Look, for instance, at the whole immense class of scrofulous diseases, including pulmonary consumption, a class probably causing, directly or indirectly, at least a quarter of our entire mortality; and consider the vast influence which circumstances exert over its development.
Of such circumstances some lie within your control, and affect masses of the people; but the more special causes of chronic disease lie rather out of your jurisdiction, and the option of avoiding them is a matter of individual will. Vicious habits and indiscretion; a life too indolent, or too laborious; poverty and privation; vicissitudes of weather and temperature; intemperance in diet; unwholesome and adulterated food; and, not least, inappropriate marriages tending to perpetuate particular kinds of disease; these words may suggest to you, briefly, that there are many influences, within the sphere of private life, by which the aggregate death-rate of a population is largely enhanced, but the control of which, if attainable, lies almost entirely at the discretion of the classes subject to their operation.
Considering all these causes, and the needless waste of life occasioned by them, I can have little doubt that as much might be done by individuals, under the influence of improved education, to lessen the mortality from chronic disease, as by sanitary legislation to stay the sources of epidemic death. And regarding both classes of disease together—those, on the one hand, which are of endemic origin (arising in imperfect drainage, in defective water-supply, in ill-devised arrangement of buildings, in offensive and injurious trades, in the putrefaction of burial-grounds, and the like) and those classes, on the other, which arise in the circumstances of individual life, I can have no hesitation in estimating their joint operation at a moiety of our total death-rate, or in renewing an assertion of my [last years’ Report], ‘if the deliberate promises of Science be not an empty delusion, it is practicable to reduce human mortality within your jurisdiction to the half of its present average prevalence.’
To revert, however, to your more special branch of the subject,—I have thought the present a convenient time for indicating to you the pressure of preventable death, arising in acute disease, because of the great addition which you have recently gained to your powers for enforcing prevention.
That an average death-rate of nearly 25 per thousand per annum prevails in the City; that three-eighths of your mortality consists in a premature extinction of infant life; that fatal disease, in more than two-fifths of its visitations, is of a kind which operates endemically and preventably;—these are the facts to which I have appealed, as my evidence of the need for sanitary activity and perseverance.
On other occasions I have endeavoured to set before you what are those agencies hostile to life, which affect the masses of an urban population; and during the last three years your Hon. Court has shown its recognition of these causes, and has devoted attention to the means of counteracting them by appropriate sanitary measures.
In too many instances, the powers first given you by the Legislature were inadequate to this great purpose. But now, armed with the further authority of your new Act of Parliament, you enjoy such means for sanitary improvement as have never yet been possessed by any Corporation in the country; such means as, judiciously wielded, cannot but produce the greatest advantage to persons living under your jurisdiction.
As you are only now entering on the exercise of these powers, it may be convenient that I should submit to you a brief account of them, and I gladly turn from contemplating the spectacle of preventable death, to analyse the means of prevention now vested in you by the Legislature.
1. In regard of public drainage or sewerage, the first and most elementary condition of endemic health, I need hardly tell you that within the City, your powers are absolute. You have entire and sole responsibility for the construction and maintenance of sewers, for their cleaning or flushing, and for the prevention of noxious effluvia from their innumerable gully-holes.
2. In the all-important particular of house-drainage, your authority is sufficient for every purpose. You can order the complete abolition of cesspools; the construction of drainage in any premises within fifty feet of a sewer; its repair, cleansing, or renewal, whenever it may be disordered: and not only can you order these works to be done, but—failing the owner’s compliance with your notice, you can devolve the performance of his duty on your own workmen, and can recover your expenses from the recusant.