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 living persons. | Over 5 Years of age. | Under 5 Years 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.
Twice in the European history of cholera, had this town seemed the 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 41⁄2 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 41⁄2 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.
But, deeply impressed as I am with the importance of these 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.
The general plan, on which I would propose that this force should be disposed, is the following:—first, as heretofore, the weekly list would contain all places needing investigation on the ground of such deaths and illness as are usually associated with preventable causes, in order that any sanitary defects may at once be remedied in them; secondly, in each week there would fall due a certain number of sanitary works (relating to house-drainage, water-supply, and the like) for which you would have previously issued orders requiring them to be completed within a stated time, and on the satisfactory execution of these it will be the Inspectors duty to examine and certify; thirdly, in each district I would have a certain rota of visitation, according to the badness of the spot and its known liability to fall into filthy and unwholesome condition, requiring one set of houses to be seen weekly, another set fortnightly, another monthly, another quarterly, and so on—a rota, varying from time to time with the changing circumstances of each locality; and, out of this rota, each week would supply a stated number of cases for inquiry, to which I should occasionally add certain of those establishments in which offensive occupations are pursued. Thus, in the large number of weekly visits which I suppose the Inspector to make, there would be a certain proportion of that more elaborate kind which involves an examination of the entire house; another proportion, made for the sole purpose of seeing that previous orders have been executed; another proportion, repeated at fixed intervals, simply to ascertain that houses, once cleansed and repaired, are not relapsing into filth, nor their works becoming inefficient.
By utilising, on some such plan as this, the increased staff which you have appointed for the purpose, and by giving to its execution my continual superintendence, I trust to be able, from time to time, to certify you that the City becomes better and better capable of resisting epidemic invasion.[85] From such statements as I have set before you, on the local affinities of disease—not of Cholera alone, but of typhus and its kindred, you will be prepared to expect increased sanitary advantage, from this more systematic suppression of the causes of death: and I believe you will not be disappointed. Whether the anticipated pestilence rage in our metropolis or not, you will be combating, day by day, the influence of other malignant diseases. Whenever it may be in my power to tell you generally of the City, that the dwellings of the poor are no longer crowded and stifling; nor their walls mouldy; nor their yards and cellars unpaved and sodden; nor their water-supply defective; nor their drainage stinking; nor their atmosphere hurt by neighbouring nuisances; then, gentlemen, whether Cholera test your success or not, surely you will have contributed much to conquer more habitual enemies. For whatever there may be specific and exceptional in the production of Cholera, at least it touches no healthy spot: the local conditions which welcome its occasional presence are, in its absence, hour by hour, the workers of other death; and in rendering a locality secure against the one, you will also have made it less vulnerable by the others.
[85] I may take this opportunity of mentioning that, during the last few months, the increased sanitary staff has been worked with very great advantage.—J. S., May, 1854.
As a last suggestion in this part of my subject, there are two steps which I would recommend to your Hon. Court, as likely to assist the labours of your officers, and to bring a large quantity of important information before you:—first (according to a plan adopted here in the last epidemic) that printed notices should be posted in every back-street, court and alley of the City, and should be renewed once a month, advising the careful maintenance of cleanliness in all houses, and inviting all persons who are aggrieved by any nuisance, or by any neglect of scavengers and dustmen, or by any defect of water-supply, forthwith to make complaint at your Office, or to the Inspector of the district, whose name and address might be subjoined; secondly, that a circular letter should be written to all persons in parochial authority, also to other clergy, to heads of visiting societies and the like, begging them to communicate with your officers on every occasion when any local uncleanliness or nuisance may come within their knowledge.
3. Finally, gentlemen—in the probable anticipation that next year Cholera will prevail in London with at least its former severity, it may be claimed of my office, that I should say something with respect to personal precautions for avoidance of the disease. While most willing to place at your disposal any useful results of my practical experience in the matter, I cannot but feel the great difficulty of making general suggestions in a form really capable of particular application.
From the eminently local prevalence of the poison, it may be inferred that, for all whose circumstances allow an option in the matter, the first and most important precaution would consist in avoiding those localities where the epidemic is active. Our knowledge of the subject enables us confidently to say that, if in one spot the chance of being attacked by Cholera is as 1 to 100, in another it becomes 1 to 50, in a third 1 to 5, in a fourth almost an equal chance whether to be attacked or not. Nothing is gained towards security by the mere act of leaving our metropolitan area, if one resorts to some other place where the system of drainage is equally vicious, or where—as at our nearest bathing-place, the beach is made almost as offensive by sewage as here the river-banks.[86] From earlier statements in my Report, it will be obvious to you that the eligible sites of residence are those which stand high and dry, with clean effectual drainage of their soils and houses, conveying all organic refuse beyond range of the local atmosphere.
[86] Unless the sanitary improvement of Brighton be soon set about in earnest, the reputation for healthiness, which established its prosperity, will undergo a very sensible reverse. The natural advantages of the place are now almost neutralised by the evil adverted to in the text, and by other filthinesses of the kind.—J. S., 1854.
I will not pass this part of the subject without admitting that the course here suggested might involve a considerable desertion of particular localities, and a transient injury to their commerce. This unavoidable result of proclaiming the laws of the disease, I must regret in regard of its personal bearings. But the facts of the case are all-important for the public; and sanitary improvement will perhaps move more quickly in the country, when it is known that the pecuniary prosperity of places may suffer from their reputation for endemic disease.
In case of Cholera prevailing with severity in spots containing a dense poor population, great assistance would be given to medical and sanitary measures, if a number of empty unlet houses, healthily situated, were at the disposal of the authorities; into which, under proper regulations, they might induce certain of the poorest families to migrate for a time, as to places of refuge, till the disease should have subsided about their original dwellings.
For persons, whose circumstances or duties retain them unavoidably in the midst of those suffering districts where the poison is most active, the best counsel I can offer—even if at first hearing it seem vague—is, that they should be vigilant as to preserving the greatest possible soundness and vigour of general health; keeping the body, so far as may be, undisturbed by extremes of heat and cold, undepressed by long confinement, unfluttered by violent passions, unexhausted by physical or mental fatigue, untried by any excess or any privation; taking for diet a sufficiency of fit and nutritive food, rather in generous measure than otherwise, but far from the confines of intemperance; and giving meanwhile a prompt attention and cure to whatever accidental ailments may arise.
Such, in general language, are our best fortifications against the poison. It may be well, however, to add that in our metropolitan climate—perhaps everywhere else—the human frame tends to require some periodical aid from medicine. It may be the excitement and labour of London; it may be its atmosphere; it may be native peculiarity: but thus the fact stands—that there are few persons who do not at intervals require the re-establishing effects of what is called tonic treatment. Probably three-fourths of the prescriptions we write are aimed at this mere tendency to depression in the human body, as manifested in one form or another. Now, as a man, going on some distant voyage of exploration, submits his chronometer to a last intelligent scrutiny, before he exposes it to the ordeal of other climates, so, in this matter of frequenting infected districts, men will do prudently, before they pass into perils which may test their powers of resistance, to see that they carry about with them no enfeeblement or disrepair which a short submission to medical discipline could effectually remove. For with epidemic poisons generally, and in a marked degree with Asiatic Cholera, it seems that all states of languor, depression, and debility enhance the risk of infection.[87]
[87] For my medical readers, I may suggest that perhaps the daily use of sulphate of quinine, in small doses, during the height of the epidemic, would seem to deserve trial as a prophylactic; subject, of course, to what each practitioner is best able to estimate—of personal peculiarity in the patient, forbidding the use of this drug.—J. S., 1854.
Beyond these general cautions, there is yet one which requires very particular mention.
In respect of the commencement and predispositions of the disease, it is now well known—first, that in this country it habitually begins with diarrhœa of a painless and apparently trivial character; secondly, that diarrhœa, however produced, is, of all known personal conditions, the one most likely to invite an attack of Cholera at times when that disease is epidemic; thirdly, that during the prevalence of Cholera, side by side with it in a district, there is always a vast amount of epidemic diarrhœa, apparently constituting slighter degrees or earlier stages of the same disease; that this condition is just as amenable to treatment as the confirmed collapse of Cholera is utterly the opposite; and—since we can never say how incurable a few hours may render this insidious symptom, that its immediate arrest is a consideration of vital importance.
Precautions against causing diarrhœa to oneself by errors of diet will vary somewhat with different individuals. Every person of ordinary discretion knows the habits of his own body, and can be tolerably confident, within certain limits of food, that he gives himself no occasion of sickness. He remembers articles of diet, which his neighbour perhaps may innocently indulge in, but which to himself are the occasion of inward disorder—of purging or vomiting, ‘bilious attack’ or nettle rash, headache, nightmare, or some other inconvenience. This knowledge fixes the limits which it primarily behoves him to regard; taking such food only into his body as experience has shown best to agree with it; and adhering to this course, without panic as to particular accustomed articles, and without abrupt discontinuance of old harmless habits. Apart from personal peculiarities, the chief dangers of diet appear to lie as follows: first, in those excesses of meat and drink, which (especially under circumstances of fatigue) occasion sickness to the stomach, or an increased labour of digestion; secondly, in taking food, solid or fluid, which is midway in some process of chemical transition—half-fermented beer and wine, water containing organic matters, meat and game and venison no longer fresh and not completely cooked, fish and shell-fish, in any state but the most perfect freshness, fruit or vegetables long-gathered or badly kept, and the like; thirdly, in a profusion of cold sour drink; fourthly, in partaking largely of those articles of diet which habitually, or by reason of imperfect cooking, pass unchanged through the intestinal canal; and fifthly, in the indiscreet use of purgative medicines, or in taking any article of diet which is likely to produce the same effect.
In short, if care be taken under all these heads to avoid occasions of intestinal disturbance; if the diet, while generous, be simple and strictly temperate; if regular hours be given to sleep, to meals, to industry, to recreation; if a fair proportion of out-door exercise be taken; if damp and extremes of temperature be guarded against; and all practical pains be given to avoid the sources of bodily and mental depression; the danger will certainly be reduced to its minimum; and whatever effects the epidemic may happen to produce can be readily recognised and boldly encountered.
Should these effects arise in their customary form of diarrhœa, it is of absolute urgent necessity that immediate medical treatment be resorted to: and so important for the safety of life is the recognition of this symptom in the earliest stage of its occurrence, that no unwonted action of the bowels should pass unobserved.
The public constantly asks to be informed of some drug, or combination of drugs, to which under these circumstances they may have immediate recourse. But after very careful consideration of this subject, after hearing arguments on both sides, and reading those prescriptions which have been recommended for adoption, I venture to express my opinion that the safest course for the public, in regard of this threatened disease, will be to follow the same principle as guides them in their ordinary seizures of illness, and to obtain as quickly as possible the aid of their customary medical advisers. There is an invincible aptitude in the public to misapply all precautionary medicines within their reach; often superstitiously to treat them as charms, under the protection of which they may neglect temperance of diet and all other solicitude for health; often ignorantly to employ them in cases for which their use is forbidden; often, at the instigation of panic, to abuse them by preposterous and hurtful excess. Nervous and uneducated persons, instead of employing their astringent dose simply to stop any undue action from the bowels, would be apt, as the danger neared them, to make it an habitual dram in order to anticipate any such action; and the frequent after-necessity for purgative medicine, thus created, would constitute the very danger they desire to avoid. Recognising, therefore, at its full value, the importance of immediately treating, in every case, the first phenomena of epidemic diarrhœa, I must yet doubt whether the conditions of medical science and general education are such as to justify the promulgation of general formulæ so liable to extensive abuse.
