AC 4375 GREENWICH GRE 70 BOARD OF WORKS FOR THE GREENWICH DISTRICT. FIRST REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE GREENWICH DISTRICT, PRESENTED TO THE DISTRICT BOARD, 5th MARCH, 1856. Greewich: PRINTED BY W. FLASHMAN, BLACKHEATH ROAD. TO THE GREENWICH DISTRICT BOARD OF WORKS. Gentlemen, In the First Report that I have the honor of laying before you, I am desirous of calling your attention to the Registrar's Returns of the mortality that has occurred in this District during the past seven years. From the 1st of January, 1849, to the 31st of December, 1855, I find that the deaths took place in the following numbers, viz:— In the year Greenwich. St. Paul, Deptford. St. Nichlos, Deptford. 1849 1633* 699 202 1850 1060 432 123 1851 1167 516 135 1852 1161 545 148 1853 1276 521 188 1854 1471 729 325 1855 1327 569 166 Total 9095 4011 1287 From the above statement you will perceive a great disproportion in the number of deaths between the different years; and from which statement your natural enquiry will be—What has been the cause of this disproportion in the mortality between one year and another? The fact that the Cholera was the cause of this increase during some of the years might to many appear a sufficient answer, and undoubtedly such a remark would be to a certain extent just:—But that reply is not sufficient for my purpose, nor does it explain the facts that I am desirous of eliciting. * These Returns for the Parish of Greenwich include a large number of Deaths from the Dreadnought Hospital Ship, Greenwich Hospital, (principally aged persons,) and a great number from the Union Workhouse. 4 The questions that will naturally be asked on the subject will be—What is the reason that, during this scourge of Cholera, all parts of your District were not visited alike? and, why did it extend its ravages to some localities more than to others? The answers to these questions have been a source of care and anxiety and deep investigation to me, and I have come to the conclusion that the following facts will form the only reply which may be relied on. Certain districts were low and ill-drained, the houses and streets badly ventilated, the inhabitants thickly crowded together, indulging in dirty habits, without proper clothing, and without the common necessaries of life. Can it be wondered at that such localities should have been more than usually afflicted with sickness, or that deaths should have occurred in a proportion much greater than in the more open parts of the neighbourhood? If we compare the District of Blackheath with the Parish of St. Nicholas, Deptford, some parts of the Parish of St. Paul, or the lower parts of Greenwich on the Banks of the River, we shall find that the one was free from any marked pestilence, whilst the population of the others was as constantly decimated by its influence. These observations do not only apply to Cholera, they are equally potent as regards other epidemics and diseases generally; whether it be Typhus Fever, Small Pox, Influenza, Scarlet Fever, or any other malady. These localities are (and will be as long as they are allowed to remain in their present condition) the focus from which will spread an infection hostile to health, and bringing direful calamities on the human race. It is true that some of us, who are more happily circumstanced in life, living in high, open situations, and possessing those comforts and luxuries which are necessary and conducive to the development of health, are sometimes afflicted with Fevers and other epidemics; but mark the difference in the violence of such attacks, and, how do we know that even these diseases are not brought upon us from the above mentioned localities, where filth and infection abound? 5 It is then to such localities that I shall first and especially direct your attention. The sanatory measures that I hope to have the honor of laying before you, and the remedies that I shall feel it my duty to recommend for your adoption, may, at first sight, appear to be likely to involve the Board and the Parishes generally in a very large outlay and expenditure. Now, I am desirous that you should take this expenditure into your consideration under two principal heads— first, for the lessening of sickness and mortality; and secondly, for the relief of Parish rates. During the last visitations of Cholera, and under the influence of diseases more particularly occurring in the unhealthy localities of your District, I have had a painful experience of the vast expenditure of human life. The father, the mother, and the heads of families were frequently carried off after a few hours of the most intense suffering, leaving their helpless orphans entirely depending on the generosity of the parishioners. What would have been the result at the present time had the measures now proposed been carried into execution previous to the visitation of that pestilence? These children would still have had their natural guardians to protect them, instead of being now an expense upon your Parishes; and your rates would have shown a different aspect, compared with the state in which they now appear before you. Your heavy rates operate also very injuriously on your towns generally, and on your tradesmen individually. Often has the remark been made to me by respectable people who were desirous of residing in this town—"We cannot "think of taking a house here, to pay a high rent, high rates and "taxes, and at the same time be inhaling the smells and noxious "vapours arising from the filthy places we see in the neighbour"hood;" at once depriving your towns of a class of persons that would lessen the rates of your District. To remedy these injurious operations on your towns, to prevent this large amount of human suffering, to relieve the vast increase of your poor rates, consequent on such suffering—I cannot but urge upon you the necessity for at 6 once laying out your capital in the furtherance of those important objects for which you are here assembled to deliberate; whether it be for the sake of humanity, or