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Appendix

1.—Circular Letter of Instructions to the Assistant Commissioners in England.

Poor Law Commission Office, Somerset House, 8th November, 1839.

Sir,—I am directed by the Poor Law Commissioners to call your attention to the following letter lately addressed to them by Lord John Russell.

Whitehall, August 21st, 1839.

“Gentlemen,—The Queen having been pleased to comply with the prayer of an humble address presented to Her Majesty in pursuance of an Order of the House of Lords, dated 19th of August, 1839, that ‘Her Majesty will be pleased to cause inquiry to be made as to the extent to which the causes of disease stated in the Appendix A., No. 1, of the Poor Law Commissioners’ Fourth Annual Report, and Appendix C., No. 2, of their Fifth Annual Report, to prevail amongst the labouring classes in the metropolis, prevail also amongst the labouring classes in other parts of England and Wales; and that Her Majesty will be graciously pleased to cause the results of such inquiry to be communicated to the House,’ I have to desire that you will cause inquiry to be made accordingly, and that you will prepare a report upon the results of such inquiry, and transmit the same to me in order that it may be laid before the House of Lords.

“I am, Gentlemen, “Your obedient Servant, “J. RUSSELL.”

The Commissioners consider this the proper time for making arrangements to obtain the returns and information on which they may prepare a report to be submitted to the House of Lords in the ensuing Session of Parliament.

The Commissioners request your particular attention to the subject, as one of great importance to the labouring classes, inasmuch as it may lead to the removal of the causes of prevalent and fatal diseases, and of consequent destitution and suffering.

The steps which the Commissioners propose to take for obtaining the information required by the order of the House of Lords, are:—

1. To procure from the medical officers of unions returns of the number of cases of contagious or infectious disease, the spread of which within their respective districts has been promoted by the circumstances referred to in the order of the House of Lords, with their observations thereon; for which purpose the Commissioners will issue the necessary circulars to the medical officers.

2. To obtain information from the Boards of Guardians of districts in which these diseases appear to have prevailed to a considerable extent, and where the guardians have applied to municipal or other authorities for the removal of circumstances promoting the prevalence of such diseases.

3. In large towns, to request some physician,[1] or general practitioner of eminent reputation, to prepare a report (founded upon data obtained from the various dispensaries, infirmaries, fever hospitals, and other similar public establishments) respecting the circumstances promoting the prevalence of contagious and infectious diseases in such large towns.

The Commissioners will be glad to receive from you the name of any physician or general practitioner of sufficient eminence to obtain the requisite data, and who will be willing to furnish them with such a report in each of the towns in your district named in the margin.

4. If the means already indicated should prove insufficient, to obtain a report from yourself founded on personal examination, on spots where, from the returns or from other information, such examination by yourself or the medical officer of the district may appear necessary.

Some of the chief considerations bearing upon the subject are set forth in the reports referred to in the resolution of the House of Lords, and if within your district there were any Boards of Health appointed during the prevalence of the cholera, it is probable that their reports founded on an examination of the condition of those classes amongst whom the prevalence of that disease was apprehended may furnish you with useful information.

The Commissioners wish further to observe that the state of the dwellings occupied by the labouring classes exercises an important influence upon their health, and the nature and frequency of the diseases to which they are subject, as well as indirectly upon the moral state of themselves and their families.

The Commissioners therefore request you to investigate the state of the dwellings of the labouring classes in your district, both in towns and in the country, with reference to the following observations,—

It will be desirable generally, after informing yourself of the various descriptions of cottage tenements in your district and the nature of the accommodation or comforts which they contain, to observe—

1. What is the common cost of erection, and the average cost of repairing each description of these cottage tenements.

2. What are the rents paid by the labourers for each description of these cottage tenements.

3. What is the general proportion of the rent paid by the labourer to his total expenditure.

You may find within your district instances where the employers of labour (whether agricultural or manufacturing) have erected on their own lands tenements of an improved description for the residence of the labourers employed by them. You are requested to take notice of all such instances which may come before you, and examine them as standards of comparison with other tenements of an inferior kind. You will inquire as to the comparative health and condition of the inmates, and whether the advantage of improved dwellings has been observed to have any salutary influence on the moral habits of the inmates;—whether the increased comforts of his house and home have tended to withdraw the labourer from the beer-shop, and from the habits of improvidence to which it leads;—whether residents in separate and improved tenements are superior in condition, as compared with the labourers who hold merely lodgings, or who reside with other families in the same house.

Where you meet with remarkable instances of improved tenements of this description, you are requested to set them forth in your report, and obtain the loan of the plans or drawings of them, together with any information as to their cost and the probable returns in rent, and whether on the whole (other advantages than the pecuniary return being taken into consideration) they are deemed profitable; or what may be the extent of pecuniary loss upon them, or how far it may be countervailed by other considerations.

Although the facts collected by you may not lead to the adoption of any legislative remedies, the publication of successful examples may be useful in stimulating to the voluntary adoption of them.

The Commissioners wish you however to consider whether any legislative measure in the nature of a Building Act (i. e. an Act prescribing certain rules to be followed in the building of cottages) would tend to introduce generally the improvements which may have been adopted partially by public-spirited persons in your district.

