to the pursuit of the chief branches of mining or manufacturing
industry, or in transport whether by land or water, it has always been
satisfactory to find that for the future, by care, the greater
proportion of them are preventible. In the case of the mining accidents,
one part of them appear preventible by care of the superior managers of
the mines—in arrangements over which the individual workman has no
control; the other portion, by intelligence and care on the part of the
workmen; and this last class of cases again reverts back to the power,
and therefore to the means of imposing responsibility on the employers
in the selection of educated and intelligent workmen—of habits of
sobriety, and care to qualify them for works of danger. But at present
they are, in a great measure, relieved from responsibility by the charge
incurred by the want of care being thrown on other funds raised from
persons who have as yet no practicable means of protection or
prevention. When continued and dreadful losses of life take place, in
the face of examples of successful prevention such as might be collected
from every part of the country, it is impossible to avoid the conclusion
that if the branch of industry were charged with the pecuniary
consequences of the losses assumed to be necessarily incident to it,
generations would not be allowed to pass away in fear, recklessness, and
misery without the early adoption of those means of prevention which
self-interest would then stimulate. A frequent suggestion made upon the
view of such casualties is that government inspectors should be
appointed to inspect and direct and regulate machinery.
This subject was brought under consideration in the course of the
proceedings of the Factory Commission of Inquiry, and it was then agreed
that such a measure as that of inspection would only give an imperfect
security, and would occasion vexatious interruptions, and that the least
objectionable mode of interference, as well as the most efficient and
just as a means of prevention, would be to charge a portion at least of
the cost of such casualties upon the branch of industry. Subsequent
observation, especially of the causes of pauperism, have strengthened my
convictions of the soundness of the principle of prevention as stated in
our Report, a passage from which I have submitted in the Appendix.[31]
In illustration of the pecuniary cost of disease, as shown in the cost
of remedies in Scotland, there are several documents. The late _Dr.
Cowan_, the professor of Forensic medicine at Glasgow, gives one in
which he states—
“If any arguments were wanting to arouse the community to the
investigation of this important subject, they might be drawn from the
heavy pecuniary tax which fever entails on the benevolent of our city,
from the poverty, misery, and crime which this disease engenders. It
is not possible, from the data before me, to give anything like an
accurate calculation of the sums spent for the treatment of fever in
Glasgow during the last twenty years. The following calculation
intentionally falls considerably under the amount, to prevent every
suspicion of exaggeration:—
£. _s._ _d._
1. Cost of the fever hospital 8,566 7 9
2. Temporary hospitals, and maintenance of patients 5,000 0 0
in them
3. 21,691 patients at 1_l._ 10_s._ treated at the 32,536 10 0
expense of the infirmary
——————— —— —
£46,102 17 9
======= == =
To this amount fall to be added the expense of treating the poor in
their own houses under the district surgeons of the burgh, and any
sums expended by the heritors or the gorbals and barony parishes for
similar purposes. But this sum must have been greatly increased by the
demands of pauperism produced by fever, on our poor’s-rates, and on
the private benevolence of our citizens; for the duration of the
disease, and the period of convalescence which must elapse before an
individual can resume his work will average rather more than six
weeks, and when to this is added the difficulty of again finding
immediate employment, we may safely assume that the 12,895 individuals
treated in the fever hospitals during the last seven years, all, with
few exceptions, depending on their daily labour and extending the
benefit of that labour to others, were out of employment for a period
of at least six weeks.”
The _Rev. G. Lewis_, the minister of St. David’s parish, Dundee, who has
answered the queries issued by the Board, and very powerfully addressed
the inhabitants on this subject, in the course of one of his addresses,
observes that—
“Apart altogether from the waste of human life, and the indescribable
suffering and sorrow which annually fall upon the working classes of
Dundee from this periodical scourge, and viewed only as a mere matter
of profit and loss to the mercantile and monied interest of Dundee, it
were easy to demonstrate, that the expenditure of several thousand
pounds per annum, in providing the means of cleanliness to this town,
in the better cleansing of its streets, but, above all, of its back
closes, courts, and lanes, and the clearing away of those pestilential
masses of building which lie concealed from view behind the front
lines of some of our principal streets, would have been rewarded by a
saving to the community of a vast sum, which the ravages of disease
and death have been, for the last few years, compelling Dundee to pay
in a way its inhabitants think not of. That this may appear, I have
brought into one table the number of cases of fever during the last
seven years.
