Refuse.

It has been said that classification is the basis of all science, and it most certainly is the basis of the scientific disposal of refuse. Refuse matter is most varied in its nature, and the items of which it is composed—excrement, rags, bones, paper, straw, sawdust, and other packing materials, cinders and ashes, old crockery, broken glass, old metal, &c.—all demand a different method of treatment.

When I see the grimy gentlemen in fan-tailed hats engaged in the marvellous operation of climbing over spiked railings with the object of filling a huge lumbering cart with a mixture of some or all of the things mentioned above, I feel that they are occupied in a bit of wilful mischief, and are merely increasing the dangers and difficulties of that sorting which is inevitable. In cities house refuse should be collected every day, and the sorting should be done at once by the collector, with the intelligent co-operation of the householder. Things dissimilar in nature should never be mixed. The first division is into putrescible and non-putrescible, and the former should be sent forthwith to the farmer to be dug into the ground. The non-putrescible refuse—glass, crockery, cinder, ash, metal—if sorted and temporarily stored in bins, would probably pay the cost of its collection and removal, and might perhaps yield a slight return. A great deal of the non-putrescible refuse might be of use to the sanitary authority on the spot for making foundations for paths and roads, or for scattering on the streets in slippery or frosty weather. Ash (not cinder) beneath the gravel on a garden path gives in time a firmness and stability which are remarkable. Whether it would work in with the macadam in road-making, and cause a similar improvement in the road, I do not know. It is difficult to understand why it should not do so. Non-putrescible refuse is not a danger to health, and it is certain that a great deal of it might be used for various purposes by the sanitary authority.

This immediate sorting is only possible when such materials are collected every day and the bulk is small.

It seems to me that much of our municipal scavenging is too magnificent, and that it is often inefficient in proportion to its magnificence. The nimble boys who collect the street droppings and store them in bins which contain nothing but the valuable and marketable manure are the type of what is good. The showy Clydesdale slowly dragging the most lumbering cart conceivable filled with an unmarketable mixture is the type of what is bad.

Farmers are shy of taking London sweepings, because, as one told me, 'they send such stuff.' All organic refuse is good for the land, but the farmer wants it in a form which does not hinder tillage. Pieces of oil-cloth, hamper lids, dead dogs and cats, and old tin canisters, are a nuisance to the farmer, and a very slight admixture of such things spoils the practical value (a different thing to theoretical value) of the manure which is mixed with them.

The sanitarian who loses sight of classification, and who, in his eagerness for a big scheme, is neglectful of details, has not mastered the elements of his trade.

The only rational treatment for excremental matters is immediate superficial burial, with a view to the production of crops, as detailed in 'Rural Hygiene.' It is to be hoped that, with this object in view, some municipality will purchase a tract of land and endeavour to give the poor an object-lesson on the right use of refuse. If convenient access to such a farm by means of canal, river, or railway siding could be obtained, it would make little difference whether it was two or twenty miles from the town, but the nearer the land is to the houses the better. Such a farm must be hand-tilled, and, if skilfully hand-tilled, would certainly produce as much food as a market-garden. It would employ an enormous amount of labour, and would at least pay its labour bill. I am not advocating that such a farm should be used as a playground for the semi-criminal, semi-imbecile, and generally incompetent class who go to form the 'unemployed'; for the trade of agriculture, to be successful, demands both skill and energy. The 'unemployed' should be set to stone-breaking, street sweeping, dung-collecting, road picking and ramming, and scavenging generally, under the eye of foremen in town, and then, if found worthy, they might be exported to the farm.

Fig. 29.—Arrangement for Small Tenements.

Fig. 30.—Section A-A.

