The Victorian City: Everyday Life in Dickens' London (33 page)

For the bathhouses were above all a health measure. In 1830, when Dickens turned eighteen, the average life expectancy of an upper-middle-class professional man was forty-four; for a tradesman or a clerk (the class in which Dickens was born), it was twenty-five; and for a labourer, twenty-two. Of course, by the time a clerk like Dickens was eighteen, he no longer expected to die at twenty-five. Life expectancy was so starkly foreshortened because of infant and child mortality rates: 150 out of every 1,000 children died before the age of five. Once people reached sixteen, in the 1840s their life expectancy went up to fifty-eight years (which was the age at which Dickens died); and when they reached twenty-five, their life expectancy
rose to sixty-one. The mortality returns in 1869 gave a fairly standard range of deaths in one winter week: 40 per cent of them were among children under five, of everything from childhood illnesses – measles, whooping cough and so on – to typhus and fevers, to specific infant ailments such as diarrhoea, or the mother’s lack of breast milk and premature birth. Of the adults, the deaths were listed as being from infectious diseases, as well as many lung problems, cancer, kidney disease, diabetes and childbirth. Just 5 per cent died of old age.

Many of these illnesses were exacerbated by overcrowding. In 1858, in the industrial cities, men of all ages died at a rate of 12.4 per 1,000; in the general population it was 9.2 per 1,000; in the countryside, only 7.7 per 1,000. For the soldiers of the Foot Guards living in barracks a decade later, the rate was 20.4 per 1,000. The
Illustrated London News
pooh-poohed the notion that the increasing numbers of deaths in army living quarters were ‘supposed’ to be caused by overcrowding and poor ventilation. As the men had no ‘healthy stimulus to exertion; their minds prey on their bodies’, and this was why, it reasoned triumphantly, the Dragoons and the Cavalry had lower death rates than the Foot Guards: in looking after horses they have ‘cheerful occupation’ and ‘escape...some of the killing ennui’.

It was not yet understood how fevers and infections were transmitted, and it took decades of work by campaigners to convince the government that social care was an important aspect of public health. When the first cholera epidemic arrived in Britain in 1831, the government’s response was neither scientific nor medical, but the declaration of a Day of Fasting and Humiliation, to pray for a remission of the fever. It was not until the Vaccination Act of 1840, enforcing the vaccination of infants, that the government accepted it had a role in maintaining the health of its citizens. As Sir John Simon, from 1848 the original Medical Officer to the City of London, later remembered, before that Act, ‘the statute book contained no general laws of sanitary intention.
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The central government had nothing to say in regard to the public health and local authorities had but the most indefinite relation to it.’

Edwin Chadwick, a non-practising barrister and formerly secretary to the Utilitarian philosopher Jeremy Bentham, was in 1834 made Secretary to the Poor Law Commissioners.
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From this position he argued for sanitary reform, stressing that it would pay for itself, since epidemics increased the amount of poor relief that needed to be paid from the rates. In 1842, his hugely influential
Report into the Sanitary Conditions of the Labouring Population of Great Britain
linked insanitary conditions to disease, showing how much it cost the country. He wrote, ‘The sewerage of the Metropolis...will be found to be a vast monument of defective administration, of lavish expenditure and extremely defective execution.’ It was not long before the General Board of Health was established.

In 1846, the Diseases Prevention Act authorized sanitary improvements under the General Board of Health’s auspices. In 1848, the Metropolitan Commission of Sewers Act and the City, with its own parallel Act, gave parishes responsibility for sanitation, drainage and water supplies; this permitted them to appoint health officials and inspectors, as well as to condemn and close houses and entire civic spaces, such as cemeteries (see below). Very soon Chadwick was universally loathed: the poor hated him because their houses were condemned and they were evicted; the Poor Law Guardians and civic authorities detested him for the increased burden on rates; and everyone agreed that he was quarrelsome, vindictive, arrogant and entirely lacking in collegial abilities. Chadwick was sacked and in 1858 the General Board of Health was dissolved, to be replaced by a governmental Board of Health. However, his legacy remained: the involvement of local and state government in the health of the nation.

