In carefully watching the fluctuations of health amid your population; in investigating the causes which determine them; and in testing, on every occasion, how far these causes are amenable to the control of your Act of Parliament, I have arrived at the conclusions submitted to you in the present and in my previous Report.
To excuse the length at which I have addressed you, I have but another word to say. My apology consists in the assurance, which again I lay before you, that in spite of all your exertions, untimely and preventable death still prevails most largely in the population under your charge. If the deliberate promises of Science be not an empty delusion, it is practicable to reduce human mortality within your jurisdiction to nearly the half of its present prevalence.
It is the sad prerogative of my Profession to have such knowledge of death as cannot lie within your experience. Knowing all that is implied in each one separate instance of its visitation—how much pain and sorrow, often how much bereavement and destitution, we, perhaps better than others, learn to appreciate that vast amount of social misery which has its symbol in the high death-rate of a population. It is from this practical point of view that I have ever estimated the importance of your functions, and have fixed the obligations of my own humbler office. Notwithstanding all that Medicine can achieve, to succour the body as it struggles against actual disease—notwithstanding those resources of drugs and handicraft, by which the physician or surgeon opposes death or mitigates pain in the detailed exercise of his art, all past experience, and every transaction of our daily practice, confirm the popular adage that prevention is better than cure. If this be true in any particular case, much more is it true in the largest application. While Curative Medicine—ministering step by step to the individual units of a population, can produce only minute and molecular changes in the health of society; Sanitary Law, embodying the principles of Preventive Medicine, may ensure to the aggregate masses of the community prolongation of life and diminution of suffering: in the working of some single enactment, it may affect the lives of generations of men, and may moderate in respect of millions the sources of orphanage and poverty.
Surely, it is no common epoch in the history of the metropolis when you are appealing to the Legislature, on behalf of the Corporation, for the grant of additional powers towards the accomplishment of so great a beneficence. To me it has always been an act of the deepest and most anxious responsibility to address you; and it would ill have become me now, in the attempt to discharge so grave a duty, if I had spared any pains or withholden any conviction.
While endeavouring in this, and in my previous Report, faithfully and in detail to depict for you the actual condition of human life within the City, and while seeking to deduce for you, from reason and experience, those sanitary principles which are applicable for its improvement, I have had no trivial or easy task; and you will pardon me, I hope, both if I have incompletely surmounted the difficulties of so large a subject, and if, by the length of my Report, I have made too great claims on your indulgence.
I have the honour to remain,
&c., &c.
Note to Column I.
Speaking generally, this column may be taken to express the number of houses in each Ward. Exception must be made, however, in respect of the four wards marked with asterisks; for in them the real number of houses somewhat exceeds the number of assessments. This discrepancy depends on the fact that, in the specified wards, a court containing several houses is often assessed by composition as a single property. Mr. Daw informs me that in order to correct on this score the numbers which stand opposite the Wards in question, addition should be made as follows:—to Bishopsgate Without, 80—raising its number to 1100; to Cripplegate Without, 150—raising its number to 1112; to Farringdon Without, 100—raising its number to 3633; to Portsoken, 150—raising its number to 1408. This would raise the total number to 16,384, which is about the estimated number of houses in the City. From the results of the last census it appeared that the population of the City was distributed as follows:—within the district of the City of London Union on an average of 7·1 persons to each house; within the district of the East and West London Unions on an average of 8·8 persons to each house.
Comparative prevalence, in the several Wards of the City, of such Deaths as particularly depend on local circumstances.