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GENERAL BOARD OF HEALTH,
MEASUREs ADOPTED FOR THE Execution of THE
NUISANCES REMOVAL AND DISEASES
PREVENTION ACT,
- ºn
Public HEALTH ACT,
w TO , - .
JULY 1849.
. prisents te sett Rouses st parliament by Tommand of Rev asinº.
LONDON,
PRINTED BY wiLLIAM CLowes & SONS, STAMFORD STREET,

* * >
º
Bºº
Yº:# F. R O M T H E L J B R A R Y O F
cº professor Karl heinrich Rau
OF THE UNIVER's ITY of HEIDELBERG
P R E S E N T E D TO T H E
U N | V E R S I T Y O F M I C H I G A N
BY
Mr. philo parsons
of DETRolt
1871

4/4.6 °4.2.
G.7%
G. 3
4
REP () RT
BY THE
ON TEIE
MEASURES ADOPTED FOR THE EXECUTION OF THE
NUISANCES REMOVAL AND DISEASES
PREVENTION ACT,
AND THE
PUBLIC HEALTH ACT,
UP TO
JULY 1849.
{}regented to floti) #ouges of flarliament by QTommamb of her ſºlajesty.
LONDON :
PRINTED BY WILLIAM CLOWES & SONS, STAMFORD STREET,
- FOR HER MAJESTY'S STATIONERY OFFICE.
1849.


6/4,0742
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G. 3
FIRST PROCEEDINGS.
MAY IT PLEASE YoUR MAJESTY,
As the Public Health Act and the Epidemic
Diseases Prevention Act, which we, the members of
the General Board of Health, were appointed to ad-
minister, constituted a new and untrodden field of
legislation, we have felt it our duty to render an
account of our first proceedings, and of the grounds on
which we have asked for amended statutory provisions
to carry out the views of the Legislature.
In presenting the following Report we beg leave
to express our regret that the pressure of incidental
and irregular demands and emergencies for the di-
rection of measures to arrest the spread of Asiatic
cholera, have prevented our submitting it earlier for
practical consideration during the present session of
Parliament. For this delay, and for unavoidable in-
completeness in the Report, which may not be supplied
by our published Notifications, and for any imperfections
in the first exercise of the powers with which we are
charged, we would bespeak a gracious consideration.
We deemed it our duty, in carrying into operation
the Nuisances Removal and Diseases Prevention Act,
to follow out the conclusions to which the Metropolitan
Sanitary Commissioners had previously arrived respect-
ing the mode of propagation, the localizing conditions,
and the means of checking the spread of epidemic dis-
eases—conclusions derived from the largest experience
of such diseases at home and abroad, and which were
generally acquiesced in. With reference especially to
the pestilence which seemed at that time to be impend-
ing, it appeared to us to be established by the evidence
which they had presented in their First and Second
Reports, that Asiatic cholera differs in no respect from
other epidemic diseases either in the circumstances
which favour its localization and extension, or in the
B 2 R. K.
4 Re-appearance of Cholera.
classes that are peculiarly predisposed to it, and con-
sequently that the means which experience has proved
to be effectual in preventing the origin and spread of
the most formidable of these common epidemics, typhus
fever, would in the same manner be found effectual in
the prevention of cholera.
The evidence also appeared conclusive that the cha-
racter which, on its first appearance in Europe, was
generally thought to be peculiar to cholera, and which
gave it its chief terror—the absolute suddenness of its
attack—was not true to the extent supposed; but that,
on the contrary, with very few exceptions, and those
chiefly on its first outbreak in a new locality, it gives
distinct warning of its approach in time for the adoption
of remedies capable of arresting its progress.
Though, when we entered on our office, cholera had
not as yet broken out in any part of the United King-
dom, it appeared to be steadily approaching us from the
Continent, advancing precisely in its former track.
The results of the experience of the disease which
had been collected from So many sources, exhibiting its
progress among populations in different climates and
under widely different Social conditions, indicated im-
portant practical measures of prevention; but it appeared
to us to be desirable, before the adoption of any system-
atic plan of prevention, to ascertain whether the disease
presented the same characters as on its former visitation,
or, should it have undergone any change, in what respects
it had become modified. In order to obtain authentic in-
formation on this point, we decided on sending our two
Medical Inspectors to Hamburgh and Berlin, the near-
est cities on the Continent in which the pestilence was at
that time prevailing. They were on their way to Ham-
burgh, when they were stopped by an outbreak of cholera
at Hull, which took place among a Prussian crew who
had passed through Hamburgh on their way to England,
whither they were coming to navigate a vessel which had
been detained in the port of Hull owing to the Danish
blockade. It appeared that these Sailors had come
from a healthy port in the Baltic, and that they had
passed only a single night near the town of Hamburgh,
Evils of Quarantine. 5
where cholera had been for some time epidemic. The
appearance of cholera in the port of Hull excited con-
siderable apprehension, which seemed to be justified by
the position of the town on the east coast, in which
cholera, in the year 1831, first broke out, namely, at
Sunderland. The event appeared to us to be of so
threatening a nature as to require a careful inquiry into
the circumstances of the case as well as into the state
of the town. This was undertaken by Dr. Sutherland
and Mr. Grainger, who reported that the general sani-
tary condition of Hull at that time, as compared to
former periods, was favourable ; and they gave it as
their opinion that, apart from the position of the town,
it was in no particular danger of an outbreak of cholera;
the correctness of which conclusion was confirmed by
the fact that these imported cases did not spread,
and that they were not followed by any appearance of
the disease among the townspeople.
While engaged with the authorities of the town in
advising on such provisions as seemed practicable for
preventing the extension of the disease, if fresh cases of
it should occur, the attention of the Inspectors was
called to the subject of quarantine, and particularly to
the cruel position in which certain quarantine regula-
tions, as enforced at Hull, placed passengers and crews
coming from infected ports; instances being brought
under their notice in which experience had proved that
it was impossible to afford to vessels under quarantine
medical assistance until all hope of relief had passed
away. The peril in which considerable numbers of per-
sons were thus placed, and the loss of life which had
actually occurred, induced us to address a special
report on this subject to the Privy Council.
Having, as above stated, suggested what precautions
seemed available for the town of Hull, the Inspectors
were on the point of embarking for Hamburgh, when we
received information that an outbreak of cholera had
occurred at Sunderland. This circumstance induced
us to direct Dr. Sutherland to proceed to that town
and Mr. Grainger to go on to Hamburgh. Dr. Suther-
land was prevented from joining Mr. Grainger on the
6 Bad Sanitary Condition of Merchant Ships.
Continent, his presence, after his visit at Sunderland,
being urgently required at Edinburgh, and subsequently
at other towns in Scotland, where his labours have con-
tinued up to a recent period.
Meanwhile, on arriving at Hamburgh, one of the
first circumstances which attracted Mr. Grainger's
notice was the great severity of the epidemic among
the crews of numerous vessels lying in the harbour, a
large proportion of the ships being English. He
found that the number of English seamen amounted
to upwards of 800, among whom, being in a foreign
port, and often unable to obtain assistance until they
were in a hopeless condition, the mortality was ex-
cessive. In order to afford what assistance seemed
available, we requested Mr. Grainger to consult with
the naval officers, and, with their advice, to draw up in-
structions for the guidance of the masters and crews of
the English traders, to cause proper medicines to be
provided at convenient stations in Hamburgh, and to
circulate notices of this among the brokers and others
connected with shipping, as well as to the captains
themselves.
These instructions were widely circulated among
merchant seamen in different parts of the United King-
dom by authorities and companies connected with
shipping, and, with the Sanction of Lord Palmerston,
among seamen in foreign ports.
It appeared, in the course of the investigation into
the state of the colliers and other English vessels at
Hamburgh, that they were in a most defective con-
dition, as to health; that the forecastle, where the
sailors sleep, was unprovided with any means of venti-
lation, and in fact that the men were, in those wretched
berths, exposed to all the evils resulting on shore from
filthy, crowded, and ill-ventilated dwellings; and in
the instructions issued as above stated, especial attention
was directed to the necessity of cleansing and venti-
lating these vessels, as constituting a much better
security against the progress of the epidemic than any
quarantine regulations. The evidence as to the greater
efficiency of such measures of precaution and pre-
Intention of the Legislature. 7
vention have been fully set forth in our Report on
Quarantine.
From the observations made on the earlier groups of
cases of the disease that occurred on its reappearance in
this country, and still more from the information commu-
nicated in the reports of Mr. Grainger, as to its character
and progress in Hamburgh (see Report in Appendix),
it appeared that no essential change had taken place in
the nature of the epidemic; but, on the contrary, the
further and more recent experience of it afforded de-
cisive confirmation of the views promulgated in the
Metropolitan Sanitary Reports, as to the conditions
which favour its localization and spread, and as to the
general existence of premonitory diarrhoea.
Seeing that, when the mortality from the developed
cases of this disease that have occurred in any country
comes to be summed up, it is proved to be similar
in all climates, and under all modes of treatment,
we arrived at the conclusion that it was our duty
to regard the impending epidemic less as a disease
to be cured by medicine, than as a pestilence to be
checked by measures of prevention. But the whole
tenor of the evidence presented under the Metropolitan
Sanitary Commission, corroborated by that subsequently
received by us, led to the conviction that the same
measures of prevention were applicable to cholera as to
other epidemics, which, though less dreaded, increase
the absolute mortality in a higher degree, and are
regarded with less terror only because they are slower
in their progress, and more constant in their presence.
In order therefore to carry out what appeared to us to
be the intention of the Legislature, we endeavoured to
embody in our Regulations and Orders the results of
the most extensive experience with reference to the
entire class of epidemic diseases, and to found upon
that experience practical measures of prevention.
Among the most available and needful measures of
this description were those of Cleansing. We therefore
called the earnest attention of the Boards of Guardians,
the authorities principally charged with the execution
of the Nuisances Act, to this subject. In our First
8 Lists of Places where Epidemic Diseases prevail.
Notification, bearing date October the 5th, 1848, we
represented to them that experience having shown that
preventive measures against cholera are also preventive
against typhus and other epidemic and endemic diseases,
it would be the duty of the Guardians to carry into
immediate effect all practical measures of external and
internal cleansing, especially in the ill-conditioned dis-
tricts; and by an Order dated November 9th, 1848, we
issued to the Parochial Boards of Scotland regulations
requiring the immediate performance of such cleansings,
and prescribing the mode in which they should be car-
ried out. See Regulations of the General Board of
Health, from I. to VIII.
The seats and subjects of cholera and the seats and
subjects of typhus being the same, we issued on the 3rd
of November, 1848, among other regulations, a Special
Order to the Boards of Guardians (see Regulations IX.,
X., and XI.) requiring them to desire their clerks to
make out from the register of deaths, or from the dis-
trict medical relief books, and from any public books
or other sources, from which information might be
obtained within the Union or parish, a list of places
where epidemic, endemic, and contagious diseases had
of late been frequent. We further requested the Guar-
dians to cause their medical officers forthwith to visit
and examine the localities contained in such list, and
to certify in writing all such places as they might find
in a state dangerous to health, or which needed frequent
and effectual cleansing, together with all such nuisances
and matters injurious to health as ought to be abated,
cleansed, and removed.
This appeared to be an essential preventive regulation,
experience having shown that unless express obligations
of the nature stated are enforced, extended and effectual
cleansings, or other Sanitary improvements in the
power of the local authorities to effect, are rarely
carried into operation. We believed that by the ob-
servance of this order the medical officers would be
guided at once to the worst-conditioned places, where
the inhabitants would be found to be in the greatest
danger. This expectation has been realized, for wher-
Organization for detecting Premonitory Stage. 9
ever this order has been obeyed, the local authorities
have been made cognizant of the most dangerous and
filthy localities in their respective districts, and the
medical officers have been directed where to search for
the diseases which usually precede an outbreak of cho-
lera, and for the premonitory stage of cholera itself.
We apprehend that this was an order founded upon
such an extent of experience that no private medical
practitioners, and no lay persons, would be justified in
neglecting it, even if it were a simple recommendation.
Yet upon the visits of the Inspectors to the places in
which cholera broke out—which we have shown com-
monly first came back to the same streets, and even to
the same houses, as on its former invasion—it was found
that these localities were still in the most filthy con-
dition, that in general no lists had been made out, and that
no inspections had taken place. In several conspicuous
instances the owners of the ill-conditioned houses, the
occupiers of which were the first victims of the disease,
were members of the Local Boards by which these
defaults were committed.
While directing the attention of the Guardians to the
most available means of prevention, we endeavoured to
prepare them for the measures which would be neces-
sary if they should unhappily experience a visitation of
the disease. Of these, we regarded the organization
of the means for detecting the existence of the disease
in its premonitory stage as among the most important.
This stage being in general of short duration, in some
instances not exceeding a few hours, and the symptoms
which denote its commencement being commonly so
slight as to appear trivial to those who are ignorant of
their signification—an impression favoured by the
general absence of pain—no dependence could be placed
on the information and prompt action of the indivi-
duals most in danger. It was necessary that the disease
should be sought out in the localities in which it might
be present and actively developing itself, though even
its existence might be unperceived and unsuspected. The
whole tenor of the evidence presented to us showed, that
if the medical practitioner waited until the individuals
ŽS
10 Euperience of Dumfries.
affected applied of their own accord for assistance, in
large numbers of instances, and especially before the ex-
tension and fatality of the disease had excited conside-
rable alarm, his services would not be called for until they
could be of no avail. Acting on this experience, we re-
presented to the local authorities in our First Notification,
that in case of an outbreak of cholera it would be in-
cumbent on them immediately to provide a sufficient
medical staff to enable a daily house-to-house examina-
tion to be made of the infected locality.
But former experience, particularly at Edinburgh,
where the expedient was first tried during the epidemic
of 1832, had shown, that in some of the worst localities
and in the most filthy and overcrowded houses in which
cholera was actually prevailing, the removal of the
inhabitants from their wretched abodes was absolutely
necessary ; the probability being, that if allowed to
remain there they would become the next victims.
The opening of Houses of Refuge for the temporary
reception of such persons, appeared therefore to be a
highly important auxiliary measure of prevention.
The agency for carrying out an efficient system of
house-to-house visitation, necessarily involved some ex-
pense and trouble; but we came to the conclusion that
it would be our duty to enforce the adoption of this system
in any case in which it might seem to be required. The
first place in which we were called upon to issue an Order
to this effect was in the town of Dumfries. Dumfries
had suffered more severely from this pestilence on its
invasion in 1832, perhaps, than any other town in Great
Britain, and knowing that little sanitary improvement
had been effected in the interval, and consequently that
the inhabitants must be in as great danger as before, we
called the attention of the authorities to the special re-
gulations of the Board. To our recommendations the
parochial Board paid no regard. The disease, mean-
time, went on committing its former ravages. Thus
within the first 29 days after its outbreak there occurred
269 deaths out of a population of 10,000. No efforts
being made on the part of the local authorities to check
this great mortality, it appeared to us that this was a
Euperience of Nordelf. | 1
case requiring a stringent enforcement of the regula-
tions of the Board, and we sent one of our medical
inspectors (Dr. Sutherland) to organize a plan of
house-to-house visitation, to open dispensaries for afford-
ing medical assistance by night as well as by day, and
to provide houses of refuge for the temporary reception
of persons living in filthy and overcrowded rooms
where the disease was prevailing, and who, though
not yet attacked, were likely to be the next victims.
The result of the adoption of these measures was, that
on the second day after they were brought into operation
the attacks fell from 27, 38, and 23 daily, to 11; on
the fifth day they diminished to eight; on the
ninth day no new case occurred, and in another
week the disease nearly disappeared.
That this remarkable and rapid cessation of the
disease was not the consequence of the natural exhaus-
tion and termination of the epidemic is proved by the
fact, that the premonitory diarrhoea did not diminish
proportionally with the diminution of cholera, but
that on the contrary, while cholera steadily decreased,
diarrhoea went on and even increased, thus showing
the continued action of the epidemic poison upon the
system ; while the true cause of the diminution of
cholera was, that the visitors detected it in its diarrhoeal
stage, and at once arrested its further progress.
A similar but still more rapid suppression of the
disease was effected at the small village of Nordelf, in
Norfolk, where, out of a population of 150 souls, there
occurred no less than 50 cases of cholera. When Mr.
Bowie, whom we requested to go to the assistance of
these poor people, arrived at the village, he found it in a
state of filth almost unexampled, the people in conster-
nation, the sick without nurses, and the single medical
attendant nearly exhausted with fatigue. Mr. Bowie
immediately arranged a plan for the daily visitation of
every house; obtained additional nurses and medical
aid, carried out extensive cleansings, caused the removal
of nuisances, and suggested improved means of venti-
lating the sick chambers. From the time that these
measures were brought into operation only four new
cases of cholera occurred; but here also the premonitory
12 House-to-House Visitation for Glasgow.
diarrhoea went on ; every case, however, being promptly
attended to was prevented from passing into the de-
veloped stage, and hence the rapid disappearance of
cholera.
The success which thus attend these measures when
applied to small populations within the control of a
moderate visiting staff, led to their adoption at Glasgow.
But here the difficulty was much greater. For the pur-
pose of ordinary medical relief, Glasgow City parish
being subdivided into 17 districts, and the Barony parish
into six districts, it was deemed expedient to base the
preventive measures on the existing system of medical
relief rather than to lose time in organizing another ma-
chinery. The entire population of the 17 districts of the
City parish is, in round numbers, 152,000, and of the six
districts of the Barony parish about 127,000. The task
was, to arrange an easy and effectual system of daily
house-to-house visitation over the whole of the affected
localities containing this large and, in the most suscep-
tible districts, shifting and migratory population. The
details of the plan will be found in Dr. Sutherland's
Report. (See Appendix.) It was briefly this:—
The existing districts being preserved, each district
surgeon, in addition to his ordinary duties, was required
to undertake the office of superintendent within his dis-
trict. There were thus in the two parishes 23 district
superintendents, and under each of these officers were
placed a few advanced medical students or qualified
practitioners to visit from house to house. These visi-
tors were provided with medicines to administer on
the spot to all persons suffering from premonitory
symptoms, a practice which had been found most
beneficial in Dumfries and Nordelf. Advantage, as
has just been stated, was taken of the circumstance that
Glasgow is a University city, to select qualified young
men from the more advanced medical students as
visitors. The entire working out of the system was
placed in the hands of a general superintendant for each
parish. General instructions, giving all needful details
of the plan, were printed and circulated among the
superintendants and visitors. For the City parish there
were 40 visitors, and for the Barony parish 28, in all
Practical Results of House-to-House Visitation. 13
68 visitors. Dispensaries were opened night and day
for all necessitous applicants, and a cholera hospital and
houses of refuge were provided. A system of sanitary
inspection was likewise introduced, into the large manu-
factories, by the aid of the Secretary of State for the
Home Department, through Mr. Stuart, the Inspector
of Factories in Scotland, with the view of detecting
and treating immediately all premonitory cases that
might occur among the work-people; and in one dis-
trict in the Barony parish a body of lay-visitors at
2s. 6d. per diem was employed with success.
Dr. Sutherland concludes his account of the arrange-
ments which were made for meeting this outbreak in
the following words:–
“I cannot conclude this part of the Report without ex-
pressing my high sense of the great ability and energy with
which the visitation system was carried out by the medi-
cal officers of the Parochial Boards; and I think it only an act
of justice at the same time to express my conviction, that
whether we consider the extent of the machinery employed
during the late fearful epidemic, or the zeal with which it was
sustained by the most active members of both Boards, or the
expense cheerfully incurred by them during a period of great
pecuniary difficulty in parochial affairs, no provision more
munificent was ever made for the relief of a great public cala-
mity, than that carried out by the humane and enlightened
citizens of Glasgow.”
At the time when these arrangements were completed,
the epidemic had attained its height. On carrying them
into operation, the first result obtained, was the discovery
of a number of corpses of persons who had died of
cholera without having received any medical aid what-
soever; the number discovered amounted to 50, but
there is reason to fear that such deaths were still more
frequent at an earlier period of the epidemic.
The second result was, the discovery of a great
number of cases of fully developed cholera, which
were going on wholly without medical assistance.
Some of the visitors found as many as 12 of these each
day for some days after the visitation commenced, and
the visitors concur in stating their belief, that in these
instances, neither the individuals nor their friends would
have applied for medical relief.
14 Proportion of Premonitory Cases.
The third result was the discovery of great numbers
of premonitory cases in various stages of progress, not
only without the application of any means to arrest
them, but without the slightest consciousness on the
part of the affected persons of the danger they were in.
The first return showed the existence of 273 cases of
diarrhoea to 68 of cholera; and of these diarrhoeal
cases, 35 had the peculiar rice-water appearance which
marks the close approach to the fully developed stage ;
but as the working of the visitation became more com-
plete, the proportion of the premonitory to the deve-
loped cases, daily increased. The tables of general
returns, reports Dr. Sutherland—
“Show, that throughout the entire districts under visitation,
the proportion of the premonitory to the developed cases,
amounted to nearly 600 per cent. ; in the City districts it was 504
per cent., and in the Barony districts 685 per cent. ; but when the
districts are taken individually, the proportions are still more
striking. They vary from under 200 per cent, to above 2,000
per cent., and in one instance, (Barony district, No. 1.) the
premonitory cases amounted to the enormous cypher of 2,379
per cent. of the cholera cases. During particular days in the
course of the epidemic a much larger proportion of diarrhoea
and other premonitory cases were discovered than during
others. This partly arose from the greater comparative
success of the visitation, and also partly from the course which
the disease happened to take at the particular period. The
per centage of premonitory cases on these occasions rose as
high as 2,000, 2,800, 3,700, and on one day in the Barony
parish, it was 3,850 per cent. of the cholera cases.
“The total number of premonitory cases treated during the
continuance of the house-to-house visitation, from December
31st, 1848, to February 26th, 1849 inclusive, was no less than
13,089, and if to this be added, the number of unreported cases
already alluded to, it is not improbable, that about 15,000
such cases were brought under treatment by the parochial
medical officers and visitors. During the height of the epi-
demic, indeed, all Glasgow appears to have been affected. The
number of cases treated by private practitioners also was very
large. One gentleman prescribed for about 1,100 such cases
in the denser parts of the city, and many cases of diarrhoea
occurring in the better parts of the town, were found to be
extremely obstinate in their character. It is to be feared, that
among the richer classes, not a few lives were lost by delay in
applying for medical aid.”
Prevented from passing into Developed Stage. 15
Dr. Sutherland adds—
“Tables compiled from the returns of Dr. Miller, and the
reports of Dr. A. M. Adams, and Dr. J. M. Adams give some in-
teresting and valuable particulars in regard to a large number
of these cases. They form as it were, a chart of the disease
throughout its entire stages, and exhibit at the same time, in a
very satisfactory manner, the results of the treatment pursued.
The total number of premonitory cases in these tables, amounts
to 1,445, and the total number of cholera cases to 392. Under
the former class, examples will be found of nearly every pro-
gressive stage of the disease, from simple diarrhoea without
complication to developed cholera, +the cases passing in their
progress through important changes by the addition of symp-
toms increasing in danger while the mortality is also found to
increase in a corresponding ratio. Thus in 1,113 cases of
simple diarrhoea, the deaths were 6, or 0.538 per cent. In
49 cases of bilious purging without vomiting or cramps, there
were no deaths, the number no doubt being too small to give
such a result. In bilious purging, with vomiting and cramps,
the cases were 43, and the deaths 3 or about 7 per cent. ;
of rice-water purging there were 280 cases, and 12 deaths, or
about 4 per cent. The addition of other symptoms in this
peculiar stage of the disease appears to be attended with a
great increase of danger. Out of 108 cases, in which the
serous character of the stools was accompanied by vomiting,
there were no fewer than 42 deaths or nearly 39 per cent., and
the addition of cramps to the other symptoms, which occurred
in 281 cases, raised the mortality to 149, or 53 per cent.
Perhaps no clearer proof could be given of the unity of the
disease and its progressive danger.
“The column in the schedules showing the cases that passed
from diarrhoea into cholera was not in use from the commence-
ment of the reporting, therefore the exact number cannot be
given, but an approximate result has been obtained, and
allowing every reasonable latitude for inaccuracies, it is cer-
tainly a remarkable fact, and conclusive as to the value of the
house-to-house visitation, that out of 13,089 premonitory cases,
reported as having been placed under treatment, only 80 are
stated to have passed into cholera.”
In one district of Glasgow, out of 596 cases of pre-
monitory diarrhoea which came under treatment, 183
were so far advanced as to have rice-water purging, yet
of this whole number only two passed into cholera;
or l in 298.
Another result of the visitation was to induce great
numbers of individuals to apply to the dispensaries that
16 Rapid reduction of the fatality of the Epidemic.
were opened in the several districts for the relief of
bowel complaints; 6,119 applications are recorded, but
there is reason to believe that this number is much
below the truth.
Another most important result was, that the numbers
in the column for developed cases progressively dimi-
nished, while those in the column for premonitory
cases continued steadily to go on, and sometimes even
increased. This was exemplified, perhaps, in a more
striking manner in the smaller towns in Scotland; but
it was not the less real in the large population of
Glasgow. At Coatbridge, for example, containing a
population of 4,000 souls, 3,314 were found affected
with premonitory diarrhoea, 665 of which had advanced
so near the developed stage as to be affected with rice-
water purging, vomiting, and cramps, while the total
number of cholera cases amounted only to 164; so that
the whole population of this place, with the exception
of 686 persons, exhibited unequivocal symptoms of
being under the influence of the epidemic, and the
numbers discovered in the premonitory stage were
upwards of 20 times greater than those that ultimately
passed into the developed stage ; so few having passed
into this stage, because prompt treatment arrested the
progress of the malady, and succeeded in stopping by
far the greater part even of the 665 cases that were
already so far advanced as to have rice-water purging,
vomiting, and cramps. A similar result was obtained
at Carnbroe, a village near Coatbridge, consisting of a
population of 1,200 souls, where the entire village, with
the exception of 100 persons, was affected; where, out
of 60 cases of diarrhoea discovered by the first visita-
tion, 55 were found to have rice-water stools, and
where, out of this Small population, 71 persons died
within the first fortnight. In Dumfries, the visitors on
the first days of their inspection were overwhelmed
with cholera cases; next they discovered the cholera
cases early, and treated them promptly; then instead
of cholera they found rice-water diarrhoea, and in a
few days the cholera cases, as has been stated, fell
from 38 to none; while at the same time from 20 to
House-to-House Visitation in Barony Parish. 17
30 new choleric affections continued to occur. Dr.
Sutherland calls attention to the important fact, that
this change was found to take place in the districts
visited, while in those that were unvisited developed
cholera went on, and in large proportion. A similar
occurrence was observed in the district of Charlestown,
in the town of Paisley. Here a circumscribed popula-
tion was placed under the visitation system, when the
cholera cases amounted to 23 daily; in the course of
four days after the visitation was in operation the cases
dropped to three, and in a few days more the epidemic
disappeared, whilst it went on in other districts.
“Had it been possible,” says Dr. Sutherland, “to place the
whole population of Glasgow under preventive measures, as
was done in the affected districts at Dumfries and Paisley, as
speedy a change might have been observed in the statistics of
the epidemic. The regulations of the General Board of Health
were specially directed against the disease, as it occurred
among the necessitous classes, but cholera prevailed almost
universally over the whole city, and assumed a character more
purely epidemic and less local than it has done in any other
part of the country. It selected its victims from all classes,
the wealthiest as well as the poorest, and it carried off not a
few of the better portion of the working classes whose cases
were treated by their own medical advisers.
“As, therefore, the visitation could be extended only to a
comparatively small portion of the affected population, no rapid
transference from the cholera to the premonitory column of the
schedule could be expected. Persons in the receipt of wages,
and mot requiring casual aid, could not, with justice, be made
chargeable on the parochial authorities any more than the richer
portion of the population, although it was generally understood
that the line of demarkation should not be rigidly drawn,
always bearing in view the fact that the object was to save life.
“In those districts, however, where the population was most
under control, as in Barony District, No. 1 (Parkhead), the re-
sult of the preventive measures was most striking. The enor-
mous amount already adverted to of premonitory cases disco-
vered and treated in this district, proves the efficacy of the
inspection under which it was placed, and the result on the
cholera was the complete breaking up of the disease, leaving
entire days during which all the cases appeared in the premoni-
tory schedule only, to which it was indeed confined with only a
few exceptions during the whole month of February.
“Upon the whole, then, though from the mature of the case
C
18 Testimonies as to Jºfficacy of Visitation System.
the exact amount of good effected by the preventive methods
adopted in Glasgow cannot be ascertained, no mind open to the
reception of evidence can doubt that much suffering was pre-
vented, and a large amount of human life preserved.”
Examples are given in the Appendix, of the testimony
borne by the medical superintendents of the several dis-
tricts, from their own personal observation, as to the
efficacy of this system ; but it may suffice to quote here
the statement of Dr. Dempster, the general superintend-
ent of the Barony parish. Having served in India for a
period of 23 years, where the troops under his charge fre-
quently suffered from visitations of cholera, Dr. Demp-
ster had had ample opportunities of becoming acquainted
with the disease. He states, that the military authori-
ties in India were so well aware of the general preva-
lence of premonitory diarrhoea, and of the great import-
ance of early attention to this symptom, that besides
other stringent measures adopted by them to detect its
very first appearance, it was their custom to place Sen-
tries over the privies, whose duty it was immediately to
report any individual seen to visit them oſtener than
once during the day.
“The result of this practice,” says Dr. Dempster, “was most
satisfactory; and that the measures above stated are absolutely
necessary I feel perfectly convinced from having had so fre-
quently to lament the infatuated carelessness of soldiers, and
the lower orders in civil life, on several occasions for days
together neglecting the premonitory diarrhoea, and not applying
for medical aid until the urgent symptoms of cholera had made
their appearance, and then only at a period of the disease when
treatment proved of little avail.
“My experience of cholera as it occurred in the Barony
parish during the late epidemic has only tended to confirm my
belief already expressed that to be of service in cholera medical
aid must be directed against the premonitory stage, and I feel
convinced that the only mode of obtaining this favourable end
is by the system of house-to-house visitation as lately intro-
duced in Glasgow. By its means numberless cases of diarrhoea
which would otherwise have been totally neglected, were de-
tected, and by suitable treatment promptly arrested; and in
the district where the system of medical or lay visitation was
most energetically carried out, and the sanitary measures
strictly enforced, the good effects were at once manifested in
the daily reports by a great increase of diarrhoea cases with a
General. Result of Eagerience in Scotland. 19
proportionate decrease of those of cholera, whilst, at the same
time, the proportion of deaths in the latter underwent a con-
siderable diminution, evidently from the visitation system
having brought the cases sooner under treatment.”
While, however, the preventive measures when car-
ried out with intelligence and energy were attended
with such results, yet upon a review of the whole expe-
rience of the recent outbreak of cholera in Scotland, it
appears to us to be requisite to state, that in this part
of the kingdom, where the general sanitary condition is
lower than in England, and where, indeed, the condition
of the labouring population, particularly in the larger
towns, such as Edinburgh, Glasgow, and others, is among
the lowest in the empire, there was experienced peculiar
difficulty in the practical working of preventive mea-
sures; and there is no reasonable ground for the expec-
tation that those measures would, as a system, have been
spontaneously adopted in a single town. But we are
not at present prepared to enter into a particular state-
ment of the difficulties and obstructions experienced.
The success which attended the preventive measures
which have been described as carried out in Glasgow
and other towns in Scotland during the winter of 1848
and 1849, led to the recommendation and adoption of
similar measures in England and Wales where cholera
has more recently broken out, and is still prevailing;
the result in general being that the impression made
upon the disease is prompt and decisive, in proportion
to the intelligence, energy, and perseverance with which
these measures are carried into effect.
The general result of the adoption of the practical
rules which, after the most careful collection of facts,
and the widest experience that the time and circum-
stances permitted, we deemed it our duty to enforce
for the attainment of the objects of the Legislature,
may be thus summed up :-
With reference to the lists directed to be made of
the places where cases of ſever have been of frequent
occurrence,—these lists wherever made out, have guided
the Guardians and their medical officers, both to the
worst places in their respective districts, and to the dwell-
ings of the most susceptible subjects, where the danger
was the most imminent, and where the application of
* C 2
20 Summary of Results.
the whole system of preventive measures was the most
urgently needed.
With reference to the houses of refuge, -the returns
hitherto received have not been sufficiently complete
to enable a general summary to be given of the num-
bers that have been admitted into these asylums, and
of the proportion of the individuals residing in them
that have been attacked with cholera; but the fol-
lowing is the experience of Glasgow. There were
admitted into the two houses of refuge opened in this
city, in all 806 persons, out of whom 25 were attacked
with cholera, but only seven died. It must be borne in
mind, that the whole of these individuals were taken
from the most filthy and overcrowded houses and
rooms, in which cholera was actually prevailing, and
that if they had been allowed to remain there, they
would probably have been the next victims. In the
houses of refuge they breathed a comparatively pure
atmosphere, and they were placed under proper regi-
men and strict medical inspection; in the mean time
their own houses and rooms, and as far as practicable,
the localities immediately adjoining, were thoroughly
cleansed and purified. No instances are recorded of
any of these persons being attacked with cholera on
their return to their own homes.
