Part 10

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2. That from this account there should be made out, at least twice yearly, a list of houses and streets remaining in an objectionable sanitary state; and a list, also, of such as may have been remedied to the satisfaction of the Committee since the formation of their last preceding list:

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3. That, while trades injurious to health or offensive to their neighbourhood are suffered to continue within the City, there should be given periodical reports on the condition of such establishments, to the end that they may be so maintained as to be least detrimental to the public health:

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4. That a record of every death registered as occurring in the population of the City should lie before the Committee; and

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5. I consider it quite indispensable, that they should likewise receive the largest and most accurate returns which can be procured of all sickness occurring among the poorer classes; and (particularly in respect of all epidemic, endemic, and infectious disorders) that the medical practitioner who communicates the fact of illness, should likewise report the existence of any local causes, or other influences of general operation, which have tended to produce, or are tending to continue, such illness.

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On the subject of returns of the nature last referred to, I have already, on various occasions, submitted my opinion to the judgment of your Hon. Court. A year ago, in the first Report which I had the honour to make here, and in various discussions which during some months followed the reception of that Report, I stated how necessary I deemed such returns, for the purpose of guiding and justifying the various recommendations which it would become my duty to lay before you. The period which has since elapsed, including its three months of pestilence, has furnished me with the strongest confirmation of those views. As I formerly stated by anticipation, so now I repeat from experience, that nothing deserving the name of sanitary administration can exist in the City, without accurate periodical intelligence of all such sickness (at least) as comes under parochial treatment; or without such reports on the local sanitary conditions, and on other causes of disease, as were desired to accompany that intelligence.

When the matter was previously under your consideration, it was argued that the reception of such intelligence formed no part of your functions as a Commission for draining, lighting, paving, and cleansing the City of London; that all sanitary matters, beyond these and the like, were foreign to your proper sphere of operation; and that your funds, raised by rates from the citizens of London, could not with propriety be applied to meet the expenses of such an arrangement. On this question of jurisdiction and finance I shall, of course, hazard no opinion. I would simply beg to repeat, with regard to so much of the matter as lies within my own professional province, that the intelligence in question is absolutely necessary for the present progress of sanitary measures within the City; that no Health-Committee can exist for a month without it; nor can any officer, having proper respect for his character, consent to be considered responsible for the health of a population, whose illnesses he learns only from their posthumous record in the death-register.

During the recent prevalence of cholera, the Health-Committee of the Common Council complied for the time with my recommendation, and established a system of daily reports, rendered still more serviceable by free personal intercourse between myself and the several gentlemen having medical charge of the three City unions. What needed to be daily during a period of pestilence, might fitly become a weekly communication at all other times. I have already reported to the Health-Committee, and I beg to reiterate here, that the advantages derived from that system of communication were such as could have been attained in no other way.

I may remind you that each of the gentlemen referred to, serving under the Poor Law, works within a certain small and definite district; that he is therefore peculiarly competent to speak on the state of the population in that district, on their habits and necessities, on their customary condition of health, and on their liability to epidemic disease; and that the total staff of these officers, taken collectively, representing the medical practice of the whole city, can supply exactly that kind of detailed and precise information which is most serviceable to your Officer of Health, in guiding him to those more general and comprehensive conclusions which it is his business to lay before you. These gentlemen are the habitual medical attendants of the poorer classes; day by day, in the unobtrusive beneficence of their calling, they pass from house to house, and from court to court--the constant recipients of complaint, or the constant observers of ground of complaint--amid all that destitute population on whose condition you require to be informed. They are in the constant presence of the pestilences which reign in our worst localities; they are the chief treaters of endemic disease within the City--of that disease which, by its proportion, measures the success of sanitary changes, or indicates their failure; and it has been the professional education of these gentlemen, as it is their business, to trace such effects to their causes. Their reports would be the authenticated statements of experienced medical practitioners, familiarly conversant with their several respective localities.

If it were your wish and object, with utter indifference to expense, to organise the best scheme for procuring to yourselves from time to time a succession of accurate and trustworthy reports on the state of health, and condition of dwellings, in the several districts of the City;--if you were willing to engage a large number of non-medical persons who should give their whole time to the duty of exploring and reporting on that state, I am persuaded that this expensive and cumbrous proceeding would have a smaller measure of success than that which I submit to you, and which consists essentially in availing yourselves of the local knowledge and daily observations of a staff of officers, already organised and in active occupation for the very purposes in question.

That such intelligence, embracing weekly returns from the eleven parochial surgeons of the City of London, and including their comments on the local causes of prevailing disease, would involve an annual expenditure of money,--and that this expenditure, sooner or later, and in some form or other, would be derived from the rate-paying portion of the community, are facts which cannot be doubted. But that the expenditure would be a judicious one; that it is indispensable to the effective working of any Health-Committee, or any Health-Officer within the City; that it would be the first step to the mitigation of the disorders reported on; that it would disclose evils which else must escape recognition and remedy; that in a few years it would render our general mortality of 3 per cent. on the entire population of the City a matter of history and a warning, instead of its being, as now, a present and awful reality; that in lessening sickness and death, it would stay a large source of pauperism, would diminish the number of occasional and habitual claimants of Union relief, and would become a measure of real and considerable economy;--these are points on which, with the utmost sense of official responsibility, I beg to record my deliberate conviction.

