First, as regards the ages at which death occurs; the respective proportions of timely and untimely deaths may, generally speaking, be inferred from the local death-rates. In general terms, we know a high death-rate indicates that many die before their time—indicates that a proportion of the population, more or less considerable, instead of reaching old age, becomes prematurely blighted and extinguished. In order to illustrate this subject to you more exactly, I append a table in which the deaths of the last two years are classified according to the ages at which they occurred. Of 3763 persons whose deaths are recorded in my last Report, 1243 died under the age of five years: of 2752 deaths registered in the present year, 1032 belong to the same early period of life.
The City of London appears peculiarly fatal to infant life. Reference to the Registrar-General’s last septennial record shows that of every 1000 male children under five years of age within the City of London (aggregately) nearly 113 die in each year; and the portion of this rate which is deduced from the East and West London Unions is as high as 119 in the thousand. In the subjoined table,[34] which illustrates some points of comparative mortality, I have endeavoured to show the extreme and disproportionate amount of this pressure on infant life. In referring (for instance, in regard of the City of London Union) to the last three columns of that table, you will observe that the mortality of children at the age stated, during the septennial period, was 1⁄2·66 of the entire mortality, although their class numerically constituted only 1⁄11·09 of the entire population; so that they died at more than four times (4·17) the rate which would have fallen to them as simple participators in the average mortality of their district. The actual infant mortality of the past year holds the same proportion to the general mortality as in the Registrar-General’s septennial period, being 1⁄2·66 of the whole.
| Places. | General death-rate per thousand per annum. | Death-rate per thousand per annum of male children under five years of age. | Out of entire living population what proportion is under five years of age? | Out of entire mortality what proportion occurs under five years of age? | By what multiple is the mortality of children under five years in excess of the average mortality of all ages? | |||
|---|---|---|---|---|---|---|---|---|
| City of London Union | 21 | 101 | 1⁄11·09 | 1⁄2·66 | 4·17 | |||
| E. and W. London Union | 26 | 3⁄4 | 101 | 1⁄9·02 | 1⁄2·24 | 4·02 | ||
| Metropolis | 25 | 93 | 1⁄8·45 | 1⁄2·45 | 3·45 | |||
| Holborn | 26 | 115 | 1⁄8·98 | 1⁄2·20 | 4·08 | |||
| St. Giles | 27 | 122 | 1⁄9·85 | 1⁄2·24 | 4·39 | |||
| St. Martin | 24 | 120 | 1⁄10·64 | 1⁄2·42 | 4·39 | |||
| Bristol | 29 | 107 | 1⁄8·73 | 1⁄2·53 | 3·45 | |||
| Liverpool | 33 | 143 | 1⁄7·35 | 1⁄1·91 | 3·85 | |||
| Lancashire | 26 | 3⁄4 | 102 | 1⁄7·19 | 1⁄2·02 | 3·56 | ||
| Surrey | 18 | 48 | 1⁄7·98 | 1⁄3·22 | 2·48 | |||
| South-east divn. of England | 19 | 52 | 1⁄7·76 | 1⁄3·03 | 2·56 | |||
| Glendale | - | 14 | 28 | 1⁄10·32 | 1⁄3·99 | 2·58 | ||
| Bellingham | ||||||||
| Haltwhistle | ||||||||
Lest any undue importance should be ascribed to the influence of bad or inappropriate articles of diet in producing this large infant mortality, I may inform you that the rate of death is highest during that very early period of life when the child depends for nourishment on its mother; so that, of a thousand male children in the first year of life there die within the district of the City of London Union 242; within that of the East and West London Unions, 276.
The causes which thus decimate the young population of London are the common conditions of district unhealthiness—the conditions which it lies within the scope of sanitary legislation to amend. But, inasmuch as the few days of these wretched children are passed mainly within doors, so their high mortality constitutes the readiest and least fallacious evidence of the unwholesomeness of the dwellings in which they die: and hence I am acquainted with no correcter material for estimating the sanitary condition of a district than is afforded by the death-rate of its infant population.
Secondly, with regard to the alleged particular causes of death; I have extracted from our general registry, and have grouped in a [separate table], those cases of death from acute disease which seem peculiarly due to physical causes affecting large numbers of persons.
There are deaths by cholera, epidemic diarrhœa, and dysentery, of which during the biennial period we have had nearly 900; by fever, of which we have had 284; by erysipelas and puerperal fever, of which we have had 84; by small-pox, of which we have had 50; and cases of this sort partake of the nature of deaths by violence, not only because they are abrupt and untimely, but because they are avoidable. If in the instances which I have specified it were possible to make inquiry into the antecedent circumstances of the dead, you would find irrefragable evidence that life was lost in each individual instance by the operation of removable causes—by the foolhardy neglect of some familiar precaution, or by the obstinate retention of some notorious ill. The death of a child by small-pox would in most instances call for a verdict of ‘homicide by omission’ against the parent who had neglected daily opportunities of giving it immunity from that disease by the simple process of vaccination; the death of an adult by typhus would commonly justify still stronger condemnation (though with more difficulty of fixing and proportioning the particular responsibility) against those who ignore the duties of property, and who knowingly let, for the occupation of the poor, dwellings unfit even for brute tenants, dwellings absolutely incompatible with health. In addition to the diseases which I have named, there are others which owe their chief malignity and numerical largeness of fatality, though not their existence, to local and removable causes. The proportionate mortality from scarlatina, measles, and hooping-cough, is greatest when the general death-rate is greatest. Under similar circumstances, too, we find among the infant population a frequency and fatality of other diseases, not commonly accounted specific, which warrant us in considering them to be mainly of endemic and avoidable origin. Such are the hydrocephalus and convulsions, the diarrhœa, bronchitis, and pneumonia of infants; often indeed referred to the irritation of teething, but prevailing in different localities with so marked a proportion to the causes of other endemic disease that we may be sure of their partial and considerable dependence on those local and obviable causes. I dwell on this aspect of the subject, and particularly invite the attention of your Hon. Court to the table[35] which illustrates it, because it is in respect of these diseases that your exertions have already effected valuable improvements for the health of the City, and because the future registry of such cases will attest year by year the further progress of your sanitary reforms. In examining this index of preventable deaths you will notice that those from fever are fewer by 29 per cent. in the year just terminated than in the previous twelve months; that those from scarlatina are 75 per cent. fewer; those from infantile zymotic disorders nearly 40 per cent. fewer; those from erysipelas and puerperal fever 9 per cent. fewer. Small-pox, it is true, is doubled; but the prevention of this disease rests, out of your jurisdiction, in the exercise of individual discretion. Under the item of infantile diarrhœa (included in the [tenth column]) there is likewise an increase of nearly a third;[36] an exception probably dependent on the fact that, during last year, many deaths which might have swelled this column were (on account of the then prevalent influence) catalogued under the head of epidemic diarrhœa or cholera.
[36] In the column referred to, this is concealed by the marked diminution, during the present year, of other disorders classed with infantile diarrhœa. Their reduction maintains the total of that column (notwithstanding the difference of diarrhœa) considerably less for this year than for last.