Poor Law Commission Office, Somerset House,
12th November, 1839.
Sir,—With the view of ascertaining the extent of the existence of circumstances promoting the prevalence of contagious and infectious diseases described in the reports referred to in the Order of the House of Lords, set forth in the letter from Lord John Russell, a copy of which is hereto annexed, you are requested to fill from the medical relief Lists the enclosed returns, and transmit them to the clerk of the union, with such observations as occur to you thereon.
You will observe that the object of the Commissioners is to ascertain the existence and extent of the visible and removable agencies promoting the prevalence of such diseases as are commonly found connected with the defects in the situation and structure or internal economy of the residences of the labouring classes.
The attention of the physicians who drew reports on the state of the metropolis was almost exclusively directed to the causes affecting the prevalence of various forms of continued fever, arranged under distinguishing names adopted by nosological writers: but in rural districts the prevalence of ague, and of small-pox, and scarlet fever, may be worthy of notice when the causes promoting their prevalence appear removable.
You will, in your observations on the class of cases returned, note the situation, character and quality of the tenements in which the diseases have occurred;—whether they are situated in a neighbourhood habitually infected with malaria;—whether there are occasional causes of malaria, such as floods, &c.; and in such cases, whether you have any suggestions to make as to the best means of diminishing the evil;—whether they are drained or undrained, whether tight or otherwise;—whether there are good means of securing ventilation with a due regard to warmth;—whether there are accumulations of filth, and if so, whether they are ascribable to the slovenly or indolent habits of the inmates, or to the want of proper receptacles for refuse;—whether the occurrence of disease amidst this part of the population is regular or otherwise, and what are the seasons at which it appears, and its characteristics.
The Commissioners request that you will favour them with any information which you may have gained in the course of your medical experience, as to the condition of the inmates of such residences;—whether there is a need of superior cottage accommodation, or to what extent the improvement of the residence would influence the habits beneficially; as, for example,—whether you have witnessed any beneficial effects on the habits of the inmates by providing cottages with a day-room, scullery, pantry, three bed-rooms, and convenient receptacles for refuse and for fuel;—whether within your district there are other labourers of the like class, who occupy improved tenements in a superior situation, and what is the general health and condition of the inmates as compared with the general health and condition of the inmates less advantageously situated;—whether you have seen any cottages constructed with a view to the most economical management of fuel both in cooking and maintaining a proper temperature in the rooms;—and further, any observations that may occur to you on the subject of the health of the labouring classes in connexion with what may appear to you to be available sanitary regulations.
The accompanying portions of the report, and the appendix referred to in their lordships’ order, are transmitted for your information as to the causes of disease existing in the metropolis, which it is deemed necessary to investigate in other parts of the country.
Signed, by Order of the Board,
Edwin Chadwick, Secretary.