[66] In the remaining number (17) the particulars of age and residence could not be correctly ascertained.
5. In it[67] an enumeration is made of such deaths, during the last three years, as have arisen in consequence of acute disease partially or entirely preventable. They amount to 3923—more than two-fifths of the entire mortality of the period.
[67] [Appendix, No. IX.] includes this Table.
I would especially beg the attention of your Hon. Court to the particulars set forth in the successive columns of this table.
The first column shows 391 deaths by fever; and of these, without hesitation, I would speak as entirely preventable. Under favourable sanitary conditions fever is unknown. The deaths arising from it befall for the most part persons in the prime of life, whose premature removal, in the midst of their vigour and usefulness, is not only a direct weakening of society, but is also, in respect of orphanage and widowhood, a frequent source to the public of indirect detriment and expense.
In the second column, swelled by the epidemic visitation of 1849, you will find 902 deaths referred to Asiatic Cholera, and to other kindred diseases. Comparatively few cases of the kind have occurred since Michaelmas, 1849; an overwhelming majority belonged to the summer quarter then terminating, when the Metropolis generally was suffering from the presence of Cholera. I have already had occasion to show you that this frightful pestilence belongs only to localities which, by their general epidemic mortality, have previously been stigmatised as unhealthy; that, over districts otherwise healthy, it migrates without striking a blow; that it may, therefore, with confidence be spoken of as a disease proportionate to removable causes—in other words, as a preventable disease.
I cannot pass over these two columns, without begging you to observe what perhaps may be novel to you. If, instead of reckoning the cholera-deaths as belonging solely to the one year in which they happened, you reckon them as belonging to the whole term of years which elapsed between the two visitations of the epidemic, and distribute them equally over that period, so as to form an average—say for fifteen years, you cannot fail to notice how largely, in the long run, the destruction by fever (which is always here) surpasses the fatality of that Eastern disease; so much so, that the average annual mortality by the latter probably does not amount to half the fatality of the former.
Nor must it be lost sight of, that if the deaths by typhus double in number those produced by cholera, the list of persons attacked by the former disease, and thereby for a long while incapacitated and suffering, is immeasurably beyond this proportion. Two or three times the number of deaths by cholera would give you the number of seizures, and enable you to estimate all the direct mischief caused by it; while, in regard of typhus, probably for one death there are twenty cases of protracted illness, tardy convalescence, and injured constitution. Not only are the deaths double in number, but each of them indicates an infinitely larger amount of sickness and suffering not immediately productive of death.
The frightful suddenness of the rarer disease, and the condensation of its epidemic fatality into some single year, give it more apparent importance than belongs to the familiar name of typhus; but I can assure your Hon. Court, that if a large amount of preventable death, and a still larger amount of preventable misery, be strong arguments for sanitary improvement and activity, those arguments are more abundantly derivable from the constant pressure of fever and its kindred maladies, than from the sharper but infrequent visitations of the foreign pestilence.
In the third column of this table come deaths by scarlatina. Of these, perhaps a certain proportion would occur even under favourable circumstances; for, whatever may have been the original derivation of the disease, it is impossible to doubt that the severity of its attack mainly depends on conditions peculiar to the person of the patient, and that no perfection of external circumstances will ensure mildness of infection. But on the other hand it is certain, that, under attacks of the disease at first equally malignant, adequate ventilation with pure air will enable one patient to wrestle successfully against the poison, while another, less favourably circumstanced, will rapidly sink beneath its influence; and hence I have no hesitation in assuring you, in respect of the 213 deaths registered under this head, that a majority would have been avoided under improved domestic arrangements.