MR. CHADWICK'S SANITARY REPORT.

TO THE EDITOR OF THE SPECTATOR.

Loudon. 7th October 1892.

Sin—My attention was only called to an article on the Local Sanitary Re- ports, in the Spectator of the 24th ultimo, several days after it appeared, or it would have received, as it appears to me to require, an immediate answer to the charges it contains of garbling the evidence obtained in the course of the in- quiry into the Sanitary Condition of the Labouring Population. By these unprejudiced persons who may read the volumes of the Local Sanitary Re- ports, or who may themselves be acquainted with the particular field of inquiry, or who may have gone over any other which I have been called upon to in- vestigate, any answer to a charge of suppressing material evidence, or of avoiding prominent objections, would I hope be deemed unnecessary. But to many persons who may neither have time or means to judge for themselves, the character of the Spectator for careful examinations, and digests of public information, may give weight to the accusations, which I must charge to be untrue and libellous and publicly as well as privately injurious. I therefore request that you will equal prominence to the answer which I am induced to make.

You, or the writer of the article whoever he may be, states—" If a party. writer, professing to found his conclusions upon the facts and opinions in docu- ments before him, should suppress all that militated against his own views, he would be considered to exceed the licence of party-writing, and subject himself to strong censure. If an author, professing to announce his own opinions, were to behave in a similar manner, he would be obnoxious to still severer re- mark. The case before us is worse than either of them; for we find a person clothed with an official character, collecting information in virtue of that cha- racter, drawing up a Report which receives the sanction of his own and his superiors' public position, and is intended to lay the foundation of a legislative measure, suppressing opinions opposed to his peculiar views."

Now I must assert, that your readers are misled when the opinion referred

to—i. e. that destitution is, and has been, the main cause of the prevalent amount of fever among the labouring classes—is represented as my peculiar view. The writer had before him references to the reports of the physicians employed in the investigation, of the causes of the fever prevalent in the Metropolis. Dr. Aesiorr, Dr. KAY, and Dr. Sournwoon SMITH, the Phy- sician to the London Fever Hospital, agreed in assigning filth, bad drainage, de- fective ventilation, and other physical and removeable agencies, as the main causes of fever. The writer had also references to the conclusions of Dr. Da- NIDSON, the Senior Physician of the Glasgow Royal Infirmary, and the grounds for a similar opinion set forth in a treatise on the sources and propagation of con- tinued fevers, for which treatise the prize instituted by Dr. THACKARY, of Chester, was unanimously awarded by a meeting of the Provincial Medical and Surgical Association. The opposite opinion was once, probably, the opinion of the majority of medical practitioners; but it is now, judging from returns received from nearly sixteen hundred medical practitioners in different parts of Great Britain, the opinion of only a small minority. Even from Scotland, where the opinion has been of late the most prominently advanced, poverty is only assigned by the minority as one concurrent cause; and I do not remember any return which goes to the same extent as Dr. ALLISON in ascribing it as the predominant cause, to the almost entire exclusion of those physical causes which were the chief and legitimate objects of investigation.

I must further deny the truth of the charge of "suppressing opinions "opposed to my own views. The opinion that fever is in general caused by destitution among the labouring classes, is implied in the statement of the nature of the evidence which appeared to me to establish the opposite conclusion. I must call upon you to act on your rule, and give equal prominence to the terms in which I have endeavoured to state the evidence in the passages themselves which I append hereto. You state that "The object of Mr. Chadwick's Report, adopted by the

Poor-law Commissioners, is to procure an act of Parliament, empowering local authorities to remove dirt, drain streets, cleanse streets and houses, arch over ditches, and in short, cleanse. One main basis of the alleged necessity for this act is the assertion that dirt and deficient ventilation cause fever. This opinion may be correct, or may be erroneous; it may be—we think it is very proper that legislative measures should be adopted to remove nuisances and enforce public cleanliness : but, as a public officer, charged with preparing a report from public documents, for a particular purpose, we think Mr. Chad- wick bound, as a matter of official honesty, to have given as much prominence to the following opinions, which contradicted, as lie did to those which favoured In own views, especially as he could travel out of the record to quote from French reports and Army orders. The passages quoted are in one sense of an unnecessary length, as they all express a somewhat similar opinion ; but it is necessary to show that the view was not that of a single individual."

You then quote some portions of the report of Dr. Srm, of Ayr, and of

three other reports, which you consider I ought to have inserted in the body of my own report. My answer is, that the passage quoted from Dr. SIM'S report stands in its own place, in its connexion with other passages in his own report on the sanitary condition of the town of Ayr, with the other Local Reports. That report, and the statement included in it, is printed uniformly With the General Report, as easily accessible to the public, and was presented to the Legislature as nearly at the same time as the printers could produce them. Each local report contained in those volumes is now, by direction of the Commissioners, in the course of preparation for public circulation within the locality which it concerns ; where it will have its own weight.

