The present inquiry, however, has shown the general primary importance of the works of sewerage and drainage throughout the country. The execution of those works would properly devolve upon the commissioners of sewers already in existence in the towns, or in the marsh districts, or upon commissions of sewers which it will be found necessary to issue to places where there has been no need of surface drainage, but which stand in need of under-drainage. These being the primary works for making the ground clear and keeping it clear for all other works, would necessarily require the highest science and skill, and the strongest establishment; and it would be only carrying farther the principle of consolidation, as the only means of obtaining the most efficient service, the most conveniently and at the lowest cost, now to recommend that the care of the roads should, of all structural works, be made to devolve upon that body which has the best means of executing them, namely, the commissions of sewers, revised as to jurisdiction, and amended and strengthened as to power and responsibility. What Colonel J. F. Burgoyne, the experienced chairman of the Board of Works in Ireland, stated in his evidence before the committee of the House Commons in 1836, (question 35,) on the consolidation of the turnpike trusts, may be applied to the consolidation of other local works:—“One office and account will then do for the whole; a superior superintendent could then be employed, and more perfect machinery; the means will be more generally available, and can be concentrated where required, by which the works will be carried on with more advantage, and a system of regular and rigid maintenance can be established so much more economical and beneficial than that of occasional and periodical repairs.”
It is due to state that in petitions from ratepayers much dissatisfaction is expressed with the proceedings of the commissions of sewers, and their objectionable working is assigned to their irresponsibility, and a favourite remedy proposed is to make them elective; but if the administration of expenditure by elective vestries be examined, it is found to be no better; and of entirely open vestries, even worse; and the practical responsibility for injustice done to individuals, or to any one who cannot get up a party, still less. It may, however, be submitted for consideration, whether the commissions for sewers might not be so far modified as to admit some infusion of the representative principle in their composition, by including, as ex-officio members of the commission, the chairman and vice-chairmen for the time being of the Boards of Guardians of the poor law unions included within the jurisdiction of the commission. These officers are elected by the elected representatives of the ratepayers—the guardians. It will be seen that much of the evil which the preventive measures within the province of the commission of sewers must provide against, is presented, in the first instance, to the Board of Guardians, in the shape of claims to relief on the ground of destitution occasioned by sickness. The chairman or the vice-chairman, before whom the cases are thus brought, would form an efficient medium of communication. The measures of drainage and structural improvement are permanent improvements of the greatest importance to the labouring men, in common with other classes; but it is matter of fact that such improvements are the least supported by those who have the least permanent interest—the smaller occupiers; or by those who have the least means and have the greatest dread of immediate expenses—the smaller owners. The chairmen and the vice-chairmen of the unions in the rural districts are, however, the chief landed proprietors, who are elected by the guardians for the interest they take in the improvement of local administration. The most important improvements in the residences of the labouring classes that have been brought to view by this inquiry have arisen from the spontaneous benevolence of the larger proprietors; and so much improvement must depend upon their voluntary exertion, that, for the sake of the labouring classes, it recommends itself as an important arrangement, that those who, as chairmen of the Boards, have the distribution of relief to the destitution attendant on sickness, should be placed in a position to represent the need of the means of prevention, and urge forward their execution.
When the extent of the removable causes of sickness and mortality are more clearly and extensively understood, as they will be, the Board of Guardians will of necessity occupy much of the position of the Leet, as a body fitted to act on complaints made, and to reclaim the execution of the law against omissions and infractions which occasion illness or injury to the most helpless classes.
Boards of Health, or Public Officers for the Prevention of Disease.
In reports and communications, the institution of district Boards of Health is frequently recommended, but in general terms, and they nowhere specify what shall be their powers, how they shall seek out information or receive it, and how act upon it. The recommendation is also sanctioned by the committee which sat to inquire into the health of large towns; and the committee state that “the principal duty and object of these boards of health would be precautionary and preventive, to turn the public attention to the causes of illness, and to suggest means by which the sources of contagion might be removed.” “Such boards would probably have a clerk, paid for his services, whose duty it would be to make minutes of the proceedings, and give such returns in a short tabular form as might be useful for reference, and important, as affording easy information on a subject of such vital interest to the people.”
