Part 10

It would be ridiculous if I should pretend to carry you into any medical consideration of this subject, or should make my present Report the vehicle of a professional argument; but I may very briefly acquaint you with such generalisations as will justify you in pursuing a particular course with respect to the haunts of cholera. While doing so, I hope your Hon. Court will believe that I have devoted to this very serious subject the best consideration of which I am capable, and have done my utmost to arrive at conclusions which may be fruitful of practical good.

Cholera visited no localities of which it could be said, that they were generally healthy; but still there seemed to be something peculiar and specific in the kind of local unhealthiness which determined its invasion. On the one hand, it is unquestionably true that many habitual seats of fever were visited by cholera; on the other hand, many of the worst fever-nests in the whole metropolis were unaffected by it; and it struck with extreme severity in a class of houses habitually exempt from fever. See, for instance, how malignantly it prevailed along the line of Farringdon and New Bridge streets, and in Fleet-street and Ludgate hill, where their line intersects that just mentioned; and here, you will observe, not only in those obscure and ill-ventilated courts and by-ways, where fever is the familiar visitant of a hungry and crowded population; but also, and very strikingly, in spacious and airy houses, situate along the main thoroughfare of the City, and inhabited by opulent tradesmen, by members of the various professions, or by officers of assurance-companies. Other infective diseases which habitually desolate the former class of dwellings are almost unknown in the latter. Cholera came as a startling exception. _Within the infected district_ (fulfilling the classical description of pale death) it trod with equal foot the gates of rich and poor.[40]

[40]

---- Æquo pulsat pede pauperum tabernas Regumque turres.

I think it very important that this fact should be fully recognised. In London it has often been overlooked, from the accident that our most infectable districts happen to contain an excess of poor population. But even here it is quite easy to note that the disease spreads irrespectively of pauperism or privation; and in other cities, (Paris and Copenhagen, for instance) where the quarters of rich and poor are less apart than in London, cholera has killed its full share of dignitaries and capitalists.--J. S., 1854.

Personal peculiarities, or vicious habits, or temporary indiscretion, may often have determined its choice of a victim; low nourishment--even temporary emptiness and exhaustion, very manifestly invited its attack; but, speaking generally, I may say that it was a disease prevailing over a certain patch of ground, and (within this limit) tending to strike equally, or nearly equally, in all classes of habitations. Crowdedness of dwellings, defective ventilation, squalor of inhabitants, and many forms of local nuisance, which are omnipotent in giving occasion to fever, and in adding malignity to many disorders of its class, did not by themselves exert so marked and specific a power in determining the onset of cholera.

What then were the conditions determining its local preference? Consideration of its statistics, or inspection of a cholera-map, enables one, with some confidence, to answer--a peculiar condition of soil, of which dampness is one sure and invariable character, and organic decomposition (promoted by dampness) probably another.[41] Its local affinities have much analogy to those of ague, and often appear identical in their range with the sphere of malarious infection. Our entire metropolis, built down to the very margins of a large river--of a river, too, which, at each retreating tide, exposes acres of mud saturated with the reeking sewage of an immense population, is placed generally in circumstances not unfavourable to the development of the disease; and its several parts will be liable to suffer especially, in proportion as they are exposed to these general circumstances, or to special circumstances of their own of a like nature. The lower level of districts on the south side of the river, their attendant failure of natural land-drainage, the consequent soddenness of a soil from which likewise the materials of house refuse were never efficiently removed, accounted sufficiently for the frightful epidemic mortality which prevailed in those quarters of the metropolis.

[41] After three years’ further inquiry I find no reason to modify this general description: but, as regards the local circumstances which determine the specified condition of soil and atmosphere, I have been able to extend my information; and the subject is therefore better treated in my Fifth Annual Report than in the paragraphs here following above.--J. S., 1854.

