Part 34
On examining the individual cases of deaths that are classed as incident to the pursuit of the chief branches of mining or manufacturing industry, or in transport whether by land or water, it has always been satisfactory to find that for the future, by care, the greater proportion of them are preventible. In the case of the mining accidents, one part of them appear preventible by care of the superior managers of the mines—in arrangements over which the individual workman has no control; the other portion, by intelligence and care on the part of the workmen; and this last class of cases again reverts back to the power, and therefore to the means of imposing responsibility on the employers in the selection of educated and intelligent workmen—of habits of sobriety, and care to qualify them for works of danger. But at present they are, in a great measure, relieved from responsibility by the charge incurred by the want of care being thrown on other funds raised from persons who have as yet no practicable means of protection or prevention. When continued and dreadful losses of life take place, in the face of examples of successful prevention such as might be collected from every part of the country, it is impossible to avoid the conclusion that if the branch of industry were charged with the pecuniary consequences of the losses assumed to be necessarily incident to it, generations would not be allowed to pass away in fear, recklessness, and misery without the early adoption of those means of prevention which self-interest would then stimulate. A frequent suggestion made upon the view of such casualties is that government inspectors should be appointed to inspect and direct and regulate machinery.
This subject was brought under consideration in the course of the proceedings of the Factory Commission of Inquiry, and it was then agreed that such a measure as that of inspection would only give an imperfect security, and would occasion vexatious interruptions, and that the least objectionable mode of interference, as well as the most efficient and just as a means of prevention, would be to charge a portion at least of the cost of such casualties upon the branch of industry. Subsequent observation, especially of the causes of pauperism, have strengthened my convictions of the soundness of the principle of prevention as stated in our Report, a passage from which I have submitted in the Appendix.[31]
In illustration of the pecuniary cost of disease, as shown in the cost of remedies in Scotland, there are several documents. The late _Dr. Cowan_, the professor of Forensic medicine at Glasgow, gives one in which he states—
“If any arguments were wanting to arouse the community to the investigation of this important subject, they might be drawn from the heavy pecuniary tax which fever entails on the benevolent of our city, from the poverty, misery, and crime which this disease engenders. It is not possible, from the data before me, to give anything like an accurate calculation of the sums spent for the treatment of fever in Glasgow during the last twenty years. The following calculation intentionally falls considerably under the amount, to prevent every suspicion of exaggeration:—
£. _s._ _d._
1. Cost of the fever hospital 8,566 7 9
2. Temporary hospitals, and maintenance of patients 5,000 0 0 in them
3. 21,691 patients at 1_l._ 10_s._ treated at the 32,536 10 0 expense of the infirmary
——————— —— —
£46,102 17 9
======= == =
To this amount fall to be added the expense of treating the poor in their own houses under the district surgeons of the burgh, and any sums expended by the heritors or the gorbals and barony parishes for similar purposes. But this sum must have been greatly increased by the demands of pauperism produced by fever, on our poor’s-rates, and on the private benevolence of our citizens; for the duration of the disease, and the period of convalescence which must elapse before an individual can resume his work will average rather more than six weeks, and when to this is added the difficulty of again finding immediate employment, we may safely assume that the 12,895 individuals treated in the fever hospitals during the last seven years, all, with few exceptions, depending on their daily labour and extending the benefit of that labour to others, were out of employment for a period of at least six weeks.”
The _Rev. G. Lewis_, the minister of St. David’s parish, Dundee, who has answered the queries issued by the Board, and very powerfully addressed the inhabitants on this subject, in the course of one of his addresses, observes that—
“Apart altogether from the waste of human life, and the indescribable suffering and sorrow which annually fall upon the working classes of Dundee from this periodical scourge, and viewed only as a mere matter of profit and loss to the mercantile and monied interest of Dundee, it were easy to demonstrate, that the expenditure of several thousand pounds per annum, in providing the means of cleanliness to this town, in the better cleansing of its streets, but, above all, of its back closes, courts, and lanes, and the clearing away of those pestilential masses of building which lie concealed from view behind the front lines of some of our principal streets, would have been rewarded by a saving to the community of a vast sum, which the ravages of disease and death have been, for the last few years, compelling Dundee to pay in a way its inhabitants think not of. That this may appear, I have brought into one table the number of cases of fever during the last seven years.
“CASES of Fever in Dundee during the last seven years, from 1833 to 1839, inclusive, calculated from the Bills of Mortality according to the proportion of nine cases to each death:—
Year. Cases. Deaths. 1833 1,188 132 1834 1,521 169 1835 1,179 131 1836 2,673 297 1837 1,881 209 1838 1,773 197 1839 1,593 177 —————— ————— 11,808 1,312 —————— —————
“Thus, in seven years, fever has fallen on much more than a tithe of the inhabitants,—choosing its victims here, as elsewhere, in the manhood of life, and compelling the citizens of Dundee to pay a tax frightful in the amount of personal sufferings and family bereavements.
