Part 6

“These cases (of diarrhœa and common fever) occurred in a house (formerly a poor house) occupied by nearly 50 persons on the ground-floor; the rooms are neither boarded nor paved, and generally damp; some of them are occupied by two families. The up-stairs rooms are small and low, and separated from each other by boards only. Eleven persons slept in one room. The house stands in a valley between two hills, very little above the level of the river, which occasionally overflows its banks, and within a few yards of it. There is generally an accumulation of filth of every description in a gutter running about two feet from its front, and a large cesspool within a few feet behind. The winter stock of potatoes was kept in some of the day-rooms, and generally put away in a wet state. The premises had not been white-limed during three years; in addition to this state of things, the poor were badly fed, badly clothed, and many of them habitually dirty, and consequently typhus, synochus, or diarrhœa, constantly prevailed. No house-rent was paid by the occupants. Many, under more favourable circumstances were clean and tidy, and if their wages were sufficient to enable them to rent a decent cottage, I have no doubt they would soon regain their lost spirit of cleanliness. In this same parish I have often seen the springs bursting through the _mud_ floor of some of the cottages, and little channels cut from the centre under the doorways to carry off the water, whilst the door has been removed from its hinges for the children to put their feet on whilst employed in making buttons. Is it surprising that fever and scrofula in all its forms prevail under such circumstances?

“It is somewhat singular that seven cases of typhus occurred in one village heretofore famed for the health and general cleanliness of its inhabitants and cottages. The first five cases occurred in one family, in a detached house on high and dry ground, and free from accumulations of vegetable or animal matter. The cottage was originally built for a school-room, and consists of one room only, about 18 feet by 10, and 9 high. About one-third part was partitioned off by boards reaching to within three feet of the roof, and in this small space were three beds, in which six persons slept; had there been two bed-rooms attached to this one day-room, these cases of typhus would not have occurred. The fatal case of typhus occurred in a very small village, containing about sixty inhabitants, and from its locality it appears favourable to the production of typhus, synochus, and acute rheumatism. It stands between two hills, with a river running through it, and is occasionally flooded. It has extensive water meadows both above and below, and a farm-yard in the centre, where there is always a large quantity of vegetable matter undergoing decomposition. Most of the cases of synochus occurred under circumstances favourable to its production. Most of the cottages being of the worst description, some mere mud hovels, and situated in low and damp places with cesspools or accumulations of filth close to the doors. The _mud floors_ of many are much below the level of the road, and in wet seasons are little better than so much clay. The following shocking case occurred in my practice. In a family consisting of six persons, two had fever; the mud floor of their cottage was at least one foot below the lane; it consisted of _one_ small room only, in the centre of which stood a foot-ladder reaching to the edge of a platform which extended over nearly one-half of the room, and upon which were placed two beds, with space between them for one person only to stand, whilst the outside of each touched the thatch. The head of one of these beds stood within six inches of the edge of the platform, and in this bed one of my unfortunate patients, a boy about 11 years old, was sleeping with his mother, and in a fit of delirium jumped over the head of his bed and fell to the ground below, a height of about seven feet. The injury to the head and spine was so serious that he lived a few hours only after the accident. In a cottage fit for the residence of a human being this could not have occurred. In many of the cottages, also, where synochus prevailed, the beds stood on the ground-floor, which was damp three parts of the year; scarcely one had a fire-place in the bed-room, and one had a single small pane of glass stuck in the mud wall as its only window, with a large heap of wet and dirty potatoes in one corner. Persons living in such cottages are generally very poor, very dirty, and usually in rags, living almost wholly on bread and potatoes, scarcely ever tasting animal food, and consequently highly susceptible of disease and very unable to contend with it. I am quite sure if such persons were placed in good, comfortable, clean cottages, the improvement in themselves and children would soon be visible, and the exceptions would only be found in a few of the poorest and most wretched, who perhaps had been born in a mud hovel, and had lived in one the first 30 years of their lives.

