Report on the SANITARY CONDITION OF THE LABOURING POPULATION, AND ON THE MEANS OF ITS IMPROVEMENT.
London, May, 1842.
GENTLEMEN,—Since my special attention was directed to the inquiry as to the chief removable circumstances affecting the health of the poorer classes of the population, I have availed myself of every opportunity to collect information respecting them. In company with Dr. Arnott I visited Edinburgh and Glasgow, and. inspected those residences that were pointed out by the local authorities as the chief seats of disease. I also visited Dumfries. An inspection of similar districts in Spitalfields, Manchester, Leeds, and Macclesfield, and inquiries formerly made under the Commission of Poor Law Inquiry, and inspections of the condition of the residences of the poorer classes in parts of Berkshire, Sussex, and Hertfordshire, had supplied me with means of comparison. Abandoning any inquiries as to remedies, strictly so called, or the treatment of diseases after their appearance, I have directed the examinations of witnesses and the reports of medical officers chiefly to collect information of the best means available as preventives of the evils in question. On the documentary evidence of the medical officers, and on the examinations of witnesses, aided by personal inspections, I have the honour to report as follows :—
Partial descriptions of the condition of’ the labouring classes, in respect-to their residences and the habits which influence their health, afford but a faint conception of the evils which are the subject of inquiry. If only particular instances, or some groups of individual cases be adduced, the erroneous impression might be created that. they were cases of Comparatively infrequent occurrence. But the following tabular return made up from the registration of the causes of death in England and Wales, which is the most complete yet attained, will give a sufficiently correct conception of the extent of the evils in question, when illustrated by the evidence of eye-witnesses, the medical officers whose duty it has been to attend on the spot and alleviate them. The table comprehends the abstract of the returns of the deaths from the chief diseases, which the medical officers consider to be the most powerfully influenced by the physical circumstances under which the population is placed—as the external and internal condition of their dwellings, drainage, and ventilation.
To the Poor Law Commissioners.
Number of Deaths during the Year ended 31st December 1835,
[Insert Table]
The registration of the causes of death for the year 1838 is selected, as that was the year when the report was made on the sanitary condition of the labouring population in the metropolis, which has served as the foundation of the extended inquiry.
There are no returns, and no adequate data for returns, to show the proportion in which deaths from the several causes above specified occur amongst the population of Scotland, but there is evidence to which reference will subsequently be made tending to prove that the mortality from fever is greater in Glasgow, Edinburgh, and Dundee than in the most crowded towns in England.
The registered mortality from all specified diseases in England and Wales was, during the year 1838, 282,940, or 18 per thousand of the population. These deaths are exclusive of the deaths from old age, which amounted to 35,564, and the deaths from violence, which amounted to 12,055. The deaths from causes not specified were 11,970. The total amount of deaths was 342,529 for that year. In the year following the total deaths were 338,979, of which the registered deaths from old age were 35,063, and the deaths from violence 11,980. The proportion of deaths for the whole population was 21 per thousand.
It appears that fever, after its ravages amongst the infant population, falls with the greatest intensity on the adult population in diseases, consumption, small-pox, and measles take place, are sufficiently well known. The proportions in which the diseases have prevailed in the several counties will be found deserving of peculiar attention.
A conception may be formed of the aggregate effects of the several causes of mortality from the fact that of the deaths caused during one year in England and Wales by epidemic, endemic, and contagious diseases, including fever, typhus, and scarlatina, amounting to 56,461, the great proportion of which are proved to be preventible, it may be said that the effect is as if the whole county of Westmoreland, now containing 56,469 souls, or the whole county of Huntingdonshire, or any other equivalent district, were entirely depopulated annually, and were only occupied again by the growth of a new and feeble population living under the fears of a similar visitation. The annual slaughter in England and Wales from preventible causes of typhus which attacks persons in the vigour of life, appears to be double the amount of what was suffered by the Allied Armies in the battle or Waterloo. It will be shown that diseases such as those which now prevail on land, did within the experience of persons still living, formerly prevail to a greater extent at sea, and have since been prevented by sanitary regulations , and that when they did so prevail in ships of war, the deaths from them were more than double in amount of the deaths in battle. But the number of persons who die is to be taken also as the indication of the much greater number of persons who fall sick, and who, although they escape, are subjected to the suffering and loss occasioned by attacks of disease. Thus it was found on the original inquiry in the metropolis, that the deaths from fever amounted to 1 in 10 of the number attacked. ir this proportion held equally throughout the country, then a quarter of a million of persons will have been subjected to loss and suffering from an attack of fever during the year ; and in so far as the proportions of attacks to deaths is diminished, so it appears from the reports is the intensity and suffering from the disease generally increased. It .appears that the extremes of niortality at the Small-pox Hospital, in London, amongst those attacked, have been 15 per cent. and 42 per cent. But according to other statements, the average mortality be taken at 1 in 5, or 20 per cent., the number of persons attacked in England and Wales during the year of the return, must amount to upwards of 16,000 persons killed, and more than 80,000 persons subjected to the sufferings of disease, including, in the case of the labouring classes, the loss of labour and long-continued debility; and in respect to all classes, often permanent disfigurement, and occasionally the loss of sight.