This may be considered:—

1. In the case of tenements intended for the residence of the labouring classes in towns;

2. In the case of cottage tenements in rural districts.

With regard to the former class of tenements, the wages of the labourers in towns being commonly double those earned in the rural districts, they may be well able to afford to procure such an increase of comfort in their houses as may be obtained by means of a Building Act, even at the cost of an additional rent. You are also requested, in your observations on this subject, to bear in mind another question, namely, the expediency of exempting small tenements from the payment of rates, or wherever rents are collected weekly, of collecting the rates from the landlord.

It has been stated that the exemption from poor’s rate tends to deteriorate the tenements of the labouring classes, inasmuch as many of such tenements are, for the purpose of obtaining the exemption, built of such quality and appearance as may bring them within the exempted class. It has been further stated, that the benefit of the exemption goes to the landlord, the rent for cottages built for letting in towns being very high as compared with rents obtained for other house property, and that such increased rents have been demanded expressly on the ground of exemption from rating. The causes affecting the construction of cottages are not expressly mentioned in the reports referred to in the resolution of the House of Lords, which treat chiefly of the external and immediately-removable causes of disease, such as stagnant pools or other out-door nuisances with which the parochial officers had to some extent been heretofore accustomed to interfere. But the defective construction of the cottages themselves, and the imperfect protection they may afford against cold or damp—the want of means for the due regulation of warmth or of conveniences for cleanliness, may often be the causes of the prevalence of disease; and the Commissioners consider not only that these subjects cannot with propriety be overlooked in any report on the sources of disease among the labouring classes, but that the beneficial moral results which may arise from the suggestion of improvements in the habitations of the labouring classes justify the Commissioners in taking this occasion to direct your attention to the heads of inquiry which are noticed in this communication.

Signed, by Order of the Board, E. CHADWICK, Secretary.

To Assistant Poor Law Commissioner.

2.—Circular Letter of Instructions to Clerks of the Boards of Guardians in England and Wales.

Poor Law Commission Office, Somerset House, 12th November, 1839.

Sir,—I am directed by the Poor Law Commissioners to inform you that they have, in compliance with a communication from Her Majesty’s Secretary of State for the Home Department, directed the enclosed letters to the medical officers of your board, together with the accompanying forms for their answers, and I am to request that you will transmit them accordingly.

The medical officers will transmit to you the returns when completed, and by you they will be forwarded when the information required is obtained from all the medical officers to the office. In case of any defect in the returns which cannot be remedied, you will state the nature and extent of the same at the time of transmission.

Before transmitting the returns, you are to read them at a meeting of the Board of Guardians, acquaint them with the answers, and annex any further information which they may be enabled to communicate in aid of the inquiry.

Signed, by Order of the Board, EDWIN CHADWICK, Secretary.

To the Clerk to the Board of Guardians.

3.—Circular Letter of Inquiry to the Medical Officers of the Unions in England and Wales, transmitted to them, with Forms of Return, through the Clerks to the Guardians.

Poor Law Commission Office, Somerset House, 12th November, 1839.

Sir,—With the view of ascertaining the extent of the existence of circumstances promoting the prevalence of contagious and infectious diseases described in the reports referred to in the Order of the House of Lords, set forth in the letter from Lord John Russell, a copy of which is hereto annexed, you are requested to fill from the medical relief Lists the enclosed returns, and transmit them to the clerk of the union, with such observations as occur to you thereon.

You will observe that the object of the Commissioners is to ascertain the existence and extent of the visible and removable agencies promoting the prevalence of such diseases as are commonly found connected with the defects in the situation and structure or internal economy of the residences of the labouring classes.

The attention of the physicians who drew reports on the state of the metropolis was almost exclusively directed to the causes affecting the prevalence of various forms of continued fever, arranged under distinguishing names adopted by nosological writers: but in rural districts the prevalence of ague, and of small-pox, and scarlet fever, may be worthy of notice when the causes promoting their prevalence appear removable.

You will, in your observations on the class of cases returned, note the situation, character and quality of the tenements in which the diseases have occurred;—whether they are situated in a neighbourhood habitually infected with malaria;—whether there are occasional causes of malaria, such as floods, &c.; and in such cases, whether you have any suggestions to make as to the best means of diminishing the evil;—whether they are drained or undrained, whether tight or otherwise;—whether there are good means of securing ventilation with a due regard to warmth;—whether there are accumulations of filth, and if so, whether they are ascribable to the slovenly or indolent habits of the inmates, or to the want of proper receptacles for refuse;—whether the occurrence of disease amidst this part of the population is regular or otherwise, and what are the seasons at which it appears, and its characteristics.

The Commissioners request that you will favour them with any information which you may have gained in the course of your medical experience, as to the condition of the inmates of such residences;—whether there is a need of superior cottage accommodation, or to what extent the improvement of the residence would influence the habits beneficially; as, for example,—whether you have witnessed any beneficial effects on the habits of the inmates by providing cottages with a day-room, scullery, pantry, three bed-rooms, and convenient receptacles for refuse and for fuel;—whether within your district there are other labourers of the like class, who occupy improved tenements in a superior situation, and what is the general health and condition of the inmates as compared with the general health and condition of the inmates less advantageously situated;—whether you have seen any cottages constructed with a view to the most economical management of fuel both in cooking and maintaining a proper temperature in the rooms;—and further, any observations that may occur to you on the subject of the health of the labouring classes in connexion with what may appear to you to be available sanitary regulations.

