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Meps, plates, charts, etc., may be filmed at different reduction ratios. Those too large to be entirely included in one exposure ara filmed beginning in the upper left hand corner, left to right and top to bottom, as many frames as required. The following diagrams illustrate the method: Lea cartas, planches, tableaux, etc., pouvent Atre filmAs A des taux da rAduction diffArants. Loraqua la document est trop grand pour Atre reproduit en un seul clichA, II est filmA A partir da I'angia supArieur gauche, de gauche A droite, et de haut an bas, an pranant la nombre d'Imagas nAcessaira. Las diagrammes suivants illustrant la mAthoda. 1 2 3 1 2 3 4 5 6 /^/-' v. t OC^ ^ r; '^^'Z :t)'^v THE MEDICAL AND LEGAL ASPECTS Of SANITAEY EEFOEM. t Br ALEXANDER P. STEWART, M.D., AND EDWARD JENKINS, Babrister-at-La^'. k LONDON: ROBERT HABDWICKE, 192, PICCADILLY. 1867. Price Half-a-Croion. Rf^^ftS*. s,a The following Papers were in substance brought before the Social Science Congress at Manchester, in October, 1866. u . THE i\rEDICAL ASPECTS OF SANITARY REFORM. There are special seasons in oui* history — whether personal, national, or social — which invite ua to pause, and look backward as well as forward; to reckon up the gains and losses, the wise and the false moves of the past; and, by the light of experience, both past and present, to forecast and hiy plans for the future. Such a season in our sanitary history is the present. Tiie Lord President of the Council stated to a deputation that waited upon him in the month of July, for the purpose of urging, among other things, the consolida- tion of our sanitary law?, that the late government thought it better, after mature deliberation, to defer the work of consolidation till next session, when it would probably occupy the attention of Parliament. The consolidation of a number of statutes is very much like the stereotyping of a book, giving permanence and the stamp of autho- rity to all uncorrected errors, which oflen pass from mouth to mouth as accepted and recognised truths, till some voice from the grave, in the shape of a posthumous diary or correspoudence, proclaims their falsehood to another generation of readers. My object, therefore, in this paper is to inquire briefly what have been the substantial results of our sanitary legislation, what great principles have been embodied in it, and accepted, at least in theoiy, by the community at large; and what, looking forward to the consolidation of our health laws, are the mistakes to be corrected, and the objects to be not only desired but striven for by all who take an interest in the health of the people. It is not that I have much that is new to say on a nearly threadbare subject, or that 1 can hope, in my mode of saying it, to emulate my betters, who have spoken and written so well upon the public ' 'iaith from time to time during the last twenty years. But I ha' thought it possible that a new voice speaking on an old and hackneyed topic might arrest some whom the familiar accents of H^o old acquaintances had failed to imprcsH, and stir to action ; and encourage the veteran labourers in this good cause by the assurance that there are others who not only wish them '• God speed," but are anxious to lend them a helping hand. And with the view of elicit- ing a thorough discussion of this vital question, my friend Mr. Edward Jenkins and I have arranged that I should present the medical, and he the legal, aspects of our sanitary laws. The laws of health, and the disastrous results of disregarding or transgressing them, though comparatively new to the public, have long been a subject of deep interest to the profession to which I havo the honour to belong. Here is a striking and instructive passage, published rather more than a hundred years ago by a great master in the art of healing: — "From this view of the causes of maliguant fevers and fluxes, it is easy to conceive how incident they must be, not only to all marshy countries after hot seasons, but to all populous cities, low and ill-aired, unprovided with common sewers, or where the streets are narrow and foul, or the houses dirty; where fresh water is scarce ; where jails and hospitals are crowded and not ven- tilated, or kept clean ; where, in sickly times, the burials are within the walls, and the bodies not laid deep ; where slaughter-houses are likewise within the walls, or where dead animals and ofFal are left to rot in the kennels or on dunghills; where drains are not provided to carry off any large body of stagnating or corrupted water iu the neighbourhood; where flesh meats make the greatest part of the diet, without a proper mixtui'e of bread, greens, wine, or other fermented liquors; where the grain is old and mouldy, or has been damaged by a wet season, or where the fibres are relaxed by immoderate warm bathing. I say, in proportion to the number of these or the like causes concurring, a city will be more or less subject to pestilential diseases, or to receive the leaven of a true plague when brought into it by merchandise," * — a passage which exhibits well the noblest aspect of medicine, making earnest, though often thankless and un- heeded efforts for the prevention of disease. Seventy years passed away, and a visitation of pestilence came, before the principles thus clearly and decisively set forth by Sir John Pringle in the middle of last century began to awaken the attention of the public. And such was the effect of the epidemic of 1832 that, though the spasmodic and almost frantic efforts made by the panic-stricken populations ceased with the departure of the un- welcome visitant, the impression made on not a few thoughtful minds, by vhe sickening glimpses they had had of " the lowest deep" of Britisb society, could not be effaced, and prompted them to enter upon a life-long career of active beneficence that has already con- ferred lasting benefits upon the entire community. In some places, as in Exeter, the history of which during the visitation cf the cholera has been graphically and impressively written by Dr. Shapter, the immediate result was a great improvement in the sanitary arrange- * Pringle's ♦• Observations on the Diseases of the Army," 6th edition. London, 1768 ; p. 324. It; ir oj li] ci tli d( C( ej oN r( or wd dil pc in I mi to thi nnl Til p. tioii and anco , are licit- Mr. t tlio ngor have have ssage, nafiter iguant i8t be, pulous ■where c fresh at ven- vvrithin ises are [tre left irovided • iu the the diet, rmented aged by te wnrm the like stilential ht into noblest and un- ice came, by Sir aken the idemic of made by the un- houghtful est deep" to enter eady con- ae places, le cholera lapter, the y arrange- n. London, n ments of the city, especially as regards water supply. It was then that the era of sanitary legislation commenced, thus affording a striking illustration of the truth of Hecker's remark, " that great epidemics are epochs of development, wherein the mental energies of mankind are exerted in every direction." We have reason to be thankful that during the last thirty years there has been a largo and steady increase in the numbers of our sanitary reformers. Few in comparison with the great mass of the nation, but still in them- selves a host, there are scattered over the face of the counties, and congregated iu considerable numbers in our large cities, men of broad and enlightened views, who thoroughly comprehend the close and reciprocal relations that subsist between dirt, disease, drunken- ness, pauperism, and crime, and who have long done their utmost to promote the adoption in their respective neighbourhoods of right sanitary opinions and effective sanitary measures. And the result is seen in the great and growing attention accorded by the legislature to all questions bearing upon the public health. Parliament has not neglected its duty in this matter. While I concur iu the feeling now becoming very wide-spread, that the tone of our sanitary legislation has of late years been rather timid and apologetic, 1 maintain that Parliament 1ms been, till lately, far in advance of the national sentiment on matters relating to the public health. Let us glance at what has been done since 1832. Beginning in the following year, with the case of the factory children, as if to intimate that the Imperial Parliament would succour and relieve the oppressed at home as v/ell as in the West India colonies, they pro- hibited, in 1834, the cruel and murderous practice of employing climbing boys for sweeping chimneys ; iu 1840 and 1841 they passed the Act to extend the practice of vaccination ; and in 1842 they declared illegal the employment of women and children in mines and collieries, the horrors connected with which inhuman system were exhibited by the noble author of the measuref in terms of indignant eloquence, which awoke a responsive echo in every corner of the realm. About this time appeared that remarkable series of volumes| on the sanitary condition of the labouring classes, for which we were indebted chiefly to Mr. Chadwick, and which, revealing as they did an almost incredible state of matters in our crowded centres of population, were read by multitudes with a strange and eager interest, and formed the basis of our subsequent legislative enact- ments. The first attempts to obtain the assent of the legislature to the recommendations of the Health of Towns Commissioners, were the Town and House Drainage Bills of Lords Lincoln and Normanby, and the Health of Towns Bill introduced by Lord Morpeth, in 1845. These attempts, though unsuccessful, contributed, not less by the * Hecker's " Epidemics of the Middle Ages;" SydeAham Society's Translation, p. 177. + Lord Ashley. X "• General Local Reports on The Sanitary Condition of the Labouring Popula- tion of Great Britain," July, 1842. 6 opposition than by the attention ami sympathy wliirli tlioy awakened, to the success of'simiUir measures in after years. Then followed, in rapid succession, the Acts for Promoting the Estahlislnueiit of IJiiths iiiid Wushhouses, bo(ii in Great Britain and Ireland, in 1846; the Towns' Iniproveniciit Act in 1847; the Puhli^ Health, tlu! Nuisances' llcnioval, and the City of London Sowers'* Acts in 184H; t!ie Metropolitan Interments Act in LSaO, ToIIowcmI in 18.'>.'J l>y a similar Act for the Avhole of En}jland,f the Act to Kncourii<;e the Estahlishment of Lodj^inp Houses for the Lnhourinjj; C'l;isses,| imd (he Common Lodfjinj; Houses' Act in 18.51; the Moliopolitan Water Act in 1852; the Smoke Nuisance Ahntemtnt (Metropolis) Act, and the Act to Extend and make Compidsory the Practice of Vaccimition, in 185;j ; the Merchant Shippin<; Act, with its stringent ])rovisions for the |)reservation of the hcMlth of oni' nKiichant seamen, in 18.14 ; the Diseases Prevention, the Metropolis Local Management, the iMetropolitan Buildings, and tlie Nuisances' Pcinoval Amendment Acts, in 18.35; and the Public Health Act, 18.)8. which abolished the General Board of Health, and vested its powers in the Privy Council. Since then there have been added to the statute book the Acts for the purification of the Thames in 1858 and 1866 ; the Nuisances' Uemoval Amendment Act in 1860; the Act for preventing the Adulteration of Articles of Food and Drink in the same year; the Acts (passed in 18G0, 1861, and 1864) which included under the provisions of the Factory Acts women and children employed in l)leaching and dyeing works, in lace fiictories, and in tho manufacture of earthenware, of lucifer matches, of percussion caps and cartridges, of paper staining tmd of fustian-cutting ;§ tho Vaccination Amendment Act in 1861 ; the Act for tho Seizure of Diseased and Unwholesome Meat, and the Alkali Works Act, in 1863; the Sewage Utilization Act in 1865; the Labouring Classes' Dwelling Houses Act, and the Sanitary Act, in 1866. Let us attempt to condense into a few sentences the great princi- ples embodied in this vast mass of legislation. They are as follows : — That the employment of women and children in laborious occupations for which they are physically unfit, is physiologically as well as politically and morally wrong ; that the sanitary state of our largo towns, and the condition, physical as well as moral, of our labouring population, are matters of imperial interest, which we cannot with impunity neglect ; that various diseases, which prevail among us, either epidemicylly or endemically, and are attended with a high * In section 91 of this Act is the only deQnition of a common lodging-house, which existed for many years. The common lodginat-house Acts contain none ! t Between 1850 aau 1861, not fewer than eight Burial Acts passed through Parliament. X Very little use has been made of this admirable measure. I See " Extension of the Factory Acts." By H. S. Tremenheere. Soe. Sc. Transaction.? 1865; pp. 291-294. , f \u u> ai ofl inJ fi-(l chl m( ter ped largo a hiyli Soc. Sc. mortality, depend wholly or in part on neglect of the laws of health and disregard of the common deconcios of life, and are in great measuro pruventihio l)y u lew simple precautionary measures; that u siifii^ient supply of puro air and water is essential to health, and therefore, that the overcrowdiiig of worksiiops, dwellings, and school.s, the eontaiiiinatiou of the air by smoke or other irritating foreign parlieles, hy noxious gashes, the product of organic decompo- sition, and by chemical Curiiea, and the pollution of water by sewage and other refuse should, as fruitful sources of disease, be prevented; that the establishment of imths and washhouses, and the erection of Huitabio dwellings for the labouring classes should be encouraged; that eflRcient drainage should everywhere be promoted, but that the conversion of streams and rivers into common sewers is a monstrous perversion of the gifts of Providence and a great public wrong ; that the practices of conveying jiersons smitten with contagious or infec- tious disorders in hackney carriages, and of retaining the decomposing remains of the dead in the crowded abodes of the living, are full of peril, and therefore to bo discouraged; that with the view of dis- covering and removing such evils as aflect directly or indirectly the health of the communi.y, medical oflieers of health and inspectors of nuisances are needed, the latter not to wink at the continuance of nuisances, but to ferret them out and drag them to the daylight, the former to report from time to time the results of inspection and inquiry to the proper authorities, with such suggestions as may seem to bim best fitted to remedy existing abuses; that it is the duty of local authorities to take cognizance of and remove all nuisances and impediments to the public health, and to promote such measures as mav bo conducive thereto ; that, in the event of the local authority declining to act, any inbabitant of any parish or place may complaia to a magistrate, who shall proceed as if he were the local authority, with a view to the abatement of the nuisance complained of; and finally, that, in the event of a local authority making default in pro- viding its district with sufficient sewers or water supply, complaint may be made to a Secretary of State, who shall inquire and proceed in the matter as he may see fit; in other words, that every facility shall be given to the inhabitants for compelling the local authority to perform its duty. Lot us nie in addition, that since 1858, we have had in the Privy Council a Public Health Department, which presents us aniiually witli a volume full of interesting and important material, and exercises a summary jurisdiction in times of epidemic visitation. When I have said that for the authoritative recognition and sanction of all these principles, so pregnant with potential benefits, we are indebted to the legiblature, 1 have surely said enough to defend it from those, and they arc many, who would lay upon its shoulders the chief blame of our sanitary deficiencies. It is a matter of great moment to have the stamp of legislative approval affixed to the great principles and doctrines for which sanitary reformers have long con- tended ; and if the country had taken the thirty or forty times re- peated hints offered them by Parliament, how very different would I our sanitary condition hnve boon nt this good hour ! But when I havo said this, I have wiid nil that is duo to tho Parliaments and Govcrn- monts of tho last thirfy-fivo years. Somehow or otlier we arc apt to looK to our law-givers not for hints, but for laws. W t\w principles reeognized and saiielioned l)y them ar(^ thoroughly sound, we luivo a right to expect that, it' not at first, they will sooner or later carry them out to their logical cons (juenees — /.ly offensive rubi»ish which had been slowly accumulating lor two years. But though the probabilities, as between air and water, were thus pretty cvu.dy balanced, the idea that Dr Snow's views might possibly be true was firmly fixed in the public minil, and many who, like myself, could not admit their being proved, were tacitly of opinion that they were highly probable. That there was some connexion, more or less inti- mate, between the water supply of towns and the spread of cholera, was further forced on the minds of many by Dr. Chapter's statements regarding Exeter in 1832, then one t>f the cities woist supplied with water and most severely visited, and the same city in 1849, when its water-supply was admirable, and it was almost exempt from the disease. The same immunity was observed in various towns, e. g. Bath, Birmingham, Cheltenham, and Leicester, which " were supplied with water quite uncoutaminated with thecoutents of sewers." These and other circumstances combined to give weight to Dr. Snow's conclusion, that " the sanitary measure most requiicd in the Metro- polis is a supply of water for the South and East districts of it, from same source quite removed from the sewers." The results of his laborious investigations into the connexion between the water-supply and the death-rate from cholera in the var- ious districts of London, were made public in November and Decem- ber 1851. f It appeared that the cholera was very nmch more severe on the south side of the Thames than on the north. Tiie water of the Chelsea Company, though taken from the Thames at Chelsea, where it was very foul, was much purer than that of the Lambeth, Vauxhall and Southwark Companies, because, having till a short time previously had "to supply the Court and a great part of the nobility, they had large and expensive filters, and also very capacious settling reservoirs, in which the water is kept for a considerable time before its distribu- tion; " whereas the other companies filtered the water suj)pHed by them very imperfectly through coarse gravel, and allowed no time for subsidence. '1 he mortality in those districts supplied by the Chelsea Company, though grea*, was considerably less than in those supplied by the other companies. The General Board of Health, in their report pi-esentcd to I'arliament in 18;jO, select, "out of great numbers" from all parts of the kingdom, the outbreak of diarrhoea in Hackney, and of cholera in Windmill Square, Shoreditch ; in * Medical Gazette, new Series, A''ol. ix.; 1849. pp. 468 to 50i; also, Snow on Cholera, 2nd edition; 1855, pp. 25-30. t " Report on the Epidemic Cholera in 1848 aad 1849," pp. 59-62. whi grej SAVl 11 row le— that - for, pol- jtlicr hliish ;h the vti.ily c was Id not were ,s inti- lolcra, ?ments d with lien its jm the If*, c. g. applied These Snow's Metro- it, Irom nnexion the var- Decem- e severe r of the Avht'i'e it hall and eviously they had servoirs, distribu- plied by no time 1 by the in those Lealth, in of great Idiairhoea I itch ; iu Rothorhithe ; iu Horsleydown ; in Waterloo Road, Lambeth; and In Hope Street, Salford, as " proving the influence of the use of impure water iu predisposing to the disease." The subject was at length brought before Parliament, and a law enacted, as we have seen, in 18o2, compelling the water companies to make arrungoinents for conveying tho water from above Tediling- ton lock. Already iu l8o3 the death-rate from cholera in the dis- trict supplied by the Lambeth Company, which alone had completed its works and brought its supply from Thames Ditton, was little more than one-half the Southwark and Vauxhall death-i'ate. The house to house incpxiry undertaken by Dr. Suow in the Lambeth, Vauxhall, and Southwark districts in the autumn of 1854,* brought to light the startling fact, that out of a total of 1,510 deaths, 1,224 occurred in houses supplied by the Southwark and \ auxhall, and only 93 in those supplied by the Lambeth Company. In other words, " while a death from cholera had occurred in one house in every 28 supplied by the Southwark and Vauxhall Company, a fatal attack of cholera had occurred in only one out of 2ol houses supplied by the Lambeth Company," showing a mortality "just nine times as great in the houses supplied by the former company as in those supplied by the latter." And now it was found that the death-rate iu the Chelsea district, Avhich had previously presented so favourable a contrast to that of the southern districts, was very large when compared with the Lambeth rate. In short, it was very clear that the extraordinary diminution of the mortality iu a district abounding in unwholesome influences, and hemmed iu on every side liy districts ravaged by cholera, from which it had itself suffered frightfully iu 1849, had more than a casual connection with the pure Avater supplied by the Lambeth alone of all the water companies. Even more striking was the immunity enjoyed by single tenements supplied by this company, while all around the pestilence was busy and terribly fatal. The evidence collected iu the same year (1854) by this indefatigable in- quirer a^i to the origin of the frightful outbreak iu the Golden Square district in the month of September, was such as to compel the assent of the most incredulous to the proposition that it was mainly attribut- al)le to the contamination of the water of the Broad Street pump- well, the favourite source of supply iu that neighboui'hood. What was then matter of doubt, or wonder, or disgust to multitudes, now forms an almost unchallenged article iu our sanitary creed, of which the Metropolis Water Act was one of the earliest expressions, as the yearly growing interest iu the question of water supply for our great towns is its natural and gratifying result. But while thankfully