In a subsequent part of this report, evidence will be adduced to show in what proportion these causes of death fall upon the poorer classes as compared with the other classes of society inhabiting the same towns or districts, and in what proportions the deaths fall amongst persons of the same class inhabiting districts differently situated.
The first extracts present the subjects of the inquiry in their general condition under the operation of several causes, yet almost all will be found to point to one particular, namely, atmospheric impurity, occasioned by means within the control of legislation, as the main cause of the ravages of epidemic, endemic, and contagious diseases among the community, and as aggravating most other diseases. The subsequent extracts from the sanitary reports from different places will show that the impurity and its evil consequences are greater or less in different places, according as there is more or less sufficient drainage of houses, streets, roads, and land, combined with more or less sufficient means of cleansing and removing solid refuse and impurities, by available supplies of water for the purpose. Then will follow the description of the effects of overcrowding the places of work and dwellings, including the effects of the defective ventilation of dwelling-houses, and of places of work where there are fumes or dust produced. To these will be added the information collected as to the good or evil moral habits promoted by the nature of the residence. These will form so many successive sections of the report, and will be followed by information in respect to the means available for the prevention of the evils described, and an exposition of the present state of the law for the protection of the public health, and of modifications apparently requisite to secure the desired results.
I. GENERAL CONDITION OF THE RESIDENCES OF THE LABOURING CLASSES WHERE DISEASE IS FOUND TO BE THE MOST PREVALENT.
The following extracts will serve to show, in the language chiefly of eye-witnesses, the varied forms in which disease attendant on removable circumstances appears from one end of the island to the other amidst the population of rural villages, and of the smaller towns, as well as amidst the population of the commercial cities and the most thronged of the manufacturing districts—in which last pestilence is frequently supposed to have its chief and almost exclusive residence.
Commencing with the reports on the sanitary condition of the population in Cornwall and Devon, Mr. Gilbert, when acting as Assistant Commissioner for those counties, reports, that he found the open drains and sewers the most prominent cause of malaria. He gives the following as an instance of the common condition of the dwellings of the labouring classes in Devon, where it will be observed that the registered deaths from the four classes of disease amounted in one year to 5893 cases.
” In Tiverton there is a large district, from which I find numerous applications were made for relief to the Board of Guardians, in consequence of illness from fever. The expense in procuring the necessary attention and care, and the diet and comforts recommended by the medical officer, were in each case very high, and particularly attracted my attention.
” I requested the medical officer to accompany me through the district, and with him, and afterwards by myself, I visited the district, and examined the cottages and families living there. The land is nearly on a level with the water, the ground is marshy, and the sewers all open. Before reaching the district, I was assailed by a most disagreeable smell; and it was clear to the sense that the air was full of most injurious malaria. The inhabitants, easily distinguishable from the inhabitants of the other parts of the town, had all a sickly, miserable appearance. The open drains in some cases ran immediately before the doors of the houses, and some of the houses were surrounded by wide open drains, full of all the animal and vegetable refuse not only of the houses in that part, but of those in other parts of Tiverton. In many of the houses, persons were confined with fever and different diseases, and all I talked to either were ill or had been so : and the vhole community presented a melancholy spectacle of disease and misery.
” Attempts have been made on various occasions by the local authorities to correct this state of things by compelling the occupants of the houses to remove nuisances, and to have the drains covered ; but they find that in the present state of the law their powers are not sufficient, and the evil continues and is likely so to do, unless the legislature affords some redress in the nature of sanitary powers. Independently of this nuisance, Tiverton )vould_be considered a fine healthy town, situate as it is on the slope of a hill, with a swift river running at its foot,