I speak of course with particular reference to the metropolis. In remote rural districts it may often be desirable that discreet and intelligent persons—the Clergy, for instance, should obtain from their medical neighbours some astringent preparation to which—in the very rare event of real emergency, temporary recourse might be had: but—for so hazardous a condition of disease, I must repeat as a general rule, that no nostrum, even in the best-intentioned hands of ignorance, can supply the place of medical discrimination.
During the acute prevalence of the epidemic in any particular locality, it becomes of great importance to bring the uneducated classes of society, as far as possible, under systematic medical care; in the absence of which they are likely to neglect all premonitions of the disease, and thus to incur much unnecessary danger. To fulfil this object as regards the poor, express provision has been made by the Law: and it might be well for other classes, under similar exposure to attack, to consider how far they could arrange for their households a similar plan of protection.
Under any Order in Council which brings into action the extraordinary powers of the Nuisances Removal Act, the General Board of Health has authority to enjoin on all Boards of Guardians throughout the country, that they provide, for ‘persons afflicted by or threatened with’ the disease, such medical aid as may be required: and the actual working of this has been that, on all occasions of epidemic Cholera prevailing in particular localities, the General Board of Health has called on the local Boards of Guardians to establish systematic house-to-house visitation, for discovering and treating among the poor all premonitory symptoms of the disease.
In the too probable event of its becoming necessary next year to establish this system of medical organisation in parts of the metropolis, I have no reason to doubt that a requisition to the above effect will be addressed to the Guardians of the City poor; and, in this anticipation, I think it desirable to bring, in conclusion, one more point under notice of your Hon. Court. During the former invasion, the Guardians within the City of London resisted the requisitions of the General Board of Health; and the first fourteen weeks of the epidemic consequently passed without the establishment of any visitational system for arresting its progress. In the fifteenth week, however, the Corporation of the City undertook the unperformed duty, not legally devolving on them, and requested me to make arrangements for the purpose of its execution. With the assistance of the several Medical Officers of the City Unions, I immediately organised the requisite staff, and from that moment to the close of the epidemic there continued under my superintendence a systematic visitation of the poor, with beneficial, though tardy and imperfect, results.
Recalling these incidents to the recollection of your Hon. Court, I would beg to observe that no similar endeavour can fully succeed, except as a system—well considered beforehand, and adjusted to the various circumstances which may require its application. Uncertainties of responsibility and conflicts of jurisdiction would inevitably occasion a sacrifice of life; and therefore, before the time when Cholera is likely to become epidemic, it should be definitively settled who is to undertake this organisation. Your Commission can have no jurisdiction in the matter; and the interference of the Corporation would be only at its own option. The legal responsibility rests solely with the Boards of Guardians: and it seems to me indispensable that, before the time for action arrives, the Corporation should determine its intentions; in order that the Boards of Guardians, if again called upon to organise arrangements of the kind in question, may know distinctly—either that the Corporation has relieved them of their task, or that there rests on them the undivided obligation of providing for the crisis.
III. Gentlemen, in concluding this report, I will not attempt to disguise from you that it has been written under feelings of considerable apprehension; and I am fully conscious that, in thus expressing myself, I am liable to the imputation of raising unnecessary alarm.
If the possible mischief to be wrought by epidemic Cholera lay in some fixed inflexible fate, whatever opinion or knowledge I might hold on the subject of its return, silence would be better than speech; and I could gladly refrain from vexing the public ear by gloomy forebodings of an inevitable future.
But from this supposition the case differs diametrically: and the people of England are not like timid cattle, capable, only when blindfold, of confronting danger. It belongs to their race—it belongs to their dignity of manhood, to take deliberate cognisance of their foes, and not lightly to cede the victory. A people that has fought the greatest battles—not of arms alone, but of genius and skilful toil, is little likely to be scared at the necessity of meeting large danger by appropriate devices of science. A people that has inaugurated railways—that has spanned the Menai Strait and reared the Crystal Palace, can hardly fear the enterprise of draining poison from its infected towns. A people that has freed its foreign slaves at twenty millions’ ransom, will never let its home population perish, for cheapness sake, in the ignominious ferment of their filth.
Therefore, gentlemen, advisedly I state the danger as it seems to me. England has again become subject to a plague, the recurrence of which—or the duration—or the malignity, no human being can predict.
But, if I state the danger, so likewise, to the best of my belief, I state the remedy and defence. Colossal statistics concur with the results of detailed inspection, to refer this disease, in common with many others that scourge our population, distinctly and infallibly, to the working of local causes—of causes susceptible of removal—of causes which it devolves on our Legislature to remove.
The exemption we seek is worth a heavy purchase. My thoughts turn involuntarily to the epidemics of former centuries, to their frequent returns and immense fatality. I reflect on the Plague, and how it influenced the average death-rate of London; how in 1593 it doubled it, in 1603 trebled it, in 1625 quadrupled it: and how (after a less considerable visitation in 1636) it actually multiplied the mortality sevenfold in the tremendous epidemic of ‘65. The ravages of that pestilence are best appreciated in the fact, that we esteem the Great Fire of London a cheap equivalent for their arrest; looking to that eventful conflagration of the metropolis with gratitude, rather than horror, because of the mightier evils that were extinguished with its flames.
To so frightful a development as this, Cholera, by many degrees, has not attained; but, ignorant as we are of its laws and resources, we dare not surmise, at any renewed invasion, what increment of severity it may have won. In the simple fact, that our country has again become subject to pestilential epidemics, there lies an amount of threat only to be measured by those who are conversant, by history or experience, with the possible developments of such disease.
Therefore, gentlemen, having the deepest assurance that these unexplored possibilities of evil may be foreclosed by appropriate means, I should ill deserve your confidence if I shrank from setting before you—however ungracious the task—my deliberate estimate of the peril.
It pertains to my local office to tell you of local cures; and this I have sought to do. I have suggested that, by active superintendence of all houses within your jurisdiction, there may be suppressed in detail those several causes of the disease which arise in individual neglect; that, by elaborate care as to the cleanliness of pavements, markets, docks, and sewers, something may be done towards the mitigation of more general causes; that, by a well-organised system of medical visitation, very much may be effected towards encountering attacks of the disease, while still amenable to treatment:—that these, with similar precautions, are therefore to be recommended.
And not for a moment would I seem to depreciate such measures, palliative only, and partial though they be. By their judicious application, from Aldgate to the Temple, life may possibly be saved to some hundreds; to children that are fondly loved, to parents that are the stay of numbers.
But against the full significance of any epidemic, I am bound to tell you that these are but poor substitutes for protection. To render them effectual, even in their narrow sphere of operation, there must be great vigilance and great expenditure; a weary vigilance and a disproportionate expenditure, because chiefly given to defeat in detail what should have been prevented in principle. And be done what may, in this palliative spirit, the sources of the disease are substantially unstayed: for the faults, to which its metropolitan prevalence is due, consist not simply in a number of individual mismanagements, but include a common and radical mal-construction as their chief.
No city, so far as Science may be trusted, can deserve immunity from epidemic disease, except by making absolute cleanliness the first law of its existence; such cleanliness, I mean, as consists in the perfect adaptation of drainage, water-supply, scavenage, and ventilation, to the purposes they should respectively fulfil; such cleanliness, as consists in carrying away by these means, inoffensively, all refuse materials of life—gaseous, solid, or fluid, from the person, the house, the factory, or the thoroughfare, so soon as possible after their formation, and with as near an approach, as their several natures allow, to one continuous current of removal.
To realise for London this conception of how a city should cleanse itself may involve, no doubt, the perfection of numberless details. Yet, most of all, it would pre-suppose a comprehensive organisation of plan and method: not alone for that intramural unity of system which is needful for all the works, as most for those of drainage and water-supply; but, equally, to harmonise these works with other extramural arrangements for utilising to the country the boundless wealth of metropolitan refuse—for distributing to the uses of agriculture what is then rescued from the character of filth—for requiting to the fields in gifts for vegetation, what they have rendered to the town in food for man.
How far the construction of London has proceeded on the recognition of such objects, or how far the advantages of such a plan have been realised, it could only be a mockery to ask. Our metropolis, by successive accretions, has covered mile after mile of land. Each new addition has been made with scarcely more reference to the legitimate necessities of life, than if it had clustered there by crystallisation. With no scientific forecast to plan the whole, with little but chance and cheapness to shape the parts, our desultory architecture has eclipsed the conditions of health. Draining up-hill or down-hill, as the case might be, and running their aqueducts at random from chalk-quarries or river-mud; or ponding sewage in their cellars, and digging beside it for water; blocking-up the inlets of freshness and, equally, the outlets of nuisance; constructing sewers to struggle with the Thames—now to pollute its ebb, now to be obstructed by its flow; the builders of many generations have accumulated sanitary errors in so intricate a system, that their apprehension and their cure seem equally remote.
Therefore—by reason of causes, ramified through the whole metropolis and deep-rooted in its soil, which bind all parts together in one common endurance of their effects—therefore cannot epidemic disease be conquered by any exertions or by any amelioration, short of the complete and comprehensive cure. Against the danger we dread, no shelter is to be found in petty reforms and patchwork legislation. Not to inspectorships of nuisances, but to the large mind of State-Policy, one must look for a real emancipation from this threatening plague.
A child’s intellect can appreciate the wild absurdity of seeking at Peru what here runs to waste beneath our pavements,—of ripening only epidemic disease with what might augment the food of the people—of waiting, like our ancestors, to expiate the neglected divinity of water in some bitter purgation by fire.
But it needs the grasp of political mastership, not uninformed by Science, to convert to practical application these obvious elements of knowledge; to recognise a national object irrelevant to the interests of party; to lift an universal requirement from the sphere of professional jealousies, and to found in immutable principles the sanitary legislation of a people.
I have the honour to remain,
&c. &c.
APPENDIX OF TABLES
ILLUSTRATING THE
SANITARY CONDITION OF THE CITY OF LONDON.
| [I.] | Area and Population of the several Districts and Sub-districts of the City. |
| [II.] | Quinquennial Synopsis of City Mortality, from Michaelmas 1848 to Michaelmas 1853; with Death-Rates calculated for this period, on the Population enumerated in 1851, for each District and Sub-District of the City. |
| [III.] | First annual enumeration of Deaths, relating to the fifty-two weeks dating from October 1st, 1848, to September 29th, 1849. |
| [IV.] | Second annual enumeration of Deaths, relating to the fifty-two weeks, dating from September 30th, 1840, to September 28th, 1850. |
| [V.] | Third annual enumeration of Deaths, relating to the fifty-two weeks, dating from September 29th, 1850, to September 27th, 1851. |
| [VI.] | Fourth annual enumeration of Deaths, relating to the fifty-two weeks, dating from September 28th, 1851, to September 25th, 1852. |
| [VII.] | Fifth annual enumeration of Deaths, relating to the fifty-two weeks, dating from September 26th, 1852, to September 24th, 1853. |
| [VIII.] | Quinquennial Mortality, classified by Age; first, for the entire City; next, for the Three Unions severally. |
| [IX.] | Number of Deaths occasioned, during the last five years, by certain Acute Diseases, chiefly epidemic, infectious, and endemic. |
| [X.] | Comparative Mortality in different seasons of the year: namely, in the Autumn-Quarters (October, November, December), in the Winter-Quarters (January, February, March), in the Spring-Quarters (April, May, June), and in the Summer-Quarters (July, August, September), of the five years from Michaelmas 1848 to Michaelmas 1853. |
| [XI.] | Autumn Mortality. |
| [XII.] | Winter Mortality. |
| [XIII.] | Spring Mortality. |
| [XIV.] | Summer Mortality. |
No. I. Area and Population of the several Districts and Sub-districts of the City of London.
| Sub-district. | Census of 1841. | Census of 1851. | Decennial increase (+) or decrease. (-) | Area of Land in Acres. | ||||
|---|---|---|---|---|---|---|---|---|
| East London. | - | St. Botolph | 20,197 | 23,435 | + | 3238 | 85 | |
| Cripplegate | 19,161 | 20,582 | + | 1421 | 68 | |||
| Workhouses[88] | 454 | 576 | + | 122 | ||||
| Total | 39,812 | 44,593 | + | 4781 | 153 | |||
| West London. | - | North | 12,138 | 12,350 | + | 212 | 47 | |
| South | 16,460 | 15,844 | - | 616 | 77 | |||
| Workhouse[89] | 387 | 409 | + | 22 | ||||
| Total | 28,985 | 28,603 | - | 382 | 124 | |||
| City of London. | - | South-West | 8839 | 9204 | + | 365 | 49 | |
| North-West | 12,427 | 11,847 | - | 580 | 72 | |||
| South | 11,954 | 11,461 | - | 493 | 82 | |||
| South-East | 10,597 | 10,594 | - | 3 | 84 | |||
| North-East | 12,103 | 12,826 | + | 723 | 92 | |||
| Workhouse[90] | 920 | 794 | - | 126 | ||||
| Total | 56,840 | 56,726 | - | 114 | 379 | |||
| Entire Population of the City of London | 125,637 | 129,922 | + | 4285 | 656 | |||
[88] One of these workhouses is situated in the North sub-district of the West London Union. In 1841 it contained 157 inmates; in 1851, 187 inmates. The other workhouse is situated in the St. Botolph sub-district: in 1841 it contained 297, in 1851, 389 persons.
