considerations, I esteem it of still higher consequence, if measures are
ever to be taken for an effective prevention of the disease, that the
principle of its _specific causation_ should be steadfastly kept in
view. What may be the exact chemistry of this process, I do not pretend
to say: urging only, that, in all human probability, the poison arises
in specific changes impressed by some migratory agent upon certain
refuse-elements of life. Perhaps nowhere, and certainly not before your
Hon. Court, can it be desirable, in the present immaturity of
pathological knowledge, to argue as to the first origin or absolute
nature of that wandering influence which determines in particular
localities the generation of epidemic malaria. Simply, since it leads to
all-important practical conclusions, let this distinction be recognised:
that which seems to have come to us from the East is not itself a
poison, so much as it is a test and touchstone of poison. Whatever in
its nature it may be, this at least we know of its operation. Past
millions of scattered population it moves innocuous. Through the
unpolluted atmosphere of cleanly districts, it migrates silently,
without a blow: that which it can kindle into poison, lies not there. To
the foul, damp breath of low-lying cities, it comes like a spark to
powder. Here is contained that which it can swiftly make
destructive,--soaked into soil, stagnant in water, griming the pavement,
tainting the air--the slow rottenness of unremoved excrement, to which
the first contact of this foreign ferment brings the occasion of
changing into new and more deadly combinations.
These are matters which it is hateful to hear, and, believe me, to speak
about. But the thing is worse than the statement; and I would suggest to
you this easy test of its reality. Take at random any consecutive
hundred entries of Cholera-Deaths in the Registrar-General’s
metropolitan returns, where local conditions are described; and let any
man decide for himself, whether what I have sketched in general terms
convey more than the essential features of these several records. In
1849, such an atmosphere as these influences engender existed
continuously and intensely on the low-lying south side of the river, and
to some distance inland, from Greenwich to Wandsworth; it existed also
continuously, but in far less intensity, and with comparatively little
extension inland, along the northern side of the river from Poplar to
Chelsea, and it existed very intensely in several independent centres,
scattered about those healthier levels of the metropolis, which, by
their better position, ought to have been exempted from such a reproach.
The Cholera struck in the same proportion as this atmosphere prevailed;
and herein, I repeat, lies that definite local condition, except for
which--to the best of my knowledge and belief, the migratory ferment
(whatever it may be) would pass harmlessly through the midst of us.
For, towards the chemical constitution of local atmospheres, it seems
that the several principles of epidemic diseases stand in the same sort
of fixed respective relations, as do the several principles of infective
fevers towards certain elements in the blood of individual persons. Just
as the infective ferment acts on man, so appears the epidemic ferment to
act on locality. We know that, in a given group of human beings,
small-pox chooses one victim, scarlatina another, measles a third, by
reason of some material quality in each person respectively, which his
blood possesses, and which his neighbour’s blood does not possess. By
virtue of this quality--not the less chemical because chemists have no
name for it, that specific exterior agency, which we call infection, has
the power of affecting each such person--has the power of producing in
him a succession of characteristic chemical changes which tend to an
eventual close by exhausting this material which feeds them.[81]
[81] For the scientific reader, I may perhaps be permitted to add,
that the very difficult Subject, at which here I can only venture to
glance, is discussed at some length in one of my Pathological
Lectures, delivered at St. Thomas’s Hospital in 1850, published at
that time in the _Lancet_, and subsequently reprinted.--J. S., 1854.
Strictly analogous to this, in its principle of choice and in its method
of operation, appears the epidemic action--not on persons indeed, but on
places. The specific migrating power--whatever its nature, has the
faculty of infecting districts in a manner detrimental to life, only
when their atmosphere is fraught with certain products susceptible,
under its influence, of undergoing poisonous transformation.
These products, it is true, are but imperfectly known to us. Under the
vague name of putrefaction we include all those thousand-fold
possibilities of new combination, to which organic matters are exposed
in their gradual declension from life. The birth of one such combination
rather than another is the postulate for an epidemic poison.
Whether the ferment, which induces this particular change in certain
elements of our atmosphere, may ever be some accident of local origin,
or must always be the creeping infection from similar atmospheres
elsewhere similarly affected; whether the first impulse, here or there,
be given by this agency or by that--by heat, by magnetism, by planets or
meteors--such questions are widely irrelevant to the purpose for which I
have the honour of addressing you. The one great pathological fact,
which I have sought to bring into prominence for your knowledge and
application, is this:--that the epidemic prevalence of Cholera does not
arise in some new cloud of venom, floating above reach and control, high
over successive lands, and raining down upon them without difference its
prepared distillation of death; but that--so far as scientific analysis
can decide, it depends on one occasional phase of an influence which is
always about us--on one change of materials which in their other changes
give rise to other ills; that these materials, so perilously prone to
explode into one or other breath of epidemic pestilence, are the dense
exhalations of animal uncleanness which infect, in varying proportion,
the entire area of our metropolis; and that, from the nature of the
case, it must remain optional with those who witness the dreadful
infliction, whether they will indolently acquiesce in their continued
and increasing liabilities to a degrading calamity, or will employ the
requisite skill, science, and energy, to remove from before their
thresholds these filthy sources of misfortune.