“In my district I do not think there is _one_ cottage to be found consisting of a day-room, three bed-rooms, scullery, pantry, and convenient receptacles for refuse and for fuel in the occupation of a labourer, but there are many consisting of a day-room and two bed-rooms, constructed with a due regard to ventilation and warmth, pantry, and fuel house, with a small garden and pigsty adjoining, and the labourers occupying such cottages, generally speaking, are far superior to others less advantageously situated. Their persons and cottages are always neater and cleaner, they are less disposed to frequent the beer-houses or to engage in poaching, whilst their children are generally sent daily to some school, in many instances chiefly supported by the clergyman of the parish. As a corroboration of my opinion, I need only state that I am frequently employed by the labourers in the good cottages to attend their wives during their confinement, and generally receive my guinea before I leave the house, whilst the labourer less favourably situated invariably applies to his parish for medical relief under such circumstances. I think there cannot be a doubt if the whole of the wretched hovels were converted into good cottages, with a strict attention to warmth, ventilation, and drainage, and a receptacle for filth of every kind placed at a proper distance, it would not only improve the health of the poor by removing a most prolific source of disease, and thereby most sensibly diminish the rates, but I am convinced it would also tend most materially to raise the moral character of the poor man, and render him less susceptible to the allurements of the idle and wicked.”

The tenor of much information respecting the condition of many of the labouring classes in Somerset, where the deaths from the four classes of disease were still higher than in the two other counties, and amounted during the one year to 5417, is exhibited in the sanitary report of _Mr. James Gane_, the medical officer of the Axbridge union, who states that,—

“The situation of this district where the diseases herein mentioned prevail, is a perfect flat called the South Marsh, in the main road between Bristol and Bridgewater. There are numerous dykes or ditches for the purpose of drainage. The cottages of the poor are mostly of a bad description, frequently mud wall, and often situated close to the dykes, where the water for the most part is in a state of stagnation. Oftentimes not more than one room for the whole family; sometimes two; one above the other; with the really poor, the latter is seldom to be met with, (unless it should happen now and then in a parish where a poor-house was built a short time before the formation of the Union). A pigsty where the inmates are capable of keeping a pig is frequently attached to the dwelling, and in the heat of summer produces a stench quite intolerable; the want of space however prevents it being otherwise. The regular poor-house (those mentioned above being detached cottages) in most of the parishes in this district are of a much worse description, several large families existing under the same roof, occupying only one room each family, and having but one entrance door to the dwelling; here filth and poverty go hand-in-hand without any restriction and under no control. The accumulation of filth being attributable to the want of proper receptacles for refuse, and the indolent and filthy disposition of the inhabitants, in no instance _have_ such places been provided. The floors are seldom or never scrubbed; and the parish authorities pay so little attention to these houses, that the walls never get white-limed from one end of the year to the other. The windows are kept air-tight by the stuffing of some old garments, and every article for use is kept in the same room. The necessary is close to the building, where all have access, and producing a most intolerable nuisance. In a locality naturally engendering malaria, the diseases with which the poor are for the most part afflicted are, fevers such as are stated in this report and which sometimes run into a low typhoid state. The neighbourhood in general is considered in as good a state of drainage as it will admit of. The occurrence of disease among the poor population is for the most part at spring and autumn, at those times agues and fevers prevail. Small-pox and scarlet fever are met with at all seasons of the year, but prevail as epidemics, the former in spring and summer, and the latter about autumn or the beginning of winter. I attribute the prevalence of diseases of an epidemic character, which exists so much more among the poor than among the rich, to be, from the want of better accommodation as residence, (their dwelling instead of being built of solid materials are complete shells of mud on a spot of waste land the most swampy in the parish, this is to be met with almost everywhere in rural districts,) to the want of better clothing, being better fed, more attention paid to the cleanliness of their dwellings, and less congregated together. The health of persons even where a large family is, and where superior cottage accommodation is afforded to them, is much better generally than others less advantageously situated. The influence over their habits will also be very beneficial, they will be less likely to run to a beer-house with their last penny, the comforts of a home after the toils of the day keeps them by their own fireside; they become better contented, less liable to disease, make better husbands, better fathers, better neighbours, and with each other better friends. There is a subject which I wish particularly to press on the attention of the Commissioners; the presence throughout the country, and to be found in every parish, of low lodging-houses, where persons of the lowest grade of society, beggars, thieves, and such like, take up a temporary abode in passing from one part of the kingdom to another, bringing with them the seeds of infectious diseases and oftentimes the actual disease itself into a neighbourhood previously in a comparative state of health. I have observed, where persons are living in a locality habitually affected with malaria, that when becoming convalescent from any other disease, are often attacked with ague, more particularly among the poorer classes.