[89] This workhouse is situated in the North sub-district of the Union.
[90] In 1841, the 920 paupers of this Union were received, partly at Marlborough House, Peckham; partly in Deacon’s Farm-house, Stepney Green. The present workhouse, erected since 1841, is at Bow.
No. II.—Quinquennial Synopsis of City Mortality, with Death-rates calculated per Thousand on the Population of 1851.
| Population, according to the Census of 1851. | East London Union, 44,593. | West London Union, 28,603. | City of London Union, 56,726. | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Entire City of London, | Saint Botolph, | Cripple- gate, | Work- houses, | North, | South, | Work- house, | S. W. | N. W. | South, | S. E. | N. E. | Work- house, | ||||||
| 129,922. | 23,435. | 20,582. | 576. | 12,350. | 15,844. | 409. | 9,204. | 11,847. | 11,461. | 10,594. | 12,826. | 794. | ||||||
| Mortality of five years from Michael- mas 1848 to Michael- mas1853. | - | 1848-9 | 3763 | 519 | 574 | 179 | 372 | 598 | 126 | 293 | 245 | 263 | 214 | 262 | 103 | |||
| 1849-50 | 2752 | 296 | 444 | 125 | 324 | 290 | 108 | 176 | 168 | 218 | 183 | 219 | 101 | |||||
| 1850-1 | 2978 | 493 | 471 | 167 | 317 | 313 | 68 | 191 | 169 | 258 | 217 | 213 | 101 | |||||
| 1851-2 | 3064 | 534 | 460 | 176 | 266 | 379 | 129 | 196 | 198 | 203 | 171 | 235 | 117 | |||||
| 1852-3 | 3040 | 516 | 534 | 155 | 289 | 309 | 164 | 170 | 188 | 223 | 164 | 224 | 104 | |||||
| —— | *** | 2458 | 2483 | 802 | 1568 | 1889 | 595 | 1026 | 968 | 1165 | 949 | 1153 | 526 | |||||
| Total | 15,597 | 5743 | 4052 | 5787 | ||||||||||||||
| Yearly Death-rate per thousand of the living Population. | - | 24.00 | 25.75 | 28.33 | 20.40 | |||||||||||||
| 24.30 | 27.41 | * | 29.19 | 27.66 | * | 23.83 | 17.96 | 21.90 | 19.52 | 19.58 | * | |||||||
| N.B. The first year’s total (3763) includes 15 deaths, which, by reason oftheir imperfect registration, it has been impossible to refer correctly to the Unions where they occurred. | ||||||||||||||||||
NOTE TO TABLE No. II.
In calculating the Death-Rates given in the last lines of this Table, I have proceeded as follows:—
First, I have counted all Workhouse-Population and Workhouse-Deaths as forming part of the aggregate population and aggregate mortality of that Union to which the particular workhouse legally belongs.
Next, I have distributed among the several sub-districts the population and the mortality of their Union Workhouses, in the ratio of the general sub-district population; so as to prevent the high Workhouse-Mortality from telling unjustly against that sub-district in which the Workhouse happens to have been erected.
Thus, for instance, the East London Union has its male Workhouse placed in the territory of the West London Union; but I have reckoned it as belonging to the East London Union, in respect both of its population and its deaths. Similarly, the City of London Union has its Workhouse situate at Bow; but, not the less, I have considered its 794 inmates and 526 deaths as belonging to the population and the mortality of our central Union.
Thus again for the sub-district death-rates—for instance, in the two sub-districts of the East London Union: reckoning the Workhouse-Population not as exclusively due either to Cripplegate or to St. Botolph, but as furnished by these sub-districts jointly, in the ratio of their populations, I have distributed 576 between them in the proportion, 23,435 : 20,582. The Workhouse-Deaths of the period (802) have been similarly distributed; and the rates, given in the last line of the table, are finally deduced from a comparison of these sums, viz:—
23,435 + 306.66 : 2458 + 426.991 :: 1000 : 121.515, which divided by 5 (to show an annual, instead of a quinquennial, result) gives 24.30 as the annual death-rate for St. Botolph; and, in like manner, 20,582 + 269.33 : 2483 + 375.008 gives 137.065 as the quinquennial, and 27.41 as the annual death-rate per thousand for the sub-district of Cripplegate.
Hospital Deaths have been distributed, as far as possible, according to the previous residence of the patients. Thus the north sub-district of the West London Union, in which St. Bartholomew’s Hospital is situated, is made to retain only its just proportion of deaths. On the same principle I have reckoned to the death-lists of other sub-districts those cases in which I could ascertain that the residents of such sub-districts had gone to die either in St. Bartholomew’s, or in other Metropolitan Hospitals.
No. III.—First Annual Enumeration of Deaths, relating to the Fifty-two Weeks dating from October 1st, 1848, to September 29th, 1849.
| Deaths in the four quarterly periods,terminating as follows:— | East London Union. | West London Union. | City of London Union. | ||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Saint Botolph. | Cripple- gate. | Work- houses. | North. | South. | Work- house. | S. W. | N. W. | South. | S. E. | N. E. | Work- house. | ||||||||||||||||||||
| M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | ||||||||
| I. | In the quarter ending Dec. 30th | - | 766 | - | 63 | 64 | 69 | 59 | 10 | 21 | 44 | 30 | 55 | 48 | 14 | 15 | 25 | 15 | 27 | 23 | 36 | 23 | 25 | 15 | 31 | 31 | 1 | 22 | |||
| 127 | 128 | 31 | 74 | 103 | 29 | 40 | 50 | 59 | 40 | 62 | 23 | ||||||||||||||||||||
| II. | In the quarter ending March 31st | - | 822 | - | 70 | 66 | 60 | 57 | 17 | 19 | 39 | 34 | 50 | 40 | 20 | 10 | 20 | 32 | 32 | 31 | 28 | 32 | 29 | 23 | 40 | 37 | 14 | 22 | |||
| 136 | 117 | 36 | 73 | 90 | 30 | 52 | 63 | 60 | 52 | 77 | 36 | ||||||||||||||||||||
| III. | In the quarter ending June 30th | - | 765 | - | 40 | 45 | 62 | 68 | 16 | 23 | 46 | 31 | 61 | 49 | 13 | 21 | 35 | 21 | 31 | 24 | 37 | 21 | 24 | 21 | 22 | 28 | 12 | 14 | |||
| 85 | 130 | 39 | 77 | 110 | 34 | 56 | 55 | 58 | 45 | 50 | 26 | ||||||||||||||||||||
| IV. | In the quarter ending Sept. 29th | - | 1395 | - | 88 | 83 | 104 | 95 | 17 | 56 | 75 | 73 | 116 | 179 | 15 | 18 | 62 | 83 | 37 | 40 | 48 | 38 | 45 | 32 | 40 | 33 | 5 | 13 | |||
| 171 | 199 | 73 | 148 | 295 | 53 | 145 | 77 | 86 | 77 | 73 | 18 | ||||||||||||||||||||
| Sum of the four quarters | 3748 | - | 261 | 258 | 295 | 279 | 60 | 119 | 204 | 168 | 282 | 316 | 62 | 64 | 142 | 151 | 127 | 118 | 149 | 114 | 123 | 91 | 133 | 129 | 32 | 71 | |||||
| 519 | 574 | 179 | 372 | 598 | 126 | 293 | 245 | 263 | 214 | 262 | 103 | ||||||||||||||||||||
| Unclassified | 15 | 1272 | 1096 | 1380 | |||||||||||||||||||||||||||
| Total for the Year | 3763 | ||||||||||||||||||||||||||||||
No. IV.—Second Annual Enumeration of Deaths, relating to the Fifty-two Weeks dating from September 30th, 1849, to September 28th, 1850.
| Deaths in the four quarterly periods,terminating as follows:— | East London Union. | West London Union. | City of London Union. | ||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Saint Botolph. | Cripple- gate. | Work- houses. | North. | South. | Work- house. | S. W. | N. W. | South. | S. E. | N. E. | Work- house. | ||||||||||||||||||||
| M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | ||||||||
| I. | In the quarter ending Dec. 29th | - | 765 | - | 62 | 56 | 72 | 65 | 22 | 22 | 42 | 43 | 30 | 40 | 10 | 13 | 35 | 22 | 26 | 19 | 27 | 28 | 30 | 21 | 22 | 30 | 9 | 19 | |||
| 118 | 137 | 44 | 85 | 70 | 23 | 57 | 45 | 55 | 51 | 52 | 28 | ||||||||||||||||||||
| II. | In the quarter ending March 30th | - | 803 | - | 49 | 47 | 68 | 56 | 21 | 15 | 50 | 41 | 42 | 42 | 21 | 19 | 23 | 23 | 16 | 29 | 48 | 32 | 22 | 36 | 45 | 29 | 15 | 14 | |||
| 96 | 124 | 36 | 91 | 84 | 40 | 46 | 45 | 80 | 58 | 74 | 29 | ||||||||||||||||||||
| III. | In the quarter ending June 29th | - | 589 | - | 39 | 41 | 42 | 48 | 6 | 13 | 39 | 35 | 45 | 26 | 5 | 22 | 13 | 21 | 14 | 25 | 25 | 15 | 23 | 20 | 21 | 29 | 9 | 13 | |||
| 80 | 90 | 19 | 74 | 71 | 27 | 34 | 39 | 40 | 43 | 50 | 22 | ||||||||||||||||||||
| IV. | In the quarter ending Sept. 28th | - | 595 | - | 57 | 45 | 57 | 36 | 12 | 14 | 35 | 39 | 26 | 39 | 5 | 13 | 20 | 19 | 18 | 21 | 22 | 21 | 16 | 15 | 15 | 28 | 12 | 10 | |||
| 102 | 93 | 26 | 74 | 65 | 18 | 39 | 39 | 43 | 31 | 43 | 22 | ||||||||||||||||||||
| Sum of the four quarters | 2752 | - | 207 | 189 | 239 | 205 | 61 | 64 | 166 | 158 | 143 | 147 | 41 | 67 | 91 | 85 | 74 | 94 | 122 | 96 | 91 | 92 | 103 | 116 | 45 | 56 | |||||
| 396 | 444 | 125 | 324 | 290 | 108 | 176 | 168 | 218 | 183 | 219 | 101 | ||||||||||||||||||||
| 965 | 722 | 1065 | |||||||||||||||||||||||||||||
| Total for the Year | 2752 | ||||||||||||||||||||||||||||||
No. V.—Third Annual Enumeration of Deaths, relating to the Fifty-two Weeks dating from September 29th, 1850, to September 27th, 1851.