Having in my own report referred to the opinion in question, in terms of which those who read the portion of the Report sent herewith, and in other portions of the Report, where 1 adduce examples of the causes of erroneous medical inferences as to the antecedents of epidemic diseases, I deny that it was incumbent on me to introduce into the body of my report the individual

statements of all or of any of the minority of the gentlemen who maintained opposite opinions. You must have been aware, and should have informed your readers, that among the first of the Local Reports, there is a paper from Dr. Ar.l.tsou, in reply to another paper on the same subject from Dr. Annorr. You could scarcely have been unaware that an inquiry into the administration of relief in Scotland, by those engaged in the administration of relief in Bor- land, has been a subject of application and controversy. A candid public writer might have seen in that circumstance, if in no other, a reason for abstain- ing from quoting in the General Report, passages on destitution, referring as the Report of Dr. Sys does to the administration of relief to the poor in Scotland.

If the passage which you cite or other similar passages were cited by me without examination or answer, the fact would wear the appearance of an ad- mission of that validity which I am not prepared to admit, nor could be ex- pected in every case to be prepared to challenge upon any local knowledge. Dr. SIM, in the passage you quote, states, that " whilst the malaria of animal and vegetable matters in a state of decomposition is unquestionably de- trimental to the general health, I consider that its influence in predisposing the system to fever is utterly insignificant in comparison with the effects of pro- tracted semi-starvation, and other evils which have poverty for their immediate source ; nor do I conceive that it contains at all the specific morbid poison of intermittents."

In support of this opinion, he adduces the fact, that whilst the residences of the colliers in the town of Ayr are as dirty and as badly situated in respect to defects of cleanliness as those of the weavers, fever chiefly selected the last of the two classes.

Though, in the course of my personal inquiries, I passed through Ayr on my way from Dumfries to Glasgow, and inspected some portions of the town. I have no local knowledge to warrant me in questioning the correctness of Dr. Sera's statement of the identity of the physical condition of the twa classes in respect to residences. My. answer would be founded upon what is deemed the preponderant experience In other places.

Dr. Srm's Report, however, and those from which you have quoted, when examined, will be found to corroborate the conclusion to which I have arrived, in the following passage, which I conceive a writer willing to submit the whole facts to the judgment of his readers would give, thus describes the condition of the residences of those whom fever chiefly selects, the hand-loom weavers-

" In respect of furniture, I believe the houses both in Townhead and \Val- lacetown, which contain our poorest population, are supplied as elsewhere, namely, according to the circumstances of their inmates. There is usually a bedstead at each side of the door, often much shattered, beneath which all sorts of rubbish and lumber are huddled together, and also the store of the potatoes for the family when they possess so much wealth ; nay, we sometimes detect a heap of horse-dung under the bed, which is collected by the children from the streets, and sold when a sufficient quantity has been accumulated. As to cleaning under the beds, this is never dreamt of; nor would it be easily effected, as they are generally closeted in upon three sides, and they are uni- versally infested with bugs. The bedding consists of straw or chaff, with a scanty supply of dirty blankets and mats, but no sheets : one or two broken chairs or stools and a fir table constitute the remaining part of the furniture, and it indicates some degree of opulence when an old chest is seen by the side of the wall. The foregoing description applies to the houses of the poorest class of hand-loom weavers, generally Irish, and to other indigent tradesmen, i. e. operatives, who support their families by their regular industry. There is, however, a still poorer class, consisting of vagrants, paupers, and persons who have no regular employment, but apply themselves to any casual work that may occur. These people live in the most miserable hovels, and are found crowded together in lodging-houses, in such numbers that when collected at night the floors are literally covered with their persons. They pay a small sum for their lodging at night, and disperse themselves during the day."

Now, although the residences of the colliers may be identically the same

with those above described, yet I conceive that the cause for fever attacking the weavers most frequently, might 'by other medical practitioners be seen in the above statement, and in the fact that, whilst the weaver is kept by his occupation in the atmosphere described during the greater part of the twenty- four hours, the collier is by his occupation removed to another, and though not healthy atmosphere, yet one less unhealthy than that in which the weaver must live continually. Tbe colliers usually have large tires, and keep more open doors ; the weavers have small fires, and keep the door closed ; and who- ever visits their abodes and places of work will usually find the air moist and. stagnant. Had Dr. Sass had the advantage of examining the weavers in other districts, he might possibly have observed other facts which would lead him to modify his opinion, and give him much more confidence in the efficacy of the sanitary cleansing and atmospheric purity in improving the health and. general condition even of this most depressed class of work-people. For ex- ample, had he seen the weavers in another neighbourhood, thus described by Mr. GIBSON, Burgeon, in his report on the condition of the labouring popu- lation of Lanark, in a passage which the writer of the article has also passed over. Mr. Ginsos states-

" The weavers in all these small villages are more comfortable, because more sober and economical, than those who reside in more populous localities. "These villages are genemlly very healthy ; epidemical diseases are seldom known among them. The few paupers to be found among them are usually weavers, who have become unable to labour through age and Infirmity. "The dwellings of these localities are usually of a very homely description; but they are dry within, and though mean and ill-furnished, one seldom meets with any nuisance in them, or the appearance of destitution. The small farmers and proprietors among whom the poor weavers reside are sometimes. mindful of them in cases of extreme hardship, occasionally affording them small supplies of milk, oatmeal, potatoes, &c."

