immediate channel of epidemic communication to our island; the disease
having on each occasion commenced in our north-eastern sea-ports within
a very short time of its outburst there. A third time, not unexpectedly,
has this dreadful guest, following the line of former visitation,
touched upon the banks of the Tyne; where[78] a worse than beastly
condition of the crowded poor, and sewage-water diluted through the
people’s drink, had prepared it an appropriate welcome.
[78] Having had recent occasion to examine judicially into the matters
here adverted to, I think it proper to mention that the allusions in
my text were long prior to this examination, and were founded chiefly
on the Registrar-General’s Reports of the time, with other official
statements.--J. S., 1854.
Next, the disease was rumoured to be in London. Hope and belief are too
near akin for this not to have been doubted and denied; but the last few
weeks have shown, with sad incontrovertible certainty, that after only
four years absence, Cholera has again obtained its footing on our soil.
Six or seven hundred deaths, registered in the metropolis since the
beginning of September, have already attested its presence.
Anxiously adverting to the future, and asking what may be the onward
progress of the disease, we can appeal only to a narrow experience.
Before us lie the records of but two complete visitations of the
disease, and the commencement of this, the third. It would be a shallow
philosophy that should pretend, from two observations, to predict the
possible orbit of this obscurely wandering plague.
Yet I dare not disguise from you that such knowledge as we have, to
justify scientific anticipation, is pregnant with threats and gloom.
For--let me remind you of the past. At each former period of attack, the
infection, after a certain course over Continental Europe, struck upon
our eastern coast in the summer of an unforgotten year. In the northern
parts of Great Britain, so soon as it had lit among the population, each
time it burst forth into explosive activity, and worked its full
measure of destruction without delay. More faintly it reached the South.
On each occasion, indeed, at the close of summer, London was sensibly
affected by the disease; but, we hoped, under a milder infliction. Here
and there, within its Bills of Mortality (as at Tooting in 1848) there
was thrown some astounding flash on a particular hot-bed of co-operating
poison; but on the whole it seemed to the sanguine, on each occasion,
that the fury of the epidemic was expending itself in our northern
towns, and that the metropolis was to be comparatively spared.
Each time, at the commencement of the new year, our London mortality
from Cholera seemed stationary within the limit of a few hundred deaths.
Each time winter and spring allowed a long respite to our invaded City,
and confirmed the omens of the hopeful.
But each time there was disappointment. Each time, as the warmth of
summer requickened the exterior conditions of chemical activity, the
dormant fire kindled afresh--slowly at first, but with speedy
acceleration of rate. Each time, in the few weeks before
Michaelmas--amid almost universal threatenings of the disease, and amid
such panic of death as the metropolis had not known since the Great
Plague, there suddenly fell many thousands of the population.
Thus then our position stands. Scientific prediction of phenomena can
arise only in the knowledge of laws. That the phenomena of this disease,
however capricious they may seem, are obedient to some absolute
uniformity as yet beyond our ken--are enchained by that same rigid
sequence of cause and effect which is imposed on all remaining
Nature--it would be impossible to doubt. But these conditions are
hitherto unknown to science. Hitherto we can speak of the facts alone,
with a short empirical knowledge of their succession. Yet in this light,
such as it is, the conclusion is only too obvious. If the disease,
already notorious for a tendency to return on its former vestiges,
repeat on this third occasion the steps of its two previous courses; or,
perhaps I should rather say, if it now proceed consistently to complete
a repetition which it has already half-effected; Asiatic Cholera will be
severely epidemic in London in the third quarter of next year--will
proceed, with a stern unflattering test, to measure the degree in which
those promises of sanitary improvement have been redeemed, which the
terror of its recent visitation extorted even from the supinest and most
ignorant of its witnesses.
In the face of so great a danger, you will reasonably claim of your
Officer of Health that he shall report to you, how far the City is
already fortified against this dreadful invasion--how far the hygienic
defences of life, if weak, may be strengthened--how far there remain
breaches now insusceptible of repair.
* * * * *
1. It forms an all-important part of these considerations for resistance
to the disease, to recognise quite accurately what is its fashion of
attack. Since I last addressed you on the subject, in my Report for
1849-50, the materials for correct generalisation have been very largely
increased by Dr. Farr’s admirable Report to the Registrar-General on the
Cholera in England, and by numerous other important publications. By
collating with these works the more restricted, yet not uninstructive,
experience which arose within your particular jurisdiction, I hope to
have enlarged my knowledge of the subject, and to have become able with
greater confidence to submit my conclusions for your acceptance.
