John Simon

“ If there be citizens so destitute, that they can afford to live only where they must straightway die—renting the twentieth straw-heap in some lightless fever-bin, or squatting amid rotten soakage, or breathing from the cesspool and the sewer; so destitute that they can buy no water—that milk and bread must be impoverished to meet their means of purchase—that the drugs sold them for sickness must be rubbish or poison; surely no civilised community dare avert itself from the care of this abject orphanage. ”

“ In the midst of inevitable domestic filth, who can wonder that personal cleanliness should be neglected? In an atmosphere which forbids the breath to be drawn freely, which maintains habitual ill health, which depresses all the natural spring and buoyancy of life, who can wonder that frequent recourse should be had to stimulants, which, however pernicious in themselves, still for a moment dispel the malarious languor of the place, give temporary vigour to the brain, and cheer the flagging pulses of a poisoned circulation? ”

“ If the deliberate promises of Science be not an empty delusion, it [164] is practicable to reduce human mortality within your jurisdiction to nearly the half of its present prevalence.
It is the sad prerogative of my Profession to have such knowledge of death as cannot lie within your experience. Knowing all that is implied in each one separate instance of its visitation—how much pain and sorrow, often how much bereavement and destitution, we, perhaps better than others, learn to appreciate that vast amount of social misery which has its symbol in the high death-rate of a population. ”

“ How far the construction of London has proceeded on the recognition of such objects, or how far the advantages of such a plan have been realised, it could only be a mockery to ask. Our metropolis, by successive accretions, has covered mile after mile of land. Each new addition has been made with scarcely more reference to the legitimate necessities of life, than if it had clustered there by crystallisation. With no scientific forecast to plan the whole, with little but chance and cheapness to shape the parts, our desultory architecture has eclipsed the conditions of health. ”

“ A single pair of persons, with their children, having such a court for their sole occupancy, would hardly be otherwise than unhealthy; the infants would die teething, or would live pallid and scrofulous; or a parent would perish prematurely—the father, perhaps, with typhus, the mother with puerperal fever. Judge then, gentlemen, how the mortality of such courts must swell your aggregate death-rate for the City, when I tell you that their population is in many instances so excessive, as, in itself, and by its mere density, to breed disease. ”

“ Last winter, when the signs of the times were making us fear that Cholera would presently again be epidemic in London, it was remembered that, in the greater part of the metropolis, nothing whatever had been done since the last invasion to give immunity against the returning disease. It was remembered—too late, how indescribably dreadful a thing is the epidemic prevalence of sudden death. And the poor were thought of—in their unprotectedness, their filth, their ignorance. ”

“ I would beg any educated person to consider what are the conditions in which alone animal life can thrive; to learn, by personal inspection, how far these conditions are realised for the masses of our population; and to form for himself a conscientious judgment as to the need for great, if even almost revolutionary, reforms. Let any such person devote an hour to visiting some very poor neighbourhood in the metropolis, or in almost any of our large towns. ”

“ At the head of this class of evils stands the flagrant nuisance of smoke. Those members of the Court who have visited foreign capitals where other fuel than coal is employed, will remember the contrast between their climate and ours—will remember (for instance even in Paris) the transparence of air, the comparative brightness of all colour, the visibility of distant objects, the cleanliness of faces and buildings, instead of our opaque atmosphere, deadened colours, obscured distance, smutted faces, and black architecture. ”

“ A people that has inaugurated railways—that has spanned the Menai Strait and reared the Crystal Palace, can hardly fear the enterprise of draining poison from its infected towns. A people that has freed its foreign slaves at twenty millions’ ransom, will never let its home population perish, for cheapness sake, in the ignominious ferment of their filth.
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Therefore, gentlemen, advisedly I state the danger as it seems to me. England has again become subject to a plague, the recurrence of which—or the duration—or the malignity, no human being can predict. ”

“ I should argue (as indeed I have already argued here) that the main conditions which constitute the unhealthiness of towns are definite, palpable, removable evils; that dense over-crowding of a population—that intricate ramification of courts and alleys, excluding light and air—that defective drainage—that the products of organic decomposition—that contaminated water and a stinking atmosphere, are distinct causes of disease and death; that each admits of being definitely estimated in its numerical proportion to the total mortality which it contributes to cause ”

“ I am unwilling, even for a moment, to seem indifferent to those remaining fertile sources of suffering that surround the poor of our metropolitan population—to their over-crowded condition, to their scantiness of ventilation, to their insufficient or disgusting water-supply, to their frequent personal dirt, to their habitually defective diet. ”

“ II. I am sure that I do not exaggerate the sanitary importance of water, when I affirm that its unrestricted supply is the first essential of decency, of comfort, and of health; that no civilization of the poorer classes can exist without it; and that any limitation to its use in the metropolis is a barrier, which must maintain thousands in a state of the most unwholesome filth and degradation.
In the City of London the supply of water is but a fraction of what it should be. Thousands of the population have no supply of it to the houses where they dwell. ”

“ And how much more justly may the neighbour appeal to you against each such nuisance, as an interference with his privacy; against the smoke, the stink, the fever, that bursts through each inlet of his dwelling, intrudes on him at every hour, disturbs the enjoyment and shortens the duration of his life. And for the rights of property—they are not only pecuniary. Life, too, is a great property ”

“ But, in strict adhesion to the principle I have professed, that protection is wanted, not for the profession, but for the public, I would suggest one exception to what otherwise might be universal free-trade in medicine. I refer to the case of druggists; who, whenever the Legislature may awake to the necessity of regulating their trade, ought, I think, to be expressly prohibited from the treatment of disease. To an immense majority of our population—to all the under-educated classes, the druggist’s shop appears an emporium for medical skill, as well as for medical appliances. ”

