Chapter XXI: Appendix (11)

┌──────────────┬────────┬──────────────────────────────────┬──────────┐ │ CLASSES. │ Total │ │ │ │ │ No. of │ │ │ │ │ Deaths │ │Proportion│ │ │ which │ │of Deaths │ │ │occurred│ Proportion of Deaths which │ above 60 │ │ │ above │ occurred at the under-mentioned │ to Total │ │ │ 60. │ periods of Age. │ Deaths. │ ├──────────────┼────────┼───────┬───────┬────────┬─────────┼──────────┤ │ │ │Between│Between│Between │ 90 and │ │ │ │ │ 60–70 │ 70–80 │ 80–90 │ upwards │ │ ├──────────────┼────────┼───────┼───────┼────────┼─────────┼──────────┤ │ _Gentry and │ │ │ │ │ │ │ │ Professional │ │ │ │ │ │ │ │ Persons and │ │ │ │ │ │ │ │ their │ │ │ │ │ │ │ │ Families._ │ │ │ │ │ │ │ │Manchester │ 20│1 in 6│1 in 8│1 in 14│ │ 1 in 2¾ │ │Leeds │ 31│1 in 7│1 in 7│1 in 13│1 in 79│ 1 in 2½ │ │Liverpool │ 42│1 in 7│1 in 7│1 in 34│ │ 1 in 3¼ │ │Bath │ 85│1 in 5│1 in 6│1 in 5│1 in 146│ 1 in 1¾ │ │Bethnal Green │ 47│1 in 6│1 in 5│1 in 9│1 in 101│ 1 in 2 │ │Strand Union │ 28│1 in 7│1 in 9│1 in 22│1 in 86│ 1 in 3 │ │Kendal Union │ 19│1 in 17│1 in 7│1 in 6│1 in 52│ 1 in 2¾ │ │County of │ │ │ │ │ │ │ │ Wilts │ │ │ │ │ │ │ │ (Unions of) │ 62│1 in 5│1 in 4│1 in 12│1 in 119│ 1 in 2¼ │ │County of │ │ │ │ │ │ │ │ Rutland │ │ │ │ │ │ │ │ (Unions of) │ 17│1 in 9│1 in 4│1 in 6│1 in 28│ 1 in 1¾ │ ├──────────────┼────────┼───────┼───────┼────────┼─────────┼──────────┤ │ Total │ 351│1 in 6│1 in 6│1 in 10│1 in 115│ 1 in 2¼ │ ├──────────────┼────────┼───────┼───────┼────────┼─────────┼──────────┤ │ _Farmers and │ │ │ │ │ │ │ │Tradesmen, and│ │ │ │ │ │ │ │ Families._ │ │ │ │ │ │ │ │Manchester │ 61│1 in 21│1 in 38│1 in 145│1 in 242│ 1 in 12 │ │Leeds │ 161│1 in 13│1 in 12│1 in 34│1 in 824│ 1 in 5 │ │Liverpool │ 224│1 in 16│1 in 22│1 in 51│1 in 869│ 1 in 8 │ │Bath │ 57│1 in 9│1 in 12│1 in 40│1 in 122│ 1 in 4¼ │ │Bethnal Green │ 44│1 in 13│1 in 15│1 in 93│1 in 278│ 1 in 6¼ │ │Strand Union │ 51│1 in 9│1 in 13│1 in 22│ │ 1 in 4¼ │ │Kendal Union │ 48│1 in 6│1 in 10│1 in 13│ │ 1 in 3 │ │County of │ │ │ │ │ │ │ │ Wilts │ │ │ │ │ │ │ │ (Unions of) │ 99│1 in 7│1 in 6│1 in 10│1 in 31│ 1 in 2¼ │ │County of │ │ │ │ │ │ │ │ Rutland │ │ │ │ │ │ │ │ (Unions of) │ 168│1 in 8│1 in 7│1 in 9│1 in 90│ 1 in 2¾ │ ├──────────────┼────────┼───────┼───────┼────────┼─────────┼──────────┤ │ Total │ 913│1 in 12│1 in 14│1 in 29│1 in 122│ 1 in 5 │ ├──────────────┼────────┼───────┼───────┼────────┼─────────┼──────────┤ │_Agricultural │ │ │ │ │ │ │ │ Labourers, │ │ │ │ │ │ │ │ Operatives, │ │ │ │ │ │ │ │Servants, &c._│ │ │ │ │ │ │ │Manchester │ 374│1 in 20│1 in 43│1 in 149│1 in 772│ 1 in 12⅓ │ │Leeds │ 377│1 in 20│1 in 23│1 in 62│1 in 485│ 1 in 9 │ │Liverpool │ 385│1 in 27│1 in 47│1 in 102│1 in 1865│ 1 in 15 │ │Bath │ 130│1 in 16│1 in 19│1 in 45│1 in 149│ 1 in 6¾ │ │Bethnal Green │ 122│1 in 21│1 in 28│1 in 97│1 in 419│ 1 in 10¼ │ │Strand Union │ 95│1 in 12│1 in 23│1 in 84│1 in 225│ 1 in 7 │ │Kendal Union │ 114│1 in 11│1 in 9│1 in 15│1 in 207│ 1 in 3¾ │ │County of │ │ │ │ │ │ │ │ Wilts │ │ │ │ │ │ │ │ (Unions of) │ 615│1 in 11│1 in 9│1 in 11│1 in 108│ 1 in 3½ │ │County of │ │ │ │ │ │ │ │ Rutland │ │ │ │ │ │ │ │ (Unions of) │ 227│1 in 10│1 in 8│1 in 10│1 in 75│ 1 in 3 │ ├──────────────┼────────┼───────┼───────┼────────┼─────────┼──────────┤ │ Total │ 2,439│1 in 18│1 in 23│1 in 43│1 in 338│ 1 in 8 │ └──────────────┴────────┴───────┴───────┴────────┴─────────┴──────────┘

On comparing the proportion of deaths amongst all classes between one district and another, as well as between class and class, the general influence of the locality becomes strikingly apparent. The difference of mortality between one large district of the metropolis and another is shown in the following tabular view, made up by Mr. Alexander Finlaison, from the superintendent-registrar’s weekly returns of the mortality prevalent in the chief registration districts of the metropolis during the different seasons of the year. But the extremes of difference are more strikingly exhibited in smaller districts:—