“There is a class of persons called the ‘second poor,’ who for the most part are constantly employed throughout the year as farmers’ labourers, and who are in much better circumstances than those to whom I have above alluded; they have much better cottage accommodation, their houses being provided with one, sometimes two day-rooms, two bed-rooms, a pantry, and other conveniences for fuel and for refuse, and whose general health and condition is much better than those less advantageously situated. Therefore detached cottages for the poor, with a moderate sized day-room, two or three bed-rooms, a pantry, receptacles for refuse and for fuel, with casement windows or some such contrivance for ventilation, will be a blessing to them, and very available sanitary regulations. I know of no better method than is to be seen in all cottages for the economical management of fuel, both in cooking and maintaining a proper temperature of the rooms.”

The following extract from the report of _Mr. Aaron Little_, the medical officer of the Chippenham union, affords a specimen of the frequent condition of rural villages which have apparently the most advantageous sites:—

“The parish of Colerne, which, upon a cursory view, any person (unacquainted with its peculiarities) would pronounce to be the most healthy village in England, is in fact the most unhealthy. From its commanding position (being situated upon a high hill) it has an appearance of health and cheerfulness which delight the eye of the traveller, who commands a view of it from the Great Western road, but this impression is immediately removed on entering at any point of the town. The filth, the dilapidated buildings, the squalid appearance of the majority of the lower orders, have a sickening effect upon the stranger who first visits this place. During three years’ attendance on the poor of this district, I have never known the small-pox, scarlatina, or the typhus fever to be absent. The situation is damp, and the buildings unhealthy, and the inhabitants themselves inclined to be of dirty habits. There is also a great want of drainage.”

_Mr. William Blower_, the surgeon of the Bedford union, to whose evidence on the influence of moral causes on the health of the population, we shall again have occasion to refer, states:—

“Throughout the whole of this district, there is a great want of ‘superior cottage accommodation.’ Most of the residences of the labourers are thickly inhabited, and many of them are damp, low, cold, smoky, and comfortless. These circumstances occasion the inmates to be sickly in the winter season, but I have not observed them to generate typhus, the prevailing form of disease being principally catarrhal; such as colds, coughs, inflammations of the eyes, dysentery, rheumatism, &c. However, when any contagious or epidemic malaria occurs, the cases are generally more numerous.”

_Mr. Weale_ reports instances of the condition of large proportions of the agricultural population in the counties of Bedford, Northampton, and Warwick. The medical officer of the Woburn union states, in respect to Toddington, that—

“In this town fever prevailed during the last year, and, from the state of the dwellings of the persons I called on, this could not be wondered at. Very few of the cottages were furnished with privies that could be used, and contiguous to almost every door a dung heap was raised on which every species of filth was accumulated, either for the purpose of being used in the garden allotments of the cottagers, or to be disposed of for manure. Scarcely any cottage was provided with a pantry, and I found the provisions generally kept in the bed-rooms. In several instances I found whole families, comprising adult and infant children with their parents, sleeping in one room.”

The medical officer of the Ampthill union states:—

“Typhus fever has existed for the last three or four months in the parish of Flitwick, and although the number of deaths has not been considerable as compared with the progress of the disease, new cases have occurred as those under treatment became convalescent, and several are still suffering under this malady. The cottages in which it first appeared (and to which it has been almost exclusively confined), are of the most wretched description: a stagnant pond is in the immediate vicinity, and none of the tenements have drains; rubbish is thrown within a few yards of the dwellings, and there is no doubt but in damp foggy weather, and also during the heat of summer, the exhalations arising from those heaps of filth must generate disease, and the obnoxious effluvia tends to spread contagion where it already exists. It appears that most of the cottages alluded to were erected for election purposes, and have since been allowed to decay; the roofs are repaired with turf dug in the neighbourhood, and the walls repaired with prepared clay, without the addition of lime-washing. Contagious disease has not been remarkable within the Union in any other spot than the one alluded to.”

_Messrs. Smith_ and _Moore_, the medical officers of the Bishop Stortford union, state,—

“We have always found the smallest and most slightly-built houses the seats of the lowest forms of disease; and although, during the last year, no epidemic or infectious disease here prevailed, it is but just to state that, generally speaking, the cottages of labourers in this district are small, badly protected from both extremes of weather, badly drained, and low in the ground.”

