REPORT
TO
HER MAJESTY’S PRINCIPAL SECRETARY OF STATE FOR THE HOME DEPARTMENT,
FROM THE
POOR LAW COMMISSIONERS,
ON AN INQUIRY INTO THE
SANITARY CONDITION
OF THE
LABOURING POPULATION OF GREAT BRITAIN;
WITH
APPENDICES.
_Presented to both Houses of Parliament, by Command of Her Majesty,
July, 1842._
LONDON:
PRINTED BY W. CLOWES AND SONS, STAMFORD STREET,
FOR HER MAJESTY’S STATIONERY OFFICE.
1842.
TO THE
RIGHT HON. SIR JAMES GRAHAM, BART.
HER MAJESTY’S PRINCIPAL SECRETARY OF STATE FOR THE HOME DEPARTMENT.
_Poor Law Commission Office, Somerset House,
9th July, 1842._
SIR,
On the 14th May, 1838, the Poor Law Commissioners presented to Lord John
Russell a report “relative to certain charges which have been disallowed
by the auditors of unions in England and Wales;” together with two
supplementary reports; one a “Report on the prevalence of certain
Physical Causes of Fever in the Metropolis, which might be removed by
proper sanitary measures, by Neil Arnott, M.D., and James Phillips Kay,
M.D.;” the other a “Report on some of the Physical Causes of Sickness
and Mortality to which the Poor are peculiarly exposed, and which are
capable of removal by Sanitary Regulations exemplified in the present
condition of the Bethnal Green and Whitechapel Districts, as ascertained
on a personal inspection by Southwood Smith, M.D., Physician to the
London Fever Hospital.” (See Fourth Annual Report, App. A, No. 1.)
On the 29th April, 1839, the Commissioners received from Dr. Southwood
Smith a “Report on the prevalence of Fever in Twenty Metropolitan Unions
or Parishes during the year ended the 20th March, 1838,” which they
appended to their Fifth Annual Report. (App. C, No. 2.)
In August, 1839, Lord John Russell addressed the following letter to the
Commissioners:—
_“Whitehall, August 21, 1839._
“GENTLEMEN,
“The Queen having been pleased to comply with the prayer of an humble
address presented to her Majesty, in pursuance of an order of the
House of Lords, dated 19th August, 1839, that ‘Her Majesty will be
pleased to cause inquiry to be made as to the extent to which the
causes of disease stated in the Appendix A, No. 1, of the Poor Law
Commissioners’ Fourth Annual Report, and Appendix C, No. 2, of their
Fifth Annual Report, to prevail amongst the labouring classes in the
metropolis, prevail also amongst the labouring classes in other parts
of England and Wales, and that Her Majesty will be graciously pleased
to cause the results of such inquiry to be communicated to the
House’—I have to desire that you will cause inquiry to be made
accordingly, and that you will prepare a report upon the result of
such inquiry, and transmit the same to me, in order that it may be
laid before the House of Lords.
“I am, Gentlemen, your obedient servant.
“J. RUSSELL.”
With the view of making the inquiry directed by Lord John Russell’s
letter, we addressed, in the month of November following, an instruction
to our Assistant Commissioners to report upon such parts of the subject
as were likely to come under their observation. We likewise addressed
letters to the several Boards of Guardians of Unions in England and
Wales, and their respective medical officers, requesting them to furnish
us with information in answer to certain queries. (App. Nos. 1, 2, and
3.)
The steps which we thus took for conducting the inquiry which we were
instructed to make have produced a large body of information, from which
we have selected for our present Report that portion which seemed to us
most important to the public, and most worthy of consideration by Her
Majesty’s Government.
From the reports transmitted to us by our Assistant Commissioners we
subjoin a report from Mr. Gilbert on the sanitary condition of the
labouring population in Devon and Cornwall: the reports from Mr. Mott
and Mr. Power with relation to the sanitary condition of the population
of Manchester and the adjacent manufacturing districts, which will be
found to be corroborative of the reports of Dr. Baron Howard and Dr.
Duncan: one from Mr. Twisleton with relation to the sanitary condition
of the population of Norfolk and Suffolk: one from Mr. Tufnell with
relation to the sanitary condition of the labouring population of Kent
and Sussex: a report from Mr. Parker on the sanitary state of the
labouring population in the counties of Berks, Bucks, and Oxford: one
from Mr. Weale on cottage accommodation in the counties of Bedford,
Northampton, and Stafford,—a report from Mr. Senior on the sanitary
condition of the labouring population in the counties of Leicester,
Lincoln, Nottingham, and Rutland: one from Sir Edmund Head on the
dwellings of the labouring classes, and on the means of procuring better
cottage accommodation in the counties of Gloucester, Hereford, Monmouth,
Salop, Worcester, Brecknock, and Radnor; three reports from Sir John
Walsham on the condition of the dwellings of the labouring population in
Durham, Northumberland, Westmoreland, and Cumberland; and a
communication from Mr. Day on the cost of erection, repairs, and rents
of labourers’ cottages in Salop, Cheshire, and North Wales.
We have likewise received several valuable reports upon towns and
districts in England from medical men resident upon the spot.
