Part 28
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._)
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.