If you now look to the disease as it raged within your own jurisdiction, you will observe its fatality in two especial directions. First, in the line I have indicated to you, northward from Blackfriars Bridge, in a band of two or three hundred yards width; _there_, in the parallelogram which lies along the main road, from Stonecutter-street to Bridewell Hospital, were 76 deaths; _there_, in the little clump of houses forming the angle of Farringdon-street and Holborn-hill, were 17 deaths; _there_, in a square space behind twenty-seven shop fronts in Fleet-street, were 57 deaths; _there_, in the small parish of St. Ann’s, Blackfriars, were deaths at the rate of 25 to every thousand of its population. This was incomparably the most afflicted portion of your territory. Those who are acquainted with the ancient geography of the City will readily conjecture a reason; they will remember when ‘the course of water running at London under Old-bourne bridge and Fleet bridge, into the Thames, was of such bredth and depth that ten or twelve ships, navies at once with merchandises, were wont to come to the foresaid bridge of Fleet, and some of them unto Old-bourne bridge;’ they will remember how this broad river (like the Thames of our day) was thronged on both sides with population; how (again like the Thames) it was a draining river, probably with wide banks of putrefying mud; how many fruitless attempts were made to cleanse and preserve its channel; but how (in Stow’s day) ‘the brooke, by meanes of continuall incrochments upon the banks, and casting of soylage into the stream, was become worse cloyed than ever it was before.’ Where that _soylage_ was cast, and where, since the days referred to, so many habitations have arisen that no sign of stream remains visible to the wayfarer above ground, its traces still remain below. Throughout at least a large portion of this district, the sub-soil (your Surveyor informs me) consists of black mud, the bed of the ancient river, in which are set the foundations of the modern houses. The river, which centuries ago fulfilled for a large population those vile uses which now pollute the Thames, has gradually yielded its foul banks to the residence of a growing population; and the sanitary relations of that population are exactly such as might be imitated, if the volume of the Thames were henceforth slowly reduced, and if those banks of mud which are now exposed only at low water, were simultaneously converted into the site of permanent habitations.

The history of the stream at Walbrook is, I believe, not dissimilar; but there is this marked difference between the two cases, that the comparative declivity of the latter district has allowed its soil to acquire a dryness and healthiness which have never been reached on the banks of the Fleet. For, owing to the extreme lowness of level in this district, the tidal influence of the Thames is very inconveniently felt; the cellars of houses are habitually exposed to dampness, even to flooding; and probably the whole porous sub-soil, at least as far north as your jurisdiction extends, is maintained in a sodden and malarious state.

With respect to the second part of the City in which considerable groups of cholera cases were observed, it has a not dissimilar peculiarity. I refer to that northern part of the City which extends (on the other side of London Wall) from Bishopsgate to Aldersgate. The epidemic prevailed there with far less severity than in the Fleet district, but still with a preference which easily shows itself in a cholera-map. At the intersection of Whitecross-street by Beech-lane, in a space that the point of one’s finger would hide in Wyld’s large map, there were 12 deaths: in that small portion of the City which lies north of Barbican and Beech-street there were 40 deaths: in the immediate vicinity of Half-moon-street, Bishopsgate, 60 deaths, of which more than half were in the workhouse. Now, certainly, in all this space (and probably still further in both directions, east and west) without the former gates of the City, there is a marked local character. It is a reclaimed marsh.[42] Throughout this district, in the olden times of the City, there lay (says Stow) ‘a moorish rotten ground, unpassable but for cawswaies purposely made to that intent;’ and one reads how ‘divers dikes were cast, and made to drein the waters of the said Moorefields, with bridges arched over them, whereby the said field was made somewhat more commodious, but yet it stood full of noisome waters;’ till gradually ‘by divers sluces was this fenne or moore made maine and hard ground, which before, being overgrowne with flagges, sedges, and rushes, served to no use;’ while ‘the farther grounds beyond Finsbury Court were so over-heightened with laystalls of dung, that divers windmills were thereon set, the ditches were filled up, and the bridges overwhelmed.’

[42] I have reason to believe that this statement, though founded on the authority of Stow, is erroneous, for so much of the district as lies west of Moorgate-street; and that the main cause of this locality suffering so severely from cholera must have lain in those very extensive defects of house-drainage, which more recently I have become better able to appreciate. With the kind assistance of Mr. Haywood, I have been enabled to look over the memoranda which are kept in his office, of deep cuttings of soil made in the construction of sewers by himself and his predecessor, Mr. Kelsey. These sections do not by any means tally with Stow’s description of the Moor, as extending in part ‘from without the postern called Cripplegate, even to the river of Wels;’ for here at least there is no trace of any such condition of soil.--J. S., 1854.

It is not as matter of literary curiosity that I quote these passages of your old historian, but simply that I may avail myself of his accurate local knowledge for the explanation and the cure of a serious existing evil. For if, as I believe, the unfortunate preference for certain localities evinced by the recent epidemic be, _primâ facie_, a reason for doubting the effectiveness of their sub-soil drainage, and if the ancient records of the City assure one that these very localities are such as, from conditions then in active operation, would be liable to retain, perhaps for an indefinite period, the materials of malarious poison, useful and practical deductions may be drawn. And as the liability to this severe recurrent epidemic is an extreme detriment to the population of such localities--one too, which, if unremoved, must inevitably lead to the deterioration of property, as well as to the sacrifice of life, I know that your Hon. Court will be solicitous to adopt whatever remedial measures are possible.

