Part 5
┌───────────┬───────────────────────────────┬───────────┬───────────┐ │ │ │Proportion │Proportion │ │ │ │ of Deaths │ of Deaths │ │ │ │ from the │ from all │ │ │ │ preceding │ Causes of │ │ COUNTIES. │ Number of Deaths during the │ Causes in │ Mortality │ │ │Year ended 31st December, 1838 │every 1000 │ in every │ │ │ from │ of the │1000 of the│ │ │ │Population,│Population,│ │ │ │ 1841. │ 1841. │ │ ├─────────┬─────────┬───────────┤ │ │ │ │ 3 │ │ │ │ │ │ │Diseases │ 4 │ Total │ │ │ │ │of Brain │Diseases │Deaths from│ │ │ │ │ Nerves │ of │ the four │ │ │ │ │ and │Digestive│ preceding │ │ │ │ │ Senses. │ Organs │Classes of │ │ │ │ │ │ │ Diseases. │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ ├───────────┼─────────┼─────────┼───────────┼───────────┼───────────┤ │ ENGLAND. │ │ │ │ │ │ │Bedford │ 304│ 131│ 1382│ 13│ 22│ │Berks │ 467│ 201│ 2399│ 15│ 25│ │Bucks │ 348│ 152│ 1696│ 11│ 19│ │Cambridge │ 318│ 189│ 1933│ 12│ 21│ │Chester │ 1442│ 421│ 5452│ 14│ 21│ │Cornwall │ 631│ 228│ 3832│ 11│ 18│ │Cumberland │ 278│ 169│ 1673│ 9│ 21│ │Derby │ 777│ 268│ 2976│ 11│ 18│ │Devon │ 1237│ 471│ 5893│ 11│ 18│ │Dorset │ 380│ 159│ 1892│ 11│ 19│ │Durham │ 1138│ 274│ 4094│ 13│ 21│ │Essex │ 782│ 268│ 3933│ 11│ 19│ │Gloucester │ 1142│ 510│ 5594│ 13│ 20│ │Hereford │ 238│ 62│ 966│ 8│ 18│ │Hertford │ 453│ 155│ 1794│ 11│ 20│ │Huntingdon │ 140│ 72│ 612│ 10│ 18│ │Kent │ 1650│ 651│ 6940│ 13│ 21│ │Lancaster │ 7457│ 3231│ 29690│ 18│ 25│ │Leicester │ 668│ 314│ 2778│ 13│ 21│ │Lincoln │ 1090│ 358│ 3437│ 9│ 17│ │Middlesex │ 6643│ 2492│ 30803│ 20│ 27│ │Monmouth │ 550│ 100│ 2181│ 16│ 24│ │Norfolk │ 793│ 395│ 3995│ 10│ 19│ │Northampt^n│ 503│ 212│ 2361│ 12│ 21│ │Northumb^d │ 709│ 388│ 3013│ 12│ 21│ │Nottingham │ 901│ 287│ 2918│ 12│ 20│ │Oxford │ 389│ 180│ 1897│ 12│ 21│ │Rutland │ 56│ 28│ 196│ 9│ 17│ │Salop │ 550│ 284│ 2856│ 12│ 21│ │Somerset │ 982│ 473│ 5417│ 12│ 21│ │Southampt^n│ 881│ 372│ 3988│ 17│ 19│ │Stafford │ 1251│ 597│ 5924│ 12│ 18│ │Suffolk │ 538│ 275│ 3634│ 12│ 20│ │Surrey │ 2325│ 763│ 9866│ 11│ 25│ │Sussex │ 863│ 295│ 3326│ 11│ 18│ │Warwick │ 978│ 638│ 5336│ 13│ 20│ │Westmorel^d│ 154│ 46│ 653│ 12│ 21│ │Wilts │ 606│ 241│ 3104│ 12│ 20│ │Worcester │ 645│ 446│ 3735│ 16│ 29│ │York, E. R.│ 1009│ 251│ 2957│ 13│ 21│ │York, N. R.│ 553│ 1861│ │ 9│ 17│ │York, W. R.│ 4374│ 1494│ 15768│ 14│ 21│ │ │ │ │ │ │ │ │ WALES. │ │ │ │ │ │ │North. │ 1311│ 198│ 4510│ 13│ 18│ │South. │ 1200│ 380│ 7034│ 14│ 21│ ├───────────┼─────────┼─────────┼───────────┼───────────┼───────────┤ │Total, 1838│ 49,704│ 19,306│ 216,299│ 14│ 22│ ╞═══════════╪═════════╪═════════╪═══════════╪═══════════╪═══════════╡ │Total, 1839│ 49,215│ 20,767│ 214,771│ 14│ 21│ └───────────┴─────────┴─────────┴───────────┴───────────┴───────────┘
Extent of evils which are the subject of inquiry
The registration of the causes of death for the year 1838 is selected, as that was the year when the report was made on the sanitary condition of the labouring population in the metropolis, which has served as the foundation of the extended inquiry.
