Part 35

Does not defective cleansing, as causing atmospheric impurity, not only tend to produce disease and shorten the duration of life, but depress the physical condition of the population?—Decidedly.

No. 5.

_Dr. Wray_, Medical Officer of the West London Union.

You have read what is stated by Mr. Blencarne, and by Mr. Abrahams—do you generally agree with them as to the effects of defective cleansing, on the condition of the population?—I agree with the whole of what they state; it perfectly accords with my own experience, which has been about 25 years in this district. I have during that time observed a great falling off in the condition of the children; they are stunted, squalid, poor-looking things, and there is a great deal of deformity amongst them.

Have you observed moral effects attendant on the physical depression?—Yes; I have observed a great deal in our neighbourhood. I think the females of the poorer classes who are not strong for work, are more apt to take to courses of livelihood other than by work;—that very many of them go upon the town.

No. 6.

_Mr. Thomas Porter_, Surgeon to the St. Botolph’s Bishopsgate District.

Have you observed any emanations from the sewers in your district?—In Liverpool-street there is now a cleansing of the sewers by opening the top, taking the soil out, and carting it away.

What is the effect of this process?—It vitiates the atmosphere to a considerable extent.

Have you observed any effects from it?—I have often found headache to result from it to myself, and parties have complained to me of the same effects.

What is the state of the drainage?—There are some districts, such as Halfmoon-street, which are imperfectly drained, where the cesspools are suffered to overflow and run along the kennels at the sides of the street, causing fœtid and deleterious exhalations; in this street and the alleys opening into it, especially Thompson’s-court, Thompson’-rents, Baker’s-court, Providence-place, and Campions-buildings, fever prevails nearly the whole year round. It also prevails very much in Bligh’s-buildings, Lamb-alley, Dunning’s-alley, Sweet Apple-court, Montague-court, Artillery-lane, Rose-alley, and Catherine-wheel-alley. These places, all of which are badly drained and not regularly cleansed, are seldom without fever for any length of time.

In these places are there any water-closets?—No; they have nothing but common necessaries, which are usually allowed to run over before they are emptied, and it is impossible to enter the tenements without being assailed by the disagreeable and unhealthy effluvia thence arising.

Have they water laid on in the rooms of the several tenements?—Seldom in the rooms; generally in some place in the court to which they all go. Many have not that even, and they resort to the common street pumps. I do not remember an instance where water is properly laid on in any house of the labouring classes.

What rents are paid for houses in this condition?—Rent for one room is from 1_s._ 6_d._ to 4_s._ 6_d._ per week. The rents are very high in proportion to the size and accommodation of the rooms.

You say you have observed emanations from the sewers within your district?—Yes; they are frequently very offensive in moist warm weather. You may, indeed, almost tell the condition of the weather from the smells from the public sewers. Recently in returning from Islington along the City-road from the Canal bridge to Finsbury-square, and along Sun-street, I noticed in passing near the gratings, as every person must have noticed, a peculiarly offensive effluvium.

Within the city itself have you perceived the same effluvium on passing the gratings of the sewers?—Frequently; it is so general that no particular place is distinguished by being free from it.

Suppose a tradesman or a merchant returning from Change in a state of depression from anxiety passing through a street, exposed to a succession of smells and breathing the effluvium from such sewers; what is likely to be the effect upon him?—A low nervous fever, with considerable gastric derangement. The greater part of fever cases which I have to treat are of this description.

Is that with every class of persons?—Yes, with every rank of life. They are mostly of the low or typhoid type, and do not bear depletion. In my ordinary course of treatment I generally begin by emptying the stomach and bowels, and by lowering the diet. I then use a moderately stimulating treatment with a perfect absence of solid food.

Is gross feeding or excess very common amongst the people of your district?—Not very common. Excess from drinking is more frequent than excess from eating.

In what proportion will there be of excess from eating or drinking in such cases?—Amongst the labouring classes perhaps there may be one case in ten from excess of drinking, and one case in thirty from excess of eating.

If these excesses had taken place in a purer atmosphere, do you conceive the results in disease would have followed?—In most instances the system in a pure atmosphere would have thrown off the inconvenience without fever.

Then excess or depression both predispose to the attacks of disease from atmospheric impurity, and especially to the direct influence of the effluvium in question?—Yes, certainly; excess of watching, want of rest, mental anxiety, every depressing cause predisposes to an attack.

Besides the defects in respect to the cleansing of the cesspools and the drains, are there not defects in respect to other portions of cleansing, such as dust-bins neglected?—Yes, in those places there is no person to regulate or to see that done which ought to be done; consequently the dustmen and scavengers duty is much neglected, and places are filled with decomposing remains, which remain there two or three weeks in summer and much longer in winter. The carelessness of the people themselves as to cleanliness is also deplorable, as it operates very injuriously on their health and comfort; the floors of their rooms, the passages, stairs, and landings are often suffered to remain unwashed for weeks and months, and the walls and ceilings are seldom cleansed or whitened, so that what with filthiness of one kind or other they present an appearance of wretchedness beyond all description.