We have obtained a report from Mr. Hodgson and a committee of medical
gentlemen of Birmingham on the sanitary condition of the labouring
population in that town.
We also append a report on the sanitary condition of the dwellings of
the labouring classes, &c., in Manchester, which we have obtained from
Dr. Baron Howard, physician to the Ardwick and Ancoats Dispensary of
that town:
Also, one on the condition of the labouring population in Liverpool,
from Dr. Duncan.
One on the condition of the labouring population in Derby, from Dr.
Baker.
One on the condition of the labouring population of Truro, from Dr.
Barham.
One on the condition of the labouring population of Brighton, from Dr.
Jenks.
One on the sanitary condition of the labouring population in the town
of Wolverhampton, by Dr. Dehane.
One on the prevalence of fever in the parish of Breadsall, Derbyshire,
by Dr. Kennedy and Mr. Senior.
One on the sanitary state of the town of Stafford, by Dr. Edward
Knight.
One on an improved description of cottage tenements for the labouring
classes, by Mr. Edmund Ashworth.
One on the sanitary condition of the town of Lancaster, Dr. de Vitrié.
One on the sanitary condition of the town of Leeds, by Mr. Robert
Baker.
The detailed statements which we received from the Boards of Guardians,
and the Union medical officers, were too voluminous for insertion at
length in the present Report; but we have caused them to be carefully
examined, and some of the most important results which they contained
have been extracted in the manner which we shall presently explain.
It will be observed that the inquiry which we were directed by Lord John
Russell to make, in accordance with the address of the House of Lords,
was limited to England and Wales. Subsequently, however, we received
instructions from the Marquis of Normanby, dated 28th January, 1840,
directing us to extend our inquiries to the causes of disease and
destitution amongst the working classes in Scotland.
On the receipt of these instructions, we caused a circular letter to the
medical practitioners to be sent to the provosts of all the Scotch
burghs, with a request that they would put us in communication with the
officers of the medical charities and establishments within their
jurisdiction. In the same letter we stated fully the objects of the
inquiry, and requested to be informed as to the general state of the
main sewers, drainage, &c., of the several towns. (Appendix, Nos. 4 and
5.)
In Scotland, with a few exceptions, none of the medical profession are
engaged in the public service as medical officers; and we were therefore
compelled to rely on the exertions of the private medical practitioners,
from whom we received extensive, zealous, and efficient aid. The
President of the College of Surgeons of Edinburgh communicated to us a
resolution passed by that body, recommending that all members and
licentiates of the college should give every aid in their power to the
inquiry into the sanitary condition of the poor. We directed additional
queries to be issued to the members of the college, from some of whom we
received information similar to that obtained from the medical officers
in England.
With respect to the sanitary state of towns and districts in Scotland,
we subjoin the following reports from medical gentlemen:—
A report from Dr. Arnott upon Edinburgh and Glasgow:
One report from Dr. Scott Alison on the sanitary condition of the
colliery population of Tranent, and the adjacent districts:
One report on the condition of the labouring population of Musselburgh
from Mr. Stevenson, surgeon:
One report on the condition of the labouring population of Ayr from
Dr. Sym:
One on the condition of the labouring population, Stirling, from Mr.
W. H. Forrest, surgeon:
One on the condition of the labouring population in Dumfries, from Dr.
M’Lellan:
One on the sanitary condition of the poor of Aberdeen, by Drs. Kilgour
and Galen:
One on the sanitary condition of the town of Lanark, by Mr. John
Gibson, surgeon:
One on the sanitary condition of the city of St. Andrews, by Mr.
Adamson, surgeon:
One on the sanitary state of the town of Greenock, by Dr. Laurie:
One on the sanitary condition of Tain and Easter Ross, by Mr. James
Cameron, surgeon.
We have likewise received a report on the sanitary condition of the
labouring population in Inverness, from Mr. Anderson, solicitor; and
one on the sanitary condition of the Old Town of Edinburgh, by Mr.
William Chambers.
As our inquiries led us to believe that considerable doubt exists as to
the provisions of the existing law of Scotland upon matters concerning
the public health, and as there is not in Scotland any local
administrative machinery similar to that of the English unions which can
exercise a superintendence over the health of the working classes, we
obtained the services of Mr. J. H. Burton, advocate of Edinburgh, to
report on the legal provisions existing in that city and in other parts
of Scotland, and on the additional legislative measures which appeared,
from the reports of the medical gentlemen, to be expedient for the
improvement of the sanitary condition of the population of that part of
the empire.
We also obtained the services of Mr. Charles R. Baird, of Glasgow,
writer to the signet, who was pointed out to our notice by the
circumstance of his having paid much attention to the condition of the
labouring population of that city to report on the powers with which the
local authorities are at present invested by law, and the additional
powers they may need for the protection of the health of the
inhabitants.
