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they are sent to the Fever Hospital. In the Whitechapel District, all the pauper cases are
sent to the Workhouse, and hence the comparatively large mortality in the sub-district in
which that Institution is situated.
The question has been frequently asked, what is the cause of epidemic diseases ?
I regret to say that I am unable to answer the question. There is however no doubt in my mind
that overcrowding will produce typhus fever, and more especially in those whose constitutions
are impaired by insufficiency of food. During the winter, distress and poverty have prevailed to
a greater extent than usual among the working classes, many of whom have been unable to
procure a sufficient quantity of food to sustain a healthy condition of the system, and have
also been without sufficient clothing and fuel to keep the body warm. These persons have
consequently herded together in small rooms insufficiently ventilated, and they have thus
been poisoned by the emanations of the many persons being crowded together. On
visiting some of the houses in accordance with the plan of the house-to-house visitation, it has
been ascertained that some families have preferred congregating together at night in a single room,
although by renting two rooms they had it in their power to divide the family. The reason
alleged for doing so, was, in consequence of the warmth engendered by the whole family
sleeping together. It is generally admitted that want of employment and consequent poverty
powerfully contributes to the extension of typhus fever, and that a prosperous state of trade,
whereby the circumstances of the people generally are improved, tends to lessen the susceptibility
of the people to the influence of the disease, and to diminish its fatal effects upon those
who are attacked by it. But to what extent meteorological changes in the atmosphere may be
productive of diseases in man—in the lower animals—and in vegetables, our present knowledge
does not enable us to determine; nevertheless, when a serious epidemic prevails, our most
zealous attention in the application of such remedial measures as experience has pointed out to
mitigate the sufferings of the patients and to prevent the further spreading of the disease. For
these purposes our attention must be directed to the enforcement of the thorough ventilation
of the apartment of the sick person, to the recommendation of the use of clean clothing,
and of wholesome food and water, to the prevention of overcrowding, and the removal
of nuisances, more especially the immediate removal of the excreta of the patient. This last
suggestion is of the utmost importance, for the disgusting and nauseating smell which pervades
the sick rooms of the poor has a most injurious effect upon all who remain in them, and
also upon those who merely enter them for the purpose of rendering advice and assistance,
It is probably owing to this cause that medical men, ministers of religion, and relieving officers,
are such frequent victims of fever when the disease is extensively prevalent. From the
mortality returns it appears that in this district fever has been principally confined to the
abodes of the poor,—that hitherto in very few instances has the disease attacked those in
comfortable circumstances. But, I regret to say that since the 29th March, the day on
which the present quarter terminated, the disease has extended to some houses inhabited by
the wealthier classes, and I may observe that it is essentially necessary at all times, but
especially at this season of the year, for all persons to cleanse periodically, say every three or
four weeks, their cisterns or water-butts; for I am persuaded that much injury to health arises
from the use of water which has been long kept in foul tanks. My attention has been on
several occasions directed to the filthy state of some of the water receptacles in houses of the
poor, and I have directed the Inspectors while visiting these houses to insist upon the periodical
cleansing of the water-butts.