“Our parish is now almost completely built over.

“In 1850, out of 1,169 deaths 565 (or one half) were under 5 years.

“In Bermondsey, 506 out of 983.

“Our parish and Bermondsey are quite ahead (of others) in this unenviable race towards death.”

“The contents of our sewers can only be discharged 4 hours each tide—8 hours each day—the remaining 16 hours daily they are reservoirs of stagnant sewage.”

“We are sadly deficient in sewers. At least 100 courts, alleys, and back streets are entirely without drainage…. Some of our sewers have remarkably little incline. That in Friar Street, a most important one, is so level from Bean Street to Suffolk Street that it has a most curious quality for a sewer, that of flowing either way equally well.

“One very prevalent evil is loose brick drains which let the deadly gases into houses.”

“… We are a most melancholy parish, low in level and low in circumstances. The lowest and poorest of the human race drop from higher and richer parishes into our courts and alleys, and the liquid filth of higher places finds its way down to us. We receive the refuse as well as the outcomings of more happily situated places.”

His report for 1857 continued his description:—

“We lose annually 30 per 1,000—there are only two parishes worse than we are. Some at least of this mortality is preventable. If we could keep to the average of all London we should lose 300 less a year; or even to that of Bethnal Green we should lose 200 less.

“Few people believe we are so bad as we really are, and if we do not believe we shall not of course try to mend it, but it cannot be denied.

“The rich Londoners pay a low poor-rate. The poor Londoners pay a high poor-rate. This bears hardly upon us; it stifles us: more and more packed, more and more impoverished; with very little space between the poor ratepayer and the pauper, there is more sickness and death.

“Density of population brings you more deaths, more sickness, more expense.

“The dreadfully vitiated air of our courts and close rooms produces and fosters consumption.”

Commenting on the common lodging-houses, he wrote:—

“The police regulations for order, cleanliness, and prevention of disease are in the highest degree satisfactory…. The benefits are so great that the employment of the same regulations in the more crowded and filthier houses of the poor can only be a question of time. It is the highest humanity to quicken the progress.

“Vestries have power sufficient for the purpose. The need is so great, so undoubted by those who have seen the evils with their own eyes, and the benefit to be obtained so certain, that if the local authorities do not enforce the improvements, the police will have to do it.

“As to the overcrowding, I have brought many cases before you, each from illness resulting in difficulty of cure, constantly recurring. ‘I can never get out of that house,’ said the district surgeon of one of them. The eight rooms in this house were always full, the receipts £2 2s. a week, yet it was dirty, neglected, and overcrowded. So the poor live, and I may say, so they die.”

“As to some manufactories, some of them are very bad, and their pernicious influence spreads widely. I do not think any manufacturer should be obliged to leave; trades must, of course, be protected; but one man must not, to save a little expense in his building and machinery, be allowed to poison a neighbourhood, containing as this does some 30,000 people.

“There are various ways of making almost all of them bearable.”

“In this parish are at least 4,000 houses rated under £10 a year, and containing 30,000 persons.”

1858. 1st Quarter:—

“Of smallpox and vaccination there are some who neglect this great precaution, and so not only imperil themselves but others. Here is the evil, and indeed, I believe, the reason why the disease is not altogether banished.”

“… A case registered as diphtheria occurred and died; it began in one of the very worst localities and then extended to opener and better places. Thus it is that modern society neglects the social condition of its poor, and the poor with a well-ordered revenge bring disease and death as a consequence.”

Referring to some tables he compiled, he said:—

“In this table appear 42 deaths from consumption; it has but recently become prominent how very preventable a disease this is … the principal causes have here been made obvious enough: sleeping closely in ill-ventilated rooms, overcrowding, and bad ventilation.”

“It is now quite established that, with close overcrowded rooms—that is, by assiduously causing the continued breathing a tainted atmosphere—you may insure consumption in the most healthy.

“3,500 years ago the Jewish legislator promulgated laws and duties almost identical with those we are now engaged in carrying out as new in the nineteenth century—but so it is.”

