Part 2

The medical officers will transmit to you the returns when completed, and by you they will be forwarded when the information required is obtained from all the medical officers to the office. In case of any defect in the returns which cannot be remedied, you will state the nature and extent of the same at the time of transmission.

Before transmitting the returns, you are to read them at a meeting of the Board of Guardians, acquaint them with the answers, and annex any further information which they may be enabled to communicate in aid of the inquiry.

Signed, by Order of the Board, EDWIN CHADWICK, _Secretary_.

To the Clerk to the Board of Guardians.

3.—_Circular Letter of Inquiry to the Medical Officers of the Unions in England and Wales, transmitted to them, with Forms of Return, through the Clerks to the Guardians._

Poor Law Commission Office, Somerset House, 12th November, 1839.

Sir,—With the view of ascertaining the extent of the existence of circumstances promoting the prevalence of contagious and infectious diseases described in the reports referred to in the Order of the House of Lords, set forth in the letter from Lord John Russell, a copy of which is hereto annexed, you are requested to fill from the medical relief Lists the enclosed returns, and transmit them to the clerk of the union, with such observations as occur to you thereon.

You will observe that the object of the Commissioners is to ascertain the existence and extent of the visible and removable agencies promoting the prevalence of such diseases as are commonly found connected with the defects in the situation and structure or internal economy of the residences of the labouring classes.

The attention of the physicians who drew reports on the state of the metropolis was almost exclusively directed to the causes affecting the prevalence of various forms of _continued fever_, arranged under distinguishing names adopted by nosological writers: but in rural districts the prevalence of ague, and of small-pox, and scarlet fever, may be worthy of notice when the causes promoting their prevalence appear removable.

You will, in your observations on the class of cases returned, note the situation, character and quality of the tenements in which the diseases have occurred;—whether they are situated in a neighbourhood habitually infected with malaria;—whether there are occasional causes of malaria, such as floods, &c.; and in such cases, whether you have any suggestions to make as to the best means of diminishing the evil;—whether they are drained or undrained, whether tight or otherwise;—whether there are good means of securing ventilation with a due regard to warmth;—whether there are accumulations of filth, and if so, whether they are ascribable to the slovenly or indolent habits of the inmates, or to the want of proper receptacles for refuse;—whether the occurrence of disease amidst this part of the population is regular or otherwise, and what are the seasons at which it appears, and its characteristics.

The Commissioners request that you will favour them with any information which you may have gained in the course of your medical experience, as to the condition of the inmates of such residences;—whether there is a need of superior cottage accommodation, or to what extent the improvement of the residence would influence the habits beneficially; as, for example,—whether you have witnessed any beneficial effects on the habits of the inmates by providing cottages with a day-room, scullery, pantry, three bed-rooms, and convenient receptacles for refuse and for fuel;—whether within your district there are other labourers of the like class, who occupy improved tenements in a superior situation, and what is the general health and condition of the inmates as compared with the general health and condition of the inmates less advantageously situated;—whether you have seen any cottages constructed with a view to the most economical management of fuel both in cooking and maintaining a proper temperature in the rooms;—and further, any observations that may occur to you on the subject of the health of the labouring classes in connexion with what may appear to you to be available sanitary regulations.

The accompanying portions of the report, and the appendix referred to in their lordships’ order, are transmitted for your information as to the causes of disease existing in the metropolis, which it is deemed necessary to investigate in other parts of the country.

Signed, by Order of the Board, EDWIN CHADWICK, _Secretary_.

To the Medical Officer of the District.

(COPY.)

Whitehall, August 21, 1839.

Gentlemen,—The Queen having been pleased to comply with the prayer of an humble address presented to Her Majesty, in pursuance of an order of The House of Lords, dated 19th August, 1839, “that Her Majesty will be pleased to cause inquiry to be made as to the extent to which the causes of disease stated in the Appendix A., No. 1, of the Poor Law Commissioners’ Fourth Annual Report, and Appendix C., No. 2, of their Fifth Annual Report, to prevail amongst the labouring classes in the metropolis, prevail also amongst the labouring classes in other parts of England and Wales; and that Her Majesty will be graciously pleased to cause the results of such inquiry to be communicated to the House,”—I have to desire that you will cause inquiry to be made accordingly, and that you will prepare a report upon the results of such inquiry, and transmit the same to me, in order that it may be laid before the House of Lords.

I am, Gentlemen, Your obedient Servant, (Signed) J. RUSSELL.

