Beyond the above points, which are of general application within the City, all your remaining precautions will relate to the condition of private houses: and of these—occupied by the poorer classes, there exist in the City some thousands over which it will be requisite, by repeated inspection, to maintain an efficient sanitary watch. From circumstances to which I have already referred, it appears that your defences against Cholera will very mainly consist in removing the causes of disease from within individual houses; and it is only by an organised system of inspection, for detecting and removing every unclean condition, that this object can be attained. For your encouragement in this task, I may venture to express my belief that, throughout a considerable portion of the City, the local affinities for Cholera are not too strong to be greatly modified and obviated by such a system.
With respect to this important work of sanitary inspection, what I now propose is no new proceeding within the City. More or less since the date of my appointment, but I hope with gradual increase of completeness and efficiency, weekly visitations on a considerable scale have been made, under my direction, by your four Inspectors of Nuisances. Acting under your authority, and guided by what information I could obtain on the existence of endemic disease[84] in your several districts, I have furnished the Inspectors every week with a variable list of houses, ranging probably from fifty to one hundred and fifty at a time, for their visitation and inquiry. The information which I have directed them to seek has referred of course to the various details of sanitary condition: to questions of lodgment, ventilation, cleanliness, drainage, water-supply, dust-removal, paving of yards and cellars, existence of nuisances, and the like: and I have constructed [tabular forms] for their use, which admit of this information being recorded and reviewed in the readiest manner. Week by week, before each meeting of your Court, I have had the habit of going through every particular of these somewhat considerable details. I have sorted out of them those very numerous cases in which your lawful powers could be usefully exerted. When I have deemed it necessary, I have myself made visits of verification or inquiry; and have finally laid before you, in the form which is familiar to your weekly meetings, such recommendations as the week’s survey has shown necessary, for enforcing works of local improvement under the powers of your Acts of Parliament. I find that within the last twelve months there have been made 3147 visitations of this nature, the results of which are recorded in your office; and, founded on the result of these inspections, there have been issued 983 orders for abatement of causes of disease.
[84] This information has been mainly derived from two sources:—first, from the weekly Death-Returns of the nine City Registrars, which the Registrar-General most kindly allows me to have transcribed so soon as they arrive at his office;—secondly, from weekly returns which the Medical Officers of the three City Unions have had the great kindness and liberality to supply for my assistance, as to the existence of fever and kindred disorders in the several localities under their charge.
I am very far from considering that these arrangements have been perfect. Circumstances beyond my control have prevented me from constructing as complete an organisation as I could wish; and the fact that your Inspectors are very largely employed in other duties, has perhaps occasionally given some hurry and imperfection to their share of the work. Still, such as it is, this system has been the means of considerable advantage; and I am glad to be able to claim for your Hon. Court the distinction of being first in the metropolis to have established an arrangement for the systematic sanitary visitation of the dwellings of the poor. In relation to this subject, I beg to inform your Hon. Court that your Inspectors have discharged, with much zeal, intelligence, and industry, the duties which you authorised me to impose on them.
During the last few weeks it has become obvious to your Hon. Court that the duties of this department of your service have grown to such dimensions as to necessitate some increase of your staff; and acting on this opinion, mainly with a view to render more complete your sanitary supervision of the City, you have just appointed two additional Inspectors of Nuisances. In making this appointment, you have determined not to restrict any two or three Inspectors exclusively to the business of house-inspection, but to allot the joint duties, sanitary and surveying, equally among their number: parting the area of the City into six, instead of four, Inspectors’ districts; so that each Inspector shall give a certain proportion of time to the duties which he has to fulfil under your Surveyor’s direction, and another certain proportion to those in which he will be engaged under the direction of your Officer of Health. It is only some experience of this arrangement that can decide whether it will be the most effectual for your purpose; but in the mean time I have studied so to dispose the industry of your increased staff, under the arrangement you have ordered, as to obtain the most systematic and efficient discharge of those duties which you have desired me to superintend.
Reckoning that each Inspector, if he fulfilled no other duty, could report on the condition of about fifty houses per diem, I presume that henceforth, in each of your five more important districts, from one hundred to one hundred and twenty houses can be visited weekly by the Inspector, without encroaching on the time required for his other duties.
The general plan, on which I would propose that this force should be disposed, is the following:—first, as heretofore, the weekly list would contain all places needing investigation on the ground of such deaths and illness as are usually associated with preventable causes, in order that any sanitary defects may at once be remedied in them; secondly, in each week there would fall due a certain number of sanitary works (relating to house-drainage, water-supply, and the like) for which you would have previously issued orders requiring them to be completed within a stated time, and on the satisfactory execution of these it will be the Inspectors duty to examine and certify; thirdly, in each district I would have a certain rota of visitation, according to the badness of the spot and its known liability to fall into filthy and unwholesome condition, requiring one set of houses to be seen weekly, another set fortnightly, another monthly, another quarterly, and so on—a rota, varying from time to time with the changing circumstances of each locality; and, out of this rota, each week would supply a stated number of cases for inquiry, to which I should occasionally add certain of those establishments in which offensive occupations are pursued. Thus, in the large number of weekly visits which I suppose the Inspector to make, there would be a certain proportion of that more elaborate kind which involves an examination of the entire house; another proportion, made for the sole purpose of seeing that previous orders have been executed; another proportion, repeated at fixed intervals, simply to ascertain that houses, once cleansed and repaired, are not relapsing into filth, nor their works becoming inefficient.
By utilising, on some such plan as this, the increased staff which you have appointed for the purpose, and by giving to its execution my continual superintendence, I trust to be able, from time to time, to certify you that the City becomes better and better capable of resisting epidemic invasion.[85] From such statements as I have set before you, on the local affinities of disease—not of Cholera alone, but of typhus and its kindred, you will be prepared to expect increased sanitary advantage, from this more systematic suppression of the causes of death: and I believe you will not be disappointed. Whether the anticipated pestilence rage in our metropolis or not, you will be combating, day by day, the influence of other malignant diseases. Whenever it may be in my power to tell you generally of the City, that the dwellings of the poor are no longer crowded and stifling; nor their walls mouldy; nor their yards and cellars unpaved and sodden; nor their water-supply defective; nor their drainage stinking; nor their atmosphere hurt by neighbouring nuisances; then, gentlemen, whether Cholera test your success or not, surely you will have contributed much to conquer more habitual enemies. For whatever there may be specific and exceptional in the production of Cholera, at least it touches no healthy spot: the local conditions which welcome its occasional presence are, in its absence, hour by hour, the workers of other death; and in rendering a locality secure against the one, you will also have made it less vulnerable by the others.
[85] I may take this opportunity of mentioning that, during the last few months, the increased sanitary staff has been worked with very great advantage.—J. S., May, 1854.
As a last suggestion in this part of my subject, there are two steps which I would recommend to your Hon. Court, as likely to assist the labours of your officers, and to bring a large quantity of important information before you:—first (according to a plan adopted here in the last epidemic) that printed notices should be posted in every back-street, court and alley of the City, and should be renewed once a month, advising the careful maintenance of cleanliness in all houses, and inviting all persons who are aggrieved by any nuisance, or by any neglect of scavengers and dustmen, or by any defect of water-supply, forthwith to make complaint at your Office, or to the Inspector of the district, whose name and address might be subjoined; secondly, that a circular letter should be written to all persons in parochial authority, also to other clergy, to heads of visiting societies and the like, begging them to communicate with your officers on every occasion when any local uncleanliness or nuisance may come within their knowledge.