‘REPORT ON THE SANITARY CONDITION OF LIVERPOOL’ E. A. PARKES MD, FRS.& J. BURDON SANDERSON MD, FRS. 1871
Parkes and Burdon looked at four questions. These were:
1. Death rates (mortality) in Liverpool compared with other large towns
2. The comparative death rates of districts in Liverpool itself
3. The comparative death rates of certain streets in Liverpool
4. the sanitary condition of those streets
(NB Direct quotes are given in inverted commas.)
Table 1 Mortality rates in Liverpool 1861 to 1870
Years Annual Mortality per 1000 living 1861 32.4 1862 33.7 1863 37.6 1864 41.7 1865 44.0 (Typhus epidemic) 1866 50.7 (Cholera epidemic) 1867 35.4 1868 35.3 1869 36.3 1870 38.8 Mean of 10 years 38.59
“In the same ten years, the mean annual mortality per 1,000 of population, calculated upon the mean annual population of 1861-1871, was as follows in the undermentioned towns.”
Table 2 Comparative death rates for other towns and cities for 1861 to 1870
“The mortality in Liverpool may be divided into two categories - ordinary and extraordinary. The ordinary annual mortality in years not marked by any great epidemic disease is about 35 per1000 of population. In the years with epidemic outbreaks of Typhus, Cholera, or diseases of that class, it may amount even to 50 per 1,000, or 1 in every 20 of the population. This division, into normal and specially unhealthy years, is common to all towns, and affords a natural division of the inquiry into the causes of mortality.
Town/city Mortality rate for 10 years Bristol 22.5 London 24.3 Hull 24.9 Bradford 26.2 Sheffield 27.2 Leeds 28.0 Manchester 30.2
To take the latter first. When epidemic diseases prevail frequently in a town, and cause in certain years an excessive mortality, they arise from two chief causes; Ist, the ready and frequent introduction of the cause of thedisease into the town; and 2nd, local conditions which always foster it or which allow its spread when introduced. Both these causes exist in a high degree in Liverpool. Its position as the great seaport of the kingdom, for emigration, as well as for commerce generally, renders' the arrival and departure of persons more frequent than in any other town of its size, and consequently increases greatly the chances of the introduction of any epidemic disease capable of being carried and imported, either from the continent of Europe or from Ireland. The introduction of Typhus, Cholera, Smallpox, or Relapsing Fever is therefore almost certain, if these diseases prevail in places with which it is in frequent communication.
It is not possible to alter this without .surrendering the commercial supremacy of Liverpool, but some precautionary measures may be taken. Arrangements for the proper and healthy accommodation of emigrants, both Contintental and Irish, so as to separate them completely from the permanent population, by locating them only in a certain district, would afford the best chance of stamping out or limiting the spread of an epidemic disease brought with them; and although it might not be possible to do this in the case of Irish, or other labourers, who enter Liverpool in search of work, still, even here precautions might be taken, whenever it is known that epidemic diseases are prevailing in the localities whence they come. As it is of such importance to Liverpool to receive early intimation of any epidemic disease prevailing in Germany and the North of Europe, or in Ireland, we suggest that arrangements should be made to obtain regular monthly Reports of the health of those countries as regards epidemic diseases, so as to be prepared for any contingency of the kind. But the local causes which aid the spread of these diseases (and which are all important as being removable) exist also in Liverpool to an unusual extent, as we shall show in a subsequent part of our Report. Passing from the unusual to the ordinary mortality, we have to enquire why Liverpool should in this respect be less favourably placed than Bristol, London, or Hull.”
Table 3 Mortality of different districts in Liverpool (1865 to 1870)
Districts 1865 1866 1867 1868 1869 1870 Scotland 38.6 43.4 26.8 28.2 27.9 29.1 Vauxhall 49.0 62.0 35.3 33.2 38.8 43.9 St Paul’s and Exchange 48.2 46.7 33.7 34.5 31.9 36.2 St Anne’s and Lime Street 45.5 47.9 33.3 31.6 34.3 36.3 Castle Street and St Peter’s 26.5 27.4 20.2 17.7 18.9 18.1 Pitt and Great George 32.0 43.4 29.4 31.3 29.3 34.6 Rodney and Abercromby 23.7 26.1 21.5 20.0 20.6 21.9 Everton and Kirkdale 29.5 32.6 24.9 26.7 26.6 26.4 West Derby 24.6 29.0 25.1 23.2 22.1 24.4 The Toxteths 32.2 37.5 24.4 27.7 27.6 33.0
“These returns show at once that the ordinary high mortality of Liverpool is not distributed over the whole town. There are districts, such as the Rodney and Abercromby, Castle Street, and St. Peter's Wards, where the mortality may compare favourably with any town in England; while, in other districts, as in Vauxhall Ward, and St. Paul's and Exchange, a mortality, always excessive, reaches sometimes a most alarming height. This table at once does away with any question of an insalubrious climate being the cause of the high mortality in Liverpool. The difference must be connected, not with general conditions of climate, but with locality, and, if so, must arise either from conditions of soil, local sanitary faults, modes of living, or from occupations and personal habits.”