acknowledging our obligations to Dr. Snow, who spent much time, and strength, and substance, in conducting this great inquiry, I cannot admit that cholera spreads only by being swallowed. That the gaseous emanations from unremoved cholera I, Snow on • Medical Timet and Gazette, New Series, vol. ix., pp. 865-6,1854. nil I Mil 1*2 1^!! disclmrges in privies, minoH, otc, nro a very fioqnont cnnBO of the oxtoiision of tho ilisoiiHO, aoomH to ino cHtnbliHliod boyond diHputo by tho facts stated in a hov'wm of letters * from the pen of that accom- l)lished and safraeious pjjysician, Dr. W. liiidd, of liristol, who has established as sironj; a ease for prompt inc^asures of isohition and dis- infi!clion as has Dr. Snow for an abundant sni)ply of pure water. This is not the tittinjj; place for disenssin;» the (jnestion whether water contaminated by ordinary aewaj^o nniy, undtir varying con- ditions whicli wo cannot as yet acctnately define, prochico only slight indigestion, or a diarrlnea more or less severe, or a destructive out- break of dyscnlerj, typhoid fevor, or Asiatic cholera. I merely remark that, even in the ease of the IJroad Stre{!t pump water, there was, as Dr. Sjjow admits,! no evidence to prov*} the presence of choleraic nuitter, though tho presence of orgaiii(! impurities was abundantly evident. " Mr. Eley . . . had long noticed that th(» water became ollensive both t(» smell and taste, after it had been kept about two days. . . . Another person had noticed for months that a film formed on tlio surface of the water, when it had been kept a few hours." As, however, 1 have been led, in illustrating the results of indi- vidual effort, to consider the moi'bific iulluence of water contaminated by sewage, 1 cannot dismiss the subject without citirg some striking fiicts which I have gleaned from public documents, or from my own experience. In July, 1849, J " the pi'ivies of a number of houses in Silkmill Row, Hackney, were pulled down," and th(> four cesspools Avliich were substituted for them were situated respectively at tho distimce of one, three, five, and twelve yards from " the oidy well which supplies with water twelve houses containing 85 inhabitants." The water, which a fortnight later began to be offensive, Avas there- after rendered "as thick as thin soup" by the admixture of sewage. Of the 85 inhabitants 22 wisely avoided tho water and escaped dis- ease, while 46 of the remaining 63 " were attacked with severe diarrhoea, one of them approaching cholera." There was no question liere of cholera discharges in the cesspools, for the "row" had been and remained free from the epidemic. "Jacob's Islan(l,"§ a portion of the parish of Christ Church, Ber- mondsey, contains between 300 and 400 houses, and is surrounded by a tidal ditch or millstrcam, which receives the contents of tho sewers and drains of all the drained houses, besides the refuse of the neighbouring houses and tho contents of their privies, and was tho i : { * Association Journal, 1854, pp. 5129, 950, 974, 1152, under tho signature "Common Sense;" 1855, pp. 207, 283, signed " W. Budd." t On " The Mode of Comrauiiication of Cholera." By John Snow, M.D., Second edition, 1855. Churchill, p, 52. + " Report of General Board of Health on the Epidemic Cholera of 1848 and 1849," p. 60. § Mr. Grainger's " Report to the General Board of Health on the Cholera of 1848 and 1849." (Appendix £.) p. 92. 18 solo Hourco of iho water Bupply of 150 houfics. Many of iho lnhal)i- tants wore in Uio habit of UHiuff it for cooking, and liad 5I). " The contractor lor the street sweepings, who is the treaicr with the Commissioners of Public nuisances in Leeds, absolutely rented and rents, or did rent a very few weeks ago, a plot of vacant land in the centre of North East Ward, the largest ward, in point of population, of the whole township of Leeds, and containing the greatest number of poor, as a depot for the sweepings from the streets and markets, both vegetable and general, for the purpose of exsiccating and ac- cumulating till they could be sold as manure and carried away. So noisome were these exhalations, that the inhab- itants complained of their utter ina- bility to ventilate their sleepiug-roonis during the day time, and of the in- sufl'erabla stench to which both by day and night they were subjected. "A great many of the priviesof the cottages are built in small passages, between clumps of houses which are different properties; others, with the ash en- trance open to the public streets; and others at a little distance from and open to the front of the houses ; whilst some streets are entirely without. The inhabitants, to use the language of an old woman of whom inquiry was made, says that ' they do as they can, and make use of the streets as the common receptacle.' These remarks apply in particular to three streets of Leeds, which contain a population of between 400 and 500 persons, where there is not a useable privy for the whole number." p. 356. in fact mere oils dc sac; more fre- (piontly they communicate one wit'i another, so as to form a complicated labyrinth of very imperfectly ventilated little streets and courts. Houses in such situations are very commonly indeed built back to l)aek, and even when not so they are often destitute of windows in the rear, and possess no efficient means of thorough ventilation. The streets of Leeds have in fact been laid out and the houses erected ac- cording to me caprice or interest of their owners, without reference to tho health, comfort and convenience of tho inhabitants, or to the fact that they were destined to form integral parts of a great town. The courts of Le^ids are rarely spacious and airy, are some- times entered through covered passages, and are by no means always clean, but more fro(|uenlly are unpaved and in ))a(l condition. Privies are almost universal, and are, from tlieir posi- tion in relation to dwellings, the most prominent sanitary defect of the town, water closets being unknown among tho poorer classes. As is common in other manufacturing towns, a single privy usually serves for several families. The situation of the privies is often most objectionable; in many of the smaller streets they are placed beneath inhabited rooms ; in others they are sometimes placed against the walls of houses, or so near to them that the efUuvia are felt within doors, and infect many of tho courts and smaller streets. Although certainly not the exclusive cause of diarrhoea, yet upon the whole that disease has been the most rife and most fatal in streets where the privy nuisance prevails in an aggravated form." — " Second Report of Medical Officer of Privy Council," 1«59, p. 134. ^ 18 I. HuNTEJ. ill 1866 aud 1800. '' To the eye of an iuspector who had just left Newcastle aud Sundcrlaud, and who in the same week vlailed Sheflaeld, Leeds, in August, 1805, pre- sented a Hui'prising hight, bringing to remembrance the condition of many Enjjlish towns of twenty years ago, but finding hardly any slandaid with which to be conipaied in the present state of any great town. Thousands c I' tons of midden tilth llllcd the receptacles, scores of tons lay strewn about where the receptacles would receive no more. Hundreds of people, long unable to use the privy because of tlie rising heap, were depositing on the floors. A few dawdling carts, under command of Mr. Sands, the corporation oBic r, and subject to no inspection, unless Mr. Sands be talien to be inspector of his own duties, would, after many apjili- cations, relieve the middens of such inhabitants as could, Ity peremptory manner or by iiiHuence obtain a hear- ing. Even then the relief was mo>!t imperfect. In one insiance the sca- venger reported a receptacle as emp- tied, yet twenty tons of stuff were removed when a second visit was in- sisted on. The pressure of ihe.se enor- mous weights was so great that liquid ordure had been seen, after penetrating the ground, to be forced up around the hearthstones of neighbouring cottages. The officers of the union complained to their board no less than 3,500 times, in about two years and a half, of dis- tinct instances of neglect. "The force employed in cleaning, which had been last spring forty-live carts, had been reduced to thirty, and with an excess of delicacy, l)adly agreeing with the universal neglect, no removals were made except by night. Such carts as were employed only car- ried the midden tilth to a deposit in the town, l)y the water side, except a few by which some railway trucks were loaded. At this deposit stood thousands of tons of midden filth need- lessly waiting for removal by boat or cart for consumption ; 7,000 tons stood there at one time this year, and yet the quantity at this moment found to be necessary is and need never exceed one hundred tons. Boxes which re- ceive closet manure from manufac- tories are here emptied in large num- bers, and though both at the original receptacles and at the deposit itself a Hole iu 1866. "To crown the imperfect construc- tion of these dwellings, they arc placed in immediate contact with j/rivies aud cess- pools, which, although soldoiu noticed by tilt! inlial)ilant8, are utterly intoler- able to a stranger. Then, again, the supply of jtrivies is quite inadequ;vto for liie onlinary re(iuirenK'nts of de- cency, and many of them are under bedrooms, p. 127. " ' On Sunday mornings,' says a woman, ' the neighbours have to watch and wait for a chance of getting into the conveniences!' In ono of the above streets I he jirivies have pigsties beside them! llow intolerable the stench, particularly in hot weather, the reader may conceive, p. I'JH. "Owing to a recent increase of fever and of the doath-rate, meetings to consider the sanitary state of Leeds hav(! been held in every ward, at which clergymen and others cognizant of the facts agreed in showing that there was serious neglect -, that numerous ash- l»its were iilied to overtlowing in im- nii'diate proximity with the house.- of the poor, and that gully-holcM in the streets had been closed up for months. "' Wa saw,' says ono of the visitors in Hunslet, ' places that had been full for weeks, not of ashes, but of Iluid matter, up to the seat, so that the women in the houses said they had to empty everything into the streets. In one yard, consisting of twenty-six houses belonging to one landlonl, there are two privies only, and an open drain down the centre. A school of sixty boys adjoins the privies, and the ashpit is only about four feet high. In another yard, belonging to the same landlord, there are thirty-two houses to two privies, and the yard itself is saturated with disgusting matter.'' p. lliO. " We can point to numerous pig- sties which have existed more than thirty years, in close proximity to dwellings in the very centre of the town, and which still Nourish aa redo- lent as ever." p. 130. thi th( sec ' til Shi H( ve^ whj Wed ancjl inesj witj eJal * t t I 1866 18«3g] 10 ruc- 2din cess- ticcd olcv- 1, Ihu it' de- unUer ays a watcb ip into of the iiigsties Ijle the /eatUer, ;H. of fever Ling* to ,1' Leeds III w\\\^-^^ lit of the llCVO WAH ons 1^8*' ■ ig in im- \h)Usc.- of ics in tlie V months- ,e visitors I V)i!en fui] il of fluid tbat the ie> had to .ticcls. ill twcnty-8»>^ liiudlonl, ,y, and an A school urivies, and „• feet high. U) the Bi»iii° .two houses tu-d itself is matter. nerous pig- niore tliun i.voxiraily to leulre of the Lish as redo- dcododzinf? powder wa.n freely Ubed, the place omitled a slronKliecal Htencb, doing il8 best to wiini iho corporation of the iniHchief they were doing." (Eighth Report of the Medical Officer of the Privy Council, p. 234.) " The orifice of the midden was even in largo highways often turned to the street, and often unprotected by any door. There were proijerties without any privies or ashpits at all, yet quite within the town. "On the 2Gth of May, 186G, the justices ordered the removal of the Waterloo depot ; the town clerk ap- peared to beg delay." p. 230. Huppily, ns we shall see, the "ancient reigu" of the pigs and pig- geries in Lcerls Ims now been effectually disturbed, and we have been lately reminded, by a letter in the Times* from Dr. F'owler in refer- ence to the state ol' privies in the City of London, that Leeds is not the only place where urgent and oft-repeated complaints and remon- strances are unheeded by the local authorities. What has been done for Leeds by those gentlemen to whoso labours I have referred, has been done for Oxford by Dr. Aclaud, whose memoir on the Cholera in 18o4f is indeed an exhaustive treatise on the then unwholesome condition of that renowned seat of learning. I shall have occasion again to refer to the interesting information with which he has lately favoured me as to its present state and prospects. Dr. Shapter's volume J and supplement have thrown much light on the history of the cholera at Exeter, and of the sanitary measures adopted with such encouraging success in con- sequence of its frightful ravages in 1832. Dr. J. C. Hall has from time to time contributed much valuable information on the state of Sheffield and the diseases prevalent there. Mr. Rendle§ and Dr. Horace Jeaffreson|| have given us precise and highly important facts regarding the principal fever haunts of London, and t*ie mode in which they are dealt with by vestries. Dr. Tyaeke has been un- wearied in his efforts to stimulate the local authorities of Chichester, and Dr. Edward Wilson, failing any vigorous and comprehensive measures on the part of the Town Commissioners, has supplied us with numerous and authentic details regarding Cheltenham in his elaborate and very able paper read before the British Association for * September 17th, 1866. t "Memoir on the Cholera at Oxford in the year 1854. with Considerations suggested by the Epidemic." By Henry Wentworth Acland, M.D., F.R.S., F.R.G.S., &c. Churchill, 1856. t '• History of the Cholera in Exeter in 1832." Churchill, 1849. I " London Vestries and their Sanitary Work." By W. Rendle. Churchill, 1865. " Fever in London : its Soeial and Sanitary Lessons," 1866. II Letters in Times, April 14, September 7, 1865, January 3, 27, March 6, 186G. Sec also leaders, April 15 and September 7, 18C5, January 3, o, 18GG B 2 I J I ft 20 iho Advuiicemont of Sci(Mico in 1S(J4.'* 01' the iiluiiulmil. lalxnirrf of my fritMul Mr. KiiiiiHcy, also of Clicltoiilimn, iiiid o\h', of our lii;f|i<'^t authorities on all mutters conm'(!t(!(l with "State iMedieine," it wonld bo superfluous in nm to say a word in connnendalion. (lloncestor and Newcaatle-upon-Tyiuuire likewise I'ortumite in havinp; (.'aeh an accom- plished and aide medical i"porter. Dr. Washlnturn, in the former city, has drawn up and pnl)lishe([ at his own eost live iinnnal repoi'ts "On the Sanitary (Condition of (rioneester and its Vi(dnity ;" and Dr. Philipson, to whom 1 am indebted for much help heartily f^iveu, has for several years pid)lishod the residt of tin? retin'ns sent> to him by the mend)ers of the Northumberland and Durham Medieal Society, in a report, which appears ovcM'y two months, of the prevalent diseases of Newcastle and the whole surronndinj^ district. As rej^ards Man- chester, the only ;^rouiid of hope for tuture sanitary reform would seem to be the existence «»f its justly eelel)rated sanitary association,! which has for a long series of years been collecting, and classifying, and publishing in weekly, (juarteily, and annual reports, which arc models of their kind, a massof details of the highest value in relation to the health of Manchester and Salford. And not only so, i)Ut they have long been endeavouring (my distinguished friend, Mr. Thomas Turner, the president, frefjuently taking part,) to inculcate sound sanitary and social doctrines among the working ])(ipulalion, by courses of lectures admirably fitted to promote the end in view. They havo also, from time to time, applied themselves to the more herculean task of stirring up the local authorities to the discharge of some of tho more obvious responsibilities devolving upon them, as the guardians of the health of the great and prosperous community, which, by a pleasant fiction, they are presumed to govern for its good. The very striking and valuable paper entitled, " Remarks on Some of tho Numerical Tests of the Health of Towns," by Messrs. Arthur Ran- some and William Royston, was published by that Association in 1864; and to its honorary secretary. Dr. John Edwanl Morgan, we owe the very interesting and instructive pap'er read at Sheflicld last yea.r,| on " The Danger of Deterioration of Race from the too Rapid Increase of Great Cities." Though some may be inclined to fear that the vis inerticc which has so long and so pertinaciously withstood such well-directed efforts, must be invincible, we cannot resist the con- viction that, in the unabated vigour with which this admirable asso- ciation maintains its protest against official neglect and incompetency, we have the pledge of an ultimate and complete victory. If the zeal and energy of a few private individuals singly and in combination, and of associations, have thus been applied, with so considerable an aggregate result, to the increase of our knowledge, * Since published as a pamphlet — " Sanitary Statistics of Cheltenham.' ' Long- maTis, 1866. t The Manchester and Salford Sanitary Association. % Soc. Sc. Tramactions, 1865, pp. 427 to 441). Since published by Longmans in a separate form. ! I 1 I 21 and tho cstubliMhinonf, on a solid basis of tho prliifiiplos that should gtiido us in uur undoavours to improve thu public huallli, much larger oontributions to our knovvlcHlgo and proj^rcss have been made, first by Mr. Cliadwick and his reporters throughout the country in IH42 and 1H4.'J, and during tho last niiu) years by tho medical ollicer of the I'rivy Council anil his stafl' of ver^ able assistants. Here wo have another force ab extra brought to bear on the sluggishness of local bodies. Alh^r the firn* vi^^itation of the cholera, tlu! mop and pail, which had for a lime been umv.h in reciuisition, were by common (ioiisent laid aside, and the whole nation fell asleep in the midst of yearly-accumulating abominations, until, in the general and local reports on the sanitary condition of the labouring population of Great Britain, Mr. Chudwick and his fellow-workers iield up tho mirror to a multitud(! of foid spots both in town and country, and produced an impression of incredulous horror, which the lapse of a (juarter of a century has not entiri-ly obliterated. But it wus not till 1858 that the foundation of oiw present system of annual reports was laid, in a small but very remarkalde Hluo IJook,* which consists mainly of a report by Dr. Heiidlam (rrcenliow, " On the Different Prevalence of Certain Diseases in Different Districts of England and Wales," with an introductory report by Mr. Simon. The very valuable reports made in subsequent years, according to the terms of sections 5 and 6 of the "Act (18.38) for vesting in the Privy Council certain jmwera for the protection of the public health, "f on diarrhcea, diphtheria, lung diseases, typhus, typiioid fever, and small-pox, by Dr. Greenhow, Dr. liurdon Sanderson, Dr. Buchanan, Dr. Seatou, Dr. Julian Hun- ter, Mr. Uadcliffe, and others, have amply confirmed the .'soundness of the principles set forth in the preliminary papers, and have from time to time placed in the pillory, for the edification of the public, some of the more incorrigible offenders. That good has been effected by this wholesome practice of publicly recording the chief sanitary events of each year, of investigating on the spot the cir- cumstances which have preceded and accompanied local outbreaks of epidemic and infectious disease, and of laying the result before Par- liament, it would bo absurd to deny. And that this work has been well and very ably done by Mr. Simon and his assistants, will, I apprehend, be universally admitted. Yet the benefit accruing there- from has consisted much more in the collection and diffusion of authentic information, than in tho communication of any decided impulse towards sanitary improvement among the great masses of the population, where preventible disease slays its annual myriads. 1 wish to speak guardedly on this subject, notwithstanding the special iiKluiries 1 Iiave instituted, because I observe that Mr. Simon, | * n] • Papers relating to the Sanitary State of the People of England." Presented to 1»nth Mouses of Piirliament, by command of Her Majesty, 1858. t 21 & 2'J Vict., ouii., '.)7. X Eighth Report of tiie Medical Officer of the Privy Council, for 180.'). pp. 18, 19. ppcakin^ of Dr. nuclmimn's invcHtigutioiiB into tho Btiitc of •' plnces ill which, for sonu'. coiiHidcrublo miinher ol" yonrs, pioper works of drniniigo iiml water supply have been fHtiiblishcd, or particular •unitary regulations ln'cn in force," cxprcsscH tho hope that ho may be able, in his next report, " to stuti! iionclusions which may bo per- manently valid as to the practiciil I'ruil. of our l)est le.>*leil sanitary improvements." Still it is impossible, whilo readiiifj; thoso vory inteieslinp and instructive records ol' local slii;:j(ishneHs and i)reventililt' mortality, to banish from one's mind theexpros terms of the '* Diseasos' Pre- vention .Vet, iH.