Reports Relating to the Sanitary Condition of the City of London

by John Simon

[80] New Bridge Street was built over the Fleet in 1765. The present site of Farringdon Street had been arched in thirty years earlier, for the purposes of the Fleet Market.

In describing to you the local affinities of cholera, I have intimated that, in its preference for our low metropolitan levels, it selects these soils specifically in respect of their being damp with organic putrefaction. A moment’s consideration will suffice to show that, if this be true, the higher levels of the metropolis will be exempt from the disease, only in proportion as they exempt themselves from the local conditions which invite it—only in proportion as they avail themselves of those natural advantages which their situation enables them to command. Let a district be defective in house-drainage, so that its soil is excavated by cesspools and sodden by their soakage; let its sewers be ill-constructed and foul, so that offensive gases are ventilated into the immediate breathing-air of the inhabitants; let its pavement be absent or imperfect, scattered with refuse and puddled with water;—you will easily conceive that, under these circumstances, all distinctions of level are merged in the strong identity of filth, and whatever diseases belong to putrefactive dampness of soil will strike here as readily as on the low-lying mud-banks of the river.

So, likewise, in still narrower limits—the predisposition of a house to Cholera may be stated in the same terms as define the liability of a district—viz., that the humid gases of organic decomposition, in proportion as they are breathed into one house in a district more than into other houses there, will engender the greater liability of that house, as compared with its collaterals, to suffer an invasion of Cholera. And thus it often happens, during epidemic prevalence of the disease, that sporadic cases are determined in localities which might generally claim to be free from infection: for, what avails it to be on the highest ground and the best soil, with every neighbouring facility of sewers and scavenage, if, owing to individual carelessness and filth, the conditions of dampness and putridity are by choice retained within a house, and its basement flooded with rotting liquids, or piled with accumulated refuse?

I might give you many instances in illustration of these points—showing you how, under the operation of specific sanitary faults, the Cholera-mortality of districts acquires an artificial exaltation; but few comparisons will suffice. At the period of the epidemic of 1849, your best conditioned sub-district was the north-west of the City of London Union; and (among those of the same level) your worst was the sub-district of Cripplegate, which at that time was in a very unsatisfactory state, abounding in open cesspools and their consequences. In the former of these sub-districts the Cholera-mortality per 10,000 was 19; in the latter 47; and it is easy to show that additional sanitary errors soon develop a larger fatality. Not far from your boundary, at the same level with these two sub-districts, in the Hackney-Road division of Bethnal-Green, it rose to 110; this large mortality being principally confined to a very small portion of the district, wherein (the local Registrar reports) sewers were almost entirely absent, houses were contaminated with the filth of years, streets were remaining for days uncleansed from accumulating dirt, and all waste water (including animal secretions) was uniformly thrown into the public way.

Such are the conditions under which, at any imaginable height in the metropolis, Cholera may decimate a population: such, in their worst form, were the conditions which at Merthyr-Tydvil—several hundred feet above the water-level, carried the Cholera-mortality to more than double the high metropolitan rate just mentioned. Taught by this case the power of human mismanagement to futilise the favours of Nature; taught that perverse ingenuity can construct poison-beds for the development of Cholera, high above the usual track of its devastation; one gladly turns from the horrible instructiveness of such a lesson, to gather the kindred evidence of contrast: and happily there is abundant evidence to show how much may be effected, even in the most tainted districts, to purchase a circumscribed exemption from the disease by the judicious application of sanitary care.

In the remarks which I have made on the local distribution of Cholera, you will have observed that I dwell particularly on one class of sanitary evils as concerned in its production; on that class, namely, which consists in the retention and soakage of organic refuse—on that class, which has its appointed antidote in a system of inodorous drainage, of uninterrupted pavement, of complete and punctual scavenage.

On this I particularly insist, because I believe that here is the very atmosphere without which Cholera would cease.

Sanitary evils abound; and, if I were speaking of other diseases, I might have more to say of other causes. I am unwilling, even for a moment, to seem indifferent to those remaining fertile sources of suffering that surround the poor of our metropolitan population—to their over-crowded condition, to their scantiness of ventilation, to their insufficient or disgusting water-supply, to their frequent personal dirt, to their habitually defective diet. These several influences have their own characteristic sequels and retribution, on which I have often addressed you, and which I am little likely to underrate; believing, as I do, that, in the lapse of years, the aggregate of their effects is far more fatal than any periodical epidemic visitation. Likewise, I cannot doubt that, under certain circumstances, and in respect of particular cases, they may assist the operation of the choleraic poison. Nor will I pretend so exactly to limit the affinities of that which evolves this poison, as to deny that rooms, fœtid with animal exhalations, may (like cesspool-sodden cellars) be ready to answer the stimulus of its infection. And at any rate, I think it highly important to recognise that all sanitary defects which embarrass the excretive purification of the human body—whether by breathing or otherwise, do naturally tend in the same direction as the causes of Cholera, and are liable—if only by indirect means, to become accessory in its destructive work.

But, deeply impressed as I am with the importance of these considerations, I esteem it of still higher consequence, if measures are ever to be taken for an effective prevention of the disease, that the principle of its specific causation should be steadfastly kept in view. What may be the exact chemistry of this process, I do not pretend to say: urging only, that, in all human probability, the poison arises in specific changes impressed by some migratory agent upon certain refuse-elements of life. Perhaps nowhere, and certainly not before your Hon. Court, can it be desirable, in the present immaturity of pathological knowledge, to argue as to the first origin or absolute nature of that wandering influence which determines in particular localities the generation of epidemic malaria. Simply, since it leads to all-important practical conclusions, let this distinction be recognised: that which seems to have come to us from the East is not itself a poison, so much as it is a test and touchstone of poison. Whatever in its nature it may be, this at least we know of its operation. Past millions of scattered population it moves innocuous. Through the unpolluted atmosphere of cleanly districts, it migrates silently, without a blow: that which it can kindle into poison, lies not there. To the foul, damp breath of low-lying cities, it comes like a spark to powder. Here is contained that which it can swiftly make destructive,—soaked into soil, stagnant in water, griming the pavement, tainting the air—the slow rottenness of unremoved excrement, to which the first contact of this foreign ferment brings the occasion of changing into new and more deadly combinations.

These are matters which it is hateful to hear, and, believe me, to speak about. But the thing is worse than the statement; and I would suggest to you this easy test of its reality. Take at random any consecutive hundred entries of Cholera-Deaths in the Registrar-General’s metropolitan returns, where local conditions are described; and let any man decide for himself, whether what I have sketched in general terms convey more than the essential features of these several records. In 1849, such an atmosphere as these influences engender existed continuously and intensely on the low-lying south side of the river, and to some distance inland, from Greenwich to Wandsworth; it existed also continuously, but in far less intensity, and with comparatively little extension inland, along the northern side of the river from Poplar to Chelsea, and it existed very intensely in several independent centres, scattered about those healthier levels of the metropolis, which, by their better position, ought to have been exempted from such a reproach. The Cholera struck in the same proportion as this atmosphere prevailed; and herein, I repeat, lies that definite local condition, except for which—to the best of my knowledge and belief, the migratory ferment (whatever it may be) would pass harmlessly through the midst of us.