_Form of Return transmitted with the above Letter to the Medical Officer._

_For the Year ended September 29, 1829._

A RETURN from Mr. ________ Medical Officer of the ________ District of the ________ Union.

┌───────────────┬───────────┬───────────┬─────────────────────────────┐ │ CASES. │Occupation │ Situation │ OBSERVATIONS. │ │ │ of │ and State │ │ │ │Applicants.│ of │ │ │ │ │Residence. │ │ ├───┬───────────┼───────────┼───────────┼─────────────────────────────┤ │No.│Nosological│ │ │(If there should not be │ │of.│ Names of. │ │ │ sufficient space for the │ │ │ │ │ │ requisite Observations, │ │ │ │ │ │ space for the requisite │ │ │ │ │ │ Observations, they may be │ │ │ │ │ │ continued on the back of │ │ │ │ │ │ the Return, or on a │ │ │ │ │ │ fly-leaf, to be attached to│ │ │ │ │ │ the Return.) │ ├───┼───────────┼───────────┼───────────┼─────────────────────────────┤ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ └───┴───────────┴───────────┴───────────┴─────────────────────────────┘

Signature of Medical Officer: ________

4.—_Circular Letter to the Provosts of Burghs in Scotland._

Poor Law Commission Office, Somerset House, London, 1840.

Sir,—The Poor Law Commissioners have received from Her Majesty directions to extend to Scotland the inquiry they have, in compliance with an address from the House of Lords, been directed to make in England as to the causes of disease and destitution arising from the situation and construction of the dwellings of the labouring classes, and from other similar circumstances affecting their sanitary condition.

The Commissioners request your aid in conducting the inquiry in the of The Commissioners have obtained valuable information in England from the medical practitioners who have the care of hospitals and dispensaries, where those contagious febrile diseases to which their attention has been specially directed come under the observation and treatment of experienced professional men.

The Commissioners ask of you the favour of putting them in communication with the officers of the medical charities and establishments in the of , whether supported by the voluntary subscriptions of the inhabitants or by payments out of the town funds, or both.

The Commissioners desire to ascertain, either from the officers of such institutions or from the medical practitioners of the most extensive practice amongst the poorer classes, or from those who visit them in their habitations, to what extent continued fever, and other contagious febrile diseases, are prevalent amongst the poor;—what is the character of the streets and houses in which these maladies most frequently arise, or spread with the greatest rapidity; the state of the paving,—scavenging, and sewerage of such streets,—their width,—the drainage of the houses,—their size,—their state of repair,—the number of families living under one roof,—the number living in cellars;—and other circumstances relating to the structure and situation of the habitations of the poorer classes, and their habits, by which they may be rendered more susceptible of the influence of contagion.

The Commissioners would also be glad to obtain information whether the main sewers of the town have been constructed in a satisfactory manner, and kept in good repair; and to what body, and with what powers this duty is confided;—whether there are any sanitary regulations of a local character for the enforcement of the paving of streets, and of drainage on the owners of houses erected within a reasonable distance of sewers;—whether any local body has power to interfere in the removal of any, and if so of what, nuisances injurious to health; or to cause lodging-houses, and dwellings liable to be infected with fever, to be cleansed and whitewashed from time to time, and by whom the expense of such interference is sustained.

The Commissioners are further desirous of ascertaining whether the authority possessed by the town council, or other local body intrusted with the paving, scavenging, sewerage, the removal of nuisances and other causes of disease, are sufficient, or might in any respect be increased with advantage to the sanitary condition of the town, and especially of those parts of the town which are inhabited chiefly or exclusively by the working classes, and which are therefore comparatively remote from the observation, and less subject to the interference of the middle classes.

The Commissioners will be glad to obtain from you or from the town council of any suggestions which you may be desirous to make on the subject; and they trust they may have the benefit of your advice and assistance in the inquiry with which they are charged in the of and its suburbs.

I have the honour to be, Sir, Your very obedient servant, EDWIN CHADWICK, _Secretary_.

_To_ The Provost of

5.—_Circular Letter of Inquiry to Dispensary Surgeons and Medical Practitioners in Scotland._

Poor Law Commission Office, Somerset House, London, 19th June, 1840.

Sir,—The Poor Law Commissioners have been directed to extend to Scotland the inquiry which in the past year they received Her Majesty’s commands to conduct in England, for the purpose of ascertaining what circumstances in the condition of the poorer classes promote the spread of continued fever and other contagious febrile diseases.