The first and most obvious characteristic of the disease is its
preference for particular localities. It is eminently a
district-disease. And the conditions which determine its local
settlement are demonstrable physical peculiarities.
After carefully reviewing the subject, I do not know that I need
qualify, except to express more confidently, the account I formerly gave
you of those peculiarities, as consisting in the conjunction of dampness
with organic decomposition.
It is in respect of these conditions--especially among dense urban
populations, that the level of occupied ground, relatively to the
nearest water-surface, becomes of primary importance. The low level, in
itself, or rather in respect of the watery dampness which it implies, is
not enough to localise the pestilence. To be afloat at sea might be the
safest lodging.
The sub-district of St. Peter’s, Hammersmith, averages only four feet
above high-water level; that of St. Olave’s, Southwark, two feet higher;
yet among the former and worse placed of these two populations, the
Cholera-mortality was only 18 per 10,000; while among the latter and
better placed it rose to 196--multiplying nearly eleven times the minor
phenomena of a lower level. So also within your own jurisdiction. Side
by side along the river lie four of your sub-districts; three at the
elevation of twenty-one feet, one at the elevation of twenty-four feet.
The Cholera-mortality, if simply proportioned to level, should have been
nearly the same for these four sub-districts, but somewhat less in the
last one than in the first three. Yet contrary was the fact; for in two
of these sub-districts the Cholera-mortality, for equal numbers of
population, was 4½ times as great as in the other two.
It would, therefore, appear that in certain low-lying levels--to
constitute them favorable soils for the disease, there must be joined to
their first condition of lowness (with the mere watery dampness which it
implies) some other and second condition; one, which is of extreme
frequency in such districts, though not essentially present there.
This second condition impends wherever there dwells at such levels a
certain density of population; _it mainly varies with the degree in
which that dense population lives in the atmosphere of its own
excrements and refuse_. In this respect I cannot refrain from saying,
that the giant error of London is its present system of drainage.
Probably in considerable parts of the metropolitan area, house-drainage
is extensively absent: probably in considerable parts, the sewers, from
the nature of their construction, are very doubtful advantages to the
districts they traverse: but the evil, before all others, to which I
attach importance in relation to the present subject, is that habitual
empoisonment of soil and air which is inseparable from our tidal
drainage. From this influence, I doubt not, a large proportion of the
metropolis has derived its liability to Cholera. A moment’s reflection
is sufficient to show the immense distribution of putrefactive dampness
which belongs to this vicious system. There is implied in it that the
entire excrementation of the metropolis (with the exception of such as,
not less poisonously, lies pent beneath houses) shall sooner or later be
mingled in the stream of the river, there to be rolled backward and
forward amid the population; that, at low water, for many hours, this
material shall be trickling over broad belts of spongy bank which then
dry their contaminated mud in the sunshine, exhaling fœtor and poison;
that at high water, for many hours, it shall be retained[79] or driven
back within all low-level sewers and house-drains, soaking far and wide
into the soil, or leaving putrescent deposit along miles of underground
brickwork, as on a deeper pavement. Sewers which, under better
circumstances, should be benefactions and appliances for health in their
several districts, are thus rendered inevitable sources of evil. During
a large proportion of their time they are occupied in retaining or
re-distributing that which it is their office to remove. They furnish
chambers for an immense fæcal evaporation; at every breeze which strikes
against their open mouths, at every tide which encroaches on their
inward space, their gases are breathed into the upper air--wherever
outlet exists, into houses, foot-paths, and carriage-way.
[79] I am informed that in large districts on the south side of the
river, this retention of sewage is prolonged for two-thirds of every
tide--sixteen hours out of every twenty-four.
To you, Gentlemen, as Commissioners of Sewers for the City of London,
these remarks may seem superfluous; the rather so, as the worst evils of
tidal drainage are not largely exemplified within your jurisdiction. But
it seems to me of extreme moment at the present time, when very costly
improvements of the metropolitan drainage are about to undergo
parliamentary discussion, that the public should be well aware how
indispensable such improvements are for the general health of London,
and how important, in fact, they are to thousands who at first sight
might think themselves little interested in their completion.
To some individual householder, dwelling at a high level, all concern
in the subject may seem to terminate with the defluxion of his own
sewage. So that his own pipes remain clear, little cares he for the
ultimate outfall of his nuisance! Perhaps, if he knew better, he would
care more. His gift returns to him with increase. Down in the valley,
whither his refuse runs, converge innumerable kindred contributions.
