l62 



NA TURE 



[Dec. 1 6, 1886 



crowded dwellings, prevailed generally among the working 

 classes in all parts of the kingdom ; and that whilst these diseases 

 could be abated by improved sanitary conditions, they were not 

 removed by high wages and abundant food if sanitary conditions 

 were absent. They also pointed out thai owing to the defective 

 water-supply cleanly habits were impossible. 



In illustration of the loss caused to the nation by these pre- 

 ventable diseases, they mentioned that out of 43,000 widows and 

 112,000 destitute orphans relieved from the poor-rates, the 

 greater number had lost their husbands or fathers from prevent 

 able diseases ; and that the youthful population of either sex 

 brought up in crowded, unwholesome dwellings, and under thi 

 adverse circumstances described, were deficient in physical 

 strength and moral conduct, and grew up improvident, reckless, 

 and intemperate, caring for nothing but sensual gratification. 

 They pointed out that the ex| enses of local public works were 

 unequally and unfairly assessed, oppressively and uneconomically 

 collected by separate collections, and wastefuUy expended liy 

 unskilled and irresponsible officers, and that the existing law for 

 the protection of the public health, and the constitutional 

 machinery for its execution, such as the Courts Leet, have fallen 

 into desuetude. 



The Commission then went on to state the conditions required 

 for improving the sanitary condition of the labouring classes. 



This report was thus one of the early fruits of the system of 

 vital statistics which commenced at the accession of the Queen, 

 under the able supervision of our late eminent member, Dr. Farr. 

 The report itself was drawn up by another eminent member of 

 this Society, ilr. Edwin Chadwick, C.B. It is a remarkable 

 tribute to the foresight of Mr. Chadwick that, during the last 

 half-century, almost all the sanitary principles laid down in the 

 report have been recognised by the Legislature as necessary to 

 the welfare of the community, and have become matters of 

 ordinary practice. The conclusions of the Poor-Law Commis- 

 sioners, and the general interest awakened in the subject, led to 

 various sanitary investigations, both by Royal Commissions and 

 Committees of the Houses of Parliament. 



When the Registration Act came into operation, an epidemic 

 of small-pox was advancing over this island. It attained its 

 maximum in the spring of 1838, and destroyed 30,819 persons. 

 Dr. Farr mentions that vaccination protected a part of the popu- 

 lation, but that there is reason to believe that inoculation led to 

 the extension of the epidemic by diffusing the infection artificially. 

 In 1840 and 1841, the first Vaccination Acts were passed. These 

 prohibited inoculation, and empowered the Guardians to provide 

 means for vaccination, and to charge the expense on the rates ; 

 and enacted that vaccination was not to be considered parochial 

 relief, thus recognising the fact that the community should bear 

 the cost of measures which are found necessary to secure the 

 pttblic health. It was not, however, till 1853 that vaccination 

 was made compulsory. 



The reports of the various Commissions and Committees of 

 Parliament which inquired into the condition of the people 

 showed the great importance of cleanliness of person and cloth- 

 ing to health, and the difficulties which the poor suffered in 

 respect of it ; and in 1844, private associations, not only in 

 London, but in Manchester, Liverpool, and other large towns, 

 were formed to encourage cleanliness amongst the working 

 classes by establishing public baths and wash-houses, and lend- 

 ing out pails, brushes, and whitewash to the poor to cleanse 

 their dwellings ; and in 1846, the Bishop of London brought in 

 a general Act empowering local authorities to establish public 

 baths and wash-houses, the expense of which was to be defrayed 

 out of the rates. 



As regards general sanitary legislation, it is probable that the 

 recommendations in the Poor-Law C.'mmissioners' report and in 

 the reports of these several Royal Commissions and Committees 

 of the Houses of Parliament, would have remained long in 

 abeyance had it not happened that the nation was threatened 

 with an epidemic of cholera. 



