RISE OF THE SANITARY MOVEMENT, 1837.
Perhaps the most necessary and the most tried quality in a reformer is
Patience. Notwithstanding the publication of the 'Treatise on Fever' in
1830, and the tribute paid by the scientific world to its masterly
exposition of the treatment and causes of the disease, notwithstanding
the constant and ardent endeavours of the author to propagate his views,
yet seven long years passed away before he was able to awaken the apathy
of the public and the authorities.
Year after year went by, and the wards of the Fever Hospital continued
to be supplied from the same districts, from the same courts and
lanes--even from the very same house--as before. The preventible
suffering, thus daily brought before my grandfather's eyes, was a daily
reminder of the urgent need for help--of the necessity for taking
practical steps to diminish it.
In 1837 the opportunity came for pressing forward in the cause. That
year a frightful epidemic fever broke out in London, arousing general
alarm, and demanding special inquiry. The pressure on the poor-rates
became excessive, and my grandfather was appointed by the Poor Law
Commissioners to report on the eastern districts of London, Drs Arnott
and Kay being appointed to other districts.
The title of the Report presented by him is at once striking. He called
it, "Report on the Physical Causes of Sickness and Mortality to which
the Poor are particularly exposed, _and which are capable of prevention
by Sanitary Measures_." Its opening words are,--
"Some of the severest evils at present incident to the condition of
poverty, which have a large share in inducing its high rate of sickness
and mortality, are the consequences of improvidence. Such evils are
capable of being remedied only by bringing the poor under the influence
of the inducements to forethought and prudence.
"But there are evils of another class, more general and powerful in
their operation, which can be avoided by no prudence, and removed by no
exertion, on the part of the poor. Among the gravest, and at the same
time the most remediable, of these latter evils, is the exposure to
certain noxious agents generated and accumulated in the localities in
which the poor are obliged to take up their abode, and to the pernicious
influence of which they are constantly, and for the most part
unconsciously, subjected.
"It is the object of the present Report to direct attention to the
nature and extent of this evil, and to show how important it is that its
mitigation, and, as far as may be found practicable, its entire removal,
should form a part of every exertion that is made for improving the
physical condition of the poor."
These words would seem to strike the key-note of Sanitary Reform.
In order to make the Report more full and impressive, Dr Southwood Smith
writes an exact account of what he saw. He went personally over the
greater part of the Bethnal Green and Whitechapel districts. "I
traversed," he says, "a circle of from six to seven miles in extent. I
wrote the account of the places I am about to notice on the spot; I
entered many of the houses and examined their condition as to
cleanliness, ventilation, as well as the state of the people themselves,
who were at the time labouring under fever."
The descriptions that follow are too dreadful to be dwelt upon in detail
here. We are shown individually the houses of Whitechapel: they are
piled storey above storey, and are teeming with people; the streets,
courts, and alleys are so built that all current of air is blocked out,
and no measures whatever are taken to secure cleanliness. We are shown
Bethnal Green, flat, low, damp, wasted. Here the houses are not so
closely packed--there are open spaces; but these are for the most part
undrained marshes, and the air coming across them is poisonous rather
than life-giving. Straggling rows of rickety cottages look out upon
stagnant swamps; their miserable gardens are scattered over with
uncleared dust and refuse of all kinds, and are surrounded with black
and overflowing ditches, to cross which you must pass over rotting
planks used as bridges: there are houses which contain only two rooms,
the larger being 9 feet by 7 and 7 feet high, the smaller not able to
contain an ordinary-sized bed.
If the house has more rooms, it probably contains many families, and a
state of overcrowding is produced nearly as fatal as that which prevails
in the parts of London where the houses stand more thickly.
The picture comes vividly before us of the dismal homes, with their
melancholy gardens where the pale children play by the black ditches;
their green damp walls; the rags stuffed into the broken windows to keep
out the tainted outside air; and the crowds huddled together breathing
the suffocating air within doors. It is easy to realise the hopeless
efforts of the poor inhabitants to fight against the dirt and disease
which all those efforts are powerless to overcome!
No wonder then, that, in the words of his Report, we are told that "in
many parts of both these districts fever of a malignant kind and fatal
character is always more or less prevalent; that in some streets it has
recently prevailed in _almost every house_; in some in _every house_;
and, in some few instances, in _every room of every house_. Cases are
recorded in which every member of a family has been attacked in
succession, of whom, in every such case, several have died: some whole
families have been swept away. Instances are detailed in which there
have been found, in one small room, six persons lying ill of fever
together: I have myself seen this--four in one bed and two in another."
He once more enforces the preventibleness of this dreadful state of
things--how entirely it was within the power of man to change it by wise
attention to the laws of health. He points out parts of the districts
which had always remained comparatively healthy, and some, formerly
haunts of fever, where during the last epidemic no single case had
occurred, owing to sanitary improvements.
The necessity for providing in some way for the airing of streets and
courts in densely populated neighbourhoods, by the knocking down of
houses or other expedients, is insisted upon. Its difficulty is
admitted, but still it is urged.