Everyone knew what the problems were. They could hardly help but know. Even the new Houses of Parliament, the pride of modern London, were in 1848 found to have defective sewers. The main sewer had been run under the length of the building, so digging it up again was a major undertaking. Then, when it was opened, the released air was so foul that
it extinguished all the lamps. Finally, it was discovered that the pipes had not been laid on an incline, so the sewage had failed to drain away: the new Parliament was sitting over a single enormous cesspool. This was, in microcosm, the predicament faced by the whole city. And solutions were excessively complicated. In 1848, the rector of Christchurch, Regent’s Park, had asked the Board of Health what could be done about sewage issues in his parish. The answer was that there were sixteen paving Boards in St Pancras parish alone, operating under twenty-nine Acts of Parliament, and all would have to be consulted before ‘an opinion could be pronounced’ on what the possibilities were – a decision on what was to be done would take much longer. Although the government knew action needed to be taken, the vested interests in both Westminster and the City vigorously protected their own powers. This was the golden age of localism, and by 1855 London was governed by 300 separate legislative bodies, operating under 250 Acts.

What finally changed attitudes were the successive waves of epidemics: two influenza epidemics between 1831 and 1833; the first cholera epidemic in 1831, which killed 52,000 across the country; scarlet fever in 1834, which killed another 50,000; then more influenza. In 1837, the footman William Tayler reported, ‘There were to of [sic] been fifty persons buried at St John’s Wood bureying ground in one day this week,’ and the following month, ‘every day the streets are regularly crowded with funerals and mourning coaches, herses and such like...The undertakers in London are [usually] very particular in having all black horses to attend funerals but now there are so many wanted they are glad to get any colour.’ This epidemic was in turn followed by waves of smallpox, typhus and typhoid, before 1846 saw the return of cholera, together with more typhus and typhoid.
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Medical orthodoxy held that many diseases were caused by fermenting particles of decomposed matter that were spread through the air in a
miasma, or poisonous vapour, identifiable by its foul smell. This miasma theory, as it was known, triggered the Building Act of 1844, obligating houses to be connected to the city sewers: by flushing the decaying matter away from the houses and into the river, it was thought that disease would also be flushed away. Many City aldermen were landlords of extremely profitable slum buildings, however, and they saw no need for expensive sewerage in these properties. The City, protested one official response, already had ‘complete house-drainage, with sewerage and all necessary provisions’. But the Health of Towns Association, on whose board sat the indefatigable John Simon, the City’s Medical Officer, countered that, on the contrary, the City sewers and drains were ‘in fact and effect, nothing but elongated cesspools’. He added for good measure that an extra 58,961 children under five had died in the City, owing to its crowded, insanitary state, compared to the population of Lewisham. As a final riposte, he reminded them that in his testimony to the Health of Towns Association, the City Surveyor to the Commissioners had confessed: ‘I am a very incompetent witness on this subject, for I cannot smell.’

While this was being fought out, the epidemics continued their deadly work. In Spitalfields Workhouse, which held 1,500 inmates, even before cholera arrived in 1831, ‘eight and ten persons were often placed, head to feet, in one bed’. One man with a fever was put in a bed from which another man, who had died of fever, had just been removed, without the bedding being changed. When a formal complaint was made to the police, the police inspector sent the Master a note telling him to deny everything. (Unfortunately for the Master, he mistakenly sent the policeman’s note to the complainant, who then handed it over to the crusading editor of the medical journal
The Lancet
.) The practice of bed-sharing was little different from what went on in the homes of most labouring families, who through the century lived and died together. In one case of many, which took place in the Minories, in the City, in 1847, the body of a man who had died in a fever hospital was returned to his family for burial. For lack of any other place, it remained in the single room in which they all slept and ate for eight days, until the funeral could be arranged. The dead man’s mother, wife and child all died soon after, as did the doctor who treated the poor in the area.
Deaths of this kind confirmed the notion of a miasma of infection: slums smelt and more people died there; the better areas did not smell and fewer people died there.

