Once more, and this time in an accentuated degree, the widespread prevalence of the disease, and the frightful mortality, were distinctly due to the inertia, laxity, or deliberate neglect of those local authorities who by law were charged with the duty of cleansing localities and removing some of the causes of disease. The General Board of Health, of which Sir Benjamin Hall was President, did all that it could do. Medical inspectors were appointed by it to visit all the parishes most severely affected; and the fullest and minutest instructions were issued to the Boards of Guardians as to the course they should pursue, and the action they should take. But several of the Boards of Guardians took no notice of the instructions sent them; others sent unsatisfactory replies. In not one of the parishes in which the epidemic was most fatal was the preventive machinery, sanitary and medical, organised in accordance with the instructions; and although some parishes did more than others, yet, speaking generally, the administration of the sanitary and medical relief measures by the Boards of Guardians was inefficient in character and extent, except in some of the larger and more healthy parishes where they were least wanted.[51] At Rotherhithe, the Guardians declined to proceed with the removal of nuisances as entailing a useless expense. At Deptford, where cholera was at the worst, no Inspector of Nuisances was appointed, even for the emergency. Nor did Greenwich, where it was also bad, appoint one. In Bethnal Green, where memories ought to have been bitter, the authorities practically did nothing, although promising almost everything. In Lambeth, the parish was left without any adequate protection against the epidemic; and it was only after urgent remonstrances by the Medical Inspector, and after his threatening to place himself in communication with the coroner in any cases of death occurring in localities where the proper cleansing measures had not been carried out, that he succeeded in obtaining the adoption of measures even to a limited extent.[52] In Clerkenwell, the Guardians utterly disregarded the recommendations of the Board of Health, and from the first there was an openly expressed determination not in any way to be interfered with by the Board. And the disastrous state of affairs was, that the Nuisances, &c., Removal Acts gave the Board of Health no power to enforce upon the Guardians the execution of the regulations made.