The accompanying portions of the report, and the appendix referred to in their lordships’ order, are transmitted for your information as to the causes of disease existing in the metropolis, which it is deemed necessary to investigate in other parts of the country.

Signed, by Order of the Board, EDWIN CHADWICK, Secretary.

To the Medical Officer of the District.

(COPY.)

Whitehall, August 21, 1839.

Gentlemen,—The Queen having been pleased to comply with the prayer of an humble address presented to Her Majesty, in pursuance of an order of The House of Lords, dated 19th August, 1839, “that Her Majesty will be pleased to cause inquiry to be made as to the extent to which the causes of disease stated in the Appendix A., No. 1, of the Poor Law Commissioners’ Fourth Annual Report, and Appendix C., No. 2, of their Fifth Annual Report, to prevail amongst the labouring classes in the metropolis, prevail also amongst the labouring classes in other parts of England and Wales; and that Her Majesty will be graciously pleased to cause the results of such inquiry to be communicated to the House,”—I have to desire that you will cause inquiry to be made accordingly, and that you will prepare a report upon the results of such inquiry, and transmit the same to me, in order that it may be laid before the House of Lords.

I am, Gentlemen, Your obedient Servant, (Signed) J. RUSSELL.

Form of Return transmitted with the above Letter to the Medical Officer.

For the Year ended September 29, 1829.

A RETURN from Mr. ________ Medical Officer of the ________ District of the ________ Union.

┌───────────────┬───────────┬───────────┬─────────────────────────────┐ │ CASES. │Occupation │ Situation │ OBSERVATIONS. │ │ │ of │ and State │ │ │ │Applicants.│ of │ │ │ │ │Residence. │ │ ├───┬───────────┼───────────┼───────────┼─────────────────────────────┤ │No.│Nosological│ │ │(If there should not be │ │of.│ Names of. │ │ │ sufficient space for the │ │ │ │ │ │ requisite Observations, │ │ │ │ │ │ space for the requisite │ │ │ │ │ │ Observations, they may be │ │ │ │ │ │ continued on the back of │ │ │ │ │ │ the Return, or on a │ │ │ │ │ │ fly-leaf, to be attached to│ │ │ │ │ │ the Return.) │ ├───┼───────────┼───────────┼───────────┼─────────────────────────────┤ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ └───┴───────────┴───────────┴───────────┴─────────────────────────────┘

Signature of Medical Officer: ________

4.—Circular Letter to the Provosts of Burghs in Scotland.

Poor Law Commission Office, Somerset House, London, 1840.

Sir,—The Poor Law Commissioners have received from Her Majesty directions to extend to Scotland the inquiry they have, in compliance with an address from the House of Lords, been directed to make in England as to the causes of disease and destitution arising from the situation and construction of the dwellings of the labouring classes, and from other similar circumstances affecting their sanitary condition.

The Commissioners request your aid in conducting the inquiry in the of The Commissioners have obtained valuable information in England from the medical practitioners who have the care of hospitals and dispensaries, where those contagious febrile diseases to which their attention has been specially directed come under the observation and treatment of experienced professional men.

The Commissioners ask of you the favour of putting them in communication with the officers of the medical charities and establishments in the of , whether supported by the voluntary subscriptions of the inhabitants or by payments out of the town funds, or both.

The Commissioners desire to ascertain, either from the officers of such institutions or from the medical practitioners of the most extensive practice amongst the poorer classes, or from those who visit them in their habitations, to what extent continued fever, and other contagious febrile diseases, are prevalent amongst the poor;—what is the character of the streets and houses in which these maladies most frequently arise, or spread with the greatest rapidity; the state of the paving,—scavenging, and sewerage of such streets,—their width,—the drainage of the houses,—their size,—their state of repair,—the number of families living under one roof,—the number living in cellars;—and other circumstances relating to the structure and situation of the habitations of the poorer classes, and their habits, by which they may be rendered more susceptible of the influence of contagion.

The Commissioners would also be glad to obtain information whether the main sewers of the town have been constructed in a satisfactory manner, and kept in good repair; and to what body, and with what powers this duty is confided;—whether there are any sanitary regulations of a local character for the enforcement of the paving of streets, and of drainage on the owners of houses erected within a reasonable distance of sewers;—whether any local body has power to interfere in the removal of any, and if so of what, nuisances injurious to health; or to cause lodging-houses, and dwellings liable to be infected with fever, to be cleansed and whitewashed from time to time, and by whom the expense of such interference is sustained.

The Commissioners are further desirous of ascertaining whether the authority possessed by the town council, or other local body intrusted with the paving, scavenging, sewerage, the removal of nuisances and other causes of disease, are sufficient, or might in any respect be increased with advantage to the sanitary condition of the town, and especially of those parts of the town which are inhabited chiefly or exclusively by the working classes, and which are therefore comparatively remote from the observation, and less subject to the interference of the middle classes.