It will be observed that the letter of Lord John Russell, in accordance
with the address of the House of Lords to Her Majesty, merely directed
us to make inquiry as to the extent to which the causes of disease,
stated in the Reports of Drs. Arnott and Kay, and of Dr. Southwood
Smith, to prevail amongst the labouring classes of the metropolis,
prevail also amongst the labouring classes in other parts of England and
Wales, and to transmit the results of that inquiry to the Secretary of
State for the Home Department. We should, therefore, have complied with
the letter of our instructions if we had merely laid before you the
information which we have collected in answer to the inquiries which we
circulated. It appeared to us, however, that so large a mass of
miscellaneous evidence would not be likely to convey a distinct view of
the subject of inquiry if we presented it in an undigested form to Her
Majesty’s Government; and we, therefore, requested our secretary, Mr.
Chadwick, to peruse the information which we had received, (including
the returns from the boards of guardians and union medical officers,)
and, by comparing the different statements with such authentic facts
bearing upon the question as he might collect from other sources, to
frame a report which should exhibit the principal results of the inquiry
which we were instructed to conduct. We subjoin the Report which Mr.
Chadwick has prepared in accordance with this request; and we present to
you this, and the other accompanying documents, in the full assurance
that, as they contain matters seriously concerning the welfare of the
community in general, and particularly of the working classes, they will
receive the attentive consideration of Her Majesty’s Government.
We have the honour to be,
Sir,
Your very faithful and obedient Servants
GEORGE NICHOLLS,
GEORGE CORNEWALL LEWIS,
EDMUND WALKER HEAD.
APPENDIX.
1.—_Circular Letter of Instructions to the Assistant Commissioners in
England._
Poor Law Commission Office, Somerset House,
8th November, 1839.
Sir,—I am directed by the Poor Law Commissioners to call your attention
to the following letter lately addressed to them by Lord John Russell.
Whitehall, August 21st, 1839.
“Gentlemen,—The Queen having been pleased to comply with the prayer of
an humble address presented to Her Majesty in pursuance of an Order of
the House of Lords, dated 19th of August, 1839, that ‘Her Majesty will
be pleased to cause inquiry to be made as to the extent to which the
causes of disease stated in the Appendix A., No. 1, of the Poor Law
Commissioners’ Fourth Annual Report, and Appendix C., No. 2, of their
Fifth Annual Report, to prevail amongst the labouring classes in the
metropolis, prevail also amongst the labouring classes in other parts of
England and Wales; and that Her Majesty will be graciously pleased to
cause the results of such inquiry to be communicated to the House,’ I
have to desire that you will cause inquiry to be made accordingly, and
that you will prepare a report upon the results of such inquiry, and
transmit the same to me in order that it may be laid before the House of
Lords.
“I am, Gentlemen,
“Your obedient Servant,
“J. RUSSELL.”
The Commissioners consider this the proper time for making arrangements
to obtain the returns and information on which they may prepare a report
to be submitted to the House of Lords in the ensuing Session of
Parliament.
The Commissioners request your particular attention to the subject, as
one of great importance to the labouring classes, inasmuch as it may
lead to the removal of the causes of prevalent and fatal diseases, and
of consequent destitution and suffering.
The steps which the Commissioners propose to take for obtaining the
information required by the order of the House of Lords, are:—
1. To procure from the medical officers of unions returns of the number
of cases of contagious or infectious disease, the spread of which within
their respective districts has been promoted by the circumstances
referred to in the order of the House of Lords, with their observations
thereon; for which purpose the Commissioners will issue the necessary
circulars to the medical officers.
2. To obtain information from the Boards of Guardians of districts in
which these diseases appear to have prevailed to a considerable extent,
and where the guardians have applied to municipal or other authorities
for the removal of circumstances promoting the prevalence of such
diseases.
3. In large towns, to request some physician,[1] or general practitioner
of eminent reputation, to prepare a report (founded upon data obtained
from the various dispensaries, infirmaries, fever hospitals, and other
similar public establishments) respecting the circumstances promoting
the prevalence of contagious and infectious diseases in such large
towns.
The Commissioners will be glad to receive from you the name of any
physician or general practitioner of sufficient eminence to obtain the
requisite data, and who will be willing to furnish them with such a
report in each of the towns in your district named in the margin.
4. If the means already indicated should prove insufficient, to obtain a
report from yourself founded on personal examination, on spots where,
from the returns or from other information, such examination by yourself
or the medical officer of the district may appear necessary.
Some of the chief considerations bearing upon the subject are set forth
in the reports referred to in the resolution of the House of Lords, and
if within your district there were any Boards of Health appointed during
the prevalence of the cholera, it is probable that their reports founded
on an examination of the condition of those classes amongst whom the
prevalence of that disease was apprehended may furnish you with useful
information.
The Commissioners wish further to observe that the state of the
dwellings occupied by the labouring classes exercises an important
influence upon their health, and the nature and frequency of the
diseases to which they are subject, as well as indirectly upon the moral
state of themselves and their families.
The Commissioners therefore request you to investigate the state of the
dwellings of the labouring classes in your district, both in towns and
in the country, with reference to the following observations,—
It will be desirable generally, after informing yourself of the various
descriptions of cottage tenements in your district and the nature of the
accommodation or comforts which they contain, to observe—
1. What is the common cost of erection, and the average cost of
repairing each description of these cottage tenements.