* * * * *
2. If, gentlemen, I have detained you long in stating conclusions as to
the habits of the disease, and as to the significance of its local
partialities, it has been in order to render quite obvious to you the
intention of those precautionary measures which it is now my duty to
recommend.
First, I would allude to influences of an exterior and public kind; and
here, all that I have to advocate might be included in a single
stipulation, that cleanliness--in the widest sense of the word--should
be enforced to the full extent of your authority.
Over the pollutions of the river, and over the tidal exposure of its
malarious banks, you have no power.
Whether for the relief of your low-lying districts--subject to imminent
risk from causes I have described--there can be found any temporary
protection to save their atmosphere from contamination, is a question
which you will resolve upon other judgment than mine.
Along the river-bank there is one especial source of nuisance which has
repeatedly been under your notice, and which is likely to become of
serious local import under the presence of epidemic disease. I refer to
the docks, and chiefly to that of Whitefriars. I mention it
particularly, not only because the accumulations of putrid matter there
have often been alarmingly great, but likewise because, at the head of
this dock, during the former invasion of Cholera, there was remarkable
prevalence of the disease; and I can well remember how often the
offensive condition of the dock was accused, not unjustly, of
contributing to the mortality of the neighbourhood. The fœtid materials,
floated into these several recesses of the river, and left stranded
there by the receding tide, are often so copious as to produce very
objectionable effects on the atmosphere which surrounds them; and I
would beg leave strongly to urge that such sources of nuisance should be
thoroughly and permanently removed.
Further--from what I have said as to the conditions of our vulnerability
by Cholera, you will be prepared to think it of great importance that,
during the next six months, you should be certified on the state of your
sewers, in every part of the City, as to their greatest possible
cleanliness and least possible offensiveness of ventilation. Fifty miles
of sewer, reticulated through the City, sufficiently attest your active
desire to provide for the complete and continuous carrying away of all
excremental matters: and you will excuse me, I hope, in consideration of
the anxieties of my office, if I seem superfluously cautious in
reminding you that the test of successful sewers lies in an inodorous
fulfilment of their duty, and that every complaint of offensive
emanations indicates, in proportion to its extent, a failure of that
sanitary object for which the construction was designed.
There is one precaution--always of great value to the health of towns,
and especially useful against any malarious infection, which happily I
find it needless to recommend. The paving of all public ways within the
City--including every court and alley--is already so complete as to
constitute a very favorable point in your sanitary defences. In order
that this excellent arrangement may give its full fruit, it will be
requisite--though this again I need hardly press on your consideration,
that the duties of scavengers and dustmen be thoroughly and punctually
performed.
Again, I would particularly advise that great vigilance be exercised in
all markets, slaughtering-places, and other establishments under your
jurisdiction, to prevent the retention of refuse-matter, animal or
vegetable. I would urge the strictest enforcement of all regulations
which you have made for the cleanliness of such places, and for the
removal of their putrefiable refuse.
Likewise, I have to suggest that after the month of May, at latest, no
disturbance of earth to any considerable depth should be allowed to take
place, either in your works or in those of gas and water companies,
except under circumstances of urgent necessity. In the lower levels of
the City, particularly, I conceive this prohibition to be a matter of
paramount importance; because the soil, never of unexceptionable
cleanliness in towns, is here especially apt to be of offensive quality.
On the subject of water in its general relations to the City, I have
only again to express my deep regret that it lies out of your present
power to compel a continuous supply, and that your means are restricted
to choosing what may best compensate for the absence of this sanitary
boon. It must be your aim to mitigate, so far as may be, the evils that
belong to an ill-regulated intermittent system in its adaptation to the
houses of the poor--evils which imply, as I have often told you, not
only much domestic dirt, but likewise a frequent suspension of all
efficiency in the drainage of innumerable houses. With a view to the
best alternative for a continuous supply, I would recommend that at
least a daily filling of all cisternage take place, and expressly that
Sunday form no exception to the advantages of this rule. If a choice of
evils must be made, I trust it is no heathen’s part to urge that the
Christian Sabbath suffers more desecration in the filth and preventable
unwholesomeness of many thousand households, than in the honest industry
of a dozen turncocks. I likewise submit, that it would be highly
advantageous to the labouring poor, most of whose domestic cleansing is
reserved for the last day of the week, that, on that day, a second
delivery of water should take place at some hour in the afternoon.