“But it were a mistake to imagine that the sufferings and death of so many citizens are the only _tithes_ which fever has compelled us to pay during the last seven years. Put wholly aside the details of domestic woe and personal suffering which 11,808 cases of fever have introduced into the families of Dundee in these seven years—omit all reckoning of the watching, want, and wretchedness, wrapped up in so many cases of acute disease, and the family bereavements implied in these 1,312 death—and let us view for a moment our fellow-creatures but as so many machines suspended from work by the derangement or destruction of the human machinery, that we may learn something of the probable money loss incurred by fever in these seven years.
“From Dr. Southwood Smith, the highest authority on these subjects, we learn that fully one-half of the cases of fever occur in the prime of life, when men are most useful either to their families or to society. Deducting then the 1,312 deaths from the whole number of cases, there will remain 10,496 cases of fever, the one-half of whom, at least, were adults,—that is, 5,248 persons in the prime of life, very many of them heads of families, had fever in these seven years. Now, the average period fever detains a patient from work, according to the same authority, is six weeks. Let us take the earnings in health of these adults at the average of 8_s._ weekly; and the loss of wages to these 5,248 adults, by six weeks’ fever, amounts to 12,595_l._; and this, after excluding all under age, and all the deaths. But these cases, whether treated at home or at the infirmary, must be also loaded with the expense of medical treatment, which is estimated in our infirmary reports at 1_l._ to each case, that is, 5,248_l._ must he added to the loss by wages. But 5,248 cases of those under age remain to be accounted for; and, as fever rarely attacks mere children, but chiefly those either in manhood or approaching manhood, we may estimate the loss of their labour at the one-half of the adults, or 6,297_l._ 12_s._, and the expense of attendance and recovery at one-half also, or 2,624_l._
“But how shall we estimate the pecuniary loss of 1,312 deaths? It seems a strange thing to go about estimating the money value of that which money did not give, and cannot restore when taken away; yet as there are those who understand better a profit and loss account than the arguments of religion and humanity, we shall attempt to estimate the money loss of these 1,312 deaths by fever.
“At least one-half, or 656 of these deaths, were deaths of adults, and very many of them heads of families, of which the 337 widows in St. David’s parish afford melancholy evidence.”
He then refers to an estimate made by _Mr. M’Culloch_, who, viewing a human being as a productive machine, reared to last a certain time, and to return so much more than he costs, estimates a full-grown workman just, arrived at maturity as having 300_l._ of capital invested in him. At the actual cost of maintaining and training a pauper child in England at the school in Norwood, 4_s._ 6_d._ per week, he will have had expended upon him at 21 years of age, 245_l._, or at 30 years, 350_l._; but he supposes—
“The money value of these male and female adults to be just the one-half of this, or 150_l._, which makes the loss, by the premature death of these 656 adults, to be 98,400_l._; and, if the remaining 656 under the age of maturity, yet approaching it, be taken at the half of the adults, or 75_l._ each, we have a loss of 49,200_l._ more; to which, if we add 1_l._ a-piece, or 1,312_l._ in all, for attendance and medical expenses, the Fever Bill of Dundee, during the last seven years, will stand as follows:—
Fever Bill of Dundee from 1833 to 1839.
£. _s._ _d._
Loss of labour for six weeks of 5,248 adults at 12,595 0 0 8_s._ a-week
Attendance, medicine at home or infirmary, at 1_l._ 5,248 0 0 each
Loss of labour for six weeks of 5,248 under age, at 6,297 12 0 4_s._ a-week
Expense of treatment of the above at infirmary or 2,624 0 0 home, at 10_s._ a-piece
Loss by death of 656 adults, at 150_l._ each. 98,400 0 0
Loss by 656 deaths under age, at 75_l._ a-piece 49,200 0 0
Treatment of 1,312 cases, at 1_l._ each 1,312 0 0
———————— —— —
£175,676 12 0
Or 25,096_l._ 13_s._ per annum.
