REPORT
ON THE
SANITARY CONDITION OF THE LABOURING POPULATION,
AND ON
THE MEANS OF ITS IMPROVEMENT.

London, May, 1842.

Gentlemen,—Since my special attention was directed to the inquiry as to the chief removable circumstances affecting the health of the poorer classes of the population, I have availed myself of every opportunity to collect information respecting them. In company with Dr. Arnott I visited Edinburgh and Glasgow, and inspected those residences that were pointed out by the local authorities as the chief seats of disease. I also visited Dumfries. An inspection of similar districts in Spitalfields, Manchester, Leeds, and Macclesfield, and inquiries formerly made under the Commission of Poor Law Inquiry, and inspections of the condition of the residences of the poorer classes in parts of Berkshire, Sussex, and Hertfordshire, had supplied me with means of comparison. Abandoning any inquiries as to remedies, strictly so called, or the treatment of diseases after their appearance, I have directed the examinations of witnesses and the reports of medical officers chiefly to collect information of the best means available as preventives of the evils in question. On the documentary evidence of the medical officers, and on the examinations of witnesses, aided by personal inspections, I have the honour to report as follows:—

Partial descriptions of the condition of the labouring classes, in respect to their residences and the habits which influence their health, afford but a faint conception of the evils which are the subject of inquiry. If only particular instances, or some groups of individual cases be adduced, the erroneous impression might be created that they were cases of comparatively infrequent occurrence. But the following tabular return made up from the registration of the causes of death in England and Wales, which is the most complete yet attained, will give a sufficiently correct conception of the extent of the evils in question, when illustrated by the evidence of eye-witnesses, the medical officers whose duty it has been to attend on the spot and alleviate them. The table comprehends the abstract of the returns of the deaths from the chief diseases, which the medical officers consider to be the most powerfully influenced by the physical circumstances under which the population is placed—as the external and internal condition of their dwellings, drainage, and ventilation.

To the Poor Law Commissioners.

Deaths in Counties from Diseases governed by Locality.
 
COUNTIES. Number of Deaths during the Year ended 31st December, 1838 from Proportion of Deaths from the preceding Causes in every 1000 of the Population, 1841. Proportion of Deaths from all Causes of Mortality in every 1000 of the Population, 1841.
1
Epidemic, Endemic, and Contagious Diseases.		 2
Diseases of Respiratory Organs		 3
Diseases of Brain Nerves and Senses.		 4
Diseases of Digestive Organs
Total Deaths from the four preceding Classes of Diseases.
Fever: Typhus, Scarlatina. Small-pox. Measles. Hooping Cough. Consumption. Pneumonia. All other Classes.
England.                        
Bedford 155 75 40 66 457 97 57 304 131 1382 13 22
Berks 204 288 21 86 739 231 162 467 201 2399 15 25
Bucks 256 85 61 27 575 131 61 348 152 1696 11 19
Cambridge 231 136 57 90 686 156 70 318 189 1933 12 21
Chester 592 279 178 87 1742 366 345 1442 421 5452 14 21
Cornwall 443 135 168 491 1270 342 124 631 228 3832 11 18
Cumberland 165 188 11 83 562 75 142 278 169 1673 9 21
Derby 394 77 79 71 905 200 205 777 268 2976 11 18
Devon 615 460 287 312 1649 564 298 1237 471 5893 11 18
Dorset 137 255 80 58 571 146 106 380 159 1892 11 19
Durham 347 316 139 304 1007 362 207 1138 274 4094 13 21
Essex 417 460 83 163 1250 276 234 782 268 3933 11 19
Gloucester 352 457 440 244 1395 578 476 1142 510 5594 13 20
Hereford 84 83 17 36 333 56 57 238 62 966 8 18
Hertford 160 116 45 48 620 107 90 453 155 1794 11 20
Huntingdon 61 18 1 17 216 45 42 140 72 612 10 18
Kent 955 510 169 214 1701 564 526 1650 651 6940 13 21
Lancaster 2866 1628 898 910 8124 2660 1916 7457 3231 29690 18 25
Leicester 273 98 17 70 941 243 154 668 314 2778 13 21
Lincoln 370 138 29 88 874 248 242 1090 358 3437 9 17
Middlesex 4422 3359 487 1749 6220 3097 2334 6643 2492 30803 20 27
Monmouth 328 321 49 91 481 183 78 550 100 2181 16 24
Norfolk 515 126 63 109 1388 325 281 793 395 3995 10 19
Northamptn 348 148 36 36 762 192 124 503 212 2361 12 21
Northumbd 366 149 46 113 715 287 240 709 388 3013 12 21
Nottingham 222 73 18 80 911 225 201 901 287 2918 12 20
Oxford 222 81 51 59 655 108 152 389 180 1897 12 21
Rutland 11 2   13 64 14 8 56 28 196 9 17
Salop 213 154 112 138 995 242 168 550 284 2856 12 21
Somerset 560 710 401 46 1446 426 373 982 473 5417 12 21
Southamptn 454 164 78 148 1222 338 331 881 372 3988 17 19
Stafford 610 249 182 268 1809 539 419 1251 597 5924 12 18
Suffolk 480 325 53 158 1306 315 184 538 275 3634 12 20
Surrey 1348 814 177 565 2196 978 700 2325 763 9866 11 25
Sussex 391 80 159 88 1047 222 181 863 295 3326 11 18
Warwick 454 415 153 164 1495 678 361 978 638 5336 13 20
Westmoreld 41 40 6 41 248 33 44 154 46 653 12 21
Wilts 246 259 263 140 869 268 212 606 241 3104 12 20
Worcester 381 305 122 258 990 353 235 645 446 3735 16 29
York, E. R. 194 92 167 149 725 194 176 1009 251 2957 13 21
York, N. R. 123 28 69 114 550 102 135 553 1861   9 17
York, W. R. 1298 993 799 507 4253 1202 848 4374 1494 15768 14 21
                         
