RJBLIO HEALTH LIB. 
 
 THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 Public Health 
 
 GIFT OF 
 
 Mrs, Robert T, Legge 
 
'\f 
 
English Sanitary Institutions, 
 
 REVIEWED IN THEIR COURSE OF DEVELOPMENT, 
 
 AND IN SOME OF THEIR POLITICAL 
 
 AND SOCIAL RELATIONS: 
 
 BY 
 
 Sir JOHN SIMON, K.C.B.; 
 
 MEMBER OF THE GENERAL MEDICAL COUNCIL ; 
 
 CONSULTING SURGEON AND PAST SENIOR SURGEON TO ST. THOMAS'S HOSPITAL ; 
 
 FELLOW AND PAST PRESIDENT OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND ; 
 
 FELLOW AND PAST VICE-PRESIDENT OF THE ROYAL SOCIETY ; 
 
 PAST PRESIDENT (NOW HON. MEMBER) OF THE PATHOLOGICAL SOCIE-^Y OF LONDON ; 
 
 D.C.L., OXF. ; LL.D., CAMBR, AND EDINB. ; M.D. HON., DUBLIN; M.CHIR.D. HON., MUNICH; 
 
 ETC. ; ETC. ; ETC. ; 
 
 FORMERLY THE MEDICAL OFFICER OF HER MAJESTY'S PRIVY COUNCIL. 
 
 CASSELL & COMPANY, LIMITED: 
 
 LONDON, PARIS, NEW YORK & MELBOURNE. 
 
 1890. 
 
Public Health 
 
 Add'l 
 
 GIFT 
 
p A 
 
 ^ b. 
 
 PREFACE. 
 
 Bt way of preface to the following pages, I desire to offer a 
 short explanation of the circumstances in which I found my 
 motive to attempt the work, and of the spirit in which I have 
 made my endeavour. 
 
 Thirteen years ago, on my retirement from official connexion 
 with the public service, flattering wishes were expressed to me 
 that I would re- publish in collective form the Reports, or the 
 substance of the Reports, which, during some twenty-eight 
 previous years, I had written in various official relations to the 
 business of Sanitary Government. It was my intention, if 
 possible, to give effect to those wishes ; but causes not within my 
 control delayed me year after year from making any real progress 
 in the matter ; and, with each postponement, it of course became 
 more and more likely that the advancing disqualifications of age 
 would finally close my hopes of accomplishing the task. In that 
 dawdled state of the case, three years ago, I was very pleasantly 
 surprised and honoured by an invitation from the Sanitary 
 Institute of Great Britain that I would assent to their re-pub- 
 lishing the Reports. On my ready acquiescence in that proposal, 
 the work was speedily put in hand, with the advantage that 
 Dr. Edward Seaton, one of the foremost of our present health- 
 officers, undertook to be its Editor; and in the autumn of 1887, 
 the two volumes of that re-publication were issued by the Sani- 
 tary Institute. 
 
 During the years when I thought I might myself be the re- 
 publisher of the Reports, I had always had in mind two accom- 
 panying hopes : first, that I might be able to prefix to the pub- 
 lication some kind of historical introduction rendering homage 
 to those who, before my time, had attained the standpoint where 
 my work began; and secondly, that, when I should have strung the 
 reports into series with some sort of running commentary on the 
 
 ^ ^ 064 
 
IV PREFACE. 
 
 occasions and conditions to which they had related, I might be 
 able to append to them, as in outlook towards the future o£ the 
 Sanitary Cause, some reflexions of more general scope on the prin- 
 ciples and methods of Public Health Government. While the latter 
 of those hopes represented no more than a personal aspiration, the 
 former would, in the circumstances, have corresponded to a debt 
 of honour. In the first words of the famous Oath which bears 
 the name of Hippocrates — an oath which in great matters 
 deserves to be for all time a law to the Medical Profession, the 
 acolyte swears that he will ever hold himself under the obliga- 
 tions of filial duty towards the Master from whom he learns his 
 Art ; and I should have thought it disloyalty to the spirit of 
 that oath, if, in setting forth my own very humble contributions 
 to the cause of English Sanitary Reform, I had not striven to 
 prolong the grateful memory of elder times : had, for instance, not 
 told of Sir Edwin Chadwick's great campaign in the first ten years 
 of her present Majesty^s reign ; or had been silent as to the men 
 who, from more than a century before that period, had 
 been pioneering forward, some of them in lines of scientific 
 study, and others in lines of political principle, towards the day 
 when state-craft and medical knowledge should sincerely take 
 counsel together for the Health of the People. 
 
 In 1887, such preparations as I had made towards the col- 
 lateral intentions just described were not nearly advanced 
 enough for immediate use ; and, as I therefore could not hope to 
 fulfil their purpose by way of graft on the object which the 
 Sanitary Institute intended, I had to reserve it for fulfilment 
 by postscript. So soon, however, as I attempted to proceed on 
 this resolution, I found that the limits which I had thought 
 convenient for my original plan would not be equally suited to a 
 work meant for separate issue ; and that the publication would 
 be comparatively meaningless, unless I gave it wider and more 
 systematic relation to the history of sanitary progress ; not only 
 beginning as far back in time as where stages of English progress 
 can first be marked, but also extending my record and com- 
 mentary to the proceedings of our latest years. It was of 
 course evident to me that I could not attempt to make so wide a 
 survey and criticism of sanitary progress, except with almost 
 exclusive final regard to the mere practicalities of the case ; but 
 
PREFACE. V 
 
 I ventured to hope that my survey of the ground, if only in that 
 practical sense, might be contributive to purposes of public 
 opinion — the more so, as hitherto there had not been any 
 published general study of the matter ; and I accordingly made 
 up my mind to the endeavour which the following pages 
 represent. 
 
 Giving overleaf a List of the Chapters of the volume, and 
 then a detailed Table of their Contents, I need not here dwell on 
 what is mere matter of plan in the work. The reader will 
 observe that, after some necessary but brief mention of times 
 and influences which in this context may be classed as pre- 
 Anglian, I have endeavoured to show in sequence the chief steps 
 of English progress, from early to present times, in Laws and 
 Administrative Organisation regarding the Public Health ; and 
 that together with what is of mere narrative as to the steps 
 (and particularly in proportion as the narrative comes into recent 
 years) I have combined more or less of commentary on the steps, 
 and sometimes more or less statement of my own opinions on 
 them. 
 
 To readers already familiar with the subject-matter, it 
 will not occasion surprise that, though the volume opens with 
 references to early historic, and even to pre-historic times, con- 
 siderably more than half of it is occupied with the achievements 
 and questions of the present Victorian reign. This period^s un- 
 exampled productiveness in acts and thoughts which will be of 
 permanent historical interest in our subject-matter has par- 
 ticularly called for that fulness of treatment; and it has also 
 seemed to me an imperative reason for endeavouring to bring 
 into just connection with it the too-often unappreciated im- 
 portance of the great incubatory centennium which preceded. 
 
 The Local Government legislation of 1871-2, and the action 
 immediately consequent upon it, have been treated as belonging 
 rather to present politics than to past history ; for the shapings 
 of the last nineteen years are hitherto but imperfectly solidi- 
 fied, and are still from day to day undergoing modification, or 
 awaiting it. It has been chiefly with thoughts towards the 
 future that I have dwelt on those comparatively recent passages 
 of the past ; discussing them in a spirit of free criticism, and 
 
VI PREFACE. 
 
 using them as a text on which to argue somewhat fully the 
 points of principle which I think have to be considered in the 
 statesmanship of Sanitary Organisation. 
 
 That I have given a special chapter (as well as many passing 
 reflexions) to the subject of Poverty will, I believe, be found in 
 harmony with the general purpose of the volume : for, though 
 Disease and Destitution are treated under different headings in 
 the statute-book, their reciprocal relations, their relations as cause 
 and effect to each other, are among the most important facts 
 which the student of Sanitary Science has to remember. 
 
 In referring to critical stages of modern progress, I have 
 generally gone somewhat into the details of the struggle ; and 
 now and then, where it has served to illustrate the position, have 
 given incidents which are but of anecdote size. My story, too, 
 I have rejoiced to know, is not exclusively of the deeds of the 
 dead. I have found it due to many persons still living, who are 
 identified with the progress of our Institutions, that I should 
 make more or less mention of them by name ; though in their 
 case often somewhat hampered by the fact, that among them in 
 pretty large proportion are former fellow-workmen, still close 
 friends, of my own; as to whom I cannot but fear that my 
 consciousness of the personal relation may probably have im- 
 posed too much restraint on my expression of the praises which I 
 think due. 
 
 As regards the general intention and spirit of the work, I 
 would first observe that I have not addressed myself to medical 
 more than to non-medical readers ; and I trust that, if the work 
 is so fortunate as to find readers of the latter class, they will 
 acquit it of being inconveniently technical. There no doubt is 
 a sense in which it may be catalogued medical ; but such Art of 
 Medicine as it purports to discuss is an Art which the laity 
 is now under legal obligation to exercise ; and every educated 
 layman is well aware that, in proportion as Medicine has 
 become a Science, it has ceased to be the mystery of a caste. 
 In relation to all doctrine which this volume discusses, there is no 
 distinction of outer and inner schools. To trace the process by 
 which Preventive Medicine has grown into scientific form, and 
 has given life to an important branch of Civil Government, has 
 
PREFACE. Vll 
 
 been an essential line in my record; but the non-medical reader 
 will, I daresay, not find me more medical than himself in 
 respect o£ the standard I apply to measure the merits of the 
 development. As sanitary laws and sanitary administration 
 mean to me laws and administration for the saving and 
 strengthening of life, so the worth which they have or 
 promise in outcome of that sort is the only worth I have 
 cared to measure in them ; and if there be separate interest 
 in the mere 'leather or prunella ^^ of the case, I leave it for 
 others to enjoy and expound. That standard of mine no doubt 
 is primarily medical ; but not medical in any sectarian sense ; 
 nor of such novelty, or such refinement, that only professional 
 observers can be deemed masters of it. It is of the province 
 where Medicine joins hands with Common Sense ; and I appeal 
 only to Common Sense for its recognition. 
 
 The argumentative parts of my work, I need hardly observe, 
 do not in any degree pretend to be contributory to the Science of 
 Medicine. Their ambition, if I may apply so large a word to the 
 very modest hopes with which they have been written, relates 
 principally to the Practice of Government in the great national 
 interest concerned. With much diffidence I offer them, as con- 
 tribution of the only sort I can make, towards counsels which 
 are now being taken on all sides as to ways of promoting 
 the Welfare of the People. My endeavour relates essentially 
 to but one section, and for the most part only to one sub- 
 section, of that great enterprise of our time. That even 
 the sub- section is of immense public importance, that to 
 procure for the life and happiness of the nation the utmost 
 possible Freedom from Interruptions by Disease is a task well 
 worthy to engage the best energies of many best minds, are 
 considerations which members of my Profession may well con- 
 template with peculiar gladness. But even within that field, 
 and still more in the fields which intermingle with it. Medical 
 Science is only joint-worker with other powers of knowledge 
 and action for the national interests which are in question ; and 
 a spirit of exclusiveness is surely least of all the spirit in which 
 it would seek to exercise for those interests the technical 
 powers which are distinctively its own. In parts of the 
 endeavour, it can work sufficiently well by itself ; but in other 
 
VUl PREFACE. 
 
 parts^ it eagerly looks around for allies. In every moral in- 
 fluence which elevates human life^ in every, conquest which 
 is gained over ignorance and recklessness and crime, in every 
 economical teaching which gives better skill and wisdom as 
 to the means of material self-maintenance, in every judicious 
 public or private organisation which affords kindly succour and 
 sympathy to the otherwise helpless members of the community, 
 the medical specialist gratefully recognises types of contribution, 
 often not less necessary than his own, towards that great 
 system of Preventive Medicine which is hoped for by Sanitary 
 Reformers. 
 
 J. S. 
 
 Christmas, 1839: London. 
 
CONTENTS. 
 
 SYNOPSIS OF PARTS. 
 
 IP art JFtrat.— INTEODUCTION. 
 
 PAGE 
 
 Chapter I. — Earliest Times 1 
 
 II. — The Roman Institutions 18 
 
 III. — Post-Roman Anarchy and the Re-commencements . . 30 
 
 IV. — Medieval Philanthropy 4o 
 
 IP art ^ernntr.— POST-MEDIEVAL England. 
 
 V. — Tudor Legislation 65 
 
 VI. — London under Elizabeth and the Stuarts ... 82 
 
 IP art t^Ijirtr.— NEW momenta. 
 
 VII. — Rise and Early Progress of British Preventive 
 
 Medicine 107 
 
 VIII. — Growth of Humanity in British Politics . . .128 
 IX. — First Experiences of Asiatic Cholera in Europe . .166 
 
 IP art 3F0tirtIr.— THE reign of queen victoria. 
 
 X. — History of the Public Health Legislation of 1848 . 178 
 XL— The General Board of Health, 1848-58 . . .214 
 
 XII. — Initiation of Medical Officerships, Local and Central : 
 
 i. The Local Appointments, and their Early Working . 245 
 
 ii. The Central Appointment, and its Early Working . 257 
 
 XIII. — The Medical Department under the Privy Council . 279 
 
 XIV.— The Royal Sanitary Commission, 1869-71 . • .322 
 
 s XV. — State-Medicine since 1871 : 
 
 i. The Opportunities of 1871-4 353 
 
 ii. Supervision by the Local Government Board . .391 
 
 iii. The Medical Act of 1886 414 
 
 iv. Local Government Legislation, 1888-9 . . .419 
 
 XVI. — The Politics of Poverty . 433 
 
 XVII.— Conclusion 462 
 
CONTENTS. 
 
 TABLE OF PARTICULARS. 
 
 CHAPTER I. 
 
 EAELIEST TIMES. 
 
 PAGES 
 
 Pre-historic Nature, and Man as part of it. Pre-historic Nests of Mankind, 
 and the beginniags of Society. First evidences of co-operative effort: 
 Communal Agriculture ; Communal Food- Stores. Water-supplies : as to 
 quantity ; as to quality. Early drainage and flood-walls. Early dealings 
 with refuse-matter. Question of definite Sanitary Aims : Indian, 
 Egyptian, Hebrew, and Greek 1 — 17 
 
 CHAPTER n. 
 
 THE BOMAN INSTITUTIONS. 
 
 From B.C. 500 : the JEdiles and the Censors. Rome under Augustus : Sewers ; 
 Pavement ; Aqueducts ; Thermae ; Latrines and urinals ; Removal of City 
 refuse ; Streets, and their cleanliness ; Law as to Nuisances, public and 
 private. Regulation of Trade. Medical Profession from Third Century, 
 B.C. ; Privileges allowed to Medical Practitioners; Public Medical Officers; 
 Medical Service of the Poor. Fall of Rome 18—29 
 
 CHAPTER in. 
 
 POST-EOMAN ANAECHY AND THE EE- COMMENCEMENTS. 
 
 Post-Roman obstacles to civil Progress: Warfare; Religious segregation; 
 Spread of Asceticism. Mediaeval revivals not much for aedile uses. New 
 rise of Corporations: municipal, industrial, and scholastic. Sacerdotal 
 Empire. Mediaeval Medicine, and the conditions of Public Health : 
 Leprosy and Leper-Houses ; Pestilences and Quarantine ; Indigence and 
 Famines and squahd life. London in 13th — 15th Centuries : Abatement of 
 Nuisances ; Lepers ; Supervision of Trade ; Supervision of Brothels, 
 Reference to other town-governments 30 — 44 
 
 CHAPTER IV. 
 
 MEDIEVAL PHILANTHEOPY. 
 
 Germs of Philanthropy ubiquitous. Early Christian institutions of bene- 
 ficence. Benedictine Monasteries in relation to the Poor. Francis 
 of Assisi, and his Order, and its Degeneration. Extensive demoralisa- 
 tion imputed to the Religious Orders generally. Mediaeval Mendicancy 
 tending to be ruinous. Criticism of ascetic vows as basis for philanthropic 
 organisation. Surviving gratitude to the Mediaeval Orders . . 45 — 64 
 
CONTENTS. XI 
 
 CHAPTER V. 
 
 TUDOE LEGISLATION. 
 
 PAGES 
 
 The Medical Profession : Physicians ; Surgeons ; Eoyal College of Physicians, 
 and its privileges ; Corporation of Barbers and Surgeons ; Separate 
 Incorporation of Surgeons, eventually as Royal College; Apothecaries 
 supervised by Physicians and Grocers, subsequently incoi-porated, and 
 eventually made a licensing medical authority. Commissioners of Sewers. 
 Previous care against floods; Act of 1532. New Poor-laws. Previous 
 provision for the poor, and against dishonest begging. Extinction of 
 the monastic charities. Principles of the new laws: against "sturdy 
 beggars" and "rogues"; for relief of the "true poor." Elizabethan 
 Acts. Works of Town Improvement 65 — 81 
 
 CHAPTER VI. 
 
 LONDON TrNDER ELIZABETH AND THE STUAETS. 
 
 Streets and Sewers ; Forbidden buildings and crowdings ; Lord Mayor as 
 social discipHnarian ; Maintenance of supplies of Food and Fuel ; Muni- 
 cipal granaries, and the Assize of Bread ; Control of brewery and of sale 
 of Beer ; Oysters. Measures against flesh- eating on fish-days. Repeated 
 visitations of Plague, and the proceedings thereon consequent: 1580-4; 
 1606-7; 1625; 1629-31; 1636; 1663-4. Development of Quarantine. 
 1665-6, The Great Plague. 1666, The Great Fire. The new London. 
 Subsequent facts as to the Public Health. Queen Anne's London . 82 — 106 
 
 CHAPTER VII. 
 
 THE RISE AND EAELY PEOGEESS OF BEITISH PEEVENTIVE MEDICINE. 
 
 The Fathers of Modem Preventive Medicine. Mead. Pringle. Lind. Con- 
 trivances for Ventilation by Hales and Sutton. Captain Cook's applica- 
 tion of hygienic rules. Blane. Baker. Jenuer.' Eighteenth Century's 
 "Alms for oblivion." Early Nineteenth Century publications: Blane 
 (continued) and Thackrah 107 — 127 
 
 CHAPTER VIII. 
 
 THE GEOWTH OF HUMANITY IN BEITISH POLITICS. 
 
 Special influences making for the N'ew Human it t/ of the Eighteenth Century. 
 England in 1738. The Methodists and other religious revivers. The political 
 influences from 1776. Greatly increased popular discussion of principles of 
 govermnent : Altruism in politics : Demands for new legislation. New 
 spirit reflected in the common literature of the time. First efforts and 
 successes in Parliament. Prison Reform : John Howard. India, and 
 Edmund Burke. Negro - slavery : the Quakers and Wilberforce. Ob- 
 structive alarms. Criminal Law : Romilly and Mackintosh. Rush of final 
 
 Summary 128—165 
 
XU CONTENTS. 
 
 CHAPTER IX. 
 
 FIEST EXPEEIENCES OF ASIATIC CHOLERA IN EUEOPE, 
 
 PAGES 
 
 State of Public. Health Government under William IV. Asiatic Cholera in 
 Europe, and in the United Kingdom. Action taken by the British 
 Grovemment : Central and Local Boards for action against Cholera : 
 Central Advice and Orders : Temporary Acts of Parliament. Action by 
 Local Boards. Lessons of the Epidemic. Popular retrospect. Further 
 effects from the period 1830-7 166—177 
 
 CHAPTER X. 
 
 THE HISTOEY OF THE PUBLIC HEALTH LEGISLATION OF 1848. 
 
 Sir Edwin Chadwick. Poor-Law Commissioners in 1838 draw attention to 
 preventable disease as cause of Pauperism : Dr. Neil Amott ; Dr. J. P. 
 Kay; Dr. South wood Smith. Instructions given for General Sanitary 
 Inquiry. Select Committee of House of Commons, 1840. Public Vac- 
 cination established, 1840. House of Commons Select Committee on Burial 
 in Towns, 1842. Reports of 1842 on the General Inquiry ; Mr. Chadwick's 
 General Report, and liis Report on Burial in Towns. Health of Towns 
 Royal Commission, 1843-5. Legislative proposals of 1845. Local Improve- 
 ment Acts. Model-Clauses Consolidation Acts. ParKamentary Proceedings 
 of 1847-8. The General Sanitary Legislation of 1848. Metropolitan Sanitary 
 Legislation. Criticism of the Public Health Act, 1848. Further history of 
 the period, 1838-48. Improvements in the apparatus of drainage. General 
 Register Office: Major Graham; Mr. Wm. Farr. Voluntary Associa- 
 tions 178—213 
 
 CHAPTER XI. 
 
 THE GENERAL BOARD OF HEALTH, 1848-58. 
 
 Persons composing the Board. Responsibilities imposed on the Board. Pro- 
 ceedings of the Board, as reported in 1854 : ordinary administration ; 
 administration regarding Cholera ; Reports on Quarantine ; RejDorts on 
 Burial ; Report on Metropolitan Water-supply, Survey of the Board's 
 general poHcy and special proposals and doctrines : Bias for centralisation ; 
 Projects for intervention in Commerce; Teachings as to district cleanliness; 
 Medical teachings; Burial proposals; Proposals as to London Water- 
 supply. Organised angry opposition to the Board : Defeat of Government 
 in 1854 on Bill to continue the Board : The Board re-constituted on changed 
 plan. Mr. Chadwick's relation to the crisis, and previously, to the public 
 service : Lord Shaftesbury : The moment of wreck. The newly-constituted 
 Board, 1854-8 : Sir Benjamin Hall as President : Cholera Epidemic of 1854 : 
 Legislation of 1855 : Cessation of the Board in 1858. Cholera studies of 
 1848-58. Army Sanitary Refonn, consequent on Crimean experiences : 
 Crimean Sanitary Commission ; Miss Nightingale ; Mr. Sydney Herbert ; 
 Royal Commission on Army Regulations ; Netley Medical School ; Dr. 
 Parkes 214—244 
 
CONTENTS. XIU 
 
 CHAPTER XII. 
 
 THE INITIATION OF MEDICAL OFFICEESHIPS, LOCAL AND CENTEAL. 
 
 PAOBS 
 
 i. The Local Appointments, and Theie Eaely Woeking. — 1847, Liverpool 
 appoints Dr. W. H. Duncan its Officer of Health. Excellent effects 
 from his official activity and influence. 1848, City of London makes 
 a like appointment. Conceptions then had of local sanitazy business. 
 Routine followed in the City office ; Weekly proceedings ; Annual 
 reports. 1854, Survey of the public needs as to sanitary government. 
 Relations of the City office to the General Board of Health. First holder 
 of the City appointment translated to the Central Office. 
 
 ii. The Centeal Appointment, and Its Eaely Woeking.— First central 
 appointment began with undefined purpose and doubtful stability. 
 1856, Report on London relation of Cholera to water-supply, 1857, Pro- 
 ceedings and Papers relating to Vaccination. 1858, Reports on Sanitary 
 State of the People of England : Legislation for the Medical Profession : 
 The PubHc Health Act, 1858. The Perpetuating Act of 1859 : Mr. Lowe, 
 now Lord Sherbrooke 245—278 
 
 CHAPTER XIII. 
 
 the medical depaetment undee the peivy council. 
 
 Nature of the Privy Council's Jurisdiction. The Council's Medical Machinery. 
 1859-68, First Series of Proceedings relative to Vaccination. 1858-71, Series 
 of Proceedings for General Sanitary Purposes. Epidemic outbreaks, and 
 Nuisances causing alarm. 1859-65, Systematic Investigations, throughout 
 England, as to the habitual diseases and their circumstances. 1864, 
 Specialised National Statistics of Fatal Diseases. 1864-6, Appeals for 
 better sanitary law : as to Nuisances endangering health ; as to Contagions 
 of Disease ; as to Industrial Diseases ; as to Deaths of Infants ; as to 
 Practice of Pharmacy, 1866, The Sanitary Act. Other Acts of the period : 
 Union ChargeabiUty, 1865 ; Merchant Shipping, 1867 ; Pharmacy, 1868. 
 Weaknesses still continuing in the law. Continuation of departmental 
 proceedings : 1867, Reports on Cholera of 1865-6 ; Report as to the 
 Sanitary Effect of Town -Improvements hitherto made ; Special further 
 inquiry into distribution of Phthisis. 1868, New Vaccination Law to be 
 applied. 1869, Further Treatment of pressing questions. Pharmacy. 
 "Animal" Vaccination. 1870, Proceedings relative to the constitution of 
 the Medical Profession: Lord Rip on 's Bill. 1871, Great Epidemic of 
 Smallpox : House of Commons Select Committee on Vaccination : Ad- 
 ministration regarding Smallpox. Renewed threatening of Cholera : 
 Introduction of new system of Port-Defence. Organisation of the Medical 
 Department : The Staff strengthened : Laboratory Investigations. De- 
 velopment of the Registrar-General's Quarterly Returns of Deaths. Steps 
 for further development of the Medical Department., July, 1871 . 279 — 331 
 
 CHAPTER XIV. 
 
 THE EOYAL SANITAEY COMMISSION, 1869-71. 
 
 1868-9, Unsystematic state of the sanitary laws and jurisdictions. Memorial 
 for appointment of Royal Commission. Commission appointed, and takes 
 evidence. 1871, the Commission reports. Abstract of the Report, and 
 
XIV CONTENTS. 
 
 PAGES 
 
 opinion on some of tlie Recommendations : Proposed consolidation of 
 central responsibilities : Proposals relating to Local Officerships of Health : 
 Previous theory of such appointments : General desirability of the Oifice, 
 but doubtful details in the Commission's Scheme for it : Evident need for 
 caution as to any universal requirement in the matter. The Commission's 
 General Scheme of Reform accepted by Government. The Legislation of 
 1871. Mr. Stansfeld made President of the new Board. Composition of the 
 new Department : The former Poor-Law Oifice, and its medical relations : 
 The former Local Government Act Office : The Medical Department 322—352 
 
 CHAPTER XV. 
 
 ENGLISH STATE MEDICINE SINCE 1871. 
 
 i. The Oppoettjnities of 1871-74. — (1) The Office of the Local Government 
 Board. — (2) The Local Appointments : Course which Mr. Goschen had 
 proposed : Mr. Stansfeld obtains imperative enactment. Communications 
 with local authorities as to appointments : The medical appointments 
 actually made : Preponderance of petty appointments : The large-area ap- 
 pointments : Stint of required assistance in the large areas : Distribution of 
 Parliamentary funds in part-payment of officers : General result in regard 
 of the appointments. — (3) The Lnspection of Local Sanitary Government. 
 Relations intended by the Royal Commission: Proposals for larger cor- 
 rective jurisdiction. Powers independent of legal compulsion. Problem 
 of sanitary supervision : Principles on which to define the duty : State of 
 the case in 1873 : Presumable need for supervisory medical service, and 
 Fp,cilities which existed for its application. Paramoimt claim for Effective- 
 ness. The system established under Mr. Stansfeld. Genei'al Inspectors. 
 Opinion on the system which was estabHshed. 
 
 ii. Supervision by the Local Government Board.— Personal changes 
 in the Board and its Medical Department. Annual Reports of the Local 
 Government Board : Absence of information on national sanitary progress : 
 Exceptional activity, 1884-86. Current working of the Local Govern- 
 ment Board ia sanitary matters : Scientific Progress in the Medical Depart- 
 ment : Consolidations and Instructional Memoranda : Advances in new 
 scientific discovery. 
 
 iii. The Medical Act of 1886. — Particular case requiring an amendment in 
 the Act of 1858: Opposed reformatory legislation impossible: New 
 provisions of law : Doubts as to their finality. 
 
 iv. Local Government Legislation of 1888-89.— Act of 1888 important for 
 sanitary objects. Parts of the Act relating to Officers of Health. Provision 
 for transfers of power from Central Departments to County Councils. 
 Policy of decentralisation requires careful distinction of cases : Variety 
 of the powers now centralised: Consequent differences of principle in 
 questions as to decentralisation. Question of decentralising control-powers : 
 Are local autonomies meant to be absolute ? — Question of sub-centralisation 
 of control-powers. Control-relations to defaulting local authorities. 
 — Act of 1889 for the Notification of Infectious Disease . . . 353—432 
 
 CHAPTER XVI. 
 
 THE POLITICS OF POVERTY. 
 
 Recent movements regarding Poverty. Housing of the Poor. Associated 
 questions : Eaming-power as compared with needs of life ; "Wages ; Land, 
 
CONTENTS. XV 
 
 PAGES 
 
 rural and urban. Parliamentary study of special cases. Auxiliary work by 
 "Volunteers. Prominent facts as to London Poverty : Automatic influences 
 pressing downwards : Laws against extreme sanitary consequences left 
 unapplied. The sanitary neglect, in its bearing on the commerce of the 
 case. Philanthropy in relation to the supply of dwellings. Extremes of 
 poverty without near likelihood of escape : Lives of the poorest of the 
 working classes in towns : Questions of remedy : Certain conditions of the 
 evil are unalterable. Self-help must be able to rely on just laws and just 
 administration of the laws. Questions of State-assistance. Question of 
 State-control. Questions of Private Charity. Question of supplementing 
 the Elizabethan law by safe-guards against wanton Pauperism . 433 — 461 
 
 CHAPTER XVIL 
 
 CONCLUSION. 
 
 The past half- century's progress, and the stage now in course. Science 
 relatively to law and to popular education. Popular standards hitherto 
 veiy imperfect in taste for cleanliness, and in sanitary knowledge and 
 sense of sanitary duty. Question of enforcement of responsibility for 
 sanitary wrong : damages ; misdemeanors. Wilful wrongs in local govern- 
 ment : ought to be prevented by local opinion in local elections. Agencies 
 by which sanitary knowledge has to be wrought into popular usefulness. 
 Public Health Acts do not exonerate from rules of personal hygiene. Care 
 for Public Health an essential joiiit-f actor in civilisation, claiming concert 
 with other factors. Analogies and affinities between the different branches 
 of civilising endeavour. Genuine national education the common hope of 
 all social reformers. Our present civilisation as a whole : Conditions of 
 progress now operating : in the growing self-helj)f ulness of the proletariat ; 
 and in the growing sense of socialistic duty. Sursum Corda . . 462 — 487 
 
 ERRATA. 
 
 Page 145, last line of text, the note-mark "t" ought to follow the semicolon. 
 Page 163, line six, for " organised" read " organising." 
 
 ,, ,, footnote, line two from bottom, for " Jellaby " read " Jellyby." 
 Page 243, footnote, line thirteen from bottom, for ^'Roukioi" read " Renkioi. 
 
ENGLISH 
 
 SANITARY INSTITUTIONS. 
 
 ^axt first*— iisrTRODucTioi!^. 
 
 CHAPTER I. 
 
 EARLIEST TIMES. 
 
 The Student who would trace from its beginning the progress of 
 Human Sanitary Endeavour has to look back beyond the genera- 
 tions which have made fame for themselves by chronicles and 
 monuments. He has to recognise that, in relation to the pro- 
 gress he would trace^ even the oldest social institutions regard- 
 ing healthy and the oldest mechanical constructions expressing 
 sanitary purpose, can only represent to him a stage which is 
 already far removed from the earliest. In times when no branch 
 of human progress had yet become subject-matter for what is com- 
 monly understood as History, in times when even historians were 
 yet but among the possibilities of the future, human sanitary 
 endeavour had learnt its first lessons, and was exhibiting its first 
 successes. Those first lessons and first successes, essentially pre- 
 historic in the ordinary sense of the term, left their evidence in 
 what is called Natural History. They left, as their biological 
 record, the fact that mankind survived. 
 
 To the Bioloffist who views from pre-historic distance the Pre-iiisto- 
 
 ° IT'/. nc Nature, 
 
 subsequent series of recorded human laws and contrivances for and Man as 
 health, these figure themselves only as details in the more de- 
 veloped exercise of a function which lives through all living 
 nature; the self -preservative instinct or intention, wherewith 
 each individual and each race maintains^ as it best can, its 
 
^ ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. I. separate struggle for continuance. The fact that, from remote 
 
 Earliest i-j.-i_- j_ - e ' \. • i. i. 
 
 Times. pre-historic time, certain races or organic beings nave been per- 
 sistent inhabitants of the earth, implies that against those races 
 disease has been but a limited power ; and, in the absence of 
 reason to the contrary, the Biologist takes for granted that the 
 conditions under which that limit has stood have throughout 
 been in general analogy with the conditions which now are. He 
 supposes, namely, that each race at each stage of its being has 
 had its own susceptibilities of disease, and has had around it in- 
 fluences which, in relation to those susceptibilities, have been 
 hostile or morbific ; that, though the particular susceptibilities 
 may not always have been exactly those which the races at 
 present show, nor the particular causes of disease always iden- 
 tically those which now operate, the antagonism in its essence 
 has always been there, a struggle for victory on one side or the 
 other ; and that, therefore, so far as life is a fact on the earth, 
 each living race represents, nob only more or less success achieved 
 against the competition of other races, but also more or less 
 success achieved against the physical hostilities which make 
 disease. With what degree of consciousness the function of 
 sanitary self-defence may have been exercised, what may have 
 been the instinct or the science concerned in it, what apparatus 
 of nature or of art may have been its instrument, — these, to 
 the biologist, are questions of but secondary importance : ques- 
 tions merely as to the detail of means by which the sur- 
 vival has been enabled to result. 
 
 In that biological point of view, and, for the moment, not 
 caring to distinguish between historic and pre-historic stages of 
 development, we assume that human sanitary endeavour has sub- 
 sisted continuously from earliest to latest times, and that man- 
 kind, in no stage, however early, of existence, can ever have been 
 without glimmerings of health-protective purpose. The exact 
 forms in which some such self-protectiveness would have shown 
 itself among the earliest representatives of our race, the particular 
 steps of quest or avoidance which it would have dictated, must 
 have depended on the local and other conditions (necessarily un- 
 known to us) in which men's earliest struggles with nature were 
 going on. We can only, in general terms, imagine that those 
 earliest efforts related to needs which we now know as universally 
 
INTRODUCTION. 3 
 
 human in respect of food, temperature, terra firma, &c. ; and to Chap. I. 
 the particular dangers which human health first experienced within Times, 
 those broad categories of requirement. The pangs of dying by 
 hunger and thirst, the poisonousness of certain foods and waters, 
 the fatality of certain sites, the hardships and dangers of extreme 
 heat and extreme cold, the destructiveness of floods, the sterilising 
 effects of drought, such, in various combination, may be supposed 
 to have been familiar conditions to the beginners of the human race : 
 the primordial field of physical evil, where man first became con- 
 scious of inclination to escape disease, and learnt ways by which 
 he partially could do so. It may be that immense quantities of 
 human life went to waste while comparatively few survivors, the 
 representatives of successful effort and so-called natural selection, 
 were slowly accumulating and transmitting their earliest lessons 
 of experience in that field of painful labour. The aboriginal 
 struggle is not even yet exhausted ; nor is it yet so uniformly 
 advanced on all parts of the earth's surface, but that, still, in 
 various of the parts, early stages (as it were) of the process are 
 yet to be seen : in parts, for instance, where even now the 
 struggle of human life for nourishment is hardly less rude than 
 that of the brutes ; or in parts where man endures such extremes 
 of temperature as in themselves are an ordeal of life ; or in parts 
 where, because of intense malaria, only special branches of the 
 human race can thrive. If we survey the earth and its inhabi- 
 tants with such inequalities as now are, and read that range of 
 local differences as if the differences were in succession of time, 
 we get suggestions towards apprehending in what circumstances 
 of physical struggle the multiplication of mankind must have 
 occurred, and amid which the individual man would have received 
 his first rude teaching to be on guard against influences physically 
 harmful. 
 
 In argument it may seem to be but one step further of con- Pre-histo- 
 jecture, when the student, who has speculated on the early physio- mankind, 
 logical relations of mankind, proceeds to speculate on the flrst rise ^ngs'^S^" 
 of Sanitary Institutions. It is easy to conceive that, in proportion society. 
 as men came into social aggregation, they must have seen that 
 they had certain life-interests in common, and would naturally 
 have conspired with each other for joint action, or for mutual 
 B 2 
 
4 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. I. service or forbearance (according to the nature of the case) in 
 Times. relation to each such interest. But be it noted, that this 
 step of speculative argument is across an incalculably wide 
 interval of time. Large aggregations could hardly have been 
 possible to any parts of the human race till immense progress 
 had been made by them from such earliest conditions as they 
 had to undergo ; and the progress must already have advanced 
 far before it could even begin to leave permanent foot-marks. 
 The masters of geology, carrying us back in these respects to a 
 distance infinitely beyond the reach of other archseological 
 methods, but which probably is but a small way in the whole 
 natural history of mankind, show us evidences of savage human 
 life divided by enormous intervals of time from the evidences of 
 even incipient socialisation. Man, as the geologist first finds him, 
 the troglodyte flint- chipper, who inhabited Europe in its alternate 
 glacial and interglacial pleistocene times, for ages with the 
 reindeer and other arctic animals, for ages again with the great 
 pachyderms which we know as African — he, apparently without 
 agriculture, without domestic animals, without pottery, without 
 metal, having for tools and weapons only his broken flints, and 
 such implements as with their aid he could cut from wood and 
 horn and bone, would have been almost as predatory towards 
 his fellow-men as towards the other wild nature amidst which 
 he struggled for continuance ; and except where the local con- 
 ditions as to food were most favourable, mere procreation could 
 hardly have had more effect to make village-communities of 
 human beings than to make village-communities of bears or 
 foxes. Gregariousness of life seems to have been somewhat 
 easier to the early savage who "drew his food chiefly from 
 the sea than to the contemporary hunter of land animals; 
 but, even with sea-board, tribes, the limits of amicable co- 
 residence would probably soon have been reached; and large 
 communities could hardly have existed till the comparatively 
 advanced stage when man had become more or less agricultural, 
 and had begun to domesticate certain sorts of animals. During 
 that unmeasured time, the existence of man on the earth did 
 not involve the existence of considerable societies of men ; and 
 though afterwards no doubt men could have aggregated more 
 easily, and in favoured centres may have done so without inter- 
 
INTRODUCTION. 5 
 
 ruption, it would seem that aggregations o£ mankind in quantity Chap. I. 
 and strength enough to leave social mark may have been but xSnel 
 comparatively recent phenomena in the developmental progress 
 of our race. 
 
 Within that nebula of times which human records do not First evi- 
 pretend to reach,, and on which science can only speculate in co-opera- 
 terms of the widest generality, the social institutions which *ive effort 
 eventually emerged into history began their embryonic existence ; 
 and for reasons which have been stated, it would seem that, 
 among such beginnings, one of the earliest to assume definite 
 form must have been the conspiration of aggregated men to 
 amend, in the circumstances common to them, the conditions 
 which they found dangerous to their lives. The first heroes in 
 that defensive strategy (like most other first heroes) are uncom- 
 memorated. As the historian of the art of war, when his 
 researches have reached back to a certain remoteness of antiquity, 
 has to admit, with Horace and Byron, that ''^ brave men were 
 living before Agamemnon,^^ so, in the archaeology of our subject- 
 matter, it must be admitted that Social Acts of Sanitary Self- 
 defence are of older date even than iEsculapius. Not with 
 record of the first movements of organising process, nor with 
 power to perpetuate the names of first organisers, but with silent 
 vitality towards times to come, social institutions began their 
 destined growth ; and when at last they became defined enough 
 for history, their stage of incipieney had become myth. They 
 appear to us with a sort of abruptness. Human life is already 
 far away from its rudiments. Men have long since come to live 
 numerously together in places of fixed residence, and have 
 learnt that in such circumstances they must regard certain of 
 their physical requirements as interests of joint concern, to be 
 dealt with by the community as a whole. Already, in their 
 urban clusterings of population, they have institutions which 
 relate to common supplies of food: and already, where the 
 locality requires it, they have institutions of common defence 
 against floods. 
 
 The proverb which describes necessity as the mother of Communal 
 invention is illustrated in the earliness with which signs of ture. 
 
6 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. I. thoughtful method appear in social institutions concerning supplies 
 Times. OF FOOD. In times while ancient Europe was yet but among the 
 fates of the future, — while the shores and islands of the ^Egean 
 Sea had not yet begun to reflect,, if even yet to receive, the first 
 faint touches of that morning light which they afterwards raised 
 into noon-day for the human intellect, — while '^the eye of Greece ^^ 
 was not yet there to see, — while, perhaps, not even the lispings of 
 Greek mythology were yet to be heard, — already in some distant 
 motherland, Aryan or pre- Aryan villagers had concerted a 
 characteristic system of communal agriculture : a system, which, 
 in progress of time, conveyed and diffused by successive civilising 
 streams of Aryan migration^ became the long-subsequent early 
 land-custom throughout Europe : a system, which (as eminent 
 modern investigators have shown) is still to be identified in India 
 among populations perhaps first in descent from the village- 
 communities which invented it ; while in the records and usages 
 of Europe it may also in all directions be traced, and even in 
 ome cases down to the present time, as a family likeness, trans- 
 mitted equally in all the main lines of pre-historic Aryan descent."^ 
 
 * For the piirpose of my passing mention, I need only refer to the late 
 Sir Henry Maine's deeply-interesting volume of Oxford Lectures; Village 
 Communities in the East and West: London, 1871. Taking the Teutonic 
 townships as illustrations of the Aryan system, each such township, he 
 says, "was an organised self-acting group of Teutonic families exercising a 
 common proprietorship over a definite tract of land, its Mark, cultivating its 
 domain on a common system, and sustaining itself by the produce" (p. 10). 
 The domain was in " three parts : the Mark of the Township or Village, the 
 Common Mark or waste, and the Arable Mark or cultivated area. The 
 community inhabited the village, held the common Mark in mixed ownership, 
 and cultivated the arable Mark in lots appropriated to the several families " 
 (p. 78). "The rights of each family over the Common Mark were controlled or 
 modified by the rights of every other family. . . . When cattle grazed on 
 the common pasture, or the householder felled wood in the common forest, an 
 elected or hereditary ofl&cer watched to see that the common , domain was 
 equitably enjoyed" (p. 79). The cultivated Land appears almost invariably 
 to have been divided into three great fields, each to lie fallow one in three 
 years. In each of the three fields, each householder had his own family lot, 
 which he tilled by his own labour and that of his sons and slaves. He could not 
 cultivate as he pleased. He must sow the same crop as the rest of the 
 community, and allow his lot in the uncultivated field to lie fallow with the 
 others. "Nothing he does must interfere with the right of other households 
 to have pasture for sheep and oxen in the fallow and among the stubbles or the 
 fields under tillage " (p. 80). The details were minutely particular and com- 
 plicated. 
 
INTRODUCTION. 7 
 
 I£ families in their early village grouping had found concert ^^^- L 
 and method necessary in the agricultural relations of f ood-supply^ Times, 
 there was a further necessity which_,in proportion as towns grew up, 
 could not fail to make itself felt in regard of food, as demanding rood- 
 a new sort of common action. In the then state of the world, ^*°'^®^- 
 namely, when war between neighbouring communities was habitual, 
 and when private commercial enterprise was hitherto undeveloped, 
 urban populations, as they enlarged, must soon have come face 
 to face with occasional grave dangers of scarcity and famine, and 
 must have seen that against these dangers they had to organise 
 special means of security. In order that any such aggregate of 
 population should at all times be able to obtain food, and to 
 obtain it on tolerable conditions, commissariat-action had to be 
 undertaken on its behalf : supplies of food, especially the in- 
 dispensable cereal supplies, had to be accumulated for it in Public 
 Store-Houses y whence (under conditions) they would be distributed 
 in the common interest ; and this food-interest was of such sort 
 that inevitably it became in each city a chief charge of the 
 supreme authority. Wherever there is early history of cities, we 
 see evidences of food-storage on that footing; and as soon as 
 city-officers, with differentiation of duty, make their appearance 
 in history, officers, acting in relation to corn-stores and corn- 
 distribution, appear among them. 
 
 Water-supply, in sufficient quantity, was always of impera- Water- 
 tive necessity for man, and tolerably easy access to water must as^o 
 always have been among the first considerations in choosing a q^^^^^^y 
 site for human settlement. As the communities grew in size 
 and became less savage, larger and larger quantities of water 
 would be used by them; and mechanical devices, by which 
 streamlets might be brought close to each dwelling or group of 
 dwellings, would come more and more into demand. Artificial 
 conduction of water, in enlargement and adaptation of natural 
 supplies, would soon, in many situations, be of almost imperative 
 necessity; and various rude forms of water-service, such as we 
 still see prevailing among remote uncivilised populations, may 
 probably have been the first local improvement-works of pre- 
 historic village-communities. 
 
 As regards the quality of water-supply, we cannot know ^^^^ 
 
8 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. I. whether our pre-historic ancestors were at all fastidious in 
 Times. preferring the clean to the unclean. [That such preference 
 might have been strongly marked in cases where option was 
 open, is, perhaps, not in itself unlikely; but it would not 
 therefore follow as probable, that the preference, in cases 
 where it existed, was a preference on sanitary grounds ; nor 
 can we suppose that [sanitary motives were of any appreciable 
 force in those early times to protect local water-supplies from 
 pollution. Where the populations abstained, so far as they could, 
 from polluting streams which gave common water-supply, more 
 probably this was under sanction of a religious sentiment which 
 we may regret that our after-times have not retained. If 
 nothing more, it is at least an interesting parenthesis in the 
 sanitary records of mankind, that various higher races in their 
 early times, and in some cases more or less permanently, have 
 professed special religious reverence for the running waters of 
 their country. How far the sentiment may have prevailed 
 among the less historical races cannot be said ; but among the 
 best- known branches of Aryan stock, as notably in India (where 
 it still holds sway) and in the successively organised parts of 
 Europe — Teutonic, Hellenic and Italic, and probably also Slavonic 
 and Celtic, it seems to have been general. To the early Greeks 
 who eminently held it, and whose literature and traditions have 
 made the world familiar with it in innumerable forms of beautiful 
 fancy, it was part of a general nature-worship, but not on that 
 account the less impressive. There, the whole popular mind was 
 pervaded by feelings of piety, at once tender and fearful, towards 
 the beneficent adorning powers which were deemed alive within 
 the fabric of Nature. The dome of sky, the sun and moon and 
 stars, the hours of day and night, the winds and clouds, the 
 valley-river and the mountain-stream, the sea^s ever-varying 
 dualism of strength and beauty, the earth and its lovely moving 
 forms, and its joyous harvests of olive and corn and grape, all, 
 under countless names, were of immediate divine presence and 
 actuation. Among those innumerable objects of natural piety, 
 none could have been nearer to the daily lives of the people, nor 
 any fitter (as one may imagine) to fix reverent and affectionate 
 thought, than the powers of running water, which the local 
 religion impersonated as River-God and Naiad : he, the patriarch, 
 
INTRODUCTION. 9 
 
 strong and masterful for good and evil, so solemn, so symbolic, ^'^^- 1- 
 as with gleaming surface he paced majestically toward the sea, ThneT. 
 beholding and remembering all things ; and she, so bright and 
 pure in her maidenhood, so sweet in her helpfulness, almost the 
 playfellow and pattern of their children, as she leapt downward 
 with happy laughter from rock to rock, or glided with soft 
 murmur through the olive-grove. Under other mythologies men 
 have found it fitting to profane with nameless abominations the 
 nature-powers which they have neither loved nor feared : their 
 "Sabrina fair,'-* their "Camus, reverend sire,"'^ their " giant Trent,'^ 
 their '^^ wizard Dee''"'; but among peoples with such religious 
 feeling towards the elements as prevailed among the Greeks, and 
 such as in regard of running water seems to have been universal 
 among the ancient nations of which we have knowledge, deliberate 
 wilful pollution of the river that gave drinking-water would have 
 been an inconceivable impiety and sacrilege. 
 
 Little by little, however, in the inevitable absence of proper 
 mechanical barriers, the streams which passed through populated 
 areas would, by mere gravitation, receive impurity from the 
 adjoining land, and, as time went on, more and more of it : and 
 in circumstances such as these there arose a case for artificial 
 supply. Whether those circumstances alone, apart from the need 
 for larger quantities of water, were of great influence in leading 
 to the construction of aqueducts, may be doubted. Townsmen 
 would not have waited for ^sop^s fable to give them a hint that, 
 going to fill their buckets at the river, they had better go above 
 the town than below it; and with feelings, not exclusively of 
 indolence, but often of lingering superstitious affection, the 
 riverside population would continue to drink from the river 
 when all its old divinities had fled before the encroachments of 
 Venus Cloacina. It is pathetic to read in Lancisi how, in the 
 Eome even of his day, there survived the old religious fondness 
 for Tiber water : just as, in our own time and country, sanitary 
 reformers have again and again had to seem sacrilegious in their 
 protests against this or that Holy Well to which cesspools or 
 burial-grounds have become contributory. 
 
 Mechanical constructions, answering purposes which we Early 
 should now call sanitary, had made considerable progress more flood-waUs. 
 
10 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. I. ^j^^n three thousand years ago. In regard of Nineveh — a city 
 Times. which ^' had almost been forgotten before history began/'' we 
 know from Sir A. H. Layard's famous explorations, that there was 
 an elaborate system of drainage, no doubt essentially rain-water 
 drainage, in the basement of the older palace of Nimroud : a 
 square brick-built main channel, which ran, at three feet depth 
 beneath the pavement of the great hall, to discharge itself into 
 the river at the foot of the mound ; and, opening into that 
 channel, a contributory pipe-drain of baked clay from almost 
 every chamber of the palace : * and that the several terraces 
 of the mound were similarly provided with drainage, f 
 In Europe (so far as we may judge from works yet known) 
 sewer-construction did not begin till some centuries later, 
 but then began with striking effect. In Rome we can to- 
 day see still standing in almost imperishable masonry a vast 
 sewer which tradition counts to have been among the public 
 works of the elder Tarquin nearly twenty-five centuries ago, 
 and with which was connected (probably still older than itself) 
 a system of drainage excavated in all directions in the Quirinal 
 and Capitoline hills. J So again Agrigentum, in the fifth 
 century before the Christian era, was already proud of the 
 sewers which she had provided for herself — marvels of work 
 only second in local interest to the great temple of the Olympian 
 Zeus, and so little **^to be despised for their humbleness of 
 use ^' that they were named by a personal name {Calami) in 
 honour of the city architect, Phseax, who had built them.§ 
 Athens may well be supposed to have had sewers at that time j 
 and indeed in modern excavations made where the Athenian 
 market-place stood, a sewer has been found which competent 
 authorities refer to the age of Pericles. Of even the oldest of 
 the above-mentioned constructions, there is no reason to suppose 
 that they, when first made, were unique in their kind in the 
 world ; nor is their quality such as at all to suggest that they 
 
 * Nineveh and its Remains, vol. ii. pp. 79 and 260-2. See also Sir A. H. 
 Layard's account, publishd in 1853, of the results of his second expedition. 
 
 f Some of those brick-built terrace-sewers have a further architec- 
 tural interest, as showing in cross-section a well-marked pointed arch. See 
 pp. 163-4 of Sir A. H. Layard's second publication. 
 
 X See Dr. Emil Braun, in Annali delV Instituto di Correspondenza ArcheO' 
 logica; 1852: Eoma. § Diod. Sic. xi. 25. 
 
INTRODUCTION. 11 
 
 were of the nature o£ first experiments. Rather it would seem Chap. I. 
 that constructions so admirable in themselves had been preceded, Times?* 
 perhaps for many ages, by a series of less successful attempts in 
 the same kind, and these again by trials (such as will presently 
 be mentioned) whether the purpose of the construction could be 
 obtained by ruder and far easier contrivances. 
 
 And what was the purpose? It is not to be assumed off- 
 hand of any such ancient institution or contrivance, that, because 
 it may have conduced to health, it had its rise in distinct 
 sanitary intention. The interests of health, and the interests of 
 common physical convenience, are in various cases identical ; and 
 it would seem that when early man had provided for his first 
 absolute needs in regard of food and temperature, probably his 
 ingenuity of self-protection was excited to its next positive steps 
 rather by the pressure of certain immediate inconveniences in 
 the physical surroundings than by any far-reaching intention 
 to combat special causes of disease. That, apparently, is the 
 natural sense in which to interpret the great drainage- works of 
 antiquity. As soon as there were communities of fixed residence, 
 the obvious mechanical effects which profuse rainfall can occa- 
 sion must have been among the first evils to call for collective 
 resistance. Especially where certain climates, and certain rela- 
 tions of soil and surface, made men familiar with the frequent 
 swift destructiveness of storm-torrents and floods, and with the 
 incalculable daily hindrances and discomforts of quagmire life, 
 it must from the first have been a pressing question with any 
 collected population, how best they might deal with rainfall in 
 scour and swamp, as with an invading and occupying enemy ; 
 and how, as against it, they might save or reclaim true terra 
 firma for their homesteads and harvests and traffic. Speaking 
 generally of such cases, one may say that artificial water-courses, 
 hard roads for traffic, and more or less pavement about dwellings 
 and in frequented open spaces, were elementary needs of social 
 life. The site of Rome, intersected by its Tiberine swamps, was 
 a well-marked case of the physical circumstances which I have 
 sketched;^ and the cloaca maxima ^ and other drainage-works 
 which won dry land for the ancient city, illustrate the energy 
 
 * " Qua velatra solent in circum ducere pompas, 
 
 Nil prseter salices cassaque canna fuit." — Ovid, Fasti^ vi. 
 
12 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. I. 
 
 Earliest 
 Times. 
 
 with which a vigorous people would defend itself against such 
 circumstances. 
 
 But_, while those ancient sewers express a certain stage of 
 the human struggle for dry land, other laborious monuments, 
 far more ancient than they, attest earlier stages of the same 
 struggle. Remains of such are yet to be seen in Egypt, and in 
 Mesopotamia, and in the Troad : sometimes the remains of 
 trenching, or partially walled canalisation, in easement of the 
 outflow of rivers ; sometimes the remains of embankments and 
 flood-walls, with, here and there, proof of roads having been 
 raised upon them. For instance, as regards Egypt : Herodotus 
 (ii. 99) quotes Egyptian traditions to the effect that Men, 
 first king of Egypt, when about to found the city of Memphis, 
 began by cuttings and embankments which turned the course of 
 the Nile, and secured the future city against inundations. Men, 
 according to modern Egyptologists, may have reigned nearly 
 four thousand years before the Christian era ; and the historian, 
 writing of what he himself saw, when visiting Egypt in the 
 fifth century, B.C., says : '^To this day the elbow which the Nile 
 forms at the point where it is forced aside into the new channel 
 is guarded with the greatest care by the Persians, and strengthened 
 every year ; for if the river were to burst out at this place, and 
 pour over the mound, there would be danger of Memphis being 
 completely overwhelmed by the flood. ^^ In another passage 
 (ii. 124) Herodotus describes a raised causeway which Cheops 
 (at the cost of ten years' oppression of the people) constructed by 
 way of introduction to the building of his great pyramid : a 
 causeway which had to be built out of inundation-reach, and 
 which, although it was only for conveyance of stones, Herodotus 
 found not much inferior to the pyramid itself.^ 
 
 Early- 
 dealings 
 with 
 refuse - 
 matter. 
 
 It cannot be imagined that, in the days when men flrst began 
 to cluster into the nuclei of future urban life, the object of 
 DISTRICT- CLEANLINESS was regarded in the light in which civilised 
 and skilled persons now regard it. Various well-known find- 
 ings of modern archaeology — such as the abundant bony remains 
 in the early cave-dwellings of mankind, and the extensive 
 
 * Bemains of Cheops' s Causeway, and of another, are still existing. See 
 Eawlinson's Herodotus, vol. ii., from which I have quoted. 
 
INTKODUCTION. 13 
 
 " kitchen-middens '* of early sea-side communities, are the now Chap. I. 
 inodorous skeletons, the mere symbols, of what once must have Times. 
 been frightfully stinking heaps of putrid organic matter in and 
 about the homes of our more remote ancestors ; and no one who 
 studies ^^ the past in the present/'' observing the popular habits 
 which now prevail at a distance from centres of civilisation, will 
 suppose that, in even the denser communities of far-off times of 
 the world, much impulse to scavenging arose either in fasti- 
 diousness of the sense of smell, or in apprehensions of danger to 
 health. Movement, languid movement, against indefinite accu- 
 mulations of refuse may nevertheless have had an early beginning 
 in other impulses. Filth and rubbish, when they had accumulated 
 beyond certain limits of quantity within areas of aggregated 
 population, would no doubt have been found mechanically 
 inconvenient, and, if only for that reason, would of course 
 at last have claimed to be removed; but, with regard to 
 some abundant sorts of refuse, prompter removal was often 
 happily promoted by the accident of a second influence. For, ■ 
 from very remote times, the immensely important discovery had 
 been made — (a discovery which even yet has not given to man- 
 kind more than a small share of the benefits which it is capable 
 of yielding) — that animal refuse is wealth in agriculture ;^ and 
 with this knowledge man}'' an early husbandman would have 
 been induced to remove filth from the neighbourhood of his 
 dwelling without waiting for that last moment when its mere 
 bulk would have stopped his gangway. Of filth not removed to 
 the fields, much would naturally from time to time be scoured 
 into the water-courses of the district ; and in any case where the 
 natural water-courses had been superseded or supplemented by 
 artificial conduits, the people of the neighbourhood would no 
 doubt at once take to discharging into these conduits, either 
 directly or by intervening channels, whatever rubbish and 
 filthy refuse they might find it convenient thus to clear aWay. 
 
 * There is incidental mention of doves' dung in the Second Book of Kings 
 vi. 25 : — " There was [? b.c. 893] a great famine in Samaria, and behold they 
 besieged it, until an ass's head was sold for fourscore pieces of silver, and 
 the fourth part of a cab of doves' dung for five pieces of silver; " and in this 
 passage the context suggests that perhaps in the crisis the article was in request 
 for human eating ; but it is certain that, in early Eoman agriculture, doves 
 dung was among the most admired faecal manures. 
 
14 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. I. The fact has above been noticed, that sewers, primarily 
 
 Times. meant for purposes of land-dramage, and adapted m size to 
 the volumes of storm-water which at intervals they had to 
 carry off, became secondarily conducive to the cleansing of their 
 districts. In regard of the Roman sewers, not only does history 
 fail to tell of any time when that double function was not done 
 by them, but indeed their secondary function is that which 
 seems chiefly to have struck the historians who first, many 
 centuries later, wrote of their existence.^ It was, of course, a 
 sanitary gain to the sewered districts that some of their refuse 
 was really carried away by the sewers ; and the time had not 
 yet come for much critical reflection on the masses of refuse 
 which, except perhaps when storm-waters were running, would 
 tend to settle and accumulate in the vast subterranean reser- 
 voirs. The rubbish and filth were at least out of sight. At 
 intervals, at great cost, the hideous work of removing the 
 accumulations could be performed by slaves or indulged con- 
 victs ; t and the magistrate under whose auspices this was done 
 could prove the restored excellence of the thoroughfare by 
 sending up it a laden hay-cart, J or by himself triumphantly 
 boating" down it to the river. § That ancient type of double- 
 functioned sewer has only of very late years ceased to be a 
 prevailing pattern. Fifty years ago, it was still a cherished 
 ideal ; and even at the present day, when no one would pretend 
 to argue in favour of '*^ sewers of deposit/'' the stinks which 
 arise from the gully-gratings in most of the cities of modern 
 Europe are a hint that we have not yet completed our improve- 
 ments on the system of Tarquinius Priscus. 
 
 Question of ^g reffards the date when social institutions of definitely 
 
 defimte o _ ^ ^ -^ 
 
 saiiitary SANITARY AIM first began — that is to say, when communities of 
 Indian, men had first conceived definite opinions as to physical causes 
 
 Egyptian, 
 
 Hebrew, 
 
 and Greek. * See in Livy, i. 56 : — " Cloacam maximam, receptaculum omnium 
 
 purgamentorum urbis;" and in Strabo, v. iii. Si—^vtovo/jlup rSbv dvvafievuv 
 
 iKKXv^eiv TO. Xv/xiuLaTa rTjs iroKecas els rbv Tifiepiv." 
 
 f See Trajan to Pliny, in Epist. x. 41. 
 
 X This is tbe size attributed to the Roman sewers by Strabo, loc. cit., and by 
 Pliny, Hist. Nat., xxxvi. 15. 
 
 § Dion Cdssius (xlix. 43) tells of this as a feat of Agrippa's magnificent 
 aedileship in the last days of the Republic. 
 
INTRODUCTION. 15 
 
 of disease, and first planned to obviate the particular morbific Chap. i. 
 causes by particular lines of counteraction^ — there are few facts Times. 
 to justify positive statement ; but^ such as they are^ they cer- 
 tainly seem to say that marked beginnings were made in days 
 before written history. 
 
 Whether there were any such in early India, can hardly be 
 guessed from evidences which have yet come to light ■* but that 
 beginnings may have been in pre-historic Egypt is not im- 
 probable; for in Hebrew and Greek history, so soon as they 
 begin, Egypt always appears as the relatively civilised and 
 skilled centre, from which the other early civilisations are 
 deriving light. Moses, for instance, is described as " learned 
 in all the wisdom of the Egyptians.^'' And, as regards Medicine 
 in particular, the mention which Homer makes of the Egyptian 
 doctors, as "truly of the stock of Pseeon, and each of them 
 knowing more than all other men together,''-' and the account 
 rendered by Herodotus of the extensiveness and minute speciali- 
 sation of medical practice in Egypt, would certainly, both of 
 them, seem to suggest that Egypt may well, from time imme- 
 morial, have had rudiments of hygienic doctrine, t 
 
 * Early brahminical teaching seems to be fully represented in the Ayur-vedas 
 of Caraka and Susruta ; abstracts of which (particularly of Caraka's more copious 
 work) are given in Dr. Th. A. Wise's Commentarij on the Hindu System of Medi- 
 cine, Calcutta, 1845, and in his later Review of the History of Medicine, London 
 1867. Parts of these Ayur-vedas refer to climatic conditions as affecting health, 
 and other parts inculcate rules of personal hygiene. The rules are especially as 
 to bathing, rest and movement, sexual relations, and, most elaborately, as to 
 diet ; and it is intimated that obedience to the rules, with the use of appropriate 
 elixirs, will prolong human life to hundreds or thousands of years. 
 
 t See Odyssey, iv. 221-2, and Herodotus, ii. 84.— The celebrated Leipzig 
 papyrus which Professor Ebers (whose name is identified with it) believes to 
 have been written in the year 1552 B.C., and j^to represent at least in part 
 originals of very much earlier date, purports to teach the preparation of medica- 
 ments for all ailing i^arts of the human body ; and, out of its about 2,300 lines 
 of hieratic writing, some 28 lines are a setting forth what medicaments are of 
 use in houses, to kill scorpions and lizards, and to keep snakes within their holes, 
 and to limit the thievings of rats and mice and hawks, and to prevent the sting- 
 ing of bees and gnats ; also what Jci/phi are good f umigators, to improve the odor 
 of houses and clothing. See Fapyrus Ebers, Leipzig, 1875. — I do not here enter 
 upon the archaeology of the practice of circumcision ; for — though I of course do 
 not doubt its having been in extensive pre-historic use among the Egyptians 
 and various neighbouring peoples (whether or not derived from the Hebrews is 
 debated among scholars) — I have never found reason to believe that the practice 
 arose in sanitary intention ; and to me it rather looks like a symbolic survival 
 
16 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. I. Be that as it may, important rudiments are very plainly 
 
 Times. expressed in passages of the Hebrew Pentateuch. The system 
 of commands which is set forth in Deuteronomy and Leviticus,, 
 as having been obligatory on the Jews from the beginning of 
 their national existence, has considerable parts to which sanitary 
 intention may be imputed — parts which minutely regulate 
 personal conduct in regard of diet, sexual relations, bodily clean- 
 liness, and the like. And of two of these, in particular, it may 
 be said that, so far as they go, they enforce two of the most 
 important principles of sanitary police : the principle that 
 ground which is to be dwelt upon must be free from accumu- 
 lations of filth; and the principle that persons who have 
 contagious disease must be restricted from common inter- 
 course.* 
 
 Opinions equally advanced may probably have been current 
 among the Greeks before the age of Pericles ; and when Hippo- 
 crates, in writings which were a glory of that age, does not 
 make mention of the disease-producing powers either of Filth 
 or of Contagion, his very noteworthy silence can hardly be 
 understood to mean that he was unacquainted with those powers. 
 It may perhaps rather express that he did not deem it worth 
 while to write for publication what his neighbours in general 
 were knowing as well as he knew it ; and, at any rate, it is 
 certain that the great contemporary historian of the Pelopon- 
 nesian war (said to have been some years senior to Hippocrates) 
 expresses himself in a strongly contagionistic sense, when he 
 
 from larger blood-sacrifices— i?ars p7'o toto. Its very remote antiquity is un- 
 questionable ; and readers of the Hebrew Sacred History in its commonly received 
 versions find an illustration of such antiquity in the operator's (supposedly 
 traditional) use of flint instruments at dates when metal would have been at 
 hand. That illustration, however, is questioned by the learned Egyptologist, 
 M. Chabas, in his litudes sur VAntiquite Eistorique ; his contention being, that, 
 in the adduced passages of Exodus and Joshua, the essential Hebrew term has 
 been misimderstood even by its Septuagint and Vulgate translators, and that^ 
 with the meaning which he claims for it, it does not affirm anything as to the 
 material of the instruments in use. 
 
 * See Deuteronomy xxiii. 12-14 and Leviticus xiii.-xv. I believe it to be the 
 opinion of competent Biblical writers that the Book of Deuteronomy is of not 
 earlier date than the seventh century before our era, and that the first twenty- 
 five chapters of Leviticus belong to an early part of the sixth century ; but, 
 in regard of what my text discusses, the real interest is as to the date of tha 
 law, not the date when the law was put into history. 
 
INTRODUCTION. 17 
 
 writes of the great pestilence which prevailed in Athens early ^^- . 
 in the war, and was the cause of the death of Pericles. Times. 
 
 Of the more remote times of Medicine in Greece, we have 
 only the slight indications which Homer gives. The highly- 
 esteemed ^IrjTpb^ of the eleventh book of the Iliad, ttoWwp 
 avrd^LO^ aXkcov, was not a general practitioner, but a mere 
 chirurgeon, by whom spear-heads were cut out, and balms poured 
 in. An epidemic (as in the first book of the Iliad) was distinctly 
 an affair for the priests. Very noteworthy, however, is the 
 description at the end of the twenty-second book of the Odyssey, 
 how Ulysses, when his vengeance on the suitors was complete, 
 proceeded to cleanse and disinfect the place of slaughter by such 
 washings and scrapings, and especially by such burnings of 
 sulphur, as would be prescribed by a modern nuisance-authority 
 in like circumstances. 
 
18 
 
 CHAPTER II. 
 
 THE ROMAN INSTITUTIONS. 
 
 So far as it is of interest to trace, from old times down to our 
 own, a sort of continuity of progress in tlie development of 
 sanitary institutions, the one line of interest, for many succes- 
 sive centuries, is in the history of the achievements of ancient 
 Rome. 
 B.C. 500-300 In that city was established as early as 494 b.c. the office of 
 the ^diles, — ^' Sunto Mdiles curatores urbisy annona, ludorum- 
 que solemnium;^^ fifty-two years later, the further office of the 
 Censors was established; and before the Samnite Wars had 
 come to an end (nearly twenty-two centuries ago) Rome had 
 planned in all essentials that admirable system of municipal 
 government which in its growth and maturity was to become 
 the most fruitful of patterns wherever Roman colonisation 
 extended. 
 
 To those early times, says Professor Mommsen, there 
 '' probably belong in great part the enactments under which the 
 four -^diles divided the city into four police districts, and made 
 provision for the discharge of their equally important and 
 difficult functions; — for the efficient repair of the network of 
 drains small and large by which Rome was pervaded, as well as 
 of the public buildings and places ; for the proper cleansing and 
 paving of the streets ; for preventing the nuisances of ruinous 
 buildings, dangerous animals, or foul smells ; for the removing 
 of waggons from the highway except during the hours of 
 evening and night, and generally for the keeping open of the 
 communication ; for the uninterrupted supply of the market 
 of the capital with good and cheap grain ; for the destruction 
 of unsound goods, and the suppression of false weights and 
 measures ; and for the special oversight of baths, taverns, and 
 houses of bad f ame.^^ * 
 
 It seems probable that the j^diles, as curatores urhis, had 
 
 * History of JRome, Dickson's translation, book ii. ch. viii. 
 
INTRODUCTION. 19 
 
 not of themselves authority to initiate great constructions at the Chap. n. 
 public cost; but that the Censors, under ordinary or extraordinary Roman In- 
 authorisation by the Senate, took action from time to time in s*i*^*i°^- 
 that larger sense ; and the early period included, as a most 
 important measure of the Censorial class, the establishment of 
 the first of the great Roman aqueducts, the Aqua Appia. Again 
 to quote Prof. Mommsen, — " It was Appius Claudius who in 
 his epochal censorship (b.c. 312) threw aside the antiquated rustic 
 system of parsimonious hoarding, and taught his fellow-citizens 
 to make a worthy use of the public resources. He began that 
 noble system of public structures of general utility, which 
 justifies, if anything can justify, the military successes of 
 Rome when viewed even in the lio^ht of the well-beino^ of the 
 nations ; and which even now in its ruins furnishes some idea 
 of the greatness of Rome to thousands on thousands who have 
 never read a page of her history. To him the Roman state was 
 indebted for its first great military road, and the Roman city 
 for its first aqueduct/' 
 
 It is not possible, nor indeed would it here be worth while, ^°^nA 
 to trace in much detail the successive steps of Roman progress 
 in works and laws which were of concern to health ; but their 
 eventual ripe result so far as we can learn it, and particularly as 
 regards the sanitary conditions of life in the capital itself, say 
 from twenty to seventeen centuries ago, is instructive matter for 
 consideration. The evidence is of course in some respects imper- 
 fect. Only few and far between are the bits of direct narrative 
 or description which bear on the matter. But there are archi- 
 tectural remains; among which, for the purpose of interpretation, 
 one may reckon the remains of Pompeii and some other con- 
 temporary cities. Again, there are instructive fragments of 
 municipal law, such as those which we have in the Heracleian 
 Tables, and those which, with comments of the great jurists of 
 later times, are reproduced in the Pandects of Justinian. 
 Additional knowledge may be got from incidental statements 
 and allusions in the pages of Suetonius, Juvenal, and Martial ; 
 and, in some respects, the Scrip tores Rei Rusticce, notably Varro 
 and Columella, are helpful. In the classical work of Vitruvius, 
 we see probably the best teaching of which the Augustan age 
 
 c 2 
 
20 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Ohap. II. 
 The 
 
 Boman In- 
 stitutions. 
 
 was capable in regard of architecture and its sanitary relations ; 
 and again in the special work o£ Trajan's water-curator, Frontinus, 
 on the aqueducts of Rome, we have the instructive work of an 
 expert. In the passages of Strabo, Dionysius of Halicarnassus, 
 and the elder Pliny, which relate to Eome, we have the language 
 of highly-educated common observers. 
 
 Rome 
 under 
 Augustus 
 
 Sewers ; 
 
 Pavement ; 
 
 Aqueducts; 
 
 Strabo, whose first stay in Rome is believed to have been 
 about the time when Octavian received the title Augustus, 
 was particularly struck with the contrast between it and Greece 
 in respect of the amount of care which the Romans had bestowed 
 on works of usefulness — as especially on pavement and drainage 
 and water-supply. He dwelt with admiration on the great 
 Sewers '^ along which a hay-cart might be driven/' and on the 
 artificial ^^ rivers'' which had been made to pass through the 
 city of Rome, giving an unstinted supply by pipe or (public) 
 fountain to nearly every house, and, as their water at last 
 scoured through the sewers, washing all the filth of the city 
 into the Tiber. 
 
 The Pavement he did not exactly describe ; but if we advert 
 to the admirable system which of late years has been brought to 
 light in the remains of Pompeii — massive closely-fitted blocks 
 and slabs, with step-stones and side-gutters, extending almost 
 universally wherever there were car-ways in the place, we 
 cannot but presume that an equally good pavement must 
 have been general in the capital city ; and this presump- 
 tion is supported by such historical records as bear upon the 
 question. 
 
 At about that time, the Aqueducts of the city were being 
 increased by Augustus from five to seven; soon afterwards, 
 under Caligula and Claudius, two others were added, doubling 
 the previous supply; under Trajan and subsequent emperors 
 further additions were made : and the liberality of distribution 
 may in some degree be illustrated by the statement made with 
 regard to M. Yipsanius Agrippa, that he, in the year B.C. 33, 
 during his magnificent sedileship, supplied the city with 700 
 wells, 150 fountains, and 130 reservoirs. Among the fragments 
 which survive of the older Roman law, none is more emphatic 
 than the command which was intended to protect the public 
 
INTRODUCTION. 21 
 
 water-supplies from pollution : " Ne quis aquam oletato clolo Chap. n. 
 malo uhi puhlice salit : si quis oletarit sextertiorum milliiim Romanln- 
 midcta esto," ^*^*^*^^^- 
 
 Of the Thermce or Gymnasia y tlie highly-developed combi- ThermsB; 
 nations of Bath and Palaestra which imperial Rome adopted 
 from Greek example, the main historical interest is not sani- 
 tary : for they, with all their elaborate apparatus and luxurious 
 adjuncts and means of pastime, were designed rather for plea- 
 sure than for health. The earliest- of them were those which 
 Agrippa opened, B.C. 21 ; and their multiplication and popular 
 importance under the emperors expressed that they were 
 palaces of entertainment, where the sweet considerateness of a 
 Caligula or Nero or Diocletian could gracefully exhibit itself 
 to the people. In that sense they were chiefly characteristic 
 of later times than Strabo^s ; but Balneoe, or public washing- 
 baths of hot and cold water, available on payment only of the 
 smallest coin [res quadrantaria) and at least partially without 
 payment, had become a popular institution in Rome perhaps 
 centuries before the days of Straboj and, at various (both 
 earlier and later) times in Roman history, local benefactors 
 founded, at their own cost, baths which were to be perpetually 
 free to the public. The Laco7iicum or hot-air sweating-bath 
 (said to have been introduced by Agrippa) was an ordinary 
 feature of the TkermcBj and, after the time of their first estab- 
 lishment, became a frequent addition to ordinary public baths, 
 and to the baths of private houses. 
 
 Public Latrines were in general use, at least for the male sex, Latrines 
 and in all likelihood were of two classes. Of some we know urinals 
 that a small payment {quadrans) was required for using them, 
 but presumably others were for gratuitous use. That at 
 least some of them discharged into the sewers is known 
 from the language of contemporary writers ; ^ and that at 
 least some of them more or less resembled the so-called 
 trough water-closets of our own time, in having an ample 
 water-service by which their contents were flushed into the 
 sewers, seems proven by the fact that apparatus of the 
 kind has in several cases been discovered in the remains of 
 
 * E.g.y Columella (x. 85) writing of manures, includes among them 
 " qumcunque vomit latrina chads. ^"^ 
 
22 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. II. Pompeii."^ Independently o£ the public latrines^ urinals for 
 Eomanin- common use were extensively provided in convenient corners of 
 
 the city. 
 Removal ^^ ^^^' ^^ ^^® latrines of Rome did not empty themselves into 
 
 of City ^iie sewers, scavengers and carts were of course needed to empty 
 them ; the carts (in common with the cars which served in 
 religious processions) were allowed certain special privileges as 
 to the hours within which they might frequent the streets of 
 the city ; and as the refuse was much in demand for agricultural 
 purposes outside the urban area, some revenue was obtained by 
 the city from the contractors [foricarii) to whom the scavenging 
 function was assigned. Similarly as to the urinals : Vespasian''s 
 famous non olet (a century after Strabo's time) referred to a 
 small revenue which he sought to raise from those conveniences 
 by farming them on the f oricary plan. 
 
 Other FiltJi and Rnhhish of the city must in the main have 
 been divided between the sewers and the scavengers ; and though 
 we cannot now tell exactly in what proportion the division was 
 made, it seems probable that, directly or indirectly, the sewers 
 must have had the chief part. They, no doubt, were most 
 miscellaneous receptacles : Nero looked to them to swallow from 
 time to time the corpses of citizens whom he had playfully 
 stabbed during his night-rambles — Inclihundiis nee sine pernicie 
 tamen, or the effigies of athletes whom he envied ; f and besides 
 the various slop-waters which they received by branch-drains 
 from private premises of the better sort, filth of all sorts brought 
 in vessels from the neighbouring houses would have been abun- 
 dantly discharored into them, 
 and their Judging by some modern analogies, we might infer that a 
 
 clean- considerable amount of filth was to be found, as in transit, on the 
 
 liness ; 
 
 Roman pavement : but against any such state of things, there 
 
 was imperative legal prohibition which the sedile was required to 
 
 enforce. It is true that Juvenal, when enumerating (in his 
 
 * See Overbeck's Fompen. Mr. Edward Cresy, in his general study of 
 the Architectural Antiquities of Rome, included an elaborate investigation of 
 the drainage of various Roman public buildings; and in 1848, in his evidence 
 before the Metropolitan Sanitary Commission, he gave a particular account of 
 the drainage of the Coliseum at Rome, and the amphitheatres of Verona and 
 Ntmes. See First Report of that Commission. 
 
 t See Suetonius's Nero, sections 26 and 24. 
 
INTRODUCTION. 23 
 
 third satire) the reasons for which his friend Umbricius declines Chap. II. 
 to continue resident in the city of Rome, mentions among them Roman in- 
 those diversa joericula noctis which consisted in the miscellaneous 
 out-throw from windows on to passing heads : but a consider- 
 able liability to be xanthippisecl during a night- walk within city- 
 boundaries was not unknown in London or Edinburgh under the 
 Georges, nor in Paris under Louis-Philippe ; and even the 
 Londoner of to-day may sometimes be pointedly asked, like the 
 Roman contemporary of Petronius, Quod pur g amentum node 
 calcdsti in trivia. 
 
 It appears that Nero, after the great Roman fire at which he 
 did his famous '^ fiddling," promoted a new plan of construction 
 for houses and streets : viz., that houses should no longer be 
 allowed to have walls in common, but should be required each 
 to have complete walls of its own, and that the streets instead 
 of being of their former narrowness (and such as we know to 
 be now in general favour in southern climates) should be made 
 considerably wider. Question, however, seems at once to have 
 been raised whether the latter change was not of disadvantage 
 to health.^ 
 
 Objects such as we of late years have aimed at by our various Law as to 
 
 T^J'iimfiiTi OPS 
 
 Nuisances-Removal Acts, and other statutes of allied purpose, pubHcand 
 were in Rome regarded as of two classes : either they were, or P^'^**®- 
 they were not, recognised as questions of common concern. 
 
 [a) For such as were so recognised, there were express pro- 
 visions of law, chiefly in praetorian edicts, and it was for special 
 public officers to enforce the enactments. Such were certain 
 laws, recorded to have been on the Decemvirile Tables : the law 
 that no dead body should be buried in the city, and the law that 
 every landowner building a horfse on his land must leave, towards 
 the adjoining properties, an ambit of at least 2J feet width of 
 the land unbuilt upon. Such further was the law, already 
 referred to, which strictly prohibited the casting of filth or. 
 rubbish into the common way : '^ptthlice enim interest sine metu 
 et periculo per itinera commeari'^ : and such again was the other 
 
 * Tacitus writes : — " Erant qui erederent veterem illam fortnam salubritati 
 mac/is conduxisse, qiioniam 'angtistia itinerum, et altitudo tectorum non perinde 
 solis vapore perrumperentur ; at nunc patulam latitudinem, et nulla umbra defensam, 
 graviore cestu ardescere.*^ Ann. xv. 43. 
 
24 ENGLISH SANITARY INSTITUTIONS. 
 
 9?^- ^' law whicli has been quoted, providing for the protection of the 
 Eomanin- public fountains. Such, moreover, were various laws which 
 existed, and some of which still survive, while others can be 
 indirectly traced, with regard to the construction and mainten- 
 ance of public ways and sewers and aqueducts, and to their 
 protection from injury, and to the rates which might be levied 
 for any of them, either generally or in case of special privilege. 
 Thus, a cloacarium and a payment /;/*<? aquae forma are both named 
 in the Pandects ; and the mention seems to indicate that while 
 the cloacarium was a general rate, payment joro aquce forma was 
 only due in the exceptional case of a distinct /br^^zd^ being allowed 
 to private premises. 
 
 {b) So far as questions of nuisance did not concern the 
 common interests of the public, but were local questions between 
 neighbours, seemingly they all fell within scope of the Roman 
 law of so-called servituSy and must have admitted of prompt 
 adjudication under the Praetor's authority. In the Pandects there 
 are declarations of law on points of reciprocal right as between 
 neighbours in town and country, in very various matters of 
 servitus : as in relation to rainfall and rain-outflow, to support of 
 beams and buildings, to approaches of drains and aqueducts, to 
 heightening of walls, to overhanging constructions, to interference 
 with lights, to interference with prospects, to location of lay- 
 stalls, to passage of smoke, and so forth ; and in reading in the 
 Pandects the deliveries of the great jurists on those questions 
 (deliveries which for the most part were particular applications 
 of the existing prsetorial and other written law) it is impossible 
 not to see that they cover, in principle, the whole area of nuisance- 
 law so far as it is of contest between private persons. 
 
 Regulation A second important class of functions concerning the public 
 health in Rome, during the centuries to which this chapter has 
 . particularly referred, was contained within the ^dilian super- 
 intendence of Commerce, The iEdiles had in general to see that 
 commodities offered for sale were of honest quality, and were sold 
 of honest weight and measure ; and they had also, in respect of 
 certain commodities, to regulate the standard of price. Whether 
 the last-named intervention between buyer and seller gave more 
 advantage in the then state of society than it would be expected 
 
INTRODUCTION. 25 
 
 to give in present times^ is a question on which I need not enter; Chap. ii. 
 but at least as regards the others, and especially in relation to Roman In- 
 the purchase of food and other necessaries of life, the people ^*^*^*^o^- 
 must probably have found it an unmixed advantage to have 
 those facilities for obtaining immediate redress against fraud in 
 the quantity or quality of things sold to them. 
 
 During the last two centuries of republican institutions in Medical 
 Rome, a distinct Profession of Medicine was acquiring extent and from third 
 importance."^ The practice of medicine had always been open to ^^c. ^^^' 
 any who chose to profess it, but had seldom been entered on by 
 f reeborn citizens of the Republic, and to a large extent was in 
 the hands of persons who were or had been slaves. Opulent 
 Romans would commonly have, as part of their establishment, 
 slaves who had been trained in Medicine, and who apparently 
 often represented high degrees of efficiency in the Medicine which 
 then was ; and, with a view to such employment, rich Romans 
 would sometimes at their own cost cause certain of their boy- 
 slaves to receive a medical education. The non-servile practi- 
 tioners of medicine were principally Grreek ; and during the last 
 two centuries of the Republic, the number of these practitioners 
 was constantly on the increase ; for, notwithstanding the 
 emphasis with which the elder Cato warned his countrymen 
 of the dangers to which the State would be exposed in thus 
 depending on the aid of foreigners. Medicine had been among 
 the chief of those arts by which ^^ captive Greece ^^ took possession 
 of its Roman captor ; and the names which come down to us in 
 Roman history, as those of great medical practitioners and teachers 
 during the late republican and earlier imperial centuries, are 
 almost without exception Greek. Celsus is believed to have been 
 a Veronese Roman; but Archagathus, Asclepiades, Athenseus, 
 Dioscorides, Soranus, Rufus, Archigenes, Aretseus, Galen, and 
 the chief of their respective followers, were of Greek (mostly 
 Greek- Asiatic) origin ; and under their auspices, before the end 
 of the second Christian century. Medicine in Rome had reached a 
 development at which it was to serve the world, for the next 
 
 * The following hrief notice of the Roman Profession of Medicine is chiefly 
 founded on the elaborate account which is given in the first book of Haeser's 
 admirable Lchrbiwh der Geschichte der Medizin. 
 
26 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. II. thirteen or fourteen centuries,, with but little important increase. 
 
 Eomanln- As early as within the first Christian century, all sorts of medical 
 specialties seemed to have been cultivated as separate branches 
 of practice; there were oculists, dentists, aurists, mulierists, 
 hydropists, fistulists, &c. ; while likewise a very extensive practice 
 of pharmacy (or of medicine from a pharmaceutical basis) had a 
 great variety of specialties, some for herbs and roots, others for 
 ointments, others for eye-washes, &c. Among the various sorts 
 of practitioners were women as well as men, and the legal 
 tribunals seemed to have recognised female obstetricians as ex- 
 perts. In the Roman cities, there seems to have been from old 
 a general adoption of the Greek system of larpeia, or optn shops, 
 or ^^ surgeries,^' for the dispensing of extemporaneous medical 
 and surgical treatment. These Tabernce Mediccey as the Romans 
 called them, differed widely from one another in rank ; some 
 being mere barbers' booths of not very reputable sort, while 
 others were such as might be served by the first practitioners in 
 Rome j "^ and it seems that some of the more important tabernce 
 were able to receive in-patients. Except in that rudimentary 
 sense, nothing in the nature of a hospital seems to have existed 
 in Rome before the second century of the Empire ; but in that 
 century Antoninus Pius (a.d. 138-161) appears to have estab- 
 lished a more definite hospital in connection with the temple of 
 iEsculapius on the Tiber-island opposite the Campus Martins. 
 
 It does not appear that the professors of Medicine made any 
 speciality of the Prevention of Disease ; but a general intelligence 
 on the subject had been shown in such non-medical writings as 
 those of Yarro. In those times, as in our own, the popular 
 desire to be free from disease expressed itself in two different 
 ways : on the one hand, there were the admirable public works 
 of pavement, drainage, and water-supply; and on the other 
 hand, there were special temples to Dea FehriSy Dea Mephitis^ 
 Bea Scabies, Dea Angerona, &c. 
 
 Privileges The settlement of foreign medical practitioners in Rome 
 
 Medical had been encouraged by the grant of special favours to them by 
 rac ition- j^j^^^g Csesar and the earlier emperors : the first having given 
 
 ers. 
 
 * It appears for instance that when Archagathus settled in Eome (about 
 218 B.C.) the senate, besides giving him the freedom of the city, provided for 
 him a taberna in a situation convenient for practice. 
 
INTliODUCTION. 27 
 
 them status as citizens,"^ and the emperors having given them Chap. II. 
 larger and larger privileges. The latter system was begun by Komanln- 
 a law of Augustus, that medical practitioners should be exempt s^^^^^^o^^- 
 from certain ordinary civil obligations; and it was continued 
 and extended by the laws of succeeding emperors_, till at last 
 Hadrian completed the immunity by exempting medical prac- 
 titioners from every sort of onus civile, whether patrimonial or 
 personal. Considerably before Hadrian''s time_, however, there 
 apparently no longer was any need of a forcing-system to 
 multiply the medical practitioners in Rome ; for before the end 
 of the first Christian century, they were in such excessive 
 numbers, that, according to Martial, the less-employed among 
 them were willing to lend a hand to the next-door function of 
 corpse-bearing at funerals, or would even (more remotely from 
 their profession) be ready to officiate as gladiators. f Such being 
 the over-crowdedness of the Profession, Hadrian''s next successor, 
 Antoninus Pius, found it prudent to restrict to a certain number 
 of practitioners, in each centre of population, the immunities 
 which had been so lavishly granted ; and from the date of his 
 law, the medical immunity from local burdens might not be 
 held by more than five practitioners in small cities, nor more 
 than ten in even the largest ; while also, in general, the immu- 
 nity could not be claimed by practitioners migrating into new 
 districts. 
 
 Long before Hadrian^s time, and at least to some extent Public 
 within the republican centuries, Roman cities had had the officers, 
 practice of appointing Medical Officers for public purposes. 
 Whether medical practitioners at large, in return for the exemp- 
 tions which they had enjoyed, had been expected to render 
 certain public services, Such as that of medical assistance to the 
 poor, cannot be positively said ; but it seems certain, that, when 
 the number of imimmes was limited by law, certain public 
 duties were made to accompany the privilege ; and that, in this 
 way, the Roman cities acquired the class of officers who after- 
 wards became distinguished by the name of ArcUatri Pojoidares. 
 About seventy years after the date of Hadrian's law, an im- 
 
 * Suetonius, Caesar, section 42. 
 
 t See, in Libr. i. the epigi^ams 31 and 48, on Diaulus tui-ned vespillo, and in 
 Libr. ^iii. the epigram 74, on the eye-doctor who had tmned hoplomachtis. 
 
28 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. II. portant step in relation to those grants of medical privilege was 
 
 Roman In- taken by Alexander Severus. He, namely, enacted, that future 
 
 stitutions. gj.aQ|;g q£ ^]jg privilege should be made on local responsibility, 
 
 and the responsibility was assigned by him ordini et posseg- 
 
 soribus cujusque civ it at is ; in expectation, as his law expresses 
 
 it, that they who were most interested would make sure of the 
 
 probity and skill of the persons to whom they had to entrust 
 
 their own and their children's lives. 
 
 Medical It is not possible to trace with exactness the development 
 
 Service of 
 
 the Poor, of this Roman institution of urban medical officers, but an 
 extremely interesting picture of it, as it existed at a compara- 
 tively late period in the city of Eome, is furnished in a memor- 
 able edict of Valentinian and Valens (a.d. 364-375) regulating 
 for the city the appointment of those district officers. Each of 
 the regiones of the city, except the gladiatorial regio of the 
 Portus Syxti, where the gladiators had a medical officer of their 
 own, and except the similarly privileged regio of the vestal 
 virgins, was to have its local medical officer: who, knowing 
 himself to be paid by salary for attending to the poor, must 
 (says the edict) think of them rather than of the rich ; and \vho, 
 where there is question of fees, must take as his standard, not 
 what men fearing for their lives will promise, but what men, 
 recovered from sickness, will offer ; and when a vacancy occurred 
 among these district medical officers, the filling of it was not to 
 be by favour, or on solicitation of magnates ; but the remaining 
 district officers, omnium fideli circtimspectoque delectu^ are to 
 propose a man who shall be worthy of their ranks, and of the 
 dignity of the office, and of the emperor's approval. Curious, 
 but not unparalleled, inconsistency : that the people which could 
 so worthily conceive the institution of a medical service for the 
 poor, should still be enjoying, as a chief public pleasure, the 
 spectacle of gladiatorial homicide ! 
 
 Fall of After the issue of that interesting edict of Valentinian and 
 
 Valens — (the main purposes of which may perhaps previously have 
 been more or less attained under other imperial constitutions 
 or under municipal authority) — Roman legislation originated 
 nothing more which can be deemed of interest to our subject. At 
 that date, indeed, the final cataclysm of the Roman Empire, 
 
INTRODUCTION. 29 
 
 the overwhelming southward rush of the neighbouring northern Chap, ii 
 races, had all but begun; and within fewer than fifty years, Eomanln- 
 Alarie was to be master of the mother-city. Long and long stitutions. 
 ago, there had passed away from all the more characteristic 
 institutions of Rome, perhaps not yet to the last trace that un- 
 equalled genius for government which had called them into 
 being, but at least all the lofty public spirit which for centuries 
 had had that genius as its instrument. And now, over the 
 merely continuing flaccid forms of Roman government, the 
 stupendous storm of change in which eventually the life of 
 modern Europe arose, was for other long centuries to prevail : 
 submerging and stifling, and at last, in its own way, re-animat- 
 ing : a revolutionary cycle of such effect, that, considered in 
 relation to the history of mankind, it suggests less thought of 
 the conscious labour of human forecast and wisdom than an 
 analogy with the unconscious transformatory acts of embryonic 
 life, superseding in individual organisms the parts which have 
 done their temporary use : but in the present case a process so 
 extensive, both in space and time, that it may rather be com- 
 pared with the great geological changes which have given out- 
 lines to our seas and continents, and have raised mountain ridges 
 from within the deep. 
 
30 
 
 CHAPTER III. 
 
 POST-ROMAN ANARCHY AND THE RE-COMMENCEMENTS. 
 
 Attention has been drawn to the facts o£ Roman antiquity, 
 because the influence of the Roman institutions was so wide- 
 spread and so strong. From the Atlantic to the Caspian, from 
 Ethiopia to the Tweed, whatever urban civilisation existed 
 during the ages of Roman ascendency was due to the direction 
 or example of Rome. Over all that '^ fairest part of the earth,^^ 
 the mother-city taught her own rules of municipal government, 
 and shewed her own standard of the works which are for urban 
 convenience. It would be idle to speculate what might have 
 been the further progress of those local institutions, if some 
 centuries more of life had been allowed them. By the actual 
 events they had been rendered little better than a mere false 
 start in civilisation. With the Roman Empire wrecked as a 
 political system, and with its cultivated area given over for 
 centuries to the wars and pillage and destructiveness of successive 
 hordes of barbarians, no prosperous continuance of the former 
 institutions was possible. And though in some cases the forms 
 of municipal government were not extinguished, or, if so, were 
 soon (perhaps under changed names) revived, all disposition to 
 advance in the old lines of Roman progress was dead, and the 
 costly constructions of the former time were not even preserved 
 from ruin. Here and there, now and then, at intervals far 
 apart in time or space, some one Theoderik or Karl or Alfred 
 would for a while keep the conditions of chaos aloof from within 
 the range of his rule : but the resting-time would be too shoi-t 
 for repair : the end of the one heroic rule would too soon come ; 
 and then again the powers of darkness would roll back their in- 
 exorable wave. True, that, after the time when ancient Rome 
 died out of Italy, and wlien successive Goths and Huns and 
 Vandals had begun their ravages and revelries in the land, 
 Constantinople, for yet a thousand years, represented in her 
 own mortmain way some of the traditions of the broken empire ; 
 
INTRODUCTION. 31 
 
 but out of that millennium of decay nothing of initiative interest ^^Y' ^^^' 
 to the arts of government could come. The famous compilations Roman re- 
 of Roman law under Justinian did indeed establish for the meuts. 
 benefit of after-times a grand and enduring monument of the 
 genius of the Rome which had passed away ; but the municipal 
 records of modern Europe, though they largely reach back into 
 times when the Byzantine Empire still existed, are sundered by 
 an interval of centuries from times when Roman rule was of 
 effect in sanitary institutions. 
 
 Throughout Europe, during that long interval, not only did ^P^^*" 
 the circumstances forbid any particular care for sedile objects, obstacles 
 but they often were even straining to the utmost all ordinary progress; 
 bonds of social union. After the ending of the old Roman R^n^fo^ug' 
 dominion in its western area, while powers of warfare and con- ^^^J^^^^^" 
 fusion were alone acting in succession to it, and while the in- 
 stability and repeated subversions of civil government were 
 rendering society chaotic, a further disintegrative influence came 
 into action. Altered modes of religious thought were tending 
 on a considerable scale, not merely to make men profoundly in- 
 different to those objects of civil government with which this 
 narrative is concerned, but to detach them altogether from 
 society. In the new light of Christian morality, the recollection 
 of latter-day Rome, with all its monstrous sensualities, and with 
 all the variety of corruption which had rotted away the greatness 
 of the Empire, was of course in the utmost degree loathsome and 
 abominable : and now, as if by generalisation from that ex- 
 perience, there seemed to arise a distrust even of the social state 
 itself ; an alarmed and agitated consciousness of the temptations 
 which society offers for the commission of certain sorts of wrong ; 
 a desponding belief that civilisation (as then understood) could 
 only develop the worse, and blight the better, of the possibilities 
 of the nature of man. In the eastern seats of early Christian 
 teaching, feelings like those would from the first have been in 
 powerful harmony with locally-existing pre-conceptions which 
 ascribed holiness to solitary life ; and with progress of time, as 
 Christianity spread, such feelings acquired wider and wider in- 
 fluence. On the one hand, there was that growing tendency to 
 deem civic life less worthy of man than spiritual meditation in 
 
32 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. III. hermitage or monastery ; while, on the other hand, was the fact 
 
 Post- ■. , , , 
 
 Roman re- that, except m hermitage or monastery, escape could hardly be 
 menSf^^^' found from the consequences of social disorder, and the riot of 
 clashing secular ambitions ; and those considerations were enough 
 to draw into seclusion large numbers of persons who might have 
 been useful workers in the social commonwealth. Still more, 
 when monastic orders were established, and their respective con- 
 vents promised to be not mere places of meditation, but centres 
 of religious teaching, and of active beneficence towards the poor 
 and sick, no wonder that, in the then state of the world, those 
 resorts seemed to be the sole and very sanctuaries of good, and 
 attracted to themselves not only large masses of indifferent human 
 material, but undoubtedly also a large proportion of what was 
 purest and noblest in the time. That such communities, through- 
 out the darkest of the dark ages of Europe, were the sole 
 guardians and transmitters of all existing knowledge and learn- 
 ing, and that from within them issued in after-times most of the 
 better light by which Europe was to construct a new civilisation 
 for itself, seems to be beyond question true : but it would seem 
 not less certain, and is matter which here needs to be remem- 
 bered, that the monastic spirit could hardly consist with much 
 care for the physical requirements of towns and cities, and that, 
 for a thousand years from the fall of the Western Empire of 
 Rome, the diffusion of that spirit was in favour of leaving to 
 ruin and decay the signally useful constructions which the elder 
 civilisation had left behind it. 
 
 Intimately mixed with the tendency to monastic life, and 
 developed by much the same influences with it, was the tendency 
 to think slightly or spitefully of the human body, and to under- 
 rate its reasonable claims for wholesome treatment. The body 
 no doubt had been the spoilt child of imperial Rome, and a 
 frequent fate of spoilt children was now to come to it in the 
 form of neglect and humiliation. In reaction from the Roman 
 tkerm^j associated as in memory they were with the whole fabric 
 of Roman luxury, bodily cleanliness fell out of favour, and a 
 cult of bodily uncleanliness began ; while also, in reaction from 
 the Roman sumptuosities of food and clothing, the most meagre 
 diet and the poorest dress were deemed the fittest for all men to 
 adopt. In the impulse towards austerer forms of life, just as 
 
 Spread of 
 asceticism. 
 
commence- 
 
 INTRODUCTION. 33 
 
 in the impulse to fly from society, those early puritans adopted ^^^^- HI- 
 with singular ease the extreme patterns which previous Eastern Roman re- 
 superstitions had already from long beforehand prepared for menSf 
 them. Not content with mere sobriety of life, many of them 
 zealously adopted fanatic exaggerations which treat the physical 
 man as fit only to be physically punished, or perhaps, better 
 still, to be exterminated. For innumerable enthusiasts in such 
 directions, it was not enough to be careless of bodily ease and 
 comfort, but the powers of the body must be studiously reduced 
 by pitiless rigors of starvation ; and the body, which starvation 
 had emaciated, must be further submitted to the elaborate cruel- 
 ties of deforming restraint or bloody self -chastisement. Similarly, 
 with remembrance of what had been vicious and often unutter- 
 ably foul in the sexual life of Kome, as depicted by the Roman 
 satirists for the everlasting aversion of mankind, honest wedlock 
 forsooth, was now not to be deemed contrast enough ; but the 
 marriage-tie itself was to be held unclean, and the propagation 
 of the human race an irreligion.* It is hardly needful to observe 
 that the spirit of asceticism, as here described, was even less 
 likely than the merely monastic spirit to be interested in favour 
 of the sanitary appliances of urban civilisation. Devotees who 
 were aghast at the notion of contributing to propagate the 
 human race could not be expected to care very much whether 
 existing members of the race were kept alive. And while an 
 unwashed verminous state of body and clothing was accepted as 
 of moral merit, there could be little hope that sewers would not 
 be let stink, or that the qualities of public water-supplies would 
 be cared for. 
 
 for ffidile 
 uses. 
 
 During^ many centuries succeeding' the fall of the Western Mediaeval 
 
 . - , . . , . revivals 
 
 Koman Empire, the monastic system, combining the two m- not much ^ 
 fluences which have been described, grew into greater and 
 greater dominion in Europe; and it was only after the begin- 
 ning of the sixteenth century that some of the governments of 
 Europe began to resist its extension or continuance. Long 
 before then, however, the life of modern Europe had begun 
 
 * EngKsh readers will remember in the Fourth Book of Paradise Lost (lines 
 736-775) the fine burst of indignation in which Milton says his say on the 
 subject of ascetic celibacy. 
 
34 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. III. 
 Post- 
 
 Boman re- 
 commence- 
 ments. 
 
 New rise 
 of Corpo- 
 rations : 
 municipal, 
 industrial, 
 and 
 scholastic. 
 
 to bud in many centres of development ; and new municipal 
 institutions had gradually acquired shape and solidity, as the 
 basis on which systems of local police in matters concerning 
 health might afterwards sooner or later be reared. In propor- 
 tion as something like orderly life began again to be known in 
 centres of population, and as new governments were here and 
 there showing themselves fairly able to promise a continuance of 
 social security, feelings, if not yet of nationality in the larger 
 sense, yet at least of local fellowship, and of joint duty towards 
 places of joint residence, began again to operate. The rude 
 institutions which first manifested themselves were probably in 
 great part resuscitated from languid remnants of Roman life, 
 though resuscitated with Teutonic differences. The functions 
 which began again to be exercised with regard to the keeping of 
 towns and the conduct of trade were such as in Rome the ^Ediles 
 had exercised ; ^ and the constructions which were to be found 
 in towns for purposes more or less sanitary could hardly till long- 
 subsequent times have been anything else than the neglected 
 and more or less dilapidated remains of Roman aqueducts and 
 sewers and pavements. 
 
 Infinitely more important than any mechanical constructions 
 inherited from Rome, was the invaluable bequest which modern 
 Europe received from Roman law, in the pregnant idea of 
 Corporations : artificial organisms, to be invested with perpetual 
 regulative powers for special purposes, municipal and other : and 
 it would be difficult to over-estimate the advantage which our 
 country in particular derived from its Teutonic applications of 
 that Roman idea, — first, in reference to the incorporation of 
 local authorities for purposes of Local Government, and secondly, 
 in reference to the creation and development of Trade-Guilds 
 and of Colleges for the promotion of learning. As the mediaeval 
 centuries passed, objects of that kind presented themselves more 
 and more to minds which were capable of appreciating their 
 
 * Probably much which came to be accepted as law by custom, and was then in 
 various cases confirmed by charters or other formal enactments, had had its origin 
 in the institutions of Rome. In our own case, certain facts of early municipal 
 interference with the sale of bread look extremely like signs of continuation from 
 Roman aedileship in places of former Roman settlement. See, as regards Chester 
 and Newcastle, Professor (now Bishop) Stubbs's collection of Select Charters and 
 other Illustrations of English Constitutional History. 
 
INTRODUCTION. 35 
 
 mportance ; and seeds were more and more copiously sown Chap. ni. 
 which, even to our present day, are yielding fruit. But when Eoman re- 
 at length those mediaeval growths began to rise, it was into an ^"^^"^®' 
 atmosphere utterly changed from the civic atmosphere of ancient 
 Eome. During the previous long futility of all forms of secular 
 rule, and as against any possible new Caesar who might arise. Sacerdotal 
 there had come into prevalence an authority of rival consti- ^"^P"^®- 
 tution ; and when civic life began to re-assert itself in Europe, 
 there was over it that second and shadowy Roman Empire 
 which had meanwhile grown up in relation to the spiritual hopes 
 and fears of mankind : the sacerdotal dominion, which (as Hobbes 
 describes) had '' started, as a ghost, out of the ruins of the former 
 heathen power, and was now sitting crowned on the grave 
 thereof/^ To that new empire the arts of peace, as one by one 
 they came into flower and fruit, had long to devote their best 
 produce. From the eleventh to the sixteenth century, such civic 
 energies as could be spared from the necessities of war and trade 
 were spent almost wholly in the building and decoration of 
 churches ; and the universities, though not always of ecclesiastical 
 origin, were almost always of ecclesiastical animus. In a world 
 preoccupied and surcharged with that spirit, the old Roman con- 
 ception of how cities should be physically cared for was little 
 likely to germinate afresh ; and though in important places, 
 there often arose town-halls and other like buildings enough to 
 show that the renascent civilisation had some cognisance of 
 secular interests, the proportion of thought vouchsafed to sani- 
 tary ordinances and constructions remained everywhere at the 
 lowest level. 
 
 That the ten dark centuries, by which the age of Attila and SSneJ 
 Genseric was separated from the auroral epoch of Gutenberg and and the 
 Columbus, had not in them anything of the nature of modern of Public 
 Medical Science, and did not originate anything of importance to ^®^^*^ \ 
 the progress of scientific medicine, is a fact which hardly needs 
 to be stated ; and medically speaking, the only important fact 
 in the five centuries which preceded the sixteenth, was the growth 
 of popular apprehensions with regard to Contagions of Disease. 
 
 First, in apparent connexion with the Crusades (1100-1300) ^^f£^^er- 
 came the greatly extended diffusion of Leprosy in Europe. Houses; 
 
 D 2 
 
tine: 
 
 36 ENGLISH SANITAKY INSTITUTIONS. 
 
 Chap. III. Previously the disease had not been quite unknown here : for 
 Eoman re- notices of it (to far smaller extent) in Europe go back to the 
 ments. fourth century, and in the sixth and seventh centuries there were 
 already leper-houses in France and Lombardy : * but with the 
 now greatly extended presence of the disease, there came a panic. 
 Each leper was regarded, not only with physical aversion as 
 capable of causing to others a loathsome disease, but equally 
 with superstitious horror as bearing (it was believed) the brand 
 of a curse from Heaven ; and this double feeling rapidly led to 
 a system, not cruelly meant, but often most cruelly appiiea, 
 under which lepers were set under strict social ban, and were 
 forced to endure their miserable remains of life apart from com- 
 munion with their fellow-men. History has few more pathetic 
 passages than its record of the religious services with which 
 lepers were bidden to inhuman exile. Then, again, those were 
 Pestilences emphatically the times of the great pestilences, which are his- 
 Quaran- torically famous as the Epidemics of the Middle Ages ; and the 
 terror of which gradually led, from the middle of the fourteenth 
 century onward, to the establishment of such quasi-military de- 
 fences and precautions as are known by the name of Quarantine. 
 When the Black Death had reached South-Eastern Europe at 
 the end of 1346, and had rapidly spread in parts of Italy, the 
 city of Milan, which did not suffer till 1350, was said to have 
 kept out the disease so long by the exercise of extreme strictness 
 as to its communications with other places j and the example of 
 Milan seems to have been followed elsewhere ; at first per- 
 haps only against the same terror, but afterwards more generally 
 against the frequent danger of ordinary Levantine Plague.t 
 Venice, which with its large eastern commerce was peculiarly 
 exposed to the latter risk, and which as far back as the thirteenth 
 century had shewn itself aware of sanitary interests, took the 
 lead in attempting permanent defences against plague : in 1423 
 it established its first lazaretto , and in 1467 an extended new 
 one; in 1485 it created a permanent health-magistracy, to which,. 
 
 * See Haeser, vol. iii. pp. 76 and 82. 
 
 t Haeser, vol. iii. p. 187. Thus, in 1374, strict rules against dangers of 
 contagion were put in force at Reggio, Calabria ; and about a century later 
 (1471) Majorca seems to have had a complete system of quarantine against- 
 plague. 
 
INTRODUCTION. 37 
 
 in 1556, offices o£ superintendentsliip were added ; and with this Chap. hi. 
 machinery it enforced regulations which at the time were of Romau re- 
 his^h repute in Europe.^ commence- 
 
 o r r ^ ^ ments. 
 
 As regards the general sanitary circumstances of life during indigeuce 
 the centuries and in the countries here under consideration, an 2?^ . 
 
 . . . ' Famines 
 
 essential fact is that, during most of the time, for most of and squalid 
 the populations, indigence and the miseries which attend it 
 prevaled in very terrible proportions. The description which 
 Gibbon (ch. xxxvi.) gives of the wretched state of Italy under 
 Odoacer, immediately after the fall of Rome, would no doubt, at 
 any moment of the middle ages, have been substantially appli- 
 cable to large parts of the area of Europe. Warfare indeed 
 hardly shews itself more cruel in the deaths and mutilations of 
 those who take part in it, than in the wide-spread desolation 
 which is about its path ; nor is the sacking of towns and cities 
 more calamitous in effect than the ruin which armies bring upon 
 agriculture. In those times, too, with comparatively difficult 
 communication between the parts of the world, regions which 
 by war or weather had lost the produce of their fields could 
 not always at once, if at all, procure help from the sufficiency or 
 surplus of other regions, but must probably for a longer or 
 shorter time endure degrees of privation which endangered life. 
 Till at least the turning-time of mediaeval anarchy (a time which 
 was not the same for all countries) slavery, or some status of 
 villenage hardly distinguishable from it, was the lot of a great 
 part, perhaps generally of the chief part, of the population : in 
 regard of Gaul, for instance, under Karl the Great, it is recorded 
 that nine-tenths of the population were slaves : f and for such 
 servile or quasi-servile quantities of population, probably the ordi- 
 nary means of subsistence were the poorest which would keep body 
 and soul together. It is horrible to imagine what must have 
 been the sufferings of mediaeval populations when times were in 
 any way harder than ordinary : when the very frequent periods 
 of scarcity, when the not infrequent periods of famine, intensified 
 
 * See Romania's Storia documentata di Vetiezia ; yvliere also account is given 
 of other early sanitary endeavours of Venice. A particularly interesting pass- 
 age (ii. p. 397) describes how Venice, in 1293, set about establishing a public 
 medical service somewhat after the notion of the Roman Archiatri Populares. 
 
 t See Kitchen's History of France, book ii. part ii. ch. iii. section iii. 
 
do ENGLISH SANITARY INSTITUTIONS. 
 
 P^^* ^^^* ^^^ir poverty to the utmost ; when freemen, in despair o£ bread, 
 Eoman re- would surrender themselves and their children to be slaves : 
 ments. when hunger would culminate in cannibalism ; when even 
 human flesh might be for sale in the market-place.^ It is 
 recorded of France that, out of the first seventy-three years of 
 Capet reign, forty-eight were years of famine. f Of the frag- 
 ments of the Western Roman Empire, England was perhaps that 
 in which the mass of the people soonest came into fairly constant 
 average comfort, as measured by the standard of other countries ; 
 but from the whole range of mediaeval history, it would be 
 difficult to select a more dreadful picture of ruin and misery 
 than is given of the state of Scotland at the close of the four- 
 teenth century. J The sanitary bearing of such facts is surely 
 not far to seek. The poverty which involved so much privation 
 of food involved, we may be sure, in even far higher degree, 
 privation of domestic comfort, and privation of wholesome clean- 
 liness ; and amid such circumstances, disease, and physical in- 
 capacitation resulting from disease, must have prevailed on an 
 immense scale. No doubt the ordinary diseases of the poor (as 
 distinct from the special fevers which may be regarded as part of 
 famine) were of much heavier incidence in those times than in 
 these. Filth-diseases of all sorts must have been everywhere. 
 Scurvy abounded. Ague of great severity was among the 
 commonest of diseases, and the poor would have been peculiarly 
 liable to its attacks. Not least, from the time when leprosy 
 came to be of wide diffusion in Europe, this new disease, with 
 the cruel social consequences which attached to it, seemed to fall 
 largely on the mass of the people in proportion as the other 
 disadvantages were weighing them down. 
 
 London in 
 13th- 15th 
 centuries. 
 
 It would require too much archaeological labour to accumu- 
 late many exact descriptions of the sanitary circumstances of 
 urban populations during the mediaeval times ; but, as to the 
 later of those times, we fortunately have at hand excellent illus- 
 trations of the circumstances of our own metropolis. For the 
 
 * See Hallam's View of 
 part ii. and its note xv. 
 
 State of Europe during the Middle Ages, ch. ii 
 
 t Hallam, in the note above-mentioned. 
 
 X See Buckle's Sistory of Civilisation in England, vol. ii. ch. ii. 
 
INTRODUCTION. 39 
 
 London Corporation o£ the present day has, with judicious Chap. hi. 
 liberality, published an extensive series of extracts from the Roman re- 
 early Archives of the City, to serve as Memorials of London and commence- 
 London Life in the Y^th \^tli and l^t/i Centuries ; and with the 
 help of that extremely interesting volume, the preparation of 
 which was the work of the late Mr. Henry Thomas Riley, we 
 can fairly enough discern how our ancestors were managing 
 London in sanitary respects during the period of nearly a century 
 and a half to which the Memorials relate.* 
 
 The Guildhall series opens characteristically with a two- Abatement 
 sectioned regulation made in 1281 ; by the first section of which sances. 
 — because that regratresses, nurses, and other servants, and 
 women of loose life, bedizen themselves, and wear hoods furred 
 with gros vair and with minever, in guise of good ladies, there- 
 fore the wearing of furred hoods is restricted to such ladies as 
 wear furred capes : while the second section provides that swine 
 shall not " henceforth be found in the streets,''-' or, if so found, 
 shall '' be killed, and redeemed of him who shall so kill them, 
 for fourpence each.'" Soon afterwards (1297) the law against 
 pigs was made stricter : such pigsties as were in the streets were 
 to be removed ; and wandering pigs were to be forfeited '^ in 
 aid of making the walls and gates/'' The bell-bearing pigs of 
 St. Anthony^s House were exempted from these laws; and 
 (1311) trouble seems to have been caused by pigs which falsely 
 pretended to be within that religious privilege. Offensive trades 
 were dealt with : tallow-melting (1283) was no more to be 
 allowed in Chepe; tailors (1310) were not in daytime to scour 
 furs, except at the utmost (if for the King or other great lord) 
 " in some dead lane, when no great lords are passing, either going 
 or coming '' : flaying of dead horses in the City or suburbs was 
 (1311) no longer to be allowed : the continuance of plumbers' 
 solder-melting in Eastcheap was (1371) made conditional on 
 raising the shaft of the furnace : eventually (as recited in a 
 Royal Order 1371) all slaughtering of oxen, sheep, swine, and 
 other large animals was banished by law from the City and 
 
 * With regard to the ancient sanitary relations of Southwark, as generally 
 with regard to the archaeology of that part of London, much information will be 
 found in Mr. William Rendle's interesting volume, published in 1878, under the 
 title. Old Southwark and its People. 
 
commence- 
 ments. 
 
 40 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. III. suburbs to no nearer tban Stratford-le-Bow and Knightsbridge. 
 
 Eoman re- -^^^ maintenance o£ street- cleanliness, every man (1297) bad to 
 keep clean the front o£ bis own tenement ; and tbe casting of filth 
 from houses into the streets and lanes of the City was (1309) 
 prohibited and made sharply punishable. What then was to 
 become of this filth ? At first (1309) people ^' ought to have 
 it carried to the Thames or elsewhere out of the town ;^' but in 
 those times^ as in our own, the carrying power of the Thames was 
 limited, and it is instructive to observe how soon our forefathers 
 had to launch themselves into new endeavours. In 1345, the 
 filth at Dowgate dock makes the Thames water there no longer 
 serviceable to the commonalty, and four carters are sworn as 
 scavengers to cleanse the dock of dung and other filth and to 
 keep it cleansed : in default of which they are to be sent to 
 prison. In 1357 a Eoyal Order, addressed to the Mayor and 
 Sheriffs, tells how the king, Edward III., passing along the 
 river, had " beheld dung and laystalls and other filth accumulated 
 in divers places in the said City upon the bank of the said river,'''' 
 and had " also perceived the fumes and other abominable stenches 
 arising therefrom : from the corruption of which, if tolerated, 
 great peril, as well to the persons dwelling within the said city 
 as to the nobles and others passing along the river, will it is 
 feared arise unless indeed some fitting remedy be speedily pro- 
 vided for the same''^: and the Order forbids the continuance 
 of practices as above, and requires proclamation to that effect to 
 be made : whereupon a new Order for the preservation of cleanli- 
 ness in the city is proclaimed : and part of it prescribes that 
 " for saving the body of the river, and preserving the quays 
 ... for lading and unlading, as also for avoiding the filthines3 
 that is increasing in the river and upon the banks of the Thames, 
 to the great abomination and damage of the people,-*^ there 
 shall henceforth no rubbish or filth be thrown or put into the 
 rivers of Thames and Flete, or into the Fosses around the walls 
 of the City, but all must be taken out of the City by carts. In 
 1372, the King again addresses the Mayor Sheriffs and Aldermen 
 of the City : complaining that " rushes, dung, refuse, and other 
 filth and harmful things " . . from City and suburbs are thrown 
 into the water of Thames, so that the water aforesaid and the 
 hythes thereof are so greatly obstructed, and the course of the 
 
INTRODUCTION. 41 
 
 said water so greatly narrowed^ that great ships are not able, as Chap. m. 
 of old they were wont, any longer to come up to the same City, Roman re- 
 but are impeded therein : and the writ strictly enjoins immediate ^SS^^*'^" 
 measures to amend this state of things, and to prevent recurrence : 
 ^' so behaving yourselves in this behalf, that we shall have no 
 reason for severely taking you to task in respect hereof ; and 
 this, as we do trust in you, and as you would avoid oiar heavy 
 indignation and the punishment which as regards ourselves you 
 may incur, you are in no wise to omit.'"' Within the first six 
 years of Richard II., the same policy appears in two cases : filth 
 (1379) was not during rain- time to be cast into the kennels so as 
 to float away with the water : and (1383) rules are made to 
 preserve the water-course of the Walbrook. Meanwhile, however, 
 latrines, especially public latrines, are again and again named as. 
 causing nuisance.* 
 
 In 1346 (20th Edward III.) is a royal ordinance in which Lepers; 
 accusations are alleged against citizens and others smitten with 
 the blemish of leprosy, that they publicly dwell among, and 
 publicly and privately communicate with the other citizens and 
 sound persons, and in some cases actually endeavour by sexual 
 and other intimate intercourse '^ to contaminate others with that 
 abominable blemish, so that to their own wretched solace they 
 may have the more fellows in suffering '' : and therefore proclama- 
 tion is to be made that all the persons having such blemish must 
 ^^ within fifteen days betake themselves to places in the country, 
 solitary, and notably distant from the said city and suburbs and 
 take up their dwelling there ; seeking their victuals through such 
 sound persons as may think proper to attend thereto, wheresoever 
 they may deem it expedient.'"' And persons, shall not permit 
 lepers to dwell in their houses and buildings in the city or 
 suburbs on pain of forfeiting their houses and buildings, and of 
 other more grievous punishment. And diligent search, with 
 skilled assistants, is forthwith to be made for lepers, in order to 
 their immediate expulsion. On a particular occasion (1372) a 
 leper, who though oftentimes commanded to go, has still been 
 remaining in the city, is made to swear that he will forthwith 
 go and not return, on pain of pillory. In 1375, the porters of 
 
 * In 1388 was enacted (12th Eich. III., cap. 13) the first English general 
 statute against nuisances near cities and towns. 
 
42 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. III. 
 Post- 
 
 Boman re- 
 commence- 
 ments. 
 
 Super- 
 vision of 
 Trade ; 
 
 the eight city gates, are severally sworn that they will not 
 allow any leper to enter the city or to stay in it or its suburbs, 
 but if any seeks to enter, will prohibit him, and if he perseveres, 
 will distrain him by his horse (should he have any) and by his 
 outer garment, the which shall not be given him back without 
 leave of the Mayor, and, if he further endeavour, will attach 
 him bodily and keep him in custody. The porters are to have 
 the pillory if they fail of this ordinance; and the respective 
 foremen of the Hackney and Southwark leper-houses are sworn 
 to aid in giving effect to it. 
 
 Commerce was supervised in London by the Mayor and 
 Aldermen, as it had been in Eome by the ^diles ; and the London 
 records contain many illustrations of the activity of this function 
 . in regard of the sale of food, and otherwise in the interests of 
 health. In regard particularly of bread, cases (the first in 1298) 
 occur again and again of punishment for selling bread under due 
 '^ assised '' weight, or for selling bread of unsound quality. In 
 regard of butcher^s meat, and fish and poultry, traders repeatedly 
 appear under punishment as having sold or offered rotten food, 
 or having used (in the case of fish) dishonest measures. Sellers 
 of wine were similarly looked after. So were sellers of fuel. 
 Men and women undertaking cures, or practising the art of 
 surgery, were under supervision of the master-surgeons of the 
 city, and defaults brought them before the Mayor and Aldermen. 
 Punishments in the various cases were rarely light, were often 
 very severe, and sometimes amid their severity had touches of 
 grim humor. The inculpated goods were always forfeited. To 
 be drawn on the hurdle, or to be put on the pillory or (if a 
 woman) upon the '' thewe,'^ were ordinary punishments, and 
 sometimes there was imprisonment, perhaps for months. As the 
 offender (male or female) stood in the pillory, having his offence 
 proclaimed by the crier, the corpus delicti — the rotten meat or 
 fish or capon or pigeon, the mouldy bread, the dishonest charcoal- 
 sacks or fish-baskets, or what not, would be burnt under him. 
 There is judgment on a certain taverner who had sold unsound 
 wine (1364) that he must himself drink a draught of his wine, 
 next have the remainder poured on his head, and then '^ forswear 
 the calling of a vintner in the City of London for ever unless 
 he can obtain the favour of our lord the King (Edward III.) as 
 
commence- 
 ments. 
 
 INTRODUCTION. 4eS 
 
 to the same.^^ Certain bakers who had had their '^molding- Chap. iii. 
 hordes '' ingeniously contrived " after the manner of a mouse- Eoman re 
 trap/^ so that they might stealthily abstract portions of the dough 
 brought them to be made into loaves, were to be pilloried with 
 dough hung round their necks. A certain quack (1382) who 
 had pretended to cure fevers by a charm of words written on 
 parchment, was ^' to be led through the middle of the city with 
 trumpets and pipes, he riding on a horse without a saddle, the 
 said parchment, and a whetstone for his lies, being hung about 
 his neck, an urinal also being hung before him, and another 
 urinal behind his back/' And so forth. 
 
 It may additionally be noted that, during the period to which Supervision 
 the Citi/ Memorials relate, and indeed from long before and till 
 long after that period, London had certain privileged stew-houses 
 or brothels, situate in South wark on the bank-side, where they were 
 within the jurisdiction, and apparently under the supervision, of 
 the successive bishops of Winchester."^ In Stow's Survey of 
 London particulars are given as to the history of the local 
 privilege : which seems to have existed from time immemorial, to 
 have received Parliamentary recognition in 1162, under Henry the 
 Second, and to have continued (except for a short while in 1606) 
 till Henry the Eighth, in 1546, proclaimed its extinction. Like- 
 wise in the same book are cited the Orders which the Act of 
 Henry the Second required to be observed by the keepers of the 
 houses, and which in part were of sanitary intention. 
 
 Thus much as to the sanitary management of mediaeval ?®%®^^® 
 London; and, for purposes of the present narrative, illustrations town-gov- 
 from farther afield need not be sought. For those who desire 
 like details with regard to other towns and cities of our own 
 country, innumerable local archaeologies, and the series of 
 Records published under the Master of the Rolls, are sources 
 of endless information, though principally for later times than 
 have here been under notice. With regard to other countries, 
 
 * Some of the taunts which in Shakespecare's play of Henry the Sixth — Part 
 I., Act I., sc. 3, are addressed by the Duke of Gloster to Cardinal Beaufort, glance 
 at that strange episcopal relation ; and INIr. Rendle, in his book on Old Southwarky 
 refers to a Bodleian manuscript of the Winchester Rules and Regulations^ supposed 
 to be of date 1430. 
 
44 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. III. more limited reference may suffice. As to France^ there are 
 Eoman re- the very instructive collections of local customary law ; * and 
 mente?^^^" ^^ ^^® ^^'^^ volume of M. MonteiFs learned and charming 
 work, Histoire des Frangais cles divers Etats, there are not 
 only, in a popular form, the author^s many admirable pictures of 
 fourteenth-century municipal life, but also abundant references 
 to the original sources of his large information. As to Germany, 
 much information and many references are to be found in J. P. 
 Frank''s classical Handhuch der Medizinischeii Polizei. As to 
 Italy, Alexander Petronius Trajanus gave a sanitary description 
 of Rome in the middle of the sixteenth century, and particulars 
 for much later times are given by Lancisi and Ramazzini in 
 their well-known works. 
 
 * That wliicli I have consulted is Bourdot de Eichebourg's Nouveau Coutumier 
 General, in four folio volumes, Paris, 1724. 
 
45 
 
 CHAPTER IV. 
 
 MEDIEVAL PHILANTHROPY. 
 
 Among influences which largely affect national statistics of 
 disease and death, few are of greater power than Poverty^ in its 
 various direct and indirect ways of operation ; and to make the 
 poverty of a people either less extensive or less intense is among 
 the best sanitary services which can be rendered. In the ages 
 which have been spoken of, when nations had not at all learnt 
 either the arts or the wisdom by which popular prosperity is best 
 secured, and the multiplication of poverty best prevented, it 
 was of immense sanitary interest that emergencies of distress 
 threatening the poorer parts of the population should be relieved 
 by palliative Philanthropy. It is therefore essential to remem- 
 ber that the so-called dark ages of European history were made 
 illustrious by the best endeavours which the world had yet 
 seen to ameliorate the lot of the poor, and to succour the sick 
 and impotent. 
 
 In the history of the development of mankind, philanthropic ^^rms of 
 endeavours are hardly to be regarded as accidental facts. An thropyubi 
 aggregation of men, not having any kindly care for one another, 
 and among whom the relatively prosperous would give no help 
 soever to the needy, could not properly be termed social ; and, 
 without discussing whether any such aggregation has ever been, 
 we may at least be sure that none such could have continued. 
 Rather, it would seem probable that offices of charity from 
 individual to individual have been exercised as long as men have 
 gathered together; and we know that by degrees, as social 
 development has advanced, the goodwill of the strong towards 
 the weak, of the rich towards the poor, has learnt to express 
 itself collectively and on system in organisations of a charitable 
 kind. In our later times, when such organisations have been 
 immensely developed, it is easy to see that, in the promotion of 
 them, and especially as regards legal enactments for the relief 
 
46 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. IV. 
 Mediaeval 
 Philan- 
 thropy. 
 
 of tlie poor, tlie common instincts o£ humanity have been very 
 powerfully seconded by considerations of political prudence as to 
 the requisites for social quiet ; but till comparatively late times 
 the prudential considerations have had no general influence ; and 
 the lot of the poor and weak would indeed have been hopelessly 
 miserable, had it not been for the instincts of human kindliness, 
 and the power of religious beliefs in which those instincts have 
 had their embodiment or sanction. In the ethics of ancient Egypt, 
 the duty of kindness to the poor and weak and aged, and even 
 to the fugitive slave, was expressly taught;^ and the Hebrew 
 Scriptures abound with testimony that consideration for the help- 
 less of all sorts had from old been of religious sanction among the 
 Jews. From twenty-four centuries ago there has operated on a 
 vast scale in Asia, especially in Eastern Asia, the insistence of the 
 Buddhist religion on the principle of human brotherhood, and on 
 the imperativeness of the duty of giving help to the poor and 
 weak : doctrines, which Sakya-Mouni spent his life in propa- 
 gating, and which at the present time are professed as articles 
 of religious belief by the millions of the human race who call 
 themselves his followers. Christian doctrine, from nearly two 
 thousand years ago, has continued and emphasised previous 
 sanctions. In terms which are familiar to the world, it has 
 specially identified itself with commands of helpful sympathy 
 towards human suffering, and with endeavours to promote the 
 survival of even the weakest among mankind. Mohammed- 
 anism professes acceptance of the same law. There apparently 
 is no widespread religion which does not recognise the duty of 
 kindness to the weak and poor. 
 
 Early 
 Christian 
 institu- 
 tions of 
 bene- 
 ficence. 
 
 In the parts of the Roman Empire which were soonest 
 affected by the promulgation of Christianity, a greatly- increased 
 thoughtfulness for the poor, with a great development of 
 charitable service towards them, was a conspicuous first-fruit of 
 the creed : so that, in all early Christian communities, the giving 
 of alms to the poor, of personal tendance to the sick, of shelter 
 to the homeless, and generally of brotherly or sisterly help to 
 
 * See, in Lepsius's Zeitschrift for 1872, Professor Bnigsch's account of the 
 Alt-cegyptishe Lebensregeln laid down in a certain Bulacq papyrus which he there 
 describes, and which is supposed to have been written about 1000 b.c. 
 
INTRODUCTION. 47 
 
 persons in necessitous circumstances o£ mind^ body, or estate, Chap. iv. 
 became, as it were, a characteristic ritual of the new faith. It pMian-^ 
 was a ritual which the surrounding Roman world may have *^^opy- 
 found the more impressive from the fact that in those early 
 days it required no apparatus of Flamens and Pontiffs, nor even 
 involved any burning of incense ; and the Emperor Julian was 
 led to confess something like envy on behalf of his co-religionists, 
 as he saw how they were exceeded in charitable action by 
 votaries of the faith which he despised.^ In various great 
 centres of population. Christian philanthropy soon shewed 
 itself in the establishment of standing asylums and houses of 
 hospitality of different sorts for persons, . old and young, 
 who might need them : hospices (in the narrow sense of the 
 term) as places of refuge for strangers and outcasts, alms- 
 houses for the helpless poor, homes for orphans and foundlings, 
 and reformatories for women who had gone wrong : and, 
 not least among such establishments, hospitals for the sick and 
 wounded, hitherto not precedented in the world, except to some 
 extent in Buddhist India, and in extremely small degree in pre- 
 Christian Greece and Rome, began to appear as Christian insti- 
 tutions. Thus, about the year 370, there was founded at 
 Csesarea, by its then bishop, Basil, an immense institution of 
 miscellaneous charity, including a hospital for the sick; and 
 some thirty years later, at Constantinople, a hospital was one 
 of many beneficences which the poor of the city owed to the 
 brief and stormy archiepiscopate of Chrysostom. In minor com- 
 munities, endeavours of the same sort, though of course on a 
 smaller scale, seem to have been general. 
 
 Instantice lampadis they indeed were, those early Christianities 
 of action; and they assimilated practice to profession with a 
 sincerity which made them worthy to live. Against their 
 continuance, however, or at least their continuance in the full 
 spirit of their founders, there were obstacles in the nature of the 
 case, and also in the circumstances of the times. The philan- 
 thropic ardour which Basil and Chrysostom had awakened was 
 perhaps too impulsive to be equally persistent. Often the 
 founders of special charities would have passed away, and suc- 
 
 * My statement is founded on a quotation from Julian, given by Haeser in 
 his Geschichte der Seilkunde, vol. i., p. 441. 
 
48 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. IV 
 
 MedisBval 
 Philan- 
 thropy. 
 
 Benedict- 
 ine Mon- 
 asteries in 
 relation to 
 the Poor. 
 
 cessors like-minded with them would not have arisen. Still more, 
 as war spread from region to region, and city after city was 
 whirlpooled in social strife, the urban organisations of charity 
 perished of mere inanition, like the children of slain parents, or 
 were shattered and trampled under foot as savagely as the 
 fences and gardens. 
 
 Meanwhile the monastic system had taken root in Europe, 
 and was beginning to represent in a somewhat changed way, 
 and for the most part in very changed local relations, the previous 
 more communal charities. From about the year 529, when the 
 religious order of Benedict of Nursia, with its great monastery 
 at Monte Cassino, was established, and in proportion as the 
 establishment of monasteries more or less after that pattern 
 became general, first in Italy, and then in all parts of Western 
 Europe, the monks, in those parts of Europe, were constant dis- 
 pensers of help to the poor; and each monastery, besides being 
 a centre of almsgiving to the poor of its neighbourhood, and a 
 home of refuge to many a forlorn wayfarer, served also generally 
 as a hospital for sick and wounded. 
 
 Yet not even the monasteries were endowed with perpetuit}^ 
 of invincible virtue. Dante (Parad. xxii. 85-93) represents 
 Benedict of Nursia as saying, with reference to such religious 
 enterprises as his own, that 'Hhe good beginning lasts no longer 
 on the earth than while an oakling grows to bear acorns ^^j and 
 certain it is that, as the monasteries multiplied in number, and 
 increased in resources, much of their original character was lost. 
 Not to mention here the grosser irregularities which eventually 
 became the scandal of monastic life, it will suffice to advert to 
 the irregularities which were of earliest date : the abandonment 
 of the rule of strictly frugal life, and the abandonment of the 
 rule of manual labour : irregularities which expressed in principle 
 the admission of indolence and luxury, and tended to render the 
 monasteries, in relation to the poor, less and less representative 
 of the spirit of early Christianity. Saying this does not at all 
 mean that they ceased to give alms to the poor : for, even long 
 after the times which are here in question, hardly even the most 
 apostate of monasteries would quite have deserved that extreme 
 reproach. What however began very early, and what in spite 
 of many attempted reforms went on from bad to worse, was. 
 
INTRODUCTION. 49 
 
 that monastic life became self-indulgent, and that, in proportion Chap. iv. 
 to its own acceptance of luxury, its relations to the poor must phUan- 
 have become superficial. During the second six centuries of the ^^^py- 
 Christian era, declension in that sense was extensively making 
 way : monasteries which had become large land-owners, and 
 large agricultural employers of labour, were, no doubt, always 
 giving help, and often a great deal both of help and of kindness, 
 to the poor of their respective neighbourhoods ; but the relation 
 between them and the poor was drifting into forms rather of 
 condescension than of sympathy, was tending more and more to 
 become a mere relation of Dives to Lazarus. 
 
 In contrast to all such tendencies, it was indeed as an Francis of 
 Apennine sunrise, when, at the beginning of the thirteenth hi? Order! 
 century, Francis Bernardone of Assisi,* declaring himself the 
 Bridegroom of Poverty, began to exercise the influence of his 
 passionately earnest nature for the benefit of the outcasts of the 
 world. In that '*^ wedlock ^^ of his, which Dante and Giotto 
 a century afterwards commemorated and interpreted for their 
 countrymen. Poverty was to be wedded for her own sake, as of 
 divine blessing to him who won her : Poverty (as Giotto^s fresco 
 in the lower church of Assisi represents her) in scanty patch- 
 work dress, and knee-deep among brambles, with curs and 
 ragamuffins yelping at her from below, but with saintly nimbus 
 about her head, and with a paradise of rose and lily behind her. 
 Francis's symbolic marriage-vow was evidently one of rigid self- 
 mortification : it meant the throwing aside of every sort of 
 worldly possession, the utter abjuration of everything which the 
 world in general understands as comfort and pleasure. Yet, 
 bent on self-mortification though Francis was, pure and simple 
 self-mortification, the asceticism which is centre and circum- 
 ference to itself, was certainly not his sole thought. It greatly 
 dominated him, no doubt, for it was a leading superstition 
 of his time: that vain brahminical belief in sanctification by 
 
 * Ascesi, an older form of the word Assisi, is the name used by Dante in 
 the comparison which my text borrows from him : — 
 Chi cVesso loco fa parole, 
 Non dica ascesi, che direbbe corto, 
 Ma ORIENTE, se proprio dir vuole. — Paradiso, xi. 
 
50. ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. IV. laborious rituals, that deplorable remnant of devil- worship, whicb 
 Phiian- hopes to propitiate by self-torture ; but, deeply possessed as he 
 ^^^' no doubt was by the sacerdotal doctrines of the time, Francis 
 had also a genius of his own ; and the context which this gave 
 to his asceticism, rendered the asceticism eventful to the world. 
 So far as we at the distance of seven centuries can discern his 
 mind, it seems to have been singularly sympathetic. With the 
 many-sided affectionateness of a poet^s imagination towards all 
 his fellow-subjects in the kingdom of Nature, with tenderness 
 towards even the mute physical universe about him, and how 
 much more towards the living forms which peopled it, infinite 
 pity filled his soul at the thought of human sin and suffering, 
 and care for self died its natural death in the soul which that 
 passion pervaded. Thus, rigid as his asceticism was, it seems 
 far less to have been of the substance of his life than the symbol 
 of something deeper than itself. It may be read as the outward 
 and visible sign of a mind ardently resolved to take brother's 
 share in all the worst heritages of the miserable of the world ; 
 the almost instinctively adopted habit of one who was in 
 deep sympathy with sorrow, and whose life was to be spent in 
 deeds of mercy. For Francis, in seeking to follow his Master\s 
 teaching, did not understand as Christianity that mere self- 
 pauperisation was the goal ; but, taking Poverty to be his Bride, 
 he adopted all her kindred as his own, and, vowing himself to 
 that wedlock, he vowed himself the Servant of the Poor.* 
 
 Francis's fulfilment of his vow, in an immediately personal 
 sense, was such as to move the wonder of his contemporaries. 
 They illustrate by countless stories, how companionable and 
 tender he was to the poor ; and, above all, how, sui victor in what 
 was most loathed by other men, he took as his peculiar care the 
 function of ministering to lepers. In telling us of those ser- 
 vices, they have also, in the spirit of their times, told us of 
 many miraculous interventions in the life of their hero : describing 
 
 **'Fater pauperum, pauper Franciscus, pauperibus omnibus se conformans, 
 pauperiorcm se quempiam conspicere gravabatur, non inanis glorice appetitii, sed 
 solius compassionis afectu." — Thomas de Celano, § 76. " Fauperes intitne 
 diligebat, eis viscerose compatiens.^' — Tres Socii, § 57. " Liquescebat animus ejus 
 ad pauperes et infirmos, et quibus non poterat manum exhibebat affectum . . . 
 Fluries cum oneratis obviaret in via pauperibus, imbecilles humeros illorum oneribus 
 «wpi>o«tfia^."— BoKAVENTURA, §107. Acta SanctoruMy doiQ ^ik OoiobxiB. 
 
INTRODUCTION. 51 
 
 how heavenly visitations came to him in leprous guise, and how Chap. iv. 
 the stigmata o£ crucifixion were impressed upon his hands and PMiin^^^ 
 feet : but the narrators of those interventions could hardly have ^iiropy. 
 deemed them more foreign to the common experience of the 
 times than that a man should care for his leprous fellow-man, 
 or that the heir of a comfortable home should voluntarily 
 descend to equal lot with the poor. What Francis could with 
 his own hands do for the innumerable afflicted of his kind was 
 as nothing ; and the good which the outcasts of that mediseval 
 world so signally owed to him was rather the service which he 
 gained for them from others by the influence of his teaching 
 and example. From even before the year 1210^ when the rule 
 which he proposed for his new religious order was approved by 
 Pope Innocent the Third,, Francises zeal had begun to infect 
 other men on a scale for which history had given but the rarest 
 precedents ; and within a very few years the Franciscan Order 
 of Mendicant Friars had become a great power in the world. 
 In 1216, when the Order's first general convention was held at 
 Assisi, missions were appointed for the chief divisions of conti- 
 nental Europe; and, after the second general chapter held at 
 Assisi in 1219, and attended, it is said, by five thousand of the 
 Order, as well as by a special legate whom the Pope had given 
 to '^ protect ■'^ them, a mission was appointed for England."^ 
 Those various missions were in general received with the warmest 
 enthusiasm ; and in 1221 a vast popular extension was given to 
 the influence of the Order by the promulgation of a supple- 
 mentary rule which enabled " penitents " in unlimited number 
 to attach themselves to the Order as a lower estate. The persons 
 attached in this capacity were not under obligation of vows, 
 nor forbidden to marry, nor to take part in worldly affairs ; but 
 they professed agreement with the Order in certain easier general 
 principles as to the conduct of life, and declared that they 
 would endeavour to bring their lives into conformity with those 
 principles. 
 
 Such were the beginnings of the great missionary brotherhood 
 
 * The extremely interesting original records of the first English mission, 
 with a very instructive introduction by the late Professor Brewer, who edited 
 them, were published a few years back, under the title Monumenta Franciseana, 
 in the series directed by the Master of the Rolls. 
 
 E 2 
 
52 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. IV. which Francis founded : an addition, and at least incidentally a 
 Phiian-^ reproachful contrast,, to the Benedictine system of his time : a 
 tbxo^j. brotherhood which was to distinguish itself from those of the 
 elder system by habits of far stricter self-denial, as well as by 
 the practice of more active good towards the poor. Of that 
 many-sided great enterprise there are sides which do not concern 
 our subject-matter. Neither into the field of theological con- 
 troversy, which was worked almost equally by Dominicans and 
 Franciscans, nor into the jungle of ecclesiastical and political 
 relations in which the Vatican rather than either Dominic or 
 Francis was instigator, is there here any need to enter. What 
 concerns the narrative, is, that the Franciscan brotherhood (beside 
 what else it may have been) was a gigantic missionary enterprise 
 to mediate between rich and poor in a spirit of true sympathy 
 with the latter ; and though this enterprise no doubt contem- 
 plated religious infinitely more than physical aims, only the 
 physical are here in question. Our present point is, that the 
 Franciscan brotherhood represented, in relation to the poverty 
 of the later middle ages, a most important organisation of 
 charitable assistance. The Franciscan vowed the ordinary 
 vows of monastic self-denial; but in the article of poverty, 
 his rule went beyond the monastic standard, and, as it bound 
 the individual that he would hold no property, so also it 
 bound the collective brotherhood to hold none. The Fran- 
 ciscans were to depend solely on their own labour, or on such 
 alms as might from day to day be given to them for their 
 poor clients and their equally poor selves. Their life was 
 not to be of the Benedictine type, sequestered and meditative 
 in peaceful solitudes of rural scenery, but was to be a life of 
 incessant combat against evil, in those busiest haunts of men 
 where evil, moral and physical, most abounds: it was to be 
 a life '^in populous city pent, where houses thick and sewers 
 annoy the air '^ : above all, it was to be a life among the poor. 
 The brethren were to dwell in the meanest quarters of the towns 
 to which they resorted. Associating as equals with those whom 
 they had to relieve, procuring for destitute persons such alms as 
 might be needful for them, rendering to the sick (including 
 above all the lepers) and to the aged and otherwise impotent 
 poor, every requisite personal tendance and kindness, they, after 
 
INTRODUCTION. 53 
 
 the example of their founder^ were emphatically to be the com- Chap. iv. 
 forters of poverty and weakness^ the servants of the helpless of phiiani 
 mankind.* *^°P>- 
 
 The Franciscan Order, from the time when it was estab- 
 lished, gave a new impulse to the care of the poor in Europe ; f 
 supplementing in that respect most usefully the action of the 
 monasteries of Benedictine rule. The relations between the 
 Franciscans and Benedictines were habitually relations of much 
 mutual disfavour ; and often also on either side there would be 
 relations more or less invidious between brotherhoods following 
 original rule^ and brotherhoods purporting to be of '' reformed " 
 type : but the two sorts of organisation were able to work side 
 by side throughout Europe ; and thus working, they together 
 represented, for some centuries, a large proportion of the charity 
 on which the necessitous poor depended for relief.}: 
 
 The Franciscan rule, however, was not destined to remain Degenera- 
 more free than the Benedictine from the invasions of human p^^ciscan 
 frailty. Francis, though he lived but for sixteen years from the ^^<^®'- 
 foundation of his Order, and was but forty-four years old when 
 he died, must already have been haunted by doubts whether his 
 lifers work could last. It is piteous to read of the weepings of 
 his later years : the weepings, which we are told almost blinded 
 him. Well might he weep with that " divine despair ^' which 
 only noble hearts can fully know, and which too many a Friend 
 of Man has had at last to feel : when the autumn fields of 
 waning life answer not to the ideals of spring-time; when all 
 within the horizon seems but the emptiness of wasted toil ; when 
 the night is descending wherein no man can work, and the aspir- 
 ations of youth — the once passionate hopes which made ambition 
 virtue — are as fallen warriors beneath that darkening dome, whom 
 never again clarion will wake, nor morning freshen. Francis 
 had already found reason to doubt whether, even for the little 
 
 * As regards this, for England, see last footnote. 
 
 t The Dominican Order, which accepted the same Eule of Mendicancy as the 
 Franciscan, did not profess the same special relation to the poor, hut no douht 
 acted towards them largely in the same spirit. 
 
 X The remainder (where not quite casual) consisted in such alms as it was the 
 duty of parish priests, and, in some cases, of the oflScers of municipalities and 
 guilds, to dispense. Of the legal hasis of the first-named of those dispensations 
 in England, some particulars will be found below in chapter v. 
 
