To this review by one of the ablest and most experienced of men of the time in matters relating to the public health, it must, however, be added that so far as the metropolis was concerned, “the meaning of this strange unprogressiveness” was not so much the formlessness of the law, as the fact that the interests against the enforcement of many portions of the law were predominant, and the non-administration of the law was due far more to that circumstance than to any ambiguities or obscurities in the laws. “Vested interests in filth and dirt” were all powerful on the greater number of the local authorities of London, and so the law which would have interfered with those interests was left severely unadministered.

Against these interests it was difficult to struggle—especially when there was no compulsion upon the administrators of the laws to administer them. Sheltered under a permissive, they would not exercise a compulsory power—a power entrusted to them with the control of public money for public good.

The true cause of the inoperativeness of the law was, in a way, pointed out by the Medical Officer of Health for St. James’, Westminster, when he wrote (1869–70):—

“The great deficiency of the Act of 1866, as of all other English legislation on sanitary matters, is that no public prosecutor is appointed. If Vestries neglect to prosecute, and individuals do not see their way to it, people may be killed by infectious diseases to any extent.”

And the Medical Officer of Health for St. Giles’ expressed a similar opinion when he wrote (1870):—

“The duty of making these sanitary improvements should be imperative instead of permissive. It was wise, at first, perhaps, that our sanitary legislation should be tentative and experimental; but experience having proved its necessity it should be made more stringent.”

But neither of them got so far as to see the natural and simple remedy, that where a local authority for one reason or another would not administer the laws made by Parliament, the central authority should step in and do the work at the cost and expense of the recalcitrant local authority.

If one set of people failed in their duty to the public, it was but right that where such tremendous issues were at stake as the health and physical well-being, not merely of the people of one parish but of over three and a quarter millions of people—and all that their health and well-being implied—the administration of the law should be placed in hands that would administer it.

That, however, was but part of the great problem, though it would have gone a long way in ameliorating things. The other necessity was the strengthening and altering of the law which itself stood in need of many and large changes before a sure foundation could be laid for the future health of the great community resident in the great metropolis of London.

And other matters which ultimately were to have great influence towards the solution of some of the worst of the health difficulties in London were coming into view, and assuming form and substance.

Tramways, with their facilities of traffic, were about to be started.

In 1869 three private Acts were passed, authorising the construction and working of tramway lines in the metropolis, and in the following year several more private Acts and “The Tramways Act, 1870,” which was a general measure. Its main object was to provide a simple, inexpensive, and uniform mode of proceeding in obtaining authority for the construction of tramways, and to give the local authorities the power of regulation and control.

In London the Metropolitan Board of Works was constituted the “local authority” under the Act; and that Board was empowered to apply for a Provisional Order itself to construct tramways, and lease them to other persons, and was given, with the approval of the Board of Trade, a compulsory power of purchase after a period of twenty-eight years on certain conditions.

And in 1870 another Act of the most far-reaching importance was passed, “The Elementary Education Act,” which prescribed the establishment of a School Board for London, and which in process of time would exercise vast influence towards a cleaner, brighter, healthier life than any hitherto within the reach of the masses of the population of London.

But though progress was being made in many ways, the progress had not affected infantile life.

“The dreary catalogue of human misery” given in the statistics of infantile mortality was as dreary as ever.

In every part of London those statistics were appalling.

In 1867, in the Whitecross Street District of St. Luke, no less than 64·4 per cent. of the mortality for the district consisted of deaths among children under five years of age. In 1868 it was close upon 61 per cent.

In Bethnal Green, in 1869–70, of 3,378 deaths, 1,900 were under five = 56·3 per cent.

In a sub-division of Whitechapel, in 1865–6, close upon 58 per cent. were under five; in Poplar a fraction short of 47 per cent.

In Kensington, in 1866, 40·6 per cent. were under five.

Each year the Medical Officer of Health for Fulham drew attention to, and protested against, the high rate, nearly 50 per cent., of infantile mortality under five, in 1867–8.

In Wandsworth, in 1870–1 = 47 per cent.

In Camberwell, in 1868 = nearly 50 per cent.

In St. Mary, Newington, and in Rotherhithe = 50 per cent.

In Bermondsey, in 1869–70 = 56 per cent.

In certain streets the percentage was much higher. Thus in Paddington (1870–1):—

The high infantile mortality betokened high infantile sickness, but of it no records have ever been kept.