Reports Relating to the Sanitary Condition of the City of London

by John Simon

[78] Having had recent occasion to examine judicially into the matters here adverted to, I think it proper to mention that the allusions in my text were long prior to this examination, and were founded chiefly on the Registrar-General’s Reports of the time, with other official statements.—J. S., 1854.

Next, the disease was rumoured to be in London. Hope and belief are too near akin for this not to have been doubted and denied; but the last few weeks have shown, with sad incontrovertible certainty, that after only four years absence, Cholera has again obtained its footing on our soil. Six or seven hundred deaths, registered in the metropolis since the beginning of September, have already attested its presence.

Anxiously adverting to the future, and asking what may be the onward progress of the disease, we can appeal only to a narrow experience. Before us lie the records of but two complete visitations of the disease, and the commencement of this, the third. It would be a shallow philosophy that should pretend, from two observations, to predict the possible orbit of this obscurely wandering plague.

Yet I dare not disguise from you that such knowledge as we have, to justify scientific anticipation, is pregnant with threats and gloom. For—let me remind you of the past. At each former period of attack, the infection, after a certain course over Continental Europe, struck upon our eastern coast in the summer of an unforgotten year. In the northern parts of Great Britain, so soon as it had lit among the population, each time it burst forth into explosive activity, and worked its full measure of destruction without delay. More faintly it reached the South. On each occasion, indeed, at the close of summer, London was sensibly affected by the disease; but, we hoped, under a milder infliction. Here and there, within its Bills of Mortality (as at Tooting in 1848) there was thrown some astounding flash on a particular hot-bed of co-operating poison; but on the whole it seemed to the sanguine, on each occasion, that the fury of the epidemic was expending itself in our northern towns, and that the metropolis was to be comparatively spared.

Each time, at the commencement of the new year, our London mortality from Cholera seemed stationary within the limit of a few hundred deaths. Each time winter and spring allowed a long respite to our invaded City, and confirmed the omens of the hopeful.

But each time there was disappointment. Each time, as the warmth of summer requickened the exterior conditions of chemical activity, the dormant fire kindled afresh—slowly at first, but with speedy acceleration of rate. Each time, in the few weeks before Michaelmas—amid almost universal threatenings of the disease, and amid such panic of death as the metropolis had not known since the Great Plague, there suddenly fell many thousands of the population.

Thus then our position stands. Scientific prediction of phenomena can arise only in the knowledge of laws. That the phenomena of this disease, however capricious they may seem, are obedient to some absolute uniformity as yet beyond our ken—are enchained by that same rigid sequence of cause and effect which is imposed on all remaining Nature—it would be impossible to doubt. But these conditions are hitherto unknown to science. Hitherto we can speak of the facts alone, with a short empirical knowledge of their succession. Yet in this light, such as it is, the conclusion is only too obvious. If the disease, already notorious for a tendency to return on its former vestiges, repeat on this third occasion the steps of its two previous courses; or, perhaps I should rather say, if it now proceed consistently to complete a repetition which it has already half-effected; Asiatic Cholera will be severely epidemic in London in the third quarter of next year—will proceed, with a stern unflattering test, to measure the degree in which those promises of sanitary improvement have been redeemed, which the terror of its recent visitation extorted even from the supinest and most ignorant of its witnesses.

In the face of so great a danger, you will reasonably claim of your Officer of Health that he shall report to you, how far the City is already fortified against this dreadful invasion—how far the hygienic defences of life, if weak, may be strengthened—how far there remain breaches now insusceptible of repair.

1. It forms an all-important part of these considerations for resistance to the disease, to recognise quite accurately what is its fashion of attack. Since I last addressed you on the subject, in my [Report for 1849-50], the materials for correct generalisation have been very largely increased by Dr. Farr’s admirable Report to the Registrar-General on the Cholera in England, and by numerous other important publications. By collating with these works the more restricted, yet not uninstructive, experience which arose within your particular jurisdiction, I hope to have enlarged my knowledge of the subject, and to have become able with greater confidence to submit my conclusions for your acceptance.

The first and most obvious characteristic of the disease is its preference for particular localities. It is eminently a district-disease. And the conditions which determine its local settlement are demonstrable physical peculiarities.