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TO THE HON. THE COMMISSIONERS OF SEWERS OF THE CITY OF LONDON.

November 6th, 1849.

Gentlemen,

During the 52 weeks dating from October 1st, 1848, to September 29th, 1849, there died of the population of the City of London 3763 persons.

The rate of mortality, estimated from these data for a population of 125,500, would be about the proportion of 30 deaths to every thousand living persons.[13]

[13] The Census of 1851, compared with that of 1841, would lead me to believe that in 1848-9 the population of the City must have been about 129,000. With this correction, the death-rate would have been about 29·16 per thousand.—J. S., 1854.

The lowest suburban mortality recorded in the fifth volume of the Registrar-General’s Reports, for the year then under estimation, gave a rate of 11 in the thousand; and we might perhaps be justified in adopting that rate as a minimum for the purpose of sanitary comparison.

According to this standard (undoubtedly a very superior one) it would appear that, during the last year, death has prevailed in the City of London with nearly three times its recognised minimum of severity.

But, to avoid all sources of fallacy, I will allow a very ample margin to this estimate; I will take 15 per thousand as a fair standard of mortality, and will assume that last year’s deaths in the City have amounted to only double their normal proportion.

Probably no one contends that the lower rate of mortality, as illustrated at Dulwich or Sydenham, indicates an over-healthy condition of the locality to which it refers. Probably no one argues that human life, in those healthier districts, is prolonged beyond enviable limits. Surely, on the contrary, every one who can measure the large amount of misery and destitution which results from a high rate of mortality, will think it most desirable that, by every means within the scope of sanitary science, exertion should be made to reduce the higher rate to the level of the lower.

Therefore, Gentlemen, I venture to assure myself, that I shall but have anticipated the wishes of this Hon. Court, in preparing for your consideration a statement of those circumstances, which apparently conspire to determine the larger mortality of the City of London.

In order to prevent any misapprehension of my remarks, I think it well to observe that, in commenting on this mortality, I purposely avoid instituting any comparison between it and the mortality of those urban districts which immediately adjoin us: for the object of my comparison is not to illustrate how, by similar or worse circumstances, an equally great mortality may have been procured elsewhere; but rather to suggest how, by other and better sanitary arrangements here, our present high mortality may be diminished.

Indeed, while I speak of the causes of that high mortality which distinguishes the City of London from the healthier sub-districts I have cited, it will be obvious that many of my observations do not apply to the City of London exclusively, but admit of equal application to various other central districts of the metropolis;—relating, in fact, generally to the characteristic evils of all urban residences.

With those other districts I have nothing to do; but I wish it to be understood, that in describing the City as healthy or unhealthy, I am not comparing it with Holborn, or Whitechapel, or Bermondsey, or other urban localities, where—whatever the relative badness of the places, the scale of comparison would be essentially vicious, and the results of comparison worthless. It is my object to test the salubrity of the City by comparison with a superior standard, in order that some definite aim may appear, towards which to direct the endeavours of sanitary improvement.

Starting, then, from our Registrars’ Returns, I invite you to inquire with me, how it has come to pass that within the City of London there have died in the last year twice as many persons as it seems necessary that there should die; and whence has arisen the apparent anomaly, that here—in the very focus of civilization, where the resources of curative medicine are greatest, and all the appliances of charitable relief most effectual, still, notwithstanding these advantages, there has passed away irrevocably during the year so undue a proportion of human life.

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. Compare, for instance, the cholera mortality in a healthy suburban sub-district with that of an unhealthy urban one. Dulwich and the parish of St. Ann’s, Blackfriars, in the City of London, are probably nearly equal in population: in the former, there was not a single death from cholera; in the latter, the deaths from this cause alone were at the rate of twenty-five to every thousand of the population. Dulwich is one of the healthiest sub-districts within the bills of mortality; St. Ann’s belongs to one of the unhealthiest sub-districts of the City of London; and the cholera visited each in proportion to its ordinary healthiness.

Such is the general rule; and accordingly I would suggest to you that the presence of epidemic cholera, instead of serving to explain away the local inequalities of mortality, does, in fact, only constitute a most important additional testimony to the salubrity or insalubrity of a district, and renders more evident any disparity of condition which may previously have been overlooked. The frightful phenomenon of a periodic pestilence belongs only to defective sanitary arrangements; and, in comparing one local death-rate with another, it is requisite to remember that, in addition to the ordinary redundance of deaths which marks an unhealthy district, there is a tendency from time to time to the recurrence of epidemic pestilence, which visits all unhealthy districts disproportionately, and renders their annual excess of mortality still more egregious and glaring.

