within and around the City, there are sanitary evils for which you are
not responsible--evils beyond your control--powerful causes of diseases
in hourly operation; and that these are so extensive in their agency, as
to neutralise much of the good which it lies in your competence to
effect.
The mere fact, that for the metropolis generally there is hitherto no
sanitary law, such as you possess for your territory, is an evil to you.
When, at the commencement of next year, you will be proceeding to
suppress the several nuisances against which you are armed; when the
various trades of the City will have ceased to send forth smoke or
stink, you can raise no barrier against invasions from around;
southward, you cannot exclude the unwholesome airs wafted from the river
and from across it; nor on either side, east or west, the soot that
showers down from innumerable shafts encircling you; nor northward, the
odours that rise from the shambles of Clerkenwell.
And likewise within the City there will be remaining--out of your
control, unremedied evils, the existence of which has long been
denounced, and the removal long expected.
In 1849, with the cholera amidst us, great exertions were made, and
greater promises. In that dreadful week, when two thousand victims of
our metropolitan population fell beneath its poison; when every
household, from hour to hour, trembled at the visible nearness of death;
the public were scared out of indifference. If the visitation could have
been bought away, at the expense of doubling all local rates in
perpetuity, no doubt the sacrifice would have been made. Public opinion
was kindled to overwhelm all opposition.
The metropolis was to be drained afresh; the outfall of sewerage was no
longer to be beneath our windows; the river was to be embanked; its
rising tide was no longer to make our sewers disgorge their poisonous
contents into our streets and houses; dead bodies in their decay, were
no more to desecrate the breathing-space of the living; water was no
longer to be supplied--clumsily, insufficiently, and unwholesomely, at
the discretion of private capitalists: all was to be amended.
For participation in these advantages, the City had to look beyond its
own representatives, and to await the more comprehensive measures of Her
Majesty’s Government.
Two years have elapsed, and none of the measures referred to has made
visible progress. The water question remains unsettled; arrangements for
extramural interment of the dead have been disconcerted at what seemed
the moment of their completion; the river still receives the entire
sewage of this immense metropolis, and still at each retreating tide,
spreads amid the town, as heretofore, its many miles of fetid, malarious
mud.
In justice it should indeed be remembered, that any one of the required
amendments could only be the result of long preparatory labour, and that
its organisation would often of necessity be the travail of some single
mind, not insusceptible of fatigue. Particularly as respects the scheme
(now understood to approach its maturity) for the complete drainage of
the metropolis, it cannot be overlooked that very extensive surveys,
superficial and subterranean, with innumerable drawings and
specifications, were necessary to the construction of so comprehensive a
plan.
But neither can it be disguised or disregarded, that meanwhile, in the
absence of these sanitary works, there are dying needlessly and
prematurely thousands of the population; that preventable death,
hitherto unprevented, is proceeding at its accustomed pace; that
children continue to perish at three or four times their due rate; that
time, which carries us from one visitation of the great epidemic and
obliterates the remembrance of our alarm, also, too probably, carries us
towards the day of another outbreak: that typhus--our home-bred and
daily visitant, rehearses the same warnings as heretofore, moving
uniformly onward like the shadow on a dial, toward the hour when that
Eastern pestilence may again be here.
Therefore, gentlemen, I have felt it my duty to represent to you that,
in the promotion of those metropolitan works, the population of the City
of London have an incalculable interest;--that the emancipation of human
life from such fetters of disease as weigh on it, can never even
approximate to completion within your City, while the saturated
burial-grounds still continue to receive their annual multitudes of the
dead, while the administration of the water-supply interposes an
effectual hindrance to your most important functions, and while the
river, contaminated and unembanked, diffuses injurious miasms through
the whole extent of your jurisdiction. And I would further venture to
urge on the consideration of your Hon. Court, that your legitimate
influence with Her Majesty’s Government and with Parliament--your
influence as trustees of the Public Health for so large a constituency,
exerted in furtherance of those metropolitan reforms to which I have
adverted--would be tending, not only to the general good, but directly
and eminently to the sanitary advantage of the City of London.
