Reports Relating to the Sanitary Condition of the City of London

by John Simon

For, towards the chemical constitution of local atmospheres, it seems that the several principles of epidemic diseases stand in the same sort of fixed respective relations, as do the several principles of infective fevers towards certain elements in the blood of individual persons. Just as the infective ferment acts on man, so appears the epidemic ferment to act on locality. We know that, in a given group of human beings, small-pox chooses one victim, scarlatina another, measles a third, by reason of some material quality in each person respectively, which his blood possesses, and which his neighbour’s blood does not possess. By virtue of this quality—not the less chemical because chemists have no name for it, that specific exterior agency, which we call infection, has the power of affecting each such person—has the power of producing in him a succession of characteristic chemical changes which tend to an eventual close by exhausting this material which feeds them.[81]

[81] For the scientific reader, I may perhaps be permitted to add, that the very difficult Subject, at which here I can only venture to glance, is discussed at some length in one of my Pathological Lectures, delivered at St. Thomas’s Hospital in 1850, published at that time in the Lancet, and subsequently reprinted.—J. S., 1854.

Strictly analogous to this, in its principle of choice and in its method of operation, appears the epidemic action—not on persons indeed, but on places. The specific migrating power—whatever its nature, has the faculty of infecting districts in a manner detrimental to life, only when their atmosphere is fraught with certain products susceptible, under its influence, of undergoing poisonous transformation.

These products, it is true, are but imperfectly known to us. Under the vague name of putrefaction we include all those thousand-fold possibilities of new combination, to which organic matters are exposed in their gradual declension from life. The birth of one such combination rather than another is the postulate for an epidemic poison.

Whether the ferment, which induces this particular change in certain elements of our atmosphere, may ever be some accident of local origin, or must always be the creeping infection from similar atmospheres elsewhere similarly affected; whether the first impulse, here or there, be given by this agency or by that—by heat, by magnetism, by planets or meteors—such questions are widely irrelevant to the purpose for which I have the honour of addressing you. The one great pathological fact, which I have sought to bring into prominence for your knowledge and application, is this:—that the epidemic prevalence of Cholera does not arise in some new cloud of venom, floating above reach and control, high over successive lands, and raining down upon them without difference its prepared distillation of death; but that—so far as scientific analysis can decide, it depends on one occasional phase of an influence which is always about us—on one change of materials which in their other changes give rise to other ills; that these materials, so perilously prone to explode into one or other breath of epidemic pestilence, are the dense exhalations of animal uncleanness which infect, in varying proportion, the entire area of our metropolis; and that, from the nature of the case, it must remain optional with those who witness the dreadful infliction, whether they will indolently acquiesce in their continued and increasing liabilities to a degrading calamity, or will employ the requisite skill, science, and energy, to remove from before their thresholds these filthy sources of misfortune.

2. If, gentlemen, I have detained you long in stating conclusions as to the habits of the disease, and as to the significance of its local partialities, it has been in order to render quite obvious to you the intention of those precautionary measures which it is now my duty to recommend.

First, I would allude to influences of an exterior and public kind; and here, all that I have to advocate might be included in a single stipulation, that cleanliness—in the widest sense of the word—should be enforced to the full extent of your authority.

Over the pollutions of the river, and over the tidal exposure of its malarious banks, you have no power.

Whether for the relief of your low-lying districts—subject to imminent risk from causes I have described—there can be found any temporary protection to save their atmosphere from contamination, is a question which you will resolve upon other judgment than mine.

Along the river-bank there is one especial source of nuisance which has repeatedly been under your notice, and which is likely to become of serious local import under the presence of epidemic disease. I refer to the docks, and chiefly to that of Whitefriars. I mention it particularly, not only because the accumulations of putrid matter there have often been alarmingly great, but likewise because, at the head of this dock, during the former invasion of Cholera, there was remarkable prevalence of the disease; and I can well remember how often the offensive condition of the dock was accused, not unjustly, of contributing to the mortality of the neighbourhood. The fœtid materials, floated into these several recesses of the river, and left stranded there by the receding tide, are often so copious as to produce very objectionable effects on the atmosphere which surrounds them; and I would beg leave strongly to urge that such sources of nuisance should be thoroughly and permanently removed.