“ They stand in bright contrast to the dark features of filth and unwholesomeness which environ them; they familiarise the poorest classes generally with all the practical advantages of cleanliness; they show that dirt is not inevitable; they therefore create and foster among the humblest members of society, a laudable discontent with defective sanitary arrangements; and they establish a strong public opinion, grounded on experience, in favour of those conditions of cleanliness and comfort, which determine the maintenance of health. ”

“ Let it not be imagined that the word cholera is a sufficient answer to these questions, or that its mention can supersede the necessity for sanitary investigation. Let it, on the contrary, be observed that the epidemic which has visited us, extends its ravages only to localities previously and otherwise hostile to life; so that, while all regions of the globe in succession are shadowed by its dark transit, the healthiest districts of each region remain utterly unharmed in presence of the pestilence. ”

“ If there be meaning in this legislation—if it imply any principle, the meaning and the principle require to be developed into a general law, that every establishment employing labour be liable to inspection and regulation in regard of whatever acts and conditions are detrimental or hazardous to life. If factory-children are cared for, lest they be over-worked; and miners, lest they be stifled; so, for those who labour with copper, mercury, arsenic, and lead, let us care, lest they be poisoned! for grinders, lest their lungs be fretted into consumption! ”

“ And likewise within the City there will be remaining—out of your control, unremedied evils, the existence of which has long been denounced, and the removal long expected.
In 1849, with the cholera amidst us, great exertions were made, and greater promises. In that dreadful week, when two thousand victims of our metropolitan population fell beneath its poison; when every household, from hour to hour, trembled at the visible nearness of death; the public were scared out of indifference. ”

“ For, not alone in Rotherhithe and Newington—not alone along the Effra or the Fleet, are traced the evils of this great miasm. The deepest shadows of the cloud lie here; but its outskirts darken the distance, A fever hardly to be accounted for, an infantile sickness of undue malignity, a doctor’s injunction for change of air, may at times suggest to the dweller in our healthiest suburbs, that while draining his refuse to the Thames, he receives for requital some partial workings of the gigantic poison-bed which he has contributed to maintain. ”

“ The landlord of some overthronged lodging-house complains, that to reduce the numbers of his tenantry, to lay on water, to erect privies, or to execute some other indispensable sanitary work, would diminish his rental: in the spirit of your Act, it is held a sufficient reply, that human life is at stake, and that a landlord, in his dealings with the ignorant and indefensive poor, cannot be suffered to estimate them at the value of cattle, to associate them in worse than bestial habits, or let to them for hire, at however moderate a rent, the certain occasions of suffering and death. ”

“ I have to report that there are houses and localities within the City which are irremediably bad;—places, which the uninterrupted presence of epidemic disease has stamped as absolutely unfit for human habitation; places, where drainage and water-supply, indeed, are defective, but where the perfection of these necessaries might exist, in all probability, without giving healthiness to the inhabitants. The predominant evil in the localities referred to is their thorough impossibility of ventilation. ”

“ Notwithstanding all that Medicine can achieve, to succour the body as it struggles against actual disease—notwithstanding those resources of drugs and handicraft, by which the physician or surgeon opposes death or mitigates pain in the detailed exercise of his art, all past experience, and every transaction of our daily practice, confirm the popular adage that prevention is better than cure. ”

“ Whatever is morally hideous and savage in the scene—whatever contrast it offers to the superficial magnificence of the metropolis—whatever profligacy it implies and continues—whatever recklessness and obscene brutality arise from it—whatever deep injury it inflicts on the community—whatever debasement or abolition of God’s image in men’s hearts is tokened by it—these matters belong not to my office, nor would it become me to dwell on them. ”

“ Perhaps from the eastern centres of its habitual dominion—from the alluvial swamps and malarious jungles of Asia, where it was first engendered amid miles of vaporous poison, and still broods over wasted nations as the agent of innumerable deaths; or perhaps from the congenial flats of Eastern Europe, where it may have lingered latent and acclimatised; the subtle ferment was spreading its new infection to all kindred soils. ”

“ It would be ridiculous to look for the operation of an ill-chosen water, after its habitual use during two centuries, as though one were inquiring for the symptoms of an acute poison. The signs that are to be ascertained among a population, if such signs exist, are those which would evidence a premature exhaustion of the power of digestion, and would testify that the machine on which we depend for that power had been exposed to unnecessary and avoidable fatigue. This, I believe, is the utmost which Medicine, proceeding from theoretical grounds, would venture to say on the subject. ”

“ By those restrictions to which I have adverted, something may be done, no doubt, for improving the arrangement of houses so tenanted—something to prevent the more glaring outrages of decency which at present prevail—something to maintain comparative cleanliness, and to check the spread of disease. I fear that no further remedy than this would prove effectual, unless it were universal for the metropolis. Unquestionably, it would be possible, with persons even of the lowest sort above pauperism, to proceed on the same principle as in the establishment of model-lodgings for the working orders ”

“ There may be difference of opinion as to the precise time when a grave can with truth and decency be thought to have become distenanted. The rapidity of decay varies in so extraordinary a degree according to soil, that some inhumations are almost equivalent to embalming; while, in other cases, the process is comparatively rapid. Only experience of a particular soil will enable you to know with precision, what length of tenure is needed there for the purposes of interment to accomplish themselves; but on general principles one can approximate pretty nearly to the truth. ”