| Deaths in the four quarterly periods,terminating as follows:— | East London Union. | West London Union. | City of London Union. | ||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Saint Botolph. | Cripple- gate. | Work- houses. | North. | South. | Work- house. | S. W. | N. W. | South. | S. E. | N. E. | Work- house. | ||||||||||||||||||||
| M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | ||||||||
| I. | In the quarter ending Dec. 28th | - | 672 | - | 47 | 54 | 68 | 57 | 7 | 25 | 29 | 33 | 35 | 37 | 8 | 6 | 27 | 21 | 24 | 20 | 25 | 24 | 24 | 31 | 19 | 29 | 16 | 6 | |||
| 101 | 125 | 32 | 62 | 72 | 14 | 48 | 44 | 49 | 55 | 48 | 22 | ||||||||||||||||||||
| II. | In the quarter ending March 29th | - | 876 | - | 87 | 67 | 77 | 63 | 19 | 30 | 51 | 36 | 46 | 43 | 11 | 11 | 28 | 31 | 22 | 26 | 39 | 42 | 27 | 29 | 35 | 32 | 12 | 12 | |||
| 154 | 140 | 49 | 87 | 89 | 22 | 59 | 48 | 81 | 56 | 67 | 24 | ||||||||||||||||||||
| III. | In the quarter ending June 28th | - | 767 | - | 72 | 43 | 58 | 43 | 26 | 22 | 45 | 47 | 38 | 41 | 11 | 10 | 26 | 18 | 22 | 16 | 40 | 35 | 35 | 35 | 31 | 25 | 15 | 13 | |||
| 115 | 101 | 48 | 92 | 79 | 21 | 44 | 38 | 75 | 70 | 56 | 28 | ||||||||||||||||||||
| IV. | In the quarter ending Sept. 27th | - | 663 | - | 63 | 60 | 62 | 43 | 13 | 25 | 53 | 23 | 38 | 35 | 9 | 2 | 24 | 16 | 21 | 18 | 29 | 24 | 23 | 13 | 17 | 25 | 14 | 13 | |||
| 123 | 105 | 38 | 76 | 73 | 11 | 40 | 39 | 53 | 36 | 42 | 27 | ||||||||||||||||||||
| Sum of the four quarters | 2978 | - | 269 | 224 | 265 | 206 | 65 | 102 | 178 | 139 | 157 | 156 | 39 | 29 | 105 | 86 | 89 | 80 | 133 | 125 | 109 | 108 | 102 | 111 | 57 | 44 | |||||
| 493 | 471 | 167 | 317 | 313 | 68 | 191 | 169 | 258 | 217 | 213 | 101 | ||||||||||||||||||||
| 1131 | 698 | 1149 | |||||||||||||||||||||||||||||
| Total for the Year | 2978 | ||||||||||||||||||||||||||||||
No. VI.—Fourth Annual Enumeration of Deaths, relating to the Fifty-two Weeks dating from September 28th, 1851, to September 25th, 1852.
| Deaths in the four quarterly periods,terminating as follows:— | East London Union. | West London Union. | City of London Union. | ||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Saint Botolph. | Cripple- gate. | Work- houses. | North. | South. | Work- house. | S. W. | N. W. | South. | S. E. | N. E. | Work- house. | ||||||||||||||||||||
| M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | ||||||||
| I. | In the quarter ending Dec. 27th | - | 800 | - | 73 | 67 | 59 | 58 | 32 | 32 | 40 | 28 | 37 | 43 | 18 | 12 | 33 | 30 | 29 | 25 | 26 | 26 | 23 | 25 | 32 | 23 | 9 | 20 | |||
| 140 | 117 | 64 | 68 | 80 | 30 | 63 | 54 | 52 | 48 | 55 | 29 | ||||||||||||||||||||
| II. | In the quarter ending March 27th | - | 773 | - | 62 | 62 | 50 | 46 | 18 | 30 | 30 | 24 | 58 | 43 | 25 | 12 | 20 | 22 | 33 | 28 | 33 | 28 | 31 | 19 | 27 | 40 | 17 | 15 | |||
| 124 | 96 | 48 | 54 | 101 | 37 | 42 | 61 | 61 | 50 | 67 | 32 | ||||||||||||||||||||
| III. | In the quarter ending June 26th | - | 774 | - | 54 | 56 | 78 | 53 | 21 | 17 | 39 | 31 | 65 | 56 | 23 | 8 | 24 | 33 | 29 | 22 | 22 | 19 | 30 | 17 | 33 | 26 | 17 | 11 | |||
| 110 | 131 | 38 | 70 | 121 | 31 | 47 | 51 | 41 | 47 | 59 | 28 | ||||||||||||||||||||
| IV. | In the quarter ending Sept. 27th | - | 717 | - | 77 | 83 | 54 | 62 | 6 | 20 | 35 | 39 | 41 | 36 | 17 | 14 | 26 | 18 | 15 | 17 | 29 | 20 | 15 | 11 | 31 | 23 | 12 | 16 | |||
| 160 | 116 | 26 | 74 | 77 | 31 | 44 | 32 | 49 | 26 | 54 | 28 | ||||||||||||||||||||
| Sum of the four quarters | 3064 | - | 266 | 268 | 241 | 219 | 77 | 99 | 144 | 122 | 201 | 178 | 83 | 46 | 103 | 93 | 106 | 92 | 110 | 93 | 99 | 72 | 123 | 112 | 55 | 62 | |||||
| 534 | 460 | 176 | 266 | 379 | 129 | 196 | 198 | 203 | 171 | 235 | 117 | ||||||||||||||||||||
| 1170 | 774 | 1120 | |||||||||||||||||||||||||||||
| Total for the Year | 3064 | ||||||||||||||||||||||||||||||
No. VII.—Fifth Annual Enumeration of Deaths, relating to the Fifty-two Weeks dating from September 26th, 1852, to September 24th, 1853.
| Deaths in the four quarterly periods,terminating as follows:— | East London Union. | West London Union. | City of London Union. | ||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Saint Botolph. | Cripple- gate. | Work- houses. | North. | South. | Work- house. | S. W. | N. W. | South. | S. E. | N. E. | Work- house. | ||||||||||||||||||||
| M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | M. | F. | ||||||||
| I. | In the quarter ending Dec. 25th | - | 675 | - | 72 | 58 | 46 | 60 | 10 | 20 | 35 | 33 | 35 | 32 | 14 | 19 | 23 | 14 | 21 | 22 | 31 | 26 | 18 | 15 | 25 | 29 | 10 | 7 | |||
| 130 | 106 | 30 | 68 | 67 | 33 | 37 | 43 | 57 | 33 | 54 | 17 | ||||||||||||||||||||
| II. | In the quarter ending March 26th | - | 878 | - | 67 | 64 | 80 | 66 | 32 | 22 | 35 | 31 | 45 | 55 | 34 | 20 | 19 | 30 | 38 | 19 | 32 | 33 | 29 | 20 | 40 | 35 | 15 | 17 | |||
| 131 | 146 | 54 | 66 | 100 | 54 | 49 | 57 | 65 | 49 | 75 | 32 | ||||||||||||||||||||
| III. | In the quarter ending June 25th | - | 817 | - | 69 | 60 | 69 | 62 | 24 | 27 | 53 | 36 | 46 | 44 | 25 | 21 | 20 | 25 | 27 | 20 | 30 | 29 | 24 | 26 | 27 | 20 | 19 | 14 | |||
| 129 | 131 | 51 | 89 | 90 | 46 | 45 | 47 | 59 | 50 | 47 | 33 | ||||||||||||||||||||
| IV. | In the quarter ending Sept. 24th | - | 670 | - | 70 | 56 | 84 | 67 | 8 | 12 | 32 | 34 | 25 | 27 | 18 | 13 | 16 | 23 | 18 | 23 | 25 | 17 | 18 | 14 | 28 | 20 | 10 | 12 | |||
| 126 | 151 | 20 | 66 | 52 | 31 | 39 | 41 | 42 | 32 | 48 | 22 | ||||||||||||||||||||
| Sum of the four quarters | 3040 | - | 278 | 238 | 279 | 255 | 74 | 81 | 155 | 134 | 151 | 158 | 91 | 73 | 78 | 92 | 104 | 84 | 118 | 105 | 89 | 75 | 120 | 104 | 54 | 50 | |||||
| 516 | 534 | 155 | 289 | 309 | 164 | 170 | 188 | 223 | 164 | 224 | 104 | ||||||||||||||||||||
| 1205 | 762 | 1073 | |||||||||||||||||||||||||||||
| Total for the Year | 3040 | ||||||||||||||||||||||||||||||
No. VIII.—Quinquennial Mortality, classified by Age, first for the entire City, next for the three Unions severally.
| Deaths in the Population of the City of London. | Under 5 Years of Age. | From 5 to 10. | From 10 to 15. | From 15 to 20. | From 20 to 30. | From 30 to 40. | From 40 to 50. | From 50 to 60. | From 60 to 70. | From 70 up- wards. | Age not re- ported. | Total. | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Year by year dating from Michael- mas to Michael- mas. | - | 1848-49 | 1243 | 202 | 92 | 90 | 292 | 345 | 396 | 355 | 366 | 367 | 15 | 3763 | |
| 1849-50 | 1032 | 83 | 44 | 70 | 166 | 200 | 251 | 254 | 318 | 334 | 0 | 2752 | |||
| 1850-51 | 1194 | 124 | 48 | 60 | 169 | 227 | 248 | 261 | 303 | 342 | 2 | 2978 | |||
| 1851-52 | 1197 | 113 | 57 | 84 | 196 | 253 | 267 | 260 | 287 | 350 | 0 | 3064 | |||
| 1852-53 | 1135 | 94 | 37 | 59 | 179 | 258 | 268 | 297 | 320 | 393 | 0 | 3040 | |||
| Sum of five year’s deaths | 5801 | 616 | 278 | 363 | 1002 | 1283 | 1430 | 1427 | 1594 | 1786 | 17 | 15597 | |||
| Deaths of five years in their Local Distri- bution. | - | East London Union | 2471 | 215 | 80 | 105 | 338 | 432 | 488 | 444 | 551 | 619 | 0 | 5743 | |
| West London Union | 1416 | 141 | 75 | 122 | 305 | 376 | 405 | 393 | 420 | 398 | 1 | 4052 | |||
| City of London Union | 1914 | 260 | 123 | 136 | 359 | 475 | 537 | 590 | 623 | 769 | 1 | 5787 | |||
| Uncertain Address | * | * | * | * | * | * | * | * | * | * | 15 | 15 | |||
No. IX.—Number of Deaths occasioned, during the last Five Years, by certain Acute Diseases, chiefly Epidemic, Infectious, and Endemic.
| In the successive years terminating severally as follows:— | Fever. | Acute Diarrhœa (not of infants), Dysentery, and Cholera. | Scarlet- Fever and Cynanche maligna. | Small-Pox. | Erysipelas, Pyæmia, and Puerperal Fever. | Diarrhœa, Bronchitis and Pneumonia of Infants under 3 years of age. | Measles, Hooping- cough and Croup. | Hydro- cephalus and Convul- sions of Infancy. | Total of pre- ceding columns. | |
|---|---|---|---|---|---|---|---|---|---|---|
| At Michaelmas, | 1849 | 166 | 825 | 135 | 17 | 44 | 285 | 196 | 264 | 1932 |
| „ „ | 1850 | 118 | 54 | 32 | 33 | 40 | 243 | 124 | 219 | 863 |
| „ „ | 1851 | 107 | 23 | 46 | 41 | 17 | 340 | 272 | 282 | 1128 |
| „ „ | 1852 | 165 | 37 | 86 | 96 | 24 | 330 | 132 | 308 | 1178 |
| „ „ | 1853 | 145 | 43 | 85 | 15 | 26 | 304 | 190 | 289 | 1097 |
| Total number of such Deaths in the Five Years 1848-53. | 701 | 982 | 384 | 202 | 151 | 1502 | 914 | 1362 | 6198 | |
No. X.—Comparative Mortality in different seasons of the Year; namely, in the Autumn Quarters (Oct., Nov., Dec.) in the Winter Quarters (Jan., Feb., March,) in the Spring Quarters (April, May, June) and in the Summer Quarters (July, Aug., Sept.) of the Five Years from Michaelmas, 1848, to Michaelmas, 1853.