To guard against further misrepresentation, if that be possible by any ex-

plicitness of statement it may be necessary IO declare, that the existence of destitution, or that absolute destitution, when it does occur, must aggravate disease, is, so far as I am aware, questioned by no one. I have stated, as facts coming within my own personal knowledge, that "all the districts I visited, where the rate of sickness and mortality was high, presented, as might be ex- pected, a proportionate amount of severe cases of destitute orphanage and. widowhood. No doubt, there are in Scotland other classes of cases of desti- tution than those of widowhood and orphanage; but the scope of this inquiry being confined to the means of improving, not what may be termed the pe- cuniary condition, but the sanitary condition of the population, it may be seen why it was not deemed necessary either to cite or to investigate passages from the Local Reports such as those above quoted from Dr. Sam or Mr. GIBSON; which were passed over as involving statements which would more properly be

i

considered n connexion with questions connected with pecuniary relief. But a fallacious opinion as to the extent of the operation of destitution as an ex- tensively-operating cause of fever being interposed as an obstacle to measures of sanitary improvement, it became a duty not to pass by that opinion without indicating the evidence of its unsoundness. Having done so, I have passed by that question, and have included in the recapitulation of conclusions that only which appeared to me to be the most material conclusion. It is in the fol- lowing terms, which it would have been but candid in the writer to have cited.

"That high prosperity in respect to employment and wages, and various and abundant food, have afforded to the labounng classes no exemption' from attacks of epidemic diseases, which have been as frequent and as fatal in periods of commercial and manufacturing prosperity as in any other."

In the article on the General Report, after some observations, of the animus of which those of your readers must judge who will read the Report itself, you make a statement which, for the prevention of unfounded impres- sions in those who may not read any part of that Report, it is necessary to contradict. You state, that " some of the provisions, (i e. of the Report,) derived from local truths, or perhaps from the conclusions of local propounders, are somewhat startling; such as that low wages are not a cause of distress."

The readers of the Report itself will be startled by the cool assertion that such a self-evident absurdity is contained in it, and attributed to me as one of my conclusions ; a statement which is not from its absurdity the less mischievous in its tendency as applied to a public officer in such a position. To keep the inquiry clear of topics of present agitation endeavours were made to limit the inquiry as closely as practicable to the period of the first inquiry in the Metropolis, when there was no unusual severity of manufac- turing or commercial distress, namely, the year 1838. But, whilst the ex- perience of that and preceding years in prosperous districts establishes the material conclusion last cited, that prosperity does not arrest epidemics, the subsequent experience may be adduced as furtherjustification of the conclusion impugned as to the independence of fever and other epidemics of general causes of distress. Sickness and mortality has not increased with the distress in the most distressed districts : it has diminished concurrently with the fine weather, and probably with other causes. In Manchester, according to the returns to the Registrar-General's office, the total deaths to the total population were, in the year 1839, 1 in 28; in the year 1840 they were, according to a Report from the Manchester Statistical Society, 1 in 2&36; and in the year 1641, they were reduced to 1 in 31.59. From re- turns published by the Registrar-General for the quarters ending in March and June last, it would appear that the present rate of mortality is reduced to 1 in 33 in that town. The deaths returned for the winter quarter ending March last, instead of rising above the average of the three preceding winter quarters, which was 1,673, fell to 1,592: the deaths during the succeeding spring quarter, instead of increasing beyond the average of the four preceding spring quarters, which was 1,597, fell to 1,327. In Stockport, the deaths during the last winter quarter were 588; the average for the three preceding winter quarters, in which the mortuary registration was completed, was 683. The deaths in the last spring quarter were in the same town 493; on the average of the four pre- ceding spring quarters they had been 664. The mortality in Bolton rose during the last winter quarter, being 774; the average of the preceding winter quarters was 749. The increase is variously accounted for by the Registrars of Deaths.

The following is an abstract of their returns- " Bolton—Tamworth. The number of deaths during the quarter has been above the average. There is no known circumstances which will account for the increase.

Lever. Measles have been most prevalent.

Tong with Haulgh. 5 The above return is certainly more than an average of deaths in the three previous quarters, but is what I noticed has occurred in correspond- ing quarters of former years ; arising principally from paralysis and in- firmities in aged persons, and consumption, convulsions, hooping-cough, and teething, in young persons and children. I only perceive one case of typhus fever, and one of measles ; so I should say any epidemic in my district is not at all serious."