“The poor, we are told, we shall always have with us, and so with disease and death. Yet the evils, both of poverty and disease, come in very different measures to different communities. As there is a poverty that is self-inflicted, and may be self-removed, so there is a certain amount of disease and annual mortality in every city that is self-inflicted; and the community that does not strive, by every available means, to reduce its disease and mortality bills to the lowest sum of human suffering, and the lowest rate of annual mortality, is as guilty of suicide as the individual who, Judas like, takes with his own hands the life God has given, and hurries unbidden into the presence of his Judge. The fever bills of the Scottish towns, contrasted with those of the English commercial towns, declare too plainly that man has not yet done his part in Dundee to avert this scourge of society; and, while fever is undoubtedly to be regarded as the visitation of God, it is also to be regarded as the visitation of God for the sin of neglecting a population fallen in character and habits.
In the following table are given the deaths in Dundee in seven years, and the rate to the population,—supposing the inhabitants in 1831 to have been 45,355 souls, and to have increased about 2000 annually, until 1839, when from bad trade the increase was checked:—
Years. Deaths. Population. Proportion of Deaths to the Population. 1833 1,482 49,355 1 in 33·3 1834 1,650 51,355 1 in 31·1 1835 1,673 53,355 1 in 31·9 1836 1,923 55,355 1 in 28·8 1837 1,963 57,355 1 in 29·2 1839 1,511 59,355 1 in 39·3 1839 1,763 59,355 1 in 33·7 —————— ——————— ————————— 11,965 385,485 1 in 32·2 —————— ——————— —————————
Thus, the average mortality in Dundee, during the last seven years, was 1 in 32 annually. * * * Here, then, in Dundee, the deaths annually are at least one-fourth more than over the rest of Scotland, Glasgow excepted, which seems to surpass Dundee in the waste of human life. If the deaths are a fourth greater, those diseases which are its harbingers must be many times greater than the deaths; and to this extent, at least, it was in the power of human means to have provided a remedy,—to have abated by one-fourth the physical suffering and mortality of Dundee, saved 2,952 persons from fever, and 328 persons from premature death, and reduced by a fourth part the pecuniary loss incurred during the last seven years,—in other words, to have saved 43,919_l._, or 6,274_l._ annually, to the profit and loss account of this city in the single item of fever.
“The statistics of small-pox in Dundee might be added to this bill of charges. It is sufficient, however, to allude to it. Last year, the deaths by small-pox were 77. In 1838, they were also 77; and in 1837, they amounted to 126. The number of cases, of course, must have been many times the deaths; by far the greater number under age and unvaccinated,—a neglect no longer confined to the Irish population.
* * * * *
“Though I am no medical authority, yet I am sure that I have every medical authority with me when I connect, as foremost amongst the causes of the enormous Fever Bill of Dundee that monstrous Tavern Bill, which last lecture I showed you was the worm in the bud of the happiness and well-being of its working classes. That Tavern Bill, according to the mean of three different estimates, amounts to 21,234_l._ a-year in my parish alone, and to 180,000_l._ a-year to all Dundee. In vain we cry out against the taxation of Government. While the words of complaint are on our lips, here is a vice of continual tasting and tippling in strong drink,—a private self-imposed tax, but heavier far than any public tax. It is this besetting sin that has been not only devouring the substance of the poor, but every year sowing the seeds of that enormous Fever Bill which for the last seven years has been taxing us, not only in purse but in person,—compelling every tenth man in Dundee during that period to pay the wages of six weeks’ labour, and to suffer all the langour, sickness, and oppression of six weeks’ fever, besides the bereaved widows and orphans, and the fatherless and motherless children it has left in Dundee.”
I now proceed to submit the reasons for believing that the immediate expenditure of so much money as would be incurred by the adoption of such of the remedial measures as appear to be available by the agency of any public administration would be sound measures of immediate economy, and of ultimate public gain: and also the grounds for believing that the same conclusion is applicable to the cost of those measures of prevention which, though directly or indirectly controllable by legislative authority, are within the province of private individuals to execute, such as the construction of the dwellings of the labouring classes.
VI.—EVIDENCE OF THE EFFECTS OF PREVENTIVE MEASURES IN RAISING THE STANDARD OF HEALTH AND THE CHANCES OF LIFE.
On viewing the evidence, which shows that, in most situations higher chances of life belong to the middle and higher classes of the population, an impression may be created that the higher standards of health are essentially connected with expensive modes of living. The highest medical authorities agree, however, that the more important means for the protection and advance of the health of those classes must be in still further reductions than those which it is the present tendency in the higher classes of society to make of the use of highly stimulating food. The evidence already adduced with respect to the labouring classes in the rural districts and those living on high wages in towns, will have gone some way to remove the erroneous impression with respect to them, and it admits of proof that a higher standard of health and comfort is attainable for them even at a less expense than that in which they now live in disease and misery. The experience of the effect of sanitary measures in the royal navy may be adduced as evidence of the practicable standards of health consistent with great labour and exposure to weather obtained at a cost not higher than that within the wages of ordinary labourers. The experience of the effects of sanitary measures in banishing spontaneous disease from crowded prisons, offers further evidence of the health obtainable by simple means, under circumstances still more unfavourable.