“CASES of Fever in
Dundee during the
last seven years,
from 1833 to 1839,
inclusive,
calculated from the
Bills of Mortality
according to the
proportion of nine
cases to each
death:—
Year. Cases. Deaths.
1833 1,188 132
1834 1,521 169
1835 1,179 131
1836 2,673 297
1837 1,881 209
1838 1,773 197
1839 1,593 177
—————— —————
11,808 1,312
—————— —————
“Thus, in seven years, fever has fallen on much more than a tithe of
the inhabitants,—choosing its victims here, as elsewhere, in the
manhood of life, and compelling the citizens of Dundee to pay a tax
frightful in the amount of personal sufferings and family
bereavements.
“But it were a mistake to imagine that the sufferings and death of so
many citizens are the only _tithes_ which fever has compelled us to
pay during the last seven years. Put wholly aside the details of
domestic woe and personal suffering which 11,808 cases of fever have
introduced into the families of Dundee in these seven years—omit all
reckoning of the watching, want, and wretchedness, wrapped up in so
many cases of acute disease, and the family bereavements implied in
these 1,312 death—and let us view for a moment our fellow-creatures
but as so many machines suspended from work by the derangement or
destruction of the human machinery, that we may learn something of the
probable money loss incurred by fever in these seven years.
“From Dr. Southwood Smith, the highest authority on these subjects, we
learn that fully one-half of the cases of fever occur in the prime of
life, when men are most useful either to their families or to society.
Deducting then the 1,312 deaths from the whole number of cases, there
will remain 10,496 cases of fever, the one-half of whom, at least,
were adults,—that is, 5,248 persons in the prime of life, very many of
them heads of families, had fever in these seven years. Now, the
average period fever detains a patient from work, according to the
same authority, is six weeks. Let us take the earnings in health of
these adults at the average of 8_s._ weekly; and the loss of wages to
these 5,248 adults, by six weeks’ fever, amounts to 12,595_l._; and
this, after excluding all under age, and all the deaths. But these
cases, whether treated at home or at the infirmary, must be also
loaded with the expense of medical treatment, which is estimated in
our infirmary reports at 1_l._ to each case, that is, 5,248_l._ must
he added to the loss by wages. But 5,248 cases of those under age
remain to be accounted for; and, as fever rarely attacks mere
children, but chiefly those either in manhood or approaching manhood,
we may estimate the loss of their labour at the one-half of the
adults, or 6,297_l._ 12_s._, and the expense of attendance and
recovery at one-half also, or 2,624_l._
“But how shall we estimate the pecuniary loss of 1,312 deaths? It
seems a strange thing to go about estimating the money value of that
which money did not give, and cannot restore when taken away; yet as
there are those who understand better a profit and loss account than
the arguments of religion and humanity, we shall attempt to estimate
the money loss of these 1,312 deaths by fever.
“At least one-half, or 656 of these deaths, were deaths of adults, and
very many of them heads of families, of which the 337 widows in St.
David’s parish afford melancholy evidence.”
He then refers to an estimate made by _Mr. M’Culloch_, who, viewing a
human being as a productive machine, reared to last a certain time, and
to return so much more than he costs, estimates a full-grown workman
just, arrived at maturity as having 300_l._ of capital invested in him.
At the actual cost of maintaining and training a pauper child in England
at the school in Norwood, 4_s._ 6_d._ per week, he will have had
expended upon him at 21 years of age, 245_l._, or at 30 years, 350_l._;
but he supposes—
“The money value of these male and female adults to be just the
one-half of this, or 150_l._, which makes the loss, by the premature
death of these 656 adults, to be 98,400_l._; and, if the remaining 656
under the age of maturity, yet approaching it, be taken at the half of
the adults, or 75_l._ each, we have a loss of 49,200_l._ more; to
which, if we add 1_l._ a-piece, or 1,312_l._ in all, for attendance
and medical expenses, the Fever Bill of Dundee, during the last seven
years, will stand as follows:—
Fever Bill of Dundee from 1833 to 1839.