From city and suburb--from an area of a hundred square miles covered by
a quarter of a million of houses, with their unprecedented throng of
metropolitan life, there pours into that single channel every
conceivable excrement, outscouring, garbage and refuse, from man and
beast, street and slum, shamble and factory, market and hospital. From
the polluted bosom of the river steam up, incessantly though unseen, the
vapours of a retributive poison; densest and most destructive, no doubt,
along the sodden banks and stinking sewers of lowest level; but
spreading over miles of land--sometimes rolled high by wind, sometimes
blended low with mist, and baneful, even to their margin that curls over
distant fields. For, not alone in Rotherhithe and Newington--not alone
along the Effra or the Fleet, are traced the evils of this great miasm.
The deepest shadows of the cloud lie here; but its outskirts darken the
distance, A fever hardly to be accounted for, an infantile sickness of
undue malignity, a doctor’s injunction for change of air, may at times
suggest to the dweller in our healthiest suburbs, that while draining
his refuse to the Thames, he receives for requital some partial workings
of the gigantic poison-bed which he has contributed to maintain.
The subject of these remoter effects I refrain from pursuing, as foreign
to my present purpose. That on which I wish to insist is the character
of the river, in its relation to the marginal sub-districts which it
habitually dampens and occasionally floods with putrescent soakage, and
in its relation to the sewers of low gradient which it converts (often
with their adjoining soil) into the similitude and hurtfulness of
cesspools. I wish emphatically to point out, that the several parts of
London have suffered, and are likely again to suffer, from Cholera, in
proportion as either this malarious influence is exerted on them, or
other kindred miasms are furnished by their soil. And it is my belief,
from such evidence as is before me, that the general liability of London
to suffer the epidemic visitation will cease, whenever an efficient and
inodorous system of drainage, conveying all refuse of the metropolis
beyond range of its atmosphere, shall be substituted for our present
elaborate disguise of an unremoved nuisance. I deem it right to state
this explicitly: not only because it is my duty to give you, in simple
truth, the conclusions to which I am led by careful reflection on the
facts; but likewise because--for the credit of sanitary medicine and for
your justification in the awful presence of a recurrent pestilence
within your jurisdiction--it ought to be thoroughly known how much of
the cause is common to the entire metropolis, and has not admitted of
removal by measures of partial improvement. And the circumstances will
perhaps excuse me if I repeat to your Hon. Court--represented as you are
both in the Metropolitan Commission of Sewers and in Parliament, where
this question must shortly be discussed--that the universal reform of
our metropolitan drainage, at whatever imaginable pecuniary cost, is an
urgent claim and necessity, unless this great city is again, as two
centuries ago, to live under the constant alarm of increasing epidemic
destruction.
Reverting, however, to the more especial relations of the disease within
your territory, you will remember that, among your four bank-side
sub-districts, two suffered in marked excess; their Cholera-mortality
having been 4½ times as great as that of the other two. The fact is
instructive; because those two suffering sub-districts (though not of
lower mean level than the others) were marginal to the valley of the
Fleet, and were therefore exposed, more than any other part of your
province, to the class of evils I have described. For a considerable
part of this locality may be regarded as but recently[80] a creek of the
Thames; its shelving banks, singularly foul from ancient misuse, though
now built over and paved, undergo in their lower levels very
considerable soakage; while those vast sewers which lie in the
mid-channel of the former river, are more liable than any within your
jurisdiction, to suffer injurious interference from the action of the
tide. At every such interference, and at every current of air setting up
the sewers, all gases generated in these large chambers would diffuse
themselves, not only in the low level, but likewise widely east and
west, up those important slopes which depend on this valley for their
drainage. I can easily understand that the radical cure of this district
may be possible, only as part of those metropolitan improvements to
which I have adverted; but I do think it of supreme importance, in
reference to any such visitation as we dread, that, during the next
twelve months, there should be taken every precaution which technical
knowledge can suggest, for restricting, even by palliative and temporary
expedients, those mischievous effects which I have endeavoured to
illustrate.
[80] New Bridge Street was built over the Fleet in 1765. The present
site of Farringdon Street had been arched in thirty years earlier, for
the purposes of the Fleet Market.
