Comparative Mortality of Great Capitals.
Our recent alarm at the appearance and progress of the cholera in London may have drawn the attention of many who had before been accustomed to pass them by with indifference, to those columns in the papers in which the reports of the Registrar-General on the state of the public health are from time to time recorded. But we are perhaps hardly yet sufficiently awake to the importance and interest of the statistics there contained, any more than to the value of the short and, at first sight, rather unintelligible tables which embody, day after day, the meteorological phenomenon collected in London from so many different points on our own coast and those of adjacent countries. These last statistics have an interest which does not yet belong to those which relate to the public health, in that they embrace reports from so many distinct places which can be compared together. We, of course, only publish our own statistics of health, disease, births, and deaths; and we have not yet seen our way to the information that might be gathered by a comparison of our own condition in these respects with that of others under similar circumstances. The interest and value of such a comparison is obvious enough; and some of the results which might be hoped from it, if it were systematically and scientifically made, may be guessed at by the perusal of a thin volume of less than two hundred pages, lately published in Paris by M. Vacher, [Footnote 136] which at first sight may seem not to promise very much except to professional readers, but from which we shall take the liberty of drawing a few facts which certainly seem worthy of the attention of the more general public.
[Footnote 136: Etude Médicale et Statistique sur la Mortalité à Paris, à Londres, à Vienne et à New-York en 1865. D'aprés les Documens officiels, avec une Carte Météorologique et Mortuaire. Par le docteur L. Vacher. Paris: F. Savy, 1866.]
Canning once said, in answer to some one who alleged "a well-known fact" against him, that there was but one thing more fallacious than a fact, and that was a figure. We must all be ready to allow that the results which we see embodied so neatly in a set of figures in statistical tables are, after all, but approaches to the truth; and they are not put forward as anything more. Still, there is often a wonderful accuracy about the average results given by statistical inquiries; and it is obvious that when the result of one calculation is confirmed by that of another independent of the former, or when one uniform result is given by a continued series of inquiries, or when there is a very decided preponderance on one side of a comparison, such as cannot be accounted for by chance, it would be absurd to refuse to assent to conclusions thus obtained. With this single preliminary remark, let us proceed to some of the facts collected for us by M. Vacher.
He begins by giving due credit to this country for having taken the lead in the publication of the kind of statistics with which he has to deal. The reports of the Registrar-General are all that he can desire. New York and Vienna have followed, more or less fully, the example set in London. It has also been copied in St. Petersburg, as far as the registration of deaths is concerned; and it is hoped that a weekly publication of the results will soon be made in that city. Paris joined the movement at the end of 1864 or the beginning of 1865. There is, however, some difference of system. The chief point is, that in England the medical man who attends a sick person reports the cause of death; in Paris there are certain official physicians, vérificateurs des décès, and these, instead of the attending physician, assign the cause. The superiority of the English system seems to be acknowledged. M. Vacher's book is founded on the reports thus produced.
His first business is, of course, to settle approximately the population of the four capitals with whose statistics he deals—a matter of considerable difficulty, even with all the results of the census before him. He calculates the number of the inhabitants of Paris in 1865 at 1,863,000; those of London were 3,028,600; those of Vienna, 560,000; and those of New York, 1,025,000, (in 1864.) At the present rate of increase, Paris will double its population in 32 years, London in 40, Vienna in 44, and New York in 13½. On the other hand, this increase is not to be set down to the excess of births over deaths, which in London, in 20 years before 1861, was only 328,189—about a third of the actual increase, (35 per cent.) In a similar period, the births exceed the deaths in Paris by only 13 (and a fraction) per cent of the whole increase. Immigration has therefore the largest share in the increase of the population. A flow is continually setting in from the country to the town in the age in which we live, and it enriches the largest towns, and the capitals especially. New York, receiving annually so many immigrants from Europe, is, of course, beyond the others in its gains from this source. Paris has undergone great vicissitudes as to the number of its inhabitants. In 1762, the population seems to have been about 600,000. It fell off immensely during the Revolution; even in 1800 it was only 547,756. From 1790 to 1810 the number of deaths exceeded the number of births. Since that time the proportion has been reversed, except in years of great epidemics.