But in the spring quarters, (the distress still continuing,) the deaths fell to 553, the average for the four preceding spring quarters being 702. I have been informed from Stockport and Bolton, that of late the diminution of the cases of fever in the dispensaries has been most marked. From Scotland there are no available returns. It is stated, however, that a reduction of sickness and mortality in that part of the kingdom has of late been generally perceptible. It is stated that in Paisley, in May last, the amount of fever as shown in the Dispensary was just one-eighth of the average amount during the same month in the preceding five years. The deaths in the whole of England and Wales during last the winter quarter are shown in the Quarterly Report of the Registrar-General to have been 2,954 less than would have occurred had the rate of mortality been even uniform, so that there is no room for the supposition that the results have been materially disturbed by any emigration from the towns : the total number of deaths in the last spring quarter, is reported to have been 2,515 less than the average of the four preceeding spring quarters, or 11 per cent below the average of the season. The average number of deaths from typhus in the whole kingdom during the winter quarters for 1838-9-40 and 41, were 633; during the winter quarter for 1842, they bad fallen to 253. The average number of deaths from scarletina were, during the four spring quarters preceeding, 330; during the spring quarter of 1842 they were 121. The total number of deaths from all diseases classed as epidemic, endemic, and contagious diseases in the winter quarter ending March 1842 was 1841: the average for the March quarters of the four preceeding years having been 2,583; the total number of deaths from that class of diseases during the succeeding quarter, ending June 1842 was 1588. The average for the spring quarters of the four years preceding was 2373. The Registrar-General's Quarterly Report for the winter quarter states,

that the "districts in which the number of deaths was less than the average of the winter quarter" were "the Central, East, and South districts of the Metropolis, Brighton, Wycombe, Northampton, Bedford, Cambridge, Col- chester; Norwich, Devizes, Dorchester, Bristol, Stroud, Kidderminster, Coventry, Nottingham, Basford, Stockport, Macclesfield, Manchester, Salford, Hull, Newcastle-upon-Tyne, Kendal, Abergavenny, Pontypool, Merthyr Tydvil, Newtown."

The medical practitioners who are the best acquainted with the condition

of the labouring population, would probably concur with the medical officers of Whitechapel and Spitalfields, in ascribing a large proportion of this unusual reduction of fever, epidemics, and mortality, in the most depressed districts, partly to the fact of the operatives having been, during the stoppage of their work, more in the open air than in their own close unventilated and filthy rooms, and partly to the circumstance of the unusually long continuance of fine dry weather. I have been informed, that in Manchester, after a time during which all the furnaces of the factories and the smoke from their chim- nies was stopped—when the atmosphere was, during consecutive days, as clear U on the Sunday—a hue of health, such as had never before been visible, began to appear on the faces of a proportion of the population ; and that other facts occurred of reductions of sickness, corroborating from this concurrence of circumstances the conclusions stated in the Sanitary Report, as to the great advance of health to be obtained by the production by well-executed sanitary measures of the like favourable circumstances of atmospheric purity, by the drainage, cleansing, and ventilation of their houses and places of work. Further on, in July and August, in the hot days, when the sky was cloudless and the air still, and favourable to active decomposition, an eminent physician in the Metropolis noted the similarity of the weather to that described by DE- FOE in his account of the plague, and began to express apprehensions which were verified by a rise of mortality and the appearance of cases of cholera. Had such weather continued or occurred upon a population closely confined in such houses as those of the weavers at Ayr, described by Dr. Suss, or

those in other towns already described in the General Sanitary occurrence of a much more extensive mortality might have been expected.

I am well aware to how many persons facts and conclusions opposite to those stated on this topic in the Sanitary Report would have been acceptable, but I --Report, the conceive it was not my province to consider their party bearing.

I shall not apologize for trespassing to you, Sir, who have rendered explana- tions necessary to meet your libellous aspersions.

In the first article on the subject of the Sanitary Inquiry, you make a state- ment which tends to make me ridiculous, or to excite animosity by represent- ing me as having travelled out of my way to question the practice ofinsurance- offices in respect to insurances by implication to the classes to whom I appre. bend the practice of those offices is confined, namely, the higher and middle classes. You state—" There is, as we have already observed, a curious section on the duration of life among diferent classes in different places; which, besides the investigation it suggests, may afford a hint to the independent, who can live where they please. It has not, however, the practical use for insurance-offices which Mr. Chadwick, travelling out of his record to correct their actuaries, supposes. The tables of life-insurance concern select not promiscuous lives ; and are now tested, if not wholly calculated, from tables formed on the ex- perience of the older insurance-offices. From those offices, also, children are practically excluded; the cases being rare in which insurances on young lives are needed."