£. _s._ _d._
Loss of labour for six weeks of 5,248 adults at 12,595 0 0
8_s._ a-week
Attendance, medicine at home or infirmary, at 1_l._ 5,248 0 0
each
Loss of labour for six weeks of 5,248 under age, at 6,297 12 0
4_s._ a-week
Expense of treatment of the above at infirmary or 2,624 0 0
home, at 10_s._ a-piece
Loss by death of 656 adults, at 150_l._ each. 98,400 0 0
Loss by 656 deaths under age, at 75_l._ a-piece 49,200 0 0
Treatment of 1,312 cases, at 1_l._ each 1,312 0 0
———————— —— —
£175,676 12 0
Or 25,096_l._ 13_s._ per annum.
“The poor, we are told, we shall always have with us, and so with
disease and death. Yet the evils, both of poverty and disease, come in
very different measures to different communities. As there is a
poverty that is self-inflicted, and may be self-removed, so there is a
certain amount of disease and annual mortality in every city that is
self-inflicted; and the community that does not strive, by every
available means, to reduce its disease and mortality bills to the
lowest sum of human suffering, and the lowest rate of annual
mortality, is as guilty of suicide as the individual who, Judas like,
takes with his own hands the life God has given, and hurries unbidden
into the presence of his Judge. The fever bills of the Scottish towns,
contrasted with those of the English commercial towns, declare too
plainly that man has not yet done his part in Dundee to avert this
scourge of society; and, while fever is undoubtedly to be regarded as
the visitation of God, it is also to be regarded as the visitation of
God for the sin of neglecting a population fallen in character and
habits.
In the following table are given the deaths in Dundee in seven years,
and the rate to the population,—supposing the inhabitants in 1831 to
have been 45,355 souls, and to have increased about 2000 annually,
until 1839, when from bad trade the increase was checked:—
Years. Deaths. Population. Proportion of Deaths to the Population.
1833 1,482 49,355 1 in 33·3
1834 1,650 51,355 1 in 31·1
1835 1,673 53,355 1 in 31·9
1836 1,923 55,355 1 in 28·8
1837 1,963 57,355 1 in 29·2
1839 1,511 59,355 1 in 39·3
1839 1,763 59,355 1 in 33·7
—————— ——————— —————————
11,965 385,485 1 in 32·2
—————— ——————— —————————
Thus, the average mortality in Dundee, during the last seven years,
was 1 in 32 annually. * * * Here, then, in Dundee, the deaths annually
are at least one-fourth more than over the rest of Scotland, Glasgow
excepted, which seems to surpass Dundee in the waste of human life. If
the deaths are a fourth greater, those diseases which are its
harbingers must be many times greater than the deaths; and to this
extent, at least, it was in the power of human means to have provided
a remedy,—to have abated by one-fourth the physical suffering and
mortality of Dundee, saved 2,952 persons from fever, and 328 persons
from premature death, and reduced by a fourth part the pecuniary loss
incurred during the last seven years,—in other words, to have saved
43,919_l._, or 6,274_l._ annually, to the profit and loss account of
this city in the single item of fever.
“The statistics of small-pox in Dundee might be added to this bill of
charges. It is sufficient, however, to allude to it. Last year, the
deaths by small-pox were 77. In 1838, they were also 77; and in 1837,
they amounted to 126. The number of cases, of course, must have been
many times the deaths; by far the greater number under age and
unvaccinated,—a neglect no longer confined to the Irish population.
* * * * *
“Though I am no medical authority, yet I am sure that I have every
medical authority with me when I connect, as foremost amongst the
causes of the enormous Fever Bill of Dundee that monstrous Tavern
Bill, which last lecture I showed you was the worm in the bud of the
happiness and well-being of its working classes. That Tavern Bill,
according to the mean of three different estimates, amounts to
21,234_l._ a-year in my parish alone, and to 180,000_l._ a-year to all
Dundee. In vain we cry out against the taxation of Government. While
the words of complaint are on our lips, here is a vice of continual
tasting and tippling in strong drink,—a private self-imposed tax, but
heavier far than any public tax. It is this besetting sin that has
been not only devouring the substance of the poor, but every year
sowing the seeds of that enormous Fever Bill which for the last seven
years has been taxing us, not only in purse but in person,—compelling
every tenth man in Dundee during that period to pay the wages of six
weeks’ labour, and to suffer all the langour, sickness, and oppression
of six weeks’ fever, besides the bereaved widows and orphans, and the
fatherless and motherless children it has left in Dundee.”
