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

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Stepney 1900

[Report of the Medical Officer of Health for Whitechapel]

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with, in 1866, a sharp outbreak of cholera. Tt would appear that each
addition to the Sanitary Staff has resulted in considerable improvement in the
sanitation of the District, and a corresponding diminution in the death-rate.
Have the ratepayers not received splendid value for their outlay ?
I scarcely care to speak of my own work, but I have, from my initial start,
made a point of knowing every week from what diseases our people were mostly
suffering, and to what causes the deaths were attributable. This information
was first obtained by extracting, every week, from the District Medical Officers'
Books particulars of every case. I assumed that this information guided me
to a knowledge of the sickness likely to be present among persons belonging
to a. different grade in life.
Upon sheets specially constructed to take each year's work, I set out
every week full details of all deaths and other particulars likely to assist me
in learning what I required to know to enable me to fight the battle which I
set myself to fight.
Every day I myself copied, upon my own Office List, every case of infectious
disease which had been notified during the previous day.
In this manner, if enteric fever attacked several persons in the same house,
or in neighbouring houses, it was possible at once to critically inspect the
property, instead of waiting until perhaps an epidemic of the disease had
As regards our method of dealing with infectious diseases, so soon as the
doctor's notification was received, the Inspector responsible for this particular
work entered the case upon his sheet, and then visited the case promptly.
Upon a form, designed for the purpose, full particulars were inserted, such as
name, age, business, general condition of house, drainage, water supply, source
of milk supply, and so on. Then, if for removal, the case was telephoned at
once to the Metropolitan Asylums' Board, and generally removal was effected
in a few hours, and the place was speedily disinfected, and fit for the re-occupation
of the other members of the family.
After all, however, I know of nothing which has caused me more trouble,
nor over which I have spent more time in thought, than the one burning
question of 'over-crowding.'
The greatest diversity of opinion appears to have been expressed as to its
cure. I take it for granted that in East End Districts at least, the disease
exists. I know it. During the year 1900, I myself visited somewhere about
4,000 houses in the District, and from information so gained I can assert that
you may accept the statement as true.
You cannot prevent over-crowding by turning out of a room an unfortunate
family because too many children have been bom into it, for, if dislodged, such
a family will occupy a room, at a similar rent as close to' the original spot as
"Make them go into a suburb," says another. You will never succeed
in this project on any usefully large scale, until you, at the same time, succeed
in removing the workshops and the markets which now compel them to live
in the over-crowded districts.
I feel persuaded that nothing can have any chance of success until it
becomes possible to undersell the 'house sweaters' by erecting good, healthy
dwellings for the people at rents which should not exceed certainly 3s. per
room per week. Who is to carry into effect this suggestion? Not, I take it,
the new Borough Councils, with their augmented legal powers. They could
not expect to erect buildings at the letting price per room which I have