Report to Her Majesty's Principal Secretary of State For the Home Department, from the Poor Law Commissioners, on an Inquiry Into the Sanitary Condition of the Labouring Population of Great Britain; With Appendices

by Edwin Chadwick

Extent of evils which are the subject of inquiry

The registration of the causes of death for the year 1838 is selected, as that was the year when the report was made on the sanitary condition of the labouring population in the metropolis, which has served as the foundation of the extended inquiry.

There are no returns, and no adequate data for returns, to show the proportion in which deaths from the several causes above specified occur amongst the population of Scotland, but there is evidence to which reference will subsequently be made tending to prove that the mortality from fever is greater in Glasgow, Edinburgh, and Dundee than in the most crowded towns in England.

The registered mortality from all specified diseases in England and Wales was, during the year 1838, 282,940, or 18 per thousand of the population. These deaths are exclusive of the deaths from old age, which amounted to 35,564, and the deaths from violence, which amounted to 12,055. The deaths from causes not specified were 11,970. The total amount of deaths was 342,529 for that year. In the year following the total deaths were 338,979, of which the registered deaths from old age were 35,063, and the deaths from violence 11,980. The proportion of deaths for the whole population was 21 per thousand.

It appears that fever, after its ravages amongst the infant population, falls with the greatest intensity on the adult population in the vigour of life. The periods at which the ravages of the other diseases, consumption, small-pox, and measles take place, are sufficiently well known. The proportions in which the diseases have prevailed in the several counties will be found deserving of peculiar attention.

A conception may be formed of the aggregate effects of the several causes of mortality from the fact, that of the deaths caused during one year in England and Wales by epidemic, endemic, and contagious diseases, including fever, typhus, and scarlatina, amounting to 56,461, the great proportion of which are proved to be preventible, it may be said that the effect is as if the whole county of Westmoreland, now containing 56,469 souls, or the whole county of Huntingdonshire, or any other equivalent district, were entirely depopulated annually, and were only occupied again by the growth of a new and feeble population living under the fears of a similar visitation. The annual slaughter in England and Wales from preventible causes of typhus which attacks persons in the vigour of life, appears to be double the amount of what was suffered by the Allied Armies in the battle of Waterloo. It will be shown that diseases such as those which now prevail on land, did within the experience of persons still living, formerly prevail to a greater extent at sea, and have since been prevented by sanitary regulations; and that when they did so prevail in ships of war, the deaths from them were more than double in amount of the deaths in battle. But the number of persons who die is to be taken also as the indication of the much greater number of persons who fall sick, and who, although they escape, are subjected to the suffering and loss occasioned by attacks of disease. Thus it was found on the original inquiry in the metropolis, that the deaths from fever amounted to 1 in 10 of the number attacked. If this proportion held equally throughout the country, then a quarter of a million of persons will have been subjected to loss and suffering from an attack of fever during the year; and in so far as the proportions of attacks to deaths is diminished, so it appears from the reports is the intensity and suffering from the disease generally increased. It appears that the extremes of mortality at the Small-pox Hospital, in London, amongst those attacked, have been 15 per cent. and 42 per cent. But if, according to other statements, the average mortality be taken at 1 in 5, or 20 per cent., the number of persons attacked in England and Wales during the year of the return, must amount to upwards of 16,000 persons killed, and more than 80,000 persons subjected to the sufferings of disease, including, in the case of the labouring classes, the loss of labour and long-continued debility; and in respect to all classes, often permanent disfigurement, and occasionally the loss of sight.

In a subsequent part of this report, evidence will be adduced to show in what proportion these causes of death fall upon the poorer classes as compared with the other classes of society inhabiting the same towns or districts, and in what proportions the deaths fall amongst persons of the same class inhabiting districts differently situated.

The first extracts present the subjects of the inquiry in their general condition under the operation of several causes, yet almost all will be found to point to one particular, namely, atmospheric impurity, occasioned by means within the control of legislation, as the main cause of the ravages of epidemic, endemic, and contagious diseases among the community, and as aggravating most other diseases. The subsequent extracts from the sanitary reports from different places will show that the impurity and its evil consequences are greater or less in different places, according as there is more or less sufficient drainage of houses, streets, roads, and land, combined with more or less sufficient means of cleansing and removing solid refuse and impurities, by available supplies of water for the purpose. Then will follow the description of the effects of overcrowding the places of work and dwellings, including the effects of the defective ventilation of dwelling-houses, and of places of work where there are fumes or dust produced. To these will be added the information collected as to the good or evil moral habits promoted by the nature of the residence. These will form so many successive sections of the report, and will be followed by information in respect to the means available for the prevention of the evils described, and an exposition of the present state of the law for the protection of the public health, and of modifications apparently requisite to secure the desired results.

I.—GENERAL CONDITION OF THE RESIDENCES OF THE LABOURING CLASSES WHERE DISEASE IS FOUND TO BE THE MOST PREVALENT.

The following extracts will serve to show, in the language chiefly of eye-witnesses, the varied forms in which disease attendant on removable circumstances appears from one end of the island to the other amidst the population of rural villages, and of the smaller towns, as well as amidst the population of the commercial cities and the most thronged of the manufacturing districts—in which last pestilence is frequently supposed to have its chief and almost exclusive residence.