I would submit that it is shown by the evidence collected in the present inquiry, that the great preventives—drainage, street and house cleansing by means of supplies of water and improved sewerage, and especially the introduction of cheaper and more efficient modes of removing all noxious refuse from the towns—are operations for which aid must be sought from the science of the civil engineer, not from the physician, who has done his work when he has pointed out the disease that results from the neglect of proper administrative measures, and has alleviated the sufferings of the victims. After the cholera had passed, several of the local boards of health that were appointed on its appearance continued their meetings and made representations; but the alarm had passed, and although the evils represented were often much greater than the cholera, the representations produced no effect, and the boards broke up. In Paris a Board of Health has been in operation during several years, but if their operations, as displayed in their reports, be considered, it will be evident that, although they have examined many important questions and have made representations, recommending for practical application some of the principles developed in the course of the present inquiry; still as they had no executive power, their representations have produced no effect, and the labouring population of Paris is shown to be, with all the advantages of climate, in a sanitary condition even worse than the labouring population of London. In the Appendix I have submitted a translation of a report descriptive of the labours of the Conseil de Salubrité, in Paris. From this report it will be seen that they have few or no initiative functions, and that they are chiefly called into action by references made to them by the public authorities to examine and give their opinion on medical questions that may arise in the course of public administration as to what manufacturing or other operations are or are not injurious to the public health.
The action of a board of health upon such evils as those in question must depend upon the arrangements for bringing under its notice the evils to be remedied. A body of gentlemen sitting in a room will soon find themselves with few means of action if there be no agency to bring the subject matters before them; and an inquiring agency to seek out the evils from house to house, wherever those evils may be found, to follow on the footsteps of the private practitioner would be apparently attended with much practical difficulty.
The statements of the condition of considerable proportions of the labouring population of the towns into which the present inquiries have been carried have been received with surprise by persons of the wealthier classes living in the immediate vicinity, to whom the facts were as strange as if they related to foreigners or the natives of an unknown country. When Dr. Arnott with myself and others were examining the abodes of the poorest classes in Glasgow and Edinburgh, we were regarded with astonishment; and it was frequently declared by the inmates, that they had never for many years witnessed the approach or the presence of persons of that condition near them. We have found that the inhabitants of the front houses in many of the main streets of those towns and of the metropolis, have never entered the adjoining courts, or seen the interior of any of the tenements, situate at the backs of their own houses, in which their own workpeople or dependents reside.
The duty of visiting loathsome abodes, amidst close atmospheres compounded of smoke and offensive odours, and everything to revolt the senses, is a duty which can only be expected to be regularly performed under much stronger motives than can commonly be imposed on honorary officers, and cannot be depended upon even from paid officers where they are not subjected to strong checks. The examination of loathsome prisons has gained one individual a national and European celebrity. Yet we have seen that there are whole streets of houses, composing some of the wynds of Glasgow and Edinburgh, and great numbers of the courts in London, and the older towns in England, in which the condition of every inhabited room, and the physical condition of the inmates, is even more horrible than the worst of the dungeons that Howard ever visited. In Ireland provisions for the appointment of Boards of Health have been made, but they appear to have failed entirely. One of the medical practitioners examined before the Committee of the House of Commons was asked, in respect to the operation of these provisions:—
“3297. But in ordinary times, when the fever is not of very great intensity, and is confined to the dwellings of the humbler classes, there is no such provision put into force?—No, but then there is another provision which may be put into force; this Act provides, that ‘whenever in any city, town, or district, any fever or contagious distemper shall prevail, or be known to exist, it shall and may be lawful for any one or more magistrates, upon the requisition of five respectable householders, to convene a meeting of the magistrates and householders of such city, town, or district, and of the medical practitioners within the same, in order to examine into the circumstances attending such fever or contagious distemper.’ There is another Act of 59 Geo. III., c. 41, which enables the parishes to appoint officers of health; that is, a permanent power. Those officers have very considerable authority; they can assess a rate.