The Commissioners will be glad to obtain from you or from the town council of any suggestions which you may be desirous to make on the subject; and they trust they may have the benefit of your advice and assistance in the inquiry with which they are charged in the of and its suburbs.

I have the honour to be, Sir, Your very obedient servant, EDWIN CHADWICK, Secretary.

To The Provost of

5.—Circular Letter of Inquiry to Dispensary Surgeons and Medical Practitioners in Scotland.

Poor Law Commission Office, Somerset House, London, 19th June, 1840.

Sir,—The Poor Law Commissioners have been directed to extend to Scotland the inquiry which in the past year they received Her Majesty’s commands to conduct in England, for the purpose of ascertaining what circumstances in the condition of the poorer classes promote the spread of continued fever and other contagious febrile diseases.

They are desirous that this inquiry should be conducted with care in large towns, where the sources of contagion or the circumstances which promote its rapid diffusion among the population are more rife than in the rural districts; they are anxious to obtain the assistance of the medical practitioners having charge of hospitals and dispensaries in such towns, because such institutions afford the best means of observing under what circumstances febrile contagious diseases are disseminated; of defining the districts of the town in which they spread; of ascertaining the character of the streets and houses in such districts; the comparative attention paid to the paving, sewerage, and drainage of these districts; and whether or not they are subject to malarious influences.

The structure of the dwellings of the labouring classes; the nature and extent of their internal accommodation, and of the means for securing cleanliness, for removing filth, for promoting ventilation, and for providing warmth with due economy, can be most easily ascertained by medical gentlemen who devote their time to the frequently gratuitous services of public institutions; they also are most competent to discriminate between the direct influence of the habits of the poorer classes, and of the external circumstances by which they are surrounded, on their sanitary condition; while on the other hand they will not be liable to fall into the error of supposing that these habits are independent of arrangements which administer to domestic comfort.

The Commissioners trust, therefore, they may rely with confidence on your affording them your valuable assistance in the inquiry which they are directed to pursue. They trust you will permit them to suggest that if the cases recorded in the books of your hospital were grouped according to the districts from which the patients were removed, you would at once be able to define in a map those parts of your town most subject to contagious febrile diseases, and to furnish the Commissioners with the number of cases of each febrile disease occurring in each of these districts, and would possess the means of ascertaining and delineating the features of those districts in all that relates to the sanitary condition of the inhabitants, and to medical police. Besides the general influences alluded to in the former part of this letter, you will probably find it useful to ascertain whether any injurious consequences are clearly attributable to certain classes of manufactories surrounded by the habitations of the poor, to the location of slaughter-houses, tanneries, ancient burial grounds, &c., amidst dense masses of the population.

In the course of this inquiry it may be found necessary to distinguish the extent of disease caused by physical or removable agencies, by malaria created by defective drainage, or the bad construction of the dwellings of the labouring classes, from disease caused by destitution of the proper means of subsistence arising from poverty. It may be expected of the medical practitioners from whom the Commissioners hope to obtain reports, that they will make the distinction wherever it is found to exist.

The Commissioners will value any suggestions you may have to offer respecting the removal of the injurious agencies which may fall under your observation. You are probably well acquainted with the nature of the powers confided to the municipal authorities or other local bodies respecting the paving, sewerage, and drainage of the town, and especially of those parts of it which are inhabited chiefly or solely by the working classes. The Commissioners request you to observe whether those powers enable the municipal or other local body to complete the sewerage, and to enforce the paving and drainage of the streets partially or wholly at the expense of the proprietors of these houses.

The spread of contagious diseases is greatly facilitated in many towns by the extreme filth of lodging-houses to which mendicants and vagrants resort, and of the habitations of certain of the lowest portion of the poorer class; measures of medical police have been resorted to on the occurrence of epidemic fevers, and at the period of the invasion of cholera, for cleansing and whitewashing these habitations at the expense of the inhabitants. The Commissioners request you to state under what circumstances you conceive such measures might be usefully resorted to, and under what superintendence, and whether the expense should fall on the owners of such habitations or on the inhabitants generally, and whether this interference should be habitual or casual.

Suggestions have been made to the Commissioners that the nature of the thoroughfares, and the structure and internal arrangement of the buildings in districts inhabited by the working classes in large towns would be greatly improved if subject to the regulations of a Building Act enforced by the municipal authorities, or by a local board of health; they invite you to reflect on the provisions of such a law, and to state under what circumstances and to what extent you conceive such interference desirable.

Generally the Commissioners are desirous to receive your impressions respecting the means of improving the sanitary condition of the working classes, especially in those parts of your town in which contagious febrile diseases most frequently prevail.

Copies of the forms and exemplifications of the mode of entering the particulars of the information sought in the returns circulated in England, and the reports on the sanitary condition of the labouring classes in the metropolis, are herewith transmitted for your use. The Commissioners have not asked for returns in any prescribed form from the medical practitioners in the towns of Scotland, because they are uninformed as to the nature of the existing records of facts relating to medical statistics in the towns, and they wish to consult the practitioners’ convenience, and be guided by them as to the best use to be made of the local circumstances for obtaining information.

I have the honour to be, Sir, Your very obedient Servant, EDWIN CHADWICK, Secretary.

