Part 52

The statements of the condition of considerable proportions of the labouring population of the towns into which the present inquiries have been carried have been received with surprise by persons of the wealthier classes living in the immediate vicinity, to whom the facts were as strange as if they related to foreigners or the natives of an unknown country. When Dr. Arnott with myself and others were examining the abodes of the poorest classes in Glasgow and Edinburgh, we were regarded with astonishment; and it was frequently declared by the inmates, that they had never for many years witnessed the approach or the presence of persons of that condition near them. We have found that the inhabitants of the front houses in many of the main streets of those towns and of the metropolis, have never entered the adjoining courts, or seen the interior of any of the tenements, situate at the backs of their own houses, in which their own workpeople or dependents reside.

The duty of visiting loathsome abodes, amidst close atmospheres compounded of smoke and offensive odours, and everything to revolt the senses, is a duty which can only be expected to be regularly performed under much stronger motives than can commonly be imposed on honorary officers, and cannot be depended upon even from paid officers where they are not subjected to strong checks. The examination of loathsome prisons has gained one individual a national and European celebrity. Yet we have seen that there are whole streets of houses, composing some of the wynds of Glasgow and Edinburgh, and great numbers of the courts in London, and the older towns in England, in which the condition of every inhabited room, and the physical condition of the inmates, is even more horrible than the worst of the dungeons that Howard ever visited. In Ireland provisions for the appointment of Boards of Health have been made, but they appear to have failed entirely. One of the medical practitioners examined before the Committee of the House of Commons was asked, in respect to the operation of these provisions:—

“3297. But in ordinary times, when the fever is not of very great intensity, and is confined to the dwellings of the humbler classes, there is no such provision put into force?—No, but then there is another provision which may be put into force; this Act provides, that ‘whenever in any city, town, or district, any fever or contagious distemper shall prevail, or be known to exist, it shall and may be lawful for any one or more magistrates, upon the requisition of five respectable householders, to convene a meeting of the magistrates and householders of such city, town, or district, and of the medical practitioners within the same, in order to examine into the circumstances attending such fever or contagious distemper.’ There is another Act of 59 Geo. III., c. 41, which enables the parishes to appoint officers of health; that is, a permanent power. Those officers have very considerable authority; they can assess a rate.

“3298. Are they appointed?—They are appointed, I think, in all the parishes in Dublin except two; but they are inoperative: they are unpaid, and it is a very disgusting duty. They can be made to serve, but there is no control as to the amount of service they perform; so that the provision is quite inoperative, unless an alarm exists.

“3299. Do you not think the appointment of some such officers, properly appointed, properly paid, and having reasonable power, for the purpose of suggesting and enforcing such measures as shall be beneficial, would be highly valuable?—I am sure it would, and it would save an amazing quantity of expenditure to the country.”

It has only been under the strong pressure of professional duties by the physicians and paid medical and relieving officers responsible for visiting the abodes of the persons reduced to destitution by disease that the condition of those abodes in the metropolis have of late been known; and I believe that it is only under continued pressure and strong responsibilities and interests in prevention that investigation will be carried into such places, and the extensive physical causes of disease be effectually eradicated.

Whilst experience gives little promise even of inquiries from such a body as Boards of Health without responsibilities, still less of any important results from the mere representations of such bodies separated from executive authority, I would submit for consideration what appears to me a more advantageous application of medical science, viz., by uniting it with boards having executive authority.

Now, the claim to relief on the ground of destitution created by sickness, which carries the medical officer of the union to the interior of the abode of the sufferer, appears to be the means of carrying investigation precisely to the place where the evil is the most rife, and where the public intervention is most called for. In the metropolis the number of cases of fever alone on which the medical officers were required to visit the applicants for relief, at their own residences, amounted during one year to nearly 14,000. The number of medical officers attached to the new unions throughout the country, and engaged in visiting the claimants to relief on account of sickness, is at this time about 2300.