"Though it might seem a hopeless task," he says, "to set about
ventilating such districts as Bethnal Green and Whitechapel, yet, if the
importance of the principle be duly appreciated and the object be kept
steadily in view, much may be accomplished. In some of the worst
localities in these districts, at moderate expense, means might be taken
to introduce free currents of air, where at present the air is perfectly
stagnant and stifling. Some of the improvements recently made in the
City of London show to what extent it is possible to introduce good
ventilation into the heart of the most densely populated part of the
Metropolis."
In this Report my grandfather also draws attention to the state of the
Workhouses. He was writing to the Poor Law Commissioners, and so he
could efficiently bring under their notice the state of those buildings.
"From what I have observed I am satisfied," he says, "that many existing
workhouses are extremely deficient in space, ventilation, and drainage."
The overcrowding in the dormitories is especially pointed out. He
writes:--
"In going over the Whitechapel Workhouse I was struck with the statement
of the fact that, out of 104 children (girls) resident in that house, 89
have recently been attacked with fever. On examining the dormitory in
which these children sleep, my wonder ceased. In a room 88 feet long,
16-1/2 wide, and 7 feet high, with a sloping roof rising to 10 feet, all
these 104 children, together with four women who have the charge of
them, sleep. The beds are close to each other; in all the beds there are
never less than four children, in many five; the ventilation of the room
is most imperfect. Under such circumstances the breaking out of fever is
inevitable.
"I was likewise struck with the pale and unhealthy appearance of a
number of children in the Whitechapel Workhouse, in a room called the
'Infant Nursery.' These children appear to be from two to three years of
age; they are 23 in number, they all sleep in one room, and they seldom
or never go out of this room either for air or exercise. Several
attempts have been made to send these infants into the country, but a
majority of the Board of Guardians has hitherto succeeded in resisting
the proposition.
"In the Whitechapel Workhouse there are two fever-wards: in the lower
ward the beds are much too close; two fever patients are placed in each
bed; the ventilation is most imperfect, and the room is so close as to
be dangerous to all who enter it, as well as most injurious to the
sick."
The Report mentions, in contrast, the case of the Jews' Hospital, where
he had been physician. In that hospital, though at one time there had
been a yearly outbreak of fever, since the number of beds in the
dormitories had been reduced, and several large ventilators had been put
in, the evil had entirely ceased. At the time he wrote eight years had
passed since the improvements, and fever had not once returned as an
epidemic.
* * * * *
After finishing this Report, my grandfather set to work to obtain exact
statistics as to fever in other parts of London; and by the next year
(1839) tables had been compiled, which proved, by a wider range of
experience, the truths he had again and again brought forward. Once more
he wrote a Report to the Poor Law Commissioners--of whom Mr (afterwards
Sir Edwin) Chadwick was one--pointing out the facts which were proved by
these figures and the duty of acting on them.[16]
Such accounts as those given by the three physicians appointed by the
Poor Law Board to inquire, could not pass unnoticed. The press, not only
in London but in all parts of England, took up the subject. Public men
began to be roused.
At first the facts were doubted. It was difficult to believe that such a
dreadful state of things _could_ exist; but attention was awakened, and
inquiry followed.
The Marquis of Normanby, then Secretary of State for the Home
Department, was much impressed with what he had read, but he could
hardly conquer a belief that there must have been some exaggeration. My
grandfather took him to see some of the places in Bethnal Green and
Whitechapel which the Report had described. Lord Normanby was deeply
moved, as every one must have been who was brought to realise the kind
of dwellings which were all that these people had for homes. "So far,"
he said, "from any exaggeration having crept into the descriptions which
had been given, they had not conveyed to my mind an adequate idea of the
truth."
Lord Ashley, too, always in the forefront to relieve the sufferings of
the poor, was taken by my grandfather on two occasions to see these
regions personally; and from that time forth he became one of the most
ardent supporters of the Sanitary Cause, working strenuously for it both
in and out of Parliament.[17] In a letter to a friend my grandfather
writes:--
"FINSBURY SQUARE, 1841.
"I have just returned from Whitechapel and Bethnal Green, over which
I have been taking Lord Ashley and his brother, and I think they
have received an impression which will be lasting, and which will
stimulate them to exert themselves for the removal of some of the
evils which they have witnessed."
The Bishop of London had the honour of being the first to bring the
question before Parliament. In an earnest and eloquent speech made in
the House of Lords during the session of 1839, he moved for an extension
of such inquiries as the Poor Law Board had caused to be made in London,
to other towns in the United Kingdom.
It must have seemed to my grandfather a glorious moment when the
principles he had so long advocated were for the first time
recognised--when the country began to hear with surprise and shame of
the existing state of things--and when the suffering, which he felt so
deeply, seemed about to be relieved.
The movement had now begun. Surely it would go quickly, since the saving
of thousands of lives each year depended on its progress?
Footnote 16:
Report on the Prevalence of Fever in Twenty Metropolitan Unions in
1838.
Footnote 17:
For the account of what was shown to Lord Ashley on these occasions
see Appendix I., p. 159.