What is the condition of the children born or kept in courts or places of the condition you describe, with badly cleansed drains, with privies, and without water or conveniences for cleansing introduced into their habitations?—The children are, for the most part, of delicate or weak frame, and subject to struma. The health of children depends partly whether they were born in such places or not, whether their parents on each side are Londoners, as there appears to be a gradual decline in physical power by a long continuance in a vitiated atmosphere, which passes from parent to progeny, and partly also in a family where one part of the children have been born and brought up in the country and the other in town; those born in the country, and not coming into London until they are five years of age, will have comparatively strong frames, and will resist such influences, whilst those born in town will be comparatively of delicate frame, weakly and strumous, liable to glandular disease, and diseased affections of the joints and the spine. Generally they are shorter in stature, sometimes they are taller, but then they are slender and very delicate, in which case they are likely to have bending of the limbs.

What is the condition of females born under such circumstances?—I have observed that the females are less depressed than the males, and are reared with less difficulty.

Why is this so?—I have not been able to determine. It may be that the male requires more extensive and powerful exercise, and that in pure air, than the female, and consequently that the female suffers less from the want of it.

What are the moral characteristics of the population brought up under these depressing physical circumstances?—They have decided unwillingness to labour. They are not so strenuous as the more healthy people from the country. They are more apt to resort to subterfuge to gain their ends without labour. Light employments they do not object to, and do comparatively well in. But it is difficult to keep a native of London, either male or female to heavy work; they will avoid it if they can. The cause is in most cases physical from the deficiency of ability to labour. The greatest part of them are mentally irritable and impatient under moral restraint.

Is any similar difference marked on the condition of the children of tradespeople between those children of tradespeople brought up in London and those born in the country?—Yes, there is a similar difference perceptible, but less in degree. Amongst tradesmen, too, it is the extensive practice of the parents to send their children out of town to school or on visits, which may powerfully affect them beneficially. In the tradesman’s family they have better sleeping rooms, and greater cleanliness in person, and in bed and body linen, and also a better regulated dietary.

What is the effect of such atmospheric impurities as those described in the chances of recovery from attacks of disease?—It lessens the chances of recovery and greatly impedes convalescence. Indeed, in many instances, very little progress can be made until the patient is sent out into the country. In a case of fever which occurred to a strong healthy man, aged 24, a carman, in a close neighbourhood, the house being without drains and ill ventilated; no progress could be effected until he was removed into the country, although the fever had decidedly subsided. I believe that in this case something else would have supervened, had he not been removed. I frequently remove patients in a respectable condition, finding no chance of recovery without it. Many of the better conditioned houses being badly adapted for the treatment of fevers, having low ceilings and insufficient ventilation.

What will be the difference in respect to the time of cure or convalescence between a well and an ill-cleansed neighbourhood?—A difference of perhaps one-half.

Suppose the rooms of each house supplied with water, the privies and cesspools removed, drains from the houses to sewers, and the sewers so constructed as to be cleansed, and to convey away daily such refuse as that which is allowed to remain decomposing in the close courts during weeks. Supposing the surfaces of the streets cleansed as frequently after the manner in use in Philadelphia and other towns where they are cleansed with water daily, to what extent do you conceive disease would be reduced?—Of fevers two-thirds certainly, and other diseases would be considerably lessened.

No. 7.

_Mr. John H. Paul_, Surgeon, Medical Officer of the City of London Union.

In what condition in respect to cleanliness are the courts and other places within your district, chiefly inhabited by the labouring classes?—The cleansing of the courts and alleys in my district is defective. I agree with what Mr. Blenkarne says in respect to cesspools. For instance, in one room in a house in Sugar Loaf-court, Garlick-hill, next to their common cesspool, I have frequently attended patients, and before going, I surmise that whatever disease they are primarily affected with, it will generally run into one of low character with tendency to typhus. In the interval of little more than a twelvemonth, I have attended several occupants of the house, one after the other, who have all been, to a certain extent, similarly affected. I have generally improved their health by giving diffusive stimuli, and have occasionally prevailed on them to remove.

How many visits in the year may you have paid to this same house?—Upwards of forty visits. But there are other houses where there are similar evils, where I have had occasion to visit them still more frequently. In one house in Star-court, Bread Street-hill, which is similarly situated, where almost the whole of the inmates were laid up with fever, and where I had to visit it three times a day for upwards of three weeks. There were deaths on each floor of that house. Fever assumed, at one time, so malignant an aspect, that there appeared to be no possibility of saving them, except by removal. I do not remember one case of a removal in time where death ensued. The ward inquest had the inhabitants removed, and the house cleansed.

