The period mentioned is indeed short for the purpose of establishing an average; but ten years at least must elapse before even similar materials can again be given for calculation, and a still longer time before the statistical basis can be enlarged. I have therefore thought it desirable to make the best use in my power of such facts as were before me, for the construction of quinquennial tables; out of which, with sufficient accuracy for all practical purposes, you may draw your own inferences as to the health of that large population which is under your sanitary government.
The facts are classified, as heretofore, in the manner which will most easily display their practical meaning. First, namely, the deaths of the period are recorded in their local distribution, so that you may compare one part of the City with another in respect of healthiness. Next, they are so tabulated according to ages, as to indicate the prevailing proportion of untimely death. Thirdly, those of them are separately enumerated which, in their several classes, chiefly occur as results of acute disease in connexion with removable causes.
In after years, when sanitary improvements, now only in contemplation or commencement, shall have produced their legitimate results and rewards, these tables may serve an important use. Indicating the standard of public health within the City before such works were achieved, and constituting a permanent record of your starting-point, they will qualify your successors to estimate the amount of amelioration which your endeavours shall have produced.
The details of your present sanitary condition, as varying in different sub-districts of the City, and as fluctuating in the several years and seasons of the quinquennial period, are expressed in the figures of these tables more compendiously and more clearly than I could hope to convey them in words. Here, therefore I restrict myself to telling you very briefly their general results.
The population of the City—about 130,000 persons—has been dying during these five years at the rate of about 24 per thousand per annum. The sub-district rates which give this aggregate vary from under 18 to above 29; the former death-rate belonging to your healthiest locality—the north-west sub-district of the City of London Union; while the latter—more than 60 per cent. higher—mortality belongs to the north sub-district of the West London Union. The lowest death-rate hitherto attained in this country for a considerable population, during a term of seven years, has been 14 per thousand per annum; which your worst sub-district mortality more than doubles.
As different districts contribute unequally to your average death-rate, so also do different ages. Among all the population exceeding five years of age, the death-rate is under 17 per thousand per annum; while, for children under five years of age, the rate is nearly 85. And these rates are unequally constituted by your three chief districts in the following proportion; viz.:—
| Annual Rate of Deaths to 1000 living persons. | Over 5 Years of age. | Under 5 Years of age. |
|---|---|---|
| East London Union | 16·68 | 91·99 |
| West London Union | 20·58 | 94·84 |
| City of London Union | 15·06 | 71·72 |
| Average death-rate in the City | 16·85 | 84·72 |
How various are the diseases which have conspired to produce your annual average of 3120 deaths, it would be tedious to describe; and in the table which I have devoted to a partial analysis of this subject, I have restricted myself to a consideration of those ailments which are likely to become less fatal under a well-developed sanitary system. To the annual average typhus has contributed 140 deaths; choleraic affections (including the epidemic of 1849) 196; scarlet fever, 76; small pox, 40; erysipelas, 30; the acute nervous and mucous diseases of children, 572; their measles, hooping-cough, and croup, 182;—making, from this class of disorders, an annual average of about 1250 deaths—nearly two-fifths of the entire mortality.
My tables will show you that the different seasons of the year have pressed somewhat differently on human life; and there is exhibited in them a point of some interest to which I would beg your attention. In your healthier sub-districts it is easy to perceive the influence, the almost inevitable influence, exerted by the inclemency of winter against the aged and feeble. In your unhealthier sub-districts, this effect is completely masked, and summer becomes the fatal season; its higher temperature acting in some sort as a test of defective sanitary conditions, and giving to the several local causes of endemic disease an augmentation of activity and virulence.
On the facts which these tables set forth, I have nothing further to say than would consist in a repetition of arguments already submitted to your notice. In my third Annual Report, especially, I endeavoured to lay before you the conclusions which are fairly deducible from the proportions of early death, and from the partial allotment of particular diseases.