I wish it were in my power to tell your Hon. Court that the supply of
water to the City of London had become, in quality, all that I think it
might be rendered. Such as it is, however, there depend other very
important issues on its being delivered in ample abundance for all the
purposes of cleanliness; and I am glad to have learned from the eminent
engineer of the New River Company, that he has it in expectation very
shortly to be able to furnish to the City a largely increased and
practically inexhaustible supply.
The subject of water in its district relations ought hardly to be passed
without a word of caution as to the use of pumps within the City. I need
hardly inform you that every spring of water represents the drainage of
a certain surface or thickness of soil, and that--such as are the
qualities of this gathering ground, such must be the qualities of the
water. You will, perhaps, remember that in my account of one celebrated
City pump, which sucks from beneath a churchyard, I showed you ninety
grains of solid matter in every gallon of its water. In virtue of that
wonderful action which earth exerts on organic matter, the former
contents of a coffin, here re-appearing in a spring, had undergone so
complete a change as to be insusceptible of further putrefaction: the
grateful coolness, so much admired in the produce of that popular pump,
chiefly depending on a proportion of nitre, which arises in the chemical
transformation of human remains, and which being dissolved in the water,
gives it, I believe, some refrigerant taste and slight diuretic action.
Undoubtedly this water is an objectionable beverage in respect of its
several saline ingredients; but my present object in adverting to them
is rather to illustrate an anterior danger which they imply. Their
presence indicates a comparative completion of the putrefactive process,
effected by the uniform filtration of organic solutions through a
porous soil.[82] Let that soil have frequent fissures in its substance;
or let its thickness be scanty in proportion to the organic matters to
be acted on: and the water, imperfectly filtered, would run off foul and
putrescent. Now this risk, more or less, belongs to all pumps within the
City of London. They draw from a ground excavated in all directions by
sewers, drains, cesspools, gas-pipes, burial-pits. The immense amount of
organic matter which infiltrates the soil does undoubtedly, for the
greater part, suffer oxidation, and pass into chemical repose: but in
any particular case it is the merest chance, whether the glass of water
raised to the mouth shall be fraught only with saline results of
decomposition--in itself an objectionable issue--or shall contain
organic refuse in the active and infectious stage of its earlier
transformations. Some recent cutting of a trench, or breakage of a drain
in the neighbourhood, may have converted a draught, which before was
chronicly unwholesome, into one immediately perilous to life. Such facts
ought to be known to all persons having custody of pumps within urban
districts; and it ought likewise to be known that this infiltrative
spoiling of springs may occur to the distance of many hundred yards.[83]
[82] This very important influence, exerted by the earth on various
organic infiltrations, is referred to in the text only under one point
of view; only as it occasions the deterioration of land-springs in
urban districts, and renders their water unfit for consumption. But
the subject has another equally important side. Such springs, having
their waters laden with nitrates, represent the continuous removal of
organic impurities which otherwise would contaminate the air. The evil
of spoiled springs, therefore--while it necessitates for every urban
population that their water-supply shall be artificially furnished
from a distance, has great countervailing advantages. A given organic
soakage will cease to vitiate the atmosphere by evaporation, in
proportion as it gravitates to lower levels, and undergoes those
chemical changes which accompany filtration through the soil. Hence it
is evident that, for the healthiness of inhabited districts (where
extensive soakage of organic matters is almost invariable) it becomes
most important to maintain, or by artificial measures to accelerate,
this down-draught through the soil; and the reader will scarcely need
to be reminded, that, in those improvements of metropolitan sewerage,
which it is a chief object of this Report to advocate, complete
provision for the continuous drainage of soil is implied as an
essential part.
[83] For a fact strikingly illustrative of this, I am indebted to my
colleague, Dr. R. D. THOMSON, Lecturer on Chemistry at St. Thomas’s
Hospital. At Liverpool--in three wells which he examined, distant
severally 760, 800, and 1050 yards from the Mersey, he found the water
brackish from marine soakage, containing four or five hundred grains
of solid matter _per_ gallon, and totally unfit for consumption.
In final reference to the quality of water, whether supplied by our
trading companies or derived from springs within the City, I think it
expedient to mention that, against its lesser impurities, great
protection is given by filtration through animal charcoal, as in various
‘filters and purifiers’ which are before the public. These protective
means do not lie within reach of the poorer classes; nor, whatever their
accessibility to individuals, can any such personal arrangements render
it less important to provide that water--the first necessary of life--be
supplied for universal use in its utmost procurable purity.