With reference to the house-to-house visitation, taken
in conjunction with the district dispensaries, which were
open day and night, it may be confidently affirmed that
by these arrangements the whole of the poor received
prompt medical relief; so that, after these arrange-
ments were completed, no individuals perished without
medical assistance. Under the system of house-to-house
visitation the disease was discovered at its very com-
mencement, and the working of this system tends to
establish among others the following facts:—
1. That, as far as the experiment has been made, the
proportion of the diarrhoeal to the developed cases
ranged from 600 per cent. to 4000 per cent, this differ-
ence arising not so much from any real difference in
the prevalence of diarrhoea, as from the greater or less
completeness and activity of the visitation, by which
the existence of diarrhoea was discovered.
of Practical Measures adopted. 21
2. That, under this system the proportion of diar-
rhoeal cases which passed into cholera, ranged from 1 in
160 to 1 in 260, and in one instance it was only I in 298.
3. That, under this system the mortality of the diar-
rhoeal cases did not in general exceed 1 in 185, while
in one instance, not a single death occurred out of 1,380
C81.SGS.
4. That, on the other hand, where diarrhoea was so
far neglected, that it was not brought under treatment
until the evacuations had become serous, and were
accompanied with vomiting and cramps, 53 persons
died out of every 100.
The foregoing facts afford data for estimating the
amount of the saving of life that has been effected
by measures which discovered diarrhoea, and which
promptly arrested it, and prevented it from passing on
to more advanced stages.
Without doubt, some of these diarrhoeal cases, how-
ever neglected, would have been checked by the resist-
ing power of the constitution, and would not have passed
into cholera; but experience has taught us that if
neglected, great numbers of them do pass into cholera,
while, if promptly treated, they are with few exceptions
arrested at once. The evidence of this is so decisive,
that the gravest responsibility rests on the local autho-
rities of any district in which cholera breaks out, who
do not make immediate arrangements for putting into
operation the house-to-house visitation.
But, however encouraging the evidence obtained, and
of which we have now given examples, of the efficiency
of dealing with this disease in its premonitory stages,
still we have, as on a due consideration of the subject
might have been expected, received evidence that con-
tinued exposure to the predisposing and localizing
causes in a high degree of intensity, will in numerous
instances frustrate any remedial measures. Overcrowd-
ing, or continued residence amidst damp, and in an
atmosphere loaded with impurities will occasionally
counteract all means of prevention. There are some
localities from which, as the only security, it is neces-
sary to remove the people.
22 State of Preparation of Local Authorities
We represented, in our First Notification, that on
account of the intimate connection between the external
skin and the internal lining membrane of the bowels,
the chief scat of this disorder, the use of warm cloth-
ing, and the avoidance of cold and wet were of much
importance during the prevalence of the epidemic, pre-
cautions which are as necessary in summer as in winter,
it being, indeed, particularly important to guard against
the comparative coldness and the occasional dampness
of the summer evenings and nights. Our recommen-
dations with respect to diet, founded on the peculiarly
irritable state of the mucous membrane of the bowels,
so general during the epidemic influence, though at
first somewhat questioned by authorities whose opinion
is entitled to respect, were yet in accordance with the
experience presented to us of all countries where this
pestilence has extensively prevailed.
Our views on these particulars, as well as on the
mode of propagation of the disease, have, with some
exceptions, been concurred in, both at home and
abroad; and we have the satisfaction of knowing, that
practical measures of prevention, based upon them,
where they have becn energetically carried out, both
in this and in other countries, have produced a manifest
effect in checking the progress of the pestilence.
When we first proceeded to put in force the powers
of the Nuisances Removal and Diseases Prevention Act,
we found the parochial bodies, the authorities charged
with the local execution of the law, generally unpre-
pared for the exercise of their duties, in some cases
entirely ignorant of them, and in others from the dread
of expense, very reluctant to perform them.
In the first place in which we were called upon
directly to interſere, at Dumfries, the parochial Board
allowed a period of 20 days to elapse with a steadily
progressive and alarming increase of the disease, with-
out adopting a single efficient measure of precaution.
On the first outbreak of the epidemic, indeed, a system
of medical relief, apparently well adapted for meeting it,
was agreed to ; but this was broken up on the following
day, by order of the parochial Board, on the alleged
for carrying the Law into evecution. 23
ground of expense. Though the attention of the local
authorities had been specially called to our regulations,
they had, up to this period, taken no steps with refer-
ence to operations of cleansing, to providing a house of
refuge, or to organizing a proper system of medical
relief. “I arrived in Dumfries,” reports Dr. Suther-
land, “on the 6th December; up to that time, I be-
“lieve, that no fewer than 147 persons had already
“been buried, after having been struck down by the
“ epidemic, and that without an effort to save them,
“although the power had been placed in the hands of
“ the parochial Board for the express purpose of being
“exercised. Precious time was wasted in mere petty
“squabbles; the town has been clothed in mourning
“in consequence. Not a moment was lost by me. I
“collected a staff as quickly as possible, arranged the
“ districts, and put everything in motion; but this
“ process required further time, equally precious with
“that which had been irretrievably lost; and it
“appears from our returns, that it was not till the
“ 13th of December that any material effect was pro-
“duced, and by that day 250 people had been con-
“signed to the grave.”
The local powers for the execution of the law were
found to be extremely defective ; the authorities for
executing them, commonly not less so ; with divided
responsibility frequently conflicting, and wanting in the
unity requisite to carry out prompt remedial measures,
even when tolerable information existed with reference
to them.
The separation of local administrative bodies in re-
spect to the execution and control of works; the separa-
tion of the works for the water supply from the works
for sewerage; the separation of the works for sewerage
from those for house drainage, and of the whole from
those for surface cleansing ; the separation of the surface
cleansing from the cleansing of sewers and drains, and
even, as is sometimes the case, the separation of the
cleansing of the main streets from that of courts and
alleys; the separation of these and other services, for
the consolidation and combination of which the Legis-
24 Obstructions and Delays arising from the
lature has provided in the Public Health Act, have
seriously impeded the execution of the Diseases Pre-
vention Act.
The Legislature contemplates the Poor-Law Union
in England and Wales with its medical officers, its
Union house with its new ſever wards, and its provision
for medical relief, as the chief local administrative body
by which preventive measures could be best carried
out; and, in general, it is the most eligible for the pur-
pose. But, in towns, there are also Commissioners of
Pavements under Local Acts, who are charged with the
duty of surface-cleansing as well as paving, who act in-
dependently, and who were frequently found to be unwil-
ling to receive directions from the Boards of Guardians
or the medical officers appointed by them. The Muni-
cipal Town Councils, have in some instances, the con-
trol over the road-ways, and they have also under their
direction a body of police, whose services are of great
importance, in the execution of orders, especially where
it is requisite immediately to carry out combined regu-
lations. Even where there is a fair and liberal desire to
co-operate, on the part of these separate authorities, there
has been a serious loss of time in the service of notices,
and in framing expositions of the grounds of requests
from one to the other. Added to these impediments,
the separation affords the means of shifting responsi-
bility from the one to the other.
Adopting a large remedial interpretation of the terms
of the Act, “for taking measures of precaution with
“ promptitude according to the exigency of the case,”
we had contemplated the issuing of regulations for car-
rying these provisions into effect, as we believe, the
Legislature would have done, had there been laid before
it the special circumstances of the case, by forming
Special Boards of Health, composed of members of the
Town Councils, of the Boards of Guardians, and of the
Paving Boards, who might give united directions to their
officers. The law officers, however, were of opinion, that
the general terms of the statute could not be so con-
strued as to authorise a combination of the local autho-
rities, with a view to bring their united powers to bear in
âmperfection, and separation of Local Powers. 25
the manner we proposed. The regulations were therefore
carried out, chiefly by the separate powers of the Boards
of Guardians, with the voluntary co-operation of the
municipal or other authorities; but, at the best, with
the inconveniences of delay from the separate action.
Had it been possible to combine the various author-
ities, as at first contemplated, a far greater unity and
efficiency would have been ensured both in England
and Scotland.
In the metropolis, the multiplicity of the Paving
Boards, some parochial and others not, charged with the
duty of surface cleansing, and the removal of refuse,
has also been productive of considerable inconvenience,
since it has prevented answers being given or direc-
tions issued, until these Acts could be sought out
and the powers and duties provided under them
ascertained.
The following reply from the General Board of Health
to an inquiry from the Rev. W. Dodsworth, the incum-
bent of Christ Church, Regent's-park, as to “what he
“should do in order to effect the cleansing and draining
“ of his parish,” in other words, what was the local law
under which the parishioners were living, is illustrative
of a very common obstacle to prompt, efficient, and
economical local administration.
“The General Board take the opportunity to state, that they
have received applications similar to your own from house-
holders, inquiring what steps they may take to obtain the re-
moval of refuse, or to enforce proper cleansing, and what is the
actual law and the state of its administration for sanitary pur-
poses within their respective parishes, and what they, as hº
holders, may do for its enforcement or aid. The General Board
have been prevented giving early replies, as well as eventually
satisfactory ones, by the excessive variety of the provisions of
the numerous local Acts by which the objects have been sought
to be attained.
“The work of surface cleansing is, in many cases, performed
by bodies of various descriptions, under the authority of local
Acts. The jurisdiction of the authorities constituted under
these Acts are as various as their powers. It is one of the
topics of the local inquiries, directed by the Legislature to be
instituted under the Public Health Act, to ascertain upon the
spot what the local Acts are, what are the bodies constituted
26 Evemplified in St. Pancras and City of London.
under them, and how the powers so conferred are executed.
Unless the General Board itself is informed upon these points,
it is unable either to apply its own orders with the particularity
which is requisite, or to give such information as that which is
now sought.
“The number, condition, and action of the bodies constituted
by the local Acts is one object of investigation by the Metro-
politan Sanitary Commissioners, and they have been hitherto
unable to complete that inquiry.
“There appear to be upwards of 120 local Acts for the more
dense portions of the Metropolis, for the management of up-
wards of 80 distinct local jurisdictions, many of which coincide
neither with parish, nor Union, nor police district, nor any
other recognized division. When a householder, who gives his
address in a particular street, applies to know how he may pro-
ceed—if the local Act be sought out, and the provision in rela-
tion to the matter in question be also sought out—he cannot
always be safely answered, inasmuch as streets are frequently
divided, sometimes longitudinally, and paved and cleansed at
different times, under different jurisdictions. At present no
public maps are known to exist by which the area of the juris-
diction could in any such cases be ascertained correctly.
“In the parish of St. Pancras, where you reside, there are no
less than 16 separate Paving Boards, acting under 29 Acts of
Parliament, which would require to be consulted before an
opinion could be safely pronounced as to what it might be prac-
ticable to do for the effectual cleansing of the parish as a whole.
“The General Board of Health can only state in answer to
such applications, that the information sought can be obtained
by no other means than local inquiry; and they hope that this
will be done on behalf of householders, by the Parochial Board
actin ; under the general directions of the Board of Health now
ISSUlCCI.
The following extract from a letter by Mr. Payne, the
coroner of the City of London, displays the general
consequences of these defects; and the inconveniences
and evils here represented will, we hope, be diminished
by the consolidations provided for by the Public Health
A ct—
“The first child was attacked 10 days ago, and died last
Sunday; the second was attacked on Tucsólay morning last, and
died in the afternoon; and the third since then ; and two more
were very ill from the same cause.
“The father of two of the children had not complained to
anybody except his landlord, because he said he did not know
the state of the law. The medical officer reported it to the
Local Ignorance of local Law. 27
clerk of the Board of Guardians on Saturday last; and Mr.
Simon, the Officer of Health, said that no report had been
made to the Guardians till Thursday morning last, which he
thought a great neglect in the clerk to the Board.
“I found that the police constable, whose attention was drawn
to the nuisance on Tuesday, reported it to his sergeant, the
sergeant to the inspector, the inspector to the Commissioner
of Police, and the latter to the Commissioners of Sewers.
“All this roundabout mode of doing business I deprecated as
injudicious, and suggested that it would be desirable if the
inmates of the courts and alleys were informed that they might
complain directly to the Inspector of Nuisances for the district,
whose duty it would be in such case to see to it immediately.
“There is every reason to believe that some of these lives
would have been saved if the matter had been properly made
known in the first instance.”
Theoretically, it is supposed, that all the inhabitants
are best acquainted with the state of their local law,
and take an interest and part in its administration.
Practically, their knowledge of it, in busy towns, is
generally found to be such as that displayed in the
above extracts ; and resistance to local consolidation
and simplification arises from the active canvassings of
office-bearers, and persons pecuniarily interested in the
administration, rather than from any spontaneous desire
on the part of the great body of the population. The
advantages, for the sake of efficiency and despatch, of
uniform local procedure and administrative arrange-
ments, have been pointed out before, but they are
strongly re-enforced by the disastrous delays recently
experienced.
The law gives to this Board no power to originate
prosecutions for neglect or violation of its orders and
regulations, and therefore we have no direct control
over Guardians, whatever course they may adopt with
reference to the orders of the Board, in consequence of
which those orders have been, to a considerable extent,
deprived of the authority which it was the intention of
the Legislature to give to them, and which they must
possess to accomplish that object fully.
The Guardians indeed incur a serious responsibility
if any fatal consequence should be proved, by the ver-
28 Case of the Whitechapel Guardians.
dict of a coroner's inquest, to result from their un-
lawful omission of the orders of the General Board of
Health ; but however important and necessary the
investigation may sometimes be, to be able to fix re-
sponsibility only by the indirect and uncertain result of
a coroner's inquest, appears to be a fundamental defect.
Exemplifications of the impunity with which some
Boards of Guardians consider they may disregard
orders made under the authority of the Legislature,
with the view of carrying out its provisions, have been
afforded by the course adopted by the Guardians of the
Whitechapel Union, by some of the Boards of Guar-
dians connected with the Tooting children, and, more
recently, by the select vestry of the borough of
Liverpool.
At a time when deaths had already occurred from
cholera, under extremely painful circumstances, and
when there was reason to apprehend a serious outbreak
of the disease, the Guardians of the Whitechapel Union
ontered on their Minutes the following resolution –
“That it is the opinion of the Guardians that, at present,
the order of the Board of Health, of the 18th of November
last, need not be acted on in this Union.”
It appears that this deliberate act of disregard to the
orders of the Board of Health was resolved upon on
the same evening when the medical officers of the
Union presented to the Guardians a written statement
to the effect that malignant cholera had broken out in
some parts of the district.
Here is an instance of a Board, composed for the
most part of persons engaged in the daily routine of
trade, not having in general, it must be presumed, the
means of judging from any large observation or expe-
rience of the matter on which they decide, deliberately
acting on a medical question against the opinion of
their own medical officers, and in direct opposition to
regulations framed on the largest experience, not only
of this country, but of the whole of Europe—regu-
lations so framed for the purpose of carrying out the
express provisions of the Legislature.
Case of the Whitechapel Guardians. 29
It further appears, that on the 21st of November
the Clerk of this Union having in conformity with
the order of the Board of Health, laid before the
Guardians returns from the four medical officers, and
from some of the registrars of births and deaths, of
those places in the Union where epidemic, endemic,
and contagious diseases have of late been prevalent,
the Guardians came to the following resolution :-
“That the Clerk forward such particulars to the various
Local Boards in the Union, but that the medical officers be not
called upon to visit the places in question.”
It must be borne in mind that this resolution was
adopted by the Guardians at a time when cholera was
not only actually prevailing in the district, but was
spreading there under circumstances of so painful a
nature,as to attract the attention of one of the coroners
of Middlesex, Mr. Baker, who, on the 24th of Novem-
ber, addressed a letter of expostulation to them on the
neglect of the measures which the circumstances of
the time obviously required.
On the 14th of December the coroner again ad-
dressed a letter to the Clerk of the Union, in which he
says:—
“My attention as coroner has this day been called to several
cases of sudden death in the parish of St. Mary, Whitechapel,
of a most awful and appalling character, and I cannot but feel
that a very heavy responsibility rests not only upon my own
shoulders, but upon those also of the Board of Guardians of
the Whitechapel Union, in reference to these and all such
cases, it appearing that there have been no less than 16 under
the care of the medical officer lately.
“I have this day been engaged in an inquiry into some of
the deaths, more particularly alluded to in that letter, in
Hairbrain-court, Rosemary-lane, and have myself viewed this
evening the dead bodies of no fewer than three persons, but
have been witness also to the most agonizing and appalling
situation of others in a dying state in the same locality (within
a few yards of the former), who were found by me to be in a
state of distress and misery, which could not but be most
afflicting to my mind, being surrounded by the most foetid and
unwholesome vapours from privics and bad drainage, and
filthiness, and much overcrowded; and allow me to say, in such
30 Guardians connected with Tooting Children.
a state as I could scarcely have deemed it possible to have
existed, after the publication of the documents to which I have
above alluded.”
We believe that the lives of several of the persons
who thus perished might have been saved if the
Guardians had carried into immediate effect the Orders
and regulations under the Act, and after a protracted
investigation of the circumstances connected with the
death of several of those persons, the coroner's inquest
brought in a verdict against the Guardians of “Very
“great neglect.”
When we first received information of the outbreak
of cholera in the establishment at Tooting for pauper
children, containing at that time 1,395 children, we
represented to the Guardians the necessity of the im-
mediate removal of every child not actually sick, and
explained to them that universal experience has shown
that for the suppression of this pestilence, especially
where there is overcrowding, dispersion is the first and
Cssential measure, without which all others are com-
paratively useless. We further stated to them that the
urgency of the occasion demanded prompt action on
their part, as each hour's delay was adding to the num-
ber of children who were dying. Knowing the already
overcrowded state of most of the metropolitan work-
houses, their deficient ventilation, and their general
bad sanitary condition, we pointed out the danger of
removing any considerable number of the children to
these establishments; we advised that separate houses
or rooms should be engaged for their temporary re-
ception, and we cautioned the Guardians against con-
gregating them anywhere in great numbers. Our
representations were, for the most part, disregarded.
Two of the Boards of Guardians persisted in refusing
to remove the children from this poisoned atmosphere;
the daily deaths, which ranged for several days toge-
ther from 14 to 20, produced upon them no practical im-
pression; invaluable time was lost, and when at length
the great mortality (no less than 180 perished) induced
them to follow the counsel they had so long neglected,
it was too late; the poison had embued the system of
Select Vestry of Liverpool. 3]
the children, and on their removal to the Several work-
houses (for a large number of them were removed to
workhouses, notwithstanding our recommendation that
they should not be so), considerably more than 300
became affected either with the choleric diarrhoea, or
with cholera itself.
Here was a case where Guardians in a state of igno-
rance as to the course which the occasion required,
reſused to be guided by the larger experience which
they had no means of acquiring of themselves; and who
occasioned by their mismanagement and delay a great
loss of life.
Yet more recently the Guardians of the parish of
Liverpool appear to have pursued the following course.
The affairs connected with the relieſ of the poor in the
parish of Liverpool, are under the control of a Select
Vestry, who here exercise the duties ordinarily per-
formed by Guardians. The Select Vestry has nominated
out of its own members, “A Medical Relief Com-
mittee,” to which the direction of what concerns the
medical relief is committed; and in order to facilitate
the carrying into operation the Act for the Removal of
Nuisances and Prevention of Contagious Diseases, a
“Joint Committee’ has been constituted, consisting of
a certain number of members selected from the Health
Committee of the Town Council, from the Medical
Relief Committee of the Select Vestry, and from the
West Derby Board of Guardians; the object of this
Joint Committee being to consider the measures neces-
sary to promote the health of the town, and to commu-
nicate the results to the other bodies.
Liverpool has the further advantage of having an
Officer of Health who so long since as August 9, 1848,
in anticipation of the probable re-appearance of cholera
in England, reported to the Health Committee of the
Town Council, that in the event of the return of
cholera, besides greater activity in the general measures
of cleansing, Scavengering, supply of water, &c., it would
be necessary to make an addition to the parochial me.
dical staff, and to that of the dispensaries, in order that
immediate assistance might be given in the early stage
32 Delay in adoption of Preventive Measures.
of the disease, and to provide hospitals in different
quarters of the town for the accommodation of the
destitute, whom it might be inexpedient to treat at
their own dwellings. A copy of this Report was sent
to the Select Vestry. -
The Joint Committee was appointed in the month of
October, J848. One of its earliest steps was to ascer-
tain what measures were proposed by the Select Vestry,
to afford medical attendance and medicines in the event
of the re-appearance of cholera in Liverpool. In reply
to inquiries made on this subject, the Chairman
reported at a meeting held on December 12, 1848, that
the Select Vestry had made preparations for appointing
additional medical officers over and above the perma-
ment staff of 13 employed by the Select Vestry; for
providing dispensaries in every district of the parish,
with hospitals attached to the same ; and for opening of
houses of refuge. The impression produced by this
statement on the mind of the Officer of Health was, that
all the measures requisite to meet an outbreak of
cholera were in such a state of forwardness that they
could be completed in a few days whenever the neces-
sity arose; and he says that this being his conviction,
he took no farther steps at that time.
On the 9th February, 1849, the Select Vestry did
open a cholera hospital, and appointed two medical
officers to take charge of it; but they chose it in a situa-
tion so remote and inconvenient, that the Medical
Officer of Health thought it necessary on the 29th
of March, to make to the Health Committee the follow-
ing statement :—
“The Medical Officer of Health begs to represent, that in the
event of cholera becoming epidemic in Liverpool, the present
cholera hospital in Queen Anne Street, will be found to be
placed at an inconvenient distance from the localities where the
disease is likely chiefly to prevail,
“On Sunday last, a woman who was removed from Henry
Edward Street, in the state of collapse was found to be dead on
her arrival at the hospital.”
A copy of this Report was forwarded to the Medical
Relief Committee.
Progress of Cholera. 33
On the 5th April, cholera still advancing, and no
change having been made in the situation of the
hospital, nor any steps, as far as could be ascertained,
having been taken to provide a house of refuge, the
Joint Committee again requested the Select Vestry to
inform them what provision had been made for treating
cholera cases among the poor.
On the 30th of April, cholera still advancing, and no-
thing having as yet been done, the Medical Officer of
Health again addressed a letter to the Chairman of the
Medical Relief Committee, stating his belief that lives
had been lost in consequence of the non-removal of the
hospital, and that the opening of a house of refuge was
urgently required. To this representation the Officer
of Health received a reply from the Chairman, stating,
that his letter was read to the Committee and entered on
their Minutes, but that it did not appear to change their
plans materially. “For myselſ,” he adds, “I may say
“that I would gladly have been guided by your advice.”
By this time the increase of cholera being very
alarming, and ſinding that none of the measures recom-
mended by him were adopted, the Medical Officer of
Health next, that is, on the 30th of May, addressed the
Joint Committee, calling their attention to the fact of
the rapid increase of cholera, and stating that the great
majority of the cases still continued to occur in a dis-
trict remote from the hospital; that immediate steps
should be taken to provide hospital accommodation in
the locality where the disease prevails; that instances
having occurred, in which several persons had been
attacked in succession in the same house, a house of
refuge ought to be opened without delay, in order that
where deemed advisable, the healthy inmates of houses
in which cholera appears may be removed for a few
days, until the infected dwellings have been thoroughly
cleanscd and purified; and that as attacks of cholera
generally take place in the night, stations should be
appointed in the affected districts, where a medical
practitioner being in attendance during the night might
be ready to give immediate aid when called upon by
the poorer inhabitants.
D
34 Want of Information on the part
On the following day (June the Ist) the Joint Com-
mittee, in consequence of this communication, passed
resolutions, recommending the Select Vestry to adopt
forthwith the several measures here recommended.
But instead of adopting these measures the Select
Vestry merely called upon the regular medical officers
of the parish, to give their attention to their patients
by night as well as by day; and appointed two addi-
tional medical officers ſor one week, to make a house-
to-house visitation in two streets.
The Joint Committee not satisfied with these pro-
ceedings of the Medical Relief Committee, on the 7th
of June again call the attention of the Select Vestry to
their recommendations, and request to be informed what
arrangements had been made for carrying them out.
During these discussions and delays, cholera had in-
creased from 16 in the week ending the 19th of May,
to 27 on the following week; 67 on the next week;
145 on the week following, and 187 on the week end-
ing the 16th of June.
Though we were not at that time cognizant of the
proceedings of the Select Vestry above described, yet,
observing the progressive increase of cholera in this
populous city, not perceiving any preparations for car-
rying the regulations under the Act into effect, and
being constantly told in the Reports forwarded to us,
that with cholera daily extending, there was no appear-
ance of premonitory diarrhoea, an event which, iſ true,
would have been an exception to the experience of
every other place, both in this country and in Europe;
we directed one of our Medical Inspectors (Mr. Grain-
ger) to obtain authentic information on all the circum-
stances connected with this dangerous outbreak.
From Mr. Grainger's report, it appears, that no lists
such as are required by the regulations of the General
Board of Health had been made out; that no adequate
medical relieſ had been provided; that no systematic
plan for detecting and treating premonitory diarrhoea
had been adopted ; that no stations or depôts had
been opened, for affording assistance to the poorer
classes in the night, and that no houses of reſuge,
of the Local Authorities. 35
and no sufficient hospital accommodation had been
afforded.
Up to this time the Select Vestry, as well as all the
authorities of Liverpool, were ignorant of the existence
in any part of the town of any unusual prevalence of
bowel complaint, and positively denied the fact, though,
for a fortnight previously, at least, these disorders had
increased to such an extent in the affected districts, that
the inhabitants were in a state of alarm, and one of the
witnesses examined said, that for the eight or ten days
previously he had had many applications for medicine
for bowel complaints, amounting to as many as 20 in a
day; while another stated, that in consequence of the
great increase of these attacks, he had been detained for
Some nights preceding till half-past 11 or 12 o'clock at
night, though his usual custom was to leave his shop
for his residence at half-past nine.
From this and other evidence which we received, we
issued on the 18th of June a Special Order requiring the
Select Vestry to adopt the several measures which our
Inspector represented to be necessary, and in the neces-
sity of which the Officer of Health for Liverpool co-
incided ; the first of which regulations was, that the
Board of Guardians forthwith appoint 12 extra medical
officers, who should make house-to-house visitations
once each day at the least, &c. On the reception of this
Order, the Select Vestry thought proper to decide that
no extra medical officers should be appointed, as re-
quired by our Order, and separated without making any
preparation for carrying into effect the other regula-
tions contained in the Order.
The body which thus deliberately violated the law,
had neglected the discharge of their duties for at least
a period of two months, in spite of repeated warnings
by the Officer of Health of their own borough, and the
earnest remonstrances of a Committee consisting partly
of their own members, and that at a time when between
30 and 40 fresh attacks of cholera were occurring in
their city daily ; a neglect of duty which is described
as inflicting much suffering and sacrifice of life.
We submit that the protection of the poor and helpless
from preventible sickness, suffering, and premature dis-
D 2
36 Regulations required for Ships as well as Houses.
ablement, and death, is a duty of the highest impor-
tance, and that negligence or omission in relation to it is
a grave offence. The examples we have now recited
show that if measures for the prevention of these evils
are placed on the footing of mere recommendations no
attention will be paid to them. Such evils can be
abated only by the exercise of powers adequate to en-
force the measures which are required for their sup-
pression. When it is intended that the operations of a
law shall be efficient, the power of prosecuting for dis-
obedience, as well as of laying down executive regu-
lations are placed not in Separate but the same hands;
and the experience of the working of this Act shows
that its provisions cannot be carried out, and conse-
quently that the intentions of the Legislature cannot be
realized, unless a power be given to the General Board
of Health, similar to that given to other Boards, such as
the Lunacy Commission, to originate prosecutions for
the neglect or violation of its regulations.
The powers conferred for the prevention of epidemic
diseases must, to accomplish their object, necessarily be
summary; but if the orders made by one department can
be enforced only by application to another department,
delay must be incurred where promptitude is essential.
On these grounds, and under the conviction that the
object of the Legislature cannot be otherwise attained,
we submit that this Board should be entrusted with the
power of prosecuting for the neglect of its regulations.
We have shown, in our Report on Quarantine, the
extent to which cholera and other epidemic diseases
prevail on board of merchant ships, and especially
those of the Smaller description, so much beyond what
we were previously prepared to expect; the danger to
the crew and passengers from the foul condition of these
vessels, and particularly from the dirty and unventilated
state of the forecastle and other parts in which the
common seamen are lodged ; and the necessity, for the
protection of the public health, that these floating
dwellings should be placed under the same regulation
as the filthy cellars on shore with which the Legislature
has endeavoured to deal. We have deemed it our duty
Private Nuisances. 37
to apply this principle, as far as was practicable, to the
case of emigrant and other ships in which cholera has
actually broken out, and in the instances in which we have
had an opportunity of doing so, with beneficial results.
But the Act does not distinctly give the same juris-
diction over shipping that it does over dwelling houses,
and the localities in which they are placed, nor does it
make the like provision for abating nuisances in ships,
and for preventing the origin and checking the spread
of diseases therein.
We submit that the tables of the mortality of sea-
men which we have adduced, and the melancholy loss
of life among passengers which we have shown
regularly goes on, justify our former representation
that the principle on which the Legislature has decided
namely, that of attempting to check the prevalence
of disease by laying the foundation of sanitary im-
provement, should be consistently carried out, and
applied to the diseases of all classes of the population,
whether on land or at Sea. -
We have found great difficulty in procuring full
returns of cases of cholera, whether from public
bodies or private individuals. Such returns have
seldom been made, unless the ravages of the disease
have been severe, and then not until the disease has
made considerable progress. Even in Glasgow, where
from the first outbreak, an effort was made to procure
full and correct returns, they proved to be so im-
perfect, that Dr. Sutherland was under the necessity of
making a second visit to the city, for the purpose of
instituting a re-examination of the whole mortuary and
other registers. With few exceptions, the Boards of
Guardians and the medical officers have neglected this
part of their duty. But it is absolutely necessary for
the public information, and for the prompt application
of preventive measures, that such returns should be
made, and that the power should be given of enforcing
them. (See Second Notification, and Appendix to this
Report, for the opinion of the General Board of Health
on the remuneration due to medical officers for their
many and arduous services).
3S Unskilful Removal of Filth.
In few places in England, where the preventive
measures have been most energetically carried out, has
the disease hitherto prevailed as extensively as on its for-
mer visitation. Extreme difficulty, however, has been
experienced in the practical application of measures for
the removal of nuisances of the gravest character, and
in affording prompt relief in cases of the most urgent
necessity. The Act gives no power over any nuisances,
but those of a private nature, and is not intended to
deal with the larger evils that constitute public
nuisances. The operations of cleansing are limited to
those of Surface cleansing, and even these, in numerous
instances, can only be imperfectly performed, in con-
sequence of the difficulty of obtaining an adequate
supply of water, and the want of machinery for its
efficient application. The powers given by the Act are
limited to works within the control of private indivi-
duals, and these are totally inadequate to deal with the
enormity of the evils that exist in numerous localities.
The masses of filth which have accumulated in some
situations, and which are the fertile sources of disease
to the neighbourhood, cannot be removed by private
exertions, and even where voluntary efforts are made
for their removal unless the operation is cautiously and
skilfully performed, the mischief is only increased.
So many instances had come to our knowledge of
positive evil produced by the incautious removal of
masses of filth, that we deemed it necessary to give a
warning on this subject in our Second Notification, to
the following effect:--
º “With reference to the larger works of cleansing, such as the
cleaning out of long lines of ditches, or the removal of large
masses of decomposing refuse, much mischief has sometimes
been occasioned, when the operation has been so ignorantly
and unskilfully conducted as to increase the extent of the eva-
porating surface; as when the contents of foul ditches have
been spread out on the banks, and allowed to remain there;
and when cesspools have been emptied into drains or sewers
having no proper fall, or no run for the discharge of the contents
from beneath inhabited houses. Works of this kind should be
conducted under the superintendence of a person who possesses
some knowledge of the nature of the gases evolved; the at-
mospheric and other conditions that promote their copious
Sanitary Evils in Small Towns and Villages. 39
evolution; their probable effects on susceptible persons; and
the mode of diminishing or averting them, either by the proper
use of deodorising fluids or by other means. The medical
officer who may be expected to be the best informed in these
respects, should, therefore, as before stated, be required to
take the general superintendence of such operations.”
Of the unskilful manner in which the operation of
cleansing is sometimes performed, and as a proof that
from ignorance of the proper mode of accomplishing
this object the very evils may be extended and in-
creased, which it is the intention to prevent, Mr. Bowie,
in his examination before the Sanitary Commissioners,
gives the following instance:—
“What were the means adopted in your district to improve
its cleanliness?--Cleaning the drains, and the surface of the
Streets.
“Were any means taken to remove the filth 2–Yes, but this
was done very unskilfully, and under the influence of great
alarm. Cesspools were emptied, drains and sewers opened and
cleaned out. The contents of the drains and sewers, if not of
the cesspools likewise, were accumulated on the streets, and
left in small heaps, for the convenience of cartage, opposite
houses where patients at the time were laid up with cholera.
This matter was highly offensive when first placed on the sur-
face, and produced, in some cases, an intolerable stench ; so
that I thought the very means taken to lessen the disease,
tended to increase the evil. The stench from these heaps
being perceptible in the houses of patients labouring under
cholera at that very time.”
