Perhaps the most necessary and the most tried quality in a reformer is Patience. Notwithstanding the publication of the 'Treatise on Fever' in 1830, and the tribute paid by the scientific world to its masterly exposition of the treatment and causes of the disease, notwithstanding the constant and ardent endeavours of the author to propagate his views, yet seven long years passed away before he was able to awaken the apathy of the public and the authorities.
Year after year went by, and the wards of the Fever Hospital continued to be supplied from the same districts, from the same courts and lanes—even from the very same house—as before. The preventible suffering, thus daily brought before my grandfather's eyes, was a daily reminder of the urgent need for help—of the necessity for taking practical steps to diminish it.
In 1837 the opportunity came for pressing forward in the cause. That year a frightful epidemic fever broke out in London, arousing general alarm, and demanding special inquiry. The pressure on the poor-rates became excessive, and my grandfather was appointed by the Poor Law Commissioners to report on the eastern districts of London, Drs Arnott and Kay being appointed to other districts.
The title of the Report presented by him is at once striking. He called it, "Report on the Physical Causes of Sickness and Mortality to which the Poor are particularly exposed, and which are capable of prevention by Sanitary Measures." Its opening words are,—
"Some of the severest evils at present incident to the condition of poverty, which have a large share in inducing its high rate of sickness and mortality, are the consequences of improvidence. Such evils are capable of being remedied only by bringing the poor under the influence of the inducements to forethought and prudence.
"But there are evils of another class, more general and powerful in their operation, which can be avoided by no prudence, and removed by no exertion, on the part of the poor. Among the gravest, and at the same time the most remediable, of these latter evils, is the exposure to certain noxious agents generated and accumulated in the localities in which the poor are obliged to take up their abode, and to the pernicious influence of which they are constantly, and for the most part unconsciously, subjected.
"It is the object of the present Report to direct attention to the nature and extent of this evil, and to show how important it is that its mitigation, and, as far as may be found practicable, its entire removal, should form a part of every exertion that is made for improving the physical condition of the poor."
These words would seem to strike the key-note of Sanitary Reform.
In order to make the Report more full and impressive, Dr Southwood Smith writes an exact account of what he saw. He went personally over the greater part of the Bethnal Green and Whitechapel districts. "I traversed," he says, "a circle of from six to seven miles in extent. I wrote the account of the places I am about to notice on the spot; I entered many of the houses and examined their condition as to cleanliness, ventilation, as well as the state of the people themselves, who were at the time labouring under fever."
The descriptions that follow are too dreadful to be dwelt upon in detail here. We are shown individually the houses of Whitechapel: they are piled storey above storey, and are teeming with people; the streets, courts, and alleys are so built that all current of air is blocked out, and no measures whatever are taken to secure cleanliness. We are shown Bethnal Green, flat, low, damp, wasted. Here the houses are not so closely packed—there are open spaces; but these are for the most part undrained marshes, and the air coming across them is poisonous rather than life-giving. Straggling rows of rickety cottages look out upon stagnant swamps; their miserable gardens are scattered over with uncleared dust and refuse of all kinds, and are surrounded with black and overflowing ditches, to cross which you must pass over rotting planks used as bridges: there are houses which contain only two rooms, the larger being 9 feet by 7 and 7 feet high, the smaller not able to contain an ordinary-sized bed.
If the house has more rooms, it probably contains many families, and a state of overcrowding is produced nearly as fatal as that which prevails in the parts of London where the houses stand more thickly.
The picture comes vividly before us of the dismal homes, with their melancholy gardens where the pale children play by the black ditches; their green damp walls; the rags stuffed into the broken windows to keep out the tainted outside air; and the crowds huddled together breathing the suffocating air within doors. It is easy to realise the hopeless efforts of the poor inhabitants to fight against the dirt and disease which all those efforts are powerless to overcome!
No wonder then, that, in the words of his Report, we are told that "in many parts of both these districts fever of a malignant kind and fatal character is always more or less prevalent; that in some streets it has recently prevailed in almost every house; in some in every house; and, in some few instances, in every room of every house. Cases are recorded in which every member of a family has been attacked in succession, of whom, in every such case, several have died: some whole families have been swept away. Instances are detailed in which there have been found, in one small room, six persons lying ill of fever together: I have myself seen this—four in one bed and two in another."
He once more enforces the preventibleness of this dreadful state of things—how entirely it was within the power of man to change it by wise attention to the laws of health. He points out parts of the districts which had always remained comparatively healthy, and some, formerly haunts of fever, where during the last epidemic no single case had occurred, owing to sanitary improvements.
The necessity for providing in some way for the airing of streets and courts in densely populated neighbourhoods, by the knocking down of houses or other expedients, is insisted upon. Its difficulty is admitted, but still it is urged.
