The City of London appears peculiarly fatal to infant life. _Reports Relating to the Sanitary Condition of the City of London

the Registrar-General’s last septennial record shows that of every 1000

male children under five years of age within the City of London

(aggregately) nearly 113 die in each year; and the portion of this rate

which is deduced from the East and West London Unions is as high as 119

in the thousand. In the subjoined table,[34] which illustrates some

points of comparative mortality, I have endeavoured to show the extreme

and disproportionate amount of this pressure on infant life. In

referring (for instance, in regard of the City of London Union) to the

last three columns of that table, you will observe that the mortality of

children at the age stated, during the septennial period, was 1/2·66 of

the entire mortality, although their class numerically constituted only

1/11·09 of the entire population; so that they died at more than four

times (4·17) the rate which would have fallen to them as simple

participators in the average mortality of their district. The actual

infant mortality of the past year holds the same proportion to the

general mortality as in the Registrar-General’s septennial period, being

1/2·66 of the whole.

[34]

+--------------+---------+--------+----------+----------+-----------+

+--------------+---------+--------+----------+----------+-----------+

|Union | 21 | 101 | 1/11·09 | 1/2·66 | 4·17 |

|don Union | 26¾ | 101 | 1/9·02 | 1/2·24 | 4·02 |

|Metropolis | 25 | 93 | 1/8·45 | 1/2·45 | 3·45 |

|Holborn | 26 | 115 | 1/8·98 | 1/2·20 | 4·08 |

|St. Giles | 27 | 122 | 1/9·85 | 1/2·24 | 4·39 |

|St. Martin | 24 | 120 | 1/10·64 | 1/2·42 | 4·39 |

|Bristol | 29 | 107 | 1/8·73 | 1/2·53 | 3·45 |

|Liverpool | 33 | 143 | 1/7·35 | 1/1·91 | 3·85 |

|Lancashire | 26¾ | 102 | 1/7·19 | 1/2·02 | 3·56 |

|Surrey | 18 | 48 | 1/7·98 | 1/3·22 | 2·48 |

|England | 19 | 52 | 1/7·76 | 1/3·03 | 2·56 |

|Glendale } | | | | | |

|Bellingham } | 14 | 28 | 1/10·32 | 1/3·99 | 2·58 |

|Haltwhistle } | | | | | |

+--------------+---------+--------+----------+----------+-----------+

Lest any undue importance should be ascribed to the influence of bad or

inappropriate articles of diet in producing this large infant mortality,

I may inform you that the rate of death is highest during that very

early period of life when the child depends for nourishment on its

mother; so that, of a thousand male children in the first year of life

there die within the district of the City of London Union 242; within

that of the East and West London Unions, 276.

The causes which thus decimate the young population of London are the

common conditions of district unhealthiness--the conditions which it

lies within the scope of sanitary legislation to amend. But, inasmuch as

the few days of these wretched children are passed mainly within doors,

so their high mortality constitutes the readiest and least fallacious

evidence of the unwholesomeness of the dwellings in which they die: and

hence I am acquainted with no correcter material for estimating the

sanitary condition of a district than is afforded by the death-rate of

its infant population.

Secondly, with regard to the alleged _particular causes of death_; I

have extracted from our general registry, and have grouped in a separate

table, those cases of death from acute disease which seem peculiarly due

to physical causes affecting large numbers of persons.

