The present and general condition of sanitary science

by Edwin Chadwick

THE

PRESENT AND GENERAL CONDITION

OF

SANITARY SCIENCE.

BY

SIR EDWIN CHADWICK, K.C.B.

CORRESPONDING MEMBER OF THE INSTITUTE OF FRANCE, ETC., ETC.

An Address,

IN REPLY TO THE MEMORIAL PRESENTED AT THE
FESTIVAL DINNER, ON MARCH 2nd, 1889.

LONDON:
PRINTED FOR THE AUTHOR BY JAMES MELDRUM.
1889.

The accompanying Address is the short and, I fear, inadequate response to the Memorial presented to me on March the 2nd, 1889, at the First Avenue Hotel during the annual dinner of the Members of the Association of Sanitary Inspectors of Great Britain, over which my old sanitary colleague and ally in sanitation, Dr. Benjamin Ward Richardson, presided. The Address, prepared merely for a passing event, which, however, will never be erased from my memory, might have passed also with the occasion, but for the fact that those who were present, to all of whom my grateful recognitions are due, wish to hold it in the more permanent form in which it now appears.

EDWIN CHADWICK.

My dear Chairman, My Lords and Gentlemen, Members of the Association of Sanitary Inspectors of Great Britain,

I presume that I may accept the great kindness bestowed on me on the present occasion, partly as having regard to the unusually advanced age of the body, and partly as to the extent of the occupation of the mind, for the promotion of our science during that unusually long period. On the bodily account, it is due to those here, who are practically engaged in sanitary work, to state that it will be found on examination that the risks of death and wounds, especially in withstanding epidemics, are fully as great as those sustained by officers of the Naval and in the Military service. I have myself participated in those common risks, and although I probably owe the duration of such working ability as may yet remain to me, to exceptional hereditariness—for my father died at the age of 84, my grandfather at 95, and my two great-great-grandfathers as centenarians—these facts do not interfere with the point I have named, that men who have to fight for sanitation have sometimes to fight for life also.

Turning from this topic, let me now briefly state the chief present conditions to which we have advanced in the practical applications of our science, which are as yet very imperfectly known. I beg to premise that I state nothing upon hypothesis—nothing but well-examined experiences.

It has been objected that if it were possible to amend communities by Utopias, Utopias would long since have been introduced. Our proceedings—assumed to be Utopian—which I have to recite, are not, however, based upon Utopian ideals, but on "experiences" carefully and separately examined—separately examined as to their assumed and strict application to common conditions. It is no Utopia that death-rates in towns under the separate system of drainage have been reduced by one-half through the work of the sanitary engineer alone. It is no Utopia that the death-rate at Rugby, for example, which was one of the towns first treated by our first General Board of Health, was then twenty-four in a thousand, and is now only twelve. It is no Utopia that at Salisbury the old death-rate, which at the beginning of the century was as high as forty in a thousand, is now about sixteen; or that at Croydon and a number of other places, death-rates of twenty-four in a thousand now average fifteen. These reductions have been effected by the system of "circulation versus stagnation," which is yet to be made generally understood, to be by constant and direct supplies of water, by the removal of the fouled water through self-cleansing house-drains and self-cleansing sewers, and by the removal of the refuse—fresh and undecomposed, and unwasted—on to the land.

On the examination of incipient experiences, and on long and careful examination, the application of this system was proposed for the metropolis, but it was opposed by what is called "Vestralisation," and by strong interests in expensive works, in the House of Commons, by which the Government at a morning sitting were put in a minority. An opposite system was adopted, which has since been examined and condemned by Lord Bramwell's Commission as "a disgrace to the metropolis and to civilisation." Our measure was carefully examined by German sanitary engineers, who proposed it for application to Berlin. It has been applied there, though not yet so completely as I consider it might be, and it has recently been re-examined by a deputation from the French Government, and it is now adopted on that examination for the relief of the sanitary condition of Paris. I greatly lament the loss, by death, of M. Durand Claye, the ingénieur en chef of Paris, a firm sanitary disciple of mine, but I hope that loss may not imperil the economical execution of the work.