These were cases of general fevers, but in 1831 a new terror had appeared: cholera. The medical community had been warning of its coming for more than a decade, after an outbreak of ‘Asiatic cholera’ in Lower Bengal in 1817. But it was another six years before it reached Europe, when 144 deaths were recorded in Astrakhan. In 1829, in Russia, 1,000 died before the disease again resurfaced in Astrakhan, and this time 25,000 may have died. By 1831, the disease had spread to the Baltic ports, and then it was only months before it reached Britain via the shipping routes: in October, the first British death from cholera was recorded in Sunderland. A medical officer who had worked in India recognized the symptoms and warned the authorities, but the local doctors refused to accept the fact, recording the death as ‘English cholera’.
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Another 201 deaths did little to change their minds or to prepare the rest of the country. The Westminster Medical Society continued to ‘vehemently contest’ the diagnoses, even as by 1832 the first cases reached London, spreading along the river, from St Anne, Limehouse, to Rotherhithe, Whitechapel, with its dock workers and sailors, then away from the Thames’ path, to Clerkenwell and the City, to Marylebone, St Pancras, St Giles and Bermondsey. In four months there were over 9,000 cases, of which 4,266 ended in death. By December 11,020 cases in London had been diagnosed in the previous six months and 5,275 died.
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The poor, as always, suffered most. In the epidemics of 1832, of 1848–9 and 1853–4, the districts south of the river, consistently poorer than those to the north, were worst affected.

How people viewed the outbreaks was in great measure dictated by the political climate during the first epidemic, which occurred against the background of political agitation for the Reform Bill. The large number of arrests of working men following the Chartist uprisings and protests for
reform meant that gaols were more than usually overcrowded: in that first cholera year, 12,543 men were committed to Coldbath Field prison, which had a capacity of 1,200. When cholera hit, prison conditions were almost designed to spread the disease, and 15 per cent of the inmates were affected. (The impact was such that prisoners who volunteered to work in the infirmary had their sentences remitted and were even given cash payouts.) Then cholera broke out on board the hulks, the prison ships moored in the Thames. Even by prison standards, conditions in the hulks were repellent. As late as the second epidemic a decade later, the
Warrior
, theoretically a hospital ship, had no regular supply of clean linen; the majority of prisoners were verminous and on average were given a change of clothes only every five weeks; no one could say when the bedding had last been washed; there were no towels or combs, and not enough sheets; the privies were ‘imperfect and neglected’, and the smell ‘almost insupportable’. Of the 638 convicts on board, 400 were stricken with cholera. Little more care was accorded the convicts after death. Their chaplain refused to conduct a funeral service until the dead numbered at least half a dozen, and even then he declined to accompany the bodies on their last journey, reading the burial service to himself on board and signalling to the burial party onshore when he reached ‘dust to dust’ by dropping his handkerchief.

The 1854–5 outbreak was the one in which John Snow, a Soho doctor, famously disabled the Broad Street pump and in so doing stopped the spread of cholera in that district. (Broad Street has become Broadwick Street, and a pub, the John Snow, marks the location of the pump.) This was not a sudden insight. During the previous epidemic, in 1849, Snow had already indicated the disease might be water-borne. Contradicting Chadwick and other proponents of the miasma theory, he suggested that the new lavatories flushing sewage into the river were facilitating the transmission of the disease. Few were persuaded, even as late as 1855, when in Soho ‘The gutters were flowing with a thick liquid, partly water and partly chloride of lime...“front parlours” were taken by dozens in every old and stuffy street for the preparations of coffins that could not be supplied fast enough, and the peculiar sharp tap of the undertaker’s hammer could be heard above the muffled sound of voices.’

The number of burials from the epidemics was bringing to crisis point a problem that had been growing throughout the century: what to do with the dead. In 1860, Dickens wrote, ‘It was a solemn consideration what enormous hosts of dead belong to one old great city, and how, if they were raised...there would not be the space of a pin’s point in all the streets and ways...the vast armies of dead would overflow the hills and valleys beyond the city, and would stretch away all round it.’ His summation came three decades after he and the rest of the city were forcibly made aware of how the dead were encroaching on the space of the living. As early as the late 1830s, Dickens was already voicing his concern. In
Oliver Twist
he described a pauper burial in a graveyard so full that each grave contained multiple coffins, and ‘the uppermost coffin was within a few feet of the surface’. This was based on a graveyard he had seen near Chatham, but the overcrowding of the dead in London preoccupied him as much as the overcrowding of the living, and he returned to the subject within the year. In
Nicholas Nickleby
, Ralph Nickleby walks past a City burial ground, ‘a dismal place, raised a few feet above the level of the street’, where the dead ‘lay, parted from the living by a little earth and a board or two...no deeper down than the feet of the throng that passed there every day, and piled high as their throats’. This was a reality for Londoners. In Drury Lane and Russell Court, churchyards belonging to St Martin-in-the-Fields and St Mary-le-Strand had originally been sunken patches of ground: by the date of
Nicholas Nickleby
(1838–9) they reached their neighbours’ first-floor windows.