A fact which must throw considerable doubt on the healthiness (i.e., a real vigorous and robust condition, which is the true meaning of health) of the population is the amount of sickness, as evidenced by the ever-increasing work which is thrown upon the hospitals.
According to a table which was published last June in The Hospital, it appears that in 1887 there were treated in the London hospitals 79,261 in-patients, and 1,180,251 out-patients, or a total of 1,259,512 persons, excluding those who received relief in the hospitals belonging to the Asylums Board (and these were very numerous, owing to the epidemic of scarlet fever), the workhouse infirmaries, the lunatic asylums, and idiot asylums. Thus it appears that in a city whose death-rate was very low more than 25 per cent. of the population had recourse to the hospitals for relief. We must therefore conclude that the death-rate and the disease-rate bear no fixed ratio to each other, especially when we consider that between 2,000 and 3,000 medical men found sufficient work among the population to furnish them with an income. If deaths be few in London, it is clear that second-rate health is by no means exceptional.
IMPROVED CONDITION OF MODERN LONDON.
Although we have to make many allowances, and take many things into consideration before we can estimate the true value of the London death-rate, it is, of course, undeniable that an enormous improvement in the health of the City has taken place since the beginning of the present century. To what is this due?
The chief cause is the increase of knowledge as to the modes in which diseases are spread. Our knowledge of the mode in which small-pox, scarlet fever, cholera, and typhoid are disseminated has led to the establishment of fever hospitals, and to the improvement of the water-supply, and the inspection of dairies. It is not only that the knowledge of doctors has increased, but what is more important, this knowledge has spread to the public, and as “self-preservation is the first law of nature,” the public has assisted in protecting itself.
The practice of vaccination, and the dealing with epidemics by the method of isolation, have also materially assisted in diminishing the death-rate.
Another very important point is the disappearance of malaria. Drainage, the filling up of low-lying places, and extensive building operations, have banished malaria from our midst, and this, be it remembered, was not only a cause of death in itself, but probably tended to make other diseases more deadly. It is conceivable that the impregnation of the soil by coal-gas may have helped to stop the growth of noxious microbes which make the soil their habitat.
Again, our system of sewers, which has carried filth away from the dwellings, has probably assisted in improving the public health. That sewers have done and are doing much harm as well as good is undoubted, but it is probable that the balance is so far in their favour. For the present typhus fever has disappeared, and this is probably due to two causes—first, the prompt separation of the sick from the healthy, and secondly, to the fact that we have had no scarcity for some years. Typhus is due to overcrowding and want. I have drawn up a scheme which shows by a curve the average price of wheat from the year 1800 to 1886. From this it appears that the staple article of food has, broadly speaking, and with some considerable fluctuation, fallen steadily in price from 1812 to the present time, when it is at its minimum. Not only wheat, but all articles of food and clothing, and also fuel, have of late years been getting steadily cheaper; potatoes and other vegetables are in common use among the masses, and thus we have kept away famine diseases, and also that taint of scurvy, which was undoubtedly a great cause of ill-health in the middle ages. A most important fact has been the removal of the in-take of the water companies to a part of the river containing less sewage than that between the bridges. It is not enough to be able to rejoice in a small death-rate. We ought to be able to look ahead and feel that to the best of our knowledge there is no probability of the return of a high one, and that our sanitary arrangements having been set a-going, will continue propriâ motu. We have to remember that diseases disappear or become unimportant, and that others become prominent. In our own day we have seen the rise in importance of diphtheria and enteric fever, and just at present we seem to have lost sight of typhus, for a long time the most important of the febrile diseases. “Leprosy,” which was at one time common in London, has practically disappeared. Plague, sweating sickness, and malarial fever have also gone. Whooping-cough was not recognised till the end of the sixteenth century, and could not, therefore, have been as common as it is now. In like manner, scarlet fever was not distinguished from measles until the seventeenth century, and from that fact we may infer that there could have been no epidemics of it, although we must remember that in the great crowd of fevers it must have been hard to distinguish individuals. The fact that diseases wax and wane must be borne in mind, and should prevent us from indulging in a feeling of false security.
WHAT IS THE OUTLOOK?
Judged by our present standard of knowledge, have we a right to hope that London is likely to remain free from epidemics?