SYNOPSIS.
| Deaths in the different seasons of five years, asfollows:— | East London Union. | West London Union. | City of London Union. | Total for entire City. | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Saint Botolph. | Cripple- gate. | Work- houses. | North. | South. | Work- house. | S. W. | N. W. | South. | S. E. | N. E. | Work- house. | ||
| In five Autumn Quarters | 616 | 613 | 201 | 357 | 392 | 129 | 245 | 236 | 272 | 227 | 271 | 119 | 3678 |
| 1430 | 878 | 1370 | |||||||||||
| In five Winter Quarters | 641 | 623 | 223 | 371 | 464 | 183 | 248 | 274 | 347 | 265 | 360 | 153 | 4152 |
| 1487 | 1018 | 1647 | |||||||||||
| In five Spring Quarters | 519 | 583 | 195 | 402 | 471 | 159 | 226 | 230 | 273 | 255 | 262 | 137 | 3712 |
| 1297 | 1032 | 1383 | |||||||||||
| In five Summer Quarters | 682 | 664 | 183 | 438 | 562 | 124 | 307 | 228 | 273 | 202 | 260 | 117 | 4040 |
| 1529 | 1124 | 1387 | |||||||||||
No. XI.—Comparative Mortality in Different Seasons of the Year.
AUTUMN QUARTERS.
| Deaths in five Autumn Quarters asfollows:— | East London Union. | West London Union. | City of London Union. | Totals for entire City. | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Saint Botolph. | Cripple- gate. | Work- houses. | North. | South. | Work- house. | S.W. | N.W. | South. | S.E. | N.E. | Work- house. | |||
| Oct., Nov., Dec., | 1848 | 127 | 128 | 31 | 74 | 103 | 29 | 40 | 50 | 59 | 40 | 62 | 23 | 766 |
| „„„ | 1849 | 118 | 137 | 44 | 85 | 70 | 23 | 57 | 45 | 55 | 51 | 52 | 28 | 765 |
| „„„ | 1850 | 101 | 125 | 32 | 62 | 72 | 14 | 48 | 44 | 49 | 55 | 48 | 22 | 672 |
| „„„ | 1851 | 140 | 117 | 64 | 68 | 80 | 30 | 63 | 54 | 52 | 48 | 55 | 29 | 800 |
| „„„ | 1852 | 130 | 106 | 30 | 68 | 67 | 33 | 37 | 43 | 57 | 33 | 54 | 17 | 675 |
| Total of five Seasons | 616 | 613 | 201 | 357 | 392 | 129 | 245 | 236 | 272 | 227 | 271 | 119 | 3678 | |
No. XII.—Comparative Mortality in Different Seasons of the Year.
WINTER QUARTERS.
| Deaths in five Winter Quarters asfollows:— | East London Union. | West London Union. | City of London Union. | Totals for entire City. | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Saint Botolph. | Cripple- gate. | Work- houses. | North. | South. | Work- house. | S.W. | N.W. | South. | S.E. | N.E. | Work- house. | |||
| Jan., Feb., Mar., | 1849 | 136 | 117 | 36 | 73 | 90 | 30 | 52 | 63 | 60 | 52 | 77 | 36 | 822 |
| „„„ | 1850 | 96 | 124 | 36 | 91 | 84 | 40 | 46 | 45 | 80 | 58 | 74 | 29 | 803 |
| „„„ | 1851 | 154 | 140 | 49 | 87 | 89 | 22 | 59 | 48 | 81 | 56 | 67 | 24 | 876 |
| „„„ | 1852 | 124 | 96 | 48 | 54 | 101 | 37 | 42 | 61 | 61 | 50 | 67 | 32 | 773 |
| „„„ | 1853 | 131 | 146 | 54 | 66 | 100 | 54 | 49 | 57 | 65 | 49 | 75 | 32 | 878 |
| Total of five Seasons | 641 | 623 | 223 | 371 | 464 | 183 | 248 | 274 | 347 | 265 | 360 | 153 | 4152 | |
No. XIII.—Comparative Mortality in Different Seasons of the Year.
SPRING QUARTERS.
| Deaths in five Spring Quarters asfollows:— | East London Union. | West London Union. | City of London Union. | Totals for entire City. | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Saint Botolph. | Cripple- gate. | Work- houses. | North. | South. | Work- house. | S.W. | N.W. | South. | S.E. | N.E. | Work- house. | |||
| April, May, June, | 1849 | 85 | 130 | 39 | 77 | 110 | 34 | 56 | 55 | 58 | 45 | 50 | 26 | 765 |
| „„„ | 1850 | 80 | 90 | 19 | 74 | 71 | 27 | 34 | 39 | 40 | 43 | 50 | 22 | 589 |
| „„„ | 1851 | 115 | 101 | 48 | 92 | 79 | 21 | 44 | 38 | 75 | 70 | 56 | 28 | 767 |
| „„„ | 1852 | 110 | 131 | 38 | 70 | 121 | 31 | 47 | 51 | 41 | 47 | 59 | 28 | 774 |
| „„„ | 1853 | 129 | 131 | 51 | 89 | 90 | 46 | 45 | 47 | 59 | 50 | 47 | 33 | 817 |
| Total of five Seasons | 519 | 583 | 195 | 402 | 471 | 159 | 226 | 230 | 273 | 255 | 262 | 137 | 3712 | |
No. XIV.—Comparative Mortality in Different Seasons of the Year.
SUMMER QUARTERS.
| Deaths in five Summer Quarters asfollows:— | East London Union. | West London Union. | City of London Union. | Totals for entire City. | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Saint Botolph. | Cripple- gate. | Work- houses. | North. | South. | Work- house. | S.W. | N.W. | South. | S.E. | N.E. | Work- house. | |||
| July, Aug., Sep., | 1849 | 171 | 199 | 73 | 148 | 295 | 33 | 145 | 77 | 86 | 77 | 73 | 18 | 1395 |
| „„„ | 1850 | 102 | 93 | 26 | 74 | 65 | 18 | 39 | 39 | 43 | 31 | 43 | 22 | 595 |
| „„„ | 1851 | 123 | 105 | 38 | 76 | 73 | 11 | 40 | 39 | 53 | 36 | 42 | 27 | 663 |
| „„„ | 1852 | 160 | 116 | 26 | 74 | 77 | 31 | 44 | 32 | 49 | 26 | 54 | 28 | 717 |
| „„„ | 1853 | 126 | 151 | 20 | 66 | 52 | 31 | 39 | 41 | 42 | 32 | 48 | 22 | 670 |
| Total of five Seasons | 682 | 664 | 183 | 438 | 562 | 124 | 307 | 228 | 273 | 202 | 260 | 117 | 4040 | |
ON THE PRESENT
BURIAL-PLACES OF THE CITY.
TO THE IMPROVEMENT COMMITTEE OF THE HON. THE COMMISSIONERS OF SEWERS OF THE CITY OF LONDON.
December 10th, 1852.
Gentlemen,
In order to an application of the Metropolitan Burials Act by the constituted authorities of the City, you have requested me to report how far, in my judgment, the existing burial-places within this jurisdiction are fit for further reception of the dead.
I have little to add to the information which I have laid before the Commission in my successive annual reports—especially in [that of 1849], and which long since induced me to express my conviction ‘that the City of London could no longer with safety or propriety be allowed to furnish intramural burial to its dead.’
It would, indeed, be ridiculous if I should pretend to you that this part of the subject requires any further inquiry. Putrefactive decomposition of one kind and another is the principal cause of town-unhealthiness. Against its occurrence round about our houses all your legislation is directed. The human body, once destitute of life, furnishes no exception to the laws of organic decay: under the common laws of chemical change, it soon dissolves itself into products neither less offensive, nor less poisonous, than those of any brute’s decomposition. And you cannot take a juster view of the subject—you cannot arrive at stronger arguments for the immediate abolition of intramural interment, than by forcing yourselves to discard for a moment all memory of the fading human outline which masks this dreadful nuisance, and to conceive it as a mere bulk of animal matter, planted every year to undergo decomposition within the City, beneath our Churches, and before our thresholds.[91]
[91] The right of interment in the City may at present be claimed in respect probably of more than three thousand corpses per annum. The number actually interred of late years has, I believe, not exceeded an average of two thousand per annum.
Dead bodies thus buried contribute importantly in their neighbourhood to the vitiation of air and water. Those that lie shelved in vaults, eventually, if not at first, spread through the atmosphere every product of their decomposition. Those that are dug into the soil have their decay modified by its influence, mingle with its drainage the products of their transformation, and thus (as I have shown in my [remarks] on the Bishopsgate pump water) find their issue in the nearest land-spring of the spot, polluting the drink of the population. Further, in all the more frequented burial-grounds, the soil seems to be saturated with animal matters only partially transformed; and at every new disturbance by the spade, a fresh quantity of this unctuous clay comes upmost, tainting the air with materials of fœtid decomposition, often to the great distress of persons who dwell in the vicinity.
On such grounds as these, I cannot hesitate in renewing my report that the City of London is absolutely unfit to serve as a further burial-place for the dead; and this, whether by inhumation or in vaults, whether in parochial burying-grounds, or in those of other communities.
Regard being had to the object of your reference, you would probably not desire me at present to enter on the ulterior questions of extramural interment.
On such representations as I have made, the Court of Common Council (acting under the Metropolitan Act already referred to) has authority to determine in respect of the City of London, whether the existing places of burial, either from their insufficiency, or from their dangerousness to health, are so unfit for their purpose as to render it necessary that other burial-space be provided.
Should they affirm this view, they can then ‘authorise and direct the Commissioners of Sewers of the City of London to exercise for the said City and Liberties all the powers and authorities vested in Burial-Boards under the Act.’
This course being taken, the Commission (subject to approval from the Secretary of State) will have authority to make all arrangements requisite for the final closure of burial-places within the City.
In approaching the subject of extramural sepulture, with its innumerable details of inquiry, for site, for conveyance, and for burial—details which form the knowledge and experience of a special class of persons, the Commission may perhaps first consider whether works so foreign to their usual functions shall be undertaken by themselves directly, or shall be made matter of contract with existing Cemetery Companies, or other associations or individuals. Till this decision is made, it seems impossible to conjecture what topics you may wish to entertain, or within what limits the industry of your officers may most usefully be exercised.
There are many very important parts of the subject with which it may hereafter become my duty to deal; but till the preliminary questions are settled, it would be idle to detain you with sanitary considerations belonging to a later stage of your inquiry.