Mr. Grainger, in his examination of the circum-
stances connected with a sudden and severe outbreak of
cholera at Chesham, in November, 1848, after describ-
ing a foul ditch in one of the localities in which the
disease was most prevalent, says:—
“A few days before my visit it was decided that this ditch
should be emptied, and a great quantity of black putrid mud
was thrown out on the bank, and there collected into heaps;
this was in process of removal when I inspected the place,
though the larger portion still remained. In one of the cot-
tages immediately facing this ditch, a poor woman named Price,
evidently a most respectable and trustworthy person, was
seized with cholera on Tuesday morning, November 21. She
informed me that on the Monday morning preceding, on going
40 Instances of Disease occasioned
into the small yard at the back, immediately adjoining the
ditch, the emptying of which was still going on, she was over-
powered with the stench and felt immediately sick at the
stomach ; she was, however, able to go to her work, that of a
nurse. On the following Tuesday morning, Mrs. Price on
going into her back-yard, was again seized with the same
feeling of sickness from the offensive stench. She proceeded to
the house where she was engaged as a nurse, but soon became
very sick, and was obliged about 10 A.M. to return home, when
she was seized with cholera.”
From these facts it appears, that the evils above no-
ticed are not confined to large cities and crowded locali-
ties; but that they are equally riſe in many of the
small country towns, and even in villages, which are
often resorted to expressly for the sake of health. Thus
in the above mentioned small town there is a stream,
which, issuing from the chalk hills of the district has,
on its approach to the town, all the clearness of similar
streams elsewhere; but even before passing into the
place itself, is poisoned by the noxious fluids of a tan-
yard, and subsequently by a number of filthy additions
from slaughter-houses, gutters, and cesspools. The
stream is thus pollutcd, and in its onward course among
the houses, becomes a Source of sickness to the inhabit-
ants; and it was therefore not a matter of surprise,
when cholera broke out, that it should have specially
located itself in the houses incar the above stream, be-
ginning in a place called Water-lane.
Again, the town of West Cowes is one of fashionable
resort; and from its position close to the sca, and from
the character of its surface, is peculiarly adapted to
efficient drainage and cleansing ; and yet all the evils
springing from filth and neglect, exist here on a small
scale, as in the worst parts of London. In one court
with eight or nine houses, no privy was provided ; all
the refuse being thrown into a hole cut in the middle
of the court, over and around which the poor people
were drying their linen; in another court was a house,
against which a midden or cesspool abutted; the ſoul
liquid of which had found its way through the wall,
and beneath the flooring of the back kitchen ; in other
places were slaughter-houses and piggeries, emitting
by Incautious removal of Filth. 4 1
the most offensive effluvia. That these sources of at-
mospheric deterioration should exist, without inducing
a large amount of preventible sickness, could be ex-
pected by no one acquainted with the causes of epide-
mic diseases. The medical evidence collected by Mr.
Grainger, shows that low fever prevails in the bad parts
of the town, and other indications of a similar character
are not wanting to prove that here, as elsewhere, the
health of the inhabitants suffers from the malaria arising
from filthy courts and choked up drains.
Of the evil resulting from the incautious removal of
large masses of filth, whether in villages or towns, Dr.
Sutherland gives the following instance as it occurred
at Cardiff under his own observation :-
“In regard to these cases which have happened near the canal,
there are about twenty houses altogether, situated in an airy
open position, but surrounded by undrained land, and having
the canal in front of them. This canal was unfortunately
emptied in order to undergo repairs, and the effluvia, under a
hot sum, occasioned most offensive exhalations, which were com-
plained of by all in the neighbourhood. Fortunately there are
only the few houses already mentioned, otherwise the effluvia
must have produced the most direful consequences; as it is,
however, no fewer than ten deaths have taken place in the
houses on one side of the canal, and four deaths in a single
house on the opposite side. Several of the workmen who reside
in the country, and in healthy localities, have been seized at
home with symptoms of cholera, but have fortunately recovered.
There are a number of loungers constantly about the works,
who have also suffered. The whole case is one of so much im–
portance on sanitary grounds that I shall endeavour to get a
full report of it for the Board.
“I have again examined into the alleged connection between
the present state of the canal and the violent outbursts of
cholera on its banks; and I have to report that the views stated
in my letter of yesterday have been amply confirmed by the
experience of the last 24 hours.
“A little after mid-day, yesterday, I told the Sanitary Com-
mittee that I considered all the workmen in danger as well as
the inhabitants in the vicinity. In the course of the night
another of the inhabitants died; and one of the workmen, who
was engaged on the works yesterday when I was there, took
ill in the afternoon, and died this morning. But this is not
42 Disease occasioned by incautious removal of Filth.
all. When I was on the spot to-day, I saw a crowd of people
on the opposite side of the canal; and, on going over, I found
that the man who had been engaged in keeping the time of the
labourers had just been struck down while standing beside the
men. He was then in the cold stage, and was conveyed home
in a cart covered with blankets.
“The casualties already among this small population have
been greater than I ever heard of elsewhere; and I feel con-
vinced that all are in danger at the present time.
“An intelligent woman described the manner in which she
was seized as follows:–The smell from the canal, she said,
became intolerable; she was seized with nausea, vomiting,
cramps in the bowels, and purging; but she rallied and resisted
the disease. In the same house, however, three persons were
attacked with cholera, and all died.
“No clearer proof could be given of the connection between
bad sanitary conditions and the outbreaks of epidemics; and
I will venture to predict that, before the canal works are finished,
there will be more victims of cholera.
“About a mile and a-half of the canal is empty, and the
bottom and sides are covered with putrid mud. Fortunately
the course of the canal is open, and there are very few houses
except at the point close to the sea, which is about a mile from
the town; and it is at this point that the outbreak has occurred.
“It was stated to me that the canal was run dry on the 26th
May, and that the sickness appeared as soon as the mud began
to smell.”
Impressed with the importance of making these facts
generally known, we addressed a circular to the dif-
ferent canal companies, putting them upon their guard
against laying dry the bottom of any portions of their
canals, especially in the neighbourhood of human
dwellings, at the present time, when in addition to the
usual consequences of exposing muddy surfaces to the
action of the sun, epidemic disease is prevailing in so
many quarters.
The complication of nuisances in particular localities
is often so great, that the dispersion of the population
until the filth is removed, and the places are properly
cleansed, is the easiest and cheapest course.
It is stated in the Third Report of the Sanitary Com-
missioners that the following approximate estimate has
been made by Mr. Phillips, surveyor to the Metro-
politan Sewers Commission, in order to convey a con-
Amount of Novious Matter in Metropolis. 43
ception of the extent of noxious matter requiring
removal in the metropolis at large —
“At the last census, in 1841, there were 270,859 houses in the
metropolis. It is known that there is scarcely a house without a
cesspool under it, and that a large number have two, three,
four, and more under them, so that the number of such re-
ceptacles in the metropolis may be taken at 300,000. The
exposed surface of each cesspool measures on an average 9 feet,
and the mean depth of the whole is about 6% feet; so that each
contains 58% cubic feet of fermenting filth of the most poisonous,
noisome, and disgusting nature. The exhaling surface of all
the cesspools (300,000 × 9) = 2,700,000 feet, or equal to 62
acres nearly ; and the total quantity of foul matter contained
within them (300,000 × 584) = 17,550,000 cubic feet; or equal
to one enormous elongated stagnant cesspool 50 feet in width,
6 feet 6 inches in depth, and extending through London from
the Broadway at Hammersmith to Bow Bridge, a length of 10
miles.”
“This,” say the Metropolitan Sanitary Commissioners,
“there is reason to believe, is an under estimate. The cess-
pool, however, in general forms but one-fourth of the evap-
orating surface : the house-drain forms half or two-fourths, and
the sewer one ; but, connected as the sewers and house-drains
mutually are, and acted upon by the winds and barometric con-
ditions, the miasma from the house-drains and sewers of one
district may be carried up to another. We cannot be abso-
lutely certain that part of the stench experienced in the Dean's
Yard may not have been due to the contents of the sewers from
the drains of the House of Commons, or at some time from
Duck-lane or Pye-street; and according to the evidence of Mr.
Batterbury, who met a strong current of air coming from the
extended cesspools near the school, the miasma from that place
would have been carried through the common sewers, and from
them into the streets and houses of other neighbourhoods.”
Among the metropolitan districts, the most seriously
visited by cholera at the present time, as it was in 1832,
is Bermondsey, where one of the medical officers, the
registrar of the district, states that 25 cases of cholera,
and 9 deaths have recently occurred in his own practice,
all within a few yards of each other, in houses close to
a ſoul tidal ditch. The surveyors of the Metropolitan
Sewers state that there are in that single district, 30
miles of such ditches. For evils of such magnitude,
the only remedies are the immediate removal of the
more susceptible portions of the population, until com-
44 Comparative Mortality in London and Paris.
bined works, and the larger engineering appliances,
such as are provided ſor by the Public Health Act,
can be carried out.
Whilst we represent, as it is our duty to represent,
the negligences and omissions which have occasioned
sickness and loss of life; yet it is right to present the evi-
dence of the fact, which we believe to be conclusive, that
the measures of precaution which have been adopted,
that the cleansings which have taken place, and which
have been carried to a greater extent than they ever
were before, have been attended with proportionate
benefits. We state these facts amidst a serious increase
of the epidemic. We cannot venture to say what may
be the extent of its further visitation ; but as far as it
has proceeded it has been light as compared with its
course in other countries. In St. Petersburg, where
little sanitary improvement has becn effected, there have
been officially reported, during the recent outbreak,
nearly 25,000 attacks and 14,000 deaths; but it is be-
lieved that there have really been upwards of 20,000
deaths. In Paris, where, as far as we have been able to
learn, little warning has been taken of the steady approach
of the pestilence, and little preparation made against its
invasion, the visitation has been more Severe than it was
formerly. We have received from the President of the
Department of the Public Health of Paris returns, from
which it appears that in 1832 the deaths in Paris were
14,503, while in 1848–9 the deaths have been 15, 196,
and the epidemic has not yet entirely subsided. In
Paris, besides bad drainage, there is over-crowding to
an extent of which some conception may be formed
from the fact, that a population of nearly 1,000,000 of
souls is crowded into little more than 40,000 houses :
whilst the 2,000,000 of people in London are distributed
amongst upwards of 280,000 houses; the average num-
ber of persons in each house being in Paris 25, and in
London 7. On comparing the mortality in Paris during
the recent outbreak of cholera, as stated in the Official
returns, with the mortality in London during the recent
outbreak, as given in the Registrar-General's Returns, it
appears, that whereasin Paris, out of a population, say of
Proceedings with respect to Public Health Act. 45
10,000 Souls, 144 persons have died, in London, out of
a population of 10,000 Souls, six persons have died.
But that the epidemic force in London is stronger than
would be represented by this general result, is we think
to beinferred from the severity of the visitation in other
parts of the country where there has been an unusual
degree of negligence, and where, consequently, the con-
ditions have been more than commonly favourable for
the localization of the disease. Under these circum-
stances the mortality has been as high, and even some-
what higher than at Paris. In some of the towns in
Wales, the attacks in proportion to the population have
been as I in 19, and the deaths in proportion to the
attacks, as 1 in 3%. If the mortality of Paris had been
at the same rate the deaths would have amounted to
15,261, instead of 15, 186.
We cannot but lament, that in the towns and villages
of our own country, where the causes tending to localize
the disease were the most apparent, we have not been
able to do more for their removal or mitigation. The
obstacles to even a limited and temporary relief have
been already stated. But if, by any means at our dis-
posal, we had been able to diminish those evils to a far
greater extent than we have found practicable, the
relief thus afforded whatever its amount, would have
been only palliative and temporary, and wholly in-
adequate to meet the permanent yet removable causes
of disease which exist in a greater or less degree in
every town and village which has been brought under
our notice. Until the whole of these removable causes
have ceased to exist, the object of the legislature which
we are charged with the duty of carrying out as far as
may be practicable, will not have been accomplished.
These causes can be effectually removed only by the
practical application of the principles recognized in the
Public Health Act, and the proceedings which we
have taken, up to the present time, with reference to
the execution of this latter Act, we now propose to
describe.
Without derogation of the duty implied by the
power, with which we were invested, of directing local
46 Towns which have petitioned for application of Public
examinations to be made where the deaths exceed
23 in 1000 of the population, we deemed it the
most expedient course, to direct the first labours of the
Inspectors upon those places from whence petitions
were received, or from whence applications were made
to us from Town Councils. In all cases we deemed this
last class of applications as equivalent to petitions from
the rate-payers, whensoever, the rate of mortality was
such as otherwise to indicate the duty of inspection.
The following is a list of the towns and places from
whence applications by petition or resolution have been
received. The towns which have been visited are thus
denoted”; and thef mark denotes those from whence the
reports of superintendent inspectors have been received.
Alnwick.
* Altrincham.
# Ashby-de-la-Zouch.
* Ashton Keynes.
t Aylesbury.
† Bacup.
f Bangor.
Barnard Castle.
* Beaconsfield.
Berwick-upon-Tweed.
Beverley.
f Birmingham.
Bishops Lydiard.
† Bowden Great.
† Bowden Little.
f Braintree.
* Brecon.
f Brighton.
Bromyard.
Broughton.
* Broxbourne.
Brynmawr,
venny.
* Bulkington.
+ Burnham (Somerset).
Burslem.
Calne.
f Cambridge.
* Cardiff.
Carlisle.
† Carmarthen.
f Chatham.
near Aberga-
# Chelmsford.
f Cheltenham.
* Chipping Wycombe.
* Cheshunt.
f Chilvers Coton.
# Clarborough (Notts.)
Coity Lower, Bridgend.
Congleton.
Corsham.
# Coventry.
† Croydon.
Darlington.
f Dartford.
# Derby.
Doncaster.
† Dover.
+ Durham.
# East Retford.
f Edmonton.
Ely.
# Enfield.
Epsom.
# Eton.
* Exmouth.
+ Fareham.
Gateshead.
+ Gloucester.
f Godmanchester.
f Great Amwell.
Halsted.
† Harrow Town and Roxeth-
hamlets.
Health Act, and have been ea'amined, and reported on. 47
Hartlepool.
* Hortford,
+ Hitchin.
* Hoddesdon.
Holbeach.
# Kendal.
* Kingston-upon-Hull.
f Knighton.
+ Lancaster.
# Taunceston.
Leamington Priors.
i Leicester.
Llanelly.
Long Itchington (Warwick.)
+ Loughborough,
+ Luton.
* Macclesfield.
f Market Harborough.
Melcomb Regis.
* Merthyr Tydfil.
# Mileham (Swaffham.) t
f Minster in the Isle of Sheppey
Morpeth.
Nantwich.
* Neithrop (Banbury.)
Newcastle Lower(Bridgend.)
Newmarket.
Newport (Mom.)
# Newton Abbot.
Northallerton.
Norwood.
+ Nuneaton.
# Ordsall (Notts.)
Ormskirk.
* Ottery St. Mary.
Padstow (Cornwall.)
Penrith.
† Penzance.
Pilton (Soms.)
* Portsmouth.
* Proston.
Reading.
Richmond (Surrey).
# Rugby.
Rusholme.
f Sandgate.
Sawtry All Saints,
Sawtry St. Andrews.
Sherborne.
Sleaford.
Stockton-on-Tees, Boroughof.
Stockton-on-Tees, Town of.
* Stoke-upon-Trent.
# Stratford-upon-Avon.
f St. Thomas, Exeter.
# Swaffham.
# Swansea.
# Taunton.
Tenby.
* Tewkesbury.
Thurmaston (Leicester.)
f Totnes.
f Tottenham.
# Uxbridge.
* Waltham Holy Cross.
+ Ware.
f Warwick.
# Watford.
# West Retford (Notts.)
f Whitehaven.
# Whitstable.
# Wigan.
+ Windsor, New.
# Witham.
Woolwich.
f Wolverhampton.
+ Worcester.
* Wormley.
Wrexham.
# York.
and
The inspections have been made under the instruc-
tions, a copy of which we have hereto appended, which
were as follows:—
“On proceeding to the town to which your service
“ is directed, you will inquire for the list of places
48 Instructions to Engineering Inspectors.
“ required to be made out by the 9th order under the
“Epidemic Diseases Prevention Act, where cases of
“typhus and other epidemic and endemic diseases have
“ most frequently occurred.
“You will seek the assistance of the clergy and
“ministers of religion, who may be able to afford va-
“luable aid in your inquiry, and you will also put
“ yourself in communication with the chief medical
“officers and the medical practitioners, who, as Union
surgeons or otherwise, have probably been led most
“frequently into the houses and streets where epidemic
“diseases have prevailed.
“You will request the Superintendant Registrar of
“ the district to attend your first meeting, with the list
of the places of epidemic disease; you will also request
“ the medical officers to attend at the same time, and
also a committee or deputation of the petitioners; the
“Surveyor, Inspector of Nuisances, and the High Con-
stable or other chief officer of police, to be in attend-
ance upon you; you will read the Registrar-General’s
return of the average proportion of deaths from
epidemic disease, and also the average rates of infan-
tile mortality, and also any other such particulars as
“may be in your possession from previous returns,
“ with which you will have been furnished, viz.: the
answers made to the first Sanitary Inquiry, also the
“ answers made to the inquiries of the Commissioners
“ of Inquiry into the means of Improving the Health
of Towns, and state that you are instructed to view
the places where epidemic diseases have been most
rife, and to judge for yourself as to the condition of
the houses, and of what may be done by public
measures, and the exercise of the powers by the
“General Board of Health, for the remedy of the evils
in question, and for the advantage of the population.”
The experience of the Inspectors has been, that these
directions to the seats of typhus and other epidemic and
endemic disease, invariably conducted them to places
ill-drained, and surrounded by filth, in which are found
the conditions in respect to the removable causes of
such disease as were anticipated, and which serve as the
G
s
&
Interest in the Investigations evinced by Poorer Classes. 49
foundation of legislation. In the course of the inspec-
tions, and after the character of the seats of epidemic
disease had been seen by the mayor or other inha-
bitants who accompanied the Inspector, it became a
frequent observation to the medical officer, on arriving
at an ill drained and ill conditioned place, “Here, Sir,
you must have fever cases.”
The positive amount of sickness, pain, premature
death, and misery, from diseases of this class being, as
we find it, constant; or with variations from year to
year chiefly in the way of excess in particular years;
the extent to which the causes of such diseases (whether
original or predisposing) appear to be removable, is a
Source of proportional hope and Satisfaction.
The feelings manifested by the inhabitants of these,
usually the poorest districts, were, in the first instance,
surprise, at the novelty of an official visit of inspection, by
an officer acting under the authority of the Government,
and then satisfaction; next, complaints as to their con-
dition, and lastly, urgent requests that something might
be done for them. They readily threw open their doors,
and gave every explanation to the Inspectors.
The extensive manifestation of a sense of their con-
dition by the poorest classes, has afforded important
promise of the success of the new works contemplated
by the legislature. Had those classes evinced a spirit
of resistance to measures of improvement, had they
shown a preference for dirt, or an indifference to works
of cleansing, their introduction might have been much
more difficult; but although the objections to new
rates and the pleas of poverty were frequent, as might
be expected, yet where there were opportunities of
informing them of the real character of the changes
contemplated, and asking them whether they were
willing to pay rates in return for the advantages pro-
mised, there was a fair and generally very hearty expres-
sion of good will to do so.
Another uniform and general result of our procedure
upon the lists of the localities of epidemic, endemic and
contagious disease has been, that the Inspectors’ Visits
of examination have taken Guardians of the Poor and
E
50 Sources of preventible Disease.
others to the sources of the greatest chargeability to
the poor's rates, which they had then almost for
the first time visibly displayed before them. Little
notice appears hitherto to have been taken, of the ex-
pense of sickness, of frequent funerals, and of premature
disablement and mortality. The following are ex-
amples of the general tenor of the evidence elicited, in
relation to such places.
In the inquiry at the Potteries, Stoke-upon-Trent,
it was stated by the Rev. Francis F. Clarke, curate
of Hartshill, which comprises part of the parish of
Stoke:–
“Within a part of Stoke-lane, comprising about 60 houses, I
have visited as a clergyman 26 cases of fever within the last six
months. The surgeons I have seen, have classed all these cases
among the typhoid forms of ſever. These fevers have attacked
alike those who strive to be clean and the dirty : in the houses
so visited, there is an almost utter want of sewerage; of this the
cleanest people have constantly complained; others seem quite
unaware of such a want. I know by the evidence of my own
senses that the complaints are well founded; yet within this dis-
trict drainage would be comparatively easy, as it lays high. It is
one of the highest parts of Stoke parish. In the Hand beer-shop,
water accumulates after every shower of rain, and has to be bailed
out. Immediately behind this house there has been one of the
worst cases of fever. Adjoining Mr. Radcliffe's house on the op-
posite side of the road, is a stagnant ditch always offensive, this
ditch was the death of his wife last year. Many privies empty
into this ditch, and it is occasionally bailed out and spread upon
the land, and is considered valuable as a manure. One side of
Steele's-buildings has an open ditch all along the side of them,
which is every now and then choked by loads of coal-ashes, left to
accumulate until there is filth enough generated to mix with it for
the land. More than one tenant in this row has complained to
me of the bad smells from the want of sewerage; and the person
in the lowest house has repeatedly, during the summer, been
obliged to sit outside the doors, the smell within has been so bad.
In all parts of the parish, good drainage would be as easy as it
could be anywhere. I find that dirt, want, drunkenness, and
disease go together. I have no doubt, but that with improved
residences, the improvements would lead to improved morals.
There are some houses to let in the worst parts of the town, and a
friend said it ought to be to burn.’”
As showing the consequences of this state of things
to the rate-payers, Mr. Hollins, another witness, said:—
Sources of preventible Pauperism. 5]
“He had frequently traced a gradual descent to the workhouse,
from such property as Mr. Clarke had described, of men whom
he had once known, as respectable and comfortable in their posi-
tion as operatives; unfortunately for themselves and for society they
went, through necessity, to live in a house of this class, and he had
generally found their hopeless poverty began with six or eight
weeks loss of time through fever, and illness caught in such places:
then debts were incurred; rent, as a consequence, fell into arrear,
goods were distrained, the man became disheartened, and the end
was pauperism for himself and family: children once degraded
into pauperism, rarely regained their former position among the
working people; he had no doubt, but that proper sanitary ar-
rangements would prevent much human misery and degradation,
and also be a direct money saving to the parish rate-payers.”
On the inquiry at Dover, the relieving officer, Mr.
Davis, stated:—
“That the amount of out-relief for the parishes of St. Mary, St.
James, Charlton, Buckland, and Hougham, within the borough
of Dover, amounts weekly to 65l. 17s. 10d. ; monthly to
2631. 11s. 4d. ; annually 3,4191. 7s. 4d. The total annual
amount of poor-rate levied upon the above-mamed parishes for
the year ending March 25, 1849, amounted to the sum of
8,828!. 12s. 4d. ; from this sum was paid the cost of the in-poor
in the workhouse, and likewise a borough rate to the Town
Council, as well as the out-relief.
“Of the out-relief, a large proportion goes to Round Tower-
street and lane, and the low districts of the pier generally; in the
parish of St. Mary, to Barwicks-alley, Paper-alley, the Old
Workhouse ground, including Colbran-street, Brook-street, and
other similar places in the parish of Charlton, in Buckland to a
mass of wretched cottages, called Manger's-rents.
“The largest proportion of out-relief distributed in the places
above-named, is caused by fever, small-pox, and other similar
complaints being very prevalent in these localities, caused, I have no
doubt, to a very great extent, by the closeness of the buildings and
their filthy state from want of proper drains and other sanitary
regulations.”
At the same time these inquiries uniformly cor-
roborated the previous statements as to the connection
between the physical and moral condition of the popu-
lation.
The Rev. R. J. Bunch, rector of Emmanuel Church,
Loughborough, stated in his evidence at the *—
E
52 ſight given by Local Investigation,
“I have found that in some parts of my parish the social and
moral condition of the inhabitants are more depressed than in
other parts; those are generally the dirtiest, the worst drained,
and contain the ill-ventilated houses. The physical and moral
condition of the people act and re-act upon each other as cause
and effect. The dirtiest and worst of the houses are occupied
by a class whom I never see at church.”
The Rev. Henry Fearon, rector of All Saints, in the
same town, says—
“I think the physical discomfort of some of my people is
closely connected with their moral inferiority. Without speci-
fying the localities, I think I have observed moral improve-
lments in particular families, in a very short time, when means
Df additional personal cleanliness have been given them. Their
self-respect has been increased. In very unfavourable locali-
ties, I think I have seen the people striving against filth.
Those were persons of well constituted minds, who revolt at
the condition of the neighbourhood, while others sink down
into a state of apathy and indifference. The wish of the people
for iumprovement has been sufficiently shown by their thank-
fulness for the recent exertions of the town authorities acting
under the Nuisances Removal Act.”
From the experience of upwards of 10 years' inti-
mate connection with the poorer classes, continues Mr.
Davis—
“I have not the slightest hesitation in affirming that there is a
most decided direct connection betwixt confined districts, bad sani-
tary arrangements, and poverty and vice. In the districts above
referred to, the moral state of the inhabitants is most deplorable,
as the youth from these places grow to manhood, they become
habitual paupers; brought up to no regular employment; grossly
ignorant and reckless, their time is spent between the Union work-
house and the gaol.
“In conclusion, I can only say, that if the Government wish to
prevent the increase of a most debased and vicious population,
they will take measures, if not to sweep away these nests of vice
and disease already built, at any rate to prevent similar places
from being erected in future.”
A further common and important feature observed
in these local inspections, has been the discovery, by
the chief inhabitants, or those holding leading local
position and office, who accompanied the Inspector in
his perambulation, how little they themselves knew of
to many of the Inhabitants themselves, 53
the real condition of their own town, or of those por-
tions of it which are occupied by the majority of the
inhabitants.
The places properly designated as “fever nests,” the
seats of epidemics, it appeared had never been visited
by them, and were almost as much unknown to them
as any foreign territory which they had never seen.
On these occasions they frequently acknowledged
frankly, that they had been, until then, entirely una-
ware of the condition of the places visited. The Town
Clerk of one town, writing to the Inspector, states that
they were unaware, until his visit and report, what
the condition of their town really was. Mr. Cresy
States :—
“In every instance these opinions I found true. Even at
Windsor, the benevolent Rev. Mr. Hawtrey observed, he was
unconscious of the state of so much filth ; for when a clergy-
man visits the poor, the dirty yard and the privy are seldom
cxposed to his view. At Gloucester, the mayor and other
gentlemen born in the town, acknowledged they were perfectly
unconscious of the filthy state of some portions of their city.”
The following example is given by Mr. Ranger:-
“In the course of my inquiry, the statement of the medical
officer, as regarded the wretched state of the numerous courts,
alleys, &c., and the wretched state of the dwellings of the
poorer class, for want of proper accommodation, water-supply,
&c., were broadly contradicted by one of a deputation from
the Boards of Highway Surveyors and Inspectors of Lighting
and Watching, whilst another member stated the parish had,
on the previous night, passed a vote of confidence in their
efficiency and fitness to carry out the necessary measures for
improving the sanitary state of the town; but within a few
hours, and in the course of my inspection, at which the depu-
tation attended, it was candidly admitted by the very man who
had been foremost in denouncing the statement of the medical
man, that he had never even seen the places until that day,
although a resident in the town for many years, and one of the
party on whom the inhabitants had been prevailed to pass a
vote of confidence for carrying out drainage, &c.”
The local examinations are concurrent in showing
that the outward appearance of our towns affords little
or no indication of their real internal sanitary condition,
and that even small towns in which the chief streets
54 Chief Opposition from Owners of worst Tenements.
and thoroughfares, or parts frequented by the higher
and middle classes, are clean and well kept and fair to
see, are, in other more retired and often immediately
contiguous parts, in the worst state of filth.
It is the most favourable presumption that the want
of information as to the state of the localities visited
by epidemic disease is the general cause of their
neglected condition, rather than wilful neglect under
a consciousness of what that condition really is. It is
proper, further to note that the business of the regular
inspection of such districts, undertaken from motives of
extraordinary zeal and benevolence, is a laborious one,
and requires an extent of time and observation incon-
sistent with ordinary trading or professional pursuits,
or with honorary service.
The reports of the Inspectors as to the condition of
the populations of the poorer districts is in accordance
with the previous reports of visitors from religious
associations.
The perception of the means of prevention, was more
clear to our Inspectors, than we might expect it to have
been to the inhabitants, who had been accustomed to
the present state of things and who had seen nothing of
new and improved works, or indeed of any other works
than those of their own town. t t
The chief opposition commonly experienced has been
from the owners of the worst-conditioned tenements,
often from those where the highest rents were obtained,
and most frequently from those where the payment of
rates was nevertheless excused.
Much of this lower class of house property is held
by persons called owners, as being in the receipt of
rents and profits, who have only short interests in the
premises, as being, for instance, either life rented in
the property, or the holders of short terms of leases.
Examples are frequent, under local Acts, of the con-
fiscations of rents, by exactions of large immediate
outlays from such owners for permanent works, from
which they can derive, at the most, only a short
advantage, but frequently no advantage whatever,
not even of charging any proportion of the increased
Improved Works diminish evisting Charges. 55
rate upon the tenant, who derived the advantage of an
improvement not contemplated at the time he took his
house.
These hitherto well-founded apprehensions of un-
equal and unjust charges require to be carefully pro-
vided for on behalf of persons of short interests in this
class of property; and justice and sound administrative
policy require that securities against waste should be
also provided, so that owners of long interests, rever-
Sioners, and others now absent, be not charged with
contributions to the expense of works of a character
not to last or not productive of benefit equivalent to the
charge.
The reports of the Inspectors show, almost invariably,
that the chief works required will (if properly exe-
cuted) be largely in reduction of existing direct charges,
as for example, that the house-drains and the appa-
ratus, with the water supply, in substitution of the
cesspool, will not be half the annual expense of cleansing
the latter. Similar works, where there had been any
executed under the uncontrolled direction of the local
Boards, had, as we shall show, been far from inspiring
confidence either in their efficiency, or their economy
of construction; while the dread of heavy immediate
outlays was frequently sufficient to preclude a fair
hearing, or a consideration of the means provided in
the Act to avoid them, through facilities for raising
money on loan, and by arrangements for repayment by
equal annual instalments of principal and interest, pro-
portioned to the benefits conferred, and distributed over
periods of time.
The persons interested in the lower class of houses
commonly demanded that securities should be given that
the expense of the works should not exceed the esti-
mates, and that they should be efficient; and they fre-
quently asked that the inspector, as an engineer, should
be made responsible for the works. At Totnes and
Launceston, and several other places, this was anxiously
expressed; and it was mentioned at Durham and else-
where as a desirable advantage, even by professional men.
56 Every description of Property justly chargeable.
The steps required by the Act, of the local publica-
tion of the recommendations of the inspector as to the
works proposed to be executed, the provision for sending
in and considering objections, denote the intention of
the Legislature, that the rate-payers should be satisfied
in respect to the fairness and advantage of the future
expenditure ; and, undoubtedly, the examination of
past works continues to confirm the apprehensions ex-
pressed, both as to the efficiency of the works, and as to
the reasonableness of the expenditure and the justness
of the assessments.
The corporations and the local commissions are
usually in debt, and frequently unable to account sa-
tisfactorily for the past expenditure. The contrasts
between the estimates made by the inspectors, upon
the improvement in economy, and efficiency of con-
struction, which have followed the investigations
under the Metropolitan Sanitary Commission, are so
great, when compared with those to which the local
authorities have been accustomed, that they have fre-
quently incredulously asserted, that such works cannot
be carried out for any such sums as those named in the
reports; nor is it to be expected that they would be,
unless under such securities as those to which we
must subsequently advert.
The entire want of faith in the improvement of the
future local expenditure has been one source of the op-
position from the owners of the tenements chiefly re-
quiring amendment, for which the highest rents in
proportion to any outlay are commonly received.
We must, however, repeat, that inasmuch as we be-
lieve in every instance the works of amendment pro-
posed will be in reduction of existing charges, and
be an improvement to the property; the abolition
of cesspools, complete house drainage and cleansing
would, by the reduction of damp, be of full money
value to the property by the saving of dilapidations;
so we have held that every description of property
must contribute: but the owners of the description of
property which is supposed to be the poorest, namely,
Lower description of Property generally Mortgaged. 57
that excused from the payment of all rates on the
ground of the poverty of the occupiers, have seen in
the imposition of rates for these improvements only
a precedent for the rating of that description of pro-
perty for other purposes, and have been most violent in
their opposition. Under the influence of these classes
of opponents, poor occupiers, who have expressed their
satisfaction at the prospect of amendment, and petitioned
for the application of the Public Health Act, have
been frequently induced to retract their declarations,
and, in Some instances, to petition against measures,
which, however, were nevertheless measures of pecu-
niary as well as of sanitary relief.
Inquiries as to the causes of the opposition made to
the application of the Act, notwithstanding the proof that
the measures proposed would really be improvements
of the property, have elicited the fact, that the lower
description of property is extensively mortgaged, almost
at their marketable value. This condition has been
foreseen, and met by the declaration of the general
principle, that the improvements contemplated were
new additions to the tenements, not contemplated at
the time they were taken by the occupier, and as much
required and justified an additional rent, as the construc-
tion of a new room, or improvements of the premises.