Of the four capitals with which M. Vacher deals, Vienna, the smallest, had the largest proportion of deaths in 1865. In Vienna the proportion was 1 to 31 of the inhabitants; in Paris, notwithstanding the ravages of the cholera in October—causing 6591 deaths (nearly an eighth of the whole)—it was 1 to 36; in New York, 1 to 40; in London, 1 to 41. In Paris, London, and New York, the death rate has diminished in its proportion to the population for some time past. In Paris, in the three decades of years from 1830 to 1860, it fell successively from 1 to 31, to 1 to 34, and then to 1 to 38. There has been the same improvement in the other two cities. In New York, fifteen years ago, the rate of deaths was 1 to 22—nearly twice as high as at present. We do not see any statement in M. Vacher's pages as to the case of Vienna. He attributes the improvement in Paris to some extent to the great public works and measures for securing the health of the population which have marked the second empire; but much more, it would seem, to the better management of the hospitals. In Paris and Vienna a much larger proportion of the inhabitants die in hospitals than in New York and London; and, as far as we are concerned, M. Vacher includes workhouses and asylums of all kinds under the general name of hospitals. He finds, on comparing some scanty statistics of the last century with the facts of the present, that in old times the number of deaths in hospitals was far greater in proportion to the cases admitted than now; and he thinks that, in Paris at least, this almost explains the improvement in the death-rate. In New York the same improvement may have had many causes, but it is remarkably coincident as to time with the magnificent changes made, at an immense cost, in the water supply of that city. From some meteorological tables compiled with great care by M. Vacher, we gather the rather surprising result that the variations of temperature during the year, which have considerable influence on the death-rate, are greatest at Vienna, (nearly 27°,) next at New York, (25°,) much lower in Paris (17°,) and lowest of all in London, (15°.)
One of the most interesting questions at the present time on this subject is that of the water supply. M. Vacher begins with a cordial tribute to the Romans on this head. The magnificent aqueducts by which the city of Rome was supplied date from the time of the early republic, though the emperors increased their number. At an early point of their history, therefore, the Romans were wise and liberal enough to dispense with the waters of the Tiber for drinking. They carried their system everywhere when they became the masters of the world; in France, in Spain, and in Italy many aqueducts can still be traced which were their work. We may be quite certain that if Britain were now a Roman province, the Thames water companies would never be allowed to supply water except for the streets, and great aqueducts would long since have brought us the pure water of Bala Lake or Windermere. Thanks to the popes, modern Rome though not so profusely supplied as in imperial times, is still very far in advance of all other cities in the world in this respect. [Footnote 137] M. Vacher reckons the water supply in ancient Rome as 1492 litres a day for each inhabitant; in modern Rome it is 1040; in New York, 159; in Vienna. 134; [Footnote 138] in Paris, according to the new system, 109; in London, 132. But no city seems to have its houses so well supplied as London; in Rome a great quantity of water is wasted, being left to run away from the fountains, while the houses are not conveniently provided with water. We suppose that our old friend the house-cistern, against which we have heard so many complaints lately, is not an essential feature in our system of house supply.
[Footnote 137: M. Vacher attributes the salubrity of Rome—for, considering its position, it enjoys remarkable salubrity—to the abundance and good quality of its water. Lancisi, who practiced there as a physician in the last century, accounts for the longevity of its inhabitants in the same way. At all events, remarks M. Vacher, "il est impossible de n'étre pas frappé de ce fait, que les historiens ne mentionnent pas un seul example de peste à Rome, et qu'au moyen age et dans les temps modernes elle a constainment échappé aux atteintes de la pests et du choléra, qui ont sévi à plusteurs reprises en Italie." But Rome has certainly been visited by the cholera more than once, and the rest of the statement is surely contrary to history.]