Figs. [29] and [30] are intended to show the plan and section of a group of the smallest town tenements, with a scavenger's alley between them and the three gutters, two closed at both ends, to be filled with absorbent material to collect the urine, and one to be filled with non-absorbent material to filter and aërate the slop-water, which should always flow in open channels when practicable. The 'scavenger's alley' should be protected by gates. It is thought that the excrement would be primarily collected in comparatively small vessels, like garden water-tanks upon wheels. The excrement having been allowed to drain before collection, and being in a semi-dry, sticky condition, would have no tendency to slop about during a journey, and in a covered vessel such as I have described might be sent any distance without danger or offence. Arrived at the farm the tank would be transferred to a second pair of wheels, and by being tilted would easily deposit its contents in a furrow previously made in the ground with a spade. The tank should be dried and lime-whitened and returned to the town, and three days after the deposit of the excrement in the ground, plants of the cabbage order should be dibbled in. Cabbages and their allies are the only plants which really flourish in the fresh material; but after the cabbage crop has been harvested any garden crop may be grown, and it will be found that the fertility of ground treated as I have suggested is very great and very persistent.

The best method of treating kitchen waste and putrescible refuse, such as cabbage leaves and the trimmings of vegetables, &c., is to throw all together into a heap enclosed by a circle of wire netting. In the course of a few months complete humification will take place.

CHAPTER IV
OVERCROWDING, ITS CAUSES AND EFFECTS

I have been at some pains to demonstrate the dangers and inconveniences which are inseparable from houses built, as are the majority of town houses, upon an area which is wholly insufficient when considered in relation to their cubic contents.

Feeling, as I do, that the question of space round the dwelling is of the greatest importance—so important that every other sanitary regulation sinks into insignificance when compared with it—I have endeavoured to show how detached houses may, to their great advantage, be independent of the public sewers, and equally independent, if their owner choose, of public water supplies; and this I have done in the hope that in country places, and places which are developing, the precious boon of living in a detached house may be recognised.

While I am not slow to admit that water under pressure is a great advantage if it be wisely used, I have pointed out persistently for some years that our present system of water-carried sewage gives a 'fatal facility' to the overcrowding of houses, and has made life, of a sort, physically possible under conditions of overcrowding which have never been equalled in the history of the world.

In China and the East generally, be it remembered, the large population lives upon one plane. It has been left to Europe and America to try the experiment of piling the city populations in heaps, of housing them in many-storeyed buildings, some of which (in America) are fifty times the height of a man.

The facilities for overcrowding which are afforded by big schemes of water-supply and sewerage are now well understood, and have caused the formation of 'Building Societies' throughout the country. A large number of these societies during the past few years have been proved to have been dishonestly managed, and have involved widespread financial disaster amongst the poor and thrifty.

The mode of proceeding of these societies is to buy up, on the outskirts of towns having a system of sewers and a common water-supply, plots of land abutting on roads which have been sewered at the expense of the ratepayers.

These plots are then sold to purchasers who pay 10 per cent. deposit for possession, and pay the rest of the purchase money in monthly or quarterly instalments for a term of years, 10 or 15, as the case may be, with 5 per cent. interest. Thus the artisan, having paid a most exorbitant price for a plot of ground, starts in life with a mortgage round his neck, and probably finds, should anything interfere with the regular payment of instalments, that he has a hard-faced usurer to deal with, who merely concealed his identity behind the title of 'Company, Limited.'

The accompanying diagram (fig. [31]) gives a good idea of the development of a district subsequent to sewering. It has been copied from the prospectus of a Building Society. A A A is an old road having houses on the north side only; B B B is an old road with houses on the south side only, i.e., seven dwelling houses in a course of more than half a mile.

The space between A A A and B B B was, until a few months ago, a market garden full of fruit trees, and about nine acres in extent.

A few years ago A A A and B B B were sewered at the expense of the ratepayers, and very soon afterwards this market garden was bought by a 'Building Society' and converted into a 'building estate.'

Fig. 31.

It is obviously a very 'eligible' estate, for there is a Railway (R.), with a Station (S.), a Post and Telegraph Office (P.O.), a Church (Ch.), and two Public Houses (P.H.). None of the elements of modern civilisation are wanting. After the sewering of roads A A A and B B B, the District Council, in a fit of zealous extravagance, destroyed the gravel paths at the side of B, and put a 12 by 6 inch kerb, and laid half a mile of granolithic pavement for the benefit of the aforesaid seven houses.