Were it practicable to attach as numerous a body of paid officers to any local Boards of Health that could be established, it would scarcely be practicable to insure as certain and well directed an examination of the residences of the labouring classes as I conceive may be ensured from the medical officers of the unions. In support of these anticipations of the efficiency of the agency. of the medical officers when directed to the formation of sanitary measures, I beg leave to refer to the experience of a partial trial of them under a clause of the recent Metropolitan Police Act, by which it is provided, that if the guardians of the poor of an union or parish, or the churchwardens and overseers of the poor of any parish within the Metropolitan Police district, together with the medical officer of any such parish or union, shall be of opinion, and shall certify under the hands of two or more of such guardians, churchwardens, and overseers, and of such medical officer, that any house, or part of any house, is in such a filthy unwholesome condition that the health of the inmates is thereby endangered, then the magistrates may, after due notice to the occupiers, cause the house to be cleansed at his expense.

The defects of the provision are, that it only authorizes cleansing and not providing for the means of cleansing and personal cleanliness, by directing supplies of water to be laid on; that it does not extend to the alterations of the external condition of the dwelling; that the immediate expense falls upon the occupier, who is usually in so abject a state of destitution as to serve as a barrier to any proceeding apparently tending to any penal infliction. With all these disadvantages, its working may be submitted to show the general eligibility of the medical officers of unions as officers for the execution of sanitary measures. The following account is given by the clerk to the Board of Guardians of Bethnal Green of the working of the provision in that part of the metropolis:—

_Mr. William Brutton._—We have taken prompt measures to execute the clause of the Metropolitan Police Act, and the Commissioners’ recommendations upon it, in our parish, and the effect produced has already been beneficial. For example, the medical officer recently reported, through me, to the Board of Guardians, that fever had arisen in certain small tenements in a court called Nicholl’s Court, and that it was likely to spread amongst the poorer classes in the district. He reported that others of the houses than those in which fever existed (and the inmates) were in a filthy condition, and that, unless measures were taken for cleansing them properly, fever must necessarily ensue. The Board, on receiving this communication, desired me to proceed instantly, and take such measures as appeared to me to be necessary for the abatement and prevention of the evil. I immediately obtained a summons from the magistrates for the attendance of the owner of the houses. He came directly, and stated that he was not aware that the premises were in the condition in which our medical officer had found them; and he promised that measures should be taken for proper cleansing. Those measures were taken: the furniture of the houses was taken out and washed; the houses were lime-washed. Some of those who were ill died, but the progress of the fever was certainly arrested.

The Board followed up these proceedings by circulating the Commissioners’ instruction and form of notification in every part of the parish. But the proceeding had a very good effect in the immediate neighbourhood. The proceeding was observed by the neighbours, and there is every reason to believe that they have set to work to cleanse and prevent a similar visitation. We have also learned that the landlords of some of these smaller tenements have been rather more particular than before: they have said we must see to the cleansing of these places lest we should be had up for it before the magistrates.

The guardians, considering the form of notifications useful, have directed that they should be issued periodically before the times when disease usually appears. In the course of a fortnight or three weeks hence, when the equinoctial gales prevail, and when we have usually much sickness and claims to relief, we shall probably have another issue of the notifications.

We have also given instructions to the relieving officer, as well as the medical officer, to report on the existence of any filth or things likely to be productive of disease that he may observe in the course of his visits to the houses where he is called by the claims to relief. The services of the relieving officer are highly important, as he has an opportunity of observing the state of filth and the obvious predisposition, and perhaps of causes of disease, preventing it before the visits of the medical officer, who is of course only called upon to attend when disease has arisen. The relieving officers visit more frequently than the medical officer, and give the tickets or orders requiring his attendance.

You are Commissioner of the Sewers in the Tower Hamlets, are you not?—Yes, I am.

And you are of course aware of their procedure?—Yes.

Do you think that body would be available for the execution of sanitary measures?—Certainly not as compared with the Board of Guardians: the Commissioners of Sewers meet only monthly, and have no medical officers and no relieving officers. The Board of Guardians meets weekly, and their officers are constantly at work, night and morning. We have not even waited for the landlords, where prompt measures appeared to be necessary for the removal of any active cause of disease. Where cesspools have overflowed, and where there has been a stoppage of water, we have directed the surveyor of the roads to ascertain the cause of the stoppage, and to remedy the mischief forthwith.

But what legal right have the guardians had to do that: they have no legal right to direct the road surveyor in the performance of his duties?—Strictly speaking, we have not, but we have forcibly suggested it as a matter of expediency.