I now proceed to submit the reasons for believing that the immediate
expenditure of so much money as would be incurred by the adoption of
such of the remedial measures as appear to be available by the agency of
any public administration would be sound measures of immediate economy,
and of ultimate public gain: and also the grounds for believing that the
same conclusion is applicable to the cost of those measures of
prevention which, though directly or indirectly controllable by
legislative authority, are within the province of private individuals to
execute, such as the construction of the dwellings of the labouring
classes.
VI.—EVIDENCE OF THE EFFECTS OF PREVENTIVE MEASURES IN RAISING THE
STANDARD OF HEALTH AND THE CHANCES OF LIFE.
On viewing the evidence, which shows that, in most situations higher
chances of life belong to the middle and higher classes of the
population, an impression may be created that the higher standards of
health are essentially connected with expensive modes of living. The
highest medical authorities agree, however, that the more important
means for the protection and advance of the health of those classes must
be in still further reductions than those which it is the present
tendency in the higher classes of society to make of the use of highly
stimulating food. The evidence already adduced with respect to the
labouring classes in the rural districts and those living on high wages
in towns, will have gone some way to remove the erroneous impression
with respect to them, and it admits of proof that a higher standard of
health and comfort is attainable for them even at a less expense than
that in which they now live in disease and misery. The experience of the
effect of sanitary measures in the royal navy may be adduced as evidence
of the practicable standards of health consistent with great labour and
exposure to weather obtained at a cost not higher than that within the
wages of ordinary labourers. The experience of the effects of sanitary
measures in banishing spontaneous disease from crowded prisons, offers
further evidence of the health obtainable by simple means, under
circumstances still more unfavourable.
The prisons were formerly distinguished for their filth, and their bad
ventilation; but the descriptions given by Howard of the worst prisons
he visited in England (which he states were amongst the worst he had
seen in Europe) were exceeded in every wynd in Edinburgh and Glasgow,
inspected by Dr. Arnott and myself, in company with the municipal
officers of those cities. More filth, worse physical suffering and moral
disorder than Howard describes as affecting the prisoners, are to be
found amongst the cellar population of the working people of Liverpool,
Manchester, or Leeds, and in large portions of the metropolis. As a
standard of the progress made in ameliorating the condition of
prisoners, I refer to his general statement of the condition in which he
found the prisons when he inspected them in England.
“_Water._—Many prisons have _no water_. This defect is frequent in
bridewells and town gaols. In the felons’ courts of some county gaols
there is no water: in some places where there is water, prisoners are
always locked up within doors, and have no more than the keeper or his
servants think fit to bring them.
“_Air._—And as to air, which is no less necessary than the two
preceding articles, and given us by Providence quite gratis, without
any care or labour of our own; yet, as if the bounteous goodness of
heaven excited our envy, methods are contrived to rob prisoners of
this genuine cordial of life, as Dr. Hales very properly calls it; I
mean by preventing that circulation and change of the fluid without
which animals cannot live and thrive. It is well known that air which
has performed its office in the lungs is feculent and noxious. Writers
upon this subject show that a hogshead of air will last a man only an
hour: but those who do not choose to consult philosophers may judge
from a notorious fact. In 1756, at Calcutta, in Bengal, out of 170
persons who were confined in a hole there one night, 154 were taken
out dead. The few survivors ascribed the mortality to their want of
fresh air; and called the place, Hell in Miniature.
“From hence any one may judge of the probability there is against
health and life of prisoners crowded in their rooms, cells, and
subterraneous dungeons, for 14 or 15 hours out of the 24. In some of
those caverns the floor is very damp; in some there is sometimes an
inch or two of water; and the straw or bedding is laid on such floors,
seldom on barrack bedsteads. Where prisoners are not kept in
underground cells, they are often confined in their rooms, because
there is no court belonging to the prisons; which is the case in many
city and town gaols; because the walls round the yard are ruinous, or
are too low[32] for safety; or because the gaoler has the ground for
his own use. Prisoners confined in this manner are generally
unhealthy.