It was, therefore, proposed that the improvement rates
in respect to new house drains or apparatus, should be
paid by the occupiers; but the rents of the worst con-
ditioned tenements are frequently so exorbitantly high,
that the owners despair of obtaining anything in addi-
tion. These are the cases where the mere pecuniary
benefit cannot be made manifest to all the opposing
parties.
We have, however, on considering the bearings of
the question, been precluded from holding out any ex-
pectation that exemption, could be countenanced or
recommended by us.
The Legislature has not hitherto, we apprehend,
been informed, as to the proportion of the houses of
the lower class to the other classes of houses in towns,
58 Occupiers of the poorer Class
or as to the extent or mischief of the practice of ex-
empting them from the payment of their pro rata
shares of contribution.
The greatest mischief is to the poorest classes them-
selves, in the obstruction presented to improvements,
which are means to economies, and which as economies,
are of the highest importance to those classes.
The first operation of the exemption is to throw con-
siderable additional expense on all the higher class of
rate-payers, and to make them pay unduly for works
for the advantage of others, and consequently to indis.
pose them to improvements. The occupiers, who gene-
rally pay additional rents equal to the amount of the
excused rates, are subjected by the consequent opposi-
tion to exclusion from the benefit of improvements;
whilst the owners themselves when the improvements
are frustrated, often lose by bad drainage, damp, dila-
pidation, and deterioration of property, more than they
save in rates.
In illustration of the strength of the motives to oppo-
sition arising from the proportions of the houses, com-
monly excused from contribution, we may mention that
the houses at Sheerness rated under 5l. are about one-half
of the whole of the houses of the town; at Ware, they
were 55 per cent. of the total number of houses; at
Aylesbury, they were 41 per cent.
If these classes of houses were excused from con-
tribution, for that which to the occupiers of that class
of houses would be of the greatest advantage, the
general increase of the rates levied upon the occupiers
of the other houses, to defray establishment charges
must be at—
Aylesbury.
Ware. Sheerness.
tºmsº
40 per cent. 54 per cent. 56 per cent.
additional rates required to be paid, on account of the
exemption of the lower class of tenements.
The following return from Leicester, affords a fair
example of the simple proportions of one class of
houses to another.
not really interested in Evemptions.

Total Number of Houses Per cent. of Grºus Proportion
of "...º.º. {{S º . produced from per Cent: of
le Poor-rate. º º each class of | each º
- *-*.* to the
Not exceeding Number. IIouses. #.º. Total Rental.
£. #. s. d.
; 7,322 57.8 ||,830 10 0| 26-0
1 2,899 22 9 1,449 10 0 20 - 6
20 1,397 11-0 i. 367 () ( iš-š
; ; 3 * 8 723 () () 10 - 3
23 1 - 8 464 0 0 6 • 6
50 128 1 - 0 340 0 () 4 • 8
60 72 () • 5 216 0 0 3 - 1
70 40 () • 3 1 40 0 () 2. ()
80 45 0 - 4 180 () () 2 - 5
i. 22 }} 99 0 () 1 - 4
13 () • 75 0 () 1 - 1
I l () () 0 - 1 49 10 0 () - 7
I 20 8 () • I 48 0 0 0 - 7
130 1 tº a 6 10 0 0 - I
140 1 tº e 7 () () 0 - 1
#. tº g 1 • * 8 0 0 0 - 1
170 0 & tº 0 & O tº gº
180 l 9 0 () 0 - 1
12,673 100 7,042 0 0 100
If all houses under 10l. were excluded from contribution,
and the interest on the whole amount of the fixed capital and
establishment charges for the supply of water were charged on
the middle and higher classes, or on those inhabiting houses
above 201 per annum, then it will be seen that the payment
must be in some such proportions as hereunder stated:—
:620 to 40. sº.10 to 60 £60 to SO =680 to 100 |sionairwi.
S. d. S. d. S. d. S. d. s. d.
Weekly charge about . 0 8 l 5 l ll? 2 4$ 3 ()
i. tº e º e 0. 5 0 8+ 0 ll l 1 l 5%
Out of 814 houses at Fareham and Wallington, 401
houses, or nearly one-half, were found to be excused
from rating ; and the Inspector reports that the main
opposition experienced to the application of the Public
Health Act was from the owners of these excused
houses.
Strong opposition was anticipated from the Local
Boards, which must be superseded, and whose powers
must be consolidated with those of the new Boards;
and such opposition has been given, but less frequently
than was expected. Our Superintendent Inspectors
60 Saving two or three-fold on former Charges
give concurrent testimony to the effect of the following
from Mr. Geo. T. Clark:—
“I am bound to say, that so far as my investigations have yet
proceeded, I have not found the Local Boards or Commissioners
in active, and very rarely in passive, opposition ; on the con-
trary, I have found their servants reasonable men, strongly im-
pressed with the faults of the present system, and quite dis-
posed to try a better one. Thus, at Durham, Caermarthen,
Swansea, Preston, Wigan, and Worcester, the Commissioners
did not oppose, after the inquiry began; and in most cases they
have promoted inquiry.” w
In some instances, though we are glad to be enabled
to state very rarely, measures of relief have been made
the subject of local party conflict.
We had, in our instructions to the Inspectors, stated,
in the following terms, our view of our own position
and functions, in relation to the local proceedings and
authorities:–
“You will bear in mind, as a representative of the
“General Board, the general nature of its objects and
“ position as collected from the tenor and spirit of the
“ provisions of the Act, first as an agency for the re-
“moval of those evils in the repression of which the
“ public at large have an interest ; next as an authority
“of appeal and adjudication between rival or conflicting
“ local interests; thirdly, as a security in the distri-
“bution of charges, for the protection of minorities
“ and absentees against wasteful works, or undue
“charges in respect to them ; and fourthly, as a means
“ of communicating to each locality for its guidance, the
“principles deduced from the experience of all other
“ places from which information may be obtainable.”
We have assumed that it was a primary duty to take
care in the imposition of new charges, as far as we might
have influence or power, that they were kept down to
the lowest amount. In this view, we have had the expense
of the labour and work analysed, and have consulted all
available experience on the subject. Our Inspectors
express their confidence in the praticability of draining
and supplying water completely to two or even three
towns at an expense, that four or five years ago would
have been thought not objectionable for one.
Principles of the Distribution of Charges. 61
Whilst the provisions for distributing charges over
periods of time were absolutely requisite to future im-
provement, as means of overcoming the obstacles, and
preventing the injustice of iarge immediate outlays for
permanent works by persons who would probably
derive no benefit whatsoever from them, we beg leave
to repeat the exposition of our view of this principle,
and the precautions requisite for carrying it out. The
necessity of these precautions is further impressed
upon us, by the claims of compensation, for worth-
less works and for interests, which ought never to have
been allowed to be created. Out of 50 towns ex-
amined by the Commissioners of Inquiry into the means
of improving the Health of Towns, they state in respect
to works and expenditure for supplies of water, that in
only six instances could the arrangements and the sup-
plies be pronounced in any comprehensive sense good
(and, consequently, the original expenditure efficient),
whilst in 13 they appear to be indifferent, and in 32 so
deficient as to be pronounced bad. Yet, for such works
heavy compensations are generally claimed. The former
expenditure on local works of town drainage, has been
found to be, for the greater part, expenditure in worse
than waste, in the creation of extended cesspools. Yet,
for this past waste, and for the waste which we have
reason to apprehend it will be shewn has been renewed
even under recent Improvement Acts, there is no real
responsibility. We have met with no examples, nor
have we heard of any, of pecuniary responsibility, or a
really effectual responsibility on the part of the numerous
and fluctuating bodies of honorary members, that for the
most part have had the management and control of
such works as those in question.
If past local works of this description are objection-
able on the ground of extravagance, when the expense
is defrayed by immediate lessors or by lessors for short
periods, what may not be expected from annual fluc-
tuating and irresponsible bodies, if they were allowed
free opportunities of shifting burthens from themselves
upon absentees?
Improvement rates, or distributed charges being, in
fact, mortgage charges, the representatives of occu-
62 Securities required against the
piers, of tenants-at-will, and of persons who have only
short interests are placed in an advantageous position
when considered as persons who have life interests; who
have never been allowed to mortgage the inheritance
for improvements. By the statute of the 3 and 4 Vic-
toria, to facilitate the drainage of settled estates, it was
provided, that any tenant for life, or the owner of a
settled estate who wishes to defray the expense of drain-
age by money raised upon mortgage, must apply by
petition for permission to do so to the Court of Chan-
cery. The Court referred the petition to a Master in
Chancery, who called for plans and estimates, and such
competent evidence and security, as to satisfy the Court
that the works would be of sufficient benefit to the re-
versioner to justify the charge. By a recent statute the
performance of this duty is charged on a special autho-
rity, the Enclosure Commissioners. -
The Public Health Act provides, that the rates shall
not be mortgaged without the consent of the General
Board of Health. Considering the legislative pro-
visions for the drainage of settled estates by the owners
to be in pari materia, we propose to exercise on the
same principles, discretionary powers wested in us for
the due protection of the several interests involved in
the works in question.
For the security then of the several interests involved,
namely, for the security of absentees and reversioners,
for the protection of minorities, for the prevention of
the failure of the objects of the legislature by such un-
skilful, inefficient, or extravagantly expensive works
as have been displayed by recent local examinations,
and acting under a sense of the responsible relations
above set forth, we propose to adopt as a principle to
Sanction the mortgage of rates, and the distribution of
charges only on conditions such as the following:—
1st. That plans and estimates have been prepared in
detail, and submitted for examination to an Inspector.
a. And upon his Report found to be deserving
of approval;
b. As being of a nature to last, and of advantage
equal to the value of the improvement rate during
continuance of Waste. 63
the period of years over which the charge is dis-
tributed. r
To secure this object, it is further proposed to pro-
vide as the ground of the consent to the payment of
money upon mortgage:–
2ndly. That the works shall be executed upon
contracts, on the following conditions: &
a. That before they are covered up, or put in ope-
ration they shall be examined by the Inspector.
b. That they shall be further examined by him
when in action, and be certified by him, to be in
conformity to the plans and specifications, and to
be of fair probable value, to justify the future
annual improvement rates.
c. That they shall be maintained in good action
by the contractor for a term of not less than five
years.
It is to be observed that the securities we propose are
not in substitution of any of such local securities against
profuse expenditure as now exist, but are additional
securities, supplementary to those local securities which
almost every inquiry, and nearly the whole of the Re-
ports on existing works, prove to have been insufficient.
The rates of charges paid would be maximum rates.
If the Local Boards could obtain the same objects by
improved means, or at reduced charges, it would be
their duty (and they will have full power) to do so.
The selection of the contractors, and the decision upon
the contracts will be entirely in their own hands.
Whensoever any officers or members of any local
Boards, devised improved methods of carrying out the
works in question, it will be the duty of the Inspector
to take note of them, for the advantage of other places.
Precautions against failures from ignorance and want
of skill appear to be more needed, on account of the
novelty and speciality of the works, than precautions
against waste and failures from direct jobbing. Thus
it has been set forth in respect to drainage works in the
Report of the Metropolitan Sanitary Commissioners.
“The more the investigation advances, the more it is apparent
that the progressive improvement and proper execution of this
(34 Specialty of New Works, and
class of public works, together with the appliances of hydraulic
engineering, cannot be reasonably expected to be dealt with in-
cidentally or collaterally to ordinary occupations, or even to
connected professional pursuits, but require a degree of special
study, which not only place them beyond the sphere of the dis-
cussion of popular administrative bodies, but beyond that of
ordinary professional engineering and architectural practice.
“In justification of this conclusion, and to show the evil of the
perverted application of names of high general professional au-
thority we might adduce examples of the most defective works
which have received their sanction.
“All the improvements which the public have yet obtained in
this branch of public works have been the result of the special
and undivided practical attention of well qualified paid officers,
and it appears to us that further improvement must be sought
by the same means, and that one of the chief objects of future
administrative arrangements must be to secure, protect, and
encourage the zealous undivided attention and efficient labour
of such officers.”
In the local works which it is necessary to execute
for the sanitary improvement of towns, it is to be recol-
lected that an entirely new system of sewerage must be
combined with a new system of house drainage, with a
new system of water supply, and with a new system of
removing and of applying the refuse of towns to agri-
cultural production. All the improvements in these
works are founded on the demonstration of actual trials
and established precedents, but the instances are distant
and widely scattered, and may be out of the reach of any
one engineer or person whom the local authorities could
employ, and to these authorities themselves they will
generally be utterly unknown.
These difficulties have in several places been clearly
perceived by the promoters of the measures of local
improvement, who have explicitly stated, that unless
the plans for the new works are designed by the
Inspectors, there is but little chance of their being
designed at all. They have, therefore, applied for their
assistance in that stage.
For the security of the works, and the attainment of
the objects in question, we are desirous that assistance
should be given. In many cases, where the labour of
the preliminary investigations have been performed by
one officer, who has obtained a clear view of the works
eatent of Eagerience required for designing them. 65
required, and properly digested a plan of the most
efficient and economical means of executing them, it
would be a mere waste of time and expense, for which
the locality must pay, to have the same labour per-
formed a second time, where there is no reasonable
chance of obtaining improvements, and a strong pro-
bability of engendering non-essential differences and
expensive delays. We here refer to the execution of the
general system of new works, under the superintend-
ence of the Inspector, in concert with the Local
Boards; the detailed superintendence must be given by
the Local Surveyor, appointed by the Local Board, for
whose competency securities are requisite.
From what has been already stated, as to the pecu-
liar nature of the works to be executed, the reasons
will be apparent which preclude the expectation of
such works being well executed by Local Boards,
consisting of numerous and fluctuating members, if
the works be executed by them. It is moreover im-
portant that local responsibility, or such responsibility
at least as may attach to honorary service, as the
loss of credit for inefficient or wasteful expenditure,
should not be weakened by being divided amongst a
large number. It is a common request that the Local
Board should not be made “too numerous.”
The provisions of the Act for the elections of guar-
dians for districts which are found to be within the
same drainage area as municipal corporations, and for
places in which there are no municipal corporations,
are objected to as too complex and cumbrous, and mul-
tiplying direct elections unnecessarily, as endangering
the measure by dividing and weakening any respon-
sibility there may be amongst fluctuating elective bodies,
by spreading it over large numbers. Amongst the great
body of respectable ratepayers there is usually found
also to be an aversion to the multiplication of the
number of local elections.
It is frequently represented to us to be unnecessary
to encumber a portion of an outlying district with
the whole electoral machinery for electing, not the
Local Board, but the minority of a Board, the muni-
F
66 Defective Constitution of Local Boards.
cipal corporation being already elected. Where the
addition made to the outlying district consists of one
parish, or the greatest portion of a parish, it is submitted
that a discretionary power may be beneficially exer-
cised of constituting the elected Guardians for the time
being members of the Local Board.
In several places the Inspectors have received objec-
tions as to the proposed composition of the Local
Boards, and the necessity of alterations or additions.
The common hypothesis of the constitution of the Local
Boards and local representative bodies, is that they
consist of persons having only common and general
public interests; whereas the practical difficulty is to
find persons having only such interests, and to secure
their attendance and attention for carrying out such
general public interests. Practically the closest atten-
tion is given by persons with particular, and too
frequently adverse, interests. Practically it is found,
Sometimes, that the Boards, or the majority of them,
are comprised of occupiers into whose hands may
fall the uncontrolled direction of works which
affect their own charges, and of works which aſſect
the properties and opposing interests of owners. In
many instances, however, it is found that, in the
Local Boards, the interests of the owners of the lowest
class of houses, which, as we have seen, most require
interference, frequently predominate, and willing co-
operation may not be expected through them. In several
instances, individuals of predominant local influence,
interested in manufactures or processes which are nui-
sances that affect injuriously the health of the popula-
tion, have declared that if the Public Health Act were
applied, it should be a dead letter. In some instances
the Smaller owners have announced their intention to
get themselves elected to frustrate the operation of the
Act. Where the owners of a higher class of property
prevail at such a Board, the measures adopted for the
enforcement of regulations such as the ejection of the
occupiers of cellar dwellings must wear the aspect of the
exercise of power by persons of rival interests. Where
the new works required are really improvements—as
Prevalence of Particular Interests. 67
those contemplated must be, often immediately and
visibly, and always eventually, if properly managed,
improvements of the property—the owners of one class
may be expected not to be zealous in carrying out im-
provements of rival properties.
Considering the provisions made for the satisfaction
of the rate-payers with the application of the Act, we
should hesitate to recommend the enforcement of its
provisions against the general and deliberate wishes
of the inhabitants of any town, when the intended
measures were placed fully and fairly before them.
But in the face of proved facts of preventible evils
under which the great bulk of the population of a town
may be suffering, we should be cautious in accepting as
the real expression of opinion, declarations against
remedies, unless under scrutinies and precautions, such
as experience has suggested in relation to the guises
assumed by such interests as those above indicated.
We should not accept as expositions of the aversion of
“ the people,” or of the unwillingness of the town,
declarations which we know to be got up on ignorant
or false representations by the owners of the worst
conditioned tenements, in respect to which it may be
requisite to adopt compulsory measures, or by local
functionaries whose powers it may be necessary to
supersede ; or by one local party in the mere spirit of
opposition against the measure which may happen to
have been initiated by persons belonging to another, or
to no local party whatsoever.
Unless provision be made for the free and fair action
of the more wide and general interests, the causes of
disturbed action, which are above indicated, must have
their effect. We submit that special provision may be
made for laying out the first works, which will not be
requisite when the works are completed.
Some of the best supporters of the measures of local
improvement in question are the larger owners, whose
interests, indeed, are the most permanent, and when
closely and strictly examined, are found to be in
respect to the proposed works, most in coincidence
with those of the poorest class of occupiers. From
68 Difficulties in fiving early on the
some places, proposals have been made that the works
should be executed by local Commissions, with en-
larged powers, on which this class of owners might be
named, or in which a selection might be made from the
ev-officio Guardians.
From promoters of the application of the Act, who
will probably be elected on the Local Boards, we have
received representations of the expediency of strong
compulsory powers as a means of protecting themselves
against the reclamations and active opposition of such
adverse parties as those which we have indicated.
We have endeavoured to display the disturbing forces
by which the application of the principles and mea-
Sures sanctioned by the Legislature may be obstructed.
We shall proceed, however, with their application,
trusting for immediate support from the influence of
public opinion, but relying on compulsory powers
being given adequate to their enforcement, if it should
be found indispensable to the due protection of the
poorest and most helpless classes of the population.
Of the future local works which require to be pro-
vided for, the sources of water-supply have hitherto
presented the greatest difficulties in fixing at once, in
every instance, on that source which could confidently
be pronounced to be the best.
Hitherto, the more common practice has been, to
take as the source of the water-supply, the nearest
river, or stream, or collection of water, without much
regard to its quality ; to erect pumping-engines, and to
drive mains through the middle of streets, leaving each
occupier to erect tanks, house, or service pipes, and
to connect them with the main before laid down.
The general character of the specimens of waters
taken from the rivers near to the towns recently
examined, has exhibited an excess of hardness and an
excess of animal and vegetable, as well as mineral
matter in suspension, in chemical Solution, or in com-
bination.
River waters may be said to be derived either from
deep springs, and subjected therefore to mineral im-
pregnations, or from surface flood water, bringing down
Sources of improved Water Supplies. 69
chiefly, animal and vegetable matter, but less of mineral
Imatter.
I'or the avoidance of the inconvenience and loss,
occasioned by river waters of high degrees of hardness,
a practice has of late been widely introduced, of taking
supplies from surface flood waters. An extent of
favourable land is taken as gathering ground, the
surface water caught and stored in reservoirs, and from
thence distributed to the town. It is considered, that
of the usual rainfall, one-third will be available for dis-
tribution. Therefore on the accustomed estimated
supply of 100 gallons per diem for each house (which
is an estimate on an average of houses including inns,
breweries, &c.), the quantity of gathering ground requi-
site for a town of 2,000 houses, supposing the fall to be
30 inches,” will be under 300 acres, or a square mile
will suffice as gathering-ground for upwards of 22,000
of population; an acre for the annual supply of about
35 inhabitants.
This mode has chiefly been resorted to, for the
supply of the northern towns; the new supplies for
Manchester and Liverpool are chiefly derived from
surface waters gathered from hilly grounds, of strata of
the secondary formations: that for Manchester at 12
miles distance, that for Liverpool at 25 miles distance
from the town; the river water near both towns being
found to be utterly unsuitable.
Manufacturers who are interested in obtaining soft
water, or water with the least mineral impregnations,
generally obtain it by the collection of surface waters.
But the surface water which has passed through a per-
meable bed of earth constituting a filter to detain the
* It is reported to us, that the quantity lost by evaporation, vegeta-
tion, springs, &c., is almost constant, and will range from 15 to 17 inches
annual superficial depth. From a rain-fall of 60 inches, as in the higher
parts of Yorkshire, Westmoreland, Derbyshire, and Cheshire, at least
40 inches would be impounded and available. In Bradford, Leeds,
Sheffield, and towns similarly situated, where the rain-fall would not
exceed 35 inches, we should obtain 15 certain. In Norfolk, Cambridge,
Suffolk, &c., with an annual rain-fall of only 24 or 25 inches, not more
than 9 inches would be obtained for supply.
70 Economies practicable.
animal and vegetable matters, which would have been
collected and carried away by the ordinary surface
flood water, and is discharged by the drains used for
thorough drainage has hitherto been found to be the least
impregnated with mineral or animal matter of any water
that does not fall on the bare primitive rock. Such water
so filtered, is in fact a shallow spring water. The
specimens obtained from different districts, and dif-
ſerent strata of earth, have hitherto been considerably
softer, from one-half to one-third the degrees of hard-
ness of the adjacent river water.
The increased expense, and the domestic incon-
veniences arising from the quality of hardness in
waters, have been fully illustrated in the Reports of
the Commissioners of Inquiry into the means of
improving the Health of Towns. See in particular the
Report of Dr. Lyon Playfair.
Though no provision of the kind is made or com-
monly practicable in respect to ordinary flood water,
which is derived from every surface whether manured
or not, yet it is usually contemplated that in respect to
the shallow spring water supplies, arrangements might
be made for diverting the water derived from any
portion of land whilst under dressings of manure.
The most eligible source for the collection either of
surface flood water, or of shallow spring or land drain-
age water, has hitherto required more extensive re-
searches, analyses, and consideration, than under the
pressure of numerous and urgent applications, and
manifest necessities of measures of immediate relief, it
has been practicable for the Superintending Inspectors
to give,
In some instances it may be expected that the quali-
ties of the available sources of supply, will only be
ascertained after land drainage works have been some
time in operation. The immediate necessities of the
population will require, temporarily, immediate available
river supplies.
In several cases the search and examinations for the
best available supplies may be proceeded with, whilst
the works for improved drainage and cleansing, and
Application of the Refuse of Towns to Agriculture. 71
much of the minor works for interior water distribution
are in progress.
It is therefore proposed that power should be given,
on the report of the Superintending Inspector, and with
the consent of the Local Board, and with proper notices
to parties, and compensations, to make provision for
the purchase of the rights to waters derived from
land drainage or shallow springs, with powers to pre-
vent pollutions, and also to purchase new gathering
grounds.
The Inspectors have been required to give their most
careful attention to provisions for the prevention of the
pollution of rivers, and for the application of the refuse
of the town to agricultural productions.
They generally find no engineering difficulties; and
in the case of several towns, have reported important
facilities for the application of sewer-water on land
adjacent to the town.
To what extent such refuse may be taken by farmers
near to the towns can only be ascertained after the
completion of the arrangements for distribution. A
priori reasonings from the known fertilizing powers of
the manure, and the apparent interests of the farmers
to use it, are not invariably to be depended upon. It
must indeed be borne in mind, that few of the farmers
have witnessed the results of the systematic application
of liquid manures. Moreover, much land requires
draining for the most successful application of manures
in any form, but especially for application in the liquid
form. In several towns, however, farmers have come
forward and expressed their readiness to receive and
pay a fair price for the sewer manure as soon as the
new works are completed.
For many places the most eligible course of pro-
ceeding appears to be to apply waste or unenclosed
commons to the purpose. Many of these are peculiarly
eligible for such applications, as being the least pro-
ductive lands under the ordinary modes of cultivation.
For the adaptation of such land the procedure of the
commons' enclosure would be requisite. When en-
72 Eligible Fields for the productive application of Reſus
closed it is recommended to drain it, and lay down upon
it pipes for the distribution of the sewer manure, and
then to relet it, prepared for cultivation, with the right
to the supply of the manure, on lease, or on such
terms as may be eligible, and to apply the surplus after
the payment of compensations for common rights and
of expenses, to the sanitary improvement of the town
in such manner as may be approved
The examples of productiveness obtainable under a
competent agricultural direction from an abundant
use of the town manures, could not fail of exercising a
beneficial influence on the surrounding agriculture of
the district.
Such works should be carried out upon approved
plans by the local surveyor, under the superintendence
of the Inspector.
We would again express our regret, that more has not
been accomplished in carrying out the intentions of the
Legislature, both with respect to measures of temporary
alleviation and works of permanent improvement; but
with reference to the measures of alleviation, we believe
that, imperfect as those measures may have been, they
have yet in numerous instances been the means of pre-
venting and arresting disease, and of saving life; and
with reference to the permanent works, that the founda-
tion has been laid for progressive sanitary amendment.
All which we humbly certify to Your Majesty.
(Signed) CARLISLE.
ASHLEY.
EDWIN CHADWICK.
T. SOUTHWOOD SMITH.
$
Proclamation of Privy Council. 73
AP P E N D H X.
I. PROCLAMATION BY THE PRIvy Council, PUTTING IN Force
THE CONTAGIOUS DISEASES AND NUISANCES REMOVAL ACT.
At the Council Chamber, Whitehall,
The 28th day of September, 1848.
By the Lords of Her Majesty's most Honourable Privy
Council.
WHEREAs by an Act passed in the last session of Parliament, in-
tituled “Am Act to review and amend an Act of the tenth year of
Her present Majesty for the more speedy Removal of certain
Nuisances, and the Prevention of Contagious and Epidemic
Diseases,” after reciting that it is expedient that when any
part of the United Kingdom shall appear to be threatened with
or affected by any formidable epidemic, endemic, or contagious
disease, measures of precaution should be taken with prompti-
tude according to the exigency of the case, it is enacted that in
Great Britain the Lords and others of Her Majesty's most
Honourable Privy Council, or any three or more of them (the
Lord President of the Council, or one of Her Majesty's Princi-
pal Secretaries of State being one), may by order or orders to be
by them from time to time made, direct that the provisions in
the said Act contained for the prevention of epidemic, endemic,
and contagious diseases be put in force in Great Britain, or in
such parts thereof or in such places therein respectively as in
such order or orders respectively may be expressed, and may
from time to time as to all or any of the parts or places to
which any such order or orders may extend, and in like man-
ner, revoke or renew any such order; and, subject to revocation
and renewal as aforesaid, every such order shall be in force six
calendar months, or for such shorter period as in such order
shall be expressed :
And whereas the United Kingdom appears to be threatened
with a formidable epidemic disease, in consequence of the pró-
gressive advance of such a disease to the western portion of the
Continent of Europe, and a case has arisen for putting in force
the provisions of the said Act; Now, therefore, it is hereby
ordered by the Lords and others of Her Majesty's most Ho-
mourable Privy Council (of whom the Right Honourable Wis-
G
74 First Notification of Board of Health.
count Palmerston, one of Her Majesty's Principal Secretaries
of State, is one), in pursuance and exercise of the powers so
vested in them as aforesaid, that the provisions contained in
the said hereinbefore recited Act for the prevention of epidemic,
endemic, and contagious diseases, be put in force throughout
the whole of Great Britain immediately from and after the
date of this Order.
And it is further ordered, that this Order shall continue in
ſorce for Six Calendar Months from and after the date hereof.
C. GREVILLE.
II. FIRST NOTIFICATION: IN RESPECT TO THE NUlsANCES
lèEMOVAL AND ContAGlous DISEASEs PREVENTION ACT.
General Board of Health, Gwydyr House,
October 5, 1848.
THE General Board of Health having considered the official
accounts which have been received of the course of Asiastic
Cholera since the presentation of the Reports of the Metropoli-
tan Sanitary Commissioners, and having consulted medical
practitioners of eminence and of special knowledge of the sub-
ject, and having compared the tenor of those recent accounts
with the observations made respecting the former mode of the
propagation of Asiastic Cholera in Europe, have now to repre-
Sent—
That the experience obtained of this disease during its
former invasions of this country in the years one thousand
eight hundred and thirty-one and one thousand eight hundred
and thirty-two, and the still larger experience acquired during
its recent progress through Persia, Egypt, Syria, Russia, Po-
land, and Prussia, appears to afford ground for the correction
of some views formerly entertained concerning it, which have
an important bearing on the measures, both of prevention and
alleviation, that are expedient to be adopted.
The extent, uniform tenor, and undoubted authority of the
cvidence obtained from observers of all classes, in different
countries and climates, and amidst all varieties of the physical,
political, and social conditions of the people, appear to discredit
the once prevalent opinion that cholera is in itself contagious;
an opinion which, if ſallacious, must be mischievous, since it
diverts attention from the true source of danger, and the real
means of protection, and fixes it on those which are imaginary;
creates panic; leads to the neglect and abandonment of the
sick; occasions great expense for what is worse than useless;
and withdraws attention from that brief but important interval
between the commencement and the development of the disease,
during which remedial measures are most effective in its cure.
Although it is so far true that certain conditions may favour
Non-Contagious Wature of Cholera. 75
its spread from person to person, as when great numbers of the
sick are crowded together in close, unventilated apartments,
yet this is not to be considered as affecting the general prin-
ciple of its non-contagious nature; nor are such conditions likely
to occur in this country; moreover, the preventive measures
founded on the theory of contagion, namely, internal quarantine
regulations, sanitary cordons, and the isolation of the sick, on
which formerly the strongest reliance was placed, have been re-
cently abandoned in all countries where cholera has appeared,
from the general experience of their inefficiency.
The evidence also proves, that cholera almost always affords,
by premonitory symptoms, warning of its approach, in time for
the employment of means capable of arresting its progress.
If, indeed, in certain situations, as where there is an unusual
concentration of the poison, or in certain individuals who are
peculiarly predisposed to the disease, the attack may appear
sometimes to be instantaneous, still the general conclusions,
that cholera is not in itself contagious, and that it commonly
gives distinct warning of its approach, are two great facts well
calculated to divest this disease of its chief terrors, and to show
the paramount importance of the means of prevention, so much
more certain than those of cure.
The proved identity of the causes which promote the origin
and spread of epidemic diseases in general, with those that
favour the introduction and spread of Asiastic Cholera, appear
to indicate the true measures of precaution and prevention
against a pestilence which, after an absence of sixteen years,
and at a season when other formidable epidemic diseases are
unusually prevalent and deadly, menaces a third visitation ;
and the General Board of Health would appeal to all classes
for their cordial co-operation in carrying into effect the mea-
sures which careful consideration has led them to recommend,
in the full conviction that the powers given by the Legislature
for this purpose, though they may not be fully adequate, and
though the time to use them may be short, cannot fail, with
such co-operation to be attended with highly beneficial results.
With a view of carrying into operation all available means
of precaution against the impending danger, the General Board
of Health recommends, that the Guardians of the Poor in
England and Wales, and the Parochial Boards for the manage-
ment of the Poor in Scotland, and their officers, should hold
themselves in readiness to execute such directions as the Gene-
ral Board of Health may see fit to issue from time to time,
under the provisions of the Act of the 11th and 12th Vict.
c. 123, entituled “An Act to renew and amend an Act of the
tenth year of Her present Majesty, for the more speedy re-
moval of certain Nuisances and the prevention of Contagious
and Epidemic Diseases.” -
G 2
76 JHouse to House Visitation.
The Guardians of the Poor and the Parochial Boards will
probably be required, eith, r by themselves individually or b
persons cmployed or to be specially appointed by them for the
purpose, to make examinations from house to house of their
several districts, and report to their Boards upon the state of
each locality as far as regards the prevalent sickness, and the
removable causes upon which it may appear to depend. These
visitations from house to house will be especially required in
the dangerous districts; and it is to be kept in view, that every
district or place is dangerous in which typhus and other epi-
demic diseases have regularly occurred.
The Boards of Guardians and Parochial Boards will have to
put in force, whenever it may appear to be required, those pro-
visions of the Act that relate to nuisances.
Great benefit having been derived from the cleansings that
were resorted to on the former visitation of Cholera, and
experience having shown that preventive measures against
Cholera are also preventive against typhus and other epidemic
and endemic diseases, the Boards of Guardians should carry
into immediate effect all practical measures of external and
internal cleansing of dwellings in the ill-conditioned districts.
The chief predisposing causes of every epidemic, and especially
of Cholera, are damp, moisture, filth, animal and vegetable
matters in a state of decomposition, and, in general, whatever
º: atmospheric impurity; all of which have the effect of
owering the health and vigour of the system, and of increasing
the susceptibility to disease, particularly among the young, the
aged, and the feeble.