“… There is a great deal of carelessness touching human life, and a great want of common sense or serious thought in the preserving it. Much is left to chance. There is either fatalism or stolid indifference upon the matter pervading highest society, and the poor, driven as they are from richer districts into poorer neighbourhoods, can scarcely help themselves; they lose at last all healthy communication with richer or better neighbours, and all taste for pure air and healthy pursuits; they pack close, they descend a little, often a great deal, toward the lower animals, and so live neither for this world nor the next.”

“There are 7,000 houses in this parish. 890 of these have been visited this year, and in 756 the work ordered has been carried out—sometimes in a most slovenly manner—an apparent compliance with your orders. In the poorer districts the most incompetent men are employed to plaster over, patch over, whitewash, or cover over the evils ordered to be not covered but amended. Still a great amount of good work has been done.

“… Overcrowding is the normal state in our poorer districts. Small houses of four rooms are usually inhabited by 3 or 4 families, and by 8, 16, or 24 persons, e.g., 133 inhabitants in 8 houses … a filthy yard generally implies a filthy house and unclean habits” … “this parish with its thousands of refuse heaps.”

“I know that we are on the right track. May Pole Alley, a cul-de-sac with its 23 houses and 180 people, was once a nest of infectious diseases. I attended some 10 cases of typhus there, some of them malignant enough to destroy life in 48 hours. With great trouble this court has been cleansed and amended. It is very much more healthy.”

1858. 2nd Quarter:—

“June—an exceedingly hot and dry month. You may judge of the effect of such temperature upon exposed dung-heaps, wet sloppy yards, and rotten, filthy, uncovered water-butts; three characteristics of this parish….

“The Surgeon of the District writes thus to the Board of Guardians: ‘The smell is very bad from a horse-boiling establishment in Green Street, which causes a great increase of sickness near that part.’ This of course refers to the bone boiling and other like establishments, of which there are, in this one small street, three cat gut manufacturers, one soap boiler, one horse slaughterer, and four bone boilers—all very offensive trades. I am receiving complaints in all directions as to this matter. I am inclined to think that this is not altogether just to the 20,000 inhabitants who live within the effluvia circle of Green Street.”

As to infantile mortality he writes: “I confess I see but little difference between that sanguinary ancient law that directly destroyed weakly and deformed children, and that modern indifference that insures at the very least an equally fatal result” … “these disturbing truths involving so much trouble and expense, and giving us painful reminders of new duties, as well as of old ones neglected.”

He complains of having to neglect a great many cases of insanitation owing to want of staff. “… Of those upon whom orders come to remove nuisances, &c., a large number are objectors, and not a few positive obstructors….”

“The items in this last table merit attention, and throw a sad sort of light upon the condition of the poor of this parish. We have visited 73 unclean and ruinous houses; 118 in which the water was stored in a most unwholesome manner; 163 in which the drains were defective enough to be disease producing; 72 in which the w.c.’s were more or less unfit for use; 110 yards sloppy, not paved, or ill-paved; and 138 in which there was no sufficient provision for house refuse….

“We are packing more and more closely.

“In the great mass of our poorer habitations the allowance of breathing room is not more than 200 cubic feet per head—often as low as 120. In one house reported to me there were 30 in four rooms with only 2,410 cubic feet, or 80 cubic feet per individual. This must, of course, be premature death to many of them….

“We cannot overlook what is going on: improvements are being effected elsewhere, the dwellings of the poor are being destroyed, a few parishes are fast becoming pre-eminently poor, over-crowded, and filthy. I need not tell you that this parish is one that gets in this respect steadily worse from the improvement in others.

“The temptation is very great to overcrowd; the poor family, however large, by crowding into one room, and by even taking a casual lodger in addition, obtains a sort of home at a cheaper rate, and the owner gets a much larger revenue out of what I must, I suppose, call human habitations. The resulting illness and death are considered inevitable, or are viewed with a stolid indifference.”

1858. 3rd Quarter:—

Of the greatness of the mass of prevalent evils he wrote: “I have often reported it here, but the very enormity of the evil blunts our appreciation of it….”