“In Baker’s Chronicle, p. 353, that historian, mentioning the assize
held in Oxford Castle, 1577 (called, from its fatal consequences, the
Black Assize), informs us, ‘that all who were present died within
forty hours; the lord chief baron, the sheriff, and about 300 more.’
Lord Chancellor Bacon ascribes this to a disease brought into court by
the prisoners; and Dr. Mead is of the same opinion.
“The first of these two authors, Lord Bacon, observes, that ‘the most
pernicious infection, next the plague, is the smell of a jail, when
the prisoners have been long close and nastily kept; whereof we have
had, in our time, experience twice or thrice; when both the judges
that sat upon the jail, and numbers of those who attended the
business, or were present, sickened and died.’
“Sir John Pringle observes that ‘gaols have often been the cause of
malignant fevers;’ and he informs us that in the late Rebellion in
Scotland, above 200 men of one regiment were infected with the gaol
fever by some deserters brought from prisons in England.
“Dr. Lind, physician to the royal hospital at Haslar, near Portsmouth,
showed me, in one of the wards, a number of sailors ill of the gaol
fever, brought on board their ship by a man who had been discharged
from a prison in London. The ship was laid up on the occasion. That
gentleman, in his ‘Essay on the Health of Seamen,’ asserts that ‘the
source of infection to our armies and fleets are undoubtedly the
gaols; we can often trace the importers of it directly from them. It
often proves fatal in impressing men on the hasty equipment of a
fleet. The first English fleet sent last war to America lost by it
above 2000 men. In another place he assures us that the seeds of
infection were carried from the guard-ships into our squadrons; and
the mortality thus occasioned was greater than by all other diseases
or means of death put together.’
“It were easy to multiply instances of this mischief; but those I have
mentioned are, I presume, sufficient to show, even if no mercy were
due to prisoners, that the gaol distemper is a ‘national concern’ of
no small importance.”
“_Sewers._—Some gaols have no sewers or vaults; and in those that
have, if they be not properly attended to, they are, even to a
visitant, offensive beyond description; how noxious, then, to people
confined constantly in those prisons!
“One cause why the rooms in some prisons are so close is the
window-tax, which the gaolers have to pay; this tempts them to stop
the windows and stifle their prisoners.
“_Bedding._—In many gaols, and in most bridewells, there is no
allowance of _bedding_ or straw for prisoners to sleep on; and if by
any means they get a little, it is not changed for months together, so
that it is offensive and almost worn to dust. Some lie upon rags,
others upon bare floors. When I have complained of this to the
keepers, their justification has been: ‘the county allows no straw;
the prisoners have none but at my cost.’”
Since Howard succeeded in gaining national attention to the condition of
prisoners, the evils of prison management have been removed. A large
proportion of the prison population is taken from the worst regulated
and most confined neighbourhoods, which have been the subject of
examination; and, with the view to judge what might be effected by
sanitary regulations, I have made frequent inquiries as to the effects
of sanitary measures on the worst class of persons, the larger
proportion of whom are taken from the worst neighbourhoods, that is, as
to the effects of living in the same atmosphere, on a less expensive
diet than that of the general labouring population, but provided with
clean and tolerably well-ventilated places of work and sleeping-rooms,
and where they are required to be cleanly in their persons.
I have obtained through Mr. Hill, the prison inspector of Scotland, an
accurate return of the number of days which the prisoners had been
absent from labour on the ground of ill health in the celebrated prison
at Glasgow, where the separate system of confinement has been tried
(Return No. 1); a similar return from the Edinburgh prison, (No. 2). I
also obtained a careful examination of the amount of sickness prevalent
amongst the prisoners at Salford prison, (No. 3). The average cost of
the diets, (principally vegetable,) at Salford, varied from 1_s._ 4_d._
to 1_s._ 6_d._ per week; at Edinburgh, 1_s._ 9_d._ per week; and at
Glasgow, 1_s._ 7_d._ per week. _Vide_ Appendix.