Table of the Comparative Mortality of the Five following Divisions of
the Metropolis:—

┌────────┬──────┬─────────┬─────────┬─────────┬─────────┬─────────┐ │Seasons.│Weeks.│ West │ North │ Central │ East │ South │ │ │ │District.│District.│District.│District.│District.│ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ ├────────┼──────┼─────────┼─────────┼─────────┼─────────┼─────────┤ │Winter │ 13 │ 2,127│ 2,588│ 3,064│ 3,227│ 3,542│ │Spring │ 13 │ 1,611│ 2,066│ 2,264│ 2,264│ 2,682│ │Summer │ 13 │ 1,486│ 1,817│ 2,064│ 2,220│ 2,458│ │Autumn │ 13 │ 1,518│ 1,959│ 2,144│ 2,476│ 2,655│ ├────────┼──────┼─────────┼─────────┼─────────┼─────────┼─────────┤ │ Totals │ 52 │ 6,742│ 8,430│ 9,536│ 10,187│ 11,337│ ├────────┴──────┼─────────┼─────────┼─────────┼─────────┼─────────┤ │Population │ 300,705│ 365,660│ 373,806│ 392,496│ 438,060│ │ enumerated, │ │ │ │ │ │ │ 1841. │ │ │ │ │ │ ├───────────────┼─────────┼─────────┼─────────┼─────────┼─────────┤ │Deaths out of │ 224│ 231│ 255│ 260│ 259│ │ 10,000 │ │ │ │ │ │ │ inhabitants │ │ │ │ │ │ │No. of │ 44·60│ 43·38│ 39·20│ 38·53│ 38·64│ │ Inhabitants │ │ │ │ │ │ │ out of which │ │ │ │ │ │ │ 1 death │ │ │ │ │ │ │ happened │ │ │ │ │ │ └───────────────┴─────────┴─────────┴─────────┴─────────┴─────────┘

┌────────┬──────┬───────────┬────────┐ │Seasons.│Weeks.│ Whole │ Deaths │ │ │ │Metropolis.│ in the │ │ │ │ │ Four │ │ │ │ │Seasons │ │ │ │ │ out of │ │ │ │ │ 10,000 │ │ │ │ │Persons.│ ├────────┼──────┼───────────┼────────┤ │Winter │ 13 │ 14,548│ 78│ │Spring │ 13 │ 10,887│ 58│ │Summer │ 13 │ 10,045│ 54│ │Autumn │ 13 │ 10,752│ 57│ ├────────┼──────┼───────────┼────────┤ │ Totals │ 52 │ 46,232│ 247│ ├────────┴──────┼───────────┼────────┤ │Population │ 1,870,727│ │ │ enumerated, │ │ │ │ 1841. │ │ │ ├───────────────┼───────────┼────────┤ │Deaths out of │ 247│ │ │ 10,000 │ │ │ │ inhabitants │ │ │ │No. of │ 40,464│ │ │ Inhabitants │ │ │ │ out of which │ │ │ │ 1 death │ │ │ │ happened │ │ │ └───────────────┴───────────┴────────┘

The West District comprises Kensington, St. George, Hanover Square,
Westminster, St.
Martin-in-the-Fields, St. James.

The North District comprises St. Marylebone, St. Pancras, Islington
and Hackney.

The Central District comprises St. Giles and St. George, Strand,
Holborn, Clerkenwell, St. Luke, East
London, West Loudon, City of London.

The East District comprises Shoreditch, Bethnal Green, Whitechapel,
St. George-in-the-East, Stepney,
Poplar.

The South District comprises St. Saviour’s, St. Olave, Bermondsey,
St. George, Southwark, Newington,
Lambeth, Camberwell, Rotherhithe,
Greenwich.

The female is most in the house; she is the most regular and temperate in her habits; the male is subject to the influence of his place of occupation—the operative to his workshop, the clerk to the counting-house, and the merchant to crowded places of business. In the following returns made up by _Mr. Farr_, and in others that will hereafter be cited, the mortality prevalent amongst the females is given separately, as probably indicating most correctly the operation of the noxious influences connected with the place of residence:—

Mean Annual Mortality of Females in the following Metropolitan districts in the two Years and a half ending 31st December, 1839:—

Districts. Annual Deaths.
1 in
Hackney 57·87
St. George, Hanover Square 57·05
Camberwell 55·34
Islington 50·03
Rotherhithe 38·58
Clerkenwell 38·54
St. Luke 38·49
Greenwich 38·42
St. George, Southwark 33·77
East and West London 33·50
St. Giles and St. George 33·46
Whitechapel 28·15

Yet it is to be observed that the best and the worst districts present striking instances of extremes of condition in the residences and the inhabitants. In the Bethnal Green and the Whitechapel unions, in which are found some of the worst conditioned masses of population in the metropolis, we also find good mansions, well drained and protected, inhabited by persons in the most favourable circumstances. Immediately behind rows of the best-constructed houses in the fashionable districts of London are some of the worst dwellings, into which the working classes are crowded; and these dwellings, by the noxious influences described, are the foci of disease. These returns are all from large parishes, containing the mean results from all classes. If it had been practicable to give correctly the average rate of mortality prevalent in different classes of streets, the variation of results, it is to be presumed, from the variations of circumstances, would have been much greater. Since the character of the residences of many of the labouring classes, and the condition of their places of work and their habits are known, it is to be considered that where the occupations are duly registered, returns, on the principle of those we have first given of the average age of death amongst particular classes will afford the most close approximation to accuracy, or the best indications of the extent of the operation of the noxious circumstances under which each of those classes is placed.[19]

A LINEAR REPRESENTATION
_of the number of Deaths in the Metropolis, from Epidemic, Endemic and
Contagious disease; Diseases of the Brain, Nerves & Senses; diseases of
Respiratory Organs and diseases of the Heart & Blood Vessels: also the
number of Deaths from Small Pox, Scarlet Fever, Measles; Typhus Fever,
Hooping Cough, and, all other Epidemic diseases, during each Four Weeks
of the Two Years, ended the 1st January, 1842._
(_Population of 1841.—1,870,727._)

_Sanitary Report P.L.C._
]

The annexed linear view of the numbers of deaths from the chief diseases during every month of two years in the metropolis will be of interest as showing the influence of the seasons, and especially of the winter, when there is the most cold, wet, and crowding.

