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:—