>o," under which, as conlirmed by '' tho Public Health Act, 18i)8," tho Privy Oouncil exercises itn present functions in lioalth matters. " WluMiever Csect. .I) any jiart of Kn^jland appears to be threatened with, or is affected by any formiil.iide epiilemic, endemic, or contajjious disease, tlie Lords and others of her Majesty's most Honoui'able Privy Coinicil, or any three or moic of them, nniy, by order or oidcrs to be by them from time to time made,dir(!Ct that tho provisions herein contained for the prevention of diseases be put in force," &c. And .section 6 {jfoos on to provide that they "may issue directions and rej^ulatinns for the speedy interment of the dead: for liouse to house visitation; for guardin}^ against the spreatl of disease, and affording to jx'i'sons afHicted by or threatened with such epidemic, endemic, or contagious diseases such medical aid and such accommo- dation as may be required." Tlieso ample jiowers were plainly con- ferred, if word.s iniv(! any meaning, with the view of emd)ling the Qxecutivo not only to prevent the introduction of epiilemics from without, but to root out, if possible, those formidable and destructive diseases which have so long dwelt or are begotten in tho Iiomes of our people. They have, however, been directed so exclusively ugainat those rare visitants, the alarm of whose approach is in itself a warn- ing to make ready, that they are generally supposed to have no force against our bosom-vipers, wiiich have a vested right to sting to death as many as they list, or as the " liberty of the subject" thinks pro|)or. If cholera threatens us, if yellow fever comes to one of our seaports, if a single case of cattle plague or sheep-pox appears among our herds or flocks, forthw^ith " my lords " Avakc up into a state of preter- natural activity, hourly telegrams flash to and fro, and voluminous orders fill tho pages of tho Gazette. But with tho de[)arturo of those intruders the wonted quietude returns, as if there wei-e no " formidable epidemic, endemic, or contagious disease " within our borders worthy to engage " my lord.s' " attention! Yet true it is that strong men and healthy women — " the bi-e.id winners" of the nation, as Dr. Trench truly remarks — aro "dying like rotten sheep" by thousands, after a fortnight's illness, of typhus, of typhoid, and of small-pox ; and we think we have done our duty when we have held an inquest on the hecatombs of dead ! For several years typhus has been raging epidemically in London ; and in Greenock, in the west of Scotland, so virulent has been its type, and so great the moriaiity occasioned by it, that a special in'^uiry, conducted by so able an observer as my J ^t' aa •\ % 4 ' frlmid Dr. niuilmuati. wns rcokonoil uocp««i\ry by tho Health Dnpart- mcMit of tlio Privy C'oiincil.* Aa regurdi Lorulon, tlio atiitomenta of Di*. Homco JoailVcson ami Mr. RcMidle, wliicU recal, a» tlioy oxaclly tally wifli, my oxpurioiico in Jlio Glas^row fovcr lioipitul thirty yeara U'^o, hIiow that its princijuil hiiiiiits aru well known, and Icavo no doubt ihiit by tbu timely r(Mnoval of tln^ sick, and l)y oniptyin^ and tiiDroii^^bly cdiMniHin^ and linunvaHhinp; tho toncnK'nts whrro it has fixed it8 abodo, (his duirioii of onr ;{roat t(«\vnH nii;{ht bo cdli'Ctually exorcised. Ileeent pxperieiicci in liristol, as I hhall show, j^oes to establish iho sanio position. L(>t it thun bo oUiarly understood that tho moans of greatly diminishing, if not of pnttiii}^ a slop to tho rava<;es of typhus are within onr rea(di ; that tlni I'livy Council has full power to |)nt these means in force for tho pul)lic ^ood and tho preservation of lilofrom wholesale dostroetion; but that, imverthelesB, tho Privy Council dcfclines Iho responsibility of savinj; tho lives of tho lie;;es, a;,'iviiist the will of interested 1,. idlords, and tho prejudices of the local authorities! I'laceil in this lij,'ht, the phantom of " vested ri;?hts" assunu?s a very hideous aspect; ami the incrlia of tlio Privy Council seems to ordinai'y minds both inexplicable and inexcusable. Their fuiuMion, it would appear, Im calmly (o watcrh Iho profrress of theslaufjiiter which ihey uiij(ht prevent, and then " to point tho moral" which dead tonojues cannot enforce, and to "adorn the tain" which the victims of otficial prudery cannot tell. The Home Secretary, ajjain, who is empowered by tlu! Sanitary Act, 186G, to interfere, if he sees Town. Birmingham . . Bradford. . . Brighton. . . Bristol and Clifton Cambridge. Canterbury Cardiff . Carlisle. . Cheltenham Chester . Chichester. Derby . . Devonport DoDcaster Dundee. . Edinburgh Exeter Gateshead. Glasgow . . Gloucester . Greenock . . Grimsby . , Halifax . . Hastings and St. on -Sea Hereford . . Hull . . . King's Lynn Leeds . . . Leicester . . Lincoln. . . Liverpool Maidstone Manchester . Merther Tydfil . . . Newcastle-upon-Tyne Newport (Monmouth) Northampton Norwich . Nottingham Oxford . . Paisley . Plymouth . Portsmouth Keading . Salford . Sheffield . Shewsbury Southampton South Shields Jieportcr. . Dr. Alfred Hill, Borough Analyst, through Mr. Watkin Williams. . Clerk of Board of Guardians, through Mr. Wm. Dunlop. . Mr. J. Cordy Burrows.* . Mr. David Davies, O. H., through Dr. Henry Marshall. . Dr. P. W. Latham . Dr. Alfred Lochcc. . Dr. H. J. Puine, 0. x . Wm. B. Page, through i>r. Goodfellow. . Mr. H. W. Rumsey and Dr. Wilson. . Mr. John D. Weaver. . Dr. Tyacke. . Dr. Wm. Ogle. . Mr. Paul W. Swain. . Mr. Francis C. Fairbank, 0. H. . Dr. Robert Cocks. . Dr. Liltlejohn, O. H., through Dr. Warburton Begbie. . Mr. P. C. Delagarde. . Dr. Wm. Robinson, O. H. through Dr. G. H. Philipson. . Dr. Wm. T. Gairdner, O. H. . Dr. Washbourn. . Dr.Wm. J. Marshall, through Rev. John McFailau . Mr. H. M. Lei)pington.* . Through Mr. W. Dunlop, of Bradford. Leonard's- Dr. Blaiiiston, F.R.S. Mr. C. Lingen. Dr. Henry Munroe. Dr. John Lowe. Dr. M. K. Robinson, 0. H., late of Birkenhead. Dr. John Barclay, and Mr. Moore, 0. H. Clerk of Local Board, through Mr. R. S.Harvey. Dr. W. S. Trench, O. H. Dr. John W. Woodfall, J. P. Sanitary Association, through Mr. Arthur Ran- some. -Mr. Thomas J. Dyke,0. H. Dr. G. H. Philipson, and clerk of Public Health Committee. Dr. Benj. Davies, O. H. Dr. John M. Bryan. Mr. Wra. Cadge. Dr. Tindal Robertson. .Dr. H. W. Acland. F.R.S. Dr. Richmond, O. H., through Dr. Wm McKechnie. Dr. Cookworthy, and Mr. J. H. Eccles. Mr. H. Bui'ford Isorman. Mr. T. L. Walford, O. H., through Mr. George May, Jun. Sanitary Association, through Mr. Ransome. . Dr. John Charles Hall. . Dr. Styrap. Dr. Wiblin. Mr. Leonard Armstrong, through Dr. PhilipBon. ita I 31 Town. Stafford. . . Sunderland. . Tyneraoulh. . Wolverliiinipton. Worchuster. York Jteportef. Dr. Henry Day. Dr. Yeld, O. H., through Dr. Philipsod. Mr. Procter, chairmim of Sanitary CommissionerSi through Dr. lieiidlam Greenhow. Mr. E. J. Hayes, Town Clerk. Mr. H. W. Carden. Mr. W. D. Husband.* I >\t Of the fil'ty-niiie towns here enumerated eighteen only have regu- larly appointed and permanent oflioersof health. In tive others appoint- ments have lately been made under pressure, but only for periods of two or three months, and with temporary salaries attached to them. 1 place the.-y a few hundredlhs. The reason is that it has a complete sy^teln of deep ; cwerage and a medical otlicer of health, and is wonderfully Avell looked alter sanitarily." As regards the populations, again, the numl)ers, it will be seen, vary very remarkably in the diti'erent tables. Thus, in Table II, group A, the population of Wolverliam[)ton is stated, according to the Municipal Corporations' Directory, at G;3,!).S5 in 18GG ; whereas it is stated by the Birmingham reporter as a2,442 ; and in the table fi om the General Register Office (Table IV.) as 126,!)02. This last, as explained in the Dailj/ Post, "deals only with registrars' districts." What a})pears aa Wolverhampton includes — besides the town of Wolverhampton — Bilston, Willenhall, Wombourn, Kinfare, and Tettenhall ; in- cluding, doubtless, ''a larger proportion of healthily than of un- healthily-housed population." It appears, however, from the small C 34 death-rate for the five yours IH()0-6o, in the Somerset House Ttthlo IV., thtu Micro has Ijcen a marked improvement during that period over the whole registration district, though, in the altscnco of the returns from the suh-districts, we cannot tell where that improve- ment has been greatest. This writer's summary of results gives in few words a striking picture of the actui.l condition of this important cluster of towns, "But taking the Birminghiim average (24'l)()) for the black country towns, and adding the three lives already arrived at," ( by allowing a larger mortality for the much larger population of Birmingham,) '* it would appear that ten persons in every tiiousand of the inhabit- ants of these towns, die fW a preventable causes. Nor is this to be wondered at, when we consider that only three of them (including Walsall) have any system of sewerage: that oidy a like number have a medical officer of health ; that only one (Tipton) has both ; and that as to one of those which have a syistem of sewerage (Bilston), the town is shamefully neglected. It seems a dreadful thing to contemplate that, while the black country towns arc on the whole healthily situated, and while their trades arc not in the main inju- rious to health, their death-rate i liould still furnish something like Jive per thousand to swell the general rate of the rural districts, which stand at something like 18." Dr. Julian Hunter mentions,* as an indication of good intentions, that " the byeluws of Dudley provide for the duties of an officer of health, should one be ap- pointed," and that " the *iir. of piirlieiilar diseases diilurs under ditlerent eircum- itiinces of climate, season, dwellinjr, aj^e, sex, and occupatio;), detlnite Btaiidiiril.s of conii)arison arc {gained, witiiout which tlic oflieer of health could not estimali^ the healthiness or uniieulthiucss of tho population under his chiu';:c : "in chciiii.sln/ (ineludiuf; tho power of microscopical observation) because wilhout such aid there can bo no accurate jud;:meut M to inipuriiies of air and wdtor, dangerous impregnations of soil, or poisonous admixtuies in food • * ♦: " in iKitinal plnloMiphji, hccanse nuiny nui'^ances arc traced, and many qiu'stions us to Ventilation and over-crowding arc answered by Us laws; furlher, because by its aid the oflieer of hcnltli sindies llio atmospheric changes, and learns tho climate of his district — im- portiiut steps in proceeding to spenk of its di-.enses; and finally, because natural plillosophy in conjiinciion wit!i dicmistry renders him cotnpetenL to report on nuiuy manufacturing processes alleged to be hurtful to health, and on the sulliciency of such means as are em- ployed to reduce the evils ascribed to them." And all thece aecouiplishmenl.s — eud)racing more than half the circle of the sciences — for five shillings, or 8even-and-ei;j;iitpenco a- wcek ! "Admirable C'richions," it would seem, arc to be had cheap nowadays. IJut Abcrdaic and Paisley at all events allow their officers of heal ill to engage in j)rivate practice, and, by the sidurics which tlipy give them, virtually tell them that tiicir sanitary duties need not c.cupy more than a fraction of their time. It is not always thus — '.viiiies' Sourhanipton. The story of tho sanitary achieve- ments of this prosperous and rapidly-growing seaport is ftir too iiistiuctive to be dismi.-sed with a passing allusion. Southampton was one of the first (having been anticipated only by Liverpool and Leicester) to appoint a medical officer of health — the ofhce having been instituted in 18o(), when that admirable and much enduring public servant, Mr. Francis Cooper, was chosen as officer of health and sanitary inspector (the la;ter being the genteel designation of an inspector of nuisances), with the modest yearly salaiy of £150. Most likely he wouhl not have undevtaken such laborious duties for so inadequate a remuneration, had he not been permitted to dcv- te to private practice the remnants of time that were not absorbed by othcial engagements. If so, he was not long of discovering how incompatible with private practice was the fear- less denunciation of abominations, in the maintenance of which some of his employers in th' Town Council had a vested interest ; and at length, 'in the ruin of his practice, which might possibly have been ntifl- tho what ion : i.ii.g cuni- iiite ' of iho or Improved hy n judicious roticonce, he found how oxpcnslvo it is to Itei'p II conscience. And if, at the outset, lie expected tliiit n zonloun di-charj?*! of liiH duties would soon secMirc for him an iiici case of nidnry, he mu-'t havo been ciiielly di.sappoinicd, for it wiis not till Im Imd lodod for tliiriccn years, tliat liis Halaiy was iJii-('d to .£200. In the autumn of IS'!.*), as nil the world knows, Souiliampton was visited wiili "an outbreak of clioler i, and " I (luoio Dr. Wiblin's words, " po')r Cloopcr's jrrcat energies were taxed luiyond eudnnuice. IIo was called to every form of miisann! that existed in the; town ; lie had to ap|»ear before magistrates to give cvidenee to prove that stinks and aboininntions did actually prevail, ulthonjrli neither ho nor they could remove tli6 most forinicialtli! ami peslilerons privy abominations which abound here. IJorne down by the multiplicity of his duties, and the want of support iu carrying them out," ho quickly succunibed to an attack of the pestilence, the further Hpread of which he was resolutely striving to prevent. A clear ollicial homiciile ; after perpcttralin;.,' wliicli tlio Council met and f)as3ed a resolution of condtdc'uce, which was duly forwarded to his bereaved and sorrowing family. I have not called it a murder, (or it was dmic iu ignorance! and not with intent lo kid; but the ignorance was such as should be accounted criminal; and ilio heartless treatment that led lo the untimely death of .-o valuable a puhlic officer not only verifies the maxim that "corporate bodies have no conscience," but shows most strikin;;ly the need of an efFicient clieck on tho wionghcadedness and parsimony of local auihm Iiic^s. The concluding Heuienee of Dr. Julian Hunter's report on Souih- ampton * addresses itself to us like a voice from f'rancis Cooper's giave, and emliodies the matured experience of ii man who was worried to ileath in the conscientious discharge of toe duties of an underpaid and thankless olHce. "The ineonveuicnce," writes Dr. H., "of combining the pro.'tecution of nuisances with private mod 1 practice, as indeed with any privali! business at all, was almost daily apparent, and Mr. Cooper thought b(!(ter n-sults would be got by a Combination of towns to support a medical otlicer who should have no other engagement, and who would be entirely free from local in- fluences." How was the lesson improved by the Town Ct.uncil? During the prevalence of the epiile nic, not only were the Satiitary • Committee unbounded in their liberality, and profuse in their expen- diture, both on the medical attendants and on those smitten with the pestilence, but the Mayor (.Mr. Emanuel) and Mr. Alderman Stebbing were unwearied in their personal efforts, visiting from house to house during hixteeu or seventeen hours of the tweuty-four, administering to the wants and comforts of the sick, and solacing the inlial)itant9 of the most suiferin^ districts. Then came the question of appointing a successor to Mr. Cooper. It was resolved to separate the offices of Officer of Health and Inspector of Nuisances, and to advertise for a gentleman to fill the fir,-«t office, who should be debarred from private * Eighth Report of the Medical OlHcor of the Privy Council. Appendix, p. 184. 38 m :. practice, and receiye the annual salary of £150 ! It will scarcely be believed that the post has been accepted on these terms by a highly educated and accomplished gentleman, who is thoroughly up to his work, and discharges his (' ities (his detractors themselves being witnesses) with singular ability. At the same time, as if in studied and bitter mockery of the medical and other learned professions, the council appointed, as inspector of nuisances, with a salary of £100 a year, "a man without education or any special qualification, and quite independent of the officer of health." If Dr. MacCormack has no respect for himself and for the profession to which he belongs, if he courts a repetition of the insults to which he has been sub- jected by the Town Council, and if he covets the melancholy fate of his lamented predecessor, he will retain, on its present footing, the menial office he has so injudiciously accepted. Let us note, however, that the mortality of Southampton (see Table IV.), which had in- creased from 23 to 24 per 1,000 between 1850 and 1861, has declined to 21 per 1,000 during the five years 1860-65. But there is no reason why, with its advantages of situation, it should not show even a lower death-rate. Happily there is another side to the picture. There are towns scattered here and there throughout the kingdom, in which much has been done by the civic authorities to improve the public health. I need not refer to Croydon, which has been so often mentioned of late years as a model in its sanitary arrangements, except to express my surprise that it has no officer of health. Those who wish for de- tailed information will *:nd it in an interesting pamphlet, in which my friend. Dr. Westall, has published the results of his ten years' experience as a member of the Local Board of Health*. Nor can I say anything of what has been accomplished in Coventry, Hud- , dersfield, Leek, and Macclesfield, in all of which, especially in Leek, the improvement has been very palpable, as I know of no corres- pondent to whom I can address myself in these and in many other towns. My space forbids me to do more than supplement the state- ments of my table by a few brief notices of special circumstances connected with some of the towns enumerated in it. It will be observed that only /our towns besides Southampton have engaged officers of health for sanitary work alone. Birkenhead gives £350, Edinburgh and Leeds £500, and Liverpool £1,000 of annual salary. Birkenhead will probably find it a judicious economy to give a more liberal allowance : for though the Sanitary Committee have found, in Dr. Baylis, an aljle successor to Dr. Robinson made ready to their hands, they may learn, as the demand for health officers becomes greater, that Birkenhead is but a training-school for the rest of England. " In Birkenhead," writes Dr. Robinson, " the authorities delegate to their medical officer of health full power to * " The advantages to be derived from the adoption of the Local Government Act. as exemplilied in Croydon." Ridgwaj, London, 1865. ly be ighly x> his being idied ions, ry of It ion, mack ongs, sub- ite of the ever, act according to his judgment, an advantage of no small moment; for when municipal bodies cripple and thwart their health-officer, his usefulness is seriously undermined and curtailed." I shall speak presently of Dr. Robinson's experience in Leeds. In the city of millionaires across the Mersey, with its frightful death-rate which has attracted so much attention of late years, the officer of health is and has long been one of the most important of its public men. The respect due both to the late Dr. Duncan and to Dr. Trench for their own high qualities has been naturally enhanced by the signal services they have rendered, in a town where 60 many of the producing causes of deadly epidemics are at work with f,n activity .and intensity unsurpassed — if oven parallelled — in any other town of the United Kingdom. The officer of health is there not only a reality, but a power in the commonwealth. I do not mean to assert that all has been done that might have been done — very far from it — or that the sanitary committee have adopted and carried out all the recom- mendations of Dr. Trench and his eminent predecessor, and of their zealous fellow-workers, Mr. Newlands, the borough engineer, and Mr. McGowen, the late town clerk, whose loss to Liverpool cannot but be a great gain to Bradford. But the officer of health is in Liver- pool recognised by the civic authorities as their official adviser, whose opinion is asked and listened to with deference in all matters relating to the public health; and having proved himself worthy of their con- fidence, he has been entrusted by them with very large discretionary powers, which he has exercised with great tact and judgment in furtherance of the views of the health committee and the provisions of the sanitary Acts. The problem of the excessive death-rate of Liverpool* is one which concerns the whole nation, and which has been carefully investigated by the "mortality sub-committee," whose report, and the evidence on which it is founded, form one of the most instructive and painfully-interesting volumes that has appeared for many years. " The result of the inquiry (Report, p. ix) is the convic- tion, supported by a mass of evidence, that the proximate causes of the increased death-rate are intemperance, indigence, and over- crowding; these two latter being generally found in the train of intemperance, although all three act and re-act on each other as cause and effect. . . . The evidence abundantly shows that the vice (intem- perance) is alarmingly prevalent among the labouring population, and that its wretched victims and their families sink rapidly into squalid poverty, resulting in overcrowding and its attendant evils, Liverpool has also this peculiarity, that it has a greater amount of unskilled labourers in proportion to its population than any other + In the table furnished by Dr. Farr (Table IV.), we find the following figures : Death Rate per 1000 living :— 1841—50, 1861—60. 1861—65. Liverpool 36 , 88 86 West Derby 26 St ' 26 40 r' town, for whom employment is uncertain and wages small and irregulnr." Tt should also he rempmliered that multitudes of its comforiflble nnd ojnilent citizens reside not only out of Liver- pool, hut out of L.'innishirc, thus fjjrcntly diniinishing in Liverpool the proportion of the diss ninon^ wliom tlio dculli-riito is smallest, and jiroMily lesseninpj the (U'!itii-r;il(3 of Birlanilicad, Claui^hton, Oxton, Kfifrcuiont, New Urifjflilon, ike. I insist very stronjrly on these imporfant fiicls, liccausc I luivc hccu aslicd, with an air of triuinpii — "Wiiat is the use of your nKMlical olliccr of hoiiiih, wlnn, in spitu of him, you have sueli a dcjith-iati' ? Just so; it is in spite of him; hut wiiiiont him, thoujihtl'nl men will he disposed to inquire, might not the twenty-live years' averafie have been forty-five inslend of tliirty-five ? The r;?s()iulion iulopted Ity the corportition, in accord- ance with the reeomnieudalions of the suh-conimiltoe. to spend £'25(\0O() in '• iirenkinji; up the niasses of crowded dvvellin;:s liy driving thoroufrh fares thionuh and across them la let in llu; lifjlit and the air," nnd so to encourage the construction of decent dwellings for the labouring classes, shows a dis|H)sition to f(dlow the example set on a mucii larger scale by the Glasgow nnlliorities, ami cannot fail to in- fluence heiielicially the health of their consliluents. Dr. Littlejohn occupies in Edinburgh a position exactly correspond- ing to that of Dr. 'J'rench in Liverpool, and meets with hearty co- operation on the part of the jiuthorities in all his endeavours to improve the sanitary coiulition of the city, the death-rate of which was in 18.')S) as low aa 21 '(ID, and in 1862 as high as 26'fir), the average for live years being L'l"!;") jier 1.000. The advantage of having otlicers of heailh set apart exclusively for sanitary work is very manifest in the reports of Dr. 