Part 19

+-------+------+---------+-------+-------+--------+-------------+ | | No. | | | | |Number | | | on |Flooring.| Fire- |Venti- | Rent. |of | | |door. | |place. |lators.| |Inmates. | | | | | | +--------+-------------+ | | | | | |Weekly, |Under | Over | | | | | | | or | 9 | 9 | | | | | | |nightly,|years |years | | | | | | | or per | of | of | |Account| | | | |person. | age. | age. | | +------+---------+-------+-------+--------+------+------+ | of | 1 | | | | | | | | +------+---------+-------+-------+--------+------+------+ | Rooms | 2 | | | | | | | | +------+---------+-------+-------+--------+------+------+ |Separ- | 3 | | | | | | | | +------+---------+-------+-------+--------+------+------+ |ately. | 4 | | | | | | | | +------+---------+-------+-------+--------+------+------+ | | 5 | | | | | | | | +------+---------+-------+-------+--------+------+------+ | |6, &c.| | | | | | | +-------+------+---------+-------+-------+--------+------+------+

Staircase, if with windows or skylight __________

Privies {Number ____ {Situation ____

{ {Material ______ {Receptacles-{Capacity ______ Water-supply-{ {Situation ______ { {Taps, where situated _____________

Sinks ____

Dustbin ____

Yard--size of uncovered area ____

Pavement ____

Laundry ____

Date ________ Signature of Owner ________________

NOTE.--I, ____________________, Inspector for the Commissioners of Sewers of the City of London, do certify that the above schedule contains a true account of the matters to which it relates; also that I have examined the privies, drains, sinks, and water-supply in the above house, and do find the same to be in an efficient and satisfactory condition; also that the house generally is in good repair, perfectly clean, and free from disagreeable smell.

Date____, signed ________________ Inspector.

FOURTH ANNUAL REPORT.

_September 28th, 1852._

GENTLEMEN,

I beg leave to lay before your Hon. Court the several tables[74] which I have prepared, to illustrate the mortality of the City of London during the past year. They refer to fifty-two weeks, dating from September 28th, 1851, to September 25th, 1852.

[74] These tables are not here reprinted in a separate form, except the enumeration of deaths for the year, which is No. VI. in the Appendix. The others are embodied in the different quinquennial tables of the Appendix.

In the first table I have distributed the 3064 deaths of the period, according to their localities and seasons; showing them as they occurred, male and female, during each quarter of the year, in the several districts and sub-districts of the City. For the foot of each column, I have calculated the year’s death’s rate, per thousand of the living, in the district or sub-district referred to; and at the head of the columns, for facility of reference, I have introduced an analysis of the population, founded on the Registrar-General’s recent census.

In the second table all the deaths of the last four years are stated, in a form which will enable you to compare one year with another, and one sub-district with another, in respect of their several contributions to the total mortality of the period.

In the third table 12,540 deaths[75] of the last four years are classified according to the ages at which they befell. This table is arranged in a manner to display its results, first for each year separately, and next for each Union separately; in order that you may observe what local or annual differences have obtained as to the ages of chief mortality.

[75] In the remaining number (17) the particulars of age and residence could not be correctly ascertained.

The fourth table also relates to the last four years. It restricts itself to those various forms of acute disease--epidemic, endemic, and infectious, which occasion, most of all, the predominant mortality of particular districts or seasons; and which are susceptible, in the highest degree, of being mitigated or removed under an efficient sanitary system.

In their general import these documents agree very nearly with last year’s record; though showing unfortunately a somewhat higher death-rate (23·62) and especially a larger proportion of fever.

On former occasions I have examined, with great minuteness, all such facts as these tables set forth, and have offered you the best suggestions in my power for the mitigation of preventable disease.

The sanitary condition of the City is now substantially the same as at the date of my last Report; and any comment which I might make on the present tables could be little else than a repetition of arguments already submitted to your notice.

Therefore, as other topics[76] of importance to the health of the City press for more immediate consideration, I refrain from occupying your time by any further remark on the materials which I subjoin.

[76] We were at this time closely occupied in considering the general questions of extramural interment for the City.--J. S., 1854.

I have the honour,

&c., &c.

FIFTH ANNUAL REPORT.

_November 29th, 1853._

GENTLEMEN,

According to the practice of previous years, I lay before you, in the annexed tables, a brief digest of your death-register for the fifty-two weeks which terminated at Michaelmas last.