Not one word do I find in my Report that mentions " insurance-offices "; and I must request you will give the passage itself, which I annex and adduce in opposition to your own, as another example of the species of wanton detraction, by which I have been assailed to a greater extent than other officers in the same service. Against such detraction, and incitements to animosity and con- tempt, the obviously beneficent nature of the service has hitherto been no more protection, from those who ought to know better, than was the service. of me. dical officers against assaults arising from popula;delusions whilst endeavouring to stop the progress of the cholera. In a minor point of view, the proneness to wanton attacks is injurious to the public service, by occasioning an extension of public reports ; the bulk of which, so much complained of, is frequently made up of justificatory documents, which add no new information to that contained in the Report itself, and which are rarely read even by ,those who impugn the conclusions, but who are ready to found an imputation of garbling or wilful suppression upon the absence of such additional matter. I have known several thousands of pounds expense incurred in printing answers and repetitions on one inquiry, for no other reason than to avoid wanton personal imputatiods of wilful suppressions of evidence from this or the other unscrupulous writer or speaker. I repeat, Sir, that this vindication is not addressed to those who may read. the Reports you have impugned, but to those who might derive their im- pressions from your unanswered statements. I am, Sir, your obedient servant, E. CHAD WICK. APPENDIX.

[Extraetsfrom the General Report, pp. 1444050.]

The more closely the investigation as to the causes of epidemic disease is carried, the more have the grounds been narrowed on which any presumption can be raised that it is generally occasioned by extreme indigence, or that it could be made generally to disappear simply by grants of money.

In the great mass of cases in every part of the couutry, in the rural districts and in the places of commercial pressure, the attacks of disease are upon those in full employ- meut, the attack of fever precedes the destitution, not the destitution the disease. There is strong evidence of the existence of a large class of persons in severe penury in some places, as in Glasgow, being subject to fever, but the fever patients did not, as a class, present evidence of being in destitution in any of the places we examined. Dr. William Davidson, the senior physician of the Glasgow Royal Iufirmary, who has written a Treatise on the Sources and Propfig,atiou of Continued Fevers, for which the prize instituted by Dr. Thackeray, of Chester, was unanimously awarded at the annual meeting of the Provincial Medical and Surgical Association, states in that treatise, when speaking of the influence of delicacy of constitution as a predisposing cause of fever—

"We have kept a record of the physical habit of the patients admitted into the Glasgow Fever Hospital from 1st May to 1st November 1839, and the following were the divisions adopted :—

"1. Moderate, by which is meant a person having an ordinary quantity of muscle and cellular substance.

"2. Full or plethoric, having an extra quantity of adipose texture or of blood.

"3. Muscular.

" 4. Spare. 5. Emaciated or unhealthy in appearance. Males. Females. Total.

Moderate 116 .... 93 .... 269 Full or Plethoric 28 73 .... 101 Muscular

Spare 24 .... 41 .... 65 Unhealthy or Emaciated

429

•• The whole of these 429 cases were characterized by the typhoid eruption, and will therefore be considered as decided eases of typhus. It appears from this table that there were only 10 cases in an emaciated or unhealthy condition ; and almost all of them, as far as could be ascertained, were engaged in their ordinary occupations at the time of their seizure. The spare and unhealthy, when added together, only form about 17 per cent of the whole number." He gives two tables of the proportionate numbers of persons admitted during the year 1839 itito the Glasgow Fever Hospital, whose persons were clean or filthy. "These two tables show, that among 611 cases admitted as continued fever, there were 340 filthy and 271 clean, or about 55 per cent filthy; that among 395 cases of eruptive ty- phus, there were 245 filthy and 150 clean, or about 62 per cent filthy ; and that among 48 cases of febricula there were 14 filthy and 34 clean, or about 29 per cent filthy."

Amoug the fever patients are found a larger proportion of the highly intemperate than appear to be usually found among the labouring classes.

Dr. Davidson. to remarking on the influence of intemperance on fever, adduces the following table to show the proportion of temperate and intemperate individuals who were admitted into the Glasgow Fever Hospital, front November 1st 1838, to November 1st 1839, whose habits could be ascertained with more or less certainty. Me states that the eruptive cases only are Included —

Temperate. A little Intemperate. intemperate. Typhus (Males) 125 51 Typhus (Females) 76 8 30

I have been informed that those were classed as "temperate" who never indulged in strong liquors to the extent of inebriety; those a" little intemperate" who now and again, perhaps at long intervals, drank to intoxication ; and those as "intemperate" who were habitually so; who drank whenever they could get ardent spirits. He adds—" In the Glasgow Fever Hospital there occurred Ill deaths from eruptive typhus in individuals whose habits were ascertained ; and 34 of these were reported as intemperate. 19 a little intemperate. and 28 temperate. In Dr. Cragie's table of the deaths, in 31 fever cases that occurred in the Edinburgh Royal Infirmary, there were 15 stated to he irregular or dissipated; only two regular ; the habits of the remainder are not stated. It is also a singular fact, which 1119 been noticed by several writers, that fever is more fatal among the higher than among the lower c'asses. Dr. Braken states, in reference to the fever which prevailed at Waterford during the years 1817-18- 19, that it would he difficult to adjust the rates of mortality in the upper classes, but it seems probable that one-fourth, or perhaps one.third of all those persons who were

attacked with fever fell victims to its power.'" • • •

The preponderant evidence given on this subject by the great majority of the medical officers to Euglaud who are accustomed to visit the labouring classes in their own dwellings, is, -however, of the tenor of the following from the medical officer of the Whitechapel Union acting in Spitalfields parish. Mr. Bytes, the medical officer of the Whitechapel Union :—" What is the number of cases you have had to visit during the year 1841 as a medical officer ?—I think the number of rascal havehad to visit during each year since the commencement of the Union, has been upwards of 2,000 cases of various disease, of which 1,400 were cases out of the workhouse.