To ________

6.—Form of General Queries addressed to Medical Practitioners and others for Information as to the Condition of the Labouring Classes in Scotland.

1. Have diseases of the various forms of continued fever, and other contagious febrile diseases, been prevalent in any, and what, parts of your parish or district, and do such diseases recur at regular intervals, or are they rare and occasioned only?

2. What are the seasons at which such diseases appear amidst any part of the population, and what their characteristics?

3. Did the cholera at the time of its general prevalence prevail to any, and what, extent within the district?

4. What is the external condition, in the following respects, of the residences of the population amidst which such diseases occur?

(a.) As to the contiguity of vegetable or animal substances in a state of decomposition, stagnant pools or undrained marshes, accumulations of refuse, either thrown from houses or otherwise?

(b.) As to the means adopted or the means available for the removal of such substances, or the prevention of the generation of malaria; whether there are sufficient drains or sewers, adequately well supplied with water to dilute, and sufficiently sloping to carry off all such refuse; whether such drains are sufficiently closed to confine noxious exhalations from them; whether there is any regularly appointed service of scavengers or otherwise for the removal of such substances; whether there is such ventilation around the residences of, as to dissipate the noxious vapours apparently irremovable?

5. Describe the internal structure and economy of the residences of the population amidst which contagious febrile diseases arise,—

(a.) State whether they, as well as the surrounding land, are drained or undrained?

(b.) Whether they are properly supplied with water for the purposes of cleanliness of the houses, persons, and clothing?

(c.) Whether there are good means of ventilation with a due regard to warmth?

(d.) Whether there are proper receptacles for filth in connexion with the cottages?

6. As to the internal economy of such residences, describe further,—

(a.) Whether they are unduly crowded, and several families or persons occupy the space which would properly suffice only for a less number?

(b.) Whether there are any inferior lodging-houses crowded by mendicants or vagrants?

(c.) Whether there is gross want of cleanliness in the persons or habitations of certain classes of the poor?

(d.) Whether there is a habit of keeping pigs, &c., in dwelling-houses, or close to doors or windows?

(e.) Whether there is an indisposition to be removed to the hospitals when infected with contagious disease?

7. Of the diseases described in question 1, are any or what proportion ascribable to other causes than those specified in questions 4, 5, and 6? if so, distinguish those other causes so far as you are able, and the extent of diseases resulting from them.

8. What is the common cost of erection and average cost of repairing each description of the tenements or cottages inhabited by the labouring classes?

9. What are the rents paid by the labourers for each description of tenements or cottages?

10. What is the general proportion of the rent paid by the labourer to his total expenditure?

11. What is the common cost of the lodgings to persons of the labouring classes?

12. Are you of opinion that any, and what, legislative measures are desirable or available for remedy of any of the evils existing within your district?

13. Have any, and what, voluntary exertions been made to improve the external or internal economy of the residences of the labouring classes within your district? and if so, describe their nature and effects.

_Name of the parish or district to which the preceding answers│ refer._ │————————

_Name of the medical practitioner or other person by whom the │ answers are given._ │————————

NOTE.—Where the space opposite to any question does not suffice for the full answer which it may be desirable to give, it may be written on the blank space at the back of the sheet, or on a separate sheet, reference being made to the number or letter of the question.

Any general observations may be hereunder annexed.

It is requested that the answer may be transmitted by the post to “The Poor Law Commissioners,” according to the address on the inside of the envelope which may be used for the purpose.

REPORT

ON THE

SANITARY CONDITION OF THE LABOURING POPULATION OF GREAT BRITAIN.

BY EDWIN CHADWICK, ESQ., BARRISTER AT LAW, AND SECRETARY TO THE BOARD OF POOR LAW COMMISSIONERS.

CONTENTS.

GENERAL PREVALENCE OF EPIDEMIC, ENDEMIC, AND CONTAGIOUS DISEASES.

PAGE

Return of the number of deaths in 1838, in each county, from epidemic, endemic, and other diseases, most powerfully affected by the physical state of a district 2

Extent of evils which are the subject of inquiry 3

I. GENERAL CONDITION OF THE RESIDENCES OF THE LABOURING CLASSES, WHERE DISEASE IS FOUND TO BE THE MOST PREVALENT— 5

In Tiverton union, Cornwall 5

In Truro, Cornwall 6

In Cerne union, Dorset 8

In Axbridge union, Somerset 10

In Chippenham union, Wilts 11

In Bedford union, Bedford 12

In Woburn union, Bedford 12

In Ampthill union, Bedford 12

In Bishop Stortford union, Hertford 12

In Witham union, Essex 13

In Windsor, Berks 13

In Epping union, Essex 14

In West Ham union, Essex 14

In Bromley union, Kent 14

In Bilston, Leicester 15

In Stafford (town of), Stafford, 16

In Macclesfield union, Chester 17

In Heaton Norris, Stockport union, Chester 17

In West Derby union, Lancaster 18

In Wigan union, Lancaster 19

In Durham (city of), Durham 20

In Barnard Castle, Durham 20

In Carlisle, Cumberland 21

In Gateshead, Durham 21

Condition of the Border peasantry 22

In Lochmaben, Scotland 23

In Glasgow and Edinburgh 23

II. PUBLIC ARRANGEMENTS, EXTERNAL TO THE RESIDENCES, BY WHICH THE SANITARY CONDITION OF THE LABOURING POPULATION IS AFFECTED— 25

Drainage.