54 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. IV. residue of liis life-time, the brothers of his Order would be faithful 
 Philau- to their vows : already he had presentiment of the seductions 
 * ®Py- which the papal protectorate might involve : already he had seen 
 that, not even within the girth of the hempen cord, would the 
 pulses of covetousness and selfish ambition remain extinct. 
 Scarcely was he dead, when his disciples obtained from the 
 new Pope (Gregory IX.) a bull which released them in various 
 respects from further obedience to their rule ; and the Francis- 
 can friaries which then at once came to be established as posses- 
 sions of the order, and as places of fixed residence for its members, 
 seem not to have differed much from the monasteries of the 
 older system except as the conditions of town-life were different 
 from those of land-owning life in the country. The Franciscan 
 establishments were often of high architectural pretensions, 
 abounding in ^^ stately refectories and churches,''^ '^^ sumptuous 
 shrines and superb monuments,^' and having libraries of dis- 
 tinguished excellence.* In various cases, as very notably in 
 Oxford, Franciscan friaries became principal seats and semi- 
 naries of learning ; and many of the brotherhood, who would not 
 have disregarded their vows of self-denial in respect of sensual 
 indulgence, did not deem it a breach of ascetic rule to enjoy the 
 pleasures of philosophy and literature. The chronicle of Matthew 
 Paris, which opens but nine years after the death of Francis, 
 contains, during its first twenty-five years, repeated bitter 
 accusations against the Franciscans : as to their encroachments 
 of all sorts, their intriguing quest of wealth, their tenure of 
 influential posts under kings and nobles, their tax-gathering 
 subserviency to the Pope, their lavish expenditure on grand 
 establishments in contrast to their professed poverty, and so 
 forth, t It was early in the fourteenth century, when the Order 
 was not yet a hundred years old, that, in the country of its 
 birth, Dante wrote of it as already degraded, and in the passage 
 before referred to) cited it as a mournful type of the speed with 
 which good beginnings come to naught. Half a century later, 
 
 * Tlie plirases within inverted commas are from Warton's History of English 
 Foetry, section ix. 
 
 t See in Matthew Paris's English History from 1235 to 1259 inclusive (hut of 
 course with recollection that the writer was a Benedictiae) the many entries 
 which there are to the ahove effect. 
 
INTRODUCTION. 55 
 
 in England, the writings of Wycliffe against the Mendicant Oaip. iv. 
 Orders began ; and before the end of the century, the English PHian- 
 popular estimate of the Friars, as they showed themselves in *^°Py- 
 common life, had evidently fallen very low."^ Meanwhile in all 
 directions the more ambitious members of the Franciscan Order 
 had been attaining innumerable positions of power and pomp, 
 and were preparing ample justification for the sarcastic remark 
 of a subsequent Italian historian, that, in proportion as poverty 
 was made a religious vow, Rdigion and Riches became convert- 
 ible terms. t The further progress of Franciscan decay seemed 
 to illustrate the popular proverb, that, of things turning rotten, 
 none turns so utterly bad as that which at starting was best : for 
 Franciscanism during the next hundred and twenty years was 
 always becoming more and more identified with whatever of 
 fraud and avarice was basest and of worst moral effect in the 
 successive papal pretences of Christianity; and the relation of 
 the Mendicant Orders to the papal sale of indulgences was con- 
 spicuous among the scandals which induced the Protestant .revolt 
 of the sixteenth century 4 
 
 For a long" while before the outbreak of that revolt, demorali- Extenaiye 
 
 ° . . demorali- 
 
 sation of various sorts had come to prevail so widely and deeply sation 
 
 throughout the body of the religious orders — not only among to the 
 
 those under the mendicant rule, but equally among those of the ordSs^ 
 
 older type, that it must have been difficult to regard them as generally. 
 
 * The satire of Piers Plowman's Crede, written at that time, illustrated the 
 sectarian spites which there were between the different Orders of Friars ; and 
 Chaucer's well-known sketch in the Prologue to his Canterbury Tales hints the 
 sort of life — "a wanton and a mery" — which the Friars of the end of the 
 fourteenth century were leading under their ascetic vows. 
 
 t Giannone's Storia di Napoli, xix. 5, 5. — It must however he remembered 
 that, amid the wide prevalence of that sort of corruption, a vast deal of service 
 to the poor was at the same time being rendered by the Friars, and that on 
 various historical occasions (as especially at times of pestilence) their devotion to 
 the poor was heroic. See, for instance, with regard to the middle of the four- 
 teenth century, the terms in which Dr. Milman describes their behaviour in the 
 South of France during the prevalence of the Black Death, and the emotions 
 which that behaviour excited among the people. Latin Christianity, book 
 xii. ch. xi. 
 
 X Of the " Indulgences" which were sold, I will only note that the published 
 versions of the Taxa Sacrce Pcenitentiarice are described, and their bibliographical 
 history given, in the articles Banck, Pinet, and Tuppius, of Bayle's Dictionary. 
 
56 ENGLISH SANITARY INSTITUTIONS. 
 
 C^. IV. fitting representatives or instruments o£ national duty towards 
 Phiian- the poor. The accusation against the houses does not pretend to 
 °^^* be universal : by general consent at the time> some of them would 
 no doubt have been declared free of reproach^ while probably 
 many more would have been declared free^ or almost free, from 
 the grosser scandals; and of course it may well have been, 
 that, even in houses where gross disorder prevailed, there were 
 individuals, perhaps sometimes many, who stood apart from 
 it : but the system was to be judged as a whole ; it was to be 
 judged by the broad proportions of black and white which it 
 exhibited to the world then around it; and the standard by 
 which those spectators had to judge it was the standard of its 
 own voluntary vows. To the knowledge of all the world the 
 votaries of poverty in monasteries and friaries were, on a very- 
 large scale, enjoying whatever state and luxury belong to wealth ; 
 and it seems to have been equally notorious, with regard to the 
 vowed continence of the orders, that, both within and without 
 tjie walls of the religious houses, monks and friars were very 
 often of incontinent, often of grossly dissolute, life, and often 
 debauching where they pretended to guide. Of such facts, and 
 of the proportions in which particular profligacies existed among 
 men and women vowed to religious and continent life, it would 
 not have been easy even at the time to speak in terms of exact 
 quantity ; and to attempt to do so now, after the lapse of 350 
 years, and with almost complete absence of documentary proof, 
 would be absurd ; but what is certain is, that the terms in 
 which the sixteenth-century Reformers spoke of the vices of 
 the religious orders declared or implied that the vices were so 
 widespread and habitual as to represent utter rottenness of 
 system.^ That such was the case in England, was the view put 
 before Parliament on various occasions during the years 1535-9 
 by King Henry the Eighth, on the particular testimony of 
 Commissioners of Inquiry who had been appointed to visit the 
 religious houses of this kingdom. The view was accepted by 
 
 * In passing, it may not be superfluous to note that, in regard of the 
 monastic scandals, the story of the sixteenth-century revolt requires to be read 
 in connexion with the story of the Council of Constance in the fifteenth century, 
 and indeed with much other previous church history, as also in connexion with 
 the text of the Taxa^ to which my last footnote referred; but these are not 
 particulars on which I need enter. 
 
INTRODUCTION. 57 
 
 Parliament ; accepted altogether for purposes of action^ and 9?^- ^• 
 partly accepted in express terms.^ And in substance it was soon PMian- 
 afterwards authoritatively asserted on behalf of the Reformed °^^* 
 Church of England (and reputedly by the hand of Cranmer) in 
 the Fifth of the Homilies of the Churchy issued in the first year 
 of the reign of Edward the Sixth.f 
 
 While that state of the case, as to the morals of the religious Mediaeval 
 orders, was displaying itself, there loomed into view beside it, ^^y 
 and on an equally large scale, the threatening form of those *^^<^g ^ 
 social dangers which attach to an unskilful system of relief to 
 the poor. Under mediaeval religious sanctions, the administra- 
 tion of alms had been regardless of economical considerations. 
 The incaution had been purposed, and on principle. To suspect 
 or question the semblance of poverty would have been deemed 
 irreligious. The Orders themselves were mendicants and 
 proselytisers for mendicancy. Men and women in swarms had 
 been urg6d by them on religious grounds to dispossess themselves 
 of other means of livelihood, and to embrace mendicancy as their 
 mode of life. A system such as that could only tend to one 
 issue. Considering how general is the inclination of mankind to 
 enjoy life on the easiest possible terms, and how many would 
 prefer not to toil for livelihood where livelihood without toil can 
 be had for the asking, communities, as they enlarge and become 
 complicated, require more and more vigilance in their almsgiving, 
 to discriminate genuine poverty from those imitations of it which 
 mean laziness and fraud ; and the uneducated benevolence which 
 cannot or will not administer its gifts with such discrimination 
 must at last inevitably find itself overwhelmed by the ever- 
 increasing demands of an empty-bellied lounging proletariat. 
 European philanthropy, in the later middle ages, was tending to 
 that sort of consummation. With its utter want of economical 
 
 * The Act of Parliament, 1536, which, dissolved the minor monasteries and 
 friaries, said to have been 376 in number, declared, in its preamble, that 
 " manifest sin, vicious, carnal and abominable Hving is daily committed among" 
 them. 
 
 t The Homily, when discussing the vows of the religious orders, and the 
 observance they had obtained, uses, as to the most delicate branch of the matter, 
 the following very appropriate language : — " And how their profession of chastity 
 was kept, it is more honesty to pass over in silence, and let the world judge of 
 that which is well known than with unchaste words, by expressing of their 
 unchaste life, to offend chaste and godly ears." 
 
58 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. IV. 
 Mediaeval 
 Philan- 
 thropy. 
 
 caution, it was increasing the poverty it desired to relieve ; and 
 at some not very distant time, when it must inevitably become 
 insolvent, its insolvency would give rise to social disorders. 
 Meanwhile, too, of moneys meant for the comfort of the poor, 
 just as of moneys intended for liturgical purposes, it was to be 
 feared that large proportions were spent in enhancing the luxury 
 of monasteries and friaries, or in tribute to the corruptions of 
 Rome. 
 
 Criticism of 
 ascetic 
 vows as 
 basis for 
 philan- 
 thropic or- 
 ganisation. 
 
 As the system on which the mediaeval philanthropy operated 
 has now, for three and a half centuries, ceased to exist in 
 England, further consideration need not be given to its merely 
 economical errors; but the other elements in the case are of 
 more abiding historical interest, and of them something further 
 may be said. Those breaches of rule which had so long been 
 increasing in the professedly religious organisations, and which 
 before the beginning of the sixteenth century had become so 
 scandalous that hardly the sarcasms of Erasmus and the wrath of 
 Luther were needed to brand them for popular opinion, had a per- 
 manent deep significance of their own. That the ascetic vows of 
 the Orders were such as evidently would be broken by a large pro- 
 portion of the vast number of persons who took them, was a con- 
 sideration which could not but bring into serious question the 
 moral fitness of the vows themselves. Verdict against them on 
 theological grounds was strongly pronounced by the general 
 voice of the Protestant Reformation ; notably in 1530 in the 
 Augsburg Confession which Melanchthon formulated ; "^ and 
 apart from any question of those particular grounds, it may be 
 said that the substance of the verdict has borne the test of time. 
 
 At our present date, when civilisation has had its further 
 centuries of experimental progress, and when the most gifted 
 minds of the successive ages have striven their best to under- 
 stand and define what are the realities of human duty, it is no 
 hasty generalisation to say, that, in proportion as moral culture 
 has advanced, the ascetic standards of morality have been judged 
 
 * In Melanohthon's Corpus Doctrince Christiance, particularly in the Apologia 
 and loci prceciptci theologici relating to the Confession, the theological grounds 
 are more amply stated : as in the articles De Conjugio Sacerdotum, Be Votis 
 Monasticis, De Castitate, and De Satisfactione. 
 
INTRODUCTION. 59 
 
 wrong. At each stage of the advance, they more and more Chap. iv. 
 distinctly have taken outHne as a gigantic, but happily diminish- Phiian^* 
 ing, shadow o£ superstition, cast, from the savage childhood of *^^°Py- 
 our race, along the ways which have led to better knowledge. 
 True, no doubt, that, outside the rule of ascetic communities, 
 the most esteemed teachers of mankind have ever advocated 
 certain sorts of self-denial : the sorts, by which each man can 
 best hope to contribute his share to the living worth and happi- 
 ness of the world. They have taught that the self-control which 
 determines to duty, and withholds from wrong, is the highest 
 accomplishment of a man. They have taught that dissolute 
 life, or life otherwise unduly surrendered to its bodily appetites, 
 is a shameful bondage. They have taught that the true worth 
 of a man is not in his circumstances and possessions ; and that 
 solicitude for pomps and redundant wealth is among the vainest 
 wastes of life. They have warned against luxury, as enfeebling 
 the lives which accept it, as debasing them into forgetfulness of 
 duty, as bribing them away from justice to others. They have 
 praised the simple frugal life which admits fewest artificial 
 wants and cravings, and least develops the greed of gain; 
 and for the training of the young they have approved such 
 strictness of discipline as shall best prepare the individual body 
 and mind for future duties of endurance and service. But 
 while in senses such as those they have advocated certain sorts 
 of self-denial, and have taught that the ^^ self '' which would err 
 from that standard of right must be " mortified,''^ self -mortifica- 
 tion, abstractedly and indiscriminately, has not been their theme 
 for praise. They have at least implied a belief that (subject to 
 considerations as above) human nature is something to be 
 cherished and utilised, not something to be arbitrarily sup- 
 pressed. And there it is, that modern thought has drawn its 
 dividing-line between the self-denials which it expects of every 
 good man, and the asceticism which it deems superstitious. As- 
 senting entirely to the principle of such self-denials as have 
 been indicated, and valuing as the noblest of human lives those 
 which by their self-devotion express the most generous feeling 
 of duty to others, it yet ascribes no merit to feats of self- 
 mortification which (terrestrially speaking) are purposeless. It 
 is unaware of any divine command exacting such cruel tribute ; 
 
60 ENGLISH SANITAKY INSTITUTIONS. 
 
 Chap. IV. and, in the multiform readiness with which men from time 
 Philan- immemorial have imposed such exactions on themselves, it 
 ®P^' discerns, as underlying fact, the untaught human mind timor- 
 ously prostrate and servile before idols of its own creation. In 
 the history of such self-mortifications is recorded a kind of 
 compounding for that fuller ritual of human sacrifice with which 
 in older times the same terror of darkness was appeased."^ Not 
 Phcenician Moloch, nor Aryan or Dravidian Kali, has ever been 
 admitted by name into our western calendar of saints; but 
 survival (more or less) of some such cult as theirs is to be 
 inferred, wherever men impute religious merit to the otherwise 
 purposeless pursuit of physical or spiritual pains and privations ; 
 and from the fakirism of the far East to the rules and practices 
 of Pachomius and Basil and Benedict, of Bernard and Bruno, of 
 Francis and Dominic, traces of that particular vein of supersti- 
 tion can be followed without breach of continuity. The wildest 
 of its extravagances are now very far back in the annals of 
 civilised countries ; and against some of them, even in the 
 sixteenth century, it may have been no longer worth while to 
 argue ; but, be it observed, the ascetic vows which the Reformers 
 of 1530 denounced were in principle an acknowledgment of the 
 same superstition, a homage to the same terror, as that which 
 had wrought the earlier Christian ascetics to phrensies of self- 
 mutilation and self-torture, had made anchorites desire to be 
 walled-up within their cells, and had produced, as its opposite 
 types of self -sterilising life, the painful acrobatics of the pillar- 
 saints and the mute introvertedness of the monks of Athos.f 
 Such vows of ascetic self- mortification as were common to all 
 the mediaeval orders were pledges for immense quantities of 
 human suffering ; and their full meaning in that respect will 
 most emphasise itself to persons who are helped by medical 
 knowledge to measure it rightly. The merely physical priva- 
 tions of strict monasticism were such as few or none could have 
 
 * At page 271, vol. i., of Mr. Andrew Lang's interesting Myth, Mtual, and 
 Religion, is the statement that *' in Mexico, where human sacrifices and ritual 
 cannibalism were daily events, Quetzalcoatl was credited with commuting 
 human sacrifices for blood drawn from the bodies of the religious." 
 
 t The respective types to which the last words of the text refer are on fami- 
 liar record in chapters xxxvii. and Ixiii. of Gibbon's Decline and Fall of the Roman 
 
INTRODUCTION. 61 
 
 endured without sacrifice of bodily health ; probably the mere Chap. iv. 
 vigils and starvation and penances brought to early death more phiiaa-* 
 than a few of the devotees who fulfilled their vows ; while, with *^°Py- 
 the sworn celibacy, those whom age or temperament had not 
 made passionless had to bear the thirsts and angers of their 
 cruelly encaged animal instinct. Under any strict monastic 
 system, the moral privations were to match. Life was to be rigidly 
 withheld from all which general mankind enjoys. Of ordinary 
 human interests, and ordinary human affections, there were to 
 be none. All ties of home and kinship and friendship had been 
 abjured ; and '^ the world " in which fellow-men were at work 
 was to be forgotten. If haply the rules of the order provided 
 for exterior functions, the prescribed functions would be done ; 
 but, with that exception, the mental energies, day after day, 
 and year after year, were to spend themselves in piacular offices, 
 or in solitary brooding and prayer ; no freedom for movements of 
 thought, no vacant hours with mirthful or careless pastime ; but, 
 instead of variety and pleasure, unbroken pleasureless monotony ; 
 and, in the restricted meetings of inmates with each other, 
 either silence, or but the scantiest permission of speech. That 
 vows to the above effect were vows of self-immolation to a 
 terribly-conceived unseen power, — that they were vows to thwart 
 every kindly intention of nature, and cruelly to torture whatever 
 instinct of life had not previously accepted nirvana for final 
 good, — stands plainly expressed on the face of them; and, as 
 regards our subject-matter, it is not imaginable that co-opera- 
 tion, founded on such vows, could be a permanent force in social 
 development. In proportion as the primfBval clouds of savage 
 belief should remain undispelled, so, in their shade, might 
 transiently continue to be seen some last survivals of con- 
 federated asceticism ; but with the growing education of man- 
 kind, they, like the man-slaying rituals of prior date, would by 
 degrees come only to be remembered as among ancient false- 
 starts of moral endeavour. That the mediaeval monastic system 
 broke down in respect of its ascetic vows, is a fact which ap- 
 parently has to be regarded in the light of those considerations. 
 The vows not only were deeply superstitious, and in that respect 
 such as the progress of time must necessarily deprive of their 
 assumed sanction ; but they also were of such cruelty, they meant 
 
62 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. IV. 
 Mediaeval 
 Philan- 
 thropy. 
 
 SO mueli useless suffering to the votaries^ that ordinary flesh and 
 blood would in general be unable to fulfil them. Organisations 
 founded on them would therefore naturally tend to anarchy and 
 disgrace ; and the mediaeval scandals in monastic life were but so 
 many attestations of that tendency. They expressed the mutiny 
 of human nature against engagements which ought not to have 
 been entered into. They in their brute form declared, what, in 
 other form, was the verdict of the Augsburg Confession^ that 
 sworn asceticism could no longer be deemed a legitimate basis of 
 co-operation for purposes of social good. 
 
 Surviving 
 gratitude 
 to the 
 mediaeval 
 Orders. 
 
 Surely, however, this conclusion does not at all clash with a 
 feeling of deep thankfulness to the Religious Orders in respect 
 of the good which they did for mankind during the ages which 
 they more distinctively served. The fact which has brought 
 them into this narrative — the fact that, against frightful amounts 
 of physical misery, they, for many centuries, were the one great 
 life-preserving influence in Europe, is surely no small praise. 
 And with deepest homage the motive power of that life-preserving 
 relation must be recognised : the humane spirit, the twice-blessed 
 spirit of mercy, which, as there embodied, was powerful to shoot 
 its rays into the hopelessness of masses of mankind. In those 
 dreadful times, when often the strongest on the earth were little 
 else than beasts of prey, and were rendering the weaker lives 
 a wretched endurance of robbery and lust and bondage and 
 slaughter, the Religious Orders, in spite of what may have been 
 at fault in their religion, and notwithstanding even the irreligious 
 which at times they showed, were generally by comparison, and 
 often in absolute fact, the one beneficent power of the time and 
 place. From them, and often only from them, millions of men 
 got their first dreamy glimmerings of belief, that, in spite of 
 the wickednesses which were done under so black a sky, the 
 world needed not for ever be mere hell. While the great monas- 
 teries, considered as feudal lords, had exacted various of their 
 feudal rights less strictly than most other masters, and had also 
 represented towards their poorer villeins (as well as to others) 
 much eleemosynary kindness, they further, with the church in 
 general, had favoured the enfranchisement of the serfs ; and, 
 from early in the thirteenth century, the new religious impulse 
 
INTRODUCTION. 63 
 
 from Assisi began to be of power for that great human interest, c^^- iv. 
 More than a century before Wyeliffe^s "poor preachers," the Philan- 
 Franciscan Mendicants, with their popular sympathies, and °^^' 
 their rude witness for our common clay, were awakening in 
 much of the feudal world its first dim conception of human 
 rights as distinguishable from the privileges of class, its first 
 vague movements towards the better times when man should 
 no longer be chattel to man. If our full-grown bodily frame 
 acknowledges humble beginnings for the organs which best serve 
 its purpose, no haughtier tone needs be taken with regard to the 
 steps of social development ; and modern civilisation, as it more 
 and more treasures the thought of equal justice between man and 
 man, should less and less forget the rudimentary forms in which 
 light-bearing to that end first began in the darkness of Europe. 
 Often, very often, no doubt, those merely human hands which 
 bore the torch were weak and let it fall to shame : but while in 
 one place it would seem quenched in degradation, in another it 
 would still shine and guide : and from then till now, in the 
 continuity of our human thought, the once-kindled ideal light 
 has never ceased to burn. 
 
 As in that, so in various other respects, the debt of modern 
 times to the mediaeval Religious Orders is far more than a mere 
 sentiment of sympathy with the populations which received 
 good at their hands. To say nothing of the obligations which 
 scholars of all sorts acknowledge to the Benedictine and Mendicant 
 Orders in respect of the stores of learning which they transmitted 
 and increased, or of new lights of knowledge and wisdom which 
 came from them,— to say nothing of those presages of scientific 
 spirit which dawned among them, as, for instance, in the mind 
 of Roger Bacon, — there are senses, purely medical, in which the 
 philanthropy of the middle ages has been a continuing good to 
 mankind. The hospital-system of modem Europe is raised 
 upon that mediaeval foundation. A large proportion of the 
 noblest hospitals in Europe, giving help year after year to annual 
 millions of the poor, exist by uninterrupted descent from monastic 
 charities : two signal instances in our own metropolis, are 
 St. Thomas's Hospital which is the continuation of a monastic 
 charity of the thirteenth century, and St. Bartholomew's Hospital 
 which is of even earlier monastic origin : and the cases which 
 
64 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. IV. have not been o£ direct descent have been cases o£ obedience to 
 Philan- example. Not least, too, in the Medical Prof ession, which counts 
 °^^* technical skill to be only half of its fitting equipment, and which 
 purports to owe heart, as well as brain and hand, to the service 
 of even the least of mankind, we may reverently feel that, in 
 those humane aspects, we inherit true light and leading from 
 the ages which in science were darker than our own, and that 
 Francis of Assisi, considered in his relation to the suffering poor, 
 is almost one of the Fathers of Medicine. 
 
IP art ^^r0nlr,— POST-MEDi^YAL England. 
 
 CHAPTER V. 
 
 TUDOR LEGISLATION. 
 
 The period of the Tudor reigns, with which England emerged 
 from mediseval ways of thought and action into ways compara- 
 tively modern, and soon gave such signs of national life as are 
 still among the proudest of her memories, was not only fruitful 
 in those decisive political achievements, and those immortal 
 works of imaginative and philosophical genius, which made it 
 so truly a dividing-epoch between the old times and the new; 
 but it was also able to spare energy and wisdom for relatively 
 humble domestic reforms ; and, among these, were some which 
 have to be noticed as of interest to the Health of the Population. 
 
 First, as regards the Medical Profession itself: — In the The 
 third year of the reign of Henry the Eighth the Legislature Profl^g^on- 
 considered, for the first time, under what conditions it should be Pliy»ciana; 
 lawful to practise medicine or surgery in England; and an Act 
 (c. xi.) was passed, limiting the practice to such persons as 
 should be duly examined and approved. The preamble of the 
 Act recites (in Tudor spelling which this needs not copy) that 
 " the science and cunning of physic and surgery, to the perfect 
 knowledge whereof be requisite both great learning and ripe 
 experience, is daily within this realm exercised by a great multi- 
 tude of ignorant persons, of whom the great part have no manner 
 of insight in the same nor in any other kind of learning, some 
 also can no letters on the book, so far forth that common artis 
 ficers, as smiths, weavers, and women, boldly and customably 
 take upon them great cures, and things of great difficulty, in 
 the which they partly use sorcery and witchcraft, partly apply 
 such medicines unto the disease as be very noyous and nothing 
 meetly therefore, to the high displeasure of God, great infamy 
 
 F 
 
6Q ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. V. to the faculties^ and the grievous hurt^ damage, and destruction 
 legislatioii. of many of the king^s liege people,, most especially of them that 
 cannot discern the uncunning from the cunning ; " and the Act 
 goes on to provide : that no one shall practise medicine within 
 the city of London, or within seven miles of it, unless he have 
 been examined, approved, and admitted by the Bishop of London, 
 or the Dean of St. PauFs for the time being, calling to him or 
 them four doctors of physic, or for surgery other expert persons 
 in that faculty, and for the first examination such as they shall 
 think convenient, and afterwards always four of them that have 
 been so approved : that, outside London and its precincts, the 
 examinations and admissions in each diocese shall be by the 
 Bishop of the diocese, or his vicar-general, with such expert 
 persons as he may think convenient : that any one, practising in 
 contravention of the Act, shall be subject to a penalty of .£5 for 
 each month in which he does so ; but that the Act is not to 
 prejudice Oxford or Cambridge. 
 Surgeons; Later in the reign important steps were taken, to enable 
 
 practitioners of medicine and surgery to turn to account for the 
 good of their profession that Roman contrivance of collegiation 
 which ordinary Trade-Guilds had successfully revived. Before 
 those later steps are described, note is requisite that, nearly sixty 
 years previously, Edward IV., in the first year of his reign, had 
 granted a charter of incorporation to " the Freemen of the 
 Mystery of the Barbers of the City of London, using the 
 Mystery or Faculty of Surgery : '' under which charter ^' two 
 Principals of the Commonalty, of the most expert men in the 
 Mystery of Surgery might with the assent of twelve, or eight 
 persons at the least, of the same community, every year elect 
 and make out of the community two Masters or Governors, 
 being the most expert in the Mystery of Surgery, to oversee, 
 rule and govern the Mystery and Commonalty aforesaid.''^ 
 Eoyai Of the steps taken in a like direction in the reign of 
 
 Physicians; Henry VIIL, the first has been officially described in the 
 following terms : ^^ Henry the Eighth, with a view to the 
 improvement and more orderly exercise of the art of physic, 
 and the repression of the irregular, unlearned, and incompetent 
 practitioners of that faculty, in the tenth year of his reign 
 founded the Royal College of Physicians of London. To the 
 
POST-MEDIEVAL ENGLAND. 67 
 
 establishment o£ this incorporation the king was moved by the Chap. v. 
 example of similar institutions in Italy and elsewhere, by the Le^siatio 
 solicitations of at least one of his own physicians, Thomas 
 Linacre, and by the advice and recommendation of his chancellor 
 Cardinal Wolsey. By the terms of the Letters Patent con- 
 stituting the College, dated 23rd September, 1518, John 
 Chambre, Thomas Linacre, and Ferdinand de Victoria, the 
 king's physicians, Nicholas Halsewell, John Francis, and Robert 
 Yaxley, physicians, and all men of the same faculty, of and in 
 London and within seven miles thereof, are incorporated as one 
 body and perpetual Community or College. To this was added 
 the power of annually electing a President . . and . . the liberty 
 of holding lands whose annual value did not exceed twelve pounds. 
 They were permitted to hold assemblies and to make statutes 
 and ordinances for the government and correction of the College, 
 and of all who exercised the same faculty in London and within 
 seven miles thereof, with an interdiction from practice to any 
 individual, unless previously licensed by the President and 
 College. Four persons were to be chosen yearly (censors) to 
 whom was consigned the correction and government of physic 
 and its professors, together with the examination of all medi- 
 cines and the power of punishing offenders by fine and imprison- 
 ment, or by other reasonable ways. And lastly the members 
 of the College were granted an exemption from summons on 
 all assizes, inquests, and juries in the city and its suburbs."'-' * 
 
 Five years afterwards, the charter was confirmed, and some and its 
 additional powers granted to the College, by Act of Parliament P^^^S^s; 
 14th and 15th Henry VIII., c. 5. In this Act provision was made 
 for the immediate appointment of eight so-called Elects : who 
 were to annually appoint from among themselves the President 
 of the College, and were to fill vacancies in their own number 
 by admitting, as need might be, one or more of the most 
 cunning and expert men of the same faculty in London : strict 
 examination of each selected person being first made by them. 
 
 * The Roll of the Royal College of Rhysicians of London : by William 
 Munk, M.D., Registrar of the College. London, 1878. The preamble of the 
 Charter declares: — " Apprime necessarium fduximus improhomm hominum qui 
 medicinam magis a/varitice suce causa, quam idlkcs bonce conscientice fiducid, projite- 
 buntm\ unde rudi ei credula plebi phcrima incommoda oriantur, audaciam compescere.''^ 
 
 p 2 
 
68 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. V. 
 
 Tudor 
 
 Lemslation. 
 
 Corpora- 
 tion of 
 Barbers 
 and Sur- 
 
 Subse- 
 quent pass- 
 
 The Act also provided that (except graduates of Oxford and 
 Cambridge) no person should thenceforth be suffered to practise 
 physic in England^ unless he had previously been examined by 
 the President and three Elects of the College, and had received 
 from them letters testimonial. 
 
 Seventeen years later in the reign, namely in 1540, further steps 
 relating to the Medical Profession were taken by the passing of 
 two Acts of Parliament, one concerning Physicians, and the 
 other concerning Surgeons. The former (32nd year, c. 40) was 
 chiefly important as providing that the incorporated Physicians 
 should have supervision of the apothecaries^ shops in the city 
 of London, and as declaring that, '^forasmuch as the science 
 of physic doth comprehend include tod contain the know- 
 ledge of surgery as a special member and part of the same,^^ 
 any of the incorporated physicians (being able chosen and 
 admitted by the president and fellowship) may practise physic 
 ^^in all and every his members and parts,^^ notwithstanding 
 any enactment made to the contrary : while, in special rela- 
 tion to Surgery, the other of the Acts (eod. c. 42) after 
 reciting that there were then in the city of London two several 
 and distinct companies of surgeons, occupying and exercising 
 the faculty of surgery, one company [the corporation made 
 by Edward the Fourth] called the Barbers of London, and 
 the other company called the Surgeons of London, enacts that 
 the two companies shall be made one, under the name of the 
 Masters or Governors of the Mystery and Commonalty of the 
 Barbers and Surgeons of London."^ In accordance with the 
 latter Act, the King in 1540 granted a charter to the new 
 company ; and many who are neither barbers nor surgeons may 
 remember with interest this particular royal act, because of 
 Holbein's masterpiece of painting which commemorates it. 
 
 In order to simplify future references to the early legal con- 
 stitution of the Medical Profession, as bearing on the constitu- 
 tion which now is, it may be convenient to interpose here, though 
 anticipatively, a mention of some subsequent passages in the 
 history of the just-mentioned Corporations. 
 
 * In section 3 of tbe Act it was provided (for fear of infections of disease) 
 that no one person should practise both, barbery and surgery, except that 
 barbers might draw teeth. 
 
POST-MEDL^VAL ENGLAiTD. 69 
 
 The Corporation of Barbers and Surgeons received from Chap. v. 
 Charles the First, in the first year of his reign, a charter con- LegSlation. 
 firming Henry the. Eighth^s, and further empowering the Cor- 
 poration to appoint Examiners of Surgeons in London. In the i^^o^oja- 
 eighteenth year of George the Second, an Act of Parliament tionof 
 dissolved (from 24th June, 1745) the old union between the eventually 
 Barbers and the Surgeons, and enacted that members of the College; 
 united company who were freemen of it, and admitted and 
 approved surgeons within the rules of the company, should 
 thenceforth be a separate and distinct body corporate — '^the 
 master governors and commonalty of the art and science of 
 surgeons in London."* In 1800 the Corporation of 1745 was 
 dissolved ; and a new charter (40th George III.) created in its 
 stead the Boyal College of Surgeons in London : which forty- 
 three years later, under a further charter (Victoria 7th) received 
 a new constitution, and became the Royal College of Surgeons 
 of England, as now existing. 
 
 In the Royal College of Physicians of London, as now exist- Apotiie- 
 ing, we have, as needs hardly be stated, the corporation which supervised 
 Henry the Eighth founded, and which, till some thirty years cians and 
 ago, had retained without change the constitution originally sub*^^^ 
 given to it. In the first year of Mary's reign, however, a gJJ.^^^Jj.. 
 further Act of Parliament (session 2, c. 9) had added somewhat ated, and 
 to the provisions of the thirty-second of Henry the Eighth : made a 
 first, to strengthen the penal powers of the College, by providing u^^eSf 
 that persons committed by it under the previous law should be authority. 
 kept in prison at their own cost until discharged by the College; 
 and secondly, which is of more historical interest, to enact that, 
 in the function of supervising apothecaries' shops, the College of 
 Physicians should be joined by the Wardens of the Grocers' 
 Company. The interest of the last-cited enactment lies in 
 the fact, that the quasi-medical relation in which the Grocers' 
 Company now came to be legally recognised, grew, with progress 
 
 * That breaking-up of Henry the Eighth's compound corporation seems to 
 have come from incompatibilities which of course showed themselves as surgery- 
 began to develop ; and a special cause for it seems to have been the resistance 
 which the barbers opposed to the growing desire of the surgeons to acquire due 
 knowledge of anatomy by dissections of the human body. Cheselden, the first 
 surgeon and anatomist of his time, was a principal promoter of the separation 
 of 1745. 
 
70 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 ^AP. V. of timej into far larger relations which were fully medical : not 
 L^iation. indeed in the hands of the Grocers-* Company, but in those of 
 the Society of Apothecaries, which, under Charter of fifteenth 
 James I., budded off from the Company of the Grocers j"^ for 
 the Society of Apothecaries, after it had existed for some 
 two centuries as an ordinary City-Guild, was transformed 
 by Act of Parliament (1815) into a licensing medical cor- 
 poration. 
 
 Thus, at the middle of the Tudor period, the Medical Pro- 
 fession had but imperfectly detached itself from other industries. 
 Three main roots for it were discernible. Apothecary, surgeon, 
 physician, each had a mark of his own : the first, his familiarity 
 with the uses of worts and drugs; the second, his skill for 
 bleeding, bandaging, bone-setting, and the like ; the third, his 
 book-learning, especially in the Greeks and Latins, and often 
 his mastery of at least one occult science : but the apothecary 
 was still a variety of grocer, the surgeon still a variety of barber, 
 and the physician but just ceasing to be an ecclesiastic.f 
 
 Commis- 
 sions of 
 Sewers : 
 
 Previous 
 
 floods; 
 
 In a second line of sanitary concern, there was passed in 1532 
 the very important Act of Parliament (23rd Hen. VIII., c. 5) 
 which provided for the institution of Commissions- of Sewers 
 in all parts of the kingdom. 
 
 This of course was not the first action in England, evincing 
 care for the maintenance of dry land ; for (as before illustrated) 
 such action is apt to be among the earliest of tokens that com- 
 munities are acquiring civilisation ; and probably there had been 
 such in England from time immemorial. Sections xv. and xvi. 
 of the Great Charter indicate that riparian towns and land-owners 
 had from old been accustomed to maintain certain embankments 
 of rivers, — for those sections make unlawful any distraint of 
 
 * The grant of tliat Charter has a painful side-interest attached to it in 
 English history. It was one of the occasions in regard of which Lord Chancellor 
 Bacon, on his arraignment, confessed that he had been guilty of receiving money 
 from suitors. 
 
 t No doubt at least one of those combinations still lingers in parts of Europe. 
 I remember to have observed in the south of Spain, forty years ago, that barbers' 
 shops generally had a notice that the barber did midwifery and surgery as well 
 as shaving ; and far more recently, in Switzerland, I have had the honour of 
 being shaved by one who had Professor Yirchow's latest publications on the 
 book-shelf beside his basin. 
 
POST-MEDIEVAL ENGLAND. 71 
 
 towns or freemen for other than tTie customary embankments ; Chap. v. 
 and section xxxix. of the Charter requires that all wears in the Legislatibn. 
 Thames and Medway, and everywhere except along the sea, 
 shall be put down. The prohibition of wears was repeated in 
 various later statutes ; "^ among which the most important was 
 one passed in the last year of Richard the Second : an Act which 
 was repealed (together with all others of the same year) as soon 
 as the next reign began,, 1st Henry IV. c. 3, but was forthwith in 
 substance re-enacted j eod. c. 12. This Act recited inter alia in 
 its preamble^ that ^^ meadows^ pastures and arable lands, joining to 
 the . . . riverSj be greatly troubled, drowned, wasted and destroyed, 
 by the outrageous enhansing and straitening of wears, mills, 
 stanks and kiddles, of old time . . . whereof great damages and 
 losses have oftentimes happened to the people of the realm, and 
 daily shall happen if remedy thereof be not provided " ; and it 
 enacted (in anticipation of the statute of 1532) that in every county 
 of England where need is. Commissioners shall be appointed " to 
 survey and also keep the waters and great rivers there, and the 
 defaults to correct and amend " . . . 'Ho survey the wears, mills, 
 stanks, stakes and kiddles, of old time made and levied " . . . *' to 
 correct pull down or amend . . . saving always reasonable sub- 
 stances of the same "" : &c. In the sixth and eighth years of 
 Henry the Sixth, further steps towards the legislation of 1532 
 were taken by Acts which provided more particularly for the 
 appointment and powers of Commissioners of Sewers. 
 
 The preamble of the Act of 1532, in accordance with the Actofl532. 
 practice of those days, gave explanation of the circumstances 
 under which the Act was deemed necessary, and did so with such 
 fulness, that it, and the first provision of ^the Act, may well be 
 quoted here, as follows : — " Our sovereign lord the King, like a 
 most virtuous and] gracious Prince, nothing earthly so highly 
 weighing as the advancing of the common profit wealth and 
 commodity of this his realm, considering the daily great damages 
 and losses which have happened in many and divers parts of this 
 his said realm, as well by reason of the outrageous flowing surges 
 
 * See Edward III. 25th, stat. 4, c. 4, and 45th, c. 2 ; Eichard II. 21st, c. 19 ; 
 Henry IV. 1st, c. 12, and 4th, c. 11 ; Edward IV. 12th, c. 7. Of the ahove 
 statutes, the first-mentioned specially objects to wears that they hinder navi- 
 gation, and the fifth that they do wrong to the fishery. 
 
72 ENGLISH SANITABY INSTITUTIONS. 
 
 Chap. V. and course o£ tlie sea in and upon fisli-grounds and other low 
 LegSation- places^ heretofore through politic wisdom won and made profitable 
 for the great common wealth of this realm^ as also by occasion 
 of land- waters and other outrageous springs in and upon meadows 
 pastures and other low grounds adjoining to rivers, floods and 
 other water-courses, and over that through mills, mill-dams, weirs, 
 fish-garths, kedels, gores, gootes, flood-gates, locks and other im- 
 pediments in and upon the same rivers and other water-courses, to 
 the inestimable damages of the commonwealth of this realm, 
 which daily is likely more and more to increase unless speedy 
 redress and remedy be in this behalf shortly provided, wherein 
 albeit that divers and many provisions have been before this 
 time made and ordained yet none of them are sufficient remedy 
 for reformation of the premisses; hath therefore by deliberate 
 advice and assent of his lords spiritual and temporal and also his 
 loving commons in this present Parliament assembled, ordained 
 established and enacted that Commissions of Sewers and other 
 the premisses shall be directed in all parts within this realm from 
 time to time where and when need shall require according to the 
 manner, form, tenure and effect hereafter ensuing, to such sub- 
 stantial and indifferent persons as shall be named by the Lord 
 Chancellor and Lord Treasurer of England, and the two Chief 
 Justices for the time being, or by three of them, whereof the 
 Lord Chancellor to be one.^'' The prescribed form of Commission 
 was a comprehensive authorisation and command to do or to 
 cause to be done all which in the premisses might be needful 
 within the appointed area of jurisdiction; and in addition to 
 giving powers of inspection, construction, amendment and 
 removal, as to the various things enumerated in the preamble, it 
 gave powers to tax and distrain, to appoint and depute officers, 
 to impress (but with payment) the labour of man and beast, to 
 take (with payment) timber and other material, to enact statutes, 
 ordinances and provisions, ^^ after the laws and customs of Romney 
 Marsh in the county of Kent,''' or at discretion otherwise, and to 
 make orders and precepts. 
 
 New Poor- Thirdly to be mentioned, as a branch of Tudor legis- 
 
 lation which most importantly concerned the physical wel- 
 fare of the people, are the successive Acts of Parliament 
 
POST-MEDIiEVAL ENGLAND. 73 
 
 which were passed in relation, on the one hand, to the Chap. v. 
 
 IMPOTENT Poor, and, on the other hand, to Mendicants and Legislation. 
 Vagrants. 
 
 During the centuries of ecclesiastical supremacy in England, previous 
 
 o X ./ o -> provision 
 
 there had been no need to press by statute on the well-to-do for the 
 classes that they should give relief to destitution. The stationary against dis- 
 poor seem to have had some sort of legal claim on lords of g^g.^ ^' 
 manors; but, apart from this, in every parish of the country, 
 the parson had (or was supposed to have) means in trust for 
 them. This parochial trust seems to have been implied, or 
 perhaps had been ecclesiastically regulated, from the earliest days 
 of the Church ; and the first mention of it in the statute-book is 
 not to enact, but to recite it. Edward the Third^s Statute of 
 Provisors, referring to the Carlisle Statute of Edward the First 
 (35th year) recites from it, that ^^the Holy Church of England 
 was founded in the estate of prelacy within the realm of England 
 by the said King [Edward the First] and his progenitors, and 
 the earls barons and other nobles of his said realm and their 
 ancestors, to inform them and the people of the law of God, and 
 to make hospitalities, alms, and other works of charity, in the 
 places where the churches were founded '' ; and that '^ certain 
 possessions, as well in fees, lands, rents, as in advowsons, which 
 do extend to a great value, were assigned by the said founders 
 to the prelates and other people of the Holy Church of the said 
 realm to sustain the same charge. ''■' * Afterwards, by § vi. of the 
 Act of the fifteenth year of Richard the Second, law was made 
 that every parish should have its trust-money for the above pur- 
 poses secured to it: viz. — '^ In every licence from henceforth to be 
 made in the Chancery of the appropriation of any parish church, 
 it shall be expressly contained and comprised that the diocesan 
 of the place, upon the appropriation of such churches, shall 
 ordain, according to the value of such churches, a convenient sum 
 of money to be paid and distributed yearly of the fruits and 
 profits of the same churches, by those that shall have the said 
 churches in proper use, and by their successors, to the poor 
 
 * With regard to that recital by Edward III., it may be noted that the 
 language of Edward the First's statute mentions only monasteries and other 
 special foundations, and does not appear to speak (as the recital does) of the 
 Church of England in general. 
 
74 ENGLISH SANITARY INSTITUTIONS. 
 
 CttAP. V. parishioners o£ the said churches, in and o£ their living and 
 Legislation, sustenance, for ever ; and also that the vicar be well and 
 sufficiently endowed/^ In districts which had monasteries 
 within them, these institutions would of course have been a 
 further security to the stationary poor, that assistance, such as 
 we should now term out-door relief, would be given to them 
 according to their needs. The migrating poor (including all 
 classes of vagrants) would probably have been to some extent 
 recognised as entitled to receive parochial ^^ hospitality '^ under 
 the conditions to which reference has been made ; but probably 
 most of such poor would have resorted to the monasteries, if 
 within reach, and would have been tolerably sure of receiving 
 temporary assistance from them. With charitable institutions 
 to the above effect existing, besides a very extensive presence of 
 guilds in rural as well as urban districts, there not only were 
 means enough for giving help to proper claimants, but often 
 unfortunately also means enough to promote a lavish or 
 indiscriminate giving of alms, and thus to promote habits of 
 mendicancy and dependence among classes which were not 
 properly necessitous. The begging of alms by non-necessitous 
 persons, and especially by the able-bodied, or — as our old laws 
 used to term them — ^^ valiant and sturdy "" beggars, whose own 
 labour ought to be their support, has, no doubt, been in all 
 countries, from the earliest times, a familiar social evil. For 
 few men love labour for its own sake ; and perhaps most men, 
 in the absence of manna from Heaven, would rather be kept in 
 comfort at other men's cost than have to drudge steadily for 
 their own maintenance. The difficulty had been noticed by the 
 English Legislature as far back as the year 1349 ; when a pro- 
 hibition against giving alms to ^' valiant beggars '' was inserted 
 in the Act, 23rd Edward III., c. 7. Early in the Tudor period, 
 namely in the 11th year of Henry VII., the Legislature, while 
 fully recognising that the impotent poor had local claims to 
 relief, found it necessary to restrict even them from migratory 
 begging; and at the same time (11th, c. 2) provided, in regard 
 of '^ vagabonds, idle, and suspected persons," that they ^^ shall be 
 set in the stocks three days and three nights, and have none 
 other sustenance than bread and water, and then shall be put out 
 of the town, and that. whosoever shall give such idle persons 
 
POST-MEDIEVAL ENGLAND. 75 
 
 more shall forfeit twelve penee/^^ In 1531^ further legislation Chap. v. 
 in the same sense, but with a severer tone against unprivileged Legislation, 
 mendicants, whether impotent or able-bodied, and with penalty 
 of whipping for certain disobediences, had to be provided by the 
 22nd of Henry the Eighth, c. 12. Almost immediately after 
 the last-named statute. Acts of Parliament relating to the Extinction 
 Protestant Reformation begin to occupy the statute-book ; and ^o^nitic 
 the progress of that legislation soon made it necessary to re- charitiee. 
 consider as a whole the laws which related to poverty and 
 mendicancy in England. The Acts of 1532-4 which freed the 
 country from further allegiance to the See of Rome, and vested 
 in the crown of England the headship of the English Church, 
 were followed during the years 1536-9 by measures for^the disso- 
 lution of all monasteries and friaries in England, and during 
 1545-7 by similar measures relating to chantries and other minor 
 religious foundations. Step by step as those dissolutions were 
 effected, the respective possessions of the dissolved bodies were 
 transferred to the crown, and the functions which the bodies had 
 discharged in relief of poverty had to be discharged by such new 
 agencies, and on such new system, as the State might see lit to 
 appoint. 
 
 In the re-consideration which consequently began, and which Principles 
 (as the subject was taken up again and again) may be said to laws: 
 have continued till the end of the Tudor period, three main 
 principles were recognised from first to last ; though not always 
 with the same degree of insistence on each of them ; nor of 
 course still less in those relative proportions, or with those col- 
 lateral considerations, which attach to them in modern times. 
 It was recognised — first, that persons of adequate means must 
 henceforth accept as an obligation the responsibility of providing 
 sustenance for the impotent poor of their respective parishes : 
 secondly, that to poor persons, not impotent, relief must only 
 be given in exchange for work, and that pretences of destitution, 
 and above all, the voluntary parasitism of idleness, must be 
 treated as criminal : thirdly, that certain roots of poverty must 
 be dealt with preventively by educating and employing the 
 children of the poor. 
 
 * The language quoted is that of Danby Pickering's edition of the Statutes 
 at large. 
 
76 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Against 
 
 "sturdy 
 
 beggars ' 
 
 and 
 
 " rogues. 
 
 I^AP. V. In -the earlier enactments o£ the period (beginning with those 
 
 Legislation, of the 27th o£ Henry the Eighth) the chief insistence is on the 
 second of those principles : the legislators taking as their axiom, 
 that any able man who would shirk his duty of self-support is a 
 traitor against the community to which he belongs ; and for 
 some fifty or sixty years they evidently felt no sort of hesitation 
 in adapting their penalties to that view of his crime. The 
 sturdy beggar^s third offence against the law was capital : he 
 was to '^ suffer execution of death, as a felon and an enemy to 
 the commonwealth : "" and his earlier offences would have been 
 proportionately dealt with. Under Henry, for a first begging 
 he would have been whipped, and for a second would have had 
 ^^ the upper part of the gristle of his right ear cut off .'"' For three 
 years under Edward the Sixth, legislation still more ferocious 
 against first and second offences was in force :* but with its repeal 
 (4th Edw., cap. 16) re-enactment was made of the Henrican law 
 of 1531 ; which again in 1572 was strengthened by the 14th 
 Elizabeth, c. 5. This Act, not mitigated till 1593, and not 
 repealed till 1597, provided as follows : ^*^ A vagabond above the 
 age of fourteen years '^ — and apparently '' vagabond ■" included 
 '^ any able-bodied common laborer who loitered and refused to 
 work for such reasonable wage as was commonly given '' — ^^ shall 
 
 * From the fierce penal provisions of tlie Act, Ist Edward VI., c. 3, tlie 
 following may be cited : — " If any person bring to two justices of peace any 
 runagate servant, or any other which liveth idly and loiteringly, by the space 
 of three days, the said justices shall.cause the said idle and loitering servant or 
 vagabond to be marked with an hot iron on the breast with the mark of Y, 
 and adjudge him to be slave to the same person that brought or presented him, 
 to have to him, his executors or assigns, for two years after ; who shall take the 
 said slave and give him bread, water, or small drink, and refuse-meat, and 
 cause him to work by beating, chaining, or otherwise; in such work and labor 
 as he shall put him unto, be it never so vile : and if such slave absent himself 
 from his said master, within the said term of two years, by the space of fourteen 
 days, then he shall be adjudged by two justices of peace to be marked on the 
 forehead, or the baU of the cheek, with an hot iron, with the mark of an S, and 
 further shall be adjudged to be a slave to his said master for ever : and if the 
 said slave shall run away the second time, he shall be adjudged a felon." . . . 
 " It shall be lawful to every person to whom any shall be adjudged a slave, to 
 put a ring of iron about his neck arm or leg." . . . " A justice of the peace 
 and constable may bind a beggar's man-child apprentice to the age of fourteen 
 years, and a woman-child up to the age of twenty years, to any that will 
 require them ; and if the said child run away, then his master may retain and 
 use him for the term aforesaid as his slave." 
 
POST-MEDIiEVAL ENGLAND. 77 
 
 be adjudged to be grievously whipped, and burned through the Chap. v. 
 gristle o£ the right ear with a hot iron of the compass of an LegSLtion. 
 inch_, unless some credible person will take him into service for 
 a year ; and if, being of the age of eighteen years, he after do 
 fall into a roguish life, he shall suffer death as a felon unless 
 some credible person will take him into service for two years ; 
 and if he fall a third time into a roguish life, he shall be ad- 
 judged a felon/^ The modified Elizabethan law against vaga- 
 bonds (39th, c. iv.) enacted that houses of correction for them 
 should be provided : an enactment which her successor developed 
 in 1609 ; with provision that in these houses (whereof one or 
 more should be in each county of England and Wales) vaga- 
 bonds must be compelled to work, and might be punished by 
 " fetters or gives '' and by " moderate whipping,^' and " shall 
 have such and so much allowance as they shall deserve by their 
 own labour and work/-* 
 
 While recognition, and at times a far too passionate recog- For relief 
 nition, was thus being given to one of the requirements of a ° true 
 new poor-law, action in respect of the other requirements lagged po^^-" 
 at first somewhat irresolutely behind. The framers of the 
 statute of 1536 seem to have assumed, as matter of course, 
 that a poor or professedly poor man, in his place of settlement, 
 would, somehow or other, be cared for according to his deserts ; 
 that the Legislature had only to give to local authorities such 
 general direction as would make them the trustees and ad- 
 ministrators of charity to the poor; and that local liberality 
 and kindness would immediately supply the necessary funds 
 for all proper functions of relief. In this spirit, the Act of 
 1536, referring to such impotent poor as had heretofore subsisted 
 by way of voluntary and charitable alms in any of the shires, 
 cities, towns, hundreds, hamlets, or parishes, of the kingdom, 
 simply directed the respective local " governors '^ to find such 
 poor persons, and to keep them with such convenient alms as 
 they in their discretion should think meet, so that none might 
 be compelled to go openly in begging ; and with regard to child- 
 ren living in idleness, and caught begging, the Act authorised 
 their being put to service to husbandry or other crafts or labours. 
 Neither under Edward, nor under Mary, was there any attempt 
 to go beyond the spirit of that legislation of 1536. Under the 
 
78 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap^ V. three Acts o£ Edward's reign (first, e. 3 ; fourth, e. 16 ; fifth, c. 2) 
 Legislation, the directions to local ^^ governors '' were somewhat amplified : 
 convenient habitations, with other relief, were to be provided 
 for the impotent poor : ofiicial collectors of alms were to be 
 appointed : even a little ecclesiastical pressure was to be invoked, 
 in regard of competent persons whose alms were not forth- 
 coming : but in substance the law remained as it was, a mere 
 invitation to charity : the appeal for the impotent poor was to 
 '^ the devotion of the good people of that city, town, or village 
 where they were bom or have dwelt three years : " ^^ the poor 
 of every parish shall be relieved with that which every parishioner 
 of his charitable devotion will give/' Under Mary, the only 
 suggestion seems to have been whether perhaps non-contributors 
 ' might be comminated in church : but at an early stage of 
 
 Elizabeth's reign, the matter was undertaken in a wiser spirit ; 
 and before the close of that splendid era, successive acts of 
 legislation, worthy of the time, had given to the country a 
 Poor Law which was complete in all essential respects, and was 
 destined to remain valid for centuries. 
 Eliza- Of those Elizabethan Acts, the earliest (fifth year, c. 3) was, 
 
 Acts. in principle, the whole thing. It provided that contribution 
 
 towards the relief of the impotent poor should henceforth be 
 legally leviable on every competent person ; that no such person 
 should have option of refusal ; that ^* if any parishioner shall 
 obstinately refuse to pay reasonably towards the relief of the 
 said poor, or shall discourage others, then the justices of peace at 
 the quarter-sessions may tax him to a reasonable weekly sum ; 
 which if he refuse to pay, they may commit him to prison." 
 The second of the Acts (14th, c. 5) provided for a more systematic 
 rating of competent persons. '^ Assessments shall be made of 
 the parishioners of every parish for the relief of the poor of the 
 same parish." Incidentally it enacted ; ^^ Every bishop shall 
 visit and reform hospitals within his diocese." The third of 
 the Acts (39th, c. 3) provided for the appointment, duties and 
 liabilities, of overseers of the poor. The fourth and last of the 
 Acts, the famous c. 2 of Elizabeth's 43rd year, is the Great 
 Charter of this branch of English law. It provides again as 
 to the appointment of overseers. It provides that the overseers, 
 ■ with consent of certain local justices of peace, shall set to work 
 
POST-MEDIiEVAL ENGLAND. 79 
 
 cliildren whose parents cannot maintain them, and persons, chap. v. 
 married or unmarried, who have no means of maintenance nor ^e^^Lti 
 any ordinary trade of life by which to get living; and shall 
 raise weekly or otherwise by taxation of every inhabitant a 
 convenient stock of all necessary wares and stuffs to set the 
 poor on work ; and shall raise from the parish, according to its 
 ability, sums of money towards the necessary relief of the 
 impotent poor of all sorts, and for putting out children as 
 apprentices. It provides that, in case of need as regards any 
 poor parish, some or all other of the parishes of the same 
 hundred, or in case of greater need some or all of the other 
 hundreds in the county may be rated in aid. It provides for 
 the apprenticing of children ; males up to the age of twenty- 
 four ; females up to the age of twenty-one or to marriage. It 
 provides for building upon waste or common land (with consent 
 of lord or lords of manor) convenient houses of dwelling for the 
 impotent poor. It contains of course many detailed provisions 
 as to the machinery and procedures for giving effect to its 
 general intentions ; and it further contains a wide safe- 
 guarding provision, that the responsibility, for relieving any 
 impotent poor person shall primarily rest on the parents, 
 grandparents and children of such person, if they be of com- 
 petent ability, and that this responsibility shall be enforced by 
 the justices. 
 
 Thus at last was provided all which the State could offer to 
 the Poor in substitution for the mediaeval charities which had 
 been swept away. And side by side with those new provisions 
 for relief, were the penal provisions which I previously described, 
 guarding against the various impostors who would consume 
 what was meant for the impotent : and of like intent with this 
 part of the law, there were the provisions of the 18th Eliz., 
 c. 3, as to children born out of wedlock. These defensive pro- 
 visions of the law were not less essential than the charitable : 
 for the relief which charity could promise was but of limited 
 amount : and so far as any " rogue " could succeed in his 
 attempts to live by charity, his success would indeed be (as the 
 last-cited statute expresses) a ^' defrauding of the impotent and 
 aged true poor."*^ Undoubtedly the defensive provisions in their 
 earlier stages were truculent, and even in their final mitigated 
 
80 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. V. form were very severe. Their more or less draconic character 
 Legislation, was a quahty which they shared with all other English 
 penal law o£ the times ; and which indeed^ till more than two 
 centuries afterwards^ continued to mark our whole penal code. 
 In the earlier Tudor legislation as to ^^ vagabonds,^' there no 
 doubt may have been a spice of the old feudal ferocity of lord 
 against troublesome serf ; but in the later Elizabethan mind, 
 the theory, we may beheve, would rather have been that of 
 domestic discipline : a pious parental wish, not so to spare the 
 rod as to spoil the child. As to the earlier times, too, it must 
 not be forgotten that they were times of extremely grave crisis 
 in regard of the poor; that, during the years next after the 
 suppression of the religious houses, the country was a swarm of 
 claimants for alms ; and that just consideration for the im- 
 potent poor could not abide with leniency to ^^ vagabonds.''^ In 
 partial apology even for the first statute of Edward's reign, it 
 seems certain that vagabondage was then in such strength as to 
 be a real social danger, and that panic may have dictated the 
 legislation. Whether the final Elizabethan law against '^^ rogues'' 
 was unduly severe in its provisions, is a question on which judg- 
 ments differ. Common humanity deprecates of course all super- 
 fluous severity of law ; but laws really meant to be obeyed must 
 be made a terror to evil-doers ; and society fighting for its very 
 life (as it does when vagabondage is in mass) cannot afford to 
 take only sugar-plums for its weapons. On the other hand, it 
 cannot but be felt that extremely severe laws against vaga- 
 bondage are a reproach to the states of society which require 
 them : that the existence of the vagabond (except as a mere 
 sporadic rascal) testifies to some past or present badness of law. 
 In proportion to the length of time for which a country has had 
 equal laws for all sorts and conditions of its people, — in proportion 
 to the length of time for which every kind of labour has been 
 free to follow its own course in its own way, — in proportion to 
 the length of time for which the children of the people have 
 had education,— in such proportions will idleness hold less 
 and less vantage ground for preference in the minds of the 
 poor of the land, and police-rules for the branding and slaying 
 of vagabonds will have become but a shameful memory of 
 the past. 
 
POST- MEDIEVAL ENGLAND. 81 
 
 Here ends the legislation of the Tudor period^ as regards Chap. v. 
 matters of general sanitary concern ; but it may be noted that. Legislation, 
 before the end of the civilising reign of Elizabeth, local Improve- 
 ment-Works on a more or less considerable scale had been started Town\m- 
 in various towns of England, either as municipal undertakings or provement 
 as gifts of private munificence. Though the present record can- 
 not enter enough on town-histories to certify in what towns such 
 works were first undertaken, there may be mentioned, as an in- 
 stance of what is meant, the famous Plymouth Water-Leet: 
 which Admiral Sir Francis Drake, at that time member for the 
 town, devised and constructed, to convey by gravitation suitable 
 supplies of water from Dartmoor (about twenty-four miles 
 distant) into the town. The Act of Parliament sanctioning 
 that important work was of the year 1585, 27th Elizabeth, 
 c. 20 : some thirty years before the time when the water-supply 
 of the city of London was to be improved by the famous New 
 River of Sir Hugh Myddelton.* 
 
 * Before the end of the reign, was also a smaller incident which deserves 
 notice. In 1596, Sir John Harington, who in earlier life had been a favourite 
 page of the Queen's, and was Her Majesty's godson, published, under the 
 punning title of Metamorphosis of A-jax^ his account of an original contrivance 
 by which he had relieved his house at Kelston, Bath, from the stench of its 
 previous " jakes : " namely, a water-adaptation, which, though not with all the 
 accomplishments of a modem water-closet, was effectual enough for its purpose, 
 and may probably have been afterwards copied in other great houses. Few 
 puns bear the test of time ; and perhaps Harington's title may already require to 
 be explained by a word of reminder, that, down to the end of the eighteenth 
 century, the word " jakes," or sometimes "heaks," was a name of the ordinary 
 privy. 
 
62 
 
 CHAPTER VI. 
 
 LONDON UNDER ELIZABETH AND THE STUARTS. 
 
 After an interval of a hundred and sixty years from the close of 
 the City of London Memorials, quoted above in chapter iii., 
 the government of London is illustrated anew for a period of 
 eighty-six years, 1579-1664, by the collection known as the 
 City Remembranciaj the records of the Remembrancer's office. 
 Of this collection, which consists of various correspondence had 
 by the Corporation during the eighty-six years, chiefly with 
 Ministers of the Crown, on matters (large and small) of 
 municipal concern, the Corporation has lately published an 
 admirable Analytical Index ; and from that Index will be 
 gathered into the present chapter such chief illustrations as it 
 affords of the sanitary government of London during the reigns 
 of Elizabeth and the three first Stuarts. 
 
 streets and The publication is not of a nature to have room in it for 
 details, such as abound in the Memorials, with regard to police- 
 administration in particular cases ; but it is easy to see that the 
 old urban difficulty, as to getting rid of filth and refuse, still 
 continued ; and there is more definite reference than before both 
 to sewers (essentially as courses for rain-water"^) and also to 
 pavement. Commissioners of sewers are now mentioned ; and 
 in 158^ and again in 1591, there is correspondence with the 
 Lords of the Council on the cleansing and conservation of the 
 Fleet Ditch. In February, 1620, the Lords of the Council 
 complained to the Lord Mayor and Court of Aldermen of the 
 impassable state of the streets of the city : where, " though the 
 frost had continued nearly three weeks, no steps had been taken 
 for the removal of the ice and snow : '^ they required immediate 
 order to be given for remedy of the inconvenience, and threatened 
 that, upon any further neglect, they would address themselves to 
 
 * In the earlier collection in one case (1373) there is mention of a right of 
 water-easement by means of '* an arched passage " beneath a certain tenement in 
 Bishopsgate. — Memorials, p. 374. 
 
POST-MEDIiEVAL ENGLAND. 83 
 
 the Aldermen o£ the several wards where such abuses and incon- Chap. VI. 
 venience should be found, and would call them individually to 158O-1714. 
 strict account. In 1628 the King, having noticed that the ways 
 in and about the City and Liberties were very noisome and 
 troublesome for passing, in consequence of breaches of the pave- 
 ments and excessive quantities of filth lying in the streets, the 
 Lords of the Council inform the Lord Mayor of this, and, at 
 the King's express command, require the Lord Mayor to take 
 effectual steps for the complete repair of the pavements^ and the 
 removal of all filth — '^ the fruits of which His Majesty expects 
 to see on his return from Portsmouth ; " and two months after- 
 wards, they write again, reminding the Lord Mayor of the near 
 approach of the King's return, and requiring him to certify what 
 has been done in the matter. Six years later, according to the 
 Index, there is a "letter from the King to the Lord Mayor, 
 recommending a proposition of one Daniel Nis, for the beauti- 
 fying and better accommodation (p. 483) of the streets of the 
 city by raising them to a convenient height, evenness, and 
 decency, leaving ample passage for coaches, carts, and horses, and 
 reserving a competent part to be made even and easy in a far 
 more elegant and commodious manner for the convenience of 
 foot-passengers, besides a handsome accommodation of water for 
 the continual cleansing of the streets by lead pipes.^^ In the 
 same year (1634) the Lords of the Council, referring to the 
 great annoyance occasioned by the Moor-Ditch, order " the Com- 
 missioners of Sewers of the City and Inigo Jones, Esq., Surveyor 
 of His Majesty^s Works, upon view and enquiry to agree upon 
 some remedy and certify the same to the Board : " which being 
 done, the reporters recommend the construction of a vaulted 
 sewer, 4 feet in breadth at bottom, and 6 feet at least in height, 
 from the Moor-Ditch to the Minories and so to the Thames, 
 and that upon completion of the sewer, the Moor-Ditch should 
 be filled up with earth, and kept without buildings thereon : and 
 the Lords of the Council, authorising this to be done, further 
 require the Lord Mayor and Aldermen to have special regard to 
 the last clause of the recommendation. 
 
 * Two previous entries in the Index give to be understood that in London 
 (as previously in Rome) individual house-holders were held responsible for the 
 pavement in front of their respective holdings. 
 
 G 2 
 
84 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VI. 
 
 London 
 
 1580-1714. 
 
 Forbidden 
 buildings 
 and crowd- 
 ings. 
 
 In the later records^ the evils o£ over-building and over- 
 inmating (mixed often with those of vagrancy and pauperism) 
 come into prominence as among the sanitary difficulties of 
 London; and for about fifty years (1582-163^) frequent refer- 
 ences are made to those evils, and to the measures which were 
 meant to prevent them."^ The City Authorities seem first to 
 have complained of " the increase of new buildings which have 
 been erected for the harbouring of poor and roguish persons '* 
 whereby the City had been greatly burthened with provision ; 
 and in 1580 the Queen issued a proclamation commanding all 
 that there should not be any new building in the City or within 
 three miles of its gates ; but the Lords of the Council in 1583 
 found that in despite of this proclamation buildings had greatly 
 increased, ^' to the danger of pestilence and riot " ; and they now 
 call on the Lord Mayor and Aldermen, who, they say, had been 
 empowered by the proclamation to prevent this, to take immediate 
 steps to bring the offenders before the S tar-Chamber, and to 
 take into custody and commit to close prison workmen who 
 should refuse to obey the proclamation. Attention is at the 
 same time drawn to the overcrowding which results from the 
 dividing of single houses ; and an Act of Parliament passed in 
 1593 (35 Eliz. c. 6) recites that "great mischiefs daily grow and 
 increase by reason of pestering the houses with divers families, 
 harbouring of inmates, and converting great houses into several 
 tenements, and the erecting of new buildings in London and 
 Westminster.''^ Under James I., fresh proclamation seems to 
 have been made, and prosecutions were repeatedly instituted or 
 threatened; but in 1619 the '^Commissioners of Buildings'' 
 inform the Lord Mayor that they find it very difficult to discover 
 and prevent offences unless they be assisted by the Constables in 
 their several precincts, and they beg the Lord Mayor, as principal 
 magistrate and himself a Commissioner, to give suitable directions 
 to the Constables. Again under Charles I. (in the years 1632-6) 
 complaint in the matter is renewed : — '^ that the multitude of 
 newly erected tenements in Westminster, the Strand, Covent 
 Garden, Holborn, St. Gilqs, Wapping, Ratcliff, Limehouse, 
 Southwark, and other parts .... was a great cause of beggars 
 and other loose persons swarming about the City ; that by these 
 * See in Rememhrancia under heads " Buildings," "Poor" and " Vagrants." 
 
POST-MEDIiEVAL ENGLAND. 85 
 
 multitudes of new erections the prices of victuals were greatly Chap. vi. 
 enhanced, and the greater part of their soil was conveyed with laso^iyu. 
 the sewers in and about the City, and so fell into the Thames, to the 
 great annoyance of the inhabitants and of the river ; that, if any 
 pestilence or mortality should happen, the City was so compassed 
 in and straightened with these new buildings that it might 
 prove very dangerous to the inhabitants " : — and the former 
 process of proclamation, threats and prosecutions, seems to have 
 been repeated. Finally, as soon as Charles II. is on the throne, 
 proclamation is again made to restrain ^^ the exorbitant growth 
 of new buildings in and about the City, and for regulating the 
 manner of all new buildings,^^ and in 1661, the Clerk of the 
 Council writes to the Lord Mayor, directing him to give effect 
 to this proclamation. 
 
 The relation in which during these years the civic authority Lord 
 was standing to the conditions of lower social life in London may socM dS- 
 be illustrated by the contents of a letter, written in 1614 to the cipli^arian. 
 Lord Chamberlain by' the Lord Mayor, detailing steps which he 
 had taken during the then past eight months of his mayoralty 
 to amend what he had found out of order in the City : — ^^ Firstly, 
 he had freed the streets of a swarm of loose and idle vagrants, 
 providing for the relief of such as were not able to get their 
 living, and keeping them at work in Bridewell, ^ not punishing 
 any for begging, but setting them on work, which was worse 
 than death to them.^ Secondly, he had informed himself, by 
 means of spies, of many lewd houses, and had gone himself 
 disguised to divers of them, and finding these nurseries of villany, 
 had punished them according to their deserts, some by carting 
 and whipping, and many by banishment. Thirdly, finding the 
 gaol pestered with prisoners, and their bane to take root and 
 beginning at ale-houses, and much mischief to be there plotted, . 
 with great waste of corn in brewing heady strong beer ; ' many 
 consuming all their time and means sucking that sweet poison,^ 
 he had taken an exact survey of all victualling houses and ale- 
 houses, which were above a thousand, and above 300 barrels of 
 strong beer in some houses, the whole quantity of beer in 
 victualling houses amounting to above 40,000 barrels; he had 
 thought it high time to abridge their number and limit them by 
 bonds as to the quantity of beer they should use, and as to what 
 
86 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VI. orders they should observe, whereby the price o£ corn and malt 
 168^-1714. had greatly fallen. Fourthly, the Bakers and Brewers had been 
 drawn within bounds, so that, if the course continued, men might 
 have what they paid for, viz., weight and measure. He had 
 also endeavoured to keep the Sabbath-day holy, for which he 
 had been much maligned. Fifthly, if what he had done were 
 well taken, he would proceed further, viz., to deal with thieving 
 brokers or broggers, who were the receivers of all stolen goods. 
 And lastly, the divided houses would require before summer to 
 be discharged of all superfluities for avoiding infection, &c/'' 
 
 Mainten- Amonof the chief sanitary functions of the Corporation in 
 
 ance of . . . 
 
 supplies of the days to wliich the Remembrancia relate was one which' 
 
 Fuel. ^^ ^as now become obsolete. Commercial enterprise, in those 
 
 days, was under conditions widely other than now are : above 
 
 all, it had not yet come into ways of easy relation with popular 
 
 demand, nor had men learnt what powers of self -development 
 
 and self-rule it could show if merely allowed freedom in that 
 
 relation : and supply and marketing were affairs of State. In 
 
 London the Lord Mayor and Aldermen, directed by the Lords 
 
 of the Council, and sometimes specially moved by a royal 
 
 message,"^ saw to the maintenance of stores of food and fuel 
 
 for the City, and regulated conditions of sale for all chief 
 
 necessaries of life. The working of that system — chiefly 
 
 relating to corn-supplies and the assizes of bread and beer, 
 
 but extending also to flesh and fish and poultry, to meat and 
 
 drink in ordinaries and hostelries, to butter and all small 
 
 '^acates,^^ to candles and all sorts of fuel — is admirably 
 
 illustrated in the Remembrancia ; and the illustrations are often 
 
 Municipal instructive as well as curious. The annual bread-consumption 
 
 and the as- of the City at that time was estimated at about 60,000 quarters 
 
 Sread; ^^ wheat, towards which the Corporation, sharply looked after 
 
 by the Lords of the Council, had to keep up a large store in 
 
 * For instance, in 1586, the Queen, apropos of signing the Lord Mayor's 
 venison- warrants, " expressed her satisfaction at his government of the City, 
 specially in the provision of grain and meal." Again, in 1630, the Lord Mayor 
 is reminded how the King, when conferring knighthood on him, gave him a 
 " special charge for moderating the prices of victuals, then grown dear by the 
 sinister practices of butchers, and also for care to be had about the prices of 
 fuel and grain." 
 
POST-MEDIEVAL ENGLAND. 87 
 
 its own granaries, and to see that an additional store, perhaps Chap, vl 
 up to 20,000 quarters or more, was in the hands of the City 1580^1714. 
 Companies. These stores seem to have been brought into 
 the market for sale at certain times, '^ to keep down the prices 
 for the benefit of the poor.''^ The Companies might have to 
 get their supplies from foreign parts, and could be put under 
 pressure to do so if necessary; in 1632, for instance,' divers 
 wardens of Companies were committed to Newgate for not 
 having made their due provision of corn ; but the Corporation, 
 in regard of its own store, was allowed particular facilities 
 for obtaining corn. Besides such general restraints as there 
 were on the exportation of grain from England, the counties 
 nearest to London had, for the sake of London, particular 
 restraints imposed on their home-transportations. County 
 purveyors of grain were required to assemble together, and con- 
 sider what quantity the county could spare from time to time for 
 the victualling of the City of London; and ships laden with 
 wheat would be stayed in the Thames and other ports, sometimes 
 to be much fought for with the Warden of the Cinque Ports, in 
 order that the City might be better supplied. Different seasons 
 had of course their different requirements. In the winter of 
 1581-2, in presence of scarcity and high prices, the Lord Mayor 
 writes repeatedly to the Lord Treasurer to have " his usual care 
 for the City,-*' and to stay the exportation of grain ; in the 
 following July he writes to him ^^ as to the store of wheat 
 remaining at the Bridge House, beseeching that on account of 
 the prospect of a plentiful harvest, it might be transported and 
 sold secretly to the advantage of the Companies. ■'■' In 1594-5, 
 which was a bad season, the Lord High Admiral is more than 
 once found sending up the river to the Lord Mayor corn-ships 
 which seem to have been intercepted in act of illegal exportation : 
 the Lord Mayor also begging him, that, if any should be found 
 '^ in the narrow seas,-*^ they may be sent to him ; and likewise 
 begging the Lord Treasurer that the City may have the benefit 
 of some '^ lately taken on the coast of Spain by the Earl of 
 Cumberland.^^ While means were thus being taken to provide 
 supplies, various artful enhancers of price in wholesale and retail 
 trade — ''forestallers ^'' and "engrossers"'^ and " regrators '^ and 
 " kydders '' and ^' badgers '^ — (tribes of men who since then have 
 
88 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VI. got to be no longer named in the vocabulary of crime, and are 
 1580-1714. perhaps now in the aristocracy of commerce) — had to be guarded 
 against as '^ making unlawful gains to the oppressing of the 
 poor/^ and had from time to time to be pilloried or imprisoned ; 
 and various mis-applications of corn, as for starch-making or 
 overmuch beer-making, were, at least in hard times, put under 
 restraint. 
 
 The assize of bread regulated the weight of the penny-loaf 
 in proportion to the price of wheat : with such fluctuations as 
 then were, the penny -loaf might at one time have less than 
 half the weight it had at another — might at one time be 
 weighing twenty-four ounces or more, at another only eleven 
 ounces or less : and the Company of Bakers would meanwhile be 
 complaining again and again, that, in consequence of their 
 inability to keep the terms imposed on them, they (1619-20) 
 were " daily punished, amerced and imprisoned, and their bread 
 taken from them and given away, to their great reproach, 
 hindrance, and undoing/^ 
 Control of Side by side with that bread-control, went a similar control 
 and of sale of beer. Brewers, in that point of view, and vintners, victuallers 
 ^ ' and taverners, in that and other points, were under constant 
 supervision in their business. In 1613, the Lord Mayor reports 
 how he, ^^ for the avoiding of abuses in tippling-houses to the 
 
 maintenance of drunkenness and vice and on account 
 
 of the excessive quantities of barley daily converted into malt 
 for the brewing of sweet and strong beer, had, with the advice of 
 his brethren, limited the brewers to the brewing of two sorts of 
 beer only, the one at 4s. and the other at 8s. the barrel;'''' he 
 boasts that by reducing the number of ale-houses, and limiting 
 their number of barrels from perhaps 200 or 300 in stock to only 
 . 20, he had, in a fortnight reduced corn and malt 5s. or 6s. a 
 quarter, and above 2,000 quarters weekly had been saved : but 
 he finds brewers continue to consume excessive quantities of corn 
 and malt in the brewing of stronger beer than was allowed by 
 ~ law, alleging it to be made for use at sea, though they conveyed 
 it at night to the tippling-houses ; and he requests the Council 
 to restrain the transportation of any beer exceeding the assize of 
 8s. and 4s. the barrel. In 1614 the Lords of the Council address 
 the Lord Mayor and Aldermen : ^^ reciting that there were divers 
 
POST-MEDL^VAL ENGLAND. 89 
 
 good and wholesome laws enacted for restraining the excesses of Chap. vi. 
 victuallers and brewers, and against the brewing and selling of 1580-1714. 
 beer and ale of unreasonable strength and price, the execution of 
 which had been so much neglected that the greatest part of the 
 tillage of the kingdom, usually employed for wheat and other 
 bread-corn, had been converted to the sowing of barley, which 
 would produce dearth and scarcity unless some remedy were 
 speedily taken : the Council intended to provide for prevention 
 of this great abuse, and for the better execution of the before- 
 mentioned laws throughout the Kingdom : to begin therefore 
 with London, the principal city of the realm, where these abuses 
 were most practised, they required every Alderman in his Ward 
 to call before him the innholders, victuallers, alehouse-keepers, 
 cooks, and all those who brewed and sold again in bye-places, 
 and to examine the quantity and prices of such ale and beer as 
 they had received into their houses and cellars since Christmas 
 1613, to ascertain the names of their brewers, and to report the 
 particulars in writing to the Council/' In 1620, the Council 
 were " informed that the City had within these few years 
 become so pestered with taverns that latterly the better sort of 
 houses were taken up by vintners at unreasonable rents, and 
 converted into taverns to the maintenance of riot and disorder, 
 and the great inconvenience and disquiet of the neighbours. 
 They understood that by ancient Acts and Laws, made for the 
 good government of the City, the number of taverns had been 
 limited to forty, and their places assigned ; but it was said there 
 were now upwards of four hundred. As the vintners, above all 
 other trades, were permitted to keep eight or ten apprentices 
 apiece, they would in time increase to such a number as to be 
 insufferable in a well-governed city. The Council therefore 
 desired that some speedy remedy might be applied by Act of 
 Common Council for the restraint of this enormous liberty of 
 setting up taverns. 
 
 Nor did the care of the Council stop at this point. In 1634, Oysters, 
 information on oath had come before them that the prices of 
 oysters within eighteen or twenty years had so much indl-eased, 
 that Whitstable oysters, instead of being sold at 4d. per bushel, 
 were now sold at 2s. ; that the best and largest oysters were 
 transported, and none but the refuse left for His Majesty's sub- 
 
90 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VI. 
 
 London 
 
 1580-1714. 
 
 jectsj and that at a very dear rate. The Council therefore order 
 that, this being a droit d/Amiral, the Lords and Commissioners 
 of the Admiralty should be required to take it into their care, 
 and, if they deemed fit, direct the Judge of the Admiralty and 
 the Farmers of the Customs to attend them, and, after hearing 
 their opinions, to advise some fit course to prevent the abuse 
 complained of. No doubt that order was obeyed ; and later in 
 the year we find the Lords of the Council requesting the Lords 
 and Commissioners of the Admiralty to give order to Sir Henry 
 Marten, Knight, Judge of the Admiralty, and to the Marshal 
 and all other officers of the Admiralty, not to suffer oysters to 
 be transported by strangers or in strangers^ vessels, but to cause 
 all such vessels to be arrested, and the owners, their farmers and 
 agents, committed to prison until they gave bond, with surety, 
 not to offend in like manner in future. 
 
 Measures 
 
 against 
 
 flesh-eat- 
 
 During the years to which the Remembrancia relate, parts 
 of the food- trade of the City were subject to special interference 
 ^ijs^ ^ under laws of Edward VI. and Elizabeth which restrained the 
 eating of flesh during Lent and on certain '^ fish-days ^^ at 
 other times. On Edward's accession Parliament had re-con- 
 sidered the question of fast-days, and had enacted fasts in the 
 light of a new doctrine : in which light, as Mr. Froude* ex- 
 plains, though the old church-distinctions between days and meats 
 no longer existed, yet, as due and godly abstinence from flesh 
 was a means to virtue, and, as by eating of fish, flesh was saved 
 to the country, and as the fishing- trade was the nursery of English 
 seamen, so Fridays and Saturdays, the Eves of Saints^ days, Ember 
 days, and Lent, were ordered to be observed in the previously 
 usual manner, under penalties for each offence of a fine of ten 
 shillings and ten days^ imprisonment. Early in Elizabeth^s 
 reign, an " Act touching certain politick constitutions made for 
 the maintenance of the Navy,^^ required Wednesdays to be 
 fish-days in addition to days previously such ; the declared 
 intention of this being '^ not any superstition to be maintained 
 in the' choice of meat,"*^ but "the benefit and commodity of 
 this realm to grow as well in the maintenance of the Navy . . . 
 
 as in the increase of Fishermen and Mariners, and repairing 
 
 * History of England, vol. v. p. 143. 
 
 of 
 
POST-MEDIJEVAL ENGLAND. 91 
 
 port-towns and navigation . . . as in the sparing- and in- Chap. vi. 
 crease of flesh- victual ; ^^ and the Act, jealously as to this declara- 158^)^1714 
 tion, provides that anyone misrepresenting the intention shall 
 be punished as a spreader of false news. Annual indulgences in 
 regard of flesh-eating could be got at pleasure on paying into 
 the poor-box of the parish certain fines ; which (according to the 
 rank of the indulged person) ranged from 6s. 8d. to four times 
 that amount ; and for cases of sickness temporary licenses wore 
 given by the bishop, parson, vicar, or curate. 
 
 The Rememhrancia up to the year 1634 contain, as might be 
 expected, constant illustrations of the difficulty of regulating 
 men^s diet by Act of Parliament. Butchers in general had to 
 be restrained from killing in Lent, and the question of exceptions 
 under this rule was matter of ever-recurring controversy. In the 
 earlier years the Lord Mayor was allowed the privilege of selecting 
 from among the City butchers five, '^ two for either shambles, 
 and one for the borough of Southwark,'' who should be author- 
 ised to kill during Lent, under bond '^ not to utter flesh to any 
 but such as were for sickness or otherwise lawfully allowed to 
 eat meat : ''■' but, while this was an invidious privilege — bringing 
 the Lord Mayor into disfavor with the mass of persons, butchers 
 and their patrons, whose wishes he could not satisfy, and even 
 leading to his being ''reviled and threatened by certain officers of 
 the Court and others of high place for not being able to comply 
 with their requests,''^ it also was frequently contested by the 
 Lords of the Council. Though Lord Burghley had from the 
 first '^ thought it quite unnecessary, infirm persons being allowed 
 poultry,^^ the system had continued in vogue, and in 1611, the 
 licentiates were eight in number; but in 1612, there was re- 
 action; and a new Order in Council then issued for the 
 keeping of Lent prohibited '^ absolutely the killing of flesh by 
 any butcher or other person in the City or any other part of the 
 Kingdom during this Lent.''^ The Lord Mayor remonstrated : 
 referring to the scarcity and dearness of fish, butter, cheese, and 
 bacon, and to the prevalence of ague and other infirmities ; but 
 in vain : the Lords of the Council telling him that '' for the 
 comfort of the infirm and sickly, he might freely license as 
 many poulterers within the City and Liberties as he deemed 
 meet and convenient.^^ In each of the following two Lents, a 
 
92 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VI. single butcher was licensed, chiefly, it seems, for the service of 
 1580-1714. foreign ambassadors ; and then, in 1615, stronger remonstrances 
 came from the City : the Lord Mayor gives the Lords of the 
 Council to understand that the irregularities under the indis- 
 criminate rule are far greater than they were under the system 
 of partial exception : he also writes to the Archbishop of Canter- 
 bury, ^' to whom he conceived the matter most especially apper- 
 tained,^' telling how he " had been much importuned by divers 
 physicians, who stated there was an absolute necessity for the 
 safety of men^s lives that some mutton and veal should be killed, 
 to make broth for the diet of the sick during the present Lent : '' 
 whereupon "my Lord of Canterbury very honorably procured 
 the Lords to assent for the licensing of one butcher ^^ — who, 
 ^' during the present Lent " was " to kill mutton and veal only, 
 and to sell the same to such as had license according to law : " 
 further, in 1619 and 1620, the number of Lent butchers was 
 extended to three, and in 1625 again (as in 1611) to eight. 
 That law such as the above, whether in any particular year tighter 
 or looser, must always have been highly vexatious to the mass of 
 the people, cannot well be doubted. Besides the constant muni- 
 cipal visitation of the premises of butchers and taverners, and 
 the occasional intrusion of " messengers " with search-warrants 
 from the Council, there was the daily minute spying into per- 
 sonal habits — " Friday-night suppers "''' and the like ; and there 
 was the vexatious overhauling of baskets at the City gates by 
 functionaries who confiscated (and half for themselves) what- 
 ever unprivileged flesh they could catch entering. The interest 
 which these ofiicials probably felt in enforcing the law was 
 certainly felt by another limited class : for^ whenever the law 
 against flesh-eating was severely administered, purveyors of 
 other food were able to run up their prices. Especially this was 
 the case with the Fishmongers : who, if the administration of 
 the law became mild, were always ready to complain that injury 
 was being done to their business, and that in consequence " the 
 navigation and trade of mariners would be discouraged and fall 
 into decay ; " and of whom it seems to have been in general 
 expected in those days, that, since their profits rose (and indeed 
 often became such as to require check) in proportion as the law 
 was strictly administered, they should be ready to act as searchers 
 
POST-MEDIEVAL ENGLAND. 93 
 
 and informers against persons who disobeyed tlie law. But, Chap. vi. 
 whatever may have been those interested efforts for the law, 1580-1714. 
 disobedience to the law continued. Last appeals and last threats 
 in the matter — last, at least, as regards the records which are 
 here under quotation, were made in 1630, in a letter which the 
 Lords of the Council, speaking in the King's name, and referring 
 to a recent proclamation of his, addressed in the November of 
 that year to the Lord Mayor, and which is of the nature of a 
 summary of the case : — His Majesty's proclamation had con- 
 tained no new thing, but pointed directly to laws and statutes 
 formerly made and still in force for the keeping of fast-days 
 and restraining the eating of flesh in Lent and on fish-days : it 
 seemed very strange to the King and the Council that a pro- 
 clamation grounded on so many good laws, &c., and in a time 
 of such scarcity, should be contemned in every tavern, ordinary, 
 &c., in the City and suburbs, and the King was resolved to have 
 it reformed : within the City (as an example to other places) it 
 was his Majesty^s command that the Aldermen and their Depu- 
 ties, &c., strictly examine as to offenders since the proclamation, 
 and should inflict due punishment on delinquents, and should in 
 future enforce the law by which offenders were to be imprisoned, 
 and kept without flesh during imprisonment. His Majesty com- 
 manded the Lord Mayor to appoint fit persons, to be nominated 
 by the Fishmongers^ Company, to make search and present 
 offenders, and to see them punished, certifying every fourteen 
 days to the Council. The officers of the ecclesiastical Courts had 
 been commanded by the King to take order, according to their 
 jurisdiction, that offenders were punished according to the Act 
 5th and 6th Edw. VI., c. 3. That the reforming of one abuse 
 might not give advantage to the practising of another, the Court 
 of Aldermen should take such course with the Fishmongers^ 
 Company that the prices of fresh Or salt fish were not enhanced, 
 and that the markets were well served. The King^s desire to 
 see a reformation of these abuses by a fair way might thus be 
 perceived ; but if he found no speedy effect, he would think of 
 a sharper course to bring such wilful contemners of the laws and 
 of his commands to better conformity.^^ Political events which 
 need not here be dwelt upon left Charles but little further 
 opportunity to follow out that line of thought. The tyranny in 
 
94 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VI. 
 
 London 
 
 1580-1714. 
 
 which those silly dietetic commands were a part was fast be- 
 coming intolerable to those who suffered under it ; side-glances 
 were beginning to be cast towards that " two-handed engine '* 
 which was to be the bitter inedicine of redress ; and for some 
 sixty years from the date of the last-quoted ordinance, the 
 national questions which were in debate were not questions be- 
 tween fish and flesh and fowl. 
 
 Bepeated 
 visitations 
 of Plague, 
 and the 
 proceed- 
 ings there- 
 on con- 
 sequent. 
 
 1580-4. 
 
 On several occasions during the years to which the Remem- 
 brancia relate there was prevalence of Plague in London ; and 
 whenever this was or threatened to be the case^ the City 
 authorities corresponded about it with the Lords of the Council, 
 and were directed by them what to do in the circumstances. 
 One severe invasion by plague was that of the years 1580-3. 
 In 1580, the disease is raging at Lisbon ; and the Lord Mayor, 
 on his application to Lord Treasurer Burghley, is authorised by 
 him to take measures in concurrence with the officers of the port 
 to prevent in regard of arrivals from Lisbon the lodging of 
 merchants or mariners in the City or suburbs, or the discharge of 
 goods from ships until they have had some time for airing, and 
 in the [meantime to provide proper necessaries on board ships 
 detained. The Lord Mayor also requests the aid of the Council 
 ^'for the redress of such things as were found dangerous in 
 spreading the infection, and otherwise drawing God''s wrath and 
 plague upon the City, such as the erecting and frequenting of 
 infamous houses out of the liberties and jurisdiction of the 
 City, the drawing of the people from the service of God and 
 honest exercises to unchaste plays, and the increase of the 
 number of the people.''^ Evils which he particularly proposes to 
 restrain by regulations are : — the crowding of inmates in places 
 pretending to be exempt from City jurisdiction, and the pester- 
 ing of such places with strangers and foreigners artificers, and 
 the presence of strangers in and about London of no Church, — 
 the increase of buildings, notably in the exempt and some other 
 places, and the building of small tenements, or the turning of 
 great houses into small habitations, by foreigners, — the haunting 
 of plays out of the liberties,' — the killing of cattle within or near 
 the City. In 1584 ^^ for the stay of infection in the City . . . 
 it had been thought good to restrain the burials in St. PauFs 
 
POST-MEDIEVAL ENGLAND. 95 
 
 Churchyard which had been so many, and by reason o£ former Chap. vi. 
 burials so shallow, that scarcely any graves could be made with- 1580-1714 
 out corpses being laid open. Some parishes had turned their 
 churchyards into small tenements, and had buried in St. Paul's 
 Churchyard. It had been determined to restrain from burial 
 there all parishes having churchyards of their own. . . . The 
 City desired the Council to issue directions to the authorities of 
 the Cathedral accordingly: the order not being intended to 
 prevent any person of honour or worship being buried there, 
 but only the pestering of the Churchyard with whole parishes.''^ 
 Then the Oxford Corporation writes to the Lord Mayor, with 
 reference to the approaching Frideswide Fair, to which it was 
 customary for Londoners to repair with their wares and mer- 
 chandise, and from which now the Lord Mayor is begged to 
 restrain all citizens in whose houses and families there was 
 infection, or who had not obtained his certificate. "With refer- 
 ence to assizes about to be held at Hertford, the Queen through 
 the Lords of the Council expressly commanded the same sort of care 
 to be taken by the Lord Mayor. In 1583, the infection having 
 much increased, the Council pressed upon the City Her Majesty^s 
 commands ^^that they should see that all infected houses were ■• 
 shut up, and provision made to feed and maintain the sick 
 persons therein, and for preventing their going abroad; that all 
 infected houses were marked, the streets thoroughly cleansed, 
 and a sufficient number of discreet persons appointed to see the 
 same done. They desired to express Her Majesty^s surprise that 
 no house or hospital had been built without the City, in some 
 remote place, to which the infected people might be removed, 
 although other cities of less antiquity, fame, wealth, and reputa- 
 tion, had provided themselves with such places, whereby the 
 lives of the inhabitants had been in all times of infection chiefly 
 preserved.-'^ The City authorities, soon after this communica- 
 tion, inform Sir Francis Walsingham that they have published 
 orders which they intend to execute with diligence ; but that, in 
 respect of certain inconveniences — assemblies of people at plays, 
 bear-baiting, fencers, and profane spectacles at the Theatre and 
 Curtain and other like places, to which great multitudes of the 
 worst sort of people resorted, restraints in the City were useless, 
 unless like orders were carried out in the places adjoining; and 
 
96 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VI. the Lord Mayor therefore moves the Council to take steps in 
 
 1580-1714. regard of that difficulty. 
 
 1606-7. In connexion with a smaller outbreak which occurred in 
 
 1606-7, we find the Lord Mayor informing the Lords of the 
 Council that the following additional order had been passed : — 
 *' that every infected house should be warded and kept with two 
 sufficient watchmen, suffering no persons to go more out of the 
 said house, nor no searcher to go abroad without a red rod in 
 their hand.^'' And a marshall and two assistants had been 
 appointed to keep the beggars out of the city. 
 
 1625. In 1625, when there seems to have been a great outbreak, 
 
 the Lords of the Council ^^ could not hear that any good course 
 had been taken for preventing it by carrying infected persons to 
 the pest-house, or setting watch upon them, or burning the stuff 
 of the deceased ; '''' and they require the strictest course to be 
 taken in these matters. Somewhat later. His Majesty was 
 absent, and the Council were forced to disperse themselves, but 
 they direct the Mayor and Aldermen to be very careful not to 
 abandon the government of the city committed to their charge, 
 and to continue and increase all usual means, &c. It appears 
 that, during the epidemic of 1625, the Lords of the Council 
 issued orders in restraint of the traffic of carriers and higglers 
 with London ; and the Lord Mayor presses on the consideration 
 of their Lordships that if, in consequence of these orders, the City 
 should be restrained of victuals, it was to be feared it would not 
 be in the power of himself, or the few magistrates who remained, 
 to restrain the violence hunger might enforce.^'' 
 
 1629-31. In 1629-31, Plague was again in ascendency. In October 
 
 1629 precautions were to be taken against arrivals from Holland 
 and France ; but at least six months before this, the disease was 
 already spreading in London, and the Lords of the Council 
 advising about it. They had issued a book of instructions. At 
 first they had shut up the sick in their houses, but, on further 
 deliberation, had thought it better the houses should be voided 
 and shut up, and the inmates sent to the pest-houses. Referring 
 to the poor Irish and other vagabond persons, pestering all parts 
 of the City, they advised steps to be taken to free the City and 
 liberties from such persons : also to see the streets kept sweet 
 and clean, and the ditches in the suburbs within the liberties 
 
POST-MEDIiEVAL ENGLAND. 97 
 
 thoroughly cleansed^, and they command the Commissioners of Chap, vi 
 Sewers and the Scavengers respectively to perform their duty. 1580-17 
 AlsO;, being informed that inmates and ale-houses were in ex- 
 cessive number, they required the law to be enforced against 
 these excesses. They require that infected houses should have 
 guards set at the door, and a red cross or "Lord have mercy 
 upon us "" set on the door, that passers-by might have notice. 
 They direct the City Authorities and the Justices of Middlesex 
 and Surrey to prohibit and suppress all meetings and stage-plays, 
 bear-baitings, tumbling, rope-dancing &c. in houses, and meet- 
 ings for prize-fencing, cock-fighting and bull-baiting and those 
 in close bowling-alleys, and all other meetings whatsoever for 
 pastime, and all assemblies of the inhabitants of several counties 
 at the common halls of London pretended for continuance of 
 acquaintance, and all extraordinary assemblies of people at 
 taverns or elsewhere. And His Majesty was pleased that the 
 College of Physicians should meet and confer upon some fit 
 course for preventing the infection. At the same time, there 
 being much increase of sickness at Greenwich ^*'all fitting 
 means '"^ are to be used " to stop and cut off all intercourse 
 and passage of people between that town and the City ; •'■' and 
 question arises of restricting elsewhere, as from London to 
 Exeter, and from Cambridge to London, the passage of things 
 and persons. Mixed with proceedings as to infected houses and 
 persons, are proceedings as to the eating of flesh on fish-days : — 
 in the latter (as well as the former) respect the City Authorities 
 " had commenced their search, and committed offenders to prison, 
 and had appointed some fishmongers to search, who, for their 
 own interest, would give them best notice." In a statement 
 dated December, on proceedings which had been taken in the 
 City under an order made some weeks previously by the Council, 
 the Lord Mayor reports, among other things, these : '^ that 
 antient women, reported to be both honest and skilful had been 
 appointed for visited houses, who appeared by certificate to have 
 carefully discharged their duties ; that infected houses had been 
 shut up, the usual marks set upon them, and strict watches ap- 
 pointed so that none went abroad ; that persons who had died of 
 the infection were buried late at night ; that people who would 
 have followed them had been sent away by threatening and 
 
98 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 1636. 
 
 Chap. VI. otherwise^ and tliat very few or none went with the bodies 
 168^1714. hut those appointed for the purpose. Some persons had been 
 punished for removing the inscriptions set on infected houses, 
 and others had been bound over to the sessions to be proceeded 
 against according' to justice.-'^ Eating flesh on fish-days and the 
 eves was being so well restrained by the punishment of some 
 offenders, that few delinquent^ were found. 
 
 In 1636, when there was again much plague, the Lords of 
 the Council ordered '^ the levying of rates in Middlesex and 
 Surrey for the erection of pest-houses and other places of 
 abode for infected persons ; also directing the Justices of the 
 Peace for Middlesex to join with the Lord Mayor and Aldermen 
 in making additional orders, to be printed, for preventing the 
 increase of the infection, and authorising them to make such 
 further orders thereon as they should see fit ; also directing the 
 Churchwardens, Overseers and Constables of every parish to pro- 
 vide themselves with books for their directions, and requiring 
 the Physicians of the City to renew the former book touching 
 medicines against infection, and to add to and alter the same, 
 and to cause it to be forthwith printed.''^ With reference to 
 the marking and guarding of infected houses, they complain 
 that the prescribed marks — the red cross and the inscription 
 '^ Lord have mercy upon us,'^ were placed so high and in such 
 obscure places as to be hardly discernible ; and that the houses 
 were so negligently looked to that few or none had watchmen at 
 their doors, and persons had been seen sitting at the doors. The 
 crosses and inscriptions must be put in the most conspicuous 
 places, the houses strictly watched, and none permitted to go out 
 or in or sit at the doors. Such as wilfully did so should be shut 
 up with the rest of the infected persons. Officers who had 
 failed in their duties should be committed to Newgate. The 
 Attorney General is to draw up a proclamation for the King 
 to sign for putting off Bartholomew Fair on account of the 
 plague. 
 
 Last come a few entries relating to the terrible visitation of 
 1663-5, and specially instructive as regards the steps which were 
 now to be taken in the way of developing Quarantine. In 
 October 1663, "the King had taken notice that the plague had 
 broken out in some neighbouring countries, and desired to be 
 
 1663-4. 
 Develop- 
 ment of 
 Quaran- 
 tine. 
 
POST-MEDIiEVAL ENGLAND. 99 
 
 informed wliat course had been taken and means used in like Chap, vl 
 cases heretofore to prevent the conveying and spread of the 1580-1714. 
 infection in the City ; " and the Lord Mayor, informed to this 
 effect by a letter from the Lords of the Council, replies that " he 
 had found many directions and means used to obviate the spread- 
 ing of the infection at home, but no remembrance of what course 
 had been taken to prevent its importation from foreign parts. 
 The plague of 1625 was brought from Holland. The Court 
 of Aldermen advised that, after the custom of other countries, 
 vessels coming from infected parts should not be permitted to 
 come nearer than Gravesend, or such like distance where reposi- 
 tories, after the manner of lazarettos, should be appointed, into 
 which the ships might discharge their cargoes to be aired for 
 forty days.^' As Amsterdam and Hamburg were known to be 
 already under visitation by the pestilence, the matter no doubt 
 seemed pressing; and so, next day, this letter received its 
 answer : — ^' the King acknowledged and approved the Lord 
 Mayor^s proposal, but recommended that the lazarettos should 
 not be nearer than Tilbury Hope, and that all ships, English or 
 foreign, coming from infected ports, should be liable to be 
 stopped and unloaded if necessary. The Mayor and Aldermen 
 should consult with the Farmers of the Customs upon the 
 subject." This consultation having been held, the following 
 plan was recommended : '^ that the lazaretto should be at Moll 
 Haven in a creek which would receive a hundred vessels ; that 
 one or more of His Majesty's ships might be placed con- 
 veniently below the haven to examine every vessel, whether 
 from infected places or not, and to see that if infected they came 
 to the haven ; that a guard of twenty persons or more should be 
 appointed to prevent any communication being held with the 
 persons on shore. On the arrival of any infected vessel a list 
 should be made of all persons on board, and, if any should die, 
 the body should be searched before casting it overboard. At the 
 end of forty days, if the surgeons reported the vessel free from 
 contagion — (all the apparel, goods, household stuff, bedding, &e. 
 having been aired in the meantime on shore) it should be allowed 
 to make free commerce. In conclusion they recommended, as a 
 cheap and easy course, that one of the King's ships should hxr 
 anchored low down the river and stop every vessel : if they found 
 
 H 2 
 
100 ENGLISH SANITARY INSTITUTIONS. 
 
 L^do^^' ^^ ^^^^^ papers that they came from any o£ the infected ports, 
 1580-1714. they should be sent back to sea. His Majesty should also issue 
 a manifesto to his allies, informing them that no ships or vessels 
 would be allowed to enter the Port of London unless they 
 brought with them a certificate from the port authorities whence 
 they came.'^ 
 
 Orders, more or less to the effect of the above recommenda- 
 tions, were now issued by the Council, and a first English 
 Quarantine was thus established. It was not enforced during 
 the winter, as the pestilence was for that season lulled ; but 
 about Midsummer it was again brought into requisition. On 
 June 27, 1664 (and this is the last communication which appears 
 in the Hemembrancia on the present subject) the Lords of the 
 Council inform the Lord Mayor that ^^ the plague had broken 
 out in the States of the United Provinces,^-' and they direct 
 '^ steps to be taken to prevent the infection from being brought 
 into this country, either by passengers or merchandise, and all 
 ships to be placed in quarantine, according to former orders, until 
 the Farmers of the Customs gave their certificate." 
 
 166.5-G. Those endeavours to exclude by Quarantine the contagion of 
 
 The Great *' ^ 
 
 Plague. the Plague were as ineffectual as if their intention had been to 
 bar out the east wind or the new moon ; and, in the sanitary 
 records of the Metropolis, the year 1665 has its special mark a& 
 emphatically the year of the Great Plague. Before the middle 
 of the year, the disease was known to be spreading in London : 
 where, as the season advanced, it became more and more pre- 
 valent, till,, in August and September, when the epidemic was at 
 its height^ the deaths by it, within the London Bills of Mortality, 
 averaged in each week not fewer than six or seven thousand, and 
 may perhaps once or twice have been as many as ten thousand 
 within the week. What may have been the total fatality of the 
 London Epidemic cannot be exactly known ; but the estimate 
 which Macaulay adopts is, that it swept away, in six months^ 
 more than a hundred thousand human beings. 
 
 1666. The The subsidence of that terrible epidemic continued during the 
 
 Great Fire. . . -n , , , -, i o 
 
 winter and sprmg of 1665-6, till the weekly deaths were fewer 
 than fifty ; but, as summer advanced, the infection again began 
 to spread ; and the London world was fearing what worse renewal 
 
POST-MEDIEVAL ENGLAND. 101 
 
 of the pestilence miglit yet come, when suddenly the most drastic Chap. vi. 
 of sanitary reformers appeared on the scene, and what had 1580-1714. 
 remained of the Great Plague yielded at once to the Great 
 Disinfector. A fire — ^^ such as had not been known in Europe 
 since the conflagration of Kome under Nero, laid in ruins the 
 whole City, from the Tower to the Temple, and from the river 
 to the purlieus of Smithfield'''' : within which area of destruction, 
 measuring 436 acres, and including 400 streets, were consumed, 
 in addition to the public buildings, 13,200 dwelling-houses.* 
 How true a blessing, or at least how great an opportunity, came 
 to the Metropolis in that guise of awful disaster, can be well 
 judged in the light of modern science. The parts of the metro- 
 polis which had perished were distinctively its ancient parts. 
 That many-gabled convivial old city must have been a stronghold 
 of stinks and unwholesomeness. No wonder that pestilence 
 lingered in it. From time immemorial, successive generations of 
 inhabitants, densely gathered there, had more and more befouled 
 the ground. In great measure it had been as some besieged 
 camp, where the surface incorporates every excrement and refuse, 
 and where the dead have their burial-pits among the living. It 
 had no wide streets for wind to blow through. In general it had 
 only alleys rather than streets : narrow irregular passages, where- 
 in houses of opposite sides often nearly met above the darkened 
 and fcetid gangway. The houses themselves, mostly constructed 
 of wood and plaster, had hereditary accumulations of ordure in 
 vaults beneath or beside them. Unsunned, un ventilated dwellings, 
 they, from when they were built, had been saturating themselves 
 with steams of uncleanliness, and their walls and furniture must 
 have stored an infinity of ancestral frowsiness and infection. 
 That destruction by fire had come to so ill-constructed and ill- 
 conditioned a city, was the best of opportunities for reform. The 
 nests of pestilence had gone to naught ; and even out of the soil, 
 congested to its depths with filth, the filth had been burnt away 
 as in a furnace. t 
 
 * Macaulay^s few words which I borrow, together with the figures quoted 
 from the inscription of the Monument^ tell the sanitary gist of the story, beyond 
 which my text needs not enter on particulars ; but details, pictured with extra- 
 ordinary vividness, are to be found, as I need hardly note, in the diaries of Pepys 
 and Evelyn. 
 
 f Pepys, under date of IVIarch 16, 1667, notes : "within tliese eight days I 
 
102 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VI. 
 
 London 
 
 1580-1714. 
 
 The new 
 London 
 
 The opportunity whicli the circumstances afforded for the 
 construction of a fitter city was to some considerable extent 
 turned to account ; but^ in view of what improvement must cost, 
 improvement was extensively stinted ; and especially the public 
 grudged the large expenditure which alone could have bought 
 uncrowdedness of building. Wren, after his survey of the ruins, 
 had designed a scheme of re-construction which would have made 
 the new city a fitting nucleus for the metropolis of later times : 
 would have made it of harmonious plan, with wide convenient 
 thoroughfares^ with proper standing-room for its chief buildings, 
 with spacious public quays along the river, and even with reason- 
 able interspaces of mere pleasure-ground ; but the largeness of 
 his proposal was beyond his contemporaries. To such purse- 
 keepers as saw little beyond the moment, and cared only to 
 escape immediate outlay, the proposal of course seemed extrava- 
 gant ; and at that particular time — (just when the worthless dirty 
 reign of Charles the Second was bringing on his subjects some 
 of their worst humiliations) — even larger-minded citizens might 
 excusably not have had much heart to spare for local questions of 
 commodiousness and adornment. But, though the matter was 
 not to be dealt with as liberally as Wren had proposed, provision 
 was made that, in several very important respects, the new city 
 should be better than the old ; and the statutes which provided 
 to that effect, and for the future paving, cleansing and sewering, 
 of the City, are documents of much mark in the history of 
 London.* Among the improvement-intentions of the Act of 
 1667, the most important were these : — that streets, specially 
 needing enlargement, should be enlarged ; that, in all the new 
 houses, the outsides and party- walls should be of brick or stone ; 
 and that in the height of stories, the strength of scantlings, and 
 other such matters, all the new houses should be constructed in 
 
 did see smoke remaining, coming out of some cellars from the late great fire, 
 now above six months since." He had previously on several occasions referred 
 to the long-continuance of the fire. 
 
 * See especially the first Rebuilding Act — 19th Ch. II. cap. 3, which received 
 the royal assent Febr. 8, 1667 ; also, three years later, the additional Act, 22nd, 
 cap. 11 ; and, next year, the Act, 23rd, cap. 17, " for better paving and cleansing 
 the streets and sewers in and about the City of London." Before the first of 
 these, there had been an emergency Act (19th, c. 2) to provide a Court for the 
 prompt determination of legal differences which might arise^ 
 
POST-MEDIEVAL ENGLAND. 103 
 
 conformity with standards fixed for them (in classes) according 9^' ^^' 
 to the dignity of the streets in which they were to be built. The 1580-1714. 
 streets to be enlarged were certain named main streets, and also 
 such streets as had less than fourteen feet of width. For the 
 ground which would be required for such enlargements, due com- 
 pensation was to be paid to those whom the improvement would 
 displace ; and, to ensure that all new constructions should be done 
 according to rule, special surveyors were to be appointed. The 
 Act was to be worked by the Lord Mayor Aldermen and Common 
 Council of the City; who, for certain of the purposes, might 
 commission '^ persons ^^ to act for them ; and, for the improvement- 
 expenses which had to be met, the Act assigned to the Corpora- 
 tion the proceeds of a special tax (then first imposed) to be levied 
 on all coal brought into the port of London. Of the subsequent 
 Acts, needs only be observed that the Act of 1670 named some 
 more streets for enlargement, in addition to those which the 
 original Act had named; and that the Act of 1671 which gave 
 the Corporation some new aedile duties, extended to those duties, 
 and confirmed as permanent, the sanction given by the original 
 Act to the Corporation's working by Commission."^ Tlie business 
 of the re-construction proceeded in due course : and the end was 
 reached surprisingly soon. Bishop Burnet no doubt expressed 
 the general exultation of his contemporaries, when he recounted, 
 how — " to the amazement of all Europe, London was in four 
 years rebuilt, with so much beauty and magnificence, that we, 
 who saw it in both states, before and after the fire, cannot reflect 
 on it without wondering where the wealth could be found, to 
 bear so vast a loss as was made by the fire, and so prodigious an 
 expense as was laid out in re-building if 
 
 Of the re-constructed city not much remains to be said in 
 the present chapter : nor, as regards the mere construction, 
 will the succeeding chapters have much to say : for, such as 
 the City was left by its re-builders under Charles the Second, 
 such, in the main, it continued till sixty years ago, and such, in 
 considerable parts, it still continues. There, of course, even from 
 
 * My reason for particularly noting this provision is, that I understand it to 
 represent an early stage of the legislation under which at the present time the 
 Sanitary Authority of the City of London is a body of Commissioners appointed 
 by the Common Council to be Commissioners of Sewers for the City. 
 
104 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VI. the first, were changes made in particular spots, as particular 
 1680-1714. new erections or other demands from time to time required : 
 such as, ahove all, the openings necessary for the Blackfriars 
 Bridge of 1760-8, for the South wark Bridge of fifty years later, 
 and at last, on a still larger scale, for the ^^ new " London Bridge 
 of 1825-31 ; but those changes, taken together, had not been of 
 nearly such effect on the general plan of the City as have been 
 the many large changes of later years; and old men of the 
 present time, who knew London in the days before railroads, can 
 re-picture to themselves a city which, at least in its central parts, 
 was the City which had disappointed Wren. 
 
 Subse- As regards the Health of the Population, it is commonly said 
 
 as to the that London, with its new City, entered on a new era ; and un- 
 Heaith. doubtedly the events which have been described did give to 
 London a great fresh start in its sanitary interests : but the 
 gains were not all of a sort to transmit themselves uncondition- 
 ally to future times, and it must be remembered that, among 
 the worst evils which the fire had burnt away, were some which 
 would by degrees re-accumulate. It would be most interesting, 
 were it possible, fully and exactly to compare London during 
 some decennia before the fire with London during some decennia 
 after the fire, in respect of the quantities of death occasioned in 
 each decennium by each chief sort of disease, say, per 1,000 of 
 living population ; but there exist no nearly sufficient means for 
 any such statistical comparison ; and from materials which 
 exist, it is impossible to compare the two periods except in very 
 general terms. It may be taken for certain, that London after 
 the fire never experienced such mortality as it had experienced 
 at particular plague-times before the fire, — never, for instance, 
 made any approach to such mortality as it had suffered in 1665 ; 
 but it seems equally certain that, at least during considerable 
 stretches of time in the eighteenth century, the death-rate 
 of London (more than double that which prevails at our present 
 time) was quite as heavy as it had been in the less afflicted part 
 of the former period : that, for instance during the term 1728- 
 67, which began some sixty years after the re-building of 
 London, and again during the term 1771-80, London diseases 
 were as fatal as they had been in the septennium 1629- 
 
POST-MEDLEVAL ENGLAND. 105 
 
 35.^ One great fact however which remains, and which must not Chap. vi. 
 
 ° . , . . London 
 
 be Tinderratedjfor it probably expresses the main difference between 1580-1714. 
 the respective worsts of the two periods, is : that, after the date of 
 the Great Fire, Levantine Plague was no longer to be counted 
 among our London diseases. The Fire had probably exerted a 
 critical influence in relation to the then existing remains of the 
 great epidemic of 1665-6; and we may assume that, for many 
 years, the re-built City would have been far less apt than the old 
 City to develop any new contagions of Plague which had come 
 into it : but yet we must not attribute too much to the Fire. 
 That our English metropolis became free from plague was not a 
 solitary fact of such emancipation ; and it is impossible to believe 
 that the exemption we have now enjoyed for two hundred and 
 twenty years is a privilege due to the Fire of 1666. Not for 
 London alone, but equally for the rest of England, — and not for 
 England exclusively, but also for Europe at large, — the decen- 
 nium 1660-70 seems to have been a turning-time in the inva- 
 sional affinities of the plague. From causes not understood, but 
 which certainly were of wider range than any destruction of 
 particular cities, the visitations which Western Europe suffered 
 in that decenoium proved in many cases to be parting visita- 
 tions : in the course of twenty years from 1661, the till then 
 familiar disease had disappeared from Italy, England, Western 
 Germany, Switzerland, the Netherlands, and Spain : and though, 
 in the first quarter of the eighteenth century, two great spread- 
 ings of infection took place elsewhere, one in Eastern Europe, 
 and the other in Provence, the disease did not on either occasion 
 extend to those previously emancipated parts of Europe, nor has 
 it ever since appeared in any of them. 
 
 Here, for the present, the narrative may cease to speak in Queen 
 detail of the Metropolis. It has no intention of attempting to London. 
 follow minutely the course of metropolitan sanitary fortunes, and 
 such further references to them as must be made will be in 
 connexion with the story of much later times. Meanwhile, as 
 regards London at the close of the Stuart reigns, very few words 
 
 * The figures on wMch I base my statements are those given by the late Dr. 
 Farr, in a paper which he contributed to McCulloch's Descriptive and Statistical 
 Account of the British Empire: see that work, 4th Edition, vol. ii. p. 613. 
 
106 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VI. will suffice to summarise the chief fact which the narrative is. 
 
 1580-1714. concerned to carry on. Whatever sanitary gains may have 
 accrued from the destruction and rebuilding of the City, London, 
 at the beginning of the eighteenth century, was but an ill-con- 
 ditioned place of residence. Provided hitherto with hardly the 
 rudiments of such sewerage and water-supply as are needful 
 for the health of cities, — with no systematic organisation for 
 removal of refuse, — with pavement grossly insufficient, — with 
 such neglect of scavenging, and such accumulations of unclean- 
 liness, as made fun for native satirists, while they scandalised 
 foreign visitors, — London under Queen Anne, the London of 
 Gay's Trivia and Swift's Citi/ Shower j was not entitled to 
 expect immunity from the diseases which associate themselves 
 with filth. And such as we leave it in those last Stuart days, 
 we shall find it again, without any essential sanitary change, 
 after more than a century of Hanoverian rule. 
 
IP art ®ljirlr.— ifTEw momenta. 
 
 CHAPTER VII. 
 
 THE EISE AND EAELY PROGRESS OF BRITISH PREVENTIVE MEDICINE. 
 
 Down to the end of our Stuart timeSj what little had been done 
 for the Sanitary Interests of the Community had rested on scarcely 
 any better medical knowledge than was common to doctor and 
 laity. Such arts of healing- as had prevailed during the Middle 
 Ages had been exercised from the widety-different standpoints of 
 the ecclesiastic, the barber, and the grocer.^ The truth which 
 we by degrees have learnt, that Medicine in its main significance 
 is but an applied Physiology, could not in those earlier times be 
 imagined ; and it was only by slow succeeding steps, extending 
 over centuries, that Medical Science, in our meaning of the term, 
 could come into self-conscious existence. But, during the Tudor 
 and Stuart reigns, changes, which we from our after-times can 
 recognise to have been the beginnings of Modern Medicine, had 
 been tending to define themselves as in embryo. The so-called 
 revival of learning in Europe, with the various literary and 
 artistic enthusiasms which at first seemed to be its only fruit, 
 had been followed by a strange eventful quickening of mane's 
 deeper interrogative faculties ; and this new intellectual spirit, 
 destined to be of far-reaching revolutionary effect in affairs of 
 Church and State, had sounded also a first reveil to the sincere 
 scientific study of Nature. From the fifteenth century onwards, 
 as that most ennobling of studies grew, fresh and fresher lights 
 gathered rapidly to a dawn of the happiest day of human know- 
 ledge. In the sixteenth century, in countries other than our 
 own, Copernik, soon to be followed by Galileo, had started the 
 
 * See above in chapter v. In the present nearly last decennium of the nine- 
 teenth century, certain antient rights of conquest of these three orders of 
 practitioners are, alas, still held to justify the sixty-odd varieties of title under 
 which men may be found practising medicine within the United Kingdom. 
 
108 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VII. new science of the stars : the alchemists had bee^un their inno- 
 
 Early . . 
 
 British vativc experiments on the dead matters of the crust of the earth ; 
 
 JvSSieT^ Vesalius had achieved his daring dissections of the human body; 
 and schools of study were on all sides arising, wherein Ptolemy 
 and Galen were no longer to be masters without appeal. It 
 was however more especially in the seventeenth century, that 
 the Art of Medicine began to quicken with new ambitions 
 to know, and with new conceptions of how to learn. In 
 the earlier half of the century, signalised by the publication 
 of the Novum Organon, and by the discovery of the Circulation 
 of the Blood,"^ noble eloquence and nobler example had taught 
 lessons, which never again could be lost from men^s minds, 
 as to the spirit and method of all scientific research — that 
 system of modest and patient Interrogation through which alone 
 any knowledge of Nature will grow. Anatomy, fairly entitled 
 to be so called, soon became able to shew triumphant progress ; 
 and during the last third of the century, our great physician, 
 Thomas Sydenham, applying the same spirit of exact observa- 
 tion to the symptoms and treatment of disease, gave to Practical 
 Medicine the new birth from which, for the two past centuries, 
 it has had its continuous development. ^' Continuous,'"' indeed : 
 for, as we look back to that age from our own, we see, work- 
 ing ever diligently onward as the genius of progress through 
 the two hundred years, the one always rewarded and always 
 increasing spirit of exactitude. There have been the bedside 
 observations of successive great practitioners — from those who 
 like Mead and Fothergill and Huxham, were Sydenham's next 
 English successors, to now when we look back on the memory of 
 Laennec and Louis and Trousseau, of Traube and Skoda and 
 Wunderlich and Graefe, of Addison and Bright and Robert 
 Williams, of Brodie and Latham and Prout : assisted, all of them, 
 more and more greatly, by those studies of the dead diseased 
 body which the great Morgagni began, — studies first by ones 
 and twos of epoch-making men, such as (in their respective 
 countries) Baillie, Cruveilhier, Rokitansky, Virchow ; and then 
 by men associated in hundreds as in our London Pathological 
 Society. Anyone who compares the nomenclature of a modem 
 
 * Lord Bacon's Novum Or^anon was published in 1620 ; and William Harvey's 
 Exereitatio de Motu Sanguinis in 1628. 
 
NEW MOMENTA. 109 
 
 hospital-report with the old Bills of Mortality, will see how more Chap. vil. 
 and more exactly the physician has become able to identify each British 
 unit of disease which he has to treat : while, side by side with ^e^c^*^^^ 
 that infinitely developed power of diagnosis, the power of 
 physiologically interpreting each morbidity or aggregate of 
 morbidities, and of applying to each its antidote, has been coming 
 into existence, as the Medicine of the Future, under guidance 
 of the great physiological experimentalists, from John Hunter 
 onward. 
 
 Even from the dawn of these better times, even from the The 
 close of the seventeenth century, members of the Medical Pro- Modem 
 fession began to be of more account than before with regard to Medic^eT^ 
 the preventability of disease. It began to be definitely expected 
 of them that, as treaters of disease, they, better than the laity, 
 should know in exact terms the conditions under which disease 
 arises and is spread, and by what (if any) means it can be pre- 
 vented. During the 18th century, and so much of the 19th as 
 preceded the accession of Queen Victoria, British practitioners 
 took the lead of the world in their endeavours to fulfil that 
 expectation. They did so with such success that we, their 
 followers in the Profession, cannot too gratefully record our own 
 obligations to them, nor can too gladly feel that Modern Pre- 
 ventive Medicine has in great part sprung from what our com- 
 patriots then began to do and to teach. 
 
 Earliest on the roll of the Fathers of our Modern Preventive 
 Medicine are the names of Richard Mead, and John Pringle, 
 and James Lind : to be followed at no long interval by those of 
 George Baker, Gilbert Blane, Edward Jenner, and Turner 
 Thackrah. 
 
 In 1720, Dr. Richard Mead, who for eleven earlier years Mead. 
 in the century had been Physician to St. Thomas''s Hospital, 
 and who now was by far the foremost of English physicians, 
 published his so-entitled Short Discourse concernhig Festilential 
 Contagion^ and the Methods to he tcsed to prevent it. Within a 
 year the work had passed unchanged through seven editions ; 
 and it afterwards, still in Meade's life- time, went (with additions) 
 through two more. The deservedly high authority of* Mead's 
 
110 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VII. name would alone have ensured circulation and influence to 
 British anything which he might have seen fit to write; and in 1720 
 MeSaeT^ the dissemination of what he had to say was greatly promoted 
 by the circumstance that his then subject-matter was one of 
 urgent public anxiety. Levantine Plague, unforgotten from its 
 last and most terrible visitation of fifty years before, was now 
 once more threatening the country : the contagion had again 
 recently been introduced into Marseilles, and was spreading 
 furiously in the South of France : and Dr. Meade's Biscourse 
 answered an appeal, which the Secretary of State had made to 
 him, that he would advise what precautions could be taken here 
 for the public safety. 
 
 The precautions which Mead named first — (for he believed 
 plague to be an eminently contagious disease) — were : that there 
 must be strict quarantine against the infected foreign countries ; 
 and that, if the infection '^^through a miscarriage in the public care^' 
 should penetrate those outward defences, and shew itself present 
 in any part of England, the part thus infected must be debarred 
 by quarantine-restrictions from communicating freely with the 
 rest of the country. Thus far his advice was in substance only 
 such as had on previous occasions of danger been given by others, 
 and been more or less followed by the authorities ; but, in con- 
 templating the possibility of a re-infection of England, he pro- 
 ceeded to give advice more distinctively his own with regard to 
 the management of the infected places themselves; and from 
 this advice of his there dates in England so greatly an improved 
 understanding (as compared with fifty years before) of the spirit in 
 which dangers of pestilence ought to be dealt with, that it may 
 be well to give here in abstract, and generally in Mead^s own 
 words, the principal of the passages in question. He begins by 
 shewing how equally cruel and futile had been the rule, enforced 
 on former occasions, that every house which had any sick in it 
 must be made a prison-house for all its inmates, sick and healthy 
 together, and "this to continue at least a month after all the 
 family was dead or recovered/' ... " Nothing could justify 
 such cruelty but the plea that it is for the good of the whole 
 community, and prevents the spreading of infection.'''' This 
 however it does not. Such " shutting up of houses is only keep- 
 ing so many seminaries of contagion, sooner or later to be dis- 
 
NEW MOMENTA. Ill 
 
 persed abroad : for the waiting a month or longer from the death Chap. vii. 
 of the last patient will avail no more than keeping a bale of British 
 infected goods unpacked : the poison will fly out whenever the Medic^eT^ 
 Pandora^s box is opened/' And in another point of view, how 
 mischievous must the system be. ^^ There is no evil in which 
 the great rule of resisting the beginning more properly takes 
 place than in the present case. ... As the plague always 
 breaks out in some particular place, it is certain, that the direc- 
 tions of the civil magistrate ought to be such, as to make it as 
 much for the interest of infected families to discover their mis- 
 fortune, as it is, when a house is on fire, to call the assistance of 
 the neighbourhood : whereas, on the contrary, the methods taken 
 by the public, on such occasions have always had the appearance 
 of a severe discipline, and even punishment, rather than of a com- 
 passionate care ; which must naturally make the infected conceal 
 the disease as long as was possible .... Other measures are 
 certainly to be taken; '■' and these he proceeds to suggest, as 
 follows. — In the first place, for Central Authority, there ought 
 to be established a Council of Health, entrusted with all re- 
 quisite powers : " some of the principal officers of state, both 
 ecclesiastical and civil, some of the chief magistrates of the city, 
 two or three physicians, kc," They should '^ see all their orders 
 executed with impartial justice, and that no unnecessary hard- 
 ships under any pretence whatever be put upon any by the 
 officers they employ.'^ For local purposes, — ^'^instead of ignorant 
 old women,'' . . . "understanding and diligent men" should 
 be the " searchers." They, wherever the distemper breaks out, 
 should without delay " order all the families, in which the sick- 
 ness is, to be removed : the sick to different places from the 
 sound j but the houses for both should be three or four miles out 
 of town: and the sound people should be stript of all their 
 cloaths, and washed and shaved, before they go into their new 
 lodgings. These removals ought to be made in the night, when 
 the streets are clear of people : which will prevent all danger of 
 spreading the infection. And besides, all profitable care should 
 be taken to provide such means of conveyance for the sick, that 
 they may receive no injury. As this management is necessary 
 with respect to the poor and meaner part of the people : so the 
 rich, who have conveniences, may, instead of being carried to 
 
112 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VII. lazarettoes, be obliged to go to their country-houses ; provided 
 British that Care be always taken to keep the sound separated from the 
 Medicine, infected. And at the same time, all the inhabitants who are 
 yet well should be permitted, nay, encouraged, to leave the 
 town, which, the thinner it is, will be the more healthy. No 
 manner of compassion and care should be wanted to the 
 diseased j to whom, when lodged in clean and airy habitations^ 
 , there would, with due cautions, be no great danger in giving 
 
 attendance. All expenses should be paid by the public, and no 
 charges ought to be thought great, which are counterbalanced 
 by the saving a nation from the greatest of calamities. Nor 
 does it seem at all unreasonable, that a reward should be given 
 to the person that makes the first discovery of infection in any 
 place ; since it is undeniable, that the making known the evil to 
 those who are provided with proper methods against it, is the 
 first and main step towards the overcoming it.^^ As the above 
 advice is ^' founded upon this principle, that the best method for 
 stopping infection, is to separate the healthy from the diseased ; 
 so, in small towns and villages where it is practicable, if the 
 sound remove themselves into barracks, or the like airy habita- 
 tions, it may probably be even more useful, than to remove the 
 sick. This method has been found beneficial in France after all 
 others have failed. But the success of this proves the method of 
 removing the sick, where the other cannot be practised, to be the 
 most proper of any. When the sick families are gone, all the 
 goods of the houses in which they were, should be buried deep 
 underground or burnt .^■' In his earlier editions he prefers burn- 
 ing, but not in the later : *' because, especially in a close place, 
 some infectious particles may possibly be dispersed by the smoke 
 through the neighbourhood.''^ " The houses themselves may be 
 demolished or pulled down, if that can conveniently be done; 
 that is, if they are remote enough from others : otherwise it may 
 suffice to have them thoroughly cleansed, and then plastered up. 
 And, after this, all possible care ought still to be taken to remove 
 whatever causes are found to breed and promote contagion. In 
 order to this, the overseers of the poor (who might be assisted 
 herein by other officers) should visit the dwellings of all the 
 meaner sort of the inhabitants ; and where they find them stifled 
 up too close and nasty, should lessen their number by sending 
 
NEW MOMENTA. 113 
 
 some into better lodgings, and should take care, by all manner Chap. vii. 
 of provision and encouragement, to make them more cleanly and Brit^h 
 sweet. No good work carries its own reward 'with it so much as Medic^^^ 
 this kind of charity : and therefore, be the expense what it will, 
 it must never be thought unreasonable. For nothing approaches 
 so near to the first original of the plague, as air pent up, loaded 
 with damps, and corrupted with the filthiness that proceeds from 
 animal bodies. Our common prisons afford us an instance of 
 something like this, where very few escape what, they call the 
 gaol fever, which is always attended with a degree of malignity 
 in proportion to the closeness and stench of the place : and it 
 would certainly very well become the wisdom of the government, 
 as well with regard to the health of the town, as in compassion 
 to the prisoners, to take care, that all houses of confinement should 
 be kept as airy and clean, as is consistent with the use for which 
 they are designed. ^^ '' At the same time that care is taken of 
 houses, the proper ofiicers should be strictly charged to see that 
 the streets be washed and kept clean from filth, carrion, and all 
 manner of nuisances ; which should be carried away in the night 
 time : nor should the laystalls be suffered to be too near the city. 
 Beggars and idle persons should be taken up, and such miserable 
 objects as are neither fit for the common hospitals or workhouses, 
 should be provided for in an hospital for incurables.''^ '^ As for 
 houses, the first care ought to be to keep them clean : for as 
 nastiness is a great source of infection, so cleanliness is the 
 greatest preservative ; which shows us the true reason, why the 
 poor are most obnoxious to contagious diseases.^' From certain 
 fumigations which have been recommended as means of disinfect- 
 ing houses, he would not expect advantage : " but the smoke of 
 sulphur perhaps, as it abounds with an acid spirit which is found 
 by experience to be very penetrating, and to have a great power 
 to repress fermentations, may promise some service this way.^^ 
 ..." The next thing after the purifying of houses, is to consider 
 by what means particular persons may best defend themselves 
 against contagion : for the certain doing of which, it would be 
 necessary to put the humours of the body into such a state, as 
 not to be alterable by the matter of infection: ..... but, 
 since none of these methods promise any certain protection : as 
 leaving the place infected is the surest preservative, so the next 
 I 
 
114 ENGLISH SANITAKY INSTITUTIONS. 
 
 Chap. VII. to it is to avoid, as mucli as may be, the near approach to the 
 British sick, or to such as have but lately recovered. For the greater 
 Medicine, security herein it will be advisable to avoid all crowds of people. 
 Nay, it should be the care of the magistrates to prohibit all 
 unnecessary assemblies; and likewise to oblige all who get 
 over the disease to confine themselves for some time, before they 
 appear abroad. The advice to keep at a distance from the sick, 
 is also to be understood of the dead bodies ; which should be 
 buried at as great a distance from dwelling-houses, as may be j 
 put deep in the earth ; and covered with the exactest care ; . . . . 
 they should likewise be carried out in the night, while they are 
 yet fresh and free from putrefaction.^^ In his eighth edition. 
 Mead prints an ofl&cial letter showing that, before the first publi- 
 cation of the Biscoursey a system of separation and isolation such 
 as he proposed had been used with advantage in the King's 
 Hanoverian possessions. 
 
 It may be mentioned in passing that, as soon as possible after 
 the publication of Mead's Biscourse, an Act of Parliament (7th 
 Geo. I., cap. 3) was passed to give effect to his recommendations ; 
 but that a year later those provisions of the Act which gave 
 ^^ power to remove to a lazaret or pest-house any person what- 
 soever infected with the plague, or healthy persons out of an 
 infected family from their habitations though distant from any 
 other dwelling,'' and '*' power for drawing lines or trenches " 
 around infected districts, with a view to the keeping of strict 
 quarantine over their communications, were repealed by 8th 
 Geo. I., cap. 8. Mead, referring to this repeal in the eighth 
 edition of his Biscotcrsej speaks of it as having been occasiojied 
 by faction, which aimed only at spiting the Ministry of the day, 
 and he quotes ^' a learned prelate now dead " {query Atterbury) 
 as having confessed so much to him : but though no doubt there 
 may have been even in those days a certain pleasure in the ver- 
 micularities of faction, it must be admitted that the repealed 
 provisions were such as could not easily have been enforced."^ 
 Mead, in recommending Quarantine, was in agreement with his 
 
 * See in Hansard's Farliamentary History of 1721, Nov. 17 to Dec. 13, the 
 various proceedings which led to the ministerial abandonment of Mead's dauses. 
 See also, the discussion of Quarantine in the Eighth Annual Keport of the Medical 
 Officer of the Privy Council. 
 
NEW MOMENTA. 115 
 
 medical contemporaries and predecessors in all parts of the Chap, vil 
 world ; and if his and their successors in the present generation Bri^h 
 would in the same circumstances not recommend it, probably S"®!®?*^^® 
 this would depend not so much on any difference of medical 
 principle as on the truer measure now taken of what in any 
 such case would be administratively possible. 
 
 Dr. (afterwards baronet) John Pringle^s work on the Peingle. 
 Diseases of the Army was founded on his official medical ex- 
 periences, chiefly as physician- general to the British forces, and 
 physician to the military hospitals, during the campaigns of 
 1742-3, in and about Flanders, and in Great Britain. In the 
 first of the three parts into which his book is divided, he describes 
 as matter of fact, and in order of time, the various attacks of 
 illness which the troops suffered, and the conditions of place and 
 season under which each illness prevailed : in the second part, 
 grouping those facts, he shows in a broad way the connexion of 
 particular sorts of cause with particular sorts of disease, and 
 proceeds to point out, in regard of the causes, "the means of 
 removing some and rendering others less dangerous '' : in the 
 third part, he speaks more fully of the individual diseases, and 
 discusses in detail the causes an4 prevention (as well as the 
 symptoms and treatment) of each of those which had been of 
 most consequence. Pringle^s work is one of the classics of 
 Medicine.^ With his plain peremptory insistence on common 
 health-necessaries for the soldier, — with his frequent inculpation 
 of " putrid air '' as the condition under which dysentery and 
 the " autumnal '^ fevers (probably both paludal and entero- 
 zymotic) prevailed in the camps, and '^jail-fever''' in the hospitals, 
 — with his excellent directions against damp and filth in camps, 
 and for the '^ right management of the air '' in hospitals, — he 
 began hygienic reform for the British Army, and gave at the 
 
 * Pringle's work was first published in 1752, and was in a fourth edition in 
 1764. Two years before the first edition of the entire work, the substance of 
 one of its sections had been separately published in the form of a Letter to 
 Dr. Mead on the Nature and Cure of Hospital and Jayl Fevers. The occasion of 
 the Lejtter was that, in the spring sessions of 1750 at the Old Bailey, there had been 
 a disastrous infection of the Court by jail-fever, killing judges, counsel and 
 others, "-to the amount of above forty, without making allowance for those of a 
 lower rank whose death may not have been heard of." See Pringle^as above. 
 
 I 2 
 
116 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VII. same time most valuable hints to the civil population how like- 
 British wise their typhus and their enteric infections might be prevented. 
 
 Preventive 
 
 Medicine. 
 
 LiHD Services, strictly analogous to the above^ and not less 
 
 memorable than they, were rendered to the British Navy, and to 
 the universal interests o£ Preventive Medicine, by the works 
 which Dr. James Lind, for many years Physician to Haslar 
 Hospital, wrote On the means of preserving the Health of Seamen : 
 
 - viz. by his general ^ssai/ having that title, and by the special 
 
 papers in which he more elaborately wrote of Scurvy and of 
 Infection.^ His declared object was to provide '' a, plan of 
 directions for preserving the British seamen from such distempers 
 as prove much more fatal to their corps than all the other 
 calamities incident to them at sea '^ : for (said he) ^^ the number 
 of seamen in time of war, who die by shipwreck, capture, famine, 
 fire, or sword, are but inconsiderable in respect of such as are 
 destroyed by the ship-diseases, and by the usual maladies of 
 intemperate climates.^^t His teaching for the purpose which he 
 had in view was at once accepted by his Profession as of the 
 highest authority; and, over and above the good which it effected 
 in making the routine of ship-life wholesomer in common sanitary 
 respects than it had been, signal success attended it in two par- 
 ticular directions which may be named : i.e., in regard of scurvy, 
 and in regard of typhus. The fact that scurvy, which used to 
 cripple fleet after fleet, and to waste thousands on thousands of 
 the bravest of lives, has, since the days of Anson^s expedition, 
 
 * Lind' 8 Treatise on Scurvy was first published in 1753, and reached its 
 third edition in 1772. His Ussay on the most effectual means of preserving 
 the Health of Seamen in the Royal JSfavy was first published in 1757, had a 
 iecond edition in 1762, and a third in 1774. In 1761 he published Two Papers 
 on Fevers and Infection, in 1763 a Postscript to them, and in 1773 a separate 
 paper. The Jail Iflstemper, and the proper methods of preventing and stopping 
 its infection. In 1774, a new edition of all the last-named papers was combined 
 in one volume with the third edition of his general Essay on the Health of 
 Seamen. I do not find evidence of Lind's having ever served in the Navy. He 
 graduated as M.D. in the University of Edinburgh in 1748, was elected Fellow 
 of the Edinburgh College of Physicians in 1750, and seems to have remained 
 resident in Edinburgh till 1758, when he was appointed Physician to the Royal 
 Hospital at Haslar. He retained that office for many years, eventually assisted 
 in it by his son ; and I do not know that he had retired from it before his death, 
 which took place at G-osport in 1794. 
 
 t Advertisement to third edition of Essay. 
 
NEW MOMENTA. 117 
 
 become an almost forgotten disease, is due emphatically to Lind : Chap. vil. 
 and to him therefore, even thus far, we owe such saving of human British 
 life as probably to no other one man except the discoverer of MeS^^ 
 vaccination. Then, as regards typhus, the value of his preventive 
 teaching has been scarcely less conspicuous : for the circumstances 
 of his official position gave him singular facilities out of which 
 to corroborate Pringle^s belief of the identity of " hospital-fever^^ 
 with ^^ jail-fever "" and ^' ship-f ever,'''' and to illustrate the laws ' 
 of that many-named infection : and the system of rules which he 
 laid down for limiting its ravages in ships and populous estab- 
 lishments is one to which our after-times have made little or no 
 material addition, and to which we no doubt are in great part 
 indebted for our comparative freedom from epidemics of typhus. 
 
 As connected with the mention of Mead and Prino^le and Contri- 
 
 vances fox 
 
 Lind, it has to be noted, that, before their time, knowledge of Ventiia- 
 the Mechanics of Air and Water had advanced to a stage H»ies; 
 in which the invention of mechanical appliances for various 
 sanitary objects might be expected gradually to give aid to 
 medicine ; and that, during the years in which those writers were 
 proclaiming the virtues of pure air, certain meritorious con- 
 trivances, which they could and did strongly recommend, for the 
 ventilation of enclosed spaces, were also being made known to 
 the public. Thus, in 1741, the already eminent physicist, 
 Stephen Hales, read before the Royal Society an account (which 
 he afterwards published in a separate volume) of an instrument 
 invented by him for changing the close air of given spaces : a 
 sort of double bellows, which, when worked by hand, would, by 
 each of its halves alternately exhaust and supply air from and 
 into the space which had to be ventilated."^ And in 174^ Dr. 
 
 * See by Stephen Hales, D.D., r.R.S.,-4 Description of Ventilators : " whereby 
 great quantities of Fresh Air may with ease be conveyed into Mines, Gaols, 
 Hospitals, "Workhouses and Ships, in exchange for their Noxious Air. An 
 account also of their groat usefulness in many other respects : " &c, &c. &c. &c. 
 London, 1743. See also, in continuation of the above, A Treatise on Ventilators : 
 Fart Second : " wherein an Account is given of the Happy Effects of the several 
 Trials that have been made of them in different ways and for different purposes : 
 which has occasioned their being received with general approbation and applause 
 on account of their utility for the great benefit of mankind : as also of what 
 farther hints and improvements in several other useful ways have occurred since 
 the publication of the former Treatise : London, 1768." 
 
118 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VII. Mead brought before the Royal Society a different contrivance 
 British by Mr. Samuel Sutton-, which was meant at the moment only 
 Medicine, for ships_, but could with modification be adapted to any houses 
 Sutton. Qj. parts of them^ or to the wards of prisons or hospitals,, &c. : 
 being, said Dr. Mead, "no more than this, — that, whereas, in 
 every ship of any bulk, there is already provided a copper or 
 boiling-place proportionable to the size of the vessel, it is pro- 
 posed to clear the bad air by means of the fire already used 
 under the said coppers or boiling-places for the necessary uses of 
 the ship.'^"^ The two contrivances came into extensive use 
 during the middle vicennium of last century : Dr. Hales's 
 " lungs/' mentioned with praise by Pringle and Lind, seem to 
 have been often advantageously used in ships, prisons and 
 hospitals ;t and Mr. Sutton, who in 1745 obtained a patent for 
 his invention, was, after a long interval, ordered by the Lords 
 of the Admiralty to adapt his "fire-pipes*' to His Majesty's 
 Navy. { Readers of the present day who may find it hard to 
 imagine the " putrid " quality of the atmospheres which in those 
 days the inmates of prisons and ships and barracks and hospitals 
 had to breathe, can well assist their imagination by referring to 
 the pages of Hales and other contemporary reformers. 
 
 Thus already the better teaching which had become current 
 as to the causes of disease was beginning to be followed by 
 better practice ; which in its turn, through the results to be 
 obtained from it, would become the most influential of all 
 teachings; and in that point of view, the proceedings of the 
 Royal Society, at its anniversary meeting of 1776, may be 
 referred to for an illustration which is monumental. 
 
 * See in second volume of Dr. Mead's Works, Edinburgh edition, 1766. 
 
 •f See Dr. Hales's above-mentioned " second part." London, 1758. 
 
 X Record of the concession to Mr. Sutton is made in the Annual Register 
 for 1764, incidentally to the biographical notice then given of Dr. Hales who 
 had died in 1761. The writer of the notice, after stating that Sutton obtained 
 the order *' after ten years' solicitation supported by influence of Dr. Mead,'* 
 proceeds, in terms of which I am not sure whether they are used in sycophancy 
 or in sarcasm, — "His contrivance to preserve his fellow- creatures from pesti- 
 lential diseases was rewarded by a permission to put it in practice : an instance 
 of attention to the public, and liberality to merit, which must reflect everlasting 
 honor upon the great names who at that time presided over the affairs of this 
 Kingdom." 
 
NEW MOMENTA. 119 
 
 From early in the century tlie Royal Society had had in its Chap. vil. 
 
 award (under bequest of Sir Godfrey Copley) an annual medal, British 
 
 by which to express year by year its grateful recognition of the m?(Hc^T^ 
 
 best works submitted to it in matters of experimental science ; 
 
 and in 1776 that Copley Medal was awarded to Captain Cook, cook's ap- 
 
 in honour of his paper, communicated to the Society earlier in plication of 
 
 ^ ^ ^ •^ hygienic 
 
 the year, on Tke Method taken for preserving the Health of the rules. 
 
 Crew of His Majesty's Ship, the Resolution, during her late 
 Voyage round the World, Sir John Pringle was then the Presi- 
 dent of the Society, himself already patriarchal in Preventive 
 Medicine, and he necessarily spoke of Cooky's achievement in lan- 
 guage of the deepest sympathy. The intention of this '^ honor- 
 ary premium,"" he said, ^' is to crown that paper of the year 
 which should contain the most useful and most successful experi- 
 mental inquiry. Now, what inquiry can be so useful as that 
 which hath for its object [the saving of the lives of men ? and 
 when shall we find one more successful than that before us? 
 Here are no vain boastings of the empiric, nor ingenious and 
 delusive theories of the dogmatist, but a concise, an artless, and 
 an incontested relation of the means by which under the Divine 
 Favour Captain Cook with a company of 118 men performed 
 a voyage of three years and eighteen days, throughout all the 
 climates from 52^ North to 71*^ South, with the loss of only 
 one man by a disease. ^^ He contrasted Cook-'s economy of life 
 with illustrations, which he quoted, of the wastefulness of pre- 
 vious experience : hideous illustrations, among which, last and 
 not least, was the recent ^^ victorious but mournful " expedition 
 of Anson : and then he gave his audience full particulars of the 
 "Method^'' of Cook's splendid success. The medal, with Cook's 
 '^ unperishing name engraven upon it,^"* he handed not to Cook 
 himself (for Cook had already sailed on his last voyage) but to 
 Cook^s representative : who, he says, will be ^^ happy to know 
 that this respectable body never more cordially nor more merito- 
 riously bestowed that faithful symbol of their esteem and 
 affection : for, if Rome decreed the civic crown to him who 
 saved the life of a single citizen, what wreaths are due to that 
 man who, having himself saved many, perpetuates now in your 
 Transactions the means by which Britain may henceforth 
 preserve numbers of her intrepid sons, her mariners, who. 
 