There are deaths by cholera, epidemic diarrhœa, and dysentery, of which

during the biennial period we have had nearly 900; by fever, of which we

have had 284; by erysipelas and puerperal fever, of which we have had

84; by small-pox, of which we have had 50; and cases of this sort

partake of the nature of deaths by violence, not only because they are

abrupt and untimely, but because they are _avoidable_. If in the

instances which I have specified it were possible to make inquiry into

the antecedent circumstances of the dead, you would find irrefragable

evidence that life was lost in each individual instance by the operation

of removable causes--by the foolhardy neglect of some familiar

precaution, or by the obstinate retention of some notorious ill. The

death of a child by small-pox would in most instances call for a verdict

of ‘homicide by omission’ against the parent who had neglected daily

opportunities of giving it immunity from that disease by the simple

process of vaccination; the death of an adult by typhus would commonly

justify still stronger condemnation (though with more difficulty of

fixing and proportioning the particular responsibility) against those

who ignore the duties of property, and who knowingly let, for the

occupation of the poor, dwellings unfit even for brute tenants,

dwellings absolutely incompatible with health. In addition to the

diseases which I have named, there are others which owe their chief

malignity and numerical largeness of fatality, though not their

existence, to local and removable causes. The proportionate mortality

from scarlatina, measles, and hooping-cough, is greatest when the

general death-rate is greatest. Under similar circumstances, too, we

find among the infant population a frequency and fatality of other

diseases, not commonly accounted specific, which warrant us in

considering them to be mainly of endemic and avoidable origin. Such are

the hydrocephalus and convulsions, the diarrhœa, bronchitis, and

pneumonia of infants; often indeed referred to the irritation of

teething, but prevailing in different localities with so marked a

proportion to the causes of other endemic disease that we may be sure of

their partial and considerable dependence on those local and obviable

causes. I dwell on this aspect of the subject, and particularly invite

the attention of your Hon. Court to the table[35] which illustrates it,

because it is in respect of these diseases that your exertions have

already effected valuable improvements for the health of the City, and

because the future registry of such cases will attest year by year the

further progress of your sanitary reforms. In examining this index of

preventable deaths you will notice that those from fever are fewer by 29

_per cent._ in the year just terminated than in the previous twelve

months; that those from scarlatina are 75 _per cent._ fewer; those from

infantile zymotic disorders nearly 40 _per cent._ fewer; those from

erysipelas and puerperal fever 9 _per cent._ fewer. Small-pox, it is

true, is doubled; but the prevention of this disease rests, out of your

jurisdiction, in the exercise of individual discretion. Under the item

of infantile diarrhœa (included in the tenth column) there is likewise

an increase of nearly a third;[36] an exception probably dependent on

the fact that, during last year, many deaths which might have swelled

this column were (on account of the then prevalent influence) catalogued

under the head of epidemic diarrhœa or cholera.

[35] _Appendix_, No. IX.

[36] In the column referred to, this is concealed by the marked

diminution, during the present year, of other disorders classed with

infantile diarrhœa. Their reduction maintains the total of that column

(notwithstanding the difference of diarrhœa) considerably less for

this year than for last.

I should be misleading your Hon. Court, and practising a deception which

next year’s registry would expose, if I pretended that the striking

difference between the two years’ several totals of preventable deaths

(a difference which, leaving cholera out of the question, probably

amounts to a diminution of 30 _per cent._ on the sum of last year) had

resulted wholly, or even chiefly, from sanitary improvement, and could

be interpreted as the evidence of permanent physical changes around the

dwellings of our poorer population. I guard you against this impression

now, because, however satisfactory it might be as a momentary belief, it

would lead to subsequent disappointment; and any future rise in the

proportion of these deaths would induce the erroneous, but

disheartening, supposition that your later sanitary steps had been less

successful than the first. In all these matters, and especially in

analysing the details of a death-registry, it is requisite (as I have

already stated) to deal with cycles of many years. Periods of

pestilence are habitually followed by periods of diminished mortality:

partly because population is diminished, and especially that share of

the population which suffers most from obviable causes of disease;

partly because the great alarm of death has induced vigilance and

precaution, public and private, against the occasions and beginnings of

illness. And, beyond both these circumstances, there are others which we

cannot analyse or explain, though we have scientific certainty of their

operation; circumstances which seem to ensure a comparative quiescence

of the ordinary causes of zymotic disease during those periods which

next succeed the prevalence of certain fatal epidemics.[37]

[37] For the professional reader I may here throw out a

hint--referring to the doctrine of epidemic disease stated in the

Fifth Annual Report, that this apparent healthiness of districts after

certain epidemic invasions probably bears relation to a temporary

exhaustion of their zymotic atmosphere under the action of a specific

ferment, and is in some respects analogous to that immunity from an

infected fever which belongs to an individual who has recently

suffered its attack. See also page 235.--J. S., 1854.

Nevertheless, that the sanitary condition of the City has undergone

considerable improvement within the last two years is a fact which no

one can gainsay; and that a considerable share of the mitigation in

mortality arises from this improvement cannot reasonably be questioned.

If even a third of the mitigation in question, if a reduction of ten

_per cent._ on the preventable mortality of the City, may be inferred

from the materials which I lay before you, it is indeed matter for the

utmost congratulation; and a continuance of the same reduction year by

year, perpetuated (as doubtlessly it may be) by a continuance of the

same exertions, would soon raise the City of London above all fear of

comparison, on the ground of healthiness, with urban or suburban

populations.