But was the cesspool removed?—Emptied but not removed.

Then in time you will have a recurrence of the same evils in the place in question?—Yes, certainly.

What is the condition of children brought up in such places?—Generally pale and emaciated, scrofulous, and apt to mesenteric disease.

You were medical attendant at the Norwood school, where the pauper children from the city of London are taken. Do you think, that on a view of the children, and without any positive knowledge of the sort of residences of the parents of the children, you could on the view select from the rest, the children who came from the courts and alleys, such as you have described in the city of London?—I have but little doubt of it, though generally speaking the children from the city were of rather a better description than those from more crowded localities. Indeed, the courts and alleys of my district are superior to those in other quarters of the metropolis. They are situated near the banks of the Thames with a considerable fall towards the river. Some parents also take their children much out into the open air, and in these the influence of the place would not be so visible, but with the majority there would be but very little mistake. Whilst at Norwood, my chief trouble arose from this sick and diseased class of children, who generally improved very much after being there some little time.

What was the moral condition of these physically depressed children, as compared with other pauper children, whose position had been less unfavourable?—The moral condition of this depressed class of children was generally worse also.

No. 8.

_Effects observed of Dark, Ill-ventilated, and Ill-drained Localities on the Moral and Physical Condition of the Population of Paris._

Dr. la Chaise, in his Medical Topography of Paris, which is an early attempt to investigate the influence of localities on the moral and physical condition of a population, gives the following description of the physical condition of the short-lived population bred up in the narrow and dark streets, and ill-cleansed and badly ventilated houses of Paris, which description may serve for comparison with those given of the native population in the crowded and badly cleansed districts of London.

“The Parisian,” he says, “in stature is often below what is commonly termed middle-size. His fair skin, soft to the touch, forms a striking contrast to that of the inhabitant of small towns, and, above all, to the countryman, who is more exposed to the various changes of the weather, and to the action of the sun and light. The hair of the Parisian is generally fair or light brown, and his eyes blue. His muscular frame is little developed, so that the form has on the whole a feminine appearance. In the labouring class the muscles of the lower limbs are sometimes developed, but irregularly and incompletely, which is explained by the exercise given exclusively to certain muscles by their employment or handicraft; these irregularities of development are much less frequent in the rural districts where the movements, and consequently muscular actions, are much more equally divided. The temperament, that is to say the physical constitution peculiar to the Parisian, differs, as is perceived, from each of the distinct and determined forms admitted by physiologists. He seems to partake of the union of many,—to be intermediate between those which are recognized under the names nervous, bilious, and lymphatic-sanguine; the first seems, however, to predominate.

“It is not, however, rare to meet in Paris with physical constitutions entirely in the extremes and contrasted with each other; that is to say, there are here, as in other large towns, large numbers of weakly and debilitated, vulgarly called sickly, and others with hollow chest and tall slim figure.

“The women of Paris are rather pretty than handsome; without regular features, they owe to the development of the cellular tissue, and to the fairness and fineness of the skin, a certain softness of form which is very graceful; and a quick and spiritual eye makes one forget the paleness of their cheeks.

“Considered morally, the portrait of the Parisian presents colours which are not impossible to seize, notwithstanding their great variety. He may be said generally to be lively, spiritual, industrious, and deserving the name of frivolous. Much less perhaps is given him. He is inquisitive, and carries into his work a taste, an ardent imagination, and inventive mind, which he is willing to believe should compensate for sustained activity. There necessarily results from this a great nervous susceptibility, an _encéphalique_ predominance, which it is important to the physician never to overlook.

“If a sound and firm organization allows a few to resist the effects of this premature exercise of the organ of thought, a rapid increase in its functions always shows itself in the injury done to the other organs, and generally to the muscular system, which bear the marks of feebleness and often of deplorable languor. In this life, too active morally and too indolent physically, the nervous system acquires not what is vulgarly called a feebleness or delicacy, but a susceptibility, or rather a predominance, which is affected by the least shock. Hence that fickleness, and that vivacity of desires, that changeableness in the tastes, in a word that coquetry, that unequal and whimsical moody character, those caprices and vapours. The character is not alone affected by this excess of susceptibility; all the organs, the whole of the economy of the body feels it in turn; the nervous system acts particularly on the uterus, developes it prematurely; thus the women generally arrive at puberty much earlier at Paris than in the provinces, and especially than in the country. It is not unfrequent to find young girls of 12 or 13 fully formed and capable of becoming mothers, whilst in the country, even in the south, they do not attain that period till the age of 15 or 16.”

No. 9. NOTE TO PAGE 128, ON SIR CHRISTOPHER WREN’S PLAN FOR EXTRA MURAL INTERMENTS, AND FOR EXCLUDING GRAVEYARDS ON THE REBUILDING OF THE CITY OF LONDON.