As it was tersely summed up by one of the most active and capable medical officers of the Board of Health:—
“We find but one cause of so much sickness, suffering and death—the prolific parent of all this diversified offspring—‘filth.’
“It is in filth, in decomposing organic matter, that the main causes of epidemic diseases are to be sought out—filthy alleys, filthy houses, filthy air, filthy water, and filthy persons.”
What the General Board of Health could do, it did, as was indeed to be expected from such sanitary enthusiasts as Lord Ashley, Dr. Southwood Smith, and Mr. Edwin Chadwick, but the local authorities were dilatory, lukewarm, or actually hostile, and their proceedings, where anything was done, were altogether inadequate for insuring those prompt, comprehensive, and vigorous measures so urgently demanded in the presence of a great and destructive epidemic such as malignant cholera.
The system of house-to-house visitation was essential for the discovery and checking of the disease, but, wrote the Board, “nothing effective was done or attempted in the metropolis. We repeatedly and earnestly urged upon the Boards of Guardians the importance to the saving of life of making immediate arrangements for special measures of prevention, but our representations were made in vain.
“The local authorities could not be induced to carry into effect the preventive measures we proposed.”
Several unions and parishes, among whom were some of the most wealthy and populous, positively refused to comply with the directions of the Board.
In the case of Bethnal Green, just described, the Board issued a “Special Order.” But even under these urgent circumstances “the Board of Guardians appointed no medical officer for five days, they provided no nurses, they established no hospital, they opened no dispensary, they appointed one inspector of nuisances instead of two, and they made no provision for extensive and effectual lime-washing.”
The explanation of the inaction and hostility of the local authorities lay in the fact that the various measures prescribed by the Act interfered with private interests, and especially with interests which were largely represented on the Boards of Guardians. Among the members of those boards there was often “an antagonistic power” at work which prevented proper attention being paid to the sanitary condition of the localities of the poor. In many instances, owners of small houses and cottage property, to which class of dwellings the provisions of the Act more particularly applied, were themselves members of such boards, and when this was not the case, they exerted an influence not the less powerful because it was indirect. This interest often conspired to impede efficient sanitary measures.[38]
Local interests also operated, the apprehension being that if active and really efficient measures were adopted the trade of the neighbourhood would suffer.