In Scotland we have not the advantage of systematized registries of mortality or of the causes of mortality, and we are therefore unable to make the same comparisons as in England; yet so far as the records of the dispensaries serve, they are confirmatory of the returns with respect to the different rates of mortality in differently conditioned districts in England. Thus, in a report from Leith, it is stated that—

“Contagious febrile diseases of all kinds are met with in Leith,
particularly typhus, which in certain seasons is prevalent to a great
extent. The parts of the town in which it seems to prevail chiefly (so
far as can be deduced from the records of the Leith Dispensary for the
last five years) are the central and most crowded districts in which
the number of cases amongst the poor during the last five years have
been in the proportion of 1 to 6 of the whole population, while in
other districts not so central in situation, but inhabited by persons
of nearly the same class, the proportion has been not above 1 to 13
within these districts. One locality containing a population of 1579,
has produced 433 cases of contagious fevers in general (of which 306
were of typhus) in dispensary practice, within five years, being in
the ratio of 1 to 3⅖ of fevers in general, and 1 to 5⅙ of typhus to
the gross population; of these 433 cases, 130 of all fevers, and 96 of
typhus, occurred in the two narrow streets (St. Andrew’s-street and
Giles’s-street) which bound the district to the north and south, the
remainder in the narrow lanes and closes communicating with them.
These may be regarded as the most unhealthy parts of the town.”

An impression is often prevalent that a heavy mortality is an unavoidable condition of all large towns, and of a town population in general. It has, however, been shown that, groups of cottages on a high hill, exposed to the most, salubrious breezes when cleanliness is neglected, are often the nests of fever and disease, as intense as the most crowded districts. The mortuary returns of particular districts (in the essentials of drainage, cleansing, and ventilation, to which it is practicable to make other districts approximate, and that too with reductions of existing charges), prove that a high degree of mortality does not invariably belong to the population of all towns, and probably not necessarily to any, even where the population is engaged in manufactures. The proportion of deaths appears in some of the suburbs of the metropolis (as at Hackney), and of Manchester and Leeds, to be lower than amongst the highest classes in two of the agricultural counties.

It appears from the report of Dr. d’Espine, one of the members of the Council of Health of Geneva, who has examined the records of the mortality prevalent amongst the population _extra muros_, as well as that in the city (which will hereafter be submitted to special notice), that the deaths were in the rural districts 1 in 39·3; whilst in the city they were 1 in 44·7 of the whole of the population in the year 1838. In the poorest and worst conditioned of the rural districts the proportions of the deaths were the greatest. In the year 1837 the deaths were in the poorest of the rural districts 1 in 38·6; in the intermediate district, 1 in 40·8; in the richest district, 1 in 53·2.

In comparison with the very high state of the chances of life in the county of Wilts, the city of Bath presents an example confirmatory of this view. The _Rev. Whitwell Elwin_ has supplied the following return of the chances of life amongst the different classes in that city. Out of 616 cases of death in 1840, the results were as follow:—

No. of Average Deaths. Age of Deceased.

146 Gentlemen, professional persons, and their families 55 years.

244 Tradesmen and their families 37

896 Mechanics, labourers, and their families 25

The very high average chances of life amongst the middle classes, which is nearly the same as that of the farmers, &c. of the agricultural districts, is the fact adduced as most strongly proving the salubrity of the place.

“In making these returns,” says Mr. Elwin, “I have thrown out all
visitors and occasional residents, and my knowledge of the locality,
with the assistance of the clerk of the union, has enabled me to
attain complete accuracy with respect to the gentry, and a close
approximation to it in the remaining cases. The difference in the ages
of these several classes presents to my mind a tolerably exact scale
of the difference of their abodes. The large houses, the broad
streets, looking almost invariably on one side or other upon parks or
gardens or open country, the spacious squares, the crescents built
upon the brows of the hills without a single obstruction to the pure
air of heaven, give the gentry of Bath that superiority over other
grades and other cities which their longevity indicates. And herein,
it appears to me, consists the value of the return. It shows that the
congregation of men is not of necessity unhealthy; nay, that towns,
possessing as they do superior medical skill and readier access to
advice, may, under favourable circumstances, have an advantage over
the country. The situation of the tradesmen of Bath, inferior as it is
to that of the gentry, is better than that of their own station in
other places. The streets they chiefly inhabit, though with many
exceptions, are wide, and swept by free currents of air, with houses
large and well ventilated. The condition of the poor is worse than
would be anticipated from the other portions of the town. They are
chiefly located in low districts at the bottom of the valley, and
narrow alleys and confined courts are very numerous. Yet even here we
have an unquestionable advantage over most large towns. It was only
yesterday that I was expressing my horror to a medical gentleman at
some portions of the habitations of the poor, when he replied, that it
excited little attention, because they were so much better than what
was to be seen in other parts of the kingdom.

“Whatever influence occupation and other circumstances may have upon
mortality, no one can inspect the registers without being struck by
the deteriorated value of life in inferior localities, even where the
inhabitants were the same in condition with those who lived longer in
better situations. The average age of death among the gentlemen was as
high as 60, till I came, at the conclusion, to a small but damp
district, in which numerous cases of fever brought down the average to
54. So again with the shopkeepers, the average was reduced two by the
returns from streets which, though inhabited by respectable men, were
narrow in front and shut in at the back. The average among the
labourers was greatly diminished by the returns from some notorious
courts, and raised again in a still higher proportion by districts
which appertained rather to the country than the town. Of three cases
of centenarians, one of whom had attained the vast age of 106, two
belonged to this favoured situation. Not but that great ages were to
be found in the worst parts as in the best, or that particular streets
did not in a measure run counter to the rule. Still, wherever I
brought into opposition districts of considerable extent, I found the
law more or less to obtain. Bath is a favourable town to institute the
comparison, from presenting such marked contrasts in its houses, and
the inquiry being little complicated by the presence of noxious
trades, which in some towns would necessarily disturb every
calculation of the kind. Even here a colony of shoemakers would bring
down the average of its healthiest spot to the age of childhood. My
attention was called to this circumstance by the clerk incidentally
remarking that more shoemakers were married at his office, and were
uniformly more dirty and ill-dressed, than any other class of persons.
The proneness to marriage or concubinage in proportion to the
degradation of the parties is notorious, and I anticipated from the
fact an abundant offspring, afterwards to be carried off by premature
disease. Accordingly I went with this view through several of the
registers, and the result was, that while the average of death amongst
the families of labourers and artisans in general was 24 and 25, that
of shoemakers was only 14. Had the shoemakers been excluded from the
former average, as for the purpose of this comparison they should have
been, the disproportion would be some years greater.

