse as long as that method is pursued.
Some persons talk of a sewage farm as a remedy, but at least 50,000
acres of land would be necessary, and, to say the least of it, that is
not a cheerful outlook for the ratepayer in these days of agricultural
depression.
At present we are spending £50,000 a year on chemical abominations to
mix with the other abominations, but it is very hard to see how that
can improve matters. The chemicals will certainly not help the fishing
industry, and if added in sufficient quantity they must absolutely
destroy the very small manurial value possessed by the sewage or its
sludge. My own belief is that the sewage problem in its present form
is insoluble. To deal with and filter slop-water, as is done in Paris,
is comparatively easy, but here in London the problem is of a wholly
different kind, and my firm conviction is that our present system of
“water-carriage” must lead us deeper and deeper into the mire.
Until the problem of “What to do with our sewage?” is settled, clearly,
we ought to do our best to stop the growth of the evil. Our present
system of sewers ought to be closed as far as permission to connect
fresh houses is concerned. As it is, the new Council, like the old
Board, will have an uncertain quantity of sewage to deal with, for
old houses are being everywhere pulled down, and houses of greatly
increased capacity erected, and this of course means a proportionate
increase in the sewage to be disposed of. In the City there are but
50,000 inhabitants in the official sense, but there are by this time
fully 300,000 daily workers and over 700,000 daily visitors to the
City, so that, in spite of an official decrease in population, the
increase of sewage from that particular spot must be enormous. The
same class of facts applies to other districts in the metropolis,
so that the evil at the outfall is not only not improving, but
is increasing daily. It seems to me quite impossible to make any
arrangement for adequately dealing with the sewage of a district,
unless you are able to say beforehand what is the maximum quantity
which will have to be dealt with. There being no adequate control of
building in London, and no relation between the cubic contents of a
building and the area it occupies (witness Queen Anne’s Mansions,
the huge pile with which we are threatened at Knightsbridge, and the
equally large pile projected in the Strand, which is to be 135 feet
high, according to the newspapers), it is evident that the volume of
sewage to be dealt with may be doubled or trebled without any increase
of the area drained by the sewers. Under such conditions as these the
sewage problem may well be insoluble. The first and main duty of any
sanitary authority should be to exercise a wise control over building.
If every house were compelled in the future to have a curtilage bearing
a definite proportion to the cubic contents, there would be an end of
these towers of Babel, which shut out from us the light and air of
heaven; the price of building land would fall; it would be possible to
make some calculations as to sewage; and the excessive overcrowding
of a city would be prevented. Without such a regulation great sewage
schemes must in the end make the sanitary condition of a city worse
rather than better.
What to do with our sewage is a very difficult problem--an insoluble
problem, I believe, on the present lines. At present the Metropolitan
Board is shipping some of the solid matter to be dropped into the sea
at the mouth of the Thames. When the Thames Conservancy see this fine
ship, “built in th’ eclipse, and rigged with curses dark,” bound on
its mission of blocking the port of London, what can they think? They
think it worth while, apparently, to have a man fined for throwing a
basket of rubbish over one of the bridges.
Again, the House of Commons passed a stringent Act to prevent the
pollution of rivers, but when, a year or so since, their own sewage
arrangements were at fault, they merely constructed an ingenious
apparatus to thoroughly suck the sewage out of their own premises and
pass it on more effectually than before to pollute the river on whose
bank their stately palace stands. What is the good of legislation
without example? If the House of Commons, at some sacrifice (more
fancied than real) of personal convenience, had adopted measures in
accordance with the spirit of their legislation, I believe we should
have been within a measurable distance of seeing the Thames once more
meriting the name of silvery. A good example is better than any amount
of legislation, and a good example set in high places is much needed in
this matter, to which there is undoubtedly a moral side.
How to alter the present arrangements in London now the houses have
been almost uniformly deprived of their curtilage is very difficult.
Under such circumstances “returning were as tedious as go o’er,” but
I am myself inclined to think that the best solution of London’s
sewage difficulty lies in the direction of cremation--certainly in the
direction of decentralisation.
I believe also that at the outskirts much might be accomplished by an
equitable adjustment of sanitary rates, and by encouraging householders
to do for themselves what no public authority can do so satisfactorily
for them. But as I have dealt with this subject very fully in a paper
on “The Shortcomings of Modern Sanitary Methods,” I shall say no more
at present.
London gets more than half its water from the Thames, and this is
another reason why the sanitary outlook is not satisfactory. The
system of water-carried sewage is now almost universal, the sewage
ultimately taking its course along the track of the watershed. Wherever
water-carried sewage is in vogue the natural watercourses must get
fouled, and the fouling will be in proportion to population. The sewage
may be deprived of its coarser ingredients by mechanical or chemical
means, but it is not possible to believe that any of the methods of
treating sewage at present in use render the effluent wholesome enough
to drink without danger. The increase of population in the valley of
the Thames is therefore a distinct danger to London. The following
table gives the population for 1871 and 1881 of some registration
districts situated in the Thames valley:--
1871. 1881.
Kingston 55,929 77,057
Richmond 26,145 33,633
Reading 33,340 43,494
Windsor 26,725 31,992
Staines 20,199 23,774
Uxbridge 25,538 27,550
Brentford 71,933 101,706
Eton 24,928 27,721
Wycombe 38,366 40,278
Henley 18,916 19,992
Oxford } 21,016 21,902
Headington } 22,756 28,723
--------- ---------
385,791 477,822
I am well aware that some of the districts in the above list are below
the intake of the water companies, but the figures serve to show how
rapid is the increase of population in the valley of the Thames,
which is one of the most popular districts in the whole country. This
concentration of people along the banks of the river must have the
effect of lessening the purity of the water which we drink.
Thus it is evident that what I have called the loose end of our
sanitation is a growing expense and a growing danger. Hygiene, to be a
permanent benefit, should move along natural lines, and organic refuse
ought to be committed to the soil as quickly as possible, when it would
cease to be a danger, and would prove a source of profit. If the evil
effects of free trade are to be counteracted, it will be by returning
the refuse of our towns free of cost to the impoverished agriculturist.
If we in England go on as we are going, and if our brethren in the
Colonies follow our example, as they are doing, I believe our race must
become extinct, and it will be a Chinaman rather than a New Zealander
who will sit in contemplation on the ruins of London Bridge.