The population during the last century has steadily flocked to the towns from country districts. Streets have taken the place of green fields; rows of unsatisfactory dwellings have replaced country cottages; we have dust and belching smoke and noise instead of sunshine and country air and quiet; bustle and turmoil instead of life in close touch with mother-earth: and this change has been associated with an almost unlimited inter-communication of human beings, and a corresponding increase in opportunities for the convection of germs of disease.
Until the time of the industrial revolution in England modes of locomotion were little if any more advanced than among the ancient Egyptians; and disease, when it travelled at all, travelled by slow and deliberate stages. Now the infections of the entire world may be sampled in any one district in the course of a few weeks. Man has, in fact, reverted from the land-tied condition involved in agriculture to the migratory habits of an earlier period of man’s life on the earth. As Wells has put it: “in every locality ... countless people are delocalised,” and it is not the least evil of urbanization that, in consequence of this, the administration of local affairs falls too often “into the hands of that dwindling moiety which sits tight in one place from the cradle to the grave,” or of persons who have a financial axe to grind.
The difficulties of water supply, of scavenging, and of drainage, until they were overcome, have made towns the inevitable destroyers of mankind. The conditions of housing are worse in towns than in country districts, higher rents and less ground space implying that each family on an average lives in fewer and more crowded rooms than in rural districts.
Furthermore, in towns there is greater difficulty in securing satisfactory arrangements for the storage of food, especially milk, and in obtaining fresh milk and vegetables; and there is the serious disadvantage, especially for children, that their playgrounds are in streets instead of the fields, and that the possibilities of deriving infection from dried expectoration and from fæcal or other organic contamination in yards and backstreets as well as directly from other children or adults are multiplied manifold.
Even more important, town life for the father of a family generally means an indoor and often a dusty indoor occupation; the mother not infrequently is also industrially employed; and these adverse circumstances, so far as they are allowed to continue, now affect three-fourths of the population of England and Wales and probably one-half of that of the United States.
And yet the death-rate from all causes, and especially from communicable diseases is steadily declining, to an even greater extent in urban than in rural communities.
It is but fair to add that the differences between urban and rural populations tend to decrease; at least this is so in England; probably the same is true to a less extent in America. The nominally rural population is becoming more and more urban in character, and composed not solely of rustics,—who live in and by the soil and are altogether more natural in their habits,—but largely of town-dwellers who only sleep in country dormitories. But this makes it all the more remarkable that notwithstanding the multitudinous circumstances which have tended to increase disease, the death-rate has been lowered to an amount already indicated, and life has been prolonged to an extent which has secured an increase in its average expectation of 10 or 11 years within the last thirty years.
Industrialism
Considerations of time render it impracticable to discuss in this address the mischievous influence of modern industrialism on national health. This influence runs collaterally with that of urbanization; and in it in the past can be seen the evil results of overwork, of dust inhalation, of chemical poisoning, of industrial infections including tuberculosis, and of the general depressing effect of protracted monotonous work. The evils of industrialism like those of urbanization are happily being in a large measure counteracted.