Thirdly, I would beg the attention of your Hon. Court to those very

important _local differences_ of death-rate which may be deduced from a

study of our death-register. I have already had the pleasure of citing

to you the low rate of mortality which has prevailed during the last

year in the north-west sub-district of the City of London Union. The

rate of death in the north division of the West London Union was nearly

double that proportion; and between these extreme terms of disparity

there were many intermediate degrees.

Similar inequalities of mortality were observable in last year’s record.

In the healthiest sub-district of the City the year’s death-rate was

about 22 in the thousand; while in the worst it stood above 41; and for

the whole West London Union exceeded 38.[38]

[38] I have here availed myself of the corrections given in the note

of page 6.

Mainly and essentially these local differences of mortality depend on

the proportion in which _preventable deaths_ enter into the total; the

differences, however partial, depending on the operation within certain

districts, of removable deleterious influences which do not exist in

certain other districts.

In classifying for your consideration the deaths which, during the last

two years, have depended on epidemic, endemic, and infectious diseases,

I have thought it desirable to distribute them according to the

municipal divisions of the City. Strongly believing, as I have

endeavoured to express, that this class of deaths is for the main part

preventable, I have thought it would interest the representatives of the

several Wards, and would more directly enlist their sympathies for

sanitary progress, if I could enable them at a glance to recognise the

ratio in which their respective constituencies contribute to this annual

death-roll. I have included in the table, under eight different heads,

all those acute diseases which depend in an important degree on local

causation, either for their existence or for their fatality. It will be

obvious, even to the unprofessional reader, that local causes are not of

equal prevalence in respect of all the diseases there tabulated. Some

(as fever and cholera) would not be known at all under perfect sanitary

arrangements; others (as scarlatina, measles, and hooping-cough) would

be far less malignant in their attacks; others (as those classified in

the tenth and twelfth columns) would no doubt exist under the most

perfect physical circumstances, but would probably prevail in numbers

quite inconsiderable as compared with those actually observed.

On consulting this table[39], it will be observed that in _Cordwainers_’

Ward, during the last year, not a single death occurred from the causes

referred to, and in the preceding year of epidemic visitation, only

five; that in _Cornhill_ Ward there have been only two such deaths in

each of these years; that in _Coleman-street_ they have been 66; in

_Queenhithe_, 59; in _Portsoken_, 143; in _Aldersgate Within_, 30; in

_Aldersgate Without_, 179; in _Cripplegate Within_, 80; in _Cripplegate

Without_, 299; in _Bishopsgate Within_, 60; in _Bishopsgate Without_,

329; in _Farringdon Within_, 153; in _Farringdon Without_, 845.

[39] Page 167.

I am unable to state with accuracy, in these several instances, what

proportion subsists between the preventable mortality and the number of

living persons, for I have no means of ascertaining precisely the

population of the separate Wards; and without this knowledge it is

impossible to arrange them in a scale of comparative healthiness. I need

hardly remind your Hon. Court that the Wards differ very considerably in

their magnitude; so that the largest majority of cases occurring in one

Ward (as in Farringdon Without) must not unconditionally be taken to

imply that the Ward, _in proportion to its population_, suffers more

deaths than one in which the apparent number is less considerable. In

the table to which these remarks refer, I have endeavoured to give you

the means of comparing (at least approximatively) the healthiness of

your several departments, by entering against the name of each Ward the

number of holdings for which it stands assessed to your rate. This

entry, with some trifling modifications specified in the table, may be

taken to express the number of houses contained in each Ward of the

City: thus it furnishes indirectly the means for estimating the local

population.

It will be noticed, that the more glaring inequalities which I have

adduced are in some degree due to the epidemic of last year, which did

not press uniformly on all parts of the City. It may, however, likewise

be observed, that the chief operation of that epidemic was to

exaggerate, but not importantly to misrepresent, the features of each

locality; that the habitual sanitary proportions of districts to each

other were for the most part preserved; that (with a qualification to

which I shall presently revert) the Wards numbering fewest deaths last

year numbered also fewest this year.

In my last Report, when the cholera had scarcely subsided, when men’s

minds were full of apprehension on the subject, and when it seemed only

too possible that, with the recurrence of autumn, we might again suffer

from its invasion, I was unwilling to dwell too pointedly on the

wonderful pertinacity with which that disease fixes itself on particular

localities, and tends to re-appear in them on each new occasion of its

rise. Believing that no extemporaneous measures could counteract these

local preferences of the epidemic, I refrained from a course which would

have produced no good result (unless indeed it had depopulated certain

spots of the City), and which might have caused unavailing and hurtful

alarm. Now, however, I think it right to tell you that the local

predilections of this dreadful disease are so marked and so obstinate,

that we may almost certainly predict in what parts of the metropolis it

would tend to arise on any renewed visitation. We may anticipate that at

any such time its latent power of destruction will kindle again in the

districts, the streets, the houses, perhaps even in the very rooms,

where it recently prevailed, _unless the determining local conditions

shall previously have been annulled_.