Various experiences in this country by these factors alone have established with such certainty that a contractor may contract with safety for the attainment of sanitary results, and by them the general death-rate may yet be reduced by ten in a thousand. Beyond the reduction of the annual death-rate from the work of the sanitary engineer, nothing is yet commonly expected or sought for. I had, however, early anticipated that the reduction of the annual death-rate would be accompanied by an advance of the life-rate, and I have recently obtained from the Registrar-General examples of what that advance may be.

I find that at Rugby the life-rate has been extended to all living there, of every class, by eight years, or from thirty-three to forty-one years. At Hastings the duration of life has been advanced for males an average of five years and five months, but for females of eight years and one month. At Leek it has been extended by ten years; at Croydon and Salisbury and other places, the extension has been from six to seven years, females, as a rule, obtaining, by our science, the greatest share, that is to say, some eight years more of life-rate, more of painless life, more of health and strength and beauty. These extensions of the life-rates, as yet little known and regarded, belong, however, to all classes, both to the well-to-do and to the lowest. Of the wage classes, whose life-rate is largely the lowest, the extension will be found to be the greatest. To them the greatest gain developed is by the house alone, the "model dwelling," the work of the sanitary architect, giving ten years more of life and working ability, a result cheap to pay for by extra rents, and which would be still further improvable by the removal of surrounding deteriorating conditions, especially bad schools and ill-conditioned places of work.

As against extant evils, there is yet to be provided the due exercise of the functions of Medical Officers of Health and the aid of the Sanitary Inspectors in the inspection of workshops and schools, and chiefly the half-time schools. As Commissioners of Inquiry into the labour of young persons in factories in 1833, it was the recommendation of myself and my colleagues that the Factory Inspector should be essentially a Sanitary Inspector. Under our first General Board of Health we made an effort to extend these functions in our regulation of the duties of the local officer of health to a weekly inspection conducted at the places of work. On the detection of the premonitory symptoms of disease—chiefly the eruptive diseases—the health officer would, to prevent them spreading, entrust the removal of the patient to the Sanitary Inspector, who would be ordered to see to the fitness of the habitation for recovery or else to provide a proper place. It is a mark of our progress that such official sanitary qualifications as now abound, which qualifications it is economical to pay for, did not then exist, or were to be obtained in a few instances only, such as that of Dr. Neil Arnott, at such salaries as we could induce a Chancellor of the Exchequer to pay for them.

The greatest and the grandest advance in the power of sanitation made in my time is, it appears to me, that for the extinction of the chief children's diseases, measles, scarlatina, typhus, and diptheria—an advance carefully and efficiently tested and ascertained in the chief district half-time schools, where the death-rate, amongst the children who come into those institutions with no developed disease upon them, is reduced to less than three in a thousand, or less than one-third of the death-rate prevalent amongst the general population. Such reduction is coincident with the reduction of the death-rates in the prisons, the former seats of epidemics, where amongst the persons who enter without developed disease upon them, the epidemics are entirely expelled, and the death-rates reduced below three in a thousand, or to less than a third of the death-rates prevalent amongst the unprotected population outside.

Physicians are beginning to declare that a large amount of the crime for which punishment is inflicted is due to insanity, and that insanity is due to low physical conditions which sanitation by early physical training would remove. There are experiences to show that this is the fact. Dr. Ashe and others conversant with the lunatic asylum declare that, as a class, lunatics are of low physical condition, and that that low condition is reducible by sanitation and early physical training; an important matter, for 80,000 lunatics are now burthening the rates. Of 30,000 blind persons, the late Dr. Rolph declared that two-thirds might have been saved by early sanitation. There are experiences, too long to particularise on this occasion, which sustain these several conclusions.

