Part 1

Transcriber’s Notes

Text between _underscores_ and =equal signs= represents text printed in italics and bold face, respectively. Small capitals have been changed to ALL CAPITALS.

More transcriber’s notes may be found at the end of this text.

REPORTS RELATING TO THE SANITARY CONDITION OF THE CITY OF LONDON.

BY JOHN SIMON, F.R.S. SURGEON TO ST. THOMAS’S HOSPITAL, AND OFFICER OF HEALTH TO THE CITY.

LONDON: JOHN W. PARKER AND SON, WEST STRAND. MDCCCLIV.

LONDON: SAVILL AND EDWARDS, PRINTERS, CHANDOS STREET, COVENT GARDEN.

TO LOUIS MICHAEL SIMON, OF THE STOCK EXCHANGE, LONDON, AND OF THE PARAGON, BLACKHEATH, I DEDICATE THIS REPRINT OF MY REPORTS: LOOKING LESS TO WHAT LITTLE INTRINSIC MERIT THEY MAY HAVE, THAN TO THE YEARS OF ANXIOUS LABOUR THEY REPRESENT: DEEMING IT FIT TO ASSOCIATE MY FATHER’S NAME WITH A RECORD OF ENDEAVOURS TO DO MY DUTY: BECAUSE IN THIS HE HAS BEEN MY BEST EXAMPLE; AND BECAUSE I COUNT IT THE HAPPIEST INFLUENCE IN MY LOT, THAT, BOUND TO HIM BY EVERY TIE OF GRATEFUL AFFECTION, I HAVE LIKEWISE BEEN ABLE, FROM MY EARLIEST CHILDHOOD TILL NOW--THE EVENING OF HIS LIFE, TO REGARD HIM WITH UNQUALIFIED AND INCREASING RESPECT.

CONTENTS.

Page DEDICATION iii

PREFACE vii

FIRST ANNUAL REPORT 1

FURTHER REMARKS ON WATER-SUPPLY 72

SECOND ANNUAL REPORT 77

THIRD ANNUAL REPORT 177

FOURTH ANNUAL REPORT 211

FIFTH ANNUAL REPORT 213

APPENDIX OF TABLES ILLUSTRATING THE SANITARY CONDITION OF THE CITY OF LONDON. 264

REPORT ON CITY BURIAL-GROUNDS 280

REPORT ON EXTRAMURAL INTERMENTS 285

PREFACE.

The following Reports, officially addressed to the Commissioners of Sewers of the City of London, were originally printed only for the use of the Corporation; and although, to my very great pleasure, they have been extensively circulated through the medium of the daily press, there has continued so frequent an application for separate copies that the surplus-stock at Guildhall has long been exhausted. Under these circumstances--believing the Reports may have some future interest, as belonging to an important educational period in the matters to which they refer, I have requested the Commission to allow their collective reprint and publication; and this indulgence having been kindly accorded me, I have gathered into the present volume all my Annual Reports, together with a special Report suggesting arrangements for extramural burial.

From the nature of the work, I have not considered myself at liberty to make those extensive alterations of text which usually belong to a second edition. I have restricted myself to a few verbal corrections, and to rectifying or omitting some unimportant paragraph, here or there, in case its matter has been more fully or more correctly stated in parts of a subsequent Report. Frequently, where I have wished to explain or qualify passages in the text, I have added foot-notes; but these are distinguished as interpolations by the mark--J. S., 1854.

My Reports lay no claim to the merit of scientific discovery. Rather, they deal with things already notorious to Science; and, in writing them, my hopes have tended chiefly towards winning for such doctrines more general and more practical reception. It has seemed to me no unworthy object, that, confining myself often to almost indisputable topics--to truths bordering on truism, I should labour to make trite knowledge bear fruit in common application.

Nor in any degree do they profess to be cyclopædic in the subject of Preventive Medicine; for it is but a small part of this science that hitherto is recognised by the law; and that--so far as the metropolis is concerned, scarcely beyond the confines of the City. It would have been an idle sort of industry, to say much of places or of matters foreign to the jurisdiction of those whom I officially addressed.

In re-publishing documents which proclaim extreme sanitary evils, as affecting the City, I think it right to draw attention to the dates of the several Reports, and to state that for the last five years many of these evils have been undergoing progressive diminution, of late at a rapid and increasing rate; while, at their worst, they represented only what I fear must be considered the present average condition of our urban population.