It would be ridiculous if I should pretend to carry you into any medical

consideration of this subject, or should make my present Report the

vehicle of a professional argument; but I may very briefly acquaint you

with such generalisations as will justify you in pursuing a particular

course with respect to the haunts of cholera. While doing so, I hope

your Hon. Court will believe that I have devoted to this very serious

subject the best consideration of which I am capable, and have done my

utmost to arrive at conclusions which may be fruitful of practical good.

Cholera visited no localities of which it could be said, that they were

generally healthy; but still there seemed to be something peculiar and

specific in the kind of local unhealthiness which determined its

invasion. On the one hand, it is unquestionably true that many habitual

seats of fever were visited by cholera; on the other hand, many of the

worst fever-nests in the whole metropolis were unaffected by it; and it

struck with extreme severity in a class of houses habitually exempt from

fever. See, for instance, how malignantly it prevailed along the line of

Farringdon and New Bridge streets, and in Fleet-street and Ludgate hill,

where their line intersects that just mentioned; and here, you will

observe, not only in those obscure and ill-ventilated courts and

by-ways, where fever is the familiar visitant of a hungry and crowded

population; but also, and very strikingly, in spacious and airy houses,

situate along the main thoroughfare of the City, and inhabited by

opulent tradesmen, by members of the various professions, or by officers

of assurance-companies. Other infective diseases which habitually

desolate the former class of dwellings are almost unknown in the latter.

Cholera came as a startling exception. _Within the infected district_

(fulfilling the classical description of pale death) it trod with equal

foot the gates of rich and poor.[40]

[40]

---- Æquo pulsat pede pauperum tabernas Regumque turres.

I think it very important that this fact should be fully recognised.

In London it has often been overlooked, from the accident that our

most infectable districts happen to contain an excess of poor

population. But even here it is quite easy to note that the disease

spreads irrespectively of pauperism or privation; and in other cities,

(Paris and Copenhagen, for instance) where the quarters of rich and

poor are less apart than in London, cholera has killed its full share

of dignitaries and capitalists.--J. S., 1854.

Personal peculiarities, or vicious habits, or temporary indiscretion,

may often have determined its choice of a victim; low nourishment--even

temporary emptiness and exhaustion, very manifestly invited its attack;

but, speaking generally, I may say that it was a disease prevailing over

a certain patch of ground, and (within this limit) tending to strike

equally, or nearly equally, in all classes of habitations. Crowdedness

of dwellings, defective ventilation, squalor of inhabitants, and many

forms of local nuisance, which are omnipotent in giving occasion to

fever, and in adding malignity to many disorders of its class, did not

by themselves exert so marked and specific a power in determining the

onset of cholera.

What then were the conditions determining its local preference?

Consideration of its statistics, or inspection of a cholera-map, enables

one, with some confidence, to answer--a peculiar condition of soil, of

which dampness is one sure and invariable character, and organic

decomposition (promoted by dampness) probably another.[41] Its local

affinities have much analogy to those of ague, and often appear

identical in their range with the sphere of malarious infection. Our

entire metropolis, built down to the very margins of a large river--of a

river, too, which, at each retreating tide, exposes acres of mud

saturated with the reeking sewage of an immense population, is placed

generally in circumstances not unfavourable to the development of the

disease; and its several parts will be liable to suffer especially, in

proportion as they are exposed to these general circumstances, or to

special circumstances of their own of a like nature. The lower level of

districts on the south side of the river, their attendant failure of

natural land-drainage, the consequent soddenness of a soil from which

likewise the materials of house refuse were never efficiently removed,

accounted sufficiently for the frightful epidemic mortality which

prevailed in those quarters of the metropolis.

[41] After three years’ further inquiry I find no reason to modify

this general description: but, as regards the local circumstances

which determine the specified condition of soil and atmosphere, I have

been able to extend my information; and the subject is therefore

better treated in my Fifth Annual Report than in the paragraphs here

following above.--J. S., 1854.

Reports Relating to the Sanitary Condition of the City of London · 第 8 / 26 段

The City of London appears peculiarly fatal to infant life. Reference to