_Mr. J. S. Nott_, the medical officer of the Witham union, states,—

“As medical officer of my district, I am glad to have an opportunity of recording my opinion of many of the causes of fever that uniformly prevails in the autumn and spring in this neighbourhood. I must first state that the situation of the town is exceedingly low, with two small rivers passing through it, and numerous open sewers intersecting the town and its environs, the effluvia of which is frequently exceedingly offensive, and at all times prejudicial to the general health, and calculated to create, by its malaria, the various kinds of fevers, (typhus and remittent). Part of the town is subject to floods; added to which, the cottages are small and crowded together. A great number of the inhabitants accumulate filth and manure for the purpose of sale. There are also many open slaughter-houses, where the refuse and filth is allowed to accumulate for weeks together without removal; and innumerable pigs are kept and fattened on the back of the premises of a great number of the inhabitants; and altogether it would be difficult to find any town of its size where so little regard is paid to cleanliness and ventilation; but where we do find the exception, roomy and well-ventilated cottages, (and they are but few,) the cases of fever are more manageable, and recover sooner.”

The state of Windsor affords an example that the highest neighbourhoods in power and wealth do not at present possess securities for the prevention of nuisances dangerous to the public health. _Mr. Parker_, in his report on the condition of his district, states—

“With regard to the drainage of the towns in the counties of Buckingham, Oxford, and Berks, it may be observed that there is no town in which great improvements might not be effected. In Reading there are commissioners appointed under a local Act to make provision for cleansing the town and removing nuisances; but their duties do not appear to be performed with due regard to the importance of the trust, for the Board of Guardians of the Reading union, by resolutions entered in their minutes, frequently point out nuisances, and remind the commissioners of the filthy condition of many of the courts and back streets. But extensive as the improvements in the state of the drainage of almost every town in these counties might be, there is no town amongst them in which there is so wide a field for improvement as Windsor, which, from the contiguity of the palace, the wealth of the inhabitants, and the situation, might have been expected to be superior in this respect to any other provincial town. Such, however, is not the case; for of all the towns visited by me, Windsor is the worst beyond all comparison. From the gas-works at the end of George-street a double line of open, deep, black, and stagnant ditches extends to Clewer-lane. From these ditches an intolerable stench is perpetually rising, and produces fever of a severe character. I visited a cottage in Clewer-lane in which typhus fever had existed for some time, and learnt from a woman who had recently lost a child the complaint was attributable to the state of these ditches. Mr. Bailey, the relieving officer, informs me that cases of typhus fever are frequent in the neighbourhood; and observes that there are now seven or eight persons attacked by typhus in Charles-street and South-place. He considers the neighbourhood of Garden-court in almost the same condition. ‘There is a drain,’ he says, ‘running from the barracks into the Thames across the Long Walk. That drain is almost as offensive as the black ditches extending to Clewer-lane. The openings to the sewers in Windsor are exceedingly offensive in hot weather. The town is not well supplied with water, and the drainage is very defective.’ The ditches of which I have spoken are sometimes emptied by carts; and on the last occasion their contents were purchased for the sum of 15_l._. by the occupier of land in the parish of Clewer, whose meadows suffered from the extraordinary strength of the manure, which was used without previous preparation.”

_Mr. Harding_, medical officer of the Epping union, states,—

“The state of some of the dwellings of the poor is most deplorable as it regards their health, and also in a moral point of view. As it relates to the former, many of their cottages are neither wind nor water tight. It has often fallen to my lot to be called on to attend a labour where the wet has been running down the walls, and light to be distinguished through the roof, and this in the winter season, with no fire-place in the room. As it relates to the latter, in my opinion a great want of accommodation for bed-rooms often occurs, so that you may frequently find the father, mother, and children all sleeping in the same apartment, and in some instances the children having attained the age of 16 or 17 years, and of both sexes; and if a death occurs in the house, let the person die of the most contagious disease, they must either sleep in the same room, or take their repose in the room they live in, which most frequently is a stone or brick floor, which must be detrimental to health.”

_Mr. J. D. Browne_, medical officer of the West Ham union states that,—

“The cases of typhus (21 cases in the parish of Walthamstow) have occurred periodically in certain localities, arising partly from want of personal cleanliness, and also from being situated near ditches into which putrefactive matter was deposited, such as the privies and pigsties emptying themselves. The medical officer called the attention of the Board of Guardians, vicar, and parochial officers to the subject; and though it was unanimously admitted that the evil was great, and an anxious desire was expressed in vestry to remove the existing evil, yet the case fell to the ground, there being no funds to meet the exigency. The medical officer feels persuaded that a power should be invested in the Board of Guardians or parochial officers to meet such cases.”

_Mr. Thomas H. Smith_, the medical officer of the Bromley union, states,—