I have the honour,
&c., &c.
_Proposed Schedule of specification for the Register of Lodging-houses._
House situate at No. __________
Name and Address of Owner _________
Number of Floors (including Cellars and Lofts) ____
„ Rooms „ „ ____
+-------+------+-------------+--------+--------+--------+--------+
| | No. | | | | | |
| | on | Situation. |Height. |Length. |Breadth.|Windows.|
| |door. | | | | | |
| | +-------------+--------+--------+--------+ |
|Account| |Floor, Aspect|ft. in.|ft. in.|ft. in.| |
| +------+-------------+--------+--------+--------+--------+
| of | 1 | | | | | |
| +------+-------------+--------+--------+--------+--------+
| Rooms | 2 | | | | | |
| +------+-------------+--------+--------+--------+--------+
|separ- | 3 | | | | | |
| +------+-------------+--------+--------+--------+--------+
|ately. | 4 | | | | | |
| +------+-------------+--------+--------+--------+--------+
| | 5 | | | | | |
| +------+-------------+--------+--------+--------+--------+
| |6, &c.| | | | | |
+-------+------+-------------+--------+--------+--------+--------+
+-------+------+---------+-------+-------+--------+-------------+
| | No. | | | | |Number |
| | on |Flooring.| Fire- |Venti- | Rent. |of |
| |door. | |place. |lators.| |Inmates. |
| | | | | +--------+-------------+
| | | | | |Weekly, |Under | Over |
| | | | | | or | 9 | 9 |
| | | | | |nightly,|years |years |
| | | | | | or per | of | of |
|Account| | | | |person. | age. | age. |
| +------+---------+-------+-------+--------+------+------+
| of | 1 | | | | | | |
| +------+---------+-------+-------+--------+------+------+
| Rooms | 2 | | | | | | |
| +------+---------+-------+-------+--------+------+------+
|Separ- | 3 | | | | | | |
| +------+---------+-------+-------+--------+------+------+
|ately. | 4 | | | | | | |
| +------+---------+-------+-------+--------+------+------+
| | 5 | | | | | | |
| +------+---------+-------+-------+--------+------+------+
| |6, &c.| | | | | | |
+-------+------+---------+-------+-------+--------+------+------+
Staircase, if with windows or skylight __________
Privies {Number ____
{Situation ____
{ {Material ______
{Receptacles-{Capacity ______
Water-supply-{ {Situation ______
{
{Taps, where situated _____________
Sinks ____
Dustbin ____
Yard--size of uncovered area ____
Pavement ____
Laundry ____
Date ________ Signature of Owner ________________
NOTE.--I, ____________________, Inspector for the Commissioners of
Sewers of the City of London, do certify that the above schedule
contains a true account of the matters to which it relates; also that
I have examined the privies, drains, sinks, and water-supply in the
above house, and do find the same to be in an efficient and
satisfactory condition; also that the house generally is in good
repair, perfectly clean, and free from disagreeable smell.
Date____, signed ________________ Inspector.
FOURTH ANNUAL REPORT.
_September 28th, 1852._
GENTLEMEN,
I beg leave to lay before your Hon. Court the several tables[74] which I
have prepared, to illustrate the mortality of the City of London during
the past year. They refer to fifty-two weeks, dating from September
28th, 1851, to September 25th, 1852.
[74] These tables are not here reprinted in a separate form, except
the enumeration of deaths for the year, which is No. VI. in the
Appendix. The others are embodied in the different quinquennial
tables of the Appendix.
In the first table I have distributed the 3064 deaths of the period,
according to their localities and seasons; showing them as they
occurred, male and female, during each quarter of the year, in the
several districts and sub-districts of the City. For the foot of each
column, I have calculated the year’s death’s rate, per thousand of the
living, in the district or sub-district referred to; and at the head
of the columns, for facility of reference, I have introduced an
analysis of the population, founded on the Registrar-General’s recent
census.
