THE MEDICO-CHIRURGICAL REVIEW. OCTOBER, 1845. I. FIRST REPORT OF THE COMMISSIONERS FOR INQUIRING INTO THE STATE OF LARGE TOWNS AND POPULOUS DISTRICTS. Folio, 1844. SECOND REPORT OF THE COMMISSIONERS FOR INQUIRING INTO II. A BILL FOR THE IMPROVEMENT OF THE SEWERAGE AND IV. CONTRIBUTIONS TO VITAL STATISTICS, being a Development of the Rate of Mortality and the Laws of Sickness from original and extensive data, procured from Friendly Societies, showing the Instability of Friendly Societies, " Odd Fellows,' "Rechabites," &c. with an Inquiry into the Influence of Locality on Health. By F. G. P. Neison, F.L.S. &c. Actuary to the Medical Invalid and General Life Office. 4to. pp. 140. London, 1845. V. PAMPHLETS PUBLISHED BY THE HEALTH OF TOWNS AssoCIATION: Abstract of the Proceedings of the Public Meeting; Speech of the Marquis of Normanby in the House of Lords on moving an Address to the Crown on the Sanitary Condition of the People; Suggestions for forming Branch Associations. By Robert A. Slaney, Esq.; Unhealthiness of Towns, its Causes, and Remedies. By R. D. Grainger, Esq. Lecturer on Physiology at St. Thomas's Hospital. VI. LETTERS ON THE UNHEALTHY CONDITION OF the Lower NEW SERIES, NO. IV.-II. U CLASS OF DWELLINGS, ESPECIALLY IN LARGE TOWNS. By the Rev. Charles Girdlestone, A.M. Rector of Alderley, Cheshire. 8vo. pp. 92. London, Longman and Co. 1845. VII. FACTS CONNECTED WITH THE SOCIAL AND SANITARY CONDITION OF THE WORKING CLASSES IN THE CITY OF DUBLIN. By Thomas Willis, F.S.S. 8vo. pp. 59. Dublin, J. O'Gorman, 1845. It is a painful but unquestionable truth, that so far from the happiness and well-being of the population of England having increased with the daily augmenting wealth of the nation, there has been almost pari passu, a fearful diminution in the material comforts of the people and a corresponding amount of suffering, sickness, and death. We more especially allude to the inhabitants of our manufacturing towns, though in many of the rural districts the population have not escaped this physical degra dation. Those who look only on the surface of society and measure the national prosperity by the property of the country as indicated by the increased imports and exports, by the returns of the income tax, and by the general progress of luxury among the higher and even middle ranks of society, may still congratulate themselves that all is well, and that the poor man's hearth shares in some degree in those excessive riches which are at once the envy and the marvel of the world. Would that it were so, and that those who by their unequalled skill and unmatched industry create the country's wealth, reaped in the comfort of themselves and of their families the just reward of their unceasing toil. It is not, however, the first time in the history of the world, that enormous wealth in the hands of the few, has been accompanied with the direst sufferings on the part of the many; nor that unbounded luxury has been seen side by side with squalid wretchedness. The state of things at this time existing in England is powerfully depicted by one thoroughly acquainted with the condition of the manufacturing districts, the Rev. John Clay, of Preston, from whose admirable report we extract the following passage. "We endeavour to civilise distant people by winning their confidence, by striving to develop the better qualities of their nature, by promoting intercourse with them, and making them alive to its benefits. The same measures are needed at home, where the moral and intellectual extremes of society are as far asunder as if separated by untrodden deserts or untried seas. This mental remoteness and local propinquity cannot long co-exist without change; a great community is never stationary; there is always a tendency upwards or downwards, according as the few above or the many below exercise influence; while, independent of the movement of the general body, there are ever some individuals sinking, and, happily, more successfully struggling to rise. But the great mass is yet chaotic; and unless, by God's blessing, breathed upon the spirit of intelligence, and of order, and of religion, it may be hurled upon all that is fair and good among us, with a momentum as sudden as irresistible."—First Report, Ap. Part 1, p. 55. To the medical observer, whose duties bring him in immediate and daily contact with the poor and suffering, the sad disclosures made by the suc cessive Commissions, which have investigated the actual condition of our manufacturing population, will only present an aggregate view of that pervading misery, with which, in detail, he has unhappily been so long familiar. But to the influential classes of society in general, it is impossible to conceive of any descriptions more startling, or more calculated to humble the national pride, and to stimulate to national amelioration, than the frightful evils depicted in the Reports and Evidence of the Health of Towns Commission. The curtain which has so long screened from the public eye the almost inconceivable afflictions of the manufacturing poor has at length been raised, and what is presented, not only to the gaze of this country, but to the contemplation of the