The deaths there enumerated amount to 3040--being 24 fewer than in the last preceding similar period.

Beyond these statistics of the past year, there are other facts which I have thought it well to tabulate for your information. They relate to the entire term of five years, during which I have kept record of your mortality. Midway in this quinquennial period--namely, in the spring of 1851, the general census happened to occur. The inhabitants of the City, then enumerated, may fairly be taken to represent the mean of your somewhat fluctuating population; and the five years’ mortality, compared with the numbers of this mean population, will express pretty accurately their habitual death-rate.

The period mentioned is indeed short for the purpose of establishing an average; but ten years at least must elapse before even similar materials can again be given for calculation, and a still longer time before the statistical basis can be enlarged. I have therefore thought it desirable to make the best use in my power of such facts as were before me, for the construction of quinquennial tables; out of which, with sufficient accuracy for all practical purposes, you may draw your own inferences as to the health of that large population which is under your sanitary government.

The facts are classified, as heretofore, in the manner which will most easily display their practical meaning. First, namely, the deaths of the period are recorded in their local distribution, so that you may compare one part of the City with another in respect of healthiness. Next, they are so tabulated according to ages, as to indicate the prevailing proportion of untimely death. Thirdly, those of them are separately enumerated which, in their several classes, chiefly occur as results of acute disease in connexion with removable causes.

In after years, when sanitary improvements, now only in contemplation or commencement, shall have produced their legitimate results and rewards, these tables may serve an important use. Indicating the standard of public health within the City before such works were achieved, and constituting a permanent record of your starting-point, they will qualify your successors to estimate the amount of amelioration which your endeavours shall have produced.

The details of your present sanitary condition, as varying in different sub-districts of the City, and as fluctuating in the several years and seasons of the quinquennial period, are expressed in the figures of these tables more compendiously and more clearly than I could hope to convey them in words. Here, therefore I restrict myself to telling you very briefly their general results.

The population of the City--about 130,000 persons--has been dying during these five years at the rate of about 24 _per_ thousand _per annum_. The sub-district rates which give this aggregate vary from under 18 to above 29; the former death-rate belonging to your healthiest locality--the north-west sub-district of the City of London Union; while the latter--more than 60 _per cent._ higher--mortality belongs to the north sub-district of the West London Union. The lowest death-rate hitherto attained in this country for a considerable population, during a term of seven years, has been 14 _per_ thousand _per annum_; which your worst sub-district mortality more than doubles.

As different districts contribute unequally to your average death-rate, so also do different ages. Among all the population exceeding five years of age, the death-rate is under 17 _per_ thousand _per annum_; while, for children under five years of age, the rate is nearly 85. And these rates are unequally constituted by your three chief districts in the following proportion; viz.:--

Annual Rate of Deaths to 1000 Over 5 Years Under 5 Years living persons. of age. of age.

East London Union 16·68 91·99 West London Union 20·58 94·84 City of London Union 15·06 71·72 ----- ----- Average death-rate in the City 16·85 84·72

How various are the diseases which have conspired to produce your annual average of 3120 deaths, it would be tedious to describe; and in the table which I have devoted to a partial analysis of this subject, I have restricted myself to a consideration of those ailments which are likely to become less fatal under a well-developed sanitary system. To the annual average typhus has contributed 140 deaths; choleraic affections (including the epidemic of 1849) 196; scarlet fever, 76; small pox, 40; erysipelas, 30; the acute nervous and mucous diseases of children, 572; their measles, hooping-cough, and croup, 182;--making, from this class of disorders, an annual average of about 1250 deaths--nearly two-fifths of the entire mortality.

My tables will show you that the different seasons of the year have pressed somewhat differently on human life; and there is exhibited in them a point of some interest to which I would beg your attention. In your healthier sub-districts it is easy to perceive the influence, the almost inevitable influence, exerted by the inclemency of winter against the aged and feeble. In your unhealthier sub-districts, this effect is completely masked, and summer becomes the fatal season; its higher temperature acting in some sort as a test of defective sanitary conditions, and giving to the several local causes of endemic disease an augmentation of activity and virulence.

On the facts which these tables set forth, I have nothing further to say than would consist in a repetition of arguments already submitted to your notice. In my third Annual Report, especially, I endeavoured to lay before you the conclusions which are fairly deducible from the proportions of early death, and from the partial allotment of particular diseases.