Mortality rates in different streets
The authors then went on to analyse mortality rates in different streets in Liverpool. They are looking at the effects of slum housing but for the purposes of comparison they “selected two healthy streets after consultation with some of the medical men of Liverpool, viz., Rodney and Egerton Streets. Rodney Street is mainly inhabited by a very respectable middle class; the number of children is small, and the average age of the population high. Egerton Street is inhabited by a class of skilled artizans getting good wages, clerks, custom-house officers, and other respectable persons. The other selected streets are inhabited by the lower class of labourers.
We have taken the mortality for the four years, 1867-70…”
Table 4 Mortality rates for different streets 1867 to 1870
Street CharacterofInhabitants Total Population Census of 1871 Deaths from all causes 1867 - 1870 Mortality per 1000 per annum Rodney Respectable First and Second Class houses inhabited by well to do persons 607 26 10.71 Egerton Clerks, Custom House Officers and Skilled Artisans 357 38 26.61 Henry Edward Poor Population, Artisans, Dock Labourers, etc., etc. 677 81 29.91 Adlington ditto 936 120 32.10 Bispham ditto 716 92 32.12 Lace ditto 715 102 35.70 Addison ditto 688 125 45.40 Sawney Pope ditto 1016 227 55.86
“It appears from this table that Rodney Street is remarkably healthy, and would probably contrast favourably with any village in the country of 600 inhabitants, Egerton Street has a mortality which is considerably below that of the town in general (as 26 to 35), though still its deaths are higher than they should be. The death-rate increases gradually in the other streets on the list, until in Addison and Sawney Pope Streets it reaches the enormous amount of 45.40 and 55.86 deaths per 1000 per annum, From this table it perhaps may be inferred that the large ordinary mortality of Liverpool must be owing chiefly to the great number of streets, which, like Lace and Bispham Streets, have a high though not excessive death-rate, but in part also to the excessive mortality of certain streets like Addison and Sawney Pope Streets.
The idea that there is something unhealthy in the climate of Liverpool is again sufficiently disposed of by the fact that a street like Rodney Street, well elevated, wide and airy, and inhabited by a respectable class, presents a degree of healthiness to which it might be difficult to find many parallels in the most healthy towns”
The authors go on to discuss the causes of death and the varying death rates at some length. They point to the effect of infectious diseases such as cholera and typhus and also the effects of diseases such as bronchitis. In all these cases they point to living conditions. The following is part of their discussion of court housing:
“In these courts, the houses are packed closely together with an ingenious economy of space which does credit to the builders, though Liverpool has little reason to be thankful for it.
We give a tracing showing the arrangement of the selected streets, where a population of nearly 5,000 people are crowded into a space which, at a liberal calculation, does not exceed 23,500 square yards, or the compression of the population nearly equals 1,000 persons to an acre. ……
Within the courts, each house is usually found to consist of a room on the ground floor, a room above this; and a third room in the attic. Most of them have cellars. It very frequently happens that there is a family in each room except the cellar. In many cases, the staircase forms part of the rooms, and is without any window, so that, in fact, there is an inevitable mixture of the air contained in all the rooms. Few constructions could be better adapted for the spread of contagious diseases. In most houses in London inhabited by the poor, a separate staircase exists with landings, from which the rooms open, and there are windows permitting entrance of air. By, this means, polluted air escaping from the lower rooms into the staircase is diluted, and more or less completely carried off ; but in Liverpool; even this amount of ventilation is wanting.”
The authors also make points about the poverty of the people in the courts and the effects of drink and drunkenness. The following rather prejudiced remarks are of interest:
“ …… the large wages which can be earned , with comparative regularity, and the amount which is spent in drink, are astonishing. One or two instances of the worst kind (if there is really any distinction) occurring in the same street may be cited.
A man earns 27s. regularly, and spends as regularly 21s. in drink; his four children are in rags.
In another instance, the wages are 30s. a week regularly; the father and mother are both drunken, and three children are half starved, and in rags. In another house is a copper ore worker, earning 27s. a week, all or which is spent in drink by himself and his wife. The children are in rags and filth, and look idiotic. In the same street, there are sober men, earning only 20s. and 23s. a week, who are living in comfort.
It is not surprising that our informants, who, as we stated, have the fullest information on the habits of the people, say decidedly ‘that drink and immorality are the two great causes of the mortality.’
We have, then, a population who are living in houses originally badly planned, and very closely crowded together, and who are placed, partly by their own faults, partly by circumstances, in conditions which necessitate their breathing an atmosphere which is highly fetid from several causes.
The unhappy people seem to know none of the comforts, and few of the decencies of life, and widespread habits of, drunkenness, and consequent want of food, aid their wretched homes in destroying their health.
Add to this, that, in accordance with the usual habits of Irish Catholic population they marry early, being induced by the advice of their priests to do so in preference to living in concubinage.”