They are desirous that this inquiry should be conducted with care in large towns, where the sources of contagion or the circumstances which promote its rapid diffusion among the population are more rife than in the rural districts; they are anxious to obtain the assistance of the medical practitioners having charge of hospitals and dispensaries in such towns, because such institutions afford the best means of observing under what circumstances febrile contagious diseases are disseminated; of defining the districts of the town in which they spread; of ascertaining the character of the streets and houses in such districts; the comparative attention paid to the paving, sewerage, and drainage of these districts; and whether or not they are subject to malarious influences.

The structure of the dwellings of the labouring classes; the nature and extent of their internal accommodation, and of the means for securing cleanliness, for removing filth, for promoting ventilation, and for providing warmth with due economy, can be most easily ascertained by medical gentlemen who devote their time to the frequently gratuitous services of public institutions; they also are most competent to discriminate between the direct influence of the habits of the poorer classes, and of the external circumstances by which they are surrounded, on their sanitary condition; while on the other hand they will not be liable to fall into the error of supposing that these habits are independent of arrangements which administer to domestic comfort.

The Commissioners trust, therefore, they may rely with confidence on your affording them your valuable assistance in the inquiry which they are directed to pursue. They trust you will permit them to suggest that if the cases recorded in the books of your hospital were grouped according to the districts from which the patients were removed, you would at once be able to define in a map those parts of your town most subject to contagious febrile diseases, and to furnish the Commissioners with the number of cases of each febrile disease occurring in each of these districts, and would possess the means of ascertaining and delineating the features of those districts in all that relates to the sanitary condition of the inhabitants, and to medical police. Besides the general influences alluded to in the former part of this letter, you will probably find it useful to ascertain whether any injurious consequences are clearly attributable to certain classes of manufactories surrounded by the habitations of the poor, to the location of slaughter-houses, tanneries, ancient burial grounds, &c., amidst dense masses of the population.

In the course of this inquiry it may be found necessary to distinguish the extent of disease caused by physical or removable agencies, by malaria created by defective drainage, or the bad construction of the dwellings of the labouring classes, from disease caused by destitution of the proper means of subsistence arising from poverty. It may be expected of the medical practitioners from whom the Commissioners hope to obtain reports, that they will make the distinction wherever it is found to exist.

The Commissioners will value any suggestions you may have to offer respecting the removal of the injurious agencies which may fall under your observation. You are probably well acquainted with the nature of the powers confided to the municipal authorities or other local bodies respecting the paving, sewerage, and drainage of the town, and especially of those parts of it which are inhabited chiefly or solely by the working classes. The Commissioners request you to observe whether those powers enable the municipal or other local body to complete the sewerage, and to enforce the paving and drainage of the streets partially or wholly at the expense of the proprietors of these houses.

The spread of contagious diseases is greatly facilitated in many towns by the extreme filth of lodging-houses to which mendicants and vagrants resort, and of the habitations of certain of the lowest portion of the poorer class; measures of medical police have been resorted to on the occurrence of epidemic fevers, and at the period of the invasion of cholera, for cleansing and whitewashing these habitations at the expense of the inhabitants. The Commissioners request you to state under what circumstances you conceive such measures might be usefully resorted to, and under what superintendence, and whether the expense should fall on the owners of such habitations or on the inhabitants generally, and whether this interference should be habitual or casual.

Suggestions have been made to the Commissioners that the nature of the thoroughfares, and the structure and internal arrangement of the buildings in districts inhabited by the working classes in large towns would be greatly improved if subject to the regulations of a Building Act enforced by the municipal authorities, or by a local board of health; they invite you to reflect on the provisions of such a law, and to state under what circumstances and to what extent you conceive such interference desirable.

Generally the Commissioners are desirous to receive your impressions respecting the means of improving the sanitary condition of the working classes, especially in those parts of your town in which contagious febrile diseases most frequently prevail.

Copies of the forms and exemplifications of the mode of entering the particulars of the information sought in the returns circulated in England, and the reports on the sanitary condition of the labouring classes in the metropolis, are herewith transmitted for your use. The Commissioners have not asked for returns in any prescribed form from the medical practitioners in the towns of Scotland, because they are uninformed as to the nature of the existing records of facts relating to medical statistics in the towns, and they wish to consult the practitioners’ convenience, and be guided by them as to the best use to be made of the local circumstances for obtaining information.

I have the honour to be, Sir, Your very obedient Servant, EDWIN CHADWICK, _Secretary_.