Wales.                        
North. 660 575 4 210 1227 102 223 1311 198 4510 13 18
South. 1613 1004 199 398 1834 129 277 1200 380 7034 14 21
Total, 1838 24,577 16,268 6514 9107 59,025 17,999 13,799 49,704 19,306 216,299 14 22
Total, 1839 25,991 9131 10,937 8165 59,559 18,151 12,855 49,215 20,767 214,771 14 21

Extent of evils which are the subject of inquiry

The registration of the causes of death for the year 1838 is selected, as that was the year when the report was made on the sanitary condition of the labouring population in the metropolis, which has served as the foundation of the extended inquiry.

There are no returns, and no adequate data for returns, to show the proportion in which deaths from the several causes above specified occur amongst the population of Scotland, but there is evidence to which reference will subsequently be made tending to prove that the mortality from fever is greater in Glasgow, Edinburgh, and Dundee than in the most crowded towns in England.

The registered mortality from all specified diseases in England and Wales was, during the year 1838, 282,940, or 18 per thousand of the population. These deaths are exclusive of the deaths from old age, which amounted to 35,564, and the deaths from violence, which amounted to 12,055. The deaths from causes not specified were 11,970. The total amount of deaths was 342,529 for that year. In the year following the total deaths were 338,979, of which the registered deaths from old age were 35,063, and the deaths from violence 11,980. The proportion of deaths for the whole population was 21 per thousand.

It appears that fever, after its ravages amongst the infant population, falls with the greatest intensity on the adult population in the vigour of life. The periods at which the ravages of the other diseases, consumption, small-pox, and measles take place, are sufficiently well known. The proportions in which the diseases have prevailed in the several counties will be found deserving of peculiar attention.

A conception may be formed of the aggregate effects of the several causes of mortality from the fact, that of the deaths caused during one year in England and Wales by epidemic, endemic, and contagious diseases, including fever, typhus, and scarlatina, amounting to 56,461, the great proportion of which are proved to be preventible, it may be said that the effect is as if the whole county of Westmoreland, now containing 56,469 souls, or the whole county of Huntingdonshire, or any other equivalent district, were entirely depopulated annually, and were only occupied again by the growth of a new and feeble population living under the fears of a similar visitation. The annual slaughter in England and Wales from preventible causes of typhus which attacks persons in the vigour of life, appears to be double the amount of what was suffered by the Allied Armies in the battle of Waterloo. It will be shown that diseases such as those which now prevail on land, did within the experience of persons still living, formerly prevail to a greater extent at sea, and have since been prevented by sanitary regulations; and that when they did so prevail in ships of war, the deaths from them were more than double in amount of the deaths in battle. But the number of persons who die is to be taken also as the indication of the much greater number of persons who fall sick, and who, although they escape, are subjected to the suffering and loss occasioned by attacks of disease. Thus it was found on the original inquiry in the metropolis, that the deaths from fever amounted to 1 in 10 of the number attacked. If this proportion held equally throughout the country, then a quarter of a million of persons will have been subjected to loss and suffering from an attack of fever during the year; and in so far as the proportions of attacks to deaths is diminished, so it appears from the reports is the intensity and suffering from the disease generally increased. It appears that the extremes of mortality at the Small-pox Hospital, in London, amongst those attacked, have been 15 per cent. and 42 per cent. But if, according to other statements, the average mortality be taken at 1 in 5, or 20 per cent., the number of persons attacked in England and Wales during the year of the return, must amount to upwards of 16,000 persons killed, and more than 80,000 persons subjected to the sufferings of disease, including, in the case of the labouring classes, the loss of labour and long-continued debility; and in respect to all classes, often permanent disfigurement, and occasionally the loss of sight.

In a subsequent part of this report, evidence will be adduced to show in what proportion these causes of death fall upon the poorer classes as compared with the other classes of society inhabiting the same towns or districts, and in what proportions the deaths fall amongst persons of the same class inhabiting districts differently situated.

The first extracts present the subjects of the inquiry in their general condition under the operation of several causes, yet almost all will be found to point to one particular, namely, atmospheric impurity, occasioned by means within the control of legislation, as the main cause of the ravages of epidemic, endemic, and contagious diseases among the community, and as aggravating most other diseases. The subsequent extracts from the sanitary reports from different places will show that the impurity and its evil consequences are greater or less in different places, according as there is more or less sufficient drainage of houses, streets, roads, and land, combined with more or less sufficient means of cleansing and removing solid refuse and impurities, by available supplies of water for the purpose. Then will follow the description of the effects of overcrowding the places of work and dwellings, including the effects of the defective ventilation of dwelling-houses, and of places of work where there are fumes or dust produced. To these will be added the information collected as to the good or evil moral habits promoted by the nature of the residence. These will form so many successive sections of the report, and will be followed by information in respect to the means available for the prevention of the evils described, and an exposition of the present state of the law for the protection of the public health, and of modifications apparently requisite to secure the desired results.