'IVcMich and Dr. Littlejohn, which emhraee not only tiie chief causes of excessive mortality, but the death-rate of diU'erent ages, seasons, districts, and even streets, indicating the chiel" haunts of so-called '"zymotic" diseases and the measures most likely to be usefid in lessening the preventible mortality. It is quite clear that very few gentlemen largely engaged in private practice can eoninuind the leisure necessary i'or fully recording their sanitary experience, and deducing the lessons to be derived tlicre- from. In his paper ''On the Cleansing Operations of Edinburgh," read before the Social Science Association in 1H()3,* Dr. Littlejohn gives an interesting account of the system which has been in use since 1839, for the immediate removal of all solid I'efuse. not only from (he streets but tVom all the houses. The inspector of cleansing has under him eijiht district overseers or assistant inspectors, and 135 scavengers, each of whom has his own beat. The old town and the poorer districts of the new are visited twice, but the greater portion of the new town only once a day; so that '-all accumulations of filih are thus prevented tor a longer ]H>riod than a few hours, and the refuse thus collected is sold as manure, so as to vield a revenue to I* Soc. Sc. lyaiisactions, 18G3, p. 513. 41 the city." " This mode of cleansing, which needs only the simplest machinery, puts £7,000 per annum into the local trensury," and "from a report presented to the Town Coimcil in 18r)9, it appears that from Whitsunday 18.39 to Whitsundjiy 1H;')9 — a period of twenty years — 830,000 tons of solid refuse were collected from the streets and sold for £158,000." Those who have perused my quotations regardinjr the condition of Leeds do not need to he informed that Dr. Uol)inson, in rep;iiring thither from Hirkenhead, undertook a task of no ordinary ma<5nitudc; and most men would have recoiled from the prospoct of grapplinjij with unparcllelled privy al.^ominations, pi;.'geries by hundreds, noisome slaughter houses, the gigantic smoke nuisance, and an average death- rate of oO in the 1,000. The work has been bravely begun, and the incidents of the struggle will bo historic. The long-denounced piggories were selected as the battlc-jiround, and Leeds was for some time convulsed with the mighty strife! We have all heard of "learned pigs," but it was reserved for the West Riding of Yorkshire to bring to light in 18()6 the new portent of political piince 18.53. Dr. Davics, (Newport,) is paid, as he justly remarks, "less than any inspector of nuisances," and for the miserable salary of £.')0 he visits overcrowded hou"l dis- missal of oHiecrs of healili, and the expediency, botii for their own interests and for tlios ■ of tlie public, of making them independent abke of local ciiprice and of private practice? But if the need of a centrid anthoiity to regulate the action of not a few of those who have availed themselves of the permission to insiiinte that office be great, how much greater the need of legishilive interference to enjoin the appointment of liealih ofHcers on those who construe the Act as giving permission not to appoint them. Fully dive as I am to the force of Mr. Kimisey's arguments* against having officers of health for email districts, and to the diUicultics in the way of u satisfactory adjustment of many small towns and country districts with scattered populations, I cannot see that either the arguments or the difficulties apply to towns with populations of 30,O0U and upwards. 1 do not see wliy parliament should not at once empower the Privy Council to enjoin their appointment in all such cases, reserving for future deci- sion the question of enlarging the districts by including outlving amaller towns, or neighbouring country parishes, where such a mea- sure might seem desirable. In many cases the registration districts miglit be at once adopted ; and the longer I consider the subji!cl, the more am I inclined to accept Mr. Rumsey's suggestion, that " regis- tration districts are the best areas lor local sanitary administration," as promising the most satisfactory solution of this difficult problem. Of the 3(> towns which have no officers of health (Table III.), in only 11 is the jiopulation under 30,000, while in 2o it ranges from 31,000 to above 380,000, thus:— Under 20,000 Above 20, (ICO and under 30,000 30,000 „ 50,000 50,000 „ 100,01)0 100,000 „ 200,000 u I) 200,000 ... 6 5 10 7 5 S 36 Birmingham and Manchester being two of the last three, with popu- lations respectively of 338,868 and 380,887. In Aberdeen " a medical officer of health should have been appointed some time ago, with a salary of £200 a year, but from some differences between the * " Comments ou the Sanitary Act, 1800," &c. lleprinted from Jourual of SociaL Science lor October, 18(i6. 46 candidates it has been postponed, Dr. 0y. Gutt'shead. MertliN r Tydfil. Newport { Monmouth.) Nottingham, OxCord. f Plymoutli. } East Stoiic'hoiisc. (Stoke Dameiel. Portsea Island. Ecclesale Bierlow. Sotitliamptuti. Sunderland. Wolveihampton. Stalionaiy In 20 DihtriclH, viz. :— Anion. ** Hath. Hirniingham. * niMdIor'd. * Brij?liton. ** Canterbury. ** Carli.sl(«. * Donc.istor. ** Exoier. ** lieiolbrd. ** Kin-j'rt Lynn. Maiiixtono. ** ManrlioHter. JVeucaslle-on-Ti/ne. Norwicli. ** IJoading. ** Sill Ibid. ** Slir(!\vsl)ury. ** Tynemoutll. York. Inrreaning in 20 Districts, viz. ;■ Clifton. Cambridge. Cliester. Gloucester. Grimsby. Iltilitax. llastingH Hiiidinjjtoii. ( Hull and I Scult!oate8. Lends. Lt'irc- in the case of Wolverhampton, already referred to, it may be too low ; in others, as in the case of Clifton, which is made respon.sible for the high mortality of '' some of the poorest and densest portions of Bristol,"* much too *Dr. Edward Wilson's "Sanitary Statistics of Cheltenham," p. 45; also "The Sanitary Statistics of Clifton," by J. A. Syraonds, M.D., F.R.S.E., Trans- actions of British Association, <5f., for 1864, p. 17tj. 49 liigli. One grcftt advimtngo likely (o flow from the jippoititmcnt of liiglily (lunlifieil medical officers of'lieHhh in nil districts, rural ns well H8 urbnii, would ho the iiu'reuHcd nceuracy of our informnlioii in re- gard not only to (ho mortality, but to the diseanes, both of difltricts and fiub-diHtrictH thi'oughout the country. After 'he obwcrvations I mad(! on the subject of inspection of nui- yanees in ti:e Metropolitan districts, my rennirks on Tiildes III. and V. Hhall bo brief. The twenty-three towns in Table II. (to which Table V. is supplementary), with temporary or )>ermanent odleers of health, and an aggregate population of 2,220,407, havelOU ordinary inspectors or Buli-inspectors, i.e. on nn average one to 21,t'5i')7 inhal)itants. Hut if Ave deduct Leeds and Liverpool, their joint population of 710,085, and their staffs of inspectors amounting to (53, there remain only 40 for the other 21 toAvns, which have a population of l,o 10,322, i.e. one ins[)cetor to 37,7.'58 ; while Leeds has one to every 10,818, and Liverpool one to 11,498 inhabitants, exclusive of meat and common lodging-house inspectors. We must also remember that in Edinburgh, Glasgow, and Duiulee, not only are there special market, slaughter- house and lodging-house inspectors, but the services of the police force, with all the local knowledge they possess, arc at the command of the health officer and his men, when necessary. In all, except six of these towns, the inspection is I'eported as being either "efficient" or " very efficient," considering the small number generally employed, and the other duties which too often occupy their time and distract their attention from their sanitary work. In Bristol, for instancei Mr. Davies writes : — " I meet all the inspectors every morning at tho office at 11 a.m. Through them I am daily informed of the state ot the general health, &c., &e. They are taken as a rule from the de- tective constables, who are favourably known to the Watch Com- mittee, many of whom are on the committee of the Board of Health. The only qualificatiois are ability to write a good hand, and a character for general shrewdness and integrity. They are all very able men, and know every body and everything in the city within their duties ; and so sharp that nothing escapes them. Being experienced de- tectives, ei.ch has his circle of informants. They work excessively hard, and are not numerous enough." In the 36 towns in Table III., with an aggregate population of 2,601,165, (or deducting Sal ford, about which I have been unable to obtain any information, 2,489,760), there are 59 inspectors of nuisances, i.e. one to 42,200 inhabitants. I am aware that there is one in- spector-in-chief for Manchester, but do not in the least know (though I have made repeated attempts to discover) the number of his staff' of sub-inspectors. Rumour asserts that they are very far from efficient, and that nuisances of the most noisome kind are fostered, instead of being summarily put down, by the corporation. But we know from their admirable reports, that the members of the Sanitary Association have voluntarily and gratuitously carried out for many years, both in Manchester and Salford, a system of inspection and a registration of disease and mortality, of unequalled excellence — an example which 50 ouglit to Htimulrtto tlio ftutliorilios to a wlu.losomo rivalry, l)iit which soeniB rather to imprcHrt thcMU with the idi.'u that they arc ihcrchv rolicvod from nil r('s|)onMil)ility. JC ^o, they in-cd lo l»o iciniiulcu, that to poHflOHH fiuch information na h regularly furnislicd to tlicni by the Sanitary Aswociution, iiiid not to act upon it, into incur the re- sponsibility and the guilt of wIioIohuIo homicide. If wo allow H inspectors for ManchcHtcr and Salford, wo hIuUI then havo 67 lor tho entire population of tho 36 towns, i.e. one to 38,823 inhabitants. The metropolitan avcrngo, whicii wo considered exceedingly defective, is one to29,l()0. In IT) of tho 30 tho inspection is reported ofncient, in four tolerably so, in eight doubtful or more than doubtful, and in four decidedly bad. It will be observed that, as in tho metropolis, somo of tho inspectors have other duties to attend to, so that tho inspection of nuisances is nearly or altogether nominjil. Another point which calls for remark is tho frccjuent employment of the police as sanitary inspectors. It is one thing to select men from tho police force for their shrewdness, tact, and local knowledge, and to sot them apart for sanitary work alone ; and quite another to make the inspection of nuisances a department of police. In tlio former plan, tho one object in view is thoroughly cflTicient sanitary inspection by men highly qualified, and well remunerated, for that special work ; while the chief recommendation of the hitter is probably tho saving of expense. The services of the police are as a general rule njjderpaid, and their duties are suiTiciently burthensomc without tho addition of a task ■whi.jh requires for its satisfactory performance the undivided energies of a separate staff. Besides, it is worthy of consideration, whether the identification of sanitary improvement with (he force which is chiefly occupied in tho prevention and repression of crime, is not calculated to prejudice the minds of many against the health-measuves they are employed to put in execution. The insi)ection of lodging-houses I have described in some instimccs (e.g., Bristol and Bradford) as " indulgent." By this phrase I mean that, owing to tho great want of proper accommodation for tho labour- ing-classes, the authorities are reluctantly compelled to refrain from instituting proceedings against over-crowding, for fear — or rather from the certainty — of increasing the mischief in other quarters. I can do little more than indicate the evil, which, not in Bristol and Bradford only, but in the metropolis and in mos*^^ of our large towns, is one of tho chief hindrances to any efFectur lioration of the sanitary condition of the masses. In Maneh' j state of many of the registered lodging-houses is positi^ . ,ome. One night, about ten o'clock, I sallied forth with sev( .nds, under the protec- tion of two police officers, and after spendii e, jearly an hour in visiting the low public-houses, and mingling in the crowds of sots and despera- does that filled them, we devoted a couple of hours to an inspection of a considerable number of lodging-houses. In all of them the atmos- phere was foul and stifling, and in many the floors were so encrusted with dirt, that they seemed not to have been washed for months. In single room, six, eight, or ten bods, about two feet apart, coutuincd r I I 51 M many couploH, uomc of tlioiii of l»otli hoxos', ami not unricquonlly ft cloHo cxaminntioii detected one or two little IiciuIn proliuding from tho foot of H bed, tlie rest of wliicli wum oecnpied by the purenw. Some of tlio children — those, probably, who hiid not long breathed the polluted utmoHphere of these dwellingH — looked pbiinp and Ciiirly lienlthy ; but we Niw others vainly trying to extraet Hnflieicnt nourinlimcnt from tho shrivelled breants of half-tipsy motherH, while their ghostlike frames, and weird, haggard looks that n)a(leone shiKlder, told n Hickening tale of slow starvation, and of long yearH of suflTering crowded into their few months of existence. In tho dim light, we often Btumblod over hcups of ragged garments swarming with all sorts of vermin, and found that in thes' police-inspected haunts, where water was as scareo as air, the personal filth was in perfect keeping with tho moral pollution of the migratory inmates. One other picture I extract from a deeply interesting n^port (sent to me by Dv. Marshall) on "Workmen'.s Houses in Gree- nock." Tho following is u sumniaiy of a table of sanitary statisticH obtained from a house to house visitation, conducted by working men in 1863. "Thirty-two persons are living in apartments having less than 50 cubic feet of air I A supply so scanty, that it is difficult to understand how suffocation does not follow. .'542 persons have less than 1(X) cubic feet. 1,179 persons have under 150 cubic feet. 3,437 persons have under 450 cubic feet, living and sleeping in a condition actually dangerous to life. But tho result by far the most appalling is this, that out of 3,749 persons whose eases have been examined, not i. small jjroportion, not a-half, but the tvhole, with tho insignificant deduction of 57 individuals, are living and sleeping in habitations in which health cannot be maintained, and in a state tho inevitable result of which must bo that tho springs of life must diy up, and may perhaps entirely fail. 'J'his is not the worst of it. Seveu hundred cubic feet of air is enough for a grown person, if it be pure ; but if it has wandered into the room from between the high gables of back lands (i.e. tenements) — if it have passed over noxious ashpits, and over courts and entries destitute of sewerage ; if it be already poisoned before it has filtered into the deadly crowded sleeping places, how much in the evil aggravated ? Now, it is to be remem- bered that this is not the picture of tho worst parts of Greenock, of dens of misery to "which the rest of the dwellings form a contrast } but it is the worst and the best taken together, where working men dwell. It is a faithful picture of how the working men in Greenock live. All the more trustworthy that it is drawn by themselves. . . All that has been said relates to physical health. What is to be said as to moral health, when tho overcrowded dwellings do not admit of even a separation between the sexes ?" The corrected death-rate was 39-0 iu 1863, and 38-0 in 1864, as stated by Dr. Buchanan,* to whose admirable " Report on Epidemic Typhus at * " Eighth Report of the Medical Officer of the Privy Council." Appendix pp. 209-225. D 2 t.1 i I' b2 Greenock" I refer those who desire further information, as to the conditlou of thia popul'^ua nnd thriving aeaport of the We«t of Scotland. If we multiply by the hundred these two dark but faithful pictures, we shall have some faint idea of the extent to which overcrowding and its accompaniments of indecency, immorality, and disease prevail throughout the kingdom, many rural districts rivalling in unwhole- someness, both physical a; liuidpiut of tlie Bcwnnc and coiivcr- HJon of llic Ht)lid into guniio, in about to be tried on a large Hcale — by beat. Bone dust i« added, to Hupply the dcllcicncy of phosphates." Hereford . . '• Good — vci-y good." " Pretty general, not compul- sory, nor unlimited." Hull . . . '• The east district is well " All the districts of the town sujiplicd with main drains ; are well and amply supplicil the west also rapidly pro- witli good water." gressing." King's Lyiin . '• Constant and pare to whole town, except in the case of many old houses, which arc supplied with water that is allowed to run into under- ground tanks. This water is often rendered impure. from the close proximity of the privy vaults and cess- pools. In some ijistntices the former are placed almobt on the top of the water tanks." Leeds . , . " Exceedingly deficient in From thcWharfe; abundant. many districts ; but the but much contaminated pollution of streams is very with the sewage and refuse great." of various towns. Leicester . , " New and good." " Good and ample for the poor." Lincolu . . " By water company ; poor supplied at a reduced rate." Liverpool . , " 100 niilcti of sewers, the " Not constant, but is put on cost of construction about twice daily. The average £281,000." number of hours during which it is on is from six to eight." Maidstone , . " Improving, but our rivers " Better than it was, but to the are abominably misused poor still very deficient." and polluted by sewage and refuse from paper mills, ga^iworks, &c." ll M TOWW. McrthyrTyillU NewcBMlc Newport . . Nortbainpton. URAINAOE. Norwich . Nottingham Oxford . . A nystcin df ihaiiui^?!! wum t'oniiiu'iii'fd ill Niivcmlicr. iNCi,'!, iiiiil JH nuNV in pm- prcHH." 14 tiilloii incxiciil, nrtcrinl. into rivor Tync ; no ; lo- viHJon for utili/.alioii ol' HOWUgC." WATER IIUPPI.T. •' Excellent." " No return." " No return." '• Main sewers made by the Highway Committee ; pri- vate sewers nnder Sanitary Committee." " Into the rivers. The Cher- well was, till lately, un- sullied by drainage. It is now unfit for bathing." Undur the Hoard of Health hinee Noviiiil)ei', IHtll ; uii- limited supply, only three degrees ol' linrdness, free from organic impurity, fur an nniiiial payment of I Wfuly-penec per head. (Report oa Sanitary ('(mdi- lioii of Mcrthyr Tvdtil for I8tl.'., pp. 14— 1«.) " Not mueh to eomplain of. Reservoirs cover 143 acres, lioliling .'.'JO.OtKl.OOO gallons. 'I'lic corpc irat ion pay annually .ei'OO for water, for pul)lio grants, urinals, and water closets, and arc at ])rescnt collecting inforniiition with a view t(t jiroeeedings ngainst owners of property who do not provide u pro- l)or supiily." " Constant and plentiful, even in poorer di.striets." '* Not by any means complete in poorer ilistriets, being partly from water compa- nies, and the remainder from wells, all of which when analysed have been found to contain a great (piantity of organic and animal mat- ter ; quite unfit for drink- ing." " To poorer neighbourhood by i)unips and taps ; is for the most part very good. The landlord is obliged lo lay on water to cottages, if it can be procured at the rate of 2d, pev week." " A stand-pipe in each court, with Avater at high pressure day and night." Iniermitting ; no reservoirs ; question of new works re- ferred to Mr. liateman, C.E. 6fi TOWN. Paisley . Plymouth Portsmouth Heading . Sheffield Shrewsbury . Southnnipton . |j»J DRAINAGK. Into the river, which is much polluted by it. " For the most part good." " Generally bad, but a thorough system of drain- ^ age is being carried out, at a cost of £100,000." " At present, cesspools — com- plete drainage about to be carried out." "A good deal has been done of late years to the sewers and surface drains of the town, but still much re- quires to be done." " Wretched ; into the Seveni. About to carry out an ex- tensive system of sewerage, at a cost of £30,000 or £40,000." " Mediocre. After spending about £20,000 sixteen years ago, it is now contemplated to spend £10,000 more." WATER SUPPLY. " Good, to all inhabitants alike ; from hills to south of town." " Intermittent ; for one hour daily in some parts of the town, and for two liours on alternate days in others." " For the most part in the hands of a water company, and is adequate to all de- mands. The poorer tene- ments are not well supplied, as it is left to the landlords, who charge their tenants about a penny a week per tenement, when they put on the water. The supply is practically uninterrupted." " Good and constant, at high pressure." By w.iter company, from an elevation of 1,200 feet above the sea level, conveyed in iron pipes into the town, very pure. 4 grains only, to the gallon, of mineral and organic matter. (Dr. J. C. Hall, Soc Sc. 7ransactlons for 18G5, p. S85.) bupply to all partsvery good. " From the Severn for domes- tic purposes; drinking wa- ter from a' spring some distance from town. Gene- ral water supply to poorer districts very insufficient." " Supply ought to be unli- mited (from the Itchen), but is extremely deficient both for poor and rich. En- gines too small; others of greater power in course of construction. During the cholera epidemic the poor were shockingly neglected ; they had not enovgh to cleanse their persons, much less to wash away sew- age, &c." I I 67 ' TOWN. DRAINAGE. WATER STIPPtY. Soutb Shields. *' Pretty complete now." " Very good ; from Sunder- land and Shields water works." Stafford . . " All on the surface, odour at times disgustingly offen- sive." " From wells much contami- nated by drainage." Sunderland . " A moat complete system of drainage." '• Ample, and excellent in quality." Tynemouth . "The main drainage is very gof;d, but a large iniiiibor of h:mseH in tiic oldest part have neither yards uur water-cIosL't.s." " Very deficient both for houses and closets, in the oldest part of the to\vn." Wolverhamp- ton .. . . " The natural drainage good, but main drainage imper- fect. A plan has been ap- proved bj' the Secretary of State, and a thorough system iw in contempla- tion." '• Ample supply to poorer dis- tricts is insisted on." Worcester •' Perfect." " Good to poorer districts." If the forcf ing summary is encouraging, as indicating progress in many of the towns enumerated, purely the tardiness of the opera- tion" ..ow