compounded of smoke and offensive odours, and everything to revolt the
senses, is a duty which can only be expected to be regularly performed
under much stronger motives than can commonly be imposed on honorary
officers, and cannot be depended upon even from paid officers where they
are not subjected to strong checks. The examination of loathsome prisons
has gained one individual a national and European celebrity. Yet we have
seen that there are whole streets of houses, composing some of the wynds
of Glasgow and Edinburgh, and great numbers of the courts in London, and
the older towns in England, in which the condition of every inhabited
room, and the physical condition of the inmates, is even more horrible
than the worst of the dungeons that Howard ever visited. In Ireland
provisions for the appointment of Boards of Health have been made, but
they appear to have failed entirely. One of the medical practitioners
examined before the Committee of the House of Commons was asked, in
respect to the operation of these provisions:—
“3297. But in ordinary times, when the fever is not of very great
intensity, and is confined to the dwellings of the humbler classes,
there is no such provision put into force?—No, but then there is
another provision which may be put into force; this Act provides, that
‘whenever in any city, town, or district, any fever or contagious
distemper shall prevail, or be known to exist, it shall and may be
lawful for any one or more magistrates, upon the requisition of five
respectable householders, to convene a meeting of the magistrates and
householders of such city, town, or district, and of the medical
practitioners within the same, in order to examine into the
circumstances attending such fever or contagious distemper.’ There is
another Act of 59 Geo. III., c. 41, which enables the parishes to
appoint officers of health; that is, a permanent power. Those officers
have very considerable authority; they can assess a rate.
“3298. Are they appointed?—They are appointed, I think, in all the
parishes in Dublin except two; but they are inoperative: they are
unpaid, and it is a very disgusting duty. They can be made to serve,
but there is no control as to the amount of service they perform; so
that the provision is quite inoperative, unless an alarm exists.
“3299. Do you not think the appointment of some such officers,
properly appointed, properly paid, and having reasonable power, for
the purpose of suggesting and enforcing such measures as shall be
beneficial, would be highly valuable?—I am sure it would, and it would
save an amazing quantity of expenditure to the country.”
It has only been under the strong pressure of professional duties by the
physicians and paid medical and relieving officers responsible for
visiting the abodes of the persons reduced to destitution by disease
that the condition of those abodes in the metropolis have of late been
known; and I believe that it is only under continued pressure and strong
responsibilities and interests in prevention that investigation will be
carried into such places, and the extensive physical causes of disease
be effectually eradicated.
Whilst experience gives little promise even of inquiries from such a
body as Boards of Health without responsibilities, still less of any
important results from the mere representations of such bodies separated
from executive authority, I would submit for consideration what appears
to me a more advantageous application of medical science, viz., by
uniting it with boards having executive authority.
Now, the claim to relief on the ground of destitution created by
sickness, which carries the medical officer of the union to the interior
of the abode of the sufferer, appears to be the means of carrying
investigation precisely to the place where the evil is the most rife,
and where the public intervention is most called for. In the metropolis
the number of cases of fever alone on which the medical officers were
required to visit the applicants for relief, at their own residences,
amounted during one year to nearly 14,000. The number of medical
officers attached to the new unions throughout the country, and engaged
in visiting the claimants to relief on account of sickness, is at this
time about 2300.
Were it practicable to attach as numerous a body of paid officers to any
local Boards of Health that could be established, it would scarcely be
practicable to insure as certain and well directed an examination of the
residences of the labouring classes as I conceive may be ensured from
the medical officers of the unions. In support of these anticipations of
the efficiency of the agency. of the medical officers when directed to
the formation of sanitary measures, I beg leave to refer to the
experience of a partial trial of them under a clause of the recent
Metropolitan Police Act, by which it is provided, that if the guardians
of the poor of an union or parish, or the churchwardens and overseers of
the poor of any parish within the Metropolitan Police district, together
with the medical officer of any such parish or union, shall be of
opinion, and shall certify under the hands of two or more of such
guardians, churchwardens, and overseers, and of such medical officer,
that any house, or part of any house, is in such a filthy unwholesome
condition that the health of the inmates is thereby endangered, then the
magistrates may, after due notice to the occupiers, cause the house to
be cleansed at his expense.