The attacks of Cholera are uniformly found to be most fre-
quent and virulent in low-lying districts, on the banks of rivers,
in the neighbourhood of sewer mouths, and wherever there
are large collections of refuse, particularly amidst human dwell-
ings. In a recent Proclamation, issued for the protection of
the population of the Russian cmpire, the important influence
of these and similar causes has been lº, and the prac-
tical recommendations foundcd thercon are “to keep the per-
son and the dwelling place clean, to allow of no sinks close to
the house, to admit of no poultry or animals within the house,
to keep every apartment as airy as possible by ventilation, and
to prevent crowding wherever there are sick.”
Householders of all classes should be warned, that their first
means of safety lics in the removal of dung-heaps and solid and
liquid filth of every description from beneath or about their
houses and premises. Though persons long familiarized to the
presence of such refuse may not perceive its offensiveness, nor
believe in its noxious properties, yet all who desire to scCure
themselves from danger should labour for the entire removal
of filth and the thorough cleansing of their premises; which
Cleansing and other Preventive Measures. 77
also the law will require of each person for the protection of
his neighbours, as well as for his own safety.
Next to the perfect cleansing of the premises, dryness ought
to be carefully promoted, which will of course require the
keeping up of sufficient fires, particularly in damp and
unhealthy districts, where this means should be resorted
to for the sake of ventilation as well as of warmth and dry-
TiCSS.
From information recently obtained from Russia, it appears
that in some barracks, and in other places in which large
numbers of people are congregated, where these conditions
have been attended to in a manner that may be equally prac-
tised in private houses, there has been a comparative immunity
from the prevailing epidemic, exactly as in this country, where,
in public institutions, though as yet by no means perfect in the
means of ventilation, there has been an almost entire exemption
from epidemics which have ravaged private houses in the very
same districts.
But while a certain amount of cleansing can be effected by
every householder, each in his own premises, the means of
thoroughly purifying the densely populated districts are beyond
the power of private individuals.
Accordingly, by the recent Act, 11 & 12 Vict. c. 123, s. 1,
in cases of inability, insufficiency, or neglect, the law has
charged the cleansing operations upon certain public bodies,
namely, “the Town Councils, or any Trustees or Commissioners
for the drainage, paving, lighting, or cleansing, or managing,
or directing the police, or any other body of a like nature, or
any Commissioners of Sewers, or Guardians of the Poor.”
By this Act it is provided, that upon notice in writing, signed
by two or more inhabitant householders, that any dwelling-
house or building is in a filthy and unwholesome condition, or
that there are upon such premises any foul and offensive cesspool,
drain, gutter, or ditch, or any accumulations of filth, or that
swine are so kept as to be a nuisance or injurious to health, the
authorities shall examine or cause the premises to be examined;
and if upon examination, or upon a medical certificate of two
legally qualified practitioners, it appears that the nuisance
exists, the public authority shall make complaint before two
justices, who are required to make order for the removal of such
nuisance. The amended provisions contained in this Act should
be early considered, promulgated, and enforced, especially those
for the proper cleansing of open and foul ditches near habit-
ations, by the labourers under the direction of Surveyors or
Trustees of Highways.
The Union Medical Officers, whose duties take them to the
relief of the destitute sick, are necessarily familiar with the
places in which disease is most prevalent and fatal, and these
78 Classes capable of affording Assistance.
are invariably found to be the dirtiest localities, where, con-
sequently, the cleansing operations are most required; and the
Nuisances Removal Act imposes upon the Guardians the duty
of directing and enforcing the proper performance of these
operations.
In several districts the police, in going their usual rounds,
have been employed with great advantage in reporting daily as
to the houses, courts, alleys, passages, and streets within their
district most in need of cleansing, as to the carelessness or
neglect of the scavengers in the performance of their duties, and
as to the existence of nuisances of various kinds. The 13oards
of Guardians, or Special Committees formed out of their body,
are therefore recommended to associate themselves with Special
Committees of Town Councils, who, by their Watch Com-
mittees, have the control of the police, and to engage for these
purposes the valuable services of this force.
THighly important services have been rendered by the paro-
chial clergy and other ministers of religion, in association with
lay committees, for the purpose of maintaining a system of
house-to-house visitation in the more depressed districts; and,
wherever it is practicable, the Boards of Guardians are recom-
mended to associate with a special committee of their own
number (who for the time may be exempted from ordinary
duties) the clergy of the respective parishes, and the ministers
of other religious denominations, and to call upon the medical
and other union officers to give their aid to this committee.
It is conceived that such Parochial Special Committee would,
among other useful purposes, be peculiarly serviceable in com-
municating information to the poorer classes as to the particular
means of prevention within their reach, and as to the urgent
necessity, at this season, of personal and household cleanliness,
of ventilation, and of a careful and temperate mode of living.
By the Contagious Diseases Prevention Act, the General
Board of Health is required to frame rules and regulations to
assist and direct the Guardians of the Poor and other local
authorities in the performance of the special duties imposed
upon them whenever the country is visited or threatened by
any ſormidable epidemic or contagious disease; and accordingly
the Board has lost no time in putting itself in communication
with the Poor Law Commissioners, with the view of taking all
practical precautions against the scourge which is so steadily
approaching our shores; and the Board is now engaged in
preparing regulations for the more public and general measures
of prevention and alleviation, which will be issued and put
in execution in the several districts as soon as their par-
ticular condition shall have been ascertained.
In the mean time, if notwithstanding every precautionary
measure which can be taken, this disease should unhappily
Premonitory Symptoms. 79
break out in any district, then it will be essential to the safety
of the inhabitants that they should be fully impressed with the
importance of paying instant attention to the premonitory
symptom that announces the commencement of the attack.
This premonitory symptom is looseness of the bowels, which
there is reason to regard as universally preceding the setting
in of the more dangerous state of the disease. Sometimes,
indeed, under the circumstances already described, namely,
where the poison exists in unusual intensity, or the constitu-
tional predisposition is unusually great, the first stage may
appear to be suppressed, as occasionally happens in violent
attacks of other diseases; but in Cholera this event is so rare
as to be practically of no account; and in all countries, and
under all varieties of conditions in which this disease has been
epidemic, the experience as to this point uniformly agrees with
what is observed at the present moment at Hamburgh.
“In most cases,” writes the British Consul, respecting the
epidemic which has just broken out in that city, “the disease
has first manifested itself in a slight relaxation of the bowels,
which, if promptly attended to, the patient generally recovers ;
but if the symptoms are neglected, spasmodic attacks ensue, and
death follows mostly in from four to six hours.
This looseness of the bowels may be accompanied with some
degree of pain, which, however, is generally slight; but in
many cases pain is wholly absent; and for some hours, and
even days, this bowel-complaint may be so slight as to appear
trifling; so that, without a previous knowledge of the im-
portance of the warning, it might easily escape notice al-
together.
It must be repeated, however, that whenever Asiatic Cholera
is epidemic, the slightest degree of looseness of the bowels
ought to be regarded and treated as the commencement of the
disease, which at this stage is capable of being arrested by
simple means; but, if neglected only for a few hours, may sud-
denly assume a fatal form.
It will be indispensable, therefore, on the first outbreak of
Cholera, that the local authorities should immediately make
arrangements for daily house-to-house inspections of the poorer
localities in their respective districts; this being the only
practical means by which, in the most dangerous situations,
and among the most susceptible subjects, the existence of the
premonitory symptom can be ascertained in time to administer
the proper remedies, so as to arrest the progress of the disorder.
#. of families, masters of schools and workhouses, pro-
prietors of large establishments and works, such as factories,
mines, warehouses, wharfs and docks, should either be their
own inspectors, or employ some trustworthy agent to examine
daily every person in their employment, and to give at once
S0 Provision for Cases of Destitution.
the proper remedy, if the premonitory symptom should be
present.
Each member of the Visiting Committee should be provided
with proper remedies, prepared in appropriate doses for ad-
ministration on the spot, in every instance in which the pre-
monitory symptom is found to exist; and should report every
person so treated as requiring the instant attention of the
medical officer.
Dispensaries for bowel-complaints should be established at
convenient stations, at which the meighbouring inhabitants may
apply for the proper remedies and advice the moment they are
attacked by the premonitory symptom.
Experience having shown that the establishment of Cholera
hospitals was not successful, the best provision practicable must
be made for affording assistance to the individuals who may
need it at their own houses; and one of the best modes of
effecting this object will probably be the selection of proper
persons who may be instructed as nurses in the special services
required on this occasion, and paid for devoting their whole
time to attendance on the sick at their own habitations, under
the direction of the medical officers.
It will also be necessary to engage a sufficient number of
medical officers at suitable remuneration, some to devote their
whole time by day and night to the service of the dispensaries,
and others to attend the sick at their own dwellings.
As, however, cases may occur of extreme destitution in
neighbourhoods and houses wholly unfit for the curative treat-
ment of the sick, provision should be made for the reception of
such cases, either in the common hospitals, in the union houses,
or in separate apartments specially prepared for the purpose,
and properly warmed and ventilated.
Medical authorities are agreed that the remedies proper for
the premonitory symptom are the same as those found efficacious
in common diarrhoea; that the most simple remedies will suffice,
if given on the first manifestation of this symptom; and that
the following, which are within the reach and management of
every one, may be regarded as among the most useful, namely,
twenty grains of opiate confection, mixed with two table-spoon-
fuls of peppermint-water, or with a little weak brandy and water
and repeated every three or four hours, or oftener, if the attack
is severe, until the looseness of the bowels is stopped; or an
ounce of the compound chalk mixture, with ten or fifteen grains
of the aromatic conſection, and from five to ten drops of lauda-
num, repeated in the same manner. From half a drachm to a
drachm of tincture of catechu may be added to this last, if the
attack is severe.
Half these quantities should be given to young persons under
fifteen, and still smaller doses to infants.
Proper Food, Regimen, and Clothing. 81
It is recommended to repeat these remedies night and morn-
ing, for some days after the looseness of the bowels has been
stopped. But, in all cases, it is desirable, whenever practicable,
that even in this earliest stage of the disorder, recourse should
be had to medical advice on the spot.
Next in importance to the immediate employment of such
remedies is attention to proper diet and clothing. Whenever
Asiatic Cholera is epidemic, there is invariably found among
great numbers of the inhabitants an extraordinary tendency to
irritation of the bowels; and this fact suggests, that every
article of food which is known to favour a relaxed state of the
bowels should, as far as possible, be avoided—such as every
variety of green vegetable, whether cooked or not, as cucumber
and salad. It will be important also to abstain from fruit of
all kinds, though ripe and even cooked, and whether dried or
preserved. The most wholesome articles of vegetable diet are—
well-baked, but not new, bread, rice, oatmeal, and good potatoes.
Pickles should be avoided. Articles of food and drink which,
in ordinary seasons, are generally wholesome, and agree well
with the individual constitution, may under this unusual con-
dition, prove highly dangerous. The diet should be solid
rather than fluid ; and those who have the means of choosing,
should live principally on animal food, as affording the most
concentrated and invigorating diet; avoiding salted and smoked
meats, pork, salted and shell-fish, cider, perry, ginger-beer,
lemonade, acid liquors of all descriptions, and ardent spirits.
Great moderation, both in food and drink, is absolutely essen-
tial to safety, DURING THE WHOLE DURATION OF THE EPIDEMIC
PERIOD. One single act of indiscretion has, in many instances,
been followed by a speedy and fatal attack. The intervals be-
tween the meals should not be long; Cholera being uniformly
found to prevail with extraordinary intensity among the classes
that observe the protracted fasts common in Eastern and some
European countries.
The practical importance of these cautions might be illus-
trated by striking examples. Dr. Adair Crawford states, that
in Russia the most intense of all the attacks were those that
followed a hearty meal, taken immediately after a protracted
fast. In our own country, during its former visitation, the
most frequent and deadly attacks were observed to be those
that took place in the middle of the night, a few hours after
a heavy supper. The three fatal cases that have just occurred
to sailors who had been at Hamburgh, and who were brought
sick to Hull, turned out on inquiry to have followed very
shortly after the men had eaten a large quantity of plums, and
had drunk freely of sour becr; and the two still more recent
fatal cases on board the ship “Volant,” of Sunderland, both oc-
curred in drunkards, who persisted in the practice of intoxication,
82 Measures to be taken at the Moment of Seizure.
notwithstanding the earnest warnings that were given them
against the dangers of intemperance.
On account of the intimate connexion between the cyternal
skin and the internal lining membrane of the bowels, warm
clothing is of great importance. The wearing of flannel next
the skin is therefore advisable. Recent oxperience on the Con-
tinent secms to show, that it was useful to wear in the day-time
a flannel bandage round the body, and this may become neces-
sary in our own country during the damp and cold weather of
the approaching season.
Particular attention should be paid to keeping the ſect warm
and dry ; changing the clothes immediately after exposure to
wet; and maintaining the sitting and bed-rooms well aired, dry,
and warm.
It may be necessary to add a caution against the use of cold
purgative medicines, such as salts, particularly Glauber salts,
Epsom salis, and Seidlitz powders, which taken in any quantity,
in such a season, are dangerous. Drastic purgatives of all
kinds should be avoided, such as senna, colocynth, and aloes,
except under special medical direction.
If, notwithstanding these precautionary measures, a person
is seized suddenly with cold, giddiness, nausea, vomiting, and
cramps, under circumstances in which instant medical assistance
cannot be procured, the concurrent testimony of the most expe-
rienced medical authority shows that the proper course is to
get as soon as possible into a warm bed; to apply warmth by
means of heated flannel, or bottles filled with hot water, or
bags of heated camomile flowers, sand, bran, or salt, to the feet
and along the spine; to have the extremities diligently rubbed ;
to apply a large poultice of mustard and vinegar over the
region of the stomach, keeping it on ſifteen or twenty minutes;
and to take every half hour a tea-spoonful of sal volatile in a
little hot water, or a dessert spoonful of brandy in a little hot
water, or a wine-glass of hot wine whey, made by pouring
a wine-glass of sherry into a tumbler of hot milk: in a word,
to do everything practicalle to procure a warm, general
perspiration until the arrival of the medical attendant, whose
immediate care, under such circumstances, is indispensable.
It has not been deemed necessary or proper to give instruc-
tions for the treatment of the advanced stage, from the conſident
expectation that the proposed arrangements will supply medical
attendance to all cases that may reach that condition, by which
means the specific symptoms of each individual case will receive
their appropriate treatment.
Though the season of danger may demand some extraordinary
exertion and sacrifice on the part of all classes, yet this period
will probably not be protracted, since, on the former visitation
of cholera, it seldom remained in any place which it attacked
I?egulations of the General Board of Health. 83
longer than a few months, and rarely more than a few weeks;
while it may be reasonably expected that the improvements
cffected with a view to check its progress will be equally effica-
cious in shortening its duration; and that these improvements
will not be temporary like the occasion that called for them,
but will be attended with lasting benefit.
In conclusion, the General Board of Health would again
urge the consideration, that whatever is preventive of cholera
is equally preventive of typhus and of every other epidemic
and constantly recurring disease ; and would earnestly call the
attention of all classes to the striking and consoling fact that,
formidable as this malady is in its intense form and developed
stage, there is no disease against which it is in our power to
take such effectual precaution, both as collective communities
and private individuals, by vigilant attention to it in its first
or premonitory stage, and by the removal of those agencies
which are known to promote the spread of all epidemic diseases.
Though, therefore, the issues of events are not in our hands,
there is ground for hope and even confidence in the sustained
and resolute employment of the means of protection which ex-
perience and science have now placed within our reach.
By order of the General Board of Health,
HENRY AUSTIN, Secretary.
III. REGULATIONS OF THE GENERAL BOARD OF HEALTH.
To the Guardians of the Poor of the several Unions and Parishes
named in the Schedules hereunto amnea cd ;
To the Councils and other Governing Bodies of Cities and Boroughs,
Commissioners under Local Acts, the Surveyors of Highways,
their Deputies and Assistants, the Trustees, County Surveyors
and others, by Law intrusted with the Care and Management of
the Streets and Public JP'ays and Places within the said Unions
and Parishes ;
To the Owner and Occupiers of Houses, Dwellings, Churches,
Buildings, and Places of Assembly within the said Unions and
Parishes, and others having the Care and Ordering thereof;
And to all to whom it may concern.
WHEREAS by the provisions of the “Nuisances Removal and
biseases Prevention Act, 184S,” for the prevention of epidemic,
endemic, and contagious diseases, and by virtue of an order of
the Lords of Her Majesty’s Most Honourable Privy Council,
bearing date the 28th day of September, 18 IS, directing that
84 Regulations of General Board of Health
the said provisions of the said Act be put in force throughout
the whole of Great Britain, We, the General Board of Health,
are authorized to issue such directions and regulations as the
said Board shall think fit for the prevention (as far as possible)
or mitigation of epidemic, endemic, or contagious diseases;
and whereas by the said Act it is provided that the directions
and regulations to be issued as aforesaid shall extend to all
parts or places in which the said provisions of the said Act shall
for the time being be in force, under the order of Her Majesty's
Privy Council, unless such directions or regulations shall be
expressly confined to some of such parts or places, and them to
such parts or places as in such directions and regulations shall
be specified.
Now in exercise of the authority vested in us as aforesaid,
we, the General Board of Health, do issue the directions and
regulations hereinafter contained, to extend to all parts and
places within the several unions and parishes named in the
schedules hereunto annexed, and to all extra-parochial places
adjoining to such unions and parishes, viz.:-
I. We direct that all councils and other governing bodies of
cities and boroughs, commissioners under local acts, surveyors,
and district or assistant surveyors of highways, trustecs, county
surveyors, and others, by law intrusted with the cure and
management of the streets, and public ways, and places within
the parts or places to which these directions and regulations
extend, shall once at least in every twenty-four hours effectually
cleanse all such of the streets, rows, lames, mews, courts,
alleys, and passages, and public ways and places, under their
respective care and management, as by the medical officer of
the guardians, or others authorized to superintend the execution
of this direction and regulation, shall be certified in writing
to be in a state dangerous to health, or to require frequent
and effectual cleansing by way of precaution against disease,
and shall remove all filth, ordure, and nuisances therefrom.
II. And where any such streets, rows, lames, mews, courts,
alleys, and any passages, public ways, or places, to which any
houses or tenements adjoin, which have not been intrusted by
law to the care or management of any council, commissioners,
surveyors, trustees, or others, have been certified in writing,
by such medical officer as aforesaid, to be in a state dangerous
to health, or to require such frequent and effectual cleansing,
we direct that every occupier of a house or tenement so adjoin-
ing shall keep or cause to be kept sufficiently cleansed, at least
once in every twenty-four hours, such part of the street, row,
lane, mews, court, alley, or passage, way, or place as adjoins the
house or tenement occupied by him.
And we direct that all such works of cleansing and removal
of filth, ordure, and nuisances as are required by these directions
as to Erternal Cleansing. S5
and regulations shall be done in such manner by effectual
washing or otherwise, and with the use of such fluids or sub-
stances for preventing the cscape of noxious effluvia during the
operation as the medical officer of the guardians or others au-
thorized to superintend the execution of these directions and
regulations shall think necessary and shall direct. -
III. We do hereby authorize and require the guardians of
the said unions and parishes, by themselves or by their officers
or persons employed under them in the administration of the
laws for the relief of the poor, or by officers or persons specially
appointed in this behalf, to superintend and see to the execution
of the foregoing directions and regulations within their respective
unions and parishes, and in any extra-parochial places adjoining
thereto respectively.
IV. And, further, where it shall appear that by want or
neglect of the council of any city, or borough, commissioners,
surveyors, trustees, or others intrusted with the care and ma-
magement as aforesaid, or by reason of poverty of the occupiers
or otherwise, there may be any default or delay in the cleansing
of or removing nuisances from any street, row, lame, mews, court,
alley, passage, or public way, or place certified as aforesaid,
within any of the said unions and parishes, or any extra-
parochial place adjoining thereto, we authorize and require the
guardians of such union or parish to cause such street, row,
lane, mews, court, alley, passage, way, or place to be effectually
cleansed, and all nuisances to be removed therefrom, and to do
all acts, matters, and things necessary for that purpose.
W. We also direct as follows:—
That,
When and so often as any dwelling-house in any part or
place to which these directions and regulations extend is
in such a filthy and unwholesome condition as to be a
nuisance to, or injurious to the health of any person; or
Where upon any premises, or any part or place as aforc-
said, there is any foul and offensive drain, ditch, gutter,
privy, cesspool or ashpit, or any drain, ditch, gutter, privy,
cesspool or ashpit, kept or constructed so as to be a nuisance
to or injurious to the health of any person; or
Where upon any such premises swine or any accumula-
tion of dung, manure, offal, filth, refuse, or other matter
or thing is kept so as to be a nuisance to or injurious to the
health of any person; or
Where upon any such premises (being a building used
wholly or in part as a dwelling-house), or being premises
underneath any such building, any animal is kept so as to
be a nuisance or injurious to the health of any person;
In each of the above-recited cases the owner or occupier,
and persons having the care or ordering of such dwelling-house,
86 Regulations of General Board of Health
or of the premises where the nuisance or matter injurious to
health may be, shall cleanse, whitewash, or otherwise purify, as
the case may require, such dwelling-house or building; or abate
or remove the nuisance or matter injurious to health as afore-
said; with all reasonable speed after the publication of these
our directions and regulations, or after the nuisance or matter
injurious to health shall have arisen.
VI. In case, by reason of poverty or otherwise, the occupier
of any such dwelling-house or premises is unable to perform
any works required by these directions or regulations, such
occupier shall give notice of such his inability to the guardians
of the union or parish comprising the place wherein the premises
shall be situated.
VII. We authorize and require the guardians aforesaid, by
themselves or by officers by them authorized in this behalf,
To see to the cxecution of the directions hereinbefore
contained for the cleansing and purifying of dwelling-houses,
and for the abatement and removal of nuisances and matters
injurious to health, in every case in which there shall not
be a council or other governing body of a city or borough,
or commissioners having jurisdiction for the removal of
nuisances, or where such council, governing body, or com-
missioners shall not cause to be effectually executed such
directions; and for that purpose
To visit, from time to time, or cause to be visited, the
several dwellings and places where there may be ground for
believing that necessity will arise for executing such di-
rections.
VIII And in every case in which, from the poverty of oc-
cupiers or otherwise, there may be default or delay in the
cleansing or purifying of any such dwelling-house, or in tho
abatement or removal of any such nuisance or matter injurious
to health, and the medical officer, or other person duly au-
thorized as aforesaid, shall certify that the same requires in-
mediate attention,
We authorize and require such guardians to cause such dwell-
ing-houses to be cleansed and purified, and such drain, ditch,
watercourse, or gutter, to be frequently and effectually cleansed,
and such nuisance or matter injurious to health to be abated
and removed respectively, and to do all acts and provide all
matters and things necessary for that purpose.
IX. And we do further authorize and require the guardians
to direct their clerk to make out from the register of deaths, or
from the district medical relief books, and from any public
books or other sources from which information may be obtained
within the union or parish, a list of places where epidemic, en-
demic, and contagious diseases have of late been frequent.
as to Duties of Medical Officers. 87
X. And we authorize and require such guardians to cause
the medical officers employed by them, or specially appointed
for the purpose, to visit the places, of which a list shall be made
out as aforesaid, and all such neighbouring and other places
within such union, as shall appear to such medical officers (from
being under like circumstances with the places included in such
list or otherwise) to require visitation or examination.
XI. And each such medical officer shall, where it may be
necessary, certify in writing to the board of guardians, and to
the surveyors, trustees, occupiers, or others required to execute
these directions and regulations, all such places as are in a state
dangerous to health, or need frequent and effectual cleansing
by way of preservation against disease, and such dwelling-
houses as are in a filthy and unwholesome condition, and all
such nuisances and matters injurious to health as ought to be
abated, cleansed, and removed under these regulations.
XII. And each such medical officer shall forthwith, upon any
case of Cholera, or of typhus, or other epidemic, endemic, and
contagious diseases becoming known to him within the parish,
union, or district under his visitation, report the same to the
board of guardians.
XIII. And we do hereby authorize and direct the said guar-
dians, where it may appear needful, to appoint such additional
medical officers, and also to appoint such other officers as may
be necessary to execute and superintend the execution of these
regulations, and to publish and circulate, by printed hand bills
or other means, notices of the provisions of the said Act for the
prevention of nuisances, and of our regulations and instructions,
or of such part of any of them as it may appear desirable to
make publicly known.
XIV. And we hereby direct that in these directions and
regulations, the words “guardians of the poor' shall mean the
guardians, directors, wardens, governors, or other like officers
having the management of the poor for any union, parish, or
place, where the matter requiring the cognizance of any such
officers arises; and the word “parish" shall include every place
where the relief of the poor is administered by a board of
guardians for such place.
88
Names of Unions to which preceding
SCHEDULE I., containing the Names of the Unions to which
the present Directions and Regulations apply :—
Aberaeron
Abergavenny
Aberystwith
Abingdon
Albans, St.
Alcester
Alderbury
Alnwick
Alresford
Alton
Altrincham
Amersham
Amesbury
Ampthill
Andover
Anglesey
Asaph, St.
Ashbourne
Ashby-de-la-Zouch
Ashford, East
Ashford, West
Ashton-under-Lyne
Aston
Atcham
Atherstone
Aucklaud
Austel, St.
Axbridge
Axminster
Aylesbury "
Aylesford, North
Aylsham,
Bakewell
Bala
Banbury
Bangor and Beaumaris
Barnet
Barnstaple
Barrow-upon-Soar
Basford
Basingstoke
Bath
Battle
Beaminster
Bedale
Bedford '
Bedminster
Belford
Bellingham
Belper
Berkhampstead
Berwick-upon-Tweed
Beverley
Bicester
Bideford
Brierley, North
Biggleswade
Billericay
Billesdon,
Bingham
Bishop's Stortſord
Blaby
Blackburn
Blandford
Blean
Blofield
Blything
Bodmin
Bolton
Bootle
Bosmere and Claydon
Boston
Boughton, Great
Bourn
Brackley
Bradfield
Bradford (Wilts)
Bradford (York)
Braintree
Brampton
Brecknock
Brentford
Bridge
Bridgend and Cowblidge
Bridgwater
Bridgnorth
Bridlington
Bridport
Bristol
Brixworth
Bromley
Bromsgrove
Bromyard
Buckingham
Builth
Buntingſord
Burnley
Burton-upon-Trent
Bury
Bury St. Edmunds
Caistor
Calne
Cambridg
Camelford
Canterbury
Cardiff
Cardigan
Carlisle
Carmarthen
Carnarvon
Castle Ward
Catherington
Caxton and Arrington
Cernie
Chailey
| Chapel-en-le-Frith
Chard
Cheadle
Chelmsford
Cheltenham
Chepstow
Chertsey
Chester
Chesterfield
Chester-le-Street
Chesterton
Chichester
Chippenham
Chipping Norton
Chipping Sodhury
Chorley
Chorlton
Christchurch
Church Stretton
Cirencester
Cleobury Mortimer
Clitſon
Clitheroe
Clun
Clutton
Cockermouth
Colchester
Columb, St., Major
Congleton
Conway
Cookham
Corwen
Cosſord
Coventry
Cranbrook
Crediton
Crickhowel
Cricklade and Wootton
Bassett,
Croydon
Cuckfield
Darlington
Dartford
Daventry
Depwade
Derby
Devizes
Dewsbury
Docking
Dolgelly
Doncaster
Dorchester
Dore
Dorking
Dover
Downham
Drayton
Driffield
Droitwich
Droxford
Dulverton
Dunmow
Durham
Dursley,
Directions and Regulations apply. 89
Easington
Easingwold
Eastbourne
East Grinstead
Tºasthampstead
Iºast Retford
£astry
East Ward
Eccleshall Bierlow
Edmonton
Elham
Ellesmere
Ely
Epping
Epsom
Erpingham
Eton
Evesham
Exeter
Faith, St.
Falmouth
Fareham
Faringdon
Farnham
Faversham
Festiniog
Flegg, East aud West
Foleshill
Fordingbridge
Forehoe
Freebridge Lynn
Frome
Fulham
Fylde, The
Gainsborough
Garstang
German's, St.
Giles, St., in the Fields,
and St. George, Blooms-
bury
Glandford Brigg
Glendale
Glossop
Gloucester
Godstone
Goole
Grantham
Gravesend and Milton
Greenwich
Guildford
Guiltcross
Guisborough
Hackney
Hailsham
IHalifax
Halsted
Haltwhistle
Hambledon
Hardingstone
Hartismere
Hartly Wintney
Haslingden
Hastings
Hatfield
Havant
Haverford West
IIay
Hayfield
Headington
Helmsley Blackmoor
Helston
Hemel Hempstead
Hendou
Henley
Henstead
Hereford
Hertford
Hexham
Highworth and Swindon
Hinckley
Hitchin
Holbeach
Holborn
Hollingbourn
Holsworthy
Holywell
Homiton
Hoo
Horncastle
Horsham
Houghton-le-Spring
Howden
Hoxne
Huddersfield
Hungerford
Huntingdon
Hursley
Ipswich
Ives, St.
Keighley
Kendal
Kettering
Keynshann
Kidderrainster
Kingsbridge
Kingsclere
King's Lynn
King's Norton
Kingston-upon-Thames
Kington
Kirby Moorside
Kuighton
Lampeter
Laitcaster
Lanchester
Langport
Launceston
Ledbury
Leek
Leicester
Leigh
Leighton Buzzard
Leominster
Lewes
Lewisham
Lexden and Winstree
Leyburn
J.ichfield
Lincoln
Linton
Liskeard
Llandilo Fawr
Llandovery
Llanelly
Llanfylliu
Llanrwst
Loddon and Clavering
London, City of
London, East
London, West
Longtown
Loughborough
Louth
Ludlow
Luton
Lutterworth
Lymington
Macclesfield
Machynlleth
Madeley
Maidstone
Maldon
Malling
Malmsbury
Malton
Manchester
Mansfield
Market Bosworth
Market Harborough
Marlborough
Martley
Medway
Melksham
Melton Mowbray
Mere
Meriden
Merthyr Tidvil
Midhurst
Mildenhall
Milton
Mitford and Launditch
Monmouth
Montgomery and Pool
Morpeth
Mutford and Lothingland
Nantwich
Narberth
Neath
Neots, St.
Newark
Newbury
Newcastle-in-Enlyu
Newcastle-under-Lyme
Newent
New Forest
Newhaven
Newmarket
90
Newport (Monmouth)
Newport (Salop)
Newport Pagmell
Newton Abbot
Newtown and Llanidloes
Northallerton
Northampton
Northleach
Northwich
North Witchford
Norwich
Nottingham
Nuneaton
Oakham
Okehampton
Olave's, St.
Oldham
Ongar
Ormskirk
Orsett
Oswestry
Oundle
Oxford
Pateley Bridge
Patrington
Pembroke
Penkridge
IPenrith
Penzance
Pershore
I’eterborough
Petersfield
Petworth
Pewsey
IPickering
Plomesgate
Plymouth
Plympton, St. Mary
Pocklington
Pont-y-Pool
Poole
Poplar
Portsea Island
Potterspury
Prescot
Presteigne
Preston
Pwllheli
Radford
Reading
Redruth
Reeth
Reigate
Rhayadar
Richmond (Surrey)
Richmond (York)
Ringwood
Risbridge
Tochdale
Rochford
Romford
Romney Marsh
Romsey
Ross
Rothbury
Rotherham
Royston
Rugby
Runcorn
Ruthin
Rye
Saffron Walden -
St. Margaret and St. John
the Evangelist, West-
minster
Salisbury, otherwise New
Sarum
Salford
Samford
Saviour's, St.
Scarborough
Sculcoates
Sedbergh
Sedgefield
Seisdon
Selby
Settle
Sevenoaks
Shaftesbury
| Shardlow
Sheffield
Sheppey
Shepton Mallet
Sherborne
Shiffnal
Shipston-upon-Stour
Shrewsbury
Skipton
Skirlaugh
Sleaford
Solihull
Southam
Southampton
South Molton
South Shields
South Stoneham
Southwell
Spalding
Spilsby
Stafford
Staines
Stamford
Stepney
Steyning
Stockbridge
Stockport
Stockton
Stokesley
Stone
Stourbridge
Stow
Stow-on-the-Wold
Strand
Stratford-upon-Avon
Stratton
Stroud
'Names of Unions to which preceding
Sturminster
Sudbury
Swaffham
Swansea.
Tamworth
Taunton
Tavistock
Teesdale
Tembury
Tendring
Tenterden
Tetbury
Tewkesbury
Thakeham
Thame
Thanet, Isle of
Thetford
Thingoe
Thirsk
Thomas, St.
Thornbury
Thorne
Thrapston
Ticehurst
Tisbury
Tiverton
Todmorden
Tonbridge
Torrington
Totnes
Towcester
Tregaron
Truro
Tunstead and Happing . .