_To_ ________

6.—_Form of General Queries addressed to Medical Practitioners and others for Information as to the Condition of the Labouring Classes in Scotland._

1. Have diseases of the various forms of continued fever, and other contagious febrile diseases, been prevalent in any, and what, parts of your parish or district, and do such diseases recur at regular intervals, or are they rare and occasioned only?

2. What are the seasons at which such diseases appear amidst any part of the population, and what their characteristics?

3. Did the cholera at the time of its general prevalence prevail to any, and what, extent within the district?

4. What is the _external_ condition, in the following respects, of the residences of the population amidst which such diseases occur?

(_a._) As to the contiguity of vegetable or animal substances in a state of decomposition, stagnant pools or undrained marshes, accumulations of refuse, either thrown from houses or otherwise?

(_b._) As to the means adopted or the means available for the _removal_ of such substances, or the prevention of the generation of malaria; whether there are sufficient drains or sewers, adequately well supplied with water to dilute, and sufficiently sloping to carry off all such refuse; whether such drains are sufficiently _closed_ to confine noxious exhalations from them; whether there is any regularly appointed service of scavengers or otherwise for the removal of such substances; whether there is such ventilation around the residences of, as to dissipate the noxious vapours apparently irremovable?

5. Describe the _internal structure and economy_ of the residences of the population amidst which contagious febrile diseases arise,—

(_a._) State whether they, as well as the surrounding land, are drained or undrained?

(_b._) Whether they are properly supplied with water for the purposes of cleanliness of the houses, persons, and clothing?

(_c._) Whether there are good means of ventilation with a due regard to warmth?

(_d._) Whether there are proper receptacles for filth in connexion with the cottages?

6. As to the internal economy of such residences, describe further,—

(_a._) Whether they are unduly crowded, and several families or persons occupy the space which would properly suffice only for a less number?

(_b._) Whether there are any inferior lodging-houses crowded by mendicants or vagrants?

(_c._) Whether there is gross want of cleanliness in the persons or habitations of certain classes of the poor?

(_d._) Whether there is a habit of keeping pigs, &c., in dwelling-houses, or close to doors or windows?

(_e._) Whether there is an indisposition to be removed to the hospitals when infected with contagious disease?

7. Of the diseases described in question 1, are any or what proportion ascribable to other causes than those specified in questions 4, 5, and 6? if so, distinguish those other causes so far as you are able, and the extent of diseases resulting from them.

8. What is the common cost of erection and average cost of repairing each description of the tenements or cottages inhabited by the labouring classes?

9. What are the rents paid by the labourers for each description of tenements or cottages?

10. What is the general proportion of the rent paid by the labourer to his total expenditure?

11. What is the common cost of the lodgings to persons of the labouring classes?

12. Are you of opinion that any, and what, legislative measures are desirable or available for remedy of any of the evils existing within your district?

13. Have any, and what, voluntary exertions been made to improve the external or internal economy of the residences of the labouring classes within your district? and if so, describe their nature and effects.

_Name of the parish or district to which the preceding answers│ refer._ │————————

_Name of the medical practitioner or other person by whom the │ answers are given._ │————————

NOTE.—Where the space opposite to any question does not suffice for the full answer which it may be desirable to give, it may be written on the blank space at the back of the sheet, or on a separate sheet, reference being made to the number or letter of the question.

Any general observations may be hereunder annexed.

It is requested that the answer may be transmitted by the post to “The Poor Law Commissioners,” according to the address on the inside of the envelope which may be used for the purpose.

REPORT

ON THE

SANITARY CONDITION OF THE LABOURING POPULATION OF GREAT BRITAIN.

BY EDWIN CHADWICK, ESQ., BARRISTER AT LAW, AND SECRETARY TO THE BOARD OF POOR LAW COMMISSIONERS.

CONTENTS.

GENERAL PREVALENCE OF EPIDEMIC, ENDEMIC, AND CONTAGIOUS DISEASES.

PAGE

Return of the number of deaths in 1838, in each county, from epidemic, endemic, and other diseases, most powerfully affected by the physical state of a district 2

Extent of evils which are the subject of inquiry 3

I. GENERAL CONDITION OF THE RESIDENCES OF THE LABOURING CLASSES, WHERE DISEASE IS FOUND TO BE THE MOST PREVALENT— 5

In Tiverton union, Cornwall 5

In Truro, Cornwall 6

In Cerne union, Dorset 8