* * * * *
Beyond the above points, which are of general application within the
City, all your remaining precautions will relate to the condition of
private houses: and of these--occupied by the poorer classes, there
exist in the City some thousands over which it will be requisite, by
repeated inspection, to maintain an efficient sanitary watch. From
circumstances to which I have already referred, it appears that your
defences against Cholera will very mainly consist in removing the causes
of disease from within individual houses; and it is only by an organised
system of inspection, for detecting and removing every unclean
condition, that this object can be attained. For your encouragement in
this task, I may venture to express my belief that, throughout a
considerable portion of the City, the local affinities for Cholera are
not too strong to be greatly modified and obviated by such a system.
With respect to this important work of sanitary inspection, what I now
propose is no new proceeding within the City. More or less since the
date of my appointment, but I hope with gradual increase of completeness
and efficiency, weekly visitations on a considerable scale have been
made, under my direction, by your four Inspectors of Nuisances. Acting
under your authority, and guided by what information I could obtain on
the existence of endemic disease[84] in your several districts, I have
furnished the Inspectors every week with a variable list of houses,
ranging probably from fifty to one hundred and fifty at a time, for
their visitation and inquiry. The information which I have directed them
to seek has referred of course to the various details of sanitary
condition: to questions of lodgment, ventilation, cleanliness, drainage,
water-supply, dust-removal, paving of yards and cellars, existence of
nuisances, and the like: and I have constructed tabular forms for their
use, which admit of this information being recorded and reviewed in the
readiest manner. Week by week, before each meeting of your Court, I have
had the habit of going through every particular of these somewhat
considerable details. I have sorted out of them those very numerous
cases in which your lawful powers could be usefully exerted. When I have
deemed it necessary, I have myself made visits of verification or
inquiry; and have finally laid before you, in the form which is familiar
to your weekly meetings, such recommendations as the week’s survey has
shown necessary, for enforcing works of local improvement under the
powers of your Acts of Parliament. I find that within the last twelve
months there have been made 3147 visitations of this nature, the results
of which are recorded in your office; and, founded on the result of
these inspections, there have been issued 983 orders for abatement of
causes of disease.
[84] This information has been mainly derived from two
sources:--first, from the weekly Death-Returns of the nine City
Registrars, which the Registrar-General most kindly allows me to have
transcribed so soon as they arrive at his office;--secondly, from
weekly returns which the Medical Officers of the three City Unions
have had the great kindness and liberality to supply for my
assistance, as to the existence of fever and kindred disorders in the
several localities under their charge.
I am very far from considering that these arrangements have been
perfect. Circumstances beyond my control have prevented me from
constructing as complete an organisation as I could wish; and the fact
that your Inspectors are very largely employed in other duties, has
perhaps occasionally given some hurry and imperfection to their share of
the work. Still, such as it is, this system has been the means of
considerable advantage; and I am glad to be able to claim for your Hon.
Court the distinction of being first in the metropolis to have
established an arrangement for the systematic sanitary visitation of the
dwellings of the poor. In relation to this subject, I beg to inform your
Hon. Court that your Inspectors have discharged, with much zeal,
intelligence, and industry, the duties which you authorised me to impose
on them.
During the last few weeks it has become obvious to your Hon. Court that
the duties of this department of your service have grown to such
dimensions as to necessitate some increase of your staff; and acting on
this opinion, mainly with a view to render more complete your sanitary
supervision of the City, you have just appointed two additional
Inspectors of Nuisances. In making this appointment, you have determined
not to restrict any two or three Inspectors exclusively to the business
of house-inspection, but to allot the joint duties, sanitary and
surveying, equally among their number: parting the area of the City into
six, instead of four, Inspectors’ districts; so that each Inspector
shall give a certain proportion of time to the duties which he has to
fulfil under your Surveyor’s direction, and another certain proportion
to those in which he will be engaged under the direction of your Officer
of Health. It is only some experience of this arrangement that can
decide whether it will be the most effectual for your purpose; but in
the mean time I have studied so to dispose the industry of your
increased staff, under the arrangement you have ordered, as to obtain
the most systematic and efficient discharge of those duties which you
have desired me to superintend.
Reckoning that each Inspector, if he fulfilled no other duty, could
report on the condition of about fifty houses _per diem_, I presume
that henceforth, in each of your five more important districts, from one
hundred to one hundred and twenty houses can be visited weekly by the
Inspector, without encroaching on the time required for his other
duties.