Between the notification of the evil and the execution of the remedy, in the example you have cited by the Board of Guardians, what length of time elapsed?—From the Friday to the Monday following.

What time, so far as you have had experience, need ordinarily elapse if execution follow immediately on the report?—Execution would follow immediately on the order of the Board of Guardians. I think, however, that the union officers should, in case of emergency, have a summary acting power immediately for the preservation of life. The Guardians thought their examination of the spot unnecessary after the report of the medical officer.

The following is the examination of the clerk to the Strand union as to the practical working of the same measure in another district:—

_Mr. James Corder_, clerk to the Strand union, examined;—

What has been done in the Strand union in respect to the provisions of the Metropolitan Police Act, 2 and 3 Vict., c. 71, sec. 41, with respect to the powers conferred by that statute for the cleansing of houses which are in an unwholesome condition?

The attention of the medical officers was immediately drawn to the section of the Act, and the instructions of the Poor Law Commissioners relating thereto; and the result has been that proceedings have been had in several cases, in all of which the necessary cleansing has been performed by the owners, without the guardians being driven to the necessity of causing the requisite lime-whiting and cleansing to be done. The medical officer had frequently complained of the condition of the places into which the cleansing had been carried. Those places had for years been in the filthiest and most unwholesome condition: in some courts and alleys the pavements were covered with an accumulation of the most offensive matter, including the carcases of dead animals, such as dogs and cats, which the scavengers said formed no part of their contract to remove: their contract was only to cleanse the carriage ways. Some of these courts and alleys abound in the principal thoroughfares in the metropolis. The public, in passing through a thoroughfare like the Strand, would scarcely imagine that an evil of so much magnitude was close at hand.

The powers conferred by the clause in question appears to be restricted to the cleansing of the houses and the passages within the cartilage. What proceedings did the guardians take with relation to these external passages?

They directed the condition of the places to be represented to the Commissioners for paving and cleansing the district, who caused the filth complained of to be removed. The cleansing of the footways, however, forms no part of the duty of the Commissioners of Pavement, nor of their surveyor, nor of the scavenger appointed by them; and what was done was done extra-officially.

It cannot, therefore, be relied upon for the future?

No; and it is to be observed that the Metropolitan Paving Act evidently contemplates that the cleansing of the footways shall be done by the inmates of the houses. In the poorer districts, however, this is entirely omitted to be done; in addition to which these courts and alleys are frequently made, on account of their obscurity, a depository for most offensive matter. In the better neighbourhoods, the service of cleansing is performed by the servants; but the poor people, who rise before daylight, go to their work, and return at a late hour, have no time to cleanse their courts, and their earnings are too scanty to allow payment to others for the performance of the duty. In the better neighbourhoods, the cleansing does not always take place. The medical officers report, that there is a better average health in the streets that are well cleansed than in others where the people are otherwise in the same condition of life.

What are the main defects you have experienced in respect to the provision of the Metropolitan Police Act, empowering the guardians to take measures for cleansing houses?

First, the delay which must take place before the provisions of the Act can be put in operation. The medical officer has first to make his report to the Board of Guardians; several days elapse before the Board meets: then guardians have to inspect the premises in conjunction with the medical officer previously to certifying as to the state thereof: then application is made to the magistrate, who issues his summons, returnable in seven days; at the expiration of which, if the cleansing be not performed, the guardians are empowered to cause it to be done; but they must first obtain a magistrate’s warrant for the purpose. All this engenders delay; in addition to which our guardians have, in the first instance, caused the landlord to be written to with a view to prevent further proceedings, which in some instances have been successful; but when it is not successful, it creates a further delay, during which disease may rapidly increase and spread. The second defect of the provision is, that the owners are not liable for the expenses incurred; and the occupiers are mostly of the poorest class, who have no effects on which a distraint could be made. With all these difficulties, however, this provision has been very beneficial in its operation; and it is very much to be desired that larger facilities should be afforded for carrying its intention more fully into effect. It may be added, that the medical officer should have remuneration for the trouble he entails upon himself, by a report, in attending before magistrates, until the object is effected.

_Mr. John Smith_, the clerk to the Whitechapel union:—

Have you taken any proceedings under the 41st clause of the Metropolitan Police Act?