120 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VII braving every danger, have so liberally contributed to the 
 Britwh fame, to the opulence, and to the maritime empire o£ their 
 ^«£» country."* 
 
 With regard to Cook^s " Method/^ and the ever-memorable 
 success which it obtained, all who would study the case must of 
 course bear well in mind that Method and Man were co-efficient. 
 The success was due to the enforcement of well-known hygienic 
 rules by a thoroughly skilled and thoroughly humane disciplin- 
 arian commander. The chief hygienic points were the following : 
 proper provision of food, which was made to include rob of 
 lemons and oranges, sourkrout, sugar, portable soup or broth, 
 and malt for making sweetwort ; avoidance of too long watches ; 
 avoidance of unnecessary exposure to weather; insistence on 
 dry shifts when wet; insistence on keeping persons and ham- 
 mocks clean ; insistence on keeping ship clean and dry ; venti- 
 lation by wind-sail and by frequent use of portable fire at 
 bottom of well; great care for fresh water to be renewed at 
 every opportunity ; and for fresh provisions, animal and veget- 
 able, whenever possible. 
 
 Blane. a few years later than this. Dr. (afterwards baronet) 
 
 Gilbert Blane began to render very influential service to the 
 progress of Preventive Medicine. During the last three or four 
 years of the American war, he served with much distinction as 
 Physician to Lord Rodney^s Fleet in the West Indies ; and, early 
 in this service, being shocked with the quantity of disease which 
 he found prevailing and believed to be in great part preventable, 
 he took two practical steps in the matter. First, in 1780, by a 
 printed tract addressed to the flag-officers and captains of the 
 fleet, and which he says " was extremely well received,"'' he en- 
 deavoured to enlighten them as to means which might be used 
 for maintaining the health and vigour of the men, and for 
 preventing invasions of disease, and for benefiting the sick ; and 
 as to the degree in which the application of such means " de- 
 pended on the good judgment and exertion of officers, who alone 
 could establish and enforce the regulations respecting ventilation, 
 
 * See Philosophical Transactions, 1776, or Dr. Kippis's separate publication. 
 of Pringle's Six Presidential Addresses 
 
NEW MOMENTA. 121 
 
 cleanliness^ and discipline/^ And secondly, in 1781, when he Ohap.vil 
 accompanied Lord Eodney in a short visit to England, he Brit&i 
 addressed to the Board of Admiralty an admirably frank and 2^c^e!* 
 judicious statement of reforms which he thought necessary for 
 the health of the navy. The end of the war in 1783 allowed 
 Blane to settle in London, where he was almost immediately 
 appointed physician to St. Thomases Hospital; and 1785 he 
 published the results of his special experience and reading in a 
 considerable systematic treatise, entitled. Observations on the 
 Diseases of Seamen/^ This work, though perhaps not scientific- 
 ally a very material addition to the teachings of Lind and 
 Cook, was at least a very opportune corroboration of them ; and 
 soon afterwards Blane, in being appointed Commissioner for Sick 
 and Wounded Seamen, and Chief Officer of the Navy Medical 
 Board under the Admiralty, had facilities, which he zealously 
 turned to invaluable account^ on the one hand for increasing his 
 knowledge, and on the other hand for bringing into application 
 the sanitary reforms which he had advocated. Partly as the 
 practical initiator of those naval sanitary reforms, and partly in 
 respect of subsequent writings, hereafter to be named, Blane 
 appears to deserve mention with Mead and Pringle and Lind, 
 as one of the most effective of the early promoters of Modern 
 Preventive Medicine. 
 
 In 1796, the year after his appointment to the Medical 
 Board, the famous reform was made which gave Lemon-juice to 
 the British Navy. How long before that time the world had 
 been aware of the special anti-scorbutic value of the citric fruits 
 is not positively known ; but it is at least certain that, nearly 
 two hundred years before, there was some such knowledge in 
 existence : for, in 1601, as Purchas most graphically shows,t 
 the virtue of lemon- juice against scurvy was illustrated in the 
 first voyage made for the East India Company under Elizabeth^s 
 Charter of 1600 : and in 1617, this value of Lemon-juice was 
 especially insisted on by John Woodall, at that time Surgeon- 
 
 * Subsequent editions of this work appeared in 1790, 1799, and 1803. As an 
 Appendix to its second part, which is on the Causes of Disease in Fleets, and the 
 means of Prevention, he gives the Memorial which he addressed to the Admiralty 
 in 1781, and a further Memorial submitted in 1782. 
 
 t See his Filgrimes, London, 1625, vol. i. p. 147. 
 
Bakbb. 
 
 122 ENGLISH SANITAKY INSTITUTIONS. 
 
 Chap. VII. General to the East India Company^ and afterwards surgeon to 
 British St. Bartholomew^s Hospital."^ 
 
 Preventive 
 Medicine. 
 
 Of the beginnings of modern Preventive Medicine in the 
 publications of the eighteenth century, highly important sec- 
 tions are represented by the names of the four writers already 
 mentioned; but two workers have yet to be named, each of 
 whom had a special section to himself. Of these, one was Dr. 
 (afterwards baronet) George Baker : who in 1767 read before 
 the London College of Physicians, and then published in a 
 pamphlet of sixty pages, his Easai/ concerning the Cause of the 
 Endemial Colic of Devonshire. The disease which was in 
 question, the associated colic and palsy of Devonshire, was one 
 of serious danger to those who suffered it; and it was so 
 frequent in the county that, for instance, the Exeter Hospital 
 alone during the years 1762-7 had among its in-patients an 
 annual average of nearly sixty cases of it. In particular 
 years it would be in extreme prevalence. Thus in the winter of 
 1724-5, Dr. Huxham (who practised at Plymouth) found it '^so 
 vastly common that there was scarce a family amongst the 
 lower rank of people that had it not, and he often saw five or 
 six lying ill of it in the same house/' t The gist of Baker's 
 Essay was a demonstration that the disease of which he wrote 
 was simply an effect of lead-poisoning : that the cider-drinking 
 population was being extensively poisoned by lead which entered 
 them with their cider in consequence of reckless applications of 
 the metal in apparatus of cider-making and cider-storage : and 
 he concludes his few pages with a hope that this ^^ discovery of a 
 poison which has for many years exerted its virulent effects on 
 the inhabitants of Devonshire, incorporated with then* daily 
 liquor, unobserved and unsuspected, may be esteemed by those 
 who have power, and have opportunities to remove the source of 
 so much mischief, to be an object worthy of their most serious 
 attention.'' Measured by world-wide standards, it was not a 
 very large field of human suffering, into which this man came 
 as emancipator : but his work was of the rare quality which 
 commands prompt and complete success : he had studied his case 
 
 * See his Surgeon's Mate, 1617 ;' and his Various Treatises, 1639. 
 
 t As quoted "by Dr. Guy in his interesting Lectures on Public Sealth, p. 137. 
 
N^W MOMENTA. 123 
 
 thoroughly well, his proofs were consummately good, and under Chjlp. vii, 
 the influence of his discovery a grievous endemic affliction rapidly Brifeh 
 became extinct where it had been habitual. Meic^^^* 
 
 The other remaining name, the name with which the century Jennee. 
 closes, is the name of Edwaed Jenner. It was in the year 1798 
 (the year in which the nations of the Continent were learning 
 from republican f^rance its newly- invented art of military con- 
 scription) that an English village-doctor, publishing his Inquiry 
 into the Causes and Effects of the Variola Vaccina, counter- 
 poised from beforehand, so far as such counterpoise could be, 
 the cruelties of mutual slaughter which men were then prepar- 
 ing for each other on a scale not before known to the world. 
 The present mention of Jenner's discovery of vaccination is meant 
 only as a passing memorandum of the date at which so great a 
 redemption from disease first became available to mankind ; ^ but 
 in connexion with that reference, it may here conveniently be 
 noticed that the earliest endeavour of the eighteenth century 
 for any purpose of Preventive Medicine had been, like this last, 
 an endeavour in relation to smallpox : consisting in the intro- 
 duction and extensive practice of smallpox-inoculation as a pro- 
 cess by which individuals might hope to secure themselves 
 against severe attacks of the disease. f Smallpox- inoculation 
 initiated, in the first vicennium of the eighteenth century, an 
 entirely new line of medical thought as to the mitigabilities of 
 disease ; and particularly, as to the one disease with which it 
 
 * I tliink it unnecessary to enlarge my present text by entering on details as 
 to the history of Jenner' s discovery, or as to the triumphs of vaccination ; but I 
 shall hereafter refer to occasions on which I have had to be official reporter or 
 parliamentary witness with regard to those matters. While these pages are in 
 the press, a recently-appointed Eoyal Commission is receiving evidence on the 
 subject of vaccination ; and I venture to predict that the new e\ddence (so far as 
 it may regard the merits of the discovery) will establish more firmly than ever 
 that Jenner' s services to mankind, in respect of the saving of life, have been such 
 that no other man in the history of the world has ever been within measurable 
 distance of him. 
 
 t On one of the occasions referred to in the last footnote, I told at length 
 the story of the temporary acceptance and the eventual abandonment of small- 
 pox-inoculation ; and the reasons which excuse me from repeating here the 
 history of vaccination will excuse me also from repeating that of smallpox- 
 inoculation. It will be found in the first chapter of my Papers relating to the 
 History and Practice of Vaccination, 1857. 
 
124 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap, vil dealt, it prepared the popular as well as tlie medical mind to 
 British accept with comparative readiness the invention which^ at the 
 MeSicbie^^ end of the century, came so beneficently to supersede it. 
 
 u^^ *"'* ^^ ^^ ^ favorite reflexion among philosophers, that, if departed 
 great benefactors of our race could now and then look down on 
 the harvest-fields where mankind age after age is gladdened by 
 the fruits of their labor, they would in general find themselves 
 less remembered than perhaps their terrestrial ambitions had 
 desired. Doubtless this is so ; but let the noble compensation 
 be noted, that often the thoroughness of a reformer's victory is 
 that which most makes silence of the reformer's fame. For, how 
 can men be adequately thankful for redemptions, when they 
 have no present easy standard, no contrast between yesterday 
 and to-day, by which to measure the greatness of them ? And 
 to some readers that reflexion may well occur at this present point, 
 as they say their beuedicite for our workers of the eighteenth 
 century. Of the present generation who in summer holidays 
 enjoy their draught of cider in Devonshire, not many know that 
 Baker unpoisoned it for them. Of those who go down to the 
 sea in ships, not many have reading and imagination enough to 
 contrast the sea-life which now is with the sea-life which was 
 suffered in Anson's days, and to be grateful for Lind and Blane 
 who made the difference. And, in some such cases, ignorance 
 best tells its tale by swaggering against the truce which protects 
 it. At the anti- vaccination meetings of which we now occasion- 
 ally read, where some pragmatical quack pretends to be making 
 mincemeat of Jenner, how small would become the voice of 
 the orator, and how abruptly would the meeting dissolve itself, 
 if but for a moment the leash were away with which Jenner's 
 genius holds back the pestilence, and smallpox could start into 
 form before the meeting as our grandfathers saw it but a 
 century ago. 
 
 Blane's 
 later pufcli- 
 catious. 
 
 From the end of the eighteenth century to the time in the 
 nineteenth when the reign of Her present Majesty began, there 
 were not any such momentous initiations in Preventive Medicine 
 as those for which the eighteenth century had deserved grateful 
 recollection ; but the years nevertheless had their own kind of 
 * Ulysses in Troilus and Gressida, Act III,, Sc. 3. 
 
NEW MOMENTA. 125 
 
 value. Especially they made a period of educational activity. Chap. vii. 
 The new discoveries were getting to be known and applied ; the B^^h 
 new ways of looking at disease, as something which might often m^^*^^^ 
 be easily prevented, were getting to be extensively familiar; 
 and, as time went on, competent witnesses were again and 
 again coming forward^ to tell how they had experimented with 
 the new knowledge, and had won victories by it. Of the men 
 who in those years were educating the Medical Profession to 
 appreciate the great new career of usefulness which had been 
 opened to it, the foremost was Sir Gilbert Blane, whose name 
 has already been mentioned, and whose life, happily prolonged 
 till 1834, was to the end distinguished by zeal for the public 
 service. In papers which he from time to time, during the 
 years 1812-19, addressed to the Royal Med. Chi. Society, and 
 in others, with which the above were reprinted in 1822, and 
 with further additions in 1833, under the title of Select Disser- 
 tations 0)1 Several Subjects of Medical Science^ Blane may almost 
 be said to have founded a new branch of professional teaching j 
 and most important indeed it was for our coming times that, on 
 the threshold of them, there was yet living from the former age 
 an intermediary, experienced and enlightened as he was, to 
 hand on to us, as incentive to further progress, his records of 
 the progress which had been already made. Such especially 
 were his papers on the Comparative Health of the British 
 Navy from the year 1779 to the year 1829, on the Comparative 
 Health and Population of England at different periods, and on 
 the Comparative Prevalence and Mortality of different Diseases 
 in London, and his Statement of Facts tending to establish an 
 estimate of the true value, and present state of Vaccination. 
 Admirable also for the time when they were written were his 
 papers on Yellow Fever, on Intermittent Fevers, and on 
 Infection. 
 
 Beyond what was done during those years to diffuse and Thai 
 apply the thoughts which the preceding century had originated, 
 one very important new line of thought in Preventive Medicine 
 was opened for England in 1831, by Mr. C. Turner Thackrah, 
 a surgeon of Leeds : who in that year published a work (next 
 year republished with large additions) on The Effects of Arts, 
 
126 ENGLISH SA2?ITARY INSTITUTIONS. 
 
 Chap- VII. Trades and Professions, and of civic states a7id habits of 
 British living, on Health and Jjongevity : with suggestions for the 
 Medicine, removal of muny of the agents which produce disease and shorten 
 the duration of life. In the medical literature of Europe^ 
 Thackrah-'s work was not the first to invite attention to the 
 subject of industrial diseases : for in Italy, a hundred and fifty 
 years before, Hamazzini had written comprehensively on the 
 subject according to the lights of his time ;* and quite recently 
 in France — (besides that in 182^ M. Patissier had published a 
 general workf founded on that of Ramazzini) — many sections 
 of the subject had been separately treated by writers who more 
 or less had made new study of them. J Though those foreign 
 works could hardly be of any direct bearing on the conduct of 
 English industries, their existence may have suggested to 
 Thackrah, how desirable it had become for our country that the 
 health and sanitary circumstances of its various branches of 
 industry should be investigated in the spirit of modern Pre- 
 ventive Medicine by some skilled inquirer. This special service 
 Thackrah set himself to render : not under any official obligation 
 or inducement, nor with any subvention from government, but 
 as his own free gift to a public cause ; and in his inquiry, which 
 extended to about 250 branches of English industry, and in- 
 cluded all the chief employments of the population, he dwelt on 
 the details of each industry so far as he found them to be of 
 significance to health. Not less meritorious than the assiduity 
 and the care for truth with which he collected his facts, were 
 the unprejudiced good sense and moderation with which he 
 weighed them; and the service thus rendered by Thackrah 
 deserves grateful recognition. § By his eminently trustworthy 
 
 * De Morbis Artificum diatriba : Modena, 1670 and 1700; and Padua, 1713. 
 The work was translated into several European languages ; among which, into 
 English in 1725, 
 
 f Traits des Maladies des Artisans, et de eelles qui resultent des diverses Fro- 
 fessims, d'apres Ramazzini, par Ph. Patissier, Paris, 1822. 
 
 X As particularly in the Annates d'' Hygiene Publique et de Med. Legale, and 
 in the two cyclopaedic medical dictionaries which were being published in Paris 
 during those years. 
 
 § Mr. Ikin, of Leeds, speaking of his feUow-townsman Thackrah in the 
 Provincial Medical and Surgical Journal, 1861, says : — *' Leeds suffered a great 
 loss in his premature death." . ..." He was an early and successful promoter 
 of public hygiene, then in its infancy. I must also in bare justice couple his 
 
NEW MOMENTA. 127 
 
 bookj he^ more than fifty years ago, made it a matter of ^^•^^• 
 common knowledge, and of State responsibility, tbat, with Brifeh 
 certain of our chief industries, special influences, often of an nS^hieT^ 
 evidently removable kind, are apt to be associated, which, if 
 permitted to remain, give painful disease and premature dis- 
 ablement or death to the employed persons. 
 
 name with the earliest founders of provincial medical schools, and commend him 
 as a most zealous promoter and teacher of anatomical science : indeed the pro- 
 fession and public of Leeds owe him much, for it was he who first gave a public 
 course of anatomical lectures in this place, and his exertions ultimately gave 
 origin to the more eJEEective organisation of the Leeds Medical School." 
 
128 
 
 CHAPTER VIII. 
 
 THE GROWTH OF HUMANITY IN BEITISH POLITICS. 
 
 At the point which the medical narrative has now reached, retro- 
 spective note has to be made of some accumulating non-medical 
 influences which will be factors in the further history. While 
 medical observers had been advancing (as before stated) in the 
 science of the prevention of disease^ the national common-sense^ 
 which in time was to absorb and apply the better medical 
 knowledge, had not been standing still. Within the period of a 
 century and a half, from the accession of William the Third to 
 the death of William the Fourth, the country had made extra- 
 ordinary progress in the art of seeing old questions in new lights ; 
 and in no respect had that progress been more remarkable than in 
 respect of the force which common humanitarian sentiments had 
 gained in the minds of the younger generations. Especially the 
 later half of the period was characterised by the vehement 
 growth of such sentiments ; and the change has been of so much 
 interest to the main subject-matter of this narrative that it seems 
 to claim more than a passing reference. 
 
 The New Humanity of the eighteenth century represented 
 
 mafcSg for "two separate and dissimilar (though often co-operating) influences : 
 
 Huma^tv ^^® dating from the second quarter of the century, and one 
 
 of the isth dating from the fourth : the former expressly religious, and in 
 
 great part identified with the '^ evangelical revivals '' for which 
 
 that period was remarkable ; the latter, essentially an outcome 
 
 of stimulated pohtical reflexion. 
 
 England in The date at which the earlier of those influences began to 
 
 * The phrase " New Humanity " is one which I owe (with much else) to my 
 reading of the late Mr. John Richard Green's History of the English People. The 
 "larger sympathy of man with man which especially marks the eighteenth 
 century as a turning-point in the history of the human race" is a text on 
 which ]VIr. Green dwells with evident delight in Books viii. and ix. of his 
 learned and eloquent work ; and for my present chapter I can wish nothing 
 better than that it may reflect the spirit of Mr. Green's deeply appreciative 
 references to this part of the national progress. 
 
NEW MOMENTA. 129 
 
 make itself felt is conveniently remembered as the year 1738, S^^-y-^^- 
 half a century from the dethronement of James the Second, and Humani^ 
 a century before the coronation of our present Queen. At that Politics, 
 date, when George the Second had been eleven years King, and 
 Sir Robert Walpole seventeen years Prime Minister, England 
 at large was in circumstances of unwonted ease. The Hanoverian 
 succession had been made secure ; and the Prime Minister with 
 his merits and successes (to say nothing of the bribery which was 
 then a ministerial resource) was showing himself more than a 
 match for the " patriots " who wanted his place. The late times 
 had been extraordinarily without war ; commerce was making 
 very large gains : agriculture/ partly through real increase of 
 skill, and partly from accidental conditions, was in high pros- 
 perity j manufactures, hitherto in great part domestic, and but 
 partially separated from agriculture, were jogging on comfortably 
 under their old low-pressure system ; and even the rural labourers 
 were having a comparatively good time.* At the highest levels 
 of society, the contentment was particularly serene ; for the 
 public service in all its branches offered ample opportunities for 
 the satisfaction of privileged family-interests, and dignitaries of 
 all sorts were deeply convinced that they were in the best of all 
 possible worlds. The ample official testimony which would have 
 been borne to the admirableness of the existing order of things 
 could have been confirmed by so many opulent and most respect- 
 able citizens that apparently the last word on the subject would 
 have been said. Yet in truth that was not the whole story. 
 England, no doubt, was in a rude sort of comfort, but was more 
 plethoric and less awake than might have been wholesomer. 
 The country had had some very hard-working centuries: its 
 process of getting a free constitution for itself had involved long 
 dire conflicts : and now, with the Georgian calm, when armour 
 had at last been put off, and easy times had begun, it was 
 
 * See chapter xvii. of Professor Thorold Rogers's Six Centuries of Work and 
 Wages. See also the late Mr. Arnold Toynhee's Lectures, p. 53. In the last I 
 read (as a quotation from Fox Bourne's Romance of Trade) that the year with 
 which my text starts was critical even in records of industry : namely, that the 
 fly-shuttle, ''the first of the great inventions which revolutioned the woollen 
 industry . . . enabling a weaver to do his work in half the time, and making it 
 possible for one man instead of two to weavQ the widest cloth," was invented in 
 1738 by Kay, a native of Bury, Lancashire. 
 
130 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VIII. 
 Growth of 
 Humanity 
 in British 
 Politics. 
 
 enjoymg" in its Saxon way a sort of holiday-rest from troubles and 
 serious reflexions. With little going forth of thought into space 
 or time, but with much, and indeed often far too much, of eating 
 and drinking, England (so to speak) was taking its ease in its inn. 
 The predominant middle- class type of the time, bluff and brawny, 
 the eighteenth century John Bull of friends and foes, was a being 
 in whom three-fourths of the nature were hitherto unawakened ; 
 and, of the fourth which had been awakened, a very marked pro- 
 portion was egotistic and coarse. The social principles which had 
 been most impressed on him were principles of a combative sort : 
 that his house was his castle ; that he had a right to do as he liked 
 with his own ; that he could thrash any number of foreigners j 
 and so on. Field sports by day, and boisterous conviviality 
 by night, were large items in his Whole Duty of Man. Not to 
 be a milk-sop was so essential, that his going to bed every night 
 drunk or half -drunk was of no particular disgust to the ladies of 
 his family ; and Hogarth and Fielding and Smollett are wit- 
 nesses enough, how much beastliness of that sort, and how much 
 grossness and vice of other kinds, pervaded the common life of 
 the time. At the higher levels of society, which preeminently 
 were abodes of self-satisfaction, the common faults of the time 
 were not at their least, and vices distinctively their own were 
 added. Their atmosphere was surcharged with corruption. 
 Politics meant place-hunting ; and for place, whether in Church 
 or State, any amount of dirt would be eaten. The Queen, who 
 had done much to keep her husband straight in his exercise of 
 power, was now (since last November) no more ; and his widowed 
 Majesty, mindful of the famous last promise he had given her, 
 was importing from Hanover, to be British fountain of honour 
 for the rest of his reign, and shortly to be created Countess of 
 Yarmouth, the woman who three years before had bargained him 
 her adultery for his ducats."^ The strong and sagacious Prime 
 Minister, a typically jovial Englishman of the time, had accepted 
 as the necessity of his position, that he could only govern by 
 means of bribes ; and he is reported to have said of the House of 
 Commons of his time, that every man of them had his price. The 
 dignitaries of the Church were not above the average of the cor- 
 rupt coarse world around them ; bishops and other high clergy 
 * See Lord Hervey's Memoirs : vol. i. pp. 499-502 ; and vol. ii. p. 514. 
 
NEW MOMENTA. 181 
 
 were among the chief flatterers of the court ; and the parish parson Chap. Vill. 
 was commonly more given to hunt and drink with the squire Humanity 
 than to be of guiding moral influence with the people. So^ on PoUticr 
 the whole^ in spite of what optimists might have said, the 
 England of 1738 had in it room for improvement, and was far 
 from having reached such perfection that its appointed guides 
 and rulers were quite entitled to be so soundly sleeping the sleep 
 of the just. 
 
 In that year, the general social atmosphere being as described, The 
 the first of the two great influences of the eighteenth century and other 
 began to operate. Then namely it was, that John and Charles rev^ers. 
 Wesley and George Whitefield (having one by one returned home 
 from a missionary enterprise which had taken them for a year or 
 two to Georgia) began to exercise in this country the powerfully 
 proselytising influence with which their names are identified : 
 the influence by which they and their followers rapidly converted 
 into a popular enthusiasm the distinctive religious spirit which 
 the Wesleys, with a few others, had professed at Oxford ten 
 years before, and for which they had then been known by the 
 nickname of MetJiodisfs. The Methodist revival which began in 
 1738 soon led to many other religious revivals, more or less akin 
 to itself, and before the end of the century . had exerted a great 
 awakening and reforming influence on the previously inactive 
 official Church. The widely-diffused new enthusiasm — which 
 for the present purpose needs not be distinguished into its com- 
 ponent forces, but may as regards them all be termed evan- 
 gelical, was in some respects comparable to that which five 
 centuries before had created the Friarhoods of the Papal Church; 
 but it was distinctively, even extremely, Protestant in its 
 character, and may indeed in the main be regarded as a re- 
 candescence of the old puritan piety of Stuart and Tudor 
 times. Between the elder and the younger puritanism however 
 there was this marked difference of relation, — that, whereas the 
 elder had had almost no exterior life except in ways of civil 
 conflict, and had itself generally been more or less under pro- 
 scription, " in darkness and with dangers compassed round,^^ the 
 new puritanism had the better fortune of being allowed peaceful 
 scope for its enthusiasms, and of being therefore more obviously 
 i 2 
 
132 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VIII. 
 Growth of 
 Humanity 
 in British 
 Politics. 
 
 confronted^ in foro conscienticej with those altruistic responsi- 
 bilities which its profession of Christianity implied. So the 
 Protestant congregations^ now that at last their time of peace 
 had come^ shewed themselves zealous in works of benevolence. 
 Their primary aim was to make religious converts ; but, little by 
 little, the circumstances widened the aim. Above all, the home- 
 missions which were so active could not but bring back to the 
 congregations a practical and sympathetic knowledge of the 
 hard struggles, and the often cruel sufferings, which the poorer 
 masses of mankind have to endure. Poverty began to be con- 
 sidered, as perhaps never before, by the prosperous parts of 
 society : poverty, not merely as subject to physical privations : 
 but poverty, as complicated with the caducity and helplessness of 
 ignorance ; poverty, as aggravated by the so frequent hindrances 
 and oppressions of disease; poverty, as susceptible of deepest 
 heartache when the pomps and luxuries of civilisation seem to 
 deride it. By degrees, the dynamics of pauperisation, the study 
 of the various factors which are degradatory in social life, were 
 seen to be more urgent religious problems than some which had 
 exercised schoolmen and mystics ; and vagrancy and vice and 
 crime, when the conditions of their multitudinous production 
 had grown to be better understood, were felt to be piteous 
 appeals to the strong of the world, brothers' blood crying from 
 the earth. So, from the middle of the century onward, the 
 evangelical revival carried among its chief consequences, that 
 man learnt to feel new solicitudes for man ; and under the new 
 influence, new associations were extensively organised for dealing 
 with the various sorts of social evil. Side by side with the 
 ordinary efforts of doctrinal missionary enterprise, activity (such 
 as had been comparatively suspended in England during our 
 two centuries of ecclesiastic and civil unsettlement) was devoted 
 to establishing new hospitals and dispensaries for the sick, and 
 new refuges for various classes of destitute and afilicted persons ; 
 important special societies were founded for the purpose of re- 
 claiming and reforming the vicious and criminal; and not 
 least, various local efforts began to be made to provide elementary 
 education for the children of the poor. * 
 
 * Robert Eaikes of Gloucester began bis Sunday Scbools in 1781, and the 
 Lancaster-and-Bell Schools began before the end of the century. 
 
NEW MOMENTA. 133 
 
 Concerned here only with the philanthropical results of the ^hap. viii. 
 movement, and with them only for the hundred years from when Humanity 
 they began, we need not discuss the general effect which the Politics!^ 
 movement produced on the habits and moral tone of the country ; 
 nor new bearings which the movement has within the last half- 
 century assumed ; nor the worthy emulation with which, chiefly 
 within that time, labours, analogous to those of the ^ evangelical ^ 
 school, have been instituted in other schools of the Church : but, 
 waiving mention of the later times, and emphasising in the 
 earlier only the characteristic which most concerns this narrative, 
 we have, as the essential fact, that, throughout the centenniun. 
 1738-1838, the tide of religious philanthropy was ever on th(' 
 rise, ever gaining more and more social influence. Preachers, 
 often not in accord on matters of doctrine and discipline, and 
 often spending themselves overmuch on minor points of sectarian 
 difference, were yet unanimous in dwelling on the sentiment of 
 human brotherhood, and in claiming practical effect from that 
 sentiment. In proportion as there resulted practical endeavours 
 to give help to classes which needed it, miscellaneous thousands 
 from the surrounding world came to co-operate in the good work ; 
 thousands, who often were in no particular sympathy with the 
 doctrinal specialties of the new school, or might even be such as 
 the school would deem pagans, but who, caring less for doctrinal 
 differences than for practical outcome, were glad to join in 
 enterprises of kindness to their fellow-men ; and, as years moved 
 on, co-operations of that Sort, in favour of practical humanity, 
 came to be powerful in the councils of the nation. 
 
 In the political, as in the religious humanitarianism of the New 
 eighteenth century, there was a rekindling of old embers. The influenceB. 
 immortal reasonings of Milton and Locke, and that voice of 
 popular statecraft which had made itself heard in the Grand 
 Remonstrance of 1642 and the Revolution of 1688-9, had been 
 of effect beyond these islands ; and during the latter half of the 
 eighteenth century, re-verberation of those great English utter- 
 ances, coming back emphatically from other shores, gave to the 
 English memory of them a new f ruitfulness. Especially the two 
 great revolts of the last quarter of the century — first, in 1776, 
 the Declaration of Independence of the British North American 
 
134 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VIII. 
 Growth of 
 Humanity 
 in British 
 Politics. 
 
 Greatly in- 
 creased pop- 
 ular discus- 
 sion of prin- 
 ciples of go- 
 vernment. 
 
 Colonies^ and secondly, in 1789-90, the momentous beginnings 
 of the French Revolution, were o£ immense educational influence 
 in this country ; and the date of the former of those events may 
 be used to define the time from which the particular new lines 
 of political thought began to be noticeable in this country. 
 
 The year 1776, the year of the American Declaration of 
 Independence, will probably never be remembered in this country 
 without a touch of pain — the kind of pain with which any 
 reasonable old man would remember to have been wrong-headed 
 and ill-tempered with the brother of his youth ; but, except in 
 that sense, the year may well be remembered without regret. To 
 have been worsted in the civil conflict which began in that year 
 was the proper punishment of the ill-advised obstinacy which 
 would have it so : the well-deserved success of the revolt, though 
 temporarily mortifying to England, was a world-wide consecration 
 of English principles of liberty : and while, to the United States, 
 it was the beginning of boundless national expansion, to England 
 it was almost equally initiative as a lesson in practical politics. 
 Even were it only in that and some other allied senses, England 
 would have to regard the year 1776 as one of demarcation 
 between her old political times and her new ; but in fact there 
 are other associations which strengthen the significance of the 
 date. From 1776, namely, dates the beginning of the influence 
 of two British writers, who have conduced, perhaps more than 
 any two of any country or of any time, to the interests of peace- 
 ful political progress : for, in 1776, modern political economy 
 began with the publication of Adam Smith's Wealth of Nations ; 
 and in 1776, a so-called Fragment on Government^ published at 
 first without the author's name, opened the series of monumental, 
 works by which Jeremy Bentham pioneered for his countrymen 
 in the whole philosophy of constitutional and administrative 
 reform. 
 
 The impulses which in 1776 and 1789 were given to the 
 political education of this country by the great revolutionary 
 movements of those years, and which after the later date became 
 immensely powerful, arose of course from the discussion of the 
 events : not in virtue of the mere emotions of sympathy or 
 antipathy which were felt for or against one side or the other by 
 persons more or less prejudiced in opinion : but in virtue of the 
 
NEW MOMENTA. 135 
 
 facts and arguments with which those emotions were defended, Chap.viii. 
 and of the unprecedented degree in which the abstract principles Humanifp^ 
 of good government, the reciprocal rights and duties of governors Politics, 
 and governed, the conditions of political stability, and indeed the 
 whole theory and practice of social organisation, were brought 
 into daily popular discussion, and were examined from the most 
 different standpoints. This, too, was not an affair of mere 
 speculative talk, as revolving some text of the Utopia or the 
 New Atlantis in tranquil academic atmospheres ; but the argu- 
 ments, passionately set forth by way of comment on passing 
 events, were debated in popular assemblies and popular tracts as 
 of urgent practical interest; and those discussions of the '^ rights 
 of man,'''' however much of drawn battle they may have shown 
 as between parties resolved to differ, and however small may have 
 been at first their influence on the statutes of the realm, gave to 
 vast numbers of persons an introduction to the rudiments of 
 political thought, and greatly contributed to predestine for 
 British politics the new spirit of the century which was next to 
 come. For, out of the popular formulations of opinion to which 
 they led, there soon came these two important consequences : 
 first, that complaints, sometimes very loud complaints, began to 
 be heard, of particular grievances which parts of the population 
 were suffering; and secondly, that strong signs of sympathy 
 with the aggrieved classes began to be shown by persons who 
 themselves were not sufferers. 
 
 In the latter respect, the sober outcome of the discussions Altruism la 
 accorded very largely with that which the evangelical movement 
 had been yielding ; the one, like the other, was having a marked 
 altruistic operation : and whether this New Humanity ex- 
 pressed particular theological beliefs, or explained itself on 
 grounds of political utility, equally it helped men to better 
 notions of legislation and government than they had yet had. 
 The elementary principles on which society has to rest and ad- 
 vance, the implied contract of mutual helpfulness, the supreme 
 sanctity of equal justice, the essential coherence of social duties 
 with social rights, — these, and the like, were found as enforce- 
 able from the religious as from the political point of view, and 
 could not but gain through being enforced from both. No 
 wonder that, under the joint influence, England advanced 
 
136 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Demands 
 for new le- 
 gislation. 
 
 immensely in its understanding of social questions, and that un- 
 aggrieved persons of humane mind were largely impelled ta 
 range themselves on the side of aggrieved classes, and to sup- 
 port their demand for legislative reforms. 
 
 Among the many grievances which at that time affected 
 large numbers of persons, those which concerned the distribution 
 of political power for the respective purposes of national and local 
 government, were by general consent placed in the first rank of 
 importance : changes being demanded, which should give to the 
 House of Commons, and to the Municipal Corporations, an elec- 
 toral basis far wider, and a character far more equally represen- 
 tative of the population at large, than they had hitherto had ; 
 and should dissociate the question of a man^s right to take 
 part in the government of the country from the question of his 
 ecclesiastical relations. Another main demand of the time, parti- 
 cularly among the better informed classes, was in respect of Law 
 Reform : there being serious grievance in the survival of statutes 
 which had been enacted in comparatively barbarous periods : such 
 as the Labor and Apprenticeship Acts, which, having begun in 
 Plantagenet and been re-inforced in Tudor times, were still 
 standing as a stupid obstruction to freedom of industry; or 
 such again as the laws relating to criminals and persons suspected 
 of crime, and especially those savage parts of the law which 
 regulated the punishment of offenders : while another serious 
 grievance consisted in the mal-administration of common civil 
 justice, and in the terrible delays and difficulties which at the 
 time made justice in certain cases unattainable except to wealthy 
 persons.* To remove grievances such as those was almost as 
 plainly an act of humanity in politics, as the giving of charitable 
 
 * A sketch of the various grievances as they existed at the beginning of the 
 century is retrospectively given hy Sydney Smith in the collected edition of his 
 works — he having been among the leading "reformers" of the time: — "The 
 Catholics were not emancipated — the Corporation and Test Acts were unre- 
 pealed— the Game Laws were horribly oppressive— Steel Traps and Spring Guns 
 were set all over the country — Prisoners tried for their Lives could have no 
 Counsel — Lord Eldon and the Court of Chancery pressed heavily upon mankind 
 — Libel was punished by the most cruel and vindictive imprisonments — the 
 principles of Political Economy were little understood — the Law of Debt and of 
 Conspiracy were upon the worst possible footing — the enormous wickedness of 
 the Slave Trade was tolerated — a thousand evils were in existence, which the 
 talents of good and able men have since lessened and removed." 
 
NEW MOMENTA. 137 
 
 succour to the impotent poor is an act of common human kindli- 
 ness ; and its significance in that respect is only expressed in 
 another form, when it is described as an act of political utility. PoSicr 
 
 The humanitarian spirit, which sprang with so much freshness ^^w spirit 
 
 rGfl6ct6d iTi 
 
 from its above-described two great sources in the eighteenth the common 
 century, and was destined to be of ruling effect in the nine- the\lmef° 
 teenth, was represented on an immense scale in the literature 
 of the period in which it arose.* It is not only to be traced in 
 the religious and political writings which more or less pro- 
 fessedly deal with it, but is pervasive of the common literature. 
 Especially the poets of the time represented and greatly 
 extended the influence. Of the old pastoral poetry, the yawn- 
 provoking shepherds and shepherdesses slumbered off into 
 mantel-piece figures of Chelsea china : its frivolous inanities 
 gave place to sincere expressions of feeling : and when Gold- 
 smith and Cowper and Crabbe and Burns began to write as 
 they felt of human life, tens of thousands who had never 
 troubled themselves to read argumentative works of divinity or 
 politics were awakened to new sympathies with their fellow- 
 men. 
 
 The earlier struggles of the New Humanity in English public First effort* 
 life, and the first successes which they achieved, have their 
 great place in English History, and happily are matter which 
 may now be regarded as away from party contentions. In 
 relation to most of the cases, during the time when the 
 struggles were in progress, no doubt party spirit was often 
 high, and parties were bitterly against each other ; but in time 
 the contests were fought out to ends which silenced controversy ; 
 and, with regard to all the main questions, the results which 
 were then arrived at have probably for the last half-century 
 been approved by all parties, with no material difference of 
 opinion, as matter for national satisfaction and pride. In that 
 view of the case, it may be convenient to illustrate the argument 
 
 * Of this I cannot pretend to treat with any proper fulness ; and instead of 
 attempting a superficial treatment of so interesting a subject, I gladly refer to 
 the volximes in which Mr. Leslie Stephen gives his admirable account of all the 
 best thought of the eighteenth century. 
 
138 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VIIL 
 Growth of 
 Humaiiity 
 in British 
 Politics. 
 
 Prison Re- 
 form: 
 
 John 
 Howard, 
 
 of this present chapter, by describing more fully some particular 
 passages of the movement. 
 
 It was near the middle of the eighth decennium of the 
 century, when the new sentiment struck its memorable first note 
 in the House of Commons. Contemporaneously with the great 
 sanitary experiment which Captain Cook had been conducting 
 in far distant parts of the world, and for the triumphant issue 
 of which he (as before told) was about to be honored by the 
 Copley Medal of the Royal Society, a certain Bedfordshire squire 
 had been making his never-to-be-forgotten studies of the horrors 
 of Prison Life in England; and if the Royal Society^s recognition 
 of Cook^s achievement was a moment of almost romantic interest 
 in the sciential relations of Preventive Medicine, not less 
 brilliant an instantia lampadis in the moral relations of the 
 subject was the coming of John Howard before the House of 
 Commons on the 4th of March, 1774, to testify what he had 
 then lately seen in the famous Winter's Journey with which his 
 long series of labours began, and to receive the thanks of the 
 House for a kind of devotion not hitherto familiar to politicians. 
 In the Annual Register of 1774, the incident is briefly de- 
 scribed: — "The House of Commons went into a Committee of 
 Inquiry into abuses committed in gaols by detaining persons for 
 their fees, Sir Thomas Clavering, Chairman. Dr. Fothergill 
 and Surgeon Potts [Mr. Percivall Pott] were called in, and 
 asked their opinions on the gaol distemper. . . . Mr. Howard, 
 Sheriff of Bedford, was called, and gave the House an account 
 that he had seen thirty- eight out of forty-two gaols in the Lent 
 circuit, besides others as Bristol, Ely, Litchfield, &c. That those 
 he had not seen, in a few days he should set out to visit. . . . 
 He was asked his reasons for visiting the gaols, and answered 
 that he had seen and heard the distress of gaols, and had an 
 earnest desire to relieve it in his own district as well as others. 
 He was then asked if it was done at his own expense, he 
 
 answered undoubtedly The thanks of the House were 
 
 deservedly and unanimously returned to this benevolent Gentle- 
 man J who at a great expense, and the continual risque of his 
 life, has thus nobly shewn himself the friend of mankind in 
 general, and of the unfortunate in particular.^"* 
 
 The particular motive which had started Howard on that 
 
NEW MOMENTA. 139 
 
 memorable Journey of visitation to the prisons o£ England was to Chap.viii. 
 see if he could furnish the Bedfordshire Justices with any Htunanity 
 precedent for paying the gaoler of the county-prison a fixed po^J*^^^ 
 salary. Fully to appreciate the meaning of Howard's search, a 
 knowledge of the prison system of 1773 is necessary; and as the 
 same information serves also to illustrate the hitherto imperfect 
 humanity of those pre-sanitary times, I proceed to quote the 
 substance of the description which Dr. Guy gives in his 
 admirable Lecture on Howard''s Journey.^ The prisons, says Dr. 
 Guy, were private property, let out at heavy rentals by gentle- 
 men, noblemen, church dignitaries, and ecclesiastical corporations, 
 to some of the worst of mankind. They were often so di- 
 lapidated and insecure that, for that reason if for no other, men 
 and even women were manacled and fastened to the walls or 
 floor. The gaolers at their best could scarcely afford to be 
 tender-hearted. Among the prisons which Howard visited, there 
 was not one where the gaoler was paid by salary. In lieu of 
 salary he was allowed to charge certain fees ; and every prisoner, 
 whatever the way in which he became a prisoner, had to pay these 
 fees before he could be permitted to leave the prison. He might 
 be some poor debtor (for more than half the prisoners were 
 debtors) and might perhaps have been incarcerated by a design- 
 ing or vindictive creditor; he might be a man awaiting trial, 
 and innocent of the crime with which he was charged; he 
 might have been tried and acquitted, or the Grand Jury might 
 not have found a true bill against him; he might be some 
 petty offender committed for a small theft; or some pressed 
 man innocent of everything but not having a stomach to fight ; 
 or some man of violence — highwayman, burglar, or murderer ; 
 or some defrauder, a forger or receiver of stolen goods ; or 
 
 * John HowarcVs Winter^ s Journey, by. Wm. A. Guy, M.D. ; London, 1882. 
 Dr. Guy, Professor of Medical Jtirisprudence in King's College, London, and a 
 physician of high intelligence and culture, was for more than forty years always 
 distinguished by the warm public-spirited interest he took in questions of social 
 economy, as well as by the ability with which he discussed such questions ; and 
 particularly he is to be remembered as one of the ablest and most respected of 
 the men who won early hearing in this country for the lessons of preventive 
 medicine. I know no better book for popular reading in introduction to sanitary 
 politics than the twelve Public Health Lectures which Dr. Guy delivered at King's 
 College, and subsequently published: Eenshaw, 1870-4. Dr. Guy died in 
 October, 1885. 
 
140 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VIII. I perhaps he might be some raving* madman : but whatever he was^ 
 Humanity ^ be must pay the gaoler's fees^ or remain in prison. No pay^ no 
 Pomics^^^ release; and innocent men by the thousand were thus kept 
 locked up in the prisons of England^ many for years, or for life ; 
 many to die there of gaol-fever, smallpox, or other such disease; 
 I some to pass into madness or fatuity. Besides the gaoler's 
 authorised fees, there was also an entrance fee, — technically 
 known as garnish, footing or chummage : levied impartially on 
 all alike, though the debtor had more to pay than the felon : a 
 fine of some shillings (perhaps as much as eight or nine) to he 
 expended on drink for the entertainment of the other prisoners 
 and the benefit of the gaoler; which fine both parties were 
 equally eager to levy — the prisoners, because it had previously 
 been levied on themselves, and the gaoler because he either brewed 
 the beer, or at least made a profit by selling it at the tap : and so 
 the local law was ^'pay or stri'p" ; i.e., if the new comer had no- 
 money to give, his clothes were robbed from him to pay the fine. 
 Readers who are acquainted in detail with Howard's publica- 
 tions, or who in any way know what was the hellishness of 
 ordinary English prisons at the time when Howard was visiting 
 them, can interlineate with a context of their own the vote 
 of thanks which the House of Commons accorded to Howard in 
 respect of his Winter's Journey.^ Not needlessly to expatiate 
 on what was horrid and shameful in those scenes, it may here 
 be enough to recall as to part of the '^ continual risque of 
 life ■" which Howard faced, that the atmosphere of the prisons 
 which he entered was distinctively the atmosphere of typhus, — 
 that the prisons were the central seminaries and forcing-houses 
 from which the typhus-contagion of those days was ever over- 
 flowing into fleets and barracks and hospitals, and was a constant 
 terror to courts of justice and to the common population. It 
 was through storms of danger such as this that Howard, as 
 with charmed life, had calmly done what his soul gave him 
 to do. And the exemplary career which he had thus begun 
 was pursued by him with unwavering constancy till his death. 
 
 * As regards part of the case, I may refer to passages from Howard which I 
 introduced long ago into one of ray Reports to illustrate the history of Fever in 
 England. See FajJers Relating to the Sanitary State of the People of Englandy, 
 1858 ; or in the Sanitary Institute's recent reprint, vol. \. pp. 450-1. 
 
NEW MOMENTA. 141 
 
 Dr. Aikin^ in concluding his extremely interesting, and but Chap. viii. 
 too compressed, View of the Character and Puhlic Services of Humanity 
 the late John Howard, gives the following summary of what he ^ ,^T^*^^^ 
 did during the last seventeen years of his life : — " 1773 : High 
 Sheriff of Bedfordshire ; visited many county and town gaols ; 
 — 1774 : completed his survey of English gaols . . . ; 1775: 
 travelled to Scotland, Ireland, France, HolUnd, Flanders and 
 Germany ; — 1776 : repeated his visit to the above countries, and 
 to Switzerland; during these two years re-visited all the English 
 gaols; 1777 : printed his State of Prisons ; — 1778 : travelled 
 through Holland, Flanders, Germany, Italy, Switzerland, and 
 part of France ; — 1779 : re- visited all the Counties of England 
 and Wales and travelled into Scotland aud Ireland ; acted as 
 Superior of the Penitentiary Houses; — 1780 : printed his first 
 Appendix; [also, in 8vo, a second edition of Prisons /] — 1781 : 
 travelled into Denmark, Sweden_^ Russia, Poland, Germany, and 
 Holland; — 1782: again surveyed all the English prisons and 
 went into Scotland and Ireland; — 1783: visited Portugal, 
 Spain, France, Flanders and Holland : also Scotland and Ireland, 
 and viewed several English prisons; — 1784 : printed the second 
 Appendix, and a new edition of the whole works; — 1785-1787: 
 from the close of the first of these years, to the beginning of 
 the last, on his tour through Holland, France, Italy, Malta, 
 Turkey, and Germany ; afterwards, went to Scotland and Ire- 
 land; — 1788 : revisited Ireland, and during this and the former 
 year travelled over all England; — 1789: printed his work on 
 Lazarettos, &c. ; travelled through Holland, Germany, Prussia 
 and Livonia to Russia and Lesser Tartary; — 1790 : January 20 
 [aged 63] died at Cherson/' 
 
 Extremely noteworthy is the fact, which Dr. Guy takes 
 pleasure in pointing out, that, before Howard began to work for 
 mankind at large, his humanity had done its work at home ; 
 that, on his paternal estate at Cardington, *^ he first showed 
 himself as a preserver of health and reformer of morals ; " that 
 here, having enlarged the estate by purchase of an adjoining 
 farm, he " did his first work of sanitary reform, and did it, like 
 all he undertook, thoroughly ; " that '' he pulled down and re- 
 built every one of his own cottages, and such others as he could 
 purchase, and erected new ones, thus gradually transforming the 
 
142 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VIII. 
 Growth of 
 Humanity 
 in British 
 Politics. 
 
 whole village from damp squalor to bright wholesome cheerf ul- 
 nesSj from sickliness to healthiness^ from barbarous neglect to 
 civilised judicious interference and supervision/^ * 
 
 As regards the outcome of Howard's labors, the following 
 may be noted. As an immediate effect of his evidence before the 
 House of Commons in 1774, two Acts of Parliament were forth- 
 with passed : the one, to provide that gaolers should no longer 
 be paid by fees, the other to provide for the sanitary amelioration 
 of prisons. Since that time, under influence direct or indirect of 
 Howard''s printed works, and in conformity with his teaching, 
 prisons and prison-administration have been so radically im- 
 proved, and such elaborate precautions have been taken to guard 
 prisoners from sanitary and other injustice, that no vestige of 
 cruelty remains, and that the sanitary advantages of the im- 
 prisoned criminal are such as unfortunately cannot yet always 
 be secured for outsiders who toil honestly for their bread. To 
 Howard's influence may also be referred that more compassionate 
 feeling on the part of society towards its various offending mem- 
 bers, which, for instance, led the late Mrs. Fry to make herself 
 for years the religious visitor of the female convicts in Newgate, 
 and which since Howard's time has repeatedly led to re-consi- 
 deration of the criminal code of the country, and has greatly 
 mitigated its harshness, f 
 
 * At p. 24 of his Lecture, Dr. G-uy gives an interesting account of the 
 village as it now is. The cottages, he says, must always he the great point of 
 attraction at Cardington. Now, after the lapse of more than a century, they 
 seem as sound and strong as when they were first built ; and having made a 
 healthy wholesome and decent life a possibility for three generations, there is no 
 reason why they should not continue to be a blessing to many more yet to come. 
 
 t Dr. Guy, whose writings about Howard are made especially interesting by 
 their true congeniality with the spirit of Howard's life and labors, rightly 
 draws attention to. yet another of Howard's deserts : — " This Howard, who saw 
 with his own eyes, and heard with his ears, and thought for himself, as only 
 men of genius do, may be said to have invented both systematic inspection and 
 periodical reporting, so largely practised in our days ; and as happily he was 
 a man of independent means, and could afford to give his services to the public, 
 he appointed himself the first unpaid Inspector of Prisons, and at his own cost, 
 published and distributed his own Eeports." — Winter'' s Journey, p. 27. It 
 may be added that Section VII. of Howard's second publication — the book on 
 Lazarettos, &c., treats of the thirty-eight Charter Schools of Ireland ; and that 
 its observations on the particular cases are so comprehensive and exact, and its 
 general reflexions so wise, as to suggest that Howard, if his life had been pro- 
 longed, might have been as great a reformer of Schools as he was of Prisons. 
 
NEW MOMENTA. 143 
 
 Greatest perhaps of all the outcome of Howard^s work^ has Chap. viii. 
 been the extremely impressive effect of his example. It seems Hmnanity 
 to have been commonly felt by Howard^s contemporaries that his Po^g^^^ 
 seventeen years of self-imposed labour constituted one of the 
 noblest careers which the world had hitherto known. Taking as ' 
 his simple rule of duty^ that his life was to be spent for the good 
 of others, and accepting without hesitation for his field of 
 industry that particular wild waste of misery and wrong which 
 his temporary official contact with prison -administration had 
 revealed to him as in urgent need of redress, he made prison- 
 reform the object of his life, and devoted himself to that object 
 with such sublime unselfish constancy as is among the truest 
 measures of moral greatness. Already, here and there in history, 
 self-devotion like his had been shown by other men, — by men, 
 alas too few, whose memories are still the heroic leaven of our 
 race in their power of moving others to good : but, in the 
 successive ages and varying circumstances of the world, it is not 
 one single type of self-devotion which can always and everywhere 
 be the most helpful to man ; and, till Howard^s time, the virtue 
 which he so transcendently displayed had little shown itself in 
 civil life except among founders and apostles of particular eccle- 
 siastical orders, and as instrumental in propagating theological 
 beliefs. In the mere matter of benevolence, Howard as much 
 took the eighteenth century by surprise as Francis of Assisi did 
 the thirteenth ; and Dante and Giotto, had they been here, might 
 have celebrated his espousals with Pestilence as they did his pre- 
 decessor's with Poverty. But, separated from each other by five 
 centuries of time, with the immense social changes therein 
 involved, and separated even more distantly by differences of 
 nationality and temperament, those two great helpers of mankind 
 had perhaps little else in common than that they both with all 
 their hearts desired to do good to their fellow-men. Howard 
 gathered no crowds around him, nor does any sworn order of 
 followers bear his name. Yet truly, in addition to what he was 
 in personal heroism of benevolence, he also by example was the 
 founder of a new school of action : a school widely different from 
 the Franciscan. His career was one continuous teaching that, in 
 regard of complicated social evils, if good intentions are to be 
 solidly effective for good, wisdom and patient intellectual study 
 
144 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VIII. 
 Growth of 
 Humanity 
 in British 
 Politics. 
 
 must be means to the end. And, great as was the career, it 
 perhaps had no greater result than this : that it taught in a 
 supreme degree the value of methodical or scientific, as dis- 
 tinguished from merely impulsive, philanthropy. 
 
 India and 
 
 Edmund 
 
 Burke. 
 
 During the decennium in which Howard ended his work, 
 the public mind was being awakened on another great question 
 of humanity : the question of the Government of India. 
 
 In 1781, in consequence of extremely untoward communica- 
 tions received from India, — first as to certain scandalous admini- 
 strative disputes in the Bengal presidency, and secondly as to the 
 invasion of the Carnatic by Hyder Ali, — Parliament had appointed 
 two committees of inquiry : one on the motion of General Richard 
 Smith, to report on the administration of justice in Bengal, and 
 generally on the government of that presidency ; the other, on 
 the motion of the Prime Minister, to report on the causes of the 
 Carnatic war, and on the condition of the British possessions in 
 those parts ; which latter reference was afterwards enlarged to 
 include also the subject of the Mahratta war. Those two com- 
 mittees — the former having General Smith as its chairman, and 
 Mr. Burke as its most laborious member, and the latter having 
 Lord Advocate Dundas as its chairman and chief worker, pro- 
 duced reports of extraordinary importance. Of the particulars 
 which the reports brought to light with respect to recent British 
 conduct in India, the general bearing may be summed up in the 
 statement : that India was being worked as a gold-mine by the 
 agents of a London joint-stock company, and with no more sense 
 of justice or compassion towards the human beings whom the 
 commercial adventure affected than any later Californian or 
 Australian gold-digger would entertain towards the dead rock 
 under his pick-axe. The emissaries of the East India Company 
 were subject to the one over-ruling condition, that they must 
 work to pecuniary profits : that, irrespectively of what gains they 
 might be putting into their own pockets, they must find means 
 for paying dividends to the proprietary body which employed 
 them, and for extending its possessions in the East. In that 
 commercial spirit, an almost absolute government was being 
 exercised in India : wars were being waged and suspended, 
 treaties of alliance made and unmade, transfers of territory and 
 
NEW MOMENTA. 145 
 
 revenue negotiated^ privileges given and taken away ; and, so far Chap, vill 
 as might at any moment seem conducive to the financial aim, Hmnani^y 
 rulers and populations were crushed or defrauded, hereditary po^tics^^ 
 rights were confiscated, vast extortions were practised, pledged 
 faith was broken, provinces were invaded and desolated, and un- 
 offending human life in vast quantity was given over to outrage 
 and extinction. 
 
 Facts of that sort, brought abundantly before Parliament 
 during the years 1781-3, in the many successive reports of the 
 two committees, were the ground on which Mr. Fox, in the 
 autumn of 1783, proposed his memorable East India Bill, and on 
 which afterwards the House of Commons decreed its momentous 
 impeachment of Warren Hastings. Mr. Fox's Bill, substantially 
 an endeavour against leaving high imperial responsibilities to be 
 dealt with as incidents of commercial adventure, anticipated by 
 three-fourths of a century the spirit of the India Act of 1858; 
 but, as the Bill gave rise to one of the fiercest conflicts in the his- 
 tory of political parties, and soon had a sort of St. Bartholomew's 
 day of its own,"^ there is need to observe that the scandals of 
 misgovernment which led to its introduction were facts which 
 had been equally recognised by both parties in the House ; that, 
 though, in November 1783, Mr. Dundas was sitting beside Mr. 
 Pitt on the opposite bench to that of the promoters of the Bill, 
 the promoters were able to appeal to him and his Committee as 
 chief witnesses to the scandals alleged; and that Mr. Pitt,t 
 
 * Fusilade from a royal balcony could hardly have had more political effect 
 against the promoters of the Bill, nor apparently could have taken them more 
 by surprise, than the royal instruction, promulgated by Lord Temple, that they 
 were to be regarded as " Enemies of the King ; " and the crisis which the Bill 
 provoked came to be of great and far-reaching effect- in the relations of English 
 political parties. It befeU, namely, that, on December 17, 1783, under influence 
 of the celebrated royal card, the Lords refused a second reading to Mr. Fox's BUI, 
 which had recently passed the House of Commons ; that his Majesty then dis- 
 missed the Ministers, and called Mr. Pitt to the Premiership ; that, three months 
 later, at general election, the constituencies sided overwhelmingly with the new 
 ministry; and that, for many a long year afterwards, " Fox's Martyrs," as they 
 were called, had but little weight in the government of the country. 
 
 t Even since the accession of the present IMinisters, Mr. Dundas had intro- 
 duced an India Bill of his own. See Parliamentary History, April 14, 1783. A 
 year earlier, on behalf of the Committee, he had led the House of Commons to 
 commence penal proceedings against the late Governor of the Madras Presidency, 
 as guilty of high crimes and misdemeanours ; and to declare it the duty of the 
 
M6 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VIII. 
 
 Growth of 
 Humanity 
 in British 
 Politics. 
 
 whose subsequent accession to power was to be through the 
 King^s defeat of the then Bill, had not hitherto (though for 
 nearly three years a member of the House) ever spoken on Indian 
 affairs. In 1784, after the general election which had more than 
 reversed the relative strength of parties in the House of Commons, 
 Mr. Pitt, carrying a bill of his own for the better government 
 of India, established the compromise which continued till 1858; 
 namely, that the East India Company, in respect of military and 
 political affairs, should be subject to the direction of a Board 
 of Control, forming part of the general ministry of this Kingdom, 
 During the years 1786-7, Mr. Hastings having in the meantime 
 retired from his Governorship of India, and returned to England, 
 formal accusations against him were brought before th6 House 
 of Commons ; and the House, after debating the accusations in 
 series, generally with much heat, and often at considerable 
 length, eventually resolved, in respect of certain of them, that 
 Mr. Hastings should be impeached before the House of Lords by 
 managers whom the Commons would appoint for the purpose. 
 In those actual resolutions for impeachment, the leaders of both 
 parties concurred ; indeed, except with Mr. Pitt's concurrence, 
 the promoters of the impeachment could not have scored any 
 noteworthy approximation to a vote for their object ; and it is 
 therefore clear that the legal proceedings, which ensued on the 
 resolutions of the House of Commons, are not to be regarded as 
 of party action."^ 
 
 For the intention with which the above references are made, 
 it is not necessary to compare the respective merits of the India- 
 
 East India Company to recall the Governor of Bombay and the Governor 
 General of Bengal, on the ground that these functionaries had in " sundry in- 
 stances acted in a manner repugnant to the honor and policy of this nation, and 
 thereby brought great calamities on India, and enormous expenses on the East 
 India Company." Parliamentary History, April and May, 1782. 
 
 * The concurrence to which the text refers moist not be understood as of 
 deeper reach than it had really had. Underneath the ceremonious accord, were 
 the inextinguishable memories of the India Bill cyclone of 1783-4. Ostensibly,, 
 the impeachment was the act of both parties ; but one of the two, the one which 
 was i mm ensely superior in strength, had accepted it only as of hateful necessity. 
 In dominant parliamentary opinion, the promoters of the impeachment were but 
 the rari nantes of a wrecked party, discomfited " enemies of the King ; " and the 
 fact that King and Court were still scowling at them could not but be of effect 
 on the issue of the impeachment so far as this might have to depend on party- 
 voting. 
 
NEW MOMENTA. 147 
 
 bills of 1783-4, nor the different opinions which have been Chap.viii. 
 expressed, from various points of view, on the subject of the Humanity 
 great impeachment of 1788. The proceedings are not here PoUticsf^ 
 brought under notice for their own sake in detail, nor even 
 with regard to their immediate issues, but only in so far as they 
 constituted the occasion for a new and searching exercise of 
 national thought in matter of common right and wrong. Their 
 interest to us is, not that they raised questions of legal kind as 
 between England and the grand privateering company to which 
 it had given its letters of marque, but that they raised questions 
 as between England and mankind : for, in connexion with them, 
 the moral responsibilities of empire in relation to subject races 
 came to be considered in this country more critically than per- 
 haps ever in any country before. 
 
 It was of signal advantage to the progress of political humanity, 
 that, during the whole important period of those proceedings, 
 the best powers of Edmund Burke, powers perhaps never sur- 
 passed in the British Parliament, were used on behalf of India, 
 in protest against the tyrannies which had been inflicted, and in 
 appeals for the just government which was due. To many of 
 Burke''s contemporaries, it was paradox or worse, that he should 
 be as capable of anger for " trampled Hindustan "" as if it had 
 been the case of his own Bristol or Malton constituents : but his 
 earnest devotion to the cause remains nevertheless a fact in 
 English history ; and the broadly humane spirit, in which Burke 
 so passionately and so persistently pleaded for justice to the 
 dependent races, made its mark in the civilisation of the world. 
 
 In order to illustrate how new a tone he brought into these 
 discussions of Indian affairs, no further going back on parliamen- 
 tary records is necessary, than to those of 1772-3; when the 
 affairs of the East India Company had last been receiving a large 
 share of attention in Parliament, and the conduct of Lord Clive 
 had been impugned, and when finally Lord North^s Regulating 
 Act was passed. The questions which at that time had above 
 all absorbed attention and drawn forth rhetoric, were in substance 
 questions as ot the partition of spoil : questions, as to how much 
 of it was due to the State, and how much to the proprietors of 
 East India Stock, how much of it the great captain might retain, 
 how much the civil and military retainers might loot, and the 
 K 2 
 
148 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VIII. 
 Growth of 
 Humanity 
 in British 
 Politics. 
 
 like."^ Those discussions had been of cruelly little interest to the 
 despoiled : they apparently were not of higher moral significance 
 than such as Gil Bias might have heard quarrelled over in his 
 robbers^ cave : and truly it is like emerging from some such den 
 into the honest holy light of day, to turn from the earlier to the 
 later series of discussions, and to see how Burke, from 1781 
 onward, illumined the whole field of debate, t 
 
 From the very beginning of these proceedings, he stands 
 forward as the initiator of a policy : " Reform your principle, 
 since it is founded in vice, and productive of calamity. Establish 
 a generous principle in its room, of fair and full and public 
 justice. Show them that you are determined to become the 
 protectors, not the oppressors of the country, that you wish to 
 hold your authority on the solid rock of their happiness. Consider 
 that there are 30 millions of souls involved in this affair ''''... 
 " teach the people that live under you, that it is their interest 
 to be your subjects."'^ That was how he already spoke in 1781 ; 
 see Parliamentary History ^ April 30th ; and the same tone 
 
 * It would not be strictly true to say that, in the debates of 1772-3, no 
 reference whatsoever was made to the state of the Indian populations : for 
 Colonel Burgoyne and Sir W. Meredith, in moving for the select committee on 
 Indian affairs, had mentioned the distresses of fifteen millions of people, and 
 Colonel Burgoyne had expressed shame "that the native of Hindustan, an 
 immemorial slave, should first have learnt from British rulers how intolerable 
 the life of a slave might be made " : but those references were scarcely more 
 than parenthetical in relation to the real matters of conflict. 
 
 t Even as regards Burke himself, there is, at least apparently, a marked 
 contrast between the Burke who in 1772 argued against General Burgoyne's 
 committee, and in 1773 against Lord Noith's Regulating Bill, and the Burke 
 who in 1783 argued for (and possibly may have planned) the India Bill then 
 before Parliament. In the year 1772-3, when he habitually spoke on the side of 
 the East India Company, he no doubt was acting in concert with the heads of 
 the Bockingham-whig party, who in the House of Lords opposed, and finally 
 protested against, the passing of Lord North's Bill. Whether the Rockingham 
 resistance to Lord North's Indian policy was rooted in any deeper conviction 
 than that the " duty of an opposition is to oppose," needs not here be guessed ; 
 but it is certain that Burke, when he took prominent part in that resistance, 
 argued from an infinitely lower level than he afterwards attained. The inde- 
 pendent and fruitful growth of his mind dated manifestly from 1781, when he 
 became a member of General Smith's Select Committee. On a subsequent 
 occasion, he incidentally mentioned that he had entered on that committee with 
 a strong bias in favour of Hastings, and was sometimes upbraided for it by 
 others ; but that ' the huge volumes of evidence which came under his inspection 
 effected a complete revolution in all his ideas.' Sistory of Parliament, July 30, 
 1784. 
 
NEW MOMENTA. 149 
 
 resounds in all his subsequent utterances. Very memorably it is Chap.viii. 
 to be beard throughout his great speech of Dec. 1, 1783, for Humanity 
 going into Committee on the India Bill ; ^ as especially in the PoUtics^^ 
 parts where he discusses the ^^ chartered rights "" of the East India 
 Company. He tells his hearers that no charter of power and 
 monopoly, tending to suspend any ^^ natural rights " of mankind 
 at large, can be valid except as a conditional grant : that every 
 such grant is, in the strictest sense, a trust: that it is of the 
 very essence of a trust to be rendered accountable, and even 
 totally to cease when it substantially varies from the purposes 
 for which it alone could have a lawful existence : and, for testing 
 whether the East India Company had substantially . broken its 
 trust, he states, as his standard, this fundamental principle ; — ^^that 
 all political power which is set over men, and that all privilege 
 claimed or exercised in exclusion of them, being wholly artificial, 
 and for so much a derogation from the natural equality of man- 
 kind at large, ought to be, some way or other, exercised ultimately 
 for their benefit.'''' The principles which Burke so advanced had, 
 from old time, been familiar to political philosophers in their 
 studies ; and thoughts of like meaning may perhaps have been 
 uttered before in Parliament on occasions when they would be 
 little heeded ; but now, when Burke, assuming those principles 
 to be universal, invoked them as his criterion of the duty owing 
 from Britain to India, a notable moment had come in British 
 politics, an eventful moment for many millions of the human 
 race.f 
 
 * In this speech, of Burke's, and in his subsequent speech on the subject of 
 the Nabob of Arcot's debts, the chief acts of British administration in India, from, 
 the time of Warren Hastings's succession to power, were elaborately examined ; the 
 many huge wrongs of oppression and perfidy which had been practised for gain 
 were exposed and stigmatised; and above aU, the cruel sufferings which had 
 been brought on masses of population by the Rohilcund and Carnatic wars were 
 represented in such terms of pathos, and with such burning indignation against 
 the authors of the misery, that, even as mere eloquence, the speeches are of 
 classical interest. 
 
 f Later in the same debate. Fox uttered his vehement assertion of tho same 
 principles : " "What is the end of all government ? certainly the happiness of the 
 governed. Others may hold their opinions, but this is mine, and I proclaim it. 
 What are we to think of a government whose good fortune is supposed to spring 
 from the calamities of its subjects, whose aggrandisement grows out of the 
 miseries of mankind ? This is the kind of government exercised by the East 
 India Company on the natives of Indostan, and the subversion of that infamou 
 government is the main object of the Bill in question." 
 
150 ENGLISH SANITAEY INSTITUTIONS. 
 
 G^^h^?' When Burke, in the last year of his life, was rendering- 
 Humanity account of all he had done or tried to do in the public service, he 
 Politics. named his endeavours for India as the labours on which he 
 valued himself the most ; * and it would probably have seemed 
 to him that the climax of those long persistent endeavours was 
 reached, and, in a certain sense, their best success achieved, 
 when the House of Commons had been led by him to decree the 
 impeachment of Warren Hastings, and when he stood as chief 
 spokesman for the House on that great historical occasion. On 
 February 13, 1788, the late holder of almost vice-regal office 
 was on trial before the supreme judicial court of Great Britain 
 in respect of abuses charged against him; not that he had 
 taken British life or property, or had broken law as commonly 
 applied within the four seas of our home-dominion; but that, 
 half way across the globe of the earth, he had been an oppressor 
 of other people than our own. To us, who from a hundred years 
 afterwards, look back to the conditions under which that State- 
 trial was held, it must appear the merest matter of course that 
 the legal procedure failed. The merely technical difficulties in 
 its way seem to have been little short of insuperable ; difficulties 
 equally great lay in the political relations of the case ; and so 
 far as the verdict would be decided by party- voting, of course 
 the managers of the impeachment could never have had the 
 shadow of a chance, f It can hardly be imagined that, even in 
 1788, the warmest approvers of the impeachment expected to 
 attain a formal success ; and the verdict of acquittal, which 
 Hastings, after more than seven years obtained, was such as 
 might have been predicted from the first, t On the other 
 
 * Letter to a noble Lord, 1796. 
 
 t See previous footnote, page 146. 
 
 J In contrast to the highly spectacular opening of the great trial in 1788, 
 was the almost unnoticed falling of the curtain on the 23rd of April, 1795. Of 
 some four hundred existing peers, twenty-nine took part in the final votes, and 
 they voted, at least five to one, for the articles of acquittal. This exoneration, 
 as regards its substance, may be compared with the vote which the House of Com- 
 mons, twenty-two years before, had passed on the subject of the charges against 
 Lord Clive. On that occasion, in order to practically exonerate Clive, the voters, 
 while recording that he had acted illegally, declared that he had at the same time 
 rendered great and meritorious services to his country; but in 1795, the Peers 
 in judgment could not by any such vote evade the simple Yes or iVo of the 
 criminal charge, and, as between those enforced alternatives, the Yes was politi- 
 cally impossible. Hastings, whatever wrongs he had done, had on the whole 
 
NEW MOMENTA. 151 
 
 hand, from the standpoint of these later times, it is easy enough Chap. vm. 
 to see that, not the verdict, not the question whether the pro- Hmnani^ 
 ceedings should bear penal fruit, but the fact of the impeach- poHtics.^ 
 ment in itself, was the matter which concerned the world, and 
 that the moral significance of the impeachment was immense. 
 It was proclamation to the world that the impeaching authority, 
 the Commons of Great Britain, regarded as highly criminal, and 
 as reflecting dishonour on this country, the sorts of action which 
 the articles of impeachment described; it was virtual pledge 
 that the impeaching authority would thenceforth guard the 
 people of India against any repetition of such wrongs ; and to 
 the administrators of the India Act of 1784, it was emphatic 
 warning as to the standards of right and wrong by which the 
 House of Commons would judge all future government of 
 India. So far as the councils of a nation may be expected 
 to show continuity of moral purpose, the impeachment of 
 Hastings promised future submission to the principles which 
 Burke had held aloft in 1781, as those on which India should be 
 governed ; and Indian records of the last hundred years contain 
 evidence enough, that Britain, throughout this new era, has faith- 
 fully endeavoured to act in the spirit of that implied promise. 
 
 At about the same time with the increased discussions of Negro- 
 
 slavery: ' 
 
 Indian affairs, a third great question of humanity began to flhe Quakers 
 attract public attention in England : the question which is force, 
 identified above all with the names of Granville Shaep and 
 Thomas Clarkson and William Wilberforce : the question, 
 whether the British nation should continue to be a slave-trading 
 and slave- owning power. ^ 
 
 greatly enlarged and strengthened the British dominion in India ; and the State 
 which meant to accept his acquisitions could hardly condemn him in respect of 
 them. 
 
 * Particulars as to the rise and progress of the slavery- discussion in England 
 are above all to be found in Clarkson's History of the Abolition of the Slave Trade, 
 and in the Life of Wilberforce, by his Sons. Also in the late Sir James Stephen's 
 Essays in Ecclesiastical Biography, the two articles William Wilberforce and 
 The Clapham Sect contain much information with regard to the chief early 
 abolitionists : specially interesting from the fact that the writer's father, Mr. 
 James Stephen, was connected by marriage with Mr. Wilberforce, and was 
 himself an eminent member of the abolitionist group. My text is entirely 
 founded on those authorities. 
 
152 ENGLISH SANITARY INSTITUTIONS. 
 
 The three philanthropists, just-named, were not the first 
 Englishmen to regard with horror and shame that their country 
 was still tolerant of that old savageness. If none else in the 
 land, at least the Society of Friends, with their steadfast simple 
 morals, and their dignified patience under tyrannies which 
 pressed on themselves, had never refrained from protesting 
 against that great wrong to the brotherhood of mankind : 
 William Penn in 1688 had denounced it as cruel and un- 
 christian j his successors in the Society had uniformly taken the 
 same tone; and in 1760, the Society, going beyond its previous 
 ^' severe censures,'''' resolved that thenceforth it would disown as 
 members all who in any way participated in the slave-trade. 
 But the Quakers were not a proselytising sect, nor were in any 
 way powerful in the State, and their resolutions against slavery 
 had been of no more effect in England than their harmless 
 peculiarities of costume. 
 
 In 1769, Granville Sharp published, in first edition, his 
 'Representation of the Injustice and Dangerous Tendency of 
 Tolerating Slavery in England, with remarks on the opinions 
 given in 1729 by the then Attorney- and Solicitor-General : 
 and in 1772, using with extraordinary vigour an opportunity 
 which had arisen for giving effect in a particular case to the 
 principles advocated in his pamphlet, he succeeded in eliciting 
 from the judges of England the memorable (unanimous) appeal- 
 decision, for which his name is so gratefully remembered : that the 
 slave who had reached English soil was no longer any man^s chattel. 
 
 In 1784, the fact of the participation of England in the 
 slave-trade seems to have been brought into increased notice, as 
 a question of public conscience, by a book published at that time 
 by the Rev. James Ramsay. Originally surgeon of a man-of- 
 war, under Sir Charles Middleton, who afterwards was created 
 Baron Barham, Mr. Ramsay, leaving the navy, and entering 
 the profession of the Church, had for nineteen years been 
 resident at St. Kittys : after which, having returned to England, 
 and become Vicar of Teston in Kent, he now, by the publication 
 above mentioned made known his West Indian observations of 
 the sufferings of the slaves."^ Mr. Ramsay's book is authorita- 
 
 * Essay on the Treatment and Conversion of the African Slaves in the British 
 Sugar Colonies : as quoted in Clarkson's History. According to Clarkson, Mr. 
 
NEW MOMENTA. 153 
 
 tively said to have ^^ commenced that public controversy which ^^^- '^^^ 
 was closed only by the abolition of the trade ; '^ and not least Humanity 
 among its effects may certainly be counted its important influ- PoUtics! 
 ence on the minds of those who are next to be mentioned. 
 
 In 1785, St. John^s College, Cambridge, had, for the subject- 
 matter of its annual prize-competition in Latin essay-writing, 
 the question, — Anne lice at invitos in servitutem dare ; and the 
 prize (like that of the year before on a different question) was 
 won by Thomas Clarkson, then an undergraduate in course of 
 study for the Church. The answer which Clarkson gave to the 
 proposed question — an answer which is said to have been received 
 with much applause when read in the Senate House in 1786, 
 was an elaborate vehement negative ; and the researches which 
 Clarkson had* made for the purpose of the essay had so filled 
 his mind with a sense of the moral relations of the question, 
 that now, with academical honors, he forthwith set aside his 
 previous plan of life : determining not to take ecclesiastical 
 service, but to accept as his best ' holy orders •' that his life 
 should thenceforward be given to work against slavery. 
 Clarkson^s essay, which he immediately published in English 
 translation, brought him at once into fellowship with Granville 
 Sharp and a few others (mostly Quakers) who had the same 
 cause at heart; and in 1787 this little group of persons con- 
 stituted themselves, with Granville Sharp as their Chairman, 
 and Clarkson as their Secretary, an Association for the Abolition 
 of Negro Slavery. 
 
 One of the first steps of the associated *" abolitionists ' was to 
 come into concert with Mr. Wilberforce ; and he, from now 
 onward, became their political leader."^ Before the end of 1787, 
 
 Ramsay published also in 1784 an Inquiry into the Effects of the Abolition of the 
 Slave Trade, and during the five next years (chiefly in answer to attacks made on 
 him) various other writings. In the Life of Wilberforce it is said that " through 
 the years 1784 and 1785 Mr. Eamsay fought alone in this holy cause, nor did he 
 quit the strife until he sank under its virulence in the summer of 1789." 
 
 * He was now twenty-eight years old, and had been seven years in Parliament. 
 When only a school-boy of fourteen, he had written to his county newspaper in 
 protest against " the odious traffic in human flesh " : from 1780, when his parlia- 
 mentary Hf e began, he had been strongly interested for the West Indian slaves ; 
 and this interest was increased in 1783 by communication with Mr. Ramsay, 
 whom Sir C. and Lady Middleton made known to him : before 1786, his interest 
 in the question had led him, he says, " to Africa and the abolition " : throughout 
 
154 ENGLISH SANITARY INSTITUTIONS. 
 
 G?wth^"^^* ^^ ^^^ noted in his journal that the suppression of the slave- 
 Humanity trade,, and the reformation of manners were the two great 
 Politics. objects to which he felt himself religiously bound ; and now 
 it waSj that^ after certain talk with Mr. Pitt ' at the root of 
 an old tree at Holwood '' — a talk so eventful that the sylvan 
 scene where it was held has become historical,^ he resolved to 
 give notice on a fit occasion in the House of Commons of his 
 intention to bring forward the subject of the slave-trade. On 
 the 9th of May, 1788, not Wilberforce in person (for he was 
 then in dangerous illness) but Mr. Pitt, who according to a 
 promise previously given acted for him in the matter^ carried a 
 resolution that the House would consider the slave-trade early 
 in the following session : and, for the meantime, in view of 
 certain shameful facts which had been brought forward by 
 Sir W. Dolben as to a slave-ship then in the Thames, a short 
 Act was passed, which it was hoped might somewhat mitigate 
 the cruelties of the traffic. In 1789 (May 12th) Mr. Wilberforce 
 brought forward, in twelve resolutions, the case for the abolition 
 of the Slave-Trade : the three foremost members of the House, 
 Pitt and Fox and Burke, supported him to their utmost : but 
 ^^ on May 21, after a debate of unusual warmth, the planters 
 succeeded in deferring the decision of the House until counsel 
 had been heard and evidence tendered at the bar."*^ 
 
 Now began to be better perceived than before, that a very 
 arduous struggle had been undertaken : a struggle, no doubt, 
 for right as against wrong ; but, at the same time, a struggle 
 for the unseen as against the seen, — a struggle for justice to 
 strangers and aliens as against familiar citizens of our own who 
 were amassing wealth by the iniquity, — a struggle for the 
 human rights of creatures whom many were half -declaring to 
 be not human. On the defending side, was an extremely in- 
 fluential mercantile class, with very large pecuniary interests at 
 stake : on the assailing side, chiefly '' a few obscure quakers " 
 with other like '^ fanatics "''' : but now the ^^ fanatics '''' saw that, 
 
 1786, he was busily pursuing his inquiries among the African Merchants, who at 
 that time were not unwilling to inform him, — " the trade not having yet become 
 the subject of alarming discussion " : and in 1787, he began to argue the matter 
 with his political friends. 
 
 * Some twenty or more years ago, the fifth Earl Stanhope placed at the spot 
 0- stone seat with an explanatory inscription. 
 
NEW MOMENTA. 155 
 
 in order to make their struggle successful, they must appeal to Chap. viii. 
 the humanity of the nation at large, and this appeal they pro- Humanity 
 ceeded to press with every possible vigor. Most disastrously Poii^^ 
 for all hopes of rapid success, most unhappily for the thousands 
 of human lives which in each single year that passed were 
 being added to the spoils of the infernal traffic, the dilatory 
 tactics by which the slave-traders had successfully opposed 
 Mr. Wilberforce in the House of Commons in the month of 
 May, were soon afterwards rendered immensely more powerful 
 by the outbreak of the French Revolution, and through the 
 political anxieties which, in sequel of that outbreak, began, and 
 for many years continued, to fall heavily on this country. For 
 nineteen years the tactics of the slave-traders, favored by political 
 circumstances, were able to delay the extinction of the trade. 
 In proportion as excesses were committed in the name of the 
 French Revolution, and were held up to British odium, en- 
 deavours were made to bring within range of that odium, the 
 principles of men who would abolish negro-slavery ; and in the 
 days when the governing classes regarded Thomas Paine's 
 Biff /its of Man much as a red-rag might be regarded on the hills 
 of Bashan, silly members of Parliament were led to believe that, 
 in order ^' not to encourage Paine's disciples,'''' they must con- 
 tinue to sanction by their votes the kidnapping and sale of 
 negroes. ^' This impression, we are told, biassed most strongly 
 the mind of the king, and created henceforth an insuperable 
 obstacle to the exercise of any ministerial influence in behalf of 
 Abolition.''^ It is painful to remember that even William 
 Pitt, with all his high qualities, and with hatred of the slave- 
 trade perhaps as great as that which his friend Wilberforce had, 
 could yet not dominate those stupid fears of others ; and that in 
 this, as in too many other aims of earlier ambition, his genius 
 was frustrated of glories it should have gained. The short-lived 
 Grenville Administration, inspired by the warmer generosity of 
 Fox, faced without fear the difficulties at which Pitt had quailed. 
 On June 10th, 1806, Mr. Fox carried by a majority of 114 to 15 
 in the House of Commons (and it was the last motion on which 
 he ever spoke there) a resolution condemning the slave-trade, and 
 pledging- the House to proceed with all practicable expedition 
 
 * Life, p. 103. 
 
156 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. yiii. to abolish it : and soon afterwards, on Lord Grenville^s motion, 
 Hiunanity the Lords concurred in that resolution.^ In 1807, in pursuance of 
 Politics.^ those votes, an Abolition Bill was introduced and carried. Though 
 to the last the royal family remained irreconcilable, and though 
 two of the princes, '^ speaking, as it was understood, the senti- 
 ments of all the reigning family,"*^ declared openly against 
 the Bill, and canvassed against it. Lord Grenville induced the 
 Lords to pass the Bill by a large majority. In the Commons — 
 where now unhappily Fox's voice could no longer be raised in its 
 favour, for his life had ended in the autumn, Lord Howick 
 (afterwards the Earl Grey of the Beform Act of 1832) intro- 
 duced the Bill, and carried its second reading by a majority 
 of 283 to 16. The Bill in its further progress was not opposed : 
 and on the 25th of March (in spite of the change of ministry 
 which was then occurring) it received the royal assent, t 
 
 Twenty years had elapsed since the abolitionists began their 
 associated labours ; twenty years during which those labours had 
 never remitted ; and now, at the passing of the Act, those who 
 had won that victory felt the Act to be their supreme reward. 
 But, in truth, the mere legislative measure was but a fragment 
 of the success they had achieved. With their long persistent 
 agitation of the question, with debates on it again and again in 
 both Houses of Parliament, with propagandism in all parts of 
 the country, with innumerable local organisations created into 
 sympathy with them, they had conduced, in extraordinary mea- 
 sure, to the higher political education of their country. Clark- 
 son, in concluding his Kistori/ of the Abolition^ rightly claims 
 for them the praise of what they had done in that respect. 
 Insistence on common humanity in politics was the wedge which 
 for twenty years they had been pressing home. Some recog- 
 nition of this expressed itself in the House of Commons at the 
 memorable second reading of the Bill : when the Grenville 
 Solicitor-General Sir Samuel Romilly (of whose own humane 
 labors in a different field something will hereafter have to be 
 said) made, in the course of his speech for the Bill, an appro- 
 
 * Clarkson's History gives a convenient compendium of the debates, and 
 contains some toucliing particulars of Fox's last acts and thoughts in relation to 
 the movement. 
 
 t Life, chapter xvi. 
 
NEW MOMENTA. 157 
 
 priate personal reference to Wilberforce : ^ ^^ whereupon the Chap. vm. 
 whole House, surprised into a forgetfulness of its ordinary Humanity 
 habits, burst forth into acclamations of applause."" f Of the PoUtics^^ 
 success with which the abolitionists had pleaded their cause, 
 and had gained the conscience of the country to their side, more 
 enduring illustrations were subsequently given by the progress 
 of events. 
 
 First, from the time when England renounced the slave- 
 trade, the successive governments of the country exerted their 
 influence with the governments of other civilised countries to 
 obtain general adhesion to the same policy, and those endea- 
 vours have had wide effect. Thus in 1814, the restored Bourbon 
 government of France was induced to agree with the British 
 Government (under a separate article of the Treaty of Paris) 
 that at the approaching Congress of Vienna, they would unite 
 their efforts to induce all the powers of Christendom to proclaim 
 the universal and absolute abolition of the trade : in 1815, during 
 the hundred days of Buonaparte^s regained ascendency, procla- 
 mation was made of the total and immediate abolition of all 
 French slave-trade, and, on the return of Louis XVIII., that 
 abolition was confirmed : while at Vienna the members of the 
 Congress declared '^ in the face of Europe " that their respective 
 governments were animated with a sincere desire to concur in 
 the most prompt and effectual action to a like effect. And 
 since that time, in result of exertions made by this country, or 
 in avowed sympathy with it, nearly all the civilised powers of 
 the world have passed laws prohibiting the traffic, or have 
 entered into treaties which declare intention to do so. 
 
 And secondly, in 1833, the triumph of the '^'few obscure 
 quakers'^ was consummated by one of the greatest facts in 
 history. Till then, though trading in slaves had for twenty- 
 seven years been suppressed in all British dominions, the 
 holding of slaves had not been prohibited, and slaves were still 
 
 * "He entreated tlie young members of Parliament to let this day's event be 
 a lesson to them, how much the rewards of virtue exceeded those of ambition ; 
 and then contrasted the feelings of the Emperor of the French, in all his great- 
 ness, with those of that honoured man, who would this day, returning to his 
 private roof, and receiving the congratulations of his friends, lay his head upon 
 his pillow, and remember that the slave trade was no more." 
 t life, p. 279. 
 
158 ENGLISH SANITARY INSTITUTIONS. 
 
 Growtho?* held in the British colonies. To the everlasting honour of that 
 Humanity generation_, and of the men who had heightened its standards 
 PoHtics. of right and wrong, the British people of 1833 would no longer 
 bear that shame on its conscience : it taxed itself twenty mil- 
 lions of pounds to buy for those others the freedom which had 
 been its own heritage, and the Legislature of the United King- 
 dom, voting the required ransom money, decreed the Emancipa- 
 tion of the Colonial Slaves. 
 
 Sarms^*^^^ The success of the Grenville administration, in passing in 
 
 1807 after a struggle of twenty years the Act which abolished 
 British slave-trading, had been the happy accident of a particular 
 political interlude. With that splendid exception, the thirty 
 years which succeeded the outbreak of the French Revolution 
 were years of almost no legislative progress in this country; 
 and during most of the time any proposal to amend a bad law 
 was likely to be met with contumely. The French revolutionary 
 excesses, though in great part caused or aggravated by the inter- 
 ference of external powers, had induced in England a terror of 
 reform equal to the Parisian terror of the guillotine : and the 
 English terror, which affected very powerfully a vast number of 
 the minds of that generation, especially of the governing and 
 opulent classes, and which perhaps never afterwards quite died 
 out of the minds it had once possessed, got an illogical increase 
 of strength, during the Napoleonic wars and the years next after 
 them, in proportion as our own malcontents, suffering from the 
 hard conditions of the times, complained that all reasonable 
 domestic reforms were withheld from them. During that 
 period, many men who had previously professed hberal opinions 
 (perhaps not always with deliberation and disinterestedness) 
 made recantation, and often more than recantation, of their 
 liberalism ; even those who had been sincerest in their liberality^ 
 could not all keep cool heads, and retain their old convictions 
 unchanged ; and among men who stood firm amid the stampede 
 of former comrades, few could dream it a fitting time to bring 
 forward any project of reform. 
 
 Law^*^ Yet, even in that unpromising time, new ground was broken 
 
 Romiiiy and in one highly important field of humane intention. Endeavours, 
 
 Mackintosh. & j r > 
 
NEW MOMENTA. 159 
 
 namely, were then made^ to bring the Criminal Law of the country Chap. viu. 
 under fresh legislative consideration : endeavours especially as to Humanity 
 those parts of the law which regulated the punishnxent of offences, Poftics^^ 
 and which at that time were indiscriminately extreme in their 
 threats ; often shamefully cruel so far as the threats were fulfilled, 
 and often ridiculously futile so far as they were not. One of 
 the greatest of English judges had two centuries before observed, 
 and the present common-sense of mankind accepts the observation 
 as just, that " too severe laws are never duly executed " : yet 
 here, at the beginning of the nineteenth century, nearly three 
 hundred crimes, differing immensely from each other in their 
 degrees of moral and social importance, were all equally punish- 
 able with death. In the endeavours which were made to obtain 
 reasonable amendments in the statutory scale of punishment for 
 crime (as also in other important endeavours for law-reform) the 
 leader of the forlorn hope was Sir Samuel Romilly, and his 
 endeavours were almost invariably defeated. He certainly did 
 in 1808 succeed in procuring from the Legislature, that 
 pickpockets should no longer be sentenced to death ; but in 1810, 
 when he tried to move a little farther in the same direction, he 
 could not induce Parliament to withdraw the extreme penalty 
 from persons who did' shop-lifting to the amount of five shillings ; 
 and further attainment of the reforms he advocated was not to 
 be during his lifetime. Deplorable for many interests was the 
 abrupt ending of his life in 1818; and rarely as it can be that 
 the death of a man in his sixty-second year awakens the kind of 
 feeling with which the premature extinction of high youthful 
 promise is regarded, something of that kind of feeling — some- 
 thing of the emotion with which the shaded figure of the young 
 Marcellus was seen by him who told its story, is hardly not to be 
 felt by those who read of the life and death of Romilly. 
 Ostendunt terris hunc tantum fata. The peculiar homage with 
 which his contemporaries regarded him, and the impressions as 
 to him which may be gathered from his own very interesting 
 journals, combine to suggest a personality of the highest worth : "^ 
 
 * See for instance, in the Memoirs of Sir James Mackintosh (vol. i. p. 34) 
 how Mackintosh, writing of Eomilly as early as 1810, refers to his moral 
 character as standing " higher than that of any other conspicuous Englishman 
 now alive." Or see, in the third volume of Lord Brougham's collected Speeches, 
 
160 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VIII. a man of deeply-conscientious tender nature, of truest integrity. 
 Humanity of high intellectual gifts, of indefatigable industry for the aims 
 Pontics!^ of duty, of generous ambition to do good to mankind : and it is 
 sad to think of the sudden broken-hearted end of a life, which 
 just before was so full of vigor and benevolence, so strenuous in 
 the hard struggles of the time. In spite of the influence which 
 his character and abilities gave him, and in spite of the strength 
 * of the cause he was pleading, he, during the last ten years of his 
 life, had been unable to procure any single mitigation of the 
 penal code : and on July 4th, 1818, on his election for West- 
 minster, when making what proved to be his last, as it was also 
 his first, address to that new constituency, he truly stated — " I 
 have indeed endeavoured to be useful to the public, but my 
 endeavours have seldom been successful.''^ After his death, how- 
 ever, the cause for which he had been contending was not allowed 
 to fall into oblivion. In 1819, it was taken up afresh by Sir 
 James Mackintosh, who with better fortune and perhaps better 
 strategy than had previously been used (but with Government 
 still strongly opposing) succeeded in inducing the House of 
 Commons to refer to a Select Committee the whole subject of 
 the extreme punishments ; and the report of this Committee was 
 in favour of abolishing capital punishment for all except a small 
 proportion of the offences which had previously been subject to 
 it. Early in 1820, Mackintosh introduced six Bills to give 
 effect to the recommendations of the Committee ; and, in spite 
 of the continued opposition of Government, got three of the six 
 passed — 1st of Geo. IV., capp. 115, 116, 117: among them a 
 repeal of the previous capital punishment for small shop-liftings. 
 In 1821, he made a second attempt with one of the lost bills of 
 
 where several pages are given to the praise of Romilly, how Brougham (1838) 
 says of him : — " Few persons have ever attained celebrity of name and exalted 
 station in any country, or in any age, with such unsullied purity of character as 
 this equally excellent and eminent person. ... No one could know Romilly, 
 and douht that, as he only valued his own success and his own powers in the belief 
 that they might conduce to the good of mankind, so each augmentation of his 
 authority, each step of his progress, must have been attended with some triumph 
 in the cause of humanity and justice. . . It was the confession of all who were 
 admitted to his private society, that they forgot the lawyer, the orator, and the 
 patriot, and had never been aware, while gazing on him with admiration, how 
 much more he reaUy deserved that tribute than he seemed to do when seen from 
 afar." 
 
NEW MOMENTA. 161 
 
 the previous year — a bill to mitigate tlie law as to forgery, but Chap. vm. 
 
 was again defeated. In 1822, in spite of the law officers of the HuiSity 
 
 crown, he procured from the House an eng-ao^ement that the ^,^F^*^^ 
 
 1111 -1 1-1 Politics, 
 
 remaining matter should be considered m the next session ; but 
 
 in 1823, when, in view of that engagement, he submitted reso- 
 lutions for the proposed amendments of the law, Mr. Peel (who 
 had recently become home-secretary) defeated him by moving 
 the previous question. Peel however now saw fit to adopt certain 
 of the resolutions as basis for action by Government; and by 
 three bills of his, which of course were carried — 4th Geo. IV. 
 cc. 46, 53 and 54, " about a hundred '' different offences were 
 relieved from the penalty of death. "^ 
 
 It might have soothed the shade of Romilly to know that Rush of 
 this tardy concession to his pleadings for humanity and common- cesses. 
 sense was inaugural of other great changes. It was the begin- 
 ning of a thaw in that omnipotent " cold obstruction ■'■' which, 
 for. the past third part of a century, had immobilised so many 
 different efforts for reform. The single first ship, though with 
 its early commander dead, had made way through the breaking 
 ice ; and now, one by one, with less and less delay, others of the 
 frost-bound squadron were to grind through. Thus, in 1824 
 was passed (but it had to be re-enacted with amendments in 
 1826) an Act repealing the long series of statutes, from the reign 
 of Edward III. downwards, under which rates of wages and 
 hours of labor had been subject to regulation by magistrates, 
 and under which it had been unlawful for workmen to take com- 
 bined action, however peaceful, on questions they might have 
 with their employers as to work or wage. In 1828, came the 
 Uepeal of the Corporation and Test Acts. In 1829, the Catholic 
 Eelief Act followed. In 1832, was passed the Parliamentary 
 Reform Act. In 1833, was passed (as before mentioned) the 
 Colonial Slavery Abolition Act. In 1834 — to remedy certain 
 extreme abuses which had been admitted into the working of the 
 Elizabethan law for the relief of the poor, and by which the aims 
 of that humane institution, and even the solvency of the 
 country, were urgently endangered^ the Poor Law Amendment 
 
 * For the number of the exemptions, I quote Mx. Walpole's Sistory of 
 I J vol. ii. p. 74. 
 
 L 
 
162 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VIII. 
 Growth of 
 Humanity 
 in British 
 Politics. 
 
 Summary. 
 
 Act was passed. In 1835^ this series of reform was completed 
 by the passing of the Municipal Corporations Act. 
 
 As^ in the last chapter, there was traced_, down to the end of 
 the reign of William the Fourth, the growth of the technical 
 knowledge with which this narrative is concerned, so, in the 
 present chapter, it has been endeavoured to trace down to the 
 same date the growth of that larger mind by which the technical 
 knowledge claims to be appreciated : a growth, which, during 
 the period spoken of, was such as had never before been known. 
 
 At the present date, when the line of that particular pro- 
 gress has been prolonged half a century further, and has so 
 become even more plainly defined, every one can see that, before 
 this nineteenth century began, a powerful new momentum had 
 come to operate in politics ; and that the Parliaments of George 
 IV. and William IV., legislating at length in obedience to that 
 impulse, practically affirmed new social theories, and took irre- 
 vocable first steps towards a far-reaching political future. 
 Underlying the legislative acts, and giving them an unity of 
 their own, was a spirit so changed from that of the old times as 
 virtually to be the adoption of new standards of weight and 
 measure in politics. An increased consideration for the units of 
 mankind, a developed apprehension of the meaning of social 
 justice, a widened consciousness of the range of social duty, were 
 prominent characteristics of the new time. Society had become 
 readier than before to hear individual voices which told of pain 
 or asked for redress of wrong ; abler than before to admit that 
 justice does not weight her balances in relation to the ranks, or 
 creeds, or colours, or nationalities of men ; apter than before to 
 perceive that the just balances which serve between man and 
 man may, in principle, serve between nation and nation. Reason- 
 able politicians had begun to recognise other tests of political 
 success than those which had satisfied earlier times. The so- 
 called " masses " of mankind had come to be of interest in other 
 points of view than those of the recruiting-serjeant and the tax- 
 gatherer. Philosophers were seeming to say, that the " mass ^' 
 which has in it most human worth and welfare is that which 
 best justifies the system of government which is over it. Our 
 own '^mass^^ was growing responsive to that suggestion. The 
 
NEW MOMENTA. 163 
 
 component units were rapidly learning to aspire. And statesmen Chap. viii. 
 could not but acknowledge that the greatest happiness o£ the Hu°i^ty 
 greatest number is at least a good security for social quiet. As poift^*^^^ 
 a force of construction in the world_, the new spirit was in direct 
 contrast to that which after Roman times had created the feudal 
 institutions; it was the first strongly organised influence which 
 had arisen since the decline of feudalism : and in spite of lapsed 
 centuries_, it found survivals enough of feudal thought, and 
 remnants enough of feudal construction, to shew how essen- 
 tially opposed to them it was, and how true a crisis was reached 
 in English history when at last it could give legislative effect to 
 its own principles. The democratising parts of the new legisla- 
 tion were those on which the flagbearers and trumpeters of rival 
 political parties would chiefly have spent their praise or dispraise : 
 but those parts taken by themselves (highly significant parts 
 though no doubt they were) did not fully represent the essential 
 spirit of the time : nor can that spirit be characterised in full by 
 any narrower praise-word than the word Humane. 
 
 In the development of that spirit, and of the religious and 
 political currents from which it rose, logical influences had been 
 of less wide effect than the very extensive influences of feeling ; 
 and any movement so largely emotional would naturally show 
 some sallies of unwisdom. Thoughts which can sustain the steady 
 lifelong work of strongly constituted minds will intoxicate others 
 into excess ; and always, too, on occasions when the popular mind 
 is really moved, vain foolish persons are apt to press themselves 
 disproportionately to the front with officiousness and tiresome 
 fuss. It may be admitted, and needs not be wondered at, that, 
 from circumstances such as those, the good cause which we have 
 followed in its progress had occasional moments of disadvantage ; 
 moments of exaggeration, of one-sidedness, of clamour, of vanity : 
 moments which vexed the common-sense of sober men, and 
 required and received correction. "^ It would now be idle to 
 
 * Thus there were demagogue and lihertine "friends of humanity" whom 
 it was well for Canning and Frere to ridicule in the witty skits of the Anti-Jacobin ; 
 and there were sectarian conceits and pretensions, which needed the kindly 
 chastisement of Sydney Smith's wisdom and humour. Even in much later times, 
 certain types of well-meaning silliness have heen usefully reminded hy Dickens 
 and Thackeray, that IVIrs. Jellaby's own home would be the better for some 
 of the exertions she devotes to the settlement of Borrioboola-Gha ; that the 
 
 L 2 
 
164 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. VIII. insist on those occasional extravagances and errors^ the mere 
 Humanity accidents o£ an advancing development. In the currents of 
 PoSs^^^ moral progress, just as in many a physical riverfiow, the early 
 rapids have features of their own. Just as the young river 
 spends some of its headlong force in tumult and echo, in waves 
 which recoil where they strike^ and in foam which is but for the 
 sunshine to sport with, so the great quickening-times of human 
 history have speech and action which run to waste. At certain 
 moments, beheld from certain standpoints, the marginal extrava- 
 gance seems the whole life of the scene, but with an interval it 
 becomes as if it had never befen. As the rainbowed spray of the 
 Schaffhausen cataract, the breakers and eddies of Lauffenburg 
 and Rheinfelden, are of no record on the broad calm river which 
 sweeps past Niederwald and Drachenfels to sea, thus it is with 
 their analogues in human history. Regarded by successive 
 generations from longer and longer distance, they become less 
 and less significant in the field of thought ; while, conversely, 
 the massive current of the great time, the *^*^one increasing 
 purpose ^^ which has been its true life, comes more and more 
 grandly into view. 
 
 That, of the hundred years to which the present chapter has 
 related, the pervading character, the one current of " increasing 
 purpose/^ was the constantly advancing influence of common 
 humanity in politics, is what the chapter has endeavoured to 
 make manifest ; and the fact of that advance has had to be here 
 specially dwelt upon, because, without it, the popular mind 
 might, for ever so long, have omitted to appreciate and utilise 
 the new teachings which Medical Science had become able to 
 supply. The influence exercised by the New Humanity in 
 promoting the rise of modern State-Medicine in England, is, of 
 its many great influences, the only one on which the present 
 narrative is entitled to insist; but, passing for the moment 
 beyond that limit, the writer permits himself a word of more 
 general homage to the progress of the hundred years. He 
 believes that the period in its entirety deserves to be counted 
 among the greatest in English history. In the cultivation 
 
 obstreperous tlast of Mrs. Pardiggle's visit to the poor is of less comfort to them 
 than the winter's wind ; and that Lady Southdown's tracts and physic are un- 
 ■uited to the case of Mrs. Eawdon Crawley. 
 
NEW MOMENTA. 165 
 
 which it gave to a sense of moral responsibility in national S^^T^-'-' 
 affairs^ — in the splendid instances which it showed of the appli- Humanity 
 cability of common ethical argument to politics^ — in the appeals Politics, 
 which it made to the consciences of rulers and nations against 
 courses of selfish wrong, — in the feeling which it propagated, 
 that nations, like persons, if they would not be ashamed of 
 themselves, must obey, at home and abroad, the common rules 
 of equal justice, — not least in the mutual understanding which 
 it promoted between the social instincts and the political philo- 
 sophy of mankind, — it represented such strides of civil culture 
 as no former age of our country had seen : strides of a far truer 
 civilisation than any which widened empire, or enhanced luxuries 
 of life, can pretend to show. By its transcendent merits in those 
 respects, a new political world was opened to the view ; and for 
 inheritors who were worthy of it, there began the era which the 
 Author of the Areojpagitica had foretold as to come from Freedom : 
 that era which he, master-patriot and master- poet, failing in 
 physical sight, but ^^with inward eyes illuminated,^'' had dis- 
 cerned across the dark mean times then next to come : the 
 brighter and better distance, when the England he loved and 
 taught should be ^* as an eagle muing her mighty youth/'' 
 
166 
 
 CHAPTER IX. 
 
 FIRST EXPERIENCES OP ASIATIC CHOLERA IN EUROPE. 
 
 The last two chapters have been intended to trace, down to 
 times immediately preceding the present reign_, first, how, from 
 early in last century, there had been an accumulating rise of new 
 scientific knowledge as to the causes and preventabilities of 
 different sorts of disease ; and, secondly, how, during the same 
 period, the country, under various new teachings, had immensely 
 advanced in the principles and practice of politics, and had 
 virtually begun a new national life with widely altered conceptions 
 of political good and evil. The social value of the new know- 
 ledge which medical men had gathered as to the preventability 
 of certain sorts of disease would surely not long fail to be appre- 
 ciated in the higher civilisation which had dawned ; but, within 
 the reign of William the Fourth, hardly a commencement of 
 such appreciation was to be traced. The new knowledge had 
 been chiefly developed in those varieties of enterprise in which 
 definite quantities of human life happen to be of immediate 
 instrumental value; as especially in great military and naval 
 undertakings, wherein such quantities are indispensable means 
 to proposed ends. In such directions, the necessity of econo- 
 mising the human tools had always so clearly been a requisite 
 for success, that great generals, even in ancient times, had 
 exercised some sanitary shrewdness in saving their legions from 
 the irregular foe ; and it was from our own army and navy of 
 the new times, that practical lessons in the scientific prevention 
 of disease had chiefly come. But, in the common civil world, 
 question had hardly yet arisen, whether economies in the expen- 
 diture of human life could be made. 
 PubUc^ Thus, in 1830, when William the Fourth began his reign, and 
 
 Health equally in 1837 when the reign ended, the new knowledge was 
 meltunder virtually unrecognised by the Legislature. The Statute-Book 
 wuiiam contained no general law of sanitary intention, except (so far as this 
 
NEW MOMENTA. 167 
 
 deserves to be counted an exception) the Act providing for Quaran- Chap. ix. 
 tine : under wliicli well-intentioned but futile Act, the Lords of tic^ChoEra 
 the Council were supposed to be always on the look-out for trans- "^^^^ope. 
 marine dangers of pestilence, and could make pretence of resisting 
 such dangers. Against smallpox. Parliament used annually to vote 
 £2,000 to support a National Vaccine Board which had a few vac- 
 cinating-stations in London, and furnished the public with vaccine 
 lymph. Outside those two matters, the Central Government had 
 nothing to say in regard to the Public Health, and Local Authorities 
 had but the most indefinite relation to it. Various important ' 
 
 towns had their special Improvement- Acts for certain purposes : 
 but among the purposes. Health had hardly yet begun to stand on 
 its own merits. The Commissions of Sewers which from long 
 ago had been empowered to defend their respective districts 
 against jfloodfrom sea or river, were institutions which, no doubt, 
 so far as they kept their districts dry, conduced to the healthiness 
 of England. But those Commissions had never been intended 
 to deal with problems of filth-removal : problems, which, as we 
 now know, and especially where towns are in question, complicate 
 to the utmost the problem of mere land-drainage. Almost no- 
 where had any competent engineering skill been brought to bear 
 on the sewerage of towns ; and town-sewers, retaining large pro- 
 portions of whatever sohd filth passed into them, and often letting 
 more liquid sewage escape into surrounding soil and house-base- 
 ments than they transmitted to their proper outfall, were among 
 the worst of nuisances to the neighbourhoods which they pretended 
 to relieve. No doubt there existed in each town more or less of 
 pavement, more or less of sewering, more or less of public water- 
 supply : but in each of those respects the standard of quantity 
 and quality did not pretend to be a sanitary standard. The 
 local question would commonly have been, what is the least 
 amount of local improvement which will suffice to avert intoler- 
 able degrees of common physical inconvenience; and probably 
 very few of our towns, in their answering of that question, 
 recognised nearly as high a standard of requirement as had been 
 recognised, two thousand years before, in Rome. As to the 
 refuse of private premises, the house-holder stored his filth as he 
 liked, or got rid of it as he could. From early in the century, 
 water-closets (such as they were) had begun to be used in the 
 
168 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 pSsfA""^' ^®^^®^ houses ; but almost all houses had cess-pools — commonly 
 tic Cholera cess-pools which both leaked and stank; and^ in towns, a cess-pool 
 of that sort would generally be in the basement of the house. 
 Nuisances injurious to health abounded everywhere ; and against 
 such nuisances, however flagrant, there was no sort of summary 
 jurisdiction. No general law existed as to the practice of the 
 medical profession, or as to the sale of drugs or poisons ; and 
 except for the purposes of excise, there was no available law 
 against adulterations of food. 
 
 Asiatic 
 Cholera in 
 Europe 
 and in the 
 United 
 Kingdom. 
 
 This was the state of things when the reign of William the 
 Fourth began, and equally was the state when his reign ended. 
 But the reign, though it produced no sanitary reform of its own, 
 was, in two senses, an important preparatory period in relation 
 to the years which next followed : first, because of its unpre- 
 cedented activity in other lines of reform which have been men- 
 tioned; and secondly, because the seven years of the reign 
 corresponded pretty exactly with the period of the earliest 
 prevalence of Asiatic Choleea in Europe. 
 
 It needs not be said that the first prevalence of Cholera 
 in Europe gave occasion to immense alarm. During two years, 
 dating from the autumn of 1831, outbreaks of the disease, some 
 of them very severe, were occurring in various parts of the 
 United Kingdom, and the popular fears which they excited 
 were such as had not been in the country since the days of 
 the Great Plague. 
 
 The story of that invasion is but very imperfectly known. 
 We know that our first-invaded town was Sunderland, attacked 
 in the autumn of 1831 ; that soon afterwards the disease was 
 spreading in Scotland ; that in February it reached London, and 
 in a little while extended to Ireland ; that during great part of 
 1832 it was widely diffused in the United Kingdom ; and that 
 our last-known (few) cases were in the summer of 1833. How 
 many deaths it caused, can not be accurately told ; for in those 
 days there was not yet any general registry of deaths in the 
 United Kingdom ; but from such returns — ^^ voluntary, partial^ 
 and evidently defective,''^ as were obtained, it seems that certain 
 named places in Great Britain, with fewer than five and a quarter 
 millions of aggregate population, suffered 31,376 deaths, and 
 
NEW MOMENTA. 169 
 
 that in Ireland tlie deaths were 21^,171.^ 0£ the measures by Chap. ix. 
 which the disease was resisted in the various attacked localifcieSj tic^choiSa 
 no general record exists ; but the successive London Gazettes o£ ^ Europe, 
 the time record the chief proceedings of the Central Govern- 
 ment in the matter, and enable this part of the story to be read 
 with tolerable completeness. 
 
 Early in 1831, when the danger of the approaching infection Action 
 began to strike the public mind, the British Government sent the British 
 two Medical Commissioners, Doctors William Russell and David ^ent™' 
 Barry, to St. Petersburg, to study the disease ; and later in the 
 year, the report, made by these commissioners on their return, 
 was published for general information. In June (by which 
 time the disease had attacked Higa and Dantzig) the superin- 
 tendent-general of Quarantine, Sir William Pym, moved the 
 Privy Council for more decided measures against the iiitroduc- 
 tion of the disease into the United Kingdom : whereupon a 
 special Order in Council was forthwith passed, to make Cholera 
 subject to precautionary rules under the Quarantine Act, such 
 as had from long before been applicable against Levantine 
 Plague j and the Privy Council, as Sir W. Pym had suggested, 
 entered into consultation with the Royal College of Physicians 
 on the subject of precautions. Soon afterwards (June 20) a 
 Royal Proclamation notified to the public the state of the case, 
 and announced the establishment of a consultative Board of 
 Health. This Board, in conformity with a precedent which had 
 been set "on the occasion of the Gibraltar sickness in 1805/'' 
 was made to consist of the President and four other fellows of 
 the College of Physicians, the Superintendent- General of 
 Quarantine, the Director-General of the Army Medical Depart- 
 ment, the Medical Commissioner of the Victualling Office, and 
 two non-medical civil servants — namely, the Comptroller of the 
 the Navy and the Deputy-Chairman of the Board of Customs, 
 together with a paid medical secretary : three members, with at 
 least .two of them medical, to be a quorum : and the Board took 
 for its President Sir Henry Halford, who was then President of 
 the College of Physicians. Four months later (Oct. 20) the 
 
 * See Dr. Fair's statements on the matter, at page xlv. of his Report on the 
 Cholera Mortality in England, 1848-9. 
 
170 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. IX. Lords of the Council had before them certain Rules and Regula- 
 
 First Asia- . iiiTiini c -i 
 
 tic Cholera tions proposed by the Board ^^ for the purpose or preventing" the 
 m urope. ijj^j.Q^^g|;iQjj ^ji^j Spreading of the disease/' and these, "with 
 a view that all persons may be acquainted therewith and conform 
 themselves thereto/' their Lordships caused to be gazetted 
 and circulated. Medically, the Rules and Regulations did not 
 represent any advance on what might have been advised in 1720 
 by Dr. Mead. ' The disease was declared to be of special affinity 
 for the poor, ill-fed, unhealthy parts of the population, especially 
 those who are of drunken irregular life, and for districts which 
 are unclean, ill- ventilated and crowded ; and the Board trusted 
 that the mitigation of those evils would be promoted by the 
 most active endeavours of persons of influence. For what re- 
 mained, rigorous quarantine was the supreme hope : and, as 
 Government could only control the regular channels of trade or 
 passage, all persons of influence resident on the coast (and par- 
 ticularly of retired villages along the sea-shore) were to impress 
 on the local populations the dangers of illicit intercourse 
 with smugglers and other such evaders of quarantine. Should 
 the disease effect a landing in the kingdom, local Boards of 
 Health should be established everywhere, consisting of the 
 magistrates, two or more medical practitioners, the clergy of the 
 parish, and three or more principal inhabitants, and in large 
 towns each Board should have district committees of two or 
 three members, including one medical. Separation of sick and 
 healthy was to be the chief care. Hospitals were to be provided, 
 and into them so far as families would consent, the sick were 
 to be removed. Houses containing or having recently contained 
 cases of the disease, were to have conspicuous marks, " Sick " 
 or " Caidion" affixed to them ; and their inhabitants were not 
 to be at liberty to move, out, or communicate with other persons, 
 until by the authority of the local Board the mark had been 
 removed. Articles of food and other necessaries should be placed 
 in front of the houses to be taken in when the bringer had 
 retired. The houses and their furniture were to be thoroughly 
 cleansed and purified, and left open to fresh air for at least 
 a week. Extreme cleanliness and free ventilation were recom- 
 mended as of the utmost importance not only for sick houses, 
 but for houses in general. The dead should be buried in some 
 
NEW MOMENTA. 171 
 
 detached ground near the cholera hospital. Convalescents from Chap. ix. 
 the disease, and those who have had any communication with tic^Ch^iera 
 them, should be kept under observation for a period not less than ^^ ^^ope- 
 twenty days. All intercourse with any infected town, and the 
 neighbouring country, must be prevented by the best means 
 within the power of the Magistrates : who in extreme cases 
 would have to make regulations for the supply of provisions : 
 and if the disease should show itself in this country in ^^the 
 terrific way*^ in which it had appeared in various parts of 
 Europe, it might '^ become necessary to draw troops, or a strong 
 body of police, around infected places, so as utterly to exclude 
 the inhabitants from all intercourse with the country/'* 
 
 Thus far, on October 20th the Board of Health; and on Central 
 November 2nd the King in Council ordered a Form of Prayer Boards for 
 against the Disease. The Board which framed the Rules and agaSst 
 Regulations had perhaps not been meant to continue : at any Cholera. 
 rate, it ceased soon after having submitted its proposals : and 
 the Gazette of Nov. 14 announced the^^appointment of a new 
 Central Board of Health : having for its Chairman the Hon. 
 Edward R. Stewart, Deputy-Chairman of the Board of Customs, 
 and, as its other members, the Superintendent-general of Quar- 
 antine, the two Medical Commissioners who had just returned 
 from St. Petersburg, and two military officers ; with Mr. 
 William Maclean, as Secretary. 
 
 This Board seems to have worked with creditable activity. Central 
 
 J . , . _ , , ^ _ Advice and 
 
 ana with as much science as was then to be had. In a first Orders, 
 circular, issued on November 14, as to the precautionary measures, 
 public and personal, which it recommended to be taken, it dis- 
 tinctly renounced the policy of the previous Board as to coercive 
 restrictions of intercourse with infected or suspected persons or 
 places : declaring that measures of coercion, when tried upon the 
 Continent, had "invariably been productive of eviF'' ; and professing 
 itself confident, ^^ that good sense and good feeling will not only 
 point out, but morally establish, as far as may be practicable, the 
 necessity of avoiding such communication as may endanger the 
 lives of thousands.''"' Alleging, moreover, that *^^ under proper 
 observances of cleanliness and ventilation " cholera '^ seldom 
 spreads in families, and rarely passes to those about the sick, 
 under such favourable circumstances, unless they happen to be 
 
172 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. IX. particularly predisposed/^ tlie Board limited to particular classes 
 tic Cholera of cases, disadvantageously circumstanced, the advice whieli the 
 in Europe, f^j-j^gj. ;Board had given as to the separation o£ members o£ 
 affected families, and the insulation of affected houses. It 
 advised that the subordinate Boards of Health, which in each 
 large town were to be constituted under a principal local Board 
 for precautionary purposes, should be charged with the following 
 duties : ^*^ (1) to appoint Inspectors : each inspector to visit daily, 
 and to inquire carefully after the health, and comforts of the 
 inmates of, say, 100 houses, more or less, according to circum- 
 stances; — (2) to receive and examine the Reports of these 
 Inspectors, which should be made up to a given hour on each 
 day; — (3) to endeavour to remedy, by every means which 
 individual a,nd public charitable exertion can supply, such 
 deficiency as may be found to exist in their respective districts 
 in the following primary elements of public health : viz., the 
 food of the poor, clothing, bedding, ventilation, space, cleanliness, 
 outlets for domestic filth, habits of temperance, prevention of 
 panic ; — and (4) to report to their principal Boards respectively 
 on the above heads, as well as on the actual State of Health of 
 their districts.'"' The circular also contained some sensible advice 
 as to medical and dietetic precautions. In a next circular 
 (Dec. 13) the Board issued '^ Sanitary Instnictions for Commu- 
 nities, supposed to be Actually Attached by Spasmodic Cholera^" 
 with '^ Observations on the Nature and Treatment of the Disease, 
 drawn up by Doctors Bussell and Barry.^^ And in a third 
 circular (Jan. 16) it sought to promote more detailed studies of 
 the hitherto unfamiliar disease, by suggesting a variety of patho- 
 logical points to be observed by medical practitioners who might 
 have opportunity. Soon afterwards (Jan. 25, 1832) the Board 
 addressed a special Circular to the authorities of the metropolis : 
 saying that ^' in defiance of winter " cholera had continued to 
 spread in the north of the Kingdom, where it was then threaten- 
 ing Edinburgh, and that, as warmer weather would favour its 
 propagation, the Board deemed it essential that each parish and 
 district of London and its suburbs should without delay prepare 
 itself, in respect of hospital-accommodation and hospital-service, 
 for the possibility of a sudden epidemic outbreak. About this 
 time also (moved by medical consideration which will be 
 
NEW MOMENTA. 173 
 
 mentioned later on) the Board besjan to recommend for general ^hap. rx. 
 
 First Asia- 
 circulation in infected districts a particular form of warning tic Cholera 
 
 handbill : see Cholera Gazette of Jan. 28th : to the effect that ^ ^rope. 
 in attacked districts^ persons who would escape cholera must give 
 immediate serious attention to any looseness of bowels which 
 might affect them. Before the middle of February, Cholera had 
 begun to show itself in the eastern riverside parts of London ; 
 whereupon the Central Board, appointing Medical Super- 
 intendents to act for the Metropolitan Districts, addressed to 
 these officers (Feb. 14) a letter of Instructions as to their duties, 
 and as to the sense in which they should advise the local boards 
 and others : particularly as to the establishment of temporary 
 hospitals and dispensaries, and suitable means for conveyance 
 of the sick, and as to the inmates of prisons and workhouses, and 
 as to the burial of the dead. Each superintendent was to reside 
 within his district, and be a member of its local Board ; was to 
 collect from medical practitioners daily returns of all cases of 
 cholera under treatment ; and was to report daily to the Central 
 Board all important occurrences. A somewhat later general 
 circular (March 20) prescribed the forms of return in which 
 medical practitioners should report their cholera cases and cholera 
 deaths to Local Boards, and those in which Local Boards should 
 report to the Central Board. On the 19th of August (when 
 probably the disease may have been at its maximum in England) 
 the previous sanitary circulars were re-issued in a consolidated 
 form with some alterations and additions ; and a fortnight later 
 (in what seems to have been a last circular) the Board, ^^ being 
 anxious to obtain from authentic practical sources short outlines 
 of the different plans of treatment in cholera which may have 
 been considered most successful,''^ begged of the medical members 
 of Local Boards, and of other medical practitioners who might 
 have had extensive practice in the disease, that they would 
 forward information as to any particular success they had had 
 in their respective modes of treating the different stages of 
 cholera. 
 
 The advice which the Central Board gave in its circulars was Temporary 
 of no binding effect on the public; nor had the Board any iiament:^^' 
 authority to do more than advise; but, in relation to some of Locai^^'^ 
 the purposes which had been indicated in the Board^s first Boards. 
 
174 ENGLISH SANITARY INSTITUTIONS. 
 
 Chm> IX. Circular^ Government, on tlie strenertli of certain ^^ unforeseen 
 
 Jftrst Asia- ... . 
 
 tic Cholera emergency "''' provisions in the Quarantine Act, followed the 
 issue of that circular by issuing (Nov. 21) two Orders of 
 Council expressed in terms of command : the one, requiring 
 that, in all such places as the Privy Council might from time to 
 time by subsequent orders name. Local Boards of Health, with 
 constitution and duties to be regulated by the respective orders, 
 should be established, and that in each such place every medical 
 practitioner should send to the Local Board a daily report of all 
 cholera-cases attended by him : and the other requiring that, in 
 all places having Boards of Health, the Justices of the Peace should, 
 on certain shewings, call upon the poor-law parochial authorities to 
 abate or remove existing Public Nuisances injurious or likely to be 
 injurious to health. Question having soon been raised whether 
 these orders were of any more legal force than the admonitory 
 circulars which had preceded them, and such doubts having ac- 
 cumulated. Government, as soon as Parliament met, obtained the 
 passing of three temporary Acts (2nd Will. IV., cc. ix.-xi.) to 
 establish beyond doubt competent regulative powers for the 
 required purposes in each division of the United Kingdom ; 
 and under these Acts, various orders de novo were issued : — 
 one (Feb. 29) requiring medical practitioners to make daily 
 returns of all cases recoveries and deaths, in their respective 
 practices; another (March 6) prescribing local-option condi- 
 tions under which it should be lawful for the Boards of affected 
 districts to provide, chargeably on the poor-rates, temporary 
 hospitals for the sick, and houses of observation for those whom 
 it might be proper to remove from dangers of infection ; also a 
 third (July 20) which on like conditions gave local powers for 
 nuisances -removal and the expenses thereof. " That the sanitary 
 advice which the Central Board of Health had previously given 
 was greatly strengthened in moral influence when express law 
 came to speak on the same side, may be assumed ; but whether 
 the law was in other respects of much effect, whether it coerced 
 many people to do more than they were independently willing to do, 
 may be doubted. For a main difficulty of the position was that, 
 in the years 1831-3, the local communities of the United King- 
 dom were in general not yet educated or organised or officered 
 up to the level of the emergency which had to be met ; and not 
 
n 
 
 NEW MOMENTA. 175 
 
 even Acts o£ Parliament can extemporise the intelligence and Chap. ix. 
 vigor and public spirit which compensate for defects of law. No tic Cholera 
 doubt there were districts in which all possible exertion was ^ ^ope. 
 made : notably this seems to have been the case in the City of 
 London, and in the town of Birmingham : but it may be believed 
 that, in most cases, the local apparatus would hardly have been 
 got into working order till the tide for which it was needed had 
 begun to ebb ; and that all the best local results were substan- 
 tially due to unforced individual exertions. 
 
 "^For the purpose of this narrative, the interest of the cholera- Lessons 
 period of 1831-3 lies chiefly in the circumstance, that, during the Epidemic* 
 alarm, many intelligent persons throughout the United King- 
 dom had occasion to become more critically cognisant than they 
 had ever before been of the sanitary conditions under which the 
 mass of the people was living; but no exact knowledge was 
 gained as to the bearing of any particular condition on the 
 spread of the disease; and the doctors did not get beyond a 
 fluffy sort of generalisation (as expressed in the Atmual 
 Register) that the disease was peculiarly attracted by "needy 
 and squalid '' states of life. "Medically, however, there was this 
 real gain : that observers of the disease became conversant with 
 its natural course in individual cases, and especially that careful 
 observers began to learn how commonly the attack begins as a 
 gradually-accelerating diarrhoea. Dr. McCann, of Newcastle, 
 who had known the disease in India, and took the lead in draw- 
 ing attention to that feature of it, insisted strongly on the 
 importance of the fact, with a view to the earliest possible 
 treatment of cases of the disease : and he urged that, for dealing 
 properly with incipient cases, there ought to be special dispen- 
 saries in infected districts. The handbill which the Central 
 Board of Health recommended for circulation in infected dis- 
 tricts, to warn people that " looseness of bowels is the beginning 
 of cholera," and the recommendation of the Board, that a principal 
 step to be taken in endangered districts is " the establishment of 
 Cholera Dispensary Stations at which the poorer classes may 
 receive medicine and medical advice gratuitously at all hours," 
 accorded exactly with Dr. McCann^s teaching, and apparently 
 were due to it. In August, 183^, on occasion of the very severe 
 
176 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. IX. epidemic of Cholera, which there was at Bilston, near Wolver- 
 tic Cholera hampton. Dr. McCann was sent down by the Government to 
 m Europe. pj.Qjjiote the adoption of the system he advised; and the local 
 
 medical opinion of the time was, that by his treatment he 
 
 stopped the epidemic.^ 
 
 Popular Here ends. the little there is to tell of our first British experi- 
 
 retrospect. • • p p • 
 
 ences of Cholera. The Annual Register for 1832, referring to 
 
 the invasion as past, commented somewhat sharply on the tardi- 
 ness with which Parliament had acted in relation to it, but 
 seemed of opinion that, on the whole, too much fuss had been 
 made about the invasion : — saying that ^' everywhere it was 
 much less fatal than pre-conceived notions had anticipated^''; 
 that ^^ the alarm was infinitely greater than the danger " ; and 
 that '^ when the disease gradually disappeared in the course of 
 the autumn, almost everyone was surprised that so much 
 apprehension had been entertained.''^ The writer of 1833 had in 
 view the skirts of a departing epidemic which had not been 
 particularly severe ; but if he, with the courage of a safe position, 
 thought perhaps too lightly of the evil which cholera can work 
 in these islands, materials for truer judgment have since that time 
 been afforded us by other and more severe experiences of the 
 disease. 
 
 Further Before passing from the reiffn of William the Fourth, which, 
 
 effectsfrom j; o & ^ ' 
 
 the period as before mentioned, gave rise to no law of direct sanitary 
 
 intention, it may be noted that two of the statutes of the reign 
 had important, though unpremeditated, sanitary results. Thus, 
 the important Poor Law Amendment Act of England of 1834 
 deserves particular mention in this place ; not because of anything 
 of sanitary intention in the Act contained ; but because accident- 
 ally — through the good luck that Mr. Edwin Chadwick was made 
 the Secretary of the new Poor Law Board, the Act gave occasion, 
 y a few years later, to a beginning of public sanitary enquiry in 
 
 Great Britain. It also deserves notice that in the last year of 
 
 * See Nos. 1 and 2 of the Minutes of Evidence appended to the Second 
 Beport of the Metropolitan Sanitary Commission, 1848. In much later times 
 Dr. Denis MacLoughlin (then resident in London) claimed to have indepen- 
 dently adopted and acted upon the same doctrine in Paris in 1831. 
 
NEW MOMENTA. 177 
 
 the reign^ tlie Act for registering Births, BeatJis, and Marriages Chap. IX. 
 became law : an Act, under which it first became possible' to tic Cholera 
 construct statistics of life and death in this country : and under ^ urope. 
 which (as will hereafter be more particularly noticed) the vast 
 instructiveness of such statistics began soon afterwards to be 
 illustrated. 
 
IP art ff0ttrtlj» — the reign of queen yictoeia. 
 
 CHAPTER X. 
 
 THE HISTORY OF THE PUBLIC HEALTH LEGISLATION OF 1848. 
 
 With regard to the subject-matter of these pages, the com- 
 mencement of the reign of Queen Victoria was emphatically 
 the beginning of a new era for England. At the present 
 time, when care for the Public Health has become a familiar 
 branch of local government, employing day by day many 
 thousands of permanent officers, and having tens of millions of 
 money already sunk in the mechanical appliances which it finds 
 needful, the recollection that, when the reign began, little more 
 than fifty years ago, there existed hardly a glimmer of intelli- 
 gent public interest in this question, shows indeed an astonishing 
 contrast. The old common-place, that without Health is no 
 Wealth, has been spreading in the national mind, as with the 
 force of a new discovery; and the spreading of the old truth 
 with so new a life has been in response to the progress which had 
 been advancing from a century before in the resources of scientific 
 medicine. Disease, always enough understood to be an evil, 
 had gradually come to be seen as an evil which could often be 
 prevented; and from the time when the community began to 
 know that, with good government, it could, at its option, escape 
 many terrible calamities of disease, Health necessarily began to 
 take rank as an object of practical politics. 
 
 Sir Edwin t' The modem demand for Sanitary Reform — the demand that 
 Chadwick. ^.^^^ better knowledge which had been gained as to the prevent- 
 ability of certain diseases should be represented in corresponding 
 laws and activities for the protection of the public health, may 
 be said to have begun in this country in 1838 ; and the successes 
 which it had gained within the space of ten years from its 
 
THE REIGN OF QUEEN VICTORIA. 179 
 
 beginning were of so very important a character, that the story Chap. x. 
 
 Public 
 
 of that decennium claims to be told in detail. Superficially Health 
 
 much o£ it will be a record of the doings of Government Depart- of ists!^^^ 
 
 ments, and Parliamentary Committees^ and Royal Commissions ; 
 
 but even oil the surface^ and still more in the deeper strata when 
 
 they are known^'iihe story of the ten years is above all an account 
 
 of the zealous labours of one eminent public servant^ the present 
 
 Sir Edwin Chadwick.^ 
 
 Considerably before the time in question, Mr. Chadwick, as 
 he then was^ had made himself known to political experts as a 
 man of very high mark. As far back as 1828, in an actuarial 
 controversy on expectations of life, he had shown that he already 
 understood in principle the dependence of much abridgement of 
 human life on conditions of unwholesomeness which are remov- 
 able; and subsequently, from time to time, he had published 
 opinions of his own, which came into influence, on various 
 questions of social economy, such as pauperism and mendicity, 
 preventive police, relief of newspapers from taxation, and others. 
 In the genealogy of our subject-matter, it is a very note-worthy 
 fact, that the earliest of Mr. Chad wick's writings had brought 
 him into intimate relation with Jeremy Bentham; and that, 
 during the last year of the old man''s life, Mr. Chadwick had 
 become resident with him in his house, and was habitually in 
 familiar talk with him on questions of legislation and govern- 
 ment. In 1832, Mr. Chadwick had been appointed one of 
 the Assistant-Commissioners of inquiry into the working of the 
 Poor-Laws, and in 1833 a Royal Commissioner to examine 
 the treatment of children in factories. The report which he had 
 made in the former capacity was judged to be of such value, and 
 was so clearly to be of special influence in determining the form 
 of the new law, that in 1833 Mr. Chadwick had been promoted 
 from his Assistant-Commissionership, to be one of the Commis- 
 sioners of the Inquiry; and in 1834, when the Report of that 
 Inquiry-Commission led to the passing of the Poor-Law Amend- 
 ment Act, and to the creation of a central administrative Com- 
 mission for the purposes of the Act, Mr. Chadwick had been 
 
 * Mr. Chadwick was bom Jan. 24, 1800. In the ninetieth year of his age, 
 and at a distance of more than fifty years from the commencement of his 
 endeavours for sanitary reform, he has recently been decorated K.C.B. 
 
 M 2 
 
180 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. X. made the Secretary of the new Commission. It was in this 
 Health Capacity that, four years later, he first became officially cognisant 
 of^i848. °^ ^^ "^^^ anarchy which (as above described) was then prevailing, 
 instead of Public Health Law, in England ; and that, under 
 influence of the knowledge, he initiated the very eventful 
 proceedings, now to be mentioned, which were taken by the Poor 
 Law Commission during 1838 and the next following years, in 
 relation to the health-interests of the labouring population of 
 Great Britain. 
 
 Co^s-"^ In the spring of 1838, in a letter to the then Home Secre- 
 
 sioners tary,*Lord John Russell, the Poor Law Commissioners pointed 
 attention out that the Act required partial amendment, inasmuch as it 
 ableSsease ^^^ ^^t Completely provide for all expenses which might have 
 pauperism* to be officially incurred in the interests of the poor ; and in 
 explaining their views as to ^Hhe charges which increasing 
 .experience proves it necessary to submit for the sanction of 
 the Legislature for allowance,''^ they give first place to charges 
 which they say are found necessary for the prevention of certain 
 burthens upon the rates, and, on one part of this class, they 
 express themselves as follows : — ^^The most prominent and 
 pressing of the first class of charges for which some provision 
 appears to be required, are for the means of averting the charges 
 on the poor-rates which are caused by nuisances by which con- 
 tagion is generated and persons are reduced to destitution. In 
 general, all epidemics and all infectious diseases are attended 
 with charges, immediate and ultimate, on the poor-rates. Labour- 
 ers are suddenly thrown by infectious disease into a state of desti- 
 tution, for which immediate relief must be given. In the case 
 of death, the widow and the children are thrown as paupers 
 on the parish. The amount of burthens thus produced is fre- 
 quently so great as to render it good economy on the part of the 
 administrators of the poor-laws to incur the charges for preventing 
 the evils where they are ascribable to physical causes, which 
 there are no other means of removing. The more frequent 
 course has been, where the causes of disease are nuisances, for 
 the parish officers to indict the parties for nuisance, and to defray 
 the expenses from the poor-rates. During the last two years 
 the public has suffered severely from epidemics. At the present 
 
THE REIGN OF QUEEN VICTORIA. 181 
 
 time fever prevails to an unusually alarming extent in the ^^^.- ^• 
 metropolis, and the pressure of the claims for relief in the rural Health 
 Unions, on the ground of destitution caused by sickness, have of^i848. °^ 
 recently been extremely severe ; but in the course of the investi- 
 gations into the causes of destitution and the condition of the 
 pauperized classes, carried on under the operation of the new law, 
 and especially in the course of the investigations of the claims for 
 relief arising from the prevalent sickness, extensive and con- 
 stantly-acting physical causes of sickness and destitution have 
 been disclosed and rendered fearfully manifest. With reference 
 to the claims for relief on the ground of sickness, in the metro- 
 polis, we have directed special enquiries to be made of the 
 medical officers of the new Unions. We have also directed 
 local examinations to be made in parts of the metropolis where 
 fever was stated to be most prevalent, by Dr. Arnott, by Dr. 
 Southwood Smith (the chief physician of the London Fever 
 Hospital) and by Dr. Kay, our assistant Commissioner."'^ . . . 
 "We have eagerly availed ourselves of the opportunity of 
 making the present Report, to submit to your Lordship the 
 urgent necessity of applying to the Legislature for immediate 
 measures for the removal of these constantly-acting causes of 
 destitution and death. "All delay must be attended with ex- 
 tensive misery, and we would urge the consideration of the fact, 
 that in a large proportion of cases the labouring classes, though 
 aware of the surrounding causes of evil, have few or no means 
 of avoiding them, and little or no choice of their dwellings. — 
 The Board of Guardians have now the services of an efficient 
 body of officers, including experienced medical officers, to guide 
 them in the application of sanatory measures more efficiently 
 than was practicable by the overseers of single parishes under 
 the old system. Until more complete measures could be ob- 
 tained, and even as a temporary measure, we should recommend 
 that the guardians should be empowered to exercise the like 
 powers that have heretofore been exercised, and incur the like 
 charges that have heretofore been irregularly incurred by parish 
 officers ; that they should be empowered to indict parties respon- 
 sible for such nuisances as those described, and to make arrange- 
 ments with the owners of property, or take other measures, 
 according to circumstances, for the removal of the causes of 
 
182 ENGLISH SANITARY INSTITUTIONS. 
 
 p^' ^' ^is^^s® ^^ cases where there is no ostensible party who can be 
 
 Health required to perform that duty. So extreme has been the social 
 
 of 1848. disorder, and so abject is the poverty of some of the places 
 
 which are now the seats of disease, that great numbers of the 
 
 dwellings have been entirely abandoned by the lease-holders.^^ 
 
 In supplement to their letter, the Commissioners submitted 
 to the Secretary of State the two reports which had been made 
 to them by their medical inspectors; viz., first, a joint-report by 
 Dr. Neil Arnott and Dr. James Phillips Kay, 0?t the prevalence 
 of certain physical causes of fever in the Metropolis which 
 might he prevented hy proper sanitary measures ; and secondly a 
 report by Dr. South wood Smith, On some of the physical causes 
 of sickness and mortality to which the poor are particularly 
 exposed, and which are capable of removal by sanitary regulations, 
 exemplified in the present condition of the Bethnal Green and 
 Whitechapel Districts, as ascertained on a personal inspection. 
 
 The reports were founded in part on inspections made by 
 the reporters themselves, and in part on information derived 
 from the new Poor Law Medical Officers, — the former method 
 being more followed in Dr. Smithy's report, and the latter more 
 in the report of Drs. Arnott and Kay. The reports did not 
 pretend to reveal anything medically new; but, in regard of the 
 readers for whom they were more especially meant, they told a 
 tale equally new and important. They showed, namely, for the 
 information of Parliament, that, under parliamentary sufferance, 
 masses of population in this chief city of the world were in 
 physical circumstances which made healthy life impossible to 
 them, — that, in quarters inhabited by hundreds of thousands of 
 the labouring classes, and irrespectively of what could be blamed 
 as faulty in the personal habits of the sufferers, the general fact 
 as to lodgment was : crowding more or less dense, in courts and 
 alleys and narrow streets almost insusceptible of ventilation, in 
 dwellings which themselves were often not fit to be inhabited by 
 human beings ; while, all around the dwellings, the utter 
 absence of drainage, the utter omission of scavenging and 
 nuisance-prevention, and the utter insujfficiency of water-supply, 
 conduced to such accumulations of animal and vegetable refuse, 
 and to such pondings of ordurous liquids, as made one universal 
 atmosphere of filth and stink. In the last page of Dr. Smith's 
 
THE REIGN OF QUEEN VICTORIA. 183 
 
 supplementary statement^ made in 1839, the state of the case. Chap, x, 
 as it appeared to him and his colleagues with particular reference Health 
 to the question of Fever, was given in the following terms : — 0/1^*^°^ 
 " "While systematic efforts, on a large scale have been made to 
 widen the streets, to remove obstructions to the circulation of 
 free currents of air, to extend and perfect the drainage and 
 sewerage, and to prevent the accumulation of putrefying veget- 
 able and animal substances in the places in which the wealthier 
 classes reside, nothing whatever has been done to improve the 
 condition of the districts inhabited by the poor. These neglected 
 places are out of view, and are not thought of; their condition 
 is known only to the parish officers and the medical men whose 
 duties oblige them to visit the inhabitants to relieve their neces- 
 sities and to attend their sick ; and even these services are not • 
 to be performed without danger. Such is the filthy, close and 
 crowded state of the houses, and the poisonous condition of the 
 localities in which the greater part of the houses are situated 
 from the total want of drainage, and the masses of putrefying 
 matters of all sorts which are allowed to remain and accumulate 
 indefinitely, that during the last year, in several of the parishes, 
 both relieving officers and medical men lost their lives in conse- 
 quence of the brief stay in these places which they were obliged 
 to make in the performance of their duties. Yet in these pesti- 
 lential places the industrious poor are obliged to take up their 
 abode ; they have no choice ; they must live in what houses they 
 can get nearest the places where they find employment. By no 
 prudence or forethought on their part can they avoid the dread- 
 ful evils of this class to which they are thus exposed. No 
 returns can show the amount of suffering which they have had 
 to endure from causes of this kind during the last year ; but the 
 present returns indicate some of the final results of that suffering; 
 they show that out of 77,000 persons (in- and out-door paupers), 
 14,000 have been attacked with fever, one-fifth part of the 
 whole, and that out of the 14,000 attacked nearly 1,300 have 
 died. The public, meantime, have suffered to a far greater 
 extent than they are aware of, from this appalling amount of 
 wretchedness, sickness and mortality. Independently of the 
 large amount of money which they have had to pay in the 
 support of the sick, and of the families of the sick, pauperized 
 

 184 ENGLISH SANITARY INSTITUTIONS. 
 
 P?bU "^ ^^ consequence of the heads o£ those famiHes having become 
 Health unable to pursue their occupations^ they have suffered still more 
 of 1848. seriously from the spread of fever to their own habitations and 
 families/'' . . . '^ There can be no security against the 
 constant recurrence of this calamity, but the adoption of measures 
 adequate to diminish very materially, if not entirely to prevent, 
 the generation of the febrile poison in every district. This 
 might be done to a large extent, by an amendment of the 
 Building Act ; by carrying into the districts of the poor improve- 
 ments similar to those already completed, or now in progress, 
 in the places inhabited by the wealthier classes ; by removing as 
 far as practicable the obstacles to a free circulation of air in the 
 closest and most densely-populated neighbourhoods; by the 
 construction of underground sewers, with effectual surface- 
 drainage into them, and by the immediate removal of refuse 
 animal and vegetable matters by an efficient body of scavengers. 
 ^ The expenditure necessary to the adoption and maintenance of 
 
 these measures of prevention, would ultimately amount to less 
 than the cost of the disease now constantly engendered. The 
 most pestilential of these places, when once put into a wholesome 
 condition, could be maintained in that state at a comparatively 
 small expense ; whereas as long as they are allowed to remain 
 in their present condition, the results must continue the same ; 
 it follows, that the prevention of the evil, rather than the miti- 
 gation of the consequences of it, is not only the most beneficent 
 but the most economical course.^^ 
 
 The Poor Law Commissioners' letter^ with the medical reports 
 which accompanied it, was published as an Appendix (A) to the 
 Fourtk Report of the Commission ; and the addition afterwards 
 made by Dr. Smith, On the Prevalence of Fever in twenty Metro- 
 politan Unions and Parishes during the year ended the 20th 
 March, 1838, was published as an Appendix (C 2) to the Fifth 
 Report. 
 
 Those publications are memorable in the Public Health 
 Annals of England : not only because of the tone now first 
 taken by a central department of State with regard to local pre- 
 vention of disease, but also because of the other new precedent 
 which had been created. The duty assigned to three members of 
 
THE REIGN OF QUEEN VICTORIA. 185 
 
 the Medical Profession^ to report in a medical sense on the con- Chap. x. 
 ditions under which the London laboring poor were then living-, Health 
 was an entirely new sort o£ Government action ; and no doubt Mr. 0/^43*^°^ 
 Chadwick deserves the credit of that precedent. As a first step 
 in the modern utilisation of Medicine by the State, it is of signal 
 interest in our present record ; and that being the case, the op- 
 portunity invites a passing tribute of respect to the three pioneer 
 reporters who acted in the matter. 
 
