| GENERAL PREVALENCE OF EPIDEMIC, ENDEMIC, AND CONTAGIOUS DISEASES. | |||
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| PAGE | |||
| Return of the number of deaths in 1838, in each county, from epidemic, endemic, and other diseases, most powerfully affected by the physical state of a district | 2 | ||
| Extent of evils which are the subject of inquiry | 3 | ||
| I. | General condition of the residences of the labouring classes, where disease is found to be the most prevalent— | 5 | |
| In Tiverton union, Cornwall | 5 | ||
| In Truro, Cornwall | 6 | ||
| In Cerne union, Dorset | 8 | ||
| In Axbridge union, Somerset | 10 | ||
| In Chippenham union, Wilts | 11 | ||
| In Bedford union, Bedford | 12 | ||
| In Woburn union, Bedford | 12 | ||
| In Ampthill union, Bedford | 12 | ||
| In Bishop Stortford union, Hertford | 12 | ||
| In Witham union, Essex | 13 | ||
| In Windsor, Berks | 13 | ||
| In Epping union, Essex | 14 | ||
| In West Ham union, Essex | 14 | ||
| In Bromley union, Kent | 14 | ||
| In Bilston, Leicester | 15 | ||
| In Stafford (town of), Stafford, | 16 | ||
| In Macclesfield union, Chester | 17 | ||
| In Heaton Norris, Stockport union, Chester | 17 | ||
| In West Derby union, Lancaster | 18 | ||
| In Wigan union, Lancaster | 19 | ||
| In Durham (city of), Durham | 20 | ||
| In Barnard Castle, Durham | 20 | ||
| In Carlisle, Cumberland | 21 | ||
| In Gateshead, Durham | 21 | ||
| Condition of the Border peasantry | 22 | ||
| In Lochmaben, Scotland | 23 | ||
| In Glasgow and Edinburgh | 23 | ||
| II. | Public arrangements, external to the residences, by which the sanitary condition of the labouring population is affected— | 25 | |
| Drainage. | |||
| Town drainage of streets and houses. | 26 | ||
| Instances of the effects on the public health of the neglect of town drainage— | |||
| At Derby | 26 | ||
| At Stockport | 28 | ||
| Comparative mortality in two similar towns, one drained, the other undrained— | |||
| At Beccles and Bungay, Suffolk | 28 | ||
| State of town cleansing at Leeds | 29 | ||
| At Tamworth | 30 | ||
| At Knutton and Chesterton, Stafford, &c. | 30 | ||
| At Liverpool | 30 | ||
| At Brighton | 31 | ||
| At Birmingham | 32 | ||
| At Edinburgh | 33 | ||
| At Tranent and Ayr | 33 | ||
| At Stirling | 34 | ||
| At Clitheroe, Lancashire | 35 | ||
| Street and road cleansing—road pavements. | 36 | ||
| Defective from want of skill or proper combination of means | 36 | ||
| Different influence on the public health of paved and unpaved streets, instance of, in Portsmouth | 37 | ||
| Instance of the effect on the public health of street cleansing in Macclesfield | 37 | ||
| Instances of the neglect of street cleansing— | |||
| In Manchester | 38 | ||
| In Leeds | 39 | ||
| Instances of the consequences on the public health of the neglect of road cleansing in rural districts in England and in Scotland | 42 | ||
| Discipline in respect to cleanliness of the army superior to the civic economy of the towns | 44 | ||
| House cleansing as connected with street cleansing and sewerage. | |||
| Instances of the sanitary condition of houses in the metropolis where the cesspools do not communicate with the drains | 45 | ||
| Small value of refuse in London, in consequence of the expense of cartage | 46 | ||
| Effects on the health of the accumulation of refuse near the residences of the labouring classes: examples in | |||
| Greenock | 46 | ||
| Leeds | 47 | ||
| Cleansing by means of water-closets applicable to the poorer districts as being the most economical | 48 | ||
| Instance of the removal of the refuse of the city of Edinburgh by sewerage, and of its application to agriculture by irrigation | 48 | ||
| Objections by the citizens of Edinburgh to irrigation by sewers in the immediate vicinity of the city | 49 | ||
| Value of the refuse of London, on the scale of value of the refuse of Edinburgh | 51 | ||
| Modifications of the mode of sewerage of Edinburgh, to make a system of cleansing innoxious and profitable, and extend it to the residences of the poorer classes | 52 | ||
| Expense of street cleansing in Manchester | 53 | ||
