Part 31

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.

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.

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.

Further--from what I have said as to the conditions of our vulnerability by Cholera, you will be prepared to think it of great importance that, during the next six months, you should be certified on the state of your sewers, in every part of the City, as to their greatest possible cleanliness and least possible offensiveness of ventilation. Fifty miles of sewer, reticulated through the City, sufficiently attest your active desire to provide for the complete and continuous carrying away of all excremental matters: and you will excuse me, I hope, in consideration of the anxieties of my office, if I seem superfluously cautious in reminding you that the test of successful sewers lies in an inodorous fulfilment of their duty, and that every complaint of offensive emanations indicates, in proportion to its extent, a failure of that sanitary object for which the construction was designed.

There is one precaution--always of great value to the health of towns, and especially useful against any malarious infection, which happily I find it needless to recommend. The paving of all public ways within the City--including every court and alley--is already so complete as to constitute a very favorable point in your sanitary defences. In order that this excellent arrangement may give its full fruit, it will be requisite--though this again I need hardly press on your consideration, that the duties of scavengers and dustmen be thoroughly and punctually performed.

Again, I would particularly advise that great vigilance be exercised in all markets, slaughtering-places, and other establishments under your jurisdiction, to prevent the retention of refuse-matter, animal or vegetable. I would urge the strictest enforcement of all regulations which you have made for the cleanliness of such places, and for the removal of their putrefiable refuse.

Likewise, I have to suggest that after the month of May, at latest, no disturbance of earth to any considerable depth should be allowed to take place, either in your works or in those of gas and water companies, except under circumstances of urgent necessity. In the lower levels of the City, particularly, I conceive this prohibition to be a matter of paramount importance; because the soil, never of unexceptionable cleanliness in towns, is here especially apt to be of offensive quality.

On the subject of water in its general relations to the City, I have only again to express my deep regret that it lies out of your present power to compel a continuous supply, and that your means are restricted to choosing what may best compensate for the absence of this sanitary boon. It must be your aim to mitigate, so far as may be, the evils that belong to an ill-regulated intermittent system in its adaptation to the houses of the poor--evils which imply, as I have often told you, not only much domestic dirt, but likewise a frequent suspension of all efficiency in the drainage of innumerable houses. With a view to the best alternative for a continuous supply, I would recommend that at least a daily filling of all cisternage take place, and expressly that Sunday form no exception to the advantages of this rule. If a choice of evils must be made, I trust it is no heathen’s part to urge that the Christian Sabbath suffers more desecration in the filth and preventable unwholesomeness of many thousand households, than in the honest industry of a dozen turncocks. I likewise submit, that it would be highly advantageous to the labouring poor, most of whose domestic cleansing is reserved for the last day of the week, that, on that day, a second delivery of water should take place at some hour in the afternoon.

I wish it were in my power to tell your Hon. Court that the supply of water to the City of London had become, in quality, all that I think it might be rendered. Such as it is, however, there depend other very important issues on its being delivered in ample abundance for all the purposes of cleanliness; and I am glad to have learned from the eminent engineer of the New River Company, that he has it in expectation very shortly to be able to furnish to the City a largely increased and practically inexhaustible supply.

The subject of water in its district relations ought hardly to be passed without a word of caution as to the use of pumps within the City. I need hardly inform you that every spring of water represents the drainage of a certain surface or thickness of soil, and that--such as are the qualities of this gathering ground, such must be the qualities of the water. You will, perhaps, remember that in my account of one celebrated City pump, which sucks from beneath a churchyard, I showed you ninety grains of solid matter in every gallon of its water. In virtue of that wonderful action which earth exerts on organic matter, the former contents of a coffin, here re-appearing in a spring, had undergone so complete a change as to be insusceptible of further putrefaction: the grateful coolness, so much admired in the produce of that popular pump, chiefly depending on a proportion of nitre, which arises in the chemical transformation of human remains, and which being dissolved in the water, gives it, I believe, some refrigerant taste and slight diuretic action. Undoubtedly this water is an objectionable beverage in respect of its several saline ingredients; but my present object in adverting to them is rather to illustrate an anterior danger which they imply. Their presence indicates a comparative completion of the putrefactive process, effected by the uniform filtration of organic solutions through a porous soil. Let that soil have frequent fissures in its substance; or let its thickness be scanty in proportion to the organic matters to be acted on: and the water, imperfectly filtered, would run off foul and putrescent. Now this risk, more or less, belongs to all pumps within the City of London. They draw from a ground excavated in all directions by sewers, drains, cesspools, gas-pipes, burial-pits. The immense amount of organic matter which infiltrates the soil does undoubtedly, for the greater part, suffer oxidation, and pass into chemical repose: but in any particular case it is the merest chance, whether the glass of water raised to the mouth shall be fraught only with saline results of decomposition--in itself an objectionable issue--or shall contain organic refuse in the active and infectious stage of its earlier transformations. Some recent cutting of a trench, or breakage of a drain in the neighbourhood, may have converted a draught, which before was chronicly unwholesome, into one immediately perilous to life. Such facts ought to be known to all persons having custody of pumps within urban districts; and it ought likewise to be known that this infiltrative spoiling of springs may occur to the distance of many hundred yards.

This very important influence, exerted by the earth on various organic infiltrations, is referred to in the text only under one point of view; only as it occasions the deterioration of land-springs in urban districts, and renders their water unfit for consumption. But the subject has another equally important side. Such springs, having their waters laden with nitrates, represent the continuous removal of organic impurities which otherwise would contaminate the air. The evil of spoiled springs, therefore--while it necessitates for every urban population that their water-supply shall be artificially furnished from a distance, has great countervailing advantages. A given organic soakage will cease to vitiate the atmosphere by evaporation, in proportion as it gravitates to lower levels, and undergoes those chemical changes which accompany filtration through the soil. Hence it is evident that, for the healthiness of inhabited districts (where extensive soakage of organic matters is almost invariable) it becomes most important to maintain, or by artificial measures to accelerate, this down-draught through the soil; and the reader will scarcely need to be reminded, that, in those improvements of metropolitan sewerage, which it is a chief object of this Report to advocate, complete provision for the continuous drainage of soil is implied as an essential part.

For a fact strikingly illustrative of this, I am indebted to my colleague, Dr. R. D. THOMSON, Lecturer on Chemistry at St. Thomas’s Hospital. At Liverpool--in three wells which he examined, distant severally 760, 800, and 1050 yards from the Mersey, he found the water brackish from marine soakage, containing four or five hundred grains of solid matter per gallon, and totally unfit for consumption.

In final reference to the quality of water, whether supplied by our trading companies or derived from springs within the City, I think it expedient to mention that, against its lesser impurities, great protection is given by filtration through animal charcoal, as in various ‘filters and purifiers’ which are before the public. These protective means do not lie within reach of the poorer classes; nor, whatever their accessibility to individuals, can any such personal arrangements render it less important to provide that water--the first necessary of life--be supplied for universal use in its utmost procurable purity.

* * * * *

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 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.

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.