These conditions, indeed, are in obvious mutual relation. To human life there has been affixed a normal range of duration; and when it prematurely fails--when children perish in the cradle, or adults amid the glow of manhood, the exception in every case is a thing to be investigated and explained. Of the 15,597 persons who have died within your jurisdiction, not an eighth part had reached the traditional ‘threescore years and ten;’ while nearly three-eighths died in the first five years of life. In proportion as facts like these appear in the death-tables of a particular district, in the same proportion we can trace the local prevalence of particular diseases, to explain the abridgment of life; and passing from such a locality to other districts, where the natural term of existence is more nearly attained, invariably we find that these diseases have fallen into comparative inertness. Finally, in grouping the fatal results of such diseases in their proportionate geographical allotment, invariably we find that their prevalence or non-prevalence, here or there, has been associated with demonstrable physical differences; that life has not capriciously been long in one place and short in another, but that, where short, it has been shortened; that its untimely extinction has depended on the direct operation of local and preventable causes.

In this recognition of cause and effect, which the experience of late years has rendered vivid and precise; and in that higher appreciation of human life, which belongs to civilized nations in peaceful times; and in that deeper sympathy for the suffering poor, which should be at the heart of every Christian government, sanitary legislation had its origin in this country; and it has been the good fortune of the City of London (in respect of your two Acts of Parliament) to precede the rest of the metropolis in acquiring and exercising authority for the mitigation of preventable disease.

Nearly five years have now passed over your tenure of this very grave responsibility; and although in many respects the period must be regarded as one of apprenticeship to a new and difficult career--although you have hardly yet arrived at what may permanently represent your method of action--although important changes which you have determined to adopt are not yet in actual working--although the far greatest evils still remain for correction--yet I rejoice to inform you that sensible improvement has already shown itself in the sanitary state of your population. My comparison of the past five years with any considerable previous period cannot be as precise as I would wish, owing to the absence of circumstantial records for the time anterior to my appointment; but, judging from such information as I can consult on the subject, I am induced to believe that the deaths, for equal numbers of population, are about four _per cent._ fewer than before your Acts of Parliament came into operation, and that the disproportionate mortality of children is decidedly lessened.

On this first improvement--the beginning, I would fain hope, of a long series of similar steps for regaining the allotted duration of human life, I beg to offer my respectful congratulations to your Hon. Court, under whose auspices it has been effected. Further impetus in the same direction will shortly be given by the removal of sanitary evils, already in fact or in principle condemned. The approaching institution of your extramural cemetery, and, I venture to hope, the translation of all slaughtering establishments to the site of your new Smithfield, will be important contributions to this effect. I therefore make bold to speak with some sanguineness of the slight change of death-rate already noticed; though, while so much remains to be accomplished, I doubt not you will welcome the amelioration rather as an encouragement to proceed, than as the final reward of a completed task.

* * * * *

Here, Gentlemen, terminates all that I have to submit for your consideration in respect of your past and present record of deaths. The greater extension which, during the last two years, I have given to my habitual Weekly Reports, and to sundry occasional statements which it has been my duty to lay before you, may seem, at least generally, to render it superfluous for my Annual Report to contain anything beyond such statistical particulars as I have now brought under your notice. But, however this may generally be, there exist exceptional circumstances at the present time which induce me to trouble you at somewhat greater length.

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II. Two years ago--adverting to the non-completion of metropolitan sanitary works, on which the health of entire London is vitally dependent, I could not but comment[77] on the utter unpreparedness with which the metropolis was awaiting any sudden return of Asiatic cholera. It was indeed impossible to foresee how soon, or how late, that dreadful visitation might recur to desolate our homes--whether it might return at once, or never. But typhus--averaging in fifteen years double the fatality of that rarer epidemic--was adding day by day to its list of preventable deaths; and other endemic diseases were co-operating with it, demonstrably, uninterruptedly, to decimate, impoverish, and abase the people.

[77] Third Annual Report, p. 206.

