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Metropolis. The General Board of Health sent their medical inspector on 13th September to insist
that the City act in place of the recalcitrant Guardians. Part of the meeting took place in the
Mansion House where the Lord Mayor lay in bed struck down himself with sickness. Immediate
compliance with the inspectors requests was given. The Times came out strongly in support of
the M.O.H. and blamed the City Authorities for having ignored Mr. Simons impressive and strenuous
warning by imposing all sorts of obstacles and delays to the M.Os. efforts, and even if we
are not greatly mistaken suppressed portions of them while in the end they had to adopt his
recommendations. The 10 temporary Medical Assistants were re-appointed and worked in conjunction
with the Poor Law M.Os. 5,000 families were visited and freely treated if found to be
suffering with premonitory diarrhoes. The City Burial grounds overcrowded at the best of times
were as a consequence of the cholera epidemic receiving more corpses than ever before. Simon
issued orders and attempted to prosecute for the misuse of these burying grounds and was again
supported by the Times. Its leader referred to them as "consecrated cesspools". Ironically
as Simon's visitations got under way the cholera epidemic began to diminish. Cholera deaths in
the City fell from 60 in the 3rd week in September to 1 9 a fortnight later. Between 9th June and
17th October 854 had died in the City whereas in London as a whole 14,601 had so perished and
in England and Wales 72,180.
Simon in his first annual report demanded a better water supply for the City. This was to be
achieved by providing an intercepting sewage system to prevent the Thames from constant pollution
and he envisaged an agricultural use of the sewage. Simon sometimes himself venturing
down the sewers, secured the laying of outfall culverts in the Thames and the filling up of some
of the small docks. (By 1854 the square mile was the only part of London with a complete workable
sewerage system in no small part due to the efforts of the M.O.H.) He was an advocate
of an unrestricted supply of water. That is a constant supply in place of the existing intermittent
and uncertain delivery of water and in addition i.e. universal, a cistern in every home and on
each floor of tenements, as well as every court its stand cock for cleansing and every privy an
abundant supply for flushing. It was not so easy to secure an adequate water supply; however in
the same year 1854 the common stand cock system was abolished and every house in the City
had a daily supply of water of some kind. As well under the Water Act of 1852 The New River
Company covered its reservoirs and filtered its water so securing a purer and safer supply, but
the quantity was still inadequate and intermittent. But as regards the Thames the Act was much
less satisfactory. The Companies were to cease to draw water from the Thames below Teddington
after 1855 and these conditions were so qualified as to be exempt from liability, so that the
deaths of many Londoners in the cholera epidemics of 1854 and 1866 were not prevented. As far
as the 1854 epidemic was concerned, Simon commented "less suffering in the City of 1854 than
in the City of 1849, less in the City clean than in the City dirty, less in the City cared than in
Metropolis neglected". 211 people died from the disease in the square mile as against 728 in
1849. Though the epidemic reached major proportions south of the Thames though milder than in
1849 the number of deaths being about one quarter less. But in the City reduction in mortality
was about three quarters less than in 1849 though with its high density population and numerous
sewage outlets it was at much greater risk than other parts of London.
Simon told the Court of Common Council "But against those threatened injuries, at least one
good was to be counted. Unlike the rest of the Metropolis the City had a sanitary government.
For some years you had been giving care to the physical conditions of public health. You had
paved and sewered the City, even through its courts and alleys. You had established daily scavenging.
You had almost abolished cesspools. You had put water within the reach of all. You had
done something (little was in your power) against overcrowding. You had set on foot the periodical
inspection of houses with a view to better cleanliness". Yet his scientific caution is seen
in what follows, "I can give you no logical certainty that you have saved even a single life.
We must wait for scientific insight, the fruit of larger observation to adjudicate on such cases
as our own. Ample pains as you have taken to deserve that cholera should space your population,
there can be given no present demonstration that this happy result has been the unconditional
effect of your sanitary labours", so he refused to deduce from the apparent correlations
between their sanitary reforms and successful avoidance from cholera. Yet Simon held and shewed
from the mortality of the City that sanitary endeavours reduced such diseases. "Links of cause
and effect may, in the particular instance, be beyond our means of demonstration" he said "but
we know as universal truth that similar reults are the promise of similar exertions and, confident
in this practical knowledge, we may waive the impossible proof to accept the suggestive lesson.
I believe that through your timely exertions many human lives have been saved and much human
suffering averted".
In retrospect we can applaud Simon's tentative claims and his caution in not making dogmatic
scientific judgments but have to reject his atmospheric notions. As so frequently since, he did
then what was right for the wrong reasons. The cholera epidemic south of the River was severe
and widespread because waterborne, but North of the Thames the New River Water supply was now
filtered so that the cholera never became so extensively waterborne but rather transmitted by
direct contact or flies — so that the removal of filth and refuse to prevent organic decomposition
helped to remove the means of transmitting the disease.