This national prevalence of sanitary neglect is a very grievous fact; and though I pretend to no official concern in anything beyond the City boundaries, I cannot forego the present opportunity of saying a few words to bespeak for it the reader’s attention. I would beg any educated person to consider what are the conditions in which alone animal life can thrive; to learn, by personal inspection, how far these conditions are realised for the masses of our population; and to form for himself a conscientious judgment as to the need for great, if even almost revolutionary, reforms. Let any such person devote an hour to visiting some very poor neighbourhood in the metropolis, or in almost any of our large towns. Let him breathe its air, taste its water, eat its bread. Let him think of human life struggling there for years. Let him fancy what it would be to himself to live there, in that beastly degradation of stink, fed with such bread, drinking such water. Let him enter some house there at hazard, and--heeding where he treads, follow the guidance of his outraged nose, to the yard (if there be one) or the cellar. Let him talk to the inmates: let him hear what is thought of the bone-boiler next door, or the slaughter-house behind; what of the sewer-grating before the door; what of the Irish basket-makers upstairs--twelve in a room, who came in after the hopping, and got fever; what of the artisan’s dead body, stretched on his widow’s one bed, beside her living children.

Let him, if he have a heart for the duties of manhood and patriotism, gravely reflect whether such sickening evils, as an hour’s inquiry will have shown him, ought to be the habit of our labouring population: whether the Legislature, which his voice helps to constitute, is doing all that might be done to palliate these wrongs; whether it be not a jarring discord in the civilisation we boast--a worse than pagan savageness in the Christianity we profess, that such things continue, in the midst of us, scandalously neglected; and that the interests of human life, except against wilful violence, are almost uncared for by the law.

And let not the inquirer too easily admit what will be urged by less earnest persons as their pretext for inaction--that such evils are inalienable from poverty. Let him, in visiting those homes of our labouring population, inquire into the actual rent paid for them--dog-holes as they are; and studying the financial experience of Model Dormitories and Model Lodgings, let him reckon what that rent can purchase. He will soon have misgivings as to dirt being cheap in the market, and cleanliness unattainably expensive.

Yet what if it be so? Shift the title of the grievance--is the fact less insufferable? If there be citizens so destitute, that they can afford to live only where they must straightway die--renting the twentieth straw-heap in some lightless fever-bin, or squatting amid rotten soakage, or breathing from the cesspool and the sewer; so destitute that they can buy no water--that milk and bread must be impoverished to meet their means of purchase--that the drugs sold them for sickness must be rubbish or poison; surely no civilised community dare avert itself from the care of this abject orphanage. And--_ruat cœlum_, let the principle be followed whithersoever it may lead, that Christian society leaves none of its children helpless. If such and such conditions of food or dwelling are absolutely inconsistent with healthy life, what more final test of pauperism can there be, or what clearer right to public succour, than that the subject’s pecuniary means fall short of providing him other conditions than those? It may be that competition has screwed down the rate of wages below what will purchase indispensable food and wholesome lodgment. Of this, as fact, I am no judge; but to its meaning, if fact, I can speak. All labour below that mark is masked pauperism. Whatever the employer saves is gained at the public expense. When, under such circumstances, the labourer or his wife or child spends an occasional month or two in the hospital, that some fever-infection may work itself out, or that the impending loss of an eye or a limb may be averted by animal[1] food; or when he gets various aid from his Board of Guardians, in all sorts of preventable illness, and eventually for the expenses of interment, it is the public that, too late for the man’s health or independence, pays the arrears of wage which should have hindered this suffering and sorrow.

[1] Twenty years’ daily experience of hospital surgery enables me to say, from personal knowledge, that our wards and out-patient rooms are never free from painful illustrations of the effects of insufficient nutrition--cases, in fact, of chronic starvation-disease among the poor; such disease as Magendie imitated, in his celebrated experiments, by feeding animals on an exclusively non-azotised diet.

Probably on no point of political economy is there more general concurrence of opinion, than against any legislative interference with the price of labour. But I would venture to submit, for the consideration of abler judges than myself, that before wages can safely be left to find their own level in the struggles of an unrestricted competition, the law should be rendered absolute and available in safeguards for the ignorant poor--first, against those deteriorations of staple food which enable the retailer to disguise starvation to his customers by apparent cheapenings of bulk; secondly, against those conditions of lodgment which are inconsistent with decency and health.

But if I have addressed myself to this objection, partly because--to the very limited extent in which it starts from a true premiss, it deserves reply; and partly because I wish emphatically to declare my conviction, that such evils as I denounce are not the more to be tolerated for their rising in unwilling Pauperism, rather than in willing Filth; yet I doubt whether poverty be so important an element in the case as some people imagine. And although I have referred especially to a poor neighbourhood--because here it is that knowledge and personal refinement will have least power to compensate for the insufficiencies of public law; yet I have no hesitation in saying that sanitary mismanagement spreads very appreciable evils high in the middle ranks of society; and from some of the consequences, so far as I am aware, no station can call itself exempt.