civilized world :—a population sunk alike in physical suffering and moral debasement; deteriorated in stature, enfeebled by sickness, and fearfully curtailed of the allotted years of human existence. This is strong language, but it is justified by the unparalleled sufferings of hundreds of thousands of our fellow-countrymen, who are doomed in the midst of civilized and Christian England to live a life compared with which the existence of savage and heathen tribes, may, as to material comforts, be termed happy. Can any words, for example, be too forcible to characterize a state of things, in which, out of 100,000 human beings born in Liverpool, in Manchester, or in Birmingham, upwards of 50,000 perish under five years of age; or in which an "artizan reaches only 15 years of age, and has 28 years less chance of life than the gentleman.' Well may the inhabitants of the crowded courts and alleys of our great cities exclaim with the inspired writer few and evil have been the days of my life.' The unhappy combination which we have noticed of increasing misery with increasing wealth, is well stated and elucidated by the Marquis of Normanby, in the speech delivered at the formation of the Health of Towns Association. That nobleman, whose strenuous and persevering exertions in the cause of Sanitary improvement are deserving of the highest praise, asks— "How then did it happen that such a state of things as was exhibited in the reports recently laid before the legislature had been permitted to grow up? His own attention had been first fixed upon the subject in consequence of particular opportunities for observing the details which had occurred to him during the time he had had the honour to hold a high public office. But from that time he had never felt more strongly than at the present moment the conviction, not only that nothing had been done to remove these terrible evils, but that they were actually in a state of daily increasing virulence; and taken, as they must be, in connexion with other circumstances in the social condition of the poorer orders, they gave room for a well-grounded anxiety for the permanence of our national greatness. The most striking instances of the deterioration of physical strength were to be found in the districts where the greatest social changes had taken place within the last thirty years-where the investment of capital and the development of mechanical discoveries had collected a large population together, without an attempt being made to secure their physical well-being. But yet there is scarcely a district exempted from some share in the charge of such neglect. If they turned their glance upon the metropolis, it was not the busy east alone which was obnoxious to it, for in the neighbourhood of the well-ventilated squares of the west there were dense courts and alleys containing within themselves the seeds of disease germinating there, ready to spread their baleful influence around. All this was disgraceful and dangerous." "The county of Lancaster stood foremost in bad pre-eminence amongst unhealthy counties; but it must be recollected that, in making calculations derived from an extensive district, the comparison was much weakened by there being * U necessarily a large admixture of a population of a different and sometimes opposite description from that which gave it its peculiar character. In some respects, however, distinct from health, Lancaster had gained greatly; for he saw by the returns upon the last repeal of the income tax, there had been an increase of property in that county as compared with the present time, of 136 per cent. It would be imagined, then, that this was a district in which prosperity most generally prevailed. How was the fact? At the time of the census preceding that repeal of the income tax, the rate of mortality was one in fifty on the whole kingdom. Now the rate of mortality was one in forty-five. How did this happen? How would they account for this diminution of the physical strength of the nation in the face of increased wealth, of improved science in the art of healing diseases, and of improved moral and temperate habits among the people? To solve the difficulty they must point to particular districts of the country, note the statistical facts, and draw their inferences. The mortality in Lancashire thirty years ago was one in forty-six, or less than the general average of England at the present moment. Now the mortality in that county was one in thirty-six. Still there was a difference in the mortality as regarded different districts in the same county. The value of life in Ulverstone, for instance, is stated by Dr. Playfair to be double what it is in Manchester-Manchester which, as he says, enjoys the unenviable notoriety of being the second unhealthy town in the kingdom, and where the mortality was, upon the most favourable estimate, 1 in 28." -Abstract of Proceedings of the Public Meeting held at Exeter Hall, p. 6. We have here disclosed the secret of the apparent anomaly we are considering the investment of capital and the development of mechanical discoveries have collected a large population together, without an attempt being made to secure their physical