There had been a high mortality in the Quarter. “We are once more, I believe, the worst parish in London….”

“The back districts of this parish require relief, as much as Ireland ever did, from a class of middlemen who, with some few most honourable exceptions, grind out all they can from the most squalid districts, and carry nothing back in the way of cleanliness or improvement.”

He gives a long list of streets and courts and places where disease was rampant and deadly owing to the insanitary conditions.

“It may perhaps be said that all this is in the order of nature, and cannot be prevented. My experience of a quarter of a century among these diseases points quite the other way. Providence does not intend that reservoirs of stinking putrid matter shall stand so close to the poor man’s door as to infest him at bed and board…. In the Jewish scriptures the places for the purposes here mentioned are ordered to be without the camp, as far from the breathing and eating places as possible; and among us, as you see, when we tolerate such abominations, He visits us with death. It is the result of the irrevocable laws of nature often averted by what appear as happy accidents, but at last, when disregarded, deadly. Gentlemen, you are the trustees for life and death to a population of well-nigh 30,000 people, who from the force of circumstances are more or less unable to help themselves….”

“Of course it cannot be expected that we can provide the homes of the poor with the orderly arrangements and benefits of these Institutions (Dispensaries, &c.)—that, however, will form no excuse here or hereafter for not carrying out the improvements we can easily achieve, and which a wise legislature has given us full authority to do.”

“Total deaths in Quarter ended October 2nd, 1858—369, of which 225 were of children under 5 years = 61 per cent!!”

The whole tone of this report was such that he could not possibly continue as Medical Officer of Health to a then existing Vestry, and he resigned.

He was succeeded by another very able man, Dr. Henry Bateson, from whose reports may be continued the description of this parish up to the census of 1861.

“The onward moral and intellectual progress of the human race depends far more upon the sanitary state which surrounds it than has ever yet entered into our imaginations to conceive….

“We have suffered severely from the ravages of smallpox. Smallpox is a disease over which we have perfect control, and which, were vaccination thoroughly carried out, might be banished from these dominions.”

“… Men whose nervous systems become depressed and the tone of their system generally lowered, become the subjects of a continued craving for stimulants.”

“… Our wells are but the receptacles of the washings from our streets, the off-scourings from our manufactories, the permeations from our cesspools, and the filterings from our graveyards.”

1860–1861. After five years’ local government:—

“The circumstances are various and complicated, which contribute to prevent the improvement of the district, and even make the endeavour seem at times hopeless. No one can know the fertile sources that exist for producing in the mind this feeling of despair save those engaged in sanitary labours; or those perchance whose duty it may be to visit our poorest and lowest localities.” … “It is no light and easy work to remove the aggregate evils of centuries which, like the coral reefs of the ocean, have grown up silently and continuously to their present magnitude…. There are hindrances all around, some of which are unsurmountable, such as those arising from the imperfections of the law itself … there are also vested rights, customs, ignorance, stupidity, and avarice, all of which have to be dealt with and overcome if possible.”

“Nature never pardons. Obey and it is well; disobey and reap the bitter consequences.”

Referring to some houses “of the worst description, having no yards, nor even windows behind, so that ventilation was impossible,” he says: “I am sorry to say that there are numbers of similar houses still standing, and occupied by the most ignorant and degraded of our population—a class living almost in the neglect of laws human and divine; and as heedless about the present and the future as the very heathen themselves….”

“The state and condition of the dwellings of the poorer classes are a stain upon our civilisation.”

“… No one can conceive, nor would they believe, unless eye-witnesses, the wretched circumstances in which vast numbers of families have to spend their lives. It is indescribable.”

“The daily task of keeping clean their houses and families, once a pleasure to them as well as a duty, having to be performed amid overwhelming obstacles on every side, from which no hope of escape remains to cheer them on, is gradually neglected and ultimately abandoned, their spirits become torpid and depressed, and this is necessarily followed by the derangement of the functions of the body. Finally they become reckless, and this recklessness increases the evil which gave it birth. There is action and reaction. What marvel then that, like unto those about them, they float down the ebb tide towards the dead sea of physical dirt and moral degradation. It has been truly said by Dr. Southwood Smith, ‘The wretchedness being greater than humanity can bear, annihilates the mental feelings, the faculty distinctive of the human being.’”

