Reports Relating to the Sanitary Condition of the City of London

by John Simon

According to this standard (undoubtedly a very superior one) it would appear that, during the last year, death has prevailed in the City of London with nearly three times its recognised minimum of severity.

But, to avoid all sources of fallacy, I will allow a very ample margin to this estimate; I will take 15 per thousand as a fair standard of mortality, and will assume that last year’s deaths in the City have amounted to only double their normal proportion.

Probably no one contends that the lower rate of mortality, as illustrated at Dulwich or Sydenham, indicates an over-healthy condition of the locality to which it refers. Probably no one argues that human life, in those healthier districts, is prolonged beyond enviable limits. Surely, on the contrary, every one who can measure the large amount of misery and destitution which results from a high rate of mortality, will think it most desirable that, by every means within the scope of sanitary science, exertion should be made to reduce the higher rate to the level of the lower.

Therefore, Gentlemen, I venture to assure myself, that I shall but have anticipated the wishes of this Hon. Court, in preparing for your consideration a statement of those circumstances, which apparently conspire to determine the larger mortality of the City of London.

In order to prevent any misapprehension of my remarks, I think it well to observe that, in commenting on this mortality, I purposely avoid instituting any comparison between it and the mortality of those urban districts which immediately adjoin us: for the object of my comparison is not to illustrate how, by similar or worse circumstances, an equally great mortality may have been procured elsewhere; but rather to suggest how, by other and better sanitary arrangements here, our present high mortality may be diminished.

Indeed, while I speak of the causes of that high mortality which distinguishes the City of London from the healthier sub-districts I have cited, it will be obvious that many of my observations do not apply to the City of London exclusively, but admit of equal application to various other central districts of the metropolis;—relating, in fact, generally to the characteristic evils of all urban residences.

With those other districts I have nothing to do; but I wish it to be understood, that in describing the City as healthy or unhealthy, I am not comparing it with Holborn, or Whitechapel, or Bermondsey, or other urban localities, where—whatever the relative badness of the places, the scale of comparison would be essentially vicious, and the results of comparison worthless. It is my object to test the salubrity of the City by comparison with a superior standard, in order that some definite aim may appear, towards which to direct the endeavours of sanitary improvement.

Starting, then, from our Registrars’ Returns, I invite you to inquire with me, how it has come to pass that within the City of London there have died in the last year twice as many persons as it seems necessary that there should die; and whence has arisen the apparent anomaly, that here—in the very focus of civilization, where the resources of curative medicine are greatest, and all the appliances of charitable relief most effectual, still, notwithstanding these advantages, there has passed away irrevocably during the year so undue a proportion of human life.

Let it not be imagined that the word cholera is a sufficient answer to these questions, or that its mention can supersede the necessity for sanitary investigation. Let it, on the contrary, be observed that the epidemic which has visited us, extends its ravages only to localities previously and otherwise hostile to life; so that, while all regions of the globe in succession are shadowed by its dark transit, the healthiest districts of each region remain utterly unharmed in presence of the pestilence. Compare, for instance, the cholera mortality in a healthy suburban sub-district with that of an unhealthy urban one. Dulwich and the parish of St. Ann’s, Blackfriars, in the City of London, are probably nearly equal in population: in the former, there was not a single death from cholera; in the latter, the deaths from this cause alone were at the rate of twenty-five to every thousand of the population. Dulwich is one of the healthiest sub-districts within the bills of mortality; St. Ann’s belongs to one of the unhealthiest sub-districts of the City of London; and the cholera visited each in proportion to its ordinary healthiness.

Such is the general rule; and accordingly I would suggest to you that the presence of epidemic cholera, instead of serving to explain away the local inequalities of mortality, does, in fact, only constitute a most important additional testimony to the salubrity or insalubrity of a district, and renders more evident any disparity of condition which may previously have been overlooked. The frightful phenomenon of a periodic pestilence belongs only to defective sanitary arrangements; and, in comparing one local death-rate with another, it is requisite to remember that, in addition to the ordinary redundance of deaths which marks an unhealthy district, there is a tendency from time to time to the recurrence of epidemic pestilence, which visits all unhealthy districts disproportionately, and renders their annual excess of mortality still more egregious and glaring.