In the second table all the deaths of the last four years are stated,
in a form which will enable you to compare one year with another, and
one sub-district with another, in respect of their several
contributions to the total mortality of the period.
In the third table 12,540 deaths[75] of the last four years are
classified according to the ages at which they befell. This table is
arranged in a manner to display its results, first for each year
separately, and next for each Union separately; in order that you may
observe what local or annual differences have obtained as to the ages
of chief mortality.
[75] In the remaining number (17) the particulars of age and
residence could not be correctly ascertained.
The fourth table also relates to the last four years. It restricts
itself to those various forms of acute disease--epidemic, endemic, and
infectious, which occasion, most of all, the predominant mortality of
particular districts or seasons; and which are susceptible, in the
highest degree, of being mitigated or removed under an efficient
sanitary system.
In their general import these documents agree very nearly with last
year’s record; though showing unfortunately a somewhat higher death-rate
(23·62) and especially a larger proportion of fever.
On former occasions I have examined, with great minuteness, all such
facts as these tables set forth, and have offered you the best
suggestions in my power for the mitigation of preventable disease.
The sanitary condition of the City is now substantially the same as at
the date of my last Report; and any comment which I might make on the
present tables could be little else than a repetition of arguments
already submitted to your notice.
Therefore, as other topics[76] of importance to the health of the City
press for more immediate consideration, I refrain from occupying your
time by any further remark on the materials which I subjoin.
[76] We were at this time closely occupied in considering the general
questions of extramural interment for the City.--J. S., 1854.
I have the honour,
&c., &c.
FIFTH ANNUAL REPORT.
_November 29th, 1853._
GENTLEMEN,
According to the practice of previous years, I lay before you, in the
annexed tables, a brief digest of your death-register for the fifty-two
weeks which terminated at Michaelmas last.
The deaths there enumerated amount to 3040--being 24 fewer than in the
last preceding similar period.
Beyond these statistics of the past year, there are other facts which I
have thought it well to tabulate for your information. They relate to
the entire term of five years, during which I have kept record of your
mortality. Midway in this quinquennial period--namely, in the spring of
1851, the general census happened to occur. The inhabitants of the City,
then enumerated, may fairly be taken to represent the mean of your
somewhat fluctuating population; and the five years’ mortality, compared
with the numbers of this mean population, will express pretty accurately
their habitual death-rate.
The period mentioned is indeed short for the purpose of establishing an
average; but ten years at least must elapse before even similar
materials can again be given for calculation, and a still longer time
before the statistical basis can be enlarged. I have therefore thought
it desirable to make the best use in my power of such facts as were
before me, for the construction of quinquennial tables; out of which,
with sufficient accuracy for all practical purposes, you may draw your
own inferences as to the health of that large population which is under
your sanitary government.
The facts are classified, as heretofore, in the manner which will most
easily display their practical meaning. First, namely, the deaths of the
period are recorded in their local distribution, so that you may compare
one part of the City with another in respect of healthiness. Next, they
are so tabulated according to ages, as to indicate the prevailing
proportion of untimely death. Thirdly, those of them are separately
enumerated which, in their several classes, chiefly occur as results of
acute disease in connexion with removable causes.
In after years, when sanitary improvements, now only in contemplation or
commencement, shall have produced their legitimate results and rewards,
these tables may serve an important use. Indicating the standard of
public health within the City before such works were achieved, and
constituting a permanent record of your starting-point, they will
qualify your successors to estimate the amount of amelioration which
your endeavours shall have produced.
The details of your present sanitary condition, as varying in different
sub-districts of the City, and as fluctuating in the several years and
seasons of the quinquennial period, are expressed in the figures of
these tables more compendiously and more clearly than I could hope to
convey them in words. Here, therefore I restrict myself to telling you
very briefly their general results.