2. What are the rents paid by the labourers for each description of
these cottage tenements.
3. What is the general proportion of the rent paid by the labourer to
his total expenditure.
You may find within your district instances where the employers of
labour (whether agricultural or manufacturing) have erected on their own
lands tenements of an improved description for the residence of the
labourers employed by them. You are requested to take notice of all such
instances which may come before you, and examine them as standards of
comparison with other tenements of an inferior kind. You will inquire as
to the comparative health and condition of the inmates, and whether the
advantage of improved dwellings has been observed to have any salutary
influence on the moral habits of the inmates;—whether the increased
comforts of his house and home have tended to withdraw the labourer from
the beer-shop, and from the habits of improvidence to which it
leads;—whether residents in separate and improved tenements are superior
in condition, as compared with the labourers who hold merely lodgings,
or who reside with other families in the same house.
Where you meet with remarkable instances of improved tenements of this
description, you are requested to set them forth in your report, and
obtain the loan of the plans or drawings of them, together with any
information as to their cost and the probable returns in rent, and
whether on the whole (other advantages than the pecuniary return being
taken into consideration) they are deemed profitable; or what may be the
extent of pecuniary loss upon them, or how far it may be countervailed
by other considerations.
Although the facts collected by you may not lead to the adoption of any
legislative remedies, the publication of successful examples may be
useful in stimulating to the voluntary adoption of them.
The Commissioners wish you however to consider whether any legislative
measure in the nature of a Building Act (_i. e._ an Act prescribing
certain rules to be followed in the building of cottages) would tend to
introduce generally the improvements which may have been adopted
partially by public-spirited persons in your district.
This may be considered:—
1. In the case of tenements intended for the residence of the labouring
classes in towns;
2. In the case of cottage tenements in rural districts.
With regard to the former class of tenements, the wages of the labourers
in towns being commonly double those earned in the rural districts, they
may be well able to afford to procure such an increase of comfort in
their houses as may be obtained by means of a Building Act, even at the
cost of an additional rent. You are also requested, in your observations
on this subject, to bear in mind another question, namely, the
expediency of exempting small tenements from the payment of rates, or
wherever rents are collected weekly, of collecting the rates from the
landlord.
It has been stated that the exemption from poor’s rate tends to
deteriorate the tenements of the labouring classes, inasmuch as many of
such tenements are, for the purpose of obtaining the exemption, built of
such quality and appearance as may bring them within the exempted class.
It has been further stated, that the benefit of the exemption goes to
the landlord, the rent for cottages built for letting in towns being
very high as compared with rents obtained for other house property, and
that such increased rents have been demanded expressly on the ground of
exemption from rating. The causes affecting the construction of cottages
are not expressly mentioned in the reports referred to in the resolution
of the House of Lords, which treat chiefly of the external and
immediately-removable causes of disease, such as stagnant pools or other
out-door nuisances with which the parochial officers had to some extent
been heretofore accustomed to interfere. But the defective construction
of the cottages themselves, and the imperfect protection they may afford
against cold or damp—the want of means for the due regulation of warmth
or of conveniences for cleanliness, may often be the causes of the
prevalence of disease; and the Commissioners consider not only that
these subjects cannot with propriety be overlooked in any report on the
sources of disease among the labouring classes, but that the beneficial
moral results which may arise from the suggestion of improvements in the
habitations of the labouring classes justify the Commissioners in taking
this occasion to direct your attention to the heads of inquiry which are
noticed in this communication.
Signed, by Order of the Board,
E. CHADWICK, _Secretary_.
_To_
Assistant Poor Law Commissioner.
2.—_Circular Letter of Instructions to Clerks of the Boards of Guardians
in England and Wales._
Poor Law Commission Office, Somerset House,
12th November, 1839.
Sir,—I am directed by the Poor Law Commissioners to inform you that they
have, in compliance with a communication from Her Majesty’s Secretary of
State for the Home Department, directed the enclosed letters to the
medical officers of your board, together with the accompanying forms for
their answers, and I am to request that you will transmit them
accordingly.
The medical officers will transmit to you the returns when completed,
and by you they will be forwarded when the information required is
obtained from all the medical officers to the office. In case of any
defect in the returns which cannot be remedied, you will state the
nature and extent of the same at the time of transmission.
Before transmitting the returns, you are to read them at a meeting of
the Board of Guardians, acquaint them with the answers, and annex any
further information which they may be enabled to communicate in aid of
the inquiry.
Signed, by Order of the Board,
EDWIN CHADWICK, _Secretary_.
To the Clerk to the Board of Guardians.
3.—_Circular Letter of Inquiry to the Medical Officers of the Unions in
England and Wales, transmitted to them, with Forms of Return, through
the Clerks to the Guardians._
Poor Law Commission Office, Somerset House,
12th November, 1839.
Sir,—With the view of ascertaining the extent of the existence of
circumstances promoting the prevalence of contagious and infectious
diseases described in the reports referred to in the Order of the House
of Lords, set forth in the letter from Lord John Russell, a copy of
which is hereto annexed, you are requested to fill from the medical
relief Lists the enclosed returns, and transmit them to the clerk of the
union, with such observations as occur to you thereon.