whether it be as an investment of your capital, I cannot but look upon the subject as being highly meritorious, and ultimately a direct saving of expense to your respective Parishes. When you take into your consideration the observations and facts that I have thought proper, and shall think necessary, to lay before you, and after carefully investigating the causes of this past sacrifice of life in the several Parishes of this District, I am confident that you will allow no expenditure (consistent with what will appear to be practicable, and with what will be borne out by experience to be eminently useful) to interfere with your feelings of humanity; but that you will render me every assistance in adopting such measures as will tend to lessen this large amount of sickness and mortality; thereby, not only affording relief to the poor, but bringing honor on your Board, as having been the instruments for effectually carrying out the important measures contemplated by the Act of Parliament. In reporting to you on the sanatory condition of your District during the past month, I can only give you a plain statement of the deaths as they have occurred; viz.:— Greenwich East 50 „ West 32* Deptford, St. Paul 42 „ St. Nicholas 12 Total 136 I purpose simply to forward you the like information in each succeeding month during the present year, reserving my remarks as to any comparative statement of sickness and mortality, until the commencement of the next year. * This is exclusive of the Deaths from the Dreadnought Hospital Ship. 7 From my own observation, and from information obtained from many of my professional brethren, I find that there has been a considerable increase of Fever and other epidemic diseases within the last few years; and it is as equally certain that there has been a gradual increase of deaths in this District, as shown in the table I have placed before you in the commencement of this Report. I believe also that there has been a disproportionate increase in the deaths during the same period. I shall now point out to you the course I intend to pursue towards adopting that system of organisation which appears to me to be necessary for the permanent improvement of this District. First, by dividing the whole District into four Sub-Districts,* and pointing out for your earliest consideration in each of these four SubDistricts the several streets and water-side localities which have previously been visited by sickness to an unusual extent, or have given cause for complaint: secondly, those districts that have been partially under epidemic influence; and lastly, those higher and more open parts which have not been hitherto visited by any decided pestilence, and such as have only suffered from the ordinary amount of disease prevailing in the more healthy parts surrounding the Metropolis. In the next place, I am desirous of obtaining correct information on the following points:— I propose to obtain and keep a Register of all streets, courts, and alleys, and every house therein, and of every establishment in the District. To ascertain their condition as regards drainage, ventilation, water-supply, and other matters necessary for the improvement of the health of the District. To keep an account of all sickness and mortality occurring in the District, and to report to you thereon. * Viz.:—Greenwich East, Greenwich West, St. Paul, Deptford, and St. Nicholas, Deptford. 8 So that from such Register I may be enabled from time to time, or when required by the Board, to furnish correct information in reply to enquiries that may be made respecting any part of the District. Without this information, I fear you will have but little chance of success in your endeavours towards the public good. In order, therefore, that I may obtain such information, I am desirous that the Inspectors shall, in respect to all sanatory measures, be placed entirely under my direction and supervision; and that they shall be instructed by your Board to follow any directions, systematic arrangements, and other measures that I shall from time to time think necessary to adopt (such as house to house visitation, and inspection in every street), and according to the routine I shall lay down for their guidance; and to report to me, upon such inspections, as to drainage, water-closets, cesspools, water-supply, and every other information I may require for your deliberation. It is now, therefore, under a sense of the deepest responsibility, that I shall proceed to lay before you what appear to me to be the principal causes existing to account for the past amount of disease; and at the same time to recommend to you the most appropriate means for its mitigation and remedy, and which I shall bring before your notice under the following heads, viz.:— First.—The condition of the streets and general surface of the District. Secondly.—The want of sewerage, drainage, and a sufficient water supply; and Thirdly.—The ill-ventilated and filthy state of the houses and personal habits of the poorer classes. On each of these subjects I shall offer such details and such general observations as appear to me to be necessary for the complete removal of such causes of disease; and shall commence with the subject of "surface cleansings;" which, in the absence of general sewerage, I consider ought first to deserve your attention, inasmuch as it is the only measure that can at present be regularly carried out through every part of your District. 