Part 29
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