well-being." It is not our wish to hold up the great capitalists and employers of the manufacturing districts to special rebuke; they have only shared in common with the lords of the soil, and we must in justice add, with all the wealthy and influential classes, in that apathetic and selfish indifference to the wants and happiness of their dependents, which is the besetting sin of this utilitarian age. There are, and have been, doubtless, many individual exceptions to this sweeping condemnation, and it is gratifying to know that, since the public attention has been more particularly directed to the existing evils, strenuous efforts have been commenced, and are now in actual progress, in many of the great towns of Lancashire and elsewhere, to obviate the causes of unhealthiness. With these prefatory remarks we proceed to lay before our readers an outline of the deeply interesting matter contained in the various documents now before us. The most important of these publications are, of course, the Reports and Appendices of the Health of Towns Commission. These comprise three folio volumes or blue books; but, in addition to these, and in order to promote the diffusion of their contents among the public generally, an octavo edition has been published, and the reports of the several Commissioners have also been issued as separate pamphlets. The scope of this inquiry will be understood by the following enumeration of the subjects which the Commissioners were instructed to investigate. "The causes of disease among the inhabitants. "The best means of promoting and securing the public health, under the operation of the laws and regulations now in force, and the usages at present prevailing with regard to— "The drainage of lands; "The erection, drainage, and ventilation of buildings; "And the supply of water in such towns and districts, whether for purposes of health, or for the better protection of property from fire, and "How far the public health, and the condition of the poorer classes of the people of this realm, and the salubrity and safety of their dwellings may be promoted by the amendment of such laws, regulations, and usages."-1st Report, p. vii. The Commissioners appear to have adopted the most judicious measures for carrying their instructions into operation. They selected for examination fifty towns, in which the rate of mortality appeared by the returns of the registers of death, with a few exceptions, to be the highest. These of course included the largest manufacturing towns and the principal ports, containing a population of more than three millions of persons. A series of questions was transmitted to the municipal and other officers, and subsequently each of these towns was visited by one of the Commissioners, who examined on the spot the general condition of the place, and received statements from medical and other officers, as well as from those among the inhabitants who were capable of affording information. It is satisfactory to find "that in these local inquiries a lively and cordial interest was taken by the inhabitants, and that the Commissioners obtained ready assistance from persons of every class and denomination." We are also happy to perceive that the members of our own profession have not been backward in giving their important aid; as we shall have occasion repeatedly to refer to the evidence, we will only here remark, that the most valuable part of the information collected by the Commission is derived from this source. In an inquiry embracing such an extended field and such a variety of subjects, we shall select those divisions of it which are of primary importance, or which are more particularly interesting to the medical practitioner; and in doing this, the following order observed by the Commissioners will, for the most part, be followed: "1. Drainage, including house and main drainage, and the drainage of any space not covered with houses, yet influencing the health of the inhabitants. "2. The paving of public streets, and courts and alleys. "3. Cleansing; comprising the removal of all refuse matter not carried off by drainage, and the removal of nuisances. "4. A supply of water for public purposes and private use. "5. The construction and ventilation of buildings for promoting and securing the health of the inhabitants."-Second Report, p. 7. I. Drainage. The Commissioners state that, "among the evils, which appear to operate with the greatest severity on the condition of all, and especially of the labouring classes, are those arising from the absence of a proper attention to drainage; they prevail almost universally, to an extent altogether incompatible with the maintenance of the public health.” And yet, upon this very subject, the public at large, and even many of those more particularly engaged in the matter, architects, surveyors, and builders, entertain the most narrow and mistaken views. As a sample of the ignorance and indifference which has prevailed upon this vital question, it may be stated, incredible as it will appear, that there was till very lately no other than surface drainage in two of the greatest thoroughfares in the metropolis, Bishopsgate Street and Cheapside. |