 Dr. Neil Amott (born 1788 — died 1874) was fifty years of Dr. Neil 
 age at the time of his above mentioned report. For the last 
 twenty-seven years he had been exercising his profession in 
 London; where (though never with any professorial appoint- 
 ment) he had risen into considerable practice, and had recently 
 been appointed one of the Queen''s physicians extraordinary, as 
 well as a member of the first Senate of the University of London. 
 Before entering on London practice, he had been for four years 
 a ship-surgeon in the service of the East India Company ; and in 
 that office, to which he had been appointed at an extraordinarily 
 early age, he, besides gaining much valuable experience, medical 
 and miscellaneous, had specially distinguished himself by his 
 attention to sanitary questions, and by various successful con- 
 trivances for the benefit of health at sea. In 1838 he was well- 
 known, not only as a competent and enlightened physician, but 
 additionally as an accomplished physicist and mechanician. In 
 his later years the general public would chiefly have known him 
 as the admirably lucid author of Arnotfs Elements of ThysicSy 
 and as the deviser of the various useful contrivances — stove, ven- 
 tilator, water-bed, &c., which bore his name, and which he had 
 given patent-free to the public. He was among the truest 
 philanthropists of his day : genuinely interested in popular 
 progress, both physical and educational, and doing it good 
 service in both respects. His qualities of mind are well repre- 
 sented in two publications of his later years; — one of 1855, On 
 the Smokeless Fireplace, Chimney -valves, and other means, old 
 and new, of obtaining healthful Warmth and Ventilation ; and 
 one of 1861, entitled A Survey of Human Progress ; and par- 
 ticulars of his life, fuller than need here be given, can be found 
 in an obituary notice of him in vol. xxv. of the Proceedings of 
 the Royal Society, 
 
186 ENGLISH SANITARY INSTITUTIONS. 
 
 PubUc^' ^^' *^^^®^ Pliillips Kay (afterwards Sir J. P. Kay-Shuttle- 
 
 Health worth ; born 1804 — died 1877) had earned some early credit in 
 of 1848. his profession as the author of a physiological paper on the 
 Process of Asphyxia ; and at Manchester, where he was for some 
 Kay. years practising as physician, he had distinguished himself as a 
 
 writer (second edition in 1832) on the Moral and Fliysical Con- 
 ditions of the Worhing Classes in the town. Before the time 
 when he reported with Dr. Arnott on the Fevers of London, he 
 had entered the service of the Crown as an Assistant Poor Law 
 Commissioner; and at a later time he became more distinguished 
 in the public service as Secretary to the Committee of Council 
 on Education. 
 Southwood ^^- Thomas South wood Smith (born 1788— died 1861) had. 
 Smith. at the time of his above-mentioned reports, been for fourteen 
 years Physician to the London Fever Hospital: a fact, which 
 entitled him to speak with particular authority of the fevers of 
 the metropolis : and, apart from his technical qualifications, he 
 was much respected as a man of thought and benevolence. 
 Before entering on the medical profession, he apparently had 
 been for some years a non-conformist minister in Somersetshire, 
 — see Dr. Munk^s Roll of the College of PhysicianSy vol. iii., 
 p. 235 ; and, as in that affinity, he had in 1814 (two years 
 before he graduated M.D. in the University of Edinburgh) 
 published, under title of The Divine Government, a theological 
 treatise which seems to have been highly esteemed. He had, in 
 1832, by an essay first published in the April number of the 
 Westminster 'Review, and afterwards issued as a pamphlet on 
 The Use of the Dead to the Living, been among the promoters of 
 the Anatomy Act, which, from that time to the present has 
 regulated the supply of subjects for dissection in our medical 
 schools. He had, in the years 1833-4, acted as a Commissioner 
 (with Mr. Thomas Tooke and Mr. Chadwick) to collect informa- 
 tion in the manufacturing districts on the employment of 
 children in factories. He had in 1835, with the useful design 
 of drawing popular attention to the elementary principles of pre- 
 ventive medicine as then understood, published the first edition 
 of his Philosophy of Health: a work which had immediately 
 become influential, and which thirty years afterwards was in its 
 eleventh edition. From 1838 onward he became more and more 
 
THE REIGN OF QUEEN VICTORIA. 187 
 
 identified with the cause o£ sanitary reform,, and he has to be Chap. x. 
 gratefully remembered as one of the worthiest and most zealous Health 
 of its early promoters. During the years 1839-54 he was always o/ms/*^^ 
 Mr. Chadwick^s chief medical associate : for the greater part of 
 the last six of those years (as will hereafter appear) his associa- 
 tion with Mr. Chad wick was official ; and all which is distinctively 
 medical in the Reports of the General Board of Healthy from 
 1848 to 54j may no doubt be regarded as Dr. Smith''s teaching. 
 It is noteworthy that Dr. Smith (like Mr. Chadwick) had been 
 in intimate relations with Jeremy Bentham during his later 
 years. When Bentham, in the memorable bequest by which he 
 hoped to correct the then popular prejudice against dissection, 
 directed that his own dead body should be publicly dissected and 
 lectured over in a place of medical teaching, he appointed Dr. 
 Smith his legatee for the purpose ; and Dr. Smith accordingly, 
 on the 9th of June, 1832, delivered an address over Bentham^s 
 dissected body in Messrs. Grainger's Anatomical Theatre, Webb 
 Street, Southwark : an address, which has been for the most 
 part reproduced by Sir John Bowring in the last volume of his 
 edition of Bentham-'s works. 
 
 In 1839, when the medical reports made to the Poor Law instruction 
 Commissioners had come before Parliament, and while they were sanitary 
 receiving a certain amount of public notice, attention was drawn ^^^^^^* 
 to them in the House of Lords by the then Bishop of London, 
 Dr. Blomfield; and on his motion (Aug. 19) an Address was 
 voted, praying that the Poor Law Commissioners might be 
 instructed to cause information of like nature to be collected 
 with regard to the causes of disease prevailing among the 
 labouring population in other parts of England and Wales."^ 
 The instructions for which the motion was made were imme- 
 diately given to the Poor Law Commissioners, with, soon 
 
 * Bishop Blomfield, one of the ablest and most influential of the public men 
 of the time, and one who spoke with particular weight in questions of social 
 reform, had (as a member of the Poor Law Inquiry Commission) been intimately 
 associated with Mr. Chadwick in promoting the Poor Law Amendment Act, 
 and afterwards, retaining always the highest opinion of Mr. Chadwick, kept 
 up habitual communication with him on questions of the present sort. I 
 understand that his motion, mentioned in the text, was made at Mr. Chadwick'a 
 suggestion. 
 
188 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. X. afterwards^ an additional instruction that the inquiry should be 
 Health extended to Scotland ; and the Commissioners^ thus instructed, 
 ^/f848*^°^ forthwith began the proposed inquiry. With regard to England 
 and Wales, they directed their several Assistant-Commissioners, 
 each for his district, to report to them on such parts of the 
 subject as were within his observation, and in certain cases to 
 invite special reports from eminent medical practitioners of chief 
 places j and they also addressed letters to the several Boards of 
 Guardians and their respective medical officers throughout the 
 country, requesting information in answer to certain queries. 
 With regard to Scotland, they in like manner appealed for 
 information to the Provosts of Burghs and, through them, to 
 officers of Medical Charities and to other medical practitioners. 
 It was not till three years later that the results of this very 
 extensive inquiry were published ; and, before they are further 
 spoken of, it will be well to notice other effects which in the 
 meantime were accruing from the original momentum of 1838-9. 
 
 Select Com. In 1840, Feb. 4, there took place in the House of Commons 
 Commons, a very diffuse, but not uninteresting, debate on the then social 
 circumstances of the people : the occasion being, that Mr. Slaney 
 had moved for a Select Committee " to inquire into the causes 
 of discontent among great bodies of the working classes in 
 populous districts, with a view to apply such remedies as the 
 wisdom of Parliament can devise, or remove as far as possible 
 any reasonable grounds of complaint, in order thereby to 
 strengthen the attachment of the people to the institutions of the 
 country.''^ Mr. Slaney stated, as his view, that the people had 
 the following three grounds for discontent : — first (and in 
 regard of this grievance he seems to have entirely rested his 
 case on the above-described reports of 1838-9) — ''^the want 
 of legislative provision for the preservation of their health, and 
 the comfort of their houses '' ; secondly, '' the want of provision 
 against the fluctuations which constantly occurred in the com- 
 merce of the country " ; and thirdly, " the want of religious 
 instruction and education/^ Mr. Smith O^Brien, who seconded 
 the motion, went into questions of the franchise, the currency, 
 the corn-laws, emigration, &c. ; and in the debate many refer- 
 ences were of course made to the ^'^ chartism ^■' of the time. 
 
THE REIGN OF QUEEN VICTORIA. 189 
 
 Objections were very naturally raised to tlie wide scope of the Chap, x. 
 resolution, — that inquiry was proposed into fifteen different 
 objects, — that it would be an inquiry into almost every object of 
 existing legislation, &c. As to the alleged discontent, Mr. Charles 
 Villiers keenly suggested that perhaps not so much the ^^ ignor- 
 ance ''■' as the " intelligence '' of the people was a cause of it ; and 
 Mr. Joseph Hume " must say '' that the noble Lord, who had 
 excited vain expectations of parliamentary reform, was himself 
 one of the causes. Finally, the noble Lord himself (John 
 Russell) objected to the political tendency of the motion : '' as 
 to the civil condition of the working classes he had no objection 
 to an inquiry, but he thought it not wise to institute inquiries 
 into their political condition.'''' So Mr. Slaney withdrew his 
 motion, saying that he would bring it forward in a different 
 shape; and accordingly soon afterwards (March 1%) referring 
 to only the first of his former three subject-matters, he moved 
 for a Select Committee, ^^to inquire into the circumstances 
 affecting the health of the inhabitants of large towns, with a 
 view to improved sanitary arrangements for their benefit.'''' This 
 motion was agreed to, and five days afterwards the Committee 
 was appointed."^ It sat for three months, taking evidence, 
 and then (June 17) made its report. Its most important 
 positive recommendations were to the following effect: — (1) 
 that there ought to be a general Buildings Act ; (2) that there 
 ought to be a general Sewerage Act; (3) that in every town 
 of a certain population there ought to be a standing Board of 
 Health, partly medical, which should observe the health of the 
 town, should move the local commissioners of sewers or other 
 authority in relation to nuisances, should suggest remedies, and 
 should from time to time report to the Secretary of State or 
 other central authority ; and (4) that in every large town there 
 ought to be an Inspector to enforce regulations for sanitary 
 purposes. The report suggested that, in order to escape the 
 costliness of private Acts of Parliament, a plan (like that of 
 cap. 82 of 9th Geo. IV. relating to Ireland) might be adopted : 
 
 * See Times of March 13th and 18th, 1840. Those two votes of the House 
 of Commons are I believe the earliest made by the House in the present subject- 
 matter ; and, in view of that historical interest which they have, I find it note 
 worthy that neither of them is mentioned in the columns of Hansard, though 
 the debate of Feb. 4 had been reported there. 
 
190 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. X. the enactment^ namely, of general sanitary provisions wliicli 
 Health shouM admit of being applied to particular places by an optional 
 o/i848/°^ local vote, "^he Report also adverted to the following as objects 
 which, in the interests of the public health, needed consideration : 
 burial-grounds, water-supply, public open spaces, lodging-houses, 
 baths, and local powers for clearing and improving sites. 
 PubUcVac- The year 1840, too, deserves particular notice with regard to 
 established that special section of Health-Law which intends the prevention 
 ^^*^' of smallpox: for in 1840, the Act 3rd and 4th Vict. c. 29, which 
 
 was passed at the motion of the Poor Law Commissioners, began 
 the present system of gratuitous public vaccination. It pro- 
 vided, namely, that thenceforth vaccination at the public cost 
 should be obtainable of local authorities in every parish of 
 England and Wales ; and in the following year, a supplementary 
 Act, as to the expenses of the service, enacted, that the 
 gratuitous vaccination (though furnished by Poor Law Guardians 
 and Overseers) should not, for any public purpose, be deemed, 
 a disqualifying parochial relief. 
 House of Early in 1842, some months before the completion of the 
 
 Commons ... . 
 
 Select Com. large general inquiry which had been ordered, a special branch 
 in Towns, of Sanitary reform had been taken up by Mr. Mackinnon in the 
 House of Commons. He namely, March 8, moved for a Select 
 Committee " to consider the expediency of framing some legis- 
 lative enactments (due respect being paid to the rights of the 
 clergy) to remedy the evils arising from the interment of bodies 
 within the precincts of large towns or of places densely populated." 
 This motion having been carried, the Committee which was in 
 consequence appointed, sat for three months, to receive evidence 
 of the alleged evils, and then (June 14) reported. It recom- 
 mended that Government should propose legislation against the 
 practice, but at first only with regard to places of more than 
 50,000 inhabitants : the legislation to prohibit after a certain 
 date with some exceptions all burial within the limits of the 
 places, and to give the authorities in the places power and 
 obligation to make exterior cemeteries. 
 
 Keportson In the summer of 1842, the results of the general inquiry 
 The general which the vote of the House of Lords of August 19th, 1839, had 
 
 inquiry. . .,.. ii'i 
 
 occasioned were ready for publication, and having been communi- 
 
THE KEIGN OF QUEEN VICTORIA. 191 
 
 cated to the Home- Secretary by the Poor Law Commissioners Chap, x 
 (date July 9th) were at once by Her Majesty's Command laid Health 
 before Parliament. They were in three volumes : two being of of®f848*^°^ 
 local reports^ respectively for England and Scotland, while the 
 other, which was founded in main part on them, treated generally 
 of the sanitary condition of the labouring population of Great 
 Britain, and of the means deemed suitable for improving it. The 
 English Local Reports from the Assistant Commissioners and 
 others (in addition to the detailed answers which had been 
 received from Boards of Guardians in quantity too great for pub- 
 lication) were twenty-four in number. The Scotch Local Reports, 
 including two particularly instructive papers on the State of the 
 Law in Scotland, and including also a remarkable paper by 
 Professor Alison on the Generation of Fever, with Observations 
 on it by Dr. Neil Arnott, were eighteen. The synoptical volume, Mr. Chad- 
 the General Report on the Sanitary Condition of the Labouring General 
 Population of Great Britain ^ was the work of Mr. Chad wick, ^®P°^- 
 and was issued by the Commissioners as distinctively his : they, 
 it was understood, not wishing to stand committed to the con- 
 clusions of their Secretary in a field so unfamiliar to themselves. 
 Mr. Chadwick^s report (372 pages of text with 85 of appendix) 
 has nine sections, headed as follows : — i. General condition of 
 the residences of the labouring classes where disease is found to 
 be most prevalent, ii. Public arrangements external to the 
 residences, by which the Sanitary Condition of the Labouring 
 Population is affected, iii. Circumstances, chiefly in the internal 
 economy and bad ventilation of places of work, workmen''s 
 lodging-houses, dwellings, and the domestic habits, affecting the 
 health of the labouring classes, iv. Comparative chances of life 
 in different classes of the Community, v. Pecuniary burdens 
 created by the neglect of sanitary measures, vi. Evidence of 
 the effects of preventive measures in raising the standard of 
 health and the chances of life. vii. Recognised princij^les of 
 legislation and state of the existing law for the protection of the 
 public health, viii. Common lodging-houses the means of pro- 
 pagating disease and vice. ix. Recapitulation of Conclusions. 
 In the last of these sections, the chief conclusions which the 
 evidence appeared to Mr. Chadwick to establish are stated by 
 him in the following terms : 
 
192 x-^' ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. X. ^ .y*f First, as to the extent and operation of the evils which are the 
 Public , . . "^ 
 
 Health suhject of the inquiry : — 
 
 o/i848.^°^ ^^That the various forms of epidemic, endemic, and other 
 disease caused, or aggravated,- or propagated chiefly amongst the 
 labouring classes by atmospheric impurities produced by decom- 
 posing animal and vegetable substances, by damp and filth, and 
 close and overcrowded dwellings prevail amongst the population 
 in every part of the Kingdom, whether dwelling in separate 
 houses, in rural villages, in small towns, in the larger towns 
 — as they have been found to prevail in the lowest districts of 
 the Metropolis : 
 
 "That such disease, wherever its attacks are frequent, is 
 always found in connexion with the physical circumstances 
 above specified, and that where those circumstances are removed 
 by drainage, proper cleansing, better ventilation, and other 
 means of diminishing atmospheric impurity, the frequency and 
 intensity of such disease is abated ; and where the removal of 
 the noxious agencies appears to be complete, such disease almost 
 entirely disappears : 
 
 '^ That high prosperity in respect to employment and wages, 
 and various and abundant food, have afforded to the labouring 
 classes no exemptions from attacks of epidemic disease, which 
 have been as frequent and as fatal in periods of commercial and 
 manufacturing prosperity as in any others : 
 
 ^^ That the formation of all habits of cleanliness is obstructed 
 by defective supplies of water : 
 
 " That the annual loss of life from filth and bad ventilation is 
 greater than the loss from death or wounds in any wars in which 
 the country has been engaged in modern times : 
 
 ^^ That of the 43,000 cases of widowhood, and 112,000 cases of 
 destitute orphanage relieved from the poor^s rates in England 
 and Wales alone, it appears that the greatest proportion of deaths 
 of the heads of families occurred from the above specified and 
 other removable causes ; that their ages were under 45 years ; 
 that is to say, 13 years below the natural probabilities of life as 
 shown by the experience of the whole population of Sweden : 
 
 '^ That the public loss from the premature deaths of the heads 
 of families is greater than can be represented by any enumeration 
 of the pecuniary burdens consequent upon their sickness and death : 
 
THE REIGN OF QUEEN VICTORIA. 193 
 
 ^^That, measuring the loss of working ability amongst large Chap. X. 
 classes by the instances of gain, even from incomplete arrange- Health 
 ments for the removal of noxious influences from places of work o/f^48*^°^ 
 or from abodes, this loss cannot be less than eight or ten years : 
 
 ^'^That the ravages of epidemics and other diseases do not 
 diminish but tend to increase the pressure of population : 
 
 '^ That in the districts where the mortality is the greatest the 
 births are not only sufficient to replace the numbers removed by 
 death, but to add to the population : 
 
 " That the younger population, bred up under noxious physical 
 agencies, is inferior in physical organization and general health 
 to a population preserved from the presence of such agencies : 
 
 '^ That the population so exposed is less susceptible of moral 
 influences, and the effects of education are more transient than 
 with a healthy population : 
 
 ^^ That these adverse circumstances tend to produce an adult 
 population short-lived, improvident, reckless, and intemperate, 
 and with habitual avidity for sensual gratifications : 
 
 ^^ That these habits lead to the abandonment of all the conveni- 
 ences and decencies of life, and especially lead to the overcrowd- 
 ing of their homes, which is destructive to the morality as well 
 as the health of large classes of both sexes : 
 
 '^That defective town-cleansing fosters habits of the most 
 abject degradation and tends to the demoralisation of large 
 numbers of human beings, who subsist by means of what they 
 find amidst the noxious filth accumulated in neglected streets 
 and bye-places : 
 
 "That the expenses of local public works are in general 
 unequally and unfairly assessed, oppressively and uneeonomically 
 collected, by separate collections, wastefuUy expended in separate 
 and inefficient operations by unskilled and practically irresponsible 
 officers : 
 
 '^ That the existing law for the protection of the public health 
 and the constitutional machinery for reclaiming its execution, 
 such as the Courts Leet, have fallen into desuetude, and are in 
 the state indicated by the prevalence of the evils they were 
 intended to prevent : 
 
 *^ Secondly, as to the means hy wJiicJi the present sanitary 
 condition of the labouring classes may he improved : — 
 
194 ENGLISH SANITARY INSTITUTIONS. 
 
 p^bf * ^' " That the primary and most important measures, and at the 
 
 Health same time the most practicable, and within the recognised 
 
 of 1848. province of public administration, are drainage, the removal o£ 
 
 all refuse of habitations, streets, and roads, and the improvement 
 
 of the supplies of water : 
 
 " That the chief obstacles to the immediate removal of decom- 
 posing refuse of towns and habitations have been the expense 
 and annoyance of the hand-labour and cartage requisite for the 
 purpose : 
 
 " That this expense may be reduced by one-twentieth or to 
 one-thirtieth, or rendered inconsiderable, by the use of water and 
 self-acting means of removal by improved and cheaper sewers 
 and drains : * 
 
 ^^ That refuse when thus held in suspension in water may be 
 most cheaply and innoxiously conveyed to any distance out of 
 towns, and also in the best form for productive use, and that 
 the loss and injury by the pollution of natural streams may be 
 avoided : 
 
 "That for all these purposes, as well as for domestic use, 
 better supplies of water are absolutely necessary. 
 
 '^ That for successful and economical drainage the adoption 
 of geological areas as the basis of operations is requisite : 
 
 " That appropriate scientific arrangements for public drainage 
 would afford important facilities for private land-drainage, which 
 is important for the health as well as sustenance of the labouring 
 
 " That the expense of public drainage, of supplies of water 
 laid on in houses, and of means of improved cleansing would be 
 a pecuniary gain, by diminishing the existing charges attendant 
 on sickness and premature mortality : 
 
 '^ That, for the protection of the labouring classes and of the 
 ratepayers against inefficiency and waste in all new structural 
 arrangements for the protection of the public health, and to 
 ensure public confidence that the expenditure will be beneficial, 
 securities should be taken that all new local public works are 
 devised and conducted by responsible officers qualified by the 
 possession of the science and skill of civil engineers : 
 
 *' That the oppressiveness and injustice of levies for the whole 
 
 * See "below, page 210. 
 
THE REIGN OF QUEEN VICTORIA. 195 
 
 immediate outlay on sucli works upon persons who have only Chap. x. 
 
 ^Public* 
 
 short interests in the benefits may be avoided by care in spreading Health 
 the expense over periods coincident with the benefits : o/i848. °^ 
 
 "That by appropriate arrangements, 10 or 15 per cent, on the 
 ordinary outlay for drainage might be saved, which on an estimate 
 of the expense of the necessary structural alterations of one-third 
 only of the existing tenements would be a saving of one million 
 and a half sterling, besides the reduction of the future expenses 
 of management : 
 
 " That for the prevention of the disease occasioned by defective 
 ventilation, and other causes of impurity in places of work and 
 other places where large numbers are assembled, and for the 
 general promotion of the means necessary to prevent disease, that 
 it would be good economy to appoint a district medical ofiicer 
 independent of private practice, and with the securities of special 
 qualifications and responsibilities to initiate sanitary measures 
 and reclaim the execution of the law : 
 
 "That by the combinations of all these arrangements, it is 
 probable that the full ensurable period of life indicated by the 
 Swedish table; that is, an increase of 13 years at least, may be 
 extended to the whole of the labouring classes : 
 
 " That the attainment of these and the other collateral advan- 
 tages of reducing existing charges and expenditure are within 
 the power of the legislature, and are dependent mainly on the 
 securities taken for the application of practical science, skill, and 
 economy in the direction of local public works : 
 
 " And that the removal of noxious physical circumstances, and 
 the promotion of civic, household, and personal cleanliness, are 
 necessary to the improvement of the moral condition of the 
 population ; for that sound morality and refinement in manners 
 and health are not long found co- existent with filthy habits 
 amongst any class of the community/'' 
 
 Mr. Chad wick further suff^ests " that the principles of ^y-, Chad- 
 
 °° \ . wick on 
 
 amendment deduced from the inquiry will be found as applic- Burial in 
 able to Scotland as to England. . . . The advantages of uni- 
 formity in legislation, and in the executive machinery, and of 
 doing the same things in the same way (choosing the best), and 
 calling the same officers, proceedings, and things by the same 
 names, will only be appreciated by those who have observed the 
 N 2 . 
 
196 ENGLISH SANITARY INSTITUTIONS. 
 
 S^' ^' extensive public loss occasioned by tlie legislation for towns 
 Health wbich makes them independent of beneficent, as of what perhaps 
 of 1848. might have been deemed formerly aggressive legislation/^ 
 
 The subject of Burial in Towns had had no special place in 
 the general inquiry, and had not been treated by Mr. Chadwick 
 in his general report ; but now, in view of the recent report of 
 Mr. Mackinnon's Select Committee, the Home- Secretary (Sir 
 James Graham) requested Mr. Chadwick to give particular atten- 
 tion to the subject; and the result was, that, in 1843, Mr. 
 Chadwick supplemented his general report by a special Report on 
 the Practice of Interments in Towns. In this supplementary 
 report, he not only gave ample confirmation to the Select Com- 
 mittee's advice for the discontinuance of interment in towns, but 
 also dealt in detail with various other social relations of death. 
 ^He particularly shewed how often in the families of the poor 
 each death which occurs is made additionally painful through 
 the expensiveness of funerals, and through the inability of the 
 poor to provide for the early removal of dead bodies from the 
 room (often the single living-and- sleeping rooms) occuj)ied by 
 survivors ; and, again, he shewed how often among the poor a 
 very dangerous inducement to secret murder was being afforded 
 by burial-clubs as then conducted. In the latter connexion, and 
 especially with a view to the verification of alleged causes of 
 death, he emphasised and developed the suggestion which he had 
 made in the General Report, for the appointment of independent 
 Officers of Health ; and, in that and other senses, in result of the 
 special inquiry, he advocated very extensive changes in our 
 . national system of dealing with the dead. 
 
 Meanwhile the public had begim to recognise the exceptional 
 and really momentous importance of the three-volume Report of 
 184^. Especially the volume which was Mr. Chadwick^s work 
 passed rapidly into common circulation : rumour ran that nearly 
 10,000 copies of it were distributed by sale or gift : and for 
 many years it continued to be held in high esteem, both at home 
 and abroad, as a model of initiative industry and intelligence in 
 the promotion of a great social interest. 
 
 BoyaiCom- The political fruits of the inquiry had now by decrees ta 
 
 mission, . ^ J ^ o 
 
 1843-5. come. Sir James Graham as Home-Secretary, and Sir Robert 
 
THE REIGN OF QUEEN VICTORIA. 197 
 
 Peel as Prime Minister, were eminently not the men to underrate Chap, x, 
 the importance of such representations as had been la/id before Health 
 them on competent authority with regard to the want of proper oli848*^°^ 
 Health-Laws for the Kingdom; but neither could they regard 
 as a light thing that the proposal virtually before them was to 
 call into jexistence an indefinitely extensile new branch of govern- 
 ment ; '^nd no doubt it was in this view of the gravity and diffi- 
 culty of the question, and of the necessity for testing to the 
 utmost the case which had to be submitted to Parliament, that 
 the Ministers who had Mr. Chadwick^s reports before them 
 determined not immediately to propose legislation for the 
 Public Health, but first to obtain the judgment of a carefully 
 chosen Royal Commission on the chief requirements of the case. 
 Accordingly, by patent of May 9th, 1843, Her Majesty ap- 
 pointed the following persons to be Commissioners : Duke of 
 Buccleuch, chairman, Lord Lincoln, Mr. Slaney, Major Graham, 
 Sir Henry de la Beche, Mr. Lyon Playfair,"^ Mr. David Boswell 
 Reid, Professor Richard Owen^, Captain Denison, Dr. James 
 Ranald Martin, Mr. James Smith, Mr. Robert Stephenson, and 
 Mr. William Cubitt, with Mr. Henry Hobhouse to be secretary : 
 for the purpose of '' inquiring into the present state of large 
 towns and populous districts in England and Wales with refer- 
 ence to the Causes of Disease among the Inhabitants, and into 
 the best means of promoting and securing the Public Health 
 under the operation of the Laws and Regulations now in force, 
 and the usages at present prevailing with regard to the drainage 
 of lands, the erection, drainage and ventilation of buildings, and 
 the supply of water in such towns and districts, whether for the 
 purposes of health, or for the better protection of property from 
 fire; and how far the public health, and the condition of the 
 poorer classes of the people of this realm, and the salubrity and 
 safety of their dwellings, may be promoted by the amendment of 
 such Laws, Regulations and Usages. "'^ 
 
 The inquiry thus ordered was at once begun, and in due time 
 the results were laid before Parliament in two reports : the first, 
 dated June 27, 1844; and the second dated February 3, 1845. 
 The Commissioners, when they entered on their business, seem 
 
 * Of the Royal Commissioners of 1843-5, only two are still living; Mr. Lyon 
 Playfair, now Et. Hon., K.C.B. ; and Professor Eichard Owen, now K.CB. 
 
198 ENGLISH SANITARY INSTITUTIONS. 
 
 p^u ^ almost at once to have perceived that it could only end in con- 
 Health firming the substance o£ Mr. Chadwick^s representations, and 
 of 1848. perhaps with his assistance somewhat developing them ; and so, 
 from an early period, Mr. Chadwick was treated by the Com- 
 mission, not as a witness in contentious matter, but as a 
 colleague working confidentially with them towards their 
 judgment.^ 
 
 Necessarily the inquiry wa& followed on the lines which Mr. 
 Chadwick had already traced. The Commission had first to verify 
 the reality of the alleged evils ; and, when it had seen proofs 
 enough of the general want of better law and administration for 
 local purposes affecting health, it next had to investigate in 
 various points of view, financial, engineering, and administra- 
 tive, whether it could propose, an effective remedial system 
 whicli would not be of immoderate cost. With regard to the 
 evils, the Commission invited contribution of some further local 
 reports (such as had previously been furnished to the Poor Law 
 Commissioners) and it also examined a few medical witnesses : 
 but its more distinctive action was that it took for its own 
 particular study fifty chief English towns, having a high rate of 
 mortality, and containing among them a population of more than 
 three millions of persons : and that each of these fifty towns, 
 besides being inquired about by letter, was inspected and re- 
 ported on by some one of the Commissioners. At the same 
 time, since considerations of expense had often been urged as 
 reasons against sanitary improvement, the Commission gave 
 special attention to the pecuniary difficulties of the case : not 
 only to those which (regarding actual amounts of cost) raised 
 question as to the reducibility of the charges, but likewise to those 
 which (regarding the incidence of the cost) raised questions 
 whether improvements could be made in the methods of local 
 taxation for such purposes : and the Commission, in this part of 
 its inquiry, endeavoured to compare the costs which under an 
 improved system would be necessary for the prevention of disease 
 
 * Sir E. Chadwick has told me that, in planning and conducting the inquiry, 
 he was the habitual assistant of the Chairman and Secretary, that he " precog- 
 nised" all the witnesses for examination, that he accompanied several of the 
 Commissioners in their tours of inspection, and that, when the Commission 
 reported, their First Keport, and the Recommendations of their Second, were of 
 his drafting. 
 
THE REIGN OF QUEEN VICTORIA. 199 
 
 with the costs which the existing system, and its unprevented Chap. x. 
 
 ,. . . Public 
 
 aiseases_, were occasioning. Health 
 
 In matters of a medical kind^ the Commission did not o/f848.*^°^ 
 establish anything materially new; but^ by its own very 
 extensive local visitations, as well as by renewed testimony from 
 Dr. Arnott and Dr. Southwood Smith, and by important state- 
 ments from other medical witnesses — Dr. Guy, Mr. Toynbee, 
 Dr. Aldis, Dr. Rigby and Mr. N. B. Ward, it powerfully con- 
 firmed the already existing case. In the various other directions 
 of the inquiry, valuable information was supplied by skilled 
 witnesses, who spoke with authority on questions of municipal 
 administration and finance, on the engineering principles of town- 
 improvement, on the economics of refuse-removal, on the 
 mechanics of drainage and water-supply, on the obstacles to 
 house-improvement, and so forth; and who, in several cases, 
 testified from large experience, both as to the power of local 
 unskilfulness and n on -organisation, to augment the cost and 
 hinder the advantage of sanitary undertakings, and likewise as 
 to the savings of cost and the augmentations of convenience 
 which proper local organisation with skilful service would 
 ensure. 
 
 In the two Reports of the Commission, with their abundant 
 Appendices of evidence, full exposure was made of the various 
 flagrant insufficiencies which were found in '^ the laws and regu- 
 lations then in force, and the usages then prevailing, with regard 
 to the drainage of land, the erection, drainage and ventilation of 
 buildings, and the supply of water ■'^; and in the Second Report 
 the Commission, having completed its statement of evils, 
 unanimously proposed its scheme of remedial measures. It 
 emphatically gave as its opinion : ^^ that new legislative measures, 
 applicable to all towns and populous districts, are required for 
 the introduction and maintenance not only of an efficient and 
 economical system of house-drainage and sewerage, paving and 
 cleansing, in all towns and populous districts, but also for pro- 
 viding ample supplies of water for public and private purposes, 
 and for the adoption of other means for promoting and securing 
 the health and comfort of the inhabitants.''-' ■ "^n proceeding to 
 consider the principles on which the legislation should be based, 
 it proposed, as of first necessity, ^^ that the Crown should have 
 
. 200 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. X. power to inspect and supervise the execution of all general 
 Health measures for the sanatory regulations of large towns and populous 
 o/i848*^°^ districts, that the local authorities intrusted with the execution 
 of such measures should be armed with additional powers, and 
 that the districts placed under their jurisdiction should in many- 
 cases be enlarged, and made co-extensive with the natural areas 
 for drainage/'' It ^^recommended that the necessary arrange- 
 ment for drainage, paving, cleansing, and an ample supply of 
 water (the most important matters conducive to health) should be 
 placed under one administrative body/' It also urged ^' the 
 necessity of some general sanatory regulations relative to build- 
 ings and the width of streets, and that low lodging-houses should 
 be placed under public inspection and control/^ For the purpose 
 of giving effect to these general principles, the Commission made 
 thirty particular recommendations, relating in detail to the 
 various powers and duties, iBnancial and other, propose^ for the 
 local authorities; with provision as to all the more important 
 matters (including the appointment of skilled officers) that the 
 local action must have the approval of the Crown; and with 
 provision that, in cases of local insufficiency of action, the Crown 
 should have power to enforce on the local authority due execution 
 of the law. In short, then, the Commission had entirely con- 
 firmed Mr. Chadwick's account of existing evils, and had approved 
 in substance the remedial scheme suggested by him. 
 
 Immediate The Report of the Commission being such as described, 
 
 proposals, there followed, as matter of course, that the Government took 
 steps to give effect to it. In the Queens's Speech, which oj)ened 
 the parliamentary session of 1845, the Report had been an- 
 nounced as immediately to be laid before Parliament, and 
 particular hope had been expressed "that the information and 
 suggestions given in it would enable Parliament to devise the 
 means of promoting the health and comfort of the poorer classes 
 of [Her Majesty^s] subjects.''^ Before the end of the session, 
 accordingly, a very comprehensive Government Bill, such as the 
 Royal Commission had recommended, " for the improvement of 
 the sewerage and drajnage of towns and populous districts, 
 and for making provision for an ample supply of water, and 
 for otherwise promoting the health and convenience of the 
 
THE REIGN OF QUEEN VICTORIA. 201 
 
 inhabitants/-' was introduced by the Earl of Lincoln * in the ^^^K- ^• 
 House of Commons (Bill No. 574 of the Session) with intention Health 
 that it should be considered by the public during the approach- o/f848.*°^ 
 ing" recess, and be re-introduced early in the next session of 
 Parliament. Lord Lincoln^s intention of proceeding with the 
 Bill in the session of 1846 was defeated (under circumstances 
 which are part of common history) by the famous resignation of 
 the great minister under whom he served : a defeat, not without 
 compensation to those who were caring for the health of the 
 people, since hardly any greater sanitary gift could have come to 
 the poorer millions of the nation than that steady cheapening 
 of their daily bread which the Corn Importation Act of this 
 session secured to them. In 1846, too, though no progress . 
 could be made with the complicated task which Lord Lincoln's 
 Health of Towns Bill had set in view, two simpler sanitary pro- 
 blems were tentatively dealt with, at the instance of the Govern- 
 ment, by the passing of a temporary Act, 9th and 10th Vict., c. 96, 
 as to the Removal of Nuisances and the Prevention of Epidemic 
 diseases. In the same session, moreover, was passed the very 
 notable Act which first enabled local authorities to establish public 
 baths and washhouses.f In the session of 1847 the intention 
 of a Health of Towns Bill on the lines suggested by the Boyal 
 Commission, was taken up by the Russell Ministry; and on 
 March 30th Viscount Morpeth (afterwards seventh Earl of 
 Carlisle) who had succeeded to Lord Lincoln^s office as First 
 Commissioner of Woods and Forests, introduced such a Bill in 
 the House of Commons. 
 
 Before further reference to this Bill, which represented the l^ocal Im- 
 views of the then Government as to what should be made law for andTaSdel- 
 
 Clauses 
 Consolida- 
 
 * Lord Lincoln, afterwards Duke of Newcastle, and, under that title, the tion Acts. 
 Colonial Secretary of Lord Aberdeen's 1852-5 Administration, was in 1845-6 the 
 First Commissioner of Woods and Forests under Sir Eobert Peel. 
 
 t This admirable Act, specially in the interests of the labouring classes, was 
 mainly due to the exertions of an Association for Promoting Cleanliness amongst 
 the Poor, which had been founded two years previously, and which, first, by 
 an instructive trial of Free Baths and Washhouses in the neighboui-hood of the 
 London Docks, and afterwards by carrying on a Model Establishment of (paying) 
 Baths and Washhouses in Gordston Square, Whitechajjel, led the public to see 
 how greatly such establishments were needed, and how readily they could be 
 made self-supporting. See the article " Baths and Washhouses, Public," in the 
 Arts and Sciences Division of Knight's English Cyclopcedia. 
 
202 ENGLISH SANITARY INSTITUTIONS. 
 
 p^' ^' ^^^ country at large, it has to be noted that, apart from any action 
 Health by Government, other endeavours towards sanitary reform were 
 of 1848. already being made in England. Stimulus to that effect may 
 probably have dated in some degree from the first cholera-period 
 of 1831-2 ; but no doubt the chief momentum came from Mr. 
 Chadwick''s publication of 1842, and from the subsequent Report 
 of the Health of Towns Commission. The exhibition, which 
 had been made of the deplorable want of common sanitary pro- 
 visions in the towns and other populous districts reported on, 
 had roused various towns to see that they ought to exert them- 
 selves to remove the reproach : and, under influence of this 
 opinion, such towns had proceeded to obtain Acts of Parliament 
 giving them independent powers (larger or smaller) for improve- 
 ment purposes. Meanwhile, however, and particularly in con- 
 nection with the new and difficult subject-matter of legislation 
 for railways, the attention of Parliament had been drawn (chiefly 
 by Mr. Joseph Hume) to the vast public inconvenience which 
 would gradually arise, if different private Acts of Parliament for 
 substantially like purposes were not made to consist of sub- 
 stantially like provisions expressed in substantially like terms ; 
 and in order to guard against that inconvenience in railway 
 legislation. Acts of Parliament had been passed containing 
 schemes of Model Clauses suitable for optional incorporation in 
 private bills. Such were the three Acts passed in 1845, known 
 as the Companies Clauses Consolidation Act, the Lands Clauses 
 Consolidation Act, and the Railway Clauses Consolidation Act. 
 ^In 1847, when evidence had arisen of the rapidly increasing 
 desire of towns to obtain adequate powers of self-government for 
 sanitary purposes, and while effect had yet to be given in that 
 direction to the recommendations of the Health of Towns Com- 
 mission, Parliament, on the motion of Government, followed the 
 analogy of 1845 by passing a series of Clauses Consolidation 
 Acts applicable at option to the various sanitary and other 
 purposes of town-government. Such was the Act 10th and 11th 
 Vic. c. 34, commonly called the Towns Improvement Clauses 
 Act, 1847, which set forth in 216 sections the provisions usually 
 contained in Acts for paving, draining, cleansing, lighting and 
 improving towns. Such again were the Markets and Fairs 
 Clauses Act, 1847, of 59 sections ; the Gas Works Clauses Act, 
 
THE EEIGN OF QUEEN VICTORIA. 203 
 
 1847, of 49 sections ; the Commissioners Clauses Act, 1847^ o£ Chap. x. 
 112 sections; the Water Works Clauses Act, 1847, of 94 Health • 
 sections; the Cemeteries Clauses Kdy 1847, of 68 sections; and o/i848/°^ 
 the Totvns Police Clauses Act, 1847, of 79 sections. A provision 
 in each of those public Acts was, that the private Act of any 
 town or populous district might declare the public Act to be 
 incorporated with it : which having been declared, all the clauses, 
 save so far as expressly varied or excluded by the private Act, 
 became (so far as applicable) applied to the particular object 
 of the private Act : the intention of the public Acts, as stated 
 in their respective preambles, being, " as well for avoiding the 
 necessity of repeating such provisions in each of the several 
 [private] Acts relating to such towns or districts, as for ensuring 
 greater uniformity in the provisions themselves/'' Those various 
 Consolidation Acts of 1847, having in general been planned in 
 the spirit of the recommendations of the Health of Towns 
 Commission, came into extensive use in subsequent private-bill 
 legislation for sanitary purposes; and if not always adoptable 
 in mass by the framers of local bills always at least suggested 
 to them the provisions which were most needful."^ 
 
 Lord Morpeth's Health of Towns Bill of 1847 had as one ParKamen- 
 
 ^ . tary Pro- 
 
 of its features, that it proposed to make a very large use of those ceedings of 
 
 Clauses Consolidation Acts; but, excellent though the con- 
 trivance had been for the purposes of private bills, it perhaps 
 was not in the then circumstances equally suited to the dignity 
 or convenience of general legislation ; and strong objection was 
 taken to Lord Morpeth's Bill on the ground that it would have 
 incorporated without immedi^ste parliamentary criticism 790 
 clauses from other statutes, besides this objection raised to the 
 form of the Bill, objections were raised to its substance : partly 
 because it was thought to be of too centralising a policy ; partly 
 because it included (and subsequently because it did not in- 
 clude) the Metropolis ; partly because it alarmed some pecuniary 
 
 * Among the model clauses thus suggested for adoption in towns, was one, 
 which had been clause 175 of Lord Lincoln's Bill, and to which the text will 
 hereafter more particularly refer : a clause providing for the appointment of 
 Medical Officers of Health in town districts, as recommended by Mr. Chadwick 
 in 1842, and by the Eoyal Commission in 1845. 
 
204 ENGLISH SANITARY INSTITUTIONS. 
 
 p^* ^' iii'^Gi'Gsts ^ ; partly and perhaps chiefly, because in its mere 
 Health novelty it was an offence to those prejudices and vague timidities 
 of 1848. which at first resist all new legislation : and though Lord 
 Morpeth made considerable concessions to his opponents, and 
 succeeded in getting the House into Committee on his Bill, 
 progress was so retarded by those various forces of friction, that 
 on July 8th the order for further consideration of the Bill 
 had (on motion by the Prime Minister) to be discharged. In 
 the following Session, however. Lord Morpeth made a second, 
 and more successful, attempt. His new Bill, introduced Feb. 10, 
 1848, was not less ppposed than the preceding one : but Lord 
 Morpeth was deservedly a favourite on both sides of the House 
 of Commons ; and also, though he was quite in earnest as to the 
 main purposes of the Bill, he was ready, on all secondary 
 questions, to meet his opponents with conciliation : so, after 
 long discussion in Committee during the month of May, the 
 Bill, reported with amendments, reached the House of Lords 
 before the end of June. In the House of Lords (where it was 
 referred to a Select Committee) it received some changes, not all 
 of which were found acceptable by the House of Commons : but 
 agreement between the Houses was eventually obtained, and on 
 the last day of August the Bill received royal assent as " The 
 Public Health Act, 1848.''^ In this same session, too, the general 
 principles which had been provisionally accepted in 1846, with 
 regard to facilities to be everywhere given for the summary 
 abatement of nuisances affecting health, and with regard to 
 regulative powers to be exercised by the central authority on 
 occasions when there should be any exceptional threatening of 
 epidemic disease, were re-affirmed by Parliament, and were 
 embodied as permanent law (with amended provisions as to 
 machinery) in the Nuisances Removal and Diseases Prevention 
 Act of 1848. *4)f the two sanitary statutes of 1848, the 
 Nuisances Removal and Diseases Prevention Act applied to the 
 Metropolis equally with other parts of the country, but the 
 Public Health Act applied only to places outside the Metropolis. 
 
 * Even at the introduction of the Bill, Sir William Clay, who prohahly was 
 spokesman for the London Water-Companies, sounded a very significant note 
 of warning as to " all the various interests " which might have objections to 
 express. 
 
THE KEIGN OF QUEEN VICTORIA. 205 
 
 Any one who would minutely investigate the spirit o£ those §^^- ^• 
 enactments of 1848, and especially if caring to read between the Health 
 lines where the recommendations of the E^eport of 1845 are not 0/1848. °^ 
 exactly followed, will find it convenient to refer to the columns 
 of Hansard for the debates which preceded the legislation.* In 
 all the chief contentions, many speakers expressed in strong 
 language their dislike of what they called ^^ centralisation '''; and 
 though the word, as used in the debates, seems to have been 
 but an indefinite term of reproach — (for nothing in the record 
 shows that the speakers distinguished in principle the centra, 
 lisations which give appeal against local anarchies and extortions 
 from those which merely tend to a system of central meddle- 
 someness) — the fact remains, that, throughout the discussions of 
 the Public Health Bill, ^^ centralisation " was always denounced 
 as the danger which had to be feared from it ; and the fact is 
 here particularly noted because later events will connect them- 
 selves with it. In other respects, the debates of 1847-8 do not 
 throw any particular light on our main subject-matters ; and the 
 narrative, therefore, instead of lengthening itself by endeavours 
 to give a fuller account of them, may turn to the more grateful 
 office of describing the legislative results. 
 
 ^ The broad effect of the new leo'islation may be summed up Effect of 
 
 .,,„,,. ^. , ^ -^ ^ thelegisla- 
 
 m the lollowmg particulars : — tion of 
 
 1. For certain local-improvement and disease-prevention pur- 
 poses, deemed to require control or regulation by the Central 
 Government, there was established, as a new executive depart- 
 ment, a General Board of Health : 
 
 2. Against all chief health-nuisances as then recognised, there 
 was established throughout the country a system of summary 
 jurisdiction, to be exercised by the respective Local Justices, on 
 complaint by respective Local Authorities specially authorised 
 for the purpose : 
 
 3. With regard to the larger powers required financially and 
 otherwise in populous places for purposes of local improvement 
 and local sanitary regulation — such powers as had previously 
 
 * See especially, in 1847, House of Commons, March 30, June 15 and July 
 6 and 8 ; and in 1848, House of Commons May 5-June 15, and botli Houses, 
 June 30-Auft-. 16. 
 
206 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap, X. been granted only under special Acts o£ Parliament, modes o£ 
 Health procedure were provided, under whicli, on the one hand, any 
 o?i848*^°^ extra- metropolitan populous place desiring to have the powers 
 could, with the sanction of the Central Authority, easily and at 
 little cost, possess itself of them ; and under which, on the other 
 hand, the Central Authority could take action to confer the powers 
 upon any extra-metropolitan populous place, whether desirous 
 or not, if its ordinary annual death-rate exceeded 23 per 1,000 : 
 
 4. For periods of exceptional danger from formidable epi- 
 demic disease, the Privy Council was authorised to bring by its 
 Order into temporary operation certain special provisions of the 
 Nuisances- Removal and Diseases-Prevention Act ; under which 
 provisions, while the Order remained in force, the General Board 
 was to have certain powers of imperative direction, and the 
 Local Authorities, subject to such direction, were to have special 
 powers of local action. 
 
 5. The General Board under the Act was to consist ordinarily 
 of three members : one ex-officioy Her Majesty's First Commis- 
 sioner of Works ; and two — one paid, the other unpaid, ap- 
 pointed by Her Majesty. For particular times, when a Diseases 
 Prevention Order of the Privy Council might be in force, the 
 Act allowed an additional paid member, who was to be medical. 
 
 6. The Act was to continue in operation for five years, and 
 - to the end of the then next session of Parliament. 
 
 Meti-opoiitan Jt has already been noted that the Public Health Act 1848 
 
 Samtary ^ •' 
 
 Commission, did not extend to the Metropolis. In 1847, when Lord Morpeth 
 first brought the matter before the House of Commons, he 
 meant that the Metropolis should be dealt with in t]ie general 
 Act j but this intention had soon to be abandoned ; and, at the 
 end of the session of 1847, with a view to future separate 
 legislation for the Metropolis, a Boyal Commission of enquiry 
 was appointed. This Metropolitan Sanitary Commission had 
 for its members Lord Robert Grosvenor, afterwards Baron 
 Ebury, Mr. Chadwick, Dr. Southwood Smith, Professor Owen 
 and Mr. Richard Lambert Jones ; who, according to the terms 
 of the Commission, were to inquire ^'^ whether any and what 
 special means may be requisite for the improvement of the health 
 of the Metropolis, with reference more particularly to the better 
 
THE REIGN OF QUEEN VICTORIA. 207 
 
 House, Street,, and Land Drainage, Street Cleansing-, and Chap. X. 
 Paving; the collection and removal of Soil and Refuse, and Health 
 the better supply of Water, for domestic use, for flushing o/f^48*^°^ 
 Sewers and Drains, and cleansing Streets ; and also to the best 
 means of using existing Works, and of erecting new Works 
 requisite, and of maintaining them in good action ; and also to 
 the most equitable provisions for regulating the Charges, or 
 assessing, collecting, and paying the Monies requisite for such 
 purposes, more especially in the Districts chiefly inhabited by 
 the poorer classes of the population/'' The Commission made 
 three reports, dated respectively 19 Nov. 1847, 19 Feb. 1848, 
 13 July 1848. In those reports, a considerable share of discus- 
 sion was given to questions, more or less medical, which had not 
 been referred to the Commission : as with regard to the causes 
 and the mode of invasion of cholera, the steps which ought to be 
 taken where cholera is prevailing, &c. : while, within the Com- 
 mission's appointed province of enquiry, the non-existence of 
 sanitary government in the Metropolis was well exposed. 
 ''^Especially it was shown that the responsibility for sewerage and 
 other like objects in the Metropolis was divided among many 
 Commissions of Sewers having no relation to each other; and 
 the reporters pressed as their main recommendation, that the 
 several Sewers-Commissions of the Metropolis should at once be 
 consolidated into a single Commission, with additional statutory 
 powers. " In consequence of that recommendation, a separate 
 measure relating to the Metropolis, and providing for the ap- 
 pointment and powers of Metropolitan Commissioners of Sewers, 
 was carried through Parliament in the latter part of the session 
 of 1848, and became law (11th and 12th Vic. c. 112) on the same 
 day with the Nuisances-Removal and Diseases-Prevention Act 
 of that year. The City of London (except for particular pur- 
 poses) was not within the intention of that Metropolitan Act ; 
 but the City Sewers Act, a separate Act with most important 
 provisions for the sanitary interests of the City, had been before 
 Parliament at the same time with the metropolitan Act, and it 
 received the royal assent immediately afterwards."^ 
 
 * nth. and 12th Victoria, Local Acts declared Public, c. 163. The Act was 
 to continue in force for two years from Jan. 1, 1848, and to the end of the next 
 session of Parliament ; but in 1851 a new Act (14th and 16th Vic. c. 91) made 
 it, with some valuable amendments, permanent. 
 
208 ENGLISH SANITARY INSTITUTIONS. 
 
 p^br" ^' That the sanitary legislation o£ 1848 was calculated to be 
 
 Health signally important in the civil history of the United Kingdom, 
 of 1848. and that the men who promoted it deserve to be remembered by 
 their country with an abiding gratitude, are the reasons for 
 the Public which the reader has been invited to observe somewhat in 
 Acf 1848. detail the ten years'* work which preceded the legislation, and 
 particularly to observe the leading part which was taken by 
 Mr. Chadwick through the whole of that laborious time. 
 v/Knowledge which came with comparative rapidity in the years 
 next subsequent to the legislation did no doubt soon show that, 
 in various important respects, the new laws would require amend- 
 ment ; perhaps even that, for the next half-century, many of their 
 provisions must be deemed experimental : but this inconvenience 
 has been as nothing, in comparison with the vast gain which was 
 made : and of various particulars in which the legislation was 
 afterwards found to need amendment, only those need here be 
 noted, wherein the Public Health Act gave serious disad- 
 vantages of constitution to the new central authority which it 
 created. 
 
 One disadvantage was, that the ordinary principle of our 
 Government-departments — the principle that, in each depart- 
 ment, all proceedings are to be controlled by a Minister who 
 shall be responsible for them to Parliament, was not fulfilled in 
 the case of the General Board of Health ; and the anomalous- 
 ness of its constitution in that respect contributed largely to 
 disasters which afterwards befell the Board. 
 
 Secondly, the Board might have fared better without the 
 authority which the Act gave it, to bring at its discretion the 
 Act into operation in populous places having a high death-rate : 
 for the application of the Act in that seemingly coercive, not to 
 say penal, way, tended to bring on the Board whatever odium 
 attaches to coercive central interference with local government ; 
 while nevertheless the interference was of no avail as against 
 reluctant local authorities ; because the law (whether applied by 
 the central board or adopted by the ratepayers) -was a merely 
 empowering law, and no place on which the powers might be 
 compulsorily conferred, would thereby be made any likelier than 
 before to use the powers. 
 ^ Thirdly, the Board started at much disadvantage through 
 
THE REIGN OF QUEEN VICTORIA. 209 
 
 not being authorised by the Act to make any permanent appoint- Gb^^. X. 
 ment of skilled inspectors for its various local inquiries ; and an Health 
 immediate consequence of the defect was, that the Board came oiiSit. °^ 
 into uncomfortable relations with the general tody of the pro- 
 fession of Civil Engineers. For, unable to engage '^'^ whole- 
 time '^ officers, and able only to pay job by job for such en- 
 gineering assistance as it must largely require, it could not but 
 leave its engineer-inspectors at liberty to be participators in 
 private practice ; so that, when any one of them, in his capacity 
 of government-officer, had recommended works of drainage or 
 water-supply for a town, and had proposed plans and made 
 estimates for such works, which under the Act would generally 
 have to be approved by his central Board, he might next, in 
 his private-practice capacity, be offering himself to the Local 
 Authority as a candidate for the execution of the works — a can- 
 didate who, for, obvious reasons, would have conditions greatly 
 in his favour ; and the priority thus secured for a few privileged 
 competitors, in relation to what was expected to prove (as in 
 the event it has proved) a vast department of engineering 
 practice, necessarily tended to excite a sense of injustice in the 
 general body of the same profession. 
 
 ^Fourthly, there was something of paradox in the fact that a 
 government-department, bearing the title of General Board of 
 Health, had not a medical man among its ordinary members or 
 officers ; but evidently the Legislature of 1848 knew its own 
 mind in this matter. A re-invasion of the country by Asiatic 
 Cholera was at the time clearly impending, and no one denied 
 that, for occasions when the foreign disease might be here, the 
 Board which had to deal with it would need to be medically 
 advised ; out the prevalent impression was, that, except in re- 
 lation to Cholera, the Board could have little or no medical 
 business to consider; and the legislators of 1848 deemed it 
 enough that, for purposes of medical inspection and advice (just 
 as for engineering purposes) the Board should be at liberty to 
 engage temporary service as it might, from time to time, 
 find requisite. ^ It will, however, hereafter be seen that, two 
 years later, a new Act of Parliament empowered the Board 
 to have a paid medical member as part of its ordinary con- 
 stitution. 
 
210 ENGLISH SANITARY INSTITUTIONS. 
 
 p^r ^' ^^ regard of the health-interests of the British people. 
 
 Health the legislation of 1848 closed with triumph a first ten years'' 
 
 Legislation ^ , ,. ., Xiij ' i o • 
 
 of 1848. struggle, and inaugurated a new sera. in that point or view, 
 
 the steps which led to the legislation, and which in this chapter 
 
 history^of have been followed from beginning to end, are the essential 
 
 1838^-48*^^' history of the decennium; and what little more remains to 
 
 tell of the period may be confined to a few supplementary 
 
 references. 
 
 Improve- - One fact for special notice is, that, during the years which 
 theappara- prepared the new health-laws, criticism in the light of modern 
 dxainage. knowledge began to be applied to the mechanical appliances in 
 use for the sanitary service of towns, and that, in consequence of 
 this reconsideration, various constructional improvements began 
 to be made. At all the stages of the movement for better 
 sanitary government, attention had been drawn by Mr. Chadwick 
 to the mechanical problems of local sanitary administration, and 
 to the general need which existed for better-organised systems of 
 refuse-removal : especially for better-constructed sewers and 
 drains, and better methods of water-supply than were hitherto 
 almost everywhere satisfying the public mind. Denouncing all 
 stagnation of filth, not only in the public ways, or in domestic 
 cesspools, but equally in those ill-fashioned inoperative sewers 
 and house-drains which were but cesspools under another name, 
 — and setting up, as the fit standard of sewerage and drainage, 
 that the sewers and drains should be self-cleansing and inoffensive, 
 — Mr. Chadwick propounded as cardinal doctrines, that all town- 
 refuse must be removed in currents of water, and that drainage- 
 works and works of water-supply (requiring to be mutually 
 adjusted as parts of a single system) ought never to be under 
 different jurisdictions. While arguing to the above effect, and 
 pressing for a more general employment of competent engineering 
 skill in the service of local authorities, Mr. Chadwick contributed 
 importantly to make way for particular technical improvements. 
 Thus, in his report of 1842, and on various subsequent occasions, 
 he brought under public notice the greatly improved brick sewers 
 (improved both as to form and otherwise) which had been 
 introduced by Mr. John Roe in the service of the Holborn and 
 Finsbury Commissioners of Sewers. Also it was specially at 
 
THE REIGN OF QUEEN VICTORIA. 211 
 
 Mr. Ghadwick^s instigation, that, from early in 1842 onward, ^^^- X- 
 trials of earthenware pipes for purposes of refuse-drainage were Health 
 made ; and that the successful results of those trials were made ©f ^848. °^ 
 widely known to the world through the reports of the two Royal 
 Commissions.^ 
 
 Another fact to notice is, that during the years which have General 
 been under review, a highly important influence in favour of ofSe. ^ 
 sanitary progress began to be exerted by the records and publi- 
 cations of the General Register office. The head of that office 
 had at first been Mr. T. H. Lister; but he in 1842 had been 
 succeeded by Major George Graham, who remained Registrar- Major 
 General till 1879, and whose administration was of eminent 
 merit.f Presumably with good natural gifts (for he was brother 
 to one of the ablest political administrators of the time) and not 
 inaptly trained for civil office-management by having had some 
 years of experience in military method and discipline. Major 
 Graham soon earned, and always afterwards maintained, the 
 credit, that his large central office, with its thousands of local 
 contributories, and with its strict need of universal exactitude and 
 punctuality, was a pattern of well-working organisation, and 
 that he, the master of the machinery, took pride in making it 
 serve the public. In 1839, in order that the Registrar- General 
 might be enabled to turn to scientific use the vast quantities of 
 detailed information flowing into his hands, and especially the 
 facts medically certified to him as to the causes of registered 
 deaths, Mr. William Farr had been appointed Compiler of Mir. Wm, 
 Abstracts in the office ; and Mr. Farr (whose appointment seems 
 to have been due to Mr. Chadwick^s early recognition of his 
 merits) had a happy combination of qualities for the position to 
 which he was named. Of liveliest intelligence, and with a mind 
 which revelled in generalisation, well-instructed in theoretical 
 medicine according to the earlier lights of the present century, 
 and a master of the methods by which arithmetic is made argu- 
 mentative, he had also considerable literary resources and powers ; 
 
 * As regards Mr. Chadwick's relation to the trials, see, in First Report of 
 Metropolitan Sanitary Commissioners, p. 370, the evidence given by Mr. John 
 Roe. 
 
 t Major Graham died May 20, 1888. 
 
 o 2 
 
212 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. X. was a wide reader^ for use and pleasure, in the books of many 
 Health languages ; was a practised writer, having for several years been 
 o/ms active in journalistic and other authorship; and wrote with 
 admirable directness and simplicity. Eminently he was the man 
 to bring into statistical relief, and to make intelligible and 
 instructive to the common mind, whatever broad lessons were 
 latent in the life-and-death ledgers of that great counting-house : 
 eminently, too, not a man to forget the practical human interest 
 of such mathematics. In 1841, the Registrar- General, publish- 
 ing his first Annual Report, had appended to it a Letter, addressed 
 to him by Mr. Farr, on the death- statistics of the first half-year 
 of civil registration, and on various general questions in the 
 statistical study oi life and death : and that Letter, with others 
 by Mr. Farr which were appended to the next-following annual 
 reports, began for this country what in effect was a new branch 
 of medical literature. Before the close of the period to which 
 this present chapter relates, seven or eight of those annual reports 
 (besides intermediate quarterly returns which gave provisional 
 information) had been published ; and since 1840 there had also 
 been published special Weekly Returns relating to the Metropolis. 
 Of the later times of these famous serials, it is quite unnecessary 
 for this narrative to say much; and in the present place, only 
 the earlier volumes are referred to. Tlven thus far, however, the 
 General Register Office was rendering immense service to sanitary 
 science, by enabling it to use exact numerical standards in place 
 of the former vague adjectives ; and Mr. Farr, in his early letters, 
 had already indicated impoYtant prima facie generalisations as to 
 places and ages and causes of death in England and Wales. ^ 
 
 lAn 
 
 conclusion it deserves notice, that, during the later of the 
 years to which this chapter has related, and while the interests of 
 the public health were frequently under discussion in Parliament, 
 the growth of unofficial knowledge and sympathy in relation to 
 the movement was shown by the rise of various voluntary associa- 
 tions, intended to promote sanitary reform. There was a so- 
 named Health of Towns Association, which particularly aimed at 
 
 * Mr. Farr continued in office till 1879. He had meanwhile received many 
 well-merited public distinctions, British and foreign, and on his retirement he waa- 
 decorated C.B. He died April 14, 1883. 
 
THE REIGN OF QUEEN VICTORIA. 213 
 
 diffusing and popularising the sort of knowledge whicli had been Chap. X. 
 brought before Parliament. And there were those signally Health 
 educational Associations which taught by example : the so-named ^^848*^°^ 
 Association for promoting Cleanliness among the Poor^ which (as 
 before noted) founded in the East-end of London a Model 
 Establishment of Baths and Wash-houses, and afterwards procured 
 the passing of the Baths and Wash-houses Act ; and two Associa- 
 tions which under slightly different names established Model 
 Lodgings at low rent, viz., — founded in 1841, the Metropolitan 
 Association for improving the Dwellings of the Industrious Classes ; 
 and, founded in 1844, the Society for tlie Improvement of the con- 
 dition of the Lai ouring Classes. As it will not be possible in 
 later stages of this narrative to say much of the outcome of those 
 three model-furnishing institutions, this opportunity may be 
 taken to observe that all of them were of beneficent effect. The 
 association which gave example of public baths and wash-houses, 
 and procured legislation to render them locally practicable, con- 
 tinued to work its model-establishment till a few years ago, when 
 it had borne fruit in most parts of the United Kingdom. The 
 two associations which took in hand the provision of model 
 house-accommodation for the poorer classes have continued their 
 admirable action to the present time, and have given rise to many 
 private and corporate enterprises of a like nature. In tne 
 Charities Register and Digest of 1884, under the heading 
 " Commercial Companies and other Agencies which are employed 
 in the Metropolis in improving the dwellings of the weekly wage- 
 earning classes,'''' about thirty such agencies (large and small) 
 are named: some on a very large scale, as the ^^Artizans, 
 Labourers, and General Dwellings Company," with 6,000 houses, 
 and the '^ Peabody Donation Fund " with more than 4,000 
 tenements : and London represents only a portion of the good 
 which has been done in the kingdom at large. 
 
214 
 
 CHAPTER XI. 
 
 THE GENEEAL BOARD OF HEALTH 1848-58. 
 
 The General Board of Healthy instituted by the legislation of 
 1848, lasted for nearly six years with no other change than 
 these; first, that the ex-officio seat at the Board was occupied in 
 succession by the four successive First Commissioners of Works 
 of those years ; and secondly, that, within two years of the start, 
 permanent place at the Board was provided for a medical member. 
 Sanction for that continuing medical appointment was given in 
 the Metropolitan Interments Act 1850 j and though there was a 
 certain formal fitness in this, in as much as the General Board of 
 Health was appointed to administer the Interments Act, the com- 
 bination seems to have struck the world as strange, and the par- 
 liamentary draftsman was given to understand he had made a 
 joke not unworthy of Moliere."^ 
 
 The ex-officio seat at the Board was occupied first by Lord 
 Morpeth, who had carried the Public Health Bill through the 
 House of Commons ; then by Lord Seymour, afterwards twelfth 
 Duke of Somerset ; next by Lord John Manners ; and finally by 
 Sir William Molesworth. The unpaid place was held by Lord 
 Ashley, who in June 1851 became Earl (seventh) of Shaftesbury; 
 the other non-medical member was Mr. Chad wick ; the medical 
 member, when appointed, was Dr. South wood Smith. Of the 
 ex'officio members all which needs here be said is that Lord 
 Morpeth took active interest in the objects of the Board, and 
 was apparently in full accord with his colleagues ; whereas Lord 
 Seymour soon came to differ very strongly from the policy of his 
 
 * Dr. Rumsey, referring to the subject some years later in the preface of his 
 Essays on State Medicine, speaks of it in the following terms : — "Who would have 
 thought that in the last decade of advancing civilisation, and in a nation boasting 
 of its intellectual and material resources, of its administrative energy and 
 efficiency, the whimsical experiment should have been actually tried of appoint- 
 ing three non-medical authorities— two Lords and a Barrister, to preserve the 
 health of the living ; and then after a year or so of doubtful . success, calling in 
 a Physician to bury the dead." 
 
THE REIGN OF QUEEN VICTORIA. 215 
 
 colleaffues, and eventually led an attack on it in the House o£ ^^^- ^• 
 
 ^ General 
 
 Commons. Board of 
 
 ythe responsibilities imposed by statute on the new Board 1848-58. 
 were chiefly two : first, under the Public Health Act, to be the 
 
 sanctioning authority for various purposes which local ratepayers Mftie?^" 
 
 or boards mio^ht desire to effect under provisions of the Act : and ii^posed on 
 
 Y 1 -VT • -r. the Board. 
 
 secondly, under the Nuisances- Removal and Disease-Prevention 
 Act, to be the regulating authority in respect of special require- 
 ments which would have to be met at times when formidable 
 epidemic disease might be present or impending. Further, a 
 special section of the Nuisances-Removal and Diseases-Preven- 
 tion Act directed the Board to make inquiry into the state of 
 Burial-grounds, and to frame if necessary a scheme to be sub- 
 mitted to Parliament for improving the burial arrangements of 
 towns. And, beside those particular duties expressly imposed by 
 statute, there seems to have been implied in the Board'^s title, and 
 in the circumstances of its origin, an indefinite sort of duty to 
 investigate and advise with regard to future questions of sanitary 
 legislation and procedure. For full information as to the Board^s 
 discharge of the above responsibilities, reference has to be made 
 to the parliamentary debates of the time, and to a considerable 
 series of parliamentary and other publications : including, of 
 course, in the first place, the Board-'s own published Reports : 
 and of the latter, one in particular may be cited, which describes 
 compendiously the business transacted by the Board from the 
 time of its institution down to the end of 1853, and sets forth 
 in appendices the distinctive doctrines of the Board on many 
 chief matters of sanitary administration."^ 
 
 With regard to the execution of the Public Health Act, the Proceed- 
 just-mentioned report states that, down to the end of 1853, the Bfardf S^ 
 Board had been memorialised from 284 places for application of jo^9^*®^„^ 
 the Act, and had applied the Act in 182 places having in all ordinary 
 more than two millions of inhabitants; that in 126 of the tiou; 
 places, surveys with a view to required improvement-works had 
 been undertaken; that in 70 of them, plans, founded on the 
 
 * Heport of the General Board of Health on the administration of the Fublic 
 Health Act, and the Kuisances-Removal and Diseases-Prevention Act, from 1848 to 
 1854: presented to both Houses ef Parliament by command of Her Majesty: 
 1854. 
 
216 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XI 
 General 
 Board of 
 Health 
 1848-58. 
 
 Of admin- 
 istration 
 regarding 
 Cholera. 
 
 surveys, had been prepared ; that in 31, the plans for combined 
 works of water-supply and drainage had been approved by the 
 Board; and that mortgages to the amount of £407,000 had 
 been sanctioned : further, that during the same time, the Board 
 had framed bye-laws to regulate the conduct of business by 
 local boards, and the duties of the local officers, and to regulate 
 the cleansing of streets and towns, and to regulate slaughter- 
 houses and lodging-houses; as also a series of instructional 
 minutes, meant to assist the local boards and other bodies in the 
 exercise of their sanitary powers. Of the Board's Instructional 
 Minutes, some had been meant to explain and supplement the 
 proposed bye-laws, others to interpret the statutes which were in 
 question, and others to inculcate special doctrines as to house- 
 drainage and the drainage of towns, lands ahd roads, and as to 
 the agricultural application of town refuse. All the above pro- 
 ceedings, technically considered, were endeavours to bring into 
 acceptance and operation those general principles of urban 
 sanitary reform, especially those precepts as to district-cleanliness, 
 and as to the structural works needful for it, which had been 
 advocated in Mr. Chadwick^s Report of 1842, and in the Royal 
 Commission Reports of 1844-8. Mr. Chad wick's doctrine, that 
 all sorts of town-refuse are best removed by the scour of running 
 water in properly-made sewers, was pressed with uncompromising 
 zeal ; and the Board, while pressing that general doctrine, 
 laboured also to spread knowledge of improvements which had 
 been devised in respect of the construction of sewers and drains, 
 and it insisted especially on the value of glazed earthenware 
 pipes for those uses. Here, too, it may be noted, that, in 
 furtherance of an important sanitary object which had been 
 proposed in the Reports of 1842-5, but had not been covered by 
 the legislation of 1848, the Board (through Lord Shaftesbury) 
 procured the passing of those two very useful Acts of Parliament, 
 1851 and 1853, which first provided for the registration and 
 superintendence of Common Lodging Houses. 
 
 Beside the proceedings under the Public Health Act, pro- 
 ceedings of an exceptional kind had had to be taken by the 
 Board in 1848-9 and 1853-4 under the special provisions of the 
 Nuisances-Removal and Diseases-Prevention Act. In 1848, 
 namely, at the moment when the Board entered on office, the 
 
THE REIGN OF QUEEN VICTORIA. 217 
 
 British Islands were anxiously anticipating a second invasion by Chap. XI. 
 Asiatic Cholera. The terrible tide of that disease, which, for Board of 
 more than two years past, had been advancing by various routes i848^-?8 
 from India, had, (during the last few months, been in progress 
 from eastern to western Europe ; and, before the Board had 
 completed its first month of existence, there were signs of choleraic 
 infection in this country. Such being the case, an Order of 
 Council, dated Sept. 28th, brought into effect for Great Britain the 
 extraordinary provisions of the Nuisances- Removal and Diseases- 
 Prevention Act ; and later orders continued those provisions in 
 force, till the new cholera-period, which lasted more than fifteen 
 months, and involved in England alone the death of more than 
 54,000 persons by cholera, had come to an end. Thus, for 
 nearly a year and a half from the passing of the sanitary Acts of 
 1848, the General Board of Health, as central authority for the 
 diseases-prevention purposes, was under the strain of having to 
 deal continuously with circumstances causing acute and wide- 
 spread public anxiety; and subsequently, within four years of 
 the crisis of that visitation, the necessity for having in force the 
 special disease-prevention parts of the law was renewed by the 
 cholera- visitation of 1853-4. The proceedings of the Board in 
 relation to those two great cholera-emergencies consisted, partly, 
 in the issue of directions and regulations for the abatement and 
 removal of nuisances in all places, and for special medical action 
 in places where the disease existed ; partly, in circulating minutes 
 of information and advice on measures to be adopted against the 
 disease, by way of precaution or otherwise ; partly, in sending to 
 infected districts medical inspectors who were to assist the local 
 authorities in organising arrangements of relief for the suffering 
 and endangered parts of the population. Particulars as to all 
 which the Board did in those and other respects, during the 
 cholera-period 1848-9, are to be found in the successive numbers 
 of an occasional Official Circular which was issued by the Board 
 during that period, and in the final Report which the Board 
 submitted in 1850, with appended reports by the Board^s two 
 chief medical inspectors — Dr. John Sutherland and Mr. Richard 
 D. Grainger, on the epidemic which had then terminated.* 
 
 * Report of the General Board of Health on the Epidemic Cholera of 1848-9 : 
 presented to both Houses of Parliament by command of Her Majesty. 
 
218 ENGLISH SANITARY INSTITUTIONS. 
 
 Generaf^' ^^® proceedings in regard of the cholera of 1853-4 were only in 
 Board of part taken under authority of the original Boards and are described 
 1848-58. in a separate series of parliamentary publications (1855-6) here- 
 after to be mentioned."^ Of the proceedings of both periods^ it 
 may briefly be said that they were in general accord with the 
 proceedings of 1832. In addressing medical advice and directions 
 to places where cholera existed, the Board insisted above every- 
 thing on what Dr. McCann had in 1832 called the " premonitory '^ 
 stage of Cholera ; and. the main purpose of the medical inspectors 
 whom the Board employed was to explain the importance of 
 bringing under treatment all cases of the disease while still in 
 that early state of development, and to assist local authorities in 
 organising such systematic '^ house-to-house visitations " as 
 would discover the incipient cases. 
 Reports on In necessary connection with other questions as to the pre- 
 ^aran- yentability of Cholera, and afterwards in relation to the pre- 
 ventability of Yellow Fever, the Board entered upon an extensive 
 criticism of the principles and practice of Quarantine. In two 
 Reports, respectively of 1849 and 1852, the Board sought to 
 disparage the contagionistic medical opinions which were repre- 
 sented in systems of quarantine, and to substitute for them a 
 doctrine that epidemic diseases have their " primary and essential 
 condition '''' in an ^' epidemic atmosphere ''■' which [irrespectively 
 of traffic] '^ may exist over thousands of square miles, and , yet 
 affect only particular [un wholesomely kept] localities.^'' '^Con- 
 tending, on the strength of that hypothesis, that quarantine 
 could not give any but a false security for the purpose it pre- 
 tended to accomplish, and adducing illustrations of the futility 
 and oppressiveness of quarantine as commonly administered, the 
 Board proposed, as practical conclusion, that this country should 
 entirely set aside its existing quarantine establishments, and 
 should rely exclusively on the protection it could derive from a 
 system of local sanitary improvements. t 
 Reports on An important section of the Board's work arose out of a 
 direction given in the Act 12th and 13th Vic. c. 3, that the Board 
 should inquire and advise in respect of the Burial-arrangements 
 
 * See below, page 238. 
 
 t Report of the General Board of Health on Quarantine, 1849 ; ditto on 
 Quarantine against Yellow Fever, 1852. 
 
THE REIGN OF QUEEN VICTORIA. 219 
 
 o£ towns. In pursuance of this direction^ the Board in 1850 Chap. xi. 
 laid before Parliament a Report on a General Scheme for Extra- Board of 
 mural Sejmltiire, with detailed recommendations as to the 1848-58. 
 Metropolis, and in 1851, in a further report, proposed enaetr 
 ments for dealing with the dead of country towns."^ In these 
 Reports the Board, after describing the evils which had been 
 found in the existing system, recommended that, except in 
 certain reserved cases, no further interment in the Metropolis, or 
 within other urban precincts, should be permitted; and that, 
 instead of the urban burial-grounds, now to be disused, extra- 
 mural cemeteries sufficient for local requirements should univer- 
 sally be provided, "^ov the management of the future burial- 
 system of the kingdom, the Board proposed that the universal 
 Burial Authority (directly or indirectly) should be the central 
 Government : that, for the Metropolis, all burial business should 
 be done by a branch of the central Government — presumably 
 the Board itself ; and that, for Country Towns, it should be 
 done by local bodies acting under regulation by the Board. 
 Under the proposed system, the Authority was to have power to 
 contract for the performance of funerals, to provide mortuary 
 reception-houses, and (as with special reference to mortuary 
 purposes) to appoint medical officers of health. It was proposed 
 that all undertakers^, and other charges for funeral purposes — 
 for grave, for coffin, for conveyance of body and mourners, for 
 ritual, for service of all sorts, and, where requisite, for temporary 
 reception of dead bodies, should be regulated by the Authority 
 according to a series of scales or classes, and that the whole of 
 such charges, according to the class, should be received by the 
 Authority in one sum. For the Metropolis it was particularly 
 recommended that, under the new system, the chief cemetery 
 should be in some river-side situation (and Erith seems to have 
 been intended) with a view to the largest possible use of steam- 
 boat conveyance. 
 
 A further undertaking of the Board was to investigate the Eeport on 
 
 Water-service of the Metropolis, and to propose a comprehensive tan Water- 
 supply. 
 
 * Reports of the General Board of Health, entitled as above, 1850 and 1861. 
 Appended to the Report of 1850 (together with some Minutes of Evidence) are 
 two reports by Dr. Sutherland : one, on burials in the Metropolis ; and the other 
 on the practice of interments in Germany and France. 
 
220 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XI. scheme for amending it. In 1850, reporting in extemo on that 
 Board of matter, the Board condemned in severe terms the system which 
 1848-^58 ^^ ^^^ investigated. It alleged that the existing supplies were 
 of inferior quality : that they all were so hard as to be ineligible 
 for domestic use, that they generally contained an excess of 
 organic matter, that certain of them were polluted by the 
 sewerage of the Metropolis, and that the water of four principal 
 companies was delivered without previous filtration. With 
 regard to the method (intermittent) on which the supplies were 
 distributed, the Board alleged against it, as sanitary and 
 economical objections, that it tended to waste with mischievous 
 effect more than half the water it supplied ; that it failed to give 
 adequate provision, either for extinguishing fires, or for the 
 surface-cleansing of houses and public ways ; that it obliged 
 consumers to provide for themselves means more or less costly of 
 storing water; and that the water which had to be privately 
 stored was exposed to sanitary and other deterioration. ' With 
 regard to the administration of the water-service, the Board 
 denounced the dependence of the Metropolis on a number of 
 trading companies : not merely blaming the costliness and in- 
 harmoniousness of the so many managements ; but further, and 
 above all, objecting to the principle of a separate commercial 
 control, and insisting that the metropolitan water-supply ought 
 not , to be regarded as administratively separable from the 
 drainage of the Metropolis. ^Tor reform of the censured system, 
 the Board recommended new sources of supply, new method of 
 distribution, and new principles of administration. It proposed 
 that the existing sources of supply should be abandoned, and a 
 supply of soft water be furnished in their stead : affirming that 
 such water could be obtained in sufficient quantity from the 
 Surrey sands, where a tract of upwards of 150 square miles 
 might be taken as gathering-ground for the supply; and 
 representing that, with the use of this water, the saving in soap 
 in the washing expenditure of the Metropolis would be probably 
 equivalent to the whole of the money at that time expended in 
 water-supply, that about one-third of the tea consumed in the 
 Metropolis would also be saved, that other culinary operations 
 would be much facilitated, and that incrustations and deposits 
 in boilers and boiler-pipes would be prevented. It proposed 
 
THE REIGN OF QUEEN VICTORIA. 221 
 
 that the new water should be furnished to the Metropolis on the Chap. xi. 
 method o£ constant supply under high pressure : to be delivered Board of 
 on that method pure and filtered into each house, while at the i848-*58 
 same time (on the plan of combined works) the waste water 
 should be removed by a proper system of drainage : and with 
 regard to the cost of those new arrangements, the Board re- 
 ported that, according to the best estimates obtained, the average 
 rate of cost for the two services would be from 30 to 50 per 
 cent, less than the existing charges for defective water-supply 
 alone. "^ In regard of administration, the Board proposed to 
 supersede the existing water-companies, purchasing their respec- 
 tive plants, and to consolidate under one management the Water- 
 supply and the Drainage of the Metropolis. "IPor the constitution 
 of the managing authority, the Board deprecated the notion of 
 ^' attempting to fix responsibility on a multitude of fluctuat- 
 ing parochial bodies,^^ and thought the duty had better be 
 assigned to some branch of the central Government : a few 
 competent and responsible officers who would be under control of 
 Parliament, and wotild give their whole time and attention to 
 the subject. ^ The Board apparently intended that the responsi- 
 bility should be not only for the larger works of metropolitan 
 sewerage and water-supply, but should extend to the construc- 
 tion and maintenance of all apparatus of drainage and water- 
 service in individual houses : * and the Report seems to imply 
 that the Board, while intending that unique centralisation of 
 communal and domestic jurisdictions, contemplated accepting for 
 itself the responsibilities of the central management. 
 
 In the Board^s various above-described publications there J^^^^^^^l, 
 
 was an abundant raising of questions which concerned bodies of general 
 
 technical experts, especially the experts of civil-engineering and spedai'pro- 
 
 of medicine ; and in which, as will hereafter appear, the Board SocSaes ? 
 met much professional dissent ; but apart from those technical 
 topics, there were administrative proposals and tendencies which 
 greatly concerned the lay public. 
 
 '^bne foremost fact in the Board^s administrative policy was Bias for 
 
 the tendency to centralise authority for local purposes ; and that tion ; 
 
 * See in the Board's Eeport on the supply of Water to the Metropolis, 
 pp. 319-320, conclusions 38-41, and various other passages. 
 
222 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XI. tendency may doubtless in part have ■ had a personal origin. 
 Board of ' Mr. Chadwick had probably derived from Bentham a strong 
 1848-58. theoretical disposition to rely less directly on natural forces in 
 society, and more directly on organised controls^ central and sub- 
 central, than would accord with the present political opinions of 
 this country : his own administrative experience had lain in work- 
 ing the Poor Law Amendment Act of 1834, which, for reasons 
 in great part special to the case, was a law of extreme centrali- 
 sation :*^his abundant familiarity with cases of gross mismanage- 
 ment and jobbery by local authorities may have disinclined him 
 to believe in the possibility of awakening an opposite spirit in 
 local government ; and not least, both to him and his colleagues, 
 the methods of central dictation may have seemed a short and 
 ready road to the reforms which they all desired to accomplish. 
 It would however be erroneous to suppose that, at the time when 
 this policy first came under discussion, the public was as prepared 
 as it now is to measure the advantages and disadvantages of 
 papal forms of civil government, or was as jealous as it now is 
 for the prior rights of local judgment in matters which are 
 primarily of local concern. At the present time there prevails 
 a pretty general consent of opinion, that matters of individual 
 interest are in general better cared for by individuals (separate 
 or in combination or through elected representatives) than they 
 can be cared for by officers of a central government, — that the 
 essential condition for effective local-government is the force of 
 local intelligence and will, — and that to despair of local energy 
 for local purposes would be to despair of the purposes themselves. 
 But, from forty to five-and-thirty years ago, definite convictions 
 of that sort were not general. In those earlier experimental days, 
 neither legislators nor administrators had yet sounded the depths 
 of the difficult problem of finding in local-government politics 
 the happy mean between the too much and the too little of 
 central interference ; and when, in those days, gross illustrations 
 of local misrule came under public criticism, utterances in favour 
 of ^^ enlightened despotisms,^' and dreamy suggestions '' how 
 much better they manage such things in France,"' used very 
 often to be mingled with the complaint. If at the present time 
 proposals were put forth, such as those which the Board of 
 Health made in its reports of 1850 on metropolitan water- 
 
THE REIGN OF QUEEN VICTORIA. 223 
 
 supply and metropolitan burials, that the duty o£ burying the ^hap. XI. 
 dead of the metropolis, and the duty of providing drainage and Board of 
 water-supply for the metropolis, should, in all their respective 1848-68. 
 details, be done or directed by officers of Her Majesty^s Civil 
 Service, the proposals would seem to have come from the moon ; 
 but so little was that the view of the publi(i-^hen the proposals 
 were originally made, that, in 1850, Parliament readily passed 
 a Bill to give to the Board of Health in relation to metropolitan 
 burials all the executive powers which had been proposed : and 
 the failure of that Act (which had to be repealed in 1852) was 
 a first grave lesson given to our legislators that local government 
 could not be done by royal commission. 
 
 Secondly, a very notable characteristic in the Board^s publica- Projects 
 tions was the spirit in which they discussed the financial aspects vention in 
 of sanitary reform ; not merely insisting on the immense finan- Commerce, 
 cial waste which deaths and incapacitations from removable 
 causes occasioned, but also advocating that the sanitary system 
 of the future should be on a new economical basis. Thus, in 
 the detailed economics of preventive measures, as in regard of 
 the water-service and funeral-services of the metropolis, and in 
 regard of private sanitary improvement- works, the Board favoured 
 a particular principle of administrative interference with freedom 
 of commerce : viz., that, with a view to the improvement or 
 cheapening of certain trade-services to the public, it should be 
 made a function of government (central or local as the case 
 might be) to intervene between buyers and sellers, by converting 
 each local trade-service into a conditional monopoly, which 
 would be conceded by auction or tender to one person, or one 
 body of persons, for each suitable district : so that, in each case, 
 there should be competition for the field of service, instead 
 of competition within the field of service, and that the service 
 instead of being unregulated should be under conditions. This 
 principle had from long before been warmly advocated by Mr. 
 Chad wick, who also some years later (1859) elaborately argued it 
 before the Statistical Society in a paper On the Economical 
 Results of different principles of Legislation and Administration 
 in Europe with regard to commercial competitions. It is not a 
 principle which in modern times has had much practical appli- 
 cation in England ; but in an unsystematic way we seem to 
 
224 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XI. Jjave admitted principles not radically different from it in some 
 
 General «.i j c • i -n ^ 
 
 Board of very few of our social arrangements ; as, tor instance, with regard 
 1848-58. to certain conditions of railway-traffic, and with regard to 
 hackney-carriages within urban areas, and with regard to the 
 employment of public vaccinators. How far it may be on 
 the whole desirable for this country, that, at particular points 
 in its domestic commerce^ the State should interfere as con- 
 troller of conditions, between the classes which (in the parti- 
 cular case) produce and sell and the classes which (in the 
 particular case) consume and buy, is a question on which perhaps 
 the best judges may not even yet have said their last word ; and 
 no attempt will here be made to discuss the right or wrong of 
 the bias shown by the Board for the application of the principle 
 in certain branches of sanitary expenditure. Only it has to be 
 observed, that the ground was of necessity controversial, and 
 that the controversy, as against the proposed policy of the 
 Board, was likely to be widely-diffused and acrimonious; for, 
 just in proportion as the suggested control in any branch of 
 commerce would be of advantage to the buying-interests in the 
 community, evidently the selling-interests would not be unre- 
 sisting assenters to it ; and the question of the suggested con- 
 trol, as between buyers and sellers in the sanitary market, could 
 not but be regarded as of concern to the sellers and middle-men 
 of other markets. 
 Teaciiings Critics who endeavour to estimate the permanent value of the 
 
 trict clean- various services which the Board rendered during the years 1848- 
 mess, g^^ ^^jj probably be of opinion that the most important of all 
 was the propagandism which it exercised in a general sense 
 against district-uncleanliness. The effect which had been pro- 
 duced by Mr. Chad wick's memorable report of 184^, and by the 
 subsequent Royal Commission reports, would almost certainly 
 after a few years have been in great part lost, had it not 
 been re-inforced by the subsequent influence of the Board : 
 whereas, thanks mainly to the Board^s persistence, the original 
 impression was sufficiently continued and sufficiently diffused, to 
 determine real progressive growth in a hitherto neglected branch 
 of national culture, and to cause that, from those days to these, 
 the nation has continued to have some sort of conscience against 
 Filth. ^It was much objected to the Board, that their advocacy 
 
THE KEIGN OF QUEEN VICTORIA. 225 
 
 of water-removal for all sorts of refuse^ and for all sorts of Chap. xi. 
 places^ particularly their recomraendation of water-closets to the Board of 
 exclusion of all other systems of dealing with excrement, was 1848-58. 
 far too unconditional and dogmatic; that not nearly enough 
 consideration had been given, either to the difficulties of finding 
 suitable outfall for large volumes of sewage, or to the difficulties 
 of ensuring safe connections of house-drains with sewers, and 
 safe construction for domestic sinks and water-closets ; that the 
 new system would be greatly more costly, and would at least for 
 a time include far larger possibilities of hygienic failure, than 
 the Board had led the public to suppose. It must be admitted 
 that those charges were, at least to a great extent, well founded ; 
 and they were at the time much emphasised by serious outbreaks 
 of disease which had occurred in certain places sewered and 
 water-supplied under the Public Health Act. But the inculpa- 
 tions were only part of the case ; and there remained beyond 
 question a large balance of advantage to the interests of the 
 public health. Against urban uncleanliness in general, and 
 especially against the familiar retentions of filth in cess-pools and 
 sewers of deposit, a new influence had come into powerful opera- 
 tion : the system of refuse-removal by water might, in time and 
 with care, come to be adequately guarded against mis-applications 
 and failures : already, when applied with discretion and skill, it 
 was shewing itself an immense improvement on the system 
 which preceded it: and the adaptation of glazed earthenware 
 pipes to serve as domestic and urban drains was the most 
 valuable sanitary contrivance which had been introduced since 
 Roman times. 
 
 In senses more distinctively pathological or medical, the Medical 
 Board does not appear to have had any notable success. "^In ^^^ ^^^* 
 relation to the scientific study of contagious diseases, it indeed 
 happened to live its life just on the confines between times of 
 stand-still and times of discovery; and the doctrines which it 
 promulgated on the subject of epidemic infection have long since , 
 
 been made obsolete by the advances of exact knowledge. Even, 
 however, at the time when those doctrines were put forth, they 
 were open to the serious reproach of scientific one-sidedness : for 
 the Board, in its perfectly proper zeal against filth, immensely 
 underrated, not to say ignored, the independent importance of the 
 
226 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XI. 
 General 
 Board of 
 Health 
 
 1848-58. 
 
 Burial pro- 
 posals; 
 
 morbid contagia ; so that readers of the Board''s publications were 
 never sufficiently put on their guard against those dangers to the 
 public health which are involved in the contagiousness of certain 
 diseases. The epidemiological theories which figured largely in 
 the Board^s argument for abolishing quarantine found but little 
 acceptance among the medical profession of the time ; and the 
 statements which the Board made as to the practical working of 
 quarantine^ though of course admitted to deserve serious con- 
 sideration so far as they went, were regarded as not doing equal 
 justice to both sides of a difficult practical question. In respect 
 of cholera, the Board acted according to the best information of 
 the time, when it made Dr. McCann''s doctrine the basis of its 
 administrative policy; and even apart from that doctrine, the 
 Board would have been entirely right in urging as it did, that 
 systematic house-to-house visitation should be made in in- 
 fected districts : for presumably no medical treatment will ever 
 cure Asiatic Cholera, unless it be a treatment begun in the early 
 stages of the disease. But, whether, in the epidemics of 
 1848-54j the house-to-house visitations which the Board caused 
 to be made, with the accompanying extensive administration 
 of common constipative drugs, were of any avail in saving the 
 lives of infected persons, much more were of such vast avail 
 as the Board then imputed to them, does not seem to be un- 
 questionable. 
 
 In regard of the burial-practices of the country, the dis- 
 tinctive proposals of the Board cannot be said to have been 
 successful : for, as before stated, the acceptance which they 
 obtained from Parliament in 1850 (13th and 14th Vic. c. 52) had 
 to be withdrawn two years afterwards; when a new Act (15th and 
 16th Vic. c. 85) repealing the former one, and annulling the special 
 jurisdiction of the Board of Health, provided afresh for the 
 closure of the metropolitan burial-grounds, and gave power to 
 the metropolitan local authorities to establish extra-mural burial- 
 places for their dead. In the interval between the two Acts, it 
 had appeared that the very extensive powers, given to the Board 
 by the Act of 1850, could not be effectively worked, unless the 
 Board were also invested with monopoly-rights in relation to the 
 London burials: and, as Government was not prepared to ask 
 parliament for this consummating act of centralisation, it adopted 
 
THE KEIGN OF QUEEN VICTORIA. 227 
 
 the alternative which the Act of 1852 expresses.* To the in- S^-^* ?^' 
 
 ^ , ^ General 
 
 terests of the public health, however, there remained this sub- Board of 
 stantial gain, which may in part be counted to the credit of the 1848-58. 
 Board : that, by the Act of 1852, which in the following year 
 was extended to England at large, and has since then been 
 extended to Scotland and Ireland, an end was given to the 
 abominable practice of burying the dead amid the habitations 
 of the living. 
 
 In regard of the water-supply and drainage of the Metropolis, Proposals 
 the Government of the day, through Home Secretary Sir George donVater- 
 Grey, distinctly declined to accept the vast proposals which the ^^PP^y- 
 Board had made. In a Bill which Sir G. Grey introduced in 
 1851 (April 29) and asked to refer to a select committee to be 
 appointed by the Committee of Selection, he only went so far as 
 to propose that the existing water-companies should be consoli- 
 dated into a single self-governing body, bound to give constant 
 supply of water, and bound to obey such directions as the 
 Secretary of State might impose as to deriving water from new 
 source s.f The second reading of the Bill having been carried 
 after considerable opposition, the Bill was referred as proposed j 
 and the Committee which had Sir James Graham for its chair- 
 man, reported at the end of the Session the Minutes of Evidence 
 which it had taken. The proposals which the Board of Health 
 had submitted were evidently out of the question ; but a Bill, 
 differing utterly from them in scope and spirit, and purporting 
 to represent a sort of compromise between the public and the 
 water-companies, was carried in the earlier session of 1852 : 
 initiated in February under one ministry, and carried in June 
 under another. "Compromise if it was, the Act seemed to do but 
 little for the public ; and in view of that result (the extreme 
 unsatisfactoriness of which has continued to the present date) it 
 may be regretted that the Board had raised before Parliament 
 
 * See, in Hansard, the speech of Sir George Grey when asking leave to 
 introduce the Bill of 1852. 
 
 t In relation to the question of new sources, Sir George Grey mentioned that 
 he was at the time awaiting a report from Messrs. Graham, Miller and HoflEmann, 
 to whom he had referred on the subject ; and he said that, in his view, govern- 
 ment ought to be enabled to enforce on the water-supplying bodies or body the 
 obligation of obtaining whatever water might ultimately be judged most 
 suitable. 
 
 p 2 
 
228 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XI. ^]^q question of reorganising the metropolitan water-supplies at a 
 Board of time when no local authority existed^ or was intended^ to which 
 1848-58. that important sanitary trust could be assigned. 
 
 anS^OT- ^^^ introduction of any important social reform involves 
 
 position to almost of necessity the cost of more or less contention with 
 
 he Board. •' . . , 
 
 individuals or classes, whose interests, pecuniary or sentimental, 
 are identified with the impugned order of things ; and in the 
 present case, even irrespectively of special controversies which 
 were raised on matters which have been mentioned, the move- 
 ment concerned so very large a range of material interests, and 
 was so sure to collide invidiously with sentiments of local self- 
 satisfaction, that the reformers could not have expected to go far 
 without encountering clamor and resistance. Such clamor and 
 resistance began to gather against the Board of Health almost 
 in its earliest days ; and the opposition soon acquired sufficient 
 strength to convert itself into an organisation of attack, by which 
 at last the Board was put on its defence. Apart from discussions 
 which were raised as to the value of some of the Board's most 
 distinctive doctrines in matters of medicine and of engineering, 
 and as to outbreaks of disease which there had been in places 
 recently reformed under the auspices of the Board, vehement 
 accusation was made that the general policy of the Board, in 
 relation to the proper freedom of local government, and of pro- 
 fessional and. commercial enterprise, was of an intolerably aggres- 
 sive kind, ^-^he accusers urged that the Board was seeking to 
 exercise a far more dictatorial influence over local authorities, 
 and to procure for authorities, central and local, a far larger 
 influence in the sphere of individual interests, than Parliament 
 could consider desirable. They urged that the Board was far 
 too impetuous and peremptory in matters of local and personal 
 concern; heedless whether such reforms as were in question 
 might be impeded by the difficulties and complications of par- 
 ticular cases, or by the social habits of the country. Especially, 
 as to technical questions, they declared that the Board had 
 insufficient technical knowledge ; that it had not considered such 
 questions in a sufficient variety of points of view, nor with 
 sufficient open-mindedness towards all witnesses; that the 
 doctrines which it put forth had not been nearly enough checked 
 
THE REIGN OF QUEEN VICTORIA. 229 
 
 from the point o£ view of experts who disputed them; that Chap. XI. 
 evidence not favourable to the doctrines had been far too easily Board of 
 assumed to be the dishonest presentment of some ^^ sinister 1848-68. 
 interest/'' while statements of the other sort had been treated as 
 of exclusive importance r'^ briefly, that the Board failed to dis- 
 tinguish between opinions and knowledge, and was imperatively 
 pressing large rules of practice, and seeking from parliament new 
 powers of coercion, in cases where lessons of experience were still 
 wanting. The attack on technical grounds came particularly 
 from the side of the civil engineers, and in connection with that 
 part of the case much reference was made to the invidious posi- * 
 tion which the engineering inspectors of the Board had been 
 enabled to hold in relation to the general body of their profession. 
 Most of the force of the attack was aimed personally at Mr. 
 Chadwick : charging against him, with much vituperation and 
 many expletives, that all the mischief was his ; that he was a 
 doctrinist and centraliser ; that his statistics and estimates were 
 moon-shine; that he was an advocate who could see but one 
 side of a case j and that his only controversial strength was in 
 imputing base motives to those who differed from him. 
 
 Among the ^^ interests " which had declared themselves Defeat <rf 
 against the policy of the Board, as injurious or dangerous to ment in 
 them, were some which in any such quarrel could not fail to have -q^h ^ 
 most powerful support in the House of Commons j'^and before J^^^^® ^ 
 long the hostile combination found, in the circumstances of the 
 Board, the best of opportunities for turning such support to 
 account. For (as before noted) the Act of 1848 had become law 
 under express provision that it should continue in operation only 
 '^ for five years and to the end of the then next session of Parlia- 
 ment " ; and, as it therefore had either to be renewed or to expire 
 in the summer of 1854, the animosity which was raging against 
 the Board, and particularly against Mr. Chadwick as its chief 
 working member, had that critical opportunity for making itself 
 felt. ■'I'he opponents of the Board insisted that the Act should 
 not be renewed except with a radical reconstitution of the 
 central authority, and (in effect) with Mr. Chadwick''s removal 
 from office. The bringing forward of the annual estimates for 
 the Board gave various occasions (July 6th, 10th, 14th) for 
 skirmishes preliminary to decisive battle ; and on July 31st, at a 
 
230 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XI. morning sitting, the final debate was taken. The proposal by- 
 Board of Government to renew the Act, subject only to a control to be 
 i848-*68. exercised over the Board by the Secretary of State, was brought 
 forward by Lord Palmerston ; who, in doing so, sought to mitigate 
 certain prejudices which he believed to be against his proposal. 
 The Board, he said, had had " to manage arrangements which 
 conflicted with the fair and legitimate interests of many very in- 
 • telligent and very active men " ; they had interfered with the 
 lucrative business of obtaining local Acts, with the profits of 
 water-companies, actual and projected, and with the previous 
 opinions and the employment of local engineers ; and *^ all things 
 considered '' it was " not to be wondered at that great prejudice 
 should be created against them, in manjr respects, without good 
 and proper justification.^^ Opposition to the government-proposal 
 was moved by Lord Seymour in a strong and very bitter speech : 
 others followed in the same tone, siding with the offended 
 "interests"'''; and the Prime Minister (Lord J. Russell) closed 
 the debate. In doing so, he referred particularly to the personal 
 attacks which had been made on Mr. Chadwick ; and here, 
 though he dwelt with earnestness on his sense of Mr. Chadwick^s 
 eminent merits and services, he seemed not able to withhold from 
 the House, that, in his opinion, Mr. Chadwick had been an 
 injudicious administrator : — " Like many other men, ardent 
 reformers, he very often, in his zeal for amendment, as he 
 conceived it, overlooked or disregarded the objection and repug- 
 nance with which his views and propositions were received by 
 
 others With respect to this Health of Towns Act, no 
 
 doubt in many instances Mr. Chadwick^s acts [like his proposals 
 formerly at the Poor Law Board] had given offence ; for obvi- 
 ously many towns would rather be let alone There were 
 
 likewise many persons who were pecuniarily interested that the 
 plans of the Board should not be adopted, and it was very 
 probable that Mr. Chadwick had not observed towards these 
 classes of persons the most conciliatory tone possible.^-' The 
 ministerial speakers stated in the course of the debate that the 
 members of the Board had placed their resignations in the hands 
 of the Government, and they also let it plainly appear that 
 Government was ready to acquiesce in Mr. Chadwick''s retire- 
 ment j but the feud was too hot for any terms of surrender, and. 
 
THE REIGN OF QUEEN VICTORIA.. 231 
 
 on the division whicli soon ensued, tlie Bill proposing to continue l^^^^ 
 
 the Board was defeated by a majority o£ 74 to 65. &°^«,°* 
 
 On the following day Sir William Molesworth, then First 1848-58. 
 
 Commissioner of the Board of Works, introduced a new Bill ^ ^ , 
 
 . . The Board 
 
 which soon became law, giving effect to the views of the majority, re-constitu- 
 "The Public Health Act 1848, amended in certain particulars, changed 
 was to be continued on the footing of annual renewability. The P ^* 
 old General Board of Health was terminated : the new Board 
 (henceforth to be a Board only in name) was to consist of certain 
 chief Ministers of State, with a paid President, eligible to sit in 
 the House of Commons, and who, according to a well-understood 
 official practice, would himself alone be the acting Board. "^The 
 Act did not provide for the appointment of any medical func- 
 tionary; but the engineer inspectors of the new Board were 
 henceforth to be salaried officers, forbidden to engage in private 
 practice. 
 
 At the present date, when thirty-five years have passed since Mr. Chad- 
 the event referred to, it does not seem worth while to discuss Elation to 
 more minutely the particulars of the quarrel in which the original ^^^^j 
 Board of Health was brought so abruptly to an end ; * but of Mr. Wsiy, to 
 Chadwick, on this termination of his official career, something service. 
 further may be said. In the common judgment of that time, it was 
 he who had upset the coach. As the credit of having originated 
 the Board of Health had been due to him, so to him was ascribed, 
 with every depreciative term, the policy which had brought it 
 to an end ; and Mr. Chadwick bore in those days the distinction 
 which has been many a great reformer's crown of laurel, that 
 he was among the best-abused men of his time. With his rare 
 abilities as an initiative investigator in matters of social pathology, 
 and with his absolute rectitude of intention towards the public 
 
 * Hansard's report of the delDates which took place in the House of Commons 
 on the occasions which I have mentioned, and on some subsequent occasions 
 when the policy of the Public Health Act came into question, as particularly on 
 January 23, 1855, is the best authority to which I can refer for the sort of 
 feeling which had become ciirrent against the Board ; and the view which the 
 Board took of its own proceedings and policy may be best read in the summary ^ 
 
 Eeport which I have already mentioned, as having been made by the Board 
 early in 1854, on its 5^ years' administration of the Public Health Act and the 
 Nuisances-Kemoval and Diseases-Prevention Acts. 
 
232 ENGLISH SANITARY INSTITUTIONS. 
 
 Genifraf ^' in every line o£ conduct which he followed^ he was an adminis- 
 Board of trator whom the Government of the day could not uphold 
 1848-58. against hostile interests, even in the political field which he had 
 himself opened; and Lord John Russeirs regretful admissions 
 in regard of him must be accepted as suggesting the explanation 
 of that fact, ^n the earlier stages of Mr. Chadwick^s career, 
 when the essence of his work was to force public attention to 
 the broad facts and consequences of a great public neglect, it 
 mattered comparatively little whether, among his eminent quali- 
 fications, he possessed the quality of judicial patience ; but in 
 his subsequent position of authority, demands for the exercise of 
 that virtue were great and constant ; and Mr. Chad wick seems 
 not to have been gifted with the quality in degree sufficient for 
 administrative success. The faults which were imputed to him 
 in his official relations — a tendency to build overmuch on founda- 
 tions of small experience, a liability to one-sidedness on questions 
 of science and administration, a failure to listen duly to dis- 
 sentient voices, a deceptive trust in central dictation as the short 
 and ready road to success, and a too despotic tone in affairs of 
 local and personal interest, — all these, so far as they were Mr. 
 Chadwick^s faults, may be generalised as faults of over-eagerness : 
 faults, no doubt, which his opponents could not have found 
 conciliatory, and which also in other respects would have tended 
 to defeat his main object ; but which, so far as they were his, 
 fall into moral unimportance as compared with his sincere and 
 disinterested zeal for the public service, and may be counted as 
 of one root with that zeal. He perhaps did not sufficiently 
 recognise that the case was one in which deliberate national 
 consents had to be obtained, and in which therefore no real, no 
 permanent, success could be won, except in proportion as the 
 people and their representative bodies should have made way 
 in a necessarily gradual process of education. He could not 
 advisedly have thought it possible to snatch his verdict, and 
 to revolutionise national habits by surprise; but he probably 
 hoped to achieve in a few years the results which not ten times 
 his few years could see achieved ; and where others on all sides 
 4 were hanging back, his ardour seemed ready to undertake the 
 
 work of all. This apparently was the substance of whatever ad- 
 ministrative unwisdom Mr. Chadwick showed, the explanation of 
 
THE REIGN OF QUEEN VICTORIA. 233 
 
 whatever was crude in his expositions^ or overbearing in his policy ; S^'^' ?' 
 and Mr. Chadwick, in regard of that too impatient pressing on- Board of 
 wardj has at least an apologetic appeal against the angry condem- 1848-58. 
 nation he underwent. Granted that he erred by impatience : but 
 patience under sufferings of one's own_, and patience towards the 
 sufferings of others^ are not equal measures of magnanimity. 
 <^r. Chadwick^ beyond any man of his time, knew what large 
 fresh additions of human misery were accruing day by day 
 under the then almost universal prevalence of sanitary neglect ; 
 and the indignation which he was entitled to feel at the spectacle 
 of so much needless human suffering is a not ignoble excuse for 
 such signs of over-eagerness as he may have shown. 
 
 Another word, too, is emphatically due. Whatever may 
 have been Mr. Chadwick''s administrative unsuccess, and how- 
 ever severely the unsuccess may be ascribed to errors of judg- 
 ment on his part, nothing therein lessens by a tittle the value of 
 what he had previously achieved. To those previous services of 
 Mr. Chadwick's — to the ten years' arduous labour which he had 
 given to the cause before the General Board of Health was 
 called into being, we of this nation unquestionably owe that our 
 statesmen of those times were first awakened to the duty of 
 caring for the Public Health, and that the first of our modern 
 legislative endeavours were made to bring Health under the 
 protection of Law. The writer of these pages, as one who 
 has personal recollection of the times, is glad to record how 
 vividly he remembers Mr. Chadwick's unique relation to the 
 beginnings of British Sanitary Beform ; how permanently im- 
 portant in his opinion has been the momentum which the cause 
 of State-Medicine received in those years from the vigour and 
 substantial conclusiveness of Mr. Chadwick^s advocacy; and 
 with what unfailing respect he always thinks of Mr. Chadwick 
 as first leader in so great a cause. 
 
 With the ending of the old Board of Health, there passed 
 out of ofiice, together with Mr. Chadwick and Dr. Smith, also 
 their true fellow- worker. Lord Shaftesbury ; * and in relation to 
 him, on his thus ceasing to take part in the administration of 
 the public health laws, the writer would also wish to say a 
 few words. That Lord Shaftesbury, during the six years' 
 » Died Oct. 1, 1885. 
 
234 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XI. existence of the General Board of Health, held place in it as 
 
 Greneral . . ^ r 
 
 Board of its unpaid member, and devoted himself to the work of the 
 1848-58. Board with real assiduity and effect, counts as but one of many- 
 labours undertaken by him for the health-interests of the people, 
 and as but a very small part of the genuinely philanthropic 
 career in which he earned gratitude and honour from his con- 
 temporaries. Gifts of fortune and social circumstances allowed 
 Lord Shaftesbury to cast his lot as he would; and had he 
 elected, either for the easy pleasures of prosperous society, 
 or for the flashy ambitions of mere party-politics, no doubt 
 he might in either career have distanced most men of his time : 
 but his conscience led him to nobler aims, and he took, as 
 his calling in life, that he would work for the weak among 
 his fellow-men. From early manhood to the very advanced age 
 at which he died, he, following that course, was an unfailing 
 representative of the truest spirit of humanity : doing his best 
 in all directions — among the poor, the untaught, the degraded, 
 the demented, the oppressed, to give help and hope to the 
 classes which he found unable to help themselves. In relation 
 to the interests of such classes, he, in his parliamentary capacity, 
 was the principal promoter of all that was best in the legislation 
 of his time, and, out of Parliament, he worked with equal 
 energy and influence in aid of the many voluntary associations 
 which were serving as supplementary to law : so that, in the one 
 way or the other. Factories, Lunatic Asylums, Common Lodging- 
 houses, Dwellings for the Labouring Classes, Bagged Schools, 
 Bagged Dormitories, Beformatories, and probably other institu- 
 tions of concern to large numbers of persons, were very largely 
 benefited by his labours. In devoting himself to his career of 
 practical beneficence, he, like William Wilberforce before him, 
 always avowed the strongest convictions of religious duty ; and 
 while ever most ardent in works of secular humanity, he also, 
 like Wilberforce, was equally distinguished in the eyes of his 
 countrymen as one of their religious leaders — specially as the 
 foremost layman of those branches of the Christian Church 
 which are farthest from affinity with Bome. To dwell on that 
 side of Lord Shaftesbury^s career would be foreign to the 
 purpose of these pages ; and here can only be noted — Happy the 
 land where professed religion bears fruit in such life as his. 
 
THE REIGN OF QUEEN VICTORIA. 235 
 
 In the issue of the conflict of 1854, the ^' interests ^' which Chap. XL 
 
 General 
 
 had clamoured against the Board of Health had every reason Board of 
 to be satisfied ; but the world around them was an ^^ interest " 1848-58. 
 which had raised no voice. The nation which was so much 
 in need of proper sanitary government^ the millions of popula- meat of' 
 tion still under the free ravages of preventable disease,, had '*^®<*- 
 not yet the self -consciousness of an " interest/^ and perhaps 
 would not^ for long to come^ awake to any high degree of 
 such consciousness. To impartial informed spectators of the 
 conflict — the comparatively few who appreciated the national 
 want of proper sanitary government, the demolition of the 
 Board of 1848 was matter of regret and anxiety. Though 
 perhaps not many of such spectators deemed the Board infallible, 
 either as to its technical teachings, or as to its administrative 
 tact, there was among them a strong belief in the excel- 
 lence of the Board's intentions; and to such spectators, 
 therefore, the catastrophe which they witnessed gave somewhat 
 of the feeling with which landsmen, looking from their cliff 
 into the sea-storm, see the failure and foundering of a life-boat. 
 An earnest powerful endeavour had miscarried ; and in the 
 thought how genuine a spirit of rescue had gone to wreck, there 
 was little humour to criticise adversely the craft of the hand 
 which had held the helm. In our sanitary case, too, the imme- 
 diate failure was only part of what had to be regretted. For the 
 invectives which had been meant to destroy the Board had been 
 too angry in their aim not to do much* collateral damage; and 
 they continued to operate for several succeeding years on a 
 considerable scale, in maintaining suspicion and prejudice against 
 sanitary proposals and those who made them. 
 
 '"^The constitution provided in 1854 for the General Board of Thenewly- 
 
 TT ij^i J' 1 1 • 1 1 •!! constituted 
 
 Jlealth contmued under successive annual renewals till 1858 ; Board, 
 but the renewal-bill of 1857, in order to save the cost of a 
 separate presidency, provided that the Vice-President of the 
 Education Committee of the Privy Council might also be Presi- 
 dent of the General Board of Health. The presidency during 
 the four years was held in succession by Sir Benjamin Hall, 
 afterwards Baron Llanover; by Hon. William Cowper (later 
 Cowper-Temple), afterwards Baron Mount-Temple; by Mr. 
 
236 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XI. 
 General 
 Board of 
 Health 
 
 1848-58, 
 
 Sir Benj . 
 Hall as 
 President. 
 
 Cholera 
 Epidemic 
 of 1854. 
 
 William Monsell^ afterwards Baron Emly; then again by- 
 Mr. W. Cowper, e x -officio ; and last by Mr. Charles Adderley, 
 afterwards Baron Norton. Under these successive presidents, 
 the former staff of the Board was for the most part retained in 
 action; and among the officers thus continued (including such 
 former occasional-inspectors as now became permanent officers) 
 were some whose names afterwards came to be well known by 
 the public : particularly the Secretary of the Board Mr. Tom 
 Taylor, and three engineering inspectors, Mr. Henry Austin, 
 Mr. Ranger, and Mr. Robert Rawlinson.* 
 
 •^ During the whole of the four years^ period, the continuance 
 of the Board was precarious; and the prospects of further 
 progress in sanitary reform were always extremely uncertain. 
 The last three of the years were so essentially a mere period of 
 suspense, that of them there is almost nothing to say ; but the 
 first year of the new-constituted Board, under the presidency of 
 Sir Benjamin Hall, had passages of considerable interest. The 
 personal antecedents of the new president were a sort of pledge 
 that the centralising administrative policy of the old Board 
 would no longer be followed; for he, as member for Maryle- 
 bone, had, with most or all of the other metropolitan members, 
 been habitually opposed to that policy. His tenure of office, in 
 which he had the intelligent and genial assistance of Mr. Tom 
 Taylor, tended importantly to bring into vogue the better con- 
 ceptions, which had then begun to declare themselves, and which 
 from then till now have been of growing influence in this 
 country, as to the proper limits of central authority in relation 
 to affairs of local government.t 
 
 ' The new Board entered on its functions on August 12, 1854 : 
 at which time the severe cholera-prevalence of 1854 was growing 
 
 * The one survivor of the above-named ofl&cers, now Sir Eohert Eawlinson, 
 became in 1871 an officer of the Local Government Board, hereafter to be men- 
 tioned, and retained that position till the beginning of 1888, when he retired 
 with the decoration of K.C.B. 
 
 t The new spirit in which such questions began from the above date to be 
 regarded may be well observed in a short but striking paper which Mr. Taylor 
 read in 1857 at the first meeting (Birmingham) of the Social Science Association, 
 and which is printed in the first volume of that Association's Transactions: 
 On Central and Local Action in relation to Town- Improvement. The former system 
 had been strongly and learnedly argued against, on grounds of constitutional 
 law, by Mr. Toulmin Smith, in various writings published some years previously. 
 
THE KEIGN OF QUEEN VICTORIA. 237 
 
 towards its maximum in the metropolis : the deaths from the £^^- ?^- 
 
 , , . , General 
 
 disease during the previous six weeks having been, successively. Board of 
 1, 5_, 26, 133, 399, 644. Orders of Council bringing into opera- 1848-58. 
 tion the emergency provisions of the Nuisances-Removal and 
 Diseases-Prevention Act had been in force since the autumn of 
 1853; and rules and regulations prescribing measures to be taken 
 against the disease had been issued and re-issued by the late 
 Board. Sir Benjamin Hall had not to vary in any material 
 respect the tenor of the previous rules and regulations; but, 
 being advised that the law gave him no power to enforce them, 
 he studiously minimised the show of command, and, while direct- 
 ing vigorous and well-planned endeavours to bring to light the 
 sufferings of infected districts, and the needs which they had for 
 local action, he aimed at making clear to the local authorities 
 that he would not divide responsibility with them in regard of 
 those needs, and that, if they failed to do their duties, as ex- 
 plained to them by the Board, he could only leave them to the 
 verdicts of coroners' inquests, and eventually to answer for them- 
 selves to Parliament. The communications of the Board with 
 local authorities were had through a number of medical inspectors : 
 two of whom. Dr. Sutherland and Dr. Milroy, were particularly 
 attached to the central office as superintendents, while the 
 others (about ten in number) were doing local duty. A note- 
 worthy fact, in Sir Benjamin HalFs relation to the epidemic 
 period, was, that he had in existence for about a year a Council 
 of members of the Medical Profession, and, from time to time 
 referred to this Council for advice, in respect of the preventive 
 measures he was taking, and in respect of scientific investiga- 
 tions appropriate to the occasion.* For the purposes of this 
 
 * The thirteen members of Sir Benjamin Hall's Medical Council were the 
 following : f John Ayrton Paris, M.D., F.R.S., President of the Royal College 
 of Physicians; Sir James Clark, Bart., M.D., F.E.S., Physician to the Queen 
 and Prince Albert ; f James Alderson, M.D., F.R.S., Physician to St. Mary's 
 Hospital; * Neil Amott, M.D., F.R.S. ; f Benjamin Guy Babington, 'M.D., 
 F.R.S. , Physician to Gruy's Hospital; f Alexander Tweedie, M.D., F.R.S. , 
 Physician to the Fever Hospital ; * William Baly, M.D., F.R.S., Physician 
 to the Millbank Penitentiary ; William Lawrence, F.R.S., Surgeon to St. Bar- 
 tholomew's Hospital ; * John Simon, F.R.S., Surgeon to St. Thomas's Hospital, 
 Officer of Health in the City of London; * Richard Owen, F.R.S., Professor in 
 the Royal College of Surgeons ; f Nathaniel B. Ward, Master of the Society of 
 Apothecaries ; John Bacot, Inspector of Anatomy ; and * William Farr, of the 
 
238 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XI. narrative, it is not requisite to describe in detail the work which 
 Board of was doTie^ under Sir Benjamin Hall and his Medical Council, by 
 1848-68. ^^ inspectors and scientific investigators whom he appointed, 
 nor to follow to its end the history o£ the epidemic in which they 
 acted; but any reader who may wish further information on 
 those matters may refer to the Board^s reports which in 1855 
 were by Her Majesty^s command laid before Parliament.*^ 
 rffsss^^^^ From the time of Sir Benjamin HalFs accession to office, 
 whatever time he could spare from the special demands of the 
 cholera epidemic, was given to a consideration of the many 
 defects which had been shown to exist in the sanitary laws as 
 they then stood ; and the latter half of his year of office was dis- 
 tinguished by his endeavours to amend those defects. In 1855, 
 as soon as Parliament met, he introduced the following Bills : 
 first, a Bill for extensive amendments in the Public Health Act 
 of 1848 : next, two Bills, to replace in an amended form the 
 Nuisances- Removal and Diseases-Prevention Acts of 1848 and 
 1849 ; and thirdly, a Bill, of first class importance, to provide 
 for the local management of the Metropolis. Of these Bills, the 
 last-named, conducted by him successfully through the House of 
 Commons, became law towards the end of the Session, as the 
 Act, 18th and 19th Vic. c. 120; under which the Metropolitan 
 Board of Works (now, through the legislation of 1888, super- 
 seded by the London County Council) was constituted and 
 empowered for the general sedile purposes of London; while, 
 for the sanitary and other sedile purposes of the individual parishes 
 and districts, vestries and district-boards were constituted the 
 
 General Register Office. Tlie marks * and f, respectively affixed to certain 
 names in the foregoing list indicate the members of two special committees 
 which did most of the work of the Council : viz., those marked * formed a com- 
 mittee for scientific inquiries, and those marked f ' formed a committee on the 
 results of different methods of treatment. The investigators appointed by the 
 Board to conduct, respectively, chemical, microscopical, and meteorological, 
 enquiries, in relation to the epidemic, were Dr. R. D. Thompson, Dr. Hassall 
 and Mr. Glaisher. 
 
 * Letter of the President of the General Board of Health to Viscount Palmerston, 
 accompanying a Report from Dr. Sutherland on Epidemic Cholera in the 
 Metropolis in 1854 ; — Report of the Medical Council to Sir B. Hall, in relation 
 to the Cholera Epidemic of 1854 ; — Beport of the Committee for Scientific Inquiries 
 in relation to the Cholera Epidemic of 1854, and Appendix to that Report; — 
 Reports (two) of the Treatment Committee on the Results of different Methods of 
 treatment pursued in Epidemic Cholera. 
 
THE REIGN OF QUEEN VICTORIA. 239 
 
 authorities^ and were severally required to appoint special ^^^- ^• 
 sanitary officers. Also Sir B. HalFs two Bills, providing Board of 
 amendment for the Nuisances -Removal and Diseases -Pre- 1848-58. 
 vention Acts, became law, as the 18th and 19th Vic. cc. 116 
 and 121. The Bill, by which he proposed to amend the Public 
 Health Act 1848, and in which he would, inter alia, have con- 
 siderably relaxed some of the centralising provisions of that Act, 
 he was finally obliged to abandon : not being able to find 
 sufficient opportunities for bringing it before the House : but, 
 towards the end of the session, when he found he must withdraw 
 that Bill, and propose in its stead a mere provisional continuance 
 of the Board of Health, he introduced into his continuance-bill a 
 clause which particularly concerns this narrative. Though he of 
 course could not assume that the Board would remain in its then 
 form for more than the year which his proposed continuance 
 would cover, he apparently took for granted, that, whatever 
 might befall the form of the Board, the main functions which 
 the Board had been exercising under his presidency would in the 
 future certainly have to be exercised, in some departmental form 
 or other j^'^and therefore, on July 9th, when he proposed the 
 temporary continuance of the Board, he proposed also that the 
 Board should have power to appoint from time to time, as it 
 might see fit, a Medical Council, and to appoint and salary a 
 Medical Officer. The Bill thus proposed by him became law, as 
 c. 115 of the 18th and 19th Vict., and gave origin to the office 
 which the writer of this narrative had afterwards the honor to hold. 
 
 In 1858, the Board, which till then had been prolonged by Cessation 
 successive temporary Acts, finally ceased under legislation which Board in 
 the then President, Mr. Adderley, promoted. Its more medical ^ * 
 duties were assigned by the Public Health Act, 1858, to the 
 Privy Council, to which department also the Medical Officer of 
 the Board was at the same time transferred : while by the 
 Local Government Act of 1858 (amending the Public Health 
 Act 1848) the other duties of the Board, so far as they remained; 
 were assigned to the Home Secretary. Of the general proceed- 
 ings of the Board during its last three years of continuance, 
 there is nothing noteworthy to tell ; but mention will hereafter 
 have to be made of some of the medical work which was done 
 under it during those years. 
 
240 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XI. 
 General 
 Board of 
 Health 
 
 1848-58. 
 
 Cholera- 
 studies of 
 1848-58. 
 
 In concluding this chapter^ reference may again for a 
 moment be made to the subject of the two great cholera- visita- 
 tions which have been mentioned in the chapter as important 
 incidents of the decennium under review. First,, it is to be 
 noted that, thanks to the existence of the General Register 
 Office, the distribution of the disease (or at least of the deaths 
 occasioned by it) during those two visitations was made matter 
 of elaborate statistical study by Mr. Farr : who on each occasion 
 reported to the Registrar General, for publication, the statistical 
 facts and his own comments on them. The Report on the visita- 
 tion of 1848-9 (a separate volume published in 1852) is a classic 
 in medical statistics : admirable for the skill with which the then 
 recent ravages of the disease in England were quantitatively 
 analysed in relation to the variety of districts and classes, as well 
 as for the stores of collateral information which were used to 
 illustrate the argument, and for the literary power with which 
 the story of the disease, so far as then known, was told. Mr. 
 Farr, having written that report, did not think it necessary to 
 write with equal fulness on the visitation of 1853-4 ; but the 
 leading statistical facts of the later visitation were set forth and 
 discussed by him, in a letter which he addressed to the Registrar - 
 General and which was published in 1856, with the Registrar- 
 Generals seventeenth annual report. Secondly is to be noted, 
 in relation to those two cholera-periods of the decennium, and 
 as of permanent interest in the records of cholera-pathology, 
 that, while London was suffering its epidemic of 1849, Dr. John 
 Snow first put forth his theory as to the propagation of cholera 
 by means of the intestinal discharges of the sick ; and that 
 during the cholera-period of 1853-4, he collected the important 
 facts which he published at the beginning of 1855 as evidence 
 of the justness of his theory. "^ 
 
 Army Sani- 
 tary Ke- 
 
 form, con- the later of the years which it has reviewed, and originating 
 Crimean from the time and influence of the first-constituted Board of 
 ence^" Health, were movements which eventually conduced to important 
 
 This chapter, before it closes, must briefly notice that, during 
 
 * On the Mode of Communication of Cholera : by John Snow, M.D. — second 
 edition, much enlarged, 1855. Th6 edition of 1848 had been a paper in the 
 London Medical Gazette, soon afterwards separately published as a pamphlet. 
 
THE REIGN OF QUEEN VICTORIA. 241 
 
 measures of reform in the Sanitary Administration of tlie Army. Chap. XI. 
 The appalling quantity of disease among the British troops_, Board of 
 during the first winter of the Crimean war, — when " the number 1848-58. 
 of men who were disabled by preventable disease amounted to 
 more than one-third of the whole strength of the army which 
 went out of England/' "^ led to the Government''s sending out, Crimean 
 in the spring of 1855, a Sanitary Commission, recommended by Commis- 
 the then Board of Health, and consisting of Dr. John Suther- ^^°° ' 
 land, Dr. Hector Gavin, and Mr. (now Sir) Robert Rawlinson. 
 The experience of the comparative healthfulness which obtained 
 in the camp so soon as the measures recommended by the Com- 
 mission had been adopted stands on record as among the great 
 lessons of sanitary science, f Equally dreadful with the early 
 camp-experiences, and in some respects even more dreadful than MissNight- 
 they, were those of the Scutari hospitals for our Crimean sick "^^aie. 
 and wounded ; and there again the change of experience was no 
 less instructive, when, under the action of the Commission, and 
 with the beneficent ministrations of Miss Nightingale and her 
 staff of nurses, the previous monstrous insalubrities had been 
 removed. J The horrors of the earlier period can never be 
 
 * See Army Sanitation, a course of lectures delivered at the School of Military 
 Engineering at Chatham, by Sir Douglas Galton, K.C.B., R.E. ; page 5. As 
 the present chapter is the only one in which references to Sir D. Galton are 
 made, and the text mentions him only in military connexions, I avail myself 
 of this opportunity to note that, during the last thirty years, he has constantly 
 taken helpful part in the promotion of civil sanitary progress, and has re- 
 peatedly, from his engineering knowledge, contributed to the education of the public. 
 
 t " During the winter of 1855-6, all the previous causes of disease had been 
 removed. The men were well clothed, fed, and sheltered, their huts were 
 properly drained and ventilated, and nuisances had been removed. Compare 
 the mortality from September 1854 to April 1855 with that from September 
 1855 to April 1856, and no more instructive lesson on army hygiene could be 
 given. The men were the same ; the conditions only had been altered. The 
 requirements of Nature had been disobeyed in every particular during the 
 first winter. . . During the second winter. Nature had been more perfectly 
 obeyed, and the stigma of her displeasure has almost ceased to appear." — Sir 
 Douglas Galton, Op. cit., p. 5; and the appended diagram (Plate I. Fig. 1) in 
 which he shows the monthly death-rate of the troops during the two years 
 in question. 
 
 J " Of the soldiers who were landed from the Crimea to be taken to those 
 hospitals, two men were lost out of every five treated in the hospitals of the 
 Bosphorus during the month of February, 1855, and one man out of every two 
 at Koulali. Improvements were begun in March, 1855, but it was not till the 
 end of June they were completed. The effect of the completion of the sanitary 
 
242 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XI. 
 General 
 Board of 
 Health 
 1848-58. 
 
 Mr. Sydney 
 Herbert ; 
 
 RoyalCom- 
 migsion on 
 Army 
 Regiila- 
 tions ; 
 
 forgotten by those who were iii a position to be rightly aware 
 of them. The details of evidence which the two surviving Com- 
 missioners * and Miss Nightingale brought back with them to 
 England^ were ample proof that the old official system had not 
 nearly enough taken into account the sanitary requirements of 
 the soldier_, and that_, for the health of the army, whether in war 
 •or peace, a systematic better application of competent knowledge 
 was wanted. Among those whom that evidence most impressed 
 was Mr. Sydney Herbert (afterwards Baron Herbert of Lea) who 
 during the first part of the Crimean experience had been in 
 office as Secretary at War ; and he henceforth, till his deeply- 
 regretted early death in 1861, continued to devote to the cause 
 of Army Sanitary Reform all the best energies of his gifted and 
 generous mind. Intimately associated with him in his endea- 
 vours, and, as regards this sphere of beneficence, never to be 
 named but with gratitude, was Miss Nightingale : who, while 
 serving devotedly as nurse and as teacher of nurses for the 
 sufferers of the Crimean time, had observed with keen discern- 
 ment the underlying causes of disaster, and was now recognised 
 as of eminent qualification to be herself among the chief 
 suggesters of reform. In 1857, the then existing Regulations 
 affecting the Sanitary Condition of the Army were referred to a 
 R-oyal Commission, having Mr. Herbert for its chairman, and 
 Surgeon-General Dr. Thomas Graham Balfour for its Secretary ; 
 the latter of whom, both as an officer of much technical expe- 
 rience and sagacity, and also as an accomplished statistician, 
 was very eminently qualified to assist the Commission in its 
 inquiries and judgment. The impressive Report of that Com- 
 mission, made in 1859, began a new era in the war-officers 
 medical organisation ; and meanwhile, under like influences, 
 successive committees or commissions of war-office appointment 
 were thoroughly studying the conditions of reform for Military 
 Barracks and Hospitals. An important commission thus ap- 
 pointed, consisting chiefly of army officials, but having as 
 
 works is most striking. The mortality fell in June, 1855, to less than a sixth. 
 part of what it was when the hospitals were occupied in October, 1854, and to a 
 nineteenth part of what it was in February, 1855." — Op. cit., pp. 5, 6. 
 
 *The Commission, at a somewhat early stage of its service, had lost one of 
 its members by death: Dr. Gavin, namely, who, by an unfortunate accident, 
 had given himself a pistol- wound which proved fatal. 
 
THE REIGN OF QUEEN VICTORIA. 243 
 
 extraneous members Dr. Sutherland and Captain (now Sir) Chap. XI. 
 Douglas Galton_, R.E., presented in 1861 a very valuable report ;* Board of 
 from which, and from the concurrent publication of Miss ^^% 
 Nightingale's Notes on Hospitals , practical reforms on a large 
 scale soon began to result. Further, in pursuance of a highly- 
 important recommendation of the Royal Commission, that there 
 should be established under war-office direction an Army Medical 
 School, in which young medical officers entering the army 
 might receive particular training in the " specialties of military 
 medicine, surgery, hygiene and sanitary science," there shortly 
 came to be established at Netley the now well-known Military Netley 
 Hospital and School, from which, during the last quarter of a g^iJ^oi^^ 
 century, hundreds of specially-trained officers have been supplied 
 to the military service, and incidentally much excellent teaching 
 has been given forth to the world at large. 
 
 The establishment of that school proved peculiarly conducive Dr.Parkes. 
 to the interests of sanitary, teaching, through the eminent 
 professional and personal merits of the first holder of the Chair 
 of Hygiene, the late Dr. Edmund Alexander Parkes,t and 
 
 * General Report of the Commissioners appointed for Improving the Sanitary 
 Condition of Barracks and Hospitals, 1861. Subsequently the services of the 
 Commission were extended to India ; and the Commission was then enlarged by 
 addition of Indian official members, and of Mr. (now Sir) Robert Rawlinson. 
 Apparently it is by continuance from that Commission that the present Army 
 Sanitary Committee exists, with constitution announced as follows : President, 
 Major-Gen. Rt. Hon. Sir Redvers H. Buller, K.C.B., V.C. ; Members: Dep.- 
 Surg. Gen. J. A. Marston, C.B., M.D. ; Col. Henry Yule, C.B. (India) ; Surg.- 
 Gen. Sir Joseph Fayrer, K.C.S.I., M.D. (India); J. Sutherland, M.D. ; Sir 
 Douglas Galton, K.C.B, ; Sir Robert RawHnson, K.C.B., C.E. 
 
 fDied March 15th, 1876. Dr. Parkes's first particular relation with those 
 who were reforming the military medical institutions was, that, in the middle of 
 the Crimean period, the war-office commissioned him to be superintendent of 
 the British auxiliary hospital then to be opened at Ronkioi. His work at that 
 hospital might alone have sufficed to certify him for the Chair at Netley ; but in 
 fact, long before that superintendentship, he had gained high- class reputation in. 
 ordinary professional work of various sorts, investigative and practical. While 
 Professor at Netley, he did duty in other spheres of public service, as notably 
 in the General Medical Council, and iu the Senate of the University of London ; 
 and it seemed that wherever he worked, his public spirit, and the kindliness and 
 bright sincerity of his nature, won the confidence and affection of his fellow- 
 workers. His life, abounding in industry and usefulness, and always of good 
 cheer for whatever duty had to be done, was an arduous gallant struggle against 
 heavy disadvantages of ill-health ; and his early death gave rise to public and 
 private expressions of such personal sorrow as is felt only for the best of men 
 when they pass away. 
 
 Q2 
 
244 ENGLISH SANITARY INSTITUTIONS. 
 
 « 
 
 Chap. XI. througli the fortunate accident that he, for the convenience of 
 Board of his class, in relation to the then state of sanitary literature, 
 1848-58. found himself moved to prepare a special text-book of the 
 branch of science he professed. Dr. Parkes's Mamial of Prac- 
 tical Hygiene, published by him in 1864, the earliest systematic 
 work of its kind in the English language, at once took rank as 
 of model excellence for its purpose; and at the present time 
 (having in meanwhile had other editions) it remains the leading 
 English classic in that branch of medical education. 
 
245 
 
 CHAPTER XII. 
 
 THE INITIATION OF MEDICAL OFPICERSHIPS;, LOCAL AND CENTRAL, 
 i. THE LOCAL APPOINTMENTS^ AND THEIR EARLY WORKING. 
 
 The present chapter must begin by reverting to years which 
 were prior to those told of in the last chapter. The fact has to 
 be remembered (see above^ pp. 201 — 3) that, about the time 
 when projects of general sanitary legislation first began to shape 
 themselves, various local authorities took separate and indepen- 
 dent action to obtain by means of local-bill legislation enlarged 
 powers for their respective sanitary purposes ; that such authorities 
 were able to take as their cue the recommendations made in the 
 Report (1845) of the Health of Towns Commission, with the 
 consequent clauses of Lord Lincoln^s Bill, and at a later date 
 the model clauses of the Towns Improvement Clauses Act, 1847 ; 
 and that among the powers which had been recommended as 
 necessary for the authorities of large towns to possess, was the 
 power to appoint Medical Officers of Health. ^ 
 
 Mm 1846 the Town Council of Liverpool procured the passing, 1847. 
 first, of an Act (9th and 10th Vic. c. 35) relating to water-supply ; appoints 
 secondly of an Act (c. 120) for street-improvements and public Stmcan its 
 buildings; and, thirdly, a very important and comprehensive 2^*^|!v^* 
 Act (c. 127) to provide for the improvement of the sewerage 
 and drainage of the borough, and for making further regula- 
 tions for sanitary regulation of the said borough. The last- 
 named Act, which was to come into operation on the first day 
 of 1847, provided, in its sect. 122, that the Town Council, with 
 the approval of the Secretary of State, might appoint and salary 
 a Medical Officer of Health ; and accordingly in 1847, when the 
 Act had come into working, the Town Council made use of that 
 new power, by appointing, in the person of Dr. William Henry 
 Duncan, the earliest of the medical profession to hold any such 
 office in this country. Dr. Duncan, a native of Liverpool, had 
 long been known there as a leader of local opinion and action in 
 the movement for sanitary reform. As far back as 1840, 
 
246 ENGLISH SANITARY INSTITUTIONS. 
 
 Chajp.XII. appearing as witness before the House of Commons select Com- 
 of Medical mittee on the Health of Towns, he had given evidence as to the 
 2um:' deplorable sanitary circumstances of the poorer population of 
 I Local Liverpool; and, later in the same year, he had answered the 
 Appoint- inquiry of the Poor Law Commissioners by a Report (No. 19 in 
 their subsequently published series of Local Reports) on the 
 sanitary state of the labouring classes in the town. At that 
 time he had already for ten years been one of the physicians to 
 the Liverpool Dispensaries ; and his evidence and report show 
 at every turn that he was most intimately acquainted with the 
 sanitary conditions of which he spoke, and had long given 
 intelligent and humane consideration to means of improving 
 them. In 1843 he had impressed public opinion in Liverpool by 
 a paper read before the Literary and Philosophical Society of 
 the city, substantially to the effect of the report he had made 
 to the Poor Law Commissioners, on the causes of the high 
 general death-rate at Liverpool — a death-rate which at that time 
 averaged annually about 36 per 1000 living; and it seems 
 certain that this paper of his was a principal influence in deter- 
 mining the subsequent activity of the Liverpool Corporation. 
 Appointed health-officer for Liverpool in 1847, Dr. Duncan 
 remained in office till 1863, when ill-health and approaching 
 death obliged him to retire. Of his sixteen years' official work, 
 there unfortunately do not exist any published circumstantial 
 records ; but, that his labours were in the highest degree meri- 
 torious, is still a tradition in Liverpool, and was at the time so 
 reputed elsewhere. While, as the first-appointed English Officer 
 of Health, he of course had an essentially novel task, he 
 also, in regard of his place of duty, had more than common 
 administrative difficulties to cope with ; and it is believed that 
 he attained every success which under those conditions was 
 possible. With the ungrudging confidence and support of a 
 very public- spirited local authority, he established methods of 
 work, and initiated courses of improvement, which have continued 
 to the present day ; and under which the average general death- 
 rate of Liverpool has been reduced by probably at least a fourth- 
 part of that which prevailed forty years ago. To his influence 
 especially has been due the abolition (probably now com- 
 plete) of what in earlier days had been among the worst oppro- 
 
THE KEIGN OF QUEEN VICTORIA. 247 
 
 bria of Liverpool : the pestiferous cul de sac courts, which some Chap. XII. 
 
 80 or 90,000 persons of the working classes then had as their o?MeScal 
 
 dwelling-places, and the 8,000 cellars which some 30 or 40,000 ^f ^g^.^" 
 
 persons were inhabiting^. . ^ 
 
 •^ ° 1. Local 
 
 Appoint- 
 
 ^n 1848 the Corporation of the City of London, which from ^^^ ^' 
 long before had been exercising old-fashioned improvement- clt^'of 
 powers with good effect, and was probably in that respect far l^o^'^'^^ 
 ahead of the other London authorities, resolved, like the Liver- like ap- 
 pool Corporation, to ask Parliament for powers adequate to the ^°^^ 
 new conceptions of sanitary improvement : the passing of the 
 valuable City Sewers Act, which has been mentioned at a former 
 page, was the result of that application : and shortly after the 
 passing of this Act, which gave power for the appointment of a 
 Medical Officer of Health, the writer of the present narrative 
 had the honour of being elected to the post. 
 
 Circumstances of place and time combined to bring the City 
 appointment into more prominence than its first holder expected, 
 or particularly desired, for it. As to place, the appoint ment''s 
 being metropolitan tended to give it a lift in the general public 
 view j while, even in the metropolis itself, the '' City '"* office was 
 made conspicuous by the circumstance that hitherto none of the 
 other sections of London were similarly officered. Likewise, as 
 to time, the newly-discovered aptitude of Asiatic Cholera to recur 
 epidemically in this country had just then prepared the public 
 mind to observe with more than ordinary interest whatever was 
 being said or done with any sort of official authority in respect 
 of precautions against the new danger, or generally of precautions 
 for the public health. Those having been the circumstances, 
 the appointment attracted more notice than it would otherwise 
 have obtained ; and as I continued to hold it for seven years — 
 namely, from Oct., 1848, to Oct., 1855, it may be proper for me 
 to furnish in this place some account of the method on which 
 Lwprked it. 
 
 ^The chief thought on which the office had been constituted was, Concep- 
 
 that the City Commissioners of Sewers, the Committee through hadof lo^l 
 
 which the Corporation did its sanitary business, needed to be sanit^-ry 
 . . . . business, 
 
 medically advised as to its function of abating the local conditions 
 
 of unwholesomeness. Local conditions, I say : for personal 
 
248 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XII. conditions,, such as those which may be incidental to particular 
 of Medical branches o£ industry^ or those which attach to the contagiousness 
 shipsT" ^^ certain current diseases^ were hitherto not distinctly within 
 i Local ^^^ ^^^^ ^^ ^^® •^^^* ^^^ Commissioners o£ Sewers were jpar 
 Appoint- excellence an authority of the sort which twenty years later came 
 to be called ^' Nuisance- Authorities.'^ What may briefly be called 
 " nuisances-removal/' and this above all in the limited sense in 
 which '^ nuisances ''■' mean " matters which stink/' was the duty 
 principally contemplated. The functions of technically advising 
 the Commission on their improvement- works, and of directing all 
 mechanical services concerning the cleanliness of the City, attached 
 to the office of Engineer and Surveyor : an office which in those 
 years was held with distinction, as it still is, by Mr. (now Colonel) 
 William Haywood, C.E. The Commission was not in any 
 formal way cognisant of sickness or death in the city. The care 
 of the sick poor, whether at ordinary times or at times when 
 diseases -prevention Orders of Council might be in force, was 
 entirely under other authorities ; and the registration of births 
 and deaths was also under another authority. ^With those as 
 the circumstances of the case, the newly-appointed Medical 
 Officer of Health had the following as his statutory duties :— 
 " To inspect and report periodically upon the sanatory condition 
 of the city, to ascertain the existence of diseases, more especially 
 epidemics increasing the rates of mortality, and to point out the 
 existence of any nuisance or other local causes which are likely 
 to originate and maintain such diseases and injuriously affect the 
 health of the inhabitants of the city, and to take cognizance of 
 the fact of the existence of any contagious or epidemic disease, 
 and to point out the most efficacious mode of checking or pre- 
 venting the spread of such diseases, and also to point out the 
 most efficient modes for the ventilation of churches, chapels, 
 schools,4odging-houses, and other public edifices within the city, 
 and to perform any other duties of a like nature which may be 
 . required of him." ^ 
 
 Mio^din "^ With regard to the main matters of duty, an essential basis 
 the City for the officer's action was that he should learn at short intervals 
 
 omce: 
 
 the behaviour of Causes of Death within the City; that he 
 should watch the fluctuations of serious disease, as varying in 
 different spots and at different times. In order to obtain the 
 
THE EEIGN OF QUEEN VICTOKIA. 249 
 
 most indispensable part of such a basis^ the first step I had t^^'3^"'"* 
 to take, when I had entered on office, was to throw myself of Medical 
 
 OfiicGr" 
 
 on the compassion of the Registrar- General ; for without ships: 
 special help from him, I should have had to wait indefinitely i. Local 
 to know of any death which might happen within the City ^^^°^*' 
 boundary; and I gratefully remember, at a distance of forty 
 years, how easy my course in that direction was made by Major 
 Graham^s friendly assistance. Punctually on every Monday 
 morning, he used to receive from the nine City Registrars their 
 returns of the deaths which they had registered during the 
 previous week (down to Saturday midnight) in their respective 
 districts; and punctually every Monday afternoon, as soon as 
 the General Registration Office could spare those papers, they 
 were placed at my disposal in a way which enabled me to 
 complete my use of them during the evening ; so that on the 
 Tuesday mornings, when the weekly courts of the City Com- 
 mission were held, I was ready with all needful particulars as to 
 the deaths which had befallen the City population during the 
 previous week, and with my scheme of such local inquiries 
 as were to be made in consequence. Adequate sickness-returns 
 were not obtainable. Even at our present time it is but very 
 imperfectly recognised in sanitary administration, that an au- 
 thority, set to diminish the diseases of a community, must begin 
 by possessing itself of exact knowledge as to the local distribu- 
 tion of the diseases ; and forty years ago practical effect could 
 not be given to any such principle. ''At that time, even as 
 to^cases of disease treated under the poor-law and under medical 
 charities, no adequate records existed for consultation by local 
 sanitary officers ; and it could not reasonably be expected that 
 such records would be brought into existence, till local authorities 
 should see their way to provide remuneration for the officers on 
 whom the trouble of preparing the records would fall. Repeated 
 endeavours which I made to surmount that difficulty were un- 
 successful ; but here again I find it pleasant to remember that, 
 in an important part of the desideratum, I received friendly help 
 beyond what the letter of the law would have given me ; and 
 that, before I had been long in office, the eleven Poor-Law 
 Medical Officers of the City voluntarily took upon themselves 
 the trouble of each sending me a weekly return (often with 
 
250 ENGLISH SANITARY INSTITUTIONS. 
 
 j^^V^"'-^' additional notes) to acquaint me of any new eases of fever 
 of Medical which/iiad arisen in their respective districts. 
 
 Officer- -,< . 
 
 ships: *^artly on the basis of the above-mentioned weekly returns of 
 
 i. Local death and sickness in the several districts of the City, and partly 
 mentr* ^^ ^^® basis of experience which soon accumulated as to the 
 sanitary habits of different localities,, I established and by 
 "Weekly degrees developed a routine of weekly inspections ; through 
 mgs ; which, with the assistance of Nuisance-Inspectors acting for the 
 
 purpose, I ascertained the state of all suspected habitations, 
 with regard to overcrowding of inmates, and to the sanitary 
 details of ventilation, cleanliness, drainage, water-supply, dust- 
 removal, paving of yards and cellars, freedom from exterior 
 nuisances, and the like : and also the state of premises on which 
 offensive businesses were carried on : which knowledge being 
 got, my next weekly report to the Commission contained an 
 application for formal orders, demanding the abatement of all 
 such abatable unwholesome conditions as had been discovered ; 
 and the routine of succeeding weeks included a systematic 
 following up of those several cases till each of the orders for 
 improvement had been obeyed. 'The weekly inspections were at 
 first chiefly relative to the particular premises where certain sorts 
 of death or disease had recently occurred ; but, as the system de- 
 veloped, it became, in addition, a methodical sanitary superintend- 
 ence of all poorer parts of the City, including within its ordinary 
 scope about seven thousand houses,^ and extending, on occasion, 
 to as many as nine thousand. f For the purpose of that suj^erin- 
 tendence, I gave to each district inspector a certain rota of visita- 
 tion ; and in proportion to the standing inferiority of lodSal con- 
 ditions, and to the degree in which cleansed and amended localities 
 tended to resume their previous faults, the localities would be re- 
 visited at quarterly or monthly or fortnightly or weekly intervals, 
 as the case might be, lest recent improvement-works should have 
 become inefficient, or the old filth have become dominant again. 
 In considerable parts of the routine, I of course acted in concert 
 with my engineering colleague, Mr. Haywood. So far as I made 
 recommendations for particular structural and scavenging im- 
 
 * See Reports for the years 1852-3 and 1854-5. 
 
 t See Report on the Cholera Epidemic of 1854, as it prevailed in the City of 
 London. 
 
THE KEIGN OF QUEEN VICTORIA. 251 
 
 provements. — as, above all, for the abolition of cesspools, and Chap. XII. 
 