To those measures I shall presently return, having here dealt with the question only as it relates to the distribution of our mortality, and explains the preponderance of a large class of deaths in some special districts of the City.

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In the Tables which accompany this portion of my Report, I have arranged in a synoptical form, convenient for reference, the chief facts of our sanitary statistics to which I have invited your attention.

In the first[43] you will read a summary of the deaths as they have occurred, male and female, in the several districts and sub-districts of the City, during each quarter of the past year.

[43] _Appendix_, No. IV.

In the second[44] table the deaths of the year are classified according to the ages at which they befell.

[44] Now incorporated in the general table, _Appendix_, No. VIII.

In the third table,[45] for the sake of comparison in respect both of general and of infant mortality, I have arranged the statistics of certain other localities side by side with our own.

[45] Now inserted at page 84.

In the fourth[46] (to which I have already especially referred) is contained an enumeration, according to the several Wards of the City, of those deaths, during the last two years, which have arisen in consequence of acute disease partially or entirely preventable.

[46] Page 167.

In tables of this nature perfection is at present impossible; partly because of trifling changes in the population which often occur, but rarely can be estimated; partly because of the slovenly manner in which deaths are occasionally recorded. While, therefore, I would not consider myself responsible for their absolute and infinitesimal accuracy (consisting as they do of so many and so various details) I may assure your Hon. Court that all proper pains have been taken to render them for every useful purpose correct and trustworthy: and that I believe them, in all essential particulars, truthfully to represent whatsoever I have sought to embody in them.

The annual ratio of deaths within your district; the local differences of that ratio; the proportion of infantile mortality; the amount of preventable disease; and, in all these respects, a comparison of parts of the City with each other, and of the whole City with other inhabited districts,--these are the materials on which your judgment must be formed as to the necessity of sanitary measures, whether for the entire City, or for its component parts: and as a main object of the appointment which I have the honour to hold is that I should furnish you with materials for forming that judgment, so I may probably stand excused for troubling you with these considerations at such great length.

II. THE CAUSES AND THE PREVENTION OF ENDEMIC DISEASE.

According to the method adopted in my last Annual Report, I now proceed to offer you such observations as another year’s experience may justify, on those physical influences which prevail against life within the City of London, and on such remedial measures as seem aptest to remove them.

_Sub-soil Drainage, House-Drainage, and Sewerage._

1. In respect of drainage, I have already adverted to those unwholesome conditions which prevail along the low-lying valley of the ancient Fleet, and have mentioned to you that frequent incursions of the river aggravate whatever mischief is inherent in the soil, by maintaining it as a perpetual swamp, and by favoring in it a constant succession of putrefactive changes. I have likewise illustrated to you the probability that, in some of the higher portions of the City, chiefly in the Out-Wards of Cripplegate and Bishopsgate, there still survive some properties of that old malarious fen, from which these districts were originally reclaimed. Stow seems in his day to have had misgivings on this subject; for after describing the improvements that had been effected there, and the gradual levelling and heightening of the ground, he adds, ‘it seemeth to me that if it be made level with the battlements of the city wall, yet will it be little the dryer, such was then the moorish nature of that ground.’

From a consideration of this former geography of the place, and from observation of the diseases which prevail there, I am led to think it highly probable, that some of its sanitary defects depend less on defective house-drainage than on a still marshy undrained condition of the ground itself, and that these defects would be removed by an efficient application of sub-soil drainage.

I would therefore respectfully recommend to you, under this head, that the state of soil in the specified districts be referred to competent authorities, and that such measures be adopted as inquiry may prove requisite, for relieving those parts where the sub-soil drainage is imperfect, and for protecting the house-foundations, and sewers, and sub-soil adjacent to the river, from being soaked or flooded by the tide.

* * * * *

2. With respect to house-drainage, I have no addition to offer to those remarks which I submitted to you in my last Report. Your Hon. Court has fully recognised that immense peril to life which is connected with the presence of cesspools beneath houses, and which depends on their poisonous emanations. At the commencement of the present year, your Surveyor stated that he might take ‘5414, as a fair approximation of the number of cesspools’ then in existence within the square mile of the City of London. This proportion, dangerously large as without doubt it is, presented an important diminution from the number which existed a year previously, when your Commission first obtained from the Legislature authority to enforce their closure; and it may reasonably be anticipated that at the termination of this present year, a still further abatement will be recorded in the magnitude of that destructive nuisance.