“The deaths from fever and contagious diseases I found to be almost
exclusively confined to the worst parts of the town. An epidemic
small-pox raged at the end of the year 1837, and carried off upwards
of 300 persons; yet of all this number I do not think there was a
single gentleman, and not above two or three tradesmen. The residences
of the labouring classes were pretty equally visited, disease showing
here and there a predilection for particular spots, and settling with
full virulence in Avon-street and its offsets. I went through the
registers from the commencement, and observed that, whatever
contagious or epidemic diseases prevailed,—fever, small-pox,
influenza,—this was the scene of its principal ravages; and it is the
very place of which every person acquainted with Bath would have
predicted this result. Everything vile and offensive is congregated
there. All the scum of Bath—its low prostitutes, its thieves, its
beggars—are piled up in the dens rather than houses of which the
street consists. Its population is the most disproportioned to the
accommodation of any I have ever heard; and to aggravate the mischief,
the refuse is commonly thrown under the staircase; and water more
scarce than in any quarter of the town. It would hardly be an
hyperbole to say that there is less water consumed than beer; and
altogether it would be more difficult to exaggerate the description of
this dreadful spot than to convey an adequate notion to those who have
never seen it. A prominent feature in the midst of this mass of
physical and moral evils is the extraordinary number of illegitimate
children; the offspring of persons who in all respects live together
as man and wife. Without the slightest objection to the legal
obligation, the moral degradation is such that marriage is accounted a
superfluous ceremony, not worth the payment of the necessary fees; and
on one occasion, when it was given out that these would be dispensed
with, upwards of 50 persons from Avon-street, who had lived together
for years, voluntarily came forward to enter into a union. And thus it
invariably happens in crowded haunts of sin and filth, where principle
is obliterated, and where public opinion, which so often operates in
the place of principle, is never heard; where, to say truth, virtue is
treated with the scorn which in better society is accorded to vice. I
have been rendered familiar with these places by holding a curacy in
the midst of them for upwards of a year, and my duty as chaplain to
the union, in visiting the friends of paupers or discharged paupers
themselves, keep up the knowledge I then contracted.

“I think these facts supply us with important conclusions. Whether we
compare one part of Bath with another or Bath with other towns, we
find health rising in proportion to the improvement of the residences;
we find morality, in at least a great measure, following the same law,
and both these inestimable blessings within the reach of the
legislature to secure. When viewed in this light, these
investigations, so often distressing and disgusting, acquire dignity
and importance.”

The suffering and expense of life prevalent in differently situated districts observed in this country, are consistent with the experience of the continent.

In a report prepared by M. Villermé, as the reporter of a committee of the Royal Academy of Medicine at Paris, appointed to investigate some statistical data on the mortality prevalent in that city, and the department of the Seine, several tables are given to show the proportions of deaths that occur in each of the several arrondissements. In the table on which the most reliance appears to be placed, the mortality in each arrondissement is exhibited as it occurs in the private residences. In the following table the arrondissements are arranged in the order of the proportions in which the houses are exempted from taxation, on the ground of the poverty of the inhabitants, beginning with the arrondissements where the exemptions are the fewest, where the houses are the largest and most valuable, and proceeding to those where the exemptions are most numerous, and the houses the least in size, as indicated by the value. The average of exempted houses, with slight exceptions, he considers a fair indication of the average condition of each arrondissement as compared with the other arrondissements. In this table I have included a column showing the deaths of persons from each arrondissement who die in the public hospitals and other places appropriated to the care of the sick. These tables perhaps comprise the whole of the mortality that occurs in that capital. I have added the proportions of deaths from cholera in each arrondissement, which followed in the highest and the lowest arrondissements the general law of mortality, with some irregularities in the intermediate arrondissements which I have not seen accounted for:—

┌──────────────────┬──────────┬─────────┬─────────────┬─────────────┬────────┐ │ ARRONDISSEMENTS. │Proportion│ Annual │ Deaths in │ Total of │Cholera.│ │ │ of │ Average │ Private │Deaths in the│ │ │ │Tenements │Value of │ Houses. │House and at │ │ │ │ exempted │Tenement.│ │ the │ │ │ │ from │ │ │ Hospitals. │ │ │ │Taxation. │ │ │ │ │ ├──────────────────┼──────────┼─────────┼──────┬──────┼──────┬──────┼────────┤ │ │ │ │Period│Period│Period│Period│ │ │ │ │ │ from │ from │ from │ from │ │ │ │ │ │ 1817 │ 1822 │ 1817 │ 1822 │ │ │ │ │ │ to │ to │ to │ to │ │ │ │ │ │1821. │1826. │1821. │1826. │ │ ├──────────────────┼──────────┼─────────┼──────┼──────┼──────┼──────┼────────┤ │ │ │ fr. │ 1 in │ 1 in │ 1 in │ 1 in │ 1 in │ │ │ │ │ │ │ │ │ │ │ 3. Montmartre │ 0·07│ 425│ 62│ 71│ 38│ 43│ 90│ │ 2. Chaussée │ 0·11│ 604│ 60│ 67│ 43│ 48│ 107│ │ d’Antin │ │ │ │ │ │ │ │ │ 1. Roule, │ 0·11│ 497│ 58│ 66│ 45│ 52│ 82│ │ Tuileries │ │ │ │ │ │ │ │ │ 4. St. Honoré, │ 0·15│ 328│ 58│ 62│ 33│ 34│ 54│ │ Louvre │ │ │ │ │ │ │ │ │11. Luxembourg, │ 0·19│ 257│ 51│ 61│ 33│ 39│ 17│ │ &c. │ │ │ │ │ │ │ │ │ 6. Porte St. │ 0·21│ 242│ 54│ 58│ 35│ 38│ 62│ │ Denis, │ │ │ │ │ │ │ │ │ Temple │ │ │ │ │ │ │ │ │ 5. Faubourg St. │ 0·22│ 225│ 53│ 64│ 34│ 42│ 67│ │ Denis │ │ │ │ │ │ │ │ │ 7. St. Avoie │ 0·22│ 217│ 52│ 59│ 35│ 41│ 34│ │10. Monnaie, │ 0·23│ 285│ 50│ 49│ 36│ 36│ 34│ │ Invalides │ │ │ │ │ │ │ │ │ 9. Ile St. Louis │ 0·31│ 172│ 44│ 50│ 25│ 30│ 22│ │ 8. St. Antoine │ 0·32│ 172│ 43│ 46│ 25│ 28│ 36│ │12. Jardin du Roi │ 0·38│ 147│ 43│ 44│ 24│ 26│ 35│ │ │ ——│ ——│ │ │ In all Paris │ 32│ 36│ │ └─────────────────────────────────────────────────────┴──────┴──────┴────────┘