The population of the City--about 130,000 persons--has been dying
during these five years at the rate of about 24 _per_ thousand _per
annum_. The sub-district rates which give this aggregate vary from under
18 to above 29; the former death-rate belonging to your healthiest
locality--the north-west sub-district of the City of London Union; while
the latter--more than 60 _per cent._ higher--mortality belongs to the
north sub-district of the West London Union. The lowest death-rate
hitherto attained in this country for a considerable population, during
a term of seven years, has been 14 _per_ thousand _per annum_; which
your worst sub-district mortality more than doubles.
As different districts contribute unequally to your average death-rate,
so also do different ages. Among all the population exceeding five years
of age, the death-rate is under 17 _per_ thousand _per annum_; while,
for children under five years of age, the rate is nearly 85. And these
rates are unequally constituted by your three chief districts in the
following proportion; viz.:--
Annual Rate of Deaths to 1000 Over 5 Years Under 5 Years
living persons. of age. of age.
East London Union 16·68 91·99
West London Union 20·58 94·84
City of London Union 15·06 71·72
----- -----
Average death-rate in the City 16·85 84·72
How various are the diseases which have conspired to produce your annual
average of 3120 deaths, it would be tedious to describe; and in the
table which I have devoted to a partial analysis of this subject, I have
restricted myself to a consideration of those ailments which are likely
to become less fatal under a well-developed sanitary system. To the
annual average typhus has contributed 140 deaths; choleraic affections
(including the epidemic of 1849) 196; scarlet fever, 76; small pox, 40;
erysipelas, 30; the acute nervous and mucous diseases of children, 572;
their measles, hooping-cough, and croup, 182;--making, from this class
of disorders, an annual average of about 1250 deaths--nearly two-fifths
of the entire mortality.
My tables will show you that the different seasons of the year have
pressed somewhat differently on human life; and there is exhibited in
them a point of some interest to which I would beg your attention. In
your healthier sub-districts it is easy to perceive the influence, the
almost inevitable influence, exerted by the inclemency of winter against
the aged and feeble. In your unhealthier sub-districts, this effect is
completely masked, and summer becomes the fatal season; its higher
temperature acting in some sort as a test of defective sanitary
conditions, and giving to the several local causes of endemic disease an
augmentation of activity and virulence.
On the facts which these tables set forth, I have nothing further to say
than would consist in a repetition of arguments already submitted to
your notice. In my third Annual Report, especially, I endeavoured to lay
before you the conclusions which are fairly deducible from the
proportions of early death, and from the partial allotment of particular
diseases.
These conditions, indeed, are in obvious mutual relation. To human life
there has been affixed a normal range of duration; and when it
prematurely fails--when children perish in the cradle, or adults amid
the glow of manhood, the exception in every case is a thing to be
investigated and explained. Of the 15,597 persons who have died within
your jurisdiction, not an eighth part had reached the traditional
‘threescore years and ten;’ while nearly three-eighths died in the first
five years of life. In proportion as facts like these appear in the
death-tables of a particular district, in the same proportion we can
trace the local prevalence of particular diseases, to explain the
abridgment of life; and passing from such a locality to other districts,
where the natural term of existence is more nearly attained, invariably
we find that these diseases have fallen into comparative inertness.
Finally, in grouping the fatal results of such diseases in their
proportionate geographical allotment, invariably we find that their
prevalence or non-prevalence, here or there, has been associated with
demonstrable physical differences; that life has not capriciously been
long in one place and short in another, but that, where short, it has
been shortened; that its untimely extinction has depended on the direct
operation of local and preventable causes.
In this recognition of cause and effect, which the experience of late
years has rendered vivid and precise; and in that higher appreciation of
human life, which belongs to civilized nations in peaceful times; and in
that deeper sympathy for the suffering poor, which should be at the
heart of every Christian government, sanitary legislation had its origin
in this country; and it has been the good fortune of the City of London
(in respect of your two Acts of Parliament) to precede the rest of the
metropolis in acquiring and exercising authority for the mitigation of
preventable disease.