As my [Report for 1849] had long been out of print, I subjoin an extract from it of so much as relates to the matter in hand.[92]
[92] The passages here referred to form a separate section of the [First Annual Report]; and therefore need not be reprinted in this part of the present volume.—J. S., 1854.
NOTE.
On considering the above Report, the Improvement Committee of the Commissioners (to whom the subject had been specially referred) at once resolved to report to the General Court that, in their ‘judgment, steps should be taken for closing the several burial-places within the City;’ and at the same time they desired that the Officer of Health would prepare for them his opinion on those ulterior arrangements which such closure might render necessary.
The following Report was written accordingly.
INTRODUCTORY REPORT
SUGGESTING THE
OUTLINE OF A SCHEME
FOR
EXTRAMURAL INTERMENT.
TO THE IMPROVEMENT COMMITTEE
OF THE
Hon. the Commissioners of Sewers of the City of London.
Gentlemen,
Under the several clauses of the Metropolitan Burials Act, and under certain clauses of the City Sewers Act 1848, the Commissioners of Sewers, acting as a Burial-Board for the City of London, will be subject to the following responsibilities—viz.:
First,—That a sufficient extramural burial-place be provided for those classes of persons who have heretofore had right of interment within the City;
Secondly,—That the facilities of transit and conveyance to such burial-place be commensurate with the purposes for which it is established;
Thirdly,—That evil no longer accrue to the health of the City from unnecessary delays of interment, or from the keeping of dead bodies in the dwelling-rooms of the poor.
I. To measure the sufficiency of a burial-place, one must know for what numbers of population it is intended to suffice.
Burial-Boards under the new Act are obliged to provide accommodation for all parishioners or inhabitants of the several parishes within their jurisdiction.
Under the term ‘parishioners’ as relating to the City, there may be included, I am told, an indefinite number of non-resident rate-payers: and although, at first, interment might not be claimed under the latter head to any considerable extent, yet, with the completion and success of your Cemetery, the applications might year by year become more numerous. From the nature of the case, such claimants would in most instances be of the wealthier classes, and might consequently be expected to apply for special allotments of ground. It seems therefore desirable that you should have some knowledge of the number for whom you may thus be required to provide.
I would accordingly suggest as expedient, that a legal opinion should be obtained on your exact liabilities under the law referred to; and especially as to whether the right of burial possessed by non-resident rate-payers does likewise extend to the non-resident households of such rate-payers.
In the meantime I will leave this set of claimants out of my argument; assuming that, whenever you have reckoned their number, you will be able, on their account, to add to your general estimate, according to a fixed proportion, the assessment of whatever additional accommodation they may legally require.
The number of deaths belonging to the ‘inhabitants’ of the City of London may be more precisely given. It would probably lie, as an average, within 3200 per annum.
In attempting to fix the extent of ground required for your purpose in respect of this mortality, I must bring before you some preliminary considerations.
First,—as regards the minimum accommodation to be given in your Cemetery; I assume that every person buried there, however humble his previous station in life, may in death claim a grave to himself. It has been the opprobrium of our previous system that, in the poorer classes of interments, many bodies have been huddled together into a single pit. Probably you will think, as regards your future burial-place, that no consideration of cheapness can justify this indecency: probably you will be unwilling that, in a presence which confounds all social comparisons, there should be drawn, with your sanction, between rich and poor any so disrespectful distinction. But at all events, on sanitary grounds, I feel bound to assure you that these multiple burials are quite inadmissible. With such concentration of organic remains in very narrow compass, the soil grows utterly fœtid; and it becomes impossible to guard against nuisance arising to the public, or against danger to those who are occupied in digging and tending the ground. These evils, indeed, are so glaring, and the indecorum of crowded interment has long been so notorious, that nothing could have given them continuance except the necessities of our narrow accommodation under the system of intramural burial: and it would of course be without excuse to perpetuate them under the changed circumstances of extramural Cemeteries, where space can so readily be obtained for all legitimate requirements of the public. So far as the experience of other countries may help to determine your judgment in this matter, I may inform you that, in every foreign interment system which can deserve to be considered an establishment of public authority, the right of single burial is universally recognised.
Next—as regards the succession of interments; according to the burial-usages of modern times, no public Cemetery with fixed limits can be permanently useful, except on a full recognition of the fact that it is a decaying place for the dead, not a place for their embalmment or mummification. For hence it follows, that ground once used for burial becomes equally fitted for a second use, whenever by gradual decomposition the bodies first interred there have thoroughly vanished from the soil.
This principle has given the common rule of burial; and for obvious reasons. Under any other plan, the entire area allotted for interment would presently be in holding. No portion, however remote the date of its first occupation, could be resumed for a second series of interments; and the provision of a new Cemetery would be indispensable. Pushed to its extreme consequences, such a system must eventually convert the entire country into its burial-ground.
Under the practice of intramural interments—that practice which the new law supersedes, the principle of temporary tenure has been made to cover all manner of brutal abuses. Graves have been disturbed—within metropolitan churchyards and other burying-grounds, in which the transformations of decay had not half accomplished themselves; and public decency has been outraged—here, in the centre of civilisation, by the spectacle of human remains being tossed about like offal. It is one chief advantage of extramural sepulture, that, while the inevitable decay of the dead will be removed from the vicinity of the living, and the latter will no longer have their atmosphere tainted by this hideous contamination; so likewise for the dead—however humble, that in this new resting-place, room will be allotted them with no indecent stint; that the dwellings and market-places of the living will no longer hem them in, grudging their narrow requirements; that their return to dust will be respected, as beseems the last phase of mortal existence; and that, against any desecration of their repose, there will be given every security which piety and affection can demand.
There may be difference of opinion as to the precise time when a grave can with truth and decency be thought to have become distenanted. The rapidity of decay varies in so extraordinary a degree according to soil, that some inhumations are almost equivalent to embalming; while, in other cases, the process is comparatively rapid. Only experience of a particular soil will enable you to know with precision, what length of tenure is needed there for the purposes of interment to accomplish themselves; but on general principles one can approximate pretty nearly to the truth. Assuming the site of your Cemetery to have been selected with due regard to those qualities of soil which determine the differences adverted to, I think it unlikely that any adult grave can properly be re-opened within twenty years[93] of the time when interment shall last have occurred in it. Very long within this time, however, all soft textures of the body would have completed their decay. Remains of the coffin and of the skeleton—materials insusceptible of putrefaction, would alone occupy the grave, and with gradual crumbling blend themselves in the soil. Not till this final disintegration of the skeleton is complete—not till the identity of its different elements is destroyed, can the first occupant of a grave be fairly deemed to have abdicated his tenure. From this time only, can his interest in it be held as having reverted to the public, for whoever next may claim a similar usufruct of the ground.
[93] Twenty years would probably represent at least four times the average period during which the bodies of the poor have been left at rest in many grave-yards of the metropolis. Yet I would willingly advocate a longer term of years as the personal tenure of a grave, if public opinion would sanction the heavier expense which must thus be entailed on the living.
Taken for granted that, as regards the general public, your Cemetery will be established on the principle of a temporary tenure of graves, it remains for you to determine to what extent you will permit wealthier applicants to purchase exemption from this rule, and obtain a freehold interest in particular portions of your ground. I have little to say on this point, because it is of no sanitary importance, provided that privileges so purchased do not in any degree interfere with the general economy of your plan. Barring any risk of this kind, it comes before you simply as a question of finance.
A precaution, however, which I would suggest, is, that, first of all, you should provide a cemeterial space sufficient for the interment purposes of your population, on the principle of temporary tenure; that no portion of this space should, under any circumstances, be alienated from its public destination; that the whole of it should remain in perpetuity the common burying-ground of the City of London. This prime necessity of your plan being secured, it will be competent for you to include in your purchase a certain redundant number of acres; and out of these you can allot, at your discretion, such quantities of ground as may be desired in freehold, either for the purposes of family interment, generation after generation, or for the fiction of perpetual tenure by some single occupant.[94]
[94] In regard of these exceptional burials, it will be requisite to fix certain regulations; especially for the construction of family graves, wherein it will be desired that many who during life have been united, shall after death have their ashes mingled together in the soil. A frequent custom in private Cemeteries for fulfilling this purpose has been, for graves to be dug to a considerable depth—sometimes such that twelve coffins could be piled there, one on the other; and these deep pits have commonly been provided with brick walls. Now, for the same reason as determined my opinion against the multiple burial of the poor, I would argue against this arrangement, as one which might occasion excessive accumulation in single spots of your Cemetery, and as being in principle bad. In preference, I would venture to recommend the endeavour to introduce an interment-custom, which is prevalent abroad, of family plots of ground instead of family pits. Under ordinary circumstances, all the accommodation heretofore sought in the one arrangement would be found superiorly in the other; and in a well-projected suburban Cemetery the larger superficial extent could probably be afforded at much less cost than is usually paid for the pit. Persons familiar with the details of Cemetery-burial would easily devise an arrangement of such plots, whereby they should be separate and secluded, admitting of appropriate decoration, and altogether likely to prove more acceptable to public opinion than many existing arrangements. In regard of such plots, too, there might be conceded a privilege which I believe has not been allowed in private Cemeteries; namely, an hereditary right to refill the ground for any successive number of times, subject only to such restrictions as will determine the succession of interments in other parts of the Cemetery.
In thus selling portions of your land for private and privileged employment, you would be satisfying what has become a habit, and may be considered a legitimate claim of the wealthier classes. Beyond this, it is also evident, that you would virtually be competing with the ordinary Cemetery-companies of the metropolis, in the most lucrative department of their trade. It would probably be easy for you, by varying your fees according to circumstances, either on the one hand to diminish, and almost prohibit, the frequency of applications for exceptional interments; or, on the other hand, to attract such applications. Even, if you thought it desirable, you might admit purchasers from other classes than those having right of burial in your municipal Cemetery;—in short, you might manage it commercially, with a view to profit, looking to its proceeds for covering many expenses of the general establishment.
With respect to the ordinary arrangement of your ground for public purposes, and the distribution of burials therein, you may estimate that, taking one grave with another, and allowing for the marginal spaces of each, the average size of a grave will be twenty-eight square feet. For illustration’s sake, I will suppose the ground to be laid out in plots—say the third of an acre in extent. Each such plot would contain four hundred single graves, mixed adult and young, with what foot-paths might be requisite for approaching them. The City mortality of twenty years (assuming this period to be the ordinary leasehold of a grave) might be reckoned at sixty-four thousand deaths; for the accommodation of which number there would be wanted one hundred and sixty plots of the above-mentioned size—say fifty-four acres of ground. I would propose that throughout each line of every such space, adult and infant graves should, as far as possible, lie alternately; and that, instead of filling all the graves together at stated periods (say every twenty years) half of them, taken alternately, should be filled at each semi-period—say every ten years. By this arrangement, half the complement of burials would take place in each plot, at a time when the decomposition of the preceding half-complement had finished itself, so far as putrefaction is concerned; and whatever contamination of air might be liable to occur under the best-considered sanitary arrangement, would certainly be reduced to the lowest conceivable amount. Or, as an alternative equal to this arrangement for the purposes of health, you might adopt the plan of filling in immediate succession all the burial-spaces of a plot; provided the surface could then at once be devoted to the growth of appropriate vegetation.
Fifty-four acres being then the quantity of ground which would suffice, on sound principles, for the ordinary interment of your entire annual mortality during a period of twenty years; at the expiration of which time (assuming your soil to be appropriate) one may reasonably expect that the ground will admit of a second similar occupation; and so forth in perpetuity: it will be requisite to add a considerable allowance of space for other accessory purposes.