Town drainage of streets and houses. 26

Instances of the effects on the public health of the neglect of town drainage—

At Derby 26

At Stockport 28

Comparative mortality in two similar towns, one drained, the other undrained—

At Beccles and Bungay, Suffolk 28

State of town cleansing at Leeds 29

At Tamworth 30

At Knutton and Chesterton, Stafford, &c. 30

At Liverpool 30

At Brighton 31

At Birmingham 32

At Edinburgh 33

At Tranent and Ayr 33

At Stirling 34

At Clitheroe, Lancashire 35

Street and road cleansing—road pavements. 36

Defective from want of skill or proper combination of means 36

Different influence on the public health of paved and unpaved streets, instance of, in Portsmouth 37

Instance of the effect on the public health of street cleansing in Macclesfield 37

Instances of the neglect of street cleansing—

In Manchester 38

In Leeds 39

Instances of the consequences on the public health of the neglect of road cleansing in rural districts in England and in Scotland 42

Discipline in respect to cleanliness of the army superior to the civic economy of the towns 44

House cleansing as connected with street cleansing and sewerage.

Instances of the sanitary condition of houses in the metropolis where the cesspools do not communicate with the drains 45

Small value of refuse in London, in consequence of the expense of cartage 46

Effects on the health of the accumulation of refuse near the residences of the labouring classes: examples in

Greenock 46

Leeds 47

Cleansing by means of water-closets applicable to the poorer districts as being the most economical 48

Instance of the removal of the refuse of the city of Edinburgh by sewerage, and of its application to agriculture by irrigation 48

Objections by the citizens of Edinburgh to irrigation by sewers in the immediate vicinity of the city 49

Value of the refuse of London, on the scale of value of the refuse of Edinburgh 51

Modifications of the mode of sewerage of Edinburgh, to make a system of cleansing innoxious and profitable, and extend it to the residences of the poorer classes 52

Expense of street cleansing in Manchester 53

Defects of the prevalent mode of removing the refuse of houses by cartage, or otherwise than by sewerage 54

Instances of defective construction of sewers 55

Evidence on the action of improved modes of sewerage 55

Effects of different descriptions of streets upon the public health 59

Proposed mode of cleansing streets by sweeping the refuse into the sewers 60

Similar mode proposed of cleansing Paris 61

Supplies of water. 63

Necessity of improved supplies of water for house and street cleansing 63

Instances of the want of water in the houses, and of the effect on the personal and domestic habits of the lower classes of the population in towns 63

In Manchester, 64; in Truro union, 65; in Audley district of Newcastle-under-Lyme union, 65; in Dunmow union, 65; in Bishops Stortford union, 65; in Lexden and Winstree union, 65; in Wootton, Bedford, 66; in Edinburgh, 66; in Glasgow, 66; in Aberdeen, 67; in Stirling, 67; in Dundee, 67; in Greenock, 67; in Ayr, 67; in Arbroath, 67; in Renfrew, 68; in Dunfermline, 68; in Tain, 68; in Tranent 68

Inapplicability of the supplies of water to be obtained by fetching from the public wells 69

The supplies of water in London by machinery and pipes, and in Paris by cartage and hand carriage, compared 70

Cost of laying on water in labourers’ tenements and the economy of supply in such a mode 71

Supplies of water by private companies, not applicable to rural districts of small population 72

Complaints against the modes of supplies of water by private companies 72

Private companies do not ensure the best practicable supplies to the public 73

Instance of supplies of water obtained by the public without private companies 74

Necessity of general provisions of supplies of water 77

Unwholesome effects of bad water 77

Sanitary effect of land drainage. 80

General land drainage, effects of, on the health of the population, instances of in—

The Isle of Ely, 80; the Newhaven union, 81; the Ongar union, 81; the Gravesend and Milton union, 81; the Eastry union, 81 and 82; the Dunmow union, 82; the Epping union 82

Instances of—

In Scotland 83

Instances of the effect of land drainage upon the health of cattle 83

Instance of the effects of land floods and deficient land drainage in—

The Langport union, 85; the Chesterfield union, 87; the Dore union, 87; the Bicester union, 88; the Leighton Buzzard union, 88; the Foleshill union, 89; the Malton union, 89; Lochmaben, Scotland 90

Foreign illustrations of the effect of drainage upon the health of the population 90

Interests opposed to the cleansing of Paris 93

Class similar to the Chiffoniers found in English towns 94

Their personal habits 95

Collateral benefit of more effectual cleansing of towns in diminishing degrading employments 96

III. CIRCUMSTANCES CHIEFLY IN THE INTERNAL ECONOMY AND BAD VENTILATION OF PLACES OF WORK; WORKMEN’S LODGING-HOUSES, DWELLINGS, AND THE DOMESTIC HABITS AFFECTING THE HEALTH OF THE LABOURING CLASSES. 98

Various effects of overcrowding places of work, as shown in the case of one class of workmen 98