In describing to you the local affinities of cholera, I have intimated
that, in its preference for our low metropolitan levels, it selects
these soils specifically in respect of their being damp with organic
putrefaction. A moment’s consideration will suffice to show that, if
this be true, the higher levels of the metropolis will be exempt from
the disease, only in proportion as they exempt themselves from the local
conditions which invite it--only in proportion as they avail themselves
of those natural advantages which their situation enables them to
command. Let a district be defective in house-drainage, so that its soil
is excavated by cesspools and sodden by their soakage; let its sewers be
ill-constructed and foul, so that offensive gases are ventilated into
the immediate breathing-air of the inhabitants; let its pavement be
absent or imperfect, scattered with refuse and puddled with water;--you
will easily conceive that, under these circumstances, all distinctions
of level are merged in the strong identity of filth, and whatever
diseases belong to putrefactive dampness of soil will strike here as
readily as on the low-lying mud-banks of the river.
So, likewise, in still narrower limits--the predisposition of a house to
Cholera may be stated in the same terms as define the liability of a
district--viz., that the humid gases of organic decomposition, in
proportion as they are breathed into one house in a district more than
into other houses there, will engender the greater liability of that
house, as compared with its collaterals, to suffer an invasion of
Cholera. And thus it often happens, during epidemic prevalence of the
disease, that sporadic cases are determined in localities which might
generally claim to be free from infection: for, what avails it to be on
the highest ground and the best soil, with every neighbouring facility
of sewers and scavenage, if, owing to individual carelessness and filth,
the conditions of dampness and putridity are by choice retained within a
house, and its basement flooded with rotting liquids, or piled with
accumulated refuse?
I might give you many instances in illustration of these points--showing
you how, under the operation of specific sanitary faults, the
Cholera-mortality of districts acquires an artificial exaltation; but
few comparisons will suffice. At the period of the epidemic of 1849,
your best conditioned sub-district was the north-west of the City of
London Union; and (among those of the same level) your worst was the
sub-district of Cripplegate, which at that time was in a very
unsatisfactory state, abounding in open cesspools and their
consequences. In the former of these sub-districts the Cholera-mortality
_per_ 10,000 was 19; in the latter 47; and it is easy to show that
additional sanitary errors soon develop a larger fatality. Not far from
your boundary, at the same level with these two sub-districts, in the
Hackney-Road division of Bethnal-Green, it rose to 110; this large
mortality being principally confined to a very small portion of the
district, wherein (the local Registrar reports) sewers were almost
entirely absent, houses were contaminated with the filth of years,
streets were remaining for days uncleansed from accumulating dirt, and
all waste water (including animal secretions) was uniformly thrown into
the public way.
Such are the conditions under which, at any imaginable height in the
metropolis, Cholera may decimate a population: such, in their worst
form, were the conditions which at Merthyr-Tydvil--several hundred feet
above the water-level, carried the Cholera-mortality to more than double
the high metropolitan rate just mentioned. Taught by this case the power
of human mismanagement to futilise the favours of Nature; taught that
perverse ingenuity can construct poison-beds for the development of
Cholera, high above the usual track of its devastation; one gladly turns
from the horrible instructiveness of such a lesson, to gather the
kindred evidence of contrast: and happily there is abundant evidence to
show how much may be effected, even in the most tainted districts, to
purchase a circumscribed exemption from the disease by the judicious
application of sanitary care.
In the remarks which I have made on the local distribution of Cholera,
you will have observed that I dwell particularly on one class of
sanitary evils as concerned in its production; on that class, namely,
which consists in the retention and soakage of organic refuse--on that
class, which has its appointed antidote in a system of inodorous
drainage, of uninterrupted pavement, of complete and punctual scavenage.
On this I particularly insist, because I believe that here is the very
atmosphere without which Cholera would cease.
Sanitary evils abound; and, if I were speaking of other diseases, I
might have more to say of other causes. I am unwilling, even for a
moment, to seem indifferent to those remaining fertile sources of
suffering that surround the poor of our metropolitan population--to
their over-crowded condition, to their scantiness of ventilation, to
their insufficient or disgusting water-supply, to their frequent
personal dirt, to their habitually defective diet. These several
influences have their own characteristic sequels and retribution, on
which I have often addressed you, and which I am little likely to
underrate; believing, as I do, that, in the lapse of years, the
aggregate of their effects is far more fatal than any periodical
epidemic visitation. Likewise, I cannot doubt that, under certain
circumstances, and in respect of particular cases, they may assist the
operation of the choleraic poison. Nor will I pretend so exactly to
limit the affinities of that which evolves this poison, as to deny that
rooms, fœtid with animal exhalations, may (like cesspool-sodden cellars)
be ready to answer the stimulus of its infection. And at any rate, I
think it highly important to recognise that all sanitary defects which
embarrass the excretive purification of the human body--whether by
breathing or otherwise, do naturally tend in the same direction as the
causes of Cholera, and are liable--if only by indirect means, to become
accessory in its destructive work.