It may be useful, for the sake of comparison, that I should remind your Hon. Court of some of the more important differences which prevail throughout the country, in regard to the local rates of mortality. The extreme rates recorded in the Registrar-General’s last publication, relating to the septennial period 1838-44, give 14 per thousand per annum as the lowest average, and 331⁄2 as the highest average, for a population male and female in equal proportion. The low average belongs to a district in Northumberland, numbering 27-28,000 inhabitants; the high average is assigned to Liverpool. For the whole south-east division of England (comprising more than a million and a half of inhabitants) the death-rate is but 19; while in parts of the division it falls very considerably below this average. I have thrown these and some similar comparisons into a tabular form, which may perhaps be interesting to you.[32]
Possibly it may occur to you that these comparisons are devoid of practical application—that it is unreasonable to suppose we can mitigate our London death-rate to the likeness of a selected country mortality—that the circumstances of the two populations are essentially and unalterably dissimilar—that the advantages of the one cannot be given to the other—that the traditional ‘threescore years and ten’ of human life are allotted only to rustic existence—that the right of participating in the higher civilisation of the metropolis, or of trading in its larger market, is not too dearly purchased by the tax of half or a third of one’s fair expectation of life.
On general grounds I should not hesitate to combat this objection, and should feel sure of convincing you of its invalidity. I should argue (as indeed I have already argued here) that the main conditions which constitute the unhealthiness of towns are definite, palpable, removable evils; that dense over-crowding of a population—that intricate ramification of courts and alleys, excluding light and air—that defective drainage—that the products of organic decomposition—that contaminated water and a stinking atmosphere, are distinct causes of disease and death; that each admits of being definitely estimated in its numerical proportion to the total mortality which it contributes to cause; that each is susceptible of abatement or removal, which will at once be followed by diminution of its alleged effects on the health of the population. Likewise, I should argue, that if there indeed exist, attached to a metropolitan residence, some really unavoidable and necessary disadvantages to life (a point which however I am not prepared to concede) there are likewise, as respects the poor, some peculiar advantages to counterbalance those evils; that in urban communities the operations of charitable relief are largest and least remitting; that the resources of medicine for curing what cannot be prevented are likewise readiest and most effective.
On all these general grounds I should be prepared to maintain that a lowness of mortality which has been attained in any considerable rustic population, may be attained by an urban population, if only the removable evils be removed, if only the practicable good be made practical.
Surely too, above all, I would maintain this possibility in respect of our capital—the treasury as she is of all means for progress in civilisation, the stronghold of all applicable knowledge. Let but the wealth, the science, the energy, and the benevolence of the metropolis deal with removable causes of death as they have dealt with subjects infinitely more difficult, infinitely less promising, and certainly of not greater importance; and few competent persons will doubt that the mortality of London might speedily be reduced to the level of any district-mortality yet recorded by the Registrar-General.
There may be those in your Hon. Court who will hesitate to accept for themselves the firm conviction which I entertain on this subject; or who, at least, will withhold their assent from the line of argument which I have advanced. To them, what I have now to state may be more conclusive than any other consideration: viz., during the year on which I am reporting, there was one sub-district of the City of London Union—one comprising from twelve to thirteen thousand inhabitants, in which (after including a due proportion of deaths which had occurred in the union-workhouse at Mile-end) the mortality stood only at 15 in the thousand; one in which, if those extramural deaths had been excluded, the local death-rate for the year would have been only 13·32.[33]
[33] These figures require some correction for decrease of population in the sub-district referred to: the death-rate, inclusive of workhouse mortality, was nearly 16, and exclusive of that mortality, nearly 14 per thousand.—J. S., 1854.
For an illustration of low and enviable death-rates, I need then no longer appeal to Northumberland, or to our south-eastern counties—though, no doubt, their septennial periods of low mortality are valuable corroborations of any inference which could be drawn from our more restricted experience;—but I may point to the last year’s death-rate in the north-west sub-district of the City of London Union as one of rare excellence, and may content myself with wishing that that partial rate might become universal for the City, and might be the permanent expression of its average mortality.
A detailed consideration of our sickness and mortality during the last year suggests to me a few other remarks, which may, I think, be of practical utility to your Hon. Court.