The Sun.
London, England, 1853-12-06 00:00:00

THE CHOLERA.-MR. SIMON'S REPORT.

At a meeting of the Commissioners of Sewers, held
last week, Mr. Simon, the Medical Officer of Health,
banded in his annual report, which was as follows :
"Upper Grosvenor-street, Nov. 29.
"Gentlemen,—According to the practice of previous
years, I lay before you, in the annexed tables, a brief
digest of your death register for the 52 weeks which termi-
nated at Michaelmas last.
"The deaths there enumerated amount to 3,040, being
24 fewer than in the last preceding similar period.
" Beyond the statistics of the past year, there are other
facts which I have thought well to tabulate for your infor-
mation. They relate to the entire term of five years during
which I have kept record of your mortality. Midway in
this quinquennial period, nearly, in the spring of 1851, the
general census happened to occur. The inhabitants of the
city, then enumerated, may fairly be taken to represent
the mean of your somewhat fluctuating population ; and
the five years' mortality, compared with the numbers of
this mean population, will express, pretty accurately their
habitual death-rate.
" The period mentioned is indeed short for the purpose
of establishing an average : but 10 years at least must elapse
before even similar materials can again be given for calcu-
lation, and a still longer time before the statistical basis
can be enlarged. I have therefore thought it desirable
to make the best use in my power of such facts as were
before ine for the construction of quinquennial tables ; out
of which, with sufficient accuracy for all practical pur-
poses, you may draw your own inferences as to the health
of that large population which is under your sanitary
government.
"The facts are classified, as heretofore, in the manner
which will most easily display their practical meaning,
First, namely, the deaths of the period are recorded in
their local distribution ; so that you may compare one part
of the city, with another in respect of healthiness. Next,
they are so tabulated according to ages, as to indicate the
prevailing proportion of untimely death. Thirdly, those
of them are separately enumerated which, in their several
classes, chiefly occur as results of acute disease in connec-
tion with removable causes.
" In after years, when sanitary improvements, now only
in contemplation or commencement, shall have produced
their legitimate results and rewards, these tables may
servo an important use. Indicating the, standard of public
health within the city before such works were achieved, and
constituting a permauentrecord of your starting point, they
will qualify your successors to. estimate the amount of
amelioration which your endeavours shall have produced.
" The details of mmg present sanitary condition, as vary-
ing in differom sit&llatricts of the city, and as fluctuating
in the several years and seasons of the equinquennial
period, are expressed in the figures of these tables, more
compendiously and more clearly than I could hope to con-
vey them in words. Here, therefore, I restrict myself to
telling you very briefly their theirag.oenuetrall3roemosult:.
"The population of the city, persons,
has been dying during these 5 years at the rate of about 24
per 1,000 per annum. The sub-district rates which give
this aggregate vary from under 18 to above 29 ; the former
death-rate belonging to your healthiest locality, the north-
west sub-district of the City of London Union ; while the ,
latter, more -than-60 per cent, higher, mortality belongs to
-
the north sub-district of the West London Union. The
lowest death-rate hitherto attained in the country for a
considerable population, during a term of seven years, has
been 14 per 1,000 per annum ; which your worst sub-dis-
trict mortality more than doubles.
"As different districts contribute unequally
toyour
average death-rate, so, also, do different ages. Among all
the population exceeding five years of age the death-rate is
under 17 per 1,000 per annum ; while for children under
five years of age the rate is nearly 85. And these rates are
unequally constituted by your three chief districts in the
following proportion— viz.,

Annual rate of Deaths to 1,000 Over Under
Five Years Five Years
livin•g Persons. of Age. of Age.
East London Union , 16.68' 91.9.;
West London Union 20.58 94'81
City of London Union 15.06 71'72
Averaze death-rate in the City 16.85 54.72