As materials which may aid you to estimate the sanitary defects of the City, I subjoin two tables[14] illustrating the relative mortality of the several sub-districts. The first of these tables indicates numerically the local distribution of the year’s deaths, and gives their proportion to the population of each district and sub-district. The second relates particularly to the last quarter, and illustrates the pressure of the epidemic. The two together furnish a synoptical view of the several rates of mortality, as calculated for the entire City, for the Unions separately, for the sub-districts separately; and for the last quarter of the year separately. In the tedious process of constructing these tables, I have been careful to avoid every source of inaccuracy, and believe that they present you with a true measure of the health of the City during the past year.

[14] I have not reprinted these tables quite as here described. The local distribution of the 3763 deaths of the year is given in the Appendix, No. III.; and the sub-district death-rates of the year, as nearly as I can get them, in a note overleaf, page 6. The high mortality of this summer quarter (in which 1395 persons died) will be best appreciated by the reader in referring to Appendix, No. XIV.; where it can be compared with the mortality of similar periods of time in the four other years there accounted for.—J. S., 1854.

From these comparative tables it will be observed, that the high mortality of the population does not affect the entire City equally; that, in some of its portions, the rate of death approaches the minimum standard much more nearly than in others; that in those districts where the general rate is best, the temporary aggravation from epidemic causes has likewise been least; and that our aggregate City rate, either for ordinary times or for a period of epidemic disease, is compounded from the joint result of several very different proportions. Reference to the Registrar-General’s tables will enable any one to see that the ordinary rate of mortality for the West London Union is a fourth higher than the rate for the City of London Union, while the rate for the East London Union bears a still higher proportion; and these very different rates are, as it were, merged in the one aggregate rate, struck for the whole City, as comprising the three unions referred to. It will be obvious, therefore, that many parts of the City are much healthier than this aggregate rate would signify, while others are much unhealthier. In regard of last year, for instance, the aggregate rate of mortality was (as I have stated) 30 per thousand of the general population of the City: but if this rate be analysed by examination of the sub-district mortality, it will be seen that in one sub-district the rate of death stood nearly as low as 20; that in another sub-district of the same union it rose to 36, and in a third sub-district (of another union) to within a small fraction of 40.[15]

[15] On account of changes of population shown by the subsequent Census, these figures would require correction. The death-rates per thousand in the several sub-districts were probably about as follows, viz.:—

EAST LONDON UNION.	W. L. UNION.	CITY OF LONDON UNION.
St. Botolph.	Cripplegate.	North.	South.	S. W.	N. W.	South.	S. E.	N. E.
261⁄2	32	34	41	38	22	24	212⁄3	22

J. S., 1854.

If it were possible to furnish you with statistics derived from a still smaller sub-division of each district, these points would be infinitely more manifest. In some limited localities of the City you would probably find an approximation to the average mortality of suburban districts; while in other spots, if they were isolated for your contemplation, you would see houses, courts, and streets where the habitual proportion of deaths is far beyond the heaviest pestilence-rate known for any metropolitan district aggregately—localities, indeed, where the habitual rate of death is more appalling than any which such averages can enable you to conceive.

These facts are quite unquestionable, and I have felt it my duty to bring them under your notice as pointedly and impressively as I can; feeling assured, as I do, that so soon as you are cognisant of them, every motive of humanity, no less than of economical prudence, must engage you to investigate with me, whether or not there may lie within your reach any adoptable measures for lessening this large expenditure of human life, and for relieving its attendant misery. It is, therefore, with the deepest feeling of responsibility that I proceed to fulfil the main object of my First Annual Report, by tracing these effects to their causes, and by explaining to you, from a year’s observation and experience, what seem to me the chief influences prevailing against life within the City of London.

My remarks for this purpose will fall under the following heads, viz.:—

 I. Defective house-drainage;

 II. Incomplete and insufficient water-supply;

 III. Offensive or injurious trades and occupations;

 IV. Intramural burials;

 V. Houses insusceptible of ventilation, and absolutely unfit for habitation;

 VI. The personal habits of the lowest classes, and the influence of destitution in increasing their mortality.

In treating of these topics, I shall not pretend to bring before you all the details on which my opinions are founded, or to enumerate under each head those infinite individual instances which require sanitary correction. It is my wish at this time to submit to you only such general considerations as may show you the largeness of the subject, its various ramifications, and its pressing importance; and it is my hope that these considerations may suffice to convince you of the necessity which exists in the City of London for some effective and permanent sanitary organisation.