 . . 1 Initiation 
 
 the creation of proper house-drams and water-supply, or for of Medical 
 amendments of surface-cleansing' in the poorer parts of the ships : 
 City, — it was only through his co-operation that the intentions I i, ^ocai 
 advocated could be brought into practical effect ; and what was ^^^^s^*' 
 sanitarily better in the City of 1855 than in the City of 1848 
 must have been at least as much due to him as to me. The 
 advance in that interval of time was great ; and though the 
 reforms which were made had not any claim to originality of 
 conception, being in fact only such as had been preached in Mr. 
 Chadwick's Reports of 1842-8, they no doubt were exceptional 
 in their time as facts of practical progress on a considerable 
 scale. So far as I know, the like were not to be seen elsewhere 
 in the metropolis, nor, except at Liverpool, elsewhere in the 
 Kingdom. The sanitary circumstances of tens of thousands 
 of the poorer population were sensibly improved, by the intro- 
 duction of new drainage and water-supply, by the enforcement 
 of periodical house-cleansing, by far stricter practice of scaveng- 
 ing, and by general mitigation of nuisances. Not least, the 
 abomination of cesspools had come to an end. At a time when 
 cesspools were still almost universal in the metropolis, and while, 
 in the mansions of the west-end, they were regarded as equally 
 sacred with the wine-cellars, they had been abolished, for rich 
 and poor, throughout all the square mile of the City. 
 
 In addition to the reports which were of weekly routine, it Annual 
 was a matter of course that, at the close of each calendary quarter, 
 and at the close of each official year, I made reports of a sum- 
 marising kind as to the deaths of the period ; and in planning 
 those reports, and the statistical tables which accompanied them, 
 I particularly aimed at such generalisations as could be popularly 
 understood and popularly applied, with regard to the causes of 
 death, and to the proportion in which diseases more or less pre- 
 ventable were killing within the City, and in its respective 
 districts. In the quarterly reports I confined myself to the 
 arithmetical facts ; but the annual reports (made after Michael- 
 mas in each year) gave convenient periodical opportunity for 
 g-eneral remarks on the health and sanitary circumstances of the 
 City ; and accordingly in most of the years, when I submitted 
 my annual statistics, I used the opportunity to take a more or 
 
252 ENGLISH SANITARY INSTITUTIONS. 
 
 ^^f:^-?^^^- less general survey of the existing sanitary situation. In- those 
 of Medical reports no detailed reference had to be made to matters which 
 ships : were within scope of the weekly routine ; but, on the other hand, 
 
 i. Local difficulties of a more baffling kind, and especially the evils which 
 ments^*' ^^J ^^^'^ ^^ ^^^^ outside the legal reach of the Commission, were 
 brought collectively into view, as hints for further legislation. 
 On several of the occasions, I had of course to speak of Asiatic 
 Cholera, according to such lights as I then had : namely, in the 
 annual reports of 1849 and 1850, to state the facts and lessons 
 of the 1848-9 visitation; in the annual report of 1853, to warn 
 with regard to the then impending danger of a new storm ; and 
 at the end of 1854, when that storm had passed, to tell (in a 
 supplement to the annual report) what had been our experience 
 of its severity. In the first and second reports (those of 1849 
 and 1850) I particularly passed under review the chief unwhole- 
 some influences which affected the City of those days, and which, 
 I need hardly say, were then operating to the same, or in general 
 to a far higher degree in other parts of the metropolis : the filthy 
 sewage-pollution of the Thames and its banks, the unsatisfactory 
 supply of water for domestic uses, the scandal of continued burial 
 in over-crowded church-yards and church- vaults, the nuisance of 
 intramural slaughter-houses and other trade-establishments 
 evolving offensive effluvia, and the manifold grievance of London 
 smoke. \/A.f ter the lapse of forty years, and happily in times 
 grown more respondent to such appeals, I rejoice to remember 
 \ that, even in those early days, I did my best to make clear to the 
 Commission, what sufferings and degradation were incurred by 
 masses of the labouring population, through the conditions under 
 which they were so generally housed in the courts and alleys 
 they inhabited : not only how unwholesome were those con- 
 ditions, but how shamefully inconsistent with reasonable stand- 
 ards of civilisation ; and how vain it must be to expect good 
 social fruits from human life running its course under such 
 conditions. In 1851, when the City Sewers Act of 1848 was 
 renewed and made permanent, several amendments, founded on 
 representations which I had submitted in the reports of 1849 and 
 1850, were made in it; among them, a first precedent for the 
 registration and regulation of the tenement-houses of the poor. 
 In the annual report of 1851, while explaining the improved 
 
THE REIGN OF QUEEN VICTORIA. 253 
 
 means which had become available in the City for the prevention Chap. XII. 
 of disease, I drew attention to the fact that London, with excep- of Medical 
 tion of the City, was deplorably without sanitary law. In the ^^^q^' 
 annual report of 1853, written in full expectation (which the . -r i 
 result justified) that in the following summer Cholera would Appoint- 
 again be epidemic in London, the neglected state of the metropolis 
 at large was again adverted to ; and on behalf of the City (as 
 proxi7nus to a probable JJcalegori) remonstrance was again raised 
 against London being any longer left without comprehensive 
 sanitary legislation."^ 
 
 It of course is not for me to iude-e whether that series of P'^*- 
 
 1 v> 1 T Survey of 
 
 reports was of good eftect ; but I may state, as matter of fact, the public 
 
 that they had an extraordinary circulation through the medium sanitary 
 
 of the daily press, and were received by the public with every ^elTt"^' 
 
 possible indulgence and favour. Clearly it was a want of the 
 
 time, that the questions which they endeavoured to treat should 
 
 be brought under serious public discussion; and so far as the 
 
 reports contributed to raise such discussion, this result may be 
 
 pleaded in set-off against the many imperfections which they 
 
 had. In the spring of 1854, an unofficial reprint was made of 
 
 those of the reports which had been published down to that date ; 
 
 and I availed myself of the opportunity to express, in a preface 
 
 to the volume, some thoughts on sanitary affairs in a fuller sense 
 
 of the term than had yet become usual. Not confining myself 
 
 to the case of the City, nor even to that of the Metropolis at 
 
 large, but speaking of the country in general, and pleading 
 
 especially for the poorer masses of the population, I endeavoured 
 
 to show how genuine and urgent a need there was, that the 
 
 State should concern itself systematically and comprehensively 
 
 with all chief interests of the public health. I submitted, as 
 
 the state of the case, that, except against wilful violence, the 
 
 law was practically caring very little for the lives of the people ; 
 
 and I gave illustrations of the harms and dangers to life which 
 
 were arising in various directions through the want of reasonable 
 
 * I need not particularise the minor special reports which from time to time 
 were needed ; but 1 may note that the passing of the Metropolitan Burials Act of 
 1852 required me to make a special report, stating grounds for the application of 
 the Act to the City, and some months later, to make a second such report, pro- 
 posing a general scheme for'the City's extra-mural interments. 
 
254 
 
 ENGLISH SANITAKY INSTITUTIONS. 
 
 Chap. XII. 
 Initiation 
 of Medical 
 Officer- 
 ships : 
 
 i. Local 
 Appoint- 
 ments. 
 
 law. Evils which I mentioned and illustrated as due, not to 
 administrative shortcomings^ but to the absence or insufficiency 
 of law, and in regard of which I suggested legislation, wer 
 particularly-' — the uncontrolled letting of houses unfit for human 
 occupation ; the unregulated industries of sorts endangering the 
 health of persons employed in them ; the unregulated nuisance- 
 making businesses; the unchecked adulterations of food; the 
 unchecked falsification of drugs ; the unregulated promiscuous 
 sale of poisons; and the absence of legal distinction between 
 qualified and unqualified "medical practitioners. '''In referring to 
 some of the existing evils, I of course found myself face to face 
 with immensely difficult social questions, which I could not 
 pretend to discuss ; questions as to wages and poverty and 
 pauperism; in relation to which I could only observe, as of 
 medical common-sense, that, if given wages will not purchase 
 such food and such lodgment as are necessary for health, the 
 rate-payers who sooner or later have to doctor and perhaps bury 
 the labourer, when starvation-disease or filth-disease has laid him 
 low, are in effect paying the too late arrears of wage which might 
 have hindered the suffering and sorrow. In that connexion, I 
 submitted that, while the law leaves wages to find their own level 
 in the struggles of an unrestricted competition, it surely ought 
 to contain strong safeguards for the poor, against those deterior- 
 ations of food which enable the retailer to disguise starvation to 
 his customers by apparent cheapenings of bulk, and against 
 those conditions of lodgment which are inconsistent with decency 
 and health. Adverting also to the specially injurious influences 
 which attach to certain large sections of wage-earning industry, 
 I pleaded that every collective industry, involving such conditions 
 of sanitary risk to the employed persons, ought to be liable to 
 inspection and regulation in respect of those conditions, ^n 
 relation to the many evils of which I spoke as requiring com- 
 prehensive and scientific legislation, and generally in relation to 
 sanitary government, I urged that the supervision of the public 
 health, in the full senSe indicated, ought to be the consolidated and 
 sole charge of some one Minister ; who sitting in Parliament, 
 and being in statutory relations with local authorities possessing 
 all the required sanitary powers, should be open to challenge in 
 respect of every public matter concerning health, and should be" 
 
Health. 
 
 THE EEIGN OF QUEEN VICTORIA. 255 
 
 responsible, not only for tlie enforcement of existing laws,, j^f-^V"^''--'-' 
 such as they were or might become, but likewise for their of Medical 
 progress from time to time as the growth of knowledge ships: 
 would make desirable. Finally a hope was expressed, that i. Local 
 the General Board of Health, when re-constituted as it then meff*' 
 shortly would have to be, might be conformed to the above 
 conception. 
 
 It was an almost necessary consequence of the working of ^®j.^f°Qf^ 
 the city office, that the officer should be regarded at Whitehall office with 
 as a person available for use in the general public service ; and Board of 
 from the autumn of 1853 (when the third cholera-period had 
 begun) I found that I was in fact so regarded. Thus, at the 
 close of 1853, when the Government had decided that enquiry 
 under Royal Commission ought to be made into the circumstances 
 of the tremendous outburst of cholera at Newcastle and Gateshead 
 which began the re- visitation of 1853-4, I had the honour of 
 being appointed one of the three commissioners of that inquiry ; 
 and in the summer of 1854, when the first Board of Health had 
 been ended, and Sir Benjamin Hall was forming a Medical 
 Council to advise him in relation to the epidemic, he did me the 
 honour of appointing me a member of his Council. Out of that 
 position, and particularly through my being a member of the 
 Scientific-Inquiries Committee of the Council, I was brought 
 into a good deal of personal intercourse with Sir B. Hall and 
 his chief officers; and I observe in Hansard that, in January 
 1855, when he was introducing his new measures in the House 
 of Commons, he named me as one who had assisted him, and 
 referred to the experiment of my city office as having been 
 instructive for such proposals as he was about to make. The 
 fact has already been mentioned, that, towards the end of the 
 session of 1855, Sir B. Hall, having to abandon the large Public 
 Health Bill which he had had before the house, introduced in its 
 stead a bill for the temporary continuance of the Board of 
 Health, with power to the Board to appoint a medical officer : 
 which bill soon became law. While the bill was still in course 
 of passing, a small political shock and subsidence partially altered 
 the constitution of the ministry to which Sir B. Hall belonged ; ^ 
 
 * Incidentally to the public discussion of negotiations which Lord John 
 Russell had been conducting at Vienna with a view to terms of pacification with 
 
256 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XII. ^nd lie had to vacate his presidency of the Board of Health in 
 
 Initiation . • . . 
 
 of Medical order to become First Commissioner of the Board of Works. At 
 the moment of leaving his old office (in which Mr. William 
 
 i. Local Cowper succeeded him) Sir B. Hall was pleased to inform me 
 ments^* that, had he remained President till the passing of his continu- 
 ance-bill, he would have offered me the appointment which the 
 bill was to create. That intention of his, though probably 
 he mentioned it to his successor, was of course in no degree 
 binding on the latter; but Mr. Cowper, shortly after the 
 time when he had settled into his new position, did me 
 the honour of sending for me, and offering me the appoint- 
 ment. "^ 
 ^^^* In accepting Mr. Cowper's flattering invitation, I carried with 
 
 the City me a grateful recollection of the years during which I had been 
 ment trans- a local Officer of Health. It was not merely that the City Com- 
 the^ central missioners had always treated me with favor and confidence, 
 office. notwithstanding all I had had to preach to them of needs for 
 
 amendment within the area of their jurisdiction ; but especially I 
 felt, and this even more strongly as time went on, that seven years' 
 familiarity with the spirit and working of local representative 
 government had taught me lessons I could not otherwise have 
 learnt, as to factors which in this country are essential to social 
 progress. My tenure of an essentially experimental office re- 
 ceived by implication the best praise I could have desired for 
 it, when the legislation of 1855 required that fixed medical ap- 
 pointments, on the plan of that early trial, should be created for 
 all the districts of the metropolis ; and when I saw with what 
 alacrity those appointments were sought by highly-qualified, and 
 in some cases already distinguished, members of my profession, 
 
 Russia, one of those amantium irce which used periodically to re-knit the 
 affections of Lord John and his political adherents had led, on July 16, to Lord 
 John's retirement from the Palmerston government ; whereupon the colonial 
 secretaryship which he vacated was filled by translation of Sir William Moles- 
 worth from the Board of Works ; and, in order to fiU the latter vacancy, Sir B. 
 Hall was removed from the Board of Health. 
 
 * I put on record those minor facts as to the appointment in order to correct 
 a fiction, which I have more than once seen in print, that I was appointed to 
 office hy Sir Benjamin Hall in consequence of my having gained favour with 
 him as his private medical attendant. I had had no acquaintance with Sir 
 Benjamin Hall except as mentioned in the text. 
 
THE REIGN OF QUEEN VICTORIA. 257 
 
 as contrasted with tlie indifference which men of that quahty j^^^™* 
 
 had in general shewn towards the experimental appointment of of Medical 
 
 1848* ''*""■ 
 
 Appoint- 
 ments. 
 
 •^K 
 
 11. THE CENTRAL APPOINTMENT, AND ITS EARLY WORKING. 
 
 HE Central Medical Officership, created in 1855, was held by ji- '^e 
 me for nearly twenty-one years, but with differences from time Appoint- 
 to time in its departmental relations. That is to say ; firsts 
 during the three years 1855-8, the office was attached to the 
 General Board of Health, as modified by the successive Con- 
 tinuance Acts; secondly J during the thirteen years, 1858-71, 
 it was under the Lords of Her Majesty's Privy Council ; tliirdly^ 
 for the remaining nearly five years, 1871-6, it was in great part 
 detached from the Privy Council, and was to that extent under 
 direction of the Local Government Board which an Act of 1871 
 had established. Since 1876 (when my tenure of office ended) 
 the Central Medical Officer has been officer of the Local Govern- 
 ment Board exclusively. 
 
 ' At the time when the General Board of Health received First 
 authorisation to provide itself with a Medical Officer, none but the pointment 
 vaguest notions had been formed as to the work which the officer undefi^d 
 ought to do. Of course he was to advise the Government for P^^ose 
 its various medical purposes; but, at that time, Government <\oubtful 
 had no statutory functions of a medical kind, except as to special 
 occasions when cholera or some other such danger might require 
 the Diseases-Prevention Act to be in force ; and under the cir- 
 cumstances probably very few persons, among those who ap- 
 proved of the creation of the office, had taken any larger view of 
 
 stability. 
 
 * Among those who were successful candidates of the election of 1855 maybe 
 named particularly — Dr. Edward Ballard, Dr. Andrew Barclay, Dr. Robert 
 Barnes, Dr. Bristowe, Dr. George Buchanan, Dr. Robert Druitt, Dr. Conway 
 Evans, Dr. Gibbon, Dr. HiUiard, Dr. Odling, Dr. Pavy, Mr. Pittard, Dr. 
 Burdon Sanderson, Dr. Thomas Stevenson, and Dr. Dundas Thomson. I permit 
 myself the gratification of adding, that, in 1856, when the newly-appointed 
 Metropolitan Medical Officers of Health had agreed to combine for purposes of 
 study and consultation in regard of their official subject-matter, they invited me 
 to join them in the capacity of first President of their Association. 
 
258 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XII. 
 
 Initiation 
 of Medical 
 Officer- 
 ships : 
 ii. The 
 Central 
 Appoint- 
 ment. 
 
 the matter, than that the serious recurring dangers o£ cholera 
 required the appointment o£ a special central officer in relation to 
 them. Those, may I be permitted to say, were not the notions 
 with which I entered on office ; for, counting it certain that the 
 activity o£ Government in matters of a medical kind would 
 soon have to extend very far beyond the provisions of the 
 Diseases-Prevention Act, I hoped that, with such extensions, 
 my office would come to have much wider public usefulness than 
 the original law had provided for it ; and I assumed that, from the 
 first, it would be my duty to suggest such extensions or amend- 
 ments of law as the interests of the public health might seem to 
 require. In the immediate circumstances, however, there clearly 
 was no room for endeavours except of the humblest kind. The 
 Board existed only provisionally. Pending steps to be taken in 
 Parliament, it had no settled structure or vocation of its own ; 
 the Legislature next year might see fit to dissolve it, or at least 
 change it in form or function ; and meanwhile nothing of pro- 
 spective policy could be framed by it, nor even could any official 
 appointment or engagement by it be deemed stable. That the 
 Board should have to remain in that plight for a year, was not 
 a pleasant prospect to start with ; but the actual future proved 
 worse ; for the inability of the Board to obtain a parliamentary 
 settlement .of its affairs continued thrice as long as had been 
 expected ; and even at the end of the third year, when the Local 
 Government Act, 1858, and the Public Health Act, 1858, pro- 
 vided in new ways for the duties previously done by the General 
 Board of Health, the latter Act, which provided for the medical 
 part of the duties, was (as will hereafter be explained) not yet 
 of a sort to end suspense. Meanwhile some of the parliamentary 
 forces which had been enlisted against the original Board of 
 Health kept up a grudge against the evacuated citadel and 
 its caretakers; so that, in each year, when the estimates of 
 the establishment were before the House of Commons, the old 
 escutcheon of the Board was still a target ; and we, who by no 
 particular fault of our own were under that sign, used to receive 
 shots which had been in store for others. Apart from those 
 casual hits, the position in itself soon became humiliating. To 
 " stand and wait ^' in the antechambers of legislation was not to 
 " serve '^ in the sense of Milton^s great verse ; nor was it, I may 
 
THE REIGN OF QUEEN VICTORIA. 259 
 
 truly say, sucli able-bodied service as my non-medical colleagues ^^f:^-?^^ 
 
 and I were desiring to render.* of Medical 
 
 Of that position, however, we had to make the best we could, ships : 
 
 A limited amount of routine business, often involving questions central 
 
 more 6v less medical, was carried on: from time to time, for -A^PPpuit- 
 
 . . , . . , ment. 
 
 particular purposes, instructional minutes were issued — as, not- 
 ably, one to indicate the duties of officers of health under the 
 Public Health Act, and the qualifications which would be needful 
 for the duties ; t sometimes too there were new alarms of cholera, 
 requiring more or less special vigilance and preparation; and 
 always, more or less, there were projects of legislation in hand. 
 To dwell at large on that business, done during the years 1855-8, 
 would not now be of interest ; but as there were within the time 
 some occasions which required formal report on matters of 
 permanent medical interest, those occasions may be specially 
 mentioned. • * 
 
 '^n the year 1856, report had to be made on an extremely 1856. 
 interesting question which had for some time been before the the London 
 Board at the instigation of the Scientific Inquiries Committee of chokm to 
 Sir Benjamin Hallos Cholera Council: see above, page 237 : the water- 
 question, namely, whether the distribution of cholera in the 
 southern districts of London during the epidemics of 1848-9 
 and 1853-4 had been influenced by certain differences of water- 
 supply. Circumstances, presently to be explained, had made 
 the southern districts a peculiarly suitable field in which to 
 study the water-supply relations of cholera; and, before the 
 time when the attention of the Board of Health was specially 
 drawn to them, right measure of the value of the opportunity 
 had been taken by Dr. Snow ; who, in view of it, and studying 
 with equal zeal and sagacity the earlier weeks of the South 
 London Cholera-prevalence of 1854, had already elicited most 
 important facts as to the water-supply relations of the first 1,514 
 
 * The two colleagues of that time, to whom I particularly refer, were Mr. 
 Tom Taylor, the Secretary, and Mr. John Campbell of Islay, the Assistant- 
 Secretary of the Board : both of them now no more. 
 
 t Issued by the Board, December 20th, 1855 : Instructional Minute, relative 
 to the Duties and Qualifications of Officers of Health, in Districts under the 
 PubHc Health Act, 1848. 
 
 E 2 
 
260 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XII. 
 
 Initiation 
 of Medical 
 Oificer- 
 ships: 
 ii. The 
 Central 
 Appotat- 
 meut. 
 
 deaths of that epidemic* The case for inquiry was as follows : 
 — that the southern districts^ having* in 1854 an estimated 
 aggregate population of more than 500,000 persons, had suffered 
 in the two epidemic periods more than 12,000 deaths from 
 cholera, besides more than 3,000 from other diarrhoeal diseases; 
 that the water-supply of those districts (except where got from 
 wells and casual sources) had been derived from two commercial 
 companies, t the Lambeth Company and the Southwark-and- 
 Vauxhall Company, and that, over most of the field, the two 
 totals of supplied persons were as two intermingled similar 
 populations, living, except as to water-supply, under similar 
 exterior conditions ; that during the period 1848-9, both com- 
 panies had drawn their water from parts of the Thames which 
 were grossly polluted with sewage, the Lambeth's place of 
 intake being somewhat the worse of the two ; that, during the 
 period 1853-4,'the Southwark-and-Vauxhall Company had still 
 drawn from the same source, amid pollutions even greater than 
 before, but the Lambeth Company, on the contrary, had drawn 
 from a higher and comparatively clean part of the river; that thus 
 in the two periods taken together (and leaving aside the cases of 
 exceptional water-supply) four different qualities of pipe-water 
 had been supplied ; three foul, in different degrees of foulness, and 
 one which, at least relatively, was clean. The aim of the inquiry 
 was to display for comparison the different degrees of mortality 
 which had accompanied those differences of water-supply. In 
 order to that object, the Board had first to identify the popula- 
 
 * See the second edition (1855) of his work on the Mode of Communication of 
 Cholera: also Medical Times and Gazette, Oct, 7, 1854 : also Journal of Public Health, 
 October, 1856. That the much larger inquiry which the Board afterwards con- 
 ducted — (including the whole epidemic of 1853-4, the whole epidemic of 1848-9, 
 and, in both epidemics, not only the deaths by cholera, but likewise the deaths 
 by other diarrhoeal diseases) — had been suggested by Dr. Snow's original enter- 
 prise, may, I think, be assumed ; for, though I have neither record nor positive 
 recollection how the Scientific Inquiries Committee came to recommend the 
 larger inquiry, I can hardly doubt but the suggestion must have come to 
 UB from Dr. Farr, who had been intimately acquainted with the course 
 of Dr. Snow's inquiry, and after its termination had himself for a short 
 time continued from the General Register Office an inquiry of the same 
 intention. 
 
 f The houses in the companies' books in 1854 had an estimated population of 
 435,000, or about six-sevenths of the whole local population. 
 
THE REIGN OF QUEEN VICTORIA. 261 
 
 tions which received the respective waters,"^ and then to assign Chap.xii. 
 rightly to each population the deaths which it had suffered, of Medical 
 from cholera and from other diarrhoea! diseases,, in the respective ^dps^-^" 
 epidemic periods, f For many months officers of the Board j^- '^te 
 were engaged in collecting and tabulating the required informa- Appoint- 
 tion ; and in the spring of 1856, when the results were ready 
 for opinion, it became my duty to report on them. J The report 
 told that the populations respectively supplied by the four 
 waters had suffered unequally from the diseases to which the 
 inquiry had related. Particularly it told that the four respective 
 Death-rates hy Cholera, per 10,000 living, had been as follows : — 
 for the population which in 1848-9 received ybz^^ water from the 
 South wark-and-Vauxhall Company, 118 ; for the population 
 which in 1848-9 received the somewhat fouler water of the 
 Lambeth Company, 125; for the population which in 1853-4 
 received from the South wark-and-Vauxhall Company the water 
 which was foulest of all j 130; for the population which in 
 1853-4 received the amended supply of the Lambeth Company, 
 37. § Considering the very large scale of the inquiry, and the 
 authenticity of the amassed facts, no reasonable person could 
 doubt the extremely important significance of that uncom- 
 plicated final arithmetic. || Within the broad verdict which it 
 
 * The companies fumislied exact lists of the houses to which they supplied 
 water in 1854 ; and it was found that these lists, immediately applicahle to the 
 period 1853-4, could, with certain qualifications, be applied also to the period 
 1848-9. 
 
 t The lists of deaths were of course derived from the General Register 
 Office ; from which office were also derived the various estimates of population. 
 
 X See Report, addressed to the President of the General Board of Health, by 
 the Medical Officer of the Board, On the Last Two Cholera Epidemics of London^ 
 as affected by the Consumption of Impure Water, May 13, 1856. 
 
 § By other diarrhoeal diseases (certain of which are in no immediate re- 
 lation to local sanitary circumstances) the respective death-rates, in the same 
 order as above, had been 27, 29, 33, 21. 
 
 II Dr. Snow believed, and 1 thin£ rightly so, that the evidence in favour of 
 the Lambeth amended supply of 1853-4 would have appeared far more striking 
 than it did, if the figures (instead of being given in mass for the whole epidemic 
 period) had been given for the different weeks in succession. In the earlier 
 weeks of the epidemic of 1854, he found the mortality falling almost exclusively 
 on the houses which were supplied by the Southwark-and-Yauxhall Company : 
 and this certainly suggests question, whether the cases which afterwards became 
 more numerous in houses supplied with other water might not often have been 
 referable, directly or indirectly, to infection from the Southwark-and-Vauxhall 
 water. 
 
262 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XII. 
 
 Initiation 
 of Medical 
 Officer- 
 ships: 
 ii. The 
 Central 
 Appoint 
 men , 
 
 expressed, there no doubt remained subtler questions wbicb the 
 figures could not pretend to answer; questions (such as those 
 with which the eminent name of Prof, von Pettenkofer is 
 identified) relating more particularly to the intimate natural 
 history of the cholera-con tagium ; but, for immediate practical 
 use, the broad verdict in itself was abundantly enough, — that, 
 with the different qualities of water-supply, different proportions 
 of cholera-death had uniformly followed. It was a verdict 
 which greatly strengthened and extended the influence of Dr. 
 Snow^s publications, and joined with them to convince medical 
 opinion in this country as to the peculiar dangerousness of 
 sewage-tainted w^ter-supplies in cases where cholera-infection 
 may be at hand. Subsequent English experience (as particularly 
 the experience of 1866) has but given greater emphasis to that 
 conclusion : the substance of which, though now more than 
 thirty years old, may probably still be counted the most im- 
 portant truth yet acquired by medical science for the prevention 
 of epidemics of cholera. 
 
 1857. 
 Proceed- 
 ings and '^ 
 Papers 
 relating to 
 Vaccina- 
 tion. 
 
 In the year 1857, comprehensive report had to be made on 
 the subject of Vaccination. In 1853 (on the basis of a Bill 
 which Lord Lyttelton in consultation with the Epidemiological 
 Society of London had introduced) Parliament had enacted the 
 law which first made vaccination compulsory; "^ and in 1855 the 
 then President of the Board of Health, Sir Benjamin Hall, had 
 been memorialised by the President and Council of the Epidemio- 
 logical Society on certain failures which they found in the 
 working of the new Act, and as to which they prayed for 
 amendatory legislation. 'In the session of 1856, a bill with that 
 object was introduced in the House of Commons by Mr. Cowper, 
 who meanwhile had succeeded Sir Benjamin Hall; but time for 
 proceeding with it was not then tb be found ; and, as its intro- 
 duction had evoked some expressions of hostility to the practice 
 of vaccination, Mr. Cowper, when withdrawing it, agreed with 
 the opponents that in the next session he would move for a Select 
 Committee to receive evidence on the matter of their objections.f 
 
 * The Act, 16 and 17 Yic, c. 100, to extend and make compulsory thepraetice 
 (^ Vaccination. 
 
 t Hansard, July 10, 1866. 
 
THE REIGN OF QUEEN VICTORIA. 263 
 
 In that state o£ the case^ it of course was my duty to prepare Chap.xii 
 myself as thoroughly as I could, in respect of the infinity of of Medical 
 questions which might he asked^ on one side or the other, as to ^-^^s- 
 the proofs of the value of vaccination ; and it appeared fitting g- ^^^ 
 that, at such opportunities as might connect themselves with Appoint- 
 that duty, I should reduce into convenient form for the intended 
 committee, and for others, the vast quantities of evidence which 
 were known to he available. Fortunately the then circumstances 
 of the Board allowed me to undertake the task on a far larger 
 scale than would have been possible under different circumstances ; 
 and the result was a quarto volume, of some 280 pages, laid 
 before Parhament in 1857. "^ In that volume, founded partly on 
 information which was already existing in a diffused state in the 
 literature of this and other countries, and in other part founded 
 on new information which was sought for the purpose from the 
 Governments of other European countries, from our own public 
 departments and great schools, and on a large scale from dis- 
 tinguished^ medical professors and practitioners of this country 
 and of France and Germany, I endeavoured to represent what 
 was then the experience of the civilised world as to the use of 
 vaccination, and as to the validity of reproaches which had been 
 raised against it. In introduction to a mass of documents which 
 made two-thirds of the volume, I prefixed a report of my own, 
 in which, referring to them and to other sources of information, 
 I furnished answer, as far as I could, to each of the five following 
 questions : — {a) ^^ What kind of an evil was small-pox before 
 vaccination arose to resist it ? '' — (3) ^^ What facts and arguments 
 led to the first sanction of vaccination, and to what sort of inquiry 
 were they subjected P^"* — (<?) "What further knowledge, at the 
 end of half a century's experience, has been gathered on the pro- 
 tective powers of vaccination ? ^' — id) " What evils have been 
 shown to attend its practice^ and to counterbalance its alleged 
 advantages ?^'' — [e) ^^ How far are there realised, in this country, 
 those benefits which can reasonably be expected from the general 
 use of vaccination ? ■''' The volume was in due course laid before 
 Parliament ; but the Select Committee which had been intended, 
 and for which specially the volume had been planned, was not 
 
 * General Board of Health : Papers relating to the History and Fractice of 
 Vaccination : — May, 1857. 
 
264 ENGLISH SANITAKY INSTITUTIONS. 
 
 Chap. XII. appointed in 1857; and fourteen years elapsed before that sort 
 
 of Medial of use was found for the volume. In 1871^ when at last (as will 
 
 ^cer- hereafter appear) a Select Committee, appointed on the motion 
 
 ii. The of Mr. W. E. Forster,, and with him as its chairman, had invited 
 
 Appoint- the opponents of vaccination to state their case, the volume of 
 
 ment. 1857 formed part of the counter-evidence; and some of its 
 
 sections were reprinted in the Report which the Committee of 
 
 1871 made to the House of Commons in favour of maintaining 
 
 and strengthening the Act of 1853."^ 
 
 1858. ^ In 1858, occasion arose for a report of larger scope, and more 
 
 ^Staiy^^ initiative aim, with regard to sanitary government, than any 
 Peo*T**f^^ which had been made since 1842 ; and as this Report of 1858 
 England, attained its purpose, and came to be of intimate relation to much 
 subsequent work, the circumstances of its inception deserve notice 
 here. 'Primarily, observation arose, that England did not possess 
 the knowledge of facts which it required for its sanitary govern- 
 ment. It was uninformed as to the respective degrees in which 
 its different districts suffered death from different diseases. The 
 Registrar-General in his sixteenth annual report (published in 1856) 
 had furnished the public with the so-called general death-rates 
 of the districts of England and Wales during the decennium 
 1841-50 ; but the composition of those respective death-rates, 
 as to the various causes by which more or less death had been 
 produced in the different districts, was hitherto not told by 
 the Registrar-General; and, with that insufficiently detailed 
 knowledge of facts, exact sanitary criticism was impossible. 
 "While districts were only to be judged and compared in respect 
 of their total unf avourableness to life, while the unf avourableness 
 could only be spoken of in lump, sanitary practice must be as 
 
 * In looking "back, from tliis distance of nearly thirty-three years, to the 
 Report which prefaces the volume, I of course find passages which I would wish 
 amended. Especially I observe that, here and there, entering needlessly on 
 questions of speculative pathology, I slid into more a priori reasoning than I 
 should in later years have deemed suitable to the matter ; and in respect of some 
 such passages, I could now amend my argument by later knowledge. In more 
 essential respects the Report is mainly a compilation of facts; in which sense I 
 trust it may still prove useful ; and I rejoice to have had the opportunity which 
 that duty of 1857 afforded me, to collect and record so much conclusive evidence 
 regarding Jenner's incomparable benefaction to mankind. 
 
how. 
 
 THE REIGN OF QUEEN VICTORIA. 265 
 
 rude in treatment as it was in diagnosis, and could hardly rise Chap. XII. 
 above the quack^s method of using one physic for all maladies, of MediW 
 While such was the public case^ it had happened that, in the di- 9^^®f " 
 rection where hitherto the General K/Cgister Office was not giving ^ The 
 light, laborious endeavours to supply the deficiency were being Appoint- 
 made by a very able private investigator. Two years before this ^^^ ' 
 time, arrangements had been made at St. Thomas-'s Hospital that 
 a short course of lectures on Public Health should form part of 
 the systematic annual teaching of the medical school, and that for 
 this course — the first of its kind in this country — the lecturer 
 should be Dr. Edward Headlam Greenhow.* When Dr. Green- Dr. Green- 
 how began to face the business of his lectureship, and, as one of 
 his first steps, would have entered upon a consideration of the 
 removable causes of disease operating in this country, he found 
 that, by reason of the above-described insufficiency in the death- 
 statistics of the country, he was as little able to advance as the 
 proverbial brickmaker without straw; and in that state of the 
 case (though for brickmaking which was purely honorary) Dr. 
 Greenhow determined, with admirable pluck and public spirit, 
 
 * I am glad to note that those arrangements at St. Thomas's Hospital were 
 in adoption of proposals which I, as memher of the School, had made there. 
 Dr. Greenhow, who at that time was of perhaps twenty years' standing in the 
 Profession, had till the end of 1853 been practising with high character at Tyne- 
 mouth, and since then had been settled in London, where he was acquiring equal 
 esteem. In addition to the technical qualifications which he had in common 
 with other highly-educated practitioners of the time, he had the accomplishment 
 (which at the time was very rare) of having read widely and thoughtfully in the 
 literature of Hygiene and Preventive Medicine, so far as then existing, and of 
 having had some experience in local sanitary administration. Just before his 
 migration from Tynemouth to London, Cholera had been prevailing frightfully on 
 the banks of the Tyne, visiting Newcastle and Gateshead with a virulence never 
 before known, but letting Tynemouth escape almost without harm ; and the 
 Boyal Commissioners who had to inquire into the circumstances of that 
 distribution of disease, ascertained that the exempted town of Tynemouth 
 had had precautionary measures vigorously and judiciously applied by a 
 Local Board, under Dr. Greenhow's chairmanship. Dr. Greenhow's Lec- 
 tures at St. Thomas's Hospital as described in the text were given annually 
 during the six years 1856-61 : after which he retired from St. Thomas's Hospital, 
 to become Physician to the Middlesex Hospital. Of his subsequent labours in 
 other branches of professional knowledge. I need not here speak, except to note 
 that in 1867 he was a principal founder of the Clinical Society of London, and in 
 the years 1879-81 was its President. In the years 1880-81, he was Censor of 
 the Koyal College of Physicians. Dr. Greenhow died Nov. 22, 1888, aged nearly 
 74 years. 
 
266 ENGLISH SANITARY INSTITUTIONS. 
 
 iSt'^'t^^"'^* ^^^^ ^^ would himself supply the deficiency. Able to extract 
 of Medical little information from the published reports of the Registrar- 
 ships : General, but permitted by the Registrar-General to use freely the 
 Central immense masses of unpublished data which were within the 
 me^t^*" <^ffice, Dr. Greenhow, with a yearns very hard work, brought into 
 existence the mortuary statistics which he needed. Respectively, 
 with regard to the entirety of England and Wales y with regard 
 to each of the 11 xQg\&tv2it\oia.-divisions of the county, with regard 
 to each of 23 icegi^trsitioii-counties , and with regard to each of 
 105 xeg\s,tY2iiioTi-districts, he had ascertained Jiow ynany persons 
 of each sex had died, during the seven years 1848-54, by each of 
 a large number of diseases or groups of diseases ; * ascertaining 
 in addition, with regard to each of 20 of the districts, at what 
 ages certain of the more important diseases had proved fatal ; 
 and then, in order that the several outcomes might be in a form 
 for comparison with each other, as proportionately to live popu- 
 lation, he had reduced them all to the one arithmetical standard 
 of a death-rate per 100,00,0 living. The death-rates, nearly 9,000 
 in number, were set forth in 143 tables : each table having at 
 its head a brief explanatory notice (founded on the census and 
 poor-law returns) as to the number, density, and distribution of 
 the population of the respective area, and, in case of districts, 
 also as to the occupations and the pauperism of the population. 
 In intimate colleagueship with Dr. Greenhow, I was well aware 
 of his undertaking and its progress; and in proportion as I 
 became acquainted with the results he had obtained, and the 
 comments he had to make on them, I could not but be impressed 
 with their extraordinary instructiveness, and with desire to see 
 them made available for public use. Taking then in the latter 
 respect a view which I felt confident Dr. Greenhow would share, 
 I did not hesitate to beg of him that he would make the public a 
 gift of his work, by communicating it to the Board of Health in 
 a form for parliamentary publication; and he having most 
 liberally acceded to that request, his account of the results of the 
 inquiry, together with an introductory report in which I 
 endeavoured to explain and enforce their great practical signifi- 
 
 * For England and Wales, and for the registration- divisions and registration- 
 counties, Dr. Greenhow's heads of disease-specification were 23 ; for the registra- 
 tion-districts, they were 27. 
 
THE REIGN OF QUEEN VICTORIA. 267 
 
 cance^ was laid before Parliament in 1858.* The gist of that Chaj.xxe. 
 blue-book^ in relation to purposes of law-making and govern- of Medical 
 ment^ may be summarised as follows : — first, Dr. Greenhow^s part ships : " 
 of the volume shewed in statistical detail that the most fatal q^^i 
 diseases of this country were proving fatal in widely different Appoint- 
 respective proportions to population in different districts of the 
 country^ and that those wide differences of mortality accompanied 
 certain broad district-differences in the residential and industrial 
 circumstances of the respective populations : secondly, in the 
 other part of the volume, I set forth, as far as I could, the 
 positive knowledge then current in the medical profession with 
 regard to the power of particular controllable causes to produce 
 those diseases which Dr. Greenhow had shewn to be so unequally 
 fatal in the districts. On the basis thus suggested, that, where 
 certain diseases were prevailing in one district more than in 
 another, presumably the cause of the excess was a cause which 
 with skilled painstaking could be removed, I submitted, as 
 practical consequence, that the new statistical knowledge seemed 
 clearly to indicate the scope of a new social claim : the claim, 
 namely, for impartial skilled inquiry and full publication of 
 facts, in all cases of the sorts referred to : the claim, that, in 
 each case where a preventable or partly preventable disease 
 should prevail to excess in any particular district, the setiological 
 facts of the case ought to be ascertained by medical investigation, 
 and be made clear to the people locally interested ; and that the 
 facts of all such cases ought to be made matter of national report 
 for the information of the general public and the government 
 and the legislature. At the time when the blue-book containing 
 these representations appeared, the suspense which had lasted for 
 four years as to the continuance of the Board of Health was 
 about to end in the dissolution of the Board ; and the blue-book 
 came opportunely, to show the necessity of constituting, in part- 
 succession to the Board, some official machinery by which the 
 central government might methodically make inquiries of a 
 
 * General Board of Health : Papers relating to the Sanitary State of the People 
 of England ; being the results of an inquiry into the different proportions of death 
 produced by certain diseases in different districts in England ; communicated to 
 the General Board of Health by Edward Headlam Greenhow, M.D., with an 
 Introductory Report, by the Medical OflScer of the Board, on the Preventability 
 of certain kinds of Premature Death: — June, 1858. 
 
268 ENGLISH SANITARY INSTITUTIONS. 
 
 9^f.^-f^l- niedical kind in relation to locally-current redundancies of 
 
 Initiation ,. rm j • 
 
 of Medical disease. Ihat its argument to that effect was accepted by Parlia- 
 ship^sT" ment, may be inferred from the legislation which almost at once 
 CeJtrai foUowed, as will below be more particularly described. Here 
 Appoint- needs only be noted that the long series of inquiries which were 
 afterwards directed by the Lords of the Council, under authority 
 given by the Act of 1858, realised (so far as they went) the 
 scheme which the Eeport of 1858 had recommended to the Board 
 of Health ; and that the Eeport of 1858 may therefore be read as 
 the reasoned programme" of work which occupied many succeed- 
 ing years. 
 
 Profession. 
 
 J'^sislation The year 1858 deserves a white mark among the years of 
 Medical sanitary progress, because in it was passed the Act of Parliament, 
 21st and 22nd Vict c. 90, which first gave a statutory constitu- 
 tion to the Medical Profession of the United Kingdom; and I am 
 glad to remember that the existence of a central office for the 
 consideration of public medical questions contributed materially 
 to promote that enactment. The previous state of the case had 
 been ridiculous. The legal titles of medical practitioners were 
 as various as the names of snuffs or sauces. Twenty-one dis- 
 connected corporate authorities within the United Kingdom 
 were issuing their heterogeneous credentials of qualification 
 (more or less) for responsibilities in Medicine. The authorities 
 were mainly of mediaeval root; some in trade-guild sort, some 
 in sorts ecclesiastical. From an authority of the former sort, a 
 man might hold a license to practise medical or surgical 
 business within particular boundaries ; or from an authority of 
 the other sort (perhaps deriving primarily from the pope) he might 
 be certified to the world at large as an orthodox teacher of 
 medicine, who, if competent to teach, was inferentially also 
 . competent to practise : but the licenses and degrees did not 
 secure anything like a professional preserve to those who held 
 them ; for though in some cases poachers were threatened, there 
 was in effect almost no restriction on practice, and any one 
 who chose might entitle himself surgeon or doctor. The 
 authoritative titles, moreover, were themselves of no settled 
 value ; for the State had hitherto not troubled itself as to the 
 terms on which they should be granted, and the qualifications 
 
THE REIGN OF QUEEN VICTORIA. 269 
 
 exacted from candidates varied greatly among the title-granting Chaj.xiI. 
 bodies. Of some of the bodies it used to be said that their of Medical 
 examiners were of extremely easy virtue ; and as the granting ghip^g^5' 
 of titles was often an important source of income^ evidently it ^- ^^® 
 was not improbable that the reproach might sometimes be Appoint- 
 deserved. Against that disorderly state of things^ public- 
 spirited members of the profession had long, but vainly, protest- 
 ed : urging that the various medical titles ought to be brought 
 to have real significance ; ought, all of them, to guarantee the 
 possession of professional skill and knowledge according to some 
 one common standard of minimum-qualification, and ought, under 
 that condition, to carry equal privilege in all parts of the King- 
 dom."^ ^Legislation for purposes such as these could scarcely 
 have been opposed on any reasonable ground ; but whenever it 
 had been attempted, the intricacies of parts of the matter, and 
 the antagonisms and jealousies of so many conflicting jurisdictions 
 and interests, had shown a chaos which statesmen in general 
 could only regard with despair. In a long succession of Home- 
 Secretaries, probably Sir James Graham was the only one who 
 had really applied himself to understand the case ; but even he, 
 after having taken much trouble with it, and having on two 
 occasions (1844 and 1845) introduced bills for Medical Reform, 
 had found the hubbub of contentious voices too strong for him ; 
 
 * Before the year 1830, questions of Medical Eeform, as above-suggested, 
 had begun to be perceptibly agitated in the Profession, and from about 1830 they 
 came by degrees to attract more and more professional interest. As early as 
 1831, the then eminent surgeon and professor, the late Joseph Henry Green, 
 who thirty years afterwards was President of the General Medical Council, 
 had published a thoughtful pamphlet on some of the relations of the subject ; 
 and in 1833, at the second meeting of the Provincial Medical and Surgical 
 Association, Dr. Edward Barlow of Bath introduced some remarks on " Medical 
 Eeform " into the anniversary address which he had to deliver. In 1834 a Select 
 Committee x)f the House of Commons was appointed " to inquire into the laws, 
 regulations, and usages regarding the education and practice of the various parts 
 of the Medical Prof ession in the United Kingdom ; " and it reported to the House 
 a large volume of evidence relating to England. The questions now came to be 
 more and more discussed in the medical journals ; and, from 1837, the Provincial 
 Medical Association had a standing Committee to watch over the interests of the 
 profession. In concert with those movements in the Profession, IVIr. Warburton, 
 Mr. Wakley and Mr. Hawes, in 1840 and again in 1841, brought a Medical 
 Eeform Bill before the House of Commons ; but their Bill was without success ; 
 and no further important step was taken in the matter till Sir James Graham's 
 intervention noted in the text. 
 
270 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XII. 
 Initiation 
 of Medical • 
 Officer- 
 sMps: 
 ii. The 
 Central 
 Appoint- 
 ment. 
 
 and, from his time, no minister had touched the question. The 
 Provincial Medical and Surgical Association (afterwards made 
 the British Medical Association) had, by a committee of which 
 Dr. Sir Charles Hastings of Worcester was chairman, addressed 
 Lord Palmerston in 1853, and Sir George Grey in 1855, in hope 
 of inducing the government to promote a reform bill which the 
 Association had prepared ; but neither of those Ministers would 
 consent to undertake the task; and the case of the Medical 
 Profession was not to be heard in Parliament, except so far as 
 some private member could be induced to bring it forward. 
 Late in the session of 1855 it was taken up, on that footing, by 
 Mr. Headlam, member for Newcastle ; who then introduced a 
 bill representing the views of the Medical Association ; and this 
 bill (somewhat modified in consequence of private discussions 
 during the recess) was re-introduced by Mr. Headlam at the 
 opening of the Session of 1856. Two years before this it had 
 happened, that, adverting in print to the unorganised state of the 
 Medical Profession, and commenting on the apparent impotence 
 or apathy of parliament in regard of our case, I had expressed a 
 belief, that, whenever the Government of the country should 
 have grown to include a properly authorised Minister of Health, 
 such Minister (having of course medical advice at his command) 
 would soon understand enough of the case to be powerful for 
 right legislation in regard of it ; * and now, in the years 1856-8, 
 
 * Eeports (reprinted) relating to the Sanitary Condition of the City of London ; 
 Preface, pp. xxix-xxx. : — " The diflSiculties which have haffled successive Home- 
 Secretaries might soon find their solution in the less divided attention which he 
 [a Minister of Health] could hring to their study. Amid conflicting opinions 
 and an apparent scramhle for power, he would soon distinguish where might be 
 the strife of jealousy and covetousness, where a truthful zeal for the honour and 
 efficiency of Medicine. I think he could not he long in curing our more 
 scandalous anomalies. Probably — unless human bowels require other doctoring 
 in London than in Manchester — he would manage that a doctor there should be 
 a doctor also here ; that no license for the partial practice of medicine should be 
 recognised — no license admitting a man to do in Edinburgh what it would be a 
 misdemeanour for him to do in Greenwich. And obviously, in order to this — 
 siace a professional diploma is the only criterion by which the public can 
 measure the competence of those who seek their patronage — he would see that, as 
 far as may be, the various licensing bodies exact from their candidates equal and 
 sufficient qualifications ; that the diploma entitling a man to call himself Surgeon 
 or Physician, Accoucheur or Apothecary, mean the same thing — imply the same 
 education, whether it be got in Scotland, Ireland, or England; and that any 
 falsification of such diploma, or any unauthorised assumption of the title which 
 implies its possession, be promptly punishable at law." 
 
THE REIGN OF QUEEN VICTORIA. 271 
 
 sometliing to that effect began to be seen. In 1856, the pro- Chap.xii. 
 posals for medical reform were brought into the province of of Medical 
 practical politics by the course which the President of the Board ^ik?-^" 
 of Health took with Mr. Headlam''s Bill : carryings namely^ that ^- The 
 it be referred to a Select Committee of the House. That Com- Appoint- 
 mittee (which had Mr. Cowper for its chairman) did not prove 
 to be of much use in respect of its recommendations to the 
 House for changes in Mr. Headlamps Bill ; since the recommen- 
 dations were in great part not such as Government could adopt ; 
 but it was very useful in respect of the insight which its indi- 
 vidual members obtained, on the one hand as to the broad public 
 interests which Parliament had (as far as possible) to secure 
 by legislation, and on the other hand, as to the many mere 
 license-mongering peculia which were being fought about. In 
 the session of 1857, two bills were before the House: one, 
 introduced by Mr. Headlam, which again represented (but with 
 some modification since last year) the proposals of the Medical 
 Association ; the other, introduced by Lord Elcho, and embodying 
 the views which had found favour with a majority of the Select 
 Committee of 1856 ; and for the former of those two bills, Mr. 
 Headlam, late in the session carried a second reading by a 
 majority of 225 to 78 ; but further progress could not be made 
 with the bill; and it appeared utterly improbable that any 
 medical-reform bill would make way through the House 
 unless introduced as a government-measure. The President of 
 the Board of Health soon determined that he would be ready to 
 deal with the matter on that footing in the next session of 
 Parliament. So, during the recess 1857-8, decision was made 
 as to the plan of legislation which Government would recommend 
 for adoption; and while the Bill to give effect to that plan 
 was being drafted for the Board, it was my duty to prepare an 
 office-memorandum which explained the then existing defects of 
 the law as to medical titles and medical practice, and stated with 
 such argument as seemed requisite the principles which had been 
 taken by Government as basis for the Bill it was about to 
 propose.^ In consequence of a political accident in the first 
 
 * This memorandum did not at the time pass into general circulation ; but in 
 later years events more than once led me to make public reference to it. In 
 1870, it was printed (No. 10 A) in the Appendix to the Twelfth Keport of the 
 
272 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XII. month of the new session^"^ Mr. Cowper, at the moment when he 
 
 of Medical would have introduced his Medical Practitioners Bill^ found him- 
 
 2^3^.^" self no longer in a position to do so officially ; but having by that 
 
 ij,- "^j^®, time become familiar with the subiect. and interested in it, and 
 
 Central . ii-ii- 
 
 Appoint- knowing of course that the advantages which during the past 
 
 months had been gained towards a parliamentary settlement of 
 
 the question could not off-hand be made available to his official 
 
 successor^ he_, with public spirit, refrained from severing his 
 
 personal relation to the draft-bill ; and after an interval (during 
 
 which he may probably have received assurances of good will 
 
 from the new ministers) he proceeded, in private-member capacity, 
 
 to introduce the bill to the House as having been prepared under 
 
 his Presidency. With regard to the Bill thus introduced, 
 
 Mr. Walpole, as Home- Secretary in the new government, was 
 
 practically master of the situation. He (I venture to think 
 
 unfortunately) declined to support an original intention of the 
 
 Bill, that the General Medical Council, subject to the approval 
 
 of the Crown, and consequently under responsibility to Parliament, 
 
 should be entrusted with full regulating powers as to the future 
 
 conditions of medical qualification ; but otherwise, in the main, 
 
 he supported the Bill, and, when it was modified as he required, 
 
 he gave Mr. Cowper all possible assistance to pass it; so that 
 
 eventually it became law, Sis'-Tke Medical Act oi 1858. The 
 
 new Act instituted for the first time a legal definition of the 
 
 British Medical Profession; it directed the establishment and 
 
 maintenance of a Medical Register , by which the public and 
 
 its courts of justice should be able to distinguish the " qualified " 
 
 practitioners of medicine from pretenders not lawfully qualified ; 
 
 it gave to each registered qualification an equal currency in all 
 
 parts of the British Empire ; it created a superintending Council 
 
 for the purposes of the Act ; it empowered the Council to strike 
 
 from the Register the names of persons who should be convicted 
 
 of crime, or whose professional conduct it should judge infamous ; 
 
 it authorised the Council to impeach before the Privy Council 
 
 Medical Officer of th.e Privy Council, and in 1879 was reprinted in the Appendix 
 to the Special Eeport from the Select Committee (IMr. Forster's) on the Medical 
 Act Amendment Bills of that year. 
 
 * Reference is made to the change of Ministry which followed Lord Palmer- 
 ston's defeat in the matter of his Conspiracy to Murder Bill. 
 
THE REIGN OF QUEEN VICTORIA. 273 
 
 any Licensing Body which should grant its diploma on insufficient ^^- /™- 
 conditions of study or examination ; and, in respect of its giving of Medical 
 that ultimate authority for impeachment together with certain ships: 
 powers of inquiry and visitation, it enabled the Medical Council central 
 to exercise gradual influence, though no direct coercion, for the -^ppomt- 
 raising of the standards of medical qualification, and for the 
 improvement of medical study. In the latter respects, repre- 
 senting objects for which the original bill would have invested 
 the Council with directive authority, the Act could scarcely 
 pretend to be more than tentative in its subject-matter; but 
 such as it was, it constituted, on the whole, a very important 
 beginning of reform in a previously chaotic state of things ; and 
 it seems certain that this beginning would not have been made 
 in 1858, unless the President of the Board of Health had been 
 there to promote it."^ 
 
 r'inally, as before noted, there came in 1858 the new legis- ThePubUc 
 lation which ended the General Board of Health, and devolved i858. 
 on other departments the duties which for ten years had been 
 in the Board^s charge ; devolved, namely, the medical duties 
 (with some important additions) on the Lords of the Council, 
 while devolving the other (but somewhat reduced) duties on the 
 Home-Secretary. In the first-named class of duties, which 
 alone need here be dwelt upon, the new responsibilities which 
 the Public Health Act of 1858 created were in relation to 
 two great needs, which had been exhibited in my above- 
 mentioned Reports of 1857 and 1858. With regard to one such 
 
 * Mr. Cowper after this date did not have any further official concern with 
 "business of Public Health ; but he held other office during the seven years of 
 restored whig administration, l«59-66 ; first, for a short while as Vice-President 
 of the Board of Trade, and subsequently as First Conunissioner of Works. He 
 died on October 16, 1888, having meanwhile (1880) been raised to the peerage as 
 Baron Mount-Temple. Though from 1858 he had nothing officially to do with 
 sanitary affairs, his interest in them continued to the end of his life ; and during 
 the thirty years he was always among the chief philanthropic endeavorers for * 
 the sanitary and general civilisation of our poorer classes. In all such endeavors 
 he worked in intimate fellowship with his brother-in-law and valued friend, 
 Lord Shaftesbury ; and the part he took, though publicly by far the less promi- 
 nent of the two, and often but little in the public eye, was, as fully and as 
 admirably as Lord Shaftesbury's, and with some characteristic graces of its own, 
 a life of generous feeling and action for the interests of the classes which need 
 help. 
 
274 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XII. need, the Act made the Privvr Council responsible for the 
 
 Initiation .. , "^ ^ 
 
 of Medical quality 01 public vaccination in England^ and for the mainten- 
 
 giiipg . " ance of the national supply of vaccine lymph. With regard to 
 
 Ce^rai ^^® other need, the all-pervading want of common sanitary 
 
 Appoint- supervision;, the Act authorised the Privy Council to cause to be 
 
 made from time to time such inquiries as they might see fit in 
 
 relation to any matters concerning the Public Health in any 
 
 place or places; it required that "the Medical Officer of the 
 
 Privy Council should from time to time report to the Privy 
 
 Council in relation to any matters concerning the Public Health, 
 
 or such matters as might be referred to him for the purpose, 
 
 and should annually, in or before the month of March, report 
 
 all proceedings taken under the Act in the last preceding 
 
 calendar year; and it directed that all reports of the Medical 
 
 Officer should, as made, be presented to Parliament. 
 
 \ The Public Health Act, 1858, which opened a very im- 
 portant new period in the sanitary relations of the British 
 Government, had not passed the House of Commons without 
 opposition ; and those who opposed its passing had been able to 
 score a temporary success. Popular education in sanitary mat- 
 ters was not hitherto sufficiently advanced to have been a force 
 in favour of what was proposed. The Bill was of Ministerial 
 promotion, but Ministers did not pretend that it represented any 
 strong conviction of theirs ; and in the House of Commons, in 
 the summer of 1858, the state of parties was eminently not that 
 in which Ministers are expected to stand to their proposals. In 
 relation to the real case for the Act, if that case had been made 
 intelligible to a listening House, controversy could hardly have 
 been raised ; but (as often happens with matters which are not of 
 party-concern) the real case had neither means nor opportunity 
 to make itself heard in the House ; and the arguments hastily 
 ejaculated in favour of the Bill seem to have been about as in- 
 ^ adequate as the arguments used against it."^ It accordingly 
 
 * Referring to Hansard, I observe that, on the one occasion when the Bill 
 came under a sort of discussion, the hard-pressed Minister who had to defend the 
 appointment of a central medical officer found the cHmax of his case in *' the 
 pestilential state of the river which flowed close by, and which really might soon 
 be a terror to this House " ; and that, with every kindness of intention, he spread 
 his shield over a supposed right of the medical officer to be engaged in the 
 private practice of his profession, though the officer, when he received appoint- 
 
THE KEIGN OF QUEEN VICTORIA. 275 
 
 came to pass^ that^ late in the session, when the Bill was in j^^i^''"' 
 Committee, and its ministerial promoters found themselves op- of Medical 
 posed by Mr. Duneombe, they, as a compromise to pacify him, ships : 
 conceded a stipulation that the Act should last only for a year."^ Central 
 Seldom can compromise have shewn itself in a more grotesque -A-ppomt- 
 form than when the essentially far-reaching provisions of the 
 Public Health Act of 1858 became law, with a rider that they 
 should cease to operate on the first day of the next yearns 
 August. 
 
 Under the circumstances last mentioned it was evident that The Per- 
 in 1859 the ^^to be or not to be^' of the Central Medical Actofi859. 
 Officership must in form be an open question for the Govern- 
 ment and Parliament of the day ; but that Government should 
 consider it an open question except in a merely formal sense, or 
 that in Parliament there should be any serious vote against 
 the continuance which Government was supposed to intend, 
 was, so far as I know, quite unexpected. By degrees, how- 
 
 ment three years before, had expressly agreed not to have the right, and could 
 never for a moment have deemed any such right to "be compatible with the 
 nature of his office. 
 
 * Eeference is made to the late Mr. Thomas Slingsby Buncombe, who for 
 many years enjoyed the full confidence of Finsbury, but who, except in that 
 sense, was hardly to be counted among the serious politicians of his time. 
 More than thirty years previously — (apropos of a speech which he interposed 
 in the ministerial-explanations debate of February, 1828, and which has its 
 amusing private history told in the Charles Greville Memoirs) — Mr. Greville, besides 
 commenting otherwise unfavourably on his life and character, had described him as 
 " of limited capacity, exceedingly ignorant, and without any stock but his impu- 
 dence to trade on, only speaking to serve an electioneering purpose, and crammed 
 by another man with every thought and every word he uttered." While Mr. 
 Buncombe was of course not a man to be taken too seriously in the House, 
 and while indeed his just-named contemporary regarded him as " the greatest 
 political comedy going," he was often an especial torment to the occupants of 
 the Treasury bench : whose weak cases he would assail, when it suited him, 
 with the warmest indignation of independent membership. At the later times 
 to which my text refers, he was of broken health, and only able to attend the 
 House during the earlier of its hours of businesiS ; but he could still attack with 
 vivacity and assurance, had a quick perception of easy openings for attack — 
 especially of such as Finsbury would like him to perceive, and was listened to 
 as a speaker who amused. Throughout the years 1856-9, he would always if 
 possible come to the front to oppose anything medical which Government 
 happened to have in hand ; and on such occasions he perhaps carried a certain 
 additional prestige as the most notable invalid in the House. 
 
 s 2 
 
276 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 :;hap.xii. 
 
 Initiation 
 it Medical 
 Officer- 
 Bhips : 
 ii. The 
 Central 
 Appoint - 
 n[ient. 
 
 ever, during the second half of Mr. Buncombe's year, the 
 question of the continuance of the office came to be one of 
 extreme uncertainty, and more than once was almost settled in 
 the negative. In the spring of 1859, when the matter had 
 begun to call for consideration under Lord Derby's government, 
 the first resolution communicated to me was that Government 
 did not intend to propose more than a temporary continuance of 
 the office; and soon afterwards I was told, as the result of 
 further consideration, that they would not propose any con- 
 tinuance whatsoever, but would let the appointment lapse with 
 the ending of the Act of 1858. Within a week of the time 
 when this demolishing resolution was made known to me, I 
 was informed that it had been abandoned, and that at the 
 proper time a Bill would be introduced to continue (and as I 
 understood perpetuate) the office. I at that time had reason to 
 believe, and at this distance of thirty years I may gratefully ex- 
 press my belief, that the sudden change of resolution was due to 
 a conversation which in the interval my political Chief had had 
 with the late Prince Consort ; whose highly -informed statesman's 
 mind, always bent on objects of public good, had long been 
 interested in the cause of sanitary progress ; and whose opinion, 
 expressed on such a point as this in question, was likely to be 
 received as conclusive. Lord Derby's government, however, 
 was not destined to give effect to the amended decision ; for, at 
 this juncture occurred the 1859 change of administration which 
 restored Lord Palmerston's Premiership, and brought Earl 
 Granville to be Lord President of the Council, with Mr. Lowe 
 (afterwards Viscount Sherbrooke) as Education Vice-President. 
 By the new ministers a bill to give permanence to the pro- 
 visions of 1858 was at once introduced in the House of Com- 
 mons, and was rapidly carried through all its earlier stages ; but 
 Mr. Duncombe and others (chiefly representatives of the old 
 enmity to the Board of Health) then determined to resist its third 
 reading; and, notice to that effect having been given, there followed 
 a few hours of ministerial hesitation, whether the temporising 
 compromise of the previous year should be repeated. Mr. 
 Lowe, who had charge of the bill, saw very plainly that the 
 functions which the Act of 1858 assigned to the Privy Council 
 and its Medical Officer could have little progpect of being made 
 
THE REIGN OF QUEEN VICTORIA. 277 
 
 serviceable to the public^ if they continued only on condition of Chap.xii. 
 an annual strug-ojle for existence : and on that view the Govern- of Medical 
 ment determined to proceed. On July 19th^ when Mr. Lowe sMpsT' 
 moved the third reading of the bill, his battle proved to be cental 
 harder than had been f oreseen ,^' f or the comparatively few mem- Appoint- 
 bers who had resisted the bill of the previous year were now 
 unexpectedly reinforced from the camp of those who had 
 proposed it; and in spite of Mr. Lowers pointed reminder, that 
 " hon. gentlemen opposite now joined in the opposition to the 
 act of their own government," the curious alliance from that 
 side of the House gave the old opponents of the bill a very near 
 approach to victory. Mr. Lowe however defeated the com- 
 bined forces by the narrow majority of 101 to 95 votes j"^ and 
 the perpetuating Bill, which soon afterwards passed the House 
 of Lords, became law as 22nd and 23rd Yict., cap. 3. From this 
 time onward the Central Medical Officership was in a "position 
 gradually to shew whether it deserved to hold permanent rank 
 in the civil service of the country. 
 
 The office was under obligation to Mr. Lowe for the prompti- M:r. Lowe 
 tude and vigor of his fight for it, and the obligation was after- Sher- 
 wards greatly increased : for the interest he had shown in the 
 office at starting continued during the five years of his Education 
 Vice-Presidency, and was renewed in after years when he was 
 Chancellor of the Exchequer ; and at both periods he powerfully 
 promoted the working of the department as against the unavoid- 
 able difficulties of its official novelty. Apart too from those 
 sorts of obligation, I (as first holder of the office) had much 
 personal reason to feel indebted to Mr. Lowe for the sort of 
 apprenticeship which my years of service under him afforded me. 
 In those relations with him I found, not only a minister who 
 with rare mental activity was always sincerely considering how 
 best he could serve the public; but also a politician, who had 
 truly studied the roots of political practice, and could apply to 
 questions of legislation and government a knowledge of social 
 
 * The result seems to have turned pretty much on accident ; for, just after 
 the division, a member who had taken part in it (a former president of the late 
 Board) told me that, when the division-hell rang, he, being at the time outside, 
 had carried in with him to the Government-lobby six members who would other- 
 wise have been absent, and whose votes made the majority for the Bill. 
 
 brooke. 
 
278 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XII. 
 
 Initiation 
 of Medical 
 Of&cer- 
 ships: 
 ii The 
 Central 
 Appoint- 
 ment. 
 
 economics and of history. He being such as he was, I could not 
 but find education in my constant opportunities of discussing 
 with him the poKtical bearings of the work to be done under our 
 Act ; and it was my first great encouragement in office, to see 
 how immediately he recognised the importance of the work, and 
 what pains he was always ready to take with its problems. 
 
%79 
 
 CHAPTER XIII. 
 
 THE MEDICAL DEPARTMENT UNDER THE PRIVY COUNCIL. 
 
 It having been my duty, from the time when I became Medical 
 Officer of the Privy Council, to prepare for Parliament annual 
 reports on the branch of the public service in which I was con- 
 cerned, the fourteen such reports, made during the years 1859-72, 
 and successively laid before Parliament, are a record of the work 
 of the Medical Department during the years to which the present 
 chapter of narrative relates; and the narrative therefore needs 
 only so far epitomise that record as to shew what was the 
 general spirit, and especially what were the chief practical 
 aims of the work. 
 
 'Except in two particular relations, the Lords of the Council Natme of 
 under the Act of 1858 were not a regulating or controlling Coimcii's 
 authority. The exceptions were — first, that they were charged tion, 
 with permanent regulative responsibility in regard of the public 
 vaccination of England and Wales, and of the national sup- 
 plies of vaccine lymph ; and, secondly, that, during occasions 
 when the Diseases-Prevention Act might be in force against any 
 formidable epidemic, endemic, or contagious disease, they had 
 authority to issue orders and regulations pertinent to the occa- 
 sion; but, except in those two relations, and in relation to the 
 Act for Quarantine and the Medical Act, their Lordships, 
 through their Medical Department, had only to fulfil functions 
 of Inqidry and Report, Apart from inquiries to be made into 
 the execution of such orders and regulations as they might have 
 in force with regard to Vaccination or to the purposes of the ex- 
 ceptional Diseases Prevention Act, my Lords were to inquire into 
 ^^any matters concerning the public health in any place or 
 places ; " and this duty would in part be determined by occasions 
 as they might from time to time arise — chiefly the casualties and 
 alarms of particular localities in respect of the ordinary epidemic 
 diseases of the country, and would in other part be fulfilled 
 
280 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIII. 
 
 Medical 
 Depart - 
 ment under 
 the Privy 
 Council. 
 
 The 
 
 Council's 
 Medical 
 Machinery 
 
 on system, with continuous regard to a general scheme of 
 progress. 
 
 ^For the inspective and other technical work o£ the Depart- 
 ment^ there of course was need of technical assistance ; and, as to 
 the persons whose skilled co-operation for such purposes should 
 be sought or accepted, my Lords always did me the honor of 
 inviting my recommendations. Obviously I had every motive to 
 justify the trust which was so reposed in me; and the praise 
 which during the series of years I had the happiness of finding 
 accorded to the work of my co-adjutors, as reported in the annual 
 blue-books of the Department, assured me that my endeavours to 
 enlist first-rate service under their Lordships^ commission were 
 successful. During the earlier yeais of the Department, a chief 
 departmental demand was for highly-specialised knowledge in 
 particular sections of subject-matter ; and this could hardly be 
 met except by isolated consultation -reports from specialists 
 already of authority in the section, or from inquirers distinct- 
 ively commissioned in relation to it. Partly for that reason, and 
 partly because of the general tentativeness of the case, the ^rlier 
 engagements of technical assistance were all temporary ; out, as 
 years went on, permanent inspectorships, first_ (1865) for the 
 vaccination-duties of the Department, and afterwards (1809) for 
 the general sanitary business, became necessary ; and by degrees 
 several who had been temporary assistants of the department 
 were enrolled as permanent ofiicers, or for permanent partial 
 duty. The Ministers who promoted the legislation of 1858 had 
 deliberately refrained from proposing to maintain for sanitary 
 purposes any such formally constituted Medical Council as Sir 
 Benjamin Hall had had in 1854-5 ; but, with the assistance 
 which has been described, a way was found in which the public 
 service could have the advantages of medical consultation; for 
 the highly-qualified persons who in different degrees and capa- 
 cities gave skilled assistance to the Department in matters of 
 special technic, or in report on local sanitary circumstances, were 
 practically Councillors, with any one or more of whom the 
 Officer responsible for advising the Government could always (as 
 it were) go into Committee of Advice for the various special 
 objects to which their assistance related; and my successive 
 reports are evidence how very highly I appreciated the value 
 
THE REIGN OF QUEEN VICTORIA. 281 
 
 o£ those consultative facilities, and how deeply indebted to them Chap.xiii. 
 I was in all my endeavours for the public service. m^n- 
 
 ment under 
 T J. 1 • f» 1 *^® Privy 
 
 In takmg" account of the work which was done by the Council. 
 Medical Department of the Privy Council, it is necessary to , 
 consider separately the part which related to Vaccination ; and, Series of 
 for the present purpose, it will be convenient to let that part kigj'^^'^" 
 stand first in order of description.— With regard to Vaccination, vlcciTa^ 
 the functions which the Act of 1858 required the Privy Council *^°^- 
 to fulfil were supplementary in an essential sense to certain 
 which the Poor Law Board was fulfilling. Since 1840, when 
 the first vaccination- act for England was passed, the Poor Law 
 Board (with no medical functionary in its service) had had control 
 over the contracts which local authorities were to make with 
 medical practitioners for the performance of public vaccination ; 
 but that secretarial control affected only the forms of the system 
 to which it applied, and it did not at all concern itself with 
 arrangements for the maintenance of lymph-supply. I^o wonder, 
 then, that, throughout the English system of public vaccination, 
 there were flagrant evidences of unskilfulness : evidences, 
 specially discreditable in the case of the country which had 
 taught vaccination to the world, and all the more serious in 
 their details in as much as our legislature in 1853 had made 
 vaccination compulsory. To that very unsatisfactory state of 
 the case, I had been obliged to refer in 1857 when reporting 
 generally on the subject of vaccination, and the provisions which 
 "the Act of 1858 contained as to vaccination were meant to begin 
 a better system : not indeed removing from the Poor Law Board , 
 the formal control over vaccination contracts, but providing, as 
 in aid of the Board, that, for all the medical requirements of the 
 case, the medically-advised Lords of the Council should regulate 
 and supervise the service. The dual government was not likely 
 to be a rapid agency of reform ; but, awkward as it was, it offered 
 better possibilities than had before existed ; and in 1859 the pro- 
 ceedings of the Lords of the Council in respect of their share of 
 the divided responsibility began. First, as security, direct and 
 indirect, against individual acts of mala praxis in the perform- 
 ance of public vaccination, they defined in technical Instructions, 
 what should in future be understood as a proper fulfilment of the 
 
2S2 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIII. 
 Medical 
 Depart- 
 ment under 
 the Privy 
 Council. 
 
 contractor's undertaking to " vaccinate ; " they required (strange 
 as it may seem that no such requisition had yet been made) that 
 persons to be in future appointed public vaccinators should be 
 persons who had learnt to vaccinate ; and_, in order to make this 
 possible^ they opened^ in proximity to the various medical schools 
 of the country, educational vaccinating-stations where medical 
 students could receive the instruction, or be examined as to their 
 competence. Secondly, with a view to the better maintenance 
 of local supplies of vaccine -lymph, they laid down the rules 
 which ought to be observed in the appointment of times and 
 places for public vaccination. Thirdly, with a view to the main- 
 tenance of the general supply of lymph, they arranged that the 
 National Vaccine Establishment (which of late years had been 
 tending to failure) should have, as its future sources of lymph, a 
 sufficient number of carefully selected stations out of those which 
 the Act of 1840 had created. The departmental Report on 1859 
 (presented March, 1860) gives exact account and explanation of 
 those early regulative proceedings;"^ as to the fundamental 
 principles of which I had profited by much special consulta- 
 tion with Mr. Ceely, t Mr. Marson, J and Dr. Seaton. § The 
 
 * Second Annual Report of the Medical Officer of the Privy Council ; 1860. 
 
 t Mr. Rohert Ceely of Ajdesbury, for half a century the leading surgeon of 
 his county, and always one of the most respected members of the profession, had, 
 from early life, in spite of the demands of active professional practice, ever been 
 among our truest cultivators of medical science. Especially in comparative 
 pathology, he was a man of cyclopaedic reading, and wide and exact observa- 
 tion ; his rural surroundings having been used by him as a great school in which 
 to study the diseases of farm-stock and other domestic animals. By the profes- 
 sion at large he was recognised as the one of us who had most perfectly studied 
 the natural history of vaccination, and as our common master in all relating to 
 it. I gratefully acknowledge that I owed to him all the best teaching I got 
 in that and in much allied matter. He died, eighty-three years old, in Nov., 
 1880. 
 
 X Mr. James Marson, who died in November, 1877, had for the last forty -two 
 years of his life been Resident Surgeon to the London Smallpox Hospital. He 
 was of unique experience as to the relations between smallpox and vaccination. 
 On that subject he had in 1852 contributed to our London Medico-Chirurgical 
 Transactions, a paper which at once became classical, giving the extremely im- 
 portant results of his extensive and minute original study down to that date ; 
 and some twenty or more years afterwards he put the Medical Department of the 
 Local Government Board into possession of the records of all his later experience. 
 As an expert in the practical knowledge of vaccination, he probably was unsiu-- 
 passed in the world. 
 
 § Dr. Edward Cator Seaton, who at this time was beginning to assist the 
 
THE KEIGN OF QUEEN VICTORIA. 283 
 
 first departmental proceeding was to enter upon a minute survey Chap.xih. 
 of public vaccination in the (about) 3,500 districts of England Depart- 
 and Wales : a survey in which Dr. Seaton, Dr. Stevens, Dr. Se'pJS^^' 
 Buchanan and Dr. Sanderson, acting as inspectors,^ amassed for Council, 
 the department during the five years 1860-4 the complete system 
 of information on which further reforms had to be based, and 
 the full particulars of which are set forth in the five annual 
 reports, third to seventh inclusive. In 1866, on the strength 
 of that mass of information, Mr. H. A. Bruce (who meanwhile had 
 succeeded Mr. Lowe as Education Vice-President) brought before 
 the House of Commons, and carried through Select Committee 
 ,of the House, a Bill to amend the vaccination-law in various 
 respects: which Bill the 1866 change of government prevented 
 from then passing : but in the following year, it was re-introduced 
 with little or no change by Mr. Bruce^s successor, Lord Bobert 
 Montagu, and became law as the amending and consolidating 
 Act, 30th and 31st Victoria, c. 84. This important sanitary 
 statute re-enacted in amended form the fundamental provisions 
 of the Acts of 1840-1841 and 1853, — providing, however by new 
 conditions and control for the much needed improvements in the 
 local service of public vaccination, and appointing special 
 
 department as occasional inspector, and who afterwards became more and more 
 importantly associated with it, had from long before, been of high account as a 
 critic of the Vaccination Acts and their administration. He had been Honorary- 
 Secretary and I believe the chief mover of the Epidemiological Society, at the 
 times when the Society promoted the compulsory Act of 1853, and afterwards 
 urged Sir B. Hall for administrative reforms in the Vaccination-service. From 
 the time when Dr. Seaton was appointed Inspector, his devotion to the details of 
 that branch of our work was an invaluable assistance to the department, and 
 most useful service to the public. Dr. Seaton became in 1876 Medical Officer of 
 the Local Government Board, and retained that office till shortly before his 
 death, which befell January 21, 1880. 
 
 * At the time of my present writing (1889) Dr. Stevens, Dr. Buchanan, and 
 Dr. Sanderson, are still actively serving the public ; the last-named as Waynflete 
 Professor of Physiology at Oxford, the other two as officials who reflect honour on 
 the Local Government Board ; and it will be for some later pen than mine to 
 praise them adequately when they shall have passed from the scene. Here needs 
 only be noted that, at the time when they respectively began work under the 
 Privy Council, Dr. Stevens had shown qualities of a very high order in the post 
 of resident-physician to St. Luke's Hospital for the Insane, and that Dr. Buchanan 
 and Dr. Sanderson were highly distinguished Metropolitan Officers of Health. 
 Dr. Buchanan had also for some years (beginning soon after his entry on practice) 
 been Physician to two of the most instructive of special hospitals, the London 
 Fever Hospital, and the Hospital for Childi-en. 
 
284 
 
 ENGLISH SANITAEY INSTITUTIONS. 
 
 f HAP. XIII. ma chineiy and method to promote the compulsory intentions o£ 
 Depart- 1853 ; it also brought within particular provisions of law the 
 the Privy performance of re-vaccination at the public expense ; and^ not 
 Council. least, it authorised the Privy Council to apply a parliamentary 
 grant, on the principle of ^' payment for results/^ to the object of 
 providing for meritorious public vaccinators a better remunera- 
 tion than they had yet had."^ The new Act came into operation 
 on the first day of 1868 ; shortly afterwards important new regu- 
 lations, necessary for various of its purposes, were issued by the 
 . Lords of the Council ; t and thenceforth, for a long while, the 
 Medical Department was very largely occupied with the reforms 
 which had to be introduced. Considerably before this time, the 
 superintendence of public vaccination had been found to require 
 a continuous employment of inspectors, and had led to the 
 earliest permanent inspectorships in the Medical Department : 
 Dr. Seaton and Dr. Stevens having entered on permanent office 
 in April 1865 ; Dr. Hunter in the summer of 1866, immediately 
 after the report of the Select Committee ; J and Dr. Brodribb a 
 few months later : § besides which appointments there was (from 
 long previously) the special inspectorship of the National Vaccine 
 Establishment. From the time when the new Act began to 
 operate, our duty of supervising its operation required that our 
 circuits of inspecting for that purpose should be arranged as 
 departmental routine. Irrespectively of special claims which 
 might have to be met where local arrangements were being 
 changed, or matters of complaint needed inquiry, and apart also 
 
 * The contrivance was founded on the hint of Mr. Lowe's Educational Code ; 
 and the clause proposing it for the Vaccination Bill had been brought before the 
 Select Committee of 1866 by Mr. Lowe. 
 
 t Eleventh Annual Eeport, pp. 7 and 36. 
 
 X Dr. Henry Julian Hunter had entered the profession in 1844, and after 
 having practised in it very actively in Sheffield for seventeen years, had in 1861 
 retired fi-om private practice ; since when he had on several occasions rendered 
 valuable assistance to the Privy Council INIedical Department in works of general 
 inspection, some of which will hereafter be mentioned. From the appointment 
 on which Dr. Hunter entered in 1866, ho, greatly to my regret, had to retire in 
 1870. The new vaccination-inspectorships, as at first arranged, were offices of 
 great labour ; and Dr. Hunter, who never spared himself in any duty he under- 
 took, found, after four years of office, that he could no longer sustain the exertion. 
 
 § Dr. Brodribb' s efficient tenure of office was unfortunately only for a year. 
 Being in London in January 1868, and visiting the London Fever Hospital, 
 he there caught typhus, and rapidly died of it. 
 
THE REIGN OF QUEEN VICTORIA. 285 
 
 from certain more particular inspections annually required for the Chap.xiu. 
 stations which supplied lymph, and for the stations which were Depart- 
 schools of vaccination, our scheme provided that, once in every ^e^pH^®^ 
 two years, the vaccination-arrangements of each local authority Council, 
 throughout the country, and the work of each individual public 
 vaccinator, should be inspected and criticised in the sense of the 
 new law, and of the regulations which had been made for the 
 award of the parliamentary grant to meritorious public vacci- 
 nators ; and that if, on inspection, defects or irregularities were 
 found in the local working of the Act, the local authority should 
 receive from the Department such notification as the case might 
 require. On the subsequent storj'- of this large branch of work, 
 it is not necessary here to dwell ; but some further reference to 
 it will be due when the proceedings of the year 1871 come to be 
 mentioned. 
 
 Strangers who looked superficially at the early reports of the Series of 
 Medical Department may perhaps sometimes have thought we mgs for 
 were bestowing disproportionate care on the one specialty of ^^^^ 
 Vaccination. The reasons, for which we at starting were re- puiToses. 
 quired to give it our first particular attention, were not far to 
 seek : the power of vaccination to prevent smallpox was already 
 so familiarly known to the general public, that the knowledge 
 seemed peculiarly to claim administrative recognition ; in that 
 one specialty preventive medicine had ripened to a point at 
 which the legislature had become able to expressly apply it; 
 and the state of the law as to compulsoriness of vaccination 
 had made it urgent, as a point of honour between government 
 and people, that public vaccination in all parts of the country 
 should be as good as the best knowledge and the utmost pains- 
 taking could render it. '^But while those considerations in- 
 fluenced the order of action, and while under the circumstances 
 an immense quantity of detail regarding vaccination was in- 
 evitably brought to the front in our earlier reports, the pre- 
 vention of smallpox was never in principle deemed of more 
 concern to the Department than the prevention of any other 
 preventable disease ; and vaccination, in that point of view, was 
 but a fraction of our statutory business. Except so far as 
 particular duties had been created for us under the vaccination- 
 
286 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIII. 
 Medical 
 Depart- 
 ment under 
 the Privy 
 Council. 
 
 law, the public-health relations of the country were to be treated 
 in all their parts with equal justice; and the first function 
 which the department had to fulfil towards them was the 
 function of exact study, as foreshadowed in the report of 1858. 
 With regard to sanitary action in general, no duties of command 
 had been assigned to the Lords of the Council ; and in truth 
 anything which their Lordships in those early days could have 
 done by way of command would have been as nothing in com- 
 parison with the good they could do by increasing applicable 
 knowledge. Their Medical Department had to develop a scientific 
 basis for the progress of sanitary law and administration. "We 
 had to invoke, for our own special province of duty, the spirit 
 which for many previous years had been tending to more and 
 more activity in other departments of medicine, as indeed 
 genei'ally throughout the biological and physical sciences : we 
 had to aim at stamping on public hygiene a character of greater 
 exactitude than it had hitherto had. * Confident that, if the 
 
 * In the report of 1858, I had mentioned various instances in which the 
 advancing exactitude of clinical and experimental pathology was giving help and 
 example to hygienic study, and in which the latter was moving into modern 
 methods. For present purposes of comparison, I may note a few dates which I 
 think significant. During the years 1849-52, Dr., now Sir "William, Jenner, 
 who at that time was a hard-working junior at University College, had esta- 
 blished his memorable discrimination between the chief continued fevers of this 
 country; and in 1858 his work was very usefully supplemented by Dr. Murchi- 
 son's endeavour to trace the different fevers to different setiological relations. 
 During the years 1854-6, the Bavarian Government had published its highly 
 instructive reports on Cholera, as observed in Bavaria in 1854-5; including the 
 classical one in which Prof, von Pettenkofer went far ahead of all previous 
 writers in endeavours to define the conditions which determine the diffusion of 
 cholera ; and including also the not less momentous one in which Professor 
 Thiersch gave a first corroboration by experiment to the theory of choleraic 
 infection which our countryman Dr. Snow had been pressing since 1849. In 
 1859-60, Dr. Snow's similar views as to the aetiology of enteric fever were 
 ardently pressed by Dr. William Budd of Bristol : who, in support of them, 
 published various cases in which persons suffering under enteric fever, and 
 migrating from place to place, had undoubtedly infected the places to which 
 they moved. In relation to a different group of hygienic questions, the year 
 1858 was signalised by the publication of Professor Eicord's epoch-making work 
 on the contagium of syphilis. In the more intimate study of contagion in general, 
 and of the various particular contagia, a new sera began in 1865 : when M. ViUemin 
 published his proofs of the inoculability of tubercle, and when Dr. Beale and Dr. 
 Sanderson were set by the Royal Cattle- Plague Commission of that year to inquire 
 into the nature of the cattle-plague virus. In 1870 Dr. Ballard contributed most 
 
THE KEIGN OF QUEEN VICTORIA. 287 
 
 knowledge were got, its utilisation would speedily follow, we Chap.xiil 
 had to endeavour that all considerable phenomena of disease- Depart- 
 prevalence in the country should be seen and measured and un- Se'privv^' 
 derstood with precision, — should be seen as exact quantities, be Council, 
 measured without fallacious admixture, be understood in respect 
 of their causes and modes of origin ; that true facts, and true 
 interpretation of facts, with regard to the diseases of the 
 country, and the causes producing them, should be supplied on a 
 sufficiently large scale for political appreciation and use. ' Under- 
 taking in that spirit to investigate as thoroughly as we could 
 the general sanitary requirements of the country, we proceeded 
 in part methodically, on lines which had suggested themselves to 
 us as necessary main- ways of a general plan; while, in other 
 part, we accepted the guidance of such merely accidental oppor- 
 tunities as were given us from time to time by the occurrences of 
 particular seasons, and by the complaints and questions of classes • 
 and persons who told us of their sanitary hurts or alarms. The 
 work advanced year by year during the period to which the 
 present section of my narrative refers ; and long before the close 
 of the period, the successive steps, recorded in the annual 
 reports, had not only made essential progress in the matter of 
 our scientific task, but had led, and were still leading, to such 
 important extensions of sanitary law as gave a hundredfold 
 reward for the labour. 
 
 '^or the first eight or nine years, the inquiries, almost 
 universally, were such as might be tabulated under two heads, — 
 sometimes were of direct reference to observed Ftxcesses of 
 Disease, epidemic or endemic, in particular districts, or among 
 particular classes of the population, and sometimes were inquiries 
 into the distribution of the comnion Necessaries of Health among 
 the population, and into the effect of deficiencies which were 
 found existing ; but, between those two sorts of inquiry, the 
 distinction was rather formal than real ; for, though they 
 respectively started from different standpoints, they tended to 
 one and the same main purpose with each other, and, as it were, 
 
 importantly to open a new line of epidemiolo^cal accuracy, by shewing that a 
 considerable outbreak of enteric fever at Islington had been consequent on the 
 distribution of a particular (presumably contaminated and infected) supply of 
 milk. 
 
288 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIII. 
 
 Medical 
 Depart- 
 ment under 
 the Privy 
 Council. 3 
 
 Epidemic 
 
 outbreaks, 
 
 1858-71. 
 
 dovetailed in their results to make the coherent sanitary chart 
 which we required. 
 
 In relation to our study of epidemic outbreaks, the period 
 1858-71 had some exceptional facts. At the moment when we 
 entered on duty, Biphtlieria had recently begun to be a source 
 of much alarm to the public^, and of extreme interest to the 
 medical profession, as a disease which (though it had been ex- 
 perienced here in former times) was well-nigh unknown to the 
 existing generation of British medical practitioners ; and one of 
 our first duties on the passing of the Act of 1858, was to institute 
 a comprehensive inquiry into recent new experiences of the disease 
 in seventeen of the counties of England, at some seventy different 
 centres where it had been prevalent.* In 1862-3, the very 
 grievous distress which prevailed throughout the cotton-work- 
 ing districts of England, with partial outbreaks of typhus in 
 some of them, made it, for some months, terribly doubtful 
 whether Famine-Diseases might not become widely epidemic 
 among the suffering populations ; and, that being the case, 
 we had to keep anxious watch over the districts, and to advise 
 as occasion required, both with regard to the diseases prevailing 
 in them, and with regard to the degrees of privation which were 
 threatening disease. t Again, the year 1865 was of extraordinary 
 epidemiological interest. J Early in that year, rumours which were 
 heard, of strange diseases spreading epidemically in the North of 
 Europe, made it necessary that the Privy Council, as quaran- 
 tine-authority for the United Kingdom, should be advised on 
 the facts of the case, and, as a first step, that inspectors should 
 
 * For the programme and results of this large inquiry, see First and Second 
 Annual Reports, and especially, in the latter, the papers in which Dr. Greenhow 
 and Dr. Sanderson give the valuable results of their numerous local studies. See 
 also (as founded on this inquiry) the separate work which Dr. Greenhow soon 
 afterwards published on the subject of Diphtheria. 
 
 t See Fifth Annual Report, and particularly the three inspectorial papers in 
 in its Appendix V. : two by Dr. Buchanan on the Health of the Operatives as 
 affected by the prevailing Distress; and one by Dr. Edward Smith, on the 
 nourishment of the distressed populations, and on the ways of best utilising such 
 money-allowances as were to be made for food. The last named paper (the 
 substance of which was afterwards published by Dr. Smith in a separate form) 
 gave, in reply to questions which I had proposed, an original and highly elaborate 
 study of the minute Economics of Diet. 
 
 X See note * above. 
 
THE REIGF OF QUEEN VICTORIA. 289 
 
 be sent from tlie Medical Department to collect information in Chap.xiil 
 the accused Russian and German territories ; whereupon, among Depart- 
 other grounds for anxiety, the very disquieting fact became STp^^' 
 known, that Cerehro -spinal Meningitis — a febrile nervous affec- CounciL 
 tion of an extremely painful and dangerous kind, which we in 
 England had hitherto hardly heard named, and which on the 
 continent had been but recently identified, was manifesting itself 
 in epidemics in north-east Germany, chiefly about the Lower 
 Vistula, and that, only within the Circle of Dantzig, at least 
 a thousand persons had died of it in the last three or four 
 months."^ Again, a little later in the same year, a fourth great 
 invasion of Europe by Asiatic Cholera began : under which, 
 partially in 1865, and more extensively in 1866, when our 
 Diseases Prevention Act had to be put in force, England suffered 
 various outbreaks of the disease : and these outbreaks, some of 
 which proved deeply and dreadfully instructive, were of course 
 attentively observed by the Medical Department, f In Septem- 
 ber of the same year we had the unprecedented experience of 
 fifteen or sixteen deaths by Yellovj 'Fever among the residents of 
 an English port-town, Swansea, to which the infection had come 
 by ship from Cuba. % Among the many memorabilities of 
 the period, one, which certainly was not last in consequence to 
 the progress of English Epidemiology, was the fact that in 1865, 
 after a century^s interval, the Cattle-Plague of the Russian 
 Steppes was imported anew, as a long-forgotten disease, into 
 this country; where, affecting very large pecuniary interests, and 
 therefore at once getting to be popularly scrutinised in regard of 
 preventability, it, and the administrative precautions which were 
 taken against it, soon led the public to reflect, more widely and 
 more practically than before, on the spreading of other epidemics 
 by contagion. Apart from exceptional occurrences such as the 
 
 * See Eighth. Annual Report, and its appendices Nos. 9-12, with reports by 
 Dr. Whitley on the Fevers prevailing in St. Petersburg, and Eeport by Dr. 
 Sanderson on the epidemics of Cerebro-spinal Meningitis prev ai ling about the 
 Lower Vistula. 
 
 t See Eighth and Ninth Annual Reports, with their Appendices, and especially 
 the contributions of Dr. Parkes and JMr. J. Netten Radcliffe. See also in the 
 appendices to the Ninth Report, the various clinical, experimental and chemical, 
 studies of the disease by Dr. Sutton and Dr. Thudichum. 
 
 % See Ninth Report, with Dr. Buchanan's appended account of the Swansea • 
 
 Yellow Fever. 
 
290 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIII. 
 
 Medical 
 Depart- 
 ment under 
 the Privy 
 Council. 
 
 Nuisances 
 
 causing 
 alarm. 
 
 above mentioned of 1858-9^ 1862-3 and 1865-6, we of course 
 had before us, throughout the whole thirteen years, the more 
 ordinary epidemics of the country ; and every year we investi- 
 gated in such number as we could, and with increasing exactitude 
 as om' knowledge increased, various local outbreaks of those 
 diseases : generally enteric fever, typhus, or scarlatina : and 
 occasionally others which are less frequent. ^ 
 
 Practically akin to the inquiries which were rendered neces- 
 sary by actual outbreaks of disease, were those which occasionally 
 had to be made on grounds of local alarm, where outbreaks of 
 disease were expected ; as because of some particular introduction 
 of contagion, or because of some widely-operating common 
 nuisance in relation to air or water ; and various of these 
 inquiries were almost as important as the others in respect of 
 the lessons we learnt from them, t 
 
 1859-66. 
 Systematic 
 Investiga- 
 tions, 
 
 throughout 
 England, 
 as to the 
 habitual 
 
 and the 
 circum- 
 stances. 
 
 " Beside the inquiries which related to epidemic outbreaks and 
 alarms, there were inquiries, at least equally important, and 
 admitting of more methodical arrangement, with regard to the 
 habitual predominance of certain diseases or groups of diseases in 
 particular districts. They began in 1859, as soon as the Privy 
 Council had received its new authorisation for such duties ; and 
 within three years, during which I had most valuable assistance 
 
 * See for special mention of Eelapsing Fever, the Twelfth Annual Report ; 
 for a local epidemic of Jaimdice, the Sixth ; for a local diffusion of Puerperal 
 Fever, the Eighth. I do not think it necessary to enumerate here the long series 
 of enquiries which were made as to epidemics, large and small, during the years 
 to which the text relates; but it may be noted that the officiators in these 
 occasional inquiries during the first eight years of the department (when 
 as yet there were no permanent inspectors for such duty) were, in order of 
 years, Drs. Greenhow and Seaton ; Drs. Ord and Sanderson ; Dr. Whitley ; 
 Dr. Bristowe ; Drs. Stevens and Buchanan and Mr. Ceely ; Dr. Hunter ; Drs. 
 Milroy and Parkes and Mr. Radcliffe. Several of these gentlemen also, as the 
 text mentions, took part in other of our early inquiries ; and some of them, I 
 am glad to say, were, in later time, able to become permanent officers of the 
 department. 
 
 t For illustration, see, in Second Annual Eeport, when there was much 
 London alarm at the very stinking state of the Thames, Dr. Ord's inquiry as to the 
 effects of that nuisance. See also, in First Annual Eeport, inquiry by Dr. Seaton 
 as to Paper Mills accused of diffusing smallpox, and in Eighth Annual Eeport 
 a more general one by Dr. Bristowe on the influence of the Eag-Trade in spread- 
 ing infections of disease. See also various inquiries as to the influence of Sewage- 
 Farms. 
 
THE REIGN OF QUEEN VICTORIA. 291 
 
 from Dr. Greenhow, the following three very important sections of Chap.xiii. 
 work were done. First, in 1859, inquiry was instituted with Depart- 
 regard to the habitually high fatality of Diarrhoea among the Se'pri^*'^ 
 eight large populations (in aggregate considerably over a million Council, 
 inhabitants) of Manchester, Birmingham, Leeds, Wolverhampton, 
 Dudley, Merthyr Tydfil, Nottingham and Coventry, Secondly, 
 in 1860 and 1861, there was inquiry, on a still larger scale, into 
 the excessive fatality of Fulmonary Diseases (tubercular and 
 bronchitic) among some thirty large populations having special 
 industries : the populations, namely, of Stoke upon Trent and 
 Wolstanton ; of Bromsgrove, Alcester and Sheffield ; of Penzance 
 and Bedruth j of Beath ; of Pateley Bridge ; of Macclesfield and 
 Leek ; of Leeds, Bradford, Stroud and Melksham ; of Leicester 
 and Hinckley ; of Preston j of Towcester and Newport-Pagnel ; of 
 Berkhampstead ; of Yeovil ; of Saffron- Walden ; of Birmingham 
 and Aston ; of Wolverhampton ; of Merthyr-Tydfil and Aber- 
 gavenny ; of Coventry; of Blackburn; and of Nottingham; 
 and this inquiry was in great part an examination of the sanitary 
 circumstances of bread- winning labour in many largest branches 
 of popular industry, — in coal-mining, iron-mining, lead-mining, 
 copper-mining, and tin-mining ; in the smelting of metals, and 
 the making of metallic instruments, large and small ; in the 
 various divisions and subdivisions of factory-work in relation 
 to cotton, silk, flax and wool; in the chiefly domestic indus- 
 tries of lace-making, glove-making, hose-making and straw- 
 plaiting ; in much miscellaneous working of pebbles, shells, 
 ivory, horn, wood, gutta-percha &c., and in watch-making. 
 Thirdly in 1861 (apropos of local visitations which Dr. Greenhow 
 had to make for the purposes of the last-mentioned inquiry) 
 reference was had to the specially high Mortality of Infants in 
 many of the districts which were in question; and separate 
 inquiry was made into the circumstances occasioning excessive 
 infantine mortality in Coventry, Nottingham, Blackburn, 
 Birmingham, Wolverhampton and Abergavenny. Two years 
 later, with Dr. Hunter's assistance, I was able to supplement 
 that third inquiry by one having reference to a particular class of 
 agricultural districts (chiefly East-Midland) in which there had 
 been as much blight of infant life as among the previously visited 
 manufacturing and mining populations. Also in 1863, the study 
 
 T % 
 
292 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIII. 
 
 Medical 
 Depart- 
 ment under 
 the Privy 
 Council. 
 
 of the Lung-diseasing Influences in large branches of national 
 industry was continued, with assistance of Dr. Ord and Dr. 
 Edward Smith, by inquiry into the sanitary circumstances of 
 three very large London industries : that of needle-women, that 
 of tailors, and that of printers. Further, in 1863, with Dr. 
 "Whitley^s assistance, information was collected in the principal 
 marsh-districts of England, with regard to the quantity and 
 severity of Ague still suffered in them. 
 
 While the various above described inquiries, starting from 
 known excesses of disease, epidemic or habitual, were in progress, 
 so likewise were inquiries of the class which I named as having 
 started from an opposite stand-point. Adverting to standards 
 which in great part were those of common social experience, as 
 to the Elementary/ Requisites for popular Healthiness, we hoped 
 by degrees to examine and display how far those conditions were 
 being fulfilled for the masses of the population : as particularly in 
 respect of food-supply , of house-accommodation and the physical 
 surroundings, and of industrial circumstances : how far were 
 precautions taken against certain notorious dangers in common 
 life, as for instance, against local nuisances, and against the 
 contagions of disease from man and beast; how far were the 
 dangers guarded against which attach to certain branches of 
 industry ; how far was the supply of medical and pharmaceutical 
 service under such securities as the public required, against false 
 pretences of qualification in either service ; how far was hospital- 
 treatment provided for the graver necessities of the sick poor ; 
 how far was the sale of drugs guarded against adulteration ; how 
 far were safeguards provided against chances of accidental and 
 criminal poisoning ; &c., &c. 
 
 During the four years 1862-5 we were much occupied with 
 studies of that sort, and were able to make extensive special 
 inquiries relating to several of them. First, in 1862-4, as 
 regarded the Food-interests of the country : — in a series of 
 inquiries which extended throughout England and Wales, and 
 gathered important side-lights from Scotland and Ireland, the 
 Dietaries of the Lowest-fed Classes of the population were 
 systematically examined by Dr. Edward Smith ; who so analysed 
 and methodised all requisite information regarding them, 
 that, in regard of their nutritive values, they could readily be 
 
THE KEIGN OF QUEEN VICTORIA. 293 
 
 compared with each other, and with physiological standards o£ Chap.xIII. 
 
 /T> • TA T. 'J' . . , . Medical 
 
 sutfaciency : Dr. Barnes assisting* us m a particular section o£ the Depart- 
 subject-matter by a report o£ his large experience as to the SeP^^' 
 dietetic origin o£ Scurvy in the Mercantile Marine : while, by ^°*^°^ 
 other inquiries on a large scale, in which I had the assistance o£ 
 Mr. John Gamgee and Dr. Thudichum, the subject of Cattle- 
 Diseases, in relation to the quantity and quality of our market- 
 supplies of Meat and Milk, and in relation to the influence of 
 Contagion (including that from foreign countries) in spreading 
 the diseases, was carefully studied. In 1862-3, with assistance 
 of Dr. Guy, Dr. Bristowe and Dr. Whitley, establishments for 
 conducting certain Dangerous Industries — ^those in which the 
 workpeople have to do with arsenic, phosphorus, lead and mercury, 
 were examined in respect of the precautions taken in them (or 
 which ought to be taken) for minimising peril to the persons 
 employed. In 1863, with the joint assistance of Dr. Bristowe 
 and Mr. Timothy Holmes, a comprehensive examination was 
 made of the Hospitals of the United Kingdom^ with regard to the 
 quantity and quality of the accommodation afforded by each of 
 them for the treatment of disease, and to their respective successes 
 in treatment. In the same year, in relation to the question of 
 safeguards against Accidental and Criminal Poisoning y Dr. Alfred 
 Taylor assisted us with a report of his large experience as to 
 dangers arising to the public health in the conditions under 
 which drugs and poisons were at that time retailed. Finally, in 
 the two years 1864-5, with assistance of Dr. Hunter, the series 
 of inquiries was crowned by a wide and elaborate study of the 
 Dwellings of the poorer labouring classes in Town and Country j 
 with regard to the quality of the accommodation afforded, and 
 to the influence of the Nuisances Removal Acts on the salubrity 
 of the dwellings and their surroundings: a study, which, in 
 regard of the agricultural and other rural labourers, was pursued 
 in each of the forty counties of England, and involved an exam- 
 ination of 5375 inhabited houses ; while, in regard of the town- 
 populations, it dealt with the vast case of the metropohs, and, 
 besides including for important purposes of comparison some 
 examination of places in Scotland, extended, in extra-metro- 
 politan England, to fifty chief provincial centres of popu- 
 lation. 
 
294 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 CHAP.xin. 
 
 Medical 
 Depart- 
 ment under 
 the Privy 
 Council. 
 
 1864. 
 Specialise 
 national 
 Statistics 
 of Fatal 
 
 Reports whicli purport to deal witli the Distribution of 
 Disease,, and the conditions which regulate it, have, at every 
 turn, to express themselves in precise statistical language ; and 
 often their arithmetic must be specialised with a certain degree 
 of minuteness. In our case, we had to distinguish particular 
 catises and particular a^es of death, in eack place and class to 
 which our studies related. The importance of Specialised 
 Mortuary Statistics had been sufficiently shown in our Report 
 of 1858 ;^ and while, in our early Privy Council inquiries, we 
 were again and again feeling ourselves in want of such statistics 
 on a comprehensive national scale, we could not but also see that, 
 for the general information of the country in sanitary matters, a 
 statistical compendium, giving specialised death-rates for all the 
 registration-districts of England, would be a publication of extra- 
 ordinary value. In 1860, there was a favourable opportunity for 
 moving in that matter ; in as much as a new census of the popu- 
 lation was approaching, when amended data would exist for the 
 calculation of exact death-rates ; and accordingly in that year, I 
 sought and obtained authority to bring the subject under con- 
 sideration of the Registrar- General. Expressing to him my 
 belief as to the value of the help which I begged for the further- 
 ance of sanitary investigation, I proposed to him that, in con- 
 nexion with the approaching census, he should cause to be pre- 
 pared, from the last ten years^ mortuary returns made to his 
 office, an account (tabulated to plan) of the Average Ammal 
 Proportions of Deaths ^ from all causes, and from specified causes, 
 and with certain specifications of age and sex, in England 
 generally, and in each Registration-Division and Registration- 
 District of England, as well as in certain standard areas, during 
 the decennial period 1851-60. Major Graham, always desirous 
 to make his office as useful as possible to the public, gave a ready 
 ear to my application; and the very important result of his 
 acquiescence (necessarily of slow production because its parts 
 could only advance in proportion as the corresponding parts of 
 the new census were finished) was laid before Parliament, on Mr. 
 Lowers motion, at the beginning of the session of 1864.t The 
 
 * See above, page 267. 
 
 t Sessional FapeVy No. 12, and its Continuation, No, 12, I. See also, ten years 
 later, Major Graham's second decennial Ketum of the same sort. Soon after the 
 
THE KEIGN OF QUEEN VICTORIA. 295 
 
 publication of this extremely important Return furnished means, Chap.xiii. 
 universally accessible, and such as had never before existed, for Depart- 
 ascertaining the amount of mortal injury which each district of ^e^pSw^' 
 England was suffering from each chief sort of morbific influence ; CoimciL 
 and it came most opportunely, with its well-marshalled array of 
 facts, to strengthen the appeal which I was preparing to submit 
 for amendments and large extensions of the sanitary law.* 
 
 That appeal was of the simplest sort. Year after year we 1864-6. 
 had been showing by successive masses of evidence, sometimes fo?^better 
 as to one part of the case, sometimes as to another, that, not- ^^^^o 
 withstanding such laws as existed, the nation was being greatly Nmsances 
 wronged and harmed through the insufficiency of its safeguards ing health; 
 for health; and especially this had been shown in three main tagionsof 
 branches of the subject-matter. — First, as to the existence and Jg^o^*^. 
 the employment of means for summarily abating Nuisances dustrial 
 
 ^ "^ . Diseases; 
 
 dangerous to Health, we had shown, not only that the Nuisances as to 
 Removal Act left uncovered various large parts of the ground infants; as 
 wherein the public needed powers of summary procedure against ^^ pj^J. °® 
 evils more or less urgent, but further, that, within the narrow °^^y- 
 ground in which the Nuisances Act purported to be applicable, 
 it was on an immense scale unapplied; sometimes because of 
 its own incidental ambiguities and insufficiencies of provision, 
 but far "more largely because of shameful administrative neglect 
 or collusion ; that while some of the worst sanitary evils (such 
 as over-crowding and foul water-supply) were certainly not well 
 within reach of the Nuisances Act, evils which were so — the 
 evils at which the Act was most distinctively aimed, and with 
 which it could quite effectually deal, had also remained without 
 remedy : that filth-nuisances on a monstrous scale were to be 
 
 first date, the General Register Office began its issue of decennial volumes in which 
 the distinct death-rates are elahorately specialised. See, f or the decermia 1851-60 
 and 1861-70, Dr. Farr's valuable supplements to the 25th and 35th Annual 
 Eeports of the Registrar- General, and, for the decennium 1871-80, Dr. William 
 Ogle's not less valuable supplement to the 45th. This last (see its pp. iii-iv and 
 Ixvi) includes the method of " Lowe's Return," and fulfils the objects at which 
 it aimed. 
 
 * For illustrations of the immense argumentative value of the facts which 
 the Return supplied, I may refer to the many uses I made of them in my Sixth 
 Annual Report : as particularly at pp. 8, 24, 30, 31, and 33-4. 
 
296 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap.xiii. seen in all directions continuing" under the eyes and noses of 
 Depart- authorities appointed to remove them, and that filth-diseases in 
 Se^P^^^ cruel and scandalous amount were being inflicted on helpless 
 CouncH. myriads of population."^ In intimate and most important con- 
 nexion with that part of our case, we had also shown that vast 
 numbers of the poorer population, in both town and country, 
 were atrociously ill-lodged ; that wholesome house-accommoda- 
 tion was not to be had by them in quantity nearly equal to the 
 need ; that, apart from question of neighbouring filth-nuisances, 
 the dwellings themselves were in general but the chance-product 
 of an unscrupulous and unregulated downward competition for 
 cheapness, yet often exacting high rent for wretched accommo- 
 dation; that even agricultural labourers (under influence of an 
 evil working of poor-law) had very largely been forced into 
 degrees of overcrowding which were unwholesome and obscene ; 
 that the so-called tenement-houses of the poorer classes, left as 
 they had been without regulation or control, and often receiving 
 as many families as they contained rooms, were hot-beds of 
 nuisance and disease ; and that the parts of towns which such 
 population inhabited, and in which they paid relatively high 
 rents, contained often in considerable proportion dwellings so 
 hopelessly ill-conditioned that they ought not to be of legal 
 tender for occupation.— ^Secondly, with regard to Contagions of 
 Disease y we had shown a huge legislative vacuum. The old 
 General Board of Health, righteously zealous against filth, but 
 not equally attentive to other causes of disease, had obtained no 
 adequate legislation against the various personal acts and 
 negligences by which different dangerous infectious diseases are 
 helped to spread in the community. Our inquiries had shown 
 that recklessness in such respects was almost universal ; bearing 
 fruit (as the statistical record told) in the very large proportion 
 which deaths from infectious diseases were contributing to the 
 total death-rate of the country : but that meanwhile the local 
 authorities had not a shred of power to control the mischievous 
 conduct, — no power to insist on the isolation of infected persons, 
 and the disinfection of infected things, — not even any command 
 of the appliances needful for such purposes. We had made it 
 
 * See especially Seventh and Eighth Annual Eeports. " 
 
THE KEIGN OF QUEEN VICTORIA. 297 
 
 clear, that, in relation to the morbid contagia, a new branch of M^df'"!^^^' 
 health-law, co-extensive with the branch against filth-nuisances, Depart- 
 was urgently needed : not only with regard to such infectious the Privy 
 diseases as were commonly current in the country — smallpox, °^^ 
 typhus, scarlatina, enteric fever, &c., but likewise, and not less 
 imperatively, with regard to occasional very deadly foreign 
 infections — Asiatic cholera, for instance ; which, for reasons 
 fully explained, we could no longer imagine ourselves able to 
 exclude by means of quarantine ; and which, we must expect, 
 would from time to time be introduced here, and would then 
 tend to be spread in the country by the same sorts of conduct 
 as were spreading the habitual infections."^— ^Thirdly, we had 
 shown that death and disease in very large quantities were 
 accruing from removable causes which attached to certain 
 branches, and in general most extensive branches, of national 
 industry ; so that certain large Industrial Popidations had (so 
 to speak) their endemic diseases, almost as marsh-populations 
 have ague : that in several of them, the workers were suffering 
 tubercular phthisis in terrible amount, through the overcrowded- 
 ness and unventilatedness of the spaces allotted to work ; that in 
 several others the workers were suffering not less terribly from 
 non -tubercular (irritative) disease of the lung, because of the 
 absence of reasonable care to remove from the industrial atmo- 
 sphere the dust or other irritating matter which the industry 
 tended to diffuse in it ; that, among smaller industries, those 
 which busied themselves with mineral poisons, and which if not 
 conducted with precautions would of course tend to poison the 
 workers, were under no legal rule as to precautions, and were in 
 some cases evidently so conducted as to endanger life; and 
 that in our sea-faring industry, merchant-sailors making the 
 longer voyages were still to be found suffering severely from 
 scurvy, in consequence of their employers having neglected the 
 dietary regulations of the Merchant Seamen^s Act. In addition 
 to showing on a very large scale those sanitary wrongs of 
 certain sorts of industry, we had also shown as an industrial 
 influence of very wide operation, that, in proportion as adult 
 women were taking part in factory labour or in agriculture, the 
 
 * See the discussions of Quarantine, and of our domestic contagion-laws in. 
 relation to it, in Eighth Annual Report, and its Appendix No. 9. 
 
298 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIII. 
 
 Medical 
 Depart- 
 ment under 
 the Privy 
 Cotmcil. 
 
 mortality of their Infa7its rapidly increased ; that, in various 
 registration-districts, which had such employment in them, the 
 district death-rate of infants under one year of age had been 
 from 2J to nearly three times as high as in our standard dis- 
 tricts j and that, in some of the districts, more than a few of 
 the infants were dying of ill-treatment which was almost 
 murderous.^Such atrocities as had been shewn under the several 
 above-given heads were evidently in the highest degree needing 
 the consideration of Parliament ; and only less urgent than they 
 were some other claims which we had brought into view : as, 
 for instance, with regard to the ordinary retail business of 
 Chemists and Druggists^ the fact that the public had no sort of 
 safeguard against the employment of grossly unskilled persons 
 as vendors of drugs and poisons, nor against the unlimited facility 
 with which persons of criminal intention could obtain deadly 
 poisons for their purpose. 
 
 1866. 
 
 The Sani- 
 tary Act. 
 
 The appeal was not in vain. Our exposure of so much gross 
 insufficiency in the laws which purported to protect the public 
 health was speedily followed by legislation of the highest 
 practical importance ; so that in regard of the spirit and inten- 
 tion of the law (though not yet in regard of administrative 
 machinery) most of the insufficiencies were within a few years 
 repaired and made good, and the law in its principles was 
 rendered comparatively complete. 
 
 The chief of those measures, the great Sanitary Act of 1866, 
 which represented such a stride of advance as virtually to begin 
 a new era, was promoted by the Lords of the Council. Mr. H. 
 A. Bruce (now Lord Aberdare) who at that time, as Education 
 Vice-President, was earnestly identifying himself with the 
 objects of the Medical Department, had introduced the Bill; 
 but with the political crisis which occurred in the month of 
 June (when the second administration of Earl Russell gave 
 place to the third of the Earl of Derby) the Bill fell of course 
 from Mr. Bruce's hands, and, in the confusion of ministerial 
 changes, ran no small chance of being lost. Just then however 
 happened to come a moment of popular piety towards the cause 
 of sanitary reform ; for Asiatic Cholera had begun to be again 
 severely epidemic in parts of London; and this ill- wind (to 
 
THE REIGN OF QUEEN VICTORIA. 299 
 
 justify the proverb) blew very favourably to fill our sails; so Chap.xiii. 
 that Mr. Bruce\Bill, adopted by the new ministry, was rapidly Depart- 
 made into law. St"' 
 
 All who had anything to do with the passing of that Act Counca. 
 may rejoice to the end of their lives in contemplating the gains 
 which it achieved. "Among its many noteworthy features, the 
 one which perhaps first claims notice, is, that, under the Act, the 
 grammar of common sanitary legislation acquired the novel 
 virtue of an imperative mood. ^The Act expressly declares it 
 '' the duty '* of the local authorities to provide for the proper 
 inspection of their districts, and to proceed for the suppression 
 of whatsoever nuisances should be found existing in them ; and, 
 as against the inaction of local authorities, it enacts that, where 
 sewers are not duly provided, or water not duly supplied, or 
 nuisances not duly removed, there, on complaint made, a 
 Secretary of State and the Court of Queens's Bench shall be 
 .able to enforce the neglected duty. Besides thus introducing an 
 invaluable must into some of the most important branches of local 
 sanitary function, the Act largely increased the powers of autho- 
 rities in relation to the needs of their districts : both as to the 
 range of cases in which the authority could intervene, and also 
 as to the remedies it could apply. The Act gave for all districts 
 the power to provide water-supply. It gave for town- districts 
 the extremely valuable power of regulating for sanitary purposes 
 the so-called '^ tenement-houses " of the poor. It gave a series 
 of enactments in relation to dangerous contagious diseases : on 
 the one hand, affixing penalties to the various sorts of personal 
 conduct which tend to spread dangerous contagions; on the 
 other hand giving power to authorities to fortify their districts 
 against such contagions, by provision of hospital-accommodation, 
 mortuaries, and other necessary apparatus and facilities relating 
 to the requirements of infected persons, and to the disinfection 
 or destruction of infected things. Not least, the Act gave 
 most important extensions to the term ^^ nuisance '''' : bringing 
 within the term, and thus making subject to summary nuisance- 
 law, various largely morbific influences which till then had been 
 under little or no control. One of those extensions made the 
 Nuisances Act operative, as it had never before been, against 
 the unwholesome overcrowding of dwelling-places ; and another. 
 
300 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIII. 
 Medical 
 Depart- 
 ment under 
 the Privy 
 Council. 
 
 Other Acts 
 of the 
 period : 
 
 Union 
 Charge- 
 ability, 
 1865; 
 
 Merchant 
 Shipping, 
 1867; 
 
 Pharmacy, 
 1868. 
 
 whieli cannot be too gratefully remembered^ concerned tbe un- 
 wliolesomeness of places of labour. By tlie latter^ together with 
 provisions of like intent introduced into the various Factory and 
 Workshop Acts of the time, proper protection was at last con- 
 stituted for the special sanitary interests of the artisan population : 
 not only enacting for all factories and workshops whatsoever 
 that they should be kept free from common nuisances of un- 
 cleanliness, overcrowding and the like ; but equally enacting 
 (as against the special insalubrities which we had shewn pre- 
 valent in so many particular branches of industry) that all gases, 
 vapours, dust, and other impurities, generated in the work and 
 tending to injure health, should, as far as practicable, be made 
 harmless by proper uses of ventilation ; and further enacting, in 
 regard of the more dangerous industries, that special sanitary 
 rules as to the conduct of the workers, or at least of the 
 children, young persons, and women, among them, should be 
 enforced. ^ 
 
 ^ To the other Acts of the period, only brief reference need be 
 made. In 1865 the pernicious influence, which we had shewn 
 .exercised by certain poor-law conditions, to deprive agricultural 
 labourers of house-room in their places of employment, was in great 
 part removed by the passing of the Union Chargeability Act.f In 
 1867, in harmony with what had been done for the artisan 
 population, amendments were made in the Merchant Shipping 
 Act, to give protection to merchant-seamen against the sanitary 
 neglects which we had seen causing them so much suffering and 
 disablement by scurvy. J And in 1868 the Pharmacy Act 
 
 * For the completed expression of this immensely beneficent legislation, see 
 the Public Health Act, 1875, sect. 91, sub-sect. 6, as amended by the sixth 
 schedule of the consolidating- Factory and Workshop Act of 1878 ; and, in the 
 latter Act, see sections 3, 33, 36 ; together with the repeal-provisions as to 
 sections 4 and 91 of the Public Health Act. The introduction of sanitary pro- 
 visions into the successive Factory and Workshop Acts of the previous years had 
 begun in 1864. 
 
 t This Act was promoted by the Poor Law Board under the distinguished 
 presidency of Mr. Charles Villiers. The evidence which the medical department 
 had collected in the previous year, on the house-accommodation of the rural labour- 
 ing population, was a material part of Mr. Villiers's case, and was in consequence 
 much attacked by those who opposed his Bill. See in Hansard, the debates on 
 the BiU. 
 
 X The Merchant Shipping Act, 1867, was promoted by the Board of Trade. 
 The late Mr. Harry Leach, at that time resident medical ofl&cer of the Dread- 
 
THE REIGN OF QUEEN VICTORIA. 301 
 
 brouglit under control o£ law the evils which had been shewn in Chap, xin 
 my sixth report^ as attaching to the practice of pharmacy by Depart- 
 unqualified persons, and to too easy purchaseability of poisons for twp^^^' 
 criminal use."^ In 1868, there were urgent proposals, that, in Council, 
 view of the venereal diseases of the civic population. Parliament 
 should be moved to establish, as part of the civil government of 
 the country, a systematic sanitary superintendence of prostitutes ; 
 but, for reasons set forth in a report on the proposals, 1 found 
 myself obliged to recommend against legislation of the proposed 
 sort! 
 
 The above-described new legislation, though immensely weak- 
 important in extending the previous range of sanitary law, did J.^^^?^ ^^ 
 not pretend to completeness of detail ; nor had it yet attempted i^ ti^e law. 
 to provide for such final accord of administrative machinery as 
 the interests of the public health would now need. Endeavours 
 were therefore made in the annual reports after 1866 to keep 
 well in the public eye the defects for which further legislation 
 
 nought Hospital Ship, and intimately acquainted with the sufferings of seamen 
 in the merchant service, was among the chief of those who pressed for the 
 remedy ; and he, after the passing of the Act, was most appropriately appointed 
 under it by the Board of Trade to he Inspector for the Port of London. Subse- 
 quently, when the provisions of the Act of 1867 had been tested by eight years' 
 working, Mr. Leach — writing the article Scurvy in Quain's Dictionary of Medicine, 
 said that, under the Act, during the eight years, scurvy in the mercantile marine 
 had been reduced by seventy or eighty per cent. 
 
 * The Pharmacy Bill of 1868, which Earl Granville in the House of Lords, and 
 Lord Elcho in the House of Commons, promoted on behalf of the Phannaceutical 
 Society, was, with some changes, adopted and carried by Government. The Act, 
 which was to be worked by the Pharmaceutical Society under the general 
 sanction and supervision of the Privy Council, provided that in future no one 
 should begin any pharmaceutical practice involving a sale of poisons, unless he 
 had first passed a sufficient examination in pharmaceutical knowledge ; that 
 poisons should not be purchaseable except with such personal identification as 
 would probably hamper any one who intended to make criminal use of them ; 
 and that the keeping and sale of poisons should be subject to particular regulation 
 under the Act. It also enacted, as against adulterations, that the provisions of 
 the Adulteration of Food Act of 1860 should be extended, mutatis mutandis, to 
 the sale of drugs. The Privy Council having been appointed controlling 
 authority im.der the Act, the exercise of the control was classed as part of their 
 Lordships' public-health business, on which it was my duty to report ; and an 
 account of various early proceedings under the Act will be found in the Twelfth 
 and Thirteenth of my Annual Keports to the Privy Council. For the supervision 
 of the examinations under the Act, we had the assistance in London of Dr. 
 Greenhow, and in Edinburgh of Dr. (afterwards Sir Kobert) Christison. 
 
 t See in Eleventh (1869) Report, Section V. 
 
302 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIII. 
 
 Medical 
 Depart- 
 ment under 
 the Privy 
 Council. 
 
 was required. Thus, even in 1867, while expressing gratitude for 
 the Sanitary Act of the previous year, the report pointed to the 
 deplorable facts of the recent East London epidemic of cholera, 
 as showing how utterly unprotected the public still was against 
 the vast injuries which purveyors of water-supply could inflict, 
 and how urgently it was needed that the purveyors who wielded 
 this colossal power of life and death should be severely punishable 
 at law for any wilful or neglectful distribution of polluted 
 water j"^ and in 1868, returning to that subject with a new 
 illustration of its significance, and citing in addition various 
 cases in which the public health is damaged by wilful or 
 neglectful malfeasances on the part of local sanitary authorities, 
 the report ventured to claim, as due to the public, both in check 
 of commercial water-companies and in check of local sanitary 
 authorities, that certain sorts of malfeasance should (on the face 
 of the law) render the company or authority liable to pay 
 pecuniary compensation to the damaged persons.f In 1869 and 
 1870 (as will in the next chapter be more fully noticed) it 
 became particularly needful for me to re-examine the then 
 sanitary code, in regard of its imperfections ; and the report of 
 1869 suggested, with other amendments, measures of new con- 
 struction for the administrative machinery.}: 
 
 Continua- 
 tion of 
 depart- 
 mental pro- 
 ceedings : 
 
 1867. 
 
 Eeports on 
 Cholera of 
 1865-6. 
 
 Turning now from questions of law-amendment (which the 
 last pages have followed into some advance on other matters) 
 and resuming, where before broken off, the thread of the depart- 
 mental narrative, I have to record that the years which had been 
 chiefly fruitful in legislation had not been without other notable 
 facts. 
 
 The year 1866, so memorable for its great Sanitary Act, was 
 also, as before noted, a year of Cholera-prevalence, requiring that 
 
 * See Ninth Annual Report, pp. 28-9. 
 
 t See in Tenth Annual Report, Section III : Remarks on the present state 
 of the law as regards the recovery of compensation by persons who have been 
 injured in health, or by the loss of relatives, through the fault of local-authorities 
 or water-companies, 
 
 X See the Eleventh Annual Report, Section YI : Question of consolidating 
 and bringing into system, the Laws and Administrative Agencies which concern 
 the Public Health. See also in Twelfth Annual Report, Section II: Local 
 Nuisance-jurisdictions and Water-supplies. See likewise Evidence, given in 1869 
 and 1870 before the Royal Sanitary Commission of 1869-71. 
 
THE KEIGN OF QUEEN VICTORIA. 303 
 
 the Diseases Prevention Act should be in force in the United Chap.xiii. 
 
 Medical 
 
 Kingdom ; and not only during that year, but from early in the Depart- 
 
 T 1 ^ 1 p 1 J ' mentmider 
 
 preceding summer, when we began to loresee what was coming, the Privy 
 that fourth visitation of Asiatic Cholera was a matter of constant ^°^"^°^- 
 care to the Medical Department ; while, also, in 1865, as before 
 mentioned, other foreign epidemics required our attention. The 
 eighth and ninth Annual Reports set forth the epidemiological 
 occurrences of those two years, together with the advice which 
 was given in relation to them, and an account of the proceedings 
 thereupon taken. The former of those reports recommended, 
 and (as effect was given to the recommendation) may be said to 
 have initiated, our present administrative system in relation to 
 Epidemic Contagia : a system, which, recognising contagiousness 
 as a property common to certain dangerous diseases, some of 
 them habitual to our climate, while others of them infect us only 
 when introduced at irregular intervals from abroad, recognises 
 also that, against the foreign infections, we in fact cannot 
 protect ourselves by national quarantine : a system, which does 
 not purport to deal differently with the two sorts of danger, but 
 intends that each local sanitary authority of the Kingdom should 
 be properly empowered to defend its district against influences 
 tending to spread contagions of disease, and that such powers 
 as would be used against our dangerous native contagia should 
 equally be used, and should be regarded as essentially our sole 
 resource, against contagia which (like cholera) may threaten us 
 from abroad. The ninth report (issued in 1867) tells of course 
 all the proceedings, general and local, which the Department 
 took with reference to the Cholera of 1866 ; it sets forth the 
 administrative Regulations which were issued under the Diseases 
 Prevention Act, and the Memoranda of medical advice which 
 were circulated with the Regulations ; it dwells on some par- 
 ticular outbreaks which required departmental action, as especially 
 the great outbreak in East London ; it renders account of various 
 new studies which we had pursued in the intimate pathology of 
 cholera, as well as of some such studies which had been under- 
 taken in other countries ; finally it endeavours to estimate the 
 state of cholera-knowledge, curative and preventive, at the close 
 of the epidemic of 1865-6, as compared with that which had 
 previously existed. 
 
304 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Ghap.XIII. 
 Medical 
 Depart- 
 ment under 
 the Privy- 
 Council. 
 
 Report as 
 to the 
 sanitary 
 effect of 
 town-im- 
 provements 
 hitherto 
 made. 
 
 The ninth annual report, besides telling o£ the Cholera of 
 1866, and telling of the Sanitary Act of that year, told also of 
 a large and searching inquiry which we had had in progress 
 during the two years 1865-6, and which had now produced results 
 for administrative application. The inquiry had related to certain 
 towns which for some years had had proper works of drainage 
 and water-supply in operation ; twenty-five towns, with an 
 aggregate population of more than 600,000 persons ; and our 
 object had been to ascertain statistically, with of course all such 
 qualifications of inference as might be needful for any particular 
 case, what, in each of the towns, had been the hygienic effect of 
 the new structjiral works. An answer to that question had long 
 been eagerly desired, both for England and almost equally for 
 other countries : an answer, which should tell how far the experi- 
 menting towns had achieved success, and given example for other 
 towns to follow : but the question could not be trustworthily 
 answered except after a certain cycle of sanitary experience in 
 each place ; and, if we had . proceeded in the matter earlier than 
 we did, we could have had comparatively little confidence in our 
 conclusions. In the inquiry of 1866-7, for which Dr. Buchanan 
 elaborated the various local facts with rare comprehensiveness 
 and exactitude, the effect of the local improvement- works was 
 tested by the more exact statistical method which we had 
 developed during late years ; and the arithmetical results, though 
 of course not so potent in evidence as centennia instead of quin- 
 quennia of experience might have been, were, for all practical 
 purposes, convincing enough on main points."^ Especially they 
 strengthened our previous arguments as to the causation of enteric 
 fever, and the various other diarrhoeal infections ; showing that 
 the fatality of such infections had greatly declined in the towns 
 which had been properly sewered and water-supplied. The 
 inqViiry further brought into view, as a new experience in our 
 national hygiene, that in certain of the examined towns, namely 
 in those where the new works of drainage had effected much 
 drying of a previously damp soil, the previous fatality of pul- 
 monary phthisis among the population had been considerably, 
 sometimes very largely, reduced. That marked reduction of 
 
 * See in Ninth Annual Eeport, pp. 11-18, and Appendix No. 2. 
 
THE REIGN OF QUEEN VICTORIA. 305 
 
 phthisis in places which had been artij&cially freed from dampness Chap. xiii. 
 of soil was a fact of such extraordinary significance in relation Depart- 
 to the deadliest of our habitual diseases, that, in 1867, with the ^g^'p^'^®' 
 assistance again of Dr. Buchanan, special further inquiry was Council. 
 made in the same aetiological direction, by examining elaborately gpeciai 
 the local distribution of the phthisis-mortality of ten years in the farther in- 
 
 . . . . . quiry mto 
 
 fifty-eight extra-metropolitan registration-districts of the three distribu. 
 south-eastern counties of England, as compared with the respec- phthisis. 
 tive local differences of soil. The results of Dr. Buchanan-'s 
 inquiry, published in 1868 in my tenth annual report, confirmed 
 to apparent certainty the conclusion which had been strongly 
 suggested by those of the towns-inquiry of 1865-6;* and in 
 reporting, as a conclusion valid for this country, that '*" dampness 
 of soil is an important cause of phthisis to the population living 
 on the soil,^^ I had the pleasure of being able at the last moment 
 to give it valuable scientific corroboration, by quoting that Dr. . 
 Bowditch of Boston, U.S., had formulated a similar conclusion 
 with regard to the phthisis-experience of the State of 
 Massachusetts. 
 
 In 1868, on the first day of the year, the vaccination Act of 1868; New 
 1867 came into operation; shortly after which the regulations tionLawto 
 necessary for various purposes of the Act were issued by the ^ ^pp ^ • 
 Lords of the Council ;t and thenceforth for a long while the 
 Medical Department was chiefly engaged seeing to those important 
 reforms of public vaccination which the new law was intended 
 to ensure. 
 
 In 1869, England had some exceptional grounds for sanitary i869; 
 disquietude and exertion : first, because an unwontedly severe TreataTent 
 epidemic of Scarlatina was prevailing throughout the country ; °^Pg^^ 
 and secondly, because Relapsing Fever, a disease generally little 
 known in England, had in 1869 come afresh into notice here, 
 and, as autumn advanced, had become notably diffused in the 
 poorer parts of London. In those circumstances, it was a de- 
 partmental duty to prepare for general use memoranda of in- 
 formation and advice, as to provisions against the two dangers, 
 and to communicate through inspectors and otherwise with 
 
 * See in Tenth Annual Report, pp. 14-18, and Appendix No. 5. 
 t See Eleventh Annual Report, pp. 7 and 36. 
 
306 
 
 ENGLISH SANITAKY INSTITUTIONS. 
 
 Chap. XIII. 
 
 Medical 
 Depart- 
 ment under 
 the Privy 
 Council. 
 
 Pharmacy. 
 
 " Animal 
 Vaccina- 
 tion. 
 
 1870. 
 Proceed- 
 ings rela- 
 tive to the 
 constitu- 
 tion of the 
 Medical 
 Profession: 
 Lord 
 Eipon's 
 Bifi. 
 
 many local authorities on the subject of such provisions. ^ In 
 the Annual Report which told of those and other central pro- 
 ceedings, renewed consideration was given to questions of the 
 local preventability of filth-diseases : the evidence which we had 
 accumulated as to the injuriousness of polluted water-supplies 
 was summed up, side by side with recent illustrations of the 
 recklessness with which such supplies were purveyed : sugges- 
 tion was again made that commercial and administrative offences 
 against health ought to involve a liability to pay penalties and 
 compensation : and in the interests of a better administration of 
 the Nuisances Act, information on a large scale, collected for the 
 department by Dr. Buchanan and Mr. Radcliffe, was given, 
 as to the various special contrivances which had of late years 
 come into use in parts of the country, for superseding (other- 
 wise than by ordinary water-closets) the nuisance of ill-con- 
 ditioned privies. The same report told of first proceedings 
 taken by the Pharmaceutical Society, and in the Medical 
 Department, under the provisions of the Pharmacy Act of 1868. 
 It likewise told of steps which had now begun towards procuring 
 parliamentary re-consideration of the Medical Act. In the 
 section which treated of the vaccination-proceedings of the 
 department, the report gave account of a particular study, 
 made for us by Dr. Ballard and Dr. Seaton, of the so-called 
 '^animal vaccination^^ which had lately come into vogue in 
 parts of the continent of Europe ; a system for maintaining 
 continuous sources of lymph-supply for the human subject 
 by keeping a constant succession of calves inoculated with the 
 specific contagium ; and the opportunity was taken to discuss, 
 according to such lights as we then had, the value of the chief 
 reason for which '^ animal vaccination " had been recommended, 
 and also to explain the arrangements which had of late years been 
 in force in England for securing as far as possible the efficiency 
 and safety of our own (different) system of lymph-supply. 
 
 In 1870, the Medical Department was actively concerned in 
 an endeavour to procure amendment of the Medical Act of 
 1858 ; amendment, namely, with regard to the qualifications 
 giving entry to the ranks of the Medical Profession as by law 
 
 * See in Twelfth Anmia,] Report, pp. 7-15, and 69-71 
 
THE KEIGN OF QUEEN VICTORIA. 307 
 
 recognised. The Lords then in command of the Department were Chap.xiii. 
 Earl de Grey and Ripon (afterwards Marquis of Ripon) as Lord Depart- 
 President, and Mr. W. E. Forster as Education Vice-President ; S^^'' 
 and the work which these two Ministers devoted, not merely Council, 
 to studying what is needful and desirable for the public in 
 the matter of medical skill and service, but likewise to the 
 dreary and thankless task of learning the intricacies and 
 jealousies of medico-professional polities, and of seeking to 
 reconcile rival interests, — and this work not only as Ministers 
 on occasion of the endeavour of 1869-70, but also unofficially 
 on later occasions not now in question, — deserves to be grate- 
 fully remembered. "In 1869, the Council of Medical Education 
 and Registration (the body administering the Medical Act) had 
 requested the Lords of the Council to promote a Bill for certain 
 minor amendments in the Medical Act ; but simple compliance 
 with that request would not, in the circumstances, have been all 
 that the public needed. The Act had already been long enough 
 in operation to shew that it very imperfectly fulfilled its 
 essential object ; that it did not nearly enough enable the 
 public to " distinguish [in a true sense] qualified from 
 unqualified practitioners ''■' ; that, apart from the question 
 whether persons not lawfully qualified were deterred from as- 
 suming or imitating the privileged titles of lawful qualification, 
 the conditions for lawful qualification did not themselves even 
 approximately ensure that the lawfully-qualified had attained a 
 fair degree of fitness for the general practice of the profession. 
 The Medical Register gave reason to believe that thousands 
 of the lawfully-qualified practitioners of the United Kingdom 
 were practising on fragmentary minimum-qualifications, — 
 minimum-qualifications in medicine with no qualification in 
 surgery, or minimum-qualifications in surgery with no qualifica- 
 tion in medicine ; and it was certain that persons, qualified only 
 in such fractional senses, were nevertheless offering themselves 
 for trust in all departments of professional practice, and were to 
 be found holding office as salaried attendants on the sick poor 
 in relation to every possible claim of disease or injury. Besides 
 this, which indicated an enormous defect in the Act, there were 
 reasons for distrusting fundamentally the system on which the 
 qualifying examinations were held. Without insisting on 
 
 u 2 
 
308 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIII. 
 
 Medical 
 Depart- 
 ment under 
 the Privy 
 Council. 
 
 charges whicli were sometimes current against the examinations 
 of this or that particular licensing-body, but referring merely to 
 the existence of nineteen independent portals of admission to 
 the Medical Profession, could it be expected that, at every one of 
 the portals, an adequate standard of proficiency, such as the 
 public required, would be steadily maintained ? was it not to be 
 expected that, other conditions being equal, candidates would 
 prefer the portals which admitted on easier examinations, or 
 offered more pretentious titles ? was it to be believed that 
 doorkeepers, exercising a lucrative privilege in competition with 
 one another, would be so insensible to the preferences of their 
 pecuniary patrons as not sometimes to apply weaker tests, or confer 
 more imposing titles, than a reasonable standard of minimum- 
 qualification, common to the whole United Kingdom, would 
 approve ? ^ In departmental correspondence with the Medical 
 Council (and of which all essential parts were published in the 
 Twelfth Report) their Lordships laid stress on questions such as 
 those, as of chief public concern in the matter ; suggesting that, 
 if the legislature had to be moved for any amendment of the 
 Medical Act, it must be moved to reconsider the whole system 
 of admission to the Medical Register; suggesting also the 
 sort of legislation which the case, viewed from the side of the 
 public, seemed to require; and in result of the correspondence 
 and other communication, it was agreed with the Medical 
 Council that their Lordships should propose to Parliament a 
 radical amendment of the Act of 1858. The Medical Council 
 fully accepted (inter alia) the following two chief principles : 
 first, that the right of admitting to the Medical Register ought 
 no longer to be exercised by a number of separate authorities, 
 acting independently of each other as granters of licence to 
 practise, but ought for the future to be exercised only as a joint 
 function, subject to certain appointed controls, and for which, in 
 each division of the United Kingdom, all the respective medical 
 authorities ought to act together as one board ; secondly, that in 
 future there ought to be no admission to the Medical Register 
 on the ground of fragmentary professional qualification, but only 
 on proof of competent all-round knowledge and skill (up to a 
 minimum standard) for all the ordinary requirements of mixed 
 practice. On the 8th April, 1870, Lord de Grey introduced in 
 
THE REIGN OF QUEEN VICTORIA. 309 
 
 the House o£ Lords a bill to provide for those and some minor Chap.xiil 
 objects j and two months later this bill, somewhat modified, as ol^rt- 
 the result of its discussion in the House of Lords and of much S?P^" 
 negotiation with medical authorities, but with no essential change, ^o^iica. 
 had its first reading in the House of Commons. In this House 
 was so much pressure of other public business, that the Bill, 
 even with Mr. Forster in charge of it, could not at once be 
 brought under consideration; and when at last its turn for 
 consideration had arrived, the stage of session had also come 
 when almost any Bill could be defeated by mere insistence on 
 the right of debating it. Such being the circumstances of the 
 moment, claims were pressed upon Mr. Forster, that he should 
 enlarge the scope of the bill by the introduction of new and ex- 
 tremely controversial subject-matter; namely, of provisions to 
 alter the constitution of the Medical Council. Though the parti- 
 cular proposals advanced were not such as the Government was 
 prepared to adopt, Mr. Forster offered to the promoters of them 
 that, if they would forego their right to press the matter in the 
 then session of Parliament, Government would in the next 
 session move for a Select Committee to consider the question 
 they desired to raise; but his offer of that compromise was 
 not accepted; and he consequently had no alternative but to 
 withdraw the Bill. To those who had promoted the endeavour, 
 this unsuccess was particularly disappointing. -The national 
 importance of the object was greater than the nation in general 
 was likely at the time to understand ; for the question, whether 
 diplomas which purport to guarantee medical knowledge and 
 skill are valid or invalid securities, is a question of daily concern 
 to the lives of vast numbers of persons ; and the Bill of 1870, 
 an endeavour to improve for the United Kingdom the signifi- 
 cance of its medical diplomas and titles without unnecessary 
 disturbance of chartered institutions, had in great part overcome 
 the inherent difiiculties of its problem, and had obtained an 
 extraordinary concurrence of support. "^ The Ministers who had 
 
 * Eeference to the Parliamentary proceedings on the Lord President's 
 Medical Acts Amendments Bill (1870) together with the office-memorandum in 
 explanation of the Bill, and notes on the two chief questions which were dis- 
 cussed while the bill was in progress, will be found in the Thirteenth Annual 
 Report and its Appendix No. 3. 
 
310 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIII. 
 Medical 
 Depart- 
 ment xmder 
 the Privy 
 Council. 
 
 1871: 
 
 Great Epi- 
 demic of 
 Smallpox ; 
 House of 
 Commons 
 Select 
 Committee 
 on Vaccina- 
 tion. 
 
 failed to carry that Bill did not renew their endeavour; and 
 though in 1877 their successors in office began other endeavours 
 in the same spirit, it was not till 1886 that any Medical Acts 
 Amendment Bill could be passed. That which then became 
 law will be noticed in another chapter.^ 
 
 Of the year 1871, only the period anterior to the 14th of 
 August (when the Local Government Board Act became law) 
 has to be noticed in the present division of narrative ; but within 
 that portion of the year, there was sanitary business of more than 
 common interest. 
 
 •^First, with regard to Vaccination, the period was doubly 
 signalised : on the one hand, because an extraordinary storm of 
 smallpox-attack, which swept furiously over all Europe about 
 that time, and was at its worst in London during the earlier 
 half of 1871, tested to the very utmost the value of the defences 
 which we, with our amended vaccination-system of later years, 
 had reared against such attacks ; f and on the other hand because, 
 during the spring-months of 1871, there was sitting a specially 
 important Select Committee of the House of Commons which 
 had been appointed to consider the Vaccination Acts, and to 
 
 * See chapter xv., part iii. As regards the intervening years, it may be 
 convenient to notice here that the principles of the Bill of 1870 were taken as 
 hasis for the Bills which the Duke of Richmond (as Lord President under Mr. 
 Disraeli's second administration) introduced in 1877 and 1878, and which in 
 1879 were referred to a Select Committee of the House of Commons, having 
 Mr. W. E. Forster for its Chairman. They also were accepted by the Royal 
 Commission which (under IVIr. Gladstone's second administration) was appointed 
 in 1880 to inquire and report as to this branch of legislation; and they were 
 represented in Lord Carlingford's Bill of 1882, founded on the report of that 
 Commission. They, moreover, during the successive years, were apparently not 
 without effect on the medical authorities ; who in various cases voluntarily took 
 steps towards the formation of joint examining boards, and towards the discon- 
 tinuance of fragmentary qualifications ; and it may be that, notwithstanding the 
 Act of 1886, not the last appeal to them has even yet been made. My personal 
 convictions as to the need of providing a proper constitution for the Medical 
 Profession, and of ensuring that the system of diplomas and titles shall be 
 trustworthy and popularly intelligible, have always been strong ; and, for my 
 opinions on those points, I permit myself to refer to the evidence which I gave 
 in 1879 before the House of Commons Select Committee, and to the part which I 
 took in 1880-1 as a member of the Royal Commission on the Medical Acts. 
 
 t Some time subsequently, I was enabled to present for parliamentary publica- 
 tion an elaborate and very instructive report by Dr. Seaton on the new evidences 
 which that gxeat epidemic gave of the value of vaccination. See Reports 
 Med. Off. P. C. and L. G. B., New Series, No. IV. 
 
THE REIGN OF QUEEN VICTORIA. 311 
 
 receive evidence for and against them. The Committee had as Chap.xiii. 
 its chairman, Mr. Forster ; by whom on the part of the govern- Depart- 
 ment the reference had been proposed, in order to afford to the anti- J^e^pJ^®^ 
 vaccinationists the full public hearing, long ago promised them, Council, 
 for all they could urge against vaccination and the vaccination- 
 law. The Committee was of course so constituted as to include 
 members of all sorts of opinion on the questions at issue; and 
 Mr. Forster^s character was in itself an ample guarantee that the 
 inquiry would be conducted with the most patient and candid 
 regard to the interests of truth and justice."^ For that object, 
 too, the inquiry fell at a most fortunate time; when circum- 
 stances were happening to bring into extraordinary prominence 
 whatever worst could be alleged against vaccination, either as to 
 its imperfections of protectiveness, or as to accidents which 
 might attend its performance; and when, therefore, not even 
 the wild exaggerations and fancies of the anti-vaccinationists 
 could cause the Committee to overlook any exceptional grains of 
 truth which might be among them. The Committee, which held 
 in all twenty sittings, gave eight days to hearing the chief anti- 
 vaccinationists — I believe all who were desirous to be heard; 
 then had me under examination ; next heard a number of inde- 
 pendent medical witnesses, on the question of alleged risks in 
 vaccination ; t and before concluding took evidence on the local 
 administrative processes by which the vaccination-law was en- 
 forced. The final report of the Committee, with its accompany- 
 ing papers and minutes of evidence, is a volume which ought not 
 to be forgotten, if vaccination comes agaia under parliamentary 
 discussion. It gave the Committee^ s unequivocal verdict against 
 the accusers who had challenged the inquiry. It proclaimed 
 
 * Further mention of Mr. Forster is made below, Chapter xv, S. 
 
 t In that branch of the inquiry, extreme interest attached to Mr. Jonathan 
 Hutchinson's account of two recently discovered groups of cases in which the 
 vaccinator had communicated syphilis. A more curious accident could hardly 
 have been, than that those two (mutually independent) groups of cases should 
 have come to light just when they did ; for in English practice down to that 
 time there probably had never occurred, certainly had never been made known, 
 any equal disaster, if even any incontestable solitary cases of such infection ; and in 
 March, 1871, when I had been questioned by the Committee, as to the reality of 
 that sort of risk, I had not been able to speak confidently except of cases or 
 groups of cases which (few and far between) had been reported by continental 
 observers. 
 
312 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIII. 
 Medical 
 Depart- 
 ment under 
 the Privy 
 Council. 
 