You will observe that the object of the Commissioners is to ascertain
the existence and extent of the visible and removable agencies promoting
the prevalence of such diseases as are commonly found connected with the
defects in the situation and structure or internal economy of the
residences of the labouring classes.
The attention of the physicians who drew reports on the state of the
metropolis was almost exclusively directed to the causes affecting the
prevalence of various forms of _continued fever_, arranged under
distinguishing names adopted by nosological writers: but in rural
districts the prevalence of ague, and of small-pox, and scarlet fever,
may be worthy of notice when the causes promoting their prevalence
appear removable.
You will, in your observations on the class of cases returned, note the
situation, character and quality of the tenements in which the diseases
have occurred;—whether they are situated in a neighbourhood habitually
infected with malaria;—whether there are occasional causes of malaria,
such as floods, &c.; and in such cases, whether you have any suggestions
to make as to the best means of diminishing the evil;—whether they are
drained or undrained, whether tight or otherwise;—whether there are good
means of securing ventilation with a due regard to warmth;—whether there
are accumulations of filth, and if so, whether they are ascribable to
the slovenly or indolent habits of the inmates, or to the want of proper
receptacles for refuse;—whether the occurrence of disease amidst this
part of the population is regular or otherwise, and what are the seasons
at which it appears, and its characteristics.
The Commissioners request that you will favour them with any information
which you may have gained in the course of your medical experience, as
to the condition of the inmates of such residences;—whether there is a
need of superior cottage accommodation, or to what extent the
improvement of the residence would influence the habits beneficially;
as, for example,—whether you have witnessed any beneficial effects on
the habits of the inmates by providing cottages with a day-room,
scullery, pantry, three bed-rooms, and convenient receptacles for refuse
and for fuel;—whether within your district there are other labourers of
the like class, who occupy improved tenements in a superior situation,
and what is the general health and condition of the inmates as compared
with the general health and condition of the inmates less advantageously
situated;—whether you have seen any cottages constructed with a view to
the most economical management of fuel both in cooking and maintaining a
proper temperature in the rooms;—and further, any observations that may
occur to you on the subject of the health of the labouring classes in
connexion with what may appear to you to be available sanitary
regulations.
The accompanying portions of the report, and the appendix referred to in
their lordships’ order, are transmitted for your information as to the
causes of disease existing in the metropolis, which it is deemed
necessary to investigate in other parts of the country.
Signed, by Order of the Board,
EDWIN CHADWICK, _Secretary_.
To the Medical Officer of the District.
(COPY.)
Whitehall, August 21, 1839.
Gentlemen,—The Queen having been pleased to comply with the prayer of an
humble address presented to Her Majesty, in pursuance of an order of The
House of Lords, dated 19th August, 1839, “that Her Majesty will be
pleased to cause inquiry to be made as to the extent to which the causes
of disease stated in the Appendix A., No. 1, of the Poor Law
Commissioners’ Fourth Annual Report, and Appendix C., No. 2, of their
Fifth Annual Report, to prevail amongst the labouring classes in the
metropolis, prevail also amongst the labouring classes in other parts of
England and Wales; and that Her Majesty will be graciously pleased to
cause the results of such inquiry to be communicated to the House,”—I
have to desire that you will cause inquiry to be made accordingly, and
that you will prepare a report upon the results of such inquiry, and
transmit the same to me, in order that it may be laid before the House
of Lords.
I am, Gentlemen,
Your obedient Servant,
(Signed) J. RUSSELL.
_Form of Return transmitted with the above Letter to the Medical
Officer._
_For the Year ended September 29, 1829._
A RETURN from Mr. ________ Medical Officer of the ________ District of
the ________ Union.
┌───────────────┬───────────┬───────────┬─────────────────────────────┐
│ CASES. │Occupation │ Situation │ OBSERVATIONS. │
│ │ of │ and State │ │
│ │Applicants.│ of │ │
│ │ │Residence. │ │
├───┬───────────┼───────────┼───────────┼─────────────────────────────┤
│No.│Nosological│ │ │(If there should not be │
│of.│ Names of. │ │ │ sufficient space for the │
│ │ │ │ │ requisite Observations, │
│ │ │ │ │ space for the requisite │
│ │ │ │ │ Observations, they may be │
│ │ │ │ │ continued on the back of │
│ │ │ │ │ the Return, or on a │
│ │ │ │ │ fly-leaf, to be attached to│
│ │ │ │ │ the Return.) │
├───┼───────────┼───────────┼───────────┼─────────────────────────────┤
│ │ │ │ │ │
│ │ │ │ │ │
│ │ │ │ │ │
│ │ │ │ │ │
└───┴───────────┴───────────┴───────────┴─────────────────────────────┘
Signature of Medical Officer: ________
4.—_Circular Letter to the Provosts of Burghs in Scotland._
Poor Law Commission Office, Somerset House,
London, 1840.
Sir,—The Poor Law Commissioners have received from Her Majesty
directions to extend to Scotland the inquiry they have, in compliance
with an address from the House of Lords, been directed to make in
England as to the causes of disease and destitution arising from the
situation and construction of the dwellings of the labouring classes,
and from other similar circumstances affecting their sanitary condition.