The defects of the provision are, that it only authorizes cleansing and
not providing for the means of cleansing and personal cleanliness, by
directing supplies of water to be laid on; that it does not extend to
the alterations of the external condition of the dwelling; that the
immediate expense falls upon the occupier, who is usually in so abject a
state of destitution as to serve as a barrier to any proceeding
apparently tending to any penal infliction. With all these
disadvantages, its working may be submitted to show the general
eligibility of the medical officers of unions as officers for the
execution of sanitary measures. The following account is given by the
clerk to the Board of Guardians of Bethnal Green of the working of the
provision in that part of the metropolis:—
_Mr. William Brutton._—We have taken prompt measures to execute the
clause of the Metropolitan Police Act, and the Commissioners’
recommendations upon it, in our parish, and the effect produced has
already been beneficial. For example, the medical officer recently
reported, through me, to the Board of Guardians, that fever had arisen
in certain small tenements in a court called Nicholl’s Court, and that
it was likely to spread amongst the poorer classes in the district. He
reported that others of the houses than those in which fever existed
(and the inmates) were in a filthy condition, and that, unless
measures were taken for cleansing them properly, fever must
necessarily ensue. The Board, on receiving this communication, desired
me to proceed instantly, and take such measures as appeared to me to
be necessary for the abatement and prevention of the evil. I
immediately obtained a summons from the magistrates for the attendance
of the owner of the houses. He came directly, and stated that he was
not aware that the premises were in the condition in which our medical
officer had found them; and he promised that measures should be taken
for proper cleansing. Those measures were taken: the furniture of the
houses was taken out and washed; the houses were lime-washed. Some of
those who were ill died, but the progress of the fever was certainly
arrested.
The Board followed up these proceedings by circulating the
Commissioners’ instruction and form of notification in every part of
the parish. But the proceeding had a very good effect in the immediate
neighbourhood. The proceeding was observed by the neighbours, and
there is every reason to believe that they have set to work to cleanse
and prevent a similar visitation. We have also learned that the
landlords of some of these smaller tenements have been rather more
particular than before: they have said we must see to the cleansing of
these places lest we should be had up for it before the magistrates.
The guardians, considering the form of notifications useful, have
directed that they should be issued periodically before the times when
disease usually appears. In the course of a fortnight or three weeks
hence, when the equinoctial gales prevail, and when we have usually
much sickness and claims to relief, we shall probably have another
issue of the notifications.
We have also given instructions to the relieving officer, as well as
the medical officer, to report on the existence of any filth or things
likely to be productive of disease that he may observe in the course
of his visits to the houses where he is called by the claims to
relief. The services of the relieving officer are highly important, as
he has an opportunity of observing the state of filth and the obvious
predisposition, and perhaps of causes of disease, preventing it before
the visits of the medical officer, who is of course only called upon
to attend when disease has arisen. The relieving officers visit more
frequently than the medical officer, and give the tickets or orders
requiring his attendance.
You are Commissioner of the Sewers in the Tower Hamlets, are you
not?—Yes, I am.
And you are of course aware of their procedure?—Yes.
Do you think that body would be available for the execution of
sanitary measures?—Certainly not as compared with the Board of
Guardians: the Commissioners of Sewers meet only monthly, and have no
medical officers and no relieving officers. The Board of Guardians
meets weekly, and their officers are constantly at work, night and
morning. We have not even waited for the landlords, where prompt
measures appeared to be necessary for the removal of any active cause
of disease. Where cesspools have overflowed, and where there has been
a stoppage of water, we have directed the surveyor of the roads to
ascertain the cause of the stoppage, and to remedy the mischief
forthwith.
But what legal right have the guardians had to do that: they have no
legal right to direct the road surveyor in the performance of his
duties?—Strictly speaking, we have not, but we have forcibly suggested
it as a matter of expediency.
Between the notification of the evil and the execution of the remedy,
in the example you have cited by the Board of Guardians, what length
of time elapsed?—From the Friday to the Monday following.
What time, so far as you have had experience, need ordinarily elapse
if execution follow immediately on the report?—Execution would follow
immediately on the order of the Board of Guardians. I think, however,
that the union officers should, in case of emergency, have a summary
acting power immediately for the preservation of life. The Guardians
thought their examination of the spot unnecessary after the report of
the medical officer.
The following is the examination of the clerk to the Strand union as to
the practical working of the same measure in another district:—
_Mr. James Corder_, clerk to the Strand union, examined;—
What has been done in the Strand union in respect to the provisions of
the Metropolitan Police Act, 2 and 3 Vict., c. 71, sec. 41, with
respect to the powers conferred by that statute for the cleansing of
houses which are in an unwholesome condition?