 Great Epi- 
 demic of 
 Smallpox. 
 
 afresh to the world the powerful protective value, as well as the 
 almost certain innocuousness, of properly-performed vaccination, 
 and expressed approval of the principle of the Act which had 
 made infantine vaccination compulsory. '^It recommended that 
 the local authorities should be bound to appoint special vaccina- 
 tion-officers, through whom to proceed systematically against 
 persons in default under the Act, but that the system of penal- 
 ties should not be cumulative ; and with reference to the central 
 controls of vaccination (regarding which the inconveniences of the 
 dual system established in 1858 had become intimately known to 
 Mr. Forster during his own official participation in the work) tfie 
 report recommended that the controls should all be in one depart- 
 ment. 'The object of the last-named recommendation was attained 
 before the end of the session by the establishment of the Local 
 Government Board, under which many different sanitary controls 
 (including those of vaccination) were consolidated ; and, for the 
 other recommendations of the Committee, Mr. Forster promptly 
 introduced a Bill, which for the most part became law as the 
 Vaccination Act 1871.* Meanwhile, the extremely severe 
 epidemic of smallpox had called for active exertions in the 
 Medical Department ; both to move the various local authorities 
 in respect of preventive measures, and to assist them in planning 
 such. To the authorities administering the Vaccination Act of 
 1867, advice was given on emergency-proceedings to be taken 
 under that Act in places where smallpox was present ; particu- 
 larly on the services to be rendered by special Vaccination-Officers 
 as authorised by the Act, and on Ile-Vax3oination, and on the 
 Supplies of Lymph required for it; while, on the other hand, 
 the authorities under the Sanitary Act of 1866 were reminded of 
 the urgent need for hospital-accommodation for infected persons 
 in order that infection should not become general, were furnished 
 with detailed suggestions for the provision of temporary hospitals, 
 and were advised as to various other preventive measures needed 
 in infected districts. At the same time, in order to ensure for 
 the public vaccination-service of the country every excellence 
 which the most recent improvements of knowledge would allow. 
 
 * The House of Commons did not accept the recommendation of the Com- 
 mittee to provide against cumulative penalties. 
 
THE REIGN OF QUEEN VIOTORIA. 313 
 
 careful revision was made of our standing Instructions for Vac- Chap.xiii. 
 
 cinators under Contract, and, on July 29tli, the amended Instruc- Depart- 
 
 tions were issued under a new Order of Council.* STprivv^'* 
 
 Another great sanitary interest of 1871, was that we were Council, 
 
 under menace of a fifth invasion of Asiatic Cholera : for this t> 
 
 ; ^ Renewed 
 
 disease, which for the last two years had been diffused in K-ussia, threaten- 
 and for the last half-year present in St. Petersburg, had, in Cholera, 
 the spring of 1871, begun to affect the Baltic provinces of 
 Russia, and, before the end of July, had spread westward in a 
 way which apparently would soon bring it within easy striking- 
 distance of English ports, t At this time it of course was the 
 duty of the Department to draw public attention to the im- 
 pending danger, to remind local sanitary authorities of precau- 
 tions which had to be taken against it, and to see that those 
 authorities had every legally-possible facility .for taking the 
 precautions. Privy Council Orders, designed to facilitate the 
 examination of ships from Baltic or other infected ports, and 
 the action of local authorities in relation to such ships, were 
 accordingly issued ; together with Memoranda of such general 
 precautionary advice as our previous experiences of cholera 
 enabled me to give. The special administrative interest of the j i^. ^ 
 period attached to the wider application which we were now tionofnew 
 able to make of the principles of defence which had been port- 
 advocated in my report of 1866. ' For adequate action in that 
 sense, it was above all to be desired that, at each endangered 
 port of the country, the local authority should be well prepared 
 with such hospital-accommodation, such means for conveying 
 the sick, such disinfection- establishment, and generally such 
 planned arrangements and skilled service, as would enable 
 proper precautions to be used without delay in any sudden event 
 of infectious arrival from abroad. In order to ensure readiness 
 of that sort, we communicated particularly with such port- 
 authorities as were most in danger ; and in forty- eightlprincipal 
 
 * See, contained in the First Keport of the Local Government Board, my 
 account of the Privy Council proceedings of 1871, and, in Appendix 37, 38, 39, 
 40, 41, 42, 42a, 50, the Circulars, Memoranda, and Instructions above mentioned. 
 The proceedings are here particularly noted, because they represent, as it were, 
 the final edition of Privy Coimcil experience in the matters to which they 
 relate. 
 
 t Early in September it was found to have reached Hamburg and Altona. 
 
 Defence. 
 
314 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIII. 
 Medical 
 Depart- 
 ment tinder 
 the Privy 
 Council. 
 
 cases, an inspector of the Department — sometimes Dr. Buchanan, 
 more generally Mr. Radcliffe, visited the port, to examine its 
 defences, and, where necessary, to make suggestions for strength- 
 ening them. ' 'With the very ahle assistance of those two officers, 
 the new system was rapidly brought into fair working order in 
 most of the places which required it, and in some of them into 
 excellent order. Particulars of what was done in the individual 
 cases may be read in my report on the year 1871,* and need not 
 here be entered on ; nor need much more be said of the epidemic 
 which was then causing European alarm. ^ It may be noted, 
 however, that the principles which we brought into operation in 
 1871, of looking to local rather than central organisation for 
 defensive machinery against foreign infections, and of letting 
 foreign infectious arrivals be dealt with in detail just as dan- 
 gerous infections of native origin would be dealt with in the 
 same localities, have, from that time, ruled the action of this 
 country in like cases, and have constituted a system which is 
 internationally known as contrasting with foreign systems of 
 general quarantine, f 
 
 Organisa- 
 tion of the 
 Medical 
 Depart- 
 ment. 
 
 During the three or four last-mentioned years, while the 
 Medical Department was often having to consider such general 
 sanitary questions as have been named, it was becoming more 
 and more familiar with detailed local demands for its attention 
 in respect of the ordinary infectious diseases of the country, and 
 with the responsibilities which it ought to be prepared to meet, 
 with regard to the local outbreaks of such diseases. 'From the 
 time of the passing of the Sanitary Act of 1866, with provisions 
 which made express claim for local sanitary exertions, we could 
 not but see that a definite new line of usefulness, virtually there- 
 fore a new line of duty, lay open for us. We should as before 
 have to criticise local excesses of disease ; but now with stronger 
 influence than before to promote the abatement of such excesses. 
 
 *See in First Report of the Local Government Board, pp. Iv-lvii, and 
 Appendix 47. 
 
 f Our English system was discussed in that sense at the International Con- 
 ference held at Vienna in 1874. See the Proces-Verbaux of that Conference, or, 
 more briefly, the papers which I laid before the Local Grovernment Board in 
 1875 (Reports, New Series, No. V) on the then European relations of Asiatic 
 Cholera. See also, below, part ii. of Chapter xv. 
 
THE REIGN OF QUEEN VICTORIA. 316 
 
 iGrranted, as of common sense, that all existing laws of the Chap.xiii. 
 country are to be obeyed,, and that, so far as administrative Depart- 
 duties and responsibilities are delegated to local authorities, the ^g^pri^^*^ 
 central government is bound to see that the administration is Council, 
 honest and effective, — surely the law which concerns the public 
 health would not be a privileged field for disobedience or evasion, 
 nor even for failures due to want of knowledge and skill. Evi- 
 dently, therefore, from the date of the new law, the statutory 
 inquiries of the Medical Department must of necessity more and 
 more tend to be inquiries into .the local administration of that 
 law, with regard to such protection of life as the law intended. 
 Making such inquiries, we no doubt might from time to time 
 come on a case of wilful and obstinate sanitary malfeasance 
 against which we must have to take the invidious position of 
 public complainant ; but tve knew that, with infinitely greater 
 frequency, the cases claiming attention would be cases of 
 imperfect local enlightenment, — imperfect often even as to the 
 provisions of the law, still more often imperfect as to the con- 
 nexion between unfulfilled law and existing local excesses of 
 disease ; and we had reason to believe that, in this very large 
 class of cases, the local authorities, which ought to be instituting 
 reforms in the spirit of the new law, would often be most glad 
 that the inquiring central Department should give them its 
 skilled intei'pretation of the local sanitary needs. -It was our 
 conviction that, in those two senses, the Medical Department, 
 if worthy of its place, could very materially subserve the inten- 
 tions of the Legislature; and we therefore, thenceforth, from 
 year to year, studied how best we could qualify ourselves for that 
 larger share of usefulness, ^t will not be irrelevant to add, that 
 the public opinion of the time had also moved rapidly in the 
 lines of thought just indicated. Any one, who, during the then 
 sittings of Parliament, observed the questions which were 
 occasionally asked of Ministers with regard to local threatenings 
 or excesses of disease, or who read the ordinary newspaper- 
 comments on local epidemics, could see that such questioners 
 and commentators assumed the Central Government to be a real 
 supervisor of local sanitary administration ; ready, where needful, 
 to assist with skilled advice ; and ready, in last resort, to enforce 
 the law. 
 
316 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIII. 
 Medical 
 Depart- 
 ment under 
 the Privy 
 Council. 
 
 The Staff 
 streng- 
 thened. 
 
 Laboratory 
 
 tions. 
 
 In face of the new circumstances which have been traced, 
 the staff of the Medical Department needed by degrees to be 
 augmented ; and, on representations which were from time to time 
 submitted in that sense during the last three years of the period 
 to which this chapter refers, the Lords, with the approval of the 
 Treasury, made successive important additions to the staff. 
 
 -^own to 1869, permanent inspectors had not been appointed 
 except specially for our superintendence of vaccination ; but in 
 1869, when it had become at least equally necessary to have 
 permanent inspectors for general sanitary superintendence, the 
 first two appointments of this sort were made ; and the depart- 
 ment was further strengthened for its work by the appointment 
 of a legal assistant. To the great advantage of the public 
 service. Dr. George Buchanan and Mr. John Netten Eadcliffe, 
 to both of whom I had long and often been indebted for the 
 best possible occasional assistance, were now converted into 
 permanent medical inspectors ; while Mr. John Francis E-otton, 
 equally strong in his different sort of qualifications, was appointed 
 our legal colleague."^ 
 
 Soon afterwards, the departmental organisation was strength- 
 ened in an important outwork ; the first beginnings of which, 
 five years previously, had been noticed in my eighth annual 
 report. The Department had then been authorised to promote 
 certain Laboratory Investigations (of sorts not likely to be un- 
 dertaken on sufficient scale by private persons) in the branches 
 of science collateral to our province of duty ; investigations, 
 not necessarily connected with our practical business of the 
 moment, but tending to be of powerful indirect influence 
 on our practical business as a whole ; investigations, which we 
 knew could be of no rapid effect, but which we hoped would by 
 degrees — even if only by the slow degrees of exact science, 
 surely lead us to more precise and intimate knowledge of the 
 causes and processes of important diseases, and would thus 
 
 * At the present time Dr. Buchanan is chief Medical Ofl&cer of the Local 
 Government Board. See below, Chapter xv, 2. Mr. Eadcliffe, I regret to say, 
 is no longer there : he died in the summer of 1884, after a long-lastiag, slowly- 
 iacapacitating, disease, which had obliged him to resign office in 1883. Mr. 
 Rotton, after continuing for seven years his special connexion with the Medical 
 Department, was in 1876 made an Assistant Secretary to the Local Government 
 Board, and in 1883 the Legal Adviser of the Board. 
 
THE REIGN OF QUEEN VICTORIA. 317 
 
 eventually augment more and more the vital resources of Chap.xiii. 
 Preventive Medicine. Under that authority, the Department had Demrt- 
 had in progress, since 1865, a certain amount of Scientific Research, ™ent imder 
 for which we had the valued assistance of Dr. Thudichum and Council. 
 Dr. Sanderson ; the former, working in a very large field of 
 study towards the chemical interpretation of morbid processes 
 and their results, and the latter studying especially the forces 
 and particulate forms concerned in contagion. Five years' 
 experience having shown the growing instructiveness of those 
 comparatively abstract departmental studies, and it being known 
 that national efforts for like purposes were in progress in other 
 countries of Europe, we had now sought and obtained authority 
 to enlarge that branch of our work, and to give it a more settled 
 form. -In 1870, under Mr. Lower's Chancellorship of the 
 Exchequer, Parliament approved the Auxiliary Scientific Inves- 
 tigations as a separate item in our departmental estimates, and 
 began to grant them an annual subsidy of £2,000. This grant, 
 comparable in principle to those which have been annually voted 
 to the Admiralty for the promotion of astronomical and meteoro- 
 logical science, was first separately voted to us in 1871 ; and the 
 vote is significant, not merely in its relation to the immediate uses 
 of the Medical Department, but as expressing a national contri- 
 bution to the world-wide general interests of Medical Research. 
 
 In the second quarter of 1870 there began to operate a new Deveiop- 
 influence for activity in sanitary administration, — an influence geg*(Je^s 
 equally valuable as stimulus to the action of local authorities, Quarterly 
 
 . ... TT -1 liet^rns of 
 
 and as guide to the inquiries of the Central Department. "Until Deaths. 
 then the case had been, that, except as to the metropolis, we all 
 had been in want of a basis of authentic information, at short 
 intervals, with regard to the Current Local Distribution of the 
 chief Diseases, In respect of the one hundred and thirty-seven 
 sub-districts of the metropolis, the weekly returns of the Regis- 
 trar-General were so prompt in issue, and so full of details as to 
 the distribution of deaths by different causes, that here nothing 
 better could be desired for administrative purposes ; but not so 
 for the rest of England. Detailed information as to the fatality 
 of each chief disease in the extra-metropolitan parts of England 
 would no doubt eventually be obtainable from the annual reports 
 of the Registrar-General ; but this not till nearly two years aftei 
 
318 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 CHAP.Xni. 
 
 Medical 
 Depart- 
 ment under 
 the Privy 
 Council. 
 
 Steps for 
 further de- 
 velopment 
 of the 
 Medical 
 Depart- 
 ment. 
 
 the time when the deaths had occurred ; and during the long 
 interval,, public knowledge as to the distribution of fatal disease 
 in those parts of England was an almost entire blank.^ The 
 administrative inconveniences of that want of knowledge had 
 often been before me, especially as to infectious diseases rising 
 into epidemics in particular places ; and Major Graham, to whom 
 I had gone with my experience of the difficulty, had listened 
 favourably to a suggestion made to him for removing it.f i- The 
 substance of the suggestion was, that in the Quarterly Returns 
 which he issued (with exemplary punctuality) a month after 
 the end of each quarter, he should do for the whole of England 
 what he was doing weekly for London ; so that the reader of each 
 Quarterly Return should be able readily to see, in what particular 
 sub-districts of England the chief infectious diseases had been 
 fatal during the past quarter, and what number of deaths in each 
 sub-district each such disease had produced. In issuing his first 
 Quarterly Return for 1870, Major Graham issued it with that 
 new development : a development which it has retained to the 
 present time : and by which (as I had assured him would be the 
 case) he gave ^' one of the most important aids which could be 
 rendered to the health-administration of the country.^'' 
 
 In presence of that amended system of Quarterly Returns, 
 exhibiting with due distinctness of places and causes the current 
 mortality of the country, and testifying, quarter after quarter, 
 to annual hundreds of local outbreaks and spreadings of prevent- 
 able fatal disease, the Medical Department found itself possessed 
 of a basis, which had not before existed, for regular and com- 
 paratively prompt inquiry as to the sufficiency of local adminis- 
 tration in the respective cases. The fact that such facilities 
 existed was felt as a responsibility that they should not be left 
 
 ♦ For eacli of the registration-districts of England, the Quarterly Eeturn 
 gave the total number of deaths which had occurred during the quarter, hut 
 ■with nothing as to the sub-district distribution, nor anything as to the causes 
 of death; and, with regard to those causes, nothing was said except in such 
 notes as individual sub-district-registrars would sometimes take the trouble to 
 supply for the information of the Registrar- General. 
 
 t In 1869 I had referred to the subject, in my Eleventh Annual Eeport and 
 in my evidence before the Royal Sanitary Commission, besides communicating 
 personally with the Registrar General about it; and in 1870, giving evidence 
 again before the Royal Sanitary Commission, I was able to refer with proper 
 sense of obligation to the commencement of the new reports. 
 
THE REIGN OF QUEEN VICTOEIA. 319 
 
 unused; and accordingly, with a view to the new requirements CnAP.xm. 
 which the new circumstances suggested, the Lords of the Depai-t- 
 Council proceeded to amend their plan of action under the Act Se^Pri^^' 
 of 1858. it had become clear that, in order to a reasonable ^o^^^ii- 
 present fulfilment of the intentions of the Act, the Medical 
 Department ought to greatly extend, and to systematise, its 
 ordinary disease-prevention inquiries ; ought to give them such 
 extension, and such methodical character, as it had already given 
 to its vaccination-inspections; and that, for this purpose, the 
 staff of the department must have a considerable further increase. 
 Very careful consideration was given to the method of work by 
 which the increased claims on the Department might best be met, 
 and, with the approval of the Treasury, first steps were taken to 
 give to the Department the stronger organisation which it 
 required. 'Towards the close of 1870, vacancy having arisen in 
 the permanent inspectorship which till then had been employed 
 exclusively on the work of the National Vaccine Establishment, 
 this office, instead of being refilled for the same use, was changed 
 into an office of general sanitary duty, and Dr. R. T. Thorne was 
 appointed to it."^ The departmental estimates for 1871-2 proposed 
 the appointment of three additional inspectors; and, when Parlia- 
 ment had approved this proposal, the new offices were filled by 
 the appointment of Dr. Gwynne Harries,! Dr. Anthony Home,J 
 
 * Before the time of the appointment mentioned in the text, Dr. Thome had 
 on various occasions acted temporarily for the Department ; and the opinion which 
 had then been formed of his qualifications has since then been more than con- 
 firmed by the fact that he has now for some years been in the position 
 of Senior Assistant Officer in the service. 
 
 t Dr. Harries, an officer of much zeal and ability, was unhappily soon 
 removed from a career which he had given every promise of filling with 
 distinction. In the autumn of 1873, little more than two years from the time 
 of his appointment, his life was prematurely ended by scarlatina contracted 
 in the performance of his public duties. 
 
 X Dr. (afterwards K.C.B.) Anthony Home had previously distinguished him- 
 self as a medical officer in Her Majesty's Army, in which he held the rank of 
 Surgeon-Major, and had earned the Victoria Cross for conduct at Lucknow. 
 His health unfortunately did not allow him to continue long in the work of our 
 Department, and towards the end of 1872 he was succeeded by Dr. Hubert Airy ; 
 but soon afterwards a spirit greatly stronger than his body carried him with 
 General Wolseley to the Ashantee expedition of 1873-4, where he attained 
 further distinction. In 1878-9 he was principal medical officer in Cyprus, and 
 from 1881, till his retirement a short while since, principal medical officer to 
 t he British forces in India. 
 
320 ENGLISH SANITARY INSTITUTIONS. 
 
 y 
 Chap. XIII. and Dr. Ballard."^ These appointments, which constituted 
 
 Depart- a highly valuable addition to the strength of the Depart- 
 Se'privy^^ . ment^ were as much as could be expected in one year ; but, even 
 Council. ^•^]j ^}jg^^ addition to the staff, we were still far from being able 
 to provide for the whole country the kind of general supervision 
 which our scheme intended. There however was reason to hope 
 that, on the next year's estimates, three more inspectors would 
 be allowed, to complete our staff ; and that then it would be in 
 my power to organise for the whole country inspectorial circuits 
 in which the short-comings of common sanitary administration, 
 equally with short-comings under the vaccination-law, would 
 come within cognisance of the Department. 
 
 July, 1871. Pausing here, I trust I shall not seem to express an undue 
 
 pride, if I say that, at the period which the narrative has 
 reached, the Medical Department had attained such success as 
 was an ample reward for its work. The endeavours, which, with 
 the assistance of most able colleagues, I had made, to provide for 
 sanitary law and administration a basis of larger and more exact 
 knowledge than before existed, had not been in vain ; and the 
 political heads of the Department, taking their stand on that 
 basis, had led Parliament greatly to extend and strengthen the 
 securities for the. Public Health in England. The sanitary laws 
 had been rendered, as to principles and intentions, tolerably com- 
 plete ; and parts of the legislation which especially concerned 
 the labouring classes of the country had given to those classes 
 greatly increased means of self -protection against various sorts 
 of sanitary wrong. Meanwhile, too, we had left far behind 
 us the hostilities and suspicions which, when we first entered on 
 duty, were extensively roused by any mention of sanitary pro- 
 gress : we now, so far as public expressions of opinion enabled 
 us to judge, were working amid general goodwill, and amid a 
 constantly-increasing interest of the public in the matters which 
 
 * Dr. Ballard had from sixteen years before been officer of health to the 
 large metropolitan district of Islington, and had filled that office with so much 
 distinction that already in 1871 he was among the foremost representatives of 
 English sanitary knowledge and practice. At the time of my present writing he 
 happily is stiU on the staff of the Local Government Board ; and the publications 
 of the Board contain evidence of the value of the services he has rendered 
 there. 
 
THE REIGN OF QUEEN VICTORIA. 321 
 
 formed our sphere of duty. It is not for me to judge how far CHAP.xm. 
 our labours may have contributed to establish those better times; Depart- 
 but I believe we had the credit of earnestly endeavouring to SiepJ^y*"^ 
 learn the truth, and tell the truth, as to the matters which our CoimcU 
 inquiries regarded. The departmental reports had been eagerly 
 sought throughout the country by persons who were interested in 
 questions of public health, and had been welcomed abroad in very 
 flattering terms by the countries which most busied themselves 
 in such questions. With such large and varied experience as the 
 Department had acquired, with such colleagues as I had, and 
 with such completion of staff as I believed we were soon to have, 
 I felt sure that the Department would be ready to meet any 
 greater claims which Parliament might throw upon it in the 
 more active times which apparently were about to come. 
 
322 
 
 CHAPTER XIV. 
 
 1868-9. 
 Unsyste- 
 matic state 
 of the sani- 
 tary laws 
 and juris- 
 dictions. 
 
 THE ROYAL SANITARY COMMISSION, 1869-71. 
 
 Before further progress can be made with the story of English 
 State- Medicine, the fact has to be noticed that, in the spring of 
 1871, there was laid before Parliament the Report of a Royal 
 Commission, which, from two years before, had been receiving 
 evidence, and forming opinions, as to the want of system in the 
 sanitary government of England, and as to the changes of law 
 by which better organisation might be provided or promoted. 
 
 That distinctive task, of re-considering the sanitary laws as a 
 whole in respect of method, had gradually come to be of urgent 
 necessity. During th^ time in which those laws had been under- 
 going so much substantial extension and improvement, their 
 form, especially in all which regarded the constitution of 
 authorities and areas of jurisdiction, had become incoherent 
 almost to the point of chaos. The legislature, for a quarter 
 of a century, on the motion sometimes of one department, 
 sometimes of another, had been proceediug tentatively, and with 
 many renewals of attempt, in section after section of the vast 
 subject-matter ; and the successive bits of piece-meal legislation, 
 uncombinable except with gaps and overlappings, and sometimes 
 with apparent inconsistencies of intention, made a parquetry 
 which was unsafe to walk upon. Authorities and persons who 
 wished to give effect to the law were often finding insuperable 
 difficulties in their way ; while authorities and persons of con- 
 trary disposition found easy excuse or impunity for any amount 
 of malfeasance or evasion. Among the worst facts of the case, 
 was the way in which many of the local jurisdictions had been 
 laid out and assigned. Except within areas having privileged 
 statutory constitution, the local administration of the law against 
 nuisances was not vested in one single authority for each place, but 
 had come to be distributed (\vith very questionable demarcation- 
 line) between two — the Vestry of the Parish as Sewer- Authority , 
 
THE REIGN OF QUEEN VICTORIA. 323 
 
 and the Union Board of Guardians as Nidsance-Aiithority y^ while Chai-.XIV. 
 various auxiliary improvement-powers might be in the hands of s^to?J^'^^ 
 yet other local authorities. Areas which had privileged statutory JseTy'r''''' 
 constitution did not, except sometimes by accident, figure sepa- 
 rately in the vital statistics of the country_, nor correspond in 
 any way with the areas of poor-law relief. Even in towns which 
 had the best consolidation of powers for general purposes of local 
 government, the relief of the poor was always a function apart ; 
 always with separate authority and distinct area to itself. Where 
 medical officers of health existed, their ofiice had no appointed 
 contact, either with the local registry of deaths, or with the local 
 system of attendance on the sick poor. Equally unmethodical 
 with the enactments which provided for local sanitary action 
 were those which assigned supervisional dutiies to the Central 
 Government : for responsibilities more or less concerning the 
 public health had been distributed among several central depart- 
 ments j and two or three central departments, variously advised, 
 might be communicating with some single locality in respect of 
 some single sanitary subject-matter. Very imperfectly, too, had 
 the law hitherto provided that such systematic information as is 
 necessary for proper judgment of the health of districts should be 
 in existence for the use either of local or of central authorities ; for 
 no obligation had been enacted, that causes of death should be 
 medically certified, or that public returns should be made of sick- 
 ness locally treated at the public expense. It is not diflScult to 
 
 * The climax of this misrule was reached in 1868. Under the Nuisances- 
 Acts of 1846 and 1848, the local authority for the purposes of tbo Act in rural 
 districts, and in such towns as had not special statutory powers, had been the 
 Board of Guardians of the Poor-Law Union, In 1855, Sir Benjamin Hall's 
 Nuisances-Act dis-empowered that Union Authority, and gave the power to be 
 separately exercised in parishes by Parish Authorities ; but, a return made to the 
 House of Commons in 1857 {Sess. 2, No. 36) having shown that this new arrange- 
 ment was working most unsatisfactorily, one of my first duties after the settle- 
 ment of my office under the Privy Council was to bring that failiu-e iinder notice 
 of their Lordships; who thereupon (by bill introduced in the House of 
 Commons by Mr. Lowe) promoted an Act to repeal the parochial arrange- 
 ment, and restore in amended shape the former jurisdiction of the Union Board. 
 In discord with this, there began in 1865 (promoted by the Home Office) a series 
 of Acts, which, in relation to the rural and other districts here under notice, 
 appointed each Parochial Vestry to be " Sewer-authority " for its parish, and gave 
 it nuisance- jurisdiction over the privies in the parish: so that, from 1868, in each 
 such parish, the privies were under one authority, and the pigsties under another. 
 
 V 2 
 
324 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIV. 
 The Royal 
 Sauitary 
 Commission 
 1869-71. 
 
 imagine the difficulties and discouragements whicli beset all 
 attempts at sanitary administration, while they had to be 
 made under such conditions of legal disorder as those described; 
 and besides that extreme want of method, there was the fact 
 that the laws which had to be locally administered were needing 
 at innumerable points such minor additions and amendments as 
 would naturally come with judicious consolidation. 
 
 Memorial 
 for ap- 
 pointment 
 of Royal 
 Commis- 
 sion. 
 
 The first public remonstrance against the disorderly state of 
 the sanitary laws came from members of the Medical Profession, 
 and was conceived with particular reference to the various cases 
 in which the State purports to make use of medical knowledge. The 
 leading voice was that of the late Mr. Henry Wyldbore Rumsey, of 
 Cheltenham, F.R.C.S. ; a man of culture, and highly esteemed in 
 his Profession, who for many years had been a distinguished writer 
 on the various relations of State-Medicine; writing of them 
 always with true public spirit, as well as with large information, 
 and with a special zeal for completeness and method ; "^ and I 
 believe it to have been at his instigation that steps which led to 
 the appointment of the Royal Sanitary Commission were taken. 
 In May 1868, namely, a certain Joint-Committee which the 
 British Medical Association and the Social Science Association 
 had appointed, " to promote a better administration of the laws 
 relating to registration, medico-legal inquiries, and the improve- 
 ment of the public health,''-' and which seemed chiefly to express 
 Mr. Rumsey's mind, memorialised the then Government for the 
 appointment of a Royal Commission in relation to those objects. 
 Referring to a memorandum which Mr. Rumsey had prepared, 
 they asked '' for a thorough impartial and comprehensive inquiry 
 by a Royal Commission, having power to visit, or send sub-com- 
 missioners to visit, the large towns and other districts of the 
 country, to obtain information and evidence, and to report on : — 
 (1) the manner in which the cases and causes of sickness and of 
 death are, and should be, inquired into and recorded in the 
 United Kingdom ; (2) the manner in which coroners^ inquests 
 
 * Writings of Mr. Rumsey's, to which I particularly refer are the following : — '■ 
 Health and Sickness of Town Populations, 1846 ; — Essays on State-Medicine, 1856 ; — 
 .Sanitary Legislation and Administration, 1858 ; — The Eight Use of Records founded 
 on local facts, 1860. 
 
THE REIGN OF QUEEN VICTORIA. 325 
 
 and other medico-legal inquiries are, and ought to be, conducted, Chap, xiv 
 particularly in regard to the methods of taking scientific evidence ; Sanitary'^^ 
 (3) the operation and administration of sanitary laws, with fg^e^^r^^' 
 special reference to the manner in which scientific and medical 
 advice and aid in the prevention of disease are, and should be, 
 afforded; and also with special reference to the extent of the 
 areas or districts most convenient for sanitary and medico-legal 
 purposes; (4) the sanitary organisation, existing and required, 
 including a complete account of the several authorities and 
 officers, — the education, selection, qualification, duties, powers, 
 tenure, and remuneration of the said officers to be specially 
 reported on; (5) the revision and consolidation of the sanitary 
 laws, having special reference to the increase of the efficiency of 
 their administration, both central and local/^ ^ 
 
 The Government (Mr. Disraeli's) having determined to comply, Commis- 
 to some extent, with the prayer of the Joint-Committee, a Royal poiuted, 
 Warrant was issued on November 24, 1868, appointing a Com- e^dence^ 
 mission with Lord Northbrook for its chairman; but almost 
 immediately a change of government occurred, Mr. Disraeli^s 
 first administration giving place to Mr. Gladstone's first ; and, 
 under those circumstances, the warrant remained inoperative, till, 
 in the following April, it was revoked by one which appointed 
 a fresh Commission, with Rt. Hon. C. B. Adderley (now Baron 
 Norton) as its Chairman. t The new warrant, differing some- 
 what from the old, provided expressly for inquiry into the 
 central (as well as the local) organisations of authority ; and 
 instead of extending (as did the old) to the whole of the United 
 Kingdom, it applied only to England and Wales, with express 
 
 * The Memorial and Memorandum are to be found in the Appendix to the 
 First Report of the Commission : Mr. Rumsey having tendered them in evidence. 
 
 t The other names in the Commission were as follows : — The Earl of 
 Eomney ; The Earl of Ducie ; Lord Robert Montagu, M.P. ; Rt. Hon. Russell 
 Gumey, M.P. ; Rt. Hon. Stephen Cave, M.P. ; Sir Thomas Watson, Bart., M.D., 
 Lieut.-Col. Charles Brisbane Ewart, R.E. ; John Robinson McClean, Esq., C.E., 
 M.P.; Samuel Whitbread, Esq., M.P. ; John TomHnson Hibbert, Esq., M.P. ; 
 Evan Matthew Richards, Esq., M.P. ; George Clive, Esq. ; Francis Sharp 
 Powell, Esq. ; Benjamin Shaw, Esq. ; James Paget, Esq. (now Bart.), F.R.C.S. ; 
 Henry Wentworth Acland, Esq. (now K.C.B.), M.D. ; Robert Christison, Esq. 
 (afterwards Bart.), M.D..; William Stokes, Esq., M.D. ; John Lambert, Esq. 
 (now K.C.B. and P.C.) ; and Francis Thomas Bircham, Esq. Officials of the 
 Central Departments interested in the inquiry were not on the Commission, 
 except Mr. Lambert of the Poor-Law Department. 
 
326 ENGLISH SANITARY 'INSTITUTIONS. 
 
 Chap. XIV. exclusion of the Metropolis. Within the limits thus prescribed, 
 Sanitaiy the new Commission was to inquire into and report upon the 
 Sjg^r^^^ operation of the various laws then in force for promoting the 
 public health and preventing epidemic diseases ; and into and 
 upon the administration of those laws, including the constitution 
 of the administrative authorities, central and local, and the 
 formation of areas proper to be controlled by local authorities ; 
 and into and upon the operation of the registration-system in 
 respect of certificates of causes of death; and the Commission 
 was to suggest improvements in all or any of those matters, with 
 the means for carrying such improvements into effect. 
 
 The Commission, thus appointed in 1869, reported as before 
 mentioned, in the spring of 1871. In the interval it had 
 examined, in addition to some of its own members, nearly a 
 hundred witnesses ; who for the most part were persons in official 
 connexion, locally or centrally, with the administration of the 
 laws under reference."^ 
 1871. The Report of the Commission of 1869-71 could not, from 
 
 the Com- the nature of the case, be of nearly equal significance with the 
 Report of the Commission of 1844-5, but it nevertheless was 
 in some respects an influential contribution to the public service. 
 Popular knowledge of the subject had advanced so much during 
 the three years since prayer was made for the appointment of 
 the Commission, that some of the most necessary recommenda- 
 tions of the Report may have seemed to come at last as mere 
 matters of course; recommendations, for instance, that the 
 multiple jurisdictions should be simplified, and the incoherent 
 laws be consolidated ; but those authoritative recommendations 
 were not the less applicable for being confirmatory of outside 
 common sense ; and it was most necessary that they should be 
 promptly applied. The general purport of the Report was that 
 "the present fragmentary and confused sanitary legislation 
 should be consolidated;^'' "that the administration of sanitary 
 
 * Among the central officers examined, the Medical Officer of the Privy- 
 Council was of course one ; and for the opinions which I then expressed on the 
 matters in question, I refer to the published minutes of evidence : May 31 and 
 June 3, 1869; February 21 and March 3, 1870 : referring further to the con- 
 nected statement given in 1869, in Section VI. of my Eleventh Annual Report, 
 on the " Question of consolidating and bringing into system the laws and 
 administrative agencies which concern the PubKc Health." 
 
 mission. 
 
THE REIGN OF QUEEN VICTORIA. 327 
 
 law should be made uniform universal and imperative through- chap. xiv. 
 out the kingdom-*^; and that '^ all powers requisite for the health saniSrv^^ 
 of towns and country should in every place be possessed by one Commission 
 responsible local authority, kept in action and assisted by a 
 superior authority .''■' Reserving separate treatment on the same 
 principle for such parts of the sanitary code as were to be 
 deemed subsidiary or special, the Report recommended that all 
 the more general objects of sanitary legislation should be dealt 
 with by one comprehensive statute, which (subject only to such 
 few exceptions as might be unavoidable, and to certain partial 
 distinctions between '^ urban ■'^ and ^^ rural'"' districts) should 
 be not for optional but for universal application to localities ; 
 emphatically, '^ that there should be one local authority for all 
 public-health purposes in every place, so that no area should be 
 without such an authority, or have more than one ; " and, in 
 judgment on the disputed question, what should be the local 
 authority for places without special statutory constitution, the 
 Report (approving the principle of Mr. Lowe's Act of 1860) 
 recommended that it should be the Board of Guardians of the 
 Union. On the constitution of the Central Authority, the 
 Report recommended ^^that the administration of the laws 
 concerning the public health and the relief of the poor should 
 be presided over by one minister . . . whose title should 
 clearly signify that he has charge of both departments : an 
 arrangement which would probably render necessary the appoint- 
 ment under him of permanent secretaries to represent the respec- 
 tive departments.'" With regard to the functions and relations 
 of this authority, the Report laid down the following as its 
 principles : ^^ The Central Authority . . charged in one of its 
 departments with the superintendence of all Sanitary Authorities, 
 and equipped with a sufficient staff of officers . . must never- 
 theless avoid taking to itself the actual work of local government : 
 
 we would leave direction only in the Central power The 
 
 new Department will have to keep all Local Authorities and 
 their officers in the active exercise of their own legally imposed 
 and responsible functions ; to make itself acquainted with any 
 default and to remedy it ; it will have also to discharge to a 
 much greater extent its present duties . . . namely, to direct 
 inquiries, medical or otherwise, to give advice and new plans when 
 
328 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIV. required, to sanction some of the larger proceedings of the 
 Sanitary^ Local Authorities, to issue provisional orders subject to 
 1869^1^^^°^ parliamentary confirmation, to receive complaints and appeals, 
 to issue medical regulations on emergencies, and to collect 
 medical reports/^ In order that the Central Authority should 
 have full general powers of supervision and inspection, and 
 defined powers of control and direction over all Local Health- 
 Authorities, and should be able to give the public connected 
 information on the matters in question, the Report recommended 
 as essential, that the new law should '^ transfer to it the Medical 
 and the Veterinary Departments of the Privy Council, the Local 
 Government Act Office, the Registrar- GeneraFs Office, and all 
 [general] sanitary powers and duties now exercised by or under 
 the Privy Council, the Home Office, or the Board of Trade 
 respectively ; '' and that the several reports, till then prepared 
 disconnectedly in those departments, should be issued under the 
 new authority as parts of one series. With regard to the Local 
 Health- Authorities, the Report recommended, inter alia, " that 
 every Local Authority should have at least one Officer of Health, 
 being a legally-qualified medical practitioner, or possessing such 
 other qualification in medical science as shall be declared by the 
 central authority to be satisfactory : in rural districts the 
 Medical Officers of Health being, as a rule, the Poor Law Medical 
 Officers acting in their respective medical districts : and where 
 this is not practicable or expedient, the relation of the Medical 
 Officer of Health and the Poor Law Medical Officers to each 
 other being arranged by the Local Health Authority with the 
 approval of the Central Authority ;" and that the Local Authority 
 should have '' at least one inspector of nuisances ; " that 
 " medical officers of health should be appointed subject to the 
 veto, and should not be removed without the sanction of the 
 central authority, and inspectors of nuisances should be remov- 
 able either by the central or the local authority ; '* that every 
 medical officer of health "should be authorised to call for 
 reports from any inspector of nuisances in his district, and that 
 every report made by an inspector of nuisances to the local 
 health authority should also be made to the medical officer of 
 health o£ that authority.^' Among the recommendations relating 
 to Local Authorities were some of considerable importance, tending 
 
THE REIGN OF QUEEN VICTORIA. 329 
 
 to increase the powers of such authorities in relation to land- Chap. XIV. 
 drainage and sources for water-supply, and to facilitate eombina- Saixitary^ 
 tions of authorities where those purposes were common to several fgog^Ti^^^^^ 
 districts. Under the head of '^ supervision and control by the 
 Central Authority/^ the first recommendation of the Report was, 
 " that the office of Chief Medical Officer now under the Privy 
 Council should be continued in the new central department ; ''■' 
 the Report having previously observed that this officer-'s "con- 
 centrated superintendence of all public sanitary arrangements, 
 whether those of local boards, or guardians, or any other local 
 authorities, would greatly add to his usefulness and power.'''' "* 
 Next, the Report recommends " that all local health districts 
 should be from time to time visited by Inspectors of the Central 
 Authority ; '^ observing " that the additional inspection thus 
 required under the new sanitary law may be provided for by the 
 employment of inspectors already attached to the departments 
 which will be under the central authority or new minister, with 
 such increase of the staff as may be necessary .^^ This Inspec- 
 torate, officiating ^' in suitable circuits '^ with regard to sanitary 
 and poor-law administration, could, the Commission believed, 
 "ascertain the defects in the execution of both sets of laws, 
 and bring the forces of the common central office to bear on 
 any defaulting quarter/'' Main points in the scheme of the 
 
 * To the words whicli my text quotes from the Commission's Report, a few- 
 words of authorised interpretation may be added. In July, 1871, while Mr. 
 Stansfeld's short Local Government Board Bill was before the House of 
 Commons, seven of the eight members of the House who had served on the 
 Royal Commission (the absentee being Mr. Hibbert, who now was in office as 
 Poor-Law Secretary) introduced a comprehensive Public Health and Local 
 Government Bill, which Sir Charles Adderley, asking leave to introduce it, 
 described as " simply the Report of the Commission in the form of a BiU." 
 Eeferring to clauses 80-85 of that BiU, as additional to the passages I have 
 quoted from the Report, I read the intention of the Commission to have been, 
 that the Medical Officer of the Privy Council should be transferred to the Local 
 Government Board with the essential purpose of his appointment unchanged, 
 and with a view to the more comprehensive fulfilment of that purpose : namely, 
 that, set under the Local Government Board, and brought into official relation 
 with all local authorities, he should be, as I under the Privy Council had been, 
 but with facilities for fuller service, initiative and independent Reporter to the 
 Board on the current interests of sanitary government in England, as well as 
 Referee for the Board on matters concerning the Public Health, and Reporter 
 of the proceedings taken with regard to them ; and that he should be Organiser 
 of the Board's Medical Supervision. 
 
330 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIV. Commission were, that all inspectors communicating with districts 
 Sanitary and their authorities on matters within the new law ought to be 
 186?^!^^°^ under the command of one minister, and that inspections of like 
 sorts ought not to be in duplicate ; but this, of course did not 
 mean that the inspectorate was to be homogeneous. On the 
 contrary, it would have started as a composite staff, and was 
 meant so to continue ; containing inspectors for general purposes, 
 and inspectors for special purposes. As of the latter sort, two 
 classes of technical inspectors were particularly named : ^^ some 
 with engineering knowledge, to judge of, advise upon, and aid in 
 executing structural works ; '' and " some with medical knowledge, 
 who would be the agents of the chief medical officer in the central 
 department, and would bring him into relation with the 4,000 
 medical officers already attached to the local authorities through- 
 out the kingdom.^"* There would probably also be wanted 
 ^^ some with special knowledge in other branches of science who 
 will either (1) be retained only on particular occasions, or (2) 
 should be attached, without salary, to the Central Office for 
 terms of years, and to whom special points of inquiry should be 
 referred with due remuneration for each such consultation."'^ 
 The Commission did not attempt to lay down any hard 
 and fast line as to the proportions in which the different 
 sorts of inspectorial service might be wanted; the new 
 statute, it said, ^^will doubtless in this, as in other in- 
 stances where the central authority has been empowered to 
 appoint inspectors, leave a wide discretion in its hands; ex- 
 perience alone can determine how far the same inspector can act 
 both for sanitary and poor-law purposes ; an inspector must in 
 any case possess knowledge of a high order, or he cannot with 
 effect exercise superintendence over the action of men who in 
 many cases devote the best years of energetic lives to the dis- 
 charge of their duties.''^ The Report recommended ^' that the 
 due action of Local Health- Authorities should be secured by 
 penalties on default, recoverable with the consent of, or by, the 
 Central Authority ; and that the Central Authority should, on 
 the default of a Local Health- Authority, have power to compel its 
 action by legal proceedings and by enforcing penalties; and 
 should also have power to interpose and perform, through such 
 agency as might appear fitting, the neglected_duty of the Local 
 
THE REIGN OF QUEEN VICTORIA. 331 
 
 Health- Authority (including' the execution of any works within Chap. Xiv, 
 the powers of the local authority which may be deemed by the Sa^ter^^ 
 central authority to be necessary) and to provide for the expense i869-n ^^°^ 
 by imposing rates^ borrowing on the security of them, and 
 taking other necessary measures/'' It recommended "that in 
 addition to the duties prescribed by the existing Registration 
 Acts, it should be made the duty of the Registrar-General, and 
 of the district registrars, to register disease and sickness, or 
 specified cases of disease and sickness ; '^ and " that in every 
 case of death the medical attendant, or where none the district 
 medical officer of health, should certify to the district registrar 
 the cause of death ; and should also, in cases of suspicion, but 
 not otherwise, give notice to the coroner/^ The Commission 
 moreover, thought it "desirable, that the Central Authority 
 should, with the consent of the managers, inspect hospitals 
 and dispensaries supported by voluntary contributions ; and 
 suggest means for the organisation of such institutions, and for 
 their co-operation with each other, and with the rate-supported 
 hospitals.'"' By way of supplement to the broader recommen- 
 dations of the Report, the Commission furnished an elaborate 
 series of detailed recommendations as to the amendments, even 
 the smaller amendments, which the existing law ought to receive 
 in course of being consolidated. ^ 
 
 Of the Recommendations made in the Report, there probably 
 are not many on which the reader would now care to dwell with 
 intention of criticism ; but those which proposed a new arrange- 
 ment for the Central Responsibilities, and those which proposed 
 the miiversal establishment of local OfRcerships of Health, have Particular 
 
 recommen- 
 dations. 
 
 * This remarkable exercise of minute criticism had been rendered possible by 
 the exertions of one member of the Commission, Mr. Francis Sharp Powell, 
 now member for Wigan, but not at that time (though he previously had been) 
 a member of the House of Commons, By carefully resolving into their elements 
 all the existing local-government and sanitary statutes, and then re-ordering the 
 elements under a sufficient number of suitable heads, so as to show in juxta- 
 position the provisions which corresponded in subject-matter in the several 
 acts, Mr. Powell had produced a systematic Arrangement which enabled his 
 colleagues to examine with him all actual provisions of law, section by section, 
 to see in regular survey the points at which they required amendment or addi- 
 tion, and to annotate such points in a form which must have been singularly 
 convenient to those who afterwards had to give efEect to the Recommendations 
 of the Report. 
 
332 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIV. 
 The Royal 
 Sanitary 
 Commission 
 1869-71. 
 Proposed 
 consolida- 
 tion of 
 central 
 responsi- 
 bilities. 
 
 notj even yet, ceased to be of practical interest; and to 
 them, for prospective reasons, it will be convenient to give more 
 particular notice at the present point. 
 
 With regard to the Central Responsibilities, it has to be 
 observed that the Royal Commission, under its warrant of ap- 
 pointment, had not been free from restriction as to the quantity 
 of reform it could propose. Not the entirety of the laws 
 concerning the public health in England had been referred to it 
 for consideration, but only the laws under which local authorities 
 officiate in that matter, and even these laws only in their extra- 
 metropolitan relations. Outside what had been assigned to 
 the Commission for consideration, there lay not only (1) the 
 great body of metropolitan sanitary interests, subject to their 
 own particular laws of administration and control, but also (2) 
 those various highly important branches of health-law which are 
 administered byotherthan local authorities; such particularly as the 
 laws which regard the constitution and exercise of the professions 
 of Medicine and Pharmacy, and those which relate to the ordering 
 of Lunatic Asylums, and those which impose sanitary regulation 
 on the chief sorts of collective Industrial Employment, and on 
 the modes of conducting sundry sorts of Chemical Manufacture. 
 On the view that branches of health-law not administered by local 
 authorities were to be classed as " subsidiary '' or '' special,^'' the 
 Commission could comparatively disregard those branches, and 
 needed not bring into its scheme of consolidation the central 
 responsibilities attaching to them ; but this, it seems to me, was 
 unfortunate. It left too open way to the danger (which after- 
 wards was fulfilled) that considerable exceptions to the con- 
 solidation of central sanitary responsibility might survive the 
 adoption of the Commission's Report, and that unconsolidated 
 portions of such responsibility might remain as patches of foreign 
 matter in departments no longer mainly or connectedly concerned 
 with such; anomalies, which would almost certainly tend to 
 developments of further anomaly. Far better, it seems to me, 
 would have been, that the framing of the new scheme should 
 have proceeded with as full consideration from the one point of 
 view as from the other. A departmental Minister, controlling 
 local authorities in respect of their Machinery and Finance and 
 Common Municipal Services, and in respect of their functions 
 
THE REIGN OF QUEEN VICTORIA. 333 
 
 under Health-law and Poor-law and Farm-law, and of the Con- Chap. Xiv. 
 servancy of Rivers and Lands, and having under his direction Sanitary^ 
 such proceeding's of Registration and Census and such making Jse^i^^^^" 
 of geodesic and geological Surveys as civil administration 
 requires, might no doubt be a sufficiently comprehensive Minister 
 of Local Government f but would not, unless he commanded also 
 the other sorts of central sanitary relation, be, in any satisfactory 
 sense, a Minister of Health. The endeavour, it seems to me, 
 ought to have been to fulfil conjointly the two objects : to have 
 aimed at consolidating in an equally full sense all the central 
 responsibilities which relate to Public Health, and all the central 
 responsibilities which relate to Local Government, with intention 
 that they all should be in charge of one political department ; all 
 under one Chief Minister, with such assistant-offices political 
 and other, and such divisions of service, as would be necessary ; 
 and with common rule, as between the component parts of the 
 staff, that, in every affair concerning two or more sections of 
 subject-matter, the respective divisions of staff should act in 
 concert. Arrangements for the transaction of central sanitary 
 business could then have been planned with proper regard to 
 scientific affinities, as well as to other exigencies and con- 
 veniences of the case. The Commission, however, had not been 
 authorised to take any such general view of the multifarious 
 business which was in disorder; and the Government of the day 
 not only showed no inclination to advance beyond the proposals 
 of the Commission, bat even (as will hereafter appear) fell short 
 of entire adhesion to them. Consolidation, to so limited an 
 extent that it could not be deemed more than provisional, 
 was an alternative with some risks of its own ; but opinion 
 prevailed that some such consolidation would be better 
 than to let things remain quite as they were ; and Govern- 
 ment, though not accepting all that the Commission had 
 recommended, accepted enough to justify the constitution of 
 a new department. It decided to propose the discontinuance of 
 the Poor Law Board, and the creation of a department to be 
 called the Local Government Board : in which new Board 
 should be vested, first, all powers and duties of the discontinued 
 Poor Law Board ; secondly, certain powers and duties of the 
 Secretaiy of State relating to Local Government outside the 
 
334 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIV. Metropolis, and to the direction of the office of the Registrar- 
 Sanitary General ; and thirdly, certain powers and duties of the Privy 
 1869^L^°^ Council relating to the Public Health, but not including (as 
 the Commission had proposed) the powers and duties as to 
 Diseases of Cattle. The decision, so far as it was affirmative, 
 accorded with the advice of the Commission, and could be 
 justified by reasons which the Commission had given. That, 
 so far as it went, it was in principle right, will probably not 
 be disputed ; but a certain quantity of experimental risk 
 would attach to the considerable powers of disorganisation 
 which the coming political organiser must have at his dis- 
 cretion ; and in the absence of details as to the scheme of joint 
 working intended for the triple combination, it was impossible 
 to say that the conditions of the partnership might not rather 
 lessen than increase the usefulness of the Medical Department. 
 
 Proposals 
 
 relating to 
 Local 
 Officer 
 ships of 
 Health. 
 
 Previous 
 theory of 
 the Office. 
 
 Of all questions in modern State-Medicine, perhaps none 
 is more deeply important than that of the system on 
 which Members of the Medical Profession should be made 
 serviceable in the administration of the Health-Laws ; and so, 
 for the purposes of this volume, I advert with particular in- 
 terest to the recommendations which the Royal Commission 
 made with regard to the institution of Medical Officerships of 
 Health. As the steps of legislative and administrative action 
 which were taken in respect of that advice must come under 
 review in my next chapter, I shall endeavour to make my 
 present remarks on the recommendations sufficiently full to 
 serve for future back-reference on the points of principle; and 
 the recommendations cannot, I think, be examined with due 
 thoroughness, unless consideration be first given to the previous 
 general theory of Health-Officerships. 
 
 If reference be made, either to the terms of the Acts of 
 Parliament which brought the earliest Health-Officerships into 
 existence, or to the nature and working of the appointments 
 which had been constituted under those and later Acts, and 
 were extant as evidences of intention at the time when the Com- 
 mission reported, it will be seen that, according to those criteria, an 
 " Officer of Health '' was understood to have two distinguishing 
 marks : first, as to qualification, that he was an Uxpert and (as 
 
THE REIGN OF QUEEN VICTORIA. , 335 
 
 compared with co-existing forms of medical practitioner) in Chap.xiv. 
 some degree a Specialist, in regard of hnowleclge and skill applic- Saidtary^ 
 able to the Prevention of Disease ; ^ and secondly, as to duty, 1869^^^°^ 
 that he had undertaken to act as impartial Public Accuser and 
 Adviser against whatsoever unwholesome influences in his district 
 should be removable under the sanitary law. On that view of 
 the meaning of the term, clearly an Officership of Health was 
 not a post which every medical practitioner of 1871 could be 
 deemed qualified to hold, nor a post which could be held in easy 
 compatibility with every other sort of professional engagement. 
 Regarding the former of those points, it no doubt might be 
 assumed that, within moderate time, improvements in medical 
 education would supersede the necessity for special inquiry 
 whether a legally-qualified medical practitioner had learnt pre- 
 ventive, as well as curative, medicine ; for this degree of com- 
 pleteness of education would surely in the future be assumable of 
 all persons registered as qualified practitioners : but, with regard 
 to the other point, no such effect was to be expected from pro- 
 gress of time, or change of circumstances ; and what might 
 briefly be termed the moral speciality of the Officership of 
 Health would always need to be strongly insisted on. The 
 Officership of Health, in certain chief parts of its working, 
 was an office for the redress of wrongs. Though not of judicial 
 authority, it was of essential bearing on the administration of 
 justice within its particular province of affairs ; its standards of 
 duty must be such standards of diligence and impartiality as the 
 administration of justice universally requires; the office could 
 not fitly be held by any man who would not work it in that 
 
 * E.g. : that, as to Tatliology, he should have exact knowledge (so far as at the 
 time existing) of the causes, and the modes of propagation, of all frequent pre- 
 ventable diseases; and that, as to Physics and Chemistry, he should be able to 
 advise properly on questions, large and small, of nuisance-prevention, and on 
 certain questions of warming, ventilation, and the like, and be competent to 
 direct proceedings for disinfection. In 1871, under what were then the lawful 
 conditions of medical education and qualification, it could not fairly be presumed 
 of any chance member of the profession, that he was possessed of those specialities 
 in a degree to justify his being named the ofiicial local representative of them for 
 purposes of law ; nor could it be expected that any member of the profession, not 
 yet familiar with those essential parts of a Health-Officer's qualification, would 
 be prepared to enter offhand upon the studies unless favourable conditions of 
 appointment tempted him to do so. 
 
336 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIV. spirit, or would flinch from accusing -where he ought to 
 Sanitary accuse. Moderate and patient he must of course be; for the 
 186?^L^^°^ cases before him would often be many-sided even in their 
 sanitary, and perhaps of tener in their legal and financial rela- 
 tions, and wrongs which had been of gradual growth and long 
 permission would more or less require time for their removal ; 
 but with all due moderation and patience, he must nevertheless 
 quite sincerely and steadfastly have the reformatory aims of his 
 office at heart, and must regard them as duties of sacred trust : 
 duties, which he would follow with strictly impartial truth and 
 justice as between conflicting local interests; never with any 
 self-seeking bias, nor any taint of fear or favour; never with less 
 perfect hearing, or slower movement, when grievances of the 
 poor might be in question. Manifestly, if those deeper condi- 
 tions of duty were to be fulfilled, the outward conditions of the 
 appointment must be adapted to them. Not all other local 
 ambitions would be consistent with the tenure of an Officer- 
 ship of Health. It would of course be unfit that the Officer 
 should be collaterally engaged in any commerce which might pro- 
 bably render his official judgment less single- sighted, or his official 
 activity less straightforward, than it ought to be ; and presum- 
 ably the duties of the office would not in general easily harmonise 
 with the interests of a practitioner who should be having to earn 
 the main part of his livelihood by ordinary private practice within 
 the same area."^ It would also seem clear that Officerships of 
 Health could hardly answer to the pretentions of their name, 
 nor be of much real account in the service of the public, except 
 in proportion as they were important items in the lives of those 
 who held them : not in each case on so petty a scale as to involve 
 mere driblets of occasional duty, but, on the contrary, on such a 
 scale that each appointment, in regard of its work and remunera- 
 tion, might satisfy, wholly or in considerable part, the claims of a 
 moderate personal ambition. Probably in general the best consti- 
 tution for the office would be, that its holder should be exclusively 
 
 * In the case of any Health-Officer so circumstanced, the duty of zeal for the 
 protection of health in the district, the duty to be general complainant and 
 instigator of proceedings wherever action ought to be taken against nuisances, 
 dangers of contagion, badness of house-accommodation, and the like, would often 
 in its discharge involve the risk of displeasing some patient or patron, perhaps 
 even several such, whose friendliness had been a condition of yearly income. 
 
THE REIGN OF QUEEN VICTORIA. 
 
 337 
 
 in the public service ; not necessarily debarred from otber public 
 employment, if his health-office left him leisure for it, and if the 
 appointers to the health-office approved ; but debarred from 
 private professional practice, and from serving as private opin- 
 ional witness in sanitary suits. Substantial offices of that 
 exclusively public sort could easily be associated with such 
 different bases of local appointment as the differences of the 
 localities might suggest : could, in one case, be for some single 
 chief town ; could, in a second case, be for several less important 
 towns, concurring in the appointment ; could, in a third case, be 
 for a county or large division of a county, with mixed rural and 
 petty-urban districts; and so forth; while, in relation to each 
 such appointment, there could be provision, on proper terms, for 
 certain sorts of contributory service to be rendered by members 
 of the poor-law medical service, and by other local officers.^ It 
 would of course be desirable that the Medical Officer of Health, 
 like judicial officers, should hold his office during good behaviour, 
 and should in his office be protected against the resentment of 
 persons whom the proper discharge of his public duties might be 
 apt to offend. 
 
 At the time when the Eoyal Commission began its inquiries, 
 there probably would have been general consent among competent 
 persons, that, in the total of what was wanted to constitute for 
 England a proper organisation of local sanitary government, one 
 factor must be, in some form or other, the existence of a system 
 of genuine Officerships of Health ; and that the expected new 
 law ought at least to lay good foundations on which such a 
 system might by degrees, and as soon as practicable, be built. 
 Necessity for the special service would evidently attach to the 
 existence of any law which should exact from local authorities 
 
 * In all cases, the Poor-Law Medical Officers should keep the Health-Officer 
 ■well supplied with information such as they would officially possess, and he would 
 officially need, regarding the diseases of the local poor ; while also, at least in respect 
 of extensive districts, each poor-law medical officer should be eligible to serve for 
 defined purposes as local assistant to the health-officer : it being of course pro- 
 vided that, for such sorts of contributory service, the poor-law officer would 
 receive payment in proportion to the duties performed by him. Likewise, in all 
 cases, the Health-Officer must of course have what information he may desire as 
 to the entries made in the Registers of Births and Deaths. And in all cases it 
 would be necessary that the local inspectors of nuisances should have to act 
 wholly or in great part under the Health- Officer's instructions. 
 
 Chap. XIV. 
 The Royal 
 Sanitary 
 Commissiou 
 1869-71. 
 
 General 
 desirability 
 of the 
 Office. 
 
 W 
 
338 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap-XIV. the true fulfilment of duties relating- to the health-interests of the 
 
 The Royal , ^ 
 
 Sanitary local populations. Each authority, endeavouring to fulfil the 
 1869-71. duties, would find itself virtually obliged to have, at least from 
 time to time, from some competent member of the Medical 
 Profession, more or less of such assistance as a dona Jide Officer 
 of Health is intended to supply ; would periodically need to be 
 furnished with a skilled impartial report on the health and the 
 sanitary requirements of its district, and would on occasions 
 require unbiassed medical certification or advice with regard to 
 points of current business, administrative or forensic. That 
 would, in principle, be true of all local authorities ; there would, 
 in every district, be some necessary dependence on medical 
 service of the special type ; but the quantity of the dependence 
 would vary immensely in different districts. In important 
 urban districts, it would unquestionably be so great as to justify 
 and demand that a regular Officership of Health should form 
 part of the municipal machinery ; while in districts of contrary 
 character, there certainly would not be work enough for the 
 separate maintenance of a substantial office, and question would 
 arise as to some alternative arrangement by which to obtain 
 trustworthy service of the required special type, though in 
 quantities comparatively small. Under circumstances of the 
 latter sort, it might often be the case that a single district 
 authority, would not, alone and independently, be able to provide 
 itself with the service it wanted, but would have to depend for 
 its power of obtaining such service, either on conditions of joint- 
 action with authorities of other like districts, or on the existence 
 of an expert appointed ad extra (say by county authority) to act, 
 continuously or occasionally, as Health-Officer for districts not 
 otherwise officered ; or, conceivably, such cases might be met by 
 the existence of a class of unattached consultation-practitioners, 
 from whom authorities needing only occasional assistance could 
 obtain it. In the list of duties which the special Health-Officer, 
 if appointed, would discharge, there no doubt would be some, of 
 rudimentary and uncomplicated sorts, which, if the special 
 officer were not appointed, might, to their limited extent, be re- 
 garded as common professional duty, dischargeable by any ordin- 
 ary local practitioner; particular single acts, not involving further 
 technic than such as every competent member of the Profession 
 
THE REIGN OF QUEEN VICTORIA. 
 
 339 
 
 might be supposed to have, and not involving questions o£ local 
 bias : "^ but the argument, that certain such matters, taken alone, 
 might not need to be in trust with an officer of special type, did 
 not affect the general argument as to the national need for the 
 class of special officers. 
 
 In considering the recommendations of the Royal Commission 
 in the matter of Officerships of Health, it is important to dis- 
 tinguish between what was of general intention and principle, 
 and what was merely of detail and method. As to the essential 
 object, that there should be instituted for all England a system 
 of Officerships of Health, the Commission's proposal was, I 
 believe, received with cordial assent by all who were qualified 
 to judge it ; but, when the Commission proposed, as its scheme for 
 that object, that every Local Sanitary Authority should be required 
 by law to have at least one Medical Officer of Health, and that 
 commonly in the rural areas, and perhaps also extensively in 
 others, each District jNledical Officer under the poor-law should be 
 the Officer of Health for the space of his poor-law district, 
 objections to this proposal were at once raised. Very weighty 
 opinions were expressed, that, in the proposed vast multitude of 
 appointments, it would be idle to expect the characteristic 
 qualities for which Officerships of Health had been desired, and 
 in short that the method would defeat the purpose. It was 
 pointed out that, with such extreme subdividedness of office as 
 would exist under the scheme, individual holders, earning nearly 
 all their livelihood in other directions, could not be expected to 
 take any serious view of the official responsibilities ; f and that 
 
 * Such were matters which I had in view in 1869, when I suggested to the Royal 
 Commission that, in districts without special Health-Officers, "rudimentary" 
 duties might he done hy the poor-law medical officers, and the services he paid 
 hy fees. I gave, as instance, the kind of medical aid which a local authority 
 would from time to time require, if it had to provide certification of the Cause 
 of Death in cases not otherwise certificated or adjudged upon. See in my 
 Evidence hefore Commission; Q. 1926 and elsewhere; or in my Report XI., 
 pp. 26-7, and 29-30. 
 
 t For estimating hy analogy, what would he the probahle public value of 
 such Officerships of Health as the scheme contemplated for rural and for minor 
 urban districts, question might be asked : AVhat would have been the usefulness 
 of county-court judgeships, if their duties and emoluments had been divided to a 
 parochial scale, so that, in each parish, some resident lawyer, having his chief 
 interests in other sorts of local business, had been charged with occasional small 
 exercises of judicial duty ? 
 
 W % 
 
 Chap. XIV. 
 The Royal 
 Sanitary 
 Commission 
 1869-71. 
 
 Unwork- 
 able details 
 in the Com- 
 mission's 
 Scheme for 
 the Office : 
 
 Extreme 
 sub- 
 divided- 
 
340 ENGLISH SANITARY INSTITUTIONS. 
 
 Th*^T?'^^T' ^^® intention of the scheme, that the new appointments should 
 Sanitary in the greater number of cases be held as it were ex officio by 
 1869-71. the local poor-law medical officers, would not be reconciled 
 with due insistence on special demands, either as to technical 
 qualification, "^ or as to facilities for freedom of official judgment.f 
 The Commission no doubt was right in attaching importance 
 to one particular qualification in which the poor-law medical 
 officers would have an initial advantage towards becoming efficient 
 Officers of Health, — the advantage, namely, of their daily 
 familiarity with current facts as to the ailments and local cir- 
 cumstances of the poorest parts of the population ; and it might 
 be taken for granted that no future sanitary system for the 
 country would be complete, which should not include some 
 provision for fully turning to account the special information 
 which in those respects can be supplied by the poor-law medical 
 service ; % but that advantage would be rated at far too high a 
 value, if, for its sake, the scheme for health-officerships- were 
 made to ignore the indispensability of special technical prepara- 
 tion, and the indispensability of official independence. It would 
 be one thing to make temporary provision (such as I had sug- 
 gested in 1869) that, in cases where no special health-officer 
 should be appointed, the local authorities might look to the poor- 
 law medical officers to do occasional particular acts of minor 
 service which the law might have required to be locally done ; 
 but it would be another, and quite different thing, to enact as 
 final arrangement and norma for the greater part of the new 
 system, that the poor-law medical officers should ex officio be 
 constituted full Officers of Health, and be ranked as permanent 
 representatives of the full intention of the law. 
 
 The very capable persons who constituted the Royal Commis- 
 sion could hardly have been unaware that their scheme of local 
 appointments had in it the weaknesses which I have indicated ; 
 and I daresay it may have been in consciousness of those weak- 
 nesses, and with intention of compensating for them, that the 
 Commission made certain subsidiary proposals which would have 
 rendered the local officers dependent in an extreme degree on 
 
 ^ * See p. 335, and its footnote. f See p. 336, and its footnote. 
 
 % See above, p. 337, and its footnote. 
 
THE REIGN OF QUEEN VICTORIA. 34 
 
 central inspiration and support. The Report, namely, recom- Chap.xiv. 
 
 mended a system of elaborate medical correspondence between Sanitary^ 
 
 the central office and the localities. All reports of all officers of S^L '°'' 
 
 health were to be transmitted to the central office, and each 
 
 officer of health was to be ^^ supplied from the central office with ^^^ 
 
 ^^, , extreme 
 
 forms for district-returns relating to health, with spaces for centralisa- 
 statements as to conditions of houses, factories, water-supply, 
 drainage, food and other recognised sources of ill-health.'"'^ The 
 Report advised that ^' great importance should be attached to the 
 preparation and collection of these local sanitary reports, and 
 assistance and encouragement should be given to medical officers 
 of health to induce them to study all sanitary questions, and to 
 make their reports as complete as possible " : the Commission 
 anticipating that the enquiries of the local medical officers would 
 '' be guided from the central office with the highest attainable 
 medical and scientific knowledge,''^ and that their reports would 
 '' supply a vast collection of facts for the study and elaboration 
 of the central officers.''^ These subsidiary proposals appear to me • 
 to have been conceived in an unwise spirit of over-centralisation. 
 My impression would be that, except in particular cases, where 
 there might be definite reasons for detailed inquiry, and where 
 unquestionably for the most part inspection would be far more 
 instructive than correspondence, the centre could have no need 
 to concern itself with such district-details as the Commission 
 specified ; and that universally to require such details, as a basis 
 from which the centre might correspond with the localities, and 
 act as reviser of the local written exercises, would be paedagogic 
 rather than administrative. Such a system would impose an 
 immense amount of trouble on local and central officers before any 
 approach to usefulness of results could bie expected ; would 
 occasion many local grumbles at the bother of central inquisitive- 
 ness, and would overwhelm the centre with haystacks to be 
 searched for needles ; while, perhaps, in all that infinity of 
 tabular returns, there might be thrown little clear light on the 
 essential questions, whether causes of disease were being rightly 
 
 * The central office was also to communicate with such local officers as might 
 be " willing to undertake observations of weather, analysis of water, or other 
 scientific inquiries bearing on public health "; it was to fimiish such officers with 
 certain sorts of assistance, and to receive records of their observations. 
 
342 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIV. 
 The Eoyal 
 Sanitary 
 CommissioD 
 1869-71. 
 
 'Evident 
 need for 
 caution as 
 to any 
 universal 
 require- 
 ment in the 
 matter. 
 
 perceived, and local measures against disease were being rightly 
 advised.^ It would seem improbable that the central office 
 could (even at great cost) work up from such returns any note- 
 worthy proportion of valuable matter for general publication ; 
 and to intend that, by means of correspondence founded on such 
 returns, the central authority should systematically compensate 
 for the defective working of a wrong principle of local appoint- 
 ments, would seem a fantastic policy of local government. The 
 endeavour, I venture to think, ought to be in a sense contrary 
 to any such intention ; ought to assume that local government, 
 once properly settled, does not require habitual guidance from 
 the centre. While a new organisation of local authorities should 
 be advancing, and during the early years of action by those 
 authorities, central inquiry as to the progress of the organisation, 
 and central assistance to the organisers and their new officers, 
 might probably have to be continuous and extensive ; but, in pro- 
 portion as that early period passed, the interference of the central 
 authority in local details ought to be less and less needed, and 
 would gradually tend to limit itself in principle to instances and 
 particulars in which local sanitary administrators should show 
 themselves definitely at fault. 
 
 On the whole case, then, it was clearly to be foreseen, that, 
 if Government should resolve to accept in principle the Commis- 
 sion's fundamental recommendation for an universal institution 
 of Officerships of Health in England, it would have to proceed 
 with extreme caution in its steps for giving legislative effect to 
 the principle. Granted that a good system of Officerships of 
 Health would be of the highest value to the sanitary progress of 
 the country : but mere creation of offices, if under conditions 
 not favourable to proper official independence, or if in greater 
 numbers than persons of good technical qualification could be 
 found to fill them, might be embarrassment rather than help to 
 
 * The Commission, when it proposed its large scheme of documents, may have 
 believed that, for the practical aims of the new system, procedure on documents 
 might work extensively as an economical alternative to the appointment of new 
 inspectors. If the Commission took that view, did it figure to itself, how large a 
 development of central service would be necessary for attempting to deal critically, 
 in reading and writing, with such masses of material as it brought into question ? 
 and did it also sufficiently consider the vast difference of efficiency between the 
 two methods of procedure ? 
 
THE EEIGN OF QUEEN VICTORIA. 343 
 
 progress ; and sucli embarrassment could easily arise, i£ each Chap. XIV. 
 local authority under the new law were required to have a separate sanitary^ 
 officer or officers for its own perhaps inconsiderable one district, ^il™™*.^^^*^" 
 In 1871, doubts might well have been felt, whether, under the 
 conditions then existing, any feasible legislation could create off- 
 hand for England a complete system of such officers as were to 
 be desired : doubts, on the one hand, whether at that time the 
 medical labour-market was ready to supply all at once so very 
 large a quantity of the required special material ; and doubts on 
 the other hand, whether the minor urban and the rural districts 
 could be satisfactorily officered except after an interval during 
 which certain expected changes in the constitution of county- 
 government should have been made."^ On those and other 
 grounds, it would, in some opinions, have been best policy to 
 proceed only by degrees in such imperative legislation as the 
 Commission had recommended ; to enact the command at first 
 only for the more considerable towns, and to reserve for a second 
 stage of legislation, when general county-government should 
 have been settled, the question as to the minor urban and the 
 rural districts. Under the law as it already stood (23rd and 24th 
 Vict. c. 77) any board of guardians could when it saw fit employ 
 its poor-law medical officers to report to it on matters of local 
 sanitary requirement ; and, for the interval till county-government 
 should be permanently settled, any desirable extension or modi- 
 fication of that existing power, and any proper new inducement 
 to make free use of it, could have been provided for the minor 
 authorities by provisional permissive legislation. Again, whether 
 it should be intended to proceed by successive acts of legislation, 
 or immediately by a single act, it was clear that a Minister, 
 intending to give compulsory effect to the principle of the 
 
 * Such changes would presumably bring into existence representative county- 
 boards, which could be made the authorities to appoint and regulate Health- 
 Officerships on a proper scale for the minor urban and the rural districts : Officer- 
 ships, namely, which might be for large areas, each including several of the less 
 irapoi-tant " districts." In the absence of county-boards, if it were desired to 
 provide for the creation of such large-area officerships, a first condition would 
 be, that all proper powers relating to the appointment and control of the officer 
 should in each case be assignable to a standing committee of delegates from the 
 several interested " district "-authorities : the committee of course to be under 
 suitable statutory provisions for its constitution, powers, and continuity. 
 
344 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIV. 
 The Royal 
 Sanitary 
 Commission 
 1869-71. 
 
 Commission's recommendation, would need to be particularly cir- 
 cumspect as to the terms of the legislation he would propose ; 
 for, unless his legislation could operate to compel hond fide 
 offices, and to give them their conditions of efficiency, he had 
 better not affect to compel. In order to really compel by law, 
 throughout the country, the creation of any new sort of local 
 officer to be supported out of local rates, it would commonly 
 seem necessary that the law should fix, or authorise the central 
 government to fix, in precise terms, all material conditions 
 relating to the qualifications, duties, and rights of the office ; for 
 otherwise the command might be differently construed in different 
 places, — might, in places where it had the goodwill of the 
 administrators, be construed in senses favourable to efficiency, 
 but might in other places (no one could say how many) be obeyed 
 only in forms more or less illusory ; and it is clear that the 
 necessity for precision of command would be greater and greater 
 in proportion as the necessity for compulsive, rather than per- 
 missive, legislation were strong. Those considerations peculiarly 
 claimed to be borne in mind in 1871 by any Minister inclining 
 to propose compulsory legislation for an universal appointment 
 of Officers of Health in England. He would have to see with 
 absolute clearness, what duties he meant the officer to perform, 
 and whether he could provide that each appointment should be 
 made under appropriate conditions, both as to its own constitu- 
 tion, and as to the contributory aids it would require. He 
 would have to know that, unless Jie could provide conditions for 
 the efficiency of the appointment, legislation purporting to 
 compel the appointment would be but a futile pretence ; and 
 he ought not to propose compulsory legislation further than 
 he could plainly see his way to make the legislation a reality. 
 
 The Com- 
 mission's 
 general 
 scheme 
 accepted 
 for action 
 by Govern- 
 ment. 
 
 Reverting now to the Report as a whole, and regarding its 
 main political purport, I may state that the scheme of reform 
 which the Commission recommended was received with almost 
 unanimous approval. It was accepted at once by the Govern- 
 ment of the day, and afterwards by the next succeeding Govern- 
 ment, as a basis for legislative proposals ; and its influence may 
 be traced in statutes of several succeeding years. Thus in 1871 
 was passed the Act which constituted the Local Government 
 
THE REIGN OF QUEEN VICTORIA. 345 
 
 Board, and in 1872 the Act which amended the constitution and Chap.xiv. 
 powers of Local Authorities; the proposed concentration o£ Sanitary* 
 central responsibilities, effected in great part by the Act of 1871, fseTn' ''''' 
 was extended to some further matters by the Act of 1872 ; ^ 
 the latter Act, together with an Act of 1874, introduced various 
 minor amendments of law recommended by the Commission ; 
 and at last in 1875, was passed the great consolidating Public 
 Health Act which it had been a chief object of the Commission 
 to secure. In outcome more or less direct from the Report of 
 the Commission, came also many other important consolidations 
 with more or less amendment of subsidiary branches of law. Thus 
 in 1875 was passed (in substitution for an unsuccessful Act of 
 1872 and in consolidation of previous enactments) the Sale of 
 Food and Brugs Act ; in 1876, the Pollution of Rivers Act ;f in 
 1878, the consolidating Factory and Workshops Act, and, for a 
 section of subject-matter nearly akin to our own, the consoli- 
 dating Contagious Diseases (Animals) Act ; in 1879, the Public 
 Health (Interments) Act-; and in 1881, the Alkali 8fc. Works 
 Regulation Act : statutes, which, with the Artisans' Dwellings 
 Improvement Acts, 1875-82, and with the Principal Act of 
 1875, constituted an intelligible and applicable code of law for 
 national sanitary purposes. 
 
 The Minister, to whom was assigned the duty of moving Par- Legislation 
 liament in furtherance of the proposed central consolidation, and 
 of such local-government proposals as were to be founded on the 
 Report of the Royal Commission, was the President of the Poor 
 Law Board; and the selection of that particular Minister for 
 the duty was probably accompanied from the first by an inten- 
 tion of Government, that, on the making of the proposed central 
 change, the Minister who had presided over the Poor Law Board 
 should pass into the Presidency of the new Department, and 
 that the Parliamentary Secretary of the Poor Law Board 
 should be similarly transferred. Such an intention (since the 
 Poor Law Board was to cease) was, for obvious reasons, likely 
 
 * The additional powers and duties transferred to the Local Government 
 Board in 1872 were those of the Secretary of State under the several Highway 
 and Turnpike Acts, and those of the Board of Trade under the Alkali Acts 
 and the Metropolis Water Acts. 
 
 f This Act, however, was more distinctively promoted hy the valuable 
 special labors of the Eoyal Commission on the Pollution of Kivers. 
 
346 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIV. to be of convenience to Ministers, and, of course, would not 
 Sanitary imply any pre-judg-ment against the other two offices as to their 
 1869^L^^°^ status in the new Department which was to be constituted. 
 
 At the moment when Government resolved on the new sanitary 
 legislation, the Presidency of the Poor Law Board was (as for two 
 years past it had been) in the able holding of Mr. Goschen. At the 
 beginning of the Session of 1871, it was understood that the new 
 scheme of law would shortly be proposed by him : but, early in 
 March, circumstances required that he should take office as First 
 Lord of the Admiralty; and on his consequently vacating the 
 Presidency of the Poor Law Board^ Mr. Stansfeld was appointed 
 his successor. Government however seems to have wished that 
 the pains which Mr. Goschen had already given to the prepara- 
 tion of a coherent scheme of local government and finance should 
 not be lost to the public ; and accordingly on April 3, notwith- 
 standing the changed official relations, Mr. Goschen on behalf 
 of Government introduced (as bills No. 105 and No. 106 of 
 the Session) the two bills which expressed his scheme. In the 
 former of those bills Mr. Goschen proposed, for England in 
 general, certain amendments of law respecting the Liability of 
 Property to Local Taxation, and proposed to transfer the House- 
 Duty to local uses ; while in the other and larger bill, he pro- 
 posed a new system of Rating and Local Government for 
 England, exclusive of the Metropolis, and also set forth pro- 
 posals for the consolidation of the central offices. Very note- 
 worthy was the completeness of Mr. Goschen's scheme of pro- 
 posals; both in respect of the financial simplifications it would 
 have effected, and in respect of its mode of dealing with 
 local authorities; for, while accepting for purely sanitary 
 administration the jurisdictions which the Commission had 
 recommended (including that the poor-law union authorities 
 should be the sanitary authorities of rural districts) Mr. Goschen 
 had extended his view to all the other objects of local government; 
 taking into consideration in that wider sense the whole series 
 of local jurisdictions, from parish to county, with regard to the 
 constitution, status, powers and duties, of the authority of each ; 
 and his Local Government Bill aimed not merely at constituting 
 authorities for " district " sanitary work, but equally at giving 
 representative government for all work of Parishes and Counties, 
 
THE REIGN OF QUEEN VICTORIA. 
 
 347 
 
 and at providing" that the respective constitutions of Parishes, 
 Unions and Counties, should be related as of one system. The 
 two bills, after their first reading on April 3rd, were not pro- 
 ceeded with, and on May 8th were withdrawn. Two months 
 later (July 6th) Mr. Stansfeld, introduced a short bill, described 
 by him as practically the Sixth Part of his predecessor's No. 106, 
 solely to provide for the creation of a Local Government Board, 
 imder which should be the proposed consolidation of central 
 functions ; and, on August 14th, that bill became law, as c. 70 of 
 the 34th and 35th Victoria. 
 
 Thereupon immediately the expected appointment of Mr. 
 Stansfeld to be President of the new Board took place ; and 
 simultaneously with his appointment, which rendered the Board 
 legally complete, the various officers who had been employed in 
 relation to the powers and duties which the Act transferred 
 became subject to the new Board^s authority. The staff of the 
 Poor Law Board, the staff of the General Register Office, the 
 staff of the Local Government Act Office, and, subject to a 
 limitation, the staff of the Medical Department of the Privy 
 Council Office, were accordingly now under the Local Govern- 
 ment Board ; ^ and the Act which had constituted the Board, 
 and had given it customary powers to make any such appoint- 
 ments as the Treasury might sanction, had also authorised it to 
 distribute its business among the transferred officers in such 
 manner as it might think expedient. Under the discretionary 
 provisions of the Act, special steps were at once taken by Mr. 
 Stansfeld which affected the management of all the transferred 
 offices, except that of the Registrar-General ; f and these steps 
 will be described in the next chapter. 
 
 Officers of 
 the new 
 Depart- 
 ment. 
 
 * The Privy Council's powers and duties of a medical kind had not all heen 
 made over to the new Department : so, in respect of some of the matters for 
 which I had been Medical Officer of the Privy Cotmcil, I remained in their 
 Lordships' service ; but in respect of those which related to local government — 
 as particularly the powers of local medical inquiry, the superintendence of 
 public vaccination, and the purposes of the Diseases Prevention Act, my office, 
 from the above given date, was " attached to and under the control of the Local 
 Government Board." 
 
 t The Eegistrar- General, in consequence of the Act, would in future address 
 his Ecports to the Local Government Board, instead of addressing them to the 
 Home Secretary ; but in other respects his office would go on much as in times 
 before the Act, and of it therefore nothing further will be said. 
 
348 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Hitherto these pages have not had occasion to refer particu- 
 larly to the Office o£ the Poor- Law Board ; but as the inclusion 
 of that Office in the consolidation of 1871 came afterwards to 
 be of over-ruling consequence^ notice may conveniently here be 
 taken of some points in the Office's previous history. The 
 Poor-Law Amendment Act of 1834 had at first for thirteen 
 years been administered under control of a Board of three Royal 
 Commissioners ; but for this Board there had been substituted 
 in 1847 a Board of parliamentary constitution ; consisting, 
 namely, of certain ex officio members (Ministers of State) 
 with a salaried President, eligible to sit in the House of Com- 
 mons, and who in general would himself be the acting Board. 
 During the twenty years 1847-67, this re-constituted Board had 
 existed only on probation, learning to adjust its behaviour to 
 the varying annual balances of parliamentary opinion; but, in 
 1867, it had been made permanent. Twenty-four years of 
 action as supervisor of Boards of Guardians, under a law of 
 extreme centralisation, had naturally given to the Office an 
 unique experience in the working of the Poor-Law ; experience, 
 not only as to the general economics of pauperism and its relief, 
 but also, and eminently, as to the innumerable details which the 
 Board had to govern in the daily routine of the various branches 
 of local poor-law business throughout the country. The Office, 
 with that very large quantity of detail-business, had an organisa- 
 tion elaborately planned for its work : it had of course a de- 
 veloped secretariat ; and it had also, as in offset from the 
 secretariat, a particular class of travelling officers who personally 
 represented the Board to Boards of Guardians, and each of 
 whom had to himself a district for which he acted, and in which 
 he resided. "^ In general relation to the business which it had to 
 transact, the Office no doubt was of high efficiency ; but with 
 regard to one group of interests with which it had to deal, and 
 
 * In. tlie days of the Commission of 1834-47, that body had found it conve- 
 nient for the transaction of business that much of its communication with the 
 newly-created Boards of Guardians should be by personal agency — the agency 
 of Assistant- Commissioners whom the Act enabled it to appoint, rather than by 
 letters ; and when the Royal Commission of 1834 was replaced by the Parlia- 
 mentary Board of 1847, the system was continued on an enlarged scale, and 
 with the title of Assistant- Commissioner changed to that of Inspector. — See Sir 
 G. Nicholls's History of the English Poor Law, Vol. II., p. 423. 
 
THE REIGN OF QUEEN VICTORIA. 349 
 
 whicli in the present context claims particular notice, there was an Chap. Xiv. 
 article of dispraise to which I must advert. The speciality of the SauiSry^^ 
 Board's sphere of duty, and of the minutely regulative influence ^§6^^^°^ 
 which it had to exercise within that sphere, necessarily with 
 precise insistence on conditions and forms, and often unavoidably 
 in questions which may have seemed smaller than the forms 
 relating to them, had necessarily given to the work of the Office 
 characteristics of tone and method. Of those characteristics I do 
 not pretend to speak in any general sense ; but, with regard to 
 the one particular province of duty on which alone I am here 
 intending to remark, I think it certain that the Office had the 
 habit of working in too mechanical a spirit, and of being far too 
 easily satisfied with mere forms of duty. Perfunctoriness had 
 characterised its work in the matters of medical responsibility 
 with which it had been charged ; and the fault is here dwelt upon, 
 because it expressed a tradition which the functionaries of the 
 Office would be likely to carry with them into new official rela- 
 tions, and which might be of much effect in those contemplated 
 for them in 1871. The root of the fault, giving rise to much 
 which had gone wrong in the medical relations of the Office, 
 was, that the Board had relied very unduly on the sufficiency of 
 non-medical officers in those relations. Among the constant 
 duties of the Office, some of the most important had been in 
 great part affairs of medical technic, demanding that the office 
 which pretended to deal with them should systematically and 
 sincerely deal with them on that basis: — (for instance, the 
 control of workhouses and workhouse-infirmaries, and of the 
 classification and keeping of their inmates, and of the service, 
 especially the nursing- service, supplied to them ; and the control 
 of local arrangements for medical and other relief to the sick 
 poor not in workhouses ; and the control of the keeping of 
 pauper children in schools and boarding-out establishments; 
 and the control of local contracts for public vaccination) : — but, 
 till recently, the official staff of the Board had contained no 
 medical ingredient. The original theory seems to have been, 
 that, on any extraordinary occasion, extraordinary assistance 
 could be obtained ; but that, for the ordinary medical business 
 of the Board, the common sense of secretaries, assistant secre- 
 taries, and secretarial inspectors, did not require to be helped by 
 
350 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIV. 
 The Royal 
 Sanitary 
 Commission 
 1869-711 
 
 doctors. Outsiders competent in the matter knew tliat^ within 
 the special sphere of poor-law medical administration, this 
 system of secretarial common sense had not worked successfully 
 for the health-interests of the poor. How it had tended to work 
 in the health-control of establishments for pauper children, had 
 been sufficiently shown, as long ago as 1849, before the coroners' 
 courts, on occasion of a memorable outbreak of cholera in a large 
 boarding-out establishment at Tooting : ^ how it had worked in 
 respect of the contracts for public vaccination, I myself had had 
 painful official occasion for many years to observe, and occasion- 
 ally to report : f how it had worked in respect of the out-door 
 sick poor had been severely, but I believe not unjustly, criticised 
 by many skilled witnesses : J how it had operated in respect of 
 workhouses and workhouse-infirmaries had been revealed during 
 the years 1865-7 in exposures of scandalous mismanagement. || 
 
 * See, in several numbers of the Times, abou the middle of January, 1849, 
 the reports of the inquests held with reference to some of the 180 deaths 
 which this outbreak caused ; and, for the present argument, let the evidence 
 which Mr. Grainger, on behalf of the General Board of Health, gave in Mr. 
 Wakley's court on the sanitary features of the case, be compared \Ndth the fact, 
 stated by the poor-law inspector, that the establishment had been under six- 
 monthly visitation by the Poor-Law Board. 
 
 f See the earlier Annual Reports, particularly the Fourth, of the Medical 
 Officer of the Privy Council. 
 
 X See the Fourth of Mr. Rumsey's admirable Essays on State Medicine. See 
 also the various publications of the Poor Law Medical Officers' Association. 
 
 II See many successive publications in the Lancet during the years referred 
 to : especially the Reports of a Commission which the proprietors of the La/ncet 
 appointed in 1865 to inquire into the system of Workhouse-Infirmaries, and 
 later the proceedings of an Association (formed in 1866) for the improvement 
 of the Infirmaries. The reforms which were effected by Mr. Hardy's Act of 
 1867 were primarily due to that agitation; and the important influence which 
 it had exercised was noticed by Mr. Hardy when introducing his Bill. The 
 three gentlemen who acted as Commissioners for the Lancet were Mr Ernest 
 Hart, the late Dr. Anstie, of Westminster Hospital, and the late Mr. William 
 Carr, of Lee ; and a most effective co-operator with these, though not under the 
 Lancet Commission, was the late Dr. Joseph Rogers, at that time Medical Officer 
 of the Strand Workhouse, and subsequently President of the Poor Law Medical 
 Officers' Association. Besides Dr. Rogers's large participation in the general 
 battle on behalf of the sick jjoor, his personal efforts to get better treatment 
 for such of them as were under his own charge were of distinguished courage and 
 constancy. An account of the difficulties against which he had to contend 
 is given in his interesting Reminiscences of a Workhouse Medical Officer, edited 
 shortly after his death by his brother, Professor Thorold Rogers : London, 
 T. Fisher Unwin, 1889. 
 
THE REIGN OF QUEEN VICTORIA. 351 
 
 After those exposures, the previous theory of medical adminis- Chap.XIV. 
 tration would not bear to be maintained quite as before. A sort Saaitary^ 
 of first breach in it was made by Mr. Villiers, when he in 1865 g^^^'f '°'' 
 filled a vacant poor-law inspectorship by appointing to it a 
 physician, Dr. Edward Smith ; with intention that the new 
 inspector, though acting for a district, should also be available 
 to the Board for medical references ; and in regard of London, 
 a far more important breach was effected in 1867 by Mr. 
 Gathorne Hardy (now Viscount Cranbrook) when he carried the 
 very important measure with which his name is identified, 
 establishing for the Metropolis an improved system of workhouse- 
 infirmaries, with a system of poor-law dispensaries, and when 
 he provided that, for the poor-law work of the Metropolis, there 
 should be a medical (as well as a non-medical) inspector : but I 
 never understood that those breaches had let into the poor-law 
 office any spirit of general welcome towards medical knowledge. 
 On the contrary, according to all that I heard in after years 
 from Dr. Smith on the subject of his work in the office, the 
 old secretarial belief, as to the best way of dealing with matters 
 of medical administration, had vigorously survived the fact of 
 his appointment as Medical Officer of the Board ; and I under- 
 stood that he, in relation to such matters, was not expected to 
 advise in any general, or any initiative sense, but only to answer 
 in particular cases on such particular points as might be referred 
 to him. Antecedents such as those which have been described 
 did not in 1871 forbid the possibility that the staff of the Poor 
 Law Department might with advantage serve under one Minister 
 with a Sanitary Department specially medical; but they cer- 
 tainly seemed enough to suggest that, if this association had to 
 be arranged, caution as to the terms of it would be necessary. 
 Presumably the intention would not be, that, with regard to 
 sanitary duty, the non-medical department should be conscience- 
 keeper for the medical, and should enjoy discretion to shunt it 
 aside. If the administration of hospitals for the sick had been in 
 question, not every one would have proposed to entrust it to a com- 
 mittee of that so-called "peculiar people" which objects on 
 religious principle to medical interference with cases of disease. 
 
 Of the Local Government Act OflSce, at the time when it 
 
352 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XIV. 
 The Eoyal 
 
 Sanitary 
 
 Commission 
 
 1869-71. 
 
 Local 
 Govern- 
 ment Act 
 Office. 
 
 was brought into tlie new combination, I need not here parti- 
 cularly speak, except to notice that, from 1858 onward, there 
 had been a continuous, and latterly a rapid, increase, in the 
 annual loans contracted under authority o£ the office for pur- 
 poses of local improvement ; that while the new loans of the 
 year 1858 had been but £260,905, those of the year 1870-1 
 had amounted to £1,212,890. For other facts as to the 
 position of the office at the time of its transfer, I may refer to 
 the special report, which the Secretary, Mr. Tom Taylor, soon 
 afterwards made to the Local Grovernment Board, and which 
 is given in the Board-'s First Report. 
 
 Of the Medical Department down to the time of the combi- 
 
 Medical 
 
 ment. nation, I have given account in chapters xii. and xiii. 
 
853 
 
 CHAPTER XV. 
 
 English State-Medicine since 1871. 
 
 i.— THE opportunities OF 1871-74. 
 
 The Local Government Board, as soon as the Act of 1871 had 
 brought it into existence, necessarily had for a while to give its 
 chief attention to questions of administrative machinery. Pre- 
 liminarily, it had to constitute its own Office. Then, in order to 
 complete, according to programme, the organisation in which 
 itself and its office were to be part, it had to carry through 
 Parliament the scheme which the Royal Commission had recom- 
 mended for the constitution and powers and duties of new 
 local authorities ; and after it had attained that object by the 
 Act of 1872, it had the responsibility of seeing that all local 
 arrangements prescribed by the Act were duly made. While 
 dealing with those matters of local organisation, and noting what 
 sorts of question would in future arise as to the working of the 
 local machinery, it had to review, as in a new light, for prospec- 
 tive purposes, the constitution and ordering of its own central staff. 
 Especially it had to define and settle, in a comparatively per- 
 manent sense, what should be its own significance for purposes 
 of supervision and control in its several great divisions of duty : 
 what should be its ordinary policy and mode of action in those 
 respective divisions, and what share of function and responsi- 
 bility it would devolve on each of its divisional chief officers. It 
 was distinctively during the first two and a half years of the 
 Board^s existence, that all such questions as the above, of local 
 and central organisation for future work, were in course of being 
 settled ; and the prospective importance of the period was there- 
 fore critical. Those two and a half years were the time for 
 which Mr. Stansfeld was in office as earliest President of the 
 Board; and the very great power which circumstances had 
 placed in his hands would necessarily be of effect, according to his 
 
 X 
 
354 
 
 ENGLISH SANITAEY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 i.— The 
 opportun- 
 ities of 
 1871-74. 
 
 1.— The 
 CeJitral 
 Office. 
 
 use of it, in the outcome of many succeeding- years. In rela- 
 tion to tlie interests of which I am writing, the opportunities 
 for good were such as no previous Minister had ever even ap- 
 proximately possessed. 
 
 1. First of all, the new Department had to be put into a form 
 in which it could begin to transact its business. Of the three 
 offices which were to be co-ordinated for that purpose, each one 
 had hitherto had its own particular mode of management, and 
 no doubt its own particular spirit of work ; and, whether any- 
 thing or nothing of those previous autonomies should survive, 
 was now in the new authority's absolute discretion. The Royal 
 Commission, when it recommended that administration concern- 
 ing the Public Health and administration concerning the Relief 
 of the Poor should be in charge of a single Minister, had ex- 
 pressed its opinion, that, if such a Ministry were established, 
 separate secretariats — one for Public Health, and one for Relief 
 of the Poor, would probably be found necessary. Had that hint 
 been followed, the Secretary and Engineer-Inspectors and others 
 who had worked the Local Government Act 1858 under the 
 Secretary of State, and the Medical Department which had 
 worked the Public Health Act 1858 under the Privy Council, 
 would presumably have constituted the Health-Division of the 
 new office, and Mr. Tom Taylor and the Chief Medical Officer 
 would then have resumed under the new Minister such co-opera- 
 tion as they had formerly had under the General Board of 
 Health. This, however, was not done ; but, instead of it, as 
 soon as Mr. Stansfeld had entered on his new Presidency, steps 
 were taken to concentre all administration in the hands of a 
 single secretariat. As prerogative for those who should be 
 appointed Secretaries or Assistant-Secretaries of the new de- 
 partment, Mr. Stansfeld had already carried statutory enact- 
 ment (with what sorts of precedent I do not know) that to 
 them the Board might delegate the exercise of any of its powers, 
 except the making of rules, orders and regulations ; ^ and now. 
 
 * See Local Government Board Act, sect, 5. Under that provision, the per- 
 mitted delegation of powers to the Secretaries and Assistant-Secretaries was 
 made by Mr, Stansfeld in 1872. As regards the terms of the provision, it 
 may be noted that at a last moment of dealing with the Bill in the House of 
 
THE REIGN OF QUEEN VICTORIA. 355 
 
 for the personal occupancy of those positions, officers exclusively Chap. xv. 
 from the roll of the former poor-law department were appointed."^ State 
 Subsequently also the transferred inspectors of that department since ^1871. 
 were appointed to be the '' general inspectors '* of the new system. i._The 
 And it was left to the other two former departments, that ?PPortuu- 
 they, in their respective sorts, should be for special consulta- 1871-74. 
 tion, and special local inquiries. Thus, in respect of adminis- i.— The 
 tration, the new Office started virtually as a continuance of the office!^ 
 old Poor-Law Office. It derived from that source, not only its 
 
 Commons (final committee of July 27tli) a significant change in clause 5 had hcen 
 made on Mr. Stansfeld's motion, viz. that the provision should apply to " any 
 Secretary or Assistant Secretarij " instead of applying (as the clause previously 
 had it) to *' a Secretary or amj other Officer,'''' 
 
 * First, Mr. John Lambert, who from 1857 had been a poor-law inspector, 
 was promoted to he Secretary of the Local Government Board, in superincum- 
 bency to such sectional secretaries as had been transferred. "With the creation 
 of that new secretaryship, apparently the officers whom it superseded had liberty 
 of retirement from the service of the Board ; and the retirement of ]\Ir. Tom 
 Taylor, who had been Secretary of the Local Government Act Office, did in fact 
 take place in 1872 ; but in the case of Mr. Fleming, who had been the Secretary 
 of the Poor Law Board, retii-ement, though at first contemplated, was not carried 
 into effect, and, instead of it, Mr. Fleming, after an interval, was associated with 
 Mr. Lambert as General Secretary to the Local Government Board ; which 
 position he retained till his death in the spring of 1876. Similarly the two 
 Assistant-Secretaries and the Chief Clerk of the late Poor Law Board became 
 the Assistant-Secretaries and the Chief Clerk of the new department. Of 
 the two former officers, one had been the Legal Adviser of the Poor Law 
 Board, and he was now made Legal Adviser of the new Board in regard to 
 all its divisions of work. 
 
 Mr. Lambert, in 1871, when appointed Secretary to the Local Government 
 Board, was a solicitor of some thirty-five years' standing, and (as above noted) 
 had for the last fourteen years been an Inspector under the Poor Law Board. 
 As solicitor, he had practised for many years in Salisbury ; where also he had 
 been distinguished in the municipal affairs, and in 1854 had been Mayor. In 
 office as poor-law inspector, he had more than once done eminent public ser- 
 vice; notably in 1865, in relation to the relief of the distress then prevalent 
 in the cotton-manufactui'ing districts of England, and again in 1867, in relation 
 to amendments which then had to be made in the system of appliances and 
 chargeabilities for the relief of the metropolitan sick poor; his special knowledge 
 of municipal statistics, and no doubt also his general ability, had been of ser- 
 vice to different ministries when considering questions of change in the 
 parliamentary representation of the country; and during 1869-71 (as before 
 noted) he had been a member of the Royal Sanitary Commission, Mr; 
 Lambert remained Secretary of the Local Goveriunent Board till the close of 
 1882. In 1879, he was decorated K.C.B., and in 1885 (after having served 
 as Commissioner under the Re-distribution of Seats Act) was made- a Privy. 
 Councillor. 
 
 X 2 
 
356 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 i.— The 
 opportun- 
 ities of 
 1871-74. 
 
 1.— The 
 Central 
 Office. 
 
 parliamentary President and Secretary^ but likewise all its per- 
 manent secretariat, and its system of provincial agencies. 
 In relation to the interests of the Public Health, it was as if the 
 Act had ordered that the old Poor Law Board, subject only to 
 such conditions of consultation and reference as itself might 
 impose on itself, should be the Central Sanitary Authority for 
 England. 
 
 It appears to me that this first constitution of the new 
 Department was not of unclouded promise for sanitary ad- 
 ministration. So unbalanced a derivation from the former 
 Poor-Law Office was itself, I think, to be regarded with mis- 
 giving ; not simply on account of that Office's having hitherto 
 had no experience in affairs of general sanitary government ; 
 but somewhat also because of the spirit of the Office's previous 
 administration in the matters where it had had medical re- 
 sponsibility."^ And akin to that point was another which de- 
 serves notice. The supremacy which had been reserved for 
 secretaries and assistant-secretaries in the new office gave ex- 
 cellent security for the due fulfilment of notarial duties, but, 
 in its announced form, did not give obvious security for the 
 deeper requirements of sanitary administration. The provision 
 that the notarial officers might do " acts "" on behalf of the 
 Board, unlimited by any condition that for '^ acts " of sanitary 
 business the notarial officer must have the sanction of skilled 
 concurrence, implied what I cannot but think to have been, in 
 the circumstances, a dangerously wide discretion or option as to 
 the cases in which skilled advice should be taken. Facts being 
 as they were, it was not unlikely that the officers charged with 
 the discretion might measure their needs for skilled assistance by 
 a standard substantially the same as that which the old Poor-law 
 Office had applied ; and if so this could hardly fail to establish 
 invidious and unsuitable distinctions between inner and outer 
 circles, respectively secretarial and technical, in the sanitary 
 councils of the Board. Nothing can be farther from my intention 
 than in any degree to under-rate the highly important and 
 necessary services w^hich would be distinctively for the secretariat 
 to render. Clearly it would be requisite that the new office in its 
 public-health business (just as in business of all other sorts) 
 * See particulars at end of last chapter. 
 
THE REIGN OF QUEEN VICTORIA. 357 
 
 should pay due reo^ard to all proper conditions of form, and S^-?^- 
 
 1 1 J 1 • 1 1 1 T English 
 
 should proceed on strictly legal lines, with orderliness and con- State 
 sistency of method ; and for the purpose of eosuring objects since 1871. 
 of that sort in a many-branched large department of State, i._The 
 clearly it might be necessary that the chief notarial officers ppport^u- 
 should be entitled to use special powers : but legality and form 1871-74. 
 and order were not all that in the present case had to be cared i.— The 
 for. It would be incumbent on the new administration to office^ 
 fulfil conditions of knowledge and initiative endeavour in 
 a subject-matter ail-importantly technical ; not merely 
 technical in its scientific foundations abstractedly considered, 
 but equally technical in the administrative applications of 
 the science to acts of sanitary government ; and the scheme 
 hitherto shows no signs that adequate care had been taken for 
 the fulfilment of those vital conditions. The sanitary branch 
 of the public service had peculiarly grown out of the exercise 
 of technical observation and contrivance, and would of necessity 
 in the future be dependent on the same faculties for its chief 
 means of usefulness to the public : but, although the officers 
 who during many years had been the amassers of sanitary ex- 
 perience, and had till then represented it in administration, had 
 been transferred to the new Department, no clear provision 
 had been made for their having influence in it : the secretariat 
 (as before shown) having been made administrative in as un- 
 conditional a sense as if no technical officers existed, or as if 
 mere clerkship were meant to be the Office's sanitary strength. 
 No doubt there was the theory of consultation ; and no doubt 
 the transferred Medical Officer of the Privy Council, as well as 
 the transferred Engineer-Officers of the late Local Government 
 Act Office, was duly pigeon-holed there for reference ; but the 
 existence of technical officers, described as for consultation, may 
 represent extremely different degrees of utility at the option of 
 those who control the service ; and the mere consultability of a 
 Medical Officer at the discretion of others would not be a definite 
 security for the interests of which I am writing. Considering 
 in how many and essential respects the responsibilities of the 
 Board were to be technical, I am clearly of opinion that the 
 powers of administration given to the secretariat ought not to 
 have extended unconditionally to such matters ; but, on the other 
 
358 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 i.— The 
 opportun- 
 ities of 
 1871-74. 
 
 1.— The 
 Central 
 Office. 
 
 hand, a system of formal conditions in such matters might 
 easily lead to disadvantages of circumlocution and delay. 
 From between the horns of that dilemma, necessarily belonging 
 to any too rigid one-secretary system, a partial alternative 
 would have been that certain powers to ^' act " for the Board 
 should be expressly reserved for technical officers ; and, 
 looking to the medical part of the question, I may note that 
 certainly in my opinion such reserve ought at least to have 
 been made with regard to the management of the inspections.^ 
 Supposed for instance, that the Board on any given occasion 
 has to inspect and assist in some local difficulty (perhaps of 
 urgent kind) as to an existing prevalence of disease, would it 
 not be prejudicial to promptitude and efficiency of service that 
 the " acts '' of directing the medical inspector and receiving his 
 reports should be only for a non-medical secretary or assistant- 
 secretary to perform ? and if rale to that effect existed only to 
 be w^aived, question might well be asked why it should exist. 
 Generally as to the constitution of the new Office and its 
 councils, reasonable priiiciples would have been, that, so far as 
 the Office was to transact sanitary business, and to deal with 
 questions of sanitary policy, the Secretaries and the Medical 
 Officer should be regarded as one consultative body advising 
 the Minister; and that delegated powers of action, whether 
 delegated to the Secretariat or to the Medical Officer, should be 
 exercised in the spirit of a joint trust. 
 
 Nothing further can here be said of the status assigned to 
 the Medical Department in the new Office ; for necessarily that 
 relation would remain in great part undefined till the inspec- 
 torial arrangements of the Board should be decided; and the 
 definition which it eventually received will be shewn hereafter 
 in the narrative. 
 
 2.— The 
 local 
 appoint- 
 ments. 
 
 2. Mr. Stansfeld's next business, first in Parliament, and 
 afterwards administratively, related to the problems of local 
 organisation for local sanitary purposes. 
 
 The Report of the Boyal Commission had practically settled 
 
 * Reserves such as the text indicates could readily have been made by the 
 Board, if Section 5 of the Local Government Board Bill had not undergone the 
 change which is mentioned in the footnote of page 354. 
 
THE REIGN OF QUEEN VICTORIA. 359 
 
 what should be the constitution o£ the new local authorities ; but, Chap. XV. 
 on the question of the offices to be constituted under those stLfe^ 
 authorities, the Report had in some respects failed to command ^^e^STi. 
 equal assent ; and, at such points, the Minister who proposed . _^ 
 legislation would be called upon to exercise very carefully an in- opportuu- 
 
 itics of 
 
 dependent judgment of his own. The Commission (as before 1871-74. 
 stated) had recommended an universal system of Medical Officers 2.— The 
 of Health and Inspectors of Nuisances ; the country had shown no ^°^^l . 
 
 . . . appomt- 
 
 unwillingness to accept that large creation of new functionaries ; meuts. 
 and Parliament, as now soon appeared, was willing to charge 
 itself annually with half the cost of the new service ; but the 
 value of the proposed appointments would almost entirely depend 
 on the detailed conditions under which they should be made ; 
 and, while the general facilities for advance were singularly 
 great, the difficulty as to the conditions of advance was consider- 
 able. Especially with regard to the Officerships of Health (as 
 was fully argued in my last chapter), while there were strong 
 technical reasons against attempting to found the system on a 
 basis of such extreme subdividedness as the proposal of the Com- 
 mission for the officerinp" of rural and minor-urban districts 
 would involve, and while on the other hand local facilities for 
 some less fractionised system were yet unformed, politicians 
 might well hesitate against the expediency of proceeding at once 
 to universal compulsory legislation in the matter, and, for those 
 and other reasons, might prefer to try more gradual legislation. 
 Anyhow, the legislator who meant to advance must face the 
 difficulty of exactitude, and must take the trouble to know what 
 object he really meant to attain. If the local offices were to be 
 made matter of express law, and especially if of compulsory law, 
 the intended functions of each office, and the intended local range 
 of function for each, would have to be considered in detail from 
 beforehana ; and particularly the medical office would need some 
 sort of legal definition and security in respect of its intended 
 qualifications and duties and rights. With regard to the par- 
 ticular proposals to be made, the scheme of the Royal Commission 
 was of course not binding on any Minister who could see his 
 way to improve on it ; and he apparently would have every 
 desirable freedom and facility for doing justice to the businesp 
 before him. 
 
360 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. It is noteworthy that Mr. Goschen, in 1871, when having 
 
 state ^ to deal with this matter in connection with his scheme of local 
 
 rinSTsn sanitary government, had decided not to attempt to compel the 
 
 ^, local appointments. He possibly would not have been satisfied 
 
 opportun- to accept in detail the scheme of appointments which the 
 
 iS7i°74. Commission had recommended, and yet may not have been 
 
 o _rjij^g prepared to propose an alternative scheme ; anyhow he seems to 
 
 1°^^^. , have concluded that the matter, even if at some time to be for 
 
 appoint- . 1 • r 1 
 
 ments. compulsory legislation, was not at that time for such treatment ; 
 Course and so, not even deeming it necessary for his purpose to make 
 (iSschen^' separate mention of the offices named by the Commission, he 
 had pro- simply aimed at securing in general terms that each local 
 authority (whether for parish or union or county) should have 
 discretion and power to appoint and pay any such officer as 
 its duties might require."^ 
 f^id ^h^^^ ^^' Stansfeld took the opposite course ; and, taking it in the 
 
 tains im- manner he did, showed plainly how many pitfalls were in it. 
 enactment. Section 10 of the Public Health Act of 1872 enacted nominal 
 compulsion for the offices ; but to compel in reality was less easy. 
 Section 10 did not provide against mere simulations of obedience ; 
 nor did it even settle, as to areas and populations, the question 
 of the quantitative scale on which the commanded appointments 
 should be made. Professedly imposing the new offices on all 
 local authorities, but not laying down any standard of quality or 
 quantity as to the constitution of the offices, nor assigning to the 
 central authority any general power to lay down such standard, 
 its command, that the offices should be created, was mere com- 
 mand of algebraic X and Z,\ Was it not to be feared that, under 
 so vague a command, each commanded authority would obey 
 only so far as it liked ; and therefore that the effect of Mr. 
 
 * Rating and Local Government Bill, 1871 ; particularly section 22. 
 
 t Section 10, no doubt, did provide that, in cases where any portion of the 
 local salaries should be derived from moneys voted by Parliament, the Local 
 Government Board might exercise the same sorts of control over the conditions of 
 appointment and duty as it exercised in the case of district medical oflficers under 
 the poor-law ; and Mr. Stansfeld seems to have assumed that, under that provision, 
 and by means of the attractions of the parliamentary grant, the Board would have 
 every desirable influence with all local authorities, and would be able to shape as 
 it might judge best the whole new system of appointments ; but if such was 
 the anticipation, events (as will hereafter be seen) did not conform themselves 
 to it. 
 
THE REIGN OF QUEEN VICTORIA. 361 
 
 Stansfeld's " shall/^ as compared with that which Mr. Goschen's Ciiap. XV. 
 
 '^may^' might have had, would chiefly consist in its giving state 
 
 wide-spread occasion to the establishment of phantom offices ? gu^ce ibii. 
 
 In apology for liabilities of that sort, and in general explanation ^ _Tiie 
 
 of the case, it was afterwards arg-ued that the policy had been opportun- 
 
 . ities 01 
 
 " experimental '' or " tentative : "''' "^ but on this argument, the 1871-74. 
 reflection seems obvious, that, if in truth the fundamental con- 2.— The 
 ditions for the offices were still needing to be settled by local a^ppoij^t- 
 administrative experiments, it had been premature to enact a ments. 
 statutory '^ shall ''^ for the universal institution of the offices, and 
 Mr. Goschen''s " may •'"' would have been the more fitting formula. 
 To the best of my belief, however, skilled persons in 1872 were 
 not in want of further experiment in order to advise 
 certain main conditions on which the local sanitary offices 
 should be appointed ; and they would certainly not have recom- 
 mended the command in blank which Section 10 pre- 
 sented. In that point of view, I again refer to the discussion of 
 the subject in my last chapter. Also, as regards one main part 
 of the matter, may be noted that, in the abundant discussion 
 which the matter had undergone during the year and a half since 
 the publication of the Report of the Commission, the reasons 
 against minutely subdividing the officerships of health, and 
 constituting them in general from the poor-law medical service, 
 had been well stated by persons of recognised special authority 
 in such questions, and had — I think I may say— been established 
 as unanswerable. In the House of Commons' debate on the 
 second reading of the Bill, those reasons had been very ably set 
 forth by Mr. (now Sir Lyon) Playfair ; but they seem not to 
 have adequately impressed Mr. Stansfeld till his time for giving 
 legislative effect to them had passed. His bill in its first 
 form, contemplating no other scheme of appointments than 
 that proposed by the Royal Commission, had been so drafted 
 as specially to favour the appointment of poor-law medical 
 officers to be health-officers for their respective poor-law sub- 
 divisions ; and subsequently, in concession to the reasons urged 
 
 * See in Reports II. and III. of the Local Government Board, and in the 
 Reports (hereafter to be more particularly quoted) which were made in 1874 by- 
 eleven Local Government Board Inspectors on the introduction of the Public 
 Health Act, 1872. 
 
362 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 i.— The 
 opportun- 
 ities of 
 1871-74. 
 
 2.— The 
 local 
 appoint- 
 ments. 
 
 Communi- 
 cations 
 with local 
 authori- 
 ties as to 
 their ap- 
 point- 
 ments. 
 
 against that scheme, he had only gone so far as to introduce 
 into his clause words which would permit any one same officer 
 to be appointed for two or more sanitary districts. The 
 bill, with that modification, was no doubt meant to be 
 impartial between the different views (better or worse) on 
 which the authorities in different cases might wish to 
 constitute their respective health-officerships ; and in that form 
 it had become law.^ Unfortunately, however, not even the in- 
 tention of indifference had been well worked out in det^l ; and 
 Section 10 still tended to favour the making of petty {ippoint- 
 ments for rural and minor-urban districts. That is to say, it 
 gave ample facilities for the appointment of rural poor-law 
 medical officers to be health-officers for their respective poor-law 
 subdivisions ; but (as will hereafter appear) it offered no 
 reasonable facilities for the organisation of a good alternative 
 system.t 
 
 After the passing of the Act of 1872, the Board im- 
 mediately entered on communication with all the local authorities 
 in regard of the appointments which these bodies had to 
 institute.^ Offering to advise with them on the detail of the 
 arrangements they should make, the Board intimated that, where 
 the appointments were approved by the Board, and made subject 
 
 * Section 10 says : " the same person may, with the sanction of the Local 
 Government Board, be appointed the medical officer of health or the inspector of 
 nuisances for two or more sanitary districts, by the joint or several appointment 
 of the sanitary authorities of such districts, and, with the like sanction, any 
 district medical officer of a union may be appointed a medical officer of 
 health." 
 
 t See below, page 367. This, and the other chief defects on which I com- 
 ment, as in Mr. Stansfeld's legislation of 1872 regarding officers of health, were 
 more or less amended as to the future by the provisions of Mr. Sclater-Booth's 
 consolidating Act of 1875. See foot-note on page 3^7. 
 
 X Of the proceedings to which the text refers, official account was given 
 in the second Report of the Local Government Board, and more fully in Reports 
 which were made in 1874 by the eleven inspectors who had acted in the 
 matter. The last-named Reports, afterwards laid before Parliament (1875, No. 
 134) on Mr. Stansfeld's motion, were specially intended "to show the course 
 which each inspector had adopted with a view of giving effect to the recommen- 
 dations of the Board, and the manner in which those recommendations had 
 been acted upon by the authorities," with regard to the local appointments. 
 Exact particulars as to the effect which the proceedings had produced down to 
 July 1873 (when about three-fourths of the authorities had made their appoint- 
 ments) had been instructively given in a Parliamentary Return (1873, No. 359) 
 moved for by Dr. Lush. 
 
THE REIGN OF QUEEN VICTORIA. 363 
 
 to its regulations, half of the salary of each office would be paid S^"^*^^' 
 
 by the Board from moneys voted by Parliament ; and the Board State 
 
 subsequently issued General Orders with respect to the appoint- since 1871. 
 
 ments and duties of Medical Officers of Health, and Inspectors of £ _The 
 
 Nuisances in those cases where the salaries were to be partly ppportuu- 
 
 ■■■ -^ ities of 
 paid by the Board. The advice and assistance proffered 1871-74. 
 
 to the local authorities was to be given by functionaries 2.— The 
 whom the circular described as ''in possession of the views appoint- 
 of the Board on the subject^''; but even at this late period the ments. 
 " views of the Board " seem to have been of the most indefinite 
 kind; and the functionaries whom the Board sent to ex- 
 pound them, and to be the guides of the local authorities in 
 this difficult discretion, were not the Board-'s medical in- 
 spectors, who alone of the Board''s staff had had experience in 
 the matter, but were the Board^s non-medical or '' general " 
 inspectors."^ 
 
 At first, under those auspices, the authorities in parts of the 
 country were recommended to appoint the poor-law medical 
 officers to be health-officers in the respective poor-law subdivisions 
 of the sanitary districts ; f and appointments on that principle 
 
 * During the few months next after the legislation of 1872, many of the 
 freshly constituted local authorities (especially those of rural and minor-urhan 
 districts) were unquestionably more or less in want of central aid, not 
 necessarily technical, to start them on their first assumption of power, to 
 assist their first readings of the new law, and to guide, or perhaps some- 
 times even to propel, their formal beginnings of the new business ; and 
 though I have not information enough to speak exactly of the part which 
 the non-medical inspectors took in meeting that temporary demand for 
 " general " assistance, I feel sure it must have been of excellent and often 
 indispensable effect in helping inexperienced authorities to begin their work. 
 The commission, however, which the text describes was essentially not " general," 
 but technical ; requiring real familiarity with the duties of such officers as had 
 to be appointed ; and when the non-medical inspectors, with no experience in that 
 technical matter, were sent throughout England and Wales, to be questioned by the 
 local aiithorities as to the best mode of ordering the new sanitary appointments, 
 some of them may perhaps have wished they had not been promoted to a 
 position so like that of the extemporised herald in Quentin Durward, I may 
 nevertheless add that, considering the inadequacy of the law, I do not suppose 
 that even the medical inspectors, had they been appointed to the task, could 
 have faced without much embarrassment the authorities they would have been 
 expected to advise. 
 
 t See, in the above-quoted Return, 1875, No. 134, IMr. Doyle's letter of 
 October 23, 1872, as to Wales and Monmouth. At a later date, when the Board's 
 combination-policy was being pressed in other parts of the country, Mr. Doyle 
 
364 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 i.— The 
 opportun- 
 ities of 
 1871-74. 
 
 2.— The 
 local 
 appoint- 
 ments. 
 
 were being made with alacrity in those parts^ when the arguments 
 which from long ago had been urged against such ex officio 
 appointments, and the suggestions which had been offered for a 
 different system, seemed at length to have reached their destina- 
 tion, and the advice of the Board took a turn. By circulars 
 of November 12th (with enclosed copies of the General 
 Orders then issued with respect to the appointments in cases 
 where a portion of the salaries would be repaid from moneys 
 voted by Parliament) the Board, in language which applied 
 equally both to the Medical Health-Officerships and to the 
 Inspectorships of Nuisances, admonished the local authorities 
 as to the necessity of selecting for appointment persons 
 thoroughly qualified to discharge the important duties ; and then, 
 reminding the authorities that the object could not be attained 
 unless they gave adequate remuneration for the services required, 
 the Board advised them that, by entering into such local com- 
 binations as the Act allowed (two or more together) for joint- 
 appointment of officers, they *^ might in many instances ^^ be 
 enabled to '^obtain the services of persons specially qualified for 
 the work at a saving of cost to each locality."" From about this 
 time, the Board seems not only to have quite parted company 
 with the recommendations of the Royal Commission in respect of 
 the Officerships of Health, but more and more to have pro- 
 mulgated that the sub-divisional appointment of poor-law 
 officers (except as assistants to higher functionaries) would 
 be radically wrong. The principles which had now come to 
 be recognised as right — (and it is to be regretted that the 
 recognition had not come twelve months earlier) — were : that 
 all appointing authorities ought to aim at the appointment of 
 high-class officers, specially skilled and adequately salaried, who 
 should give their whole time to the public service, and for whom 
 the poor-law officers should (or at least might) act as sub- 
 divisional assistants ; that authorities, not able to make such 
 high-class appointments by their separate action, ought to 
 combine for the purpose with other authorities in such number 
 
 recommended for his division (in effect) that the poor-law officers who had been 
 appointed officers of health should be converted into assistant-officers, and act 
 under Superintending Health-Officers, of whom the authorities should appoint 
 four for the division; but the authorities declined to follow this recommendation. 
 
THE REIGN OF QUEEN VICTORIA. 365 
 
 as would jointly support the high-class appointment ; that this Chap. XV. 
 system of joint-action was the only one which the Board could state ^ 
 deem generally fit for the rural districts and (at least) the ^^e^j^n 
 smaller towns of the country. By the inspectors, this new . _ 
 policy seems to have been advocated and pressed with much zeal in opportun- 
 all parts of the country ; most of them urging that appointments 1871.74, 
 on any other system would be of comparatively little public 2— The 
 value : but they had no legal power to enforce the policy ; nor ^^^^^. 
 had their argument any other extrinsic support than in such ments. 
 references as they may have been authorised to make to the 
 Board's discretionary command of the parliamentary grant. 
 
 The degree in which the local authorities could be induced to The 
 accept the new recommendations may be learnt, in great part, appoint- 
 from Dr. Lush''s Return, made at a time when about three- wSchwere 
 fourths of the entire number of authorities (1,104 out of enume- actually 
 
 ^ made. 
 
 rated 1,468) had filled their appointments."^ There does not, I be- 
 lieve, exist any official abstract of that Return ; but according to Preponder- 
 an unofficial abstract which is before me, and which I believe to be petty ap- 
 substantially accurate, the facts with regard to the 1,104 sanitary ^e^ts. 
 districts (omitting cases where the information is insufficient for 
 analysis) were as follows : — that large-area combinations, debar- 
 ring their respective officers from private practice, had been 
 established in 35 cases, including 142 rural and 108 urban 
 districts ; f and further that, of uncombined districts, there were 
 23 (16 urban and 7 rural) where the one authority had similarly 
 appointed a " whole- time " officer ; J but that, in all the remain- 
 ing 831 districts, the appointed officers of health (sometimes 
 several in a single district) were persons continuing in private 
 practice ; and that, so far as the salary of an officer may be taken 
 to indicate the quantity and quality of work expected from him, 
 these officers in a large majority of the cases were not subject to 
 
 * Return (before mentioned) No. 359 of the Session of 1873. 
 
 f Besides the 35 large-area combinations which had "whole-time" officers of 
 health, there were 29 combinations, for the most part on a comparatively small 
 scale, which did not debar their officers from private practice. 
 
 X It is not to be understood that all those "whole-time" appointments by 
 single authorities were consequent on the recommendations of the Local Govern- 
 ment Board, or even on the legislation of 1872. Some of them dated from 
 earlier times : — €.(/., the Liverpool appointment, with its salary of £1,000, dated 
 from 1847. 
 
366 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 i.— The 
 opport\in- 
 ities of 
 1871-74. 
 
 2.— The 
 local 
 appoint- 
 ments. 
 
 The large 
 area 
 appoint- 
 ments. 
 
 any serious public demands in proportion to their business as a 
 whole. It would appear, namely, that in some instances, no pay- 
 ment was assigned, while in others, the salary ranged down to £2 
 or £3 per annum ; that, out of 273 uncombined rural districts for 
 which the facts had been given, 81 had among them 360 health- 
 officers with an average salary of j821 10s. for each officer; "^ and 
 that out of the 453 uncombined urban districts for which the 
 facts had been given, there were 250, or more than half, in 
 which no salary exceeded £25, and in which the average salary 
 was bat £14 10s. Facts such as those have to be read in con- 
 nection with various statements incidentally made in some of the 
 inspectors^ reports, as to the unwilling temper in which the ap- 
 pointments were often being made, and as to the facilities which 
 existed for ^^ a merely colourable compliance with the Act.'''' f 
 
 The 35 large-area combinations, which peculiarly represented 
 the later policy of the central Board, and which the Board had 
 ardently used its efforts to promote, did not present the features 
 
 * In the remaining 192 uncombined rural districts, the appointments appear 
 to have ranged as follows. In each of 35 cases, the rural district was divided 
 between two officers, and the average salary of each officer was £44 12s. 6d. In 
 each of 157 cases, the whole rural district was assigned to a single officer, at a 
 salary which in 45 cases averaged £40, in 58 cases averaged £80, in 47 cases 
 averaged £153, and in 7 cases (the 7 in which the officer was debarred from 
 private practice) averaged £343. If the last-named 7 cases were omitted, the 
 average salary for each imdivided rural district was £91 ; and the range was 
 from a minimum of £15 (in two cases) to maxima (in twelve cases) of £200, 
 £210, £225, £250, and £260. 
 
 t The words are I^Ir. Corbett's, at page 43 of Mr. Stansfeld's Eeturn, 1875, 
 No. 134. At page 10 of the same Return, Mr. Peel reminds the Board that 
 " the Act was most distasteful to many Boards of Guardians " ; he says that 
 " many sanitary authorities were strongly opposed to the appointment of medical 
 officers of health at all, feeling that the real work to be done would rest with the 
 inspector of nuisances, and that the power of calling in a medical officer when 
 requisite would have answered all pm-poses " ; and he points out how easily an 
 authority (not receiving money from the parliamentary grant) can "make ap- 
 pointments at nominal salaries with undefined duties, and so practically defeat 
 the Act altogether." At page 90 IMr. Longe observes that " undoubtedly many 
 of these officers, both officers of health and inspectors of nuisances, are 
 inadequately paid ; and I certainly think that in some cases the smallness of 
 salary implies a disinclination on the part of the authority to encourage an active 
 administration of the law." At page 106, Mr. Fleming fears that "in too 
 many cases the appointments have not been made to fm'ther the intentions of the 
 Public Health Act, but with the view of preventing irksome interference, and of 
 complying, with the least expense, with the absolute requirements of the 
 statute." 
 
THE REIGN OF QUEEN VICTORIA. 367 
 
 of good organisation. Anyone could see tliat they were . facts Chap. XV 
 of administrative after-thought,, under a law not intended to state 
 provide for them. Authorities might have concurred in the ap- since^isn 
 pointment of an officer, but, when once the appointment was made, j _rj^g 
 no further concurrence existed : nor did the law contain any pro- opportun- 
 
 ities of 
 
 vision for the creation and maintenance of a joint-committee, to 1871-74. 
 which the co-appointing authorities might delegate for continuous 2.— The 
 use any of their powers in relation to the appointed person.^ The ^p^p^jj^t- 
 officer was the servant of many different authorities, each of ments. 
 whom was entitled to hold meetings, and to consult and order and 
 regulate, with entire independence of the others ; and the officer, 
 unless of more than average ubiquity, could hardly find himself 
 able to attend in person at the meetings of the respective 
 authorities as often as would be requisite for the duties and 
 influence of his office. Also, the law had provided no sort of 
 safeguard for the reasonable stability of the joint-appointments, 
 even when they involved renunciation of private practice ; no 
 stability, even as against the mere whim or ill- temper of an 
 individual authority ; and since the first co-appointments were 
 for limited terms, an officer's " whole-time "'' engagement was 
 liable to come to an end, not for any fault attributed to himself, 
 but simply because the authorities which had co-appointed him 
 would not agree again to act together. f 
 
 * This defect was noticed in some of the Inspectors' Reports ; see in the 
 Return, page 9, Mr. Henley ; pp. 104-5, Mr. Fleming. The state of the case 
 was altered as to future appointments by the passing of the Public Health Act 
 of 1875. That Act's 286th section, allowing the Local Government by order or 
 provisional order imder certain conditions to unite districts for the purpose of 
 the appointment of an Officer of Health, gave the Board full power to provide 
 that the districts so united by it should be able to act in joint-committee by 
 persons respectively representing them ; and, so far as that section has been 
 used since 1875, no doubt the appointments which have been made under it are 
 without the difficulty which hampered the early appointments. From the 
 statement, however, which is given at page cxxi of the Board's Eighteenth 
 Annual Report, it appears that, at the end of the year 1888, combinations 
 affecting 29 rural and 24 urban districts were all that had yet been made under 
 section 286. 
 
 t That many of the early combinations were discontinued at the earliest 
 opportunity is sho^vm in the Reports of the Local Government Board : which, for 
 the end of 1874, counted 80 existing combinations, but, for the end of 1876, 
 only 44. Dr. Cornelius Fox, one of the ablest and most zealous of the first 
 appointed Officers of Health, has publicly stated, with detailed reference to 
 facts, that in his own case, and two other cases of the same class, large-area 
 
368 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. In addition to weaknesses as above, whicli were due to in- 
 State considerateness of legislation, there was in some of the larger 
 ^ceTsfi. joint-appointments very damaging shabbiness of construction. 
 • —The ^^^ acceptance of combinations had often rested too much on 
 opportun- the hope of making a specially cheap compromise with the 
 1871-74. intentions of the law; and the conditions requisite for the 
 2.— The efficiency of the office had not been enough insisted on. Com- 
 ^^^^^nt binations had been sanctioned of such magnitude, sometimes as 
 ments. to mere number of authorities, and sometimes also as to the 
 area over which the officer would have to act, that a single- 
 required handed discharge of the duties would be more than any 
 in the large reasonable system could expect; for there were cases where an 
 officer of health was appointed to advise (and presumably to 
 attend) thirteen or fourteen or even seventeen different authorities; 
 and there were cases where the one officer^s area of duty ex- 
 tended to more than a thousand square miles. No competent 
 person, so far as I know, had ever suggested the large-area 
 appointments, except on the supposition that, in such a system, 
 the poor-law medical officers in their respective localities would 
 be regular assistants to the areal chief officer; but, in the 
 organisation of these actual appointments, that condition had 
 been left unfulfilled. The advising inspectors, when they began 
 their advocacy of the system, had seemed fully aware of the 
 importance of the condition ; ^ but when it came to be under- 
 stood as a drawback from the promised cheapness of the large 
 combinations, they apparently were not instructed to insist upon 
 it ; t and the Board which sanctioned the huge appointments 
 above described must be supposed to have considered the duties 
 possible. 
 
 combinations which had engaged " whole-time " officers were brought to an end, 
 and the respective officers were thrown out of employment, through the circum- 
 stance, in each case, that one of the authorities had taken offence at its officer's 
 truthful report to it of certain village-nuisances requiring removal. See a re- 
 mouvstrative paper, entitled 27ie Impairment of the Efficiency of the Officer of 
 Health Produced by his fFant of Independence as a Public Official, read by Dr. 
 Fox in 1880 before the Cambridge meeting of the British Medical Association, 
 and afterwards published by him as one of his Dozen Papers Relating to Disease- 
 Prevention : Churchill, London, 1884. 
 
 * See in above-quoted Return : p. 5, Mr. Henley ; p. 42, Mr. Corbett ; p. 76, 
 Mr. Doyle ; p. 95, Mr. Hedley. 
 
 t See again in same : Mr. Henley, Mr. Corbett, Mr. Doyle. 
 
THE REIGN OF QUEEN VICTORIA. 369 
 
 As regards the Parliamentary grant in relation to the Chap. XV. 
 present matter, Mr. Stansfeld, on his estimates for 1873-74, state" 
 obtained a vote of £100,000 towards the year^'s payment of the gince^iSTi. 
 local sanitary officers. It was to be presumed that, in the long . _rpj 
 run, the assignments from any such grant as this would, so far opportuu- 
 
 itlGS of 
 
 as possible, be awarded on evidence of " results ^'': as had been 1871-74. 
 with the two subventions which the Privy Council had dis- 2. The 
 tributed — the one in aid of national education, and the one for ^'^^^^. . 
 
 ' appoint - 
 
 gratuities to public vaccinators : but, at this first starting with ments. 
 the new grant for sanitary officers, the only question which could . 
 
 be raised was as to the merits of the constitution of the appoint- tion of 
 ments. The principle having been laid down, that Parliament tary funds 
 was to pay the half -cost of only those appointments which the payment of 
 central Board should deem satisfactory, judicious rules as to the officers, 
 conditions of satisfactoriness would make the grant an important 
 influence in favour of really good local arrangements ; inasmuch 
 as local authorities, desiring to participate in the grant, would have 
 to conform to the standard of the rules. It was of course not 
 to be desired that enforcement of any unduly strict standard 
 should confine the distribution of the grant within narrower 
 limits than Parliament presumably intended ; especially it was 
 to be remembered that subsidised officers would be under positive 
 regulation by the Board, and that thus, if regulations should be 
 well enforced, and the work of individual officers be at times 
 inspected, siibsidisation might be made a valuable security for the 
 public service : but, on the other hand, it was certainly not to be 
 understood that largesse to local authorities was the principle of 
 the grant, and that the standard might be such as to attract 
 undeserving authorities to accept assignments of public money. 
 It was noticeable in 1872-73, at first blush of the present 
 business, that the local authorities were far from showing them- 
 selves indiscriminately eager to share in the Parliamentary grant 
 under such conditions as they supposed would attach to it ; and 
 particularly it was to be observed that, while the rural authorities 
 (previously habituated to subsidies under the poor-law) were 
 for the most part well-inclined to come to terms with the new 
 grant, the urban authorities were far more disposed to stand 
 aloof, as in doubt what consequences a subsidy might bring on 
 y 
 
370 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 i.— The 
 o|>portun- 
 ities of 
 1871-74. 
 
 2. The 
 local 
 appoint- 
 ■ments. 
 
 General 
 result in 
 regard of 
 the ap- 
 point- 
 ments. 
 
 them."^ In the present matter, however, they would not have 
 much to fear from the central authority's rigour of judgment ; 
 for a very little reading of Dr. Lush^'s Return is enough to 
 show that health-officerships, organised on plans against which 
 the Board had for months past been arguing, were now deemed 
 not unfit to receive pecuniary signs of the Board^s approval. 
 Incongruous though it might be, that the Board should 
 subsidise local arrangements of the sorts against which it had 
 most pointedly reasoned and remonstrated, this was but tribute 
 to the Act of 1873. Loose law would have been discounten- 
 anced by stricter administration; and Section 10 being such 
 as it was, administration equally loose must keep tune with it. 
 
 The essential interest of the public in a national system of 
 health-officerships is, that each local authority or convenient 
 aggregate of authorities shall have in its service an officer of 
 adequate special qualification, responsibly commissioned and 
 bound to observe and inquire and advise with impartial public 
 spirit in all matters concerning the health of his district ; and 
 on examination by that standard, whether the above-described 
 legislative and administrative proceedings of the years 1872-3 
 had been successful, it must be evident, even at the present 
 point, that, in very large proportion, the purpose was not satis- 
 factorily attained. The system which had been compelled into 
 
 * According to the Abstract which I have before quoted, it would appear 
 that of the 1,104 authorities who at the time of Dr. Lush's Return, had appointed 
 their Ofificers of Health, 625 (including the 315 who were in combinations of 
 different sorts) were to receive half-payment of their respective salaries. As to 
 64 cases, definite infoixnation on the point had not been given ; but the number 
 stated as not to receive was 415 ; and, out of those 415, 343 were lu-ban. In that 
 large number of urban authorities withstanding the attractions of the grant, 
 there no doubt were some who had hitherto fulfilled their sanitary duties, and 
 were intending still to fulfil them ; but who, with legitimate pride of independence, 
 preferred to do their own duties in their own way, and did not want to be relieved 
 of the fair cost of the duties. It was believed, however, that the non-accepting 
 class included a far larger proportion of authorities, more or less inefficient and 
 neglectful, whom a subvention from the Parliamentary grant would not have 
 consoled for the necessity (supposed to attach to it) of undertaking real sanitary 
 work ; and when authorities of that sort had been practically left to themselves 
 under the law which told them to appoint new ofiicers, they were not likely 
 to appoint more effectively than the letter of the law obliged. Should it appear 
 that, during the years next after 1873, the proportion of subsidised authorities 
 consideraibly increased, the fact would perhaps not admit of onl}^ a fjivourable 
 interpretation. 
 
THE REIGN OF QUEEN VICTORIA. 371 
 
 being was likely in many parts o£ the field to prove unsound Chap. XV. 
 and inoperative ; and in large numbers of cases the appointments^ Stefe^ 
 judged by common rules of business-bargain, could hardly be ^^ce^sfi. 
 deemed of serious public purpose. It of course is not to be . 
 supposed, that, even with so large a quantity of failure, there opportuu- 
 would be no accompanying good. The fact that the Medical 1871-74. 
 Profession had been brought into statutory relations with the 2. The 
 Local Government of the kingdom, even though the relations ^^^^^. 
 were yet but of rude kind, was obviously in principle a fact of ments. 
 good sanitary promise; and it might also be deemed certain 
 that, in many of the appointments which had been made, proper 
 quaUtications of skill and character had been brought into those 
 new relations of public duty. No doubt, too, even where the 
 flood of appointments had l)een most indiscriminate, there fre- 
 quently would be elements of merit tending to fertilise where 
 their chance lay. The Medical Profession being of such spirit as 
 it happily is, those who knew it could feel sure that, by many of 
 its members who had become officers of health under conditions 
 most disadvantageous and discouraging, great exertions would 
 be made, great disinterestedness be shown, in trying to make 
 their individual appointments bear fruit : but a system is not to ^ 
 
 be judged by the good which a particular class, or exceptional 
 members of the class, can perhaps by personal self-sacrifice make 
 it yield ; nor will wise men expect that a great national reform 
 shall be achieved by casualties of good-nature. What had to 
 be deplored as the outcome of the proceedings was, not that the 
 new system of appointments offered no prospect of good, but 
 that its relative proportions of good and bad promise were 
 widely other than might have been expected, under skilful 
 management, from an opportunity which had been peculiarly 
 favourable. In view of the multitude of personal interests now . 
 identified with faulty local arrangements, there could be little 
 hope of soon substituting for such arrangements others which 
 might be of better promise for the public ; and the waste of oppor- 
 tunity was to that extent irremediable. Competent observers, who 
 had watched the progress and saw the issue of the enterprise, 
 uttered their thoughts of disappointment ; but for the time 
 it was a closed chapter. During the sixteen years which have 
 since elapsed, the opinions expressed in 1873 have been subjected 
 V 2 
 
372 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 i.— The 
 opportun- 
 ities of 
 1871-74. 
 
 3. Inspec- 
 tion of 
 Local 
 Sanitary 
 Govern- 
 ment. 
 
 Relations 
 intended 
 by the 
 Royal 
 Commis- 
 sion. 
 
 to the test o£ experience ; and to some of the latest of such 
 experience I shall hereafter have occasion to advert.^ 
 
 3. A third point at which to observe the influence of Mr. Stans- 
 feld^s Presidency is that of the scheme which had to be laid down 
 for the Board^s future relations to Local Sanitary Government. 
 
 In 1871, when the question was whether the Board should 
 be called into existence, there certainly was not any ambiguity 
 as to the objects for which the creation was proposed. Language 
 could hardly be more precise than that in which the Royal Com- 
 mission had described the utilities which the new Board must be 
 expected to fulfil. Besides what related to the continuance or 
 extension of merely sanctioning powers for different purposes of 
 Local Sanitary Government, everywhere in the Report intention 
 had been expressed or implied, that the new Authority should be 
 an energetic motive power for acceleration of sanitary progress : 
 helpful towards local authorities needing help ; admonitory and 
 stimulant towards local authorities in states of indolence or leth- 
 argy ; compulsory, so far as need should be, towards local authori- 
 ties in wilful neglect of duty. Intention to that effect had been 
 the very backbone of the Commission's Report. It was a 
 main ground on which the new Department had been recom- 
 mended; and it seems to me that in 1871, when the Local 
 Government Board came into being, its President had before 
 him in that Report a programme of endeavours to which the 
 Board was implicitly pledged. The policy, thus foreshadowed, 
 would have a legislative and an administrative side. In a legis- 
 lative sense, it would aim at procuring amendment in the com- 
 pulsive provisions of the law ; not necessarily in detail the pre- 
 cise changes which the Commission had recommended, but 
 amendment in the spirit of the recommendations; amendment, 
 enabling the Central Authority to bring adequate pressure to 
 bear on any Local Authorities whom, either on local complaint 
 or on its own initiative, it should find in wilful default of legally- 
 
 * See below, pp.403 and 420. For intermediate evidence on the working of 
 the Health-Officerships, see, in the Transactions of the Society of Medical Officers 
 of Health, 1881-82 and 1885-86, papers respectively by Dr. Armistead and 
 Dr. Seaton, and the discussions on those papers. See also Dr. Cornelius Fox's 
 before-quoted pamphlet of 1884 : likewise a letter by Dr. Seaton in the Times of 
 June 1, 1887. 
 
THE REIGN OF QUEEN VICTORIA. 373 
 
 appointed sanitary duties. And correspondingly, in an aclminis- Chap. XV. 
 
 trative sense, it would, as a first step, organise for itself a sK^^ 
 
 thoroughly efficient system of supervision, by which to observe ^co^mi 
 
 continuously and skilfully the progress of sanitary administration . 
 
 in all the jurisdictional districts of the country ; and by which to opportuu- 
 
 apply in particular districts any such information and guidance, or 1871-74. 
 
 any such, stirring-up to action, or any such more cogent pressure to 3 i^spec. 
 
 duty, as observation in the respective cases should show needful. *Jo^ o* 
 
 Sanitary 
 
 With regard to the first-named of those branches of policy, ment. 
 what took place was as follows. Mr. Stansfeld's Public Health 
 
 Bill of 1872, purporting to be based on the Report of the Com- f*orTarger 
 
 mission, did certainly in its first form contain clauses, such as the ^o^rective 
 
 . . . . junadic- 
 
 Commission had strongly advised, for extending and amending tion. 
 the powers of the Central Authority in relation to Local 
 Authorities in wilful default of sanitary duty, — see clauses 74 — 7 
 of the Bill of February 16th; but, during the interval which 
 passed before the Bill came to be discussed in Committee, Mr. 
 Stansfeld, desiring to lighten his task, had, in pro formd Com- 
 mittee, substituted a shorter Bill in which no such provisions 
 were proposed — see Bill of June 27th,- and that Bill having 
 become law as the Public Health Act, 1872, he did not, in the 
 next yearns session of Parliament, renew his proposal of the 
 dropped clauses. It may be that on second thoughts he pre- 
 ferred not to ask for his Board the greater corrective power, with 
 the consequent larger and more obvious legal responsibility, 
 which the Royal Commission had so expressly desired the new 
 Authority to bear. The humbler standard of legal responsibility 
 would no doubt be of much easier weight for official shoulders, 
 and, when apparently adopted by the first President of the Board, 
 was not likely to be soon abjured by his successors. It in fact 
 almost immediately became the Board's declared policy, and has 
 so continued to the present time."^ 
 
 * In 1874, when the Local Government Board promoted a Public Health 
 Act supplementary to the Act of 1872, the Bill contained no proposals of the 
 sort to which the text refers ; and in 1875, when the consolidating and amending 
 Act of that year was under discussion in the House of Lords, an independent 
 proposal (made by Lord Aberdare) to strengthen the Bill at the principal of the 
 points in question was resisted and defeated on behalf of the Local Government 
 Board. A remarkable subsequent assertion of the policy will hereafter come 
 under notice. — See below, p. 430. 
 