The Commissioners request your aid in conducting the inquiry in the
of The Commissioners have obtained valuable
information in England from the medical practitioners who have the care
of hospitals and dispensaries, where those contagious febrile diseases
to which their attention has been specially directed come under the
observation and treatment of experienced professional men.
The Commissioners ask of you the favour of putting them in communication
with the officers of the medical charities and establishments in the
of , whether supported by the voluntary subscriptions
of the inhabitants or by payments out of the town funds, or both.
The Commissioners desire to ascertain, either from the officers of
such institutions or from the medical practitioners of the most
extensive practice amongst the poorer classes, or from those who visit
them in their habitations, to what extent continued fever, and other
contagious febrile diseases, are prevalent amongst the poor;—what is
the character of the streets and houses in which these maladies most
frequently arise, or spread with the greatest rapidity; the state of
the paving,—scavenging, and sewerage of such streets,—their width,—the
drainage of the houses,—their size,—their state of repair,—the number
of families living under one roof,—the number living in cellars;—and
other circumstances relating to the structure and situation of the
habitations of the poorer classes, and their habits, by which they may
be rendered more susceptible of the influence of contagion.
The Commissioners would also be glad to obtain information whether the
main sewers of the town have been constructed in a satisfactory manner,
and kept in good repair; and to what body, and with what powers this
duty is confided;—whether there are any sanitary regulations of a local
character for the enforcement of the paving of streets, and of drainage
on the owners of houses erected within a reasonable distance of
sewers;—whether any local body has power to interfere in the removal of
any, and if so of what, nuisances injurious to health; or to cause
lodging-houses, and dwellings liable to be infected with fever, to be
cleansed and whitewashed from time to time, and by whom the expense of
such interference is sustained.
The Commissioners are further desirous of ascertaining whether the
authority possessed by the town council, or other local body intrusted
with the paving, scavenging, sewerage, the removal of nuisances and
other causes of disease, are sufficient, or might in any respect be
increased with advantage to the sanitary condition of the town, and
especially of those parts of the town which are inhabited chiefly or
exclusively by the working classes, and which are therefore
comparatively remote from the observation, and less subject to the
interference of the middle classes.
The Commissioners will be glad to obtain from you or from the town
council of any suggestions which you may be desirous to make on
the subject; and they trust they may have the benefit of your advice and
assistance in the inquiry with which they are charged in the of
and its suburbs.
I have the honour to be, Sir,
Your very obedient servant,
EDWIN CHADWICK, _Secretary_.
_To_
The Provost of
5.—_Circular Letter of Inquiry to Dispensary Surgeons and Medical
Practitioners in Scotland._
Poor Law Commission Office, Somerset House,
London, 19th June, 1840.
Sir,—The Poor Law Commissioners have been directed to extend to Scotland
the inquiry which in the past year they received Her Majesty’s commands
to conduct in England, for the purpose of ascertaining what
circumstances in the condition of the poorer classes promote the spread
of continued fever and other contagious febrile diseases.
They are desirous that this inquiry should be conducted with care in
large towns, where the sources of contagion or the circumstances which
promote its rapid diffusion among the population are more rife than in
the rural districts; they are anxious to obtain the assistance of the
medical practitioners having charge of hospitals and dispensaries in
such towns, because such institutions afford the best means of observing
under what circumstances febrile contagious diseases are disseminated;
of defining the districts of the town in which they spread; of
ascertaining the character of the streets and houses in such districts;
the comparative attention paid to the paving, sewerage, and drainage of
these districts; and whether or not they are subject to malarious
influences.
The structure of the dwellings of the labouring classes; the nature and
extent of their internal accommodation, and of the means for securing
cleanliness, for removing filth, for promoting ventilation, and for
providing warmth with due economy, can be most easily ascertained by
medical gentlemen who devote their time to the frequently gratuitous
services of public institutions; they also are most competent to
discriminate between the direct influence of the habits of the poorer
classes, and of the external circumstances by which they are surrounded,
on their sanitary condition; while on the other hand they will not be
liable to fall into the error of supposing that these habits are
independent of arrangements which administer to domestic comfort.
The Commissioners trust, therefore, they may rely with confidence on
your affording them your valuable assistance in the inquiry which they
are directed to pursue. They trust you will permit them to suggest that
if the cases recorded in the books of your hospital were grouped
according to the districts from which the patients were removed, you
would at once be able to define in a map those parts of your town most
subject to contagious febrile diseases, and to furnish the Commissioners
with the number of cases of each febrile disease occurring in each of
these districts, and would possess the means of ascertaining and
delineating the features of those districts in all that relates to the
sanitary condition of the inhabitants, and to medical police. Besides
the general influences alluded to in the former part of this letter, you
will probably find it useful to ascertain whether any injurious
consequences are clearly attributable to certain classes of
manufactories surrounded by the habitations of the poor, to the location
of slaughter-houses, tanneries, ancient burial grounds, &c., amidst
dense masses of the population.