It will be observed that in each table the mortality is the lowest in the three richest arrondissements (1, 2, and 3), and is the highest in the three arrondissements, which are positively the poorest, namely, the 8th, 9th, and 12th. Similar results were deduced from comparisons of the mortality prevalent in streets inhabited by different classes; and from comparisons of the different rates of mortality prevalent amongst persons of the same condition as to income, but residing in houses of favourable or unfavourable construction and situation.

If we could ascertain the rates of mortality formerly prevalent in the separate districts of each large town, it is probable we should find that the improvement in the average chances of life of the whole town has been raised principally by the improved chances in the districts where the streets have been widened, paved, and cleansed, and the houses enlarged and drained; and that the amount of sickness and chances of life in the inferior districts are as little altered as their general physical condition. The present condition of those parts of London where the average mortality is 1 in 28 annually, appears to be not dissimilar to the general condition of the whole metropolis about a century ago, which was said to be about 1 in 20, a rate still to be found in some of the most neglected streets.

_Dr. Heberden_, in an able paper which he wrote at the beginning of the present century, on the disappearance of several diseases in London, ascribes the fact, and the advance of the public health, to the improvements that have gradually taken place in the widening, paving, and cleansing the streets since the great conflagration. He observes that “the annual pestilential fever of Constantinople very much resembles that of our gaols and crowded hospitals,” and “is only called plague when attended with buboes and carbuncles.” He ascribes the exemption to “our change of manners, our love of cleanliness and ventilation, which have produced amongst us, I do not say an incapability, but a great inaptness any longer to receive it.” The examination of the disease prevalent, in the poorer districts, however, raises the question whether they have not, in the “pestilential fever by which they are ravaged,” any other than a type of the malady from which it is supposed the country is exempted. The fever itself is almost as severe in particular neighbourhoods and in unfavourable states of the weather, as it is stated to be in the bad quarters of Constantinople.

The like improvement in the public health that has followed the slow structural improvements in the best districts of the metropolis has been displayed in Paris, where some of the worst districts which remain in a condition not dissimilar to that in which the whole of Paris is described to have been, in closeness and filth, and where the chances of life have remained nearly in the same low condition. M. De Villermé, in proof of an improvement commensurate with the improvements that have been made in the condition of the streets and houses, and the habits of the inhabitants, cites a curious document of the date of the fourteenth century, namely, the register of a tax levied upon all assessable persons of Paris, when Philip-le-Bel knighted his eldest son, who afterwards succeeded him under the name of Louis the Xth. The persons assessed were housekeepers, manufacturers, merchants, masters of the different handicrafts, master jewellers, master masons, master upholsterers, haberdashers, confectioners, butchers, brewers, wine, corn, and cloth merchants, the heads of houses, amongst whom mortality in the present times would be slight compared with that prevalent amongst the lower classes. From the number of this class who are named and registered street by street by the parish priests, as having died between the date of the assessment and the date when the tax was levied, it appears that 232 out of 6042 died in thirteen months and a half, during a time which was not remarked for any extraordinary sickness. From hence it is inferred that the general annual mortality in Paris could not be less at the commencement of the 14th century than one-twentieth or a twenty-second part of the whole population; whereas in later times the general mortality has not been known to exceed one thirty-second part. The general mortality, therefore, or rather the mortality of a high and select class, was worse in the 14th century than the mortality in the worst districts in the 19th, where it was 1 in 24.

“But it will be said,” observes M. Villermé, “how can so dreadful a
mortality be admitted to have taken place in a climate so salubrious
as that of Paris? I confess that if, in order to justify that
statement, I had nothing but the book of assessment of the year 1313,
I should not have allowed myself at this distance of time to have made
any use of the facts which are found recorded in the book of which I
am speaking; but the accounts of the time inform us how much public
_hygiène_ was then neglected, and that in Paris particularly, the
horrible filth of the streets was insupportable, so much were they
encumbered with dirt of every kind.

“Some idea may be formed of the dirtiness of the streets of Paris,
towards the end of the fourteenth century, from the words of an
ordinance of Charles VI. issued in 1388, ‘And whereas the pavements of
Paris are much injured and fallen into decay, so that in many places
no horse or carriage can go without very great danger and
inconvenience, and whereas this town has long been, and still is, full
of dirt, rubbish, and ordure, which each person has left at his own
door, so that it is a great horror, and a great displeasure to all
persons of respectability and honour, and a great scandal and shame to
this city, and a great grief and prejudice to the human beings
dwelling in and frequenting the said city, who by the infection of the
stinking mass of filth have fallen in times past into great illness
and infirmities of body, and great mortality.’

“It must be borne in mind (many other facts prove it),” observes M.
Villermé, “that the humble citizens of the present day, artisans for
example, are for the most part much better off, as regards air, and
those conveniencies which preserve life than persons of much greater
wealth were in former times in this capital.” From a passage in
Ulpien, it is estimated that the chances of life is in ancient Rome as
deduced from the experience of a select class was 30 years.