in hand is fitted to awaken our astonishment. It is very remarkable that in large towns, such as Aberdeen, Birmingham, Brighton, Canterbury, Gateshead, Hull, Leeds, Merthyr Tydfil, Portsmouth, Slirew.sbury, and Wolverhampton, the authorities should only now be carrying out, or about fo commence, systematic drainage works; and still more so, that in Chichester, Devonport, Grimsby, Keading, and Staltbrd, the arrangements are wholly, or for the most part, 80 primitive that the whole soil and the surface wells are be- coming continualiy more impregnated with organic impurities. The pollution of the rivers, again, by the sewage and refuse of Bristol, Cambridge, Chester, Doncaster, Glasgow, Leeds, Maidstone, !Man- chester, Newcastle, Oxford, Paisley, Sheffield, and Shrewsbury has become a gigantic evil, towards the removal of which the attention and efforts of sanitary reformers should be unceasingly directed. As regards water supply, while in some places, as in Aberdeen, Cardiff, Glasgow, Merthyr Tydfil, and Sheffield, the arrangements are perfect, and, while in many others they are very satisfactory, it appears that in Birmingham, Cambridge, Canterbury, Dundee, Gateshead, Gloucester, Hereford, Liverpool, North anipton, Norwich, E 2 I OS Kottingliaui, Oxford, PlyinoiUli, Soiitliiiiuplon, and Slirewsbury, there is either no house-sujiply at all, or (hat it ia Hadly deficient, in ti»o poorer districts. In many of tliese towns, it will be observed, the poor are dependent on pnmps or taps, one l)eing often made to serve for a Avhole court containing a large population — a most defective and objectionable arrangement. But 1 question whether any part of any town in Englan(i will be found in a much worse condition than a district of Kensington, with a return of which I have been favoured by my friend Dr. O'Bryen. It contains 99 houses, with J502 rooms and 07O inhabitants, who are sui)plied with hard water from three pumps, but receive the company's soft water, ■when it is on for an hour daily, from leaking butts and cisterns, in pails or i)itchers, in which it is kept standing in the close rooms till it is used. No other supply of soft water is available during the remainder of the twenty-four hours, the water in the cisterns being polluted by the gases from the closets above which they are placed. Seventeen houses in one court- have each a closet, but with a very insufticient water supply ; while the remaining 82 have 41 closets, a number of them so filthy as to be unfit for use, and only fifteen cisterns and four water butts, containing, after deducting waste, 2,942 gallons — the whole supply, exclusive of pump water, both for domestic purposes and fiushing of closets. The entire su])[)ly tor «ll purposes to the 99 houses (deducting waste) is 3,611 gallons. The allowance to the 970 inhabitants, at the minimum rate of 15 gallons, should be HjO.jO gallons daily. During the preva- lence of cholera a few stand pipes Avore provided, but these have since been removed. It is nearly two years since a connnittee of the vestry, after very careful examiuation, gave in their report, recom- mending the enforcement of stringent measures against the owners, but the vestry, though often urged to act, have as yet done nothing in the way of compelling landlords to provide a sufficient supply of water. The magistrates, when applied to by the vestry to compel landlords to comply with the notices served upon them, have uni- formly refused, on the ground that vestries have power, under the Act 25 & 26 Vict. c. 102, to execute the works themselves and recover the costs. Rather than incur the risk, they prefer leaving matters in the disgraceful condition I have described. In Chichester, Greenock, Grimsby, Northampton, and Stafford, the pump-\vater, which is consumed by the greater part of the inhabi- tants, is much contaminated with organic impurities. In Carlisle, Chester, Doncaster, and Leeds, the whole supply is draAvn from rivers which receive the sewage of large populations. The case of Doncaster merits special notice. *' Our only supply of water," writes Mr. Fairbank, " is from the rive'* Dun ; 18, 12, and 11 miles respectively up this river, stand Shefiield, Rotherham, and Mas- borough; besides many populous vilhiges. Into this river these places all send their sewage, so that our water is well fecalized before we get it. In July, 1 heard Dr. Letheby swear on the Four Gospels, before the Lords, Committee, that the sewage of Shefiield (a towu ^ 69 containing 216,000 souls) was so far oxidized before it got to Don- caster, tiiat it could do no harm here ; so we go on drinking it, and some people rather like it." If so, the tidings communicated to me by Dr. Hull, that the Sheflield authorities think of keeping the sewage out of (he rivers, will not be altogether welcome to some of the in- habitants of Doncaster. De ffiistibu/f non disputandiim. But this doctrine of the speedy conversion, by oxidation, of the sewage and refuse of 300,000 huniiin beings, and of nudtitudes of animals, clean and unclean, into perfectly innocuous material, lias a very suspicious look, especially when placed alongside of Professor Frankland's statement,* that even boiling does not destroy the noxious properties of cholera discharges, when these are diffused in water. The oxidation theory may be true, to the extent alleged by Dr. Lotheby, but its probable laisscz faive results are not pleasant food for thought, nor, I apprehend, for wholesome fish. With a ^kiw sti'iking facts in reference to the propagation of in- fectious disorders, I conclude this too lengthened paper. In no department of our social economy has the liberty of the subject held more uncontrolled sway than in tliis death-haunted region of epidemic and infectious disorders. From "my lords" of her Majesty's Privy Council, as we have seen, down to the snuggest parish vestry in the land, there seems to be a prevailing disposition, like Izaak Walton with his worm, to "haiulle them tenderly as though we loved them." The means for limiting their ravages are in oirir hands ; the discovery of the agent that gives effectual protection against the most deadly and loathsome of them all is one of the hygienic glories of England; yet the United Kingdom is the chosen habitat of typhus, and the mortality from small-pox is greater in the country of Jenner than in any other country of Europe. We know that the prompt isolation of persons smitten with infectious diseases, and the emptying and cleansing and lime-washing of those dwellings which furnish a steady — often a perennial — supplyof such cases, will assuredly prevent thi L multiplication ; yet though in almost every toAvn from which I have received returns, cholera hospitals were being provided, and " disinfectants," such as quicklime, chlorides of lime and zinc, car- bolic acid, sulphate of iron, and MoDougall's powder, were being liberally used, in only a very few have any systematic efforts been made to limit the prevalence of communicable disease. We have already seen how thoroughly and speedily successful were the measures taken in I860 to arrest the spread of typhus in Bristol; and in Birkenhead, the energetic proceedings of Dr. Robinson were followed in the same year by a remarkable diminution in the mortality from contagious diseases. In his first report (for 1864), speaking of scarlatina, he says, " means should therefore be devised to check the progress of this epidemic by early isolation of the sufferers; and before the convalescent is again permitted to enter into the society of * Tmea, Sept. 6, 1866. 11 (0 the liealthy, copioiirf ablutioiiB, togetlier with tlie use of disinfectnuts, bIiouUI be resorted to; iiiul lho.se elotlics \vliicli cnriuot be purified by ■washing, &e., sliouhl be ex|)0!^ed to a dry heat of 2C6^ Fahr. The interesting fxpcrinicuts of ])r. Ili'ury and others have elearly shown the value of dry boat as a dost ojer of tlie specific p isons which produce cont_agious di.-eascs.* The Ilcaliii Coniuiitlcc of Liverpool, acting under tlie advice of their intelligent medical oHicer of health, are taking the iniliiitive steps towards providing a public building for the purpose of washing, disinfecling, aud exposing to dry heat the clothes of those who have sutfei'ed from contagions diseases, and I trust that, attached lo the fever wards about to be built in connection with the Birkenhead union, a similar provision will be made." This su'jgestion has been acted on. In his report for 1865. he gives the following summary of sanitary operations during the year : — *' Pigs were removed from 62 i)Iaces where the keeping of them was a cause of nuisance to the neighbourhood ; 124 privies have been converted into water-closets; 21 pits of stagnant water were drained ; 2,451 nuisances arising from obstruction of drains, defect ivo traps, &c., were reported by the inspector, and ])roceedings taken to remedy the same; 4,827 houses, containing 19,263 ap»rtn;cnts, were visited with a A'iew to improving their sanitaiy condition ; 1,043 lime- washing notices were served upon the occupiers of dirty houses, and attended to by them ; 25 cellars, used as dwellings, were vacated ; 70 overcrowded houses«liad their numbers reduced ; 37 persons were convicted before the magistrates of offences against sanitary laws, and penalties amounting in the aggegrate to £18 10s. inflicted." Tliat the sudden fall exhibited in the tbllowing table is in some degree owing to these precautions, it is only reasonable to infer. Deaths from 1864. 1805. Small Pox Scarlf.tiua Measles Typhus (including Typhoid Fever) 121 81 7'i 71 37 37 21 63 349 158 The other towns which have either fever hospitals or fever wards for the iiuolation of lie patients are Carlit-le, Derby, Edinburgh, Gates- head, Glasgow, Greenock, Hull, Leicester, Maidstone (at union * See an excellent paprr "On the DiMnfeclinn; Property of Ileut," in the Soc. Sc. Transactions for 180 1, by Dr. Shann of York, pp. 556-503. I 1 i mmmi 71 infirmary three miles from town), Manchoster, Newcastle, and, I believe, Sunderland. Liverpool, besides fever wards attached to the Workhouse Infirmary, has another fever hospital available for other classes. In Glasgow, where the enforcement of strict, police regulations in common lodging-houses, ind the early removal of pa- tients to one or other of the hospitals, h i made a decided impression on the endemic typhus, there are not less than five fever hospitals — one at the Royal Infirmary, the City of Glasgow Fever Hospital under the magistrates and town council, and (hice others under the parochial boards. " Tliere is also a regular service of disinfec- tion and a special washiug-iiousc for the clothes of infected persons. This is done without charge, on the order of the medical officer." In Liverpool "a disinfecting appaiatns on Henry's principle was erected in the north district, and ready for use in February 1860 ; another is ordered for the south-end of the town." In his report for 1868, Mr. Moore states that he was led, in consequence " of the rapid extension of scarlet fever, measles, &c., in their respective neigh- bourhoods, whenever these diseases ap[)eared in them," to iiislituto epecuil inquiries into the state of the ' Dames' schools, in Leicester. It turned out that in eleven of them the cubic space for each child varied from 26^ to oS'l, though in only two did it exceed 42 cubic feet. In two, each had only 2G^, and in two others 28^ cubic feet, an allowance snguestive of suffocation to the tiny pupils. Since then the dames' schools have been frequently visited, and placed under regnlarions which are strictly enfbrccd, very much to the advantage of thehealih not only of the children but of the town. In 1H64:, when 104 persons died of sniall-pox, he vainly repeated a recommen- dation he had previously made, tliainn institution should be provided for the reception of small-})ox cases, which are excluiled from the fever- house, and must bi; treated at their lodgings, with the certain re.-u!t of an extension of the disease to others in the house and surround- ing neighbourhood. In Edinburgh, there is, in the bye-laws for common lodging-houses, a special provision " that in case of fever, cholera, or other contagions, infectious, or epidemic disease occurring in such lodging-house, whether to any lodger or to any other person residing or being in such house, the keeper of such house Avho shall neglect or omit forthwith to give notice thereof to the superintendent of police, in order that the nature of the complaint may be ascer- tained, shall, for every such neglect and omission, be liable in a perndty not exceeding forty shillings." The result is seen in the following statement (p. 3f) of Dr. Litilejohn's report): "It is cer- tainly remarkable that, of the lu3 cases of death from fever (in lb(i3) not one occurred in these t!i(; poorest and most crowded houses in Ediiibuigh. ... Of coui.-e the overcrowded state of their popu- lation renilers them the hotbeds of disease in epidemic years, and when cholera and fever w ere raging, ihe^e houses attained an unenviable noto- riety. Weio not unusual faciliiies presented in Edinburgh — the seat of a medical school — for the speedy treatment of the sick, and the removal of cases of inlectious disease to our noble charity, the Royal n li Infirinnry, a single case of fever allowed to run its course unwatched in such tenements would spread contagion all sides, and the district mortality would bo greatly inoreai*cd." Such, however, is the case in most towns throughout the kingdom. The general reply to my inquiry as to the isolation and conveyance of persons ill of infectious disorders is, " no attention is paid to the isolation of such patients." "There is another mode* of mediate' communication, the mere mention of which excites astonishment at the apathy that permits the continuance of a practice by which a largo amount of preventible disease is occasioned. I allude to the common practice of conveying patients, known to be labouring under or convalescing from highly contagious disorders, in hackney carriages. That this is the mode of infection in cases which every now and then startle the fashion- able woi Id, e. g. the death by small-pox of a distinguished Italian diplomatist about two years ago (1860), is in the highest degree pro- bable. At a small reunion of medical men the summer before last (186 1 ) in the house of my friend Dr. Cotton, one of the company detailed the following instructive case which had fallen under his notice some weeks before. It was suggested by the mention of the sudden death, from small-pox, of Mr. Henry Gray, of St. George's Hospital. The gentleman in question hailed a cab, and told the cabman to drive to a certain number in a fashionable west-end street. He went in to see his patient, but found his services no longer required. She had died of small-pox. When he came out, the cabman, who had been struck by the clo:^ed window-shutters, asked if there was any one ill within? My friend replied in the affirmative, and ordered him to drive to another address. He had given him his fare, and was about to leave, when the man, to his surprise, asked if any one had died in the last house they had been at? An affirmative reply elicited the involui.-ary exclamation, " Oh ! Lord," and the explanation that, on a certain day, having just put down a small-pox patient, he was hailed by a lady, whom he had conveyed to the house where she now lay dead." Was this, I ask, a case of "justifiable homicide?" In my opinion it should be made a felony. A society has been formed in London for the provision of ambulances for infectious cases, and has already been very successful in its operations; but so far as the vestries and local boards are concerned, the enabling clause of Acts 1860 and 1866 may be said to. have been quite inoperative. Here is the result of my inquiries as to the arrangements in other towns : — Aberdeen. " Three litters at call when wanted." Birkenhead. — " One special carriage for conveying infectious cases was provided some years ago, but another one was added six months ago on account of the approach of the cholera. I cannot learn any case where a cab-driver has been convicted of conveying . * I quote from one of my lectures on medicine, as delivered at the Middlesex HoBpital in October, 1862. T 73 infectious cases. When they have been observed doing so, it has been found they have used * unlicensed cabs,' alleged by them to be used for that purpose only. We have a hackney cjiiriage bye-law, as follows : — 'Tho driver or owner of any such carriage shall not knowingly carry or convey therein any person afHicted with any infectious or contagious disease, or any dead body,' The penalty for so doing is 20*." Bradford. — " A van is kept at the workhouse for the purpose. Cab owners are prosecuted if they allow their cabs to be used for con- veyance of persons ill of infectious disorders." Bristol. — " The different boards of guardians have each an ambu- lance for the removal of infectious patients." Carlisle. — " One at tho Fever Hospital." Chester. — " Fever cases are taken into the infirmary and paid for by the parishes at the rate of L the country for their convnleacents ; anil Mrs. Ghulstonc is settiiijf an exftinplo worthy of all imitation by social reformers throughout the country. My returns on this subject are not coin- plyto, as I ni'glectel to put tho question to somo of my corres- poiidciits. IJ it I (Ind, from Dr. Floining, that Hirminghain is now providing itsi'lf with an oe pvo\itled by tho local authorities. 10. Disinfecting ap[)aralu8 for clothes and betiding must likewise be provided by local authorities. 11. We urgently need a well-considcrcil Act, which shall facilitate tho acquisition of low house property, and shall empower the govern- ment to grant loans on easy terms, on the security of the new build- ings, to those who shall undertake to provide wholesome dwellings for the labouring population. 12. The su[)ply of gas and -water should be taken out of the hands of private companies, and entrusted to public and responsible bodies, in the interest of the consumer. 13. It should bo made lawful for Boards of Guardians to apply a portion of the rates to the providing of jonvalescent accommodation for those Avho re(iuire, but cannot procure it. 14. A strict government inspection should be made during the progress of all works, for the execution of which the government sanctions tho borrowing of money, and before instalments are sanc- tioned, the iuspectui s reports and certificates being published. K:' !|l In 78 SANITARY QUERIES. I. Town? 2.pop«..u„„ in"&'"'""'"°'" 3. Medical OftlctT of neiilth ? 4. Date of npiioiiittnciil? C. When was oOlcc llrst iiiHtiluted ? 0. Salary, increiixcil, (UniiniHhcil, or stationary ? 7. Area of dislrict? 8. Duties required of him i II. If allowed to practise? I Ordinary stafT? 10. Inspectors of Nui.anci-8 jJilaJiei'v [Extrnordinnry? 11. Under the control of the otficer of health .' 12. Inspectors of common lodging-honscs < 13. Inspectors of markets and slauglitcr-housea ? 14. What qnalilications, if any, required of these various in-spectorB ? 15. If chosen from the police? If). Discharge of duties eflicient ? 17. Sei/Airc of unwholesome articles of food, to whom confided .' Convictions frequent 'i IH. Drainage 1 Main, thorough and general ? J House, eflicient ? "jlnterccjjting? 19. Water < (into rivers, or sen? . « Whence obtained .' • Quality? Supply constant ? „ it intermitting, how often on, and for how long daily? ,, to poorer districts, by wells, pumps, stand-pipes, butts? ,, If in houses, at what ciiarge? „ by Water Company, or in hands of local authority ? 20. Early isolation of persons sick of infectious disorders? i / tions lily? butts 1 [[ i r TAlH.i; I. ^Hdropolitiin ♦iealth (i>]\\(m and ^aiiitart) ,iiii.'ipiHion;. tti*ii>M McMrtL nrrKkH nr ItiAi.rii. s»u«t. I'Ol'l L.vnoN. lllllllMBV IUHPtCrORH. 1 -NuiR .Ml I'li'Ai. Orrii til, oil .Nor. ■ DIS'luii I. 1.01 \l. ID II UN. iiit.iKK) ii.;,..7i .|-..IHHI lti;il|rtTII\R-(ir\KHAI.'ll SiMMiiir. n 1,1110 110,U8« With I'oplar llrrmuiuUoy Hi'lhiuil UrMli liow Mr \V. I'nikiT lir. 1. Sarti I'r. M'lMtdfurdt' l:i'( ,,,, (iil.'iii I'-r cholera I \ K'rvice. 1 I.- 1 Uno Three .,., \\ chief Biul two futi-ln»i-.;. llirce...^u« Ye.... Yon. No. CamlHTWoll Dr. .1. S. llrlJluHi' ... ;;(Hi Kl.lllMI 81,818 Four ...JTuroonlrtmiwlJuly. Clil.'lly. riicNco Hr. A. W llaroloy ... :iiii Niiiiiiimlly fl.'iD... r.:i,ii.H) r,3,|.i,"i7 SOVtIl .. P 'I'll*'' "ll'' '1* •Ub.llHIHV- i ..ir«. Chlelly, ( liTkcnwcIl lir. I'.illlitl liid cri.Tim r,;i,'j.-,7 •r«„ ' No. I'ulliam lirranwlcli Mr. 1'. J. lliirn Mr. II. X. I'liik l.vi I.v> 4(l,ll«l '.iii.imi 18,ii.J7 li7,47;l Olio 1 Utimnrli ntlifr W'Vk l"! I..ir. Ivlnaid llallaid ... ■ •.<»\ till iw.r, i;r,n, ... ■2m,!- m 11.1:1,1; IH I I'uiir, till lileljr only two Ye,. KoniiiiKlon Mr, I'raiKi* (iodrlcli. jiii> •JiKt Illll.llUl W.I 7 1 Three Yen. l.«ml.cMlj 1 ir. littirRC I'liolili' 'i :liii) I7it,iiiiii ni.liiH Three Yen. Ix-KijliAra iiinil IVngo) \>r. V. K. \Vilkiii»nii.... T:1 li>» .{II.IHMI »l,:i7;i Two ....IIivo olhrr L'lnploymcnt.i I'arily. Linu'hdtiM' l-oiiiliiii (I'rciM'ii Mile Krulul.lTuuii Mr. TIiDiim^ tirl.iti ... t Dr. 11. I..il,rl.y Dr. .M. ('..rn..!* M) l.'iil llM.-.ti fl.'i.lHIII fiiUOS Kiwt r',7.ii'.I, W.'Ki.i'i, 170, [ liiJ,hH7 1.:'.;, o.'.iui) ) »o,W.-. Thii.,.,\V :h many itlier -iiiiii's ... , 1 '".rn'T^ii I.I"-. M^-iKi;! hiKht... ; "". ii'iit mviktu, ii. .., 1 . u.-, ihliii'lnK. I 1 Twu \'cry parliftliy. Entirely. Ncwingloii Dr. Hill, jiiii •.'IKI >>i,im UiMO Olio Ve,.. I'luldiiigtnn Su^-fliilrii-ti. M'harlion I'Inmtti'ml and riiiTiuli'iiil I'harlinii («t.'« uIh.k' L.'u ond KiUbruke Il,iK.Hi«cri-.«.) ^KltUaiu Dr. Iliirdipu Haiidcr«t>ii Dr. I'lmli ' Dr. A. W. .Ml iii-on .. .Mr. JoKpU S. Uurluii Dr. D. Kiiitt ;n»» .'.'1 Ii(Nliu''d Iri.iii l'7.'». .'.It .\1 IT«l I'T'i. tlnMl, :"i 'iVi. uuiv anainl Uri. ■ S ■ •'* II.IIH) :l,.«» Il).lll10 J,t»'l !iimMi > r.i.iKiii !l;l,3ii.-. Two * '^ *'' "'™* recently ui-. 1 ;«'ino«l. One, \eiv .u'live (Hie 1)11,. ' "'•'■' ''"!'' '^■'•"I'l'^l 1' 1 »«.l-i»nt •'irrtyur One Ve.. l^nlirely. Yen. Ye». Nil. Poplar Untticrhlihi' Mr.S. K. i:ili».ti Mr Sainuil 'iillejr* ... l.M> I.W 4H.IN«1 iiiUI"! I'ltlar A Ilow '.i'.i,7(;j 'i>i,7il7 Thr".' • n,. ,t,i..( ui i»,. ,„i,. ' .u^iU'cl.ini One Ye«. Nol cnllrely. Dr lirultt Dr. .\l.li» '.;.*i.i •J'lil 113,1" "I m.ix t) j 111..11.-. One due Ye.. St. (ienrgn in tlic K»>t Iir. Uti!»Hi* IflU 47,T7'J 17.77'.! Two •■ I'racliailly " .M.