There are no returns, and no adequate data for returns, to show the proportion in which deaths from the several causes above specified occur amongst the population of Scotland, but there is evidence to which reference will subsequently be made tending to prove that the mortality from fever is greater in Glasgow, Edinburgh, and Dundee than in the most crowded towns in England.
The registered mortality from all specified diseases in England and Wales was, during the year 1838, 282,940, or 18 per thousand of the population. These deaths are exclusive of the deaths from old age, which amounted to 35,564, and the deaths from violence, which amounted to 12,055. The deaths from causes not specified were 11,970. The total amount of deaths was 342,529 for that year. In the year following the total deaths were 338,979, of which the registered deaths from old age were 35,063, and the deaths from violence 11,980. The proportion of deaths for the whole population was 21 per thousand.
It appears that fever, after its ravages amongst the infant population, falls with the greatest intensity on the adult population in the vigour of life. The periods at which the ravages of the other diseases, consumption, small-pox, and measles take place, are sufficiently well known. The proportions in which the diseases have prevailed in the several counties will be found deserving of peculiar attention.
A conception may be formed of the aggregate effects of the several causes of mortality from the fact, that of the deaths caused during one year in England and Wales by epidemic, endemic, and contagious diseases, including fever, typhus, and scarlatina, amounting to 56,461, the great proportion of which are proved to be preventible, it may be said that the effect is as if the whole county of Westmoreland, now containing 56,469 souls, or the whole county of Huntingdonshire, or any other equivalent district, were entirely depopulated annually, and were only occupied again by the growth of a new and feeble population living under the fears of a similar visitation. The annual slaughter in England and Wales from preventible causes of typhus which attacks persons in the vigour of life, appears to be double the amount of what was suffered by the Allied Armies in the battle of Waterloo. It will be shown that diseases such as those which now prevail on land, did within the experience of persons still living, formerly prevail to a greater extent at sea, and have since been prevented by sanitary regulations; and that when they did so prevail in ships of war, the deaths from them were more than double in amount of the deaths in battle. But the number of persons who die is to be taken also as the indication of the much greater number of persons who fall sick, and who, although they escape, are subjected to the suffering and loss occasioned by attacks of disease. Thus it was found on the original inquiry in the metropolis, that the deaths from fever amounted to 1 in 10 of the number attacked. If this proportion held equally throughout the country, then a quarter of a million of persons will have been subjected to loss and suffering from an attack of fever during the year; and in so far as the proportions of attacks to deaths is diminished, so it appears from the reports is the intensity and suffering from the disease generally increased. It appears that the extremes of mortality at the Small-pox Hospital, in London, amongst those attacked, have been 15 per cent. and 42 per cent. But if, according to other statements, the average mortality be taken at 1 in 5, or 20 per cent., the number of persons attacked in England and Wales during the year of the return, must amount to upwards of 16,000 persons killed, and more than 80,000 persons subjected to the sufferings of disease, including, in the case of the labouring classes, the loss of labour and long-continued debility; and in respect to all classes, often permanent disfigurement, and occasionally the loss of sight.
In a subsequent part of this report, evidence will be adduced to show in what proportion these causes of death fall upon the poorer classes as compared with the other classes of society inhabiting the same towns or districts, and in what proportions the deaths fall amongst persons of the same class inhabiting districts differently situated.
The first extracts present the subjects of the inquiry in their general condition under the operation of several causes, yet almost all will be found to point to one particular, namely, atmospheric impurity, occasioned by means within the control of legislation, as the main cause of the ravages of epidemic, endemic, and contagious diseases among the community, and as aggravating most other diseases. The subsequent extracts from the sanitary reports from different places will show that the impurity and its evil consequences are greater or less in different places, according as there is more or less sufficient drainage of houses, streets, roads, and land, combined with more or less sufficient means of cleansing and removing solid refuse and impurities, by available supplies of water for the purpose. Then will follow the description of the effects of overcrowding the places of work and dwellings, including the effects of the defective ventilation of dwelling-houses, and of places of work where there are fumes or dust produced. To these will be added the information collected as to the good or evil moral habits promoted by the nature of the residence. These will form so many successive sections of the report, and will be followed by information in respect to the means available for the prevention of the evils described, and an exposition of the present state of the law for the protection of the public health, and of modifications apparently requisite to secure the desired results.