We have issued notifications to every house in the union of the necessity of cleansing the houses by whitewashing them inside and out, and that the owners and occupiers were amenable for any neglect. The relieving officers report to me, that these notifications have already been productive of very good effects, and that whitewashing has been actively practised. The relieving officers were instructed, wherever they found a case of neglect, to threaten the landlord that he would be proceeded against unless the tenement was duly cleansed. But as yet we have taken no legal proceedings, because we have advised with the magistrates, who do not consider that the owners can be proceeded against in the first instance, and the occupiers of the tenements, which are liable to be proceeded against, are most of them paupers and persons in extreme poverty.

With respect to the remedies, I find that the personal inconvenience to which the clause subjects the guardians of visiting the spot is a provision which will greatly obstruct its operations, and will at all events greatly delay proceedings from time to time. The guardians who, in our union, are men of business, consider that their time is fully occupied at the Board, and they object to any attendance out of the Board, and would give it reluctantly. If the cases are taken before the magistrate, it appears desirable that the medical officer should not be compelled to attend unless it were absolutely requisite, and that the relieving officer should be allowed to prove the facts as to the state of the dwellings recited in the medical officer’s certificate, which could rarely be disputed. If the point were disputed by the owner, then the medical officer or other witnesses might be forthcoming.

What is the number of houses in the union?—About 8000.

How many cases on the average do your medical officers visit in the year?—About 4000.

Those visits of course are sometimes to different rooms of the same tenement?—No doubt of that, and very frequently to the inmates of the same room.

Are the visits of the relieving officers to the dwellings of the labouring classes more extensive than the visits of the medical officers?—I should say more extensive.

Between the two, are any class of the poorer and otherwise neglected residences that would probably escape visitation?—I should say that they must visit every spot within the district.

Within such districts as that of Whitechapel, do you think the three present medical officers and the relieving officers would suffice to carry out sanitary measures actively and efficiently?—I think that for efficiency additional strength would be required; perhaps one officer, whose especial duty it should be to attend to the duties connected with sanitary measures, supposing them carried out by the agency of the existing establishments.

From the consideration of such practical evidence, it will be seen that the ordinary duties of the relieving officer in the first instance, and of the medical officer afterwards, ensure domiciliary inspection of large districts to an extent and with a degree of certainty that could scarcely be ensured or expected of any agents or members of a board of health unconnected with positive administrative duties. The inspection of these officers of the boards of guardians more than supplies the external inspection of inquests or of the leets; and it is submitted that in their position these boards may most beneficially exercise the functions of the leet in reclaiming the execution of the law, as against acts of omission and of commission, by which the poorest of the labouring classes are injured and the ratepayers burdened.

It may therefore be submitted as an eligible preliminary general arrangement, that it shall be required of the medical officer as an extra duty, for the due performance of which he should be fairly remunerated, that on visiting any person at that person’s dwelling, on an order for medical relief, he shall, after having given such needful immediate relief as the case may require, examine or cause to be examined any such physical and removable causes as may have produced disease or acted as a predisposing cause to it; that he shall make out a particular statement of them, wherein he will specify any things that may be and are urgently required to be immediately removed. This statement should be given to the relieving officer, who should thereupon take measures for the removal of the nuisance at the expense of the owner of the tenement, unless he, upon notice which shall be given to him, forthwith proceed to direct their removal. Except in the way of appeal by the owner against the proceedings of either officer, or where a higher expense than 5_l._, or a year’s rent of the tenement, were involved by the alterations directed by the medical officer, it appears to be recommended that no application to the Board of Guardians or the magistrates should be required in the first instance, as it frequently happens that the delay of a day in the adoption of measures may occasion the loss of life and the wide spread of contagious disease; and an application to the Board of Guardians or to the petty sessions would usually incur delay of a week or a fortnight. To repeat the words of Blackstone,—“The security of the lives and property may sometimes require so speedy a remedy, as not to allow time to call on the person on whose property the mischief has arisen to remedy it.” When any tenement is in a condition to endanger life from disease, as it comes within the principle of the law, so it should be included within its provisions, and should be placed in the same condition as a tenement condemned as being ruinous and endangering life from falling.