| Defects of the prevalent mode of removing the refuse of houses by cartage, or otherwise than by sewerage | 54 | ||
| Instances of defective construction of sewers | 55 | ||
| Evidence on the action of improved modes of sewerage | 55 | ||
| Effects of different descriptions of streets upon the public health | 59 | ||
| Proposed mode of cleansing streets by sweeping the refuse into the sewers | 60 | ||
| Similar mode proposed of cleansing Paris | 61 | ||
| Supplies of water. | 63 | ||
| Necessity of improved supplies of water for house and street cleansing | 63 | ||
| Instances of the want of water in the houses, and of the effect on the personal and domestic habits of the lower classes of the population in towns | 63 | ||
| In Manchester, 64; in Truro union, 65; in Audley district of Newcastle-under-Lyme union, 65; in Dunmow union, 65; in Bishops Stortford union, 65; in Lexden and Winstree union, 65; in Wootton, Bedford, 66; in Edinburgh, 66; in Glasgow, 66; in Aberdeen, 67; in Stirling, 67; in Dundee, 67; in Greenock, 67; in Ayr, 67; in Arbroath, 67; in Renfrew, 68; in Dunfermline, 68; in Tain, 68; in Tranent | 68 | ||
| Inapplicability of the supplies of water to be obtained by fetching from the public wells | 69 | ||
| The supplies of water in London by machinery and pipes, and in Paris by cartage and hand carriage, compared | 70 | ||
| Cost of laying on water in labourers’ tenements and the economy of supply in such a mode | 71 | ||
| Supplies of water by private companies, not applicable to rural districts of small population | 72 | ||
| Complaints against the modes of supplies of water by private companies | 72 | ||
| Private companies do not ensure the best practicable supplies to the public | 73 | ||
| Instance of supplies of water obtained by the public without private companies | 74 | ||
| Necessity of general provisions of supplies of water | 77 | ||
| Unwholesome effects of bad water | 77 | ||
| Sanitary effect of land drainage. | 80 | ||
| General land drainage, effects of, on the health of the population, instances of in— | |||
| The Isle of Ely, 80; the Newhaven union, 81; the Ongar union, 81; the Gravesend and Milton union, 81; the Eastry union, 81 and 82; the Dunmow union, 82; the Epping union | 82 | ||
| Instances of— | |||
| In Scotland | 83 | ||
| Instances of the effect of land drainage upon the health of cattle | 83 | ||
| Instance of the effects of land floods and deficient land drainage in— | |||
| The Langport union, 85; the Chesterfield union, 87; the Dore union, 87; the Bicester union, 88; the Leighton Buzzard union, 88; the Foleshill union, 89; the Malton union, 89; Lochmaben, Scotland | 90 | ||
| Foreign illustrations of the effect of drainage upon the health of the population | 90 | ||
| Interests opposed to the cleansing of Paris | 93 | ||
| Class similar to the Chiffoniers found in English towns | 94 | ||
| Their personal habits | 95 | ||
| Collateral benefit of more effectual cleansing of towns in diminishing degrading employments | 96 | ||
| III. | Circumstances chiefly in the internal economy and bad ventilation of places of work; workmen’s lodging-houses, dwellings, and the domestic habits affecting the health of the labouring classes. | 98 | |
| Various effects of overcrowding places of work, as shown in the case of one class of workmen | 98 | ||
| Comparative ease and economy of measures of prevention rather than of relief | 104 | ||
| Sanitary effects of ventilation on workpeople at Glasgow | 107 | ||
| Effects of defective ventilation on the health of milliners and dressmakers in the metropolis | 107 | ||
| Instances of the effects of defective ventilation of sleeping rooms of the working classes | 108 | ||
| Effects of the defective economy of lodging-houses and places of repose exemplified in the duration of life of one class of workmen | 112 | ||
| Instances of errors in respect to the sanitary effects of particular occupations | 113 | ||
| Injurious effects of deficient ventilation in schools | 119 | ||
| Bad ventilation and overcrowding private houses. | 120 | ||
| Great apparent increase in the proportionate number of houses according to the last census attributable to a different mode of making the return | 120 | ||