In the course of this inquiry it may be found necessary to distinguish
the extent of disease caused by physical or removable agencies, by
malaria created by defective drainage, or the bad construction of the
dwellings of the labouring classes, from disease caused by destitution
of the proper means of subsistence arising from poverty. It may be
expected of the medical practitioners from whom the Commissioners hope
to obtain reports, that they will make the distinction wherever it is
found to exist.
The Commissioners will value any suggestions you may have to offer
respecting the removal of the injurious agencies which may fall under
your observation. You are probably well acquainted with the nature of
the powers confided to the municipal authorities or other local bodies
respecting the paving, sewerage, and drainage of the town, and
especially of those parts of it which are inhabited chiefly or solely by
the working classes. The Commissioners request you to observe whether
those powers enable the municipal or other local body to complete the
sewerage, and to enforce the paving and drainage of the streets
partially or wholly at the expense of the proprietors of these houses.
The spread of contagious diseases is greatly facilitated in many towns
by the extreme filth of lodging-houses to which mendicants and vagrants
resort, and of the habitations of certain of the lowest portion of the
poorer class; measures of medical police have been resorted to on the
occurrence of epidemic fevers, and at the period of the invasion of
cholera, for cleansing and whitewashing these habitations at the expense
of the inhabitants. The Commissioners request you to state under what
circumstances you conceive such measures might be usefully resorted to,
and under what superintendence, and whether the expense should fall on
the owners of such habitations or on the inhabitants generally, and
whether this interference should be habitual or casual.
Suggestions have been made to the Commissioners that the nature of the
thoroughfares, and the structure and internal arrangement of the
buildings in districts inhabited by the working classes in large towns
would be greatly improved if subject to the regulations of a Building
Act enforced by the municipal authorities, or by a local board of
health; they invite you to reflect on the provisions of such a law, and
to state under what circumstances and to what extent you conceive such
interference desirable.
Generally the Commissioners are desirous to receive your impressions
respecting the means of improving the sanitary condition of the working
classes, especially in those parts of your town in which contagious
febrile diseases most frequently prevail.
Copies of the forms and exemplifications of the mode of entering the
particulars of the information sought in the returns circulated in
England, and the reports on the sanitary condition of the labouring
classes in the metropolis, are herewith transmitted for your use. The
Commissioners have not asked for returns in any prescribed form from the
medical practitioners in the towns of Scotland, because they are
uninformed as to the nature of the existing records of facts relating to
medical statistics in the towns, and they wish to consult the
practitioners’ convenience, and be guided by them as to the best use to
be made of the local circumstances for obtaining information.
I have the honour to be, Sir,
Your very obedient Servant,
EDWIN CHADWICK, _Secretary_.
_To_ ________
6.—_Form of General Queries addressed to Medical Practitioners and
others for Information as to the Condition of the Labouring Classes in
Scotland._
1. Have diseases of the various forms of continued fever, and other
contagious febrile diseases, been prevalent in any, and what, parts of
your parish or district, and do such diseases recur at regular
intervals, or are they rare and occasioned only?
2. What are the seasons at which such diseases appear amidst any part of
the population, and what their characteristics?
3. Did the cholera at the time of its general prevalence prevail to any,
and what, extent within the district?
4. What is the _external_ condition, in the following respects, of the
residences of the population amidst which such diseases occur?
(_a._) As to the contiguity of vegetable or animal substances in a state
of decomposition, stagnant pools or undrained marshes, accumulations of
refuse, either thrown from houses or otherwise?
(_b._) As to the means adopted or the means available for the _removal_
of such substances, or the prevention of the generation of malaria;
whether there are sufficient drains or sewers, adequately well supplied
with water to dilute, and sufficiently sloping to carry off all such
refuse; whether such drains are sufficiently _closed_ to confine noxious
exhalations from them; whether there is any regularly appointed service
of scavengers or otherwise for the removal of such substances; whether
there is such ventilation around the residences of, as to dissipate the
noxious vapours apparently irremovable?
5. Describe the _internal structure and economy_ of the residences of
the population amidst which contagious febrile diseases arise,—
(_a._) State whether they, as well as the surrounding land, are drained
or undrained?
(_b._) Whether they are properly supplied with water for the purposes of
cleanliness of the houses, persons, and clothing?
(_c._) Whether there are good means of ventilation with a due regard to
warmth?
(_d._) Whether there are proper receptacles for filth in connexion with
the cottages?
6. As to the internal economy of such residences, describe further,—
(_a._) Whether they are unduly crowded, and several families or persons
occupy the space which would properly suffice only for a less number?
(_b._) Whether there are any inferior lodging-houses crowded by
mendicants or vagrants?
(_c._) Whether there is gross want of cleanliness in the persons or
habitations of certain classes of the poor?
(_d._) Whether there is a habit of keeping pigs, &c., in
dwelling-houses, or close to doors or windows?
(_e._) Whether there is an indisposition to be removed to the hospitals
when infected with contagious disease?
7. Of the diseases described in question 1, are any or what proportion
ascribable to other causes than those specified in questions 4, 5, and
6? if so, distinguish those other causes so far as you are able, and the
extent of diseases resulting from them.