When the Building Society issued its prospectus the plots abutting on the old roads A A A and B B B were sold at once, and the reason is obvious, viz., that the roads are ready made and sewered; and a note with regard to road B B B says, 'This road is a highway maintainable by the local authorities, who will provide a proper footway in front of the plots in due course.' The ratepayers as a whole are to provide pavements for the speculative builder in this particular instance, and it is evident that the owners of the plot and the Local Council had come to an agreement in the matter. The houses abutting on the new roads, Z Z Z, will, in addition to the purchase money for the land, be charged 3s. per foot frontage for sewers, and 'also such a proportion as their surveyor shall assess of the expense of repairing and maintaining the road or roads, until the same shall be handed over to the local authorities.' On an adjoining property the cost of 'making up' a private road was estimated at 12s. per foot run, so that the cost would amount to between 10l. and 11l. for a plot having a frontage of 18 feet, and might form a ruinous charge on some of the corner plots.

The ground will accommodate 177 plots, and the plots facing the old roads fetched 3l. a foot. Of these there is room for fifty-nine, having a frontage of 20 feet each, so that the price paid for these at 60l. per plot would be over 3,500l.; and if the remaining 118 plots fetched 40l. each (4,720l.), the total price realised for this 9 acres would be over 8,000l., in addition to the charge for sewerage and road-making.

When, moreover, it is remembered that the society may possibly hold a mortgage on every plot and every house, for which they get 5 per cent. and excellent security, it will be admitted that running a 'Building Society' is a tolerably profitable business.

If all these plots are sold there will be a population of over 1,200 persons on 9 acres of ground, and the ratepayers will be at the charge not only of educating the children, but of providing hospitals for the segregation of infectious diseases, allotments, free libraries, open spaces, and additions to the sewerage works for dealing with the sewage of 1,200 persons.

When a 'progressive' municipality sets to work to 'develop' its district (a speculative and hazardous process, which it should leave to private enterprise), the ratepayer soon begins to see that a great diversity of interests has to be served.

The little shopkeeper (and it is of this class that Boards and Councils are largely composed) wants the greatest number of people on the smallest space; and he sees that in proportion as the dwelling has an insufficient curtilage, so are its inhabitants wholly and entirely dependent on the shop.

The person with a fixed income who settles in a district wishes the district to remain picturesque, rural, and quiet, and, above all, he desires that the 'rates' may be kept down. He naturally objects to be taxed for the sewering of country roads in order that the fields may be covered with courts and alleys of jerry-built houses, and equally he objects to be taxed in order that every railway station in the country may display a large invitation to trippers to invade his solitude and make his life a burden.

All sanitarians are agreed that mortality and density of populations are directly proportional. The following figures, taken from Table R (p. xlvii.) of the decennial supplement of the Registrar-General (1895), show this very clearly, as does also the diagram of the mortality figures for London (p. [144]).

Persons to a square mileDeath-rate (corrected)
138 12·70
187 14·48
307 16·47
662 18·55
1,803 20·43
3,299 22·30
4,295 24·51
19,584 33·00

The corrected death-rate for 'Urban England,' as given by the same authority, is 22·32, as against 16·95 for 'Rural England.'

To form a just estimate of the comparative healthiness or unhealthiness of a great city like London is no easy matter. The composition of the population is, especially in the central parts, so abnormal in regard to age and sex that unless corrections be made for this abnormality any comparison of London with other places is futile. Such corrections are now made by the Registrar-General.

It is probable that in no city are the annual variations of population greater than in London. The population of June (the height of the season) and the population of September (when 'everybody is out of town') must be very different. In September the rich go to the country, the shopkeepers go to the seaside, and the poorest of the poor go hop-picking. The School Board attendances for the first week of September show a deficit of 80,700 children, or 11·1 per cent., figures which clearly demonstrate that the autumn exodus is not limited to the wealthy classes.

It is at this season that we see paragraphs in the paper to the effect that the death-rate of some London parish for the Michaelmas quarter reached an incredibly low figure, and we are asked to infer that the population, thanks to the wise policy pursued by the vestry, is fast making for immortality. Of course such statements are not worth the paper they are written on, because there are no data as to population, and the period chosen is so short as to be valueless.