374 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XY. At this less ambitious level, with the proposed enlarg^ement of 
 
 Stafe^ central powers not brought into effect, the administrative respon- 
 
 sfnce^l87i. sibilities of the Board had still to be viewed, and as far as possible 
 
 ^ _rj,^^ fulfilled, in the spirit of the Royal Commission's Report : the 
 
 opportun- Board was, as far as possible, to fulfil, though by other means, 
 
 itiGs of 
 
 1871-74. the intention with which the withdrawn clauses had been pro- 
 3 Inspec- posed. When the Commission had urged that the law ought to 
 tjon of i^g more coercive than it yet was, nothing had been less in the 
 Sanitary mind of the Commission than that legal coercion was to be made 
 ment. an ordinary momentum for progress. Not even as to the more 
 
 tardigrade authorities had the Commission expected such to be 
 other'^thau the cvcnt. '^ The knowledge that [coercive] power is in reserve '' 
 oom fu/ would, the Commission believed, " act as a stimulus to Authorities, 
 sion. and render frequent recourse to these extraordinary powers un- 
 
 necessary/' Had the powers been as proposed, actual use of 
 them would probably never have been made except in isolated in- 
 stances of grossly obstinate and injurious illegality. In an 
 infinite majority of cases of local default, the amply sufficient 
 coerciveness of a Central Office is the coerciveness of knowledge 
 and public conscience ; and the Local Government Board's non- 
 possession of the greater legal coerciveness was a deficiency for 
 which compensation could probably be found in a more active 
 appeal to those other infiuences. Anyhow, the value of the 
 Board, as a motive power for sanitary progress under the new law, 
 would depend almost exclusively on the educational influence it 
 could exercise; and this must above all be a question of the 
 system on which it would inspect and advise. Its inspectorial 
 service would have to be a highly-qualified Intelligence-Depart- 
 ment in relation to the different aspects of local duty : and the 
 effectiveness which the inspectoriat would need for purposes of 
 local observation, it would equally need for purposes of giving 
 local advice and assistance. In the circumstances, too, it was 
 much to be desired that the proper system of superintendence 
 should be brought into work as promptly as possible ; for t/ien 
 was the time, the passing time, in which the promised central 
 influence could be used with better effect than perhaps ever after- 
 wards. In 1873, namely, there stood the many new authorities 
 and new offices, beginning as it were to take their bias for life. 
 Sapiunt vasa quicquid j^rimum acceperint ; and the state of local 
 
THE REIGN OF QUEEN VICTORIA. 375 
 
 sanitary government in England at a distance of twenty or thirty Chap. XV. 
 or forty years from the date of the Public Health Act of 1872 state 
 would in great part depend on beginnings made within the first since ^871. 
 two or three years of the period, and on the question whether . _rpj^g 
 those beffinnino^s, if often at first not rightly made, had been opportun- 
 
 . . ities of 
 
 allowed to become rooted habits. Surely the first constitution of i87i-74. 
 the Board^'s supervisional service had to be planned with mindful- 3 jngpec. 
 ness of that issue. ^^J^f 
 
 Sanitary 
 
 The field of local sanitary administration over which the ment. 
 Board was to exert influence had to be supervised, with right 
 proportions of care, from two essentially different points of view, g^nita^y 
 which may be distino^uished as the legal and the medical ; ^ supervi- 
 and it was to be desired that, from those different points of view, all 
 requisite knowledge should systematically reach the Board with 
 regard to each district under its supervision. From the le^al 
 point of view, and with the statute-book as its chief standard of 
 judgment, the Board would have to observe the constitution and 
 movements of the administrative machinery in relation to the 
 express requirements and permissions of the law; whether all 
 requirements concerning the functions of authorities, particu- 
 larly in matters of regulation and finance, and in the appoint- 
 ment and ordering of officers, and in the provision of appliances 
 and services, were at least ostensibly obeyed ; whether all per- 
 mitted facilities for the expedition of business were being 
 
 * It would "be easy to name other possible points of view beside the two 
 which my argument opposes ; but the others, in my understanding of the case, 
 would be found to represent subdivisions of view rather than essential contrasts. 
 Thus, it of course is not overlooked that, in a large proportion of cases, engineer- 
 ing technic is an important factor in the Board's sanitary supervision ; but the 
 argument needs not therefore assign to that technic a third and separate point of 
 view, as apart from the two which the text mentions ; for generally the introduc- 
 tion of engineering technic is of secondary relation to one of the other points of 
 view; either is on legal motion, in consequence of some statutory complaint 
 relating to sewerage, or water-supply, or nuisance-removal ; or else is on medical 
 motion, in consequence of injuries found resulting to health from the absence 
 of proper engineering action as to sewers, water-supply, or otherwise. In the 
 mere logic of the case, however, there evidently is no reason why the Board 
 might not, if it saw fit, charge its Engineer-Inspectors to be systematic contri- 
 butors to its scheme of legal supervision ; annual reporters, how far the sanitary 
 law is being obeyed in respect of the engineering appliances and services which it 
 expressly commands. See footnote below, p. 382. 
 
876 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 Euglish 
 State 
 Medicine 
 since 1871. 
 
 i.— The 
 opportun- 
 ities of 
 1871-74. 
 
 3, Insjiec- 
 tion of 
 Local 
 Sanitary 
 Govern- 
 ment. 
 
 duly turned to account ; and whether the local bodies per- 
 formed their expressly defined statutory business in a regular 
 and business-like manner. On the other hand, from the medical 
 point of view, the Board would have to know how far the 
 objects were being attained for which the law had consti- 
 tuted the local machinery ; how far the machinery was working 
 with reality and success for the removal of causes of disease ; 
 and how far in each district under the law the existing con- 
 ditions of life were conditions proper for health. From its 
 legal standpoint, manned exclusively by legal or quasi-legal 
 officers, the Board could obtain its record of all formal acts of 
 local sanitary administration, but would hardly approach the 
 question of their substantial merits ; and if it desired to measure, 
 in respect of any of the recorded acts, how far the intentions of 
 the law in matters deeper than forms of law had been fulfilled, 
 it would have to employ as its observers persons specially 
 skilled in the respective branches of subject-matter — engineering, 
 or medical, or both, as the case might be. "^ So soon as this 
 stage in the process should be reached, the further central super- 
 vision would in general admit of being exercised with more con- 
 venience and better effect from the medical than from the legal 
 point of view. Of the distinctive relation of Medicine to the 
 business of sanitary supervision, I cannot think it requisite to 
 say much. Over the whole field which is in question, if local 
 administration is to be intelligently supervised, not as mere 
 mechanism but as mechanism of definite purpose, the standards 
 of medical knowledge must be almost everywhere applied. 
 Every object at which the local administrator has to aim in 
 his sanitary business has been dictated to him, directly or in- 
 directly, by medical science; and it is for medical observation 
 eventually to pronounce whether or not he has attained his aim. 
 To Medicine therefore belongs, not an accidental, but an essential 
 share, in whatever supervisory function the Central Authority 
 has to exercise in respect of local sanitary government; and 
 to a very large extent the medical considerations are those 
 which must be of first use in any central criticism of local action. 
 
 * Take for instance the question, whether a local authority has fulfilled the 
 true requirements of the Public Health Act, 1875, as to sewers, or the true require- 
 ments of that Act, and of the Public Health (Water) Act, 1878, us to supplies of 
 water. 
 
THE llEIGN OF QUEEN VICTORIA. 377 
 
 The sanitary law no doubt gives direct command with regard to Chap. XV. 
 the creation of local authorities and officers and as to some of state 
 their duties; and it can be assumed that thus far the matter ^^J^71 
 belongs primarily to the province of legal supervision ; but such . 
 direct command is of small proportion to the whole subject- opportun- 
 
 it IPS of 
 
 matter of sanitary administration ; incomparably the larger part 1871-74. 
 of the field over which the Central Authority has to watch is 3 jngpec. 
 province for the exercise of discretion ; and over that very wide *?-°^ ^^ 
 extent of discretionary administration, questions of right and Sanitary- 
 wrong are hardly to be raised except with more or less appeal ment. 
 to medical judgment. 
 
 The Royal Commission, in its comments and recommendations 
 on the supervision which would have to be exercised by the new 
 Authority, had not treated all parts of the subject with equal 
 fulness, but had more particularly contemplated the field from 
 the point of view which I have spoken of as the legal ; and 
 estimating chiefly as from that side the machinery needful for 
 supervision, it had had more to say of the inspections which it 
 classed as '^ general '^ than of those which it classed as ^^ special.'" 
 The former it had regarded as homogeneous with the work of the 
 non-medical poor-law inspectors; so that probably the "general' 
 inspection in those two branches could be done by one class of 
 officers ; and it had recommended that inspection of this sort 
 should be systematic. "^ Regarding ^^ special '' inspections, the 
 Commission had not made detailed recommendations : but it of 
 course had not overlooked that there must be medical as well as 
 legal supervision ; and, in terms which though indefinite were not 
 obscure, it had given leading suggestions on which the Minister 
 could act — the suggestions which the abstract in my last chapter 
 mentions ; that the inquiries under the new system were to be in 
 much-enlarged extent, that the chief medical ofiicer was to be in 
 superintendence of all sanitary arrangements, and that medical 
 
 * In the Bill to which I have hcfore referred as an aid to interpretation of 
 the Keport (see footnote of page 329) the proposals as to " general " inspec- 
 tion are given in somewhat amplified form. With regard to the difference 
 noted in the text, that the views of the Commission are more definitely formu- 
 lated as to the '* general" than as to the "special" inspections, it may be 
 remembered that the Commission- had had the advantage of counting among its 
 members, in the person of Mr. Lambert, an experienced and most able repre- 
 sentative of the poor-law system of "general" inspections, but that the other 
 sorts of inspectorial experience were not similarly represented on the Commission. 
 
378 
 
 ENGLISH , SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 i.— The 
 opportun- 
 ities of 
 1871-74. 
 
 3. Inspec- 
 tion of 
 Local 
 Sanitary 
 Govern- 
 ment. 
 
 Principles 
 on which 
 to define 
 the new 
 duty. 
 
 inspectors would act as communicators between him and the local 
 officers of health. As to the whole matter of inspectorial 
 machinery, however, the Commission had expressly taken for 
 granted that the Minister to be put into charge of the Depart- 
 ment must have a ^' wide discretion " in his hands ; and the free 
 exercise of such discretion was mqst of all to be expected where 
 the recommendations of the Commission had been least precise. 
 
 The discretions which the Commission had supposed in the 
 hands of the Minister with regard to the future working of the 
 Medical Department, and of the other services classed as " special,'^ 
 concerned matters on which already there was technical experience 
 enough to suggest policy. On assumption that, from the legal 
 point of view, adequate control would be exercised over Local Sani- 
 tary Authorities in respect of their conforming to law in matters 
 of express legal requirement or condition, and that the central 
 assistance they might need in and about such matters would be 
 duly afforded them through appropriate officers, the question as 
 to other central interference in affairs of Local Sanitary Govern- 
 ment had to be argued, I think, to some such effect as the follow- 
 ing. In the British system of local government, the general in- 
 tention is, that all which ought to be done for local interests 
 shall be done by locally elected authorities, with discretion as to 
 modes and means of doing, and subject only in certain cases to 
 certain central sanctions. It is not intended that the central 
 authority should act in local affairs unless the local authorities 
 have defaulted ; it is presumed that localities, like individuals, 
 will, in what primarily concerns their own interests, not wait 
 for the State to act for them. And as the central authority is 
 not needlessly to act in local matters, so it is not needlessly to 
 direct or dictate in them, — is not to intervene by anticipation in 
 anything which the law leaves for local discretion, — as, for 
 instance, with regard to modes of action, and to the choice 
 between different adequate means for attaining prescribed ends. 
 But on the other hand, the name of local government is not to 
 be made a pretext for leaving localities without the benefits which 
 civilisation intends; and inasmuch as local government is a 
 legislative trust for the prosecution of certain essential purposes, 
 it is for the central government to see that those purposes be as 
 far as practicable fulfilled by the local bodies which have them in 
 
THE REIGN OF QUEEN VICTORIA. 379 
 
 trust, and that local failure to fulfil the intended purposes do not Z^^y'^^- 
 arise from local omission to use adequate means for fulfillino^ them. State 
 Secondarily, therefore, though not primarily, the central govern- since 1871. 
 ment, in a large range of cases, may have to be the prompter, i,_The 
 even sometimes virtually the director, of local authorities, in respect "pportim- 
 of their modes of action, and their adaptation of means to ends ; 1871-74. 
 for, watching the local institutions as they work, and judging them 3. Inspec- 
 in their respective results, it may find that adopted means are Local 
 proving inefficient for purposes which the law intends ; and it then Q^^em- 
 (with the best special knowledge it can command) has to press ment. 
 for amendment of the means. In respect of sanitary govern- 
 ment, such considerations as the above are easily applied to 
 define the relations of duty between the central and the local 
 sanitary authorities : relations in which of course the central 
 authority should not be officious, but in which equally it should 
 of course not be neglectful. The terms " officious ''■' and *' ne- 
 glectful^^ may in certain cases be words of vague sentiment 
 according to the prepossessions of persons who use them ; but 
 fortunately the sanitary case is one in which their application 
 can be measured on principle, and in which the administrative 
 Fia Media between offieiousness and neglect becomes plain to 
 those who will duly regard the end for which the organisation 
 of authorities exists. Our sanitary law, by reason of its having 
 had to provide in detail for a vast variety of more or less 
 mechanical subsidia to its main purpose, is so voluminous, 
 and incidentally concerns so many secondary interests, that 
 persons, too exclusively intent on particular sections of it, seem 
 sometimes to need a reminder of what is its one real purpose. 
 Sewers and water-pipes, rates and mortgages, local boards and 
 local officers, central office and right honourable president, secre- 
 taries and assistant-secretaries and seal and wax, are not final 
 purposes of sanitary law, but are only of the machinery for its 
 final purpose ; machinery which, sooner or later, has to be judged, 
 on the evidence of its results, in practical relation to the Public 
 Health. On the basis, then, that each local sanitary authority 
 has for its purpose under the law to lessen to the utmost it can 
 the incidence of disease within its district, there must be at least 
 one class of local contingencies in which it will be the duty of 
 the central authority to intervene ; where its intervention can 
 
380 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. never be judged officious, nor its non-intervention fail to be 
 
 State^ judged negligent. That is to say, where the preventable disease 
 
 sM^Tsn ^^ ^^^ prevented, there, even if nowhere else, the intervention is 
 
 . in principle due; and whether the new central authority pro- 
 
 opportim- vides adequately for the fulfilment of that duty, will be the 
 
 iljlGS of • • • 
 
 1871-74. main test by which to judge its merits or demerits as an 
 
 3. Inspec- authority for sanitary purposes, 
 
 tiouof Ij^ ^]jg autumn of 1873, when the statute of 187£ was a 
 
 Local ... p • 1 ^ 
 
 Sanitary year old, and all initiatory arrangements for its local working 
 
 ment. had been completed, the general case stood as follows. Fifteen 
 
 or sixteen hundred district-authorities, with their newly-appointed 
 the case in sanitary officers, were legally responsible for action against 
 1873. certain chief sorts of disease in the respective districts, and 
 
 in consequence of amendments which had been made in the 
 law, were undeniably confronted with their responsibilities. 
 A district-authority, omitting in any main matter within 
 the -statute to provide against disease in its district, was now 
 not able to plead uncertainty as to its powers : but in general 
 the case would either be, that express commands of the law 
 had been disobeyed by the authority, or else that powers given 
 to the authority for discretional use, had, in spite of need for 
 their use, been left idle. That the total of preventable disease in 
 the country represented a very large field of work for those local 
 administrators of the law, was a fact beyond possibility of 
 question. The current estimate of persons skilled in vital 
 statistics was that, out of the about half-million deaths which 
 were being annually registered in England, probably some 
 125,000 were dependent on influences which proper admini- 
 strative use of sanitary knowledge could remove. Parliament 
 had for the previous dozen or more years been receiving from 
 the Lords of the Council successive instalments of official 
 evidence as to the local distribution of that preventable disease, 
 and as to the variety of conditions under which the various sorts 
 of disease were remaining unprevented. As to parts of the case, 
 other action than that of the new district-authorities would (at 
 least for the then time) be in some instances wanted — sometimes 
 more or less action by a different authority, or sometimes more 
 or less action of unofficial kinds ; but these, in proportion to the 
 whole, were minor parts ; and there remained a vast total of 
 
THE REIGN OF QUEEN VICTORIA. 381 
 
 preventable disease, preventable throuo^h the powers of the dis- Chap. XV. 
 
 trict-authorities. On the principles before indicated, the whole state^ 
 
 of that field of grievance would demand the constant watchful ^ct^^i87i 
 
 observation of the newly constituted central authority ; and . _rj,, 
 
 g-reat parts of the field were likely to need frequently the central opportun- 
 
 authority's positive intervention."^ An important feature in the 1871-74. 
 
 case was that, even in districts where the sanitary authorities 3. inspec- 
 
 were well disposed to exert themselves, there often existed but ^^^'^^ 
 
 very imperfect knowledg'e of the means requisite for success ; Sanitary 
 
 . Groveru- 
 
 and it was probable that, over most of the field, the local meut. 
 authorities and officers could be <^reatly assisted by such skilled 
 information and advice as the central authority was able to give 
 them. Such were the circumstances with which the new Local 
 Government Board had to deal. Against wilful or negligent 
 failure of local authorities to do in their respective districts 
 what ought to be done for the protection of health, the 
 Board was the authority of supervision, and partly of control, 
 to which injured human life appealed for its rights : while, 
 lor a far larger class of districts, it was the centre to which 
 
 * Two explanations may here he subjoined. First, there is do intention of 
 imjilying that, in all actual instances of default, the Central Executive can, 
 either by public argument or by legal process, compel the defaulting authority to 
 do its duty ; but it is assumed as constitutional view of the case, that the Central 
 Executive, where not itself able to cause correction of defaults, ought, neverthe- 
 less, and indeed all the more, by means ' of its Annual Reports, to keep Parlia- 
 ment well-inforaied as to them ; and this not merely in order that the more im- 
 portant defaults may be brought within reach of stronger public opinion, but 
 also that Parliament may have means of judging how far from time to time the 
 law against defaults requires to be strengthened. Secondly, there is no intention 
 of ignoring that, in relation to the defaults of local authorities, individuals, 
 apart from any initiative by the central authority, have certain means of moving 
 for themselves ; on the one hand (but this in a sense which for most sufferers 
 would be merely theoretical) that they can, take common-law proceedings against 
 their defaulting local body ; and on the other hand that in respect of particular 
 defaults (named in section 299 of the Public Health Act, 1875) they can by 
 formal complaint cause the Central Authority to take action on their behalf. 
 I would be last to underrate even the present value of the statutory pro- 
 vision just mentioned, and I can well conceive that, with advances in popular 
 education and independence, the power of individual complaint against de- 
 faulting authorities may gi-ow into an extremely influential resource — perhaps 
 at last sufficiently so to render much centi-al initiative superfluous ; but I deem 
 it certain that, at least for many years yet to come, the power cannot be found 
 operating on a nearly sufficient scale at those levels of society where the 
 defaults of authorities are most injurious. 
 
382 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. the local communities and their authorities and officers would 
 English . . .... 
 
 State look for the scientific results of previous sanitary investiga- 
 
 since 1871. tion and experience. In those and other ways^ the 
 
 ^ _Tlie Board had to be made an effective influence towards the annual 
 
 opportun- saving of many thousands of human lives. It was to be hoped 
 
 1871-74. that the Board's standard of merit in sanitary government would 
 
 3, Inspec- from the first be reasonably high ; and that, inspirited by it, 
 
 Locai^ local authorities would year by year learn to take a stricter and 
 
 Sanitary stricter account of their respective responsibilities for the wastin": 
 Govern- '^ ^ _ " 
 
 ment. of life, and would more and more fully apply under guidance of 
 
 knowledge the powers which the law had given them for pre- 
 vention of disease. 
 Presumable The supervision which on the above showing claimed to be 
 supervisory exercised by the Board with regard to the prevention of disease 
 service. ^7 district-authorities was such as the Board could execute by 
 means of its Medical Department ; and that this in some form 
 would probably be the Board^s mode of action in the matter 
 seems to have been anticipated by the Royal Commission, when 
 assuming (as quoted above) that, on the creation of the new 
 system, the chief Medical OflBcer under the Board would ba 
 in " superintendence of all public sanitary arrangements.'^ * 
 
 * My language is not intended to exclude the possibility previously recognised 
 (see foot-note of page 375) that, in a certain part of the field of sanitary 
 superintendence, particularly with regard to means and appliances for the 
 Prevention of Filth, the Board might, if it saw fit, initiate systematic inquiry 
 from the surveyor's or engineer's or nuisance-inspector's point of view, irre- 
 spectively of any question of disease-prevalence, and might, by agency of that 
 non-medical sort, inspect district after district throughout the country as to the 
 suflSciency of the sewerage, house-drainage, paving, scavenging, water-supply, 
 nuisances-removal, &c., in each district ; but, I am not aware that any such 
 survey has ever been contemplated as a mode of action by the central 
 authority'", and I have not any reason to believe that, even if it could be put 
 into practice, it would supersede the necessity for such medical supervision as 
 the text describes. Faults of certain sorts, when discovered, would at once be 
 seen to require engineering technic for their remedial treatment; but, in 
 past experience, the exposure of such . faults had in general been due to 
 medical interpretation of facts of disease-prevalence, and the engineer's relation 
 to the case had come afterwards. At the beginning of 1870, with a view to 
 joint endeavours to procure better local administration of nuisance-law in cases 
 of neglect, Mr. Tom Taylor and I, with approval of our chiefs, had consulted 
 together carefully on the respective relations of our departments to that 
 branch of sanitary service ; and our recommendation, which was adopted, had been 
 that, in working the law as to such cases, the proceedings of first instance should 
 uniformly be taken in the medical department. See our papers printed at pp. 
 83-4 of Vol. III. of the Second Keport of the Eoyal Sanitary Commission. 
 
THE KEIGN OF qUEEN VICTORIA. 383 
 
 Under such, better sanitary counsels as had been promised, Chap. XV. 
 
 exertions would have to be given equitably over the whole State 
 
 shadow-land of preventable disease, not to be unduly restricted gi^ce 1871. 
 
 to parts of it ; and, for the supervisional purpose, the j _The 
 
 Board^s medical inspections would apparently for many opportun- 
 
 earlier years require to be exercised on a large scale. The 1871-74-. 
 
 attention of the Board, while of course it would be due to those 3. inspec- 
 
 epidemies of contagious disease which alarm great towns, and Local* 
 
 are made famous in their newspapers, would in proportion Sanitary 
 
 • n 1 Govern- 
 
 equally be due to the same diseases m smaller places ; and more- ment. 
 
 over, in all places, whether large or small, it would be due to the 
 preventable diseases which are chronic and constant, as well as 
 to those which are of only occasional sharpness. Sanitary super- 
 intendence, not paying regard to those comparatively noiseless 
 occurrences of disease, would deal with only a small share of 
 the preventable mortality of England ; but, if showing them 
 due regard, it would for a while find its inquiries more or less 
 called for in a large proportion of the sanitary districts of 
 England, and might expect that in each year hundreds of 
 different places, scattered through the country, would require to 
 be medically visited, and in many cases revisited, in order to 
 conference with authorities and officers on the subject of local 
 excesses of disease. Supervisional work on so large a scale 
 would of course require to be done on system ; and the allot- 
 ment of each year's inspections among the several inspectors 
 taking part in them could hardly be on any other plan than 
 that of territorial division, with inspectors specialised for each 
 territory. Here, however, it becomes essential to remember that 
 supervision relating to excesses of disease was not the only 
 medical supervision which the Board would have to exercise 
 throughout England. Equally diffused with that responsibility, 
 were other medical responsibilities which it likewise had to meet ; 
 notably (1) its various medical responsibilities under the Poor- 
 Law J and (2) its responsibility for Fuhlic Vaccination through- 
 out the country j and (3) its responsibility as to Local Sanitary 
 Officers to whom it would be awarding payment from the par- 
 liamentary grant. Presumably all the inspections required for 
 those various medical responsibilities of the Board, as well as 
 for the responsibility relating to Excesaes of LiseasCj could be 
 
nspi 
 tion of 
 Local 
 
 884 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. dealt with on one territorial system ; could be jointly assigned 
 State^ to a group of Medical Inspectors^ each of whom, under central 
 ^nce^sfi. instructions, would act for a defined district of his own. 
 . „, Apparently nothing could have been easier than for the new 
 
 opportun- Board to advance in that direction by means of the machinery 
 1871-74. which had been working under the Lords of the Council; 
 Inspec- ^^^ already, under that system, all parts of the country were 
 being visited by medical inspectors once in every tv/o years with 
 Sanitary special reference to vaccination ; and recently (as was noted at 
 ment. the closc of chapter xiii.) their Lordships had taken first steps 
 
 towards an intention of bringing into joint system with those 
 wWche^x- inspections of vaccination a considerable development of their 
 istedforits general sanitary inspections under the Act of 1858^ so that each 
 tion. inspector should report systematically in district-relation to both 
 
 branches of work. Their Lordships if those arrangements had been 
 completed (for which only three more inspectors were required) 
 would have had under fairly adequate observation the whole of 
 the disease-preventive action of England, except such as was 
 specially under the poor-law. If that intention had been con- 
 tinued under the new organisation, the Board would at once have 
 had suitable means for the discharge of this portion of its respon- 
 sibilities ; could readily have extended the same machinery to an 
 improved discharge of its responsibilities under the poor-law ; "^ 
 and, with those purposes accomplished, would have been, as 
 presumably intended to be, a competent supervising authority 
 for the medical, as well as the other, purposes of local govern- 
 ment. t In the Office of the Board, the duties and discretions 
 
 * For medical supervision in matters of poor-law, the Local Government 
 Board could give to its Medical Department the assistance of the two medical 
 functionaries who had previously been under the Poor Law Board ; hut if pro- 
 vision had to he made (as surely it ought) for the systematic medical visitation 
 of all workhouse-infirmaries, this poor-law duty would have required some 
 further addition to the medical staff, beyond that which had been contemplated 
 for general sanitary purposes ; so that, for the entirety of the combined pui-poses, 
 probably a total addition of four or five new inspectors might have been necessary. 
 
 t Under an organisation as suggested in the text, for the early years of the 
 Board's sanitary superintendence, the scheme of function for a districted medical 
 inspector might have been about as follows. It would have been his duty 
 thoroughly to know his district in respect of its cuiTent preventable mortality, 
 and of the action or inaction, the efficioncy or inefficiency, of its sanitary 
 authorities and officers, including those who have to do with the service of public 
 vaccination. In successive circuits throughout the district he would have had 
 
THE REIGN OF QUEEN VICTORIA. 
 
 385 
 
 of the Secretariat could tlien have been co-ordinated with those 
 of a properly constituted Intelligence Department. 
 
 Against the particular form of organisation which the pre- 
 ceding paragraphs suggest, it might have been said that such 
 organisation would give to one sort of " special '' inspection a 
 methodical character which the Report of the Commission had 
 not sketched for it, and that the Commission had in general 
 terms deprecated what it called '^ parallel inspectorates/'' "^ In 
 fact, however, as before noted, the Commission had not pretended 
 to final judgment on matters of administrative detail ; assuming 
 that such would be ultimately for the discretion of the new Au- 
 thority ; and now in 1873, with regard to any such side-question 
 
 to visit, say, once in every two years, each of the jurisdictions on his list ; 
 observing progress, and, where necessary, conferring with authorities or officers 
 on observed insufficiencies of disease-prevention ; also specially seeing that the 
 appointed duties of officers subsidised by the central office were satisfactorily 
 performed. He would have had to make supplementary visits to jurisdictions, 
 where unusual outbreaks of disease, or other unusual facts, might so requii-e. He 
 would have had to visit at least once annually each workhouse infirmary in his 
 district, and from time to time, as requisite, such other infirmaries and institutions 
 (if any) as should be subject to medical \isitation by the Board. For particular 
 purposes, and under special instructions, he would have had occasionally to 
 concert joint action with other local inspectors of the public service — e.g.^ 
 inspectors of factories, or veterinary inspectors, on certain such questions 
 of disease-prevention as are more or less in the province of those other in- 
 spectors ; and would also, where special matters might require, have had to com- 
 municate with coroners and other public functionaries having authority for the 
 protection of life. To him would have been referred, with such queries and 
 instructions as had in the particular cases been necessary, all reports received by 
 the central office from the officers of health within his district, and all sanitary 
 complaints coming from the district, and, with regard to the mortality of the 
 district, the quarterly returns of the Registrar- General. He would have had to 
 report, as occasion required, to the Chief Officer of his Department ; to answer 
 with local knowledge the references which the latter would have made to him ; 
 and annually to furnish for use in the Departmental Annual Report, an account 
 of the progress of his district. 
 
 * Report of the Commission, p. 33: "We deprecate the maintenance of 
 parallel inspectorates of sanitary and poor-law administration under the same chief 
 Minister, not only on the ground of waste of powers, but still more of probable 
 conflict." That deprecation seems quite to fit the case of " parallel inspector- 
 ates " which are for identical or closely similar purposes : such as would be two 
 circuits of "general inspectors," or (as described in a special Memorandum 
 attached to the Report) three circuits of hospital-inspectors ; but I do not see 
 how it could fitly apply to inspectorates which differ in their purposes of circuit, 
 as, for instance, if financial inspection of poor-law proceedings were parallel 
 with medical inspection of the work of public vaccinators. The question raised 
 in the text is as to inspectors widely differentiated for duty. 
 
 Chap. XV 
 English 
 State 
 Medicine 
 since 1871. 
 
 i.— The 
 opportuu- 
 ities of 
 1871-74. 
 
 3. Inspec- 
 tion of 
 Local 
 Sanitary 
 Govern- 
 ment. 
 
 Para- 
 mount 
 claim for 
 effective- 
 ness. 
 
386 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 
 since 1871. 
 
 i.-^The 
 opportun- 
 ities of 
 1871-74. 
 
 3, Inspec- 
 tion of 
 Local 
 Sanitary 
 Govern- 
 ment. 
 
 The system 
 estabHshed 
 under Mr. 
 Stansfeld. 
 
 as the present, the course to be taken ought apparently to be that 
 which would best conduce to the main practical effect intended by 
 the Commission. An administrative point to be remembered was, 
 that already, for parliamentary purposes under the vaccination- 
 law, a certain quantity of medical inspection was systematic, and 
 by common consent was so to continue ; and to have enlarged the 
 functions of that existing circuit in the manner I have described 
 would, I think, have been the best way of fulfilling for the new 
 Office a function which in the before-stated view of the case was 
 imperatively needing to be somehow fulfilled. While, however, I 
 thus indicate the lines of organisation on which I think effective 
 sanitary supervision could best have been provided, I have no 
 intention of insisting exclusively on those lines as against others 
 (if such there were) which might have been equivalent to them 
 in effect : for Effectiveness of Supervision was the real problem, 
 and detail of apparatus was not otherwise of concern. The aim, 
 as I understand it, should have been such supervision as could 
 systematically discern the unsuccesses and defaults (as well as the 
 more favourable facts) of local sanitary administration, and could 
 systematically apply endeavours to induce amendment in cases 
 requiring it. 
 
 In relation to that aim, or to whatever definite or indefinite 
 aim was accepted instead of it, the arrangements established 
 under Mr. Stansfeld^s Presidency were briefly as follows. They 
 did not entrust to the Medical Department any systematic 
 share in the supervision. The essentially supervisional arrange- 
 ments were to be non-medical ; and except as to the superintend- 
 ence of vaccination (which was let continue much as it had 
 previously been) the Medical Department was only to have un- 
 systematic functions. In cases, or sorts of cases, where the 
 President or a Secretary or Assistant-Secretary might think 
 reference to the Department necessary, the individual reference 
 or references would be made ; and, where the President or a 
 Secretary or Assistant-Secretary, on motion from the Medical 
 Department or otherwise, might think medical inspection neces- 
 sary, -he would specially order the inspection ; but these unsys- 
 tematised inspections could not extend to more than compara- 
 tively few localities in a year, for the medical staff was not 
 allowed the enlargement which had been hoped for as provision 
 
THE REIGN OF QUEEN VICTORIA. 387 
 
 for larger usefulness. In general, the business of the PuhHe Chap. XV. 
 Health seems to have been understood as not reqmring any other Stefe^ 
 system of supervision than the non-medical officers of the Board ^^'^^S'"! 
 could supply — a system essentially resting on the distribution of . 
 the so-called ^^ general ^^ inspectors, and on their relations with opportun- 
 the central secretariat. 1871-74. 
 
 Of the General Inspectors it has before been noted that the re- 3 jngpec. 
 lation in which they stood to the Local Government Board was in l^^^ S** 
 
 . ... . Local 
 
 continuance and extension of a similar relation they had had with Sanitary 
 
 the previous Poor Law Board ; they had been declared '^ inspec- ment. 
 tors '"^ for sanitary as well as poor-law purposes, '^ inspectors '' for 
 all purposes of local government under the new law ; and now, ^.^i ,ff^, 
 in view of the predominance reserved for them in Mr. Stansfeld's spectors. 
 system, and of the large surface of duty over which they were 
 entrusted with ^^ general ^^ functions, it becomes important to 
 consider what sorts of duty they had hitherto done in the public 
 service, and what sorts they were henceforth likely to do. 
 Under the Poor-Law Board (see above, p. 348) they had been, 
 as it were, a provincial prolongation of the Board's secretariat, a 
 personal agency in aid of written correspondence or in substitu- 
 tion for it, an organ of speech for the Board in its communica- 
 tions with Boards of Guardians ; they also had held sittings of 
 judicial inquiry for the Board in cases where charge had been 
 brought against the local administration of poor-law; and 
 besides acting in those quasi-secretarial and quasi-legal capacities, 
 they had been for all ordinary purposes the Board^s " inspectors '' 
 of local poor-law establishments : a function which it is here 
 important to distinguish from the others previously mentioned ; 
 for in it had been the weak point of the system. With regard 
 to the general spirit of poor-law administration, the poor-law 
 inspectors of 1847-71 had no doubt been fully competent repre- 
 sentatives of their Board, and among them had been some of 
 distinguished ability ; but, even in the field of poor-law adminis- 
 tration, growing experience had very plainly shown that con- 
 siderable parts of the local service habitually require a far 
 more real quality of medical inspection than inspectors of 
 merely " general ■'^ qualification can supply; and thus in 1871, 
 even for poor-law purposes, " general ^' inspection was requiring 
 to be supplemented by medical inspection not less systematic 
 z 2 
 
388 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap, XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 i.— The 
 opportun- 
 ities of 
 1871-74. 
 
 3. Inspec- 
 tion of 
 Local 
 Sanitary 
 Govern- 
 ment. 
 
 than itself. It of course was to be assumed that the poor-law 
 inspectors transferred to the office of the Local Govern- 
 ment Board would well render in the latter connexion the 
 sorts of service which they had well rendered under the 
 former : but more was not to be assumed : and if that was 
 all, the sanitary supervision provided would be but little towards 
 the needs of the case. While it might properly be assumed 
 that the " general ''"' inspectors would be good observers and 
 advisers and negotiators, as from the legal point of view, with 
 regard to conformities with statute, and to all merely mechanical 
 conditions in the constitution of authorities and offices, and 
 with regard to questions of regularity and convenience in the 
 conduct of common business, it certainly was not to be assumed 
 that they could "" inspect ■'■' or advise with regard to the substance 
 of sanitary duty.^ As officers of aid to local administration, they 
 no doubt, within the limits of their particular competence, could 
 often be useful assessors at the meetings of the local authorities, 
 chiefly during the first year or two of the working of the Act of 
 1872, and especially in cases where the authorities were new to 
 the sort of work; but their particular competence was within 
 narrow limits of subject-matter, and local demands for assistance 
 within those limits would rapidly diminish with time.f So far 
 
 *• One of the general inspectors of 1872-3, IVIr. Longe, in his contribution to 
 the volume from which I have already often quoted, seems to express his con- 
 sciousness of some such limit as that which my text describes : — " My inforaiation 
 as to the actual work done by the several authorities in my district is not sufficient 
 to enable me to express any certain judgment on the efficiency of their adminis- 
 tration or their officers. I can speak to activity displayed by many boards, and 
 to the apparent indifference of others ; but how far the activity of the one has 
 been judiciously applied, and how far the comparative inaction of the others may 
 be justified by the character of their districts, requires infoimation which I 
 cannot pretend to have acquired." — Return, 1875, No. 134, p. 91. 
 
 f A former foot-note (p. 363) referred to the particular kind of service 
 which had been in demand during the few months next after the legislation 
 of 1872, and which "general" inspectors had been quite competent to 
 render ; but, for assistance of that elementary kind, it is presumed the re- 
 quirement would only have been brief. It is not in the English theory of 
 local government, that local authorities, even of the weakest sort, shall per- 
 manently have to be pinafored by central bonnes ; and the authority which is 
 not confessedly in nursery-stage, is understood to be in active duty. If in 
 this stage central assistance is needed (as no doubt it very largely is) the need 
 almost invariably is technical ; and also, as explained in the text, it is almost 
 universally from a technical basis that supervision of the discharge of duty has 
 
THE REIGN OF QUEEN VICTORIA. 389 
 
 as my experience enables me to say what sanitary supervision Chap. XV. 
 means, action as above, unless very largely extended and state^ 
 strengthened by the action of technical inspectors, would not even ^n^^^j^n 
 approximately suffice for it, nor probably could in the long . 
 run represent any higher degree of supervisional usefulness than opportuu- 
 would consist in the supervision of mere forms of business. The 1871-74. 
 utility of the appointments, as means of viva voce communication 3 j^^^^, 
 between the Central Office and the Local Authorities, would of 1^°^ ?* 
 
 Local 
 
 necessity, I apprehend, be similarly limited, and could hardly be Sanitary 
 deemed existent in that large field of sanitary business where the ment. 
 merits of particular sorts of sanitary action would be for technical 
 officers to explain and recommend. With regard to functions 
 more distinctively inspectional — functions of truly seeing and 
 looking into what is of essential interest in the sanitary case, it 
 might, I think, even in 1873, have been prognosed, that ^*^generar' 
 inspection, as a system chiefly by itself, would after a year or two 
 rapidly decline towards mere formality, and if it nominally sur- 
 vived for some further years, would soon be found of little more 
 concern to the real sanitary drama than the by-play which stage- 
 managers assign to their '^ walking gentlemen.''' 
 
 Before going farther let the reader pause for a moment to Opinion on 
 define what here has to be criticised. Within the jurisdiction which^wS 
 of the Local Government Board are many objects which are only established 
 sanitary in a remote instrumental sense, and some which are only in 
 part sanitary, and some which are not sanitary at all ; questions 
 of local elections and finance, and boundaries and arbitrations, 
 questions of mere common or commercial convenience in various 
 local matters, questions as to highways and lighting, as to markets 
 and their stalls and weighing-machines, as to hackney-carriages and 
 public bathing, as to local steam- whistles and public clocks. In 
 these pages, however, Local Government is under consideration 
 only as an agency for the prevention of disease ; and our only con- 
 cern with the above-described system for looking after the Local 
 Authorities is to see how far it included proper provision for 
 supervising them in their disease-preventive capacity. That local 
 
 to be exercised. By the middle of 1873, the new local sanitary authorities of 
 England were supposed to have entered on the stage in which their fulfilment 
 of effective duty might be expected, and in which the supervision of the central 
 authority as to the success of their working, in respect of the intended better 
 protection of life, might well have begun. 
 
390 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 i.— The 
 opportun- 
 ities of 
 1871-74. 
 
 3. Inspec- 
 tion of 
 Local 
 ►Sanitary 
 Govern- 
 ment. 
 
 administration take good aim at the saving of human life 
 from disease is the essence of the sanitary interest ; and the duty 
 of the supervisional system, with its inspecting officers, is to 
 observe comprehensively and (where need may be) correctively 
 and helpfully, the local endeavours made for this highest 
 purpose. ^^ Highest purpose,'"* I venture to emphasise j not only 
 in abstract opinion that human life counts for more than the 
 mere machinery and the et ceteras of sanitary law ; but also with 
 reminder, special for the period of Mr. Stansfeld^s Presidency, 
 that the word " sanitary,"*^ in its unsophisticated sense, had been 
 the word of pretext, and had represented the great principle of 
 inducement, with which the new organisation of Local Govern- 
 ment had been recommended to parliamentary and popular ap- 
 proval."^ What then, with regard to that supreme interest of the 
 organisation, was the value of the scheme of supervision which 
 Mr. Stansfeld had provided ? In very important respects it 
 seems to me to have been utterly inadequate. It was a 
 scheme under which, to the- best of my knowledge and 
 belief, the Board could not observe with reasonable sufficiency 
 the progress of sanitary administration throughout the country, 
 nor could influence in proper extent for the prevention of 
 disease the authorities who were in default of duty : it was 
 a scheme under which, if I have not misunderstood the case, 
 the highest function of the Board would in great part 
 be in abeyance. Its radical defect, its extensive acceptance 
 of formal for effective action, its failure to recognise to how 
 large an extent it stood in need of properly-trained technical 
 service for the purposes of duty, was an apparently inherited 
 characteristic. It recalled to memory the way in which the 
 former Poor-Law Office had dealt with its medical responsibili- 
 ties : it represented afresh that least laudable tradition of the 
 old machinery applied where it could be most obstructive in 
 the new. Privileges once conferred are apt to be of strong root; 
 and the system of service established under Mr. Stansfeld"'s 
 direction has in substance, both as to its positive and as to its 
 negative pro-sdsions, continued in force to the present day. So, 
 
 * It was, I think, in 1873 that Mr. Disraeli, in an extra-parliamentary speech, 
 played with the words Sanitas Sanitatum, Omnia Sanitas, as expressing how 
 greatly, of late years, the public mind had been exercised on the subject of Health. 
 
THE REIGN OF QUEEN VICTORIA. 391 
 
 even now, though so many years have intervened, I do not Chap. XV. 
 refrain from saying how grievously wrong I believe to have State 
 been the policy which that system represented. In relation to since 1871. 
 the flag under which I had had the honour of serving, I regard . _-pj^g 
 it as having been virtually a policy of retreat. The opportunity opportun- 
 which circumstances at that critical time had offered to the new 1871-74. 
 department to become a widely accelerative influence for the 3_ inspec- 
 bettering of local sanitary government, and the moral claim Local* 
 which the existence of such an opportunity constituted, had, so Sanitary- 
 far as I can see, been met with but poor appreciation; and ment. 
 especially it seems to me that, in relation to local neglects and 
 defaults in matters of sanitary duty, there had been created, 
 instead of the effective supervising authority which the Report 
 of the Royal Commission had prefigured to the hopes of sanitary 
 reformers, an authority of but doubtful courage for unpleasing 
 responsibilities, an authority '' be-stilled almost to jelly "" at points 
 where chief need for initiative usefulness existed, an authority 
 not even so far organised as to command full cognisance of the 
 evils against which its organisation was to have been our strength. 
 What in all this at the then time may have been matter of opinion 
 and prophecy, remained of course for future time to confirm or 
 refute ; and at the present date, when nearly sixteen years have 
 passed since the close of the first period in the life of the Local 
 Government Board, any skilled person who surveys a sufficiently 
 large proportion of the field of existing sanitary administration 
 can estimate for himself by that test of experience the merits of 
 the system which was then established. 
 
 11. SUPERVISION BY THE LOCAL GOVERNMENT BOARD. 
 
 From telling of the establishment of Mr. Stansfeld's scheme li.— Super- 
 
 of organisation, I now turn to the years which have followed : the°\ocal 
 
 during: which the scheme has had time to show itself in Gtovem- 
 *5 ^ ment 
 
 action; while also, as I may conveniently first note, many Board, 
 successive personal changes have taken place in the Presi- 
 dency of the Local Government Board, and some changes, 
 personal and other, in the constitution of the Medical Depart- 
 ment. 
 
392 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. On the change of ministry which occurred in February, 1874, 
 
 StatJ^ with Mr. Disraeli's second accession to the premiership, Mr. 
 Jfn^e^isn. Stansfeld, ceasing* to be President of the Local Government 
 .. e. Board, was succeeded in the office by Mr. Sclater-Booth, now 
 
 u.— Super- ' . . 
 
 vision by Lord Basing. Mr. Sclater-Booth remained President for more 
 Govern- than six years — i.e. till April, 1880, and during his tenure of 
 BoM-d. office promoted much useful legislation for sanitary purposes ; 
 as especially the Sale of Food and Drugs Act of 1875, the 
 Personal Pollution of Rivers Act of 1876, and, above all, the con- 
 
 changes in ^ ' ' 
 
 the Board solidatinff Public Health Act of 1875. During the more than 
 
 and its .... 
 
 Medical five years of Mr. Gladstone's second administration (April, 1880, 
 ment.^ ' ^^ June, 1885) the Presidency of the Board was held at first by 
 Mr. Dodson, now Lord Monk-Bretton, and subsequently by Sir 
 Charles Dilke. During the less than eight months of Lord 
 Salisbury's 1885-86 ministry, Mr. Arthur Balfour was President 
 of the Board ; then, under the six months of Mr. Gladstone's 
 re-administration, first Mr. Chamberlain ; afterwards, again Mr. 
 Stansfeld; and in August, 1886, with Lord Salisbury's return 
 to the Premiership, Mr. C. T. Ritchie was appointed. 
 
 Within the same period the post of Medical Officer to the 
 Board has twice changed hands. In 1876, on my retirement 
 from that post and from the Medical Officership under the Privy 
 Council, Dr. Seaton, who had long been associated with me in 
 the work of the Department, was appointed Medical Officer to 
 the Board ; but apparently with some understanding as to a 
 change in the legal relations of the office;^ and the appointment 
 under the Privy Council was left vacant. Even Dr. Seaton's 
 experience and unsparing industry could not bring into much 
 effectiveness the very circumscribed office to which he had 
 been called ; before long, his health began to fail him ; and 
 his resignation of office at the end of 1879, after only three and 
 a half years' tenure of it, was followed within a month by his 
 death. Mr. Sclater-Booth was fortunate in having at hand, 
 
 * See the opening sentences in his first report ; June, 1877. What I had 
 had to report to the Local G-overnment Board on the work of my office under the 
 new system will be found in the Annual Eeports on the years 1873-5 : Reports 
 M.O.F. C. and L.G.B., New Series, Nof. I., IV., VII. My last Repoit to the Lords of 
 the Council, dated February, 1877, and relating to the Medico-Scientific Investi- 
 gations on which I had been advising their Lordships, was, in an official sense, 
 posthumous : my retirement having been recorded some eight months previously. 
 
THE REIGN OF qUEEN VICTORIA. 393 
 
 in the person of Dr. Buchanan, one whom he could at once Chap. XV. 
 
 unhesitatingly appoint to the vacant office. From the year state^ 
 
 1861 Dr. Buchanan had been associated with the Medical Medicine 
 
 since lh/1. 
 
 Department under the Privy Council, first as frequent occasional 
 inspector, then (1869) as permanent inspector, and soon after- vision by 
 wards as assistant medical officer ; always rendering the very (j^ovem-'^ 
 best service which the occasion required or permitted ; and g^^^^j 
 in various cases the author of reports which have become 
 classical in sanitary literature. Of thorough training and 
 habit in all ordinary relations of practical medicine, highly- 
 informed in the sciences which assist it, and of sanitary ex- 
 perience such as only of late years had been possible to any 
 man, and in his case many times larger and more various than 
 almost any of his contemporaries could have had, Dr. Buchanan 
 had always shown himself of extraordinarily active and dis- 
 criminating mind, and always intent on that exactitude which is 
 essential to scientific veracity, whether in observation of facts 
 or in argument on them. He too had had the advantage of 
 apprenticeship in schools of science nearly twenty years more 
 modern than those in which his two predecessors had learnt. 
 Devoted to his branch of the public service, and with every 
 intellectual qualification for excelling in it, he equally had the 
 rectitude and unselfishness of character without which there can 
 be no good official leadership in such duties. His career in the 
 chief office, though yet, we may hope, with many more years to 
 run, has already been rich in fruits which will be gratefully 
 remembered by those who follow him."^ 
 
 * Within two years of Dr. Buchanan's accession to the chief oflScership, 
 incapacitating illness overtook Mr. Kadcliffe ; whose service in the Dej)artment, 
 as Inspector and Assistant Medical Officer, had for many years been of eminent 
 value, not only in those common inspectorial duties which chiefly regard the 
 local excesses of customary English diseases, but also in the special duty of 
 continuously observing the movements abroad of such foreign infections as may 
 be of concern to England ; and on Mr. Kadcliffe's retirement from office, 
 Dr. Thome, already of long experience and known merit in the department, was 
 appointed Assistant Medical Officer in his stead. — Dr. Stevens, of oldest standing 
 in the department, and of highly distinguished merit in it, had preferred not to 
 exchange his inspectorship for the post of Assistant Medical Officer, but had 
 accepted special charge of the superintendence of public vaccination. — About 
 th.e same time with Mr. Radcliffe's retirement, occurred also that of Dr. Beard ; and 
 of those with whom I had had the honour of acting in the Department, there now 
 only remained (in addition to the three previously named) Dr. Blaxall, Dr. Ballard, 
 
394 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. The proceedings of the Local Government Board in matters 
 State o£ Public Health during the years 1874-89 are on record (with 
 
 ^^^^^Wi ^^^ Board^s other proceedings o£ the period) in the fifteen 
 
 ii. — Super- 
 
 Annual Reports (IV.-XVIII.) which the successive Presidents 
 vision by have laid before Parliament; each, in certain respects, supple- 
 Govem- mented as to detail by a report from the Medical Officer on 
 Board. ^^^ particulars of the work which has been assigned to his 
 
 Department. Persons who would judge, as matter of sanitary 
 Re^ort^ f science, what the Medical Department has been able to do 
 
 theL. G. within the limits which had been fixed for it in 1871-4, will of 
 Board 
 
 course refer to the supplementary volumes, and I shall hereafter 
 again mention them ; but for general evidence on the Board's 
 administrative relations to the Public Health Government of 
 England, the Presidential Reports are complete in themselves ; 
 purporting to deal with the whole field of the Board's sanitary 
 responsibilities, and thus enabling judgment to be formed 
 whether all parts of the field are duly covered. "^ 
 
 The Presidential Reports are .likely to impress very dif- 
 ferently, according to the point of view from which they are 
 regarded ; and, if the reader's point of view be simply clerical, 
 they no doubt will satisfy his mind. In text or appendix, in 
 abstract or in extenso, they render account of all formal business 
 transacted under the principal statutes. They enumerate all 
 acts done or sanctioned by the Board in relation to the matters 
 of finance and administrative machinery. They give statistics of 
 loans authorised, moneys granted in aid, powers acquired, areas 
 altered, combinations effected, bye-laws approved, officers ap- 
 pointed, local inquiries directed, provisional and other orders 
 
 Dr. Airy, and Mr. Power. The vacancies which retirements and promotions had 
 occasioned were filled hy the appointment of Dr. Parsons, Mr. Spear, Dr. Barry, 
 and Dr. Page. Since then, an additional Assistant-Medical-OflQ.cership having 
 been created, and Mr. Power having been appointed to it, the Inspectorship 
 vacated by Mr. Power has been filled by the appointment of Dr. Bruce Low, 
 
 * Each Annual Report of the Local Government Board has always presented 
 two principal divisions ; — the one, as to the administration of the Foor-Zaw, the 
 other as to the administration of the laws affecting Local Government and the 
 Fublic Health ; and in all later years, the Reports have had a further division 
 relating to Local Taxation and Valuation. In the last-issued (eighteenth) Report, 
 these three divisions are preceded by one relating to the Local Government Act, 
 1888, and County Councils. For our present argument, it is not important to 
 discuss other divisions of the Reports than the one which expressly relates to 
 Local Government and Public Health. 
 
THE REIGN OF QUEEN VICTORIA. 395 
 
 issued, and various other acts done for purposes conducive (or Chap. XV. 
 meant to be conducive) to health. With regard to certain out- state 
 lying bits of subject-matter dealt with under special statutes, gu^ceTsn 
 more or less sanitary, they communicate the reports or returns .. 
 which the Board receives from the respective special officers."^ vision by 
 Similarly, they describe in general terms the statutory work Govern- 
 which has been done in the Medical Department, and, for its §oard. 
 details, refer to the Medical Officer's supplementary report. 
 They also state the number of annual copy-reports which the 
 Eoard has received from local officers of health, and in general 
 terms, what the Board has done with them.f They doubtless 
 are not deficient in any material information which the clerks of 
 the office have had in documents before them; and they may 
 therefore, in a merely clerical sense, be deemed such reports as 
 they ought to be. 
 
 If, however, the point of view be changed, and the reader, Absence of 
 instead of regarding the Reports in their merely clerical rela- tionon 
 tions, regards them in their relation to the essence of the great ganitary 
 national interest which they concern, he will see that they are progress, 
 curiously destitute of a kind of information he might most of all 
 expect to find in them. With regard to one important class of 
 functions for which the Board is responsible — that which consists 
 in the issuing of sanctions and other warrants for various pur- 
 poses under the sanitary law, the Reports no doubt give copious 
 information. The Board in that ca})acity is seen doing large 
 quantities of important business with such local authorities as 
 have chosen to bestir themselves for local improvement purposes : 
 a class which happily has from long ago always been increasing 
 in number. Both from the Reports themselves, and likewise 
 
 * Such sectional reports or returns are furnished by the Chief Inspector 
 under the Alkali, ^c, TForks Regulation Act, by the Public Analysts under the 
 Sale of Food and Drugs Act, by the Inspector under the Canal Boats Act, and by 
 the Examiners (respectively engineering and chemical) of Water-works and 
 Water under the Metropolitan JFater Acts. 
 
 t For instance Report XVIII., presenting a tabular statement of the sources 
 from which 1581 such reports had been received during the year 1887, adds as 
 foUows : '* The Reports have been examined, analysed, and carefully considered, 
 and in particular instances have been the subject of communications with the 
 Sanitary Authorities as to the action required with regard to water-supply, 
 drainage, systematic scavenging, the abatement of nuisances, the provision of 
 means of isolation for infectious cases, and other kindred matters." 
 
396 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State _ 
 Medicine 
 since 1871. 
 
 ii. — Sujier- 
 vision by 
 the Local 
 Govern- 
 ment 
 Board. 
 
 from exterior testimony, there is every reason to believe that in 
 parts of such business much good has been done : especially 
 that, in the sanctioning of by-laws and in the sanctioning of 
 certain sorts of expenditure, the Board, with constantly increas- 
 ing service from its technical reference-officers, has been able to 
 exercise in detail a large amount of beneficial influence, as further- 
 ing the wishes, and often as amending the aims, of local authori- 
 ties whose intentions have been for progress. But while the 
 Reports give copious evidence as to the work of the Board in those 
 solicited sanctioning relations, what do they tell of work in the 
 unsolicited relations of siqjervision and inquiry ? and what is the 
 value of the Reports for public and parliamentary reading, as 
 measures of the sufficiency of present law and administration in 
 the matters to which they relate ? Those, I venture to say, are 
 vital questions. From the Supervising Authority's annual reports 
 on the Sanitary Government of England, the reader might par- 
 ticularly hope to derive exact and discriminative information 
 as to the fulfilment of the intentions of the law in the respective 
 supervised jurisdictions : information given year by year, in a 
 systematic and differentiating way, as to the local rates of pro- 
 gress throughout the country in the removal of known causes of 
 disease. The Board, when it was called into existence in 1871, 
 presumably started with such knowledge as was at the time 
 current with regard to various then pressing administrative 
 requirements of the public health ; and an account, or at least 
 approximative account, from year to year, how far those require- 
 ments had been satisfied, would not have seemed too difficult 
 an account for the Board to keep. During the last few 
 previous years, sanitary grievances, affecting masses of popu- 
 lation, had been reported to Parliament for redress : — for instance, 
 that Filth-Diseases were still almost universally diffused, and in 
 quantity but slowly and unequally diminishing ; ^ that dangerous 
 
 * At a certain slow pace diminution of these diseases as to their aggregate 
 prevalence in England had previously been advancing for a long while : cer- 
 tainly since Mr. Chadwick began his agitation against them ; and in my ninth 
 Annual (1867) Report to the Lords of the Council, I had had the pleasure of pub- 
 lishing evidence as to several districts in which reduction, sometimes very large 
 reduction, of Filth-Disease had been effected ; but to obtain evidence at short 
 intervals as to the non-improving districts seems to me to have been among the 
 most imperative duties of the new authority. 
 
THE REIGN OF QUEEN VICTORIA. 397 
 
 Contagions of Disease were still almost universally multiply- Chap. xv. 
 ing, with little or no local check on such personal conduct as state^ 
 spreads them^ and with almost nothing yet done towards the ^^^^Jg-j 
 creation of proper local systems of action for cases of infection .. 
 as they arose ; that Industrial Diseases were largely wasting vision by 
 adult life among the best of our population, and especially in Govern- 
 some of our chief industries, in consequence of unwholesome ^^^(^ 
 conditions — (since then declared " nuisances '' under the public 
 health law) in factories and other work-places ; and that Deaths 
 of Infants were habitually occurring in large proportions in par- 
 ticular districts under extreme conditions of inadvertence and 
 maltreatment — the latter not always to be acquitted of criminal 
 intention. The Local Government Board, so distinctively created 
 to be an influence against evils such as those, might have been 
 expected to keep some sort of score in relation to them. What 
 evidence do the Reports afford, that our Supervising Sanitary 
 Authority has kept any such kind of continuous watch ? 
 Especially with regard to the oldest and most rudimentary 
 duties of local authorities — those as to the prevention and re- 
 moval of nuisances, and those as to measures for limiting in- 
 fection, how far do the Reports distinguish between districts 
 in which the duties are being done, and districts in which 
 the duties are not being done ? Granted that during the 
 last forty years there has been, on the whole, a large reduction 
 in the fatality of Filth- Diseases in England, what have the 
 Annual Reports made known as to the non-contributories to that 
 reduction ? what, as to the districts (commonly believed to be 
 many) in which little or no improvement has taken place ? 
 what, as to the districts in which the positive laws as to 
 sewerage, water-supply and nuisance-removal, have been indo- 
 lently or connivingly ignored by the local authorities? what, as 
 to the districts in which the law requiring sanitary officers to be 
 appointed has been obeyed in form, only that it may be dis- 
 obeyed in spirit, and in which the old filth-diseases have been 
 still going on at their old rate ? what, in short, as to the very 
 numerous cases in which the legally-required local measures 
 against filth are not taken ? And similarly, as regards the 
 distribution of Infectious Diseases — scarlatina, diphtheria, and 
 the like — in the different districts of the country, as compared 
 
398 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV 
 English 
 State 
 Medicine 
 since 1871. 
 
 ii. — Super- 
 vision by 
 the Local 
 Govern- 
 ment 
 Board. 
 
 . witli the rules and practice of the several local authorities in 
 respect of precautions which the law enables them to take 
 against the spread of infection, — what say the Annual Reports ? 
 Do they show that the Board has systematically detected the 
 districts in which proper precautions have not been taken, and 
 has promptly moved the local authorities to be more active for 
 the protection of life ? In proportion as the Reports of the 
 Local Government Board are consulted for such information as 
 the above queries suggest, they will deeply disappoint the in- 
 quirer j for with regard to that real essence of the ease, they in 
 general are little better than a void. In the statements which, 
 they contain, regarding local expenditure and administrative 
 machinery, we no doubt find evidence, which so far as it goes is 
 highly welcome, that in very many of the districts of England the 
 authorities under the Act of 1872 have in various ways, and often 
 with considerable expense, shown themselves of good intention 
 towards the purposes of the Act : evidence, that within the 
 particular local jurisdictions, particular sorts of movement have 
 been made : but such evidence, even as to the districts for which 
 it purports to speak, carries no conclusive sanitary meaning. 
 The waste or non-waste of men, women and children, is not to 
 be judged in ciphers of pounds, shillings and pence ; information 
 as to the boundary-lines of local jurisdictions is many removes 
 from being information on the public health ; and readers who 
 care to know of mere administrative inceptions would still more 
 care to know of completions and results."^ Inconclusive as the 
 Reports are in regard of the districts to which their above-de- 
 scribed information refers, what do they tell of the remaining 
 
 * Even the best-intentioned authorities, voting money for sanitary con- 
 structions and sanitary appointments, do not always secure their purpose, — not 
 always even the immediate purpose, much less that which is their true end. 
 Sums of money may have oeen voted for works of sewerage and water-supply, 
 and such works may ha^e been constructed, but yet, from one cause or another, 
 the intended good tc che health of the populations may have been imperfectly, 
 or not at all, realised ; as, for instance, where the works themselves have been 
 more or less seriously at fault ; or where in spite of the existence of sewers, 
 house-drainage has remained so inadequate that the sewers have fulfilled but 
 little of their purpose. — For various illustrations to this and like effect, see in 
 Appendix No. 2 of the Ninth Report of the Medical Officer of the Privy 
 Council, Dr. Buchanan on the Results which have hitherto been gained in various 
 Farts of England by IForks and Regulations designed to promote the Rublio 
 Health. 
 
THE REIGN OF QUEEN VICTORIA. 399 
 
 districts ? In general they tell nothing. They do not purport Chap. XV. 
 to embody systematic local reports from the Board's districted state 
 " general ''■' inspectors ; nor do they intimate that any such reports since ^mi. 
 are received ; nor have they, except most rarely, borne record of .. _g^ ^^_ 
 any sort of sanitary information received from those officers, vision by 
 Of existing insufficiencies of disease-prevention throughout Govem- 
 the country, and of the Board's exercise of responsibilities Board, 
 in respect of such, they uniformly refrain from speaking in 
 any systematic way."^ Equally from that silence, and from 
 the bearing of such positive information as is contained in the 
 Reports and their medical supplements, it cannot but be judged 
 that, in the sanitary system which the Reports represent, super- 
 vision by the central authority is exercised with but most 
 imperfect eyesight. The President's not telling what most 
 needs to be told of the sanitary districts of the country 
 means no doubt that he is unpossessed of such information, 
 and implies but too plainly that he has therefore been with- 
 out means of exercising, except in a desultory and most imper- 
 fect way, the influence which his office was meant to have. 
 This brings to practical test the organisation which Mr. 
 Stansfeld established : for the essential insufficiency which 
 betrays itself in the Reports of the Board is at the point where, 
 in that organisation, the means of efficient supervision had been 
 withholden. It seems to justify the anticipation expressed in my 
 last section (pp. 388-9) that a predominantly ^' general " super- 
 vision would rapidly tend to become no supervision at all. If 
 the recommendation of the Royal Sanitary Commission in 
 respect of the former medical officership under the Privy Council 
 had been followed in spirit as it was in letter, and the objects 
 contemplated in the Act which originated that office had been kept 
 in view in the Department to which the office was transferred, 
 the Medical Officer under the Local Government Board would 
 have been allowed ample facilities for informing himself on such 
 matters as are here in question ; and in that officer's statutory 
 annual report the President might of course have claimed to find, 
 
 * In contrast to tills is to be observed that each of Presidential Reports of late 
 years has in its Appendix a collection of tributory statements from the general 
 inspectors on the facts as to Pauperism and Relief in the respective inspectorial 
 districts. 
 
400 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. for his own use, a methodical statement of the progress of 
 
 State^^ disease-prevention in England. That such facilities have not 
 
 ^^^871 existed is a fact to which the successive Medical Officers of the 
 
 .. „ Board have repeatedly referred in their reports^ and which any 
 
 vision by skilled reader of the Board''s publications would hardly fail to 
 
 Govern- notice for himself. Not only has the Medical Department 
 
 Board ^^en without systematic inspectorial relation to the local work- 
 
 ino" of the common sanitary law, but also, with its limited 
 
 staff, and in view of the heavy other claims it has had to meet, 
 
 it has been unable to make occasional inspections in nearly 
 
 sufficient number to compensate for the want of system.^ 
 
 Exceptional In the last pages I have shown what, since Mr. Stansfeld's 
 im-eJ' time, has been the general character of the Local Government 
 Board's sanitary supervision ; but I have now to note that, during 
 a period of about two years, it was modified. The supervision 
 having till the middle of 1884 been only such as I have described, 
 circumstances then seemed likely to raise question, in a practical 
 and popular form, whether such supervision with shut eyes was 
 worth maintenance. For there then began a new period of 
 Cholera-alarm for England. In the summer of 1883, Egypt had 
 suffered a new invasion by that disease ; in the summer of 1884, 
 various French and Italian and Spanish ports in the Mediterranean 
 showed themselves infected ; and thenceforth, till the spring of 
 1886, successive further ravages of Cholera in parts of Southern 
 Europe, together with the outbreak of it in various north-western 
 parts of France, and its presence during many months in Paris, 
 constantly kept England more or less expectant of invasion. At 
 Midsummer, 1884, with cholera advancing as it was, and already 
 
 * During tlie ten years next following Mr. Stansf eld's presidency, the juris- 
 dictional areas medically visited with reference to more or less of their common 
 sanitary work (as distinguished from the business of public vaccination) seem to 
 have averaged only 48 per annum ; an annual proportion of but little over 3 
 per cent, on the total number of jurisdictions. Had the Board really intended 
 to criticise with reasonable strictness of standard the various local excesses 
 of disease throughout the country, to inquire as to the action of local authorities 
 and their officers in relation to those excesses, to assist such newly -appointed 
 officers as might need practical suggestions on their work, and to see that 
 the officers who received part-payment from the pailiamentary grant did thdir 
 full duties prescribed by the Board, probably the medical inspections would 
 have been at least ten times as many as they were. 
 
THE REIGN OF QUEEN VICTORIA. 401 
 
 within easy striking-distance of our shores, the Local Govern- Chap. XV. 
 rnent Board, in face of the alarm, appeared suddenly to become state ^ ^ 
 conscious that its Intelligence-Department, as organised under Mr. ^^"gfi. 
 Stansfeld, had not given it any glimmer of knowledge as to the .. 
 preparedness of local authorities to meet emergencies of infectious vision by 
 disease. I do not say that the ignorance signified more in 1884, Qoveml 
 in relation to the foreign danger of that year, than it had signified Joard. 
 for the previous thirteen years in relation to the habitual diseases 
 of the country ; but the less familiar alarm served to draw • 
 attention to it, and led to an important (though only temporary) 
 increase of the Board-'s supervisional efficiency ; inasmuch as Sir 
 Charles Dilke, who at the time was President of the Board, at 
 once decided that the state of the national defences against 
 cholera should be examined by the Medical Department ; and, 
 from the nature of the case, this examination would necessarily 
 be a general sanitary examination of the places to which it 
 extended. So, under Sir Charles Dilke^s auspices, there was 
 made, in July — September, 1884, a preliminary and somewhat 
 hasty visitation of some chief English ports ; and then, with 
 four inspectors added for two years to the staff of the Depart- 
 ment, a systematic '^ Cholera Survey '' of England was entered 
 upon, to be continued as long as the reinforcement of staff would 
 allow. By this Survey during the years 1885-6 the Medical 
 Department was enabled to critically examine, at 92 chief points 
 of coast-line, the state of the local administrative arrangements 
 for dealing with ship-borne arrivals of infectious disease, and 
 similarly to examine, in 501 of the 1574 extra-metropolitan sani- 
 tary districts of England, the general state of the local sanitary 
 administration ; so that, with regard to this important proportion 
 of the field of English sanitary government, the local authorities atjd 
 their officers had at length an opportunity to profit as freely as might 
 be requisite by the criticisms and advice of central skilled officers. 
 Dr. Buchanan^s description (in supplement to the Board''s 
 Report XV.) of the method on which the Survey was conducted 
 is as follows : — '^ In each district that was visited by inspectors 
 of the survey, investigation was made of the general sanitary 
 circumstances of the district with reference to cleanliness, 
 sewerage and drainage, excrement and refuse disposal, water- 
 supply and condition of dwellings ; also as to the general sanitary 
 
402 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. administration of the district and the performance of duty bj 
 Stete^^ sanitary officers ; and^ further, inquiry was made as to the pro- 
 sSS^mi. vision of means of isolation and disinfection, both as concerns 
 .. current English infections, and in anticipation of the possible 
 
 ^-ision by advent of cholera. Moreover, in the ports and coast districts of 
 Govern- the kingdom, note was taken of various anomalies of their 
 Board Sanitary constitution with a view to amendment of them here- 
 after; and the arrangements made by the several sanitary 
 • authorities, for giving effect to the Cholera order of this Board 
 (July 12th, 1883) were examined. The inspectors were charged 
 to take counsel, in every instance, with the sanitary authority 
 and its executive officers about matters that were capable of 
 amendment ; to place their experience derived from other districts 
 at the disposal of every sanitary administration ; and, when 
 needful, to leave with the authority a written memorandum of 
 the advice which they had given in conference. This system of 
 inspection and advising was uniformly pursued ; and I have 
 reason to believe that it was generally appreciated by local 
 sanitary bodies ; that, where sense of responsibility for sanitary 
 duty had been wanting, the inspections conduced in valuable 
 measure towards its development ; and that when local 
 authorities were desirous of performing their sanitary duties 
 towards their own districts and the kingdom generally, they 
 have been greatly aided by the inspectors^ visits and have been 
 correspondingly grateful to the Board for the advantage thereby 
 afforded them.''-' In the Medical Supplements to the Board's 
 Reports XV. and XVI., Dr. Ballard and Dr. Blaxall, who had 
 been Dr. Buchanan''s chief lieutenants in the Survey , report 
 amply on its results : both as to the local conditions which they 
 and the other inspectors had found existing, and as to the 
 nature and effect of the communications they had had with 
 the respective local authorities and officers. It would be 
 cumbrous, and is not necessary, to quote here any details of 
 the reports : but with regard to their general bearing, I may 
 ^ay that their every page justifies beyond question the policy of 
 the Survey, and equally condemns the policy which had for so 
 many previous years forbidden any systematic action of like 
 purpose. To two broad statements made in the reports I would, 
 in that point of view, particularly refer. First, as regards the 
 
THE REIGN OF QUEEN VICTORIA. 403 
 
 local authorities which, the Act of 1872 had established,, Dr. Chap. xv. 
 
 Ballard points out that " one result of the survey has been to state^^ 
 
 bring prominently into notice the very varying ^^^^^5.871. 
 
 degree of efficiency of their administration. This is the first 
 
 — -Super- 
 thmg that must strike a reader of the reports Many vision by 
 
 sanitary authorities have been working and are still working Govern- 
 
 ment 
 
 earnestly for the improvement of the districts in their charge, Board, 
 not in one direction only, but in all directions of importance. 
 Others have since their constitution done no efficient work^ or 
 little of primary importance. Indeed, some of these latter 
 authorities^ it will be seen, evince no desire even to be properly 
 instructed as to the sanitary requirements of their districts, asking 
 for no reports from their medical officers of health, and paying 
 little or no regard to them when presented. And, unfortunately 
 (though this is only what was to be expected) it is the very 
 districts which are in the most unwholesome condition in which 
 this sanitary apathy of the authorities is most observable. .' . . . . 
 There is yet a third class of authorities, the most numerous of 
 all, especially in the rural districts, which is intermediate between 
 these extremes, where laxity and tardiness is the rule of the 
 administration, a laxity and tardiness which shows itself in a 
 variety of ways (as exhibited in the several columns of the precis) 
 not the least infrequent of which is a tenderness in dealing with 
 private premises, and with recurring nuisances on and about 
 them, and in the neglect of the conditions under which the 
 poorer part of their population live, that part of the population 
 least capable of self-help. ^^ Then, at last, as regards the spirit 
 in which the local authorities and their officers received the 
 inspectors of the central authority. Dr. Ballard (p. 127) reports 
 as follows : — " I cannot properly bring these observations to a 
 close without alluding to one incidental advantage which has 
 accrued from the survey. I allude to the encouragement which 
 the personal interview with the Board^s inspectors has afforded 
 to many medical officers of health, who under multiform 
 difficulties, discouragements, and impediments, have been anxious 
 and have striven to perform their duties efficiently and for the 
 benefit of the communities in their charge. The inspectors 
 engaged upon the survey have all told me of the gratification 
 at the inspectors' visit experienced and expressed by these 
 A A 2 
 
404 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 ii. — Super- 
 vision by 
 the Local 
 (Tovem- 
 meut 
 Board. 
 
 gentlemen, and of their thankfulness for the advice 'givien them 
 personally as to the best methods of discharging their fmictions 
 and of attaining the ends they have in view. Especially has 
 this been the case with medical officers of health newly appointed, 
 who, when they have not filled a similar post before, and have 
 not been specially prepared for it, have been most grateful for 
 the opportunity thus afforded them of acquiring a kind of know- 
 ledge which they could scarcely acquire in any other way so 
 effectually.''^ With regard to each of the two matters on which 
 I have quoted Dr. Ballard, I may quote Dr. Blaxall as reporting 
 to the same effect from his different field of observation. In 
 respect to the coast-survey, with which he was particularly 
 charged, his report (pp. 131 and 149) is as follows : — ^'Evidence 
 
 was forthcoming of much good Work done in the 
 
 way of sanitary administration with reference to measures 
 adopted, both to prevent the spread of disease and to ensure a 
 wholesome condition of vessels. On the other hand many weak 
 points were revealed, together with much neglect of sanitary 
 administration. The riparian [common sanitary] authorities 
 [to be distinguished from special joor /^-authorities] had, as a rule, 
 omitted to carry out the duties imposed upon them, owing 
 generally, it would seem, to ignorance of the requirements of the 
 Public Health Acts. The opportunity offered by these inquiries 
 for personal intercommunication between the medical inspectors 
 and local health authorities proved of essential service in enabling 
 the authorities to apprehend the nature and importance of the 
 duties devolving upon them as administrators of the Public Health 
 Acts and Cholera Regulations, and to inform themselves on a 
 variety of points which they had before neglected or had 
 
 imperfectly understood.^' "The various authorities 
 
 with whom we were brought in personal communication evinced 
 considerable interest in the health question, and for the most 
 part were desirous of acquiring information : many of them who 
 had previously been careless of their duties promising to carry 
 them out in future. '"' . . . '' The present inspection has certainly 
 procured for the Board the confidence and gratitude of many 
 port sanitary authorities who are desirous of efficiently perform- 
 ing their sanitary duties."" 
 
 Altogether admirable was the tone of that inspectorial work 
 
THE REIGN OF QUEEN VICTORIA. 405 
 
 done under the Board^s authority during the two years 1885-6; Chap. XV. 
 and very striking was the contrast between it and the previous Stefe^ 
 insignificance of the Board's supervision. It was essentially Jf^^e^syi 
 such work as the Board, on my contention, ought to have been .. 
 doing from the time when it was established. That the Survey vision by 
 tended powerfully to stimulate the sanitary progress of the Govem- 
 country will be clear to any competent person who reads the Board 
 reports. That, during the two years for which it advanced, it 
 did great good — good incalculably greater than the Board could 
 by other action have done, and good distinctively of the sort 
 which the Board had been commissioned to do, — seems to me 
 quite unquestionable. And in the light of the trial which had 
 been made, it apparently might have been well foreseen, that 
 the steady prosecution of such work for ten or twelve more 
 years would secure results which otherwise not half a century's 
 endeavours could be expected to attain. With those considera- 
 tions in the mind, it is indeed deplorable to know, that, towards 
 the close of 1886, the unfinished act of supervision was allowed 
 to come to an end, and that the previous system of " how not to 
 do it '' was tranquilly resumed.^ 
 
 Under this restored reign, the benefit permitted to reach the Current 
 country from the existence of the Central Medical Department the L. G. 
 has been but of small proportion to that which the Department, sanitary^ 
 with moderate extension and proper facilities, could certainly ^^atters. 
 render ; and it seems clear that, for want of such exten- 
 sion and such facilities, large parts of the business which the 
 Local Government Board purports to transact with district 
 authorities must be transacted under disadvantageous conditions. 
 The system seems far too much to suppose that a free consump- 
 tion of stationery may serve instead of skilled visitation ; that 
 central opinion on local sanitary cases may in general be an affair 
 of correspondence ; that average local reports will in general be of 
 such completeness and exactitude that the central skilled officer 
 can readily advise on them, without having first in person or by 
 deputy examined as to facts. My experience has not been to 
 any such effect as that. A central skilled officer, desired to 
 
 * The financial decisions under which this result came were no doubt of much 
 earlier date than the result itself. 
 
406 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 ii. — Super- 
 vision by 
 the Local 
 Govern- 
 ment 
 Board. 
 
 advise day by day on masses of average local reports and corres- 
 pondence, but not aided by special inspection at the time, or by 
 reference to notes or memories of fairly -recent previous inspec- 
 tions, will in a very large proportion of the cases — (when I was in 
 office I should have said an overwhelming majority of them) — find 
 that he cannot advise in a way to satisfy himself, or likely to 
 satisfy others. The materials referred to him will in most cases be 
 in some degree incomplete or inexact, will in many cases be un- 
 answerably vague or fragmentary till further information is given, 
 and more than a very few of these will be such that no practic- 
 able correspondence on them seems likely to do good. In sanitary, 
 as in other affairs, sound advice cannot be given except on de- 
 fined premisses ; and the sanitary adviser who is but imperfectly 
 made aware of the facts of his case, can only give his advice with 
 such speculative qualifications as will make it rather an exercise 
 in casuistry than a help to administrative practice. Critics who 
 observe how very few are the medical inspections which the 
 Local Government Board allows for general sanitary purposes, as 
 distinct from vaccination-business, in comparison with the fact 
 that the Board^s paper-references to the Medical Department on 
 general sanitary business number now some seven thousand in 
 the year,^ may wonder from what knowledge of local facts 
 that mass of local references is to be answered ; and suspicion 
 will perhaps arise that they who make these references to 
 the Medical Department may at times go through their official 
 ceremony with somewhat of the smile of augurs. In the grow- 
 ing number and variety of the references made to the Medical 
 Department in respect of the Board^s sanitary business, there of 
 course is every reason for gratification ; f and it may be taken 
 for granted that at present in matters of daily detail (if not 
 equally in larger matters) the administrative officers of the 
 Board are alive to the necessity of fortifying themselves with 
 medical advice when sanitary interests are in question ; t but the 
 
 * See Dr. Buchanan on the business of 1886 and 1887 : in Meports XV. and 
 XVI, Medical Supplement. In 1886 the references, including vaccination, were 
 8,500 ; in 1887, ^a:cluding vaccination, were 7,000. 
 
 t In 1884 Dr. Buchanan, in the opening paragraph of his Eeport, speaks of "the 
 increased recognition which the Board has during recent years been pleased to ac- 
 cord to the advice of its Medical Staff." — L. G. B. Annual Report XIII. ^Supplement. 
 
 X In. this respect it is satisfactory to observe that of late years the Medical 
 
THE REIGN OF QUEEN VICTORIA. 407 
 
 very large disproportion which exists between the number of local Chap. xv. 
 
 sanitary questions on which advice is expected from the Medical state^ 
 
 Department, and the quantity of the means allowed to the De- ^^^lyyi 
 
 partment for acquiring- the proper local knowledge on which to .. _„ 
 
 found its advice, is a weakness which must certainly affect the vision by 
 
 Board^s correspondence with the authorities it purports to guide.^ Govern- 
 ment 
 
 Board. 
 While the Medical Department, under . the circumstances Scientific 
 which I have described, has in great part been debarred from the Medi"^ 
 the administrative uses it might have rendered throughout the ^g^^.^^'^*'" 
 country, with reference to the reduction of disease, and to the 
 improvement of sanitary organisation, happily it has been able to 
 make progress in very important sorts of collateral work. Un- 
 like those government offices which, at least relatively speaking, 
 
 Department has been admitted to take part in conferences held at the office with 
 representatives of local sanitary authorities where matters evidently sanitary have 
 required consultation: e.g. in 1885, "principally with reference to the medical con- 
 siderations involved in proposals for local byelaws where the adaptation of sanitary 
 principles to the circumstances of particular localities came into question ; and 
 with reference to the medical points to be held in view by authorities proposing 
 to borrow public money for the erection of isolation-hospitals, or for other objects 
 of local sanitary advantage ; " and of course in A^arious of these cases more or less 
 of medical inspection has been found necessary. — See Dr. Buchanan's Supple- 
 ments to L. G. B. Annual Reports, XIV-XVII. 
 
 * Probably some of the correspondence is further weakened by the indirect- 
 ness of the Medical Department's relation to it. The Medical Department 
 (when referred to) advises on the Board's official letters, but does not itself 
 correspond. Generally in regard of local questions of sanitary practice, written 
 communications, even at their best, cannot be more than an imperfect 
 substitute for personal colloquy in presence of the local facts; and when the 
 written communication must have the additional disadvantage of indirectness, 
 there may often be doubt whether entering on it can be worth while. For 
 instance, in the large niunber of cases where medical officers of health are 
 supposed to be advised on their official reports, and on points of sanitary practice 
 involved in them, not only does the secretarial signature fail to add weight to 
 the advice of the letter, but the advice may to some extent have had to adapt 
 itself to the signature : for the common usages of professional life would hardly 
 allow the central medical officer to express himself through a non-medical secre- 
 tariat as freely as if he were writing in his own name. There would be difficulty 
 in medical consultation-correspondence on the treatment of disease, if it were 
 made similarly circuitous : if, for instance, a foremost London consultant, having 
 to suggest to his professional brother in the country some diiferent method of 
 treatment for the sqiiire's asthma or the lady's megrim, were not in direct 
 correspondence with his fellow practitioner, but must have his medical sugges- 
 tions adopted by the family solicitor, and expressed to the distant doctor in the 
 form of a lawyer's letter. 
 
408 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 ii. — Super- 
 vision by 
 the Local 
 Govern- 
 ment 
 Board. 
 
 may be said to work from the basis of a completed and final 
 experience, the central Medical Department must always be 
 endeavouring to learn. Among its most imperative duties to 
 the public, is, that it shall maintain and continually increase its 
 own scientific efiiciency as an advising department; that the 
 knowledge on which its advice in particular cases, and its stand- 
 ing memoranda of general advice, are based, shall always be the 
 most exact and complete knowledge which at the time is 
 possible; that it therefore shall be incessantly watchful to 
 recognise and appropriate for the public service all new ex- 
 periences which concern the various moot sanitary questions of 
 the day, whether such experiences arise in its own administrative 
 sphere, or in the independent work of others, and that, where such 
 experiences are fragmentary, it shall, in important cases, 
 integrate them by systematic special studies of its own ; that 
 in itself, and in publications to be renewed by it from time to 
 time as circumstances require, it shall be foremost in a constantly 
 advancing gain and proclamation of such new knowledge as 
 may be of benefit to the Public Health. Claims for more or 
 less scientific work to be done in that spirit are apt to develop 
 themselves incidentally in the course of common sanitary 
 inspections, primarily undertaken only in the interests of some 
 single district, but where the skilled inspector, amid local facts 
 not previously understood, comes on clues for scientific dis- 
 covery ; so, again, claims for extensive and connected scientific 
 study requiring to be conducted on system, and likely to be of 
 long duration, arise in obscurities of disease, or difficulties of 
 sanitary administration, common to a plurality of districts ; 
 while also and always, in the deeper scientific relations of 
 Preventive Medicine, there are questions constantly coming 
 forward, which require elaborate study by methodical Laboratory 
 Investigations, such as those which the Medical Department, 
 under favour of the special Parliamentary vote previously men- 
 tioned, is enabled to conduct. In those fields of industry, not 
 immediately administrative, but of really infinite concern to 
 future administration, the Medical Department, during the 
 years which are here under review, has done what work it 
 could, and with results which are on record in the successive 
 departmental reports. 
 
THE REIGN OF QUEEN VICTORIA. 409 
 
 Thus, from time to time during* these years, endeavours Chap. XV. 
 have been made to produce for the common information of local state 
 authorities and officers, consolidated statements of knowledge as gu^ce^Wi. 
 at the time existing, with regard to particular objects of ad- •j_g^ 
 ministrative duty. For instance, in 1874, in a Report on vision by 
 Filth- 1) 18 eases and their Prevention, endeavours were made to Govem- 
 codify for g-eneral use all the knowledge which down to that Board. 
 date had been obtained as to the various forms of that one 
 class of dangers to the public health, and as to the corresponding Consolida- 
 varieties of precaution to be used against them ; and among the instruc- 
 Appendices to that Report was one which Mr. Netten Radcliffe, Memor- 
 after a long series of special investigations, had prepared for the ^^^a: 
 purpose, — a description of all such irnproved contrivances as 
 were yet at work in towns and villages throughout Great Britain 
 for dealing with offensive refuse. At that time, and during 
 several subsequent years, Mr. Radcliffe had in continuous charge 
 the duty of observing the movements abroad of Asiatic Cholera 
 and Levantine Plague ; and his assistance enabled the Medical 
 Officer to furnish for public use annual statements of information 
 on those matters. In 1875 there was initiated a large and 
 systematic study by Dr. Ballard, concerning the Effluvium- 
 Nuisances which arise in connection with various manufacturing 
 and other branches of industry, and specially with regard to the 
 effect upon health of each such nuisance, and to the degree in 
 which the nuisance can be prevented : the results of which 
 study, presented by Dr. Ballard in three successive reports 
 during the years 1877-79, constitute a complete body of scientific 
 and practical information, for the guidance, both of the traders 
 who produce the nuisances in question, and of the authorities 
 who ought to control the nuisances ; such a body of information , 
 as is, I believe, not only without equal in its own branch of 
 sanitary subject-matter, but certainly without superior — as to 
 thoroughness of work — in any sanitary publication known to 
 me.^ During Dr. Seaton^s tenure of office. Dr. Ballard's 
 continuation-work being in progress, no opportunity was found 
 for initiating any other similarly synoptical work in matters of 
 
 * I regret to have to record a doubt whether at the present time Dr. Ballard's 
 extremely -v-aluable Reports exist in such form of publication as that the classes 
 for whom they were written can have access to them. 
 
410 
 
 ENGLISH SANITAKY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 ii. — Super- 
 vision by 
 the Local 
 Govern- 
 ment 
 Board. 
 
 Advances 
 in new 
 Bcientific 
 discovery ; 
 
 by In- 
 spectors ; 
 
 sanitary administration; but in 1880 Dr. Buchanan initiated 
 an inquiry into the experiences of such Infectious Disease 
 Hospitals and Disinfection Estahlishments as were then existing ; 
 and this inquiry, ably conducted by Dr. Thorne and Mr. Power, 
 and reported on by them, gave results full of instruction for 
 local administrators. Further, in the same year, for the 
 assistance of sanitary authorities who might be proceeding to 
 take action for their districts under the provisions of the 
 Interments Act of 1879, Dr. Buchanan, with the assistance of 
 Dr. Parsons, prepared an instructive departmental memorandum 
 on the Sanitary Rules to be observed in the establishment of 
 Public Cemeteries. In 1881, Dr. Stevens made a large fresh 
 inquiry (which in regard of London was exhaustive) as to the 
 control of small-pox by vaccination, and especially as to the 
 Preventive Merits of Public Vaccination. In 1882, with 
 Dr. BlaxalPs assistance, extensive inquiries were made into the 
 Sanitary Conditions of Migration into and from this country : 
 especially as to the conditions of travel and lodgment of im- 
 migrants and intending emigrants, and as to the arrangements 
 on board of emigrant ships ; above all, as to the precautions 
 taken at ports of debarkation and embarkation, and their 
 lodging-houses, and on ship-board, for detecting infectious 
 disease and guarding against its spread : and Dr. Blaxall, who, 
 as inquirer into those matters, had the advantage of previous 
 naval experience, was able to present a general report calculated 
 to be of much value both to shipping-companies and to local 
 authorities. In the same year Dr. Buchanan himself issued a 
 valuable memorandum, drawing attention to the frequent in- 
 fluence of Elementary Public Schools in the diffusion of Infectious 
 Disease J and pointing out the conditions under which particular 
 scholars ought to be excluded from schools, or particular schools 
 to be closed. 
 
 Again, in several instances during the last few years, inquiries 
 originally undertaken by the Medical Department for some ad- 
 ministrative object, perhaps of small scope, and not obviously of 
 any exceptional scientific interest, have brought to light the 
 scientific need for some wider or deeper investigation ; and out of 
 such incidentally enlarged studies, extremely valuable additions to 
 previous knowledge have been made. Especially this has been 
 
THE REIGN OF QUEEN VICTORIA. 411 
 
 the case with work by Mr. Power and Dr. Ballard: and both S^^\^^' 
 
 ... . English 
 
 these officers are contributing* importantly to widen the founda- State 
 tions of sanitary practice. — Thus, with regard to the Dissetmna- since 1871. 
 Hon of Smallpox, Mr. Power, in connection with his joint-inquiry ii._super- 
 o£ 1 880 into the working of hospitals for infectious disease, began 7^^^ ^^ 
 to see what, by subsequent elaborate extensions of work, he Govem- 
 appears at last to have solidly proved : that, from groups of Board, 
 smallpox patients brought together in hospital, the contagium of 
 the disease is capable of diffusing in the external air, irrespec- 
 tively of personal intercourse, to the distance of at least a mile ; 
 and that to this distance it can be traced and measured as 
 operating in the successive zones of area with proportionate dimi- 
 nutions of intensity. — On a later occasion, working with the same 
 rare sagacity and perseverance from difficulties which he found in 
 accounting by recognised doctrine for a certain outbreak of Scarla- 
 tina, Mr. Power proceeded step by step to establish (as at present 
 appears) the startling discovery, with all its extremely important 
 administrative consequences : that bovine, as well as human 
 beings, are susceptible of scarlatina ; that, between brute and 
 human subject, the disease is communicable ; that authorities 
 who would guard their districts against epidemics of scarlatina 
 have to think not only what human scarlatina may be within 
 the area, but also what bovine scarlatina may be in the cow- 
 houses, and may be infecting the milk which is for human 
 use. — Within the same period with those works by Mr. Power, 
 has been a work of extraordinary importance by Dr. Ballard, 
 growing out of an instruction which at first (1880) related 
 exclusively to the town of Leicester. Since 1881, namely. Dr. 
 Ballard has at every opportunity been conducting, and since 
 the close of the Cholera- Survey has been gradually bringing 
 towards completion, an investigation on very large scale, and of 
 peculiarly searching character, into the exact nature and the 
 localising conditions of the Summer D'mrrhma which is of well- 
 known fatality, especially to infants and young children, in 
 many chief urban districts of England. According to a first 
 instalment of report which Dr. Ballard has recently made, and 
 which he in his admirable scientific spirit characteristically 
 describes as merely ^^ provisional,^' he seems to have succeeded 
 in identifying a hitherto unrecognised specific disease — specific in 
 
412 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 
 English 
 State 
 Medicine 
 since 1871. 
 
 ii. — Super- 
 vision by 
 the Local 
 Govern- 
 ment 
 Board. 
 
 the sense in which enteric fever or measles is specific ; and the 
 report gives good reason for suspecting that the endemicity of 
 the disease must probahly be due to the zymotic power of a 
 specific micro-organism which under certain conditions of season, 
 and under certain (happily controllable) local conditions, would, 
 Dr. Ballard suggests, be capable of breeding in the superficial 
 layers of the earth, and of spreading from them to infect the 
 lower levels of the air. — Very appropriately, in the same volume 
 with that important addition to our knowledge of diarrhoea, is 
 published a highly suggestive contribution to the endemiological 
 study of JDipktkeria : a report by Dr. George B. Longstaff ; 
 whom '^a faint hope of lighting upon some clue^^ as to the 
 causation of diphtheria had *' induced to undertake a tedious in- 
 vestigation into the distribution of 89,603 deaths from the disease 
 recorded in England and Wales during the twenty-six years from 
 1855, when it first appears in the returns of the Registrar- General, 
 to the close of 1880.''^ The result of this laborious statistical 
 study (embracing a variety of carefully-drawn distinctions) has 
 been to exhibit diphtheria as apparently at first a disease of rural 
 rather than urban affinity ; and it seems to argue very strongly 
 in favour of extensive exact investigation, whether perhaps the 
 essential cause of diphtheria can be found in something which 
 '^ the country " has sent, and is sending, into towns : — for, in this 
 connection, says Dr. Buchanan, " it is impossible not to recall the 
 relations that have occasionally been witnessed between outbreaks 
 of diphtheria and particular milk-supplies, and the relations, 
 strongly suspected, but not yet sufficiently demonstrated, between 
 diphtheria in man and disease in various domestic animals.'^ — 
 The year 1889 in which the two last-mentioned reports have 
 emanated from the Medical Department, has had the further 
 departmental success of Dr. Barry^s report on the Sheffield 
 Smallpox Upidemic of the years 1887-8, and on the influence of 
 vaccination in limiting its spread and its severity : a report, 
 which, from its copiousness of exact detail, is of rare evidentiary 
 value ; and as its publication has fortunately coincided with the 
 appointment of a Royal Commission, having to certify on the 
 merits of vaccination, the public will no doubt learn in due time 
 whether the anti-vaccinists have anything to say against the 
 argument which the report furnishes. 
 
THE REIGN OF QUEEN VICTORIA. 413 
 
 In addition to the various works of doctrinal consolidation, Chap. XV. 
 
 and to such instructive pursuits of new knowledge as have on state 
 
 different occasions grown out of administrative visits to par- ^^e^]^7i. 
 
 ticular districts, there has been continuous work in Laboratorv .. « 
 
 . . . . . "• " Super- 
 
 Investigations. • Those Investigations, while under direction of vision by 
 
 the Lords of the Council, had been mainly divided between two Govem- 
 great objects : the one — in which Dr. Sanderson and Dr. Klein Board • 
 and Dr. Creighton took chief parts, a multiform study of Infec- 
 tive Processes J Acute and Chronic ; the other, which it was hoped 
 would afterwards have pathological application. Dr. Thudichum's 
 studies in Organic Chemistry ; and till 1883, both those lines of 
 work were followed : but from 1883, when the more physiological 
 study was brought to a close, the Investigations have found 
 sufficient subject-matter in questions of hifection and Dishifec- 
 tioTij including the intimate special pathology of various Infective 
 Diseases, and of late much particular study relating to questions 
 of Prophylaxis. Sometimes in co-operation with Inspectorial 
 Research,^ and sometimes in separate action, the Laboratory In- and by 
 vestigations have always been increasing that basis of exact gtuS!^^ 
 knowledge from which the Department derives its pretensions 
 to advise. Here and there have been certain quantities of 
 work, not pretending to give immediate administrative return; 
 for example, various of the zymologieal studies which have been 
 diligently pursued by Dr. Sanderson and Dr. Klein and their 
 assistants, or Dr. Thudichum's singularly arduous undertaking in 
 respect of the chemistry of the nervous system; but though 
 these, in a provisional sense, have been* of comparatively abstract 
 science, they of course have been undertaken with ulterior regard 
 to demands of practical significance. In other directions, results 
 already attained are in near and nearer readiness for applications 
 in medical practice, human and veterinary, or for purposes of 
 sanitary action. Thus, for instance. Dr. Klein, ever at work in 
 the microphytology of the morbid contagia, has, during these 
 years, not only made large additions to previous knowledge of 
 the habits and modes of action of contagia within the animal 
 body affected by them, but has succeeded in clearly identifying 
 
 * See for instance Dr. Klein's contributions to Dr. Ballard's studies of 
 Diarrhoea, to Mr. Power's study of Scarlatina, and to various departmental studies 
 of Poisoning by articles of Food. 
 
414 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 
 English 
 State 
 Medicine 
 since 1871. 
 
 ii, — Super- 
 vision by 
 the Local 
 Govern- 
 ment 
 Board. 
 
 and isolating the contagium o£ the pneu mo-enteritis of swine, the 
 contagium of the foot-and-mouth disease of farm-stock, and, he 
 believes also, the contagium of scarlatina. Of extraordinary in- 
 terest, too, in relation to questions of prophylaxis against the more 
 deadly infections, is the fact that Dr. Wooldridge, in a line of re- 
 search distinctively his own, and which he has developed out of such 
 special studies of the blood as might have been deemed abstract- 
 edly physiological, appears to have arrived at an essentially new 
 method of giving immunity against the infection of anthrax ; 
 and the reflection is obvious, that, in the discovery which Dr. 
 Wooldridge seems to have made, limited though it yet is to but 
 one disease, and but imperfectly understood even within those 
 limits, there may be, for future development, very powerful 
 possibilities of extension and usefulness."^ 
 
 The very conspicuous ability of the Department under Dr. 
 Buchanan at the present time, as shown in the works to which 
 my last pages have referred, and in the administrative advice 
 which the Department supplies, is something of which English 
 Medical Science has every reason to be proud. In proportion as 
 it is recognised, and as its eminent adaptedness for practical use 
 is understood, so much the more must regret be felt that the 
 Department was not allowed to retain the increase of staff which 
 for two years had vastly increased its powers of public service, 
 and with which the Board had been rendering it an instrument 
 of real effect to stimulate sanitary progress in many back- 
 ward districts of the country. 
 
 iii. — ^THE MEDICAL ACT OF 1886. 
 
 iii.— The In 1871, when the Local Government Board Act removed 
 
 Act of from the Lords of the Council the responsibility they had had 
 
 in local sanitary affairs, no change was made in their Lordships' 
 
 other sanitary responsibilities, and especially the Lords remained 
 
 * "With deep regret at the last moment I have to add to my above mention 
 of Dr. Wooldridge the sad record of his untimely death, on June 6, 1889 : the 
 end of a career of rare scientific promise and enthusiasm, after but a few days of 
 illness during which he would not cease to work. It is to be hoped that others 
 may appreciate and continue the eminently original lines of research which he 
 had opened, and which seemed likely to give him very great results. 
 
THE REIGN OF QUEEN VICTORIA. 415 
 
 responsible to Parliament in questions regarding the Professions Chap. XV. 
 of Medicine and Pharmacy. On various occasions during the stafe^ 
 years 1877-82 (as mentioned at page 310) their Lordships had ^^c'^tsfi 
 shown renewed desire to obtain comprehensive legislation for the ... ^ 
 Medical Profession ; but in their attempts for that purpose they Medical 
 had never made real progress. At last, in 1886, an almost 1886? 
 accidental impulse, operating under conditions which were also 
 in great part accidental, led to the passing of a Medical Acts 
 Amendment Bill of a certain sort. 
 
 A difficulty had come before the Colonial Office with regard to Particular 
 claims of medical privilege in the self-governing British Colonies, q^rw an 
 — primarily, a question with the State of Ottawa as to the right amendment 
 of the Colonial Legislature to limit by local statute the run of of 1858. 
 privileges which had been conferred under the Medical Acts of 
 the United Kingdom ; and as this difficulty, which Government 
 deemed urgent, could not receive the solution intended for it 
 unless a certain provision in the Medical Act of 1858 were 
 repealed or modified, so, for the purpose of carrying that amend- 
 ment, a Medical Acts Bill must now be brought before Parlia- 
 ment. The clause which Government urgently needed to carry 
 was not likely to be opposed on any ground special to itself ; 
 but, at the moment when its passing was so urgently desired, 
 the merest breath of opposition would have sufficed to stop any 
 bill not of first-rate importance ; and it was certain that opposi- 
 tion would be raised against the Government's colonial clause, 
 unless clauses of certain other sorts, agreeable to interests which 
 could make themselves heard, accompanied it. The general 
 public had hitherto learnt far too little of its own interest in the 
 constitution of the Medical Profession, to be feeling any concern 
 on the subject ; and it was chiefly with deference to far narrower 
 interests, that this Bill would have, to be fashioned and trimmed. 
 The line of least resistance would of course not be the line of 
 such endeavours as the Ministers of both political parties had 
 hitherto deemed essential to a Medical Acts Amendment Bill ; 
 and the promoters of the colonial clause could not afford to touch 
 those greater objects of endeavour, except so far as they would 
 be ready, on demand, to slur them over with almost any sort of 
 compromise. It was unfortunate that any Medical Acts Bill 
 should have to come before Parliament under conditions such as 
 
416 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 iii.— The 
 Medical 
 Act of 
 1886. 
 
 those ; and a worse misfortune o£ the time was^ that just then 
 the House of Commons was losing by death one of its foremost 
 members, Mr. W. E. Forster ; whose relations to the subject, first, 
 as a promoter of the Bill of 1870, and afterwards as Chairman 
 of the Select Committee of 1879-80, had been peculiarly close ; 
 and who, both because of the knowledge he had acquired in those 
 relations, and because of his character and the confidence which 
 was reposed in it, would have been of recognised high authority 
 on such questions of compromise as were about to be raised, and 
 especially would have been as a tower of strength for the 
 interests of the public in those questions.^ But, however 
 unfavourable the auspices, action had to be taken in the matter ; 
 and accordingly in 1886, soon after Mr. Gladstone's third accession 
 
 * After a six months' struggle with painful illness, Mr. Forster died on the 
 5th April, 1886. He had been Education Vice-President throughout Mr. Glad- 
 stone's 1868-74 premiership ; and the habitual intercourse which I had with hiTn 
 in that relation, as well as afterwards in others, gave me a respect for him which 
 I would wish not to leave unexpressed. Already for years before his connection 
 with the Council Office, he had made his mark in Parliament as a man of 
 conscience and purpose ; and in office he more and more displayed the individu- 
 ality of a great Englishman. Of earnest political convictions, he also was of 
 immense vigour and industry, and of commanding clearheadedness and good 
 sense ; not effusive, not rhetorical, but powerful in the matter of what he said, 
 and in his evident care for the truth of it. Magnanimous, but self-restraining 
 and circumspect, he moved with a soldierly sort of caution against surprise, or 
 as the mountaineer who guides across crevasses. Unstudious of conventional 
 graces, and with a straightforwardness so intent and often so abrupt that it 
 perhaps did not always appear sufficiently polite, he, under cover of that some- 
 what rugged manliness, abounded in deep stores of humane feeling and impulse. 
 No speculative casuist or hair-splitter, he yet had an ever- watchful subtilty, both 
 of intellect and of feeling, where the rights of others had to be understood, or 
 their sufferings to be measured or redressed. ' In dealing with provinces of con- 
 troversy — (and even our medical business had some such on its borders) — his 
 care for justice was conspicuous. That in him which before all else struck me, 
 and in which I have never known his superior, was the solicitude he always 
 showed to understand both sides in every contested matter, and to make sure that 
 the side of less authority should be heard at least as patiently as the other. 
 Utterly hating injustice, and unfailingly ready to do battle against it, his liberal- 
 ism was not of the sort which contents itself with justification by faith. Before the 
 too early death which his incessant overwork brought on him, the world had 
 begun to appreciate the heroic elements in his character ; with what complete 
 self-devotion he served his country ; with what absolute courage and constancy 
 he took his great share in some of the painfullest duties of statesmanship ; 
 shrinking from no magnitude of toil, nor from any obloquy, nor from any 
 danger ; ever in the front where good work was to be done, and knowing no fear 
 but lest he shoiild do wrong. 
 
THE REIGN OF QUEEN VICTORIA. 417 
 
 to the Premiership, Sir Lyon Playfair, who was Education Vice- Chap. xy. 
 President during the six months o£ that administration, introduced state ^ ^ 
 in the House of Commons a Medical Acts Amendment Bill.^ ^^ct'lsn. 
 
 In that very exceptional session of Parliament, with parties ... _rp, 
 excited to the utmost in discussions of an immense national Medical 
 interest, and then with the House of Commons for some weeks 188G. 
 all but formally in dissolution, it was not to be imagined that 
 any Medical Acts Bill would receive general notice, or that any refonnatorv 
 progress with such a Bill could be made except through private -nf^^^^ib]^^ 
 negotiations for silent assent. The fact that the promoters of 
 the Bill of 1886 did not raise issue with any section of the 
 House, but were left free to carry their Bill as unopposed, is 
 evidence enough that the measure was not to effect any important 
 reform in the previously existing order of things. Accordingly 
 the provisions of the Act of 1886 do not correspond with the 
 principles of 1870, or with the recommendations of the Boyal 
 Commission of 1880-1, except so far as agreement without dis- 
 cussion in the House had been easy; and beyond that point, they 
 appear to be little more than make-shift contrivances, by which 
 various threatened discussions had been postponed. 
 
 Thus, as regards one main principle of 1870, no doubt the New pro- 
 Act of 1886 does decree the abolition of fragmentary qualifica- i^^^^" ^ 
 tions ; f aud of course it was right that the abolition should be 
 so decreed by statute ; but, in this long-delayed decree, the 
 Act only puts statutory seal on a reform which the Medical 
 Council had already in late years taken independent measures of 
 its own to effect. As regards the other main principle of 1870, 
 
 * Sir Lyon Playfair, till recently, had for many years been member for the 
 Universities of Edinburgh and St. Andrew's, and, in that relation, had, from 
 1870 onwards, been the chief parliamentarj- representative of the unwillingness 
 of the Scotch Universities to lose their privilege of separate licensing. 
 
 t For corporations not otherwise having legal authority to grant diplomas of 
 all-round qualification in medicine and surgery and midwifery, the Act gives 
 two sets of facilitating provisions ; ^rsf, concerning bodies in combination, to 
 the effect that the required diploma of all- round qualification may be the joint 
 act of any two or more bodies if at least one of them has authority in respect 
 • of medicine, and at least one has authority in respect of surgery ; and secondly, 
 as to other cases, to the effect that any medical corporation having only partial 
 authority, and not able to enter into combination as last-mentioned, shall be of 
 authority to give the diploma of all-round qualification, if the Medical Council 
 or the Privy Council have appointed for it such assistant-examinars as its case 
 may have been found to require. 
 B B 
 
418 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 
 State 
 Medicine 
 since 1871. 
 
 iii.— The 
 Medical 
 Act of 
 1886. 
 
 Doubt.5 as 
 to their 
 linali'r. 
 
 the Act o£ 1886 fully recognises that the too easy obtainability 
 o£ licences to practise, by candidates not possessing due know- 
 ledge and skill, is a danger against which the public needs to be 
 safeguarded ; but it raises no question as to the roots of that 
 danger, and apparently does not care how many competing 
 licence-boards there may be in the United Kingdom or in any 
 division of it. Against the supposed probability that with a 
 multitude of such bodies there will be a tendency to downward 
 competition in the strictness of conditions for licence, the Act 
 does not aim at constituting the security of a well-regulated 
 " one-portal system '' for the United Kingdom. Instead of 
 so doing, the Act takes as its security the principle of inspec- 
 tions to be directed by the Medical Council under responsibility 
 to the Privy Council ; and subject to that security (the provisions 
 for which were far more easily enacted in words than they can 
 be fulfilled in practice) the Act continues the old system of 
 many independent portals, and continues to each teaching 
 university the privilege of passing its own graduates on to the 
 national Register. 
 
 With regard to the constitution of the Medical Council, the 
 framers of the Act adopted the proposal which the Royal Com- 
 missioners had approved, and to which now no opposition 
 remained, that the Council should contain a proportion of 
 members elected by general vote of the Medical Profession ; but, 
 ignoring the recommendation of the Commission, that this 
 change should form part of a reconstitution by which the size of 
 the Council should be reduced from 24 to 18 members, and 
 ignoring the general testimony which had been borne to the 
 already inconvenient largeness of the Council, the legislators 
 could face no liarder task than that of agreeing to applications 
 for additional seats ; and accordingly the Act, instead of reduc- 
 ing the Council to 18, has increased it to 30 members. 
 
 Dealing in a somewhat similar spirit with our wilderness 
 of medical titles, it not only made no attempt to introduce 
 the beginnings of order, but, with general complacency to 
 applicants, it accepted some additional elements of confusion. 
 
 Whether the funds which the Medical Council has at its 
 disposal will suffice for the maintenance of its new constitution, 
 and of the new officers it is required to appoint, — whether 
 
THE REIGN OF QUEEN VICTORIA. 419 
 
 especially its inspections of the very numerous separate and Chap. XV. 
 independent examinations can be o£ such, frequency and state 
 thoroughness as to lessen in any sensible degree for the benefit ^j^qq ^71^ 
 of the public the insecurities which have been ascribed to the yi^_rrhe 
 system of so many portals of admission to the Medical Register,, Medical 
 — are questions which will in time be answered by experience ; 1886. 
 but, till sufficient answer in the affirmative has been given, the 
 Act of 1886 can hardly be regarded as more than provisional ; 
 and meanwhile it would be premature to suppose that the last 
 word has yet been spoken for some such simplification of system 
 as the Bill of 1870 aimed at introducing. 
 
 iv. — LOCAL GOVERNMENT LEGISLATION OP 1888 — 9. 
 
 In 1888, under Lord Salisbury's premiership, and with Mr. g; 
 
 -Local 
 Govern - 
 
 Ritchie in the presidenev of the Local Government Board, the J^ent 
 
 11 r. -n 1 1 • legislation 
 
 general plan of local government for England was importantly of 1888-9. 
 augmented, according to the standard of modern intention, by the 
 Act of Parliament 51 and 52 Vict., c. 41. Under this Act, which 
 confers on each county for prescribed purposes the right of self- 
 government by an elected representative council, the government 
 of counties, as to matters not of "district jurisdiction, is brought 
 into analogy with the previously established government of 
 boroughs. The Act transfers to the county councils, from the 
 jurisdiction of County Justices of the Peace in Courts of Quarter 
 Sessions and otherwise, the manifold administrative business 
 which the Justices had been doing on behalf of the counties ; and 
 it provides facility for hereafter transferring to the councils, out 
 of the statutory local-government powers hitherto vested in central 
 government, any which Parliament may see fit so to transfer. 
 
 It may be expected that the reconstitution of county Important 
 government effected by the Act of 1888 will indirectly be of objects! ^'^^ 
 advantage in sanitary affairs. Some such change had for many 
 past years been contemplated by Parliament ; and (as formerly 
 mentioned) a definite scheme for the purpose had formed part of 
 Mr. Goschen^s comprehensive Rating and Local Government Bill 
 of 1871 ; but Mr. Stansfeld, when succeeding to Mr. Goschen^s 
 task, had not continued that attempt, nor, from then till 1888, 
 B B 2 
 
420 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 iv. — Local 
 Govern- 
 ment 
 
 legislation 
 of 1888-9. 
 
 had any subsequent Minister resumed it. During the long- 
 period of legislative suspense, with old jurisdictions about to 
 cease, and new jurisdictions hitherto undetermined, it had been 
 difficult to develop county administration by the addition of 
 new responsibilities; and the disadvantage had been very 
 notable in regard of the sanitary government of country places, — 
 as for instance in the difficulty (before explained) of instituting 
 suitable officerships of health for rural and minor-urban districts. 
 Now, however, with the establishment of representative county 
 government, difficulties of that sort have come to an end ; and 
 partly by direct provisions of the Act, partly through the fact 
 that the new councils are ready to receive such further new 
 powers as Parliament may find necessary, easy way has been 
 opened for various advances in rural sanitary administration. 
 
 Parts of 
 the Act 
 relating 
 to Officers 
 of Health. 
 
 Objects immediately sanitary could not on a large scale be 
 brought within scope of this particular measure ; but the oppor- 
 tunity had been taken to aim at some such objects ; and especially 
 it deserves notice that, in Sections 17-19 of the Act, parts of the 
 law relating to Officers of Health were amended. During the 
 time when the Bill was before the House of Commons, in- 
 fluential voices had drawn attention to the experience which had 
 been had of the working of Mr. Stansfeld^s system of health- 
 officerships. Especially Sir Lyon Playfair, who in this con- 
 nection evidently had the ear of the House, — speaking with the 
 responsibility of one who had held ministerial office, as well 
 as with scientific reputation, and with the prestige of an almost 
 unique veteranship in the subject-matter,^ — had pressed in 
 strong terms that the rural officerships of health, as arranged 
 under the legislation of 1872, had in great part proved illusory, 
 and that, unless radical improvement were made in the system 
 of those appointments, the proposals of the Local Government Bill 
 could not give good county administration for sanitary purposes ; f 
 
 * Sir Lyon Playfair had served on the Health of Towns Commission of 
 1843-45, and in 1888 was, with exception of Sir Richard Owen, the only survivor 
 from that Commission. 
 
 t See in the Times of April 14th, 1888, the speech of Sir Lyon Playfair on 
 the second reading of the Bill. Among its censures on the existing system are 
 these : " The whole organisation of the sanitary service in rural districts was 
 even now, though under the direct control of the Local Government Board, 
 
THE REIGN OF QUEEN VICTORIA. 421 
 
 and subsequently he had given notice of an amendment, pro- C'a-^. XV. 
 posing to transfer to the County Councils all the powers which i.i^T 
 the provisions of the Public Health Act relating- to Medical ^' "^^^an-. 
 Officers of Health vested in the district sanitary authoritipj, . 
 and all which they vested in the Local Government Board. It G.>vem- 
 does not appear that the amendment, exactly in its original form, le-isiation 
 was pressed ; but in its stead an amendment was agi eed to, -^^^-^^ 
 which now stands as Section 17 of the Act ; providing that the 
 Council of any County, if it sees fit, may appoint an Officer or 
 Officers of Health, and may by agreement with district councils 
 render the services of such officer or officers available for the 
 respective districts in substitution for the services of officers 
 previously required to be of district appointment. There also is 
 enactment (Section 19) that every district health-officer shall 
 send to the county council a copy of every periodical report which 
 he makes to his district council, and that, if the report shows 
 the Public Health Act not to have been properly applied in the 
 district, or the health of the district in any other respect not to 
 have been duly cared for, the county council may represent to 
 the Local Government Board accordingly. Section 18 improves 
 the previous law with regard to the professional qualifications 
 for officerships of health : enacting (with reserve of exceptional 
 dispensing-power for the Local Government Board) that in 
 future every one to be appointed an officer of health must possess 
 an all-round legal qualification in medicine and surgery and 
 midwifery; and that, after the year 1891, if the appointment is 
 for a county or county-borough, or for any area containing a 
 population of 50,000 or more inhabitants, the candidate (unless 
 privileged by previous tenure of a high-class sanitary office) must 
 show that he holds a special sanitary diploma under Section 21 
 of the Medical Act, 1886. 
 
 The large general provision mentioned above, as having been 
 
 desperately inefficient." ..." Country surgeons . . . gave some fragments 
 of their time to sanitary duties." . . . . " The less these officers did, the 
 more they were pleasing to local boards. (Hear, hear.) " . . . " They were 
 paid to do nothing, and they did nothing. (Hear, hear.) " The parliamentary 
 secretary of the Local Government Board, following in the debate, declared his 
 department's sense of the high authority with which Sir Lyon Playfair spoke 
 in the matter. 
 
422 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 
 English 
 State 
 Medicine 
 since 1871. 
 
 iv. — Local 
 Govern- 
 ment 
 
 legislation 
 of 1888-9. 
 
 Provision 
 for trans- 
 fers of 
 power 
 from Cen- 
 tral De- 
 partments 
 to County 
 Councils. 
 
 made in the Local Government Act with regard to the statutory 
 powers exercised in counties by central government, is contained 
 in Section 10 of the Act; and this enactment deserves particular 
 attention, both as regards its actual scope, and as regards its 
 history. In scope apparently co-extensive with the range of 
 local administration in England, it applies to '^ any such powers, 
 duties and liabilities of Her Majesty^s Privy Council, a Secretary 
 of State, the Board of Trade, the Local Government Board, or 
 the Education Department, or any other Government depart- 
 ment, as are conferred by or in pursuance of any statute, and 
 appear to relate to matters arising within the county, and to 
 be of an administrative character,^' and applies also to certain 
 powers of local pubHc bodies, and to '^ any power vested in Her 
 Majesty in Council. ^^ It does not expressly direct any transfer 
 of powers; but it assumes that more or less transfer to the 
 county councils may be found desirable ; and it prescribes the 
 steps by which, with approval of Parliament, any of the 
 statutory powers can be so transferred. The promoters of the 
 measure had originally intended that the Act, before offering 
 that sort of facility for possible future transfers, should itself in 
 express terms have devolved upon the county councils a certain 
 proportion of the powers in question ; and, with this intention, 
 the Bill in its first stage had enumerated in a schedule of some 
 pages the powers which it proposed to transfer. Before long, 
 however, it was found that the contents of the schedule would 
 require examination of a far more critical kind than the House 
 could at that time afford to them; and the original proposal was 
 therefore withdrawn in favour of one which shaped Section 10 of 
 the Act : to the effect that, in regard of any such transfers of 
 power as were in question, it shall be lawful for the Local 
 Government Board from time to time to submit proposals to 
 Parliament in the form of Provisional Orders, which Parliament, 
 if approving, will make law. In recollection of the contents of 
 the withdrawn schedule, and all the more when the whole field 
 of the case is regarded, it could hardly not be judged fortunate 
 that this opportunity for farther consideration of the subject 
 was given, and that the course of events, tending to bring 
 as a whole before Parliament the question of the relations which 
 ought to exist between local and central administrative authority. 
 
THE REIGN OF QUEEN VICTORIA. 423 
 
 would almost necessarily oblig-e Parliament to bestow on that C!hap. xv. 
 
 . . English 
 
 great political problem tlie deep and comprehensive attention State 
 which it requires. In the session of 1889, the subject was again since 1871. 
 brought forward by Mr. Ritchie : the Local Government Board ^^ _Local 
 having then, under section 10 of the recent Act, made a Pro- Gi^ovem- 
 
 . . ment 
 
 visional Order for transfers nearly the same as had been proposed legislation 
 in the withdrawn schedule of 1888 ; and Mr. Ritchie intro- 
 ducing a Bill to confirm that Order. This Bill having been 
 referred to a Select Committee, witnesses at once appeared as 
 objectors to the proposed transfers of jurisdiction : first (as to 
 certain Board of Trade matters) from the point of view of com- 
 mercial enterprise ; and secondly (as to Local Government Board 
 matters) from the point of view of municipal government, — the 
 minor or non-county boroughs throughout the country objecting 
 strongly to the proposal that they should be made subject to the 
 county-authorities : which evidence having been received by the 
 Select Committee, and by it reported to the House, the Pro- 
 visional Order Bill was dropped. 
 
 While the subject is thus legislatively in abeyance, some of S^g^^jJ*^ 
 the more general principles on which it has to be discussed will traiisa- 
 probably be found to deserve greater attention than they have quires 
 yet received. Mr. Ritchie, when introducing his Bill of 1888, tSctionof" 
 had spoken of decentralisation as the object for which the ^^^®^- 
 reconstitution of county government was especially to be desired ; 
 but before advances towards that object (in the sense of section 
 10 of the Act) shall have to be considered in detail, it 
 certainly seems a first requisite to take stock generally in the 
 matter, and to observe how various are the sorts of powers 
 as to which the question of " decentralisation " would have 
 to be discussed. 
 
 The magnitude and heterogeneousness of the matter are Variety of 
 perhaps less to be learnt from the samples contained in the ^^V^^en!'^ 
 Schedules of 1888-9 than from an analysis of the general traiised. 
 terms which are in the Act. The sorts or degrees, in which 
 Central Government has statutory relations (more or less) 
 with local affairs, may be regarded as chiefly these : 
 
 (1) that, in one class of cases, the central government is the 
 direct executive authority for a local purpose ; — as, for 
 instance, where (under the Alkali, &c.. Works Reg"* Act) 
 
424 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 iv. — Local 
 
 Govern- 
 ment 
 
 legislation 
 of 1888-9. 
 
 it acts by officers of its own against particular varieties o£ 
 local nuisance ; or where (under the Factory and Work- 
 shop Act) it acts by officers of its own as protector of a 
 particular class of the local population ; or where (under 
 the Fairs Acts) it permits and regulates the holding of 
 fairs ; or where (under the Burial Acts) it takes proceedings 
 to procure the closure of burial grounds : 
 (2) that, in a second class of cases, it is the appointed 
 facilitator for particular varieties or stages of local business, 
 — as, for instance, where (under the Public Health Act) it 
 arbitrates for district authorities which have points of con- 
 tention between themselves or with other parties ; or where 
 (under the Acts relating to Piers and Harbours, Gas and 
 Water Works, Tramways, and Electric Lights) it settles 
 with the public and private promoters of various local 
 enterprises the terms on which Parliament shall be moved 
 to confirm Provisional Orders establishing what is pro- 
 posed, and where afterwards it moves Parliament ac- 
 cordingly : 
 
 (3) that in a third class of cases (as under the Education Act 
 and in relation to Poor-Law Medical Officers and to Public 
 Vaccinators and to Sanitary Officers) it directly or indirectly 
 represents to localities the power of the parliamentary 
 purse : the power to require, as regards subsidies voted by 
 Parliament for local purposes, that those who would receive 
 from the subsidies must have fulfilled definite conditions of 
 local service : 
 
 (4) that in a fourth, and most extensive class of cases, its 
 relations to local action are those of positive control ; very 
 often in the forni that this or that act of the local authority 
 is not valid till the central authority confirms it; some- 
 times (as under various sections of the Public Health Act) 
 in the form, that, for certain of the objects of the law, or in 
 relation to particular contingencies, the central authority 
 regulates the local action, or issues particular orders regard- 
 ing it ; and sometimes (as eminently under the Poor-Law 
 and the Vaccination- Acts) in the form that the central 
 authority regulates by general and particular orders the 
 whole province of business. 
 
THE REIGN OF QUEEN VICTORIA. 425 
 
 With ever so slight a glance at the multiplicity and variety Chap. xv. 
 
 of those relations, it will be evident that no one formula of state^ 
 
 so-called '^decentralisation^^ is likely to adapt itself to all of ^n^^^ic-j 
 
 them ; and doubts cannot but arise, whether they are all of a . 
 
 nature to be treated on the method of Section 1 0. — As to cases of Govem- 
 
 the frst class, the question is comparatively simple ; for, where legislation 
 
 proper local authorities exist, it can seldom if ever be permanently °* I888-9. 
 
 desirable that duties of purely local concern should be done by conse- 
 
 any central department. Transfers would presumablv not be q^^ntdiffe- 
 
 , ^ . ^ / ^ rences of 
 
 made without due regard to the ripeness and admmistrative principle in 
 efficiency of the local authorities ; and so, in some of the cases, as^todecen- 
 the transfer might have to be delayed till collateral conditions, ^^^^^^^^o^- 
 involving time, should have been fulfilled ; and further it may 
 be that, in some of the cases, the county - authority would be 
 judged less fit than the district authority to be charged with the 
 particular local duty : but subject only to such reserves as those, 
 it would seem that decentralisation in the spirit of Section 
 10 may be generally applicable to this class of cases. The 
 question as to cases of the second class seems in theory equally 
 simple : for, as it would in one point of view be unreasonable 
 that localities should be entitled to require any central de- 
 partment to do for them what they can readily do for them- 
 selves, and as it would in the other point of view be no less 
 unreasonable that localities should be compelled to accept forms 
 of central assistance they do not need, so here the appeal for 
 decentralisation may be conceived as coming from either side, or 
 from both ; and so far as county councils should be able and 
 willing to do in an impartial public spirit for the county and 
 its consenting district-jurisdictions such arbitrative and bill- 
 promoting functions as are chiefly in question, there appa- 
 rently could be no reason against the transfer ; with reserve of 
 course as to local bills, that Parliament would always require 
 security as to their due consideration of general principles. 
 Cases of the t/iird class are not of inevitable existence — (for of 
 course it might be that parliamentary funds were no longer 
 applied to local purposes) — but so long as that financial relation 
 does exist, any discretionary condition-making power which 
 accompanies it can hardly be conceived as not central ; and 
 apparently no true audit in regard of any such relation can be 
 
426 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. made, unless the department which represents Parliament in 
 
 State ^ respect of the subsidised local purpose verifies, by some effective 
 
 ^nc^^isn. method, that the subsidised purpose has been duly fulfilled. At 
 
 ^ , this point, however, bes^ins a new order of considerations : for, 
 IV.— Local r ^ ^ :r> , « i /> • 7 
 
 Govern- side by side with the thought or a merely financial control, 
 
 legislation arises the thought of the controls which central government has 
 of 1888-9. ^^ exercise in respect of the suhstance of local action : and here, 
 where cases of the fourth class come under review, the problem 
 of decentralisation is soon seen not to be one for hasty poli- 
 ticians. 
 Question With reference to that class of cases, it is necessary to dis- 
 
 01 decen- ' _ •' 
 
 tralising tinguish two qucstious ; — first, whether (or in what degree) 
 powers. such and such controls shall be exercised ; and, secondly, to 
 
 what hands the exercise of the necessary controls shall be 
 
 assigned. 
 Are Local That local autonomies within the country ought to be in 
 
 autonomies i'T'iii 
 
 meant to be themselves aosolute, — that the individual sub-governments of 
 districts and counties should each have unlimited liberty to do as 
 it will, — is not, so far as I know, the contention of any decen- 
 traliser. That the action of local authorities must be subject to 
 conditions of general law, and that the appointed conditions must 
 be (in case of need) enforceable at law by an authority superior 
 to the local, are propositions which probably no one disputes. 
 Even for the local purposes as locally understood, and still more 
 for the purposes of local justice as understood by the country at 
 large, security has to be taken that local administration will 
 work consistently with the reasonable rights of minorities and 
 unrepresented persons, and will actively fulfil the national in- 
 tentions which it has in trust. Thus, for instance, probably no 
 one will contend that the power of enacting local bye-laws to 
 restrain previous individual liberties of action within a district, 
 or the power of mortgaging local taxation for long terms of 
 years, ought to be independent of superior confirmation and sanc- 
 tion; or that a local authority which has let its roads and 
 bridges become impassable, or has omitted to make necessary 
 exertions for the health of its district, should retain uncontrolled 
 freedom to do nothing. If local anarchies are to be avoided, 
 certain powers to restrain, and certain powers to propel, must be 
 reserved (expressly or implicitly) as supra-local, — reserved^ in 
 
THE REIGN OF QUEEN VICTORIA. 427 
 
 such measure as the law for the time being appoints, to be exer- Chap. XV. 
 cised by Parliament or by Ministers responsible to it. State^ 
 
 In what exact quantity the local autonomies ought to be g^^J^Jgyi 
 subject to the higher sanctions and directions, is not for any per- . 
 manent and uniform standard to show : on the contrary, the Govem- 
 '^ just mean^'' in this case is necessarily variable and manifold : it legislation 
 must be defined by the statesmanship of each given time accord- 1888-9. 
 ing to the stage of national growth and culture, and with 
 differences according to the respective needs of the different 
 portions of subject-matter. It is obvious that, with the progress 
 of education and of local representative government, there ought 
 to be less and less need for controls over local action in matters 
 which are of purely local concern ; and decentralisation in that 
 sense is to be hoped for, as accompaniment and index of the 
 social progress which Englishmen most desire for their country. 
 It would be utterly against the spirit of our English political 
 constitution, that local government should have to work under a 
 system of petty interferences, or should, except where definite 
 reasons require, be subject to fiats and vetos from without. The 
 wise decentraliser will terminate from time to time by j)rocess of 
 repeal the controls which no longer need be used, and will pro- 
 mote the merging of minor controls in controls of more general 
 purpose."^ In following that line of policy, he of course will 
 know that his steps of advance must be regulated by certain 
 conditions of caution : both with reference to the nature of the 
 subject-matter, for in some matters the essence of the control 
 may require a comparatively minute particularity ; f and also 
 
 * Compare, for instance, the three stages of policy which have heen 
 mentioned, in respect of the qualifications of Officers of Health : — how, in 1846, 
 when the Corporation of Liverpool distinguished itself by first obtaining legal 
 power to appoint an officer of health, the condition was imposed on it that its acts 
 of appointment to the office must be individnallt/ sanctioned by the central 
 authority ; how in 1875, when the Public Health Act made revised law for a 
 national system of such officers, the central authority was empowered, not to 
 deal with the personality of appointments, but to fix in general tei-ms the 
 qualifications needful for an officer of health; and how, in 1888, this power of 
 the Local Government Board was practically superseded by the action of Parlia- 
 ment, which, in Section 18 of the L, G. Act, made statutory qualifications for the 
 office. 
 
 t See, for instance, under the vaccination-laws, how indispensable it is for 
 the control of public vaccination, that the local keeping of a particular form of 
 register should be insisted on. 
 
428 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. with reference to the ripeness of the local institutions, for 
 StS^ controls which would be superfluous towards full-grown institu- 
 £^^1871. ^^^^^ ^^y ^^ indispensable towards those which are yet but as 
 
 Govern- As regards the question, to what hands shall the exercise of 
 
 legislation contfol-powers he entrustedy hitherto the law's one alternative to 
 
 of 1888-9. igi^^i^g gach separate local case be for special judgment by Act 
 
 Question ^^ Parliament has been to vest limited powers in some branch of 
 
 of sub-cen- -^he Central Executive; and in 1871, the declared motive for 
 
 tralisation _ ' 
 
 of control- calling the Local Government Board into existence was the 
 desire to create a satisfactory centre for the exercise of such 
 powers. Henceforth, however, in virtue of Section 10 of the 
 Local Government Act, the possibility of a different alternative 
 — the alternative of sub-centralisation — is recognised by the law 
 for by that section — (since its very wide terms include all central 
 powers at present exercised under statute in relation to local 
 government) — control-powers, equally with other powers, are 
 regarded as capable of being transferred to county councils. It 
 has to be noted, too, that, among the proposals contained in the 
 schedule of Mr. Ritchie's Bill of 1888, were several for transfers 
 of that sort, — transfers, w^hich, if made, would have introduced 
 an entirely new principle into the organisation of our local 
 government, would have empowered one class of elected local 
 authorities to exercise jurisdiction over another class. The 
 county council, besides receiving the powers previously held by 
 justices and by central departments for the immediate aims of 
 county-government in matters not governed by separate district- 
 authorities, rural or urban, would further, in respect of control- 
 powers named in the schedule, have been constituted a sort of 
 superior court over the several district-councils within the county. 
 Such transfers of central influence would of course tend to 
 exonerate the central departments from certain of their respon- 
 sibilities in local affairs; but, as regards the object of district- 
 autonomy, they would not have the effect of decentralisation ; 
 and in that point of view it is of interest to observe that, neither 
 at the time when the schedule of 1888 was proposing them, nor 
 in 1889, when consideration of the subject was revived by Mr. 
 Ritchie's Provisional Order Bill, did the notion of substituting 
 County Councils for the Local Government Board as authority of 
 
THE REIGN OF QUEEN VICTORIA. 429 
 
 control, commend itself to the district-authorities whom it would Chap. XV. 
 concern. Apart, however, from that point o£ view, there are others state ^ 
 in which, if I may express my own thoughts on the subject, I ^^e^J^Ti 
 would say that the notion of sub-centralising powers of control . 
 strikes me as of very doubtful promise. The schedulisers appear govem- 
 to me to have confounded, for purposes of treatment, two sorts of legislation 
 cases almost contrary in their claims, — the case of central powers 1888-9. 
 for local action, and the case of central powers for control of 
 local action ; and to have assumed over- hastily — that, because 
 powers of the former sort ought in general to be localised, so too 
 ought powers of the latter sort. The essential difference between 
 tlie two cases requires to be more vividly borne in mind ; and 
 with regard to the second of them, it appears to me certain that, 
 if controls are to be maintained, it must be on system as a 
 whole, and that at least the system^s last appeal must necessarily 
 be central. Supposing proposals to be renewed for transferring 
 to county councils a variety of existing central powers of control, 
 and to be under criticism in detail, article by article, with 
 reference to the various questions of public service involved, and 
 of the controls which in each matter ought to be had, I can 
 well conceive that, in result of such an analysis, there might 
 be found many minor powers suitable for repeal j but that many 
 would be found suitable for transfer to county councils does not 
 seem to me probable. As regards the controls with. which I 
 am best acquainted, I believe they would be found in one of two 
 categories : either would be such as might (subject to due 
 cautions) be entirely repealed, and such as it w^ould therefore be 
 not worth while to transfer ; or else would be controls of such 
 sort that the central government could not properly make un- 
 conditional transfer of them, could not transfer them except with 
 well-considered large reserves as to an inevitable superior jurisdic- 
 tion."^ If it be not intended to weaken as to local affairs the prin- 
 ciple hitherto understood for all branches of civil government, that, 
 
 * My argument assumes that the principle of suh-centralisation could not be 
 applied without limit ; that the civil government of England is not to be deemed 
 resoluble into a number of independent and absolute county governments ; that, on 
 the contrary, the system now existing would be intended in substance to con- 
 tinue, under which all Local Executives (whether of counties or of districts) are, 
 at least in last resort, controlled by the Central Executive which represents 
 Parliament. 
 
430 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. in last resort, it is for the Ministers of the Crown to act as en- 
 
 State^^ forcers of the law and of protectors the public interests, the County 
 
 shiS*^i87i Councils could not exercise powers of control except in a limited 
 
 , and secondary sense. The Ministers of the Crown would have 
 IV.— Local "^ ' • p 
 
 Govern- to posscss (in some form or other) all powers requisite for supreme 
 
 of 1888-9. control; and their participation of control-powers with an inter- 
 mediate local authority would almost inevitably constitute an 
 awkward division of responsibility, and render the relations of 
 control ambiguous. Common sense would seem to say, that 
 risk of such confusion ought not to be needlessly incurred in any 
 branch of local government. Above all, with regard to sanitary 
 administration, it could at present ill be afforded that any strength 
 of control should run to waste in intermediary apparatus, or that, 
 because of any such apparatus, the Central Executive should dream 
 itself less bound in duty than before, to claim an effective working 
 of the health-laws in the individual sanitary districts of England. 
 Control- In the last point of view, I cannot refrain from adverting to 
 
 to default- a particular feature which showed itself in the withdrawn sche- 
 aShorities ^^^® ^^ 1888. The schedule, while before Parliament, might be 
 regarded as expressing (say in rough draft) the views of the 
 various contributory Departments as to the powers with which 
 they were ready to part, or the responsibilities of which they 
 would wish to be relieved ; and it deserves notice that the Local 
 Government Board proposed unreservedly to transfer to County 
 Councils all the powers which it now has under the Public 
 Health Act to enforce on defaulting district- authorities the per- 
 formance of their sanitary duties."^ To those who remember with 
 what particular reference to the interests of sanitary administra- 
 tion the Local Government Board of 1871 was called into 
 existence, it will appear a striking contrast, that in 1888 the 
 Board expresses desire to divest itself of corrective relation to 
 that branch of local government, or at least to make sure that, 
 between itself and the local administrators of sanitary law, 
 there shall be some sort of buffer-jurisdiction; and the explan- 
 ation of that contrast is perhaps to be found in the lopsided 
 constitution which was originally given to the office of the 
 Board. It may well be that the Board, with only such relations 
 
 * The proposal which would have transferred the important powers given by 
 Section 299 of the Public Health Act was not renewed in the Schedule of 1889. 
 
THE REIGN OF QUEEN VICTORIA. 431 
 
 for intelligence and advice as were provided for it in that con- Chap. XV. 
 stitution, feels sanitary superintendence an embarrassment ; but, stete ^ 
 if so, perhaps a braver line of relief could have been advised ^^J^5s7i 
 than that which the schedule suggested. Had the office been 
 as sufficiently organised for its medical, as for its financial Govem- 
 and legal, responsibilities, it needed not have shown itself legislation 
 in 1888 more anxious to abdicate its powers of sanitary control, o* 1888-9. 
 than its control over the mortgaging of rates, or its control 
 over the making of byelaws. Assuming, as I most confidently 
 do, that the sanitary iaterests of the population are not to be cut 
 adrift from that general body of great national interests over 
 which Her Majesty^s Executive Government is appointed to 
 watch and guard, — assuming, rather, that the common sense of 
 the country will some day resolutely insist on the Government's 
 vigilant exercise of properly-defined powers of supreme control 
 against such neglects and abuses as shall be found in local sani- 
 tary administration, — -I cannot for a moment believe that any 
 Provisional Order, repeating that abdicative proposal, would 
 receive the assent of Parliament. 
 
 It remains to be noted here that in the Session of 1889, on Act for 
 
 motion from the Local Government Board, a step onward was J^^^^^^'^l" 
 
 . . . tion of In- 
 
 taken in that branch of legislation by which local authorities fectious 
 
 Tt' 
 
 are enabled to take measures against the spreading of dangerous ^^®^^®- 
 human infections. In principle it had always (at least from 
 the days of Mead) been amply recognised among skilled persons, 
 that local authorities could not be expected to control the 
 spreadings of infectious disease in their districts, except so far 
 as they should be empowered to insist on receiving immediate 
 information of the occurrence of new cases of such disease ; 
 and during the last twenty years, as public attention has been 
 more and more called to this branch of disease-prevention, 
 instances have become many in which district sanitary authori- 
 ties, desiring special Acts of Parliament for their local objects, 
 have procured enactments for that particular purpose : enact- 
 ments, enabling them to enforce systematically in their districts, 
 a prompt notification of each new case of any disease to which 
 their system extends, Mr, Ritchie's Act of 1889 (c. 72 of 52nd 
 and 53rd Vict.) is the first general law in the matter. Using 
 
432 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XV. 
 English 
 State 
 Medicine 
 since 1871. 
 
 iv. — ^Local 
 Govern- 
 ment 
 
 legislation 
 of 1888-9. 
 
 the experience already obtained under more than fifty local Acts^ 
 it prescribes for the districts to which it is applied a certain 
 system of double notification ; obligatory both on persons who 
 are in domestic charge of the patients^ or are occupiers of the 
 buildings in which the patients are, and obligatory also on the 
 medical practitioners by whom the patients are attended ; 
 requiring from both classes of persons, under penalty for 
 default, that they, so soon as they become aware of the existence 
 of any case of disease within the statute, shall forthwith give 
 notice of such case to the medical officer of health of the district. 
 The Act appointed this obligatory system to become operative 
 throughout the Metropolis at the end of two months from the 
 passing of the Act ; and the Act further provides that any local 
 sanitary authority in the United Kingdom may, by resolution, 
 bring its district within the provisions; Diseases to which the 
 Act expressly applies are cholera, smallpox, typhus, scarlatina, 
 enteric fever, relapsing fever, puerperal fever, diphtheria, and 
 erysipelas; and, for the purposes of any particular district, the 
 local authority may, by resolution as it sees fit, extend the pro- 
 visions of the Act to the case of any other infectious disease. 
 
433 
 
 CHAPTER XVI. 
 
 The Politics op Poverty. 
 
 During the last five and twenty years, there has been in the Chap. xyi. 
 public mind, and eminently in the mind of Parliament, a very of Poverty.^ 
 considerable requickening of thought in relation to the circum- 
 stances of the Poor. 
 
 From early in my term of service under the Privy Council, Recent 
 
 movements 
 
 as reporter on matters of concern to the Public Health, I had regarding 
 found it my duty to endeavour to draw special attention to the 
 lives of the Poorest Labouring Classes, in respect of the privations 
 they endure; and in that endeavour, in the years 1864-6, I had 
 submitted for presentation to Parliament masses of evidence, both 
 rural and urban, often of most painful character, as to the very 
 meagre nourishment on which low-priced labour is done, and 
 as to the frequent extreme want of proper housing for local 
 quantities of labouring population. From 1866 to 1882 the 
 subject of the Housing of the Poor was repeatedly under considera- Homing of 
 tion of Parliament : first, in connection with certain of the Privy 
 Council proposals for the Sanitary Act of 1866, and in connec- 
 tion with a Bill which Mr. Torrens in 1866 had introduced in 
 the House of Commons, ^^ to provide better dwellings for artisans 
 and labourers,-'^ — a Bill, which, after reference to a Select Com- 
 mittee and modification by it, became law in 1868 ; further in 1875 
 and 1879, when Bills introduced by Sir Richard (now Lord) Cross 
 became law ; and again in 1881-2, when inquiry into the 
 working of Mr. Torrens's and Sir Richard Cross's Acts was 
 made by Select Committees of the House of Commons, and 
 when eventually, on the reports of those Committees, a Bill, 
 promoted by Mr. Shaw-Lefevre for the amendment of the Acts, 
 was passed into law as the Artisans' Dwellings Act, 1882. That 
 branch of the subject, however, was not yet done with ; in the 
 autumn of 1883, powerful popular writings drew much public 
 attention to it ; and early in 1884, on motion by Lord Salisbury, 
 the House of Lords addressed the Crown for a Royal Commission 
 c c 
 
 the Poor. 
 
434 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVI. 
 The Politics 
 of Poverty. 
 
 Associated 
 questions. 
 
 Earning- 
 power as 
 compared 
 with needs 
 of life : 
 
 Wages 
 
 Land, 
 rural and 
 urban. 
 
 to inquire into the Housing of the Working Classes. A Com- 
 mission was consequently appointed with Sir C. Dilke (at that 
 time President of the Local Government Board) as its Chairman ; 
 a Commission of exceptional strength, both as to the varieties of 
 social influence which were represented on it, and as to the 
 eminent special qualifications which many of its members 
 possessed ; and on the Report of this Commission, laid before 
 Parliament in 1885, a Government Bill "to amend the law 
 relating to Dwellings of the Working Classes " was introduced 
 by Lord Salisbury within the first month of his new administra- 
 tion, and soon became law : two years after which, in continu- 
 ation of the same movement, was passed the Labouring Classes 
 Allotments Act, 1887. 
 
 Again and again, since the question of the Dwellings of 
 the Poor has been under discussion, the inseparability of that 
 question from various other questions regarding Poverty has 
 become manifest ; and the discussion, in its progress, has more 
 and more compelled thought on Poverty in general, with reference 
 to all its conditions and circumstances, domestic and industrial. 
 The smallness of earning-power in the lowest-paid branches of 
 industry, as compared with the necessary costs of wholesome and 
 decent living, has of course always been the main fact ; and the 
 possibility of rendering that ratio less unfavourable to the poorer 
 workers, either by cheapening their costs of life, or by bettering 
 their conditions of employment, has, in a variety of forms, been 
 the essential problem for study. In each division of the subject 
 there have been difl[icult side-questions. The industrial relations of 
 poverty vary of course with the different organisations of the dif- 
 ferent branches of commerce ; and whether the workers in any par- 
 ticular branch shall obtain larger shares than they do in the gross 
 profits of the work, is a matter to be haggled over in the labour- 
 market, with reference to the arithmetic of the particular business 
 as a whole, and to the degree in which middlemen in it absorb 
 profits, and to the question whether competing labour offers itself 
 at the time on cheaper terms. Again, in respect of domestic 
 economy, there are somewhat broad differences between the rural 
 and the urban cases. Closely connected, from the first, with the 
 question of the housing of the rural poor, has been the question 
 of providing some limited supply of land for the agricultural 
 
THE REIGN OF QUEEN VICTORIA, 435 
 
 labourer, too generally without any such accommodation and Chap. XVI, 
 help ; and, just as closely connected with the question of housing of Poverty, 
 for the urban poor, has been the question how to surmount the 
 difficulty of the high urban ground-rents. Discussion whether 
 the circumstances of poverty can be improved resolves itself 
 generally into a discussion of one or more of those side-questions 
 in relation to particular classes of the poor ; and, during the 
 later years of the period here under notice, several of such side- 
 questions have been under investigation by Parliamentary Com- 
 mittees or Royal Commissions. 
 
 In particular relation to our immense metropolis, and most Pariiamen- 
 loudly as to its eastern parts, irresistible demands have been raised of^Jedai^ 
 for attention to the abject penury of the poorer industrious classes, ^^^^^• 
 and to the losing conditions under which they seem to be waging 
 their contest for subsistence : masses of population, described as 
 at some cruel disadvantage amid the increase of commercial enter- 
 prise around them : numbers, on the one hand, who declare they 
 cannot obtain employment enough for their maintenance, and 
 numbers, on the other hand, who, though employed to their ut- 
 most strength, and with work often pushed far beyond the proper 
 limits of industry, gain for themselves only what are known as 
 ** starvation- wages,^' with such insufficiency of food and shelter as 
 these will purchase for them. Of late, with reference to industrial 
 conditions supposed to be more or less local or temporary in parts 
 of the London case, it had been alleged that the competition of 
 destitute immigrants from foreign countries was depressing the 
 market- value of the home-industry ; and also that in some of the 
 poorest industries, the recent course of commerce had brought 
 into power new varieties of middlemen, known as sweaters, who 
 were cruelly grinding the faces of the poor. Much public 
 interest has been taken in the matter of these allegations ; both 
 Houses of Parliament appointed Committees of inquiry in rela- 
 tion to them ; and especially the House of Lords Committee, 
 which early in 1888 was appointed on Lord Dunraven's motion 
 to inquire and report on the sw eating -systeyni — (a reference at first 
 only for East London,, but afterwards extended to the whole of 
 the United Kingdom) — sat taking evidence till the end of the 
 double session of 1888, and continued the same work during all 
 the session of 1889. This Committee is expected to make its. 
 cc2 
 
436 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 of Poverty. 
 
 Auxiliary 
 work by 
 volunteers. 
 
 Chap. XVI. final report early in the session of 1890, and meanwhile has 
 reported a large and extremely valuable body of information as 
 to the circumstances of the hardest-pressed industries. Be- 
 sides this, there was in 1888 the instructive report of a House 
 of Lords Committee, of which Lord Kimberley was chairman, 
 appointed " to inquire as to the various powers now in possession 
 of the Poor Law Guardians, and their adequacy to cope with 
 distress that may from time to time exist in the Metropolis and 
 other populous places ; and as to the expediency of concerted 
 action between the poor-law authorities and voluntary agencies 
 for the relief of distress/'' 
 
 In addition to what has been done by parliamentary and 
 departmental work to improve public knowledge of Poverty and 
 its circumstances, much has of late been done for the same pur- 
 pose by private endeavour ; and voluntary associations have been 
 actively promoting and supplementing the administration of laws 
 which concern the poor. Thus, for the last twenty years, the 
 Charity Organisation Society, with its District Committees 
 throughout London, has been strenuously endeavouring to educate 
 the public towards a better economy of its charitable resources ; 
 and since 1883, when an influential public meeting was held at 
 tlie Mansion House on the then much agitated question of the 
 Dwellings of the London Poor, a committee, originated at that 
 meeting, and known as the Mansion House Council on the 
 Dwellings of the People, has been very usefully at work in 
 drawing the attention of inactive district-authorities to cases 
 where they ought to enforce sanitary improvement in the poorer 
 sorts of house-property within their control. In the present 
 year, Mr. Charles Booth, a volunteer investigator of the case of 
 the London poor, has furnished, towards better knowledge of 
 that case, a contribution of extraordinary merit ; * the result of 
 three years'' laborious study of the East London districts (with 
 population exceeding 900,000 persons) by himself and seven 
 fellow-workers who have taken part with him : a result which 
 does not purport to be more than instalment of a contemplated 
 comprehensive work on the vast national interest it concerns, but 
 which already in itself seems to be of unique value as the record 
 
 * Labour and Life of the People ; 
 Booth : Williams and Norgatc, 1889. 
 