The fact is, as I have said, that, except against wilful violence, life is practically very little cared for by the law. Fragments of legislation there are, indeed, in all directions: enough to establish precedents--enough to testify some half-conscious possession of a principle; but, for usefulness, little beyond this. The statutes tell that now and then, there has reached to high places the wail of physical suffering. They tell that our law-makers, to the tether of a very scanty knowledge, have, not unwillingly, moved to the redress of some clamorous wrong. But--tested by any scientific standard of what should be the completeness of sanitary legislation; or tested by any personal endeavour to procure the legal correction of gross and glaring evils; their insufficiencies, I do not hesitate to say, constitute a national scandal, and, perhaps in respect of their consequences, something not far removed from a national sin.

In respect of _houses_--here and there, under local Acts of Parliament, exist sanitary powers, generally of a most defective kind; pretending often to enforce amendments of drainage and water-supply; sometimes to provide for the cleansing of filthy and unwholesome tenements; in a few cases to prevent over-crowding; very rarely to ensure stringent measures against houses certified to be unfit for human habitation. Occasionally--but a few lines would exhaust the list, an application of the Public Health Act, or some really efficient local Act, has put it within reach of the authorities to do all that is needful under certain of these heads. But I know of no such town that would bear strict examination as to its possession of legal powers to fulfil, what I presume must be the principle contemplated by the law--that no house should be let for hire unless presenting the conditions indispensable for health, or be hired for more occupants than it can decently and wholesomely accommodate.[2] However this may be expressed, and in whatever laws embodied, local or general, I will venture to say that no Government should suffer a town, either to be without the means of enforcing this principle, or, having such means, to shirk their exercise. Our Constitution may properly concede that local representative authorities shall have their option whether, for sanitary purposes, to fall under a general law, or to have Local Improvement Acts of their own; but, in the present state of knowledge, it certainly seems incontestable that one or other of these alternatives should be compulsory, and that all Local Improvement Acts should be required, in their sanitary clauses, to come up to the standard of the Public Health Act of the time, whatever it may be.

[2] In addition to the ordinary powers--given, for instance, in the Public Health or City Sewers Act, for abating accumulated nuisances and for enforcing wholesome constructional arrangements; a principal requirement of all bodies having jurisdiction for the public health is, that there should be vested in them some authority, _enabling them to regulate_, in the spirit of the Common Lodging House Act, _all houses which are liable to be thronged by a dangerous excess of low population_. Almost invariably such houses are of the class technically known as ‘tenement-houses,’ i. e., houses divided into several tenements or holdings; whereof each--though very often consisting but of a single small room, receives its inmates without any available restriction as to their sex or number, and without regard to the accommodation requisite for cleanliness, decency, and health. The inhabitants of such houses, especially where of the lower order of Irish, constantly lapse into the most brutal filthiness of habits, and live in almost incredible conditions of dirt, over-crowding, and disease. See sections of the following Reports, beginning severally at pages 44, 146, and 195. Powers for dealing with these evils might be given to Local Boards of Health, most usefully, I think, in some such form as the following: 1) that--in respect of any house occupied by more than one family, if it be situate in any court, alley, or other place having no carriage-way, and be not assessed to the poor-rate at a higher rental than £...... _per annum_; or if in it any occupied holding consist of only one room, provided the rent of such room do not exceed the sum of ......shillings per week, or if in it there reside, or within three months previous have resided, any person receiving parochial relief, medically or otherwise; on the certificate of a duly authorized medical officer, that any such house, or part thereof, is habitually in a filthy condition, or that from over-crowding or defective ventilation the health of its inmates is endangered, or that there has prevailed in it undue sickness or mortality of an epidemic or infectious kind; the Local Board may call upon its owner to register it in a book kept for this purpose; and in respect of all houses thus registered, the Local Board may make rules for periodical washing, cleansing, and limewhiting, and for the regular removal of all dust or refuse-matter, may fix the number of tenements into which it shall be lawful to divide any such house, or the total number of inmates who may at one time be received therein, may require its better ventilation by the construction of additional windows or louvres, and may from time to time make such other regulations and orders as they shall judge necessary for the maintenance of health and decency; and may recover from the owner or lessee of any such house penalties for neglect of any legal requisitions, rules, and orders, as aforesaid: 2) that--on the certificate of a duly authorised medical officer, that the condition of any house or room is such as to render probable the rise or the spread of infectious and dangerous disease among its inmates, the Local Board may cause the owner or lessee of such house to be summoned before a magistrate; who, after due hearing, or in default of the owner’s or lessee’s appearance, may order the house, or any part of it, to be evacuated of all tenants within such time as he shall judge fit, and not again to be tenanted till after licence from the Local Board given on the certificate of their medical officer that its causes of unhealthiness are abated; and the magistrate may enforce penalties for non-compliance with his order, as aforesaid: 3) that--after an Order in Council bringing into action the extraordinary clauses of the Nuisances Removal Act, the Local Board, on receiving the certificate of their medical officer that any house, or part of house, is in such condition as to be imminently dangerous to the lives of its inmates in respect of the prevailing epidemic, or any similar disease, may issue a peremptory order for its evacuation, and may recover, from the owner or lessee to whom such order is addressed, penalties for every day during which, or part of which, after such order, the house, or any part thereof, continues to be tenanted; nor, under like penalties, shall it be lawful, except after written licence from the Local Board, given as aforesaid, to allow such house to be re-occupied.