“The heedlessness shown in the building of houses is astonishing. No care is taken about the nature of the subsoil, the position, the ventilation, and means of cleanliness. They are run up anywhere and almost anyhow, and too often become the prolific source of disease.” And he quotes: “No man has a right to erect a nuisance, and the public has clearly as good a right, as great an interest in enforcing cleanliness to prevent the outbreak of an epidemic as in requiring walls to prevent the spread of fire. Yet, where one is destroyed by fire, how many thousands are there destroyed by disease, the indirect result of such erections?”

“We are desperately careless about our health, and apparently esteem it of small value. A great modern writer has truly said: ‘The first wealth is health. No labour, pains, temperance, poverty, nor exercise that can gain it must be grudged. For sickness is a cannibal which eats up all the life and youth it can lay hold of, and absorbs its own sons and daughters.’”

The descriptions here given enable us to realise how terrible and pitiable a state of things had been reached, and the depths of filth, and misery, and abomination into which the people had been allowed to sink through the indifference of Parliament, the absence of any local government, and the neglect or avarice of the “owners.”

One hope there now was. Parliament had at last made laws to remedy these evils, and local governing authorities had been created to administer and enforce the laws.

In 1858 a Public Health Act was passed by Parliament, which put an end to the existence of the Board of Health, and transferred to the Privy Council the administration of the Diseases Prevention Act. And the Privy Council was authorised to cause inquiry to be made in relation to matters concerning the public health. In 1861 a medical department of the Privy Council was formed which has in many ways been of immense service to the cause of public health, and which, as time went on, developed towards a true Ministry of Public Health.

All things considered, by the end of the first five years of the working of the new local constitution conferred upon the metropolis, a real beginning had been made in the sanitary evolution of the great city. Some of the grossest evils had been attacked, and a start made in lifting London out of the depths of the appalling slough of abominable filth in which it had become submerged.

In some of the vitally important matters progress was material. The improvement in the water supply was considerable, the main drainage works had been started; the construction of many new sewers, the abolition of great numbers of cesspools, and the better drainage of houses, were all events of a decidedly satisfactory character.

And the death-rate of London as a whole showed a slight decrease—from 23·38 per 1,000 in 1851 to 23·18 in 1861. In some districts there was an increase—in the majority, however, there was a decrease.

But most encouraging of all was the direct evidence afforded by experience as to the effects of sanitary improvements.

Thus, in Whitechapel, the Medical Officer of Health, in reporting that the cases of fever had diminished from 1,929 in 1856 to 190 in 1860, said:—

“This diminution may be fairly attributed to the additions made to the sewerage of the district, the improvements effected in the drainage of 2,172 houses, the abolition of 3,002 cesspools, the better paving of many of the courts, the systematic inspection, &c., of houses where fever occurred, the removal of 37,607 nuisances, and to the abolition of several offensive trade nuisances.”

And the Medical Officer of Health for Shoreditch wrote, in 1861:—

“That the diminished mortality and the lesser frequency of epidemic diseases are really due in great measure to sanitary works and inspection is proved by the diminution and even disappearance of certain forms of sickness from streets, courts, and districts where sewers have been constructed, ventilation provided, and other improvements effected; whilst, on the other hand, the districts still requiring those necessary reforms furnish far more than their proportion of the epidemic sickness and mortality.”

Philanthropic individuals were increasing their efforts for the improvement of the people; and societies, working on a self-supporting basis, were taking more active interest in the housing problem, and erecting model lodging-houses and more healthy habitations.[80]

Public opinion was more interested than before in sanitary matters, and it was thought that the working classes had also in some degree awakened to the care of their own health.

“Altogether,” wrote the Registrar General, in his report on the health of London after the census figures of 1861 were known, “there is abundant proof of that increased regard for human life that attends civilisation.”