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 of Tenements exempted from Taxation. | Annual Average Value of Tenement. | Deaths in Private Houses. | Total of Deaths in the House and at the Hospitals. | Cholera. | |||
|---|---|---|---|---|---|---|---|---|
| Period from 1817 to 1821. | Period from 1822 to 1826. | Period from 1817 to 1821. | Period from 1822 to 1826. | |||||
| fr. | 1 in | 1 in | 1 in | 1 in | 1 in | |||
| 3. | Montmartre | 0·07 | 425 | 62 | 71 | 38 | 43 | 90 |
| 2. | Chaussée d’Antin | 0·11 | 604 | 60 | 67 | 43 | 48 | 107 |
| 1. | Roule, Tuileries | 0·11 | 497 | 58 | 66 | 45 | 52 | 82 |
| 4. | St. Honoré, Louvre | 0·15 | 328 | 58 | 62 | 33 | 34 | 54 |
| 11. | Luxembourg, &c. | 0·19 | 257 | 51 | 61 | 33 | 39 | 17 |
| 6. | Porte St. Denis, Temple | 0·21 | 242 | 54 | 58 | 35 | 38 | 62 |
| 5. | Faubourg St. Denis | 0·22 | 225 | 53 | 64 | 34 | 42 | 67 |
| 7. | St. Avoie | 0·22 | 217 | 52 | 59 | 35 | 41 | 34 |
| 10. | Monnaie, Invalides | 0·23 | 285 | 50 | 49 | 36 | 36 | 34 |
| 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.