Thus, room would be required for the various buildings that belong to the institution of a Cemetery: partly for the dwelling of such officers as you may require to be there resident, partly for the temporary accommodation of persons resorting thither for the burial of their friends, partly for the religious services of different congregations.[95]
[95] The distinction of the ground into a consecrated and an unconsecrated portion, as required by the Act of Parliament, will require no addition to its total area; and therefore the proportion which these parts should bear to one another need not now be discussed.
Something likewise must be added for such mainways as will be wanted along various lines of the burial-ground, for the carriage traffic which belongs to funeral ceremonies among the richer classes of society, and for other like purposes.
Further, I dare say you would think it inexpedient that your Cemetery should be entirely without decoration and elegance. Fifty-four acres of head-and-foot stones, or the same extent of bare mounds, might vulgarise even the aspect of death. By the judicious introduction of trees and turf and shrubs, of bends and undulations, you would probably seek to interrupt the long perspective of so many tombs, and, by these artificial resources of planning and planting, to enhance the native solemnity of the spot. Amid such ornamental portions of your ground might be scattered irregularly the various sites of exceptional interment,—family graves, personal graves in perpetuity, long leasehold graves, and the like; and the interposition of these large portions of comparatively un-occupied soil, with as much appropriate vegetation as could conveniently be introduced, might not only allow much tasteful decoration of the ground, but would likewise conduce to the healthful accomplishment of those purposes for which the Cemetery is established.
In respect of these and many other details of your plan, you will doubtless be guided by the direct and responsible advice of men specially skilled in the subject. I have, therefore, confined myself to the mention of those points which may determine your judgment merely as to the quantity of land required for your purpose.
Without offering any opinion as to the possible claims of non-resident parishioners, on which liability I would again suggest your obtaining a legal opinion; and without pretending to advise what allowance should be made for purely decorative purposes; I may yet conclude from such information as I have collected, that, with a hundred acres of suitable soil at your disposal, you would be amply able to meet all legitimate burial-requirements of your population in perpetuity, and would likewise (for many years at least) have a considerable excess which might be applied to the uses of ornamental arrangement.
From what I have said on the influence of soil, in determining the period after which burying-grounds may be resumed for a second series of interments, it will be obvious to you that this condition is an important element in deciding the sufficiency of any area for given burial purposes. And the site of your Cemetery might be such as somewhat to lessen, or greatly to increase, the suggested extent of your estimate. It would be fruitless, however, now to detain you with any endeavour to trace the several influences which different soils exert over animal decay. Such remarks, at the present time, could only be addressed to hypothetical cases, or stated in the most general form. Therefore, instead of attempting this anticipative argument on the subject, I hold myself ready to report to you, specifically, on the suitableness of whatever soil may be proposed to you for the purposes of your Cemetery.[96]
[96] For similar reasons, I defer any discussion of the depth at which bodies may most properly be deposited in the ground. The thickness of superjacent soil, which will deodorise, before their escape, the gaseous products of any given decomposing mass, or which will retain these gases more or less permanently in combination, varies most importantly with certain chemical and mechanical qualities of the soil: and on these it would be useless to dwell by anticipation. For accurate results, it may be necessary, after the selection of a site and during its preparation, to institute experiments on the subject.
There is yet one other consideration which may affect the extent of your purchase. The law restricts you from approaching within 200 yards of any dwelling-house, without the previous written consent of its owner, lessee, and occupier. But there is no law restricting the nearness within which any builder may approach your wall with his design for new habitations; and it might easily occur to you, within a short time of establishing your Cemetery, to find a new town growing in close proximity around it. If there be any meaning and value in the clause, which forbids your undue approach to inhabited houses—if it truly represent that this approach would be a sanitary evil, then obviously the law is deficient in the respect adverted to. It would be in your power to guarantee the continuance of a belt of unoccupied ground, as an immediate circuit to your Cemetery, in either of two ways:—either, namely, you might purchase a considerable extent of ground beyond the actual requirements of your Cemetery, might devote its central hundred acres to interment, and might let its remaining circumference for agricultural purposes; or, if you were fortunate enough to be treating for the central portion of some considerable estate, you might stipulate, as a condition of purchase, that no building should be reared within such distance of the wall of your Cemetery, as you, on due consideration, may deem fit.
II. In the provision of a Cemetery, it is required by the Act of Parliament, that ‘the Burial-Board shall have reference to the convenience of access thereto from the Parish or Parishes for which the same is provided;’ and it is legalised, that ‘any Burial-Board may make such arrangements as they may from time to time think fit, for facilitating the conveyance of the Bodies of the Dead from the Parish, or the place of Death, to the Burial-ground which shall be provided.’
It cannot but be obvious to you, that the choice of a site for your Cemetery might be such as to interpose very serious obstacles in the way of interment, even for the richest classes; and under the most favorable circumstances, the removal of the dead to a distance of some miles from their previous residence, cannot but threaten serious difficulty to the poor. Assuming—what various conditions of the Act of Parliament render almost inevitable, that your Cemetery must be distant at least six miles from the centre of the City, the present funeral charges can hardly be maintained without increase, if the traffic is to be conducted on the same principles as heretofore. The price for which an artisan could procure a decent funeral for his wife or child, within a stone’s throw of his door, will unavoidably be augmented by every mile you add to the distance, if the conveyance is still to depend on the old means and arrangements.
When I consider the classes of persons likely, as inhabitants of the City, to claim interment in your Cemetery—classes, among which the predominance of narrow, if not necessitous, circumstances will be frequent; when, for instance, in a year’s official returns, I see that artisans and paupers make more than two-thirds of your entire classified mortality; I cannot but think this aspect of the matter a very important one. From some years’ experience of your death-register, I should say that, of City funerals, there would not be one in ten where the friends could afford to disregard an additional expenditure of half a guinea; and, in the majority of instances, I am persuaded that a smaller addition would be enough to cause inconvenience and distress. It therefore seems to me certain, that your plan for extramural sepulture, however perfect at all other points, might either entirely fail of its purpose, or become cruelly oppressive to the poor, by the simple expensiveness of approaching the burial-place. And I suppose it was in anticipation of the difficulties here adverted to, that the framers of the Metropolitan Burials Act introduced the permissive clause, which I just quoted, empowering Burial-Boards ‘to facilitate the conveyance’ of the dead, and thus virtually rendering them responsible, so far as the poorer classes are concerned, for the cheapness and efficiency of such conveyance.
I would therefore submit, that in your decision as to the site of your Cemetery, so soon as the indispensable conditions of appropriate soil are given, the first point to examine is accessibility; that the spot to be chosen should have, in addition to its carriage roads, the utmost facility of railway approach; and that, for those with whom small differences of price are an important consideration, you should be able to guarantee a rate of transport for coffin and mourners, not in excess of existing charges.
From observation of arrangements which have lately been made with Railway-Companies by the Directors of Cemeteries, and from inquiry of persons engaged in such undertakings, I entertain little doubt that you might make a contract to the following effect with the authorities of any line convenient for your purpose—viz., that every day, at a fixed hour, there should be a train, or some portion of a train, exclusively adapted to the funeral purposes of the poorer classes; that for this train there should be issued funeral tickets, franking the conveyance of a coffin with some stated number of mourners, who should also be entitled to return; that the introduction of funeral traffic should be by a special entrance, and its exit at a special terminus.
Such contract supposed,—in connexion with this funeral train, you might further arrange to maintain public hearses; which, at the option of persons concerned, and on due requisition being made, should convey any coffin from its former home to the railway terminus; and which again, if necessary, at the distal station, should complete its conveyance to the grave. This facility might even be extended, if the distances were considerable, to the similar conveyance of a certain number of mourners, with the undertaker in charge of their procession.
Also, if desirable, it could no doubt be arranged, with a view to economy, that the undertaker’s responsibility for a funeral should terminate at the railway terminus, up to which he would have conducted it; and that its reception at the distal station should be entrusted to servants of your Cemetery, who would then fulfil all remaining duties in respect of it.
Arrangements to the above effect would be much simplified in working, and their general adoption much promoted, if all disbursements for funeral tickets, and for such other facilitations of conveyance as I have adverted to, were made by your Burial-Board,—their cost to be included in an uniform Cemetery fee; so that the friends of the deceased, after paying for his grave, should, without further payment, be entitled, if they desired it, to claim conveyance for his coffin from home to the Cemetery, and for themselves (in stated number) by a funeral ticket, at least for the railway portion of their transit. Thus to have one single and inclusive price for all that belongs to the new system—for the extramural grave, namely, and for conveyance thereto, would enable your Burial-Board to maintain its total cost at a level within reach of the poorer classes, and probably below that of existing prices.
In addition to what I have here suggested, there are many other steps which might be taken, if unforeseen circumstances should render them necessary, to diminish the pressure of new burial-charges on the poor. Time will develop, better than one can foretell, the exact operation of our reformed system; and for such inconveniences as it may bring, you will have no difficulty, I think, in finding appropriate cures. Nor could it be otherwise than easy, if you thought it desirable, to extend to the comparatively few funerals of wealthier classes which occur from within the City of London, those same arrangements for facilitating conveyance, which I have here deemed it requisite to consider only in their relation to the poor.
For the latter, it has seemed indispensable that your scheme should provide assistance, equivalent at least to the difficulty which its adoption must occasion them. Beyond this, I believe you would wish to disturb as little as possible the ordinary routine of interment; and I have aimed, therefore, at suggesting assistance only in such kind, and in such degree, as may least interfere with any interests of trade, least derange any established habits, least offend any prejudices of the people.
III. There is no part of the subject which I have considered with more anxiety than that which relates to delays of interment, and to the prolonged keeping of dead bodies in the rooms of their living kindred.
Evils arising in this source are unknown to the rich. Soldered in its leaden coffin, on tressels in some separate and spacious room, a corpse may await the convenience of survivors with little detriment to their atmosphere.
Not so in the poor man’s dwelling. The sides of a wooden coffin, often imperfectly joined, are at best all that divide the decomposition of the dead from the respiration of the living. A room, tenanted night and day by the family of mourners, likewise contains the remains of the dead. For some days the coffin is unclosed. The bare corpse lies there amid the living; beside them in their sleep; before them at their meals.
The death perhaps has occurred on a Wednesday or Thursday; the next Sunday is thought too early for the funeral; the body remains unburied till the Sunday week. Summer or winter makes little difference to this detention: nor is there sufficient knowledge on the subject, among the poorer population, for alarm to be excited even by the concurrence of infectious disease in a room so hurtfully occupied.
I have no means of telling you, with statistical precision, in how many of your annual deaths the corpse is detained in dangerous proximity to the living. But I have already quoted an official classification of deaths, by which it would appear that more than two-thirds of your deaths are of the artisan class or below it. Among them at least, it would be exceptional for the corpse to have a room to itself. On an average, then, there would probably be lying within the City at any moment, from thirty to forty dead bodies in rooms tenanted by living persons.
This very serious evil is well known to all persons who have taken an interest in the sanitary advancement of the poor; and ineffectual endeavours have been made for its diminution. The law does indeed empower your Officer of Health, under certain circumstances, to order the removal of a corpse from any inhabited room. And, under the Nuisances Removal Act, the General Board of Health may be authorised, during times of epidemic disease, to issue directions and regulations for the speedy interment of the dead. Both laws have remained inoperative, and are likely to remain so.
If one were starting anew—legislating for a people with unformed habits, nothing might be easier than to devise regulations of a perfect kind with regard to the sanitary management of the dead. But our case is widely different. The evils against which we have to contend are among the deepliest-rooted habits of the country. In defence of what exists there are many stupid and ignorant prejudices: but, interwoven with these are feelings of tenderness and affection, to which all consideration and reverence are due;—feelings which would be shocked and outraged by any abrupt endeavour to reduce the care of the dead to a system of fixed regulations.