He states, that the first agent to improvement is changing the infected air that they inspired in Paris for air that is pure. In the recent progress of the same change it has been observed there, as in this country, that parts of streets better paved and cleansed are marked by the comparative infrequency of disease.

Yet how much remains to be done is shown by the fact that in Paris, with a drier and more salubrious climate, the mortality is still greater than in London; and that the advantages of which M. Villermé justly speaks so highly, are distributed with extreme inequality, is apparent from his tables, which show that in one district the mortality has diminished to 1 in 52; whilst in another it remains as great as 1 in 26 annually. So we have seen that in London it ranges from 1 in 28 to 1 in 57; and it will be seen that in the township of Manchester, a population of nearly 80,000, one twenty-eighth are swept away annually, whilst, in a favoured suburban district, no more than one sixty-third part die.

I have been favoured by M. Ducpetiaux, the Inspector-general of prisons in Belgium, with the copy of a report on an inquiry similar to the present, into the condition of the labouring population in Brussels. I have submitted an extract from it in the Appendix, descriptive of the general condition in which their residences were found. When the proportion which the well-conditioned houses of that city bear to the great mass is considered, it will not excite surprise to those who have traversed the poorer districts to find that the average mortality amongst the whole population was, in the year 1840, 1 in 24. In 1829, it appears to have been 1 in 21.

In illustration of the moral and social effects to be anticipated from measures for the removal of the causes of pestilence amongst the labouring classes, and for the increase of their duration of life, concurrently with an increase of the population, I refer to the effects experienced in Geneva from the like improvements effected during the lapse of centuries. That city is, so far as I am aware, the only one in Europe in which there is an early and complete set of registers of marriages, births, and deaths. These registries were established in the year 1549, and are viewed as pre-appointed evidences to civil rights, and are kept with great care. This registration includes the name of the disease which has caused the death, entered by a district physician who is charged by the State with the inspection of every person who dies within his district. A second table is made up from certificates setting forth the nature of the disease, with a specification of the symptoms, and observations required to be made by the private physician who may have had the care of the deceased. These registries have been the subject of frequent careful examinations. It appears from them that the progress of the population _intra muros_ of that city has been as follows:—

In the Year Inhabitants. Proportionate rate of
Increase as compared
with 1589.

1589 13,000 100

1693 16,111 124, or 24 per cent.

1698 16,934 130, or 30 per cent.

1711 18,500 142, or 42 per cent.

1721 20,781 160, or 60 per cent.

1755 21,816 168, or 68 per cent.

1781 24,810 191, or 91 per cent.

1785 25,500 196, or 96 per cent.

1789 26,140 201, or 101 per cent.

1805 22,300 171, or 71 per cent.

1812 24,158 186, or 86 per cent.

1822 24,886 191, or 91 per cent.

1828 26,121 201, or 101 per cent.

1834 27,177 209, or 109 per cent.

It is proved in a report by _M. Edward Mallet_, one of the most able that have been made from these registries, that this increase of the population has been followed by an increase in the probable duration of life in that city:—

│ Proportionate rate of
│Years. Months. Days. Increase as compared
│ with the end of 16th
│ Century.

Towards the end of │
the 16th century │
the probabilities│ 8 7 26 100
of life were, to │
every individual │
born ... │

In the 17th century│ 13 3 16 153, or 53 per cent.

1701–1750 │ 27 9 13 321, or 221 per cent.

1751–1800 │ 31 3 5 361, or 261 per cent.

1801–1813 │ 40 8 0 470, or 370 per cent.

1814–1833 │ 45 0 29 521, or 421 per cent.

The progression of the population and the increased duration of life had been attended by a progression in happiness: as prosperity advanced marriages became fewer and later;[20] the proportion of births were reduced, but greater numbers of the infants born were preserved;[21] and the proportion of the population in manhood became greater. In the early and barbarous periods, the excessive mortality was accompanied by a prodigious fecundity. In the ten last years of the 17th century, a marriage still produced five children and more; the probable duration of life attained was not 20 years, and Geneva had scarcely 17,000 inhabitants. Towards the end of the 18th century there was scarcely three children to a marriage, and the probabilities of life exceeded 32 years. At the present time a marriage only produces 2¾ children; the probability of life is 45[22] years, and Geneva, which exceeds 27,000 in population, has arrived at a high degree of civilization and of “_prospérité matérielle_.” In 1836 the population appeared to have attained its summit; the births barely replaced the deaths.

M. Mallet observes, that it is difficult, if not impossible, to distinguish the different causes, and the different degrees of intensity of each of the causes that have tended to produce this result. It is, however, attributed generally to the advance in the condition of all classes; to the medical science of the public health being better understood and applied; to larger and better and cleaner dwellings; more abundant and healthy food; the cessation of the great epidemics which, from time to time, decimated the population; the precautions taken against famine; and better regulated public and private life. As an instance of the effects of regimen in the preservation of life, he mentions that, in an establishment for the care of female orphans taken from the poorest classes, out of 86 reared in 24 years, one only had died These orphans were taken from the poor. The average mortality on the whole population would have been six times as great.[23]

An impression of an undefined optimism is frequently entertained by persons who are aware of the wretched condition of a large portion of the labouring population; and this impression is more frequently entertained than expressed, as the ground of inaction for the relief of the prevalent misery from disease, that its ravages form the natural or positive check, or, as Dr. Short terms it, a “terrible corrective” to the pressure of population on the means of subsistence.