 Vol. I. ; East London ; edited by Charles 
 
THE REIGN OF QUEEN VICTORIA. 437 
 
 of SO laro^e an amount of exact observation in districts so populous Chap. xvi. 
 
 , ^ ^ The Politics 
 
 and so poor. of Poverty. 
 
 London Poverty, contiguous as it is to the largest resources Prominent 
 of succour which the world contains, would peculiarly seem London *° 
 a case in which the best possibilities of helpful treatment might poverty. 
 be expected to fulfil themselves ; but the case is of unique 
 magnitude, and the problem of its treatment is correspondingly 
 difficult. The poverty of London is in great part an imported 
 poverty. Generally throughout the Kingdom, during many past 
 decennia, the larger urban centres of population have more and 
 more attracted industrial immigrants from other districts ; 
 immigrants, who, broadly speaking, have hoped that the change 
 would better their prospects in life, and who therefore, in relation 
 to the centres they have sought, may be assumed to have been 
 (more or less) a poorer class. Attraction of that sort has in the 
 very highest degree been exercised by London. As the largest 
 and most miscellaneous labour-market in the country, supposed 
 to offer the best and most various chances of employment, it has 
 drawn competitors from all parts of England, as indeed also 
 from the other divisions of the United Kingdom, and from else- 
 where ; and so far as the innumerable immigrants have not found 
 employment in adequately paid industries, they of course have 
 added to the poverty of their new settling-place. The attractions 
 which London offers are not only those of its more settled 
 industries. Its lowest-class chances of " casual '' work, besides 
 serving as temporary resource for persons accidentally out of 
 better employment, are unfortunately also attractive to persons 
 (both native and immigrant) who are of the least satisfactory 
 industrial type — the abhorrers of ''regular''^ industry ; and under 
 mixed influences of necessity and option (the proportions of 
 which I am unable to estimate) the London labour-market has 
 been distinguished by a terribly large " casual ^^ department, in 
 which the so-called workers, apparently next-door to destitution, 
 are perhaps for two-thirds of their time idle : much relying, 
 however, on the indiscriminateness with which large amounts of 
 money are disbursed in London for purposes called charitable, 
 and which gives to even the most worthless of the unemployed 
 the expectation of not too greatly suffering through their 
 
438 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVI. 
 The Politics 
 of Poverty. 
 
 Automatic 
 
 iufluences 
 pressing 
 down- 
 wards. 
 
 idleness. The above-mentioned two facts as to London — the fact 
 of its so largely attracting industrial immigration^ and the fact 
 that in its lower-class industries a large proportion of working- 
 power is left unemployed^ are facts of cardinal importance in the 
 case ; * for the distresses, domestic and industrial^ which have been 
 most brought under notice as attaching to London poverty_, are 
 facts of Over- Competition for em'ployment and for house-room. 
 
 Over large metropolitan areas (not to say anything here of 
 the minor patches) the local quantities of population seeking to 
 subsist by various sorts of low-class labour are far in excess of 
 any likelihood that their aggregate earnings will purchase for 
 them all (at local prices) adequate food and shelter and other 
 necessaries and comforts of life. Those who with their families 
 constitute that form of over-population in the various districts, 
 whether as born inhabitants or as immigrants from other places, 
 are presumably in the place which they deem best for themselves, 
 best even in view of its drawbacks : but their over-numerousness 
 operates doubly to their disadvantage : first that, as competing 
 vendors of labour in a market where labour is redundant, they 
 steadily keep down, or progressively reduce, the rate of wages ; 
 and secondly, that as competing buyers of dwelling-space where 
 the accommodation is relatively deficient, they raise higher and 
 higher the rent of lodging, or depress lower and lower the quality 
 of the shelter. Against those disadvantages they in themselves 
 are virtually powerless so long as their numbers are unreduced. 
 Under an influence which may be regarded as automatic (and for 
 which the sweater and the house-jobber are mere apparatus of 
 conduction) they have to give more and more toil for equal or 
 less wage, and they find themselves less and less able to procure 
 
 * Mr. Booth, in the parts of London which he investigated, foxmd that more 
 than a third part of the whole population (314 out of 909 thousand) were below 
 the level of regular standard earnings, and must therefore, even relatively to 
 the working population, be classed as "poor "or "very poor;" that his little- 
 earning "poor" (numbering 203 thousand) were in about equal proportions 
 " irregular " and " regular " workers ; and that below them were 111 thousand 
 "very poor" whose work was but "casual" or "occasional." Mr. Booth 
 regards the existence of the class of "casual" workers as most prejudicial to 
 the welfare of the classes next above them in the scale of labour : the class, he 
 says, " is not one in which men are born and live and die, so much as a deposit 
 of those who from mental, moral, and physical reasons are incapable of better 
 work," but whose competition in the labour-market " drags down " the others. 
 
THE REIGN OF QUEEN VICTORIA. 439 
 
 house-accommodation fit for human beings. The inexorable Chap. xyi. 
 pressure of the commercial screw is towards starvation-wages, of Poverty.^ 
 and towards extortion of killing amounts of labour under hap- 
 hazard sanitary conditions : it is indifferent whether the workers 
 lodge in gutters or pigsties ; and its tendency is not to stop of 
 its own accord. As against certain extremities of such pressure, Laws 
 Parliament has purported to provide resistances; not indeed by tSm?sa?i- 
 laws relating to wag-es, but by laws relating? to some of the taryconse- 
 
 ^ . . ^ . ^ quences 
 
 sanitary conditions of collective labour, and by laws generally left uu- 
 
 relating to the public health and to the wholesomeness of 
 dwellings. Whether those laws cover in principle the whole 
 ground in respect of which the more helpless classes of the 
 community ought to be protected in the matters referred to is a 
 question on which I do not enter ; but what I must notice, and 
 would wish to emphasise, is that, in districts which have been 
 specially studied, the common sanitary laws as to dwellings 
 and their occupation have to a great extent been inefficiently — 
 not to say, sometimes corruptly, administered by the authorities 
 appointed to give them effect, and that the poor have con- 
 sequently not received, in this important respect, the protection 
 which the law had intended for them."^ Under cover of that 
 maladministration, a three-fold injury has been done : — first, 
 that the poor have been unduly exposed to the diseases which 
 proper sanitary administration prevents, and to the increased 
 impoverishment which such diseases occasion ; — secondly, that by 
 the tolerance of dwellings unfit for human habitation, and of 
 gross tenemental overcrowding, and of offensive trades in single 
 family living-rooms, facilities have been given for greater and 
 
 * See in the First Report of the Royal Commissmi on the Sousing of the 
 Working Classes, tlie facts referred to in the earlier pages of the Report, and 
 the conclusion expressed at page 34. " It is evident from the foregoing that 
 the remedies which legislation has provided for sanitary evils have heen im- 
 perfectly applied in the metropolis, and that this failure has heen due to the 
 negligence in many cases of the existing local authorities," See also, at 
 page 23, the account given of the Clerkenwell Vestry, and the more general 
 statement made by the Commission : — " Clerkenwell does not stand alone ; from 
 various parts of London the same complaints are heard of insanitary property 
 being owned by members of the vestries and district boards, and of sanitary 
 inspection being inefficiently done, because many of the persons, whose duty it is 
 to see that a better state of things should exist, are those who are interested in 
 keeping things as they are. " 
 
 applied. 
 
440 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVL 
 
 The Politics 
 of Poverty. 
 
 The sani- 
 tary ne - 
 gleet, in its 
 bearing on 
 the com- 
 merce of 
 the case. 
 
 greater congestions of population in districts already congested 
 beyond their earning powers, and beyond their power to afford 
 wholesome shelter; thirdly that, by the indulgence shown to 
 house-qualities of the basest sort, more or less privilege has been 
 constituted against dealers (individual or associated) who might 
 for equal or less price have given such accommodation as there 
 ought to be. 
 
 Neither in London nor elsewhere is it possible that the life of 
 the labouring classes should be such as in a prosperous civilised 
 country it ought to be, unless sanitary government firmly insists 
 on a reasonable standard of what is fit dwelling-accommodation 
 for human beings ; and the difficulty of cost is in principle no 
 other than that which has to be met in regard of food and of 
 clothing. The economical conditions under which the difficulty 
 presents itself are of course not the same in town and in country ; 
 but the distinctions between the two cases (though highly im- 
 portant in reference to some remedial questions) do not here concern 
 the main argument. When housing infamously unfit is permitted 
 to tender itself for hire, and when the laws which have been 
 enacted against nuisances, and against the overcrowding of 
 population within stated limits of room or house or area, are 
 by negligence or corruption left unenforced, the pretence is 
 commonly to be heard, that the wrong has been committed 
 or condoned in compassion for the exiguous earnings of the 
 poor ; but persons conversant with the subject will in general be 
 able to discern that the real compassion has not been for the 
 earnings of the poor, but for the profits of the house-jobber 
 or landlord ; and that to have permitted the making of profits on 
 such states of dwelling has been as contrary to the true interests 
 and rights of the poor, and as contrary to the methods of good 
 government, as would be to have permitted, in the provision- 
 market, the making of profits on the sale of diseased or rotten 
 meat and fish. In the one case, just as in the other, there 
 is wanted for public protection the strict practical enforcement 
 of a limit to the downward-competition in quality. To the 
 provision-monger — the vendor of ^^meat, poultry, game, flesh, 
 fish, fruit, vegetables, corn, bread, flour, or milk,-'"' the Public 
 Health Act does not allow under heavy penalty (however 
 plausible may be his pretence of cheapness) that he shall offer 
 
THE REIGN OF QUEEN VICTORIA. 441 
 
 for sale provisions which are " diseased or unsound or unwhole- Chap. xyi. 
 some or unfit for the food of man ^^ ; and the first object at of Poverty. 
 which sanitary reformers have to aim, in regard of the dwelHngs 
 of the poor, is, that the tender of an unfit commodity shall there 
 be as illegal and as punishable as it would be in the case of 
 food. Were but that condition secured, the question whether 
 the wage-earning classes obtained their sufficiency of proper 
 house-accommodation would in substance be on a like footing' 
 with questions as to their sufficiency of food : would be a simple 
 question of the relation of their wages to the market-price of a 
 necessary of life."^ A genuine demand for labour must be 
 expected to provide the cost of the labourer's maintenance ; and 
 in the supply of dwellings, as in the supply of food, for the self- 
 supporting labourer, when once the conditions of qualitative 
 fitness ai*e duly secured by law and administration, facts of 
 quantitative insufficiency are for ordinary commercial enterprise 
 to meet. Peculiarly the case would seem not to be one for any 
 exceptional eleemosynary interference, public or private ; on the 
 one hand, because any subvention from outside would but go to 
 defray a charge which the employer of labour ought to count 
 among his necessary costs of production ; and, on the other 
 hand, because it would no doubt be found that, in proportion as 
 the natural cost of living in the favourite district were reduced 
 by any such agency, this artificial cheapening would tend further 
 to over-populate the district which already ex liypotliesi is too 
 crowded. The object to be desired is, that the demand for 
 increased quantity of house-accommodation should if possible be 
 met on purely commercial principles : with honest commerce (not 
 commerce of the jerry-builder sort) operating as the organ of 
 supply, and with public authorities in general not acting except 
 for purposes of qualitative control. Sometimes no doubt it may 
 
 * So far as the matter is one of commerce, it would apparently tend to settle 
 itself on some such lines as the following : — In a given district where the com- 
 petition-price for house-accommodation is extraordinarily high — so high that 
 ordinary wages for such sorts of labour as may be in question will not suffice to 
 purchase proper lodging, is it, or is it not, the case that the demand for labour 
 is of proportionate height ? If yes, then {cceteris paribus) the labourer ought to 
 be able to obtain from his employer such additional payment as will cover the 
 local extra-cost of proper lodging; but if no, then (cceteris paribm) it presumably 
 will be for the labourer's interest to carry his labour to some locality where the 
 relative cost of proper lodging is not higher than he can afford to meet. 
 
442 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVI. 
 
 The Politics 
 of Poverty. 
 
 Philan- 
 thropy in 
 relation to 
 the supply 
 of dwell- 
 ings. 
 
 be the ease, that commercial enterprise cannot start in works of 
 construction till public authorities shall have taken steps by 
 which land will be made purchaseable for the purpose ; but in 
 cases of this sort, if the principle of almsgiving is to be 
 excluded, the enterprise will of course be required to pay- 
 ordinary market-value for the land which it proposes to take."^ 
 
 While arguing as above, that the supply of house-accommoda- 
 tion for the poorer wage-earning classes has in general to be 
 governed by the same commercial conditions as those on which 
 their supply of food depends, and that the matter is one in 
 which pecuniary subvention from charitable sources might 
 easily bring harm rather than good to the labourer, I do 
 not at all mean to suggest that the matter offers no 
 place for philanthropic action. On the contraiy, I am 
 strongly of opinion that, of private philanthropic action taken 
 within the last half -century for the benefit of the poor, none has 
 more eminently deserved praise than the exertions which have been 
 made by individuals and societies to create or promote better 
 systems of cheap house-accommodation. t In those exertions, 
 
 * It is much, insisted on by Professor Eogers, in his Six Centuries of Work and 
 Wages, that our present land-laws facilitate or produce an " artificial stint of 
 marketable land," and are in that sense a serious obstacle to the proper housing 
 of the poor. Though I take for granted that every local stint in the market 
 supply of land is likely to press most of all on the local poor, I yet, for the 
 purpose of my text, have not thought it requisite to follow that line of argument. 
 The distinctive difficulty of the urban poor in acquiring good space for their 
 dwellings turns essentially on the difference between rich and poor as competing 
 bidders for ground ; and no mere emancipation of the land-market would relieve 
 the poor from that relative disadvantage. Apparently no land-law could fulfil 
 the purpose, unless it were one which expressly reserved a certain proportion 
 of the urban area to be inalienably for labourers' use. 
 
 t Though I have at an earlier page (p. 213) mentioned some chief commence- 
 ments of philanthropic effort in that direction, I here recur to the subject for 
 the purpose of drawing attention to the evidence which the Royal Commission 
 on the Housing of the Poor received in 1884 from persons who have been of 
 highest merit in such efforts, and who are still beneficently engaged in them. 
 Especially valuable as representing large commercial experience in the creation 
 of new dwellings for the labouring classes, was the evidence given by Sir Curtis 
 Lampson, trustee of the Peabody Donation Fimd, by Sir Sydney Waterlow, 
 founder and chairman of the Improved Industrial Dwellings Company, and by 
 Lord Shaftesbury and others, directors of the Artisans', Labourers', and General 
 Dwellings Company ; and not less interesting, though for different application, 
 was the evidence given by Dr. W. A. GreenhiU and (on a larger scale) by Miss 
 Octavia Hill, in regard to improvement-exertions addressed to the worst sorts 
 of old house-property. An. essential aim in all those endeavours has been that 
 
THE REIGN OF QUEEN VICTORIA. 443 
 
 however, the philanthropy has not taken an eleemosynary form, Chap. XVI. 
 except so far as the generous personal devotion of ability and of Poverty 
 thought and labour can be translated into pecuniary terms ; and 
 its value is not measured by merely counting the number of 
 better dwellings it has brought into market for the accommoda- 
 tion of the labouring classes. The good which the philanthropy 
 'has most distinctively wrought has been educational. By 
 the pioneering work which it has done on a large scale in 
 ground of much difficulty, and by having exhibited, for many 
 past years, in commercially successful operation, abundant types 
 of the sort of landlordship which is wanted in respect of the 
 dwellings of the labouring poor, it has furnished highly signi- 
 ficant teachings with regard to points which I have above 
 invited the reader to consider. The conditions on which it has, 
 for so many years, with commercial success, given proper house- 
 accommodation to many thousands of tenants, are conditions on 
 which we may expect that ordinary commerce, supervised by 
 eflBicient local authorities, and not operating through house- 
 knackers, will, as future occasions arise, be ready to supply 
 similar accommodation. Landlords and sub-landlords who desire 
 to fulfil the duties, as well as to receive the profits, of their 
 relation to the lives of the labouring classes, may, in many 
 cases, be able to gather useful lessons from the records of the 
 philanthropic experience ; and the administrators of local govern- 
 ment, anxious to protect the poor against any avoidable re- 
 petition of such wrongs as they have often suffered in respect of 
 their dwellings, will find in the same experience an excellent key 
 to the conditions on which they must insist.* 
 
 It of course cannot be expected in regard of house-accommo- 
 dation, any more than in regard of other commodities of life, that, 
 in present social circumstances, the Poorest of the Labouring 
 
 the endeavour should he a financial success ; and the histories which Sir Sydney 
 Waterlow and Miss Hill tell of their respective large undertakings in that 
 merely commercial point of view are lessons of most important experience. 
 
 * With regard exclusively to the educational influence of the philanthropic 
 exertions in this field of work, it is of course to be desired that the exertions 
 should continue till they become educationally unnecessary ; and as regards the 
 other aspect of the case, if ordinary commerce should prove slow to act upon 
 the lessons which philanthropy has given, the more widely the philanthropy 
 could extend its commercial operations, the better no doubt it would be for the 
 world. 
 
444 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVI. Classes will be free from very hard conditions of stint. Be 
 ofPovertyf done what may under the Sanitary Acts to banish from the 
 dwellings of the poor all worst degrees of uncleanliness and 
 overcrowding, the condition remains, that scanty earnings can 
 buy but scantily of the necessaries and comforts of life ; and 
 that, where the sternest frugality has to be exercised with 
 regard to necessary food and clothing, where indeed but too 
 often severe privation in those respects has to be endured, only 
 very humble purchase of dwelling-space, and still humbler pro- 
 vision of means of comfort and cleanliness within the space, can 
 be afforded. Question, how the house-accommodation of the 
 poorer labouring classes may be rendered such as humane persons 
 would wish it to be, is therefore necessarily in great part ques- 
 tion, how far poverty can be turned into non-poverty, how far 
 the poor can he made less poor. 
 
 Extremes 
 of Poverty 
 without 
 near likeli- 
 hood of 
 escape. 
 
 Lives of the 
 poorest of 
 the work- 
 ing classes 
 in towns. 
 
 In the whole range of questions concerning the Public 
 Health, there is not, in my opinion, any one to be deemed more 
 important than the question which those last words raise in an 
 almost accidental connexion. In various earlier passages of this 
 volume, I have more or less expressed my conviction that 
 Poverty in its severer forms is among the worst of sanitary 
 evils ; and whenever I reflect what chief factors have to be 
 desired for progressive improvement in our conditions of public 
 health, I doubt if any can be considered more essential, or ought 
 to be hoped for with more ardent hope, than that the poverty of 
 our poorer classes may be lessened. The sanitary sufferings of 
 the poor, and the physical privations and hardships which conduce to 
 them, are merely a fragment of the case; and though here our essen- 
 tial subject-matter is no more than sanitary, yet even here the other 
 features of the case have to be remembered. While the lives of 
 the very poor, in their merely physical relations, are such as no 
 normally-constituted man — himself in prosperity and perhaps 
 luxury — will contemplate without emotion, they, on the whole, 
 are equally sad in relations which are not physical. Exemptions 
 no doubt are enjoyed by the earlier periods of life : for, among 
 the poorest as among the richest, childhood will be light-hearted 
 in its bliss of ignorance, and youth, in spite of poverty, will have 
 what Hobbes calls its own '^natural drunkenness'^ to sustain 
 
THE REIGN OF QUEEN VICTORIA. 445 
 
 it: but those are not enduring lights."^ When youth is past, Chap. XVI. 
 and the severer meanings of poverty have come to be under- of Poverty, 
 stood, the monotonous hunger for hope may become even worse 
 than the hunger for bread ; and the unvarying cloud-canopy 
 which lets no sky show through is an awful weight for the 
 human heart to bear. For the average adults of the very poor, 
 prospects of real emergence are next to none. Of better circum- 
 stances, there commonly either is no hope, or only such little 
 hopes as are bounded by the morrow or the week, and even thus 
 far are but thinly partitioned from despair. Overhead is the 
 dreariest grey, and, for horizon, death in workhouse or hospital. 
 Let those who realise to themselves the physical facts which are 
 to be observed on a large scale in the poorest quarters of our 
 large cities, try also to realise other facts which are endemic in 
 the same quarters : what hopelessness and what bitter fruits o£ 
 hopelessness, what inducement to abandon the better self- 
 restraints of life, what pressure towards degradation of personal 
 character and conduct, must often necessarily be among those 
 ill-fed and ill-sheltered multitudes. Assuredly for rich and poor, 
 there is only one standard of right and wrong; but adhesion to 
 the right is not of equal effort in all cases as against all tempta- 
 tions ; and certain virtues which may be easy to the opulent, 
 and may by them be classed as virtues carrying their own 
 reward, will be of far less easy cultivation, and will to many 
 seem of less remunerative result, when they have to be exercised 
 within tether of a house-knacker's slum, and with labour and 
 
 * It needs hardly be noted that the youth of slums estivates in very large 
 proportion into reckless improvidence, which makes fresh centres of necessitous 
 life : not only shirking care for the present, but complacently mortgaging the 
 future; sometimes in mere aversion from industry, sometimes in loafing and 
 gambling and drinking, and often (even under these auspices) in utterly hap- 
 hazard beginnings of what purports to be new family-life. Coupling in some 
 form or other takes place with every possible inconsiderateness. Young people, 
 often mere boys and girls, neither of w^hom has yet saved the amount of a week's 
 wages, and who can only subsist together on condition that girl as well as boy 
 shall be breadwinner, pass into conjugal relations as light-heartedly as sparrows 
 on the housetop, and, with even less preparatory nest-making than the sparrows 
 use, set themselves to multiply mankind. It is a sorry estate for which they beget 
 inheritors ; and every additional infant born to them tends to be at least for many 
 years an addition to the difficulties of their self-support. Soon therefore they 
 like their predecessors, learn more and more of the severer meanings of poverty 
 in, respect of its life-long stint, and its life-long squalidity of surroundings. 
 
446 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVI. 
 
 The Politics 
 of Poverty. 
 
 Questions 
 of remedy 
 
 wage at the rates of boot-making and trouser-making in the 
 slop-trade. Where those painful approaches to destitution 
 prevail, there necessarily for many will be strong attractions to 
 particular sorts of immorality and crime, as well as in general to 
 reckless life ; and no one can be surprised if, from amid so 
 dreary a world, recruits are often added to the ranks of the 
 dangerous and criminal classes. Is it not only too intelligible, 
 ho^, from among the sufferers, many will turn to gin as their 
 one brightener of life, and some will gain their few extra pence 
 by prostitution, and some will try their hands at theft, and 
 some will fearlessly fly to that dark escape which the river 
 offers ? Is it a wonder, if family affection does not always resist 
 the strain, — if care for offspring, even the mother's tenderness 
 for her child, sometimes dwindles to nought, — if infantine 
 diseases come to be described as ^^ gifts of providence '^ to lighten 
 the burthen of the poor man's family, — if touters for baby life- 
 assurance appear upon the scene, — even if, now and then, an 
 infant is pitilessly done to death, or is more cruelly left for 
 hunger to kill ? The rarity of the worse degrees of wrong is 
 marvellous and most touching. Honour to the thousands who 
 through long painful lives bear up steadfastly against the 
 demoralising influences, and, in their own depths of penury, 
 are constantly to be seen doing kindnesses and generosities to 
 each other. 
 
 " How the poor can be made less poor '' is surely, on all 
 grounds, a question which must everywhere be recognised as of 
 almost incomparable social importance. But those who duly 
 appreciate the object, and would wish to give aid towards 
 the attainment of it, must start by clearly apprehending how 
 much study the matter requires ; how much knowledge of the 
 conditions which determine the more or less of adversity in the 
 lot of the poorer classes ; and how much knowledge of the 
 responses which those conditions have given to influences 
 hitherto brought to bear on them. Whether there are ways not 
 inconsistent with recognised first principles of good government, 
 and if so what are the ways, by which the community can 
 usefully intervene in the struggles of industry, and can help the 
 poorer workers to better means of self-support, or to other im- 
 provements in the circumstances of life, is not a simple question 
 
THE REIGN OF QUEEN VICTORIA. 447 
 
 o£ benevolence. On the contrary, it is a question in which Chap. xyi. 
 mere crude good-intention would be peculiarly apt to go astray, of Poverty, 
 and in which appeal must be made to the wisest heads, as well 
 as to the kindest hearts, having influence in public affairs. The 
 separateness of the question from questions of actual pauperism 
 is a point which the student has to observe. Since more than 
 three centuries ago, thanks to the well-considered socialism of 
 the great Elizabethan Acts concerning the poor, and to many 
 successive improvements in their system, extreme poverty among 
 us is entitled not to be left destitute : the impotent poor have 
 right of sustenance and comfort in the localities to which they 
 belong ; the able-bodied, in casual danger of destitution, can 
 conditionally claim protection against the danger ; and children, 
 left in poor-law dependence, are helped forward to live by their 
 work. For discharge of those eleemosynary duties towards 
 extreme poverty, England has everywhere its Boards of Guar- 
 dians of the Poor, acting in all particulars under central direction 
 and control, responsible to Parliament ; an administrative system 
 of more elaborated effort than perhaps any other branch of 
 English government can show, and purporting to deal as bounti- 
 fully with its clients as will consist with justice to its supporters. 
 From all which is within the intention of that settled province 
 of law, the present question has to be distinguished ; and the 
 more exactly that distinction is observed, the more will the 
 new question show both its importance and its difficulty : for 
 practically it is question of the community's accepting new sorts 
 of communal responsibility ; and that, in the particular matter, 
 is question which no thoughtful person can face without at once 
 perceiving how various, and how extremely grave, are the con- 
 siderations to be invoked in answering it. 
 
 The educated spectator who contemplates in mass the toils Certain 
 and the sufferings of the very poor, as exhibited on so terribly of^he^evfi 
 large a scale among the least-earning classes of the population, ^[® ^°" 
 will probably not fail to apprehend the biological meaning of 
 what he sees. It is hardly a figure of speech to say, that he has 
 before him, as in latter-day form, the still-continuing aboriginal 
 struggle of mankind for existence, and is informed, by the 
 samples he beholds, that hitherto, even where general progress is 
 most advanced, a considerable proportion of the strugglers have 
 
448 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVI. attained but an imperfect and precarious success. Not in any 
 Jf^P^erty.^ apathy of fatalism, but on the contrary with most definite regard 
 to methods of treatment, the ruler who would deal on a large 
 scale with the relief of poverty must always in due degree 
 remember that evolutionary aspect of the case, — must remember 
 that he is not unlimited master in a province of exclusively 
 human institutions, but is, to some extent, face to face with 
 inexorable laws of Nature; and that Nature (as Lord Bacon 
 teaches) non nisi parendo vincitur. 
 
 The harsh-sounding primal condition, that mankind has to 
 shift as it best can for its own survival, must inevitably have its 
 counterpart in the conditions under which communities of the 
 race exist ; and no community can exonerate its individual 
 members from bearing in fair proportion among themselves the 
 brunt of that primal law. Thus it is that communities, and even 
 individuals, in respect of what they can wisely attempt to do in 
 relief of poverty, are limited as by iron walls. Older than parlia^ 
 ments, and stronger than parliaments, are essential limitary con- 
 ditions which rulers and ruled must alike obey. Developed 
 civilisation can provide, and most imperatively ought to provide, 
 generous rules for the relief of its impotent and casually-destitute 
 classes ; but, barring what is legitimate under such rules, the 
 community has to claim from each of its members that he shall 
 provide for his own and his family^s maintenance, and shall so 
 far as possible pay his due to the needs of the State. As to the 
 exact scope of the individual liability, and as to the sorts of 
 inducement or compulsion which shall cause it to be obeyed, 
 different communities may in small details take different views ; 
 but as to the main principle there cannot safely be any difference 
 of policy, and the community which tampers or trifles with the 
 principle is surely providing for its own ruin. Whether it be 
 question of excuse from bearing a due share of public burthens, 
 or be question of sustenance (more or less) out of public rates, or 
 be question of organised appeal to private purses, we have to 
 guard, not less vigilantly than our forefathers of Tudor date, 
 against the encroachments of the '' rogue " and " sturdy 
 mendicant " ; and have to remember that, even in relation to the 
 most genuine poverty, alms-giving, and indulgences akin to 
 alms-giving, have limits in the funds on which they depend, and 
 
THE REIGN OF QUEEN VICTORIA. 449 
 
 render at best but mere stop-gap service. Also and equally (or in Chap. xyi. 
 some senses even more than equally) it has to be remembered of Poverty 
 that, in proportion as individuals and families are too loosely per- 
 mitted to expect welfare from their neighbours' efforts rather 
 than from their own, the community fosters a class of population 
 admittedly unfit for the status of free citizen ; while at the same 
 time it widely weakens among other units of its mass the motives 
 which most impel to individual exertion and thrift, and which in 
 their collective operation are as fibres of strength to the State. 
 It is therefore among the first conditions of good government, 
 that the community shall sharply distinguish between those of 
 its body who are self-supporting in regard of the claims they 
 ought to meet, and those who more or less depend on support 
 from public alms ; and it has been an early axiom in political 
 science, as well as an early rule of thumb in the building of 
 popular constitutions, that they who do not live independently 
 of alms and indulgences from their neighbours^ compulsory rates 
 ought not to be sharers in political privilege.^ 
 
 * From the days of the Roman republic, the significance of that barrier has 
 not needed much explanation. Under any democratic constitution, unless the 
 principle be held sacred, and the barrier be jealously guarded, political disin- 
 tegration must ensue. Unscrupulous candidates for popular " sweet voices " 
 will seek to do their briberies out of the public purse, will promise to their 
 pauper suffragants unlimited panem et circenses, or vs^hatever other impossible 
 moon is in demand, and will rapidly excite such unreasoning appetites, and 
 develop such hordes of privileged parasitism, as no remaining powers in the 
 social constitution can withstand. In England the general principle, that 
 persons receiving assistance from the poor-rates shall be inadmissible as voters 
 at parliamentary and local government elections, has, -within the last twenty 
 years, been subjected by Parliament to two very important exceptions : first, by 
 provision under the Elementary Education Acts, that, where any parent is from 
 poverty unable to pay the required school fees for his child's elementaiy 
 education, the payment for the child shall be made out of the poor-rate by 
 the guardians of the poor, but that the parent shall not in consequence be under 
 any electoral disqualification ; and, secondly, by provision under a special Act of 
 1885, that Medical Relief supplied at the charge of the poor-rate (and including 
 whatever of apparatus or of diet may be supplied on the poor-law medical 
 officer's recommendation) shall not disqualify. It must be admitted on all hands 
 that the two objects for which the exceptional provision has been made are 
 objects with special features distinguishing them from the common daily need 
 of food and shelter; and that, as to both of them, the State (as well as the 
 individual) has an interest. Especially as to the elementary education of the 
 poor, the State-interest was so immensely great that, in view of all the circum- 
 stances of the case, practical politicians saw fit not to insist strictly on the claim 
 for parental contribution ; but, in the debates on the Medical Relief Disqualification 
 
450 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVI. 
 The Politics 
 of Poverty. 
 
 The main 
 conditions 
 for rescue 
 are not 
 oxtriusic. 
 
 Self-help 
 must be 
 able to rely- 
 on just 
 laws and 
 just ad- 
 juiuistra- 
 tion of the 
 laws. 
 
 If influences are anywhere to be found which may avail to 
 diminish the poverty of our poorer wage-earning classes, it 
 would seem from the above considerations that, both in the 
 interests of the community at large, and also in the permanent 
 rightly-understood interests of those classes themselves, influ- 
 ences directly eleemosynary are not those which ought to be 
 first in request. On the contrary, provided that no unjust im- 
 pediment be operating, to interfere with the success of in- 
 dividual effort, undoubtedly, from every point of view, the 
 ihfluence most of all to be counted on, and indeed the only one 
 which can be regarded as direct in the matter, is the power of 
 what individuals and classes can do for themselves; and help 
 from outside can hardly be of permanent value, except in pro- 
 portion as it tends to develop the self-helping faculties of the 
 poor, or to remove unjust obstacles from their ways of self- 
 help. 
 
 In order however that any State, when appealed to by the 
 hungry and ill-sheltered of its subjects, shall be entitled to 
 refer them to self-reliance as their remedy, it is essential that 
 the State should be of clean record in the article of justice 
 towards labour. That, since seventy years ago, English labour 
 has been relieved from huge quantities of unjust restriction, — 
 so that, under present law, each man is his own master as to 
 the place and kind of market in which he will offer his work, 
 and as to the conditions on which he will accept employment, 
 and as to the fellowships into which he may enter for joint- 
 insistence on conditions, — is something for which deep thanks 
 
 Bill, very weighty expressions of dissent were heard; and though those 
 protests could not in the then relations of political parties avail anything against 
 the floods of competitive dr]fiw^(\eia which were speeding the Bill, they remain of 
 important political record. Doubtless it is in part for the general interest (as 
 well as humanely to be desired) that all requisite medical treatment should be 
 obtainable on very easy terms by the sick of the labouring population ; but 
 whether the labouring poi)ulation requiring medical treatment ought to be so 
 absolutely relieved from even contributing to its cost, and yet not be under the 
 ordinary disqualifications of poor-law relief, is a very different question ; and, 
 without pretending to express an opinion on what may prove the best final 
 answer to that question, I cannot but deeply regret that the tumultuous decision 
 of 1885 prevented a calm parliamentary consideration of the question of a 
 national system of Provident Dispensaries which should in part be liberally 
 subsidised from local rates, but should in part be supported by those who would 
 profit by them. 
 
THE REIGN OF QUEEN VICTORIA. 451 
 
 are due to men (mostly now ffone) whose efforts won that srreat Chap. xvi. 
 
 p . , , 1 . , , . 1 ThePolitka 
 
 emancipation or industry; and it may be that, in the same of Poverty. 
 
 line, there remains nothing further of importance for the present 
 generation to achieve. Whether in other directions there still 
 be injustices of which the struggling poor may rightly com- 
 plain — survivals either of unjust law, or of chronic consequences 
 resulting from such law, is a question which of course deserves 
 the utmost possible care of inquiry, and which present Parlia- 
 ments do in fact shew every possible readiness to entertain. It 
 appears certain that, in the case of one main division of English ' 
 
 life, some of the worst pinch of poverty corresponds to the 
 grievance of such a survival ; and that this grievance — the 
 essentially dispropertied state of the agricultural labourer in rela- 
 tion to the soil which he cultivates, urgently requires some sort of 
 remedial treatment."^ Relatively to that grievance, the agri- 
 cultural labour of this country has had the continuity of an 
 hereditary caste ; and our present ordinary labourer who culti- 
 vates the land, without any acre of it he can call his own, and 
 in general not even able to hire the rood of ground on which to 
 grow garden-stuff for his family, has inherited a right to be 
 heard against the iniquities which in past times ousted his 
 ancestors from their hold on the land, and gave appeal to the 
 poor-rates in exchange for it. As against the cruel paradox of 
 that position, it is to be hoped that Parliament may see its way 
 to ransom for the agricultural labourer some distinctive right to 
 
 * See, in Report of the Royal Commission on the Housing of the Working Classes, 
 p. 27, the extremely important statement : ** It seems clear that in hardly any 
 case do the wages of the agricultural labourers permit them to pay such a rent 
 as would enable a builder to provide suitable accommodation at a remunerative 
 rate of interest ; but, according to evidence given before the Commission, the 
 addition of plots of land to the cottages would go far to remove the diflficulty." 
 In face of that statement, I think it matter for regret that the Commission did 
 not see fit to enter far more freely on the question of improving the relation in 
 which at present the labourer stands to the land, and to propose emendatory 
 legislation of far more cogent sort than the merely permissive enactment which 
 the Report (p. 42) recommended ; and I cannot but think that Mr. Jesse CoUings's 
 remonstrances and arguments on that point (see his separate report at page 79 of 
 the general volume) deserved more success than they at the time attained. It 
 however has to be added that, two years after the legislation which immediately 
 followed the Report of the Commission, a more positive step of advance in the 
 interests of the agricultural labourer was taken by the passing of the Labouring 
 Classes Allotments Act of 1887 ; and at the present time, the practical working 
 of that tentative Act claims to be most attentively observed. 
 D D 2 
 
452 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. xvi. a limited allowance o£ land ; and, if the land-grievance be con- 
 of Poverty.^ sidered in connection with what is known as to the frequent 
 scantiness and badness of existing house-accommodation for 
 agricultural labourers, it may not be too much to hope that 
 every landed property of certain magnitude shall be required to 
 provide a proportionate number of fit dwellings for labourers, 
 each dwelling with its appointed strip of ground."^ Apart from 
 what is special to the case of the agricultural labourer, it can- 
 not be said that mere dearness of land in England — the dearness 
 of an indispensable commodity which exists in but limited 
 quantity, and for which in particular localities there is ravenous 
 general competition with readiness to pay famine-prices, is, in 
 strict sense, an inji(,stice to the labouring classes ; for in pro- 
 portion as land is more in demand for building or other purposes, 
 all classes alike have to pay more highly for it : but the labour- 
 ing classes are certainly liable to disproportionate hardship in 
 consequence of local dearnesses of land. In principle, no doubt, 
 higher local wages ought to meet the higher dwelling-prices 
 which the labourer has to pay in the districts which have higher 
 ground-rents ; t but time and conflict are necessary elements for 
 his bringing practice into agreement with that principle; and 
 meanwhile (as is now extensively the case in London) the 
 working-man will be forced into house-room grossly insufficient 
 for his needs. In relation to that very real hardship, political 
 economy may be supposed to offer two alternatives : — one, that 
 of leaving the workman to fight out the wage-question with his 
 employer, on the basis that the employer, when obliged to pay 
 higher wages, will recover from his customers the increased cost 
 of his production ; the other, to make it a principle of muni- 
 cipal government and finance, that, in all urban areas, a pro- 
 portion of land, sufficient for such quantity of labouring popu- 
 lation as the area may be deemed to require, must be held 
 inalienably for the more or less privileged use of the labouring 
 classes; privileged, namely, as against any unrestricted com- 
 petition-appraisement of the land ; and that the cost of con- 
 
 * It seems certain that a restitutive justice of this kind, besides immensely 
 benefiting the labourers concerned, would also (as lessening the pressure now 
 put upon them to become competitors for urban employment) be of indirect 
 advantage to the" poor in towns. f See above, p. 441. 
 
THE REIGN OF QUEEN VICTORIA. 453 
 
 serving this privilege must be a charge on the local rates. Chap. xyi. 
 Considering the objections to which the privilegiary alternative of Poverty. 
 would be open, as a policy of exceptional interference between 
 buyer and seller in the marketing of a chief national commodity, 
 and considering also the extreme difficulties of detail, and the 
 facilities for abuse, which there probably would be in any 
 attempt to administer it, I cannot but believe that the 
 adoption of that alternative might very possibly lead to even 
 greater social evils than those it could cure ; and that, on the 
 whole, probably the wiser policy, even at the cost of some pre- 
 sent pain, is that the hardship should remain to be dealt with in 
 detail by the more strenuous efforts, individual and collective, 
 of those on whom it presses in the particular cases. 
 
 With further reference to the claim, fundamental in all 
 reasonable Politics of Poverty, that the labouring classes shall 
 not be under any injustice of law in matters which are of im- 
 portance to their welfare, it may in passing be noted that justice 
 of law must be understood to include justice of administration 
 of law ; and I would draw attention to the supreme significance 
 of that principle in regard of administration for sanitary pur- 
 poses. Sickness, in the case of the poor, is as terrible an aggra- 
 vation of the poverty as the poverty is an aggravation of the 
 sickness ; and the sickness, irrespectively of what widowhood and 
 orphanhood it may occasion, is an almost necessary cause of at 
 least temporary dependence on the poor-rate. It cannot be too 
 loudly proclaimed that an efficient administration of the 
 SANITARY LAWS is among the best helps which can be given to 
 the poorer classes of the population; and that authorities who 
 negligently or corruptly fail of their duties in such administration 
 are among the worst oppressors of the poor. 
 
 When adequate provision has been made bv poor-law for the Questions 
 T • 1 \ o 1 • • Ti f -I .-. . 1 of State- 
 
 poverty which except tor such provision would be destitute, and assistance. 
 
 when all conditions of equal social justice have been secured for 
 
 all classes of the self-supporting poor, is there more which the 
 
 State ought to do ? In respect of further action to be proposed, 
 
 two considerations have to be remembered : first, that any such 
 
 action would be essentially eleemosynary, and would of course 
 
 need all the precautions which alms-giving in general requires. 
 
454 ENCLISH SANITARY INSTITUTIONS. 
 
 Chap. XVI. Jest motives for self-reliance and individual effort be taken away : 
 
 ThePohtics . ., . , / 
 
 of Poverty, and secondly, that, as it would almost necessarily involve in- 
 creased taxation of the other classes of the community, it would 
 in this sense, as well as in the other, require to be very carefully 
 guarded against abuse. In the reasonable interests of those who 
 would be compelled to pay the additional socialistic taxation, it 
 might fairly be claimed, that, wherever practicable, the expendi- 
 ture should either be in form of loan, or should be such as to 
 find its return in a reduction of the cost of pauperism. Money 
 spent in promoting the elementary and industrial education of 
 the poor, money spent on reformatory^ schools and on the training 
 and eventual settlement of the children of pauper and criminal 
 parents, and money spent in well-devised schemes of colonisation, 
 including especially such as would provide for the emigration of 
 young persons whom the State had trained, are perhaps the best 
 types of such expenditure as would promise to be remunerative, 
 and more than remunerative, in respect of the quantities of 
 pauperism and crime they would tend to prevent. 
 
 That influences such as these cannot be more than auxiliary 
 in the matter, is a limit imposed by the nature of the case. The 
 essentially prime condition is, that the members of the classes in 
 question should, individually and collectively, do their utmost to 
 help themselves. Individually, they have to strengthen them- 
 selves in the qualities of intelligence and industry and trustwor- 
 thiness which make value in the labour-market ; and in those 
 habits of forethought and self-control (among which needs 
 hardly be specified the habit of alcoholic temperance) by which 
 wages, however unraised in amount, are greatly raised in signifi- 
 cance. Collectively, they have to take example from what has 
 been best in the action of the more successful industries : have 
 to effect such organisations among themselves as may free them 
 from unnecessary dependence on middlemen, and may promote 
 their obtaining the best wages which the circumstances of their 
 respective branches of business will allow. Whether separately 
 or in union, they particularly will do well to note, that every 
 step upward in industrial skill is a step of escape from the level 
 at which sweaters can tyrannise over labour. So far as there is 
 non-possession or non-exercise of the self-saving qualities, no 
 statesmanship and no philanthropy can prevent for result, that. 
 
THE REIGN OF QUEEN VICTORIA. 455 
 
 down at the bottom of the social scale, with constant renewal Chap. xyi. 
 from upper levels, there will be a more or less unmoving sedi- of Poverty, 
 ment of squalid parasitic life. And let there be frank recog- 
 nition of the two chief causes, physical and moral, which, in 
 separate or in joint action, tend to perpetuate this deeply pitiable 
 result. No social effort can equalise the natural capabilities of 
 men, and the degrees of strength with which they respectively 
 try to rise ; or can prevent that some, in sheer weakness of nature, 
 will be without faculty to help themselves. Nor can it be 
 expected that the efforts of any single generation will conquer 
 the essential downwardness of perverse natures, or will convert 
 into effectual self-helpers the inveterate loafer and the sot. 
 
 In the modern politics of poverty there is perhaps no more Question 
 difficult problem than the question, how the community ought control." 
 to deal with the elements which have settled, or are tending to 
 settle, into that relatively hopeless sediment of low-level idle- 
 ness and mischief; but on this problem I do not feel myself 
 competent to speak except in a few most general terms. It 
 appears essential that present society should be more on its 
 guard, not in the angry spirit of Tudor times, but in a spirit 
 equally resolute, against recruitals of loafer life, and of the 
 pauperism which represents wilful idleness. Among the able- 
 bodied who, on plea of being unemployed, beg alms of the public, 
 or recurrently apply for poor-law relief, there undoubtedly are 
 large numbers whose unemployedness is more or less voluntary ; 
 probably many in whom the idleness is so wilful an offence 
 against the community as to deserve treatment of a penal 
 character ; and probably many more, to whom it would be of 
 incalculable advantage that magistrates should be able to sentence 
 them to periods of strictly disciplinary, though not otherwise 
 penal, treatment.^ One principle, which appears to me abso- 
 lute, is, that the State ought with all possible peremptoriness to 
 intervene against the hereditary continuance of pauperism ; that 
 
 * In this connection I would refer to the novel, but evidently not hasty, 
 suggestion which Mr. Charles Booth puts forward ; that his East London Class 
 B, numbering some 100,000 persons, and including the best-known ''unemployed" 
 of London life, should be brought under a compassionate system of industrial 
 maintenance by the State.— See in his Labour and Life of the Feople, vol. i., 
 ch. vi., pp. 165-70. 
 
456 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. xvi. it ought by law to have the amplest discretion to treat as 
 of Poverty, parentless, and to take into its own charge, all children whose 
 natural parents or guardians cannot, or will not, bring them up 
 otherwise than into pauperism, or presumably into crime. 
 
 Questions 
 of Private 
 Charity. 
 
 For the success of a sound Public Policy towards the Poor, 
 it is essential that Private Charity, and especially Co-operative 
 Private Charity, purporting to assist the poorer classes, should 
 loyally range itself on the side of the law, and work in the same 
 spirit with it. It should clearly define for itself what is its 
 proper province of action as distinguished from the province of 
 poor-law relief ; and within its own province it should (after the 
 spirit of the other province) be at all possible pains to dis- 
 criminate between proper and improper claims for assistance, and 
 to discourage all the many fraudulent forms of mendicancy and 
 parasitism — all the sham-poverty and wanton un thrift and 
 laziness which would live at the cost of others. Where giving 
 help, it should, as far as possible, adapt its help to the aim of 
 restoring or creating the power of self-help, and should be 
 specially careful not in any avoidable degree to diminish, but on 
 the contrary as far as possible to confirm or increase, in those 
 whom it helps, the cultivation of proper habits of prudence and 
 self-support. Private Charity, working in that spirit, and par- 
 ticularly if organised for localities on a coherent local system of 
 its own, and in well-planned concert with local poor-law 
 authorities and their officers, may be productive of incalculable 
 good; but in the contrary case, and in proportion as it disregards 
 the principles of the public policy, it tends almost equally to do 
 harm. Genuine inquiry into individual cases is the indispensable 
 basis for its acting aright ; and in innumerable cases mere money- 
 giving is of little or no avail, unless more or less personal pains- 
 taking go with the gift. It is painful to have to recognise as 
 regards this country, and most of all as regards London, that, 
 through non-recognition of those elementary principles, infinite 
 quantities of vaguely-benevolent intention, together with vast 
 sums of money, run to waste, year after year, under the much 
 misused name of Charity ; while also, with that waste of means 
 and of good intention, mischief, sometimes far-reaching mischief, 
 is done to the classes whose benefit has been intended. London^s 
 
THE REIGN OF QUEEN VICTORIA. 457 
 
 unequalled charitable resources, endowed and casual, are ab- Chap. xvi. 
 solutely without organisation among themselves ; the immense of Poverty, 
 almsgiving of the metropolis (outside the province of poor-law) 
 is under no system, nor is subject to any sort of responsible 
 guidance ; and on occasions of plausible appeal to compassionate 
 feeling, lavish supplies of money are contributed with such in- 
 security for their proper use that practically they seem appointed 
 for scramble."^ Among the most flagrant illustrations of the 
 general case are the facts regarding the very numerous medical 
 charities of London : institutions, differing widely among them- 
 selves as to scope of work, and as to standing and character and 
 resources : all of them more or less mendicant or expectant as to 
 charitable gifts from the public, and most of them loud in pro- 
 fessing financial difficulties, yet none of them under any sort of 
 exterior audit or control : all of them independent of each other: 
 all of them free from any relation to the admirable system of 
 Asylums, Infirmaries and Dispensaries which the Poor-Law has 
 at work within the same area : all or nearly all of them — (except 
 so far as subscribers' tickets may be required and the individual 
 subscriber may choose to investigate) — ready to give gratuitous 
 medical treatment without any sort of inquiry whether the 
 recipient is really so poor as to need that form of alms ; and the 
 chief of them giving out-patient treatment, in this indiscriminate 
 Way, on so immense a scale as to raise doubts against the value 
 of what they give. Other illustrations (but which I have not 
 space to describe in detail) can be observed in deplorable quantity 
 in the various forms of indiscriminate, and almost competitive 
 almsgiving which are exercised in London, especially during 
 each winter-season, by bodies of persons intending charity, some- 
 times on its own account and sometimes as make-weight for 
 
 * With reference to the Mansion House Fund for the London Unemployed 
 of 1885, Miss Potter, in her paper on the Bock Labour of East London, writes 
 as follows : " Eighty thousand pounds dribbles out in shillings and pence to first 
 comers. The far-reaching advertisement of irresponsible charity acts as a 
 powerful magnet. Whole sections of the population are demoralised, men and 
 women throwing down their work right and left in order to qualify for relief ; 
 while the conclusion of the whole matter is intensified congestion of the labour 
 market — angry, bitter feeling for the insufficiency of the pittance or rejection 
 of the claim." — Mr. Booth's East London, page 207. For various further evidence 
 as to the ill-e£Eect of that fund, and others of like sort, see last year's Eeport of 
 the Lords' Committee on Poor-Law Eelief. 
 
458 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. xyi. other purposes."^ That which so calls itself charity is on a vast 
 of Poverty, scale proselytising for pauperism, and in parts is often little 
 better than a lottery-system for the benefit of such idlest classes 
 of the population as count on these chances rather than on 
 industry. As regards those almost bacchantic forms of bene- 
 volence which offer hospitality to all comers — beds or breakfasts 
 or dinners or suppers, the educated observer will hardly have 
 failed to see that they " create a demand which they can never 
 meet/^ that their tendency is "to make relief a source of social 
 disorganisation, an excuse for heedlessness and vice, a counter- 
 attraction to the sober gains of thrift and foresight, an incentive 
 to restless discontent and the ceaseless expectation of bounties/'t 
 And even as to what seems the more limited proposal to 
 provide '^ cheap meals" or "free meals ^^ for groups of ill- 
 nourished children coming to elementary schools, surely the 
 public when besought for alms to fulfil that purpose (unless it be 
 limited to actual paupers) ought to demur to the principles — the 
 indefinitely extensible principles — which the proposal involves : 
 ought to consider whether the principle of exonerating parents 
 from the duty of finding food for their children, and the prin- 
 ciple of admitting children to expect from outside alms other 
 food than the food of their family, are principles which in the 
 long run can work for the common weal, either in their relation 
 to public economy, or in their not less important relation to the 
 family-life, and the morals and the self-respect of the people. 
 With regard to all such abuses as have been glanced at, and with 
 regard altog-ether to the wiser and nobler tone which ought to 
 rule the relations between wealth and poverty, rich and poor 
 alike have reason to be deeply thankful to the Charity Organisa- 
 tion Society, for the real labour which its leading members in 
 Council and District-Committees throughout the past twenty 
 years have given to the cause they have had in hand, and for the 
 
 * " Belief is used, and charities are established, by the promoters of all kinds 
 of religious and moral views, as agents to supplement their work. School- 
 Boards introduce relief indirectly where, as they believe, without relief they 
 cannot educate. Clergy and ministers frequently use relief as a potent element 
 in their ministrations. The Church Extension Association uses relief to extend 
 the Church. The Salvation Army is developing into a large relief society. 
 Everyone wants to put a bounty on the success of his own endeavours." — Annual 
 Report of the Council of the Charity Organisation Society, 1889, p. 31. 
 
 t Same, p. 28 and p. 3. 
 
THE REIGN OF QUEEN VICTORIA. 459 
 
 admirable teachings by which during these years they have been Ghap. xyi. 
 educating and helping us all to better principles and practice in of Poverty, 
 that branch of civil duty. The labour has not been wasted. In 
 1888, before the House of Lords Poor-law Committee, the ex- 
 perience of several of the East London Unions testified admirably 
 to the practical success of the Society^s principles in a most 
 difficult field of operation ; and at the present time it seems to be 
 certain that the almost chaotic relations of medical charity in 
 London will shortly undergo in some form or other under 
 auspices of Government the radical examination for which the 
 Society has raised demand.^ It may be hoped and expected 
 that, if provision shall have to be made for trusts of a public 
 kind, relating to the control and co-ordination of local charities, 
 the County Councils, which the Act of 1888 called into existence, 
 will in such respects be found eminently capable of serving 
 the public. 
 
 Finally, so far as I may presume to estimate the progress Question 
 
 of events and opinions bearing on the present subject, I would mentmg^" 
 
 observe that the time apparently is now not far off, when a J,ethjm^aw 
 
 radical reconsideration of English Poor-Law will be found ^y s^fe- 
 
 11 T • o guards 
 
 requisite. Among persons who have been most solicitous for against 
 the welfare of the masses of the people, there long, or perhaps pauperism. 
 always, have been some who have deliberately disapproved of 
 the policy of the Elizabethan law ; arguing that a law which 
 specially protects against extremes of privation will necessarily 
 operate as a kind of sanction to improvidence and idleness ; and 
 arguing that our present poor-law has been of vastly pernicious 
 operation in that sense. f Retrospectively speaking, I am so far 
 
 * See Proceedings of the House of Lords on July 29th, 1889 ; when Lord 
 Sandhm-st presented a petition praying for such inquiry, and when the Lord 
 President of the Council, with evident recognition of the importance of the 
 matter, promised that it should have the attention of the Grovernment. 
 
 t " A law which teaches men in their early life (the period when to secure 
 self-provision is easiest) that they shall always have a right to be supported 
 by other men, and that starvation shall be impossible for them, must surely 
 weaken the natural incentive to prudence, and deaden the divine instinct of self- 
 preservation ; and thus make a vast mass of our people improvident. Again, 
 the use of right conferred by such a law, — right only claimable, but readily 
 claimed, by those who, under its sanction, have learned to neglect the natural 
 duty of self-provision — is pauperism, and thus a vast mass of our people has 
 
460 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVI. from sharing in disapproval of the Elizabethan law, that, on the 
 of Poverty, contrary, I regard it with deep admiration and with gratitude : 
 not only believing it to have been of urgent national necessity at 
 the time when it was enacted, but believing also that, during the 
 past centuries, it has been an infinitely valuable element of 
 security in our slowly progressing social system, has immensely 
 mitigated the mischief of faulty laws relating to labour, and has 
 repeatedly saved the government of the country from liability to 
 • rude and perhaps subversive assault by masses under threat of 
 starvation. But, while I deeply entertain that sense of past 
 national obligation to the Elizabethan law, I do not in any 
 degree deny the contention of its opponents, that it has given a 
 dangerous impunity to improvidence and idleness, and has, to 
 that extent, imposed an unjust tax on those who fulfil the duty 
 of self-support.^ In view of the important changes which dur- 
 ing the last sixty years have been made in various related parts 
 of our social system, there seems at the present time to be ample 
 reason for re-considering the Elizabethan law in respect of that 
 particular weakness contained in it, and of the abuses to which the 
 weakness has led. England, after three centuries of poor-law, is not 
 likely to afiirm the negation of law which would leave destitution 
 to the options and chances of time and place, or would mer- 
 cilessly enforce, even on the most worthless of its idlers and 
 wasters, the extreme penalty of death by starvation and exposure. 
 But the problem which our forefathers tried to solve by the lash 
 and the branding-iron and the gallows, the problem of con- 
 verting to decent citizenship the "rogue^^ and 'Waliant beggar^' 
 and "sturdy mendicant ■'■' — the many-named absorber of other 
 men^s substance, remains a problem for modern England with 
 its modern methods to solve. The essential question, by what 
 means shall it be possible for the community to enforce on 
 
 become pauperised. And thirdly, the apparent wisdom of keeping themselves 
 qualified for pauper relief by being destitute tends to teach the young that self- 
 indulgence is an advantage and self-denial a mistake ; that it is better policy to 
 spend money, and be helped by the parish in need, than to save money and get 
 nothing from the rates." See footnote, next page. 
 
 * " It compels, not merely the rich to pay for the poor, or the fortimate to 
 pay for the unfortunate, but it makes all the thrifty, poor as well as rich, pay for 
 all the wasteful, in addition to fulfilling that duty of providing for themselves, 
 which the wasteful have chosen to leave unfulfilled." See footnote, next page. 
 
THE REIGN OF QUEEN VICTORIA. 461 
 
 individuals such industry as will suffice for their present and £?^ ^J^' 
 prospective self-support, and to exact from the early earnings of of Poverty, 
 the industry such proportionate payment as will ensure against 
 future chances of sickness, and against the eventual certainty of 
 old age, is a question which England may perhaps not yet be quite 
 prepared to answer in detail ; but it is a question which the country . 
 will soon be obliged to answer in a form sufficiently precise for 
 practical application. As a recent writer has well shown in a 
 little book specially addressed to " working men,''' the tendency 
 of universal compulsory insurance (as on a method which the 
 book explains) would be, within measurable time, to leave the 
 poor-law '^ without paupers on whom to operate ; the sick and 
 aged poor would be supported independently by their own 
 money, instead of being demoralised by a compulsory levy from 
 other people ; ratepayers would be relieved from a needless 
 burden, and the multitudes otherwise doomed to pauperism 
 would be raised into the class of self respecting and self -provided 
 citizens. ■'■'^ Under our present social conditions, the question of 
 adopting and strictly enforcing that principle (subject of course to 
 such exceptions as individual cases of bodily or mental inability 
 might require) tends almost inevitably to connect itself with all 
 questions of future benefaction to the poor. Especially it would 
 seem reasonable to connect the principle of Compulsory Insurance 
 with the principle of Free Education ; for surely, if the State is 
 to provide gratuitous education for the masses of the people, it 
 may reasonably require, as first-fruits from the receivers of such 
 education, , that they shall, as far as practicable, secure them- 
 selves against future pauperism, and thus guarantee the com- 
 munity against further costs on their behalf. 
 
 * See, in the People's Library, published by the Society for Promoting 
 Christian Knowledge, Thrift and Independence : a word for working men : by the 
 Kev. W. L. Blackley : 1885. The quotations in my last two footnotes are from 
 this work. 
 
462 
 
 CHAPTER XVII. 
 
 CONCLUSION. 
 
 Chap. xvh. With regard to the progress of English sanitary administration 
 one usion. ^^j,jj^g. ^^^ seventeen years between the establishment of the 
 Local Government Board and the passing of the Act of 1888 for 
 the constitution of County Councils, some admixture of disap- 
 pointment may be confessed ; for if, during those years, the 
 Local Government Board had exercised more influence of real 
 supervision in favour of progress, and against the many local 
 inactivities and defaults which have been known to exist, — 
 especially if in the first instance it had been started with organi- 
 sation and spirit for that branch of work, — presumably the 
 present sanitary position of England would have been much 
 more uniformly advanced than it is. 
 The past That drawback, however, has not had power to reverse the 
 
 tury's pro- generally advancing tide ; and, in spite of it, the total of our 
 SrSage past half-century's British progress in sanitary knowledge and 
 course^ government has been such as will make the Victorian period 
 memorable for future history. The Science of Preventive 
 Medicine has immensely advanced ; not only in the immediate 
 gain, that various diseases, and their respective causes and 
 respective modes of propagation, are far more exactly understood 
 than before, and that the diseases can therefore of course be 
 more readily prevented ; but also, and even more largely, because 
 new methods of pathological research have been created, full of the 
 utmost promise for future augmentations of exact knowledge."^ 
 Popular acceptance of the scientific teaching, and popular experi- 
 ence in confirmation of it, have also made very considerable 
 progress, — enough to have inclined local populations to tolerate 
 with but little grumbling, or even in many cases to promote 
 with more or less zeal, large financial expenditure for purposes of 
 
 * Observe, for instance, even since twenty years ago, how the knowledge of 
 the infective diseases has been increased by cultivation of the morbid contagia 
 in artificial media, and by more discriminative methods of experimf ntal inoculation, 
 and by exact comparative studies of the powers of alleged disinfectants. 
 
THE REIGN OF QUEEN VICTORIA. 463 
 
 Public Health : the Medical Profession has come to be recognised Chap.xvii. 
 as an ally of indispensable helpfulness for the State in affairs of 
 both local and general government : while, further, in conse- 
 quence of the more specific demands which Preventive Medicine 
 has made for various mechanical and physical and chemical aids 
 and appliances, new branches of commerce, purporting to fulfil 
 various dictates of Preventive Medicine, have begun to arise, and 
 in some cases have grown to excellence."^ On the new founda- 
 tions of Science, a new political superstructure has taken form. 
 For the purpose of locally protecting the Public Health, a great 
 body of new law, and a vast apparatus of administrative 
 machinery, wherein medical officers form an essential part, have 
 come into existence ; the Public has begun to feel its own incal- 
 culable interest, that this new branch of our national politics 
 should be worked with intelligence and honesty ; and, more and 
 more throughout England, men, possessed of the qualifications to 
 be desired, have been girding themselves in answer to that 
 appeal. Evidence enough is already to hand, that, where local 
 government has been reasonably attentive to modern sanitary 
 rules, great improvements in local salubrity, great diminutions 
 in the quantity of local disease and death, have, as had been pre- 
 dicted, come to pass.f 
 
 It is peculiarly gratifying to note that the English progress 
 of the last half-century has been of influence far beyond the 
 limits of the United Kingdom; not only in the colonies and 
 other transmarine parts of the British Empire, but also in 
 countries under other government ; and the early English workers, 
 who have joyfully witnessed that wide extension of a great 
 beneficence, have at the same time had the happiness of finding 
 
 * Compare, for instance, the details of present house-drainage, as laid down 
 under competent direction, with the details which passed muster in times before 
 the General Board of Health. Or compare the present time with thirty years 
 ago in respect of the means (commercial as well as municipal) which can be 
 invoked, to assist iu preventing the spread of infectious diseases. 
 
 t Details of such evidence are to be found in very many reports of local 
 Officers of Health. For more collective statements, see Dr. Ogle's highly 
 instructive Letter to the Registrar-General, in decennial supplement to the latter's 
 45th Annual Report. See also, in the oOth Annual Report of the same depaitment, 
 the Registrar- General's reflexions on the past Fifty Years of Civil Registration ; 
 and, in the just-published 51st Annual Report, the encouraging statements 
 which are made as to the death-rates in this current decennium. 
 
464 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVII. their own pioneer- work approved and honoured by the chief 
 
 Conclusion 
 
 foreign promoters of the extension."^ 
 
 Science re- 
 latively to 
 law and to 
 popular 
 education. 
 
 The progress which has been made consists essentially in 
 practical applications of Pathological Science ; and happily that 
 branch of knowledge shews every sign of continuing to give 
 lessons for application. In the eyes of those who cultivate it in 
 a spirit of becoming modesty towards the magnitude and the 
 difficulty of their subject-matter, it, no doubt, like many other 
 branches of the infinite study of Nature, appears hitherto as only 
 in that first stage of true growth where the known is immeasur- 
 ably less than the unknown ; but even in this early stage it has 
 already given ample light for very large preventions of disease ; 
 and, so far onward as we can foresee, we may expect that its light 
 will continue to be an ever-advancing guide for advances of law 
 and conduct. It is now proceeding with such activity as the 
 world has never before witnessed, and the various kinds of 
 knowledge which supply resources for the prevention of disease 
 are increasing with immense rapidity. Clearly we have to hope 
 that, in proportion as exact knowledge is gained of agencies 
 prejudicial to the public health, the nation will provide against 
 them by appropriate law and by effective administration ; but, 
 for obvious reasons, it is not likely that practical reforms will 
 
 * It -would be most agreeable to me were it in my power to offer here some 
 analysis of tbe sanitary literature of the last twenty or thirty years ; to show 
 how much merit there has been in many admirable reports which have been 
 issued under local administration in the United Kingdom, and under our 
 colonial and Indian jurisdictions ; and at the same time also to tell something 
 of the activity which has been shown in other countries — as, above all, in 
 Germany, and in the more advanced of the United States of America ; but with 
 my present limits of time and personal strength, I dare not enter upon any so 
 ambitious attempt. If I may permit myself partial exception where necessarily 
 my chief rule must be silence, there are two foreign names which all contemporary 
 opinion will, I feel sure, justify me in mentioning with peculiar respect: the 
 names of two, whose life-long devotion to the advancement of sanitary science 
 and practice, has laid all us their fellow- workers under obligation ; one, the 
 happily still living and vigorous Munich Professor, Dr. Max v. Pettenkofer ; the 
 other. Dr. Georg Varentrapp, the lately deceased patriot citizen of Frankfort. 
 I may add that, during the time, the chief English Medical Journals have in 
 general guided their readers to what has been of most interest in current British 
 work ; and that all chief sanitary thought of the last twenty years has been well 
 represented in the valuable JJeutsche Vierteljahrschrift fur offentliche Gesund- 
 heitspjlege, now edited by Dr. Alexander Spiess and Dr. M. Pistor. 
 
THE KEIGN OF QUEEN VICTORIA. 465 
 
 keep themselves immediately abreast of scientific progress. For Chap. xvii. 
 
 them, namely, the rate of advance must in chief part depend on 
 
 the proj^ress of popular education as to the facts and interests 
 
 and duties of the case, and can therefore hardly be expected to 
 
 be other than gradual and somewhat slow. Thus it has been 
 
 that down to the present time, our disease-preventive provisions 
 
 of law have certainly not in all respects kept pace with what we 
 
 know as to the causes of disease; and even less advanced in 
 
 most instances is the readiness of persons and authorities to make 
 
 full use of the provisions which exist. 
 
 Even as regards those parts of the case where popular educa- Popular 
 tion might now be supposed to have become comparatively ripe — hitherto ^ 
 the parts which specially regard the Cultivation of Cleanliness^ it Ject^^"^^^' 
 would be flattery to pretend that average England has yet e.g. in taste 
 reached any high standard of sensibility to dirt.^ Against uess; 
 accumulated obvious masses of filth, against extreme ferocities 
 of stench, local protests no doubt are pretty commonly to be 
 heard, and, at moments when there is panic about disease, may 
 often rise to considerable warmth of indignation ; but in regard 
 of the less riotous forms of uncleanliness, far too much in- 
 sensibility is widely shown. — See, for instance, how little 
 fastidiousness prevails in the popular mind as to the domestic 
 and commercial arrangements which supply Br inking Water. To 
 say nothing of domestic neglects as to the cleanliness of cisternage, 
 and nothing as to the frequency with which private supplies of 
 
 * When I speak of average England still having to learn lessons, and even 
 rudimentary lessons, in various matters of sanitary cleanliness, I do not intend 
 to imply that the wealthier classes of society are an exception to that average 
 reproach. It is by no means alone in comparatively poor and ungarnished 
 dwellings, that filth-diseases and odours of filth are to be found. In the houses 
 of wealthy and self-indulgent persons, who perhaps may be spending money and 
 raptures on the fine arts, and who certainly would think it strange to find them- 
 selves under imputation of dirt, and in the highly-paid lodging-houses which 
 these classes inhabit from time to time at their so-called health-resorts, it is not 
 very rare — indeed, as to the lodgings, it is i-ather frequent, that the staircase is 
 pervaded by more or less sewage-odour from defective drain-structures there- 
 abouts or in the basement; and even the wealthiest know but too well that 
 enteric fever, with its congeners, does not leave them unscathed. Persons, not 
 fairly eduwited to profit by their sense of smell, stumble as naturally into certain 
 sorts of disease as the more or less blind stumble into other pitfaUs ; and a 
 suggestion that the non-observant Johnny Sead-in-Air wUl come to grief in 
 matters of scent, as well as in matters of sight, is one which some ingenious 
 future Struwelpeter might fitly endeavour to bring into his nursery picture-book. 
 E E 
 
466 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVII. water are derived from surface- wells sunk in foul soil_, and 
 imbibing from cesspools and muck-heaps, merely let note be 
 here taken of the general inattentiveness to questions of public 
 supply. Now and then, no doubt, may be heard an expression 
 of mild surprise, that water which purports to be '' filtered '' 
 under Act of Parliament has much of the aspect of third-class 
 ditch-water, or is found to have plugged its service-pipe with 
 some live or dead body of an eel ; but, of proper watchful 
 insistence that the drinking-supplies shall be systematically 
 guarded from pollution, there is hardly a trace to be found; and 
 the consequences of this carelessness (quite apart here from any 
 question of its bearing on health) are often disclosed in forms of 
 such filth as ought to be blushed for. That even the London 
 water-supply, after half-a-century of disgusting disclosures, and 
 after various very terrible disasters, is not yet secured against 
 gross defilement, is a fact to be sufficiently gathered from the 
 reports of the official examiner under the Metropolis Water Act, 
 1871, and is in other ways deplorably notorious."^ In the 
 summer of 1886, the Lancet medical journal brought to light 
 that, during the week of the Henley Regatta, the Thames, for 
 about a mile^s length of its course, where supposed to be sacred 
 to the water-supply of London, had had, on and about its sur- 
 face, a floating and riparian encampment of some thousands of 
 holiday-makers, using the river as their latrine and middenstead, 
 and with their house-boats purposely closet-piped into it : all 
 this apparently not anything new, but a story which would 
 perhaps strike the popular mind when the medical journal had 
 commented on it ! j* What sentiment of cleanliness prevailed 
 among the thousands who could thus deal with their neigh- 
 bours' drinking-water, and among the millions who were 
 plaxjidly bearing the outrage, is a question which may be left for 
 such future historians as will discuss the curiosities of English 
 civilisation at the close of the nineteenth century ; and in the 
 meantime national education will perhaps have taught that a 
 river, having manured fields and sewage-farms and populous 
 
 * See, for instance, with particular reference to certain intakes from the 
 Thames, the Report on September, 1888. 
 
 t See Lancet, July 17, 1886; and, for such amendments as followed on that 
 exposure, see the reports of the same journal in succeeding years. 
 
THE REIGN OF QUEEN VICTORIA. 467 
 
 urban districts along its banks, and constituted by law '^ a Chap.xvii. 
 navigable highway on which all persons have right to pass and 
 re-pass for pleasure or profit/^ is not (even apart from regattas) 
 likely to supply such drinking-water as moderate sentiments of 
 cleanliness would seem to demand. — Again, to look in another 
 direction, see with what apparent indifference our nineteenth- 
 century England acquiesces in a daily-increasing sacrifice of 
 daylight to dirt. There are immense masses of our population — 
 the inhabitants, for instance, of London and of many chief 
 manufacturing towns, who endure without revolt or struggle the 
 extremities of general Smoke Nuisance; not only condoning the fact 
 (on which here the argument does not turn) that the nuisance is 
 of painful injury to an appreciable proportion of persons, and in 
 certain states of weather kills many of them ; but further (which 
 is here the point) accepting, as if in obedience to some natural 
 law, that their common life shall in great part be excluded from 
 the pure light of day — that incomparable source of all physical 
 gladness — by an ignoble pall of unconsumed soot ; and hardly 
 murmuring, in their self-imposed eclipse, that their persons and 
 clothing and domestic furniture are under the incessant grime of 
 a nuisance which is essentially removable. — It is of purpose that 
 I have adverted, though but in few words, to some comparatively 
 non-sanitary aspects of the question of cleanliness : for disease- 
 preventive degrees of cleanliness will hardly be attained, unless 
 something more than disease-prevention be included in the 
 popular aim. A great people, determining what it will deem 
 to be proper purity for air and water, has not to measure only 
 from the scavenger's point of view, but surely also with some 
 sense of the help which accrues to the human mind from behold- 
 ing the pure aspects of nature, and with some readiness for dis- 
 pleasure when the beauty and bounty of nature are wantonly 
 affronted by slovenliness and waste. For rich a,nd poor alike, it 
 cannot be too clearly understood that the claims of cleanliness 
 are fastidious. In order to sanitary self-protection by its 
 means, there must be sufficient refinement of taste to abhor even 
 minor degrees of dirt, and to insist throughout on the utmost 
 possible purity of air and water ; there also must be sufficient 
 sharpness and cultivation of sight and smell, to immediately 
 discover even minute infractions of the sanitary rule ; and there 
 E E :i 
 
468 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVII must 
 Couclusiou 
 
 in sanitary- 
 knowledge, 
 and sense 
 of sanitary- 
 duty. 
 
 be sufficient intelligence and watchfulness as to the 
 channels, commercial and other, which can clandestinely admit 
 uncleanliness from without.^ 
 
 "While average English life is but imperfectly educated in 
 standards of cleanliness, and in knowledge of the dangers which 
 uncleanliness involves, it may be taken for granted that popular 
 education is even less advanced in the other rudiments of sanitary 
 knowledge ; and with so widely defective an appreciation of the 
 causes of disease, there of course will be corresponding voids in 
 the practice of sanitary self -protection. The uneducatedness 
 has, for one of its consequences, that, in various ways of neglect 
 and passivity, sometimes by individuals omitting to do for their 
 own persons or premises something which they personally ought 
 to do and sometimes by their omitting to invoke from appointed 
 authorities or officers such assistance or protection as the law 
 intends these to afford, very many incur disease, who, with 
 better education, would know how to escape it, and could in 
 general be expected to exert themselves to that effect, f Thus 
 far, however, is mentioned only one of the chief preventable 
 evils against which advancing education has to contend; and 
 there remains for mention a second which is at least equally 
 important. Diseases do not spread only through the passive- 
 ness of tho'=5e who suffer them, but spread, in immense quantity, 
 through the influence, essentially voluntary ^ of wrongful acts, 
 ne^^-lcct, or defaults, on the part of Others. It is to be hoped 
 that, with advancing popular education, those aggressive activities 
 of disease-production in various J)arts of our social system will 
 be seen in stronger and stronger light, and be more and more 
 plainly understood, as very ierious forms of social wrong; 
 and that there may accordingly be developed against them, 
 on the one hand, such public^ opinion as will insist on higher 
 standards of social duty, and, on the other hand, such sufficient 
 stringency and punitivenene of the law as may be a terror to 
 evil-doers. In illustration of my meaning (but of course without 
 intending that the argtiftient should limit itself to the instances 
 
 * See next page. ^' 
 
 t In general, I say : for (as at least one necessary qualification) it must 
 always particularly be remembered, that persons in various forms of social 
 dependence may be in extreme difficulty as to their power of claiming sanitary 
 rights, and obtaininj^^mancipation from causes of disease. 
 
THE REIGN OF QUEEN VICTORIA. 469 
 
 cited) I would refer to the frequently-recnrriiiT: cases in which Chap.xvii. 
 
 -r\ "I ' p T o ' -r\' Conclusion. 
 
 wrongful conduct creates an Epidemic of Infectious Disease, or 
 widely spreads such disease beyond its first limits ; — to the 
 cases, where either local authorities or commercial companies, 
 purveying" public water-supply, have made epidemics of cholera 
 or of enteric fever, sometimes on a frightfully large scale, by 
 distributing polluted water ; to the cases, where local authorities, 
 by non-construction or mal-construction of sewers, or by 
 omitting to make proper application of the nuisances-removal 
 law in their districts, have occasioned similar epidemics ; to the 
 cases where dairies or dairy-farms have supplied to masses of 
 customers a polluted milk, infectious of enteric fever, or a milk 
 otherwise infectious ; and, not least, to the innumerable instances 
 in which improper conduct on the part of an infectiously- 
 diseased person, or of persons in charge of him, has propagated 
 infectious disease, — necessarily with more or less possibility of 
 further personal propagation, and perhaps, sooner or later, of 
 wide dissemination through some commercial or other apparatus 
 having large contact with the public — some school or laundry, 
 or food-shop, or water-source, or dressmaking or upholstering 
 industry, — and this improper conduct representing either an 
 almost savage ignorance as to the nature of the disease, or else an 
 utterly selfish indifference as to the hurt one's conduct may cause 
 to others. So, again, to add illustration from another branch of 
 health-government, I may refer to the quantities of disease and 
 death brought upon the public through the almost unbounded 
 facility which exists for abuses and dishonesties in the house- 
 trade, and by the frequency with which jerry-built and other 
 unfit houses, having in them latent malconstructions dangerous 
 to health, are let for hire to persons who have not knowledge 
 enough to protect themselves against the harm. 
 
 It is no part of my intention here to enter upon any general Question 
 
 n TO' 1 ix^ o^ eniorce- 
 
 cnticism of our present code or sanitary law ; but i cannot pass ment of 
 
 without comment that at present some curiously anarchical state ^mty^or 
 
 of law or custom concedes among us an almost unlimited im- ^^^J^^^^T 
 
 punity to those who inflict sanitary wrong. From more than 
 
 twenty years ago, and on occasions both official and unofficial, I 
 
 have endeavoured to enforce two principles, which, in justice to 
 
470 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVII. the public as against all such wrong, ought, I submit, to be em- 
 bodied in thoroughly workable law, and to be of familiar applica- 
 tion in legal practice : principles equally valid, whether the wrong 
 have been done by an individual member of the community, or 
 have been done by any commercial association, or have been done 
 by a local authority constituted for sanitary duties : first, the 
 principle of criminal responsihility for whatsoever wilful acts or 
 neglects gravely injure, or gravely endanger, the public health ; 
 and secondly the principle, that the doer of any sanitary wrong 
 shall be liable to y^2,y pecuniary compensation to those whom his 
 misconduct has harmed.^ Not pretending to write as a legiil 
 expert, I hazard no opinion how far new law may be absolutely 
 necessary in order that those common-sense principles should 
 have their due influence in practice; but that, in order to the 
 full effectiveness of the second of them, some revision of present 
 law, and some new special enactments, would at least be advan- 
 tageous, appears to me certain; and, with reference to part of the 
 case, I think it significant that, in 1885, when the Royal Com- 
 mission on the Housing of the Working Classes was recommend- 
 ing amendments of law to be made in that matter, it expressly 
 proposed as one such amendment, that " there should be a simple 
 power by civil procedure for the recovery of damages against 
 holders or owners of property by those who have suffered injury 
 or loss by their neglect or default in sanitary matters." f That 
 
 damages ; such ^^ simple power ^^ as the Commission there described should 
 be available throughout the entire field of sanitary relations, and 
 that, by means of it, a person who had suffered any sort of 
 sanitary hurt from the wrongful act or default of another 
 (whether person or company or authority) should be able easily 
 
 * The application of the above principles to wrongs done by local authorities 
 and water-companies was argued by me (1867-70) in the Ninth, Tenth, and 
 Twelfth of my Annual Reports to the Privy Council ; see previous mention, 
 above, page 302 ; and the argument will -be found in the extracts which Dr. 
 Seaton gives from those Reports, in his re-edition of 1887: viz. at pp. 287-9, 
 331-4, and 395-411 of his second volume. In respect of the spreading of infectious 
 disease in ordinary life, my argument will be found in the article Contagion of 
 Dr. Quain's Dictionary of Medicine, and (re-printed) in Dr. Seaton's Vol. II., 
 pp. 582-4. 
 
 f First Report, page 56. In § 12 of the Dwellings Act of 188-5, an indirect 
 step was made towards fulfilling that recommendation ; but it only referred to 
 properties of very poor class, and has not, even to that extent, nearly closed the 
 question of law-amendment in respect of sanitary wrongs done in the house-trade. 
 
THB REIGN OF QUEEN VICTORIA. 471 
 
 to recover pecuniary compensation from his injurer, is what I Chap.xvii. 
 
 submit ought to be law ; and I believe that such an amendment 
 
 of law would tend to ameliorate the sanitary government of the 
 
 country more rapidly than any other which could be named. In 
 
 respect of a certain class of cases, however, it is conceivable that misde- 
 
 individual plaintiffs suing for damages might often be at forensic 
 
 disadvantage unless their injurer had previously been indicted 
 
 and convicted for misdemeanor in respect of a public wrong, — as, 
 
 for instance, that by gross negligence or other misconduct (under 
 
 statute or otherwise) he had caused a certain epidemic of disease, 
 
 and thereby certain deaths ; and the importance which attaches 
 
 to the principle of criminal responsibility, in respect of serious 
 
 sanitary offences, may in part, though only in part, be judged 
 
 from its forensic relation to that class of cases. The other, and 
 
 even weightier reasons, for which the principle has to be kept 
 
 well in view, are obvious reasons of common public interest. I 
 
 am not aware that the Local Government Board, during its 
 
 eighteen years of existence, has, in any case of public sanitary 
 
 wrong, promoted the indictment of the malfeasant party ; 
 
 but I am deeply persuaded that legal action of that sort, 
 
 taken in even a very few well-cbosen instances of such wrong, 
 
 would be of infinite reformatory power over our whole area 
 
 of sanitary government; and I cannot but think that, in the 
 
 present state of knowledge and general education as to the means 
 
 of not wasting human life, it would be dereliction of duty on the 
 
 part of Government, if any further repetition of certain sorts of 
 
 homicidal action or default in sanitary affairs were allowed to 
 
 escape public prosecution.^ 
 
 It may well be hoped and expected that common-law Wilful 
 
 wrongs iu 
 local 
 * Take, for instance, some gross case of wrong done in respect of a public govem- 
 water- service. Any municipal or commercial body, authorised by law to purvey ^^^^'^ '• 
 water, must be deemed to have at command the knowledge now common to all 
 skilled persons, as to the dangerousness of polluted water, and as to the mechanical 
 means by which water ought to be made secure against such pollution ; and if 
 nevertheless a directing body, or its acting o£&cer, has, by negligence or other 
 misconduct, allowed the water to be in such state of pollution as to have pro- 
 duced a serious epidemic of enteric fever or cholera, surely the body or officer 
 ought to be indicted in respect of the public offence, and, so far as deaths have 
 resulted, to be indicted for manslaughter ; and this quite irrespectively of the 
 question of damages which may have to be paid by the body to those whom its 
 foul water-supply has injured. 
 
472 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVII. misdemeanors relating' to the public health will in the future not 
 often be of such sort and dimensions as to suggest question of 
 public prosecution ; but the principle which defines the misde- 
 meanor will, I think, more and more prove itself to be funda- 
 mentally important in the politics of public health ; and the 
 relation of the principle to neglects which cause sanitary danger 
 ought certainly not to be left out of view by those who desire to 
 correct certain occasional gross abuses in local administration. It 
 is true that, where a district-authority of bad type persistently 
 omits to fulfil duties commanded by sanitary statute — as, for 
 instance, those which sections 15, 40 and 92, of the Public 
 Health Act of 1875 impose, common law (irrespectively of 
 what may be done under section 299 of that Act) can bring 
 a writ of mandamus to bear on the non-feasant authority ; and 
 that therefore, the public needs not, in all the instances, be equally 
 concerned to have a second good string to its bow. But there 
 has to be remembered that, among cases of chronic administrative 
 default, corrupt non-feasance is a possible case ; that, according 
 to evidence which has been publicly given with regard to par- 
 ticular cases, men have held seats on district -boards in order to 
 screen bad house-property of their own from a due application of 
 public law, or for some other selfish and sinister purpose ; "^ and 
 with reference to cases of this sort, it certainly would be of 
 public advantage, that the Court of Justice, entertaining the 
 question of mandamus in relation to any obstinately non-feasant 
 sanitary authority, should also entertain the question whether 
 the persons or any of the persons composing the authority, had 
 made themselves misdemeanants at common law, and were in- 
 dividually liable to punishment. Here, however, the argument 
 has brought us again face to face with the all-important question 
 of popular education in the interests which the argument dis- 
 cusses. Our last sixty years of English political life have been so 
 transformatory of local administrative relations, that popular 
 intelligence has hardly had time to follow the change, and to 
 realise conscientiously for itself how large a new creation of 
 popular duties and responsibilities has taken place. A period of 
 immaturity in such relations may be expected to have its transient 
 weaknesses, requiring treatment more or less transitory; and, for 
 * See above, page 439. 
 
THE REIGN OF QUEEN VICTORIA. 473 
 
 them, all candid minds make allowance ; but, in the more pro- Chap. XVII. 
 spective sense which regards permanent norms of action, it of 
 course is supremely to be hoped that democratised local govern- 
 ment will know how to secure due diligence and honesty in the 
 administration of its affairs, without having in any great degree 
 to depend on the punishing powers of Courts of Justice. Surely, ought to 
 far more than on any such exterior corrective, it ought to be able vented by 
 to rely, preventively, on itself ; for educated local patriotism can opinion in 
 ensure from beforehand, that misdemeanors in local government J?^^ ®^®°* 
 shall not arise. In this, as in other parts of our electoral system, 
 the high integrity, the dutiful ness and disinterestedness of each 
 representative of the people, must be for the people itself to 
 regulate, and, with its respect and gratitude, to reward. Equally, 
 too, the nation is concerned in this correlative hope : that to be 
 elected member of a district, or county-council of local govern- 
 ment, and thus to become a participator in functions of essential 
 service to the State, will more and more commend itself, as an 
 object of legitimate and generous ambition, to persons of good 
 business-ability and of sufficient leisure, who would have in view no 
 other purpose than that of being actively useful in public duty ; 
 and that thus, while true popular education shall be strengthen- 
 ing all electoral bodies to identify and reject the candidatures of 
 persons who are intent only on personal aims, the bodies shall 
 have before them in increasing numbers candidates whom it will 
 be honour to themselves to elect. 
 
 For the further development of our sanitary institutions and Agencies 
 their working, the educational onward impulses may be expected sanitary 
 to come pretty continuously from members of the Medical Pro- has to be^ 
 fession, and are perhaps not in any essential sense to be expected ^o^fopu- 
 largely except from them. This is not meant only with regard ^^ useful- 
 to the abstract science of the matter, but equally with regard to 
 administration. Regarding the science, it has long been evident 
 enough, that, for such new researches and observations as will 
 supply increase to the body of exact knowledge on which the pre- 
 vention of disease depends, the world cannot expect much help 
 except from the work of the Medical Profession ; and the same is 
 now constantly becoming more and more clear in regard of 
 public sanitary administration. Whether for kingdom, or for 
 
474 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVII. county, or for district, the organisation or procedure which pur- 
 ports to prevent disease must sooner or later be judged from 
 the medical standpoint, — from the standpoint of question, 
 whether it has attained, or can attain, the disease-preventive good 
 which is its professed aim. Thus, more and more, the practice 
 of sanitary administration is having to adapt itself to the ex- 
 perience and judgment of the medical officers engaged in it j and 
 whatever other services may be auxiliary in the matter, the 
 administration, in essence, tends more and more to define itself 
 as a specialty of medical skill. "^ Therefore and for other reasons, 
 the progress of popular education in sanitary knowledge, and in 
 the art of sanitary government, will depend, to an incalculable 
 extent, on the personal influence of the Health-Officers through- 
 out the country ; each of whom is virtually authorised to be the 
 sanitary educator of his district; and it may reasonably be 
 hoped and expected, that, in proportion as those officers are of 
 attainments and character entitling them to have weight, each 
 of them will be accepted as an influential public teacher, and es- 
 pecially will be encouraged to inform and inspirit for sanitary pur- 
 poses the local authority under which he acts. Further, referring 
 to the principles on which the Local Government Board was 
 established in 1871, the public is entitled to expect that this Board 
 (irrespectively of what compulsory orders it may have to issue in 
 certain sorts of cases) shall be a highly important educational 
 influence towards the general sanitary progress of the country ; 
 and it is certain that the Board, having under its command, in 
 the department of which Dr. Buchanan is chief officer, the most 
 progressive scientific spirit, the most trained skill, and the largest 
 practical experience, ever yet combined in the sanitary service of 
 any government, could readily use means for stimulating and 
 assisting local education and progress in cases where backward- 
 ness is shown. The present state of the case is : that the Reports 
 of the Medical Department contribute invaluably to the growth 
 of sanitary science (abstract and applied) as understood by the 
 comparatively small class of persons who are experts in it, and 
 
 * As regards the central service, a good illustration is given in the 17th 
 Annual Report of the Local Government Board. See, namely, in the Medical 
 Officer's Supplement, App. A., No. 18, Dr. Blaxall's Report on the Inspections 
 directed by the Board for the purpose of settling on a permanent basis the constitu- 
 tion of Port Sanitary Authorities in England and Wales. 
 
THE REIGN OF QUEEN VICTORIA. 475 
 
 that probably the foremost local officers of health in the country Chap. XVII. 
 are those most conscious of habitual indebtedness to the advanced 
 scientific teaching of the central publications; but that, in more 
 diffused relation to the progress of the country, as particularly in 
 relation to the administratively backward districts, the Medical 
 Department can do but little unless it be allowed systematic per- 
 sonal communication with the districts and their health-officers 
 by the agency of its own inspectors ; and that this, unfortunately, 
 is the method of influence which hitherto the Local Government 
 Bjard has shown itself least willing to adopt. The Board cannot 
 expect to exert educational influence through agencies them- 
 selves uneducated ; and in proportion as it shall desire to be con- 
 tributive of real usefulness to the purposes in view, it assuredly 
 will have to reconsider the proportions in which skilled and 
 unskilled service have hitherto been used by it in professed 
 superintendence of local sanitary government. 
 
 The question of popular education in such sanitary matters as Public 
 have been under review ought hardly to be left without a word of Law^does 
 reminder as to the boundarv-line between ^'public" and "private" ^^^ ^\' 
 
 •{ ■'- -^ onerate 
 
 in affairs of Health. While modern times are recognising on a from rules 
 large scale, as general principles, that every community has an Hygieue. 
 interest in the health and strength of its individual members, 
 and that in various important respects the aggregated individuals 
 cannot secure health for themselves unless they act solidly to- 
 gether by appropriate defences of law and administration, those 
 principles do not at all imply that the community relieves its in- 
 dividual members from the general responsibility of caring for 
 themselves, or undertakes to prevent individual acts of unwisdom 
 by which the individual causes injury to his own health. Long 
 before our modern codes of public sanitary law had begun to 
 shape themselves, elaborate counsels of personal hygiene had 
 become current in the world ; counsels, as to the ways and 
 habits of life which would most conduce to healthful longevity; 
 counsels, above all, for moderation in life — " the rule of not too 
 7Yiuch ; " and those counsels for personal self-government, en- 
 forced from age to age by the ever-growing common experience 
 of mankind, are not now to be deemed superfluous because boards 
 of local government have arisen. In relation to the sexes and 
 
476 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVII. their union, and to the many personal influences which are here- 
 oncusion. j'^j.^^ — |^ relation to eating and drinking, — in relation to 
 work and repose and recreation for mind and body, — in rela- 
 tion to the charge of infancy, and to proper differences of 
 regimen for the different after-periods of life, — there are hygienic 
 rules, perhaps not less important to mankind than the rules which 
 constitute local authorities; but to enter even slightly on the 
 discussion of them would be far beyond the intention of these 
 pages ; and I cannot in passing do more than thus advert to the 
 importance of the subject. 
 
 In ending this volume, in which I have endeavoured to follow 
 the growth, and in some degree to examine the principles of a 
 comparatively new branch of politics, I need not attempt to 
 elaborate any argument as to the importance of the social object 
 which is in question. My own humble opinion on that point is 
 sufficiently implied in my relation to the present volume ; and 
 it seems to me that, in the course of events, the common judg- 
 ment of the country has shown itself practically convinced. 
 The fact that Preventive Medicine has now been fully adopted into 
 the service of the State is indeed the end of a great argument ; and 
 if the institutions of the country are to be valued in proportion as 
 they favour the greatest good of the greatest number, it may be 
 assumed that those which represent the counsels of Preventive 
 Medicine will never henceforth be held in low esteem. There no 
 doubt exist schools of thought, to which this branch of political 
 duty may appear but a trivial and niggling kind of industry. 
 From beside the Main it has been expounded to us in language 
 equally learned and lugubrious, that the radical error of the 
 universe (next to the fact of its having come to be) is the fact 
 of its preferring not to come to an end ; and, in the light of that 
 creed, it may seem an absurd anachronism that even the millions 
 of mankind, whom a late much-respected philosopher of ours 
 used from time to time to describe as '^ chiefly fools,^^ should be 
 willing to let their existence be prolonged. But however great 
 may ])e the academic interest of those opinions, there seems no 
 likelihood of their being accepted as bases for national policy ; 
 and to minds which have had the happiness of discipline in the Art 
 
THE REIGN OF QUEEN VICTORIA. 477 
 
 o£ Medicine, they will not count as of more pra3tical import Chap.xvii. 
 than any mere curious wreathiug of tobacco-smoke. 
 
 Granted, however, and granted a hundred times over, that Care for 
 
 good sanitary government is but a partial and initiatory contri- Health an 
 
 bution to the great whole for which patriots have to think and joS? 
 work. The human future as poets in prose and verse have ^^^P.^^ 
 conceived it — and "poets are the unacknowledged legislators of tion, claim- 
 mankind '' — is not a mere affair of animal robustness. Jeshurun, with other 
 we know, may have waxen fat, but have grown for no higher ^*^*°^^- 
 activity than to kick. And they to whom conservare quam 
 PLURIMOS is among the most sacred precepts of life will surely 
 not regard their duty as fulfilled till the client qnam plurimi 
 shall be well-to-do in far more than physical surroundings. 
 Among the many thoughts of difficulty and hope which crowd 
 on the minds of men who in various ways are working for the 
 abject of their kind, it may be that sometimes, even within the 
 slum, and over the poor heads in it which are being counted, 
 there suddenly stands forth, at first with unutterable pathos 
 of contrast, and then as the veriest rainbow of cheer, the memory 
 of Shakespeare^s words:* " What a piece of work is a man! how 
 noble in reason ! how infinite in faculty ! in form and moving, 
 how express and admirable ! in action, how like an angel ! in 
 apprehension, how like a god ! the beauty of the world ! the 
 paragon of animals ! " Surely the realisation of man in some 
 such sense as that is the goal towards which sanitary, as well as 
 all other social reformers, would work ; and when sanitary 
 reformers appeal to the conscience of modern civilisation against 
 the merely quantitative waste of human life, their deeper protest 
 is against the heedless extinction of those high and beautiful 
 possibilities of being, against the wanton interception of such 
 powers for good, against the cruel smothering of such capacities 
 for happiness. But, for the development of those possibilities 
 and powers and capacities, agencies, not commonly classed as 
 sanitary, have to be invoked ; and while, towards the higher 
 stages of the social future, the physical foundations are truly 
 indispensable, we, whose duties are with the physical, do not 
 pretend to authority in other duties. Relatively to the building 
 as a whole, the nature of the case has necessitated division of 
 
 * Hamlet, II. 2. 
 
478 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVII, 
 
 Couclusion. 
 
 Analogies 
 a id a-ffiu - 
 ties be- 
 tween the 
 different 
 branches of 
 civilising 
 endeavour. 
 
 labour; assigning to several sorts of special workmen their 
 respective specialties of endeavour ; and the particular share or 
 stage of duty which we " doctors ^' have in trust concerns but 
 the relatively raw material of the schemed construction. That 
 raw material, as it comes to us, we humbly receive ; to treat it 
 on impartial terms according to the lights of our specialty. 
 Not ours happily is the invidious duty to discriminate between 
 the ^^ chiefly fools •'■' and the others ; nor does the Art of Medicine, 
 any more than the radiance of its mythical patron-star, shine 
 differently on the just and the unjust. We undertake that we 
 will do our best to keep men alive, and to lessen the sufferings 
 and weaknesses of the physical life. For that function we are 
 sworn servants, and there our specialty ends. But we surely 
 should be less than human, if our hearts were not likewise for 
 the after-interests. Our Science, which is becoming more and 
 more able to preserve and strengthen to men their gift of life, 
 would indeed offer but a joyless task to its administrators, if 
 they had not in hope that the lives they endeavour to maintain 
 would be lives of growing worth and happiness ; and in propor- 
 tion as we medical workers have to recognise that ours is only a 
 divisional and preparatory labour, so much the more ardently 
 must we wish God-speed to those who are specialists in the 
 later divisions. 
 
 Into those other fields of endeavour as we gaze, we see 
 numberless close analogies to our own work. We see there 
 another Pathology than that which our clinics and dead-houses 
 teach us, yet a pathology almost parallel in its teachings. There, 
 as in our own province, we see a pathology of the deformed, the 
 aborted, the mutilated, the blood-poisoned ; a pathology which, 
 like our own, must measure from true ideals of health, must 
 perceive where straight lines have been lost, where normal 
 spheres are not yet duly rounded, where essential types are for 
 the while under eclipse; a pathology which, like ours, must be 
 deeply interrogative of causes, and must be patiently studious of 
 all natural processes of recovery and repair ; a pathology, from 
 which at every turn the would-be therapeutist has to learn humility 
 and reverence in relation to the problems of cure or prevention he 
 would attempt. To our technical eyes, indeed, the idolon specus 
 is as if Statesmanship, in some of its chief relations, were but a 
 
THE REIGN OF QUEEN VICTORIA.. 479 
 
 magnified Art o£ Medicine ; and the possibility whispers itself ChXp. xvii 
 to us that, in political practice, just as in the practice o£ our 
 more special art, damage may perhaps at times be done by 
 " unqualified practitioners,^' and by quacks who promise what 
 they cannot perform. Looking too into that larger world from 
 the more compact experience of our own specialty, we can vividly 
 see, in relation to many of its chief evils, that the Profession of 
 Statesmanship, like the Profession of Medicine, must be intent on 
 methods of Prevention no less than on possibilities of Cure, and 
 must derive its preventive methods from a genuine science of 
 Causes. We, perhaps more than most men, have facilities for ob- 
 serving how much study is yet needed for the Preventive Medicine 
 of many social shames and miseries, and how too often results are 
 expected where hitherto the first true steps towards attaining them 
 are only beginning to be made. We are able to see that the true 
 Prevention of Crime is more than an affair of police ; that society 
 has to strike at the roots of criminal intention, has to precognise 
 the stage where crime is first mentally conceived, has to substitute 
 moral influences for influences which tend to make the will 
 criminal. We can see that the true Prevention of Drunkenness 
 is not a mere stricturing of taps ; that society, besides having to 
 abolish those loathsome surroundings of life which now some- 
 times revolt sober men almost into envy of the drunkard, has to 
 develop the reasonable minds to which drunkenness shall have 
 neither charm nor excuse, the minds which shall not fly to it for 
 help, the minds to which it shall only mean filth and degradation. 
 We can see that for the true Prevention of Pauperism, alms- 
 giving contributes no help, and, if injudicious, contributes 
 hindrance; that, for the general prosperity of the proletariat, 
 so far as its able-bodied members are concerned, the proletariat 
 itself m^lst struggle, and that, in this struggle, if conducted 
 under just laws, no extrinsic assistance is likely to be of more 
 than slight avail as compared with the interior forces oi' personal 
 character, the faculties of activity and self-control, the thrift- 
 powers of labour and frugality. Thus, over great territories of 
 social evil, adjacent to the field of our merely medical work, we 
 seem to see on all sides, just as in our own province, the com- 
 mon pervasion of one deep want : the want of riper national 
 education. 
 
480 
 
 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVII 
 Conclusion. 
 
 Genuine 
 national 
 education 
 the com- 
 mon hope 
 
 Education, in the full sense of the word, is the one far-reach- 
 ing true reformer, for which in all the domains the sufferers have 
 to work and hope : not the mere elementary school-business of 
 reading and writing and arithmetic, nor even merely those bits 
 of learning with some super-addition of a bread- winning technical 
 of all social proficiency ; but the education which completes for self-help and 
 for social duty, by including wisdom and goodness among its 
 objects ; t*he education which teaches standards of moral right 
 and wrong, gives height to character and aim, acts orthopaedically 
 on the twisted mind, and applies its own hygienic discipline to 
 the shaking-palsy of purposeless life. Education in that sense 
 is not something which one man can receive passively from another, 
 as he might receive an inunction or a legacy, but is something 
 which his own nature must actively grow forth to meet. It in 
 truth is as a process of fertilisation, a process in which one 
 generation of minds can only awaken the germs of another, a 
 process in which fructification requires time. The progressive 
 development, the continuity with increase, is not an effect which 
 can be registered as from day to day ; but the results of the 
 true education are as sure as those of '^ the tree planted by the 
 rivers of water, that bringeth forth his fruit in his season.^' 
 The specialists who are variously striving for progress in different 
 chief branches of national life can all observe how greatly their 
 respective causes have that one essential interest in common ; 
 how true national progress has a solidarity of its own, in respect 
 of the educational roots from which all its different branches 
 derive impulse; and how the several chief branches thrive in 
 such sort of sympathy with each other, that deadness in any 
 one branch of the growth tends to delay progress in other 
 branches. 
 
 Our 
 
 present 
 civilisation 
 as a whole. 
 
 While, in the point of view to which the above considerations 
 have led, we see Medicine but as one among many servants in 
 the confederated endeavour for human civilisation, while we see 
 that the object of improving to the utmost tne conditions of 
 man's social existence is an aim for which many different 
 agencies must co-operate, and while we see that throughout the 
 whole range of civilising endeavour man is in courses of move- 
 ment which involve periods of time, we also, as regards the great 
 
THE EEIGN OF QUEEN VICTORIA. 481 
 
 joint task whicli is in question, are happily able to see that Chap.xvii. 
 momentous progress has already been made ; progress at accele- ^°^^^^''^°"- 
 rating rate in each succeeding half -century of our later times ; 
 and retrospect on that progress justifies us in very strong hopes 
 for the future. 
 
 In comparing different states of civilisation^ one must not 
 let the eye dwell overmuch on the mere individual pinnacles in 
 the scene — the extreme upward reaches of certain sorts of 
 personal or sectional prosperity, whether in accumulation of 
 wealth, or in eminence of knowledge and culture; for the 
 exceptional possessions, attaching as by temporary accident to a 
 small minority of persons, and not of concern to others except so 
 far as the respective proprietors pass them into general distribu- 
 tion and use, may be of extremely limited significance. The 
 essential signs of civilisation are the strength and worth and 
 happiness of the people at large ; and, for due measurement of 
 those signs, the observations must be on a corresponding scale. 
 The test-inquiries are chiefly of two sorts : first, how far is the 
 community free from well-defined social evils — from crimes of 
 violence and fraud, and from civil wrongs, and from drunken- 
 ness, and from prostitution, and from the pauperism of able- 
 bodied persons, and from injuries by preventable disease ? — and 
 secondly, what is the state of the proletariat as to conditions of 
 labour and living, — how far downward in the scale is it capable 
 of self-support without alms, — how far downward does it enjoy 
 reasonable comfort and decency of life, with means of providing 
 proportionately for sickness, and for old age, — how far down- 
 ward does it show itself able to secure for itself the just 
 profits of its own industry, and to protect itself against unjust 
 exactions in the quantity or the quality of its work? If, 
 with tests such as those, the England of to-day be compared with 
 the England of sixty years ago, triumphant signs of advan- 
 cing civilisation are everywhere to be seen : almost everywhere 
 there is the record of actual improvement — often of great, even 
 very great improvement, in the matteps^iof question ; and in the 
 exceptional cases where such improvement cannot yet be strongly 
 affirmed, there is the record, next best in quality, that endeavours 
 and influences for improvement are continuing and increasing. 
 Among the more characteristic facts of progress to be observed 
 
482 
 
 ENGLISH SANITAEY INSTITUTIONS. 
 
 Chap. XVII, 
 Conclusion. 
 
 Conditions 
 of progress 
 now 
 operating : 
 
 in the 
 growing 
 self-help- 
 fulness of 
 the 
 l^roletariat; 
 
 in our present stage, there are two, which,, for their prospective 
 significance in relation to vast national interests, seem to me 
 especially important : one, the increasing strength of the prole- 
 tariat for purposes of self-help; the other, the increasing solicitude 
 of the community for the welfare of its weaker members. 
 
 That, through our universal enforcement of elementary school- 
 teaching since eighteen years ago, the adolescents of the poorer 
 classes of our population are already stronger for self-help than 
 were their predecessors of earlier time, and that the lifting-j)ower 
 of elementary knowledge will be made of still greater value to 
 their successors as years go on, is unquestionably a fact of great 
 importance ; but not less important is the progress which the 
 elder proletariat had previously made, and is still steadily making, 
 in direct practical relation to its own economical interests. On 
 the one hand, there is the evidence of savings-banks and other 
 kindred institutions, as to the proletariates growing appreciation 
 of the value which even very small savings, prudently employed, 
 may have in helping men forward from conditions almost of 
 slavery to conditions of comparative independence, — growing 
 appreciation (in the spirit of Benjamin Franklin's memorable 
 teaching and example) that, for the welfare of future years, 
 early self-denial, even in very strict degree, may be a relatively 
 cheap price to pay, — growing appreciation how unwise an in- 
 vestment it is, in pot-houses or otherwise, to '^ buy the merry 
 madness of an hour with the long penitence of after- time," — 
 growing appreciation that, painfully hard as it must be to deal 
 in a provident sense with those poor earnings which allow no 
 legitimate margin for pleasure, yet that such providence, even on 
 penny wise scale, may be the labourer-'s only safeguard for 
 future promotion, and his only ransom for such domestic life as 
 shall deserve respect. Concurrent with the proletariat's progress 
 in senses such as those, has been its very remarkable and very 
 promising progress in the art of confederating for common 
 interests. Its members have been learning that, when at length 
 they were invested with a legal right to act in union for objects 
 which would be lawful to them singly, they were made conditional 
 masters of a great increase of power for purposes concerning 
 their welfnre, — masters of a power which would be great in 
 lu'oportion as they should use it with wisdom; and during the 
 
THE REIGN OF QUEEN VICTORIA. 483 
 
 last half-century, innumerable combinations of workpeople in ^^^^-^T^^* 
 
 . . . Conclusiou. 
 
 societies of comradeship and mutual help and insurance, in 
 societies of co-operative supply, and partially in societies of co- 
 operative production, have been pioneering in this immensely im- 
 portant line of national economics, have learnt great elementary 
 lessons, and have, in large part, attained such success as is of 
 most encouraging promise for the future. The progress of those 
 experiments has of course not been un chequered by such oc- 
 casional streaks of disappointment as are to be expected in the 
 early stages of every great social movement : there have been 
 instances in which the newly -discovered power has been immorally 
 or unwisely used, and in which discredit or misfortune has resulted : 
 but, on the whole, the tale of the industrial confederations strikes 
 me as among the most satisfactory of our century. As regards 
 the progress and the promise which it represents I will take 
 leave to quote the language of one who speaks with the authority 
 of learning and insight in the subject-matter, and who, while 
 he has been among the most sympathetic observers of the 
 movement, has probably also been among the strictest of its 
 critics : — ^' Three processes,''^ says Professor Thorold Rogers, 
 " have been adopted by the working classes, each of which has 
 had a vast, and should have an increasing influence in bettering 
 the condition of labour, and making the problem of dealing with 
 individual distress, however caused, easier and readier. They 
 should be viewed by statesmen with unqualified favour, and be 
 treated by working men as the instruments by which they can 
 regain and consolidate the best interests of labour. They are 
 trade-unionism, or, as I prefer to call it, labour-partnership ; co- 
 operation, or the combination in the same individuals of the 
 function of labour and capital ; and benefit- associations, or the 
 machinery of a mutual insurance society. So important do I 
 conceive these aids to the material, intellectual, and moral elevation 
 of the working classes to be, that I would, even at the risk of 
 being thought reactionary, limit the privileges of citizenship, 
 the franchise, parhamentary and local, to those, and those only, 
 who entered into these three guilds — the guild of labour, the 
 guild of production and trade, and the guild of mutual help. 
 Nor do I think it extravagant to believe that were those associa- 
 tions rendered general, and finally universal, the social problems 
 I? F 2 
 
484 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVII. which distress all and alarm many would ultimately arrive at a 
 Conclusion. ]^^^^y solution.""^ Among the forms in which labour has of late 
 times been able to win improved conditions of employment for itself, 
 there is one which^ though not separately named by Mr. Rogers, 
 may probably be within the full meaning of his language, but 
 which, if not so, is here to be remembered as a fourth chief 
 *^ process''^ of hope for the labouring classes, viz., that sort of 
 limited or contingent partnership between employer and employed 
 which is known as the system of profit-sharing : a system which 
 perhaps for many years to come may be of easier attainment to 
 the wage-earning classes than productive co-operation exclusively 
 their own, and which meanwhile seems an influence of singularly 
 good tendency to reconcile the interests of capital and labour, 
 and in the The constantly increasing care of the community at large for 
 
 fense^of the welfare of its individual parts is an eminently characteristic 
 dutv^^^*^^ and influential fact in our present stage of civilisation ; wherein 
 it represents the continuance and further development of the 
 philanthropic spirit which (as shown in a former chapter) 
 started into new growth among us more than a century ago. 
 On the surface, where none can fail to see it, is the immense 
 development of altruism in forms often comparatively crude and 
 impulsive, but of significance entirely good; while deeper, 
 among the more thoughtful classes, is the gradually settling 
 conviction that forms of civilisation are but futile forms, unless 
 the mass around which they are cast be pervaded from rank to 
 rank by the kindliness of man to man. It is something curiously 
 unlike what Machiavelli taught as politics. It is socialism of 
 the sort which consists with social justice, and tends to social 
 consolidation : not a sort which appeals to one-sided envies and 
 cupidities, and offers plebiscitary permits to rob; but a sort 
 which, as from the opposite stand-point, represents human 
 friendliness and generosity, and rejoices in its power to give and 
 
 * Six Centuries of Work and Wages : pp. 440-1. In a few striking sentences 
 at pp. 566-7, Mr. Rogers speaks with emphasis on some moral aspects of trade- 
 unionism, and explains how " entirely essential it is, not only to the dignity, but 
 to the strength of labour, that it should do what it has to do as well as it possibly 
 can " : insisting that, in this respect, the interests of employer and employed are 
 identical, and suggesting that the endeavours of any craft to establish for its 
 members a minimum of wages ought to be accompanied by proper securities for 
 a minimum standard of efficiency. 
 
THE REIGN OF QUEEN VICTORIA. 485 
 
 to help. This more and more has been becoming an influence in CnAP.XVli 
 England. Towards the distresses o£ the poor, the rich in purse 
 are so ready to give amply from their means, that in fact often, 
 from want of judgment, their money runs uselessly to waste or 
 to mischief, and the true demand has come to be less for supplies 
 of money than for supplies of administrative discretion. Then 
 again, in deep response to a different sort of claim, there is the spirit 
 with which, at the present day, incessant endeavours are being 
 made by associations and individuals, to develop freer intercourse 
 and better mutual understanding between the differently-con- 
 ditioned classes of society : very notably the spirit in which the 
 Charity Organisation Society and its District Committees are at 
 work, and with which numbers of educated men and women are 
 offering themselves as missionaries of civilisation to the poorest 
 of the poor, ready to share with them the surroundings in 
 which they dwell. From the collective observations of 
 workers of these sorts, society is constantly acquiring the 
 better exact knowledge by which to amend its dispensations 
 of succour : knowledge truly indispensable to the performance 
 of that great national duty ; for the function of social succour 
 (like all other political functions) requires to be exercised from 
 a basis of true knowledge; and the branch of political economy 
 here in question has now, with the assistance described, begun 
 to be cultivated as it ought to be. In the same sense, let note 
 be taken of the number and quality of the men who, during 
 the last thirty years, in Royal Commissions, and in Select 
 Committees of one or other of the Houses of Parliament, and in 
 all possible varieties of local action, have sincerely given the best 
 powers of their minds to studying the interests and promoting 
 the happiness of the common masses of the people. All this is 
 of daily familiarity among us to a degree for which, so far as I 
 know, there exists no precedent in history ; and while I am 
 saying it particularly of England, I have no intention of so 
 limiting it. On the contrary, though I cannot attempt to 
 speak in precise terms of the progress of countries less known to 
 me than my own, I will venture to express my conviction, that, 
 almost universally throughout Europe, and throughout the vast 
 populations which Europe can claim as its descendants in other 
 quarters of the globe, there have been at work, for the last 
 
486 ENGLISH SANITARY INSTITUTIONS. 
 
 Chap. XVII. hundred years and more^ never insignificantly, generally in 
 Couc usion. g^j.gjjg.^jj^ ^^^ often in ascendency, the same ferments of intellect 
 and conscience as those which have given products in England. 
 The German Reichstag^s recent completion of a code of law, 
 which, while it compels on the employers and employed of that 
 great people a system of graduated insurance for the wage- 
 earning classes against sickness, against accident, against casual 
 incapacitation and against old age, enacts also that this provident 
 system shall be liberally subsidised from the funds of the State — 
 that is to say, from the proceeds of general taxation, stands 
 forth, at the present moment, as a signal illustration of the 
 advance of principles which a century ago would have been 
 deemed Utopian or wild. On the whole, as it seems to me, 
 observers are in presence of a great acceleration-period in the 
 development of human social relations ; and among those who 
 contemplate it, not many, I think, will be disposed to say that 
 Vanitas Vanitatum is the last word of our nineteenth century. 
 Sursum The so-called Natural Sciences, it may be admitted, are 
 
 more obviously the giants of the hour. The rate at which 
 discovery and generalisation during the past century have secured 
 new firm ground in all departments of physical and biological 
 research, has been such as to rival the speed of imagination; 
 and in London, at the moment of my present writing, the most 
 advanced students of Nature are almost spell-bound as they 
 contemplate the stupendous magnitude of new generalisations 
 which are being set before them, with regard to the elementary 
 constitution, and the mysterious chemical rhythmicality, of all 
 which we call the material universe."^ Ever may the Sciences of 
 Nature continue to be, as they long have been, a principal 
 upward momentum to the noblest faculties of the human mind, 
 and infinitely contributive of those material benefits which the 
 world is ever requiring at their hands. Yet with all love and 
 reverence towards the studies of Nature, it is not only to them, 
 
 * On June 4, 1889, the Faraday Lecture before the Chemical Society of 
 London, was Professor Mendelejeif 's exposition of the Feriodic Laiv of the Chemical 
 Elements. More recently. Dr. Haughton, Tresident of the Royal Irish Academy, 
 has laid before that learned body a paper in which he discusses the abstruse 
 geometrical relations of the atomic weights and valencies of the elements, and 
 propounds from that basis a very widely enlarged reading of the Periodic Law 
 of Newlands and Mendelejeit'. 
 
THE REIGN OF QUEEN VICTORIA. 487 
 
 nor indeed even chiefly to them, that in this last word I refer. Chap.xvii 
 As my mind reverts to the reflexions with which this volume 
 opened, and as I see before me again the stone-breaking cave- 
 dweller whom our present generations call their ancestor, I doubt 
 whether modern man be more ahead of him in science than he is 
 ahead of him in conceptions of social duty ; and, when I end this 
 volume with a special Sitrsum Cor da to fellow-workmen like- 
 minded with myself as to the interests which the volume 
 has discussed, my thankfulness is not more for the great 
 Interpreters of Nature than for the men who in nearer and more 
 distinctive senses have been the organisers of help and hope for 
 their kind, and have made human sympathy a power in politics. 
 Great physicists set before us from time to time the gloomiest 
 horoscopes of the earth''s destiny. They warn us of successive 
 glacial periods yet to come, when, again and again, our northern 
 camps of civilisation must shift themselves to what they can 
 perhaps reach of negroland ; they warn us that, in remoter 
 doom, there bides for all earth the one sepulchral frost when 
 the sun which now cheers us will have grown dim with 
 age. From those dark prophecies of dead mechanical nature, 
 one turns with gladness to read the pointing of the human 
 index. While our unconscious planet, " with inoffensive 
 pace that spinning sleeps on her soft axle,"*^ glides by suc- 
 cessive yearly rounds towards her last haven, whether of 
 darkness or of light, Man — her '^ paramount creature "''' — is 
 seen ripening in his ordained development. Beast of prey is 
 not yet all extinct in him, but his organs of higher life are in 
 growth. More and more, as the cycles are trodden, he rises to 
 the religion of mutual helpfulness. Stronger now than ever 
 in the history of the world, and of wider range than ever in that 
 history, thoughts of loyalty to his kind are gaining sway with 
 him. And surely in the years to come, so far forward as man's 
 moral outlook can reach, they who shall be in the front will more 
 and more have to count it sin and shame for themselves, if their 
 souls fail of answering to that high appeal, and they strive not 
 with all their strength to fulfil the claims of that allegiance. 
 
INDEX 
 
 L.G.B. = Local Government Board, 
 G.B.H. = General Board of Health. 
 
 ABBREVIATIONS. 
 
 P.C. = 
 P.H. = 
 
 Privy Council. 
 Public Health. 
 
 Agriculture, Communal, early institu- 
 tion of, 6. 
 
 , utilisation of refuse in, 13. 
 
 Anthrax, Dr. Wooldridge's researches 
 on, 414. 
 
 Armyy Diseases of, by Dr. Pringle, 
 115. 
 
 , Reform of, after the Crimean 
 
 War, 241. 
 
 Arnott, Dr. Neil, his sanitary work, 
 185 ; with Dr. J. P. Kay, on pre- 
 ventable disease in London, 182. 
 
 Artisans' Dwellings Improvement Acts 
 passed, 1875-82, 345, 433. 
 
 Asceticism, confederated, as basis for 
 social action, 32. 
 
 Assize of Bread, 88. 
 
 B 
 
 Baker, Dr. George, afterwards Bart., 
 preventive work as to lead poison- 
 ing, 122. 
 
 Ballard, Dr. Edward, P.C. Med. Insp., 
 320 (note); L.G.B., Report on the 
 Cholera Survey, 403 ; on Effluvium 
 Nuisances, 409 ; on Endemic Sum- 
 mer Diarrhoea, 411. 
 
 Barry, Dr. David, sent (1831) to St. 
 Petersburg to study Cholera, 169. 
 
 , Dr. Fred. Wm., L.G.B., his re- 
 port, 1887-88, on Small-pox at 
 Sheffield, 412. 
 
 Baths and Wash-houses, Public, estab- 
 lished 1846, 201 ; Act passed, 213. 
 
 Blane, Sir Gilbert, M.D., his services 
 to Preventive Medicine, 120, 125. 
 
 Blaxall, Dr. Francis H., P.C. Med. 
 Insp. L.G.B. Report on sanitary 
 Coast- defences, 404^ on sanitary 
 conditions of Migration, 410. 
 
 Blomfield, Dr., Bishop of London, 
 moves, 1839, for general sanitary 
 inquiry, 187. 
 
 Board of Health, 1831, Provisional, 
 against Cholera, 171. 
 
 , General, under P.H. A., 1848, 
 
 205 ; officials, 214 ; and re- 
 sponsibilities, 215 ; action against 
 Cholera, 217; Report on Quaran- 
 tine, 218 ; on Water-service of 
 London, 219, 227; its centralising 
 policy, 221 ; its economics of sani- 
 tation, 223 ; its service to cleanli- 
 ness, 224 ; policy of Board opposed, 
 229 ; reconstruction, 1854, 231 ; 
 Presidents, 1854-58, 235 ; Medical 
 Council under Sir B. Hall, 237 
 (note). 
 
 Booth, Mr. Charles, Labour and Life 
 of the People, 436; on "Casual" 
 Workers, 438 (note). 
 
 Bruce, Right Hon. H. A. (Lord Aber- 
 dare), introduces, 1866, Bill for 
 Sanitary Act, 282, 
 
 Buchanan, Dr. George, P.C. Med. 
 Insp., 283, 316 ; L.G.B. Chief Medi- 
 cal Officer, 1879, 392 ; various Re- 
 ports, 410. 
 
 Buildings, Commissioners of, imder 
 James I., 84. 
 
 Burials, House of Commons Select Com- 
 mittee, 1842, under Mr. Mackinnon, 
 
490 
 
 INDEX. 
 
 190 ; Eeports by Mr. Chadwick and 
 G.B.H., 196, 219, 226. 
 Burke, Rt. Hon. Edmund, in relation 
 to India, 147. 
 
 Chadmck, Sir Edwin, K.C.B., early 
 Sanitary Work, 179; Keport, 1842, 
 on the Sanitary Conditions of the 
 Zabottring Fopulation of Great Bri- 
 tain, 191-6; on Interment in Towns, 
 196 ; assistance to the Royal Com- 
 mission in 1843, 198 (note) ; intro- 
 duces new system of drainage-re- 
 moval, 210, 216: Member of the 
 G.B.H., 214; termination, 1854, 
 of his official career, 231 ; value of 
 his services, 233. 
 
 Charities, Monastic, extinction of, 75 ; 
 private, questions as to, 456. 
 
 Charity Organisation Society, its edu- 
 cational work, 436, 458. 
 
 Cholera, Asiatic, epidemics of, in 
 England, first, 1831-3, 168-176; 
 second, 1848-9, 217 ; third, 1853-4, 
 236; fourth, 1865-6, 289, 303; 
 threatening of fifth, 1871, 313; 
 statistics of, 1848-58, by Mr. Farr, 
 240; relation to water-supply, 
 259. 
 
 Cholera Survey, L.G.B., 1884-6, 401. 
 
 Chrysostom, Hospital founded at Con- 
 stantinople by, 47. 
 
 Circumcision, intention and antiquity 
 of, 15 (note). 
 
 Clarkson, Thomas, his anti-slavery 
 work, 153. 
 
 Cleanliness, popular indifference to, 
 465. 
 
 Commission, R. Sanitary, of 1843-5, 
 197. 
 
 ■ , , of 1869-71, 322-352. 
 
 Contagious Diseases (Animals) Act 
 passed, 1878, 345. 
 
 Cook, Capt., his hygienic precautions 
 on board the Resolution, 119; re- 
 ceives Copley Medal of Eoyal 
 Society, 138. 
 
 Corporations, Post -Roman rise of, 
 34. 
 
 County Councils, establishment, 1888, 
 419 ; authorised to appoint Officers 
 of Health, 421. 
 
 Cowper, Rt. Hon. William (Baron 
 Mount-Temple), his Medical Act 
 of 1858, 272; his philanthropic 
 efforts, 273 (note). 
 
 Crimea, Sanitary Commission as to 
 Army in, 1855, 241. 
 
 Dilke, Rt. Hon. Sir Charles, Pres. 
 L. G-. B., 1884, Cholera Sui'vey in- 
 stituted under, 401; R. Commission, 
 1884, on the Housing of the Work- 
 ing Classes, 434. 
 
 Duncan, Dr. W. H., first-appointed 
 Officer of Health in England, 245 ; 
 good efitected by him, 246. 
 
 Duncombe, Mr. T. S., M.P. for Fins- 
 bury, 275 (note). 
 
 E 
 
 East India Company, India under the, 
 
 144 ; made subject to the Board of 
 
 Control, 146. 
 Education, Free, reasonable connection 
 
 of, with Compulsory Insurance, 
 
 461. 
 Egypt, early care against floods, 12 ; 
 
 early medicine, 15: early phil- 
 anthropy, 46. 
 Elizabeth, Mendicity laws under, 75 ; 
 
 Poor Laws of 1563—1603, 78 ; their 
 
 lasting efi:'ects, 459. 
 Engineers, Civil, relations wdih the 
 
 G.B.H., 209. 
 Engineer Inspectors, sanitary, 236, 
 
 375 (note), 382 (note). 
 
 Factory and Workshops Act passe 
 
 345. 
 Farr, IMr.Wm., work in the Registrai 
 
 General's Office, 211; his Cholei 
 
 Statistics of 1848-58, 240. 
 Floods, early care against, Rome, llj 
 
 Egypt, 12. 
 
INDEX. 
 
 491 
 
 Food-stores, communal, 7; of Tudor 
 London, 86. 
 
 Forstcr, Rt. Hon. W. E., Education 
 V.P., 307 ; Med. Acts Amend- 
 ment Bill, 1871, 309; Vaccn. Com- 
 mittee, 1871, 311 ; his death, 1886, 
 416 (note). 
 
 Fox, Rt. Hon. C. J., fate of his East 
 India Bill, 145. 
 
 Fox, Dr. Cornelius, on the precarious- 
 ness of officer ships of Health, 367 
 (note). 
 
 G 
 
 Galton, Sir Douglas, K.C.B., on Armi/ 
 Sanitation, 241, 243. 
 
 Goschen, Rt. Hon. G. J., his Scheme 
 of Local Government and Finance, 
 346. 
 
 Graham, Major G., Registrar- General, 
 1842-79, 211, 249, 294, 318. 
 
 Greece, early Medicine in, 16. 
 
 Green, Joseph Henry, afterwards Pros. 
 Gen. Med. Counc, writes, 1831, 
 on Medical Profession, 269 (note). 
 
 Greenhow, Dr. Edward H., first lec- 
 turer in London on Public Health, 
 265 ; mortuary statistics worked 
 out by, 266. 
 
 Grey, Rt. Hon. Sir George, on Con- 
 solidation of Water Companies, 
 227. 
 
 Grocers' Company, early quasi-medi- 
 cal relations of, 69. 
 
 Guardians, see Poor Law. 
 
 H 
 
 Hales, Dr. Stephen, on Ventilators, 
 
 1743, and 1758, 117. 
 Hall, Sir Benjamin (Lord Llanover) 
 
 Pros. 1854-5 of the reconstituted 
 
 Board of Health, 235 ; his Medical 
 
 Council, 237 ; his Sanitary Acts, 
 
 238. 
 Hardy, Gathorne (Viscount Cranbrook) 
 
 his amendment, 1S67, of the Poor 
 
 Law, 351. 
 
 Harries, Dr. Gwjmne, 319 (note). 
 
 Hastings, Sir Charles, M.D., efforts for 
 Medical Reform, 270. 
 
 • , Warren, impeachment of, 
 
 146. 
 
 Haywood, Mr., -now Col. Wm., C.E., 
 Engineer to the City Commis- 
 sioners of Sewers, 248, 251. 
 
 Headlam, Mr., M.P. for Newcastle, his 
 Bill, 1855, for Medical Reform, 
 270. 
 
 Herbert, Mr. Sydney, afterwards 
 Baron Herbert of Lea, his Ser- 
 vices in Army Sanitary Reform, 
 242. 
 
 Home, Dr. Anthony, afterwards K.C.B., 
 P.C. Med. Inspector, 319 (note). 
 
 Hospitals, early Christian Foundation 
 of, 47 ; their frequent monastic 
 origin, 63; of the United Kingdom, 
 P.C. inquiry, 1863, into their work- 
 ing, 293. 
 
 Housing of the Poor, inefficiency of 
 Sanitary Laws regarding, 439; 
 commercial enterprises for, 442 
 (note). 
 
 Housing of the Working Classes, Royal 
 Commission, 1884, to examine into, 
 434 ; report of Commission, 439 
 (note), 451 (note). 
 
 Howard, John, efforts for amendment 
 of gaol abuses, 138-144. 
 
 Hunter, Dr. H. J., P.C. Med. Inspector, 
 284; on the Dwellings of the poorer 
 Labouring Classes in Town and 
 Countrt/, 293. 
 
 India, early medicine in, 15 (note). 
 Industries, dangerous, P.C. inquiry, 
 
 as to precautions taken, 293. 
 Infant Mortality, P.C. inquiries into, 
 
 291, 298. 
 Infections, Foreign, local defensive 
 
 action against, 314. 
 Infective processes, investigations into, 
 
 413. 
 Insurance, Compulsory, as against 
 
 Pauperism, 481. 
 
492 
 
 INDEX. 
 
 Jenner, Edward, M.D,, discoverer of 
 Vaccination, 1798, 123. 
 
 Kay, Dr. J. P. (Sir J. P. Kay-Shuttle- 
 worth) Assistant Poor Law Com- 
 missioner, 186. 
 
 Klein, Dr., his identification of various 
 contagia, 413. 
 
 Lambert, Mr. John, afterwards Rt. 
 Hon. and K.C.B., Poor Law In- 
 spector, made Sec, L. G. B., 355 
 (note) . 
 
 Lancet, The, Commission on manage- 
 ment of Workhouse Infirmaries, 
 350 (note) ; on Henley Regatta, 466. 
 
 Land, question of allotments for agri- 
 cultural labourers, 434, 451. 
 
 Layard, Sir A. H., on the drainage of 
 Nineveh, 10. 
 
 Leach, Mr. H., Board of Trade Med. 
 Inspector for the Port of London, 
 300 (note). 
 
 Lemon-juice, its use in the British 
 Navy, 121. 
 
 Lent, Compulsory diet in, under the 
 Tudors, 90, 91. 
 
 Leprosy, mediaeval spread of in Europe, 
 35 ; legislation, 41. 
 
 Lind, Dr. James, his hygienic work 
 for the British Navy, 116. 
 
 Liverpool, Sanitary Acts of 1846, 
 245. 
 
 Local Government Act Office, 1858-71, 
 239, 346, 351. 
 
 Local Government Board, 1871, 333, 
 344-432. 
 
 , Presidents, 347, 392. 
 
 , Secretaries, 355 (note). 
 
 , Inspectors, " General," 355, 363, 
 
 377, 387. 
 
 , administrative supervision, legal 
 
 and medical aspects of, 375-7 ; need 
 for medical service, 382. 
 
 L. G. B., Medical Department, Chief 
 Medical Officer, 392. 
 
 L. G. B., Med. Dcpartmt., Assistant 
 • Medical Officers, 393. 
 
 , Medical Inspectors, 377. 
 
 , Annual Reports, 1871-1889, 394. 
 
 , advances in Codification and in 
 
 Scientific Discovery, 407, 414. 
 
 London, Government of, mediaeval, 39 
 -43; under Charles I., 83; under 
 James I., 84 ; under Elizabeth and 
 Edward VI. as to Food- Trade, 
 86, 90. 
 
 London, the City Eemembrancia, 82- 
 100 ; Plague, various visitations, 
 1580-1636; 94-8 ; Plague, Great, of 
 1665, 100; Great Fire, 1666, 101 ; 
 re-building of, 102 ; first appear- 
 ance of Cholera, 173; Sanitary 
 Inspection of parts of, 1838, 181 ; 
 Royal Commission 1847, for, 206 ; 
 not included in the inquiry of the 
 R. Com., 1869, 325. 
 
 , Poverty in, 435-7 ; Chaos of 
 
 Charities of, 457. 
 
 , City of, first Medical Officer of 
 
 Health appointed, 247 ; Annual 
 Reports, 1848-55, 251. 
 
 Long-staff, Dr. G. B., on Diphtheria, 
 412. 
 
 Lowe, Rt. Hon. Robert (Viscount 
 Sherbrooke) Bill for perpetuating 
 the P. H. Act of 1858, 277; his 
 Nuisances Rem. Amendment Act 
 1860, 323 (note). 
 
 Lush, Dr., M.P., Return as to ap- 
 pointments of officers under P. H. 
 Act, 1872, 365. 
 
 M 
 
 McCann, Mr., on the premonitory 
 stage of Cholera, 175, 218. 
 
 Mackintosh, Rt. Hon. Sir James, 
 attempts to mitigate the criminal 
 law, 160. 
 
 Mansion House Council, 1883, on the 
 Dwellings of the People, 436. 
 
 Marson, Mr. James, Resident Surgeon 
 to the London Smallpox Hospital, 
 282 (note). 
 
 Mead, Dr. Richard, his precautions 
 against Plague, 109-115; on Ven- 
 tilators for Ships, 118. 
 
 \ 
 
INDEX. 
 
 493 
 
 Medicine, Profession of, in Rome, 25- 
 29 ; in England, under Tudor 
 legislation, 65 ; Royal College 
 of Physicians founded by Henry 
 VIII., 66; Acts relating to the, 
 69 ; . Royal College of Surgeons, 
 charter granted by George III., 
 69 ; Apothecaries, Society of, 70; 
 incorporation, 1540, of the Barbers 
 of London practising Surgery with 
 the Company of Surgeons, 68 ; 
 Statutory constitution given to, 
 1858, 268. 
 
 Medicine, Preventive, early progress of, 
 107-127 ; its recent advance, 462. 
 
 MedicalRelief Disqualification Bill,449. 
 
 Mendicancy, encouragement of, by 
 Monastic Orders, 57 ; Tudor legis- 
 lation on, 74-76 ; modern need of 
 dealing with, 448. 
 
 Merchant Shipping Act, sanitary 
 amendments, 1867, 300, 
 
 Methodists, influence of the, 131. 
 
 Montagu, Lord Robert, amendment of 
 Vaccination Act by, 283. 
 
 Moorditch, obliteration of, 83. 
 
 Morpeth, Lord (Earl of Carlisle) his 
 Health of Towns Bill, 1847, 203. 
 
 N 
 
 Navy, hygienic Reform, Dr. James 
 Lind, 116; Stephen Hales, 117; 
 Capt. Cook, 119; Dr. Blane, 120 ; 
 lemon juice, 121. 
 
 Negro-slavery, abolition of, 152-158. 
 
 Netley, Military Hospital, 243. 
 
 Nightingale, MissFlorence, her services 
 to the Army in the Crimea, 242 ; 
 and afterwards, 243. 
 
 Nineveh, drainage of, 10. 
 
 Nuisances, Roman laws as to, 10 ; me- 
 diaeval abatement of, 39 ; Act, 
 1846, for removal (fi, 201 ; Act 
 extended, 299 ; jumble of authori- 
 ties for enforcing, 323 (note). 
 
 OflScers of Health, first proposals for, 
 195, 200; first appointment, 1847, 
 
 for Liverpool, 245 ; for London, 
 1848, 247; Royal Sanitary Com- 
 mission, 1869-71, on, 334-344; 
 general system of, established under 
 Act of 1872, 362, 387. 
 
 Orders, ecclesiastical, establishment of, 
 48 ; Benedict of Nursia, 48 ; 
 Benedictines, become of easy life, 
 48 ; Francis of Assisi, 49 ; Fran- 
 ciscans, their mission to England, 
 51 ; their gradual degeneration, 
 53-55 ; their encouragement of 
 mendicancy, 57 ; the services they 
 rendered, 62. 
 
 Overseers of the Poor, duties under 
 Elizabeth, 78. 
 
 Oysters, restriction on the sale of, 
 89. 
 
 Papyrus, the Ebers, its medical teach- 
 ing, 15 (note). 
 
 Parkes, Dr. E. A., first holder of the 
 chair of Hygiene at Netley, 
 243. 
 
 Pauperism, hereditary tendency to- 
 wards, 455. 
 
 Pavements, early need of, 11; Roman, 
 20 ; responsibility, 17th century, for 
 maintenance, 83 (note). 
 
 Pentateuch, sanitary regulations in, 16. 
 
 Pharmacy Act passed, 1868, 300. 
 
 Philanthropy, Egyptian, Buddhist, 
 Mohammedan, and early Chi-istian, 
 46 ; monastic and media) val, 48 
 -58. 
 
 Phthisis, local distribution of, 305. 
 
 Pipes, earthenware, for drainage, in- 
 troduced, 211, 225. 
 
 Pitt, Rt. Hon. W., his India Act, 146 ; 
 against slave-trade, 154. 
 
 Plague, visitations and consequent pre- 
 cautions, 94, 100; the Great, mor- 
 tality from, 100. 
 
 , disappearance of from Europe, 
 
 105. 
 
 Playfair, Rt. Hon. Sir Lyon, Educa- 
 tion V. P., on Officers of Health, 
 361, 420; his Medical Acts 
 Amendment Act, 417. 
 
494 
 
 INDEX. 
 
 Political privileges, pauperism a dis- 
 qualification for, 449 (note). 
 
 Pollution of rivers, early avoidance 
 of, 8 J Act passed, 345; Thames, 
 466. 
 
 Poor, medical attendance on, Rome, 28 ; 
 religious regard for, 46 ; Tudor 
 legislation as to, 72 ; early ecclesi- 
 astical charge of, 73 ; various par- 
 liamentary proceedings, 1866-82, 
 as to, 433-444. 
 
 , Acts relating to, under Elizabeth, 
 
 78 ; as substitute for mediaeval 
 charities, 79. 
 
 Poor Law Amendment Act of 1834, 
 161, 176. 
 
 Commissioners of 1838-9, London 
 
 sanitary inspection, 180-4 ; general 
 sanitary inquiry, 187 ; control, 1840, 
 over vaccination contracts, 281. 
 
 Poor Law Board, 1847; discontinuance 
 of, 333, 345; previous relations to 
 medical service, 348-351. 
 
 Poor Law, House of Lords Committee, 
 1888, on, 436; reconsideration of 
 needed, 459. 
 
 Poverty, mediaeval relief of, 45. 
 
 , as regarded by the Methodist 
 
 revival, 132. 
 
 , Politics of, 433-461. 
 
 of London, 437. 
 
 , questions of lessening, 444, 
 
 446. 
 
 Powell, Mr. Francis Sharp, M.P., his 
 work for the Royal Commission of 
 1869, 331 (note). 
 
 Power, Dr. W. H., L. G. B. Assistant 
 Medical Officer, on Dissemination of 
 Smallpox, 411; on human and bovine 
 Scarlatina, 411. 
 
 Pringle, Sir John, M.D., hygienic work 
 for the Army, 115; his testimony to 
 Captain Cook's work, 119. 
 
 Prison Reform, John Howard's work 
 in, 138. 
 
 Privy Council, Tudor sanitary work 
 under, 82-100. 
 
 proceedings, 1 83 1 - 2, as to Cholera, 
 
 168. 
 
 , Medical Department, 1858-71, 
 
 under P. H. Act, 1858; Annual 
 Reports, 1859-72, 279. 
 
 Privy Council, organisation, 314. 
 
 , laboratory investigations, 316. 
 
 , transference (1871) of most of 
 
 the P. C. duties to the L.G.B., 347, 
 
 414 (note). 
 Public Health Act of 1848, 204. 
 
 of 1858, 273-4. 
 
 Punishment, capital, till 1820, for 
 
 minor offences, 159. 
 
 Q 
 
 Quakers, their resolutions against sla- 
 very, 152. 
 
 Quarantine, Mediaeval establishment 
 of, 36 ; precautions against Plague, 
 98. 
 
 Act applied to Cholera, 169 ; criti- 
 cism of by the Board of Health, 
 218. 
 
 R 
 
 Radcliffe, Mr. John Netten, P.C. 
 Medical Inspector, 316 ; L.G.B., 
 on contrivances for dealing with 
 refuse, 409, 
 
 Ramsay, Rev. James, his anti-slavery 
 efforts, 152. 
 
 Rates, Levy of, for Pest-houses, 98. 
 
 Register of Medical Practitioners es- 
 tablished, 1858, 272. 
 
 Registration of Bii'ths, Marriages, and 
 Deaths, Act passed, 1836, 177. 
 
 JRentembrancia, the City, 82-100. 
 
 Rome, earliest sewers in, 10, 14, 
 20. 
 
 , duties of ^diles and Censors, 
 
 18-19. 
 
 under Augustus, 19-23 ; laws 
 
 concerning nuisances, 23. 
 
 , Medical^ Practitioners in, under 
 
 Republic, 25-28 ; under Alexander 
 Sevenis, 28 ; under Valentinian and 
 Valens, 28. 
 
 Romilly, Sir Samuel, on the amend- 
 ment of criminal law, 159. 
 
 Rumsey, Mr. Heniy W., F.R.C.S., 
 promoter of Royal Sanitary Com- 
 mission, 1868, 324. 
 
INDEX. 
 
 495 
 
 Sanderson, J. Burdon, M.D., P.O. 
 
 Medical Inspector, 283 ; laboratory 
 
 investi<^ations, 317, 413. 
 Sanitary Act of 1866, 298. 
 Sanitary Commission, Eoyal, 1869- 
 
 1871, 322-352. 
 Reform, unofficial associations in 
 
 aid of, 212, 213, 234. 
 Sclater-Booth, Rt. Hon. Geo. (Lord 
 
 Basing) Pres. L.G.B., 1874-1880, 
 
 392. 
 Scurvy, Disappearance of from the 
 
 Navy, 116. 
 Seaton, Dr. Edward Cator, P.O. Med. 
 
 Inspector, 282-3; L.G.B., Medical 
 
 Officer, 392. 
 Sepulture, Extra-mural, Report by the 
 
 Board of Health, 219. 
 Sewers, Roman, 10, 20; under Henry 
 
 VIII., 70; of brick, 210. 
 Shaftesbury, Lord, his philanthropic 
 
 career, 234. 
 Sharp, Granville, against slavery, 152. 
 Simon, Mr, John, F.R.S., afterwards 
 
 K.C.B., Officer of Health for the City 
 
 of London, 1848-1855, 247; Medical 
 
 Officer to the General Board of 
 
 Health, 1855-1858; Medical Officer 
 
 P.C., 1858-1876, 273, and L.G.B. 
 
 1871-6, 355 ; retirement from office, 
 
 1876, 392. 
 Slaney, Mr., M.P., on discontent of 
 
 working classes, 188. 
 Slavery, mediaeval prevalence of, 37; 
 
 vagabondage punishable by, 76 ; 
 
 negro, abolition, 153-157. 
 Smallpox, legislative precautions 
 
 against, 123, 190 ; epidemic, 1871, 
 
 310; at Sheffield, 1887-8, 412. 
 Smith, Dr. Southwood, on preventable 
 
 disease in London, 181 ; his sanitary 
 
 work, 186, 187. 
 Smoke -nuisance, toleration of, 467. 
 Snow, Dr. John, on the mode of com- 
 munication of Cholera, 240, 259, 
 
 286. 
 Scotland, Sanitary inquiry of 1839, 
 
 188. 
 Stansfeld, Rt. Hon, James, his L.G.B. 
 
 Bill passed, 347; first Pros. L.G.B,, 
 
 1871, 353; proceedings under his 
 Presidency : as to constitution of 
 Central Office, 356 ; as to Local 
 Officerships of Health, 358 ; as to 
 supervision of Local Government, 
 374. 
 
 Stevens, Dr. Henry, P.C. Med. In- 
 spector, 283 and note ; L.G.B. 
 Report, 1881, on London Public 
 Vaccination, 410. 
 
 Sulphur as disinfectant, Homer, 17 ; 
 Mead, 113. 
 
 Sutton, Mr. Samuel, his " fire-pipes," 
 118. 
 
 Sweating System, Lord Dunraven's 
 Select Committee, 1888-9, on, 435. 
 
 Sydenham, Dr. Thomas, his influence 
 on Practical Medicine, 108. 
 
 Taylor, Dr. Alfred, on the sale of 
 
 poisons, 293. 
 , Mr. Tom, Secretary G. B. .H. , 
 
 236 ; retirement in 1872, 355 (note). 
 Thackrah, Mr. C. Turner, on industrial 
 
 diseases, 125. 
 Thames, mediaeval protection of against 
 
 pollution, 40 ; Lancet reports on 
 
 Henley Regetta, 1886, 466. 
 Thome, Dr. R. T., P. C. Med. Insp., 
 
 L, G, B, Assistant Med. Officer, 
 
 319 (note). 
 Thudichum, Dr. J. L. W., work for 
 
 the Medical Department, 293. 
 Torrens, Mr,, M,P., Act for the better 
 
 housing of Artizans, 433. 
 Typhus, Dr. Lind's teaching, 117 ; the 
 
 prisons of the 18th century the 
 
 central sources of, 140. 
 
 U 
 
 Union Chargeability Act 1865, 300. 
 
 Vaccination, gratuitous public, estab- 
 lished 1840, 190; G.B.H. Report 
 
496 
 
 INDEX. 
 
 on, 1857, 262 ; P.O. answerable for, 
 1858, 274, 279; summary of legis- 
 lation till 1859, 281 ; amendment of 
 law, 283; new Law, 305; animal, 
 306 ; fl. of Commons, Select Com- 
 mittee, 1871, on Working of 
 Acts, 311; Act of 1871, 312; Dr. 
 Stevens's inquiry, 1881, 410. 
 
 Vagabonds, enactments concerning, 74 
 -80. 
 
 Ventilators, a description of, by Dr. 
 Stephen Hales, 117 (note). 
 
 Vestries, parochial, 1865-9, as Sewer- 
 authorities, 322, 323 (note). 
 
 Vows, ascetic, as basis for organised 
 philanthropy, 58. 
 
 Wages, magisterial regulation of, 
 abolished, 1824, 161. 
 
 Water-Leet at Plymouth, constructed 
 1585, by Sir F. Drake, 81. 
 
 Water, early supplies of, 7 ; religious 
 reverence for streams, 8, 466 ; Roman 
 care for, 20 ; removal of refuse by 
 means of, 194,224; defective service 
 in London, 1850, 220 ; supply for 
 London, its connection with cholera, 
 260 ; suggested legal action against 
 peccant purveyors, 302, 471 ; or- 
 dinary indifference to quality of, 
 465. 
 
 Wealth of Nations, published 1776, 134. 
 
 Wesley, John and Charles, and George 
 Whitefield, 131. 
 
 Wilberforce, William, parliamentary 
 leader of the " Abolitionists," 153, 
 
 Wooldridge, Dr., method of safeguard- 
 ing from Anthrax, 414 ; his death, 
 414 (note). 
 
 Wren, Sir C, scheme for reconstruc- 
 tion of London, 102. 
 
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