Comparative ease and economy of measures of prevention rather than of relief 104

Sanitary effects of ventilation on workpeople at Glasgow 107

Effects of defective ventilation on the health of milliners and dressmakers in the metropolis 107

Instances of the effects of defective ventilation of sleeping rooms of the working classes 108

Effects of the defective economy of lodging-houses and places of repose exemplified in the duration of life of one class of workmen 112

Instances of errors in respect to the sanitary effects of particular occupations 113

Injurious effects of deficient ventilation in schools 119

Bad ventilation and overcrowding private houses. 120

Great apparent increase in the proportionate number of houses according to the last census attributable to a different mode of making the return 120

Instances of great overcrowding in cottages in—

Greenock, 121; Tranent, 121; Sleaford union 122

The want of separate apartments and overcrowding of private dwellings. 122

Effects of the overcrowding of private dwellings on the morals of the population, instances of, in—

The Ampthill union, 122; the Leighton Buzzard union, 123; the Bicester union, 123; the Romsey union, 123; among the border peasantry, 124; in Manchester, Liverpool, Ashton-under-Lyne, and Hull, 124; in Leeds, 126; in Nottingham, 126; in Clitheroe 126

Instances of the injurious influences of bad tenements upon the personal condition and moral habits of the inmates 128

Effects of noxious agencies in preventing frugality and promoting intemperance 129

In preventing the influence of education 132

Force of habits of intemperance in the use of spirituous liquors against all habits of decency, or frugality, or morality 133

Misconceptions as to casualties occurring among the indigent or profligate 134

Intemperance the cause of fever 136

Domestic mismanagement a predisposing cause of disease. 137

Mismanagement of earnings obstructive to the domestic improvement of the sanitary condition of the labouring classes.

Instances of in—

Derby, 137; Birmingham, 138; Manchester, 139; Preston union, 140; Ayr, 141; Tranent, 141; Dundee 142

Attacks of fever most frequent on workmen in full employment and ordinary health 145, 147

Irrelevancy of controversy on the generation of fever, in respect to practical means of prevention 148

Concurrence of medical opinions as to the most efficient means of preventing fever 150

IV. COMPARATIVE CHANCES OF LIFE IN DIFFERENT CLASSES OF THE COMMUNITY. 153

Instances of the comparative chances of life amongst the gentry, tradesmen, and working men—

In Truro, 154; in Derby, 155; in Manchester, 157; in Rutland, 157; in the Bolton union, 158; in Bethnal Green, 159; in Leeds Borough, 159; in Liverpool, 159; in the Whitechapel union, 160; in the Strand union, 160; in the Kensington union, 161; in Wiltshire, 161; in the Kendal union 161

Tabular views of the ages at which deaths have occurred in different classes of society 162

Comparative mortality of differently circumstanced districts of the metropolis 164

Comparative prevalence of fever in different districts of Leith 167

High mortality not essential to towns 167

Comparative mortality in three classes of the community at Bath 168

Corroborative experience from Paris as to the influence of local circumstances on mortality 170

Improvements in the health of large towns chiefly confined to improved districts 171

Instance of progressive improvement in the social condition of the population concurrently with its increase in numbers 175

Prevalence of disease no evidence of the pressure of population on food 177

Variations of the proportion of deaths and births in different districts of the same town 178

Proportion of births to the population greatest where there is the greatest mortality 179

Proof that pestilence or excessive mortality does not diminish population 182

Numbers merely not the test of strength or prosperity of a community 185

Deterioration of the strength of the population by disease without diminishing its numbers 185

Increase of food or production concurrently with the increase of population 188

V. PECUNIARY BURDENS CREATED BY THE NEGLECT OF SANITARY MEASURES:— 188

Cost of remedies for sickness and of mortality which is preventible 188

Average ages of death of the heads of families of widows and orphans chargeable to the Manchester, Whitechapel, Bethnal Green, Strand, Oakham and Uppingham, Alston with Garrigill, and Bath unions 190

Table of the number of widows and dependent orphans chargeable in eight unions 191

Table of the chief cause of death producing widowhood and orphanage in eight unions 192

Detailed instances of the causes of widowhood and orphanage in Alston with Garrigill 193

Examples of the sanitary effects of superior care in the residences and the places of work of labourers—in the Reeth union, North York, 196; in Gwennap, Illogan, and Camborne, Cornwall, 198; in Great Bradford and Horton, West York 199

Comparison of a young population under favourable and a mature population under unfavourable circumstances 200

Effects of noxious physical agencies on the moral and intellectual condition of the working classes 202

Jurisprudential measures for the prevention of deaths from accidents 203

Cost of disease as compared with cost of prevention, instances of in Glasgow and Dundee 206

VI. EVIDENCE OF THE EFFECTS OF PREVENTIVE MEASURES IN RAISING THE STANDARD OF HEALTH AND THE CHANCES OF LIFE:— 211

Former health of gaols as compared with the present state 211

Effects of sanitary measures of prevention on the health of prisoners 214

Comparison of the experience of sickness amongst different classes of people 216

Amount of sickness experienced by the labouring classes 217

Defects of Insurance tables 218

Effects of sanitary measures in the prevention of disease in the army and navy 219

_Cost to tenants and owners of the public measures for drainage, cleansing, and the supplies of water, as compared with the cost of sickness_:— 222