(iror|((>tlioMirl)r.N'Ulhwark Dr. 11. Ilatcw)!! |-..) .■..'•,.',i,-.':i'. 34,16.1 IH.'.'II Tl.reo }', .',' Jj;'"' !• ii'T-rt" "' Thrco )'' r » h.'i K incimtar o( 1 W>-t l.UlMiacVK, one, »ilh"ih.T diiliea Two. Two. rartially. Si. LiilkC'rt, Middlesex Dr. I'uvy, ril.S. l.vi ,>.lliM •■|i5.7|il 1 Two Ye.. SI. Manin's in the Fi»l(l« Mr. 1,. J 11. all' ,..- I i;!' .'» lor rlH'l. ra i 2\.:',.'. :i..;7o line, verjr illiiuni i l-jilirely. 1 St MttryluiKjiii- Dr. J. Wliiiiiioro lini 1(1.1,111111 li'.l,K-| Two Ye-. St. I'ancra- Dr. Tlioiiiaii llillicr ... •Ji') •JliD.OiK) Jii,8-:r> Two YCK. SI. Savi.uir'n, SMUihwark Mr. ItnliiTt lliamlii ... l.'.'l ^;'),i)i*i .•.i;.4j^ Two YlK. Shnmlilcli (Si. Lfunard>) Slrand Wand^wortii ... Dr. UiiUtI ^.arllc^t ••. Dr. ( onway Kvam ... Dr. i;. |.;. Nuliidiu- ... •Ji»i IMI 5« M.llKl 1 '.ILIKMI 4V11K1 i:)ii,s.uj 4o,b8a Ollfl 1 '1 ■!' "Ihfr .l.itir* Tm.. 1 ..•.i.tanuiluriniiclioltra. One Two, chief .il-o Kunryir v.. !y. Knlirely. j , line ' inspect. : liicf nol. \\'rtnd!«wortli t la[iliaiu .Mr J. .Mai:D..ia.^li ... W •-•I.K"! Iwo, chief uNo Mirveyor 1, One nuli-.nniiector, ■Iiief nol. (ar<-u tx'lttci'ii 1 l.tXHl iltid I!.ltti'm'a In. W. ( .llllnn■ Ml 2.I,IH)0 ^ 7 ''.'Mill t-2.!l7'.i < Two, cliici uIko Mirveyor '; One suh-iimpoi-lor. liicf not '-•'■'"" »^""> 1st ILat. ... Mr. D. C. No 1 .'.11 11,0110 ' One, aliui Mirxrvor ? No. I Dr. It. 11. Wliilrinaii . Ill 7,61 K) (Hie, also .purveyor , i No \V>siiiiin!*t«T Mr. IliTnaiil Unit loll li.*i,ljlHI w:'i)» Two Tarlly. \Vliiipdia|.id Mr. JuliP Lid.ll.' Ll.ill 78,001) 7ii,asi; Knur iui(ili:ly. Woulwiiii ... None l7..-ir.:; 47,:iil:l t'i'JM) ll'». o II ;;,oai,s'jr) to 1)1, .',08 .;,oa7,'.i'.i| 100 1 /. to ••H,[.y, or(I!ef, .en.l'J'.i.lli'.i • Dr. Corner and Dr. Kypaie have micccedeil the laie Mr. f 11. Krei'iiian, wlio lu'M Uilli appoint iiienls ; aii 10.« Not fixed JCoO Whk.s First ArrnixTEn. For 2 mouths in July, 18U0 ., :i „ August, „ ., :; „ August, ,, Under I'livy^ fouiicil V July, „ Orders ) For ilnionth.s in August „ Amowei) to 1'ractice. Yes Yes Yen Yes Yes PoPUtAlMX. Insi-ectoks. A Lincoln Maidstone Oxford Beading Wolverhampton 22,1)7!) 2I,'J77 27,."ii;o 2:.,(i|.-, o;).'.i8') One Ono iSiirvojor with') One ' ni\iili luivatc ••• ( Imsincss. One Two No. Sup Xo. Sui No ln;i,s|i, Six. B. PERMANENT APPOINTMENTS. Name of Town, Aberdare Bath Birkenhead Bristol Cardiff Doncaster Dundee Edinburgh Gateshead Glasgow Leeds Leicester Liverpool MerthyrTydfll ... Newport (Monmoutli) Paisley Southampton Sunderland Medical Officer or Health. iJAI.AKV. Appointed. (.)FFirK Instituted. Allowed to Practice. Mr. David Davies Mr. C. S. Barter Dr. Baylis* Mr. David Davies Dr. Paine Mr. Francis C. Fairbank ... Dr. Pirie t Dr. Littlejolin Dr. William Hobinson inml four iJii-- trirt sarpctiii." unilcr liim. Dr. M. K. Kobinson Mr. John Moore Dr. W. S. Trenclit Mr. Thomas J. Dyke Dr. Benjamin Davies Dr. Richmond Dr. MacCoiniack§ ... Dr. Ycld Mr. E. A. Maling 12 125 350 200 •10 50 105 500 50 L'OO 500 ICO 1,000 t;i) 50 20 150 50 50 In 1801. April 3, IStiO. May, 1806. ! andjE-lOaa } Tol ice Surgeon j / '>nn ) (to Assistants ^ aid according > Work done. N 1 18-17 ... £350; 1848 ... £750 ISOG ...£1000] Feb., 1805. In 1853. 1, 18()4. .Ian., 1800. In 1803. [1850 ... £150 i I 1803, £200 ubV I [O, ILAlnsptr. ) | ) ■ •J X3,012 12. April, 18G5. In 1803. May 17, 1800. In 1853. 1804. Octnljcr, 1805. In 1802. Jan., 1859. Marcli, 1800. July, 1800. In 1801 ., 1800 Jan, 1SG4 In 1805 ., 1853 ,. 1804 Jan. 1805 lu 1803 ,, 1805 ,. 1803 „ 1800 „ 1849 M 1847 ,, 1805 „ 1802 „ 1859 „ 1860 „ 1800 Y'es Y'es Yes Yes Y'es Yes Yes Y'es Yes Yes Vcs Yes Y'es No No No No No Porrr.ATioN. 35,(iOi) 52,.j2.'< 53,300 107,228 33,000 HVKiO 30,0u0 170,114 38,475 100,000 227,180 72,131 482,905 55,000 25,000 48,000 54.15'J VIG,8o5 2,057,501 IxsPECTOItS. ■iiilnry .Clmi a-ycor. i Twonr tlircdii-') J Imurers uiijcr > I him. ) ( w iLli a.-sistiuice ( wlii'M iiL'Ctssury. One One One F'ive One One Two, and two assistants Two One Five or more \Onp, and twenty sub-) i inspectors J ^Omp. and Ibityonesub ( inspectors I um> ox lift for "■ (chultru ijiiikinic No Ni Two One \ One, and one sub- ) l inspector I (biilnry tlooiitr \ iiuiinni. One 'I'Wd Ninety-seven. N( N( N( * Successor of Dr. M. K. Robinsor., now O. H. at Leeds. \ Successor of Dr. Cowper who died of typhus, | Successor of Dr. Duncan. § Successor of Mr. Francis Cooper, who was both ('flicer of Health and Inspector of Nuisances from 1850 till his death in 1805. 'i 1 tana! «jii I ) r r TAHLE II r. SToirnf) miUwi ^^fpc^i;^ TOWK. Popula- tion. OuDiNAnv Inspectobs or NllS.VMKS. CllOSKN rnoM PoLKK. Spkciai. qualii'icatio A'tcrilccn 73,701 1 WntiT-workK i, mu' lunixtniu. Only the anslHtant Doth qiialincd cng Itinningliam ... 338,808 Six Pno rlili'f mil (Ivu n^■^ll•lalll■'. No None Itindfurd lli'il^litun Cumbridga 107,450 97,750 20,301 ,,, r Till iiililiiixniil iliiiiiii; clioli.'ml l^^O t tlllli'. J ..,, < One ililif, (tie fur KluUKlilcr-] J IIVCO J li.iM-ic.i, ami uiR. fur IikIkIiic- ( lluUKCi'. J One \i>, but aided by them) when necestiury. j Lodging-house inspector Yes None None "Able bodied and Canterbury 22,957 One, a builder No None whatever ... Cai'tiHlc 29,417 flnn ( Supi-lllltiniUlltOf IKllicP.llllIoill "-""^ I l,j' hi^ men. J Yes None L'lit'lti'iibnm 40,157 One No " The right politic Chester 81,110 One ; formerly a grocer No None Chichester ... 8,059 One / ^Vll" is nl*' idloviniJ cfflccr.l { Hilary £2". J No " A steady man" Derby 43,091 One, with occasional assistance ... No None Dcvonport 04,7M ,, f Tciniuirin-y ; is also IjoroiiKli ''*^ 1 .-iirviyur. J No Surveyor E.vi'tcr 41,71'.' (j^e f .S.iiui' nsBistftiUrf lUiriiig cliu-1 [ Icra I'l'lduiiiio. J No None Gloiiceslor 10,512 One, also surveyor No Surveyor Greenock 50.000 One Yes None Grimsby 10,089 One Tlitf •mUiil of in.lico. Yes j None ; except hU bei ( of the police force. Hnlilnx 08.859 One Yts None lIa»tingM 2G,.JC7 One, who acts under the sui-veyor No None Ilcrefovil 17,682 One. The chief of the police ... Yes Efflclency Hull 104,873 Two. Under Board of Health ... No (?) King's Lynn ... 16,170 Otio No None whatever .. Manchester 380,887 (\n„ f 1 caniint ascertain ;iiow inan.\\ ^"^ \ assistants. J i!) ( '•' ) NewcaHllu 121,040 Two, and two assistants Three of llie four ( '• Kllleicnt jicrfuriM ( iKilice duties." Nortlinniiiton ... Norwicli 00,405 78,185 One, and one assislant / With n.j niiiilar ^lall.lnit a-- j Clnn ) i-i-'li»»™ "'■ casual paiilK'rs I ^"'^ ) ii.s nic'SstiiKurs, ami other 1 (^ ni'l if iKCff^iirjr. } No f na 1 servfd on railway and \ in i~jUu.'. None J None, except g ( olliciciicy.. Xoltinghain 85,200 f i„n f Also "•><■ f"'"' i»six«tur, ami ""0 ( iPiiL- iilfc-lii-puii iiisjiwiur. No f" Lonff aeinmintnn( \ iliit its, and ellieieiH- Plymouth Portsmouth 02,599 108,705 -, ^ ( With salary uf JCIO", ami one *-""- \ piih-in-pcctor. f Tho iiiPi)Oc;ior of iKiUco, ami One 1 two sfrytaiits iiniliT liini. Yes Yes Nono t " Able and cor X tiouj oflicer." Salford 112,403 Could not ascertain ; ■•' ) {■<) Sheflield 210,020 0„„ J A purveyor, with two, tliiw, I or luure fub-iii"|Kctor.^. The sub-inspectors Surveyor Shrewsbury 23,619 One. A municiiial factotum ... No Jack of all trades South Shields ... 38,803 (•, f Tlio town fiirvoyor, mi'l one •JDO 1 a'-i-tiiiit. No None Stafford Tynemouth Worcester 12,899 00,741 33,259 One, a One One cooper The Biiporiutendeiit of police, and one of hia men as asiist- nnt, at JCiO a year. Also inspector of common lodg- ing-houses. Last, but not present one Yes No None fOne of the most in ( policemen. None York 40,433 rinn / <^''''<''' cnnstablc, assisted by ^'1'^ his men. Yes None 2,001,105 Fifty-nine. TAIJLE in. luitltDut (l)f|ic^ijj[fi of Ijealth. Si'KCIAI, QuAiai'ICATIONII. Doth qiiulincd engineers •ti ••• None Xoiio Xono "Able bodied and acllvo" None wlmlevcr None "Therigbt politicH" ... Nono "ABteadyman" None Surveyor None Surveyor None j None ; pxccpt liU being licml ) ( of the police force. j None None EHicicncy ( •!) None whatever ( ■' ) ( i)olice ilutic's." j None ( None, except general / ( ollicieiicy., j f" Lonff nf'iimintnncfl witii ) I iliilitB, .'iiiil illk'li'iicy." j None ^"Alile nnd conscien- "^ X tiouj oniccr." i ('■') Surveyor Jack of all trades None None fOnp of tlio most intelligent) { policemen. j None None Errn'iKNT. Yes Tolerobly Yes Yes Yes Doubtful (») Tolerably Yes Certainly not .. Very Doubtful Not very No Not very "Tolerably" Y08 (') Yes Tolerably Doubtful "LooEciy performed" ... "Very vigilant" Not very Yes " Does tlio woi It well"... Docs his duly well " So fiir as he can, very* cflicient." ) ( • ) ( •' ) (1 ) ('•No; peetnr df nuisances; I loler.ibiy ellieient. " No regular inspection." f Hy ins)iectfir of nuisances, " pro- ^ ceediiiKH always successlul." !Hy Kurveyoi' and police; nc- couiuiudalion very delicient. rSy inspector of lodging-houses. !15y su|ioriiitendeiit of police ; no l)roceedings taken. J Ellieient ; jiroceedings against } overcrowding. j Etllcicnt ; great improvement of ( late in cottage nccommo^^. 1.0 I.I 1.25 v lU 12.2 S 114 ■— US ^ lllllio 1.8 U ill 1.6 Photographic Sciences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 £-^ \ \\ -^.^A ^ TABLE IV. RETURNS OF MORTALITY IN 58 REGISTRATION DISTRICTS, FURNISHED FROM THE GENERAL REGISTRAR'S OFFICE. REGISTRATION IIISTRICTS OF ENGLAND. I'DPUIJITION. Dea TUD. IlK.NSIIY or I'orUlATIO.N. Annual Mohtautt. Deaths to 1,000 LiviNti. 1801. 18lil. In 10 Years, 1851-00. In Years, 1801-05. Acres to a Person. 10 Years. 1841.60. 10 Years, 1861-00. 5 Years, 1801-06. 1841.60. 1851-60. B»th r,!l,847 42,18!l 17:!,il51 (m,852 18HMi4 (18,:i:m 1)1,421) 212,021 1011,522 iyu,470 77,0'.i;! 00,(127 114,087 20,.'1()1 10,043 15,224 5'i',238 17,585 48,000 7,701 7,145 20,380 11,00." ■20,728 •44 "■02 •53 •20 •44 '"■I'li 24 20 21 20 • )(> 21 20 22 2T 2U 21 26 Birkenhead f UirmlnKham i, Anton Bradford (York) 1 Brighton (•,5.5l'.'.l t)5.7ir, 77,'.'5(1 27,bl5 14,U)(J 15,7.57 17,5'.i| 1.M23 5,5114 3,517 0,000 8,803 10,000 2,'.l.'-8 2.IL2 •01 1 Ti:', ■03 ' -iili ■11 -3 1 ■21 ■2i'l 1 21 20 •A .i<> 28 20 20 22 20 11., 2-2 23 f Brialol ■ Clifton Cnmbridge Canterbury Cardiff 4i;,)'ii 4 1 ,5.i7 44,184 52,'.K-.0 14,4;!8 4;!,ll>*l ;;i.ii75 ".2.H2i; IS.dSl i;2,045 71, .575 41,82(1 4'.i,7'.i2 58.501 14,775 51.01'.! :i'.»,.'188 .'13,742 5U,40'.l 34, 050 14,(l'.iO 0,',i8S 8,025 12,:,74 3,1 '.13 11.4117 7.07.'< 7.031 13.S70 7,450 0.740 2',1.308 4.;)I8 7.>*1! I3,27'.( io,7o; 7,010 5, 182 1,737 7.213 1,472 0,100 4..v;i 4.100 7,707 4,240 2 98 I'.C, 182 11)4 2 11 i 1-03 150 1 144 1 *22 24 20 21 23 V.I •'1 18 23 IK 24 1M CnrllMc Chi'lloiihnm Urciit noiigliton (iiicliu'lng Chester Cit)) Chichesl«r . 1 Derby •08 -liO 3-25 ' •.-•'.14 •111) -11.-, •OO •4'^ l-m •00 21 21 24 IS 24 24 20 tl.l 24 24 23 20 25 20 21 20 24 Doncastcr Exeter Uloiiceatcr Caistor ^including Grimslfv) .■i4.2!il I2(l.'.'."iS 21,215 :;■"., 151 5ii,i.7(P 44,7 1'J 37.517 128.073 20,031 ::'.i,287 50,S.ss 51, '..150 3.8.-,; 10.102 2.855 o.oo.s 5'.)7 510 •15 41 •7s , -.vi 4^17 i 3-00 ■111 1 -(13 111 •03 10 24 18 21 25 }lulirn\ " Hereford (Hull ^Sculcoutos King's Lynn 2n,5.!(1 l(il.:i4:! i;(MM2 42.1 m;2 25,s.2:i(J ij;!,27y Ifi.tlOl 117.500 OS.l'.MI 47.003 200,742 220,'i40 4,048 30.325 10.300 0,1(17 87,.V'S 43,083 1,838 18,431 0,002 5,'25(l 40,.V.W 33,110 •30 •02 •07 4 •07 ■01 •42 •30 •02 •00 3^57 ■01 •27 23 30 27 21 30 20 28 2.'» 20 33 .30 28 21 30 20 Leeds Lincoln West Derby .•;r,,(TO7 22s.4:i;< 7ii.8(l4 t-'.l,15li 4.;,472 ;!:i,(-.'.7 ,'1.S070 i:4.-.,',l8H 107.105 1 KI.'.IIIN 51,112 41.11.0 74,35'.' 20,311 27, 3^^:- |ii,.>-;2 .1}*.j1i 4,002 3'.i.l,Sl l.;,712 ."t. 7.S,*, Ml ■00 174 •00 2 ^8 ■1)7 102 •05 123 •07 ■50 •'3 28 27 21 .31 22 25 23 31 Uo 27 21 20 24 Mnnchcster Newport iMonniouth) r^oi'tbamplon (;8.1!)5 5S.41!t 20,172 15,771 74,440 75,705 20.037 17,185 17771 17,W10 4,101 3,814 0,450 0.011 2,047 2,111 •07 •03 ■82 •or. •03 t 1.50 i 15 24 20 25 Nottingham - f Oxford ... 27 422 23 20 I22 24 1 (PlTinouth 52.221 11. ','7 1) .•;8,18il 72.12(; 22,170 S7,52;t li);!,r,2ti "7,'.il4 2;!,1(I4 y4,0'J8 02.5i)!t 14,343 .-,(• 440 '.il,*<28 25,1*70 1 3.5.-.0 3.502 10.103 10,017 5,210 7..3.55 1.887 5.22 1 10,24:; 2,002 ■04 •01 •07 •12 •03 •(i:i •115 ■HO •LO 2.'i 2'.* 20 25 24 24 •23 25 10 25 • Kant Stnnfhotifo PortPea Island (including roitBmoutli) IlGadinir Sftlford 105,335 128.'.p51 03,018 2,5.784 43,414 25,070 33,084 11,040 0,150 0,477 14,470 10,010 7,700 3,430 0,008 •00 •11 •Oil •81 •00 •05 •O'.l •n ■74 •07 •38 2-20 •15 •.■)0 •47 28 27 2(1 23 20 • >o 24 24 27 III! 24 20 20 21 20 21 25 23 23 23 24 JSheffield Shrcwshurv ••.. South Shirldx 35,790 22,787 70,u7i«laiit ; ixeci:diujjly elllcieiil. I crowding. | ; I Very . .. ; liy e-onior liiMiU'iMiiit of police: Uy iwo niarliei inH|«'cioi-n ,,, ailniiialily cflicicnt. Ye?, had previous By police ; sUicl and ellici'.'ul .. I'.y in-peclorof nuisances under oxpencnce. Very Yes Very oUici'r of beallli. By Caiiinin Snian and Ids men; ; Uy meal iii'ipeclor under Glas- 'vcry mlmiialie. (.-',,■ Dr. .In- ' ynw IViice Aci. lian llunlcr, .''ili Ifipoil, &c. ' By in-peclor of cnnmion jodKiuK "y uical iiii-pectora lion>e!i : slricl and elfcclive. j By police; not very cflicieni IK infp"elor of nui.aances and ulliccr of lii'allli. iNSrEl'TION OP SLAt'llllTEU-Uol'.Hks. I'niVATK OR PUULIC. rublie, under Mnvkel Company, ami privale, regislored liy the loeol hoard. IVivale, lhrnni;linnl lown; pnldic one oll'iii d nndi r Dr. Kalciner s mayor- ally, liiil llii'ii oppoM'd, tliongh now desired, )iy I he linlcliers. By supi'rinlcndi'nl orslun(flilerIionses, «ldcli lire pnlilic, under Improve- menl •'iiieiiiis.siiiner-i. Hcalierod lliroiigli (own, and very oH'en-ive. I'nMie, onl of (own, under >iiecial le^iulalioiH. In town, private ; public ones are con- leinplaled. I'nlilic and private ; latter licensed by niiiHlslratex, under penally for any olfence, I'niilie, under special regulations and in>pi'eliuh. Nnnierous piivato ones throughout town, very had; public one con- templated. 1;!0 |irivale ones in lown, some very bad. I'ntilic one conleniplatcd. 'Ji; l)rivale i.nes in town, under strict re;;ulalions and inspection, but many verv liad. Toleralilv No return . No reiurn , Livcrjiool ! Very .. j By one chief and four sub-in- liy four spee'ally .sliillcd meat 1 " ' sjiectors of loilgiii;; house-'. in-pcelors. Maidstone M 1. 1 thy r Tydfil Newport (Mou.) No Very inelVnient, cxieiit when .No return Tolerably Yes .... No ... Yes ... clioleru threatened. Hy superiiuendent oreoiioly po- ' li(e. iiinUr l!o;ird ol lleallli and ollicer ol heullli. By inspeelor of uni-;inei- and ollircr of lieallli ; prci>ei Ulions for overcrowdiii'.; frKinenl. " I'n.*atisractory," by ins]K'clor of nuisances. •• Nightly by i"dice" 1 ; By in'-iicclor of nuisances No Yes Yes Uy in-]ierli'i' of nni-anees and roiinly poliie under ollieer of he.dlli. ;nvpeeior of niiUances, under olliei r of liealtli. Uy market inspector. liy superbdeudent of pnliie as insiiccior of nuisances. By .-npei'ntendent of police a-^ ii^i:eelor of nuisances. No return. Ily si»eeial inspectors. No return. One lnr>,'e puldio, and 12 piivatc, in town, under police. Public, outside lown, at Dr. D's re- romuicndalion, .'! vears ago. Cost Jtl,li(.H>. " None in loi\n. one in snbnrbs," under ^pccial regulalions, " No neiv ones allowed in lown, ex- cept by special lijeute. Public aliattoir outside." " ^\'o^thy ol imiialion: it is perfect." 11! houses, recently coi.strncled, answer admi- rably. liy poruT, under inspector of nuisances and of common lodg- ing houses. By lodj;ing house inspectors; • Frofiucnt seizures made, so By inspectors. •' very perfect." that otl'ences are very rare." | Uy inspectors of nuisances ; " sr- veral seizures." Within the town." Noli;. — In suiiio jduccs. as in tlio City of Ldiuldii, wIiitc. dm iuf^ fivo yoar.s, Olill.OllllliH. of meat, have been conjciniiod us unfit for human food ; as also in IJiikcnbonil, Birmiiiglinni, Dundee, Edinburgh, Liverpool, and AVolvcrhninpton, the insj)eetion of markets is highly efficient. Hut in many other places it is merely nominal, as might be expected under un Act, the enforcement of which is left by the Legislature to the free will of the local authorities. Hence " iii the mstrcpolis," {Leeds Intelligencer, Sept. 6, 186C) "outside the city there is no effective supervision, and animals in the most diseased condition mf.y be .slaughtered and sold." 'I '^i JLi 70 21. Special carriages for their conveyance ? 22. Public carrlagoB prohibited from tok'ng thera tinder a penalty? 23. Means for disinfection 1 or houses and privies ? Of pewers ? Of clothing, bedding, &c. 24. District hospitals or refuges ? 25. Fever or small-pox hospitals, or wards ? 26. Receiving houses for the dead ? 27. Coupalcscent establishments, In town or country? 28. Nature and extent of lodging accommodation for the working classes ? 29.. Proceedings against overcrowding under Sanitary Act, 1866, or previous Acts ? 1 Public, under local authority? \ Private, in what condition, and under what regu- 30. Slaughter-houses J iaiions? I Within the town? ( Outside the town ? If any of my previous correspondents, or any one into whose hands this pamphlet may fall, can furnish me with additional information regarding the towns I have referred to, or others not included in my enquiries, they will confer a very great favour by filling up this schedule, or any part of it, and returniug it signed, to me, at 75, Grosvenor Street, London, W. A. P. STEWART. J-r THE LEGAJ. AhiPECTS OF SANITARY REFORM. BY EDWARD JENKINS, Bareister-at-Law. 11 M Public health is public wealth. Every peisou luiil aside by ill health ia so much subtracted from the power and capacity of the State ; and more than this, every person so laid aside is a drain upon the resources of the state. It takes more money to keep him than if he were well ; one or more other persons in health are withdrawn from productive opcnvtions to expend their strength and time upon his recovery. If one-third of ii town, or city, or state, is suffering from disease, there is cast upon the other two-thirds a proportionately greater amount of exertion than would otherwise be i-eciuired of them, and there is exacted from them a proportionately greater contribution to the general expenditure, while there is less capacity both of work and contribution in the whole community. Time was when this obvious principle was unrecognised, and the state, which wade paternal regulations to secure the health of men's souls — the state, which went to war to protect their liberties, and spent lives to save them' — wholly avoided any observation of those permanent and subtle causes of danger to the health of the citizens that were likely to exist wherever two or three were gathered together in community of houses or homes. Even in England, where every sort of ill and grievance lias been searched out with keen anxiety, while we were emancipating negroes, enfranchising householders, and aboiish'ig oppressive taxations!, the public health, a matter one would conceive of super-eminent importance, was neglected. By the course of two or tliree eiiidemics, and the philanthropic activity of a few earnest men, the public was fairly frightened into inquiry, and the result of inquiry alarmed the government into action. Since 1847, a succession of statutes has attested the importance assumed by this subject, sind virtually the whole of our public health legislation is comprised within the last two decades. This legisla- tt n' •1 tion hns worked wonders, mid, with all its imperfection, wns accomplished in tho face of indiifcrenco and opposition, and ImH been impeded by tho stupidity or neglect of local auMiorilics. Tlio govern- ment, obstructed on all liandH, lias been obliged to do its work in detail, and to carry measure after measure against the protest of what n recent writer on this question terms "indignant Bumbledom." The Acls which constitute this legislation have been most various in their subjects and extent, and are enunicruted in tho paper of my friend. Dr. Stewart. The compass of this legislation proves how vast and numerous were the evils to be remedied; its fragmentary character shows how gradually the public has been aroused to see the necessity of action ; and it might have been supposed that after so largo and apparently exhaustive a course of enactments, but little remained to be done to make the measures for tho preservation of public health perfect and complete. In truth i*. is far otherwise. The Sanitary Act of the h.3t session was an attempt to redress the imperfections and follies of past legislation — an attempt said to have been the result of many years' consideration — yet we think we shall bo able to show that at this moment the whole of our sanitary system is constructed upon a bad basis, nnd requires both amendment and consolidation. The number and variety of Acts, of amendments to them, of bodies or persons to whom their execution is committed — the fact that in many important cases the wording of the Acts leaves a dis- cretion as to the execution of their provisions in the local authorities, who generally are disinclined to do anything that involves an addition to the rates, are chief among many reasons for ji compi'ehensivo review and amendment. Again, there are sections in local Acts and in general Acts which are collateral, aimed at the same nuisances, but in different words, and with differing remedies. Does " The Sanitary Act of 1866," in an effectual way modify or remove the faults and deficiences of former legislation ? Does it grasp the whole subject in a comprehensive way and propound a scheme whiyh is at once feasible and complete? We think not. We think its most ardent propagators will acknowledge that it does not, and that it cannot be accepted as a piece of final legislation. It is eminently suggestive, but in many instances, as we shall see, far from efficient. It makes Important advances from a sanitary point of view, but from a legal point of view it continues the errors of previous enactments. We can only liope in the few minutes allotted to us to show in u general way what we conceive to be the main faults of our present system, and we shall endeavour to refer only to those upon which there is likely to be the broadest antagonism. The most obvious and important deficiency is the absence of a central overlooking power. The bodies appointed in different places to carry out the statutory provisions require to be placed under a capital council, committee, or ministry of public health, exercising over them a salutary supervision, and, in proper cases, endued with power to compel them in a summary manner to do their duty. This F If \\M been objected to as n 6tep in ihu iliieulioii of cciilrnliHiition Avbich would bo injiirioii-i fo locnl liluM (y iind fiaiijrlit with poliliral dnngcr. Tho distiiictinn must, bov.cvcr, bi' rciniirkcd bolwci-n central supervision and central (utminitttratinn. 