In estimating the death-rates of different sanitary areas of London it has been customary for the last six years to distribute the deaths occurring in institutions to the districts to which the deceased 'belonged,' and to exclude entirely the deaths of persons belonging to districts outside registration London; in this way about 1·5 per cent. of the deaths occurring in registration London may be excluded. This manœuvre helps to diminish the London death-rate, but, as no account is taken of sick people who leave London to die elsewhere, it is manifestly an unjustifiable thing to do.

If the strangers who die in London institutions are to be excluded, it is a question whether all strangers merely sojourning in London ought not to be excluded from the estimate of population. Again, a man comes from the country and is knocked down by a vehicle in the street and dies in a London hospital; or during a sojourn in London he gets caught in a London fog and dies of bronchitis; or he 'catches' influenza, or pneumonia, or diphtheria in London and dies. Surely the deaths of these three ought to be credited to London in all fairness. It is a very dangerous thing to 'cook' statistics, and we do not get much nearer the truth by doing so.

The best indication, probably, as to whether the conditions of life in any locality are healthy or the reverse is the infant mortality; in this way we exclude the fallacies due to abnormal age distribution, because we compare identical age periods; and the proportion of the sexes among children is practically the same everywhere. We exclude also the influences of occupation. By studying the mortality of children under five we are studying the influence of the home and home surroundings on the incidence of disease, which is particularly what we wish to do.

In the decennial supplement of the Registrar-General published in 1896, Dr. Tatham gives a table (Table II. p. lxxxii. et seq.) of the 'annual death-rate per million living among children under five years of age, from all causes and from several causes, 1881-90.' This valuable table ought to be most widely studied. Being based upon statistics of ten years intervening between the censuses of 1881 and 1891, the estimates of population have a maximum of reliability, because we are relieved of the errors inseparable from statistics referring only to short periods of time.

It is constantly stated that London is the healthiest city in the world, a statement which, if true, must make us very sorry for the other cities. In Dr. Tatham's table, alluded to above, he first deals with counties.

We find that the death-rate of children under five from all causes in England was 56,825 per million; that the highest death-rate among children was in Lancashire (72,795), and the next highest was in the county of London (68,164). The lowest death-rate was in the county of Dorset (35,651).

Table Legend:
A = Smallpox
B = Measles
C = Scarlet fever
D = Diphtheria
E = Whooping cough
F = Fever
G = Diarrhœa
H = Tuberculosis Disease
I = Respiratory Disease

All CausesABCDEFGHI
Lancashire72,795375,0532,4547063,8052856,4615,36417,037
London68,1642404,7431,7801,3715,3421655,4446,58116,021
Hampshire42,222102,0055059392,5082802,7833,2999,011
Dorsetshire35,65141,7484884931,815621,3052,4019,390

I have also thrown in Hampshire, because not only is it my own county, but it is a mixed county, largely rural, but also containing the big towns of Southampton and Portsmouth.

Looking at these four in tabular form, we see that in Lancashire the mortality from measles, scarlet fever, fever, diarrhœa, and respiratory disease was greater than in London; and in London the mortality from small-pox, diphtheria, whooping cough, and tuberculous disease was greater than in Lancashire.

In Hampshire and Dorsetshire the mortality was very much less from every cause than in either Lancashire or London.

It is important to point out that the deaths of children from tuberculous disease are greater in London than in any other county, and that the deaths from tuberculous and respiratory diseases combined are greater in London than in Lancashire.

We have seen that the mortality of children under five averaged for the whole of London 68,164 in the decennium 1881-90, while that for England and Wales was 56,825, or, omitting the last three figures, let us say they were 68 and 57.

Examining the various registration districts more closely, we find that the child mortality was less than the average for England and Wales in four London districts only, viz., Lewisham (44), Hampstead (48), Woolwich (51), and Wandsworth (56), districts which are all on the outskirts of the place we call London. Certain other districts had a child mortality less than the average of London as a whole, viz., Camberwell (59), Hackney (60), Islington (61), Paddington and Kensington (63), Greenwich (63), St. Pancras (66), Fulham, Poplar, and Lambeth (67).