I.—GENERAL CONDITION OF THE RESIDENCES OF THE LABOURING CLASSES WHERE DISEASE IS FOUND TO BE THE MOST PREVALENT.
The following extracts will serve to show, in the language chiefly of eye-witnesses, the varied forms in which disease attendant on removable circumstances appears from one end of the island to the other amidst the population of rural villages, and of the smaller towns, as well as amidst the population of the commercial cities and the most thronged of the manufacturing districts—in which last pestilence is frequently supposed to have its chief and almost exclusive residence.
Commencing with the reports on the sanitary condition of the population in Cornwall and Devon, _Mr. Gilbert_, when acting as Assistant Commissioner for those counties, reports, that he found the open drains and sewers the most prominent cause of malaria. He gives the following as an instance of the common condition of the dwellings of the labouring classes in Devon, where it will be observed that the registered deaths from the four classes of disease amounted in one year to 5893 cases.
“In Tiverton there is a large district, from which I find numerous applications were made for relief to the Board of Guardians, in consequence of illness from fever. The expense in procuring the necessary attention and care, and the diet and comforts recommended by the medical officer, were in each case very high, and particularly attracted my attention.
“I requested the medical officer to accompany me through the district, and with him, and afterwards by myself, I visited the district, and examined the cottages and families living there. The land is nearly on a level with the water, the ground is marshy, and the sewers all open. Before reaching the district, I was assailed by a most disagreeable smell; and it was clear to the sense that the air was full of most injurious malaria. The inhabitants, easily distinguishable from the inhabitants of the other parts of the town, had all a sickly, miserable appearance. The open drains in some cases ran immediately before the doors of the houses, and some of the houses were surrounded by wide open drains, full of all the animal and vegetable refuse not only of the houses in that part, but of those in other parts of Tiverton. In many of the houses, persons were confined with fever and different diseases, and all I talked to either were ill or had been so: and the whole community presented a melancholy spectacle of disease and misery.
“Attempts have been made on various occasions by the local authorities to correct this state of things by compelling the occupants of the houses to remove nuisances, and to have the drains covered; but they find that in the present state of the law their powers are not sufficient, and the evil continues and is likely so to do, unless the legislature affords some redress in the nature of sanitary powers. Independently of this nuisance, Tiverton would be considered a fine healthy town, situate as it is on the slope of a hill, with a swift river running at its foot.
“It is not these unfortunate creatures only who choose this centre of disease for their living-place who are affected; but the whole town is more or less deteriorated by its vicinity to this pestilential mass, where the generation of those elements of disease and death is constantly going on.
“Another cause of disease is to be found in the state of the cottages. Many are built on the ground without flooring, or against a damp hill. Some have neither windows nor doors sufficient to keep out the weather, or to let in the rays of the sun, or supply the means of ventilation; and in others the roof is so constructed or so worn as not to be weather tight. The thatch roof frequently is saturated with wet, rotten, and in a state of decay, giving out malaria, as other decaying vegetable matter.”
The report of _Dr. Barham_, on the sanitary condition of the town of Truro, gives instances of the condition of the town population in that part of the country. He states—
“The perfect immunity from deaths by _febrile_ and _acute_ diseases, enjoyed by Lemon-street during the long period of three years and a half, is a strong testimony to the value of the breadth of its roadway, the openness of its site, and the judicious construction of the houses; for it has to contend with a great deficiency of sewerage. Fairmantle and Daniell-streets are modern, and are occupied by small traders, and by decent artisans and labourers; the _former_ lies rather low, the _latter_ is on a considerable elevation; both are fairly drained, and are healthy. Charles, Calenick, and Kenwyn-streets present some of the worst specimens of defective arrangement, rendered worse still by the recklessness of the very poor, which can be met with in Truro. The amount of _pauper sickness_ is considerable, the deaths not few. The two latter streets are, in the greater part of their length, but little raised above high-water mark. Passing into _St. Mary’s_ parish, the proportion of sickness and even of deaths in Castle-street and Castle-hill is, to their extent and population, as great, perhaps, as that of any part of Truro; yet their situation is elevated and favourable. There is, however, no mystery in the causation. Ill-constructed houses, many of them old, with decomposing refuse close upon their doors and windows, open drains bringing the oozings of pigsties and other filth to stagnate at the foot of a wall, between which and the entrances to a row of small dwellings there is only a very narrow passage; such are a few of the sources of disease which the breeze of the hill cannot always dissipate. Similar causes have produced like effects in the courts adjacent to Pyder-street, to the High Cross, and to St. Clement’s-streets, and in Bodmin-street and Good-wives’-lane, the situations being all more or less confined. The benefits, on the other hand, derived from open rows, and cottages of a better construction are evidenced in Boscawen and Paul’s-row, and St. Clements’-terrace, which are well ventilated, and consequently suffer less from the scanty provision of drains and other conveniences.