Nearly five years have now passed over your tenure of this very grave
responsibility; and although in many respects the period must be
regarded as one of apprenticeship to a new and difficult
career--although you have hardly yet arrived at what may permanently
represent your method of action--although important changes which you
have determined to adopt are not yet in actual working--although the far
greatest evils still remain for correction--yet I rejoice to inform you
that sensible improvement has already shown itself in the sanitary state
of your population. My comparison of the past five years with any
considerable previous period cannot be as precise as I would wish, owing
to the absence of circumstantial records for the time anterior to my
appointment; but, judging from such information as I can consult on the
subject, I am induced to believe that the deaths, for equal numbers of
population, are about four _per cent._ fewer than before your Acts of
Parliament came into operation, and that the disproportionate mortality
of children is decidedly lessened.
On this first improvement--the beginning, I would fain hope, of a long
series of similar steps for regaining the allotted duration of human
life, I beg to offer my respectful congratulations to your Hon. Court,
under whose auspices it has been effected. Further impetus in the same
direction will shortly be given by the removal of sanitary evils,
already in fact or in principle condemned. The approaching institution
of your extramural cemetery, and, I venture to hope, the translation of
all slaughtering establishments to the site of your new Smithfield, will
be important contributions to this effect. I therefore make bold to
speak with some sanguineness of the slight change of death-rate already
noticed; though, while so much remains to be accomplished, I doubt not
you will welcome the amelioration rather as an encouragement to proceed,
than as the final reward of a completed task.
* * * * *
Here, Gentlemen, terminates all that I have to submit for your
consideration in respect of your past and present record of deaths. The
greater extension which, during the last two years, I have given to my
habitual Weekly Reports, and to sundry occasional statements which it
has been my duty to lay before you, may seem, at least generally, to
render it superfluous for my Annual Report to contain anything beyond
such statistical particulars as I have now brought under your notice.
But, however this may generally be, there exist exceptional
circumstances at the present time which induce me to trouble you at
somewhat greater length.
* * * * *
II. Two years ago--adverting to the non-completion of metropolitan
sanitary works, on which the health of entire London is vitally
dependent, I could not but comment[77] on the utter unpreparedness with
which the metropolis was awaiting any sudden return of Asiatic cholera.
It was indeed impossible to foresee how soon, or how late, that dreadful
visitation might recur to desolate our homes--whether it might return at
once, or never. But typhus--averaging in fifteen years double the
fatality of that rarer epidemic--was adding day by day to its list of
preventable deaths; and other endemic diseases were co-operating with
it, demonstrably, uninterruptedly, to decimate, impoverish, and abase
the people.
[77] Third Annual Report, p. 206.
Whatever doubts might have existed as to a return of the foreign
pestilence were soon solved: whatever hasty conclusions had been formed,
as to its again remaining absent during half a generation, were soon
disappointed and reversed. Even while I was addressing you on the
subject, the plague had again kindled its smouldering fire, and was
widening its circle of destruction. Perhaps from the eastern centres of
its habitual dominion--from the alluvial swamps and malarious jungles of
Asia, where it was first engendered amid miles of vaporous poison, and
still broods over wasted nations as the agent of innumerable deaths; or
perhaps from the congenial flats of Eastern Europe, where it may have
lingered latent and acclimatised; the subtle ferment was spreading its
new infection to all kindred soils. Repelled again from the dry and airy
acclivities of the earth, and their hardier population, it filtered
along the blending-line of land and water--the shore, the river-bank,
and the marsh. Conducted by the Oder and Vistula from the swamps of
Poland to the ports of the Baltic, it raged east and west, from St.
Petersburg to Copenhagen, with frightful severity, and, obedient to old
precedents, let us witness its arrival at Hamburg.