" Has the present winter been unhealthy ?—I do not think it has; there has been an increase of fever cases during the last month. The number of eases is, however, still below the aterage of 1838. " Is there not however, unusual distrees in your district, comprehending Spitalfields and a portion of Whitechapel? —Yes, there I. : I believe that more than half the looms are out of work.

" Do you not find that fever attacks in greatest number those who are out of work ? On the contrary, the greatestuumber of the cases of fever we have are thuee who fall ill during the time they are in emploament. I think they are more attacked when in work. when the windoe are closed, and there is no ventilation. Many of them are obliged to work with closed windows, to keep out the moist air, and present the dart blowing upon their work. When they are out of work they are more out of doors looking after work, more in the open air. aud that very exercise may be the means of keeping them in health. This observation applies to the weavers. I find thatthey have generally less fever when they are out of work. The reverse, I think, holds as respects out-door labourers ouch as those who work at the docks. When they are out of work, they stand about waiting in the cold, and when cold. they generally take cheap giu, and uo food : they catch cold, and on going to their close filthy habitations, their cold is apt to generate fever.

n There was an unusual amount of fever prevalent in Spitalfields and Whitechapel, was there not, in the year 1838?—Yes. there was; in the proportion, perhaps. of more thou two to one of the present amount. My last account for the year endiug Lady Day 1842 was about 250 fever cases; it luis been as high as 800.

n Did it prevail prop rtionately among the wearers?—Yes. I believe it did. tt Was there any marked or unusual distress at that period ?—Not that I remember. " Do you find in the course of your experience that the diminution of food is followed by fever?--Not as a general cause. I sliculd say. Of these two persons. casually ex- posed to the contagion of feser, the one hi full vigour, and with a full stomach: the other with an empty stomach, the person with the empty stomach would be the most obnoxious to its influence. In my experience, houever, intemperance is a much more frequent antecedent to fever than destitution or want of food.

" Have you ever observed that habits of intemperance are created by distress of mind? - Such cases, may occur, but I have not obaerted them, and I think it does not operate as a general cause.

e What are the chief remedies which yt ur experience in this district would lead you to recommeud for the prevention of fever and coutagious diseases ?—The promotion of cleanly habits among the poor; the promotion of sewerage and drainage; having proper supplies of water laid on in the houses; the removal of privies from improper situations. I could point ut in our neighbourhood many houses, and some courts, that ought to be pulled down as wholly unfit for human habitation.

t• What is the personal state of the labouring classed in your district ?—Generally ex. tremely filthy. I have said that I could almost smell from what street a man came who came to my surgery: I do not think the poor themselves are conscious of it ; but the smell to other persons must be extremely offensive. I certainly think that the want of personal cleanliness, and of cleanliness in their rooms, and the prevalence of fever, stand in the relation of cause and effect.

"Your colleague has pointed out that the want of proper and convenient supplies of water is an antecedent to the filth and the fever. Does your experience enable you to concur with him ?—My experience entirely agrees with his on that point."

