I should be misleading your Hon. Court, and practising a deception which next year’s registry would expose, if I pretended that the striking difference between the two years’ several totals of preventable deaths (a difference which, leaving cholera out of the question, probably amounts to a diminution of 30 per cent. on the sum of last year) had resulted wholly, or even chiefly, from sanitary improvement, and could be interpreted as the evidence of permanent physical changes around the dwellings of our poorer population. I guard you against this impression now, because, however satisfactory it might be as a momentary belief, it would lead to subsequent disappointment; and any future rise in the proportion of these deaths would induce the erroneous, but disheartening, supposition that your later sanitary steps had been less successful than the first. In all these matters, and especially in analysing the details of a death-registry, it is requisite (as I have already stated) to deal with cycles of many years. Periods of pestilence are habitually followed by periods of diminished mortality: partly because population is diminished, and especially that share of the population which suffers most from obviable causes of disease; partly because the great alarm of death has induced vigilance and precaution, public and private, against the occasions and beginnings of illness. And, beyond both these circumstances, there are others which we cannot analyse or explain, though we have scientific certainty of their operation; circumstances which seem to ensure a comparative quiescence of the ordinary causes of zymotic disease during those periods which next succeed the prevalence of certain fatal epidemics.[37]
[37] For the professional reader I may here throw out a hint—referring to the doctrine of epidemic disease stated in the [Fifth Annual Report], that this apparent healthiness of districts after certain epidemic invasions probably bears relation to a temporary exhaustion of their zymotic atmosphere under the action of a specific ferment, and is in some respects analogous to that immunity from an infected fever which belongs to an individual who has recently suffered its attack. See also [page 235].—J. S., 1854.
Nevertheless, that the sanitary condition of the City has undergone considerable improvement within the last two years is a fact which no one can gainsay; and that a considerable share of the mitigation in mortality arises from this improvement cannot reasonably be questioned. If even a third of the mitigation in question, if a reduction of ten per cent. on the preventable mortality of the City, may be inferred from the materials which I lay before you, it is indeed matter for the utmost congratulation; and a continuance of the same reduction year by year, perpetuated (as doubtlessly it may be) by a continuance of the same exertions, would soon raise the City of London above all fear of comparison, on the ground of healthiness, with urban or suburban populations.
Thirdly, I would beg the attention of your Hon. Court to those very important local differences of death-rate which may be deduced from a study of our death-register. I have already had the pleasure of citing to you the low rate of mortality which has prevailed during the last year in the north-west sub-district of the City of London Union. The rate of death in the north division of the West London Union was nearly double that proportion; and between these extreme terms of disparity there were many intermediate degrees.
Similar inequalities of mortality were observable in last year’s record. In the healthiest sub-district of the City the year’s death-rate was about 22 in the thousand; while in the worst it stood above 41; and for the whole West London Union exceeded 38.[38]
[38] I have here availed myself of the corrections given in the [note] of [page 6].
Mainly and essentially these local differences of mortality depend on the proportion in which preventable deaths enter into the total; the differences, however partial, depending on the operation within certain districts, of removable deleterious influences which do not exist in certain other districts.
In classifying for your consideration the deaths which, during the last two years, have depended on epidemic, endemic, and infectious diseases, I have thought it desirable to distribute them according to the municipal divisions of the City. Strongly believing, as I have endeavoured to express, that this class of deaths is for the main part preventable, I have thought it would interest the representatives of the several Wards, and would more directly enlist their sympathies for sanitary progress, if I could enable them at a glance to recognise the ratio in which their respective constituencies contribute to this annual death-roll. I have included in the [table], under eight different heads, all those acute diseases which depend in an important degree on local causation, either for their existence or for their fatality. It will be obvious, even to the unprofessional reader, that local causes are not of equal prevalence in respect of all the diseases there tabulated. Some (as fever and cholera) would not be known at all under perfect sanitary arrangements; others (as scarlatina, measles, and hooping-cough) would be far less malignant in their attacks; others (as those classified in the tenth and twelfth columns) would no doubt exist under the most perfect physical circumstances, but would probably prevail in numbers quite inconsiderable as compared with those actually observed.
On consulting this table[39], it will be observed that in Cordwainers’ Ward, during the last year, not a single death occurred from the causes referred to, and in the preceding year of epidemic visitation, only five; that in Cornhill Ward there have been only two such deaths in each of these years; that in Coleman-street they have been 66; in Queenhithe, 59; in Portsoken, 143; in Aldersgate Within, 30; in Aldersgate Without, 179; in Cripplegate Within, 80; in Cripplegate Without, 299; in Bishopsgate Within, 60; in Bishopsgate Without, 329; in Farringdon Within, 153; in Farringdon Without, 845.