Tynemouth
Uckfield
Ulverstone
Uppingham
Uptom-upon-Severn
Uttoxeter
Uxbridge
Wakefield
Wallingford
Walsal
Walsingham
Wandsworth and Clap-
ham
Wangford
Wantage
Ware
Wareham and Purbeck
Warminster
Warrington
Warwick
Watſord
Wayland
Weardale
Wellinborough
Wellington (Salop)
Wellington º
Wells
Welwyn
Directions and Regulations apply. 91
Wein Whitchurch (South- Wisbeach
Weobly ampton) Witham
Westbourne Whitechapel Witney
West Bromwich Whitehaven Woburn
Westbury-upon-Severn Wigan Wokingham
Westbury and Whorwels- || Wight, Isle of Wolstanton and Burslem
down Wigton Woodbridge
West Derby Williton Woodstock
West Firle Wilton Worcester
West Ham Wimborne and Cranborne | Worksop
West Hampnett Wincauton Wortley
West Ward, Winchcombe Wrexham
Weymouth Winchester, New Wycombe
Wheatenhurst Windsor
Whitby Winslow Yeovil
Wirrall
SCHEDULE II., containing the Names of the Parishes to
which the present Directions and Regulations apply:—
Alston with Garrigill St. Giles, Camberwell St. Mary Magdalen, Ber-
Birmingham St. James, Clerkenwell mondsey
Brighthelmstone St. James, Westminster St. Mary, Newington
last Stonehouse St. Leonard, Shoreditch St. Mary, Rotherbiſhe
Great Yarmouth St. Luke, Chelsea St. Matthew, Bethnal
Leeds St. Luke, Middlesex Green
I.iverpool St. Martin in the Fields St. Pancras
Paddington St. Mary Abbots, Ken- || Stoke Damerell
St. George, Hanover sington Stoke-upon-Trent
Square St. Mary, Islington Whitchurch (Salop)
St. George the Martyr, St. Mary-le-Bone Whittlesea, St. Mary and
Southwark St. Mary, Lambeth St. Andrew.
St. George in the East
Given under our Hands and under the Seal of the
General Board of Health this Third Day of Novem-
ber One thousand eight hundred and forty-eight.
CARLISLE.
EDWIN CHADwick.
T. SOUTHWooD SMITH.
To the Guardians of the Poor of the several Unions named in the
Schedules hereunto amneved ;
To the Councils and other Governing Bodies of Cities and
Boroughs, Commissioners under Local Acts, the Surveyors of
Highways, their Deputies and Assistants, the Trustees, County
Surveyors, and others by law intrusted with the Care and
Management of the Streets and Public Pays and Places within
the said Unions ;
To the Owners and Occupiers of Houses, Dwellings, Churches,
Buildings, and Places of Assembly within the said Unions, and
others having the Care and Ordering thereof;
And to all to whom it may concern.
WHEREAs by the provisions of the “Nuisances Removal and
Diseases Prevention Act,” 1848, for the prevention of epi-
H 2
92 g Special Regulations
demic, endemic, and contagious diseases, and by virtue of an
order of the Lords of Her Majesty's Most Honourable Privy
Council, bearing date the 28th day of September, 1848, directing
that the said provisions of the said Act be put in force through-
out the whole of Great Britain, we the General Board of
Health are authorized to issue such directions and regulations
as the said Board shall think fit for the prevention (as far as
possible) or mitigation of epidemic, endemic, or contagious
diseases; and whereas by the said Act it is provided that the
directions and regulations to be issued as aforesaid shall extend
to all parts or places in which the said provisions of the said
Act shall for the time being be in force, under the order of
Her Majesty’s Privy Council, unless such directions or regula-
tions shall be expressly confined to some of such parts or places,
and then to such parts or places as in such directions and
regulations shall be specified:
Now in exercise of the authority vested in us as aforesaid,
we the General Board of Health do issue the directions and
regulations hereinafter contained to extend to all parts and
places within the several Unions named in the Schedules
hereunto annexed, and to all cKtra-parochial places adjoining
to such unions, viz.:-
I. We direct that all Councils and other governing bodies of
cities and boroughs, commissioners under local acts, surveyors,
and district or assistant surveyors of highways, trustees, county
surveyors, and others, by law intrusted with the care and
management of the streets and public ways, and places within
the parts or places to which these directions and regulations
extend, shall once at least in every twenty-four hours effectually
cleanse all such of the streets, rows, lanes, mews, courts, alleys,
and passages, and public ways and places under their respective
care and management, as by the medical officer of the guardians,
or others authorized to superintend the execution of this direc-
tion and regulation shall be certified in writing to be in a state
dangerous to health, or to require frequent and effectual
cleansing by way of precaution against disease; and shall
remove all filth, ordure, and nuisances therefrom.
II. And where any such streets, rows, lanes, mews, courts,
alleys, and any passages, public ways or places to, which any
houses or tenements adjoin, which have not been intrusted by:
law to the care or management of any council, commissioners,
surveyors, trustees, or others, have been certified in writing, by
such medical officer as aforesaid, to be in a state dangerous to
health, or to require such frequent and effectual cleansing, we
direct that every occupier of a house or tenement so adjoining
shall keep or cause to be kept sufficiently cleansed, at least
once in every twenty-four hours, such part of the street, row,
as to Eaternal and Internal Cleansing. 93
lane, mews, court, alley, or passage, way, or place as adjoins
the house or tenement occupied by him. .
And we direct that all such works of cleansing and removal
of filth, ordure, and nuisances as are required by these direc-
tions and regulations, shall be done in such manner by effectual
washing or otherwise, and with the use of such fluids or
substances for preventing the escape of noxious effluvia during
the operation as the medical officer of the guardians or others
authorized to superintend the execution of these directions and
regulations shall think necessary and shall direct.
III. We do hereby authorize and require the said guardians
by themselves or by their officers or persons employed under
them in the administration of the laws for the relief of the poor,
or by officers or persons specially appointed in this behalf, to
superintend and see to the execution of the foregoing directions
and regulations within their respective unions, and in any
extra-parochial places adjoining thereto respectively.
IV. And further, where it shall appear that by want or
neglect of the council of any city or borough, commissioners,
surveyors, trustees, or others intrusted with the care and
management as aforesaid, or by reason of poverty of the
occupiers or otherwise, there may be any default or delay in
the cleansing of or removing nuisances from any street, row,
lane, mews, court, alley, passage, or public way, or place
certified as aforesaid, within any of the said unions, or any
extra-parochial place adjoining thereto, we authorise and
require the guardians of such union to cause such street, row,
lane, mews, court, alley, passage, way, or place to be effectually
cleansed, and all nuisances to be removed therefrom, and to do
all acts, matters, and things necessary for that purpose.
W. We also direct as follows:—
That,
When, and so often as any dwelling-house in any part
or place to which these directions and regulations extend,
is in such a filthy and unwholesome condition as to be a
muisance to or injurious to the health of any person; or
Where upon any premises, or any part or place as
aforesaid, there is any foul and offensive drain, ditch,
gutter, privy, cesspool, or ashpit, or any drain, ditch,
gutter, privy, cesspool, or ashpit kept or constructed so
as to be a nuisance to or injurious to the health of any
person ; or
Where upon any such premises swime or any accumula :
tion of dung, manure, offal, filth, refuse, or other matter
or thing is kept, so as to be a nuisance to or injurious to
the health of any person; or
Where upon any such premises (being a building used
94 Special Regulations
wholly or in part as a dwelling-house), or being premises
underneath any such building, any animal is kept so as to
be a nuisance or injurious to the health of any person,
In each of the above-recited cases, the owner or occupier,
and persons having the care or ordering of such dwelling-house,
or of the premises where the nuisance or matter injurious to
health may be, shall cleanse, whitewash, or otherwise purify
as the case may require, such dwelling-house or building; or
abate or remove the nuisance or matter injurious to health as
aforesaid, with all reasonable speed after the publication of
these our directions and regulations, or after the nuisance or
matter injurious to health shall have arisen.
VI. In case, by reason of poverty or otherwise, the occupier
of any such dwelling-house or premises is unable to perform
any works required by these directions or regulations, such
occupier shall give notice of such his inability to the guardians
of the union, comprising the place wherein the premises shall
be situated.
VII. We authorize and require the guardians, aſoresaid by
themselves or by officers by them authorized in this behalf,
To see to the execution of the directions hereinbefore
contained for the cleansing and purifying of dwelling-
houses, and for the abatement and removal of nuisances
and matters injurious to health, in every case in which
there shall not be a council or other governing body of a
city or borough, or commissioners having jurisdiction for
the removal of nuisances, or where such council, governing
body, or commissioners shall not cause to be effectually
executed such directions; and for that purpose—
To visit ſrom time to time, or cause to be visited, the
several dwellings and places where there may be ground
for believing that necessity will arise for executing such
directions.
VIII. And in every case in which, from the poverty of
occupiers or otherwise, there may be default or delay in the
cleansing or purifying of any such dwelling-house, or in the
abatement or removal of any such nuisance or matter injurious
to health, and the medical officer or other person duly author-
ized as aforesaid, shall certiſy that the same requires immediate
attention ; and in every case in which from want of co-opera-
tion of the owners or occupiers there is any default or delay in
cleansing any such drain, ditch, watercourse, or gutter into
which several dwellings or tenements may drain ;
We authorize and require such guardians to cause such
dwelling-houses to be cleanscd and purified, and such drain,
ditch, watercourse, or gutter to be frequently and effectually
as to Duties of Medical Officers. 95
cleansed, and such nuisance or matter injurious to health to be
abated and removed respectively, and to do all acts and
provide all matters and things necessary for that purpose.
IX. And we do further authorize and require the guardians
to direct their clerk to make out from the register of deaths, or
from the district medical relief books, and from any public
books or other sources from which information may be obtained
within the union, a list of places where epidemic, endemic, and
contagious diseases have of late been frequent.
X. And we authorize and require such guardians to cause
the medical officers employed by them, or specially appointed
for the purpose, to visit the places, of which a list shall be made
out as aforesaid, and all such neighbouring and other places
within such union, as shall appear to such medical officers (from
being under like circumstances with the places included in such
list or otherwise) to require visitation or examination ;
XI. And each such medical officer shall, where it may be
necessary, certify in writing to the board of guardians, and to
the surveyors, trustees, occupiers, or others required to execute
these directions and regulations, all such places as are in a
state dangerous to health, or need frequent and effectual cleans-
ing by way of preservation against disease, and such dwelling-
houses as are in a filthy and unwholesome condition, and all
such nuisances and matters injurious to health as ought to be
abated, cleansed, and removed under these regulations.
XII. And each such medical officer shall forthwith, upon any
case of Cholera, or of typhus, or other epidemic, endemic, and
contagious diseases becoming known to him within the parish,
union, or district under his visitation, report the same to the
board of guardians.
XIII. And where it shall be certified to the guardians by
their medical officer or officers, or where it shall otherwise suf-
ficiently appear to such guardians that extraordinary medical
aid is required for persons attacked or threatened by Cholera
or epidemic, endemic, or contagious disease, we authorize and
require such guardians to provide sufficient medical aid, and,
in suitable places, such medicines as may be required within
their respective unions for necessitous persons attacked by
Cholera or by premonitory symptoms, and to make arrange-
ments for the distribution of notices, stating the places where
aid and medicines shall have been provided.
XIV. Whereas it has heretofore been found impracticable
to ensure proper treatment in their own houses to many of the
poorer classes, we authorize and require the said guardians,
where it shall appear that such extraordinary aid is required,
to provide suitable rooms or places, capable of accommodating
necessitous cases, to which persons attacked by Cholera, who cam-
not be properly treated in their own houses, may be conveyed.
96 Special Regu lations,
XV. And we also authorize and require the said guardians,
where it shall appear needful, to provide rooms or, places of re-
fuge, to which may be removed the families of such necessitous
persons as have been attacked with Cholera, and also such ne-
cessitous persons living under the same roof with, or in the
vicinity of, persons so attacked, as the medical officers acting
under the authority of the said guardians may deem, it necº-
sary to remove; and the houses, rooms, or dwellings from which
persons may have been so removed to the houses of refuge, Shºll
be cleansed and purified by the owners or persons having the
care or ordering thereof, or, in their default, by the said guar-
dians.
XVI. And on the occurrence of any case of Cholera or other
epidemic, endemic, or contagious disease, in any room occupied
by one family or more, we hereby authorize and require the
medical officer to remove, or cause to be removed, either the
patient, or so many of the occupants of such room as he shall
consider would, unless removed, tend to prevent the recovery
of the patient, or endanger the spreading of the disease. º
XVII. And in case of death by Cholera, or any other epi-
demic, endemic, or contagious disease, we hereby authorize and
require the last medical attendant upon the person of the de-
ceased, or in case of there having been no medical attendant,
the housekeeper or person present at the death, or who is in
charge of the body, forthwith to motify the fact of the death to
the medical officer of the district who is charged with the exc-
cution of these orders for the prevention of the spread of such
disease.
And we do hereby authorize such medical officer to give such
directions as may appear to him to be needful, in respect to the
care, removal, and the time of interment of the body for pre-
venting the communication or spread of disease.
And we hereby authorize and require all persons to give
such information or such assistance to such medical officer, and
to be otherwise aiding him as he may need in the execution of
these orders.
XVIII. And in the event of the fatal termination of any
case of Cholera, or of epidemic, endemic, or contagious disease,
in any room occupied as a living or sleeping-room by one family,
or more, or by numerous persons, we hereby authorize and re-
quire the medical officer to remove, or cause to be removed as
speedily as may be, either the corpse or the persons occupying
such rooms, until the corpse can be conveniently removed and
properly interred.
XIX. And we do authorize and direct the said guardians
to make arrangements for obtaining daily lists of persons at-
tacked by Cholera or other epidemic diseases within their
respective unions, with the particulars of their cases and treat-
Second Notification. 97
ment, and for communicating the same daily to the General
Board of Health.
XX. And we do hereby authorize and direct the said guar-
dians, where it may appear needful, to appoint such additional
medical officers, and also to appoint such other officers as may
be necessary to execute and superintend the execution of these
regulations, and to publish and circulate, by printed hand bills
or other means, notices of the provisions of the said Act for the
prevention of nuisances, and of our regulations and instructions,
or of such part of any of them as it may appear desirable to
make publicly known.
SCHEDULE to which this order relates.
Blandford Kingston-upon-Hull Wolverhampton
Dudley Newcastle-upon-Tyne York
Gateshead Sunderland
Given under our Hands and under the Seal of the
General Board of Health this Third Day of No-
vember One thousand eight hundred and forty-
eight.
CARLISLE.
EDWIN CHADw ICK.
T. SOUTHWOOD SMITH.
IV. SECOND NoTIFICATION OF THE GENERAL BoARD OF HEALTH
IN RESPECT TO INSTRUCTIONS ON THE ORDERS AND REGU-
I, ATIONS ISSUED UNDER THE AUTHORITY OF THE NUISANCES
REMOVAL AND DISEASEs PREVENTION ACT.
General Board of Health, Gwydyr House,
31st Öctober, 1848.
THE special object of those provisions of the Act 11 and 12
Vict. c. 123, which are brought into operation by the Order in
Council, appears to the General Board of Health to be that
measures of precaution may be taken “with promptitude, ac-
cording to the exigency of the case.”
It was clearly within the view of Parliament, that other and
more summary measures for cleansing and the removal of nui-
sances than those contained in the first and second sections of
the Act might be required, when the provisions for the preven-
tion of epidemic and contagious diseases should be called into
operation; and it has appeared to the Board to be requisite
that the duties which in ordinary times devolve upon the
owners and occupiers of dwellings, where an order of justices
98 Second Woffication.
has been obtained, should, under the threatened visitation of
postilence, be performed by the owners or occupiers, without
the previous complaint and adjudication ; and whom the poverty
of the occupier or any other cause may delay the cleansing or
the removal of the nuisance, that the guardians should at once
perform the necessary work.
Among thc results of the Sanitary inquiry, one of the most
important was that which established the identity of the track
of Cholera with the track of typhus and other epidemic dis-
cases; and as some who will be called upon to carry into effect
the orders and regulations of the General Board of Health, may
not have read the statements on this point contained in the
Reports of the Sanitary Commissioners, it may be desirable to
display the mature of the evidence on which this conclusion and
the general course of action deduced from it are founded, and to
show not only what are the true measures of prevention, but
where those measures should be specially applied.
“It is now universally known,” say the Commissioners, “that
in the metropolis, as in every town and city, the places in
which typhus is to be ſound, from which it is rarely if ever ab-
sent, and which it occasionally decimates, are the neglected and
filthy parts of it; the parts unvisited by the scavenger; the
parts which are without sewers, or which, if provided with
sewers, are without drains into them ; or which, if they
have both sewers and house drains, are without a due and re-
gulated supply of water for washing away their filth, and for
the purposes of surface-cleansing, and domestic use. The track
of typhus is everywhere marked by the extent of this domain
of filth ;” and in illustration of the fact that, in 1832, this was
equally the domain of Cholera, the following, among other in-
stances, are given.
“Cholera,” says Mr. Bowie, “first appeared in those localities
in which typhus was accustomed to prevail, taking the place of
typhus, affecting the same persons, and being influenced by the
same circuumstances.”
“Cholera raged,” says Dr. Murdoch, describing the manner
in which it spread in Rotherhithe, “in the filthy places in which
typhus ſever is always prevalent; and were cholera again to
reappear, it would follow the law of typhus and typhoid ſever,
and first visit such neighbourhoods.”
Of Southwark, Mr. Leadham says, “This was certainly one
of the districts the most severely visited by Cholera in the
metropolis. The disease prevailed chiefly in the filthy dens
which we have about us in the courts and alleys. The Cholera
track and the typhus track in this district were identical.”
Mr. Hooper, describing such places as Three Tun Court,
where there are 150 inhabitants with only one privy, and that
without a covering, the fluid soil running down the court in
Outbreak of Cholera in London. 99
front of all the houses, says, “These are the constant abodes
of ſever, and these are the places where Cholera prevailed.”
“The localitics in which typhus is constantly present,” says
Mr. Wagstaff, “are the very localities in which Cholera chiefly
raged. I have at the present moment many cases of fever in
the very places in which Cholera was most prevalent.”
Observations carefully made of the condition of the localities
in which Asiatic Cholera has again broken out in the metro-
polis, afford a striking corroboration of the evidence which, in
1832, established the identity of its track with that of fever.
The places in which the pestilence is now numbering its
first victims, are the very spots which are known to be the
filthiest in their respective districts, and to be the constant
seat of typhus and other epidemic diseases. In tracing the
individual cases reported to the General Board of Health, the
medical, inquirers, who, under the direction of the Board,
have made a special investigation of the circumstances con-
nected with the earliest attacks of the disease during its pre-
sent visitation, have been led not only to the streets, courts,
and alleys, but sometimes even to the very houses that are
notorious as “fever nests.”
As early as the middle of September, the attention of the
Board was called to a case which proved fatal in eight hours,
with the characteristic symptons of Asiatic Cholera pro-
minently marked. On examining the surgeon, Mr. William
Mutrie Fairbrother, 64, London Road, Southwark, who at-
tended the case, it appeared, that though the street and house
in which the individual lived was not more filthy than the
neighbouring streets and houses, yet that the whole district is
in a wretched condition as to want of drainage and cleanliness.
After describing the symptons which induced him to believe
that this man died of Asiatic Cholera in its intense form, Mr.
Fairbrother gives the following evidence:–“I wish particu-
larly to call your attention to another case of Cholera which
has come under my care in the same neighbourhood—the case
of a woman, who was in extreme danger many hours, being
speechless, pulseless, and affected with severer cramp than I had
ever before witnessed. This woman lived within ten yards of
an open ditch, in a horrible condition, in one of a row of houses
called Pleasant Place, from which typhus is never absent in any
part of the year; and I have at this time two very bad cases
of this disease within thirty yards of this same ditch. Close
to my own residence, there is a court within a court, from
which, ever since I have resided here, I have never known
typhus fever absent. A family still residing in one of the
houses of this court has lost four children by typhus ſever
within the last mine months; and the inhabitants of the place
in general are very unhealthy. , I may add, that diarrhoea has
:
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:
:
100 Seats of Typhus and Cholera the same.
recently been general both among children and adults; small-
pox, also, has been prevalent; scarlatina has been raging, and
I have never witnessed so severe a form of this disease, which
has proved unusually and very rapidly fatal, and great num-
bers who have struggled through the stage of fever have died
of the dropsy that has supervened upon it. In one district, in
the immediate neighbourhood of Uxbridge Street, Newington
Causeway, there is scarcely a child in any house that has
escaped an attack of this disease. In one of the houses, the
father, mother, and child, that is to say, the whole of the
family, were all attacked with it on the same day. Close to
the houses thus affected, there is an open drain in a most filthy
condition, concealed from the view of the passers-by by a
wooden paling. On looking over this paling, which I have
sometimes done, to see the condition of the drain, I have been
seized with the feeling of suffocation, and have been unable
to bear the odour arising from it for a moment.”
One of the assistant surveyors of the Metropolitan Sewers
Commission, Mr. Donaldson, being officially engaged at Lam-
beth on the 28th and 29th September, was informed of the
prevalence and malignity of fever, and particularly scarlet
fever, in several houses in Fore Street, and in King's Head Court,
Lower Fore Street. “Four cases,” he states, “were children
under twelve years of age. The mother of two of them, re-
siding in house No. 23, showed me one of her children, a girl
apparently of six or seven years of age, just recovering from
fever, and she said, “the doctor had remarked to her, that
there seemed to be something particular about that immediate
neighbourhood, as the fever was worse there than anywhere
else.” In the First Report of the Metropolitan Sanitary Com-
mission, Mr. Wagstaffe, examined October, 1847, gives the
following evidence;—“I have myself passed through two feet
of water to get to the houses, being obliged to walk along the
planks, the doorways of the houses at the time of high tide in
Fore Street, Lambeth, being blocked up with boards and
plaster to prevent the water from getting into the dwellings.
I have often seen the soil from the cesspools swimming about
in the water. Whenever typhus is prevalent in the metropolis,
it is invariably found in these localities, and common fever is
very apt, in these places, to assume a typhoid type. This is
the case at the present time with several cases now under my care.
Scarlet fever, measles, and small-pox also are very apt to become
malignant here under certain atmospheric conditions. These
localities, in which typhus is constantly present, are the very
localities in which Cholera chiefly raged; and if Cholera were
again to re-appear, these would be the places which it would
first visit, and in which it would be most prevalent and fatal.”
Accordingly, on the 1st October, 1848, two days after Mr.
:
;
:
tº gº
o
:
:
;
o
• * Q
Whether in Villages, Towns, or Cities. I01
Donaldson's visit, the occurreuce of a fatal case of Asiatic
Cholera is reported on this very spot, namely in Lower Fore
Street (No. 26.); a few days later another fatal case occurred
in the same house; on the 4th October a third fatal case oc-
curred at No. 29, in the same street, and a fourth in that same
house on the same day.
About the same time, namely, on the 30th September, four
fatal cases of Cholera occurred in rapid succession in White
Horse Court, Chelsea; “one of the most filthy localities,”
says Mr. Keen, who attended the cases, “in the neighbour-
hood. The water foul; the drains all untrapped; the
privies common to all the inhabitants;” “and at the entrance
to the court,” says Dr. Parkes, “there are large dunghills
where offal is thrown, and the effluvia from these and the
drains are most offensive.”
Two fatal cases of Cholera have occurred in a court in Pitt
Street, Old Kent Road, to which the officers had previously
called the attention of the Sewers Commission, on account of
its inhabitants having lately suffered severely from scarlet
fever. “In three of the houses,” says Dr. Parkes, who was
requested to make an examination of the place, “every child,
and one of the adults, have been ill with it; one child has
died of dropsy following scarlatina, and this sequence has
indeed been almost universal. All the inhabitants to whom
I spoke complained of the place being unhealthy on account of
the damp, and the effluvia from the cesspools; both adults and
children have a pallid, sickly hue.”
The first decided case of Cholera in the city of London,
which occurred as early as the 2nd of October, at No. 2, Harp
Court, broke out close to one of the alleys which was reported
some time ago to the Sanitary Commissioners as an example of
the wretched condition of the habitations of the poorer classes;
the court itself being described by Dr. Parkes as one of the
dirtiest and most miserable places in the district of St. Bride's.
Mr. Bowie states, that the cases of Cholera recently attended
by him have occurred in the usual abodes of fever, and in the
very places in which Cholera formerly prevailed ; and that the
merchant vessels and colliers in the river, in which it has broken
out, have been moored close to the openings of sewer mouths,
while the ships themselves have been dirty and unventilated.
Where the chief conditions of disease are present, they operate
alike in the village, the town, and the city. In the early part
of October four rapidly fatal cases occurred in the town of Ux-
bridge, three marked by the unequivocal characters of Asiatic
Cholera, and the fourth with symptoms nearly approaching it.
One of these persons, attacked on the 5th of October, lived in
a house motoriously insalubrious, in which three cases of malig-
mant fever had already proved fatal ; and so convinced was the
102 Return of Cholera to the same Localities and Houses.
surgeon who attended these fever cases, that this spot presented
all the conditions ſavourable to the origin and spread of epi-
demic disease, that he publicly stated his belief, that if Cholera
should visit Uxbridge, the first case would occur in this house
—a prediction which has unfortunately been but too speedily
verified.” “Since I inspected the house,” says Dr. Parkes,
“another case of Cholera has been reported as having occurred
in it.”
The conditions under which the pestilence is extending in
Scotland are exactly similar. Closeness and filth are there also
the cradle of the disease, and numerous instances have already
occurred in which two, three, or even more persons have been
either at the same time or in rapid succession seized in the same
locality, and even in the same house.
The filthiest parts of Edinburgh are the Grass Market and
West Port, and the closes and wynds running out of them, where
tan-yards, manure manufactories, stables, piggeries, and all
kinds of nameless abominations are permitted to exist in the
closest proximity to human habitations. Next in order stands
the Cowgate, with the various closes and wynds adjacent, and also
the wynds of the High Street and Canongate. In Leith there
is a similar district, composed of a collection of narrow filthy
wynds, crowded by a wretched population. These are the
perennial abodes of the cpidemic diseases that affect Edinburgh
and Leith, and to these localitics chiefly the cholera of 1832
confined its ravages. Since that visitation they have been often
scourged by typhus fever and other epidemics; and here, with
a few exceptionable cases in equally bad localities, Cholera has
now again found its first, and hitherto, indecd, its only victims.
There are instances in which it has returned to the very same
house which it ravaged on its former visitation. The first case
of Cholora which occurred in Leith in 1832, was in a house in a
narrow, filthy cul-de-sac behind King Street; and the spot
where it broke out in Leith, for the first time at the beginning
of the present month, was in the same lane, in a wretched
lodging-house, a few fect from the dwelling whence it formerly
commenced its career. Four cases of Cholera have already oc-
currred in that house.
This evidence as to the influence of certain conditions of
place, on the first outbreak and the rapid spread of Cholera and
other epidemic diseases, appears to indicate courses of action of
primary importance with reference to the objects both of preven-
tion and mitigation.
Operations of cleansing, both external and internal, are the
primary means of prevention ; and the places where the first
measures of cleansing should be carried into effect are indicated
in the registers of death, in the case books of the medical officers,
and in the list of the relieving officers, which show the streets,
Cleansing and Lime-washing. 103
courts, alleys, and the very houses in which sickness from epi-
demic disease has been prevalent, in many instances pauperising
the inhabitants, and in all increasing the necessity for parochial
relief.
From these sources, therefore, as full a list as may be practi-
cable should be made out of the places in which the measures of
cleansing are the most urgently needed, and those lists should
be completed by the aid of the reports of the physicians and
surgeons having charge of dispensaries and hospitals.
As these lists are completed, copies of them should be for-
warded as directories to the parochial clergy and other members
of the district committees, who will aid the local authorities in
their examination from house to house of these epidemic locali-
ties. Not only should the particular houses in which epidemic
disease has been prevalent be examined, but also the adjacent
houses, which will generally be found to be in the like unhealthy
condition.
The police force under the direction of the watch committees
of the town councils, have been usefully employed in seeing that
the cleansing operations are regularly and completely performed,
in conveying information, and in aiding local investigation ; but
the general direction of the measures of cleansing should be
charged upon the medical officer, whose duty it will be to see
that the owners and occupiers promptly carry those measures
into effect. If, however, on account of sickness or poverty, or
any other cause, the medical officer see reason to apprehend
neglect or delay in the execution of those measures, then he
must immediately report such cases to the board of guardians,
or to persons authorized by them to act in this behalf, who
should forthwith direct able-bodied paupers to perform the
work.
Where circumstances will not admit of the employment of
able-bodied paupers, or where the assistance of paupers
would be less officient than the services of persons accus-
tomed to the work, a sufficient number of men should be en-
gaged for the special purpose of lime-washing and purifying
the houses and apartments that may stand in need of such
cleansing. Ample experience has shown the efficiency and
economy with which operations of this kind may be carried on.
By the aid of two men, and with no other implements than a
common pail and a painter's whitewashing brush, Mr. Ramsay,
inspector of the Edinburgh cleansing committee, has shown
that a second or third rate tenement, containing two or three
apartments, may be effectually lime-washed at an expense not
exceeding from 9d, to 1s. per tenement. “The solution of
lime in water,” says Mr. Ramsay, “is very quickly applied,
and when the workmen become accustomed to it, which they
soon do, they put the inmates to very little trouble, and do not
104 Cleansing by Iſose and Jet.
occasion the usual splashing about of the material, the fear of
which creates an aversion to the operation, in the minds of in-
dolent and infirm persons, not always to be overcome. When
one or two houses have been cleansed and lime-washed, many
of the neighbours, gratified with the fresh smell of the lime,
and its light and agreeable effect on the black and dirty walls,
apply to have their houses also washed ; and others, seeing
with how little inconvenience to themselves it is accomplished,
and its agreeable effects, on their permission being asked, very
rarely refuse.”
Fumigation with chlorine gas, under the eye of a medical
man, this being a process which cannot be safely conducted ex-
cept under medical inspection, is performed at an expense of
less than twopence for each room.
All the streets, courts, and alleys, the atmosphere of which is
shown to be in a state of pollution by the presence of epidemic
disease, should be thoroughly scoured out daily, and the dung-
heaps of mews and stables also should be removed daily.
Where water is not laid on at high pressure, but can be
otherwise obtained, the most efficient means of cleansing will be
by the use of a small fire or garden-engine; but wherever water
is laid on at high pressure, advantage should be taken of the
hose and jet, which removes the dirt from the carriage-way
much more effectually than the street-sweeping machine; gives.
to the pavement the appearance of having been as thoroughly
cleansed as the stone steps in front of private houses; and when
properly applied in close and dirty courts and alleys, rapidly
carries off the filth, destroys offensive smells, and by suddenly
changing the temperature and so causing a current of air, pro-
duces a sense of coolness and refreshment.
Cesspools may be cleansed in one-third of the usual time, and
one-third of the usual cost, by means of a two-handled pump
and hose, wherever there is a sewer within reach into which the
contents may be discharged.
With reference to the larger works of cleansing, such as the
cleaning out of long lines of ditches, or the removal of large
masses of decomposing refuse, much mischief has sometimes
been occasioned, when the operation has been so ignorantly and
unskilfully conducted as to increase the extent of the evaporat-
ing surface; as, when the contents of foul ditches have been
spread out on the banks and allowed to remain there; and when
cesspools have been emptied into drains or sewers having no
proper fall, or no run for the discharge of the contents from be-
neath inhabited houses. Works of this kind should be con-
ducted under the superintendence of a person who possesses
some knowledge of the nature of the gases evolved ; the atmo-
spheric and other conditions that promote their copious evolu-
tion ; their probable effect on susceptible persons; and the
Caution in Removing Masses of Refuse. 105
mode of diminishing or averting them, either by the proper use
of deodorising fluids, or by other means. The medical officer
who may be expected to be the best informed in these respects
should therefore be required to take the general superintendence
of such operations. &
The removal or distribution of large masses of decomposing
refuse cannot be expected to be effected without some danger;
on the other hand there is a certainty of evil, if such matter is
allowed to remain permanently near human habitations, while
the risk from the act of removal, if it be tolerably well con-
ducted, is but slight, and at all events can only be temporary.
In following the track of fever, the inquirer will soon be led
to the low lodging-houses, in which the conditions most favour-
able to the generation and spread of every form of epidemic
disease will be found to be the most intense and constant. The
over-crowding and the neglect of ventilation produce, in these
places, an insufferable closeness, which cannot be endured by a
person unaccustomed to the pestilential atmosphere. “At
night,” says Dr. Duncan, “the floor of these dark and miserable
abodes, often the bare earth, is covered with straw, and there
the lodgers, all who can afford to pay a penny for the accom-
modation, arrange themselves as best they may, until scarcely
a single available inch of space is left unoccupied ; and in this
way as many as thirty human beings or more are sometimes
packed together, each inhaling the poison which his neighbour
generates.” Even in lodging-houses of a somewhat better class,
“the beds and bedding,” says Dr. Howard, “are seldom washed
or changed, and are generally in the most filthy condition ;
even if a bed has been occupied by a fever patient who has
died, it is often immediately used by fresh lodgers.” “In one
room containing seven beds,” says Dr. Lyon Playfair, “each
occupied by two persons, I found a young sailor of about twenty-
five years of age, suffering from synochus (common continued
fever); his sister, a girl of twenty, occupied the same bed. In
another house, I found a little girl suffering from scarlatina,
and in the same bed slept her father ; and, as the keeper of the
house said, “any other lodger that might come :” so literally
true is it, that keepers of these lodging-houses are, as Dr.
