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In 1838 in their fourth report, the Poor Law Commissioners commented on the financial cost to the Poor Law authorities of neglecting sanitation. Taken from Parliamentary Papers, 1837/8. xxxviii, pp. 211-213. Appendix A1.
In general, all epidemics and all infectious diseases are attended with charges immediate and ultimate, on the poor-rates. Labourers are suddenly thrown, by infectious disease, into a state of destitution, for which immediate relief must be given. In the case of death, the widow and the children are thrown as paupers on the parish. The amount of burthens thus produced is frequently so great as to render it good economy on the part of the administrators of the poor laws to incur the charges for preventing the evils, where they are ascribable to physical causes, which there are no other means of removing. The more frequent course has been, where the causes of disease are nuisances, for the parish officers to indict the parties for nuisance, and to defray the expenses from the poor-rates.
During the last two years the public has suffered severely from epidemics. At the present time, fever prevails to an unusually alarming extent in the metropolis, and the pressure of the claims for relief in the rural Unions, on the ground of destitution caused by sickness, have recently been extremely severe; but, in the course of the investigations of the claims for relief arising from the prevalent sickness, extensive and constantly acting physical causes of sickness and destitution have been disclosed and rendered fearfully manifest. With reference to the claims for relief on the ground of sickness, in the metropolis, we have directed special inquiries to be made of the medical officers of the new Unions. We have also directed local examinations to be made, in parts of the metropolis where fever was stated to be the most prevalent, by Dr. Arnott by Dr. Southwood Smith (the chief physician of the London Fever Hospital), and by Dr. Kay, our Assistant Commissioner. The more important communications of the medical officers are comprehended in the medical report prepared by Dr. Kay, with the concurrence of Dr. Arnott, We have given their opinions in a Supplement to this Report, and also the report made to us by Dr. Southwood Smith, on the sanitary condition of the districts comprehended by Bethnal Green and Whitechapel. From this last report we select the following instances of the condition in which several neighbourhoods, densely populated by the labouring classes, have been found: -
"Lamb's Fields. -An open area, of about 700 feet in length and 300 feet in breadth. Of this space about 300 feet are constantly covered by stagnant water in winter and summer. In the part thus submerged there is always a quantity of putrefying animal and vegetable matter, the odour of which, at the present moment, is most offensive. An open filthy ditch encircles this place, which, at the western extremity, is from 8 to 10 feet wide. Into this part of the ditch the privies of all the houses of a street called North-street open: these privies are completely uncovered, and the soil from them is allowed to accumulate in the open ditch, Nothing can be conceived more disgusting than the appearance of this ditch for an extent of from 300 feet to 400 feet, and the odour of the effluvia from it is at this moment most offensive.
Lamb's Fields is the fruitful source of fever to the houses which immediately surround it, and to the small streets which branch off from it. Particular houses were pointed out to me, from which entire families have been swept away; and, from several of the streets, fever is never absent. In several houses in Collingwood-street, fever of the most severe and fatal character has been raging for several months. Part of the street called Duke-street is often completely under water: this street consists of about 40 houses; in 12 of them all the members of the families residing in them have been attacked with fever, one after another, and many have died.
"Virginia-row.- In the centre of this street there is a gutter, into which potato parings, the refuse of vegetable and animal matter of all kinds, the dirty water from the washing of clothes and of the houses are all poured, and there they stagnate and putrefy. In a direct line from Virginia-row to Shoreditch, a mile in extent, all the lanes, courts, and alleys in the neighbour-hood pour their contents into the centre of the main street, where they stagnate and putrefy. Families live in the cellars and kitchens of these undrained houses, dark and extremely damp. In some or other of these houses fever is always prevalent, 'My assistance here,' said the medical officer who was attending me, 'is always required: I am never without cases of fever here'"
An instance of other prevalent causes is stated in the communication of Mr. Tensh, the medical officer to the Hackney Board of Guardians: "In my district, comprising Homerton and Mare-street, of the Hackney Union, I am seldom without cases of a typhoid character, and have carefully searched through my register of sickness from Lady-day 1837 to Lady-day 1838, and find there have been 24 cases of severe typhus, of which four were fatal; 15 of the number were, in one locality named Silkmill-row and Wick-street, attributable, I think, to an obstruction by a dam to a mill, which allows a large accumulation of decaying and other matter of deleterious nature, likely to cause an atmosphere not at all congenial to health, which aided by, I am sorry to say, the innate want of cleanliness and care on the part of the poor, frequently gives rise to fevers of this description, notwithstanding my very urgent and strenuous endeavours to inculcate their importance to their own welfare and comfort. There are two or three other places where the drainage is not so good as it might be: Cross-street and College-street, Homerton; Wood's-yard and Wells-street, These are, I believe, private property. As to that previously mentioned, it has been the subject of litigation between, I believe, the parochial authorities and the party to whom it belongs."'