| Instances of great overcrowding in cottages in— | |||
| Greenock, 121; Tranent, 121; Sleaford union | 122 | ||
| The want of separate apartments and overcrowding of private dwellings. | 122 | ||
| Effects of the overcrowding of private dwellings on the morals of the population, instances of, in— | |||
| The Ampthill union, 122; the Leighton Buzzard union, 123; the Bicester union, 123; the Romsey union, 123; among the border peasantry, 124; in Manchester, Liverpool, Ashton-under-Lyne, and Hull, 124; in Leeds, 126; in Nottingham, 126; in Clitheroe | 126 | ||
| Instances of the injurious influences of bad tenements upon the personal condition and moral habits of the inmates | 128 | ||
| Effects of noxious agencies in preventing frugality and promoting intemperance | 129 | ||
| In preventing the influence of education | 132 | ||
| Force of habits of intemperance in the use of spirituous liquors against all habits of decency, or frugality, or morality | 133 | ||
| Misconceptions as to casualties occurring among the indigent or profligate | 134 | ||
| Intemperance the cause of fever | 136 | ||
| Domestic mismanagement a predisposing cause of disease. | 137 | ||
| Mismanagement of earnings obstructive to the domestic improvement of the sanitary condition of the labouring classes. | |||
| Instances of in— | |||
| Derby, 137; Birmingham, 138; Manchester, 139; Preston union, 140; Ayr, 141; Tranent, 141; Dundee | 142 | ||
| Attacks of fever most frequent on workmen in full employment and ordinary health 145, | 147 | ||
| Irrelevancy of controversy on the generation of fever, in respect to practical means of prevention | 148 | ||
| Concurrence of medical opinions as to the most efficient means of preventing fever | 150 | ||
| IV. | Comparative chances of life in different classes of the community. | 153 | |
| Instances of the comparative chances of life amongst the gentry, tradesmen, and working men— | |||
| In Truro, 154; in Derby, 155; in Manchester, 157; in Rutland, 157; in the Bolton union, 158; in Bethnal Green, 159; in Leeds Borough, 159; in Liverpool, 159; in the Whitechapel union, 160; in the Strand union, 160; in the Kensington union, 161; in Wiltshire, 161; in the Kendal union | 161 | ||
| Tabular views of the ages at which deaths have occurred in different classes of society | 162 | ||
| Comparative mortality of differently circumstanced districts of the metropolis | 164 | ||
| Comparative prevalence of fever in different districts of Leith | 167 | ||
| High mortality not essential to towns | 167 | ||
| Comparative mortality in three classes of the community at Bath | 168 | ||
| Corroborative experience from Paris as to the influence of local circumstances on mortality | 170 | ||
| Improvements in the health of large towns chiefly confined to improved districts | 171 | ||
| Instance of progressive improvement in the social condition of the population concurrently with its increase in numbers | 175 | ||
| Prevalence of disease no evidence of the pressure of population on food | 177 | ||
| Variations of the proportion of deaths and births in different districts of the same town | 178 | ||
| Proportion of births to the population greatest where there is the greatest mortality | 179 | ||
| Proof that pestilence or excessive mortality does not diminish population | 182 | ||
| Numbers merely not the test of strength or prosperity of a community | 185 | ||
| Deterioration of the strength of the population by disease without diminishing its numbers | 185 | ||
| Increase of food or production concurrently with the increase of population | 188 | ||
| V. | Pecuniary burdens created by the neglect of sanitary measures:— | 188 | |
| Cost of remedies for sickness and of mortality which is preventible | 188 | ||
| Average ages of death of the heads of families of widows and orphans chargeable to the Manchester, Whitechapel, Bethnal Green, Strand, Oakham and Uppingham, Alston with Garrigill, and Bath unions | 190 | ||
| Table of the number of widows and dependent orphans chargeable in eight unions | 191 | ||