Under circumstances like those just adverted to, may be found traces of enactment against _offensive and injurious trades_. Unregulated slaughtering throughout all London, except the City, tallow-melting in St. Paul’s church-yard, bone-boiling beside Lambeth Palace, may serve to illustrate the completeness and efficiency of these laws--even in our metropolitan area. Here we greatly lack some competent authority, on the part of the Government, to investigate all circumstances connected with such establishments, generally; to suggest laws for their prospective restriction, as to places wherein they may lawfully settle; and to frame regulations--enforceable by any Local Board of Health, for ensuring that all available measures be employed to mitigate their nuisance. Considering the circumstances under which many of these establishments have existed, no one can entertain a thought, that--even for the public health, they should be liable to the tyranny of an unconditional displacement. But if there existed--as undoubtedly there should exist, some skilled tribunal, competent to speak on the subject; then, I will venture to say, it might be quite in accordance with our English sense of liberty, that--after a certain condemnatory verdict by this tribunal, it should be open to the Local Board of Health to procure their expulsion, on payment of whatever compensation an ordinary jury might award.

Again, with _factories_; thanks to Lord Shaftesbury’s indefatigable benevolence, the law has appointed an inspection of certain establishments, a restriction of their hours of labour, and some care against the dangers of unboxed machinery. And with mining also the law has interfered, chiefly as to the ventilation of mines; but hitherto so ineffectively that, while I write, the coal-miners are remonstrating with the Legislature on the thousand lives _per annum_ still sacrificed through the insufficient protection accorded them. If there be meaning in this legislation--if it imply any principle, the meaning and the principle require to be developed into a general law, that every establishment employing labour be liable to inspection and regulation in regard of whatever acts and conditions are detrimental or hazardous to life. If factory-children are cared for, lest they be over-worked; and miners, lest they be stifled; so, for those who labour with copper, mercury, arsenic, and lead, let us care, lest they be poisoned! for grinders, lest their lungs be fretted into consumption! for match-makers, lest their jaws be rotted from them by phosphorus! And here let it again be noticed, as in the class of cases last spoken of, how greatly wanted is some skilled tribunal, to form part of any lawful machinery which might ensure that, in these and similar instances, no precautions necessary to life are withheld through ignorance or parsimony.

Against _adulterations of food_, here and there, obsolete powers exist, for our ancestors had an eye to these things; but, practically, they are of no avail. If we, who are educated, habitually submit to have copper in our preserves, red-lead in our cayenne, alum in our bread, pigments in our tea, and ineffable nastinesses in our fish-sauce, what can we expect of the poor? Can they use[3] galactometers? Can they test their pickles with ammonia? Can they discover the tricks by which bread is made dropsical[4], or otherwise deteriorated in value, even faster than they can cheapen it in price? Without entering on details of what might be the best organisation against such things, I may certainly assume it as greatly a _desideratum_, that local authorities should uniformly have power to deal with these frauds (as, of course, with every sale of decayed and corrupted food) and that they should be enabled to employ skilled officers, for detecting at least every adulteration of bread and every poisonous admixture in condiments and the like.

[3] The proverbial dilutions of milk are not its only deteriorations. Cows are so ill kept in London, and in consequence so often sickly, that milk suffers--sometimes by mere impoverishment, sometimes by much graver derangements. If there were instituted a proper Inspection of Provisions, one function of its officers should be to visit cow-houses, and to prevent the distribution of milk thus damaged or infected. I suspect that a sanitary reform of these establishments would make a sensible difference to the nursery-population of the metropolis.

[4] A chief artifice in the cheapening of bread is to increase its weight by various means which render it retentive of water. The other usual frauds consist in the employment of inferior flours--either not cereal, or damaged and partially deglutinised.