When the matter was last under consideration of the Commissioners, it appeared that the expense of such an arrangement would be about £250 annually.--J. S., 1854.

Accordingly, I have to recommend that any Committee, which may undertake the administration of sanitary affairs for the City, shall be furnished as completely as possible with information of the nature I have specified.

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Another element to which I think it necessary to advert, in connexion with a future sanitary organisation for the City, is this,--that some permanent arrangement should be made, by which the maintenance of exterior and interior cleanliness, the enforcement of scavengers’ duties, the suppression of nuisances, and the like, should be brought under habitual and systematic surveillance; one, by which all breaches of your present or future sanitary regulations may be quickly detected, and may be visited with their appropriate penalties as speedily and as certainly as possible. I am induced the rather to bring this subject before you, as complaints of scavengers’ duties being neglected have reached me at every turn. I am informed that it is usual for them to refuse to remove dirt and rubbish from houses, according to the terms of their contract, except on the tenants’ payment of an additional gratuity; and it must be obvious to your Hon. Court that the arrangements which you have made by contract for this purpose are virtually defeated, as regards the poorer population, when the removal of refuse-matter is made contingent on the gift of beer-money by those whose means are so restricted.

It is in respect of matters of this sort, and of such only, that I think the services of the Police-Force might usefully be employed. Their want of special education, and their employment in other duties, are circumstances which appear to me quite conclusive for objecting to their utilisation as sanitary reporters. But while I entertain the opinion that their employment in the latter direction would be both fruitless and inconvenient, I would submit that their numbers and their diffusion through the City qualify them well to act against all causers of nuisance, as they act against other offenders, both detectively and preventively; and I would venture to repeat a suggestion, which I made in January last, ‘that the police should consider it part of their duty, to report on every nuisance within their knowledge, and on every infraction of such sanitary rules as this Court may establish.’

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Here, Gentlemen, terminates the list of subjects which, on this occasion, I have thought it my duty to bring before you. Long as the enumeration may have appeared, I can assure you that my present Report bears a small proportion, in point of dimensions, to the very large and very various mass of materials on which it is founded. In compressing it within the narrowest limits consistent with intelligibility, and in excluding from it nearly all details on the matters treated of, I have consulted the convenience of your Hon. Court, notwithstanding the greater labour and difficulty of execution which belong to the plan I have adopted. At any time, in Court or in Committee, when you may wish to pursue the subject, I shall be ready to enter at far greater length, and with more elaborate minuteness, on any of those subjects which, at the present opportunity, I have only sketched for your general information.

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In the matters which I have enumerated, some lie distinctly within your province, as assigned by the Act of Parliament; while others may be thought to lie, just as distinctly, without that province. In affairs strictly under your jurisdiction, and within the present scope of the law, there remains very much to achieve. The complete enforcement of house-drainage, till every house washes itself into the sewer; the more general distribution of water, till every individual within the City has an abundant supply within his immediate reach; the effective preservation of public cleanliness; the construction and maintenance of sewerage, paving, lighting, for all the streets, courts and passages of this great City;--these constitute an immense amount of responsibility and labour. Those other objects to which I have referred, are partly such as cannot be accomplished without the further interference of the Legislature. It is a point solely for the discretion of your Hon. Court to determine, how far you may be willing to enlarge the sphere of your sanitary operations, and to undertake the difficulties of a new campaign.

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To your Officer of Health the Act of Parliament allows no such option. ‘Whereas the health of the population, especially of the poorer classes, is frequently injured by the prevalence of epidemical and other disorders,’ therefore it is appointed for his duty that he shall report on whatsoever ‘injuriously affects the health of the inhabitants of the City,’ and that he shall ‘point out the most efficacious mode of checking or preventing the spread of contagious or other epidemic disease.’ Actuated by obligation of the duty thus expressed in your Act of Parliament, after full reflection on all that those expressions imply, and with the deepest sense of the responsibility belonging to one who is honoured with the task of advising the first Corporation of the country in respect of its sanitary proceedings, I have been compelled, in the course of my present Report, to trench upon many subjects which do not customarily fall under your consideration, and which (as I have stated) may by some be considered as utterly foreign to your jurisdiction and province.

It rests with your Hon. Court to determine what course you will adopt in respect of such departments of the great sanitary scheme;--whether you will retain them under your consideration, and will assume the responsibility of dealing with them in proportion to their magnitude and importance, or will transfer them to the Court of Common Council for the less restricted deliberation of that body.

Let me once more declare my profound conviction of their importance to the health and welfare of the City.