Average death-rate in the City

" How various are the diseases which have conspired to
produce your annual average of 3,120 deaths it would be
tedious to describe ; and in table which I have devoted
to a partial analysis of this subject I have restricted myself
to a consideration of those ailments which are likely to be-
come less fatal under a well-developed sanitary system. To
the annual average, typhus has contributed 140 deaths;
choleraic affections (including the epidemic of 1849), 196 ;
scarlet fever, 76 ; small pox, 40 ; erysipelas, 30 ; the acute
nervous and mucous diseases of children, 572 ; their mea-
sles, hooping-cough, and croup, 182 ; making, from this
class of disorders, an annual average of about 1,240 deaths,
nearly two-fifths of the entire mortality.
"My tables will show you that the different seasons of
the year have pressed somewhat differently on human life,
and there is exhibited in them a point of some interest to
which I would beg your attention. In your healthier sub-
districts it is easy to perceive the influence—the almost
inevitable influence—exerted by the inclemency of winter
against the aged and feeble. In your unhealthier sub-dis-
tricts this effect is completely masked, and summer becomes
the fatal.season ; its higher temperature acting in some sort
as a test of defective sanitary conditions, and giving to the
several local causes of endemic disease an augmentation of
activity and virulence.
" On the facts which these tables set forth, I have nothing
further to say than would consist in a repetition of argu-
ments already submitted to your notice. In my third annual
report, especially, I endeavoured to lay before you the con-
clusions, which are fairly deducible from the proportion of
early deaths, and from the partial allotment of particular
diseases.
" These conditions are, indeed, in obvious mutual rela-
tion. To human life there has been affixed a normal range
of duration; and when it prematurely fails—when children
perisb in the cradle, or adults amid the glow of manhood,
the exception iu every case is a thing to be investigated
and explained. Of the 15,597 persons who have died
within your jurisdiction, not an eighth part had reached
the traditional three score years and ten,' while nearly
three-, ighths died in the first five years of life. In propor-
tion as facts like these appear in the death-table of a parti-
cular district, in the same proportion we can trace the local
prevalence of particular diseases, to explain the abridgment
of life ; and passing from such a locality to other districts,
where the natural term of existence is more nearly attained,
invariably we find that these diseases have fallen into com-
parative inertness. Finally, in grouping the fatal results
of such diseases in their proportionate geographical allot-
ment, invariably we find that their prevalence or non-pre-
valence, here or there, has been associated with demon-
strable physical differences; that life has not capriciously
'been long in one place and short in another; but that,
where short, it has been shortened; that its untimely ex-
tinction has depended on the direct operation of local and
preventible causes.
" In this recognition of cause and effect, which the expe-
rience of late years has rendered vivid and precise ; and in
that higher appreciation of human life which belongs to
civilised notions in peaceful times ; and in that deeper
sympathy for the suffering poor wlich should be at the
heart of every Christian Government, sanitary legislation
had its origin in this country ; and it has been the good
fortune of the city of Loudon, in respect of your two acts
of Parliament, to precede the rest of the metropolis in ac-
quiring and exercising authority for the mitigation of pre-
ventible disease.
" Nearly five years have now passed over your tenure of '
this very grave responsibility; and although in many re-
spects the period must be regarded as one of apprenticeship
to a new and difficult career—although you have hardly
yet arrived at -what may permanently represent your
method of action—although important changes which you
have determined to adopt are not yet in actual working
although the far greatest evils still repain for correction—
yet I rejoice to inform you that sensible improvement has
already shown itself in the sanitary state of your popula-
tion. My comparison of the past Ave years with any con-
siderable previous period cannot be as precise as Ii would
wish, wish, owing to the absence of circumstantial
the time anterior to my appointment; but, •uirecrieogVnfr
such information as I can consult on the subject, I ain'm
in-
duced to believe that the deaths for equal aumbers of po-
pulation are about 4 per cent. fewer than before your acts
of Parliament came into operation, and that the dispro-
portionate mortality of children is decidedly lessened."
On this first improvement—the beginning, I would
fain hope, of a long series of similar steps for regaining the
allotted duration of human life—l beg to offer my respectful
congratulations to your hon. Court, under whose auspices
it has been effected. Further impetus in the same direc-
tion will shortly be given by the removal of sanitary evils,
already in fact or in principle condemned. The approach.
ing institution of your extramural cemetery, and, I yen-
- ture to hope, the translation of all slaughtering establish-
ments to the site of your new Smithfield, will be import-
ant contributions to this effect. I therefore make bold to
speak with some sanguineness of the slight change of
death-rate already noticed, though, while so much remains
to be accomplished, I doubt not you will welcome the
amelioration rather as an encouragement to proceed than
as the final reward of a completed task.
" Here, gentlemen, terminates all that I have to submit
for your consideration in respect of your past and present
record of deaths. The greater extension which during the
last two years I have given to my habitual weekly reports,
and to sundry occasional statements which it has been my
duty to lay before you, may seem, at least generally, to
render it superfluous for my annual report to contain any-
thing beyond Such statistical particulars as I have now
brought under your notice. But, however, this may gene-
rally be, there exist exceptional circumstances at the pre-
sent time which induce me to trouble you at somewhat
greater length.
" ll.—Two years ago, adverting to the non-completion
of metropolitan sanitary works, on which the health of
entire London is vitally dependent, I could not but com-
ment* on the utter unpreparedness with which the metro-
polis was awaiting any sudden return of Asiatic cholera.
It was, indeed, impossible to foresee how soon or how
late that dreadful visitation might recur to desolate
- . our homes—whether it might return once or never, But
tYPhus, averaging in 15 years double the fatality of that
rarer epidemic, was adding day by day to its list of pre-
- venitible death; and other endenaic diseases were co-ope-
rating 'with it
demonstrably, uninterruptedly, to decimate,
iland abase the people.
the foreign whateverpestilence
doubts might have existed as to a return of
conclusions had been
were soon solved. 'Whatever hasty
sent during half aee,n formed as to its again remaining ab-
.,43lneeration were soon disappointed and
reversed. Even
was addressing you on the subject
the plague had while
cleat the smouldering fire and was vvidening its circle of
t.ion. Perhaps from the Eastern
centres of its habitual denim
Atm—from the alluvial swamps
" and malarious jungles of
where it was first engen-
&red. amid miles of vapouronf:
and still broodsover
ill'uoxzim'ao.netr:arble deaths, or, per.
wasted nations as an agent of i
- ha s, from the congenial flats or
atienetEl:utloePef:tlythlf:fri"'erit-
may have lingered latent a,nd acclimatised,
kindred. soils.
spreading- its now infection to all
acclivities of the
went was
the dry and airy
the
B,epelled again from
earth and their hardier population, it filtered aloof
blending line of land and water- the shore, the river bank
Conducted by the Oder and Vist 1 '
and the marsh. u a from
of Poland to the ports of the Baltic, it ra
the swamps
to Copenhagen, gee.
' east and west, from St. Petersburg
frightful severity, and, obedient to old precedents, has let
us witness its arrival in Hamburg.
" Twice in the European history of cholera had this town
seemed the immediate channel of epidemic communication
to our island, the disease having on each occasion coal_
menced in our north-eastern seaports, within a very short
tithe of its outburst there. A third time, not unexpect-
- edlv,has this dreadful guest, following the line of former
iiisitatinnktouched upon the banks of the Tyne, where a
worse thankteastly condition of the crowded poor, and
sewage'waferAliluted through the people's drink, had pre-
,
pared it'an ifivropriate welcome.
",Noxt
the, disease was rumoured to be in London.
• 'llepe and bey are too near akin for this not to have been

Third Annaal Report, p. 40.
iyazzAlasit
•