I am unable to state with accuracy, in these several instances, what proportion subsists between the preventable mortality and the number of living persons, for I have no means of ascertaining precisely the population of the separate Wards; and without this knowledge it is impossible to arrange them in a scale of comparative healthiness. I need hardly remind your Hon. Court that the Wards differ very considerably in their magnitude; so that the largest majority of cases occurring in one Ward (as in Farringdon Without) must not unconditionally be taken to imply that the Ward, in proportion to its population, suffers more deaths than one in which the apparent number is less considerable. In the [table] to which these remarks refer, I have endeavoured to give you the means of comparing (at least approximatively) the healthiness of your several departments, by entering against the name of each Ward the number of holdings for which it stands assessed to your rate. This entry, with some trifling modifications specified in the table, may be taken to express the number of houses contained in each Ward of the City: thus it furnishes indirectly the means for estimating the local population.
It will be noticed, that the more glaring inequalities which I have adduced are in some degree due to the epidemic of last year, which did not press uniformly on all parts of the City. It may, however, likewise be observed, that the chief operation of that epidemic was to exaggerate, but not importantly to misrepresent, the features of each locality; that the habitual sanitary proportions of districts to each other were for the most part preserved; that (with a qualification to which I shall presently revert) the Wards numbering fewest deaths last year numbered also fewest this year.
In my [last Report], when the cholera had scarcely subsided, when men’s minds were full of apprehension on the subject, and when it seemed only too possible that, with the recurrence of autumn, we might again suffer from its invasion, I was unwilling to dwell too pointedly on the wonderful pertinacity with which that disease fixes itself on particular localities, and tends to re-appear in them on each new occasion of its rise. Believing that no extemporaneous measures could counteract these local preferences of the epidemic, I refrained from a course which would have produced no good result (unless indeed it had depopulated certain spots of the City), and which might have caused unavailing and hurtful alarm. Now, however, I think it right to tell you that the local predilections of this dreadful disease are so marked and so obstinate, that we may almost certainly predict in what parts of the metropolis it would tend to arise on any renewed visitation. We may anticipate that at any such time its latent power of destruction will kindle again in the districts, the streets, the houses, perhaps even in the very rooms, where it recently prevailed, unless the determining local conditions shall previously have been annulled.
It would be ridiculous if I should pretend to carry you into any medical consideration of this subject, or should make my present Report the vehicle of a professional argument; but I may very briefly acquaint you with such generalisations as will justify you in pursuing a particular course with respect to the haunts of cholera. While doing so, I hope your Hon. Court will believe that I have devoted to this very serious subject the best consideration of which I am capable, and have done my utmost to arrive at conclusions which may be fruitful of practical good.
Cholera visited no localities of which it could be said, that they were generally healthy; but still there seemed to be something peculiar and specific in the kind of local unhealthiness which determined its invasion. On the one hand, it is unquestionably true that many habitual seats of fever were visited by cholera; on the other hand, many of the worst fever-nests in the whole metropolis were unaffected by it; and it struck with extreme severity in a class of houses habitually exempt from fever. See, for instance, how malignantly it prevailed along the line of Farringdon and New Bridge streets, and in Fleet-street and Ludgate hill, where their line intersects that just mentioned; and here, you will observe, not only in those obscure and ill-ventilated courts and by-ways, where fever is the familiar visitant of a hungry and crowded population; but also, and very strikingly, in spacious and airy houses, situate along the main thoroughfare of the City, and inhabited by opulent tradesmen, by members of the various professions, or by officers of assurance-companies. Other infective diseases which habitually desolate the former class of dwellings are almost unknown in the latter. Cholera came as a startling exception. Within the infected district (fulfilling the classical description of pale death) it trod with equal foot the gates of rich and poor.[40]
———Æquo pulsat pede pauperum tabernas
Regumque turres.
I think it very important that this fact should be fully recognised. In London it has often been overlooked, from the accident that our most infectable districts happen to contain an excess of poor population. But even here it is quite easy to note that the disease spreads irrespectively of pauperism or privation; and in other cities, (Paris and Copenhagen, for instance) where the quarters of rich and poor are less apart than in London, cholera has killed its full share of dignitaries and capitalists.—J. S., 1854.
Personal peculiarities, or vicious habits, or temporary indiscretion, may often have determined its choice of a victim; low nourishment—even temporary emptiness and exhaustion, very manifestly invited its attack; but, speaking generally, I may say that it was a disease prevailing over a certain patch of ground, and (within this limit) tending to strike equally, or nearly equally, in all classes of habitations. Crowdedness of dwellings, defective ventilation, squalor of inhabitants, and many forms of local nuisance, which are omnipotent in giving occasion to fever, and in adding malignity to many disorders of its class, did not by themselves exert so marked and specific a power in determining the onset of cholera.
What then were the conditions determining its local preference? Consideration of its statistics, or inspection of a cholera-map, enables one, with some confidence, to answer—a peculiar condition of soil, of which dampness is one sure and invariable character, and organic decomposition (promoted by dampness) probably another.[41] Its local affinities have much analogy to those of ague, and often appear identical in their range with the sphere of malarious infection. Our entire metropolis, built down to the very margins of a large river—of a river, too, which, at each retreating tide, exposes acres of mud saturated with the reeking sewage of an immense population, is placed generally in circumstances not unfavourable to the development of the disease; and its several parts will be liable to suffer especially, in proportion as they are exposed to these general circumstances, or to special circumstances of their own of a like nature. The lower level of districts on the south side of the river, their attendant failure of natural land-drainage, the consequent soddenness of a soil from which likewise the materials of house refuse were never efficiently removed, accounted sufficiently for the frightful epidemic mortality which prevailed in those quarters of the metropolis.