The prisons were formerly distinguished for their filth, and their bad ventilation; but the descriptions given by Howard of the worst prisons he visited in England (which he states were amongst the worst he had seen in Europe) were exceeded in every wynd in Edinburgh and Glasgow, inspected by Dr. Arnott and myself, in company with the municipal officers of those cities. More filth, worse physical suffering and moral disorder than Howard describes as affecting the prisoners, are to be found amongst the cellar population of the working people of Liverpool, Manchester, or Leeds, and in large portions of the metropolis. As a standard of the progress made in ameliorating the condition of prisoners, I refer to his general statement of the condition in which he found the prisons when he inspected them in England.
“_Water._—Many prisons have _no water_. This defect is frequent in bridewells and town gaols. In the felons’ courts of some county gaols there is no water: in some places where there is water, prisoners are always locked up within doors, and have no more than the keeper or his servants think fit to bring them.
“_Air._—And as to air, which is no less necessary than the two preceding articles, and given us by Providence quite gratis, without any care or labour of our own; yet, as if the bounteous goodness of heaven excited our envy, methods are contrived to rob prisoners of this genuine cordial of life, as Dr. Hales very properly calls it; I mean by preventing that circulation and change of the fluid without which animals cannot live and thrive. It is well known that air which has performed its office in the lungs is feculent and noxious. Writers upon this subject show that a hogshead of air will last a man only an hour: but those who do not choose to consult philosophers may judge from a notorious fact. In 1756, at Calcutta, in Bengal, out of 170 persons who were confined in a hole there one night, 154 were taken out dead. The few survivors ascribed the mortality to their want of fresh air; and called the place, Hell in Miniature.
“From hence any one may judge of the probability there is against health and life of prisoners crowded in their rooms, cells, and subterraneous dungeons, for 14 or 15 hours out of the 24. In some of those caverns the floor is very damp; in some there is sometimes an inch or two of water; and the straw or bedding is laid on such floors, seldom on barrack bedsteads. Where prisoners are not kept in underground cells, they are often confined in their rooms, because there is no court belonging to the prisons; which is the case in many city and town gaols; because the walls round the yard are ruinous, or are too low[32] for safety; or because the gaoler has the ground for his own use. Prisoners confined in this manner are generally unhealthy.
“In Baker’s Chronicle, p. 353, that historian, mentioning the assize held in Oxford Castle, 1577 (called, from its fatal consequences, the Black Assize), informs us, ‘that all who were present died within forty hours; the lord chief baron, the sheriff, and about 300 more.’ Lord Chancellor Bacon ascribes this to a disease brought into court by the prisoners; and Dr. Mead is of the same opinion.
“The first of these two authors, Lord Bacon, observes, that ‘the most pernicious infection, next the plague, is the smell of a jail, when the prisoners have been long close and nastily kept; whereof we have had, in our time, experience twice or thrice; when both the judges that sat upon the jail, and numbers of those who attended the business, or were present, sickened and died.’
“Sir John Pringle observes that ‘gaols have often been the cause of malignant fevers;’ and he informs us that in the late Rebellion in Scotland, above 200 men of one regiment were infected with the gaol fever by some deserters brought from prisons in England.
“Dr. Lind, physician to the royal hospital at Haslar, near Portsmouth, showed me, in one of the wards, a number of sailors ill of the gaol fever, brought on board their ship by a man who had been discharged from a prison in London. The ship was laid up on the occasion. That gentleman, in his ‘Essay on the Health of Seamen,’ asserts that ‘the source of infection to our armies and fleets are undoubtedly the gaols; we can often trace the importers of it directly from them. It often proves fatal in impressing men on the hasty equipment of a fleet. The first English fleet sent last war to America lost by it above 2000 men. In another place he assures us that the seeds of infection were carried from the guard-ships into our squadrons; and the mortality thus occasioned was greater than by all other diseases or means of death put together.’
“It were easy to multiply instances of this mischief; but those I have mentioned are, I presume, sufficient to show, even if no mercy were due to prisoners, that the gaol distemper is a ‘national concern’ of no small importance.”
“_Sewers._—Some gaols have no sewers or vaults; and in those that have, if they be not properly attended to, they are, even to a visitant, offensive beyond description; how noxious, then, to people confined constantly in those prisons!
“One cause why the rooms in some prisons are so close is the window-tax, which the gaolers have to pay; this tempts them to stop the windows and stifle their prisoners.