Whatever doubts might have existed as to a return of the foreign pestilence were soon solved: whatever hasty conclusions had been formed, as to its again remaining absent during half a generation, were soon disappointed and reversed. Even while I was addressing you on the subject, the plague had again kindled its smouldering fire, and was widening its circle of destruction. Perhaps from the eastern centres of its habitual dominion--from the alluvial swamps and malarious jungles of Asia, where it was first engendered amid miles of vaporous poison, and still broods over wasted nations as the agent of innumerable deaths; or perhaps from the congenial flats of Eastern Europe, where it may have lingered latent and acclimatised; the subtle ferment was spreading its new infection to all kindred soils. Repelled again from the dry and airy acclivities of the earth, and their hardier population, it filtered along the blending-line of land and water--the shore, the river-bank, and the marsh. Conducted by the Oder and Vistula from the swamps of Poland to the ports of the Baltic, it raged east and west, from St. Petersburg to Copenhagen, with frightful severity, and, obedient to old precedents, let us witness its arrival at Hamburg.

Twice in the European history of cholera, had this town seemed the immediate channel of epidemic communication to our island; the disease having on each occasion commenced in our north-eastern sea-ports within a very short time of its outburst there. A third time, not unexpectedly, has this dreadful guest, following the line of former visitation, touched upon the banks of the Tyne; where[78] a worse than beastly condition of the crowded poor, and sewage-water diluted through the people’s drink, had prepared it an appropriate welcome.

[78] Having had recent occasion to examine judicially into the matters here adverted to, I think it proper to mention that the allusions in my text were long prior to this examination, and were founded chiefly on the Registrar-General’s Reports of the time, with other official statements.--J. S., 1854.

Next, the disease was rumoured to be in London. Hope and belief are too near akin for this not to have been doubted and denied; but the last few weeks have shown, with sad incontrovertible certainty, that after only four years absence, Cholera has again obtained its footing on our soil. Six or seven hundred deaths, registered in the metropolis since the beginning of September, have already attested its presence.

Anxiously adverting to the future, and asking what may be the onward progress of the disease, we can appeal only to a narrow experience. Before us lie the records of but two complete visitations of the disease, and the commencement of this, the third. It would be a shallow philosophy that should pretend, from two observations, to predict the possible orbit of this obscurely wandering plague.

Yet I dare not disguise from you that such knowledge as we have, to justify scientific anticipation, is pregnant with threats and gloom. For--let me remind you of the past. At each former period of attack, the infection, after a certain course over Continental Europe, struck upon our eastern coast in the summer of an unforgotten year. In the northern parts of Great Britain, so soon as it had lit among the population, each time it burst forth into explosive activity, and worked its full measure of destruction without delay. More faintly it reached the South. On each occasion, indeed, at the close of summer, London was sensibly affected by the disease; but, we hoped, under a milder infliction. Here and there, within its Bills of Mortality (as at Tooting in 1848) there was thrown some astounding flash on a particular hot-bed of co-operating poison; but on the whole it seemed to the sanguine, on each occasion, that the fury of the epidemic was expending itself in our northern towns, and that the metropolis was to be comparatively spared.

Each time, at the commencement of the new year, our London mortality from Cholera seemed stationary within the limit of a few hundred deaths. Each time winter and spring allowed a long respite to our invaded City, and confirmed the omens of the hopeful.

But each time there was disappointment. Each time, as the warmth of summer requickened the exterior conditions of chemical activity, the dormant fire kindled afresh--slowly at first, but with speedy acceleration of rate. Each time, in the few weeks before Michaelmas--amid almost universal threatenings of the disease, and amid such panic of death as the metropolis had not known since the Great Plague, there suddenly fell many thousands of the population.

Thus then our position stands. Scientific prediction of phenomena can arise only in the knowledge of laws. That the phenomena of this disease, however capricious they may seem, are obedient to some absolute uniformity as yet beyond our ken--are enchained by that same rigid sequence of cause and effect which is imposed on all remaining Nature--it would be impossible to doubt. But these conditions are hitherto unknown to science. Hitherto we can speak of the facts alone, with a short empirical knowledge of their succession. Yet in this light, such as it is, the conclusion is only too obvious. If the disease, already notorious for a tendency to return on its former vestiges, repeat on this third occasion the steps of its two previous courses; or, perhaps I should rather say, if it now proceed consistently to complete a repetition which it has already half-effected; Asiatic Cholera will be severely epidemic in London in the third quarter of next year--will proceed, with a stern unflattering test, to measure the degree in which those promises of sanitary improvement have been redeemed, which the terror of its recent visitation extorted even from the supinest and most ignorant of its witnesses.

In the face of so great a danger, you will reasonably claim of your Officer of Health that he shall report to you, how far the City is already fortified against this dreadful invasion--how far the hygienic defences of life, if weak, may be strengthened--how far there remain breaches now insusceptible of repair.

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