Ferrier calls them, “keepers of fever-beds.” And, in some
places, these “fever-beds” produce on a large scale their
natural results. “The lodging-houses,” says Dr. Cowan of
Glasgow, “are the media through which the newly-arrived im-
migrants find their way to the fever hospital; and it is re-
markable how many of the inmates of that hospital coming
from lodging-houses have not been six months in the city.”
Under the authority conferred upon the guardians, their
medical officer may enter these lodging-houses and require
them to be duly ventilated and cleansed, and where he finds a
l
106 Influence of Over-crowding.
dangerous over-crowding, he may order the parties to be re-
moved.*
Having thus denoted, more fully than they were enabled to
do in their first notification, some of the most important
measures of prevention, the General Board of Health would
now advert to the measures of alleviation that may be found
available, should the disease, which has broken out nearly at
the same time in many widely distant parts of the country, un-
happily prevail as an epidemic.
The importance of the precaution already given in the first
notification, as to the urgent necessity of the earliest attention
to the premonitory symptom, is confirmed by every day's ex-
perience. Opportunities have been recently afforded for care-
fully observing the circumstances connected with the first out-
break of this disease, both in this country and abroad, and the
clear result of such observation is, that some of its earliest vic-
tims are seized without warning, but that this is the case with
comparatively few. In the great majority of instances, even in
the early days of its invasion, and almost universally after the
violence of its first blow has been spent, distinct warning of its
approach is given. That warning, as has been explained, is a
relaxed state of the bowels ; and whoever has that complaint,
in however slight a degree, should, during the present season of
danger, place himself immediately under medical care. The
medicines recommended in the first notification were intended to
be placed in the custody of the heads of families, the masters of
schools and workhouses, the owners or agents of large establish-
ments, clergymen, and other intelligent persons, for administra-
* Indian experience as to the influence of over-crowding in promoting the spread of
Cholera is in perfect accordance with our own. “The disease commiſs its greatest
ravages,” says Mr. J. Kellie, surgeon, 4th battalion, artillery, “in crowded ill-venti-
lated barracks, bazaars, densely populated towns, particularly such as are surrounded
by walls, preventing the ingression of pure air; and in that portion of them where car-
bonic acid gas is, by the decomposition of animal and vegetable refuse, being evolved,
crowded school-rooms, the inhabitants of a portion of a barrack in the vicinity of an
open drain, native huts into which the e is but one opening, and that closed at night,
whole families are frequently swept away from their exposure to this existing cause;
but when Cholera appears in a family occupying a superior station in life, and in whose
house pure air always cxists, the disease is almost invariably confined to the individual first
attacked, and which in most instances is to be attributed to an accidental exposure to
a poisoned atmosphere beyond the walls of his own dwelling.” “Cholera,” continues
Mr. Kellie, “is a usual attendant at native festivals, where crowds of people are col-
lected. At Juggernaut it is an annual visitant.” “The town of Poorce,” writes Dr.
Cumberland, “ contains 35,000 inhabitants, and the number of pilgrims sometimes
amount to 150,000. The inhabitants are usually quite healthy before the occurrence
of the ſestival, which takes place in June or July, but immediately on the arrival of the
pilgrims, and when the lodging-houses are literally crammed with inmates, Cholera
suddenly breaks out, and in the space of a few days hundreds are cut off by it. This
is not au occasional or accidental occurrence; it is an invariable one; and the disease
which had thus been generated as suddenly disappears on the dispersion of the crowd, a
few isolated cases only occurring for two or three days after the departure of the pil-
grims.” See Reports on Asiatic Cholera in Regiments of the Madras Army, by Mr
Samuel Rogers. g - *
Importance of Removal and Dispersion. 107
tion only at times and under circumstances when medical assist-
ance could not be promptly procured. With such a disease as
Cholera impending, a due regard to his own safety and to the
Safety of those who are naturally dependent on his care, should
induce every one to avail himself without delay of the best as-
sistance within his reach. And for those who cannot afford to pay
for medical attendance, or who would not be likely to incur the
expense of it, for a complaint, apparently so trifling, Dispen-
saries must be opened in convenient situations, with proper
medical attendance, if practicable, day and night, where medi-
cal advice and medicine may be procured.
It is of the utmost importance that the local authorities and
others should be satisfied as to the measures which it will be ex-
pedient to adopt promptly and thoroughly, when, notwithstand-
ing all the means of precaution and prevention that may have
been taken, this disease actually breaks out in any place.
The main object of the recital of much of the preceding evi-
dence has been to fix attention on the influence of place in pro-
moting the spread of this pestilence; but the conditions of place
which so powerfully predispose to it, in the great majority of
instances, cannot be immediately changed. Under circum-
stances in which no material improvement can be at once effected
in the house or locality, the most simple and effectual remedy
would be, removal from the neighbourhood, and temporary
change of habitation; and where, as is commonly the case, the
susceptibility is increased by errors in diet, the security would
be increased by an immediate change to a suitable regimen.
Hitherto the proportion of attacks to the population has no-
where in this country been so large as to render it impracticable,
or even difficult, to make provision for the temporary removal
of such indigent persons as have appeared to be in imminent
danger; and it is a subject deserving consideration, whether,
instead of the indiscriminate removal of the sick, it would not
be more effectual, as well as less expensive, while provision is
made for the proper treatment of the sick, to take some care of
those who, in all probability, will be the next victims of the
disease, though the blow may not yet have actually fallen on
them.
As an extensive trial of this plan of removal was made in
Edinburgh during the prevalence of the pestilence in that city
in 1832, the General Board of Health have endeavoured to
ascertain the result of that experience. On consulting Pro-
fessor Dr. W. Pultney Alison, who took a principal part in
this matter, he has made the following statement:—“As the
system of taking the inmates of the houses, and in cases of
much crowding, the next door meighbours of Cholera patients
into houses prepared for their reception, called houses of
refuge, and keeping them there in comfort and under observa-
- I 2
108 Effect of Houses of Refuge in Edinburgh.
tion, at least until their rooms had been thoroughly fumigated
and cleansed, appeared to work well, it was continued whenever
the prejudices of the people did not violently oppose it, so long
as the Cholera continued to show itself distinctly in Edinburgh.
In most places, after the first day or two of successive cases
occurring in one stair or close, the people were very glad to
avail themselves of it, and almost all the places where any
considerable succession of fatal cases occurred, were places
where the people refused to avail themselves of this method of
protection. After the Cholera was first seen in Edinburgh
on the 27th Jan. 1832, eighteen houses or rooms in which it had
appeared were evacuated before the 5th April, after the death
or the removal to hospital of the persons who had taken the
disease; and their inhabitants, in number 105, all of whom had
had close intercourse with the sick, were placed in houses of
refuge, from periods varying from a week to a fortnight,
during which time the rooms they had left were fumigated and
thoroughly cleansed. In mine of these cases, one individual
only had been affected when this operation was commenced ; in
four, two had been affected; in four, three ; and in one, four
had been affected. In no one of these instances was there a
single fresh case in any of the adjoining rooms. There were
several attacks and five deaths in the persons thus received
into the houses of refuge; but there was no case of any person
who had been in these houses and returned home, being sub-
sequently affected. I remember perfectly, that in a small
district round the college and the infirmary, of which I took a
personal charge, the Cholera broke out seven times, at different
points; that we had the inhabitants of the rooms in which it
appeared, and in some instances of the rooms immediately
adjoining, placed in houses of refuge directly, and that we saw
no more of it at any of those places. Of course we cannot
speak with absolute confidence as to what would have been the
course of the disease in Edinburgh and its neighbourhood at
that time, if no such measure had been adopted ; but I think
we had such evidence of its probable efficiency as fully justifies
our wishing to try the same system again here, and recommend
it to others.”
On the general experience before cited, so strongly corrobo-
rated by the particular experience of Edinburgh, and with the
advice of the Edinburgh College of Physicians, the General
Board of Health have authorised the re-adoption of this
measure in Scotland, and have deemed it their duty to confer
by their regulations the requisite authority for carrying it into
effect in England, in all cases where occasion may appear to
require it, as one important means of meeting the present
visitation.
But while the General Board of Health have thought it
Sense in which Cholera may be Catching. 109
needful to make this provision for the greater security of the
poor and destitute, they cannot too earnestly impress upon
those in better circumstances, and who can consult their own
safety, the importance on the first outbreak of this disease of
immediate removal from a low, damp, dirty, and confined
situation, to one that is high, dry, and open; and of the adop-
tion at the same time of a careful regimen.
Though the General Board of Health have expressed their
decided conviction that Cholera is not contagious, in the
common sense of that term, yet neither they nor those who
coincide in their opinion consider that there is no danger in
over-crowding, or that the disease is not “catching” in ill-
ventilated and ill-conditioned places. The Metropolitan San-
itary Commissioners have observed :—“The result of recent
inquiries has been, a progressive approach to the conclusion,
that the injurious effects produced by the exhalations from the
living body, whether in health or disease, are confined within
much narrower limits than was formerly supposed. The
rapidity and completeness with which such exhalations are
diluted, and rendered innoxious by free admixture with pure
atmospheric air is now better understood than at any former
period. Concentrated in confined and crowded apartments,
they exercise a most injurious influence on the progress of
disease in the sick; concentrated still more, they affect the
healthy, and under circumstances in which ventilation is
neglected, or cannot be sufficiently applied and maintained,
first the nurses, then the members of the family who may have
been only occasionally in the sick chamber, and last of all the
medical attendants suffer; at the same time, casual visitors
are liable to be attacked, in proportion to the concentration of
the poison and the weakness and susceptibility of the constitu-
tion; and persons so attacked and going to ill-conditioned and
confined places, may form new centres of disease.”
It is in the belief that such facts should be regarded as true
lessons of experience that the General Board of Health attach
* By the use of the term “catching,” the witnesses referred to were not understood to
represent that, in their opinion, Cholera is ever communicable from person to person;
but merely that the respiration of an atmosphere corrupted by over-crowding, is one
among other circumstances, powerfully predisposing an individual to the attack of
whatever disease may happen to be epidemic ; scarlatina, if scarlatina be epidemic;
typhus, if typhus be epidemic; inſluenza, if influenza be epidemic; and Cholera, if
Cholera be epidemic. The meaning of these witnesses appears to be expressed in the
following passage:– “I do not believe,” says Mr. Kellie, “Cholera to be contagious
under any circumstances; but I do believe that when the pestilence has been attracted
to a town or camp, the atmosphere becomes tainted, and all who come within its in-
ſluence are liable to be attacked. A cholera patient may be brought from an infected
spot into one where a pure atmosphere exists, with perfect, safety; he will rarely com-
municate the disease to other persons, even when subjected to the most intimate expo-
sures. But it becomes infectious in the mass, and it spreads by infection, wherever the
poison is assisted in its operation by the presence of those peculiar states which are ac-
knowledged to predispose the body to disease,”
110 Removal of the Dead from Living or Sleeping Rooms.
great importance to the prevention of over-crowding, to the
removal of the weak and susceptible from the vitiated air of
the apartments of the sick, and to the maintenance in sick
chambers of the freest ventilation.
Many cases having occurred in which the long retention of
the dead body in living or sleeping rooms has greatly promoted
the spread of disease, the Act has called special attention to
the need of regulations for the early removal and the proper
interment of the corpse; and the General Board of Health
have authorised the medical officer, after having ascertained
the true cause of death, to give such directions as may appear
to him to be required, for the due observance of the regulation
relative to this highly important subject.
It appears to the General Board of Health to be absolutely
necessary, in the present emergency, to concentrate respon-
sibility on the medical officers, and to entrust them with dis-
cretionary powers, because the rapidity of the course of Cholera
will not allow them to wait for direction from the guardians at
their weekly meetings; and seeing the many and arduous
duties that devolve upon the medical officers, the General
Board of Health cannot but express a hope that the remune-
ration of these officers will be more proportionate to the value
of required services than it was upon the former occasion.
The law having vested the general management of medical
relief to the destitute in the Boards of Guardians, and having
made them the authorised channels for the expenditure of the
rates raised for the benefit of the poor, the instructions and
regulations of the Board of Health have been mainly directed
to them. They are aware, however, of the important ex-
ertions which in many instances have been made by town
councils and local commissioners for the improvement of the
public health, and where any of the functions herein prescribed
are either by law or practice exercised by such town councils
and local boards or commissioners, they would by no means
wish to take them out of their hands; they will have the best
means of considering how far they can act by their own powers,
or conveniently with the boards of guardians, and it is only in
the absence of any such powers, or in default of their effectual
exercise, that the Board of Health would call upon the boards
of guardians to take the duties on themselves.
The Board of Health will, from time to time, communicate
to the local authorities additional information on matters
relating to the removal of nuisances, and the prevention and
mitigation of disease, in their official circular.
Signed by Order of the Board,
HENRY AUSTIN, Secretary.
Plan of House-to-House Visitation. III
V. ABSTRACT OF REGULATIONS FOR CARRYING OUT THE SYS-
TEM OF Hous E-To-House VisitATION FOR THE PREVENTION
OF CHOLERA IN GLAsgow.
THE city of Glasgow is divided into two parishes, namely, the
city parish and the barony parish. The city parish is divided
into seventeen districts, and the barony parish into six. To
each of these districts, in both parishes, there is appointed a
medical superintendent, and over the whole a general superin-
tendent. Each district is divided into a convenient number of
sub-districts, over each of which is placed one advanced medical
student, whose duty it is, 1. Under the direction of the su-
perintendent of the district, to visit each house within his sub-
district, at least once a-day. 2. To inquire into the state of
the health of the inmates, and particularly as to the existence
among them of bowel complaints, and other premonitory
symptoms of Cholera. 3. To carry with him medicines for
administration on the spot, wherever necessary; and 4, to report,
without delay, all cases of emergency, as well as all instances
where cleansing is required, to his district superintendent.
The duties of the district medical superintendent are:—
1. To visit all cases of emergency reported to him by the
visitors of his district, or which may otherwise come to his
knowledge.
2. To report immediately to the responsible officer charged
with cleansing operations, all cases requiring cleansing.
3. To meet the visitors of his district at a stated hour each
day, to receive the reports, and to consult with them on the
general business of each sub-district,
4. To join at a stated hour each day the whole staff of dis-
trict medical superintendents, along with the general superin-
tendent, as their chairman. At the aggregate meeting reports
of all cases, both of diarrhoea and of Choléra occurring during
the preceding twenty-four hours are made up, and a copy of
the summary is sent each day to the General Board of Health.
5. To have his surgery open all day for the purpose of dis-
pensing gratuitously to all applicants such medicines as their
cases may require.
6. If his house happen to be one of the houses deemed con-
venient for the purpose, to have his surgery open all night for
the use of the legally qualified medical man who may be ap-
pointed for the night service, and the senior student appointed
to assist him.
A supply of blankets, sand, salt, fuel, &c. is kept at a con-
venient place in each district for the use of the sick, but no
article is given out, except on the written order of the District
or General Superintendent.
112 Third Notification with Reference to Special Regulations.
The whole system of the House of Refuge, with its conco-
mitant cleansing of rooms and houses is enforced.
Notices are sent to each house detailing the arrangements
which are from time to time made for the public safety.
The difficulty of carrying out such a plan in a city consisting
of nearly 400,000 inhabitants, and with so varied a population,
composed to a large extent of persons in the most destitute
circumstances and under the most unfavourable influences, may
be conceived.
In proportion as it fails to be realised, the experiment must
be regarded as imperfect, but there is evidence that many lives
have already been saved by it; it has been spontaneously
adopted in several other places in Scotland, and the result of
the whole experience as to the extent to which it may be found
capable of checking the progress of Cholera, cannot but be
looked forward to with interest.
VI. THIRD NOTIFICATION.
General Board of Health, Gºft House,
18th November, 1848.
THE General Board of Health having, under the authority of
the statute, issued one set of Orders, directing that the places
frequently visited by epidemics should be sought out and ex-
amined and that measures of prevention should be carried into
effect, as far as practicable, by cleansing; having also, in addi-
tion to these Orders, issued Special Regulations for the direc-
tion of Medical Relief in places where cases of Cholera have
appeared, and numerous applications having from time to time
been made to the Board from other places for these Special
Regulations.
It has appeared to the General Board of Health to be desi-
rable that these Special Orders and Regulations should here-
after take effect, without further notification, in all places
forthwith upon the actual occurrence of cases of Cholera, and by
these Orders and Regulations they do so provide.
In all cases, however, in which these Orders are acted upon,
immediate notice of the fact must be sent to the General Board
of Health, and the Medical Officers will be required to notify,
from time to time, for the information of the Board, any progress
which the epidemic may make in their respective districts.
Signed by Order of the Board,
HENRY AUSTIN,
f e
J * a y w /
Fourth Notification. II 3
VII. FourTH NOTIFICATION IN RESPECT TO THE RE-APPEARANCE
OF CHOLERA.
General Board of Health, Gwydyr House,
June 1 1, 1849.
THE General Board of Health, in a letter addressed to the
Boards of Guardians on the issuing of the Order in Council
bearing date March 27, 1849, for renewing for a further period
of six calendar months the operation of the Act “for the Re-
moval of Nuisances and the prevention of Epidemic Diseases,”
called attention to the fact, that recently in Scotland, and in
various citics and towns on the Continent, Asiatic Cholera had
again broken out, after it had disappeared for some time; and
they represented the necessity, notwithstanding the general
i. of the epidemic in Great Britain, of continuing to
enforce every practical measure of precaution against this dis-
Ca,SC.
The General Board of Health have continued to watch with
anxiety the progress of the pestilence abroad, the similarity of
its present to its former course indicating its probable return
to its former seats. The identity of that course in past years
led the Board to apprehend its probable increase in Russia
and its return to Holland; and the fear that it might also again
reach this country induced the Board to recommend the re-
newal of the Order in Council, continuing in force the Nuisances
Removal and the Diseases Prevention Act. Their apprehen-
sion has been realised. It has again prevailed as an epidemic
at St. Petersburgh ; it has returned to Rotterdam; and it is
now the painful duty of the Board to announce that it has re-
appeared in this country, having again broken out in various
and distant places in England, Wales, and Scotland.
The circumstances under which the disease has re-appeared
leave no doubt that these local outbreaks ought to be regarded
as general warmings, proclaiming the necessity of the imme-
diate and general adoption of every practical measure of pre
caution, as well on the part of private individuals as of col-
lective communities.
The accompanying summaries show the daily, weekly, and
monthly cases of Cholera that have occurred in the Metropolis,
in England and Wales generally, and in Scotland, since the
renewal of the Order in Council, as far as those returns have
becm made to the General Board of Health ; but there is reason
to believe that numerous attacks have occurred in different
parts of the country from which no returns have been made to
this Board.
From these returns it will be seen that, since the latter end
of March, Cholera has broken out in twelve different localties
in the Metropolis, in twenty-seven towns in England and
114 Efficiency of House-to-House Visitation.
Wales, and in seventeen towns in Scotland, and that in several
of these places, as in Sunderland, Liverpool, Durham, Weston
(in the Hitchin Union), Gloucester, Keynsham, Merthyr
Tydvil, Cardiff, Kilbirnie, Galashiels, Kelso, and Dundee, the
disease has continued to spread.
Another fact is declared by these returns of great signifi-
cance, which calls for the earnest attention of the local authori-
ties charged with the execution of the Nuisances Removal and
and Diseases Prevention Act : namely, that the attacks within
the last twelve days have exceeded those which have occurred
during the preceding two months.
Thus in two months from the 29th of March to the 29th of
May, both inclusive, the total number of cases is 428; but
within the last twelve days, that is, from the 30th of May to
the 11th of June, both inclusive, there have been no less than
673 cases, and at the same time the disease has manifested a
decided tendency to spread epidemically, as is shown in the
numbers attacked on board the American emigrant ship at
Plymouth, and in the extent to which the disease has prevailed
in Glover Hall Court, Beech Street, Barbican, in the city,
and also in Bermondsey.
The total number of deaths, up to the time of the renewal of
the Order in Council were 6,319 out of 14,332 attacks, or in
the proportion of three deaths to seven attacks: whereas the
returns now made give 638 deaths, out of 1,203 attacks; or a
proportion of more than one-half—a proportion exhibiting the
severity that usually marks the commencement of a general
outbreak.
Under circumstances which thus afford ground for apprehen-
sion that another visitation of the scourge may be impending,
the General Board of Health deem it highly satisfactory to be
enabled to report the uniform success which has followed
prompt and continued attention to the premonitory symptoms
which generally precede an attack of this disease. In their
first notification on the re-appearance of the pestilence in
September, 1848, they announced that there is no real founda-
tion for the extent of popular alarm arising from the apparent
suddenness of the attack; that, except at the first outbreak of
the disease in a locality, it is the developed stage only that is
sudden; and that, in general, distinct warning is given of the
approach of the disease in sufficient time for the cmployment
of effectual remedies against it. Recent experience has fully
confirmed the truth of this representation. In Dumfries,
Paisley, Glasgow, and numerous other places, special arrange-
ments have been made for the daily visitation of every house
in the infected localities, with a view to search out incipient
attacks, and to bring all such cases without delay under ap-
propriate dietetic and medical treatment. The success of this
Effect of Cleansing in Arresting Disease. 115
measure, wherever it has been adopted, has been so decided as
to establish the fact that we have now arrived at the knowledge
of an effectual mode of dealing with this pestilence, and the
authorities charged with the execution of the Nuisances
Removal and Diseases Prevention Act in any place in which
Cholera may hereafter break out will incur the gravest re-
sponsibility if they do not forthwith organize an adequate staff
to carry out this plan of visitation in its full efficiency.
The General Board of Health have to regret the failure of
any mode of treatment that has been hitherto adopted in the
developed or collapsed stage of this disease. They would not
discourage efforts to arrest the progress of the malady in this
stage: they believe, from information communicated to them,
that individuals have been recovered from it who have received
from the hands of their medical attendants the unremitting
attention which is given to a person in a state of suspended
animation ; but few can receive such attention when the
sufferers are numerous; and the register of deaths in all
countries, in all climates, among all ages and classes, and what-
ever mode of treatment may have been adopted, shows that
the only well founded hope of saving life is by prompt and con-
tinued attention to the very first indications of an attack.
Recent experience has fully confirmed the evidence previously
adduced that the localities of this disease and the localities of
other epidemics are the same, not a single instance having
come to the knowledge of the Board of the spread of this
scourge in groups in any other than the ordinary seats of
typhus and other zymotic diseases; those seats being uniformly
marked by the existence of filth, bad ventilation, overcrowding,
and other local causes of atmospheric impurity. This is so
certain and constant as to afford stronger grounds than ever
for the presumption of culpable ignorance and neglect wher-
ever successive case continue to occur in any locality, or wherever
the disease widely spreads through a court, street, or district.
Recent experience further establishes the advantages that
have resulted from the operations of cleansing. The first
cases of Cholera that occur in a locality are sometimes sudden,
without any premonitory symptom ; this suddenness of attack
is in itself evidence of the local presence in unusual intensity of
the causes of atmospheric impurity. As soon as cleansing
operations have been carried into full effect, these sudden cases
cease, and instead of them diarrhoea appears, which, if promptly
and properly treated, does not pass into Cholera. Uniform
experience shows that the first and certain effect of these
cleansing operations is to stop these sudden attacks; and the
cases of premonitory diarrhoea that follow, if early and properly
attended to, are, in the great majority of instances, arrested at
once; and thus the extension and the great mortality of
cholera are checked.
I 16 Precautions Addressed to Captains of Ships.
The proportion of deaths to attacks already stated shows
that the severity of the disease itself, whereyer it actually
breaks out, is as great as at any former period, if not greator ;
and a strong presumption arises that, but for such exertions as
have been made, the general visitation would be equally,
severe, as it still is in those localities of the towns and cities of
Egypt, Russia, and other places where no sanitary improve-
ment has been effected.
The General Board of Health have to renew their former
representation, that what is done against this one disease will
have been done against the entire class of epidemic diseases.
It is scarcely possible to over-estimate the importance of the
conclusion to which the whole tenor of recent experience leads,
that in proportion to the intelligence and energy exerted for the
removal and prevention of the localizing conditions on which
the presence of this disease depends, it is practicable in a great
degree to secure immunity from it, and that, if happily Cholera
should not again prevail to any great extent, those exertions
will be equally effectual against typhus, scarlet-fever, diarrhoea,
and other native and prevalent epidemic, endemic, and con-
tagious diseases.
By order of the General Board of Health,
HENRY AUSTIN, Secretary.
VIII. PRECAUTIONS AGAINST CHOLERA AND OTHER EPIDEMIC
DISEASEs, ADDRESSED BY THE GENERAL BOARD OF HEALTH
To CAPTAINs of MERCHANT SHIPs, STEAMERS, AND Col-
LIERS.
THE attention of the General Board of Health having been
called to the circumstance, that the first cases of Cholera that
appeared in Hull and Sunderland occurred on board of merchant
vessels in those ports, it appeared to the Board to be very
desirable to ascertain the sanitary state of these vessels, and
with this view they directed Dr. Sutherland and Mr. Grainger
to proceed to Hull and make the necessary inquiries. After
completing their examination of the commercial shipping at this
port, Dr. Sutherland proceeded to Sunderland and Mr. Grainger
to Hamburgh. From their statements it appears that in con-
sequence of the filthy state of the ships, and the inattention to
ventilation, and to the common precautions for the preservation
of the health of the seamen, precautions which to a consider-
ſple extent are taken in the royal navy, there is on board the
&ommercial shipping an excessive amount of sickness and an
undue susceptibility to epidemic disease, both amongst the crews
and the passengers. From the whole tenor of the information
Sanitary Condition of Merchant Shipping. 117
communicated to the Board, it appears that the state of the com;
mercial shipping, at least in the ports examined, has cxperienced
but little improvement since the former appearance of "Cholera
in 1832; at which time its condition is thus described by Mr.
Bowie:—
“What is the general sanitary condition of merchant ships?—The
accommodation of the smaller class of ships, especially coasters, is very
confined; they are filthy, unpleasant, and unwholesome; the men often
sleeping, feeding, and cooking in the same place, which is very badly
cleansed and ventilated. Frequently, moreover, considerable quantities
of wet clothing are thrown down upon their chests or boxes, or anywhere
else they can place them. Fever is very frequent among the crews of
these vessels, and very severe. w
“That is to say, fever occurring on board the ship 2–Yes.
“May not such circumstances give rise to the popular supposition of
fever or epidemics being imported by such vessels, which have arisen on
the spot, on board, and with sufficient cause ?—Undoubtedly. In the
very instance of the “Felicity' it was given out that the Cholera had been
imported into the metropolis by that vessel. Now the neighbourhood
where this case occurred was one of the dirtiest along the river. What
were called the “bone vessels,” vessels employed to carry old bones for ma-
mure, usually lay there, and some of them lay there at that time. The smell
was exceedingly sickening, and was perceptible at a great distance.
Such was the recklessness of the crews of these vessels, that I have fre-
quently seen them using the bones as fuel, and cooking their provisions
With them; the most offensive smoke meantime penetrating into the
houses along the shore. Putrid carcases of dogs, cats, and other in-
ferior animals, likewise the refuse from the shipping in the neighbour-
hood, thrown into the river, or left on the muddy beach by the tide, were
allowed to remain there, deteriorating the atmosphere, until removed by
nature's scavengers. The whole of the coast, extending from St.
Katharine's Docks, the entire length of High-street, Wapping, was very
bad, with the exception of a few houses at and near the entrance of the
London Docks. And I know it to be a fact, that the water for all
domestic purposes was pumped into many of the houses from the parts
of the river where these impurities abounded.
“From the circumstance of seamen, though robust and young in life,
living in such condition as you describe, would not you consider them
to have a special susceptibility to such a state of atmospheric impurity ?
—Yes; but even at sea, and away from all ports, Cholera has apparently
broken out spontaneously.
“Do you attribute that to the confined and unwholesome state of the
ship itself, or that part of the ship in which the seamen take their meals
and sleep?—Principally to that part of the ship where the seamen take
their meals and sleep. But the whole of the internal part of a ship may
be very unwholesome, according to the nature of the cargo, or where
bilge-water is allowed to collect. Wessels containing putrid hides, or
other animal matters in a state of incipient putrescence, particularly
guano ships, I would say, are likely to be dangerous where Cholera
prevails epidemically.
“Would it be conformable to your experience of the susceptibility of
-
118 Same Regulations applicable to Ships as to Houses.
individuals to malaria, that seamen on board vessels from healthy ports,
but lying for weeks in the vicinity of the bone ships, and amidst the
surrounding deleterious influences, would be more liable to be affected
by such circumstances than the seamen on board the bone ships them-
selves, accustomed to the foul atmosphere of such vessels, and, as it
were, acclimated to them 7–Yes, I believe they would be. I believe
that those who are acclimated are less liable than those who are not.”
From all the information received, it appeared to the General
Board of Health that the crews and passengers on board these
vessels were in greater danger of a sudden outbreak of Cholera
under circumstances which far more urgently required assistance
than equal populations on shore, who may generally obtain
medical aid promptly. After much inquiry, however, the
General Board found that the only means in their power of
affording the assistance they desired to give to persons on board
of such vessels was by circulating information. On consulting
with several persons having large interests in this branch of
commerce, the Board, with the assistance of Mr. Grainger,
prepared the subjoined modification of the instructions contained
in their first notification.
These precautions and directions have been sent to the consul
at Hamburgh for distribution amongst the captains there, and
measures have been taken for their general circulation in all the
ports in which Cholera has already broken out, or may be ex-
pected to appear. The directors of the General Steam Navi-
gation Company have engaged that these directions shall be .
circulated and observed in their own vessels.
The cvidence of the frequent occurrence of various epidemic
diseases on board the commercial shipping, such as at the
present time are rarely if ever found in the navy, suggests the
urgent necessity for the protection both of passengers and crews,
that the like measures of precaution and prevention which ex-
perience has shown to be so successful in the navy should be
adopted in merchant vessels.
It appears to the General Board of Health to be very im-
portant to state, that when cases of Cholera do occur on board
of vessels in port, the same rules as to change of place and as
to the regulation of diet, are applicable to ships, as have becm
shown to be necessary to persons on shore. Wessels, indeed, as
has been already stated, are often stationed in port in the most
dangerous places, in the very spots where Cholera is observed
to make its first appearance in almost all countries, and where
it spreads with the greatest rapidity, and proves the most fatal.
The evidence of Mr. Bowie as to the first appearance of Cholera
on the river Thames, on its former visitation, in vessels moored
ncar to the mouths of sewers, and other sources of filth, has
been already cited; and Mr. Roberton, of Manchester, gives
the following instance of the same fact:—“One morning,” he
Instructions to Captains of Vessels. 119
says, “it was discovered that several men had been seized with
Cholera during the preceding night, on board of a vessel lying
in one of the docks. The men were sent to hospital, and the
vessel having been immediately warped in the river, another
ship with a healthy crew took up her station. The next morn-
ing all hands on board were ill of Cholera. On examining
the dock, it was found that a large sewer discharged its contents
under the spot where the vessel was placed. I give this most
instructive fact on the authority of Dr. Gaulter, an accomplished
physician (since deceased), the author of a valuable work on
the “Origin and Progress of Malignant Cholera in Manchester,’
published 1833.”
Impressed with the great importance of removing all vessels
attacked by epidemic disease from such localities, the General
Board of Health deemed it their duty to represent to the
Government the necessity of changing the situation of the con-
vict ships at Woolwich, on the recent outbreak of Cholera on
board; and it is stated by the medical officer in charge of the
prisoners, that the adoption of this recommendation was imme-
diately followed by a diminution of the number attacked,
and by a highly beneficial effect on the character of the disease.
Having thus directed attention to the general want of clean-
liness and ventilation in the vessels themselves, and the un-
healthiness of the situation in which they are often moored, the
General Board of Health deemed it desirable to issue some
special instructions on the present occasion in consequence of its
having been ascertained that the captains, although for the
most part provided with medicine chests, had no knowledge
whatever of the treatment proper to be adopted in the event of
any of the crew being attacked with diarrhoea or Cholera. Many
sailors, it was further learnt, had been attacked whilst on the
voyage, and some had died, without any efficient treatment
having been applied. Great evil, and frequently fatal results
had also ensued in consequence of captains neglecting to obtain
early medical assistance when any of their crew were attacked
whilst in port; and especially owing to the neglect of the pre-
monitory diarrhoea, the general occurrence of which, before an
attack of Cholera, was not known. The medicine here recom-
mended, laudanum, was selected as being that with which the
captains were best acquainted, and with which most ships are pro-
vided. It must be apparent that only the most general treatment
could, in the peculiar circumstances of the case, be directed.
First Instruction,-Guard against Looseness of the Bowels and
Purging.
Before a person is attacked by the Cholera, he is almost sure
to have for a day or two, or for several days, or only for a few
120 In Premonitory and Developed Stages.
hours, some looseness of the bowels or purging ; there is often
no pain, but this must not put any one off his guard, as to the
importance of this warning. The captain or mate ought,
therefore, without alarming the men, to inquire of the crew
daily, whether any of them have looseness or purging, as this
might by chance become worse. If a man is purged, let him
go to bed, be kept quite warm, and if he is cold, apply bottles
of hot water, or bags filled with hot salt, or bran, to the stomach
and fect. Give him immediately,
Eight drops of laudanum in a wine glass of hot and weak
brandy and water; give the man this every two hours, as long
as he is purged; the same dose should be given night and
morning for one or two days after the purging has stopped.