* * * * *

3. Notwithstanding the variety of stink-traps to which you have given trial, and notwithstanding the fact (recorded by your Committee of Health on the Surveyor’s authority) that ‘there does not exist within your jurisdiction a single gully which is untrapped,’ there continue to be frequent complaints of offensive exhalations from the sewers.

The mechanical difficulties in this matter of trapping have appeared to be, from the nature of the case, almost insuperable. It may, indeed, easily be conceived, how incompatible are the common uses of a gully-hole with such fineness of adjustment and delicacy of balance as would render the apparatus air-tight from within, and effectually preclude an escape of the gaseous contents of a sewer. Under such circumstances, your Hon. Court has desired that I should express my opinion, how far a different course might be adopted in respect of these exhalations; how far, namely, they might be neutralised within the sewers; how far it might be chemically feasible, and in a sanitary point of view expedient, that a systematic use should be made of deodorising agents; so that any gas escaping from the sewers should at least be divested of its original smell.

On this subject, I would submit to you the following considerations. As respects its feasibility (putting aside as foreign to my province all questions of the expense, and all details of the daily arrangement) a first and obvious objection is this: Granted in the abstract, that sewer-gases can be converted by appropriate agents into inodorous compounds; in the practical application of these agents, you would find impediments with which you are already familiar. Theoretically, there may be no difficulty in providing air-tight traps; practically there is said to be every difficulty. Just as that mechanical problem has defeated you in practice, so would the chemical one; and for the same reason. The fulfilment of either problem is a matter of nice adjustment. In proportion as your gully-hole is exquisitely trapped, it becomes liable to obstruction; it loses its use as an inlet to the sewer, nearly in the same measure as it becomes an effective obstacle to regurgitant gases. Similarly, in proportion as these alleged deodorisers might succeed in completely stifling the characteristic odour of sewage, they would be liable to diffuse perfumes peculiarly their own, and to establish, in the vicinity of gully-holes, the alternation of a new nuisance with the old. To proportion with accuracy the introduction of these chlorinous preparations to the amount of refuse traversing the sewers--an amount varying most considerably at different hours of the day, seems to me quite a visionary hope. Failing such accurate proportions, I am not prepared to say that the result would be useful; and I accordingly consider the scheme as not chemically feasible.

Further--as involving an important sanitary principle, I would say, that the great object which must be aimed at is not the mere chemical neutralisation of certain stinks which arise within your jurisdiction, but the closest possible limitation, and the promptest possible removal of all those materials which are decomposed into fœtid products. Admirable, no doubt, is that arrangement by which Nature, stationing a sense of smell at the inlet of our breath, cautions us by this vigilant sentinel against the inhalation of many poisonous airs; but, in respect of organic decomposition, I am in no degree satisfied that its odorous products are its only, if even its principal, agents of injury; nor have I any reason to suppose that the real detriment to health which arises from breathing the miasms of sewers or marshes, of cesspools, burial-grounds, or slaughter-houses, would in any important degree be lessened by the mere mitigation of fœtor in their effluvia. Offensive as these are, they at least answer the useful purpose of warning us against the other poisons with which they are associated.

Let me likewise take the opportunity of correcting a misapprehension, which, by the use of an inappropriate word, is sometimes shown to exist on this subject. The agents in question are spoken of as _dis-infectant_. As there is no scientific reason whatever for believing that they in any degree interfere with the spread of epidemic or infectious disease, and as an erroneous opinion on this point may lead to the neglect of measures which are truly precautionary and useful, I think it well to state explicitly, for your information, that I have no evidence of their possessing any other utility, in the respects under consideration, than simply and singly that of removing stink from the atmosphere around them.

For reducing to a _minimum_ the exhalations which arise from sewers and house-drains, it appears to me that the following are the essential principles: First, to render the current through them as rapid as possible; and, above all, by every care for their form, their junctions, their slope, and their material, to provide against the occurrence of obstructions and deposit: Secondly, to employ in their construction, so far as may be possible, such substances as are porous in the least procurable degree; such as consequently will be least apt to imbibe and retain in their interstices any considerable impregnation from the fœtid fluids running over them at intervals; such, too, as will be least likely to permit soakage into the surrounding soil: Thirdly, by reducing the size of drains and sewers to the lowest dimensions compatible with a full performance of their uses, to diminish to the utmost the extent of their interior evaporating surface, and of those large chambers which they now offer for the evolution, retention, and diffusion of gases.