Adverting to the local reports they have received, the Commissioners state—“These reports have awakened in us the sad conviction that many localities are quite devoid of even the most simple ideas on public health; the inhabitants live surrounded by marshes, drains, stagnant pools, manure heaps, without having the slightest idea of the dangers they are incurring. Indeed, many of them blindly speculate in these heaps of infection, increasing the manure which is to enrich their fields at the expense of their health, and often of their lives.”
The Commissioners observe,—“Most of the improvements in public health have been brought about through the experience and science united in our large cities; so much so that now epidemics often come to us from the rural districts. These epidemics are generally much less fatal than formerly, but are still very prevalent even in the wealthiest and the most civilized departments. It would be an important problem to solve, what are the causes which produce these epidemics in the agricultural as well as in the manufacturing counties, as in ancient Normandy and Picardy. One cause is certainly the unhealthiness of the houses. The inhabitants of these districts are, in general, well fed, well clothed, but ill lodged. We are surprised to find in the midst of a fertile plain wide districts covered with luxuriant vegetation, villages buried in the ground, smothered with large trees, and cottages constructed without any art or plan, and almost entirely without windows.” The Commissioners state, further,—“If you wish to have a robust and healthy people, you must have a care for their physical education, their houses, and their modes of living. Do not allow generation after generation to be depressed under the evil effects of recurring epidemics, which must eventually ruin the strongest constitutions, as is seen to be the case in marshy and ill-drained districts, where fevers, goitres, and scrofulas constantly prevail.”
In another report made on the proceedings of the Conseil de Salubrité, the diseases prevalent amongst the population in the towns is adverted to:—“We must be like the men so well painted by the Psalmist, to reject such evidence—eyes have they, and see not. How shall we explain, or rather to what shall we attribute the difference that is remarked between the mortality of one quarter and that of another quarter of the same town; of one street and that of another street of the same quarter or of the same village; or, lastly, the difference that is observed in this respect between the houses of the same street and those houses which are completely isolated? Misery, it is replied to us, is the cause. Yes, without doubt, misery is a powerful cause; but it is so especially when it is driven back into the most insalubrious quarters, streets, and houses; when it lives habitually in the midst of filth and dirt, that is to say, in the midst of an infected atmosphere; and when there is no misery, or when it exists in the same degree in the quarters, in the villages, in the streets, and in the houses with which the comparison is made; and, stronger still, when poverty is met with precisely there where there is the least mortality; in what is to be found the cause of this difference, if it is not in the insalubrity of the dwelling-places?”
The report on the local epidemics concludes by earnestly recommending to the government—“That sanitary measures be adopted by means of which the constitution of the people may be renewed, and their longevity increased. If this recommendation be fulfilled, we may then hope to see the condition of some of the departments ameliorated, in which now the population is so degenerated that the men seem to diminish in size each time they are measured for the conscriptions.”
Evidence on the mismanagement of expenditure in respect to supplies of food, on mismanagement also in respect to clothing and fuel by the labouring classes, might be added to complete the view of the principal causes of disease prevalent amongst them, but these do not come within the immediate scope of the present inquiry, which has been directed chiefly to the investigation of the evils affecting their sanitary condition, that come within the recognized provinces of legislation or local administration.
The information on the means for the prevention of epidemic disease arising in the common lodging-houses maintained for the accommodation of trampers and vagrants, might also have been considered in connexion with the subject of the effects of overcrowding and filth which they strongly exemplify; but it appeared most convenient to consider them apart, from the exposition of what may be termed the indigenous evils that afflict the settled inhabitants of the labouring class.
I would now submit for consideration, 1st, the total expense of the present state of things, so far as a proximate view of it can be obtained, on the health, strength, and life of the lower classes of the population. 2d, a proximate view of the pecuniary expense of such partial remedies as are at present applied or applicable to alleviate the consequences of these preventable diseases.
IV.—COMPARATIVE CHANCES OF LIFE IN DIFFERENT CLASSES OF THE COMMUNITY.
Very dangerous errors arise from statistical returns and insurance tables of the mean chances of life made up from gross returns of the mortality prevalent amongst large classes, who differ widely in their circumstances. Thus we find, on inquiry into the sanitary condition of the population of different districts, that the average chances of life of the people of one class in one street will be 15 years, and of another class in a street immediately adjacent, 60 years. In one district of the same town I find, on the examination of the registries, the mortality only 1 out of every 57 of the population; and in another district 1 out of every 28 dies annually. A return of the average or the mean of the chances of life, or the proportions of death in either instance, would and does lead to very dangerous errors, and amongst others to serious misapprehensions as to the condition of the inferior districts, and to false inferences as to the proper rates of insurance. With the view of arriving at some estimate of the comparative extent of the operation of the chief causes of sickness and mortality proved to be prevalent, amidst the different classes of society, in the towns where the sanitary inquiries have been made; I have obtained the following returns from the clerks of the several unions acting as superintendent registrars. These returns have, as far as practicable, been corrected by particular local inquiry, and are submitted as the best approximations that can readily be obtained. In all districts, and especially in the manufacturing districts, there is some migration of labourers which would, for the obtainment of perfect accuracy as to the chances of life in particular localities, have rendered necessary an examination of every individual case enumerated. This extent of labour has been considered unnecessary. In the returns from single towns, the numbers of deaths of persons of the first class are too small not to be affected by accidental disturbances, but when large numbers of the like class are taken, the uniform operation of the like circumstances are shown in the like results. It is at present a general defect of the important head of information, “the occupation of the deceased,” that the deaths of masters are not carefully distinguished from the deaths of journeymen. So far as this error prevails, it will tend to raise the apparent chances of life amongst the labouring classes. In some instances the occupations of the deceased, or of the parents of the deceased, in the case of children, are not described in the registries. With these and possibly with other defects that may have escaped notice, these returns will be received as corroborative of the reports of the medical officers and physicians who have attended and observed many of the individual cases themselves, though not enumerated by them. Had the mortality prevalent amongst workpeople of particular trades and their families been taken, instead of the mean chances of persons of all occupations deriving subsistence from weekly wages, the case of classes with still lower chances would have been presented; but these would have appeared to suggest particular remedies. Such returns of the effects of common evils were therefore taken as appeared applicable to the consideration of common or general means of prevention.
One of the first returns obtained is from Dr. Barham, as to the different rates of mortality in Truro:—