Cost of measures of prevention as compared with the cost of sickness and mortality 222

Means of payment for improved accommodation 227

Impolicy of exemptions of tenements from proper charges 229

Injurious effects of exemptions of labourers’ tenements 230

Inability of workmen to improve their own condition 231

Necessity of extrinsic aid for the improvement of the condition of the working classes 232

_Employers’ influence on the health of workpeople, by means of improved habitations_:— 233

Advantages to labourers of holding tenements in connexion with their employments 233

Instance of a superior moral and sanitary condition enjoyed by workers in a cotton factory 236

Elevation of a manufacturing population by improvements in the condition of their dwellings 238

Most advantageous construction of manufactories for the health of the workpeople 240

The employers’ influence on the health of workpeople:— 245

By modes of payment which do not lead to temptations to intemperance 245

By the promotion of personal cleanliness 253

By the ventilation of the places of work and the prevention of noxious fumes, dust, &c. 256

By promoting respectability in dress 261

Employers’ or owners’ influence in the improvement of habitations and sanitary arrangements for the protection of the labouring classes in the rural districts 261

Instances of, in the Bedford Union, 262; Stafford Union, 263, in Norfolk and Suffolk, 264; at Harlaxton, Lincolnshire, 266; at the Earl of Rosebery’s estate, Scotland, 266; at Closeburn, Dumfries, 266; Turton and Bollington, Lancashire, 267; Birmingham 267

Instances of the influence of the materials used in building upon the health of the inmates in Cheshire, Lancashire, Buckingham and Berkshire 267

Instances of efficient improvements in the detail of labourers’ dwellings in Scotland 270

Improvements proposed for the construction of the dwellings of the lower classes in towns 272

_Effects of public walks and gardens on the health and morals of the lower classes of the population_ 275

VII. RECOGNISED PRINCIPLES OF LEGISLATION AND STATE OF THE EXISTING LAW FOR THE PROTECTION OF THE PUBLIC HEALTH:— 279

Necessity of legislative interference for the protection of the health of the population 279

Spread of old evils in unprotected new districts by inefficient legislation 280

Dangers of increased charges for inefficient sanitary measures shifting without improving the population 282

Expulsion of labourers from old tenements without providing appropriate new ones, not invariably beneficial 286

Advantages in the regulation of the sites of dwellings 287

General state of the law for the protection of the public health:— 288

Medical police in Germany 288

Existing laws for the protection of the public health in England 289

Early state of the law for the protection of the public health 291

_State of the special authorities for reclaiming the execution of the laws for the protection of the public health_:— 296

General desuetude of the laws for the protection of the public health 296

State of the administration of the laws for the protection of the public health, by court leets and local trusts 299

_State of the local executive authorities for the erection and maintenance of drains and other works for the protection of the public health_:— 302

State of the obstructions to land drainage and works of private profit redounding to the public health 302

Injuries to private property as well as to the public health, occasioned by defective administration 305

Continuance of the causes of disease in the face of representations of their effects on the population 307

Areas of jurisdiction for drainage inconsistent with efficient operations 309

Prevalent misconceptions as to the objects and state of management of existing sewerage 311

Objections made to the existing local administration of the sewers’ rate 315

Securities requisite to obviate opposition to new expenditure for sewerage 316

Necessity of the subordinate drainage of private tenements being comprehended as part of one system 319

Disturbing local interests opposed to efficient management of expenditure in new districts 322

Obstacles arising from defective local arrangements for efficient expenditure in local public works 323

Inconveniences of legislation on details, and the want of scientific and trustworthy direction 328

High rates of charges, by fees, for superintendence of imperfect structural arrangements 329

Extent of waste in expenditure on local public works, and on separate collections 333

Public facilities for private land drainage afforded by consolidation 337

Grounds of unpopularity and distrust of new local expenditure 339

Boards of Health or public officers for the prevention of disease:— 340

Inefficiency of Boards of Health, as ordinarily constituted 340

Failure of Boards of Health in Ireland 342

Importance of the functions of medical officers in connexion with the executive authority 343

Means and economy of skilled services for the prevention of diseases 348

Administrative measures for the prevention of disease amongst the labouring classes 349

Administrative means for promoting the extension of medical science 352

VIII. COMMON LODGING-HOUSES THE MEANS OF PROPAGATING DISEASE AND VICE:— 356

State of the common lodging-houses in the Barnet union, 357; in Birmingham, 357; in Brighton, 358; in Manchester, 358; in the Stockport union, 360; in the Macclesfield union, 360; in Durham, 361; in the Teesdale union, 361; in the Tynemouth union, 361; in Newcastle-on-Tyne, 362; in Tranent, Haddingtonshire, 362; in Tain, Ross-shire, 362; in the borough of Warwick, 363; in Chelmsford 364

Grounds for subjecting common lodging-houses to the responsibilities of public-houses and beer-shops 364

Practical illustration of the regulations of common lodging-houses 366

IX. RECAPITULATION OF CONCLUSIONS:— 368

Recapitulation of the chief conclusions deduced on the information obtained in the course of the inquiry 369

Conclusions as to the available means of prevention 370

Grounds for uniformity of legislation 372

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