These experiences are also of vital importance in their application to prison life. But there is another part of our national life and strength which yields the same results. I refer to the latest manifestation of the power of our science for the maintenance of the force of our army. At the Congress of Social Science, held at Liverpool in October 1858, I proposed that the science which had saved the second army in the Crimea should be applied to the protection of our excessively death-rated army in India, and after much persistent labour of representation, a Commission of Army Sanitary Inquiry was appointed at the instance of Lord Stanley, now the Earl of Derby, in May 1859, and the change which has since taken place is surprising even to stolid minds. The old death-rate in the Indian army was sixty-seven in a thousand. In the last decade it has been reduced to twenty in a thousand. The saving of life in India in that decade was in men 28,130, in sickness 25,000. This was affirmed, on examination, by Sir Louis Mallet on a claim for due recognitions, when he was Secretary to the India Board. The services of the Army Sanitary Commission, which comprised those of Dr. John Sutherland and of Sir Robert Rawlinson—the remaining officers of the Crimean Sanitary Commission—were extended over the whole army, and the aggregate saving of life, as returned by the late lamented Professor de Chaumont, of the Army Statistical Department of Netley, has been 4,058 men per annum, and for the decade 40,500 men; or in money, at £100 per man, £40,053; and in sickness £41,680, an equivalent sum at £100 per man. The saving in life by sanitation is immensely greater than the losses of life by war.

At this time a further reduction has been made from the 26 per 1,000 of the last decade to about 14 per 1,000, and further advances may yet be made in the sanitation of the Indian army. A strong party has been formed in India to obtain the application of the experiences of the successful sanitation in the army to the relief of the civil population of India, and moreover to apply those experiences to large tracts of unoccupied but fertile land, capable of permanent military settlement or of the civil settlements of a population much greater than the present population of all India. My aid by exposition of sanitary and administrative principle has been besought for this movement.

So much for our own Empire, but a still greater advance in army sanitation has been made in the German army, where the death-rate has been reduced to six, and even to five, in a thousand, with an increased value of thirty per cent. for civil work after three years of military service. We have not yet attained to that increased value of labour, although I have been informed of the value of the labour of the volunteers being increased by five shillings a week by the aptitude imparted by the drill. The foremost sanitation of the German army is largely advanced by a factor which is new to us, but which is extensively available for the civil as well as the military population. Mr. David Grove, the eminent sanitary engineer of Berlin, applied a means of washing constantly half a million of soldiers, with tepid water, at the cost of a shilling for every 100 men. But I find that we now improve upon that sanitation, and can effect it better for ninepence per 100 men. Now also in our schools and district institutions about ten children can be washed with tepid water for about a penny, soap and towel included, at a rate of time of three minutes per head—much more cheaply and effectually than they can be washed at home. Trained nurses devoted to the care of patients with the most infectious diseases have long protected themselves by a double washing, head to foot, daily, with tepid water and a change of clothes; and experienced sanitary officers use the same precautions on the occurrence of extraordinary visitations of epidemics. Populations may now be trained to do the same.

Let me state one large gain in sanitation, which I now believe to be attainable for the satisfactory ventilation of public buildings, and of large schools and workshops.

I have for a long time collected observations of the height of attacks of epidemics on the population of tall buildings, and have found the attacks to be generally confined to the cellar dwellings or the lower floors, whilst the occupants of the upper floors have been distinctly exempted from them, that is to say, the occupants of dwellings above the range of the visible fogs, made up of the heavier, low-lying, and visible fogs. Mr. Glaisher, the experienced aeronaut, gives me his testimony that the visible fogs are low and close lying to the land. From the height at Highgate or Hampstead, fogs are seen covering London like a level white blanket, out of which the upper and bright portion of the dome of St. Paul's Cahedral is seen bright and clear above it. By tubular arrangements (largely economical in result) intakes may now be opened into the purest superior strata of air, and it may be pumped down and delivered at a rate required, into public edifices, into the larger schools and workshops, warmed in cold weather, and cooled in hot weather. Had this new means of sanitation been understood at the time of the erection of the new public offices, two sets of officers might have been enabled to work well, where one now works ill, and not with comfort, above half a day, in the large, ill-ventilated rooms, which are reservoirs of impurity, from which Ministers of State have declared that they have been driven to work at home. From India I have collected experiences where the fog just covered the infantry, but where the cavalry were seated above it, and another experience also where a foot messenger could not pass, but where a messenger on an elephant might. In such places, by shorter tubular arrangements, the fresher air may be reached at an expense less than that of the punkha, and healthy rest obtained free from the torment of mosquitos.