| Table of the chief cause of death producing widowhood and orphanage in eight unions | 192 | ||
| Detailed instances of the causes of widowhood and orphanage in Alston with Garrigill | 193 | ||
| Examples of the sanitary effects of superior care in the residences and the places of work of labourers—in the Reeth union, North York, 196; in Gwennap, Illogan, and Camborne, Cornwall, 198; in Great Bradford and Horton, West York | 199 | ||
| Comparison of a young population under favourable and a mature population under unfavourable circumstances | 200 | ||
| Effects of noxious physical agencies on the moral and intellectual condition of the working classes | 202 | ||
| Jurisprudential measures for the prevention of deaths from accidents | 203 | ||
| Cost of disease as compared with cost of prevention, instances of in Glasgow and Dundee | 206 | ||
| VI. | Evidence of the effects of preventive measures in raising the standard of health and the chances of life:— | 211 | |
| Former health of gaols as compared with the present state | 211 | ||
| Effects of sanitary measures of prevention on the health of prisoners | 214 | ||
| Comparison of the experience of sickness amongst different classes of people | 216 | ||
| Amount of sickness experienced by the labouring classes | 217 | ||
| Defects of Insurance tables | 218 | ||
| Effects of sanitary measures in the prevention of disease in the army and navy | 219 | ||
| Cost to tenants and owners of the public measures for drainage, cleansing, and the supplies of water, as compared with the cost of sickness:— | 222 | ||
| Cost of measures of prevention as compared with the cost of sickness and mortality | 222 | ||
| Means of payment for improved accommodation | 227 | ||
| Impolicy of exemptions of tenements from proper charges | 229 | ||
| Injurious effects of exemptions of labourers’ tenements | 230 | ||
| Inability of workmen to improve their own condition | 231 | ||
| Necessity of extrinsic aid for the improvement of the condition of the working classes | 232 | ||
| Employers’ influence on the health of workpeople, by means of improved habitations:— | 233 | ||
| Advantages to labourers of holding tenements in connexion with their employments | 233 | ||
| Instance of a superior moral and sanitary condition enjoyed by workers in a cotton factory | 236 | ||
| Elevation of a manufacturing population by improvements in the condition of their dwellings | 238 | ||
| Most advantageous construction of manufactories for the health of the workpeople | 240 | ||
| The employers’ influence on the health of workpeople:— | 245 | ||
| By modes of payment which do not lead to temptations to intemperance | 245 | ||
| By the promotion of personal cleanliness | 253 | ||
| By the ventilation of the places of work and the prevention of noxious fumes, dust, &c. | 256 | ||
| By promoting respectability in dress | 261 | ||
| Employers’ or owners’ influence in the improvement of habitations and sanitary arrangements for the protection of the labouring classes in the rural districts | 261 | ||
| Instances of, in the Bedford Union, 262; Stafford Union, 263, in Norfolk and Suffolk, 264; at Harlaxton, Lincolnshire, 266; at the Earl of Rosebery’s estate, Scotland, 266; at Closeburn, Dumfries, 266; Turton and Bollington, Lancashire, 267; Birmingham | 267 | ||
| Instances of the influence of the materials used in building upon the health of the inmates in Cheshire, Lancashire, Buckingham and Berkshire | 267 | ||
| Instances of efficient improvements in the detail of labourers’ dwellings in Scotland | 270 | ||
| Improvements proposed for the construction of the dwellings of the lower classes in towns | 272 | ||
| Effects of public walks and gardens on the health and morals of the lower classes of the population | 275 | ||
| VII. | Recognised principles of legislation and state of the existing law for the protection of the public health:— | 279 | |
| Necessity of legislative interference for the protection of the health of the population | 279 | ||
| Spread of old evils in unprotected new districts by inefficient legislation | 280 | ||
| Dangers of increased charges for inefficient sanitary measures shifting without improving the population | 282 | ||