8. What is the common cost of erection and average cost of repairing
each description of the tenements or cottages inhabited by the labouring
classes?
9. What are the rents paid by the labourers for each description of
tenements or cottages?
10. What is the general proportion of the rent paid by the labourer to
his total expenditure?
11. What is the common cost of the lodgings to persons of the labouring
classes?
12. Are you of opinion that any, and what, legislative measures are
desirable or available for remedy of any of the evils existing within
your district?
13. Have any, and what, voluntary exertions been made to improve the
external or internal economy of the residences of the labouring classes
within your district? and if so, describe their nature and effects.
_Name of the parish or district to which the preceding answers│
refer._ │————————
_Name of the medical practitioner or other person by whom the │
answers are given._ │————————
NOTE.—Where the space opposite to any question does not suffice for
the full answer which it may be desirable to give, it may be written
on the blank space at the back of the sheet, or on a separate sheet,
reference being made to the number or letter of the question.
Any general observations may be hereunder annexed.
It is requested that the answer may be transmitted by the post to “The
Poor Law Commissioners,” according to the address on the inside of
the envelope which may be used for the purpose.
REPORT
ON THE
SANITARY CONDITION OF THE LABOURING POPULATION OF GREAT BRITAIN.
BY
EDWIN CHADWICK, ESQ.,
BARRISTER AT LAW, AND SECRETARY TO THE BOARD OF POOR LAW COMMISSIONERS.
CONTENTS.
GENERAL PREVALENCE OF EPIDEMIC, ENDEMIC, AND CONTAGIOUS DISEASES.
PAGE
Return of the number of deaths in 1838, in each county, from
epidemic, endemic, and other diseases, most powerfully affected
by the physical state of a district 2
Extent of evils which are the subject of inquiry 3
I. GENERAL CONDITION OF THE RESIDENCES OF THE LABOURING
CLASSES, WHERE DISEASE IS FOUND TO BE THE MOST PREVALENT— 5
In Tiverton union, Cornwall 5
In Truro, Cornwall 6
In Cerne union, Dorset 8
In Axbridge union, Somerset 10
In Chippenham union, Wilts 11
In Bedford union, Bedford 12
In Woburn union, Bedford 12
In Ampthill union, Bedford 12
In Bishop Stortford union, Hertford 12
In Witham union, Essex 13
In Windsor, Berks 13
In Epping union, Essex 14
In West Ham union, Essex 14
In Bromley union, Kent 14
In Bilston, Leicester 15
In Stafford (town of), Stafford, 16
In Macclesfield union, Chester 17
In Heaton Norris, Stockport union, Chester 17
In West Derby union, Lancaster 18
In Wigan union, Lancaster 19
In Durham (city of), Durham 20
In Barnard Castle, Durham 20
In Carlisle, Cumberland 21
In Gateshead, Durham 21
Condition of the Border peasantry 22
In Lochmaben, Scotland 23
In Glasgow and Edinburgh 23
II. PUBLIC ARRANGEMENTS, EXTERNAL TO THE RESIDENCES, BY WHICH
THE SANITARY CONDITION OF THE LABOURING POPULATION IS
AFFECTED— 25
Drainage.
_Town drainage of streets and houses._ 26
Instances of the effects on the public health of the neglect
of town drainage—
At Derby 26
At Stockport 28
Comparative mortality in two similar towns, one drained, the
other undrained—
At Beccles and Bungay, Suffolk 28
State of town cleansing at Leeds 29
At Tamworth 30
At Knutton and Chesterton, Stafford, &c. 30
At Liverpool 30
At Brighton 31
At Birmingham 32
At Edinburgh 33
At Tranent and Ayr 33
At Stirling 34
At Clitheroe, Lancashire 35
_Street and road cleansing—road pavements._ 36
Defective from want of skill or proper combination of means 36
Different influence on the public health of paved and
unpaved streets, instance of, in Portsmouth 37
Instance of the effect on the public health of street
cleansing in Macclesfield 37
Instances of the neglect of street cleansing—
In Manchester 38
In Leeds 39
Instances of the consequences on the public health of the
neglect of road cleansing in rural districts in England
and in Scotland 42
Discipline in respect to cleanliness of the army superior to
the civic economy of the towns 44
_House cleansing as connected with street cleansing and
sewerage._
Instances of the sanitary condition of houses in the
metropolis where the cesspools do not communicate with the
drains 45
Small value of refuse in London, in consequence of the
expense of cartage 46
Effects on the health of the accumulation of refuse near the
residences of the labouring classes: examples in
Greenock 46
Leeds 47
Cleansing by means of water-closets applicable to the poorer
districts as being the most economical 48
Instance of the removal of the refuse of the city of
Edinburgh by sewerage, and of its application to
agriculture by irrigation 48
Objections by the citizens of Edinburgh to irrigation by
sewers in the immediate vicinity of the city 49
Value of the refuse of London, on the scale of value of the
refuse of Edinburgh 51
Modifications of the mode of sewerage of Edinburgh, to make
a system of cleansing innoxious and profitable, and extend
it to the residences of the poorer classes 52
Expense of street cleansing in Manchester 53