London's Pulse: Medical Officer of Health reports 1848-1972

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Mile End 1860

Report of the Medical Officer of Health to the Vestry of Mile End Old Town

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17.
Cursorily to follow to a short distance this view, we must
suppose for the existence of such disease,—
1st. A source generated by one or more persons, or by
an impure state of atmosphere; and then take into consideration,—2nd,
the local condition, whether capable of largely
diluting and dispersing, or of confining, aud concentrating the
means of infection previously generated;—3rd, the personal
condition of those who are exposed to its influence.
The local condition, or that of the interior of houses,
especially those of small size, is that to which I am desirous
to draw your attention, inasmuch as small houses are more
usually defective than houses of a superior class, the
defects being there more speedily reformed where discovered.
More power, too, rests with the occupier in this case than
in the former, a poor tenant seldom being able to do much
more than to change from bad to worse.
It is true that much remains with the tenants themselves,
some preferring filth to cleanliness, and who almost universally
select unwholesome places for residences, if they are to
be had. It is obvious that the best opposition would be to
have no such places for persons of such perverse habits to
shelter in.
Certain diseases affect individuals alnost indiscriminately
who have not previously undergone the ordeal of a sustained
attack; others are only to be avoided by attention to
ordinary but important preventive measures; but, if the first
are to be considered as almost a natural evil, the force of
such diseases is to be foiled and their fatality conseequently
reduced, while for the very existence of the latter we are in
a great measure responsible.
The undisturbed concentration of those subtle agents
which cause disease, and to which the term infection or
contagion is applied, should by every reasonable means be
opposed and counteracted, but obviously mainly by cleanliliness;
with the exterior, or public portion of the Hamlet,
such as streets, roads, and pavements, the Vestry have amply