In the most crowded districts, which have been the subject of the present inquiry, the facts do not justify this impression; they show that the theory is inapplicable to the present circumstances of the population. How erroneous the inferences are in their unrestrained generality, which assume that the poverty or the privation which is sometimes the consequence,—is always the cause, of the disease, will have been seen from such evidence as that adduced from Glasgow and Spitalfields, proving that the greater proportion of those attacked by disease are in full work at the time; and the evidence from the fever hospitals, that the greatest proportion of the patients are received in high bodily condition. If wages be taken as the test of the means of subsistence, it may be asked how are such facts to be reconciled as these, that at a time when wages in Manchester were 10s. per head weekly on all employed in the manufactories, including children or young persons in the average, so that if three or four members of a family were employed, the wages of a family would be 30_s._ or 40_s._ weekly, the average chances of life to all of the labouring classes were only 17 years; whilst in the whole of Rutlandshire, where the wages were certainly not one half that amount, we find the mean chances of life to every individual of the lowest class were 37 years? Or, to take another instance, that whilst in Leeds, where, according to Mr. Baker’s report, the wages of the families of the worst-conditioned workers were upwards of 1_l._ 1_s._ per week, and the chances of life amongst the whole labouring population of the borough were only 19 years; whilst in the county of Wilts, where the labourer’s family would not receive much more than half that amount of wages in money, and perhaps not two-thirds of money’s worth in money and produce together, we find the average chances of life to the labouring classes 32 years?

If, in the most crowded districts, the inference is found to be erroneous, that the extent of sickness and mortality is indicative of the pressure of population on the means of subsistence, so is the inference that the ravages act to the extent supposed, as a positive check to the increase of the numbers of the population. In such districts the fact is observable, that where the mortality is the highest, the number of births are more than sufficient to replace the deaths, however numerous they may be.

This fact is shown in the following returns from the eight townships which comprehend Manchester and its suburbs, made by the Statistical Society of that town. But I believe the results would be more strongly manifest if the registration of the births and of the residences of the mothers were complete. I have reason to believe that in the lower districts many births, and especially illegitimate births, escape registration, and that many take place in hospitals and workhouses out of the township; whilst in the better conditioned districts the registration is comparatively accurate. I have caused attempts to be made in several of the worst neighbourhoods in Bath and other places, to ascertain with greater precision the actual number of births; but from the migratory character of the population and other circumstances, the efforts failed to do more than to confirm the impression that many had hitherto escaped registration.

The proportion of mortality in the several townships denotes with little variation the state of the streets and houses, and the condition of the inhabitants. The township of Broughton is inhabited almost exclusively by the upper classes, who are connected with Manchester. The houses are new, spacious, and well built; the site is elevated, and offers great facilities for drainage. The township of Cheetham and Crumpsall is also inhabited for the most part by the upper classes, who live in peculiarly good houses, with a superior natural drainage. There is a proportion of the working population resident in this district whose houses are well built, and also favourably situated for drainage. The condition of the habitations of a large proportion of the labouring population in Manchester has already been described.

It will be observed also that the moral as well as the sanitary influences have a coincidence in the larger proportion of the illegitimate births in the worst conditioned districts. In the best conditioned districts the great majority of illegitimate births belong almost exclusively to the more dissipated of the labouring classes who inhabit them.

┌───────────┬────────────────┬───────────────┬────────┬───────────┬──────────┐ │Localities.│ Population. │ Deaths. │ Total │Proportion │Proportion│ │ │ │ │ Deaths │ of Births │of Illegi-│ │ │ │ │of Males│ to │ timate │ │ │ │ │ & │Population.│Births to │ │ │ │ │Females.│ │ Total │ │ │ │ │ │ │ Births. │ ├───────────┼───────┬────────┼──────┬────────┼────────┼───────────┼──────────┤ │ │Males. │Females.│Males.│Females.│ │ │ │ ├───────────┼───────┼────────┼──────┼────────┼────────┼───────────┼──────────┤ │ │ │ │ 1 in │ 1 in │ 1 in │ 1 in │ 1 in │ │Broughton │ 1,554│ 2,239│ 44·40│ 89·56│ 63·21│ 36·82│ 51·50│ │Cheetham │ 3,963│ 4,862│ 45·03│ 63·14│ 53·48│ 34·74│ 50·80│ │ and │ │ │ │ │ │ │ │ │ Crumpsall│ │ │ │ │ │ │ │ │Pendleton │ 5,109│ 5,796│ 40·22│ 49·96│ 44·87│ 25·47│ 12·58│ │Chorlton- │ 12,551│ 15,771│ 30·91│ 47·79│ 38·48│ 26·05│ 32·93│ │ upon- │ │ │ │ │ │ │ │ │ Medlock │ │ │ │ │ │ │ │ │Hulme │ 12,850│ 13,969│ 37·24│ 38·48│ 37·87│ 23·17│ 24·10│ │Ardwick │ 4,586│ 5,320│ 35·55│ 34·54│ 35·00│ 24·27│ 34·00│ │Salford │ 24,762│ 26,760│ 27·30│ 36·60│ 31·42│ 22·83│ 21·90│ │Manchester │ 79,061│ 84,606│ 26·61│ 30·15│ 28·33│ 26·79│ 19·20│ ├───────────┼───────┼────────┼──────┼────────┼────────┼───────────┼──────────┤ │ Total │141,436│ 159,323│ 28·84│ 34·62│ 31·60│ 25·74│ 21·26│ └───────────┴───────┴────────┴──────┴────────┴────────┴───────────┴──────────┘

In the ten registration districts of Leeds the mortality prevalent in them varies coincidently with their physical condition, and the recklessness and immorality as shown in the proportion of illegitimate births, increases in a greater proportion than the mortality; and in this instance also, as in most others, if the registration were more accurate, the proportion of both legitimate and illegitimate births would be still closer to the deaths in the worst conditioned districts.