| Expulsion of labourers from old tenements without providing appropriate new ones, not invariably beneficial | 286 | ||
| Advantages in the regulation of the sites of dwellings | 287 | ||
| General state of the law for the protection of the public health:— | 288 | ||
| Medical police in Germany | 288 | ||
| Existing laws for the protection of the public health in England | 289 | ||
| Early state of the law for the protection of the public health | 291 | ||
| State of the special authorities for reclaiming the execution of the laws for the protection of the public health:— | 296 | ||
| General desuetude of the laws for the protection of the public health | 296 | ||
| State of the administration of the laws for the protection of the public health, by court leets and local trusts | 299 | ||
| State of the local executive authorities for the erection and maintenance of drains and other works for the protection of the public health:— | 302 | ||
| State of the obstructions to land drainage and works of private profit redounding to the public health | 302 | ||
| Injuries to private property as well as to the public health, occasioned by defective administration | 305 | ||
| Continuance of the causes of disease in the face of representations of their effects on the population | 307 | ||
| Areas of jurisdiction for drainage inconsistent with efficient operations | 309 | ||
| Prevalent misconceptions as to the objects and state of management of existing sewerage | 311 | ||
| Objections made to the existing local administration of the sewers’ rate | 315 | ||
| Securities requisite to obviate opposition to new expenditure for sewerage | 316 | ||
| Necessity of the subordinate drainage of private tenements being comprehended as part of one system | 319 | ||
| Disturbing local interests opposed to efficient management of expenditure in new districts | 322 | ||
| Obstacles arising from defective local arrangements for efficient expenditure in local public works | 323 | ||
| Inconveniences of legislation on details, and the want of scientific and trustworthy direction | 328 | ||
| High rates of charges, by fees, for superintendence of imperfect structural arrangements | 329 | ||
| Extent of waste in expenditure on local public works, and on separate collections | 333 | ||
| Public facilities for private land drainage afforded by consolidation | 337 | ||
| Grounds of unpopularity and distrust of new local expenditure | 339 | ||
| Boards of Health or public officers for the prevention of disease:— | 340 | ||
| Inefficiency of Boards of Health, as ordinarily constituted | 340 | ||
| Failure of Boards of Health in Ireland | 342 | ||
| Importance of the functions of medical officers in connexion with the executive authority | 343 | ||
| Means and economy of skilled services for the prevention of diseases | 348 | ||
| Administrative measures for the prevention of disease amongst the labouring classes | 349 | ||
| Administrative means for promoting the extension of medical science | 352 | ||
| VIII. | Common lodging-houses the means of propagating disease and vice:— | 356 | |
| State of the common lodging-houses in the Barnet union, 357; in Birmingham, 357; in Brighton, 358; in Manchester, 358; in the Stockport union, 360; in the Macclesfield union, 360; in Durham, 361; in the Teesdale union, 361; in the Tynemouth union, 361; in Newcastle-on-Tyne, 362; in Tranent, Haddingtonshire, 362; in Tain, Ross-shire, 362; in the borough of Warwick, 363; in Chelmsford | 364 | ||
| Grounds for subjecting common lodging-houses to the responsibilities of public-houses and beer-shops | 364 | ||
| Practical illustration of the regulations of common lodging-houses | 366 | ||
| IX. | Recapitulation of conclusions:— | 368 | |
| Recapitulation of the chief conclusions deduced on the information obtained in the course of the inquiry | 369 | ||
| Conclusions as to the available means of prevention | 370 | ||
| Grounds for uniformity of legislation | 372 | ||
| APPENDIX. | |||
| 1. | Evidence of Mr. John Roe, civil engineer, on the practical improvement in sewerage and drainage tried in the Holborn and Finsbury divisions of the metropolis | 373 | |