"Though it might seem a hopeless task," he says, "to set about ventilating such districts as Bethnal Green and Whitechapel, yet, if the importance of the principle be duly appreciated and the object be kept steadily in view, much may be accomplished. In some of the worst localities in these districts, at moderate expense, means might be taken to introduce free currents of air, where at present the air is perfectly stagnant and stifling. Some of the improvements recently made in the City of London show to what extent it is possible to introduce good ventilation into the heart of the most densely populated part of the Metropolis."
In this Report my grandfather also draws attention to the state of the Workhouses. He was writing to the Poor Law Commissioners, and so he could efficiently bring under their notice the state of those buildings.
"From what I have observed I am satisfied," he says, "that many existing workhouses are extremely deficient in space, ventilation, and drainage."
The overcrowding in the dormitories is especially pointed out. He writes:—
"In going over the Whitechapel Workhouse I was struck with the statement of the fact that, out of 104 children (girls) resident in that house, 89 have recently been attacked with fever. On examining the dormitory in which these children sleep, my wonder ceased. In a room 88 feet long, 16-1/2 wide, and 7 feet high, with a sloping roof rising to 10 feet, all these 104 children, together with four women who have the charge of them, sleep. The beds are close to each other; in all the beds there are never less than four children, in many five; the ventilation of the room is most imperfect. Under such circumstances the breaking out of fever is inevitable.
"I was likewise struck with the pale and unhealthy appearance of a number of children in the Whitechapel Workhouse, in a room called the 'Infant Nursery.' These children appear to be from two to three years of age; they are 23 in number, they all sleep in one room, and they seldom or never go out of this room either for air or exercise. Several attempts have been made to send these infants into the country, but a majority of the Board of Guardians has hitherto succeeded in resisting the proposition.
"In the Whitechapel Workhouse there are two fever-wards: in the lower ward the beds are much too close; two fever patients are placed in each bed; the ventilation is most imperfect, and the room is so close as to be dangerous to all who enter it, as well as most injurious to the sick."
The Report mentions, in contrast, the case of the Jews' Hospital, where he had been physician. In that hospital, though at one time there had been a yearly outbreak of fever, since the number of beds in the dormitories had been reduced, and several large ventilators had been put in, the evil had entirely ceased. At the time he wrote eight years had passed since the improvements, and fever had not once returned as an epidemic.
After finishing this Report, my grandfather set to work to obtain exact statistics as to fever in other parts of London; and by the next year (1839) tables had been compiled, which proved, by a wider range of experience, the truths he had again and again brought forward. Once more he wrote a Report to the Poor Law Commissioners—of whom Mr (afterwards Sir Edwin) Chadwick was one—pointing out the facts which were proved by these figures and the duty of acting on them.[16]
Such accounts as those given by the three physicians appointed by the Poor Law Board to inquire, could not pass unnoticed. The press, not only in London but in all parts of England, took up the subject. Public men began to be roused.
At first the facts were doubted. It was difficult to believe that such a dreadful state of things could exist; but attention was awakened, and inquiry followed.
The Marquis of Normanby, then Secretary of State for the Home Department, was much impressed with what he had read, but he could hardly conquer a belief that there must have been some exaggeration. My grandfather took him to see some of the places in Bethnal Green and Whitechapel which the Report had described. Lord Normanby was deeply moved, as every one must have been who was brought to realise the kind of dwellings which were all that these people had for homes. "So far," he said, "from any exaggeration having crept into the descriptions which had been given, they had not conveyed to my mind an adequate idea of the truth."
Lord Ashley, too, always in the forefront to relieve the sufferings of the poor, was taken by my grandfather on two occasions to see these regions personally; and from that time forth he became one of the most ardent supporters of the Sanitary Cause, working strenuously for it both in and out of Parliament.[17] In a letter to a friend my grandfather writes:—
"Finsbury Square, 1841.
"I have just returned from Whitechapel and Bethnal Green, over which I have been taking Lord Ashley and his brother, and I think they have received an impression which will be lasting, and which will stimulate them to exert themselves for the removal of some of the evils which they have witnessed."
The Bishop of London had the honour of being the first to bring the question before Parliament. In an earnest and eloquent speech made in the House of Lords during the session of 1839, he moved for an extension of such inquiries as the Poor Law Board had caused to be made in London, to other towns in the United Kingdom.
It must have seemed to my grandfather a glorious moment when the principles he had so long advocated were for the first time recognised—when the country began to hear with surprise and shame of the existing state of things—and when the suffering, which he felt so deeply, seemed about to be relieved.
The movement had now begun. Surely it would go quickly, since the saving of thousands of lives each year depended on its progress?