The attention of the medical officers was immediately drawn to the
section of the Act, and the instructions of the Poor Law Commissioners
relating thereto; and the result has been that proceedings have been
had in several cases, in all of which the necessary cleansing has been
performed by the owners, without the guardians being driven to the
necessity of causing the requisite lime-whiting and cleansing to be
done. The medical officer had frequently complained of the condition
of the places into which the cleansing had been carried. Those places
had for years been in the filthiest and most unwholesome condition: in
some courts and alleys the pavements were covered with an accumulation
of the most offensive matter, including the carcases of dead animals,
such as dogs and cats, which the scavengers said formed no part of
their contract to remove: their contract was only to cleanse the
carriage ways. Some of these courts and alleys abound in the principal
thoroughfares in the metropolis. The public, in passing through a
thoroughfare like the Strand, would scarcely imagine that an evil of
so much magnitude was close at hand.
The powers conferred by the clause in question appears to be
restricted to the cleansing of the houses and the passages within the
cartilage. What proceedings did the guardians take with relation to
these external passages?
They directed the condition of the places to be represented to the
Commissioners for paving and cleansing the district, who caused the
filth complained of to be removed. The cleansing of the footways,
however, forms no part of the duty of the Commissioners of Pavement,
nor of their surveyor, nor of the scavenger appointed by them; and
what was done was done extra-officially.
It cannot, therefore, be relied upon for the future?
No; and it is to be observed that the Metropolitan Paving Act
evidently contemplates that the cleansing of the footways shall be
done by the inmates of the houses. In the poorer districts, however,
this is entirely omitted to be done; in addition to which these courts
and alleys are frequently made, on account of their obscurity, a
depository for most offensive matter. In the better neighbourhoods,
the service of cleansing is performed by the servants; but the poor
people, who rise before daylight, go to their work, and return at a
late hour, have no time to cleanse their courts, and their earnings
are too scanty to allow payment to others for the performance of the
duty. In the better neighbourhoods, the cleansing does not always take
place. The medical officers report, that there is a better average
health in the streets that are well cleansed than in others where the
people are otherwise in the same condition of life.
What are the main defects you have experienced in respect to the
provision of the Metropolitan Police Act, empowering the guardians to
take measures for cleansing houses?
First, the delay which must take place before the provisions of the
Act can be put in operation. The medical officer has first to make his
report to the Board of Guardians; several days elapse before the Board
meets: then guardians have to inspect the premises in conjunction with
the medical officer previously to certifying as to the state thereof:
then application is made to the magistrate, who issues his summons,
returnable in seven days; at the expiration of which, if the cleansing
be not performed, the guardians are empowered to cause it to be done;
but they must first obtain a magistrate’s warrant for the purpose. All
this engenders delay; in addition to which our guardians have, in the
first instance, caused the landlord to be written to with a view to
prevent further proceedings, which in some instances have been
successful; but when it is not successful, it creates a further delay,
during which disease may rapidly increase and spread. The second
defect of the provision is, that the owners are not liable for the
expenses incurred; and the occupiers are mostly of the poorest class,
who have no effects on which a distraint could be made. With all these
difficulties, however, this provision has been very beneficial in its
operation; and it is very much to be desired that larger facilities
should be afforded for carrying its intention more fully into effect.
It may be added, that the medical officer should have remuneration for
the trouble he entails upon himself, by a report, in attending before
magistrates, until the object is effected.
_Mr. John Smith_, the clerk to the Whitechapel union:—
Have you taken any proceedings under the 41st clause of the
Metropolitan Police Act?
We have issued notifications to every house in the union of the
necessity of cleansing the houses by whitewashing them inside and out,
and that the owners and occupiers were amenable for any neglect. The
relieving officers report to me, that these notifications have already
been productive of very good effects, and that whitewashing has been
actively practised. The relieving officers were instructed, wherever
they found a case of neglect, to threaten the landlord that he would
be proceeded against unless the tenement was duly cleansed. But as yet
we have taken no legal proceedings, because we have advised with the
magistrates, who do not consider that the owners can be proceeded
against in the first instance, and the occupiers of the tenements,
which are liable to be proceeded against, are most of them paupers and
persons in extreme poverty.
With respect to the remedies, I find that the personal inconvenience
to which the clause subjects the guardians of visiting the spot is a
provision which will greatly obstruct its operations, and will at all
events greatly delay proceedings from time to time. The guardians who,
in our union, are men of business, consider that their time is fully
occupied at the Board, and they object to any attendance out of the
Board, and would give it reluctantly. If the cases are taken before
the magistrate, it appears desirable that the medical officer should
not be compelled to attend unless it were absolutely requisite, and
that the relieving officer should be allowed to prove the facts as to
the state of the dwellings recited in the medical officer’s
certificate, which could rarely be disputed. If the point were
disputed by the owner, then the medical officer or other witnesses
might be forthcoming.
