The work, too, being done by the Metropolitan Asylums Board was greatly diminishing the dangers of infection in the metropolis, as well as restoring to life and health thousands who would otherwise have fallen victims to disease.

And by “The Poor Law Act, 1879,” the Vestries and District Boards were authorised to enter into contracts with the Board, for the reception and treatment of infectious sick who were not paupers, thus in a measure depauperising the Metropolitan Asylums Hospitals.

And a very large amount of most valuable work was done by the Port Sanitary Authority; in the year 1879–80 over 15,000 vessels of all classes having been visited and inspected, the infectious sick removed, and disinfection carried out.

Writing of the year 1877 the Registrar General said:—

“London maintains its position as the healthiest city in the world. During the past year its prosperity was indicated by a birth-rate above the average of the preceding 10 years, while a remarkably low death-rate bears testimony to the success which has attended the efforts that have been made during the last half of a century to promote the public health and safety.”

Among the public authorities from which much might have been hoped in the way of improving the public health of the inhabitants of London was the School Board. The Board stood in an exceptionally favourable position for moulding the physical constitution of hundreds of thousands of children and of successive generations, but education appeared to have almost excluded the consideration of health.

In 1871 the Board resolved “that it is highly desirable that means shall be provided for physical training, exercise and drill in public elementary schools established under the Board.” But beyond this, little if anything was done, and even it was not made applicable to the girls. And no Medical Officer was appointed, and no systematic means organised for the prevention of the diffusion of diseases by the schools. Indirectly, however, good results were flowing from the schools. The attendance of the children at the schools took them out of their overcrowded tenement-homes for several hours in the day; their playgrounds afforded better means of exercise; the cleanliness expected of them raised their ideas as to cleanliness; the supervision over them was of great use in improving their conduct and character, all helped to improve their physical condition. But how infinitely greater the improvement might have been, not merely at the time but to the rising generation, if the School Board had given greater attention to this branch of the children’s welfare. About 230,000 children were in attendance in the Board’s Schools in 1880.

The really encouraging feature of the general position was that a larger section of the public was taking an interest in matters relating to the public health.

In Battersea, wrote the Medical Officer of Health (1881):—

“Much assistance is now derived from the general public, who are more alive to the necessity of sanitary measures than at any previous period.”

The Medical Officer of Health for St. George-the-Martyr, Southwark, reported:—

“The health of the people occupies the thought and consideration of an ever-increasing number,” and he quoted the declaration of the head of the Government that “the sanitary question lies at the bottom of all national well-being.”

The Medical Officer of Health for North Poplar stated that—

“Gradually the labouring portion of the population, which so largely outnumbers the remainder with us, is becoming educated to the fact that they must neither breathe air, drink water, nor take food, polluted by filth.”

But, as a whole, public opinion was more or less inert.

“The apathy of the public in matters of health is truly lamentable.”

Nor was all the apparent progress as genuine as appeared on the surface. The Medical Officer of Health for St. Mary, Newington, in his report of 1874 disclosed this material fact.

Writing of some Returns which he had prepared of sickness in seventeen years, he said:—

“In the period we have seen the end of many fever haunts. We have seen hundreds and hundreds of the old tenements removed and new abodes raised in their stead; but with it, alas! we have seen all the defects of new buildings, all the defects of badly laid drains, all the evils of work ill done, its dangers too often not capable of recognition until sickness and death forced the discovery. We have seen too often in the new houses defects of ventilation, of construction, of drainage, and of overcrowding: we have seen many an evil allowed by law, and over which we cannot extend our sanitary rules. We have also to contend with the indifference, the carelessness, the blindness of the people themselves—intemperance and crime stand in our way….”

But in 1881 he wrote: “Sanitary work has borne fruit.”

The progress of sanitation is almost necessarily slow.

“There is not,” wrote one of the Medical Officers of Health, “a more difficult task than that of carrying out sanitary reform, for although every one agrees that sanitary laws should be put in force, they are greatly objected to when they interfere with one’s self.”

And another wrote:—

“Nuisances crop up, are removed, and re-appear. It is a continuous warfare due to many causes, such as carelessness and wilfulness on the one hand, and accidental circumstances on the other.”

And another:—

“The sanitary labours of your officers increase year by year as the population becomes denser, and the need for sanitary precautions grows more urgent.”

And underneath all was the view expressed by the Medical Officer of Health for Islington (1881):—

“I fear the public have not even yet learned to regard health as a matter of infinitely greater moment than rates and taxes.”

How far-reaching were the effects of disease was admirably set forth by Dr. Simon:—

“I do not pretend to give any exact statement of the total influence which preventable diseases exert against the efficiency and happiness of our population, for it is only so far as such diseases kill, and even thus far but very imperfectly, that the effect can be reported in numbers. Of the incalculable amount of physical suffering and disablement which they occasion, and of the sorrows, and anxieties, the permanent darkening of life, the straitened means of such subsistence, the very frequent destitution and pauperism which attend or follow such suffering, death statistics testify only in sample or by suggestion.”[148]

Few people realise the infinite importance of health to a great community.

As one of the Medical Officers of Health truly wrote:—

“It is a question whether the greatness of countries will not in future to a very large extent depend upon the standard of public health.”

One of the very best and most experienced of the men who held the responsible office of Medical Officer of Health during the last half century—Dr. Bateson, the Medical Officer of Health for St. George in Southwark—in his reports often dwelt upon this aspect of the subject:—

“The only true and lasting foundation upon which the glory and safety of a nation can be built must be upon the cultivation of the moral and physical powers belonging to man.”

“… The quality of a race is of far more importance than the quantity.”

“Health to the majority of the population is their only wealth; without it they become pauperised.”

“The welfare and safety of this country need a healthy, stalwart race of men—men who can labour and endure.”

And in his last report (1878), after twenty years’ service as Medical Officer of Health, he quoted the Prime Minister (Lord Beaconsfield) as saying:—

“The health of a people was really the foundation upon which all their happiness and all their powers as a state depended. If the population of a country was stationary, or that it yearly diminished, or that whilst it diminished it diminished also in stature and strength, then that country was ultimately doomed.”

“Nothing,” said Dr. Bateson, “could be more solemn and emphatic.”

“For the success and permanence of national existence a high standard of health is absolutely necessary. To maintain in its integrity the vast power which England now wields, and to retain the high position which she now holds will depend upon the nation’s health.”

Before considerations such as these, how lamentable the blindness of those who could not see that even a measurable expenditure in health matters would have been productive of immeasurable benefits; how reprehensible the conduct of those who refused to administer laws which it was their duty to administer, and the administration of which would have been of inestimable value to their fellow citizens; and how disastrous their studied inaction to the great metropolis, and through it, to the nation itself.