In the course of this inquiry it may be found necessary to distinguish the extent of disease caused by physical or removable agencies, by malaria created by defective drainage, or the bad construction of the dwellings of the labouring classes, from disease caused by destitution of the proper means of subsistence arising from poverty. It may be expected of the medical practitioners from whom the Commissioners hope to obtain reports, that they will make the distinction wherever it is found to exist.
The Commissioners will value any suggestions you may have to offer respecting the removal of the injurious agencies which may fall under your observation. You are probably well acquainted with the nature of the powers confided to the municipal authorities or other local bodies respecting the paving, sewerage, and drainage of the town, and especially of those parts of it which are inhabited chiefly or solely by the working classes. The Commissioners request you to observe whether those powers enable the municipal or other local body to complete the sewerage, and to enforce the paving and drainage of the streets partially or wholly at the expense of the proprietors of these houses.
The spread of contagious diseases is greatly facilitated in many towns by the extreme filth of lodging-houses to which mendicants and vagrants resort, and of the habitations of certain of the lowest portion of the poorer class; measures of medical police have been resorted to on the occurrence of epidemic fevers, and at the period of the invasion of cholera, for cleansing and whitewashing these habitations at the expense of the inhabitants. The Commissioners request you to state under what circumstances you conceive such measures might be usefully resorted to, and under what superintendence, and whether the expense should fall on the owners of such habitations or on the inhabitants generally, and whether this interference should be habitual or casual.
Suggestions have been made to the Commissioners that the nature of the thoroughfares, and the structure and internal arrangement of the buildings in districts inhabited by the working classes in large towns would be greatly improved if subject to the regulations of a Building Act enforced by the municipal authorities, or by a local board of health; they invite you to reflect on the provisions of such a law, and to state under what circumstances and to what extent you conceive such interference desirable.
Generally the Commissioners are desirous to receive your impressions respecting the means of improving the sanitary condition of the working classes, especially in those parts of your town in which contagious febrile diseases most frequently prevail.
Copies of the forms and exemplifications of the mode of entering the particulars of the information sought in the returns circulated in England, and the reports on the sanitary condition of the labouring classes in the metropolis, are herewith transmitted for your use. The Commissioners have not asked for returns in any prescribed form from the medical practitioners in the towns of Scotland, because they are uninformed as to the nature of the existing records of facts relating to medical statistics in the towns, and they wish to consult the practitioners’ convenience, and be guided by them as to the best use to be made of the local circumstances for obtaining information.
I have the honour to be, Sir,
Your very obedient Servant,
Edwin Chadwick, Secretary.
To ________