“A detailed account of the public sewers is given in the Appendix, and is believed to be nearly, if not quite, complete. Many of these are of recent date, and owe their existence to the alarm excited when the cholera was near at hand. Some of them are made to discharge themselves into the rivers; and such of these as are swept by a stream of water are unobjectionable in themselves. Several others stop short of this desirable termination, and, after collecting filth from various localities, deposit a portion in catch-pits here and there, and finally open on the surface, frequently in some street or lane, where a neglected deposit of a mixed animal and vegetable nature is allowed to become a probable source of annoyance or mischief. Much of this incompleteness may be removed (as regards the main lines of sewerage) at no great expense; and it is said to be the intention of the commissioners of improvement to remedy the deficiency, when they are free from the debt with which they are now encumbered. Many of the smaller sewers are, however, much too narrow to be effective, and some of them are no better than covered drains. But the greatest evils in this department are unquestionably those which spring from the ignorance, cupidity, or negligence of landlords. It is useless to have a good sewer carried through the centre of a street, if the houses at the sides, and still more those situated in courts and lanes adjoining, have no communicating drains; and it is worse than useless to furnish these backlets with the mere semblance of drains—gutters forming pits here and there—then as they approach the street, perhaps slightly covered so as to produce obstruction more frequently than protection, a concentrated solution of all sorts of decomposing refuse being allowed to soak through and thoroughly impregnate the walls and ground adjoining. One or more of these mischievous conditions is to be found in connexion with a large proportion of the older houses in Truro, excepting the better class; and in many of the courts and backlets all these evils are in full operation. I have repeatedly noticed in the country that the occurrence of fever has been connected with _near proximity to even a small amount of decomposing organic matter_; and it is certain that all measures for effecting improvement in the sewerage of streets, the supply of water, and ventilation, may be rendered nearly inoperative for the obviating of the causes of disease, if a little nidus of morbific effluvia be permitted to remain in almost every corner of the confined court; where the poor man opens his narrow habitation in the hope of refreshing it with the breeze of summer, but gets instead a mixture of gases from reeking dunghills, or, what is worse, because more insidious, from a soil which has become impregnated with organic matters imbibed long before; and now, though, perhaps, to all appearance dry and clean, emitting the poisonous vapour in its most pernicious state. Nothing short of the placing in proper hands a peremptory authority for the removal of what is hurtful, and the supply of what is defective, making the exercise of that authority a duty, can remedy the existing evils.
“The houses occupied by the lower orders do not often exceed two stories in height, and it is rare to find families occupying less than two rooms. The more recent additions to the town—I speak of residences of the humbler class—have mainly consisted of rows of moderate cottages, having, the majority of them, gardens in front, and usually containing four rooms, commonly occupied by a single family. Some instances have, however, occurred of the building of a very inferior class of dwellings, which will be hereafter pointed out.
“No interments now take place in the town, the present burying-ground being at the distance of a third of a mile to the north of the church. The slaughter-houses are all, or nearly all, situated in populous parts, and occasionally constitute a decided nuisance. No manufactories exist which can be looked upon as prejudicial from any effluvia to which they give rise. The gas-works and smelting-houses are so placed that no mischievous effects can fairly be attributed to them.”
The state of the dwellings of many of the agricultural labourers in Dorset, where the deaths from the four classes of disease bear a similar proportion to those in Devon, is described in the return of _Mr. John Fox_, the medical officer of the Cerne union, who, remarking upon some cases of disease among the poor whom he had attended, says,—