Experiments may be required to determine the height for a tubular intake (which may be of copper sheathing) to be raised above the clock tower to avoid the discharges of the high chimneys of bone boilers and others (which themselves require correction) and to ensure for the Houses of Parliament, and the new public offices, air of complete purity for their ventilation.

Let me do justice to the intellectual by referring to some of the experiences of the working of the half-time school principle. At the half-time District School of Anerley, and of others of them, excluding absolute idiots, full ninety per cent. are got to "the good," that is to say, to wages when they leave of 8s., 10s., and 12s. per week, or nearly the former wages of adults. When I last visited the half-time school of Manchester, at Swinton, the head-mistress there asked what need they had of emigration when they have three applications for every girl as soon as she was fitted for a place. When the Dowager Empress of Germany visited the half-time school of Norwood, the head-mistress declared that she had the greatest difficulty in meeting the pressing applications for girls for good places. And there can be no doubt that many will be carried from them who would have been left with the helpless insane. The late distinguished inspector of schools in Ireland, Sir John Lentaigne, declared that the system, if duly applied, would beneficially change the character of a nation. Lord Shaftesbury has put it on record that the mothers of the factory children in Lancashire had declared to him that the half-time system of school and work had made their children as of another race to them. And this, too, is practicable at a reduced charge from often using the same school buildings for double sets the same day to accommodate industry, as they are finding out they may do in the colonies. And this may be done for one pound ten per head, with a superior physical training, as against two pounds five per head, the charge of the long-time board schooling. School teachers have declared that if they were left to their own devices as to classification, they would save three years of school life to every child, and that with a superior physical training which can be got at no time afterwards. This will effect the abolition of the "snail's pace," and will make the school the happy assemblage of the millions of children during the first days of their life.

What may be further attained, by a combination of more effective work of the sanitary architect, with better sanitary inspection of schools and places of work, by the Local Health Officer, with the aid of the Sanitary Inspector, would, it appears to me, be ascertained by what I have called a close clinical examination carried out by a competent specialist, as was done with great advantage for Brighton.

The selection of emigrants is now a subject of much consideration, but it may be submitted that one great object would be to ascertain the sanitary fitness of the locality to which it is proposed to send the emigrant—as, for example, that it is not one where the chances of death from phthisis are doubled, or one where, of the children born, more than half will be in their graves before their fifth year—common conditions in some places to which emigrants and their families are now sent.

The orphan children in the district half-time schools are in a large proportion the children of hereditary vagrants, mendicants, and delinquents. Our experiences now display a considerable reduction from them of juvenile delinquency, and enable us to declare that if the children of these classes were given to us from very infancy they need be vagrants and delinquents no longer, but honest and productive citizens.

To those who are unacquainted with the subject in detail in principle—the popular test of central legislation and of local administration, of either political party, may be deemed extravagant; yet on due examination it will be found that the wastefulness of ignorance, of bad central legislation, and of bad local administration, causing sickness and premature mortality, may actually be tested by the nose—now by the odours of stagnation and of putrefaction, now by the gases of stagnation, by putrefaction in rooms, by defective supplies of water, by stagnant cisternage which absorbs foul gases, by the odours of putrefaction from sewers of deposit, by the odours of putrefaction from ill-formed and ill-cleansed streets, and by the eye indeed, as well as the nose, in unwashed children and unwashed workpeople in the byways and the highways.

In a sentence, low sanitary conditions of populations are everywhere the sources of irritations, of despair, of disorder; whilst high sanitary conditions are the sources of satisfaction, of political security, prosperity, order, and peace.

Mr. Chairman, Lords and Gentlemen, I thank you most sincerely for the consolation and happy assurance of the great future which your testimonial conveys to me. Looking further back than perhaps any one here present can look, I do see, I confess, in the progress of the past, an augury for the future which fills me with all the delight that can fill with the brightness of hope a human heart that has beat so long as mine. I see in the happier, because healthier children that are being nurtured, what may fitly be called the new birth of health that is in promise for the world. My satisfaction may not be equal to my thankfulness, but it is sufficient in this respect, that it is a richer satisfaction than has fallen to the lot of most men who have devoted all their energies to the work of national reform, in matters that lie nearest to the most vital of all that is national, the vitality of the nation and its power for strength and endurance in the career of nations.