In the fourth column, you will read of 91 deaths by small pox. Your judgment will not be a harsh one, if you assume that 90 of these were the result of criminal negligence. Under the present administration of the Poor Laws, vaccination is not only accessible to all members of the community, but is literally pressed on the acceptance of the poor. Those stupid prejudices, which for some years retarded the universal adoption of Jenner’s great discovery, have now died away; the neglect of vaccination must be regarded as the omission of a recognised and imperative duty. Deaths of children, arising in this parental neglect, ought to be considered in the same light as if they arose in the neglect to feed or to clothe; and I am disposed to believe, that the readiest way of bringing this view of the case before those uneducated classes, where the omission usually arises, would be to procure Coroner’s inquests every year in respect of some half dozen or more instances where the evidence of neglect might happen to be glaring.
In the fifth column of the table stand recorded a hundred deaths by the poison of erysipelas, in one form or another; arising sometimes spontaneously, sometimes in connection with the child-bearing state, sometimes in sequel of accidental lesions and surgical operations.
My daily experience as a Surgeon—especially as a Hospital-Surgeon, enables me confidently to speak of these diseases as an artificial product of unhealthy exterior conditions. The contrasting results of surgical operations in town and in country—of operations undertaken amid pur-ventilation, in spacious cleanly rooms and dry localities, with those undertaken under opposite circumstances (in the dwellings of the poor for instance, or wherever else amid damp, dirt, and over-crowding), and the similar experience which exists as to the origination of puerperal fever, would be quite conclusive as to the fact, that of the 101 deaths under this head, a large majority might have been prevented.
Next, in the sixth, seventh and eighth columns, stand deaths arising in the chief acute diseases of infancy, those to which the disproportionate mortality of infants is mainly due. Many careful statistical observations, as well as personal experience, convince me that the immense fatality recorded under this head, is, to a very great extent, due to obviable causes.
To bring this matter distinctly before you, I must take, as a standard of comparison, some district where the general death-rate is sufficiently low to distinguish it as eminently healthy; and in such an one you will notice a marked diminution, not only (of course) in the number of infant deaths, but likewise in their proportion to the total mortality.
Such a district is that of the combined parishes of Glendale, Bellingham and Haltwhistle, in the county of Northumberland. In it the general death-rate is 14; in the East and West London Unions of the City of London, the general death-rate is 26·73. In the former district, children under five constituting more than an eighth of the population (1⁄7·6), their deaths form about a quarter of the whole mortality; while in the latter district, where the children are in smaller proportion—namely about 1⁄9 of the population, their deaths are not much less than half (1⁄2·21) of the whole mortality. Thus, in the healthier district they die at less than double the average rate for all ages; in the unhealthier, at more than four times that average.
A still better method of district-comparison, is to arrange in a series the death-rates prevailing in several localities for persons over five years of age, and side by side with this column, another for the death-rates of children under five years of age. The first column will of course indicate very well the relative sanitary conditions of the districts; but the differences between them will be expressed far more clearly, and, as it were, in a magnified form, in the column of infantine death-rates. Thus, for instance—to repeat the comparison just instituted between the Northumberland and the London district; the death-rate for all ages over five is about 12 in the former district, and nearly 15 in the latter; a difference quite sufficient to establish the inequality of their sanitary conditions. But, how much more strongly is this disparity expressed in the comparison of the infantine death-rates—26·5 for the healthier district, 107·57 for the unhealthier one!
Nothing can be more conclusive than the evidence afforded by statistics, as to the dependence of high infantine mortality on the general causes of endemic unhealthiness. My own observation within the City gives complete confirmation to this view, showing me that the diseases specified in my table (diarrhœa, bronchitis and pneumonia, hooping-cough, croup and measles, hydrocephalus and convulsions) however various in nature they may seem, and however apt you may be to dissociate their occurrence from the thought of local causation, yet unquestionably multiply their victims, in proportion to the otherwise demonstrable unhealthiness of a place, owe most of their fatality to local causes, and may, therefore, to a great extent he disarmed of their malignity.
The last column gives the total of those which have preceded it, and shows, out of 9493 deaths, 3923, all from acute disease, in intimate dependence on local and obviable causes. It will be a moderate computation with respect to these deaths, if we estimate that two-thirds of them might have been hindered.
And yet it is not only by acute disorders, that preventable death succeeds in ravaging the population. If we turn to the examination of chronic ailments producing death, we may quickly recognise many indications of their preventability, and may satisfy ourselves that here also the general mortality might be very largely reduced.