9 There is one subject in connection with surface cleansing that I wish particularly to advert to, viz.:—That it will be my purpose to make a systematic arrangement for the enforcement of the duties of the scavengers, and the removal of the street sweepings collected by them. I am induced to bring this matter before you, inasmuch as I have had frequent observations made to me of the neglect or want of method exercised in carrying out their duties; and more particularly I would bring to your notice the disinclination on the part of the Contractor for Greenwich, amounting almost to a refusal, to remove such rubbish excepting at such times as suited his convenience. I have myself noticed that this street refuse has been allowed to remain in heaps two or three days after the scavengers have completed their work. It must therefore be evident to you that the arrangements you have made with the Contractor have been virtually neglected. In Deptford, I am informed that no Contractor has been employed to remove this rubbish, but that it has been swept together and removed in wheelbarrows to the nearest vacant spot suitable to the men employed. For the purpose of surface cleansing, therefore, I would recommend— That the scavengers be at once placed under the superintendence of the Inspectors; that a sufficient number should be employed in each parish to sweep and thoroughly cleanse the surface of the whole District once in every week. When I recommend the cleansing of the whole District but once in each week, I only wish to apply that observation as a general rule, inasmuch as there are many streets and many localities which, at certain seasons of the year, I consider absolutely necessary should be swept at least twice in every week; and which localities I shall feel it my duty to point out to the Inspectors as soon as I have examined each in detail. I cannot too strongly impress upon you the importance of enforcing upon the Contractor the conditions of your agreement with him, and giving positive orders that he shall, in every instance, 10 cause the cart to follow the scavengers, and remove the refuse as soon as swept together. Another point connected with the removal of these surface materials, I wish particularly to bring to your notice. It has been the custom for a very long period, for the street refuse to be deposited near the dwellings of the poor, in many already unhealthy parts of the District. One large accumulation has taken place at the bottom of Roanstreet, Greenwich; another in that space of ground on either side of the Railway, Deptford, extending through Knott-street to Mr. Wheen's Soap Works; and others in various parts of the District, too numerous to mention at present. The effect of such large accumulations of filth must be to render the already unhealthy parts much more liable to the influence of disease; a constant fermentation takes place in these heaps of rubbish, and as constant an evaporation is going on, particularly during the hot season of the year, thereby diffusing unwholesome smells and noxious gases through the surrounding atmosphere. Mr. Hollingsworth, the Medical Officer of the West District of the Parish of Greenwich, informs me that Fever is always prevailing about Roan-street, Union-street, Church-fields, and all the adjoining alleys and courts. The same prevails in other parts near all those heaps of filth. I do not wish the Board to suppose that Fever and the other diseases infesting these localities are entirely dependent on these accumulations; but, undoubtedly, a greater intensity is given to the symptoms in all cases occurring within the range of such a polluted atmosphere. Under these circumstances, I would advise that the street refuse should be conveyed to some distant spot, where the product of such large accumulations will not be injurious to the health of the inhabitants. It is possible that although every street and house shall be properly and thoroughly drained, and to all appearance kept in as good order as circumstances will admit of—it is even possible, I say, that a small heap of such matter constantly heating and fermenting 11 might be spreading Fever and disease amongst the unsuspecting population. So soon as organic matter undergoes decomposition, so soon does the Medical Man recognise the most fertile source for the increase of diseases. The formation of Ash-pits I consider to be one of your most necessary provisions. Those who are in the habit of visiting and entering the dwellings of the poor must have remarked the unwholesome state of those dwellings, arising from the quantity of refuse matter covering the surface, not only of the little garden, the back yard, or small premises attached to each house, but, in a very great number of instances, this refuse is swept up into one corner of the sitting-room, and there allowed to rot and ferment, thus becoming a most fertile source of disease. By providing Ash-pits indiscriminately, you will remove such cause of disease. The Clergy who are members of your Board, I am confident, can bear me out in the truth of these observations. I find the Metropolis Local Management Act, Sect. 81, provides, that all houses not having Ash-pits, shall be supplied with such within a given period. To this clause I particularly wish to draw your attention, and advise that a peremptory notice be given to all persons to provide Ash-pits within a certain time; and that, after each house shall have been provided with an Ash-pit, an order be given to the Contractor, to empty such Ash-pits once in every week, and that the Inspector be directed to enforce compliance with this order. I also advise that a notice be issued, prohibiting the practice of throwing ashes, cabbage leaves, and other rubbish, into the streets; thereby decreasing the amount of labour, and consequently decreasing the expense and number of scavengers. There are two other important points to be considered in respect to the surface cleansing, viz.:—The laying down of hard road materials on the different streets, and a general system of paving the gutters in such streets. On going over the District, I find that the streets in many parts are from 10 to 12 inches deep 12 in mud; that in these same localities there does not exist a single gutter to convey away the refuse water from the houses, the whole of which is thrown over the streets, and there allowed to evaporate; and that, as a consequence, the inhabitants themselves are of the most dirty and filthy character, pale-looking, and constantly inhaling the effluvia from their own filth. How, I would ask, can these people be expected to take pride