In overcrowded places the danger is great when contagious disease makes its appearance. The spread of such diseases as typhus, measles, and whooping-cough is very much favoured by overcrowding.
I have prepared a table, taken from the Registrar-General’s decennial abstract, which shows this fact very clearly with regard to London. I have arranged the various registration districts of London according to the density of population, and in another column I have given the death-rate per 100,000 from whooping-cough and measles, two diseases which are rarely treated in hospitals, and which are very prone to follow each other in epidemics, so that when we have not measles with us we have whooping-cough, and vice versâ.
Annual Death-Rate per 100,000 Living of Children under 5 Years of Age from Whooping-cough and Measles during the 10 Years 1871–80.
The above figures show the effects of overcrowding, on the mortality from two important diseases, very conclusively; and it is interesting to note how very far the mortality from these two diseases in Dorsetshire is below that of even the best parts of London.
Among other diseases which are very common in London are the tubercular and respiratory diseases. Thus the mortality from scrofula, tabes mesenterica, phthisis, and hydrocephalus in London, during the ten years 1871–80, was (collectively) 349 per 100,000 (no correction being made for abnormal age distribution), as against 224 in Dorsetshire, and the death-rate from respiratory disease was 460, as against 315 in Dorsetshire. During the fifteen years 1872–1886 I find that 34,254 in-patients have been treated in University College Hospital. Of these, 3,798 were cases of respiratory disease, and 2,453 were cases of disease of bones and joints, a very large proportion of which, according to recent investigations, are tubercular. Thus we have 6,251 cases of disease (or more than 18 per cent. of the whole) in which tubercle plays an important part.
There were also 459 cases of enteric fever, 276 cases of diphtheria, and 1,020 cases of rheumatic fever. These, taken together, amount to 1,755, or about 5 per cent. of the whole. Rheumatic fever is one of the common diseases of London, which attacks young adults, and very often cripples them for life. It is a disease of great importance, and appears from the last report of the Registrar-General to have been on the increase since 1858.
Besides the greater liability to premature death which is caused by overcrowding, there are other drawbacks which are scarcely less important. One of these, with which we are well acquainted in London, is an increase in the dirtiness and smokiness of the air, which is mainly due to private fireplaces. When huge piles of offices are run up in the City or elsewhere, we like to imagine that, because most of them are tenantless at night, they cause no inconvenience, forgetting that each office has its fireplace, which helps to foul the air, and that each office supplies its quota of sewage to help to foul the river. The state of the air in London is such that the most beautiful of all arts, gardening, has become impracticable from the fact that comparatively few flowers or shrubs will flourish. This absence of green plants entails a great loss of nascent oxygen or ozone, which gives to air its peculiar quality of freshness. It is hardly conceivable that a high level of health can be maintained in a spot where vegetable life languishes, animal life and vegetable life being complementary to each other.
The overcrowding in London has, of late years, been mitigated by the conversion of old grave-yards into gardens, thanks to the society over which the Earl of Meath so ably presides. If cremation as a means of disposing of the dead should become general, and spacious cemeteries be replaced by furnaces, it is clear that these spaces bequeathed us by the dead will not be available for “lungs” in the London of the future, and that cremation, unless it be counteracted by suitable legislation, is certain to intensify our state of overcrowding.
The moral side of overcrowding must not be forgotten, but it is not necessary to dwell upon it, as the Whitechapel horrors are still fresh in the memory, and the difficulty of detecting crime in a labyrinth of hiding-places has been demonstrated. The first aim of a sanitary authority should be to prevent overcrowding, and its most important duty is to control building operations, a duty which is never performed because buildings help to pay the rates.