The late De. Cowan, ef Glasgow, and the great majority of the medical officers, 311. sign the foremost place to these physical agencies as antecedents to fever. The medical controversy as to the causes of fever ; as to whether it is caused by filth and vitiated atmosphere, or whether the state of the atmosphere is a predisposing cause to the reception ol the fever, or the means of propagating that disease, which hati really some other superior, independent, or specific cause, does not appear to be oue that for practical purposes ueed be considered, except that its effect is prejudicial in diverting attention from the practical means of prevention. Dr. Bancra jt, one of the controversialists cited by Dr. Davidson, observes—" that fever often exists in them" (gaols) "cannot be denied; but this circumstance can afford no evidence of its being generated therein, any mere than the multiplication of vermin in such places could demonstrate the spontaneous generation of these and other insects by the nastiness which favours the deposition and hatching of their eggs." Taking the controversy at this point, and admitting the force of this statement, the decision upon it will uot alter the practical value of cleanliness, or of its protective effects in prevention, whether it remove an original or only a predisposing cause. Yet it cannot but be regretted that the enlightened force of the professional opinion should sustain any diminution from an apparent want of unanimity on an important a question as the necessity of removing these causes, whether original or predisposing: that, for example. whilst the fleets were ravaged by fever and disease, men of high standing should have occupied the attention of the public with speculations on conta- gion, and infection from the goals as the original cause, and diverted attention trom the means of prevention, cleansing and ventilation, the means by which, as will hereafter be shown, the pestilence was ultimately banished. The main error of those who have ascribed fever to destitution, appears to have been in adopting too hastily as evidence of the fact of destitution, such prima facie appearances as are noticed be Dr. Scott Alison. an error which non-professional experience may correct. In more than one in- stance where, in a district in which the demand for labour was still great, and the wages high, benevolent gentlemen have propounded similar doctrines, which, being at variance with the known state of the labour-market. I have requested that the names of these fever cases might be given, that their antecedent circumstances might be ex- amined, and the accuracy of the conclusions tested, by officers of experieuee in such investigations; but I think it right to state, the names or means of inquiry have never been forthcoming. In general, medical practitioners and benevolent individuals are extremely liable to deceive themselves and to deceive others, by what they call the evidence of tlteir own eyes. The occurrence of severe destitution is denied as a gene- ral cause of fever, not as a consequence. The evidence shows that the best means of preventing the consequent destitution are those which prevent the attacks of fever and other epidemics upon all classes of the community. By an extract from a report of the late Dr. Currie. of Liverpool, given in the Ap- pendix, it will be seen that at the time he wrote, 1797. when only 9,500 of the popula- tion are reported to have lived in cellars, the proportion of fever cases was nearly the sante as at present, when the cellar population has risen to 40.000; the disease has been almost as constant as the surrounding physical circumstances of bad ventilation, filth, and damp then pointed out as removable, and the disease has continued in every period of the prosperity of the town in its progress from a population of 77,0110 to 223,000

to 1841. So the late Dr. Ferriar, of Manchester, when writing between thirty and forty years ago, of the state of the population in periods of great prosperity, especially for

hand-loom weaving, described the effect of the bad economy of the habitations much as they were described is the year 1829 by Dr. Kay. and as they are described in 1840 by Dr. Baron Howard. Dr. Ferrier, when he wrote to warn the labouring clamed as to the choice of their dwellings, stated that-

" The custom of inhabiting cellars also tends to promote both the origin and preser- vation of febrile infection. But even in them the action of filth anircuullued air is always apparent when fevers arise. I have often observed that the cellar of a fever Patient was to be known by a shattered pane, patched with paper or stuffed with rags, and by every external sign of complete dirtiness." The false opinions as to destitution being the general cause of fever, and as to its propagation, have had extensivelythe disastrous effect of preventing efforts being made for the removal of the circumstances which are proved to be followed by a diminution of the pestilence. [Passages are then cited in corroboration from Dr. Davidson and a Commission of medical men appointed to investigate the causes of epidemics in France.)

Having waded, how we might, through this "boggy syrtis," we will bnetly reply to the three points which concern us, seriatim.

1. The facts on which the charge of suppression was founded are not denied : Mr. CHADWICK does not attempt to say that he quoted the ad- verse opinions of Dr. SEM, Dr. Arasost, Dr. HOWARD, Dr. DE Vrrne, Mr. DAY, and the Physicians and Surgeons of Birmingham. The most cogent-looking excuse for the omission is, that the inquiry was into the sanitary condition, not into the pecuniary circumstances of the poor.. But if their circumstances are alleged to affect their sanitary condition, we hold that the facts and reasons on which that opinion Was founded, by those persons who entertained it, should have been Produced, as well as the facts and reasons of those who maintained an opposite view. We said before, what we say now, that the sound- ness. of the opinion was beside the question. Mr. CHADWICK may be right in his startling assertion at page 3 of his General Report, that of " 56,461 deaths arising (in one year) from epidemic, endemic, and contagious disorders, the great proportion are PROVED TO BE VENTIBLE ": we cheerfully admit the professional eminence of Dr. Aasaarr, Dr. KAY, and Dr. SOUTHWOOD SMITH, and the weight of their opinion as to the origin of fever ; we readily allow that Mr. CHADWICK has medical opinions in his favour, that filth, &c. is the cause of febrile disorders—it was the essence of the charge, that he only quoted those who agreed with his views; but we maintain, that as a responsible official—paid by the public, collecting materials by the public authority, writing a book to be published by the public, and which professed to convey the stamp of official authority and was to be made the foundation of a legislative enactment.— he was not justified in omitting the views of Dr. Set, Dr. ALISON, Dr. HOWARD, Dr. DE VITRE, and the Physicians and Surgeons of Birmingham, (not to mention Mr. DAY,) because he differed from their conclusions. To dissent from them he had a perfect right ; he had a right to confute them if he could ; but he had no right to sup- press them. His duty was clear, even had his instructions—" to com- pare the different statements with such authentic facts bearing upon the question as he might collect from other sources, and frame a report which should exhibit the principal results of the inquiry "—been less specific. A person directed to examine and report upon evidence may have a right to offer his estimate of its value, but he has no right to omit such as he disapproves of. If opinions of value, however, are to be received, we should say that, apart from preconceived theories, the passages omitted by Mr. CHADWICK are more valuable than the majority which he quotes, for native good sense, largeness of view, and closeness of deduction. Mr. CHADWICK seems altogether to have mistaken his primary function, which was to arrange information, not to promulgate his own notions at the public expense. The argument that the passages could be read in the volumes of Local Reports, might have had weight had Mr. CHADWICK written a condensed account of his own conclusions, instead of a bulky volume of 457 pages, (though then he should have stated one general view as well as another,) or had he altogether omitted quoting from such local reports as were designed for separate publication. But when he quotes freely from these reports where they answer his purpose, and from several, if not from all of the authorities, whose views he has omitted when they differ from his own, this excuse is not even specious. The statement that the Local Reports are to be printed for local circulation seems still more idle. If the opinion of Dr. SYM is true, that poverty not filth is the more immediate cause of fever, its truth is independent of the Doctor's place of residence : it is a law of nature, that will operate in other districts as well as Ayr.