in themselves and their habitations, when the public streets are so much neglected? As instances of these remarks, I would mention that there are many streets and thoroughfares in the Parish of St. Paul, Deptford, which are in the state I have described, and which I shall bring to your notice in the subsequent part of this Report. On going through the Parish of St. Nicholas, and comparing its present state with its condition some two or three years since, I cannot but congratulate the parishioners on the improvement which has taken place in that Parish: and great credit is due to two or three Gentlemen (members of your Board) for the attention they have given towards its better condition: but, still, much remains to be done, particularly in the formation of gutters to convey away the surface water. The drainage, ventilation, &c., of that Parish is also very defective, to which I shall call your attention in my future Reports. The plan of laying down flat pavement for the gutters, lately adopted in many parts of Greenwich, has been of essential service in removing much unwholesome refuse, and facilitating the work of the scavengers; and such a plan I would recommend to be carried out generally through the District, with such expedition as the finances of the Board will admit of. As a matter of course, these last operations that I have brought forward must extend over a considerable period, and must naturally involve a great expense; but the necessity for these improvements appears to me to be so urgent that I cannot refrain from recommending your Board to lose no time in devising plans for the execution of such works. On my part, neither time nor care shall be wanting in seeing that your projects are carried out efficiently; 13 and I shall be happy to attend any parochial or other committees which may be formed for sanatory purposes, and to give them my best aid in furtherance of the objects for which they will be formed. Connected with this my first subject that I have laid before you for discussion, I am desirous of drawing your attention to some gigantic nuisances existing in the Parish of St. Paul, Deptford, and which I partially adverted to in the earlier part of my Report, viz.:— Addey-street.—In bad condition, from the want of hard road materials and side gutters. Slaughter-house-lane.—In very bad condition, requiring the surface mud to be removed, the roadway to be covered with hard road materials, and gutters to be made on each side. Creek-street.—Mud and filth 12 inches deep in this street; no gutters, and altogether in the worst possible condition: with an open ditch, the receptacle of the privies and drains, and for all refuse matter from the adjoining streets. John-street.—In bad condition from the want of road materials and gutters. Ravensbourne-street, and the Open Space of Ground in Front. —In the most filthy condition, from a vast accumulation of street refuse, and being a reservoir for all the drainage from the south side of John-street. Sun-street.—In bad condition, and requiring road materials and gutters. Lime-street.—In the same condition. Knott-strect.—From 10 to 12 inches deep in mud, which requires removing, and then good road materials and gutters to be laid down. The Open Space between the Creek-road, St. Nicholas, Deptford, and Mr. Wheen's Soap Factory, is the receptacle for street refuse, and contains large pools of stagnant water. 14 In reporting to you these nuisances, I am at a loss how to express myself in terms sufficiently strong to impress on you the necessity of immediate action towards the removal of the same. During the prevalence of Cholera, these localities were particularly infested by the disease; Fever is incessantly at work in all its fearful forms; and, in fact, every disease occurring in these streets assumes its most virulent character. I have not touched upon the sewerage or drainage of these streets, as I am aware that your Board is not in a position to give those subjects your consideration until the Metropolitan Board of Works shall have taken the initiative in the matter. My next Report will be on sewerage, drainage, and watersupply, when I shall make the necessary remarks on the above mentioned localities. Gentlemen, I am aware that I have undertaken a heavy duty and a great responsibility; that duty and responsibility I shall not shrink from; I shall endeavour straightforwardly, irrespective of persons, friends, or connections (knowing no party either for or against the purposes for which you have honored me with your confidence)—I shall endeavour, I say, to perform those duties with an impartiality that shall at all times command the good opinion of the public, and the support of your Board. Should my remarks not appear to you sufficiently clear and explicit, I trust you will attribute it to the novelty of my undertaking, and the short period which has been allowed me to ascertain the facts and classify the details. If, on the other hand, my Report should appear to you to be too lengthened, my excuse will be, that the magnitude of the subject demands a searching enquiry into all its details; or, if, while endeavouring to lay before you the real condition of your District and the remedies to be applied for its relief, I have failed in, or have incompletely surmounted the 15 difficulties of my task, I must cravc your indulgence and say, that actuated by a deep sense of the importance of the duties committed to my care, and fully appreciating the necessity for thoroughly developing the measures prescribed by the Act of Parliament, I will labour the more to prepare for you a scheme, which shall (as your Chairman observed to you at the last meeting) make your District one of the most healthy in the environs of the metropolis, and a model and example for the guidance of other Boards, who are at the present time undertaking the same responsibility. I have the honor to remain, Gentlemen, Your most obedient servant, HENRY N. PINK. Crooms Hill, March 5, 1856. W. FLASHMAN, PRINTER, QUEEN'S PLACE, BLACKHEATH ROAD.