Edwin Chadwick, Secretary.
To
The Provost of
5.—Circular Letter of Inquiry to Dispensary Surgeons and Medical Practitioners in Scotland.
Poor Law Commission Office, Somerset House,
London, 19th June, 1840.
Sir,—The Poor Law Commissioners have been directed to extend to Scotland the inquiry which in the past year they received Her Majesty’s commands to conduct in England, for the purpose of ascertaining what circumstances in the condition of the poorer classes promote the spread of continued fever and other contagious febrile diseases.
They are desirous that this inquiry should be conducted with care in large towns, where the sources of contagion or the circumstances which promote its rapid diffusion among the population are more rife than in the rural districts; they are anxious to obtain the assistance of the medical practitioners having charge of hospitals and dispensaries in such towns, because such institutions afford the best means of observing under what circumstances febrile contagious diseases are disseminated; of defining the districts of the town in which they spread; of ascertaining the character of the streets and houses in such districts; the comparative attention paid to the paving, sewerage, and drainage of these districts; and whether or not they are subject to malarious influences.
The structure of the dwellings of the labouring classes; the nature and extent of their internal accommodation, and of the means for securing cleanliness, for removing filth, for promoting ventilation, and for providing warmth with due economy, can be most easily ascertained by medical gentlemen who devote their time to the frequently gratuitous services of public institutions; they also are most competent to discriminate between the direct influence of the habits of the poorer classes, and of the external circumstances by which they are surrounded, on their sanitary condition; while on the other hand they will not be liable to fall into the error of supposing that these habits are independent of arrangements which administer to domestic comfort.
The Commissioners trust, therefore, they may rely with confidence on your affording them your valuable assistance in the inquiry which they are directed to pursue. They trust you will permit them to suggest that if the cases recorded in the books of your hospital were grouped according to the districts from which the patients were removed, you would at once be able to define in a map those parts of your town most subject to contagious febrile diseases, and to furnish the Commissioners with the number of cases of each febrile disease occurring in each of these districts, and would possess the means of ascertaining and delineating the features of those districts in all that relates to the sanitary condition of the inhabitants, and to medical police. Besides the general influences alluded to in the former part of this letter, you will probably find it useful to ascertain whether any injurious consequences are clearly attributable to certain classes of manufactories surrounded by the habitations of the poor, to the location of slaughter-houses, tanneries, ancient burial grounds, &c., amidst dense masses of the population.