2. With respect to the position that "low wages are not a cause of distress," it is evident, by the phrase of "local propounders," that we did not intend to ascribe the conclusion to Mr. CHAnwicx individually,— though when the compiler of a report adduces facts or opinions without dissenting from them, he may be held to adopt them. Besides scattered passagts where the " position" seemed to us implied, we drew our impressions from page 139 et seq. Those who may take the trouble to turn to that part of the General Report will find there, headed " Con- trast in the Economy of Families," an account of persons who are corn: fortable on low wages, whilst others receiving the same or higher wages are in distress; and this account is followed by the evidence of different individuals, tending, in our opinion, towards the same conclusion, that distress is independent of the absolute amount of wages. After the extraordinary space devoted to Mr. CHADWICK'S defence, we cannot encumber our columns with several pages of close print from his Report; but we will take one sample from the ten instances of the" Contrast."

"John Salt of Carr Bank (labourer), "George Hall,ofCarr Bank (labourer), wages 12s. per week; a wife, and one wages 10s. per weak; has reared ten child aged 15; he is a drunken, die- children ; he is in comfortable circiun- orderly fellow, and very much in debt. stances."

3. We have not printed the passage on insurance from the Report, sent by Mr. CHADWICK, because it contains questionable matter which we should controvert if we gave it currency, and because it is perfectly true that Mr. CHADWICK does not mention the word "insurance-offices"; though it is also true that he mentions insurance at another place be- sides the passage he has enclosed to us from the section on the "Evi- dence of the Effects of Preventive Measures in raising the Standard of Health and the Chances of Life," (pages 218-219.) At page 153 there is this somewhat pompous announcement, introducing the sub- ject— " W.—COMPARATIVE CHANCES OF LIFE IN DIFFERENT CLASSES OF

THE COMMUNITY.

" Very dangerous errors arise from statistical returns and insurance-tables of the mean chances of life made up from gross returns of the mortality prevalent amongst large classes, who differ widely in their circumstances. Thus we find, on inquiry into the sanitary condition of the population of different districts, that the average chances of life of the people of one class in one street will be fifteen years, and of another class in a street immediately adjacent, sixty years. In one district of the earn,: town I find, on the examination of the registries, the mortality only one out of every fifty-seven of the population; and in another district one out of every twenty-eight dies annually. A return of the average or the mean of the chances of life, or the proportions of death in either instance, would and does lead to very dangerous errors, and among others to serious misapprehensions as to the condition of the inferior district., and to false inferences as to the proper rates of insurance." Bringing page 153 in juxtaposition with pages 218-219, and reading the passage just quoted by the light of Mr. CHADWICK'S present letter, we now conceive that, in the passage quoted, he did not say what he meant ; but meant to say, That the rates of insurance-offices, being de- duced from select lives, and the tables of the mean duration of life embracing the upper and comfortable classes as well as the lower, their statistics injuriously mislead benefit societies and similar institutions for the very poor, as their value of life is mach less For this mis- apprehension we are obnoxious to any censure the reader may think it fairly deserves, and Mr. CHADWICK is entitled to any advantage he may gain by the explanation. But, when inferring "wanton detraction" in the critic as the only cause of the misconception, the possible want of perspicuity in the author should also have been present to his mind. In a private but threatening letter which accompanied his limn- bration, Mr. CHADWICK reiterated his public charges of "libel " and "malice," and vapoured about legal proceedings. It is something too much, at this time of day, to hear the temperate and strictly critical censure of the writer of a book and a responsible public officer, for the manner in which he has executed his task, called " more especially when the main facts on which that judgment was founded are not impugned. This indiscreet and ungoverned sen- sitiveness is all the more absurd, because the work of the irritable author himself is one involving an examination of the opinions, prac- tices, and conduct of large classes of society, as well as of public officers; and we believe no reader of his book will consider that it suffers from the want of "a becoming freedom" in Mr. CHADWICK'S animadversions, whilst many readers will think it suffers very greatly from the unbecoming self-sufficiency in which Mr. CHADWICK assumes his own infallibility.