'Jhe f'orriior in CDiiipclling otIioM to «lo their duty, the hitter is doing duty by menus of others. In tl.o one case then* is n certain nmount of indepeiidenco in tlie agents, in tho bitter there is none. This di,-tiiielion onght to ho regi.nled in assigning its duties to tlio profjosed body. Jt shouhi also be remembered that tho administration of sanitary measuren is of national as well as of local importance. Diseases amongst men and cattle, if not stayed in one district, proceed to another. The cholera at Soutlinmpton or Liverpool is an event of thrilling interest at London and Birmingham and Bristol, and, nnfoi tunatsly, ex* perienco proves it. to be unlikely that local authorities will have BulRcient breadth either of patriotism or f)ower to move for anything but self-preservation. Mcreover, sanitary administ;'ati(.n, to be at all efFectivo, must be of the most sutnnuiry charaeier. The question of health or sickness to a whole !usting. It had no water supply. Tiie pan was overflow- ingly full, the contents, indeed, covered seat and flooring buth. Thesa lethal matters were also scattered all over the otherwise suifl- ciently filthy yard, and even on the different floors of the rooms. The house was, indeed, a most fit palace for the goddess Cloacina. From the cellar of No. 21 the seventeen inhabitants of the house ara daily regaled with the fumes arising from the cleaning and preparing of cowheels and tripe. On September 15, at "^^o. 2H, lived twenty- four people in six rooms, one of which, on .iie second floor, was apparently the sole bed-room for eleven human beings. The one privy of this house was in a similar slate to the one above described. It had no waier supply ; neither was there, nor hud there been for some time, a single drop of water for the other wants of these two dozen poor. Need I say that I have cases of diarrhoea in almost every house in this alley? " A nimilar condition of things obtains in the adjoining cholera and diarrhoea nests — Windsor and Sandy Streets. '• Ou the 10th of September, atNo. 10 in the former, resided nineteen people, and their one privy was unsupplied with water, and so on at No. 9 with its twenty-five tenants, Nos. 11, 13, 8, with its twenty tenants, and No. 2. The same votive offerings to Cloacina were here and there conspicuou^y present, especially in tlie privies and yards of Nos. 9 and 13. From these several houses the dust had not been removed for weeks. On the 17th of September these disgusting details were still unrectified. Ou the 4th of September, at No. 5, Sandy Street, there was only one filthy privy, out of repair, for the use of forty-seven people. On the 11th of September there was neither any water supply nor any privy at all for the accommodation of the fifteen inhabitants of No. 3, Montague Court. In the fifteea houses of this court lived 152 people, and most, if not all, of the privies, were unsupplied with water, were filthy, and were covered with human excreta. In two of these houses girls of fourteen and fifteen were ascertained to sleep in the same bed with their fathers. "On September 13, at No. 1, Swan Yard, which is a large mews and depot for carrier's carts, there resided over tlie several stables fifty-six people, besides the dogs and cats. The six families of twenty-eight people were allotted one waterless privy and one water- tank ; to eight other families of twenty-four people were allotted one other privy and one water-tank. The whole yard was in a beastly state. Pools of liquid manure were running from the several dungheaps to amalgamate with a mass of filth in the centre of the yard. One of the dungheaps had not been emptied for three or four weeks, and adjoining thereto was a stinking public privy. The water-tank, which was said to supply only the horses, was uncovered. i ! : V > l*.!; ii 88 and full of animalcuTas and vegetable organisms. On September 17, a case of cholera was taken from one of these rooms to the temporary Cholera Hospital in New Street. '* Lamb Alley passes from alongside my house behind the right- hand side of Sun Street. Each day finds its gully-holes and gutters blocked up and reeking with semi-liquid, stinking filth. At No. 3 in this said alley lived, on September 10th, seveuteen people, without any water supply or privy accommodation. In six of the houses in Blyth's Buildings (which form a hollow square opening into this alley) resided, on September 10th, seventy-eight people, for whose use there were only two filthy waterless privies. In Clement's Place, another blind offshoot from Lamb Alley, resided, on the same day, in eight small houses, nea-ly \f^') people. " At No. 6, one room 1 1 feet by 7^ feet, was the dormitory for three aduP^ and five childi'en. Most of the privies in this place had no water. Two cases of cholera, each fatal in less than twenty hours, were furnished last week from one of these tene- ments. On the 1st of September, at 65, Sun Street (fronting Lamb Alley), both diarrhoea and small pox were in the house, which literally stunk of sewer gas emanating from the one privy, which, with the uncovered and uncleansed water-butt and house refuse, was in the cellar and practically useless. It was in such a filthy, water- less state, with the old excrement welling up and filling the pan, that no one of the nineteen inhabitants had been able to avail themselves of it for some considerable time. On the 14th of September this house was in the same state. No attention to or alteration of these disgusting matters had been paid or effected. " Such are some few instances of the present flagrant condi on of affairs in my district. " A retrospect of my earlier inspections would furnish numerous similar details. Day after day have I transmitted the result of my own and my assistant's inquiries to the deputed receiver of these reports. By section 6 of the aforesaid Order of Council it is the duty of the Board of Guardians to, without delay, cause a repdrt of such facts to be made to the nuisances removal authority — i.e., the Commissioners of City Sewers. Some half-dozen repetitions have I in as many weeks sent in of some of the above statements. My very first report was of the filthy and overcrowded condition of No. 140, Bishopsgate Street Without. Although I then stated that 'This house requires the constant supervision of an inspector of nuisances,' its state on the 15th inst. was in the main no better than it was six weeks ago when visited with cholera. " Although west of the boundary line of the field of the East London VV'aterworks' mains, the sub-district of St. Botolph, East London district, has (as has been authoritatively stated) suffered severely from the present visitation. During the last week four deaths out of five admissions occurred in the temporary cholera hospital in New Street. There was. indeed, a sudden outburst of .V fated cholera in Bishopsgate parish. 89 •*• 1-^ » " The facts I have delineated porhaps explain this. At all events, they sufficiently show the palpable absurdity of drenching our streets "wilh carbolic acid, and of even lime-whiting the interior of houses, while blots far deeper and more foul are left to poison the physical and moral humanity of our poor." The medical profession throughout the country concur in the opinion that the local authorities generally need to bo overlooked. Dr. Druitt suggests that their powers should be enlarged, but the opinion of his medical brethren is against him. " Is it not a fact," says a writer in the British Medical Journal, " that in many places the local authorities are the systematic and bitter opponents of sani- tary reform ? We are anxious to ascertain in how many instances the wise and beneficent intentions of the legislature are defeated by the passive resistance or dogged opposition of the local authorities, who will not avail themselves of the ample permissive powers which the law gives them ; and whether the time has not come when, in the interest of the public, the discharge of duties which is now optional should not be made compulsory — whether in short there should not be some court of last resort, to which the enlightened few may appeal for speedy justice from the ignorance, prejudice or parsimony of the local authorities." The 49th section of the "Sanitary Act" en- deavours to provide a remedy for the difficulty to which we have just adverted, and to establish a sort of court of speedy resort in cases of default on the part of local authorities. Should a sewer authority make default in providing its district with sufficient sewers, or in main- taining its sewers, or in supplying water, or should a nuisance authority " make default in enforcing the provisions of the Nuisance Bemoval Act, &c., complaint may be made to a Secretary of State, who, after due inquiry, may make an order limiting a time for the performance of its duty in the matter of such complaint." The incon- venience of these applications to, and inquiries by Secretaries of State, on subjects quite foreign to their usual duties, and for the due prosecu- tion of which no proper machinery is ready, need hardly be pointed out. If such powers may be intrusted to them they may more safely, as well as efficiently, be conveyed to a body selected and endowed vnth a special organisation for the purpose. Moreover, if the provi- sions of the Acts are permissive merely, there can be, since the cases will be cases of discretion, no legal " default in enforcing those provi- sions " which is cognisable by a Secretary of State. The new Act, for instance, enacts that it shall be lawful for nuisance authorities to pro- vide carriages for the conveyance of infected persons, and that the sewer authority may provide district hospitals ; it cannot for a moment be supposed that these or any other merely suggestive provisions come within the scope of the 49th section to which we have alluded. The word " duty " implies something which has been enjoined, and not something which has only been suggested. We may now shortly state who the authorities are. They are differently constituted in the City ot London, in the metropolitan districts, in places under the Local Cs "ernment Act, and in other 90 ■■I) I i' -' t places throughout tho country. In London the corair'ssioners of sewers are the local authority for carrying out sanitary measures I'oder the City Sewers Act. In the rest of the metropolis, tho vestries of the parishes or the district boardu formed umJer the Metro- polis Management Acts, arc the local authorities. In pliices under tho Public Health and Local Government Acts, tho Board of Health for the place, that is, in corporate towns the council, and in other places the town improvement commissioners or an elective board iti the local authority. It ouglit to be observed that the Nuisnnces Removal Acta operate collaterally or cumulatively with the Metropolis Manage- ment and other Loc 1 Government Acts, and that there may be foiiud instances of two different enactmeuts applicable to the same cases, with diifering penalties for the same ofTenues. Elsewhere, under the Nuisances Removal Acts, the local authority consists of the mayor, aldermen, and burgesses by the council, where a council exists: where there are trustees or commissioners under an Improvement Act, such trustees or commissioners ; where none of these, the board of guardians of the poor; and if no such board, the overseers of the poor for the place or parish. We have thus particularly described the local authorities because of their variety, and we shall hereafter have occasion to mark, that various as they are, ihey have not had entrusted to them all the details of sanitary administration ; a fact from which, as may readily be supposed, no little complication arises. Properly speaking, however, and generally the real local authority before and we suppose since the recent Act, has been a sanitary committee appointed by the various bodies for the purpose of enforc- ing the " Nuisances Removal," the " Diseases Prevention," and now the '"Sanitary" Acts. The sanitary provisions of other Acts do not ordinarily come within the scope of this committee's powers, and cases under them are referred to the vestry, " which," says Dr. Druitt, " is sure to be a larger, more divided, and less manageable body than the smaller committee which constitutes the usual local authority." When we come to examine the machinery by which these bodies are to perform their duties, we light upon a curious anomaly. In the metropolis, the local authority is obliged to appoint medical officers of health and inspectors of nuisances, but under the Public Health and Local Government Acts the appointment of a medical officer is optional, that of an inspector necessary, while in all other places, with but few exceptions, there is no obligation on the local authority to employ either. This anomaly is the result of retrograde legislation. Under the Nuisances Removal Act of 1855, the local authority was bound to employ or join with other local authorities in employing a sanitary inspector or inspectors. The Amendment Act of 1«60 repealed this provision, and substituted a permission to the guardians of any union or parish not within an union to employ one of their medical officers to report upon the sanitary state of the union or parish. How this ni permission has been accepted and taken advantago of by the authori- ties, we may judge from tho important statistics collected by the energy of Dr. Stewart. From these we can form an idea of the nature of that supervis'^n under which a large number of towns existed at a time when the kingdom was exposed to an outbreak of cholera. From these it is not too v.'ide an inference to draw, that two-thirds of England is practically destitute of sanitary control. Tho importance ot this point was earnestly brought to the attention of tho government when the Public Health Bill was in committee, but it received no solution at their hands. We haruly think it necessary to urge, with any lergthened argu- ment, that the power to appoint medical officers, analysts, and in- spectors of nuisances ouj^'ut to be exercised throughout the kingdom. Where tho appointmunt of any of these lias been compulsory, as in the metropolis, the valuable services they have rendered the public by bringing scientific knowledge and practical experience to bear upon the multitudinous nuisances of collected population cannot be estimated. Private persons will endure a great deal before they will engage in anything involving expense. To look after these people when they are themselves in fault, or to lend a ready ear to their complaints when they are aggrieved by others, to scent out nuisances and abolish them, is the business of officers and inspectors, and no corner of the country should be unknown to their supervision. But we have seen that even where these officers have been ap- pointed, they may yet have to contend against the ignorance and stupidity of local authorities. The renowned instance of St. Pancras proves that vestries and boards, composed of tradesmen, or licensed victuallers, or small householders and the like, are not open to the warnings and suggestions of capable officers. The value of a propo- sition is by them likely to be estimated in the inverse ratio of the demand it involves upon the rates. Under these circumstances, it is essential that the officer should be independent of the local authority. There is less danger in his independence, because he only suggests and reports ; but if his appointment is at the will of the local authority, he may be simply their creature, or if not their creature, may suffer from the displeasure with which they view his sanitary activity. The appointment and removal of every local inspector and medical officer should therefore be subject to the approval of a central autho- rity, which is itself responsible to Parliament. The oversight of the medical oflficers is, however, but a slight part of that sanitaiy system, at the head of which we desire to place a ministry or board of health. There is the more extended and impor- tant oversight of locahties and local authorities. The complaint now is, that unless the statutes specifically ordain that certain things shall be done, the authorities will not do them. Very often the statutes give an uncertain sound, and persons who wish to have a judicial exposi- tion of them must resort to the expensive machinery of the Hvf. The law, in too many cases guided more by the letter than the spirit, refuses to enlarge the meaning of Acts which involve personal 92 ,1; .; ,* n IM i ■I' ')' I m 1^! rights, and presents the inan who appeals against the sanitary inactivity of a board or vestry witha logicul reason for the perpetuity of a nuisance. Two things, therefore, require to be done. The pro- visions of the siututes should be enacted plainly and imperatively, and the central authority should employ national inspectors to watch the sanitary condition of the kingdom, to suggest improvements, to report and investigate complaints. A few instances will prove ihe first necessity. The want of plain- ness in the wording of the Acts often leads to serious perplexity. The metropolitan officers give an example in their " Suggestions." "Section 8 and section 27 of the Nuisances Removal Act (1855) hftve practically been found to clash. If, in a case of nuisance, e.g. offensive odours, arising from a trade accumulation, substances used in a business, &c., a summons be taken out under section 27, it is pleaded that the summons should have been taken out under section 8. On taking one out under section 8, an order is objected to, on the ground that the means adopted are sufficient for the protection of public health, or that the deposit was not kept longer than the de- fendant required ii for the purposes of his business. The latter excuse can never bo got over. As to the former, it has to be proved that what causes offensive odour also damages health, and in many cases of offensive accumulations this car.not be maintained in the present state of our knowledge. Again, if an order bhould by any chance be obtainable, and the accumulation be removed, the offensive matters may be immediately replaced, and being newly deposited, must remain again, so long as the manufacturer has need for them in his business." Again, under section 21 of the Nuisances Removal Act 1855, where ditches are foul or offensive, there is a discretion left in the surveyor as to cleansing them. Under section 22, " Whenever any ditch, &c., used, or partly used, for the conveyance of any water, filth, sewage, or other matter from any house, &c., is a nuisance within the meaning of the Act, and cannot, in the opinion of the local authority, be rendered in- nocuouSj wi\^out the laying down of a sewer, or some other structure, &c., they shall, and are thereby required", to make and keep it in repair. But by the words italicised, absolute discretion is left to the authorities, fur no court would inquire into the reasonableness of the "opinion of the local authority," although the succeeding words are strongly imperative. In none of these instances has the new Act afforded any relief. The manufacturers may still baffle the local authorities by their difficult dilemma, the surveyor and local authori- ties retain their discretion. It is true, that the 20th section of the Act enacts that " it shall be the duty of the nuisance authority to make, from time to time, either by itself, or its officers, inspection of the district, with a view to ascertain what nuisances exist, calling for abatement under the powers of the Nuisance Removal Acts, and to enforce the provisions of the said Acts, in order to cause the abatement thereof." But we have shown " the provisions of the said Acts'^ be inadequate, making it optional with the surveyor to clean, and - 93 with the local authority to do struelurul works, and as it is tboso provisions which are to bo enforced, the new enactment would not, iu these instances at least, produce any le;;al diiTorence. Let us take another case. The IGth section of the Nuisances Removal Act enacts that when "it shall appear to the jusi ices that the execution of structural works it* required for the abiitemont of ii nuisance they may direct such works to be carried out." A case in which the abatement of a nuisance depended upon structural works would bo one of etrong necessity, yet the Court of Queen's Bench has decided that such an enactment is only permissive, and the justices cannot be compelled by mandamus to direct tlie works to bo done.