In 1832-33, the cholera had visited our shores and snatched 

 16,437 victims. It again appeared in London on Septem- 

 ber 22, 1848, and in Edinburgh in the beginning of October, 

 J 848. So long as the insanitary conditions remain, epidemics 

 invariably haunt the same localities, and the first appearance of 

 the cholera in Bermondsey in 1848 was close to the same ditch 

 in which the earliest fatal cases occurred in 1832. The first case 

 of cholera that occurred in the town of Leith took place in the 

 same house and within a few feet of the very spot from whence 

 the previous epidemic of 1832 commenced its course. On its 



reappearance in 1848 in the town of Pollocksh.avvs, it snatched 

 its first victim from the s.ime room and the very bed in which it 

 broke out in 1S32. It did not, however, attain its full intensity 

 until 1849, and it ceased on December 22, 1849. Its pro- 

 gress fully corroborated the report of the Poor-Law Commis- 

 sioners. It attacked those towns and houses which offered to it 

 the best inducements to visit them, in their filth, decaying refuse, 

 crowded and dirty population, bad water, damp polluted sub- 

 soil, or any other of those conditions which lead to bad health 

 in a population, and which, when cholera is absent, afford an 

 evidence of their existence by the prevalence of scarlet fever, 

 small-pox, typhoid and oiher fevers, measles, whooping-cough, 

 &c. The total number of victims was 53,293. 



The near approach of the cholera led Parliament, in 1848, to 

 the conclusion that — 



" Further and more effectual provision ought to be made for 

 improving the sanitary condition of towns and populous places 

 in England and Wales, and it is expedient that the supply of 

 water to such towns and places, and the sewerage, drainage, 

 cleansing, and paving thereof, should, as far as practicable, be 

 placed under one and the same local management and control, 

 subject to general supervision." 



An Act was passed creating a General Board of Health. The 

 main feature of this Act was, that when the Registrar-General's 

 returns showed th.rt the number of deaths on an average of the 

 preceding seven years exceeded 23 per 1000, the General Board 

 of Health were empowered to send an inspector to make a public 

 inquiry as to the sewerage, drainage, water supply, burial-grounds, 

 number and sanitary condition of inhabitants, and local Sanitary 

 Acts in force ; also as to natural drainage areas, the existing 

 local boundaries, and whether others might be advantageously 

 adopted. The General Board were empowered to issue pro- 

 visional orders, creating a system of local administration by 

 means of Local Boards of Health, consisting partly of municipal 

 authorities and partly of elected members. These Local Boards 

 were empowered to appoint necessary officers, including medical 

 officers of health, surveyors, .and inspectors of nuisances. The 

 public sewers were vested in the Local Board, and they were to 

 maintain, cleanse, and regulate the use of sewers. All houses 

 rebuilt were required to be provided with drains approved by the 

 surveyor ; and, before any new house was commenced, the levels of 

 the cellars or lowest floors, and the position and character of the 

 drains or cesspools, were to be approved by the surveyor. The 

 occupation of cellars as dwellings was prohibited. Water-closets, 

 or privies, and ash-pits were to be provided to all houses and 

 workshops. The Local Board was also required to manage, 

 repair, and clean the streets, and to provide for removal of refuse. 

 They were to abate nuisances, regulate slaughter-houses, register 

 and make by-laws to regulate common lodging-houses. The 

 local authorities were empowered to provide public recre.ation- 

 grounds, and to provide a water supply, except where a water 

 company would supply, on reasonable terms. They were also to 

 provide mortuaries ; to obtain power to close burial-grounds 

 which they considered to be unhealthy, a'ld to open new ones. 



The Local Boards were empowered to make by-laws and 

 impose penaltie-, subject to confirmation by the Secretary of 

 -Slate, and to levy rates, to mortgage the rates, and to borrow 

 from the Public Works Loan Commission. The Act also pro- 

 vided for sewers, wells, pumps, c&c. , to be made where desired 

 by the inhabitants in parishes containing less than 2000 persons. 

 The me'ropolis was exempted from the operation of this Act. 



The General Board of Health came into existence in 1S48, 

 just before the outbreak of cholera in this country, and it took 

 measures at once to check the disease, and proclaimed the prin- 

 ciples upon which the preventive and other measures for meeting 

 the epidemic ought to be conducted, .\mongst these measures, 

 probably the one which had the greatest effect in promoting 

 subsequently a general feeling of the necessity for sanitary im- 

 provements, and wdiich awoke in the nation the needs of moral 

 improvement, was that requiring house-to-house visitation, and 

 the cleansing of the houses and streets, and obtaining an 

 adequate water supply. 



This epidemic also brought into notice the necessity of ap- 

 pointing efficient medical officers to supervise the sanitary 

 condition of the different towns .and districts. 



Further Acts for regulating the public health were passed in 

 1858, 1S61, and subsequent years; and all their provisions were 

 embodied in a General Act in 1875, from the operation of which 

 the metropolis was exempted. Subsidiary to these may be 

 mentioned the .\cts regulating rural water supply, the Artisans' 