┌────────────────────┬───────────┬───────────┬───────────┬────────────┐ │ Registration │Population.│ Ratio of │ Ratio of │ Ratio of │ │ Districts. │ │ Deaths to │ Births to │Illegitimate│ │ │ │ the whole │ the whole │ Births to │ │ │ │Population.│Population.│ Total │ │ │ │ │ │ Births. │ ├────────────────────┼───────────┼───────────┼───────────┼────────────┤ │ │ │ 1 in │ 1 in │ 1 in │ │Chapeltown │ 4,538│ 57·7│ 30·6│ 74·0│ │Whitkirk │ 3,194│ 56·0│ 29·0│ 36·7│ │Kirkstall │ 17,816│ 45·6│ 24·8│ 23·1│ │Rothwell │ 5,557│ 45·1│ 28·2│ 24·6│ │Wortley │ 16,185│ 44·4│ 24·9│ 26·0│ │Holbeck │ 16,668│ 41·9│ 25·4│ 24·3│ │Leeds, West │ 32,286│ 40·4│ 28·4│ 19·2│ │Hunslet │ 15,784│ 35·5│ 24·2│ 21·7│ │Leeds, North │ 30,465│ 30·9│ 23·9│ 14·3│ │East District │ 24,862│ 28·8│ 24·3│ 20·0│ │ (Kirkgate) │ │ │ │ │ ├────────────────────┼───────────┼───────────┼───────────┼────────────┤ │Total of Leeds │ 167,355│ 37·3│ 25·5│ 20·1│ └────────────────────┴───────────┴───────────┴───────────┴────────────┘

We have seen that in the lowest districts of Manchester of 1000 children born, more than 570 will have died before they attain the fifth year of their age. In the lowest districts of Leeds the infant mortality is similar. This proportion of mortality M. Mallet designates as the case of a population but little advanced in civilization, ravaged by epidemics—a population in which the “influences on the lower ages are murderous, but where the great mortality in infancy is compensated by a high degree of fecundity. It is the case of the population in many large towns, especially in past ages.” But whilst in Manchester, where one twenty-eighth of the whole population is annually swept away, the births registered amount to 1 in 26 of the population; in the county of Rutland, where the proportion of deaths is 1 in 52 of the population, the proportion of births, as shown by an average of three years, (by a registration which I apprehend is more complete than in the lower districts of Manchester,) is only 1 to 33 of the population.

The increase of births after a pestilence has been long observed; the coincidence of an increase of births in a proportion to the high rate of mortality in the worst districts has frequently been noted on the continent. M. Quetelet has observed the fact in several countries and gives instances from which the following are selected:—

┌─────────────────────┬───────────────────────────────────────────────┐ │ Countries. │ Inhabitant. │ ├─────────────────────┼──────────────┬─────────────────┬──────────────┤ │ │For one Death.│For one Marriage.│For one Birth.│ ├─────────────────────┼──────────────┼─────────────────┼──────────────┤ │Department of Orne │ 52·4│ 147·5│ 44·8│ │Department of │ 30·4│ 113·9│ 26·0│ │ Finisterre │ │ │ │ │Namur │ 51·8│ 141·0│ 30·1│ │Province of Zealand │ 28·5│ 113·2│ 21·9│ └─────────────────────┴──────────────┴─────────────────┴──────────────┘

He states that he had often been tempted to attribute these discrepancies to a faulty census of the population; but more attentive researches had induced him to believe that this state of things is dependent on local causes.

M. Bossi, in the Statisque du Department le l’Ain, gives a striking example of the effect of the locality. With a view to study the influences of locality, he divided the department into four portions; and from documents collected during the years 1812, 1813, and 1814, he obtained the following results:—

Inhabitants.

———————————— ———————————— ————————————

To 1 Death To 1 To 1 Birth
annually. Marriage annually.
annually.

In mountain parishes 38·3 179 34·8

On the seaside 26·6 145 28·8

In corn districts 24·6 135 27·5

In stagnant and marshy districts 20·8 107 26·1

Notwithstanding the depression of many districts, and the decrease of health amongst the classes in the manufacturing towns from which a large proportion of conscripts are taken, the annual proportions of deaths appear to have decreased.

In 1784, from researches taken in France under Necker’s directions, it appeared that there was one birth for every 25·56 inhabitants

In 1784, from researches taken in France under Necker’s directions, it appeared that there was one death for every 30·02 inhabitants

From 1816 to 1831 there was one birth only for every 32 inhabitants

One death 39·8 inhabitants

M. Quetelet’s returns show that so far as the present state of information can be relied upon, the same law is observed in general action, not only in provinces but in whole countries throughout Europe. It is confirmed by extensive experience occurring in the new world. The trustworthiness of the registration of births and deaths in Mexico are attested by the examination and use of them by Humboldt, and have been the subject of legislative proceedings. The ratios of births and deaths in the province of Guanaxuato have been referred to by Sir F. d’Ivernois, in illustration of the position that pestilence does not check the progress of population. A large proportion of the inferior Mexican population are reported to “have converted the gifts of heaven to the sustenance of disgusting misery.” It is reported of this populace that it is “half clothed, idle, stained all over with vices; in a word, hideous and known under the name of _leperos_, lepers, on account of the malady to which their filth and bad diet subjects them. Nothing can exceed the state of brutality and superstition to which they have been subjected.”[24]

The fecundity of this population, sunk in the lowest vice and misery amidst the means of the highest abundance, was greater than amidst any other whole population in Christendom;[25] they stood thus in 1825 and 1826:—

1 in
Deaths 19·70
Births 16·08

They are much mistaken who imagine that a similarly conditioned population is not to be found in this country; it is found in parts of the population of every large town; the description of the Mexican populace will recall features characteristic of the wretched population in the worst parts of Glasgow, Edinburgh, London, and Bath, and the lodging-houses throughout the country.

Seeing that the banana (with the plantain or maize) is the chief food of the inferior Mexican populace, their degraded condition has been ascribed to the fertility of that plant, as the degradation of a large proportion of our population has been ascribed to the use of the potatoe, whereas a closer examination would have shown the fact of large classes living industriously and virtuously chiefly on simple food, and preferring saving money to better living; and that, if a high and various meat diet were the cause of health, industry, and morality, those virtues should stand highest amongst the population of the lodging-houses, for more meat and varied food is consumed in those abodes of pestilence than amongst the industrious population of the village. In Manchester, where we have seen that the chances of life are only 17 years, the proportions and varieties of meat consumed by the labouring classes, are as their greater amount of wages compared with the meat consumed by the labouring classes in Rutlandshire, whose mean chances of life are 38 years.[26] But I apprehend that the superior health in Rutlandshire is as little ascribable to their simpler food as the greater amount of disease amidst the town population is ascribable to the greater proportion of meat which is there consumed. It is probable indeed that the standard of vitality in Rutlandshire might be raised still higher by improvements in the quality of their food. There are abundant reasons to render it desirable that the food of the population should be varied, but it is shown that banishing the potatoe or discouraging its use, or introducing any other food, will not banish disease.