All the other districts had a child mortality greater than the average of London, viz., Mile End (69), St. George's, Hanover Square (71), Westminster (72), Chelsea and St. Olave's (73), Marylebone (75), Bethnal Green (76), Shoreditch (78), St. Saviour's (79), St. Giles's (80), Holborn (82), Whitechapel (85), St. George's in the East (87), the City (90), Stepney (99) and the Strand (109).

With the exception of the City, Stepney, and the Strand, there are only two registration districts in the whole country which have a child mortality over 90, viz., Manchester (93) and Liverpool (114). To Liverpool therefore belongs the distinction of being the most unwholesome place for little children in the whole country, and the 'Strand,' which constitutes the very centre of London, comes next.

Let us examine these figures more closely, and let us throw the child mortality of Liverpool and the Strand into tabular form, and contrast them with the registration district of Andover, in Hampshire, a district which I select for reasons which will appear later.

Table Legend:
A = Smallpox
B = Measles
C = Scarlet fever
D = Diphtheria
E = Whooping cough
F = Fever
G = Diarrhœa
H = Tuberculosis Disease
I = Respiratory Disease

All CausesABCDEFGHI
Liverpool114,253299,4922,9668525,8944839,8187,13826,080
Strand109,596386,6261,8284,7606,359767,69211,88130,122
Andover32,26001,2273072252,5051531,0742,0967,209

From this table it appears that the mortality from measles, scarlet-fever, and diarrhœa was greater in Liverpool than in the Strand; but that the other diseases scheduled were more fatal in the Strand than in Liverpool.

We have previously pointed out that the deaths of children from tuberculous and respiratory diseases are greater in London than in any other county, and now we find that the death-rate of children from these two classes of diseases amounted in the 'Strand' to 42,003, far and away the highest figure in the country, Liverpool coming second with 33,218. The death-rate of children from the same causes in Andover was only 9,305, considerably less than a quarter of the Strand death-rate.

Thanks to vaccination and the purity of the water-supply the mortality in the Strand from small-pox and fever is very small, but the mortality of children from the acute air-borne contagia (measles, whooping cough, scarlet-fever, and diphtheria), and still more from the chronic air-borne contagia, is fearful to contemplate.

The big mortality from tuberculous disease forces upon us the reflection that a large number of children who become tuberculous in the 'Strand' do not die within the age limits with which we are concerned, but drop off later in life after years of invalidism and suffering. We have seen that children under five are decimated yearly in the Strand. How many more are crippled for life?

The deaths of children under one year of age per 1,000 births is a safe criterion of the health conditions of a locality. This figure for the ten years 1881-90 was, for the whole of England and Wales, 142. In London, we find that in five districts (Hampstead 117, Lewisham 121, Woolwich 124, Hackney 137, and Wandsworth 141) this mortality was below the average of the whole country, while in the remaining twenty-five districts it was above the average.

In Paddington, Islington, Camberwell, Lambeth, Greenwich, Mile End, Poplar, and Marylebone, it was above 142 and under 150. In St. Pancras, Kensington, St. George's (Hanover Square), St. Giles's, Bethnal Green, and St. Olave's, it was above 150 and under 160; in Chelsea, Fulham, Westminster, Holborn, Shoreditch, and St. Saviour's, it was over 160 and under 170. The City was 171, Whitechapel 173, St. George's-in-the-East 182, Stepney 196, the Strand 226.

To show what this figure of 226—the infant mortality of the Strand—means, I will give the infant mortality of some of the worst towns in Lancashire: in Liverpool 219, Wigan 161, Bolton 163, Salford 183, Manchester 193, Ashton-under-Lyne 173, Oldham 169, Rochdale 145, Burnley 184, Blackburn 178, Preston 203. On the other hand, one may say that the infant mortality of Andover, which has just adopted a great part of the London Building Act, with the approval of the Local Government Board, was (for the ten years 1881-90) 91, or 23 per cent. less than the best of the London districts, and nearly 60 per cent. better than the Strand.

Glancing at the other Hampshire districts, one may note that in the New Forest the infant mortality was as low as 80, and that it was only in Portsea Island (139), Alverstoke (123), and Southampton (135) that even the lowest of the metropolitan figures were approached. It is interesting to note that even the worst districts in Hampshire are below the average of the whole kingdom in the matter of infant mortality.