Several officers have fallen victims to the prevalent disease. The excuse from one Union, for answers being only given by one medical officer is, that the other officer had fallen a victim to typhus fever, caught in the course of the performance of his duties in the infected neighbourhoods. In one Union, two of the relieving Officers have, within a short time, been carried off by fever, caught in a similar manner. The extent of the pressure upon the rates, in many instances arising from the causes specified, may be judged of from the following return from the parish of Bethnal Green, which has a population of 62,018 : -
St. Matthew, Bethnal Green.
"Numbers of fever cases attended by the medical officers of this parish, for one quarter ending 25th March 1838.
Mr. Taylor, out-door surgeon 256 cases
Mr. Goodwin, ditto 136
Mr. Ager, house surgeon 129
"'The cost of in-door cases is at least 5s.weekly, averaging 20s. for each case, before the patient is sufficiently recovered.
"Twenty-six cases were admitted into the London Fever Hospital, at the cost of £ 27. 6s. to the parish for the last quarter, in addition to the number above reported."
It is stated that the number of fever cases which have been attended by the medical officers in the parish of Whitechapel, within one year, is upwards of 2,000.
All the evidence is strongly expressive of the want of immediate legislative measures to check the evil against which the Boards of Guardians have made such exertions as were within their power. The guardians of Camberwell state that they have made representations to the Commissioners of Sewers, from which we extract the following, of the date of the 18th ultimo :- "They, the guardians, beg to represent that a proper drainage is extremely essential to a great part of this parish, on account of its exceedingly low level, while it is comparatively easy of attainment by reason of the gravelly nature of its soil.
"They beg to remind the Commissioners that an attempt to drain the village of Peckham was made some years since, but this drain has been left in an unfinished and imperfect state, and the guardians wish to impress on the Commissioners the necessity of its immediate completion.
"The guardians have been given to understand that this completion has been hitherto delayed by the want of funds; but they cannot admit this to be a valid excuse, when it consists with their own knowledge that a great number of the inhabitants are rated to the sewers, which, as far as they, the inhabitants, are concerned, have no existence, and from which, of course, they can derive no benefit.
"The guardians therefore earnestly request the Commissioners to take this matter into their immediate and most serious consideration; and they press it more earnestly at the present time, because, in addition to the ordinary nuisances, the pond on the green, which is situate in the very heart of the village, has, ever since the frost, sent forth such a terrible effluvia as to render the front rooms of the houses around it scarcely habitable, and to fill the whole neighbourhood with alarm at the probable consequences when the hot weather shall arrive."
Mr. Bowling, a medical officer of the Kensington Union, states,- "We have always had, at certain seasons of the year, fever prevailing to a great extent among the poor, attributable in a great measure to miasma, produced by a quantity of water which has been left stagnant on the surface of the earth after brick-making, and which, in process of time, had become full of vegetable matter. Some years ago this evil had become so alarming that the inhabitants, influenced by the respectable medical men in the neighbourhood, agreed to adopt measures for improving the drainage, and the parish expended considerable sums in so doing; but we have still several places, inhabited by paupers, without any drainage at all, or what there is so very insufficient that a great quantity of filth of all descriptions is constantly lying on the surface.
"It appears, by the register of sickness and mortality, that we have had 104 cases of fever from the 29th of September to the 25th of March, and the greater part of these are certainly to be attributed to causes that might be removed by improved drainage or greater cleanliness. These are independent of small-pox and other diseases, the malignancy of which must be increased by the above circumstances."
Mr. Wagstaffe, one of the medical officers of Lambeth, represents that not only the existence of disease, but of particular diseases, may be inferred from obvious physical and removable causes: -"According to the district or situation, so you will have the different degrees of fever, such as ague, typhus in all its stages, yellow, and many other kinds."
We have eagerly availed ourselves of the opportunity of making the present Report to submit to your Lordship the urgent necessity of applying to the Legislature for immediate measures for the removal of these constantly acting causes of destitution and death All delay must be attended with extensive misery, and we would urge the consideration of the fact, that in a large proportion of cases the labouring classes, though aware of the surrounding causes of evil, have few or no means of avoiding them, and little or no choice of their dwellings. The Boards of Guardians have now the services of an efficient body of officers, including experienced medical officers, to guide them in the application of sanitary measures more efficiently than was practicable by the overseers of single parishes under the old system. Until more complete measures could be obtained, and even as a temporary measure, we should recommend that the guardians should be empowered to exercise the like powers that have heretofore been exercised, and incur the like charges that have heretofore been irregularly incurred by parish officers; that they should be empowered to indict parties responsible for such nuisances as those described, and to make arrangements with the owners of property, or take other measures, according to circumstances, for the removal of the causes of disease in cases where there is no ostensible party who can be required to perform that duty. So extreme has been the social disorder, and so abject is the poverty of some of the places which are now the seats of disease, that great numbers of the dwellings have been entirely abandoned by the leaseholders.