| 2. | Evidence of Mr. John Darke, contractor for cleansing, as to the obstacles to cleansing, and the conversion of the refuse of the metropolis to productive uses | 379 | |
| 3. | Evidence of Mr. John Treble, contractor for cleansing, as to the obstacles to cleansing, and the conversion of the refuse of the metropolis to productive uses | 380 | |
| 4. | Extract from the report of Fourcroy and others, showing the calculation of the extent of pollution of the Seine from the discharge of the refuse of the streets of Paris | 381 | |
| 5. | Communication from Captain Vetch, of the Royal Engineers, on the structural arrangements of new buildings, and protection of the public health | 382 | |
| 6. | Evidence of Mr. George Gutch, district surveyor, on shifting and building inferior tenements in the suburbs, to avoid the provisions of the Metropolis building Act | 394 | |
| 7. | Estimate by Mr. Howell, of the cost of structural arrangements of sewerage, drainage, water-tank, and means of house cleansing for labourers’ tenements in the metropolis | 394 | |
| 8. | Description of specification of Mr. Loudon’s agriculturists’ model cottage | 395 | |
| 9. | Statement of the requisites of cottage architecture, by Mr. Loudon | 396 | |
| 10. | Specification of the cost of erection, weekly rents, interest on the capital invested, and the numbers of the tenements and cottages occupied by the poor and labourers; taken from returns made by the relieving officers of their respective districts in 24 unions in the counties of Chester, Stafford, Derby, and Lancaster | 400 | |
| 11. | Tables of the expense of building cottages and repairs, in England and Scotland | 401 | |
| 12. | Examination of the Rev. Thomas Whateley, Cookham, Berks, on cottage allotments and the keeping of pigs by cottagers | 403 | |
| 13. | Arrangement of public walks in towns: plan of the arboretum at Derby, laid out by Mr. Loudon | 405 | |
| 14. | Boards of Health: report on the labours of the “Conseil de Salubrité,” of Paris, from 1829 to 1839, by M. Trebuchet | 409 | |
| 16. | Qualifications of officers of public health: statement by M. Duchâtelet | 423 | |
| 17. | Instance by MM. Duchâtelet and D’Arcet, of the erroneous medical inferences as to the insalubrity of particular trades | 424 | |
| 18. | On the habitations of the lower orders of Paris | 426 | |
| 19. | On the habitations and lodgings of the lower orders in Paris | 428 | |
| 20. | Extract from the report of the commission appointed by the Central Board of Public Health, to ascertain the condition of the dwellings of the working classes in Brussels, and to suggest means for their improvement | 429 | |
| 21. | Principles of sanitary police in Germany: extracts from Professor Mohl | 431 | |
| 22. | A report on the statements of Dr. Mauthner, regarding the sanitary condition of the operatives in the new cotton manufactures, Vienna, given at the monthly meeting on the 2nd of November, 1841. By Herr L. M. Von Pacher | 432 | |
| 23. | Typhus fever, the vast amount of, produced amongst the poor of Liverpool, from want of ventilation and cleanliness: extract from Dr. Currie’s medical reports | 441 | |
| 24. | Extract from Dr. Ferriar’s “Advice to the Labouring Classes in Manchester,” given in 1800 | 441 | |
| 25. | Principles of jurisprudence and responsibility for accidents: extract from the First Report of the Commissioners of Inquiry into the Labour of Children in Factories | 442 | |
| 26. | Extract from the report of Mr. John L. Kennedy, barrister-at-law, to the Commissioners for inquiring into the Labour of Young Persons in Mines and Manufactories | 445 | |
| 27. | Tables of Sickness in prisons | 449 | |
| 28. | Tables of Sickness in the wynds of Edinburgh | 452 | |
| 29. | Suggested form of notification to owners or occupiers, for the distribution of the expense of permanent alterations and the avoidance of overcharges on persons enjoying only portions of the benefit | 453 | |
| 30. | Extracts from evidence as to the moral and physical evils that may be created by defective arrangements for hiring and paying workpeople | 454 | |