... You mentioned that, in visiting this class of the population, you find the want in personal cleanliness one collateral cause of disease? - Decidedly so.
Has the action of want of cleanliness as a cause been shown by the effects of cleanliness in abating it or removing it? - Yes; in the case of porrigo or scald head and ring-worm in the children, and some inflammations of the eyes - very common disorders amongst them - which I have removed mainly by the strict enforcement of cleanliness and general ablutions. I believe that a variety of diseases, such as affections of the chest, rheumatism - which are not generally considered to have any connexion with personal cleanlienss - are greatly aggravated by the neglect of it.
How far, in such places, does this want of personal cleanliness appear to be influenced or governed by the nature of the supply of water, its quality, whether it be accessible or has to be fetched from inconvenient distances or otherwise? - It was only this morning that a patient stated that she could not drink the water that was supplied to the house, it being "full of insects". Patients have said that they only drink water when they cannot get beer, &c., the water is so bad. I find that generally the water is in an impure state, sometimes having an offensive odour; at times it is, as they describe it, "thick" or muddy, and very disagreeable to the taste. They have complained to me that they are often compelled to go to a distances to fetch water, because the water supplied to the house is so bad. Sometimes they have said that they put up with the bad water, because it is just as bad in the neighbourhood.
Have you observed how far the impurity of the water may have arisen from neglect to cleanse the water-butts? - I have observed that water-butts do not look very proper receptacles, being made of wood, from which the paint has decayed, and the wood itself having decayed, no cover on the top, and a film of blacks and dust on the surface of the water. The water is generally laid on in the yard or the lowest part of the premises, and a supply is generally given three times a week, and, at each time the water comes on, the film of dust and blacks that has been deposited on the surface is mixed up with the previous accumulations. Even in a more open and less sooty and dirty neighbourhood, as on the surface of the Water Company's reservoir, in the Green-park, the deposit of soot, or dust or dirt, may be at times observed, as a dark scum or carpet spread over it. One patient complained very much of the quality of the water taken from an old wooden butt. In respect to it, I learned that this same water is used for making bread by a baker who supplies a great number of the poor. Since attention was directed to the subject by the sanitary report, I have availed myself of opportunities of making observations upon it and the result is, the strong conviction that the quality of the supplies of water, and the mode in which it is received and kept in such atmospheres, influences the dirt and health of the population to a much more serious extent than has hitherto been imagined.
As to the state of the household economy, have you observed an effects apparent from water not being conveniently accesssible or laid on in the rooms which form separate tenements? - I have observed the same water, which is very filthy from having been used in washing some clothes, used again to wash others. They have told me, indeed, that they have done this to avoid the inconvenience of fetching water from a distance and from the inability to carry the water up stairs when the rooms inhabited have been on the upper floor. My informants on this topic, it should be remembered, are patients, sickly people, weakened by sickness, and who cannot afford to pay for attendance. To the mothers who are debilitated, the carrying water up stairs is a very great exertion; mothers not daring to leave a child in the room have to carry the child in one arm and the vessel of water with the other. I have had even sick children neglected and left dirty, and the excuse given has been the inability to fetch the water. Recently I have had a case of this kind. I have attended three children, two of them with scrofulous inflammation of the eyes, the othero f them with a scrofulous affection of the throat; all of them rarely washed, and in an extremely filthy condition. The mother is a poor woman, who has been in a respectable condition, but she is now so far advanced in pregnancy as to be incapacitated from going up and down stairs to fetch water. She continually deplores her condition of having neither the strength to fetch a sufficient supply of water nor the means of paying for it being brought to her.
Again, as to drainage and venitlation:
Supposing a complete ventilation effected in the upper portion of any of such houses as those you visit, but cesspools still allowed to remain on the ground floor and give off their exhalations, though those exhalations might be diluted and rendered less noxious; from the observations you have made on the tenements not ventilated, have you any reason to doubt that the cesspools would still, to some extent, impair the general health of the inhabitants? - I have no doubt of it; indeed, that is one of the sources which it is absolutely necessary to remove before there can be any effectual cure. Some of the cesspools are in the cellars, and give out their exhalations from thence; others are in a yard, close to the door, which door is always open on account of the want of windows in the passage. I continually visit houses in which the smell from the cesspools throughout the whole of the house is so noxious as to be unbearable, and I have found the poor lodgers closely shut up in their rooms, no air being allowed to enter by the door or windows, with the hope of exlcuding the offensive effluvia. When I have proposed to ventilate some of the rooms by means of the window ventilator, the occupants have made the well-founded objection, "We are afraid of any opening in the window on acount of the bad smells which come up from the yard." I preceived at once that fixing a ventilator in the window would only have been the means of introducing the noxious air. When I have proposed to fix a ventilation in the door of the room, a similar objection has sometimes been made: "The bad smells from the privy and the drain will only get into the room by that way." "The smells from the pssage are often worse than those in our rooms." ... In places which are not overcrowded, and which do not need ventilation so urgently, I have had cases of debility, which were attributed and correctly attributable to the bad odours arising from the cesspools. The patients continually complain of the smells. It is a common expression amongst them, "We owe some rent, but as soon as we can pay it we shall get away from this place on acccount of the bad smells from the cesspool." The strong bear these stenches, but they take beer, which they consider necessary to counteract their effects.
Were there generally sewers in the fronts of near to the houses which you have visited? - In some streets and courts there are no sewers; in others, in which there are sewers, there are scarcely any drains from the houses into the sewers, and the gullyholes are so far apart that the slops thrown out from the street-door mix with the dirt of the street, and very little of the fluid appears to arrive at the sewer. There are great complaints that the gullyholes emit very offensive smells.
Daily News, April 22, 1847