Second Instruction,-- What is to be done if a Man is seized or taken
with Cholera.
This comes on with cold, giddiness, sickness, vomiting and
purging of what looks like dirty water, or rice and water. Let
the man get into a hot bed; cover him well with blankets;
apply bottles of hot water, or bags filled with hot salt, sand, or
bran to the stomach, spine, and feet; be sure he is not exposed
to a draught or cold, the object being to get him into a sweat.
Put a large poultice of mustard and vinegar over the stomach,
and keep it on fifteen or twenty minutes. Give the man fifteen
drops of laudanum, with a teaspoonful of brandy (or whisky or
other spirit in the absence of brandy) in a little hot water; a
little ginger or cloves may be added. This medicine may be
given every hour for six hours, but not longer ; it must then be
left off. When the man begins to sweat, give him some hot
tea, with a teaspoonful of brandy in it, and keep him warm in
bed.
Third Instruction.
When the ship is in port, medical advice should be got as
soon as possible in any case of seizure, as the delay of even one
hour may cause death.
Fourth Instruction,-On Food.
All kinds of fruit, salads, cucumbers, celery, and pickles had
better be avoided; also oysters, lobsters, crabs, mussels, or other
shell fish.
The most wholesome articles of food are well-baked bread,
good biscuits, rice, oatmeal, peas, and good potatoes: solid food
is better than fluid, and therefore at this time it would be a
good thing to give the crew beef and mutton instead of soup.
Fifth Instruction,-On the Danger of Spirits, Corn-Brandy, Wine,
Beer, &c.
It is a very common notion among sailors and other people,
Avoidance of Ardent Spirits. 12I
that brandy, whisky, rum, wine, and the like, are good as a
protection against the Cholera. This is a total and fatal
mistake : in every country and town where the Cholera has
broken out, drunkards, and those who drink freely, have been
the first and greatest sufferers from the disease; temperate men
usually escape, drunkards usually die. It is therefore earnestly
hoped and requested that captains will warn their crews against
all excess in drinking: more especially warn them from taking
corn-brandy or gin, which often acts as a poison; they should
also not drink any of the white and brown beer sold at Ham-
burgh and other ports, especially if it be sour. The Elbe
water is bad, and likely to purge ; therefore it would be better
to use water brought from England; and captains are recom-
mended to take in a supply accordingly.
Sixth Instruction,-Against Exposure to Wet and Cold.
Wet and cold should as much as possible be guarded against
by warm dry clothing and stout shoes: a thick flannel belt or
bandage around the stomach and loins is a good defence for
sailors; when they go to bed, if the shirt is damp or wet, they
should change it and put on a dry one. They should not stop
out at night on shore: many sailors who have been drinking at
Hambro’ Bar, and lying about on Sunday night, have been
seized on Monday with Cholera, and died in a few hours.
Seventh Instruction,-Concerning Cleanliness and Ventilation.
Nothing is of greater importance as a protection against
Cholera than cleanliness and a good supply of fresh pure air.
It is, therefore, the duty of captains to take all the means in
their power to improve and keep up the health and strength of
their crews, who are placed under their care and protection.
The owners are particularly requested on the return of their
ships to English ports to see these instructions complied with.
The forecastle should be frequently cleansed, and the hatches
be opened in fine weather, so as freely to admit the fresh air.
The forecastle should be whitewashed. To sweeten the ship,
bleaching salt or powder (called also chloride of lime), which is
very cheap, and may be got at any druggists, should be mixed
with water and poured down the pumps; it should also be
sprinkled about the forecastle and in the cabins. Keep the
ship as free as possible from bilgewater, using the pumps daily
for this purpose, because it prevails most when ships are ver
tight; and open the hatches to purify the hold. All the
bedding should be kept well dried, and be brought on deck in
fine weather, and well aired.
MARK THIS WELL–The Cholera is not Contagious ; so no one
need be afraid of catching it: there is no dauger in waiting on
K
122 Cholera on Board “American Eagle.”
and nursing any one of the crew who may unfortunately be
attacked.
The captains of all vessels trading to the port of Hamburgh
are hereby informed that proper medicine, ready made up for
use, and with plain directions, can be procured at prime cost of
all the shipbrokers and agents for English ships in Hamburgh,
and they are hereby requested to provide themselves with the
same, in order to afford all the protection to their crews which
the circumstances of the case admit.
Signed by order of the General Board
of Health of England,
Oct. 18, 1848. HENRY AUSTIN, Sec.
IX. ExTRACT FROM “REPORT ON THE OUTBREAK OF CHOLERA
ON BOARD THE AMERICAN SHIP ‘AMERICAN EAGLE, AT
PRESENT LYING AT PLYMOUTH.” By Dr. SUTHERLAND.
THE circumstances connected with the outbreak of Asiastic
Cholera on board the ship “American Eagle,” which I have the
honour of laying before the General Board of Health, appear
to me to afford strong proof of the necessity for substituting
a system of well-arranged sanitary regulations for preventing,
as far as possible, the localization of epidemics on board mer-
chant-vessels, instead of the expensive, incfficient, and danger-
ous system of quarantine now in use. Besides the saving of
sickness and life, this case presents an example of the greater
saving of time, or, in other words, of money, by the substitu-
tion of sanitary for quarantine regulations.
A large vessel, which in an ordinary season might possibly
have carried its crew and passengers across the Atlantic in
safety, is laid in dock, close to an epidemic locality (which,
moreover, ought to have had no existence there); the stag-
nant water of the dock leaks into the vessel, and becomes
offensive; the ventilation is very defective; an overcrowded
population of emigrants is placed on board; their food is un-
wholesome, and the personal habits of many of them filthy.
Possibly all these circumstances might have been inoperative
in ordinary seasons; but during a prevailing epidemic consti-
tution they become matters of immense importance. Cholera
strikes the ship, just the same as I have seen it again and again
strike a similarly circumstanced locality on shore, although few
places on land have been altogether so badly situated as this
ship has been. The plan of procedure on land is to spread the
population, by taking them out of the infected localities. This
is absolutely necessary to their safety; while those who are re-
Fatal Consequences of Sailing with Cholera on Board. 123
moved, and all in the neighbourhood, are placed under strict
medical inspection. Every needful sanitary precaution in the
way of cleansing, ventilation, &c., is also enforced. But sup-
pose the “American Eagle” had arrived in England from a
foreign port; if there had been no Cholera here, she would
have been put in quarantine; her overcrowded population kept
in her; no system of medical inspection, or sanitary amend-
ment, would have been possible. I am warranted in stating,
from experience in similar cases on shore, that a large propor-
tion of the crew and passengers would have perished in a very
short time under such treatment.
Every man of common sense must recognize that the methods
adopted at Plymouth in the case of the vessel in questron were
infinitely superior to such a barbarous expedient as leaving a
large number of our fellow-creatures to perish under circum-
stances in which death comes in one of its most fearful aspects,
and beset with more than ordinary terrors. Had due care
been taken to preserve the neighbourhood of the docks in a
proper sanitary state, we have every reason from experience
to believe that an epidemic centre would not have existed there;
and had the requisite precautions been taken on board of the
“American Eagle,” it is equally certain that the crew and
º would have escaped Cholera. But after the neglect
as been committed, and the consequences have shown them-
selves, it is surely a mark of ignorance as well as of inhumanity
to subject the sufferers and their friends and fellow-passengers
to all the dangers and horrors of a pest-ship, in order to ward
off some imaginary danger from people at the port where the
vessel arrives.
The present case illustrates forcibly the origin of presumed
instances of importation of the disease. Should Cholera break
out in Plymouth or its neighbourhood, a presumption of im-
portation would be advanced; and in after-years, when all the
circumstances are forgotten, the arrival of the “American
Eagle” at Plymouth, the dispersion of the passengers, and the
appearance of Cholera in the town, would, no doubt, be placed
in the relation of cause and effect in the narrative: but let it
be remembered that Cholera had shown itself in the neigh-
bourhood of Plymouth before the arrival of the ship, and that a
man, who had actually been in Plymouth, had died of the
disease.
The case of the “American Eagle” further shows the im-
portance of preventing the sailing of an emigrant ship, or any
other vessel, when Cholera has broken out on board. Had this
vessel put to sea with her depressed and over-crowded popu-
lation, a large sacrifice of human life would have been in-
evitable. The greater purity of the air at sea, and the getting
out of the epidemic atmosphere, which the ship by sailing might,
K 2
124 Absolute Necessity of Dispersion.
perhaps, soon do, may appear at first view to be reasons for her
putting to sca with all possible despatch. But this view is a
fallacious one, and, if acted on, would involve the certain de-
struction of numerous persons. Every man, woman, and child,
under the circumstances which are here supposed, has been
breathing a poisoned atmosphere. That some portion of the
poison is already in the system of many of them, and has taken
hold of them, is unequivocally shown by the prevalence of the
premonitory diarrhoea. To the full development of the disease
in every one of those persons nothing is wanting but favourable
conditions. Such conditions are combined and concentrated in
the intensest degree conceivable in an emigrant ship at sea
under the circumstances supposed;—all more or less predis-
posed to disease; the disease actually existing in some ; filth,
over-crowding, imperfect ventilation, unsuitable food, panic.
The concentration of these conditions, which it requires extra-
ordinary care and skill to prevent, accounts for the fact, that
outbreaks of epidemic diseases on shipboard are usually much
more extensive and fatal in proportion to the numbers attacked
than outbreaks in courts and alleys on shore. No matter how
pure the atmosphere into which the ship may sail; this purer
atmosphere cannot be got to the unhappy passengers. There
is no possibility of substituting it for the poisoned atmosphere
which is in the ship, which she carries with her, and which her
over-crowded population continues to breathe. In port the
affected individuals may be removed from the ship, may be
dispersed, and placed in a comparatively pure atmosphere,
while the ship itself may be thoroughly purified. By these
means the progress of the disease is arrested in the persons
already affected, and the further extension of the disease is
stopped; but nothing of all this can take place at sea. To
send a vessel to sca with Cholera on board is to follow the
example of those guardians of the metropolitan unions
who persisted in keeping their pauper children in the
poisoned atmosphere of Drouet's establishment at Tooting,
obstinately refusing to remove and disperse them, the result
being that 180 perished.
The ship “American Eagle” is of about 1,000 tons burden.
She left London on the 31st of May with a cargo and a number
of emigrants on board, for New York. She touched at Ports-
mouth and took in about half-a-dozen passengers, which made
the whole number of souls aboard 370. Of this number about
90 were German emigrants, who had come over from Rotterdam
after having remained there a single night or two, the Cholera
having been prevalent in that city at the time, and the poorer
class of emigrants sleeping in the low class of lodging-
houses.
Two or three Germans, who had come over from Rotterdam,
Progress of Cholera among Passengers and Crew. 125
are reported to have died of Cholera in London, near the place
where the “American Eagle” was lying before she sailed.
At the time of her leaving dock all were well on board except
a little child of German parents, which had diarrhoea, of which,
however, it recovered, under the treatment of Dr. Brown, a
retired medical practitioner of London, who was on board as a
passenger to the United States. The German emigrants had
been in London for three or four days before the vessel sailed.
The father of the child already mentioned, was the first
person attacked with Cholera. He was taken ill on the 1st
June, very suddenly, and when Dr. Brown saw him he was
already collapsed, and died in twelve hours from the period of
attack.
On the 2nd of June there was no fresh case.
On the 3rd of June one of the sailors took ill. This man
had been ashore at London several days without leave, and had
been intoxicated. He assisted in sewing up the body of the
first patient who died, but, except in this act, he had no com-
munication with the steerage. He died after an illness of
twelve hours.
It may be proper to state that the first fatal case happened
in a weakly man, who had exhausted himself very much while
in London, by attention to his baggage and moving it from
place to place.
Another fatal case took place in an Englishman, who slept
in a berth nearly opposite the first case. He was seized at
11 p.m. and died on the following morning.
On the 4th of June four fresh cases occurred. Two of these
were Germans. They slept in the steerage, but their berths
were at some distance from any of those in which the preceding
cases occurred. Both of them died after an illness of about
sixteen hours. Another fatal case occurred in a sailor who
slept in a separate forecastle from the one where the first sailor
was attacked. This man was not known to have had any com-
munication with any affected person. He died on the 6th.
About the period when this man was attacked a good deal
of bowel complaint began to appear on board, and the captain,
with great judgment and humanity, put into Plymouth on the
5th of June. Had he mot done so, I am fully of opinion, for
reasons already stated, that a very great sacrifice of life must
have incvitably ensued.
On the 16th there were no fewer than eight new cases of
Cholera, three of which, an Englishman, an Englishwoman,
and an Irishwoman, died after about six hours' illness. On the
7th June two Englishmen died. On the 9th (yesterday), when
I went on board, there had been twenty-one cases; thirteen
deaths, six recoveries, and two under treatment. There were
also twenty-five cases of severe diarrhoea under treatment. All
126 Measures Adopted to Arrest the Disease.
those cases will apparently recover; but the epidemic influence,
I am sorry to say, has, up till to-day (Sunday), shown no dis-
position to abate in activity, for the cases of diarrhoea have
been increasing in number ; and another German, an old man,
was seized with Cholera this morning, and at mid-day was in
a state of collapse, in which, I fear, he will die.
I have much pleasure in stating that the authoritics in
Plymouth have done all in their power to alleviate this great
calamity. The “Tyne’’ hulk was immediately sent by the
Admiral to receive the sick and passengers; and an additional
medical man, Mr. Fox, was put on board this hulk to take
charge of the whole. The authorities permitted all such as
chose to come on shore to do so; and as many as one hundred
persons have thus been withdrawn from those agencies which
appear to have tended to fix the epidemic on the ship and
passengers.
The cabin of the “American Eagle” is fitted up with com-
fort and elegance, and not one of the passengers in it has suf-
ſered from indisposition.
The steerage runs under the cabin, and nearly the whole
length of the ship. A portion at the stern has been separated
as a store-room, into which there are stern lights, which also
answer for ventilation; and there is a wooden grating at the
upper portion of the partition through which air can pass from
the store-room into the steerage.
The following are the dimensions of that portion Sct apart
for the passengers:—
Length, 155 feet; breadth, 35 ſect; height, 8 feet; superſicial
area, 5,425 feet; total cubic contents, 43,400 fect. This cubic
space includes that portion occupied by the baggage of the pas-
sengers, as well as all that space occupied by the crections for
berths, the bedding, &c.
Four ranges of berths, each intended to accommodate two
persons, extend the whole length of the ship, interrupted only
by the hatches, two in number, one of which is about eight feet
square, and the other about six feet square.
Amongst other purposes, these hatches, if open, will answer
to a certain extent for ventilation; but, in addition, there are
three of the iron tube ventilators, one of which is about eighteen
inches across the funnel-shaped mouth on deck, and the other
two are about fifteen inches in diameter at the same part. Of
course where these tubes perforate the deck they are much
smaller in area, Lapparently not above one-half the measure-
ment stated. Besides these there are ten dead lights, ſive on each
side of the steerage. Each is about six inches in diameter, and
circular, the glass being capable of opening inwards so as to
afford ventilation.
Conditions of Outbreak the same as on Land. 127
The total number of passengers accommodated in the steerage
was 250,—a number considerably below the proportion ad-
mitted by the regulation, which is, I believe, one passenger to
fourteen fect superficial area: but after all this is admitted, it
will be secn that the cubic space only amounted to about 173
feet for each, including baggage. There can, in my opinion,
be no question as to the defect of ventilation on board this vessel.
It is quite true that, in this respect, she is better than the great
proportion of our own emigrant ships; but, to a practised eye,
the whole amount of air which it is possible to supply to such a
great number of inmates, especially during the night, must
appear wholly inadequate for the ordinary purposes of ventila-
tion. I have seen no conditions on shore so defective in this
matter as those presented by the ship in question; and yet the
results on shore are sooner appreciated than they are on board
ship. The fresh breeze to which the passengers are exposed
during the day on deck, is evidently their only safeguard from
certain destruction.
The water-closets are very difficult to keep clean, on account
of their small number, and the filthy habits of many of the
cmigrants.
The decks were stated to me to be all cleaned every morning,
and kept in as good a state as the habits of the people would
admit of.
It is complained that the habits of the Germans are so very
filthy that the English, and even the Irish emigrants cannot en-
dure them. They appeared to be a quiet orderly people, but
generally not so clean in their persons as either of the other classes.
Bad dict, mental depression, over-crowding, defective venti-
lation, superabundant moisture (for it is impossible to keep the
people from slopping the decks), and, above all, an epidemic
stroke coming along with these co-existing circumstances, have,
no doubt, all contributed to produce the result.
The outbreak so closely resembles an epidemic seizure of a
village on shore, that, in my opinion, it ought to be considered
in this light. All the early cases have been sudden, and nearly
all have died; and diarrhoea is now very prevalent. This is
precisely the history of an attack of Cholera in a land population
under unſavourable circumstances.
Under ordinary circumstances, there was nothing that would
have produced more than an ordinary amount of sickness, but
quite enough during an epidemic to determine its localization.
A number of people seemed to have been poisoned before
the usual results showed themselves; and now that most of the
defective conditions have been removed, the symptoms of diar-
rhoea are showing themselves in persons who would, without
doubt, have been seized with sudden Cholera had the vessel
proceeded on her voyage.
I28 Ventilation to be Effectual must be Mechanical.
The first time I went on board (yesterday), I found the whole
ship undergoing a thorough cleansing. The decks, planking,
and roofs, as well as the berths, have been thoroughly washed
with quick-lime, and disinfected with Sir W. Burnett's liquid ;
the passengers had all becm previously transferred on board
the “Tyne,” or drafted into the town.
On board the hulk all the arrangements have been made for
accommodating both the sick and the healthy, at least, so far
as circumstances would admit. The sick who are confined to
bed are about half-a-dozen, and are on the lower deck; the
healthy are accommodated on the deck above ; but this arrange-
ment is still very faulty, for the sick should be by themselves,
and the healthy are still too crowded to be safe.”
While on board the “Tyne " hulk I summoned the German
passengers together, and, through a very intelligent countryman
of their own, I impressed on them the need of immediate attem-
tion to premonitory symptoms, and urged on them to apply to
the medical officer on board whenever they were attacked. A
similar communication was also made to all the other emi-
grants, -
The only remaining difficulty is in the matter of food. It
would be very desirable, if it could be managed, to substitute
fresh provisions for the salted meats now used. I have expressed
this opinion strongly, and I believe that all persons absolutely
suffering from diarrhoeal symptoms will be provided with the
needful change of dict; but there appears no solution for the
difficulty on the part of the great bulk of the emigrants.
I suppose there is no power to compel the ship “American
Eagle” to remain, as long as it may be needful for safety; but
I cannot help expressing a very strong opinion, that so long as
any passenger is liable to diarrhoea, and for several days after
this symptom has ceased, there will be absolute danger in pro-
ceeding to sea. I have protested verbally against such a step,
and shall do so in writing, in order to justify the captain with
the owners. He appears a humane and enlightened man, and
willing to adopt, to the utmost, cvery possible precaution, He
has done so hitherto, and I think it right to say so.
I have advised that the decks of the ship be thoroughly dried
before any one is received on board, and that every available
means of ventilation and cleanliness be adopted for the future.
One of Dr. Arnott's air pumps would do the work effectually;
and the more I sce of shipping, the more I seck to apply physical
laws to the solution of the question of ventilation, the more I
am convinced that by a MOVING POWER ALONE, can any cffectual
change in the air in the hold of a ship be accomplished. All
* On a representation of this to the Port Admiral, Sir William Gage, he immediately
ordered another ship, the “Andromache,” for the accommodation of the emigrants.
Instructions to Superintending Inspectors. 129
ventilating tubes and open hatches are inadequate to the task,
and while we have so very simple and cheap a mechanical power
at our disposal, it is a duty to recommend and enforce its use
whenever we have an opportunity.
(Signed) John SUTHERLAND, M.D.
Plymouth, 10th June, 1849.
X. INSTRUCTIONs of THE GENERAL BoARD OF HEALTH TO THE
SUPERINTENDING INSPECTORS.
SIR,
ON proceeding to the town to which your service is directed
you will inquire for the list of places required to be made out
by the 9th Order, under the Epidemic Diseases Prevention
Act, where cases of Typhus and other epidemic and endemic
diseases have most frequently occurred. You will seek the
assistance of the clergy and ministers of religion, who may be able
to afford valuable aid in your inquiry, and you will also put
yourself in communication with the chief medical officers and
the medical practitioners who, as union surgeons or otherwise,
have probably been led most frequently into the houses and
streets where epidemic diseases have prevailed.
You will request the superintendent registrar of the district
to attend your first meeting with the list of the places of epi-
demic disease; you will also request the medical officers to attend
at the same time, and also a committee or deputation of the
petitioners, the surveyor, inspector of nuisances, and the high
constable or other chief officer of police to be in attendance upon
you; you will read the Registrar-General's Return of the
average proportion of deaths from epidemic disease, and also
the average rates of infantile mortality, and also any other such
particulars as may be in your possession from previous returns
with which you will have been furnished, viz. –the answers
made to the first sanitary inquiry; also the answers made to the
inquiries of the Commissioners of Inquiry into the means of Im-
proving the Health of Towns; and state that you are instructed
to view the places where epidemic diseases have been most rife,
and to judge for yourself as to the condition of the houses and
of what may be dome by public measures and the exercise of the
powers by the General Board of Health, for the remedy of the
evils in question, and for the advantage of the population.
You will then ask, if there be any evil, or any place to which
any person in the meeting wishes you to direct your special
attention? If there be, you will take a note of it, and endeavour
to attend to it as far as it may appear to require it and as your
time may enable you.
You will endeavour to confine your first meeting to the hear-
I 30 Examination of Sanitary Conditions.
ing of such statements, and ascertaining the parties who will
ive the most trustworthy information.
If there be any parties opposed to the petitioners, or to the
inquiry generally, or to proceedings on the ground of expense,
the objection will involve references to the condition of some
places, or to the condition of the town generally; and you must
necessarily suspend your judgment until you have seen with
your own eyes. After you have done so, you will judge how
far it may be necessary to incur the expense or delay of a
further hearing before you have made your Report, when they
will see what is proposed to be done, and when it is hoped
that their apprehensions will be removed, and when, if not,
they will have the opportunity of being heard according to
Section 9. You will select the medical or the relieving officers,
or other persons who will guide you to the track of fever cases,
and also any town surveyor or inspector of nuisances, or officer
of police, who may be required to attend you to give explana-
tions.
From what is established in relation to the haunts of typhus
and epidemic disease, it may be presumed that the list of places
of their occurrence will have carried you to ill-drained and ill-
cleansed and filthy places. In these places you will inquire and
examine as to the state of the water supplies.
From the inspection of these places you will proceed to the
other better-conditioned districts, and to the general perambu-
lation of the town, and to the suburbs.
You will next collect your information as to the soil, subsoil,
the beds of clay or strata, and the geological condition of the
site of the town, its permeability and absorbency, and its state
as to springs and surplus water, as affecting the state of damp,
whether of tenements within the town or of lands in the suburbs.
Having taken a general view of the covered portion of the
town, and of the whole site, it is to be presumed from the
known common causes of epidemic disease that you will have
been brought upon ill-drained and ill-cleansed districts, with
accumulations of filth and cesspools in yards, or in extended cess-
pools constituted by ill-constructed drains and covered sewers, or
by stagnant open ditches which serve as sewers, upon houses with
damp floors, or walls, and upon spaces surcharged with moisture.
You will then have to consider in what way the soil and ani-
mal and vegetable matter, filth, and refuse may be most rapidly,
conveniently, safely and economically removed.
From trials of works it may be taken as demonstrated that
you will find that such removal may be best effected by means
of impermeable tubular drains, which will allow of no escape of
noxious gases; and from their comparative smoothness, and the
better adaptation of forms and concentration of the stream, will
allow of the best scour and consequently the least deposit.
Drainage and Removal of Refuse. 131
You will have next to consider the direction of the discharge,
which usually need not be to the pollution of the nearest stream,
but in the direction of agricultural demand and application for
the purpose of production; but in making this provision you
will consider of the discharge of the drainage into such channels
as will not pollute the atmosphere of the town, but will yet serve
for relief: should the early demand for it for agricultural produc-
tion prove inadequate, the system of impermeable tubular drains
might convey the refuse of the town through sites surcharged
with surface watcr from the rain-fall on the uncovered spaces,
or from springs, and from the percolation of upland-waters, and
thus avoid adding to the noxiousness of the emanations from
stagnant water charged with the common marsh impurities.
You will have to consider, together with the means of relief
by the conveyance of night-soil and other refuse in tubular im-
permeable drains, the clearance of the table site or natural area
of the town from surplus rain or spring water by means of a
corresponding system of permeable agricultural tile drains, and
other means, according to the position of the land; and you will
have to direct your attention to the protection of low-lying dis-
tricts from upland flood waters as well as from the ordinary
rain-fall.
The natural drainage area usually determines itself by the
line of water shed from the hill top to the river or stream,
dividing the valley or the lines of water shed of a matural basin.
But where a river dividing a town through the natural drainage
area on each bank, might in an engineering point of view, be
drained separately, yet this would require double, or weaker,
or less economical establishments, clashing regulations and ad-
ministrations, in parts of the same town, you will find the
advantages resulting from the principle of administrative con-
solidation exemplified in a charge delivered to a jury at a Court
of Sewers at Westminster by Lord Morpeth.
You will, however, wheresoever you can, avoid going beyond
existing civil boundaries for the sake of time in procedure and
on other grounds. In all places where there is no corporate body,
it will be desirable that you should report your views upon the
best mode of constituting the local board in conformity with
the provisions of the Act as to numbers and the continuance or
incorporation of any local body.
Considering the superior economy as well as the sanitary
advantages of removing, as far as may be practicable, all the
refuse and filth in a state of suspension in water, and the greater
efficiency and economy of distributing all such matters as
manure in the like suspension in water, you will next have to
consider of the application of existing supplies, or of new
supplies of water for these purposes, and also for domestic and
manufacturing purposes and other uses.
132 Supply of Water.
You will have to consider of the sources of such supply,
and of gathering grounds or storage grounds, for the collection,
storage, and distribution of water for the purposes above spe-
cified.
The consideration of the works necessary for these purposes
will lead to the determination of the natural drainage arca, and
also of the jurisdiction of the administrative area within which
the several objects above described may be most economically
and conveniently accomplished.
You will only go beyond the existing civil boundaries where
there is a physical necessity for doing so, or where there will
be manifest advantage to the occupiers and owners of the dis-
trict included in the new jurisdiction, as well as the owners and
occupiers within the existing civil jurisdictions.
Where schemes of local amendment have been proposed in
relation to any place, you will see and examine the place itself,
and make your own motes of what appears to be necessary to be
done, and of the applicability of established principles of works
before you look at any of the schemes and plans of works which
may be tendered for examination. You will bear in mind that
you will not be warranted in incurring delay and expense in the
examination of plans which primâ facie are erroneous in prim-
ciple or defective in detailed application in respect to the im-
portant subject of the application of the refuse of the town to
agricultural production. It is desirable to ascertain and de-
termine to what extent town manure is at present used by
the farmers near the town 2 What is paid for it according to
the present methods? What is the expense of hand labour
in its collection, and of cartage in its removal 2 and also
what is the usual expense of its application as top-dressing 2
and what is the produce from the manure as at present
applied ?
W. will inquire as to the state of the adjacent land for the
reception of sewerage manure as to its permeability from
drainage or from the natural condition of the soil and sub-soil,
and also as to any waste or common land, or public lands held
under tenures favourable to adaptation as examples of success-
ful cultivation.
You will endeavour to make known as widely as you can,
that every district will be protected by the General Board of
Health from contributing more than its fair share of rates, pro-
portioned as nearly as may be practicable to its share of the
advantages which it is hoped will be derived from the measures
which you will be required to prepare.
The Reports of the Commissioners of Inquiry into the means of
Improving the Health of Towns show an extent of expenditure
in useless and wasteful works which may well justify apprehen-
sion as to future expenditure under the same management for
Comparative Expenditure—Distribution of Charges. 133
the same objects. In the present depressed state of many com-
mercial and manufacturing districts you will probably experience
a great dread of any new outlay whatsoever. The Legislature,
in authorizing a new expenditure, has appointed the new Board,
whose agent you are for carrying the Act into effect, for the
purpose of preventing the repetition of the former insufficiency
and waste.
It will be your duty by your Report to allay, as far as may
be practicable, unfounded apprehension on these heads.
You will show the description of works required, and state
the charges at which it may be confidently pronounced that
such works may be executed under a proper management.
You will allay apprehensions of immediate outlays being re-
quired by expounding the principle and the equity of the dis-
tribution of charges over periods of time as sanctioned by the
Legislature.
You will state the weekly charges per house, and the charges
per head on the population, in order that the annual rental, as
well as the immediate outlay which is to last for years, may
not, as is commonly done, be fallaciously set against the daily
and weekly convenience and economy.
You will moreover take care to ascertain and set forth what
are really the existing charges in respect to which it is hoped
the new charges will serve as means of reduction, the existing
immediate charges of emptying cesspools by hand-labour and
cartage; the charges of repairing defective house-drains and
cleansing badly constructed sewers; the charges for the con-
struction and repairs of pumps and wells, and of tanks and
cisterns where supplies of water are only intermittent; the
charges of fetching, carrying, and distributing water by hand-
labour, and the charges of dilapidations of premises arising from
damp and ill-drained foundations.
It is important to ascertain such existing charges, as a point
of departure as well as of contrast. One mode of doing this
will be by a set of house-to-house queries, such as have been
distributed by the Metropolitan Commissioners of Sewers.
You will exercise your discretion as to the distribution of these
queries. In order to keep them within a manageable extent,
you may send them to be answered by the petitioners, or you
may distribute them to the occupiers of different classes of
houses. You may take a block of houses of each of the chief
classes, and after having ascertained the existing charges in
relation to them, set forth the proposed house-drainage and
other works, and show in detail the proposed new charges in
relation to them.
You will also advert to the expenses of sickness and mor-
tality. The extent of inquiry and exposition on this topic
will be entirely at your own discretion.
134 Functions of the General Board of Health.
In the event of your deciding to hold an adjourned meeting
to hear any parties on any contested question, you will remind
the persons applying, or the rate-payers, of the expenses
incurred by any delay, and ask from what fund the prosecutors
of the contested question expect payment?
You will bear in mind that your examination is mainly one
as to works, or as to engineering appliances for the removal of
the evils in question, and you will conduct the inquiry ac-
cording to the best of your judgment for the attainment of the
chief objects, according to your own professional views and
methods of investigation; and where you deem it necessary to
examine witnesses, it will be inexpedient that you should
attempt to adopt the technical procedure of the Courts of Law,
which is instituted for the determination of questions as to
matters of fact with a view to legal decisions. You alone will
be responsible for all inquiries, and you only are authorized to
conduct them. . The statute gives no authority for incurring
the expense of hearing counsel and attorneys. It will be your
duty to put such questions to witnesses as may appear to be
necessary. If any one wishes any questions to be put on points
to be investigated, you will request him to hand them to you
in writing, and you will judge of their relevancy and direct
the inquiry. You will bear in mind, and state to parties, if
requisite, the inutility and grievous expense of former inves-
tigations as to the necessary or comparative merits of engineering
works, when conducted according to the methods adhered to
by Courts of Law on the trial of more definite questions of fact
which are put in issue in those courts.
You will also point out the privilege of appeal secured by
the Legislature to parties interested by the provision, “that
within a certain time, being not less than the time of such pub-
lication and deposit, written statements may be forwarded to
the Board in respect to any matter contained in or omitted
from the said Report, or further Report or any amendment
proposed to be made therein.” You will give the assurance
that the General Board will, to the best of their power, pay
attention to all written and deliberate appeals on a matter in
which their only desire and interest must be to see that no just
cause of dissatisfaction prevails.
You will bear in mind, as a representative of the General
Board, the general nature of its objects and position as collected
from the tenor and spirit of the provisions of the Act, first, as
an agency for the removal of those evils in the repression of
which the public at large have an interest; next, as an au-
thority of appeal and adjudication between rival or conflicting
local interests; thirdly, as a security in the distribution of
charges, for the protection of minorities and absentees against
Wasteful works or undue charges in respect to them; and,
Communication of Information. 135
fourthly, as a means of communicating to each locality for its
guidance the principles deduced from the experience of all
other places from which information may be obtainable.
In this last view in respect to works, each of you will be
expected to note and communicate to each other reciprocally in
detail whatsoever information you may obtain.
You will keep diaries of your proceedings and accounts of
your expenses, and transmit them weekly to the General Board
in the forms provided.
In the diaries you will note any facts or observations that
may occur to you, and that you may not deem of importance
enough for a separate letter.
The Board will regard your labours with great interest, and
will be glad to hear #. you upon all matters that may illus-
trate the progress of the measure.
The Board will in general refer to you any correspondence
relating to the places with which you may be charged.
Signed by Order of the Board,
HENRY AUSTIN,
Secretary.
Gwydyr House, Whitehall.

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