The fifth report of the Poor Law Commissioners in 1839 commented on the correlation between fever and pauperism. Taken from Parliamentary Papers, 1839/xx, p. 118, Appendix C 2
There is no disease which brings so much affliction into a poor man's family as fever. From the ages which the preceding Table shows to be peculiarly predisposed to this malady, it is obvious that it most commonly attacks the heads of the family, those upon whose daily labour the subsistence of the family depends. The present returns afford melancholy evidence of the pauperising influence of this prevalent and fatal disease. They show that out of the total number of persons in London who received parochial relief during the last year, more than one-fifth were the subjects of fever. In Bethnal-green the proportion was one-third, in Whitechapel it was nearly one-half, and in St. George the Martyr it was 1,276 out of 1,467. Placing out of consideration the suffering of the individual attacked with fever, which is one of the most painful maladies to which the human being is subject, placing out of view also the distress brought upon all the members of the family of the sick, it is plain that this disease is one of the main causes of pressure upon the poor rates. That pressure must continue, and the same large sums of money must be expended year after year for the support of families afflicted with fever, as long as those dreadful sources of fever which encompass the habitations of the poor are allowed to remain. They would not be allowed to remain if their nature were really understood, and if the ease with which the most urgent of them might be removed were known.
While systematic efforts, on a large scale, have been made to widen the streets, to remove obstructions to the circulation of free currents of air, to extend and perfect the drainage and sewerage, and to prevent the accumulation of putrefying vegetable and animal substances in the places in which the wealthier classes reside, nothing whatever has been done to improve the condition of the districts inhabited by the poor. These neglected places are out of view and are not thought of; their condition is known only to the parish officers and the medical men whose duties oblige them to visit the inhabitants to relieve their necessities, and to attend the sick; and even these services are not to be performed without danger. Such is the filthy, close and crowded state of the houses, and the poisonous condition of the localities in which the greater part of the houses are situated, from the total want of drainage, and the masses of putrefying matters of all sorts which are allowed to remain and accumulate indefinitely, that during the last year, in several of the parishes, both relieving officers and medical men lost their lives in consequence of the brief stay in these places which they were obliged to make in the performance of their duties. Yet in these pestilential places the industrious poor are obliged to take up their abode; they have no choice; they must live in what houses they can get nearest the places where they find employment. By no prudence or forethought on their part can they avoid the dreadful evils of this class to which they are thus exposed. No returns can show the amount of suffering which they have had to endure from causes of this kind during the last year; but the present returns indicate some of the final results of that suffering; they show that out of 77,000 persons 14,000 have been attacked with fever, one-fifth part of the whole; and that out of the 14,000 attacked nearly 1,300 have died. The public, meantime, have suffered to a far greater extent than they are aware of, from this appalling amount of wretchedness, sickness and mortality. Independently of the large amount of money which they have had to pay in the support of the sick, and of the families of the sick, pauperised in consequence of the heads of those families having become unable to pursue their occupations, they have suffered more seriously from the spread of fever to their own habitations and families. It is notorious that this disease has been very prevalent during the last year among the industrious classes who have never received parochial relief, and that it has found its way even into the dwellings of the rich, where it has proved extremely mortal. Generated in Bethnal Green, in Whitechapel, in St. George the Martyr, in Lambeth, in Holborn, &c., it has spread to the better streets in the immediate neighbourhood of these and similar places, and thence to still wider and more airy streets at a greater distance, and ultimately to the most remote streets and the great squares. There can be no security against the constant recurrence of this calamity, but the adoption of measures adequate to diminish very materially, if not entirely to prevent, the generation of the febrile poison in every district. This might be done to a large extent by an amendment of the Building Act; by carrying into the districts of the poor improvements similar to those already completed, or now in progress, in the places inhabited by the wealthier classes; by removing as far as practicable the obstacles to a free circulation of air in the closest and most densely populated neighbourhoods; by the construction of underground sewers, with effectual surface-drainage into them, and by the immediate removal of refuse animal and vegetable matters by an efficient body of scavengers. The expenditure necessary to the adoption and maintenance of these measures of prevention, would ultimately amount to less than the cost of the disease now constantly engendered. The most pestilential of these places, when once put into a wholesome condition, could be maintained in that state at a comparatively small expense, whereas as long as they are allowed to remain in their present condition, the results must continue the same; it follows, that the prevention of the evil, rather than the mitigation of the consequences of it, is not only the most beneficent but the most economical course.
I am, &c.
(Signed) Southwood Smith
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