For myself, having the deepest sense of the evil in question, and having officially the power to order the removal of the dead, I may repeat that I have never yet exercised my authority. Practically speaking, I can hardly conceive an instance in which I should attempt to do so. It would require the strongest case that could be shown of actual mischief in progress—of disease and death multiplied day by day through the presence of some particular dead body, to justify interference even in that single instance. Nothing like the operation of a general law would be tolerated;—nothing like including the dead in a compulsory plan of hygienic police.
After very careful consideration of the subject, I may confess myself even more impressed with its difficulties than when I first began to give it my attention; and in the few suggestions which follow I cannot pretend to do more than intimate where, in my opinion, a beginning may usefully be made towards an improvement which it will take many years to accomplish.
Legislative remedies, proposed for the evils which I am bringing under your notice, have been of two kinds—viz., first, to restrict the time during which it should be lawful to keep a body unburied; secondly, to promote the use of reception-houses (as they have been called) whither bodies might be removed from within all dwelling-places, and be kept under certain regulations during the days preceding their interment.
As regards the first point;—there are many foreign countries (and even some parts of the United Kingdom) where either law or custom has made it imperative to bury within two, three, or four days of death. Our habit, unfortunately, is to keep the corpse unburied for twice as long. A week may probably be considered our medium interval between death and interment; and with this delay, I need hardly tell you, the body becomes putrid—sometimes intensely so, before the time for its removal arrives.
Among the wealthier classes, as I have said, this delay is practically unimportant; except in so far as every repetition maintains the pernicious custom. Scarcely on account of any risk arising to themselves in emanations from the dead, but mainly for the sake of influence and example, would one wish the educated classes of the community to adopt the usage of earlier burial. Our present practice is upheld by no law of necessity; nor for the most part does it represent any extravagance of grief, or fond reluctance of separation. Chiefly it subsists by our indolent acquiescence in a habit, which former prejudices and former exigencies established. Fears of premature interment, which had much to do with it, are now seldom spoken of but with a smile. The longer interval, once rightly insisted on as necessary for the gathering of distant friends, has now, in the progress of events, become absurdly excessive: in a vast majority of cases, all whose presence is needed, live within a narrow circle; and the more distant mourner, who, fifty years ago, would have spent several days in coming from Paris or Edinburgh, can now finish his journey in twelve hours. It is much to be wished that, under these changed circumstances, an altered practice might ensue in the upper classes of society, fixing their time of burial within three or four days of death. Such example of wealthier neighbours, aided by greater enlightenment and education among themselves, would greatly tend to detach the poor from many observances and delays, in relation to the dead, which, in their narrow dwellings cannot continue with impunity.
But, as regards these poorer classes, cannot anything be done in connexion with your new arrangements, to abridge the period of delay? As for any positive regulation, limiting the time during which it should be allowed to retain dead bodies in certain dwelling-houses,—such could only be enforced by an extensive organisation of sanitary police, which you would have to call into existence for the purpose, and which, in the present state of public opinion, would encounter insurmountable difficulties on every occasion of its authoritative interference.
It is by indirect means and inducements alone, that I can hope at present to effect the desired alteration; and by them, I think, something can be ensured toward shortening the delays of interment.
First, I believe that everything which cheapens the cost of burial, will conduce to such a result; for, among the poor, one considerable cause of procrastination must often be the immediate absence of money. The plan of conveyance and payment which I have suggested, would at least ensure you against any increase of this difficulty, and might readily be applied to diminish it. For, under such a system of single payment for grave and conveyance, it would be practicable, and, I think, most advantageous, to fix two prices, with a difference of at least five shillings between them; to charge the lower fee whenever the funeral should occur within eighty hours of death, the higher whenever this period should be exceeded. If, by the general adoption of the former alternative, the Cemetery receipts should be diminished in respect of artisan funerals, even to the utmost extent—say five or six hundred pounds per annum—this money, or much more, would have been advantageously expended in purchasing so great a reform. If, on the contrary, the immediate option of the working classes should be in favour of continuing a system so injurious to themselves and to their neighbours, there would be no injustice in leaving them the incumbrance of a cost, from which it would require only their own will to escape. The difference of price would soon be recognised as a municipal tax on delays of interment;—a tax, rendered legitimate by the public evil which it is designed to correct, and guarded against remonstrance, because any man may avoid it who will. And since the delays in question often arise in a passive habit of the people, founded on no deliberate intention or reason, I cannot but believe that a well-marked difference of fee would, as it were, startle the poor into considering the question, which would come to be of daily argument in their houses:—‘Is it worth while that our funeral cost should be increased by the amount of one or two days wages, in order that we may retain within our dwelling-rooms four days longer, that which every one tells us is hurtful to ourselves and to others?’
It has been suggested to me, that many delays occur owing to Sunday being considered specially as a funeral day among the labouring classes; that an equal distribution of burials over the week would be preferable to this waiting for a particular day; and that the closure of your Cemetery on Sundays might accordingly be beneficial for the purposes under consideration. Many arguments will doubtless occur to you, both for and against the desirability of Sunday interments; but this probably may be regarded as a point of detail, more fitly to be considered when your scheme is complete, or even when it has actually given you some experience of its operation.
As regards the second point adverted to—the establishment of special reception-houses for the dead, I do not hesitate to say that, if they could be brought into general use, their institution would confer great advantages on the poor. But against this event, at least as an immediate one, I grieve to see strong probabilities.
A first proposal made to some mourning household, that they should trust to strangers’ hands the custody of their unburied dead, would in most instances greatly and suddenly clash with their customs, and prejudices, and affections. Whatever success you might have in conquering this difficulty would of necessity be slow: and my practical familiarity with the poorer classes makes me so little hopeful of their immediate acquiescence in the plan, that I should hardly feel justified in urging you to incur any very large expense, or to embarrass yourselves at starting with any elaborate machinery, for the sake of so scanty an expectation.
The reception-houses of Germany, as you probably know, are founded with a double intention; partly for the purpose which I am here chiefly considering—that the dead may be removed from an injurious contiguity to the living; partly also, that the bodies may be vigilantly observed, in case of suspended animation. With the latter view, many of them are specially furnished and specially officered. In that at Frankfort, for instance, each body is placed in a separate, warmed and ventilated cell; cords are attached to the fingers in such manner that the slightest movement occasions the ringing of an alarum; night and day watch is kept in a central apartment which looks into each cell, and has the several alarum-bells hung round it; adjacent is a room designed for acts of resuscitation, with bath, galvanic apparatus and the like, always in readiness for instant use; and, so long as any corpse lies within the reception-house, the medical superintendent of the establishment never goes beyond its walls. Dr. Sutherland, whose report to the General Board of Health is full of interesting information on the burial-institutions of the Continent, praises the completeness and ingenuity of these contrivances; adding, however, that ‘after careful inquiry at all the cities where he found them to exist, he could not learn that any case of resuscitation had as yet occurred.’ I may add, too, as regards my own personal experience in this country, that, with extensive opportunities, it has never happened to me, either to see any case of suspended animation where doubts of death and question of interment could arise, nor to hear in professional circles of any such occurrence, I therefore think it quite unnecessary to recommend any arrangement of reception-houses, with reference to the resuscitation of persons apparently dead.
The object for which I would desire their institution, is exclusively that of receiving dead bodies out of the houses of the poor, in order to mitigate those evils which arise in prolonged retention of the corpse. That this object is in itself very desirable, and that under the prevalence of epidemic disease its accomplishment might be of urgent necessity, you will not doubt: and the responsibility for fulfilling it—or at least for giving all facilities to its fulfilment, is so distinctly imposed on you by the letter and spirit of the law, that you will probably wish to take measures accordingly.
The extent, then, to which my information on the subject would lead me to recommend provision to be made, is this: I would advise that accommodation of an appropriate character (savouring in style rather of an ecclesiastical construction, than of the workhouse or dissecting-room) be arranged for the reception of fifty coffins. Tor this purpose I would suggest—not the building of several separate reception-houses within the City of London, in order to their being respectively adjacent to the portions of population which might use them,—but rather the establishment of one only, and that on the site of your Cemetery. Thus the conveyance of bodies which would take place under your auspices, might be made with greater economy, since it could work into the plan I have already suggested. The advantage of having only a single edifice (especially since its use is likely to be limited) and of including its superintendence in the general organisation of your Cemetery, cannot be questioned. And it seems to me, likewise, that a building designed for the reception of many dead bodies, cannot conveniently be established in the heart of the City.
I would of course recommend that the use of this building should be entirely optional with the poor, and that its advantages should be allowed gratuitously to persons burying in your ground: so that any one who, in respect of his cemetery-fee, would be entitled to have a corpse conveyed thither for funeral purposes, might claim this conveyance as soon as he chose after the occurrence of death, and might have the coffin kept with all proper formalities in the reception-house, till the moment fixed for its interment.
On further particulars connected with this part of your arrangements, I do not think it requisite at present to dwell; especially because, while I regard the establishment of a reception-house to be quite indispensable to the complete fulfilment of your new responsibilities, I still look upon it as an institution to be gradually developed in the course of years, and according to circumstances yet undetermined, rather than as something which ought at once to assume its permanent character and proportions.
Here, too, in concluding this introductory report, I may observe that I have endeavoured as far as possible to avoid encumbering it with detail. For myself, in its construction, I have thought it indispensable to pursue the subject into minuter ramifications, to consider a vast number of circumstances here scarcely mentioned, to make myself acquainted with the burial customs of other countries, to review a great variety of opinions and arguments which have been advanced on the several matters alluded to, and to consult with persons practically versed in them. But to have brought all this material before you, would have prolonged my report to an inconvenient extent with no proportionate utility.
Further, as regards these details of the subject, there are many parts on which I cannot address you with the confidence that belongs to personal knowledge. The general principles which I have set before you, do indeed lie within range of my official and professional observation. But the next stage of your inquiry relates to matters of special pursuit with which I am only indirectly conversant: and whatever information I may have compiled for myself from other sources, you will probably best obtain at first hand. Practical experience in the construction and working of Cemeteries has now for many years been the growing knowledge of persons connected with their administration by ties of business, or by official appointment. In many instances it has been dearly purchased, and notorious failures have arisen from its absence. Regard being had to the magnitude of your undertaking—hitherto unprecedented in the country, and to the immense interests involved in your success, I cannot but earnestly hope that such experience may be made available for your information.
At an early period you will have to determine what appointments will be requisite, with a view to the architectural and other designs of your cemetery, to its economical planning and decorations, to the superintendence of its daily working, to its financial management, to the conveyance of bodies, and to all intramural organisation connected therewith. Minute details will be best considered when these appointments are made, and when you will naturally have the benefit of such practical experience as may best assist your deliberations.
For the task on which you are engaged extends, I need hardly say, far beyond the purchase of certain acres for your burial-ground. It implies for its completion, that you shall possess an adequate plan on which the interment of your population may be managed during many succeeding generations; a plan constructed, first of all, with entire regard to the general good of the public, and next, with as little violence as may be to those habits, prejudices, and interests, which are involved in the present system of interment.
The construction of such a plan constitutes a very large question of municipal policy;—one which, because of its solemn subject, and because of the degree in which human feelings and affections are involved in it, requires to be handled with peculiar discretion and delicacy; but which not the less requires to be contemplated in a large and comprehensive manner.
I have therefore thought I should best fulfil the object of your reference, by bringing before you those general principles which lie at the root of all minute considerations: in order that, having first determined on them, and having taken one collective view of the subject, you may better know at what time, and in what order, and to what extent, you would wish the minor details to be developed for your information.
I have the honour,
&c. &c.
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