* The "Sanitary Act, 1866," is in many of its new and most important particulars permissive. Wo cannot doubt the inten- tions of the government iu urging its adoption upon I'arliament with some earnestness. The threatened invasion of cholera enabled them to exercise a preasure which was judicious, if the Act be considered as a merely temporary enactment, but not so if it should be permanent. It was felt and said at the time of its passage by members of the government that further consolidation and revision were required. Wc have endeavoured to show what direction any new legislation should take. To a sanitary reformer there is no greater bugbear than a permissive enactment. A suggestion which involves expense to persons interested in that expense is sure, in nine cases out of ten, to be unheeded. "We have not far to search in the late Act for such suggestions. The 10th section provides that, " If a dwelling-house within the district of a sewer authority is without a drain, or without such drain as is sufficient for effectual drainage," two cases of vital importance, the sewer authority may require the owner to make a drain emptying into one of their sewers ; or if no such means of di'ainage are within a specified distance, then emptying into such covered cesspool or other phice, not being under any house, as the sewer authority directs, &c." We hare been unable to discover a reason why this should not have been mandatory. If no sewer runs within a practicable distance of a house, the unly altei'nativo must be to make a proper ccs3[)ool. Why should not the nuisance authority be compelled to see that the house is made habitable by one or the other method? So, as we have already seen, the provision of means of disinfection, of sick carriages, of places for the reception of dead bodies, of sick hospitals, is left to the option of the authorities. Let any one look over tiie lists, prepared by Dr. Stewart, of the ap- pointment of medical officers, and judge whether it is probable that these latter suggestions will be received and acted upon. The appointment of national inspectors to act under the central authority, seems necessarily to follow from the existence of that authoriiy. "Wide as its powers might be, its presence and observation * In re The Local Board of Health of the parish of Ham, 7 E. & B. 280; 26 L. J. M. C. 43. mm 94 B U 5 > ■ i til? If m i Could not bo everywhere. It would need nf^eut'', like those aldo men who have been employed with such greut success by the Privy Council on n)any occnaious — to exnmino into mid report upon com- plaints (which, under certain restrictions, ought to bo ensily nnd in- expensively received) — to suggest nnd overlook improvements — to invcstigiile causes of disease — whoso iluty, in fact, it should bo to watch the sonitary condition of the whole kingdom. Thcso inspec- tors, uninfluenced by local prejudices, would bo able to riiturn im- partial rcpjrts upon the action of local authorities and the needs of places. Through them, when there was a conflict of interests, the committee could justly balance the obligations of those interests. This machinery would bo simple and comparatively uncostly, and th«) courts would be relieved of a great burden. We have now approached in contemplation something like a system. A central authority, with a staff of officers, overseeing and directing local authorities with their otHcers. 13ut supposing this to bo constituted, there v.ould still remain to be remedied the deficiencies nnd inefitciencies of the laws which this organisation was to put in execution. Some of these we have designated, others we are obliged for the present to avoid. Many have been ably pointed out by Mr. Rumsey in the Journal of Social Science for October, 1 866. The exclusion of clergymen from participation in sanitary management, the intrusion into sanitary boards of members of water and gas com- panies, whoso interests are naturally opposed to those of the rate- payers, are matters that require redress. More important is the question, whether the supply of water and gas by private companies should not be forbidden, and the consumers bo also the makers. This question should be discussed by itself, and perhaps at no distant day we may have it properly treated by some competent member of this Association. But one obvious deficiency we think it needful to mention. All sanitary matters should come within the manage- ment of one authority. In administration of laws human, unlike laws divine, " diversities of operations" are obstructive. The common lodging houses Acts are not carried out by the local authority, but by police magistrates and justices. The local authority for the appointment of analysts out of the metropolis, is the court of quarter sessions of every county, and the town council of every borough having a separate jurisdiction. Such appear to us to be the main faults and needed improvements in our public health laws. With compulsory enactments, and an efficient ministry or board of health, we might see some prospect of the sanitary regeneration of the country. Two things, let us again urge, concur to enforce upon us the necessity of the proposed super- vision, namely, the iudifference of private persons to sanitary pre- cautions, and the inefficiency of the bodies whose duty it is to watch the public health. The former of these causes will exhibit itself even in cases where only a little personal attention is needed in the pursuit of relief ; while that uncertain and expensive machinery of the law, whether in inferior or superior courts, to which we have alluded, and V J 95 from which all men iinturnlly sliriiik, Ih not alwnys ductile. Its motions nro subject to fixed rules; its inrttrueliotm nrn Hcttlcd nrid precise, leuvin}^ no discretion ; it is constiained by tlio inflexibility of words, and drilled into the repimonts of logic. The judgr; dure not ignore the Imigungfl in extiactinjj the spirit; ho dare not stretch his power beyond the dimensions of bis oihco, which is to declare, and not to miike the luw. Often, iherelore, when the whole niorul foreo of an enactment, at I of judicial conviction, and of popular opinion, is jtgninst some act or thing, that act or thing may exi«t and be done in spite of all, because it is iuipossiblc for I ho most keen-eyed legislator to loreeast every contingency in a world of perpetually- varying combinations, and to prescribe in tlistinct terms the remedies or penalties fur every evil that might naturally bo included within the sphere of a law. In most cases that come within the province of legislation it is not of so much consc(|uence that the law should bo Bummnry as that it should be sure. Tlie march of criminal justice, and the settlement of civil rights, acquire both certainty and dignity from the deliberation of their process. But there are cases where the benefit of the body social demands a flexible jurisdiction and a suranmry proceeding — demands even a little temporary or individual injustice f(»r the lasting good of a great number. 8ome such juris- diction and process might, perhaps, with great industry and much parliamentary wrangling, be devised for the sanitary security of the kingdom. It might be possible to construct a series of regulations so numerous and so minute that but few and rare instances y^^ in- effectual powers or remedies could occur. Yet there wouM still stand and face us the two cardinal difRculties — Indifference and Expense. The very minuteness and delicacy of our instrument would make men shrink from using it — would be likely to bring about the complication which increases costs. The very summariness which is proved to be essential to the practicability of a sanitary system, would make the judges cautious in their interpretation, the justices hesitating in their orders. To define, therefore, peremptorily the most obvious and important duties of the local authorities, — to give them a fair opportunity of voluntarily pursuing them, — to place over them a body whose office it shall be, not to regulate their rctions, but to redress thtir errors and omissions, aiul to prosecute at the public, and not at individual expense, those who disobey sanitary enactments, — to give this body a wide discretion with refer- ence to the thousand matters and things relating to public health which legijilation cannot provide against, — are the propositions which we now press upon Parliament as the result of our inquiry and argu- ment. The imperfection of the present laws in themselves, and the inadequacy of their practical enforcement, will, during the meeting of this Congress, be sufficiently evidenced. It is needless to appeal to sentiments of fear, of self-preservation. It cannot now be required to be shown that the best preventive of epidemic disorders is con- Btant sanitary vigilance, or even that the truest economy is that which, by a moderate expenditure, reduces the probabilities of disease to a ■%^^iS?*i •^^^^ mm 0« minimum, not thai wrhich neglects until tho fntnl hour tho mouaures of precaution, and wastes a taviflh sum upon nioauH of cure. We cannot touch upon the relations of this subject to the moral improvement of the people. Wretched houfica make wretched homes ; ami while im- moral or slatternly habits convert fine dwellings into styes, it is almost as true that dirty and unhealthy habitations transfer a taint to the character and habits of the persons who occupy thim. Tho depressing influences of filth and disease write their evidences on men's manners as well as on their skins ; and if the body social and politic is to bo sound, the body physical must be healthy too. li, '. I \ t On tho 2nd of April, a Deputation from the National \8sociation for tho Promotion of Social Science waited on, and submitted to, tho DcKB OF Marlborough, President of the Privy Council, the fol- lowing Memorial : — The Council of the National Association for the Promotion of Social Science clcsircfl to submit to your Grace the following considcrationH rcsperiiug nn amendment and consolidntion of (he laws relating to Public Health. These laws are numerous and diverse ; and, as different subjects of legislative interference arise from year to year, become more complex and more difficult to interpret and apply. Some of the enactments are general, some local. The provisions of the latter are often of universal value and applicability, and might beneficially be introduced into the former. In other instances there wc different enactments relating to the same cases, with different penalties for the same offences. For instance, section 63 of " The Public Health Act, 1848," and section 2 of "The Nuiaanccs Removal Amendment Act," 2(5 and 27 Vict., c. 117, intended to prevent the sale of diseased meat, and collateral in their operation, impose a penalty; the one of £10, the other of £20, in i)recisely similar cases. This, of necessity, leads to confusion. Some important enactments are permissive ; indeed this principle very exten- sively pervades sanitary acts of the greatest importance, and consequently they are seldom acted upon. For instance, section 22 of " The Nuisances Removal Act, 1865," where, when ditches, etc., are a nuisance, it is left to " the opinion of the local authority " to decide whether the nuisance requires a sewer for its abatement ; and sections 23 and 24 of " The Sanitary Act, 1866," relating respectively to the pro^'ision of means for disinfection, and of carriages for the conveyance of persons sick of infectious disorders ; section 27 of the same Act ard section 81 of " The Public Health Act, 1848," concerning the establish ; ment of places for the reception of dead bodies ; and section 52 of " The Public Health Act, 1848," with reference to compelling a proper provision of closets in factories, are all permissive. The bodies appointed to administer health laws are not always identical, as it is evidently expedient that they should be. There are natural connections which ought not to bo disregarded — eg,, the supply of water with the removal of waste ; the large with the small means of drainage. These are under diverse authorities. Without bodies of more general and uniform powers, wider districts, and highly qualified officers of health precluded from private practice, health laws cannot be made fully successful in their operation. "The Sanitary Act, 1866," constitutes sewer authorities, differing, in some respects, from local authorities undT other statucos. The Common Lodging 07 lldiiMOH Actfl firo committed to the mminKcmoiit of the police in the metropolis, Id FiOcnl BoiinJM of Ilcnltlj, to Town ('oiiiiiiiH«ifiyt'r.s iind .Fimtim in other jilftccH. The iippoiiitinctit of aimlyHln roHlM with tlic Court of (jimrtcr He««ionii in conntitR, and witlj tho Town C'oiiiu'il in horoiij^lis liavin^ a ucpnrato peaco jurimliction, iimtoad of witii tho iiiual aiilimritios fur Hanitary pii 'ixmcH. Fur* thor, thiH luoHt important appoiiitinent in Hcldoni nuulo, a.i thu hiw nicruly ^ivot H purmiHMion to appoint. The h)cal aiithoritioH arc more or lesH unlearned, and for that rcawm rc(piiro plain and Hpccillo diri'ctionH. Thrj aio intnrcHtt'd in diiiiinisiiin^' the rates, nnmindful of >he prohaltlo costlim'SM of tlicir paiainiony ; and they are, there- fore, freipiently unwillint? to ai-t in Hanitary nialli-rrt, uxcopt under uompulflion. They aie often ignorant of tlio importaiiC(! of Hanitary preeautionH, and in- difTorent to (laj^rant nuisanocK, am' to tiio sorioUH fonMt;(|uenceM ariHing there- from to individualH, to othcrn beyond tlie onVmiiiij,' district, and to Hociety at larj^e. Hence tlio need of a npccial and central department to Htimulate an nnwilliiiK or inoHlcicnt local authority, to act as a (Jourt of Ai)peal, to dilfuBO to all the knowludKo ol)taincd from districts tliat have no connection with each other, to protect individuals and mi"oritK's at,'aiiist injustice, and, beinj? pos- sessed of the hi(^liest practical know i ilge, to construct or sanction bye-luws and local regulations. The HuildiiiK Acts, which should at Icunt contain sound rules for insuring duo attention to health in the erection '>f hal)itations. are very delicient indeed, in this point of prinmry importance. In some few })lacca bye-laws are even now made to serve tlie purpose. It is uudcniabh' that without some very uniform and stringent additions aiul alterations to Huilding Acts (such as that which is now being promoted by the Metropolitan Board of Works), the constrnction of healthy dwellings, especially for the poorer classes, acknowledged to be re one of the secretaries of the Health Department of the Association, in presenting the memorial, ackiiowledgcd the great progreas G 98 'i ■ i ','. '. already made in health legislation ; but he said that it had up to thia time been mainly for special cases and piecemeal, and that hence sanitary legisla- tion had become in some instances contradictory — that various parts of it were out of harmony with each other- sometimes the B.ame provision, vnth or without difference, bchig repeated — that much was permissive, which should bo obligatory, and as a result there was confusion, with much waste of force, and discouragement in carrying out the Acts. The bodies appointed to carry out were often diverse, occasionally opposed to and hindering one another, and generally more or less unlearned, and requiring clear and specific Acts for their guidance. The great objections now hindering the due carrying out of the Sanitary Acts would for the most part be removed with a better organisation. He instanced the difli^iultics experienced by boards wishing to carry out the law, and handed in a statement from Chelsea to this eflPect, which he said was a statement which might be made by almost all other bodies desirous of working the sanitary laws. He pointed out the need of a better provision as to magistrates, the police magistrates having too much to do of a kind very little in harmony with true sanitary legislation, and, consequently, almost generally failing to help willing local authorities by their judgments. The Building Acts were almost without provisions under which healthy habitations might be erected for the poorer people in case unfit places were pulled down under any Artizans' Dwellings Bill, and he g.ave instances where new dwellings of this class, built, as they usually were, by poor speculative builders, very speedily became as bad or worse in their unhealthy conditions as any of the oldest. The Vaccination Acts were objectionable, because they had always been admiuistei*ed by the Poor Law authi^ritics. People were taught to avoid poor-1 ^v help, and this feeling had seriously impede vaccination, the vacci- nators for a neighbourhood being too usually the poor-law surgeons only. Vaccination, of course, did not commend itself to the class of people a little above the poorest. The officer vaccinating certainly should not certify to the success of his own operation. It required a more liberal paj', an inspector who should certify and not vaccinate, and who should care for the lymph and certify as to its fitness for use. The Adulteration of Food Act, he said, was also a failure, and the poorer buyers were not protected. All that he had said by no means exhausted the catalogue of evils in the present sanitary laws of the country. Mr. RuMSEY urged the necessity for the union and consolidation of the central authorities in sanitary matters, which are at present distributed between the Privy Council, the Home Office, the Poor Law Board, and the Registrar-Ge- neral, producing uncertainty and confusion in local administration. He also pointeci out the great anomalies which mark local administration in the pro- vinces, the variety of boards existing under poor-law and local government and Public Health Acts ; and the remarkable difference in the area and popu- lation of the districts under these several boards, the inhabitants of a district varying from less than a hundred to many thousands. He recommended an improved constitution of local boards with higher qualifications for their members and the extension of areas of local govcnment, so as to provide -for an economical and efficient administration of <'ie healt i laws. He showed how this extension of area affected the appointment of health officers, and urged the necessity for an entirely different system of those appointments which in the provinces were made under the Public Health Acts. He instanced the inspection of factories and work places, especially the extension of the Factory Acts now before the House of Commons, as a reason for appointing a highly- qualified class of officers rendered independent of private practice and debarred from it. He noticed the importance of such independence as regards certifi- cates of health, age, and fitness for labour of the children employed. He also mentioned Mr. Torrens's Bill tor dwellings for the labouring classes as requir- ing the action of a health officer, who ought certainly to be independent of the proprietors and householders of the wretched hovels he might have to condemn. The basis of an improved organisation, he considered, was to be found in the registration division of the country which are identical with the poor-law unions. It is in these districts that the great facts of disease and mortality are ^--....^.--..^.....■^..^...j 99 rcconled ; in these, therefore, n sclentilii; oHicer i.s especially nccJcd, both to correct and verify those retnrns, and to apply them to the anpgestion of prac- tical remedies. It would bo a most false step in sanitary legislation to compel every small local board to appoint its own officer of health on its own terms. He warned the Government against enforcing, or even encouraging the present defective system of these appointments, and urged the importance o? making a new organisation of scientific persons the foundation of a truer sanitary reform. Dr. Lankester said he wi.shcd generally to confirm the views expressed by Mr. Rendle. He had taken an intoiCnt for the last twenty-five years is sanitary legislation. The great defect .n this legislation was its permissive character. Those to whom pov.er was given to act for the benefit of others, might refuse to act for the benefit of their fellow citizens, and there was no power above them to compel their action. He had thus seen successive Acts of Parliament become dead letters in sjntc of all powers the state had given. What every one wanted who had an interest in the sanitary welfare of their fellow citizens, was some definite law on which they could act. The present position of our legis- lation >vas that local boards ar authorities, might, if they thought tit, prevent disease and death, but if they ..-.A not think fit to do so there was no superior authorit}' to compel them. The deputation was anxious to impress upon the (lovernment the neccs.sity for the consolidation of the present Acts of Parlia- ment, and for jilacing in the hands of the central authoi'ity a power of seeing that they were carried into effect. At the present time various l)odies had some kind of control in relation to si nitary legislation. The Privy Council, over whom his Grace presided, had authority in certain things, but this i^ower was limited. By the Act of IBiJt), the Home Secretary was invested with power, but which at present had exerted little or no effect. Then there was the Poor Law Board, which represents the Boards of Guardians, and gives them the power of supervising vaccination and its practice throughout the country. To show the utter powerlessness of this authority to deal with the subject, it. was only necessary to say that upwards of 2,000 pox in England and Wfiles dui'ing the year ]8l3G. supervision of lodging-houses, and the coiulition missioner of Police had power to act. Powers of other bodies, and it was a most difficult thing for an officer of health, in the parishes of London, to know to what authority he was to look to to abate or prevent nuisances injurious to health. What was wanted was a unification of the laws in relation to public health, and a department of the Government having power to act in individual cases. Such a body constituted by Govern- ment should have power to compel vestries to do certain things which were obviously necessary for securing the public health. He saw with great pleasure that Mr. Ilumsey was present in the deputation, as he had written one of the best books in the English language on the subject of Sta Medicine, and he knew no one who was more entitled to be listened to i>/ statesmen of the present day than Mr. llunisey. Mr. James Bkal urged the necessity for some measure of revision and con- solidation. The permissive character of the present en.actments was a mere loophole by which to avert responsibility. The provision of carriages for the removal of the sick of infectious diseases, and proper hospital accommodation for such cases, was avoided in this way, either to save the expense altogether, or to shift it on to other shoulders. Suggestions emanating from the district officers seldom or ever received proper consideration, and of course were as seldom acted up to. Conflicting interests woi.!d often prevent the carrying out of orders already made. Tlie analysation of food or gas may be ordered, but a dead lock came when the expenses of providing apparatus for working it were to be provided. He complained that whilst last session the Sanitary Act of 18GG imposed upon the vestries the duty of providing hospitals for infectious diseases, this year the Poor Law Board had passed through the House, apparently without any concert with the Board of Health, a Bill imposing similar duties on Boards of Guardians. What was wanted waa enlarged areas of administration for local purposes, and one central board for persons had died of small- Then, with regard to the of houses, the Cliief Com- other kinds were given to iro all London, nrnicd with sufticieiit iiowcr: t.) eiiCiivi' tlic !\ctioii I'arliniiiriit desired. The confliotiiif,' notion rif depnrtnicritH of (lovcrnniont wns a fruitful source of vrealvncsa. JiCt London be plncc