What is the number of houses in the union?—About 8000.
How many cases on the average do your medical officers visit in the
year?—About 4000.
Those visits of course are sometimes to different rooms of the same
tenement?—No doubt of that, and very frequently to the inmates of the
same room.
Are the visits of the relieving officers to the dwellings of the
labouring classes more extensive than the visits of the medical
officers?—I should say more extensive.
Between the two, are any class of the poorer and otherwise neglected
residences that would probably escape visitation?—I should say that
they must visit every spot within the district.
Within such districts as that of Whitechapel, do you think the three
present medical officers and the relieving officers would suffice to
carry out sanitary measures actively and efficiently?—I think that for
efficiency additional strength would be required; perhaps one officer,
whose especial duty it should be to attend to the duties connected
with sanitary measures, supposing them carried out by the agency of
the existing establishments.
From the consideration of such practical evidence, it will be seen that
the ordinary duties of the relieving officer in the first instance, and
of the medical officer afterwards, ensure domiciliary inspection of
large districts to an extent and with a degree of certainty that could
scarcely be ensured or expected of any agents or members of a board of
health unconnected with positive administrative duties. The inspection
of these officers of the boards of guardians more than supplies the
external inspection of inquests or of the leets; and it is submitted
that in their position these boards may most beneficially exercise the
functions of the leet in reclaiming the execution of the law, as against
acts of omission and of commission, by which the poorest of the
labouring classes are injured and the ratepayers burdened.
It may therefore be submitted as an eligible preliminary general
arrangement, that it shall be required of the medical officer as an
extra duty, for the due performance of which he should be fairly
remunerated, that on visiting any person at that person’s dwelling, on
an order for medical relief, he shall, after having given such needful
immediate relief as the case may require, examine or cause to be
examined any such physical and removable causes as may have produced
disease or acted as a predisposing cause to it; that he shall make out a
particular statement of them, wherein he will specify any things that
may be and are urgently required to be immediately removed. This
statement should be given to the relieving officer, who should thereupon
take measures for the removal of the nuisance at the expense of the
owner of the tenement, unless he, upon notice which shall be given to
him, forthwith proceed to direct their removal. Except in the way of
appeal by the owner against the proceedings of either officer, or where
a higher expense than 5_l._, or a year’s rent of the tenement, were
involved by the alterations directed by the medical officer, it appears
to be recommended that no application to the Board of Guardians or the
magistrates should be required in the first instance, as it frequently
happens that the delay of a day in the adoption of measures may occasion
the loss of life and the wide spread of contagious disease; and an
application to the Board of Guardians or to the petty sessions would
usually incur delay of a week or a fortnight. To repeat the words of
Blackstone,—“The security of the lives and property may sometimes
require so speedy a remedy, as not to allow time to call on the person
on whose property the mischief has arisen to remedy it.” When any
tenement is in a condition to endanger life from disease, as it comes
within the principle of the law, so it should be included within its
provisions, and should be placed in the same condition as a tenement
condemned as being ruinous and endangering life from falling.
The instances above given of the working of the provisions of the
Metropolitan Police Act for the cleansing of filthy tenements are,
however, instances of zealous proceedings taken by competent officers in
unions, where the attention of the guardians was specially called to the
subject, and where there were no opposing interests. But several other
instances might be presented, where the execution of the law is as much
needed, but where it is already as dead as any of the older laws for the
public protection, and the reason assigned is, that the local officers
will not, for the sake of principle and without manifest compulsion,
enter into conflicts by which their personal interests may be
prejudiced. Medical officers, as private practitioners, are often
dependent for their important private practice, and even for their
office, on persons whom its strict performance might subject to expense
or place in the position of defendants. Under such circumstances it is
not unfrequent to hear the expression of a wash from these officers,
that some person unconnected with the district may be sent to examine
the afflicted place, and initiate the proper proceedings. The working of
the provisions of the Factory Act for the limitation of the hours of
labour of children has been much impeded by the difficulty of obtaining
correct certificates of age and bodily strength from private medical
practitioners. On this topic a large mass